|Health and Social Care Bill
Mr. Hammond: There is a conflict between the objectives of the legislation. I do not want to jump ahead in the Committee's consideration of the Bill, but clause 33 deals with the ability of the relevant authority to direct a health authority to wind up or modify a scheme. That implies that the schemes cannot be based on firm, long-term contractual arrangements with private sector parties. While the scheme might be fine for improving quality and remuneration arrangements, it is difficult to tell how it could be used to provide a physical presencepremises for dispensingin an area that lacks one.
Mr. Denham: We are slightly anticipating a later debate. It will be necessary to make provision for the return of an LPS scheme to the national contract arrangements, rather as assurances have been given about the return of personal medical services GPs to general medical services. Different approaches will be necessary, because we would not want LPS to become a loophole in the current entry requirements for pharmaceutical services. Someone might set up an LPS scheme, and then three months later abandon it and go back to the national contract, having evaded the rules. LPS will require a slightly different approach to that for PMS. The hon. Member for Runnymede and Weybridge makes a telling point. We cannot expect anyone to make a fairly substantial capital investment in scheme that might run for only three yearsor, as proposed in one of the amendments, for only two years. We shall need to address that point.
I turn next to resale price maintenance. The current hearing on the subject is being led not by the Government, but by the relevant competition authorities. The Government are not involved. The matter was first dealt with by the Office of Fair Trading, and it is now in the hands of the restrictive trade practices court. Our view is that the court is best placed to weigh the matter. What effect, if any, the ending of resale price maintenance will have on pharmacy provision cannot be considered until the court has reached its decision. I understand that the original court proceedings were halted and a new hearing is set to start on 24 April. Once the court has made its ruling, we shall need to consider its implications for the organisation of NHS pharmacy services. It would be premature to speculate on the outcome of the hearing.
Dr. Brand: I hear what the Minister says, but it would help if he were to acknowledge that resale price maintenance pays for some of the professional services that are provided by pharmacists. An acknowledgement would help pharmacists, who are anxious about the outcome of the case, because it would be a recognition of the fact that action may have to be taken by the Department rather than by the Office of Fair Trading.
Mr. Denham: I acknowledge those concerns, but in view of the imminent restarting of court proceedings, a ministerial statement of the sort that the hon. Gentleman suggests would probably be unhelpful. Resale price maintenance is a matter for the court to consider, and we shall have to wait for the court to make its decision before considering the implications.
A number of remarks were made about the various knock-on effects of the provisions. I was asked about additional services that are not directly remunerated. It is a voluntary and discretionary initiative, and health authorities are responsible for handling the development of LPS pilot schemes. We shall discuss later the wider factors that they will need to take into account, including the implications for existing pharmaceutical services, but I do not see why the proposals should lead to anything other than an enhancement of services to patients. Health authorities will be clearly have a role in ensuring that LPS is used effectively as a local strategy.
Mr. Hammond: How much additional cost will the change impose on the public purse if resale price maintenance is not abolishedand how much if it is abolished? Clearly, its abolition will reduce in aggregate the income of community pharmacists, and that money will have to be made up from other sources.
Mr. Denham: I cannot give the hon. Gentleman the answer that he seeks.
Mr. Hammond: Cannot, or will not?
Mr. Denham: I cannot. It clearly is not sensible to try to predict in detail the possible consequences of a court hearing that is not due to start until 24 April. Our long-standing system of remuneration is based on the price that the NHS pays for a set of services. I do not think that it is helpful to speculate or anticipate that a different system might be needed in future.
If an LPS scheme were developed, one would expect the health authority to receive an appropriate sum for the cost of providing the core services through the national contract, with additional services to be paid for by the health authority. However, it is difficult to put a firm figure on the likely costs, because it is difficult to predict the pace at which the schemes will develop. Even two years ago, few would have estimated that PMS pilots would have achieved the popular support among GPs that they have done.
It is critical that the health authority contribution to the LPS scheme comes out of the unified budgets at local level. Thus the decision on the sum to be appropriately invested at local level in the development of pharmaceutical services is made locally.
