Health and Social Care Bill

My Lords, the preceding speakers put their finger on a big issue, namely the quality of primary medical services and GPs. As noble Lords tactfully put it, the Government propose to give enormous power to GPs when the quality of their provision is variable, as we know. There is a fundamental question about why the Government consider that GPs are so well placed to exercise this huge commissioning responsibility. All Governments have struggled with this area. Out-of-hours services is an example of where GPs should have been in the driving seat, but it was not a great advert for their commissioning abilities. There is a genuine question, although it is probably a bit late for the noble Earl to answer it in depth, about the great ability that GPs are supposed to have in relation to commissioning. I am extremely puzzled by the logic of the government reforms. We have never been given an answer about why so much power will be given to general practitioners. It is extraordinary. My Amendment 213 in this group concerns the power conferred in new Section 14Z7 on the board to exercise the functions of the clinical commissioning group at the request of a clinical commissioning group. I also have another probing amendment, Amendment 213ZA, concerning the power conferred in new Section 14Z8 for the board to ““provide assistance or support”” to clinical commissioning groups. Can the noble Earl clarify the kind of circumstances in which those powers can be used? Could he also say how this relates to the failure regime for clinical commissioning groups? On a somewhat different tack, Amendment 220C concerns new Section 223G with regard to the financial allocations to clinical commissioning groups. The amendment requires the board to publish each year details of the methodology used to determine allocations to clinical commissioning groups. It is important that there is transparency in the allocation process, and the best way to ensure that is to publish full details of the methodology behind the allocation. For instance, will socio-economic factors influence the allocation? How much will health inequalities be taken into account? It would be helpful if the noble Earl could give an indication at some stage of the methodology and how transparent it will be.