Health and Social Care Bill

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Mr. Hammond: I draw the Committee's attention again to my registered interests in relation to commercial property since, self-evidently, many pharmaceutical services are provided from commercial property. I am grateful to the Minister for providing some background to part II of the Bill. It will not have escaped his notice, or that of his grateful officials, that there are a relatively modest number of Opposition amendments to part II. That does not mean that there are not important issues to discuss, but it is fair to say that this part of the Bill contains no burning political matters likely to cause huge divides. Instead, we want to explore a series of technical and operational issues.

We have not seen a deluge of representations from the relevant establishment, which tends to suggest that it is broadly happy with the direction that the Bill proposes. It is our duty not only to represent the concerns of the establishment, be it medical or pharmaceutical, but to consider issues that may affect people who do not have powerful bodies to articulate their interests. I hope that over the next few hours we can probe the Minister on the issues and have a genuinely constructive debate, exploring what will happen as a result of the clauses. They set out a framework, but they are not precise—they cannot be expected to be—about what will happen in practice.

We support the concept of broadening the way in which pharmaceutical services can be provided. We all agree with what the Minister said about pharmacies being an under-used asset in the primary health care delivery system, whether we are objectively considering the professional capacity of pharmacists, which is so evidently not being used, or models of the role of pharmacies in other European countries.

Has the Department of Health undertaken any formal work to gather evidence of specific failures in the current arrangements? The Minister said in his opening remarks that the new arrangements would enable the focus to be on quality rather than the provision of bare minimum services. The explanatory notes and other documents give a slightly different emphasis, suggesting that the changed arrangements will enable pharmaceutical services to be extended into areas in which coverage is inadequate.

How does the Minister perceive the balance between the need to achieve greater coverage and the need to improve the quality and depth of services offered? He might say that both are important, but there would need to be different arrangements to extend coverage into inadequately covered areas. Several of my remarks this morning will go to the heart of the distinction between encouraging existing providers with premises and facilities to change how they work—they will have financial incentives, as that is what private sector players respond to—and achieving provision of services where there is currently inadequate provision. I will deal with that more specifically later.

Will the Minister tell us how the provisions fit into the long-established and broad debate about the role of dedicated small community pharmacists versus the role of large multiple retailers, especially in supermarkets? I also want to know about retail maintenance of over-the-counter medicine. The Minister did not touch on the matter, but I am sure that he would acknowledge that the pharmacy contract underpins the viability of many retail pharmacies, which provide a broad range of services, such as over-the-counter medicines and baby products. We must explore how to ensure— as the financial incentives currently delivered through the part II arrangements are replaced by the local pharmaceutical arrangements—that we do not discourage people who currently deliver, as incidental to their dispensing contract, an over-the-counter service. We need to be careful that they do not become more of a service provider and less of a retail operation because of the different nature of their operations.

It would be useful if the Minister said something about the retail price maintenance and the issues of community pharmacy versus supermarket, and the cross-subsidisation between over-the-counter products protected by retail price maintenance and the services provided by community pharmacies. Implicit in the Bill is the notion that health authorities will pay for the incidental benefits of community pharmacists and for the role they play in the primary health care system. At present, to some extent, that role is financed by cross-subsidisation from the retail price maintenance on some over-the-counter products.

I appreciate that the Minister has talked about local flexibility and that different models will exist in different areas. However, I hope he will not shelter entirely behind that and claim that he has no idea how those matters will operate in practice. That would alarm the Committee. The Government must have some models in mind. Does the Minister envisage a system of direct negotiable payments—as it were, contracted amounts over and above the remuneration pharmacists receive for their routine dispensing activity? That might be the way to secure provision in areas where it is sparse and to some extent that is already reflected in the essential small pharmacies premium arrangements.

Can the Minister tell us what role he envisages for NHS trusts and primary care trusts in the model? There is a competition issue here. At the moment, pharmaceutical services are provided almost entirely by private sector contractors. If in future NHS trusts and primary care trusts are to have a significant role, the issue will arise of the appropriateness of public sector bodies competing—perhaps head on—with private commercial providers. The Minister must recognise that the Bill could lead to competition issues and practices that are incompatible with the open and free competition that we expect to see in a retail market. The consequences could be that NHS trusts and primary care trusts that dip their toes in the local pharmacy market end up, perversely, driving out commercially based providers. If those public sector bodies then found themselves unable or unwilling to continue providing the service, the result would be gaps in the market.

Perhaps I have not been diligent in doing my homework.

Mr. David Jamieson (Plymouth, Devonport): Hear, hear.

Mr. Hammond: The Government Whip is, I think, rather uncharitable. This is the first clause of the morning. My mugging up might be a little scanty on the later clauses, but I pride myself on usually reading the background notes to at least the first clause of the day.