Mr. Hammond: The Minister said two things that I may have confused. A few moments ago, he talked as though a grant would be attached to the approval of a pilot, but he then talked about costs coming out of the unified budget. Will specific grants attach to the approval of pilot schemes?
Mr. Denham: We must keep three sums of money in mind. When schemes are running, part of the funding will, appropriately, be money that would otherwise have been in the global sum for pharmaceutical services, as the global sum would have covered the costs of the schemes. A second sum will be provided by the health authority in respect of the local agreement about additional specialist services to be offered. The third sum will be the additional funds that could be put into the initial approval process or set-up costs of LPS. On a later clause, we will discuss the power to make specific provision for the set-up costs of a local pharmaceutical pilot scheme.
The hon. Member for Runnymede and Weybridge invited me to detail our estimate of the shape of an LPS contract and the system of remuneration at local level, saying that the issue had caused the Committee alarm or distress. He suggested that it may have an element akin to the dispensing fee in the current system, and that there may be specific payments to social services. That is certainly possible, but we have not yet sketched out a model LPS contract. We want to see the proposals of health authorities and the potential providers of the services, and work with them on the details of the schemes. That is prudent and practical.
The next issue concerned the role of trusts, especially primary care trusts. The issue of principle is that we should not rule out primary care trust or NHS trust involvement in LPS schemes. In some places, that may be the best way to give local people access to high-quality services on which they would otherwise miss out. Patients will remain free to choose which pharmacy they want to go to, so patient choice is in the system. It is possible, however, to imagine circumstances in which the involvement of an NHS trust or the primary care trust would be the best way of providing a service. For example, a pharmacist post could be based partly in a community pharmacy and partly in an NHS trust. That might make recruiting to a particular geographical location more attractive for a pharmacist than coming into a traditional community trust or working in an NHS trust or primary care trust setting.
Mr. Hammond: The Minister made the specific statement that patients will retain the choice of which pharmacist to go to. Will he be clear that that is an absolute commitment, because I could sketch out what may look like logical and plausible pilots, but which would involve electronic transmission of prescriptions, so patients would not have the choice to take their prescriptions to any pharmacist they wished.
Mr. Denham: Patients will be able to go to the pharmacy of their choice, although an LPS scheme might design a particular type of service so that it would make sense, and be more convenient, for the patient to go to a particular pharmacy scheme. That is obviously possible in the design of LPS schemes, but the fundamental position is that patients should be able to take their NHS prescription to the pharmacist of their choice. The hon. Gentleman is perhaps thinking of a system in which an LPS pilot is providing sufferers of a particular condition services that are not generally available. Under those circumstances, it might well make sense for the patient to take advantage of the service that would not be available to them elsewhere. However, that is not the same as saying that they can obtain their NHS prescription from only one specified pharmacist.
We have made it clear, and no doubt we will discuss this issue again when we deal with electronic transmission of prescriptions, that patients must be able to retain the final choice of pharmacy to dispense their prescription.
The hon. Member for the Isle of Wight asked me to deal specifically with GP expenses and whether they adequately cover the type of relationship between a GP practice and a pharmacist that he would like to see. This is not a matter that I have previously been invited to consider in any detail. If he would care to drop me a line, I will do so, but I make no promises, given the usual thorny issues of GP expenses. He is certainly welcome to raise the matter with me.
The hon. Gentleman asked me also whether it is our intention that pilots should become permanent. The later clauses deal with that. It is certainly envisaged, as it has been with PMS and PDS, that both individual pilots and the general provision of LPS should become permanent arrangements, so the early pilots may became permanent arrangements, subject to review and evaluation.
Similarly, the ability to use LPS would become part of the local health authority's armoury, without the need to refer to the Secretary of State, as in the pilot scheme process. That is some way down the line. The hon. Gentleman will know that we have not reached that stage with PMS yet, although we are using pilots quite widely and it is envisaged in the Bill.
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