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"( ) The regulations shall provide for setting service standards, imposing conditions (including conditions as to qualifications, training and experience) to be satisfied by persons providing LP services, and for National Health Service redress mechanisms to be available in relation to the provision of LP services."

The noble Baroness said: In moving Amendment No. 228A, I wish to speak also to Amendment No. 229A and to the section more generally in the interests of time. We welcome much that we see here, especially the extension of prescribing rights. We hope that there will be flexibility in the way that that is implemented in terms of any lists to be used. However, we are concerned to ensure that in any new arrangements high standards will apply and that there is full professional accountability.

Where pilots are concerned, we are anxious to see the same standards apply that we see elsewhere in the National Health Service, for example as regards the rights of patients to redress should things go wrong. In addition, where online services are concerned, it is vital that information on patients is secure and that a high standard of service is offered. How is that system to be policed? I beg to move.

Lord Hunt of Kings Heath: We shall certainly expect contracts for local pharmaceutical services to include service standards. We shall also expect them to reflect specific local needs and circumstances, but also national priorities and standards.

On training, qualifications and expertise, we shall expect local contracts to make clear what is expected of the people taking part. Similarly, on what the

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amendment calls "redress mechanisms", we intend that local pharmaceutical services will fall within the ambit of NHS complaints mechanisms. Where I disagree with the noble Baroness is on the question of how much detail should be included on the face of the Bill. In this schedule we are dealing with the substantive arrangements for LPS, which will follow the pilot stage, if--as I am confident it will--piloting shows that the continuation of LPS is in the best interests of the National Health Service. It will be at least two years--and it could be more--before those powers are used. By then we shall have learned much more from pilot schemes. For that reason we have made the regulation-making powers in the schedule deliberately wide. I believe that that is the best approach.

Amendment No. 229A concerns the provision of pharmaceutical services by remote means. Clause 50 provides substantive new powers. In particular, subsection (4) confers an explicit reserve power to require providers' mail order or e-pharmacy services to be accredited for that purpose. Some of the other changes are rather more technical. For example, subsection (6) would allow local pharmaceutical committees to continue to represent pharmacists based in their area, even if they provide services to people in another area.

I believe that subsection (3), to which the noble Baroness's amendment relates, falls into the latter category of essentially technical changes. Its effect is to allow us to exempt from control of entry rules those who intend to supply services exclusively by remote means. I stress that they would not have to show that their service was necessary or desirable to secure adequate pharmaceutical services in the neighbourhood in question, which is part of the criteria in relation to control of entry. I stress that it does not mean that such providers will have an advantage over other pharmacies. Their business will not be dependent on the local population. People would always be able to find a location where their application would be granted. They would merely have to find somewhere where there was no local pharmacy. Because they are not primarily serving the local population, we think that it is rather odd to judge their application by reference to the needs of the population. The general thrust of control of entry rules is to limit the number of pharmacies serving any given neighbourhood. That concept is obviously not relevant to services being provided mainly by remote means. That is why we have taken a power to exempt from the rules, if that seems appropriate.

I should add that that new power applies only to people who provide all their services by remote means. Furthermore, in an attempt to avoid that system becoming a way of evading control of entry rules, we are taking an explicit power by which we would require health authorities to make the grant of such applications subject to conditions; and I emphasise that the health authorities would be responsible for overseeing that. One condition for a health authority may be to ensure that the service did not subsequently change to a more traditional service in which patients

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would visit the premises. We want to make sure that this would not be a back-door way of evading the control of entry rules.

Baroness Northover: I am very reassured by what the Minister has said on Amendment No. 228A. Although Amendment No. 229A is more specific than the issue that I addressed, I hope that the system of which the Minister speaks in terms of health authorities does work satisfactorily. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 3 agreed to.

Clause 48 [Corresponding provision and application of enactments]:

[Amendment No. 229 not moved.]

Clause 48 agreed to.

Clause 49 agreed to.

Clause 50 [Remote provision of pharmaceutical, etc. services.]

[Amendment No. 229A not moved.]

On Question, whether Clause 50 shall stand part of the Bill?

Earl Howe: I trust that the Committee will forgive me if I initiate a very short debate on Clause 50. In doing so, I make it clear at the outset that I harbour no desire whatever to frustrate its very positive proposals.

My concern arises because I believe that the concept of remote dispensing raises a number of fundamental issues relating to patient care. If one asks a pharmacist what his role is in dispensing a prescription, he will always say that it is primarily a checking role. He would include in that definition the role of making sure that patients understood how to take their medicine, the purpose of it, and the instructions relating to the dosage.

During that process, a pharmacist occasionally will discover a doctor's prescribing error. Doctors' errors of that sort are rare; I do not want to suggest otherwise. These days computer systems in GPs' surgeries are very sophisticated. At the time of prescribing, the computer checks the compatibility of the medicine with the patient's medical condition and any other medicines being prescribed. Despite that, however, a computer will never provide a pharmacist's full service.

My concern--a nagging worry more than anything else--is that when remote dispensing gets under way, it will turn into a van-delivery service, perhaps run by a large national pharmacy chain, with electronic transfer of prescriptions. We need to look carefully at what we shall gain and what we shall lose by that sort of streamlining. We will obviously gain convenience and speed. What we may lose will emerge only over time--perhaps the livelihood of the local chemist, or even that of the local dispensing doctor, and the sort of face-to-face professional advice that a pharmacist is able to give. In that regard, there is a risk, however small, to patient safety. Beyond a certain point, that

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would be an unacceptable price to pay for progress. I would welcome any comments that the Minister has to make.

Baroness Northover: I should very much like to associate these Benches with the concerns expressed by the noble Earl, Lord Howe.

Lord Hunt of Kings Heath: I understand the concerns, which are well expressed. Although I do not believe that mail order or on-line pharmacies will suddenly sweep away traditional community pharmacy services, they can provide a useful service and an extra option for some people. Ideally, the choice should be made by patients themselves. Equally, I accept that the public must be assured that mail order and on-line pharmacies meet the same legal and professional standards as any other pharmacy. Legally, that means that all pharmacy and prescription-only medicines must be supplied only from registered retail pharmacy premises. Those premises are regularly inspected by the Royal Pharmaceutical Society of Great Britain, which I have always found to be a particularly rigorous regulating authority.

In addition, pharmacy and prescription-only medicines may be supplied only by or under the supervision of a registered pharmacist. For prescription-only medicines, there must also be a prescription. A breach of any of those conditions would amount to a criminal offence. On-line pharmacies must also meet the standards expected of the profession as a whole, as well as the particular standards set by the Royal Pharmaceutical Society in relation to Internet-based services.

Given those standards, the Government's view is that if legal and ethical safeguards are met, there is no reason at all why on-line pharmacies should not be safe and provide patients with new choices when obtaining their medicines. However, we have made it clear that if additional safeguards prove to be necessary, or if providers of on-line services cannot demonstrate their own quality and security of service, we shall work with the professions and patient groups to introduce further controls. We have not taken any decision as to whether such further controls will be needed. We shall have to assess that in the light of our experience, following discussion with patient and professional groups.

In conclusion, we believe that on-line pharmacy services would be useful to a number of people, but we accept that we must ensure that they are provided professionally and safely.


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