General Practitioners: Hippocratic Oath

Baroness Jolly Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Trefgarne]

To ask Her Majesty’s Government whether general practitioners working within the National Health Service are bound by the Hippocratic Oath, and if so, whether they will place a copy of the said oath in the Library of the House.

[Baroness Jolly (LD)]

My Lords, there is no requirement for doctors to take an oath in the UK. Some medical schools may choose to include an oath in their graduation ceremonies, but that is not a requirement. When a doctor requests registration with the General Medical Council, before they can submit payment, and therefore as the final mandatory step, they must sign a declaration, part of which reads:

“I have read Good Medical Practice and understand my actions may be judged against the standards and principles it contains”.

[Lord Trefgarne (Con)]

My Lords, I am most grateful to my noble friend for that reply. Is it not the case that the GP contract, with or without the Hippocratic oath, is now not fit for purpose, despite its 208-page length? Does my noble friend not therefore agree that it is time the contract was considered from top to bottom, particularly as regards the provision of out-of-hours and evening services?

[Baroness Jolly]

My Lords, the 2004 contract has been reviewed and renewed on an annual basis, and has proven to be a fairly robust document. The Government are not at the moment minded to change its basis. As for out-of-hours services—the nub of the Question—GPs can decide whether they opt out. Where they do opt out, the providers are inspected by the CQC and the local CCG.

[Lord Walton of Detchant (CB)]

My Lords, does the Minister accept that although there are several absolutely admirable principles embodied in the Hippocratic oath, its archaic language is totally inappropriate to the 21st century? For example, I do not believe that the noble Lords, Lord McColl and Lord Kakkar, would be prepared to swear that they would not cut for stone—and many doctors would be unwilling to honour their teacher as they do their parents. Is the Minister aware that the full original Hippocratic oath is fully reprinted in the Oxford Medical Companion, which I had the privilege to edit many years ago—and of which there is a copy in the Library?

[Baroness Jolly]

The noble Lord is absolutely right. I congratulate him on his editorship. I had to rely on Wikipedia.

[Lord McColl of Dulwich (Con)]

My Lords, is the Minister aware that the first half of the Hippocratic oath is all to do with protecting doctors and that there is no mention of patients until way down the page? Furthermore—I used to read this out to my medical students—it contains a promise to supply “all the financial needs of those who taught me medicine”. None of them did.

[Baroness Jolly]

My Lords, I think that doctors have always been very good at looking after their own interests.

[Noble Lords]

Oh!

[Lord Howarth of Newport (Lab)]

My Lords, does the noble Baroness acknowledge that many general practitioners and other medical professionals have sworn the Hippocratic oath and regard it as a very serious statement of principle? Does she acknowledge the view widely held among medical professionals that to perform the role assigned to them in the Assisted Dying Bill would not be consistent with the principles of the Hippocratic oath?

[Baroness Jolly]

That is an interesting point. The Government believe that any legal change should be made by Parliament rather than by government. However, doctors may choose to opt out of providing a medical procedure if it conflicts with their personal beliefs or values. The Assisted Dying Bill makes provision for a person not to participate in anything authorised by the legislation to which they hold a conscientious objection.

[Lord Purvis of Tweed (LD)]

My Lords, while the GP contract is separate for Scotland and the modern Hippocratic oath is consistent with the ethos and the meaning of the proposals in the Assisted Dying Bill that have been debated in this House, does my noble friend the Minister agree that the principle of the oath being taken in its modern form, consistent with the duties of the General Medical Council, is a fundamental part of the service provided by doctors? Will she assure noble Lords that the ethos of the oath is a fundamental part of the training? On a wider front, could other professions that provide essential services benefit by learning and stating the principles of good professional conduct?

[Baroness Jolly]

My Lords, patients trust doctors with their lives and well-being and need to have confidence that they are competent in their field and abide by high ethical standards. Therefore, doctors must be registered with a licence to practise from the GMC.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that yesterday’s vote in the National Assembly for Wales that rejected the principles of the Assisted Dying Bill is compatible with the 77% of general practitioners who do not want that Bill to come in, and with the view of a high percentage of doctors who are looking after such patients full-time?

--- Later in debate ---

[Baroness Jolly]

That is the case.

[Lord Hunt of Kings Heath (Lab)]

My Lords, going back to the point raised by the noble Lord, Lord Trefgarne, will the noble Baroness repeat the words of the noble Earl, Lord Howe, when this issue was raised a couple of weeks ago—namely, that the core part of the 2004 contract that the noble Lord complained about was negotiated in the 1990s by the previous Conservative Government? Will she confirm that?

As far as the oath is concerned, the noble Baroness will be aware that part of it states:

“Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient”.

Would Hippocrates be surprised by how few home visits are now done by doctors?

[Baroness Jolly]

I cannot say whether or not Hippocrates would be surprised. However, doctors—certainly, those in the out-of-hours service—are committed to home visits where it is decided that they are clinically appropriate.

[Lord Cormack (Con)]

My Lords, in my former constituency, a well respected GP said to me that no doctor can truly know his patient unless he knows him at home as well as in the surgery. Does she agree?

[Baroness Jolly]

I really do not have the experience on which to draw. It sounds like a good idea, but how practical it is I do not know.

[Lord Patel (CB)]

My Lords, does the noble Baroness agree that part of the problem with GP contracts is that GPs are independent practitioners who can negotiate their contracts, whereas hospital doctors, when they apply for a job, have to comply with the job description for that job?

[Baroness Jolly]

That is probably an issue for the BMA, the GMC and others to sort out.