Health and Social Care Bill

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Dr. Brand: I raised a small point about the role of hospital pharmacies, especially in out-of-hours prescribing. I should like the Minister to respond to the anxieties that have been expressed. Will that facility no longer be available, or should it be encouraged?

Mr. Denham: Certainly we are keen to see better and more sensible means of access to out-of-hours dispensing. It is a bizarre part of the NHS that the approved method of finding out which pharmacy is open out of hours is to ring the police. The fact that that was the best we could come up with caused some surprise the other day among some American visitors to this country who a member of the Conservative party put in touch with me. In the near future, NHS Direct will be able to play that role, which is rather more appropriate—[Interruption.] If the hon. Member for Runnymede and Weybridge rings 999 to find out whether the pharmacy is open, perhaps he is not making the best use of the emergency services—unless he does so in an emergency, of course.

If the hon. Member for Isle of Wight was suggesting that an aspect of the provisions that we are considering would lead to a reduction in the service provided by hospitals, I cannot see his point.

Dr. Brand: The point is that at present it is assumed that pharmacies will volunteer to provide adequate out-of-hours cover. That is done on an ad hoc basis and no health authority can require them to open, yet alternatives are not readily available. Perhaps the Minister should deal with that issue.

Mr. Denham: Two issues arise from what the hon. Gentleman has said. One is that LPS provides a way of improving out-of-hours services. Clearly, we should discuss those services with the profession as part of the wider discussion of the national contract, in which we want improvements.

Dr. Brand: Theoretically, would it be possible for a pharmacist employed by a primary care trust to apply to operate as a limited pilot in the provision of out-of-hours services?

Mr. Denham: It would certainly be theoretically possible for an NHS trust to enter into an LPS contract with the health authority to provide an out-of-hours service.

It should be acknowledged that in the past two years the co-ordination of out-of-hours provision, particularly in winter, has greatly improved. Local pharmacists have often been actively involved in local winter planning groups, which did not happen previously. However, there are still aspects of the system that need to be sorted out.

Sir George Young: The Minister has been helpful in sketching in details of how the brave new world will operate. However, in a 20-page document a passing reference could have been made to the role of dispensing GPs, from whom 3.5 million people receive their prescriptions. An issue of joined-up government is involved. The Department of the Environment, Transport and the Regions is doing all that it can to minimise the number of journeys. The preferred model outlined by the Minister involves a medical centre underpinned by a range of community pharmacists. The hon. Member for Isle of Wight told us that the nearest pharmacist to his practice was three miles away. Inevitably, the approach that has been identified will lead to more journeys.

Dr. Brand: I also said that we arranged a collection service for our patients, so that while the prescriptions and pills had to travel the three miles, the patients could stay in their home village.

Sir George Young: I am not sure whether that desirable service is available to all the hon. Gentleman's patients, or whether his explanation fully deals with my point about the number of journeys. I still maintain that if medicine were dispensed where it was prescribed, fewer journeys would be made overall. However, underpinning that is another point, which is that many patients prefer to collect medicine from the doctor. A journey of three miles might be inconvenient to them.

An even better model than that outlined by the Minister is one in which there are medical centres and a range of community pharmacists, and doctors can dispense if they want to. That choice, except in a controlled area, is not available to them in the model before us. Nothing that the Minister said raised my hopes about the prospect of change. I have heard many reasons for a Minister's inability to respond to a Committee. Normally, the Minister does not know the answer. In this case, he told us that he knew the answer, but that the parties involved had urged him not to give it, which is a new and ingenious response.

10.45 am

The Minister explained that GPs cannot apply for LPS, because they can knock at another door: they can apply to provide pharmaceutical services under PMS. That raises the issue of how the two schemes are to be integrated. In a given area, there may be a pharmacist who has read ``Pharmacy in the Future'' and the Bill and wants to apply for a pilot scheme and provide a range of services, and a GP who has read the Bill, but despite the powerful speech by Sir George, is not allowed to apply for LPS. The GP knocks on the door of PMS and undertakes to provide a range of services similar to those that the pharmacist is planning to provide under LPS. How will those two be integrated? How will we ensure that we do not get two pilot schemes in the same area, operating under different regimes? It would be tidier to allow the GP to apply under LPS to provide pharmaceutical services, rather than under PMS.