Will the Minister clarify who is the relevant authority? I assume that it is either the Secretary of State of the Welsh Assembly. The Minister nods. My right hon. Friend the Member for North-West Hampshire spoke about the Secretary of State having an alibi. The alibi in this case is the relevant authority. It will be the Secretary of State in England; but I cannot find a definition in the Bill. It would be useful for the Minister to point us to the place—it may be in other legislation—where relevant authority is defined. I assume that it is not defined in the base statute because the Welsh Assembly had not been created then.

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I should place on record that we warmly welcome the idea that a community pharmacy could provide a wider range of services than the simple dispensing of medicines. The Opposition have had many discussions with bodies representing community pharmacy and pharmacy retail chains about what they might be able to do. It is clear that their walk-in capability would far exceed the Government's most optimistic ambitions for their own walk-in centres programme. Thousands of High street walk-in centres are waiting to be used, admittedly for a limited range of activities, although diagnostic testing is an obvious one that springs to mind. We have also had discussions with one or two pharmaceutical chains about the practicality of undertaking PSA prostate screening tests at retail pharmacies if the test proved effective and if it were decided to introduce a broad screening programme along those lines.

We envisage an increasing role being placed upon general practices in the overall scheme of health delivery. It is, therefore, important that the process passes on down the line. As we try to move procedures out of the secondary sector into the surgery, we shall have to help GPs shed some of their more mundane tasks. If pharmacists can take some of the load, it would be a sensible way to proceed.

In conclusion, I share the concerns expressed by my right hon. Friend the Member for North-West Hampshire when speaking to amendments Nos. 39 and 280. He said that we have no reason to draw a distinction, in terms of their ability to participate in such arrangements, between doctors delivering PMS and doctors delivering GMS. I was not persuaded by the Minister's response and I hope that he will reflect further on the matter. He might admit to the suspicion that the Department of Health has, at official level if not at ministerial level, shown a sense of hostility towards dispensing doctors, perhaps because they were thought to be more expensive because of a propensity to dispense at a different rate from non-dispensing doctors, although I have seen no evidence to support that. It would help if the Minister answered the debate in the context of his Department's corporate view on dispensing doctors and their place in the overall scheme.

Dr. Peter Brand (Isle of Wight): We very much welcome this part of the Bill. The change is long overdue. Primary care does not mean general practitioner services but a team in which pharmacists play an important role, as do the other professions mentioned later, with their extended prescribing rights. We need to discuss accountability, but I imagine that we will do so on clause 42.

I welcome the implied flexibility of pilot schemes. As the hon. Member for Runnymede and Weybridge pointed out, it is important that the arrangements to provide a broad range of services can be truly local. Some of the reward structures may have to be tailored to specific pharmacies in specific locations. Supermarkets, which can cross-subsidise with ease, are not alone in having different requirements. The large pharmaceutical chains have much greater opportunities to absorb losses and are less dependent on such contracts than the community pharmacies that for too long have subsidised the NHS with shopkeeping abilities. Some community pharmacies that provided excellent services have been lost to the NHS as they did not have the opportunity to expand their commercial activities.

Pharmacists—the dispensers of drugs—are important members of the clinical team. Although I appreciate the fact that it is impossible or impractical to have a separate pharmacist from the prescribing GP in some parts of the country, such an arrangement should be encouraged as the norm. My practice is three miles away from the nearest pharmacies, but we deliberately decided not to dispense because we value the second opinion, the safety check and the extra professional input that one can receive from pharmacists having a fresh look at prescriptions.

One of the problems that we faced—I hope that it can be tackled under the private schemes—was that we effectively had to act as an agent for pharmacies. We have provided a pick-up and delivery service for our patients on the pharmacies' behalf, the cost of which comes out of scant staff resources. In this new, joined-up age, it would be useful if the Government were to consider how the services are delivered, so as to promote flexibility.

I should like the Minister to tell us what will happen when pilot schemes become permanent. Those who go to sea often use pilot services, but when they arrive they dispense with their pilots. I hope that we will not be in a state of perpetual flux, as is implied by the term ``pilot schemes''. The Minister suggested that some of the schemes will become permanent, but we might consider the terminology. Any provider of health services needs to be able to plan and needs a degree of confidence in the future that is not necessarily implied by the term.

The hon. Member for Runnymede and Weybridge touched on the issue of who else could dispense. Although I recognise his concerns about the primary care trust or an out-of-hours co-operative not undermining the commercial activities of pharmacists, that is a two-way process. When I was last on call for our local co-operative on a bank holiday I found that only two pharmacists, 20 miles apart and open for an hour a day, were dealing with the medical needs of 200,000 people. That was clearly unacceptable.

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