The Minister did not really answer the question about integration and how one avoids overlap and confusion caused by having two separate routes to the same destination. I hope that he is both able and allowed to respond to my point. The proposed system is untidy, and may lead to allegations of a less-than-even playing field if GPs are denied the right to apply for a pilot scheme under LPS.

Mr. Denham: I hope that I will not appear in ``Erskine May'' as having invented a new kind of response for Ministers. The disputes between the professions have been rumbling on since 1911. If they are working closely together towards a solution, I would rather respect their wishes and find a satisfactory way forward.

We would like patients to have the full skills of a pharmacist available to them, as well as those of a doctor. However, we acknowledge that there is support for dispensing practices in areas where full community pharmacy services cannot be made available.

GPs who are trying to develop innovative services can do so under PMS. A PMS practice may employ a pharmacist under a PMS contract. The issue of duplication will have to be dealt with when both PMS and LPS are moving towards a permanent regime. However, the current piloting system--especially given the central role of the health authority in both PMS and LPS schemes--provides an adequate mechanism to ensure that there is no duplication of activities in a given area. Although I understand the fears raised by the right hon. Gentleman, I am not convinced that they are quite as powerful as he has suggested.

Amendment agreed to.

Amendment made: No. 207, in page 30, line 4, leave out from beginning to end of line 8 and insert—

    `( ) ``Practitioner dispensing services'' means the provision of drugs, medicines or listed appliances (within the meaning of section 41 of the 1977 Act) by a medical practitioner or dental practitioner to a patient of his pursuant to arrangements made by virtue of section 43(1) of the 1977 Act.'.—[Mr. Denham.]

Clause 29, as amended, ordered to stand part of the Bill.

Clause 30 ordered to stand part of the Bill.

Schedule 2

Pilot schemes

Mr. Denham: I beg to move, amendment No. 218, in page 60, line 19, leave out

    `as to the circumstances in which a Health Authority must'

and insert

    `requiring a Health Authority to'.

The Chairman: With this it will be convenient to take the following: Amendment No. 219, in page 61, line 17, at end insert—

    `( ) Sub-paragraphs (3) to (6) of paragraph 2 apply in relation to an application for preliminary approval of proposals under this paragraph as they apply in relation to proposals under that paragraph.

    Effect of proposals on existing services

    . —(1) Proposals for a pilot scheme submitted under paragraph 2, or included in an application for preliminary approval of proposals under paragraph 4, must include—

    (a) an assessment by the Health Authority of the likely effect of the implementation of the proposals in the Health Authority's area on the services mentioned in sub-paragraph (2);

    (b) any assessment supplied to the Health Authority by another Health Authority under sub-paragraph (4).

    (2) The services are—

    (a) pharmaceutical services (within the meaning of section 41 of the 1977 Act);

    (b) local pharmaceutical services provided under existing pilot schemes or LPS schemes (within the meaning of Schedule 8A to the 1977 Act);

    (c) general medical services provided under arrangements made under section 29(1) of the 1977 Act;

    (d) personal medical services provided under arrangements made under section 28C of the 1977 Act or under pilot schemes made under section 1 of the National Health Service (Primary Care) Act 1997.

    (3) If it appears to a Health Authority that the proposals would, if implemented, affect any of the services mentioned in sub-paragraph (2) provided in the area of another Health Authority, they must consult that other Health Authority about the proposals before submitting them under paragraph 2 or including them in an application for preliminary approval under paragraph 4.

    (4) A Health Authority consulted under sub-paragraph (3) must prepare an assessment of the likely effect of the implementation of the proposals on those services and supply it to the Health Authority which consulted them.'.

Amendment (a), at end of amendment No. 219, insert—

    `(e) the provision of retail pharmacy services for the supply of non-prescription medicines.'.

 
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