Health and Social Care Bill

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Mr. Hammond: Just to be clear, my concern was that if public sector bodies providing dispensing services were to drive out of business community pharmacies that, in addition to providing dispensing services, had provided a wider range of over-the-counter and non-medicinal provision, that would be a considerable loss to some isolated communities.

Dr. Brand: I take that point. My example concerned the need to explore the provision of out-of-hours pharmaceutical services if it was not possible for them to be guaranteed locally through contracts with pharmacies—perhaps through a hospital-based pharmacy. Our out-of-hours call-in centre is based on the local hospital pharmacy. It seems ridiculous to send people who live at the other end of the island 10 miles for their pills.

The details need to be explored. I suspect that most of them will be dealt with by regulations. However, I hope that the Government will take the opportunity to secure the future of community pharmacies, although I appreciate that there is a significant problem in their negotiation. Providing support for all pharmacies is a bit like the common agriculture policy. I should not like one set of subsidy regulations or one type of contract to be made available, to suit both Boots the Chemist, with its enormous range of activities, and my local man in the high street of Sandown, who must struggle on his own. I hope that we shall aim not for administrative convenience but for true local flexibility.

Mr. Denham: We have had a useful and constructive debate and I shall try to reply to all the points that have been raised. I am sure that right hon. and hon. Members will pick me up on any that I miss.

We shall of course discuss later the way in which existing pharmacies need to be taken into account in the development of LPS schemes. I hope that the Committee will agree to focus on that when we reach the relevant Government amendment. The key consideration must be to ensure that services to patients are protected and enhanced. In practice, broader issues may need to be taken into account, but that must be our starting point.

It was suggested during the debate that pharmacies subsidise the national health service. I am not sure that I accept that. In our view, pharmacies are fairly and appropriately remunerated for the NHS service that they provide. The number of pharmacies providing such services has remained pretty stable for more or less a decade. There has been some shift in distribution. Relatively few pharmacies open or close each year, but those that open tend to be more than 500 m from the nearest pharmacy, which suggests some opening out of distribution and less concentration in a few small areas. The trend is slight but probably in the right direction.

Dr. Brand: Does the Minister recognise that although there may not have been a shift in numbers of pharmacies, quite a number of licences have been transferred from community pharmacies to superstores, which has distorted the relevant pharmaceutical market considerably? I am sure that the Minister will recognise too that pharmacists have extended their role without a contract to do so, and that that activity, outside their purely dispensing responsibilities, is subsidising the national health service to a great extent.

Mr. Denham: I shall come later to the issue of additional services, which was also raised by the hon. Member for Runnymede and Weybridge. However, I would not necessarily accept that that was a NHS subsidy; it is part of the operation of the community pharmacy. The patterns of ownership may change, but the basis of our approach must be on whether the patient is receiving a quality service.

10.15 am

Mr. Hammond: The Minister seems to have missed the point made by the hon. Member for the Isle of Wight (Dr. Brand). The current arrangements remunerate a pharmacist for dispensing. Whether he spends his time giving good advice to patients who may then buy nothing or whether he refuses to do so does not alter his remuneration.

Mr. Denham: No member of the Committee would accept the unfortunate caricature that pharmacists, with their professional training and responsibilities, simply dole out medicine without giving advice. The royal society guide makes it clear to pharmacists that it is their professional responsibility to give advice. We need to be careful not to caricature them.

Mr. Hammond: They are not paid for it.

Mr. Denham: Remuneration is linked to dispensing, but that does not obviate pharmacists, who are paid as professionals, from their professional responsibilities.

Mr. Michael Jabez Foster (Hastings and Rye): Will my hon. Friend give way?

Mr. Denham: I shall give way when I have completed the point.

We have signalled in the pharmacy strategy document that we want to address the shape of the national contracts. That is common ground across the Committee. We would all like more direct emphasis on the quality of services. I want to avoid our going down in history as the Committee that somehow agreed that pharmacists are not bothered professionally about quality. We need to change the way in which the contract operates.

Mr. Foster: Is that not a matter for the market? In Hastings, one pharmacist failed to give advice and now people do not go to him. Pharmacists who give good advice they build up their trade and do well as a consequence.

Mr. Denham: My hon. Friend is right. Many of the additional services provided by pharmacists have the beneficial effect of building up customer loyalty.

Mr. Hammond: I am grateful to the Minister because I would not like to be recorded as suggesting that pharmacists do not provide advice. The hon. Member for Hastings and Rye (Mr. Foster) made a good point. Not everybody has access to competitive pharmacists and can decide where to take their business.

The point relates not to medicines being dispensed against prescription, but to the advice—for which they are not remunerated—that pharmacists give in relation to minor ailments and over-the-counter products, including medicines. The fact that they give advice freely and that becomes part of the local culture relieves to a significant extent the burden on GPs of dealing with minor conditions. I would be grateful if the Minister acknowledged that. If he does, I in turn will acknowledge that the Government amendments seek to address precisely that point, so there is no difference between us.

Mr. Denham: Of course, the hon. Gentleman is absolutely right. It is acknowledged more effectively than anything I can say in the Committee by the winter campaign that was run by the Department together with the professionals—including pharmacists—urging patients to make full use of community pharmacists for minor ailments in order to avoid unnecessarily visiting their GPs. Millions of pounds were invested in that campaign precisely to recognise the skills of pharmacists, so we are at one on that.

We must be clear about the Government's approach on the important issue of dispensing doctors. We acknowledge the valuable role of dispensing doctors in areas where a pharmacy service are not available. The hon. Member for Isle of Wight, who is a GP, made the point—more tellingly than I could—that typically, dispensing doctor services do not directly employ the skills of a pharmacist. We would prefer patients to have the full range of primary care skills, including those of pharmacists, available to them. Dispensing doctors rarely employ qualified pharmacists. Indeed, they do not usually sell over-the-counter medicines or offer general advice on health or health care in the way in which a pharmacist would. Our view is that wherever it is sensible, patients should have access to GPs and community pharmacists, so that they can benefit from the complementary skills and expertise of both professions.

As the right hon. Member for North-West Hampshire has noticed, nothing in the Bill will directly change the existing rules for the award of dispensing rights in rural areas. It is, as he has said, a separate, complex and hotly debated subject in its own right. I am advised that the rules date back to a compromise between the professions that was worked out in 1911. The most recent change to the rules was made in the late 1980s. We are reluctant to make changes to those rules that would simply renew the dispute between the two professions, particularly when we are focusing on getting them to work together. The right hon. Gentleman asked me about the current state of play on the issue. The pharmacy and medical professions have, on their own initiative, been discussing joint proposals for changes to the rural dispensing rules. We have said that we will consider those proposals very carefully, but, at the request of the two professions, I shall not go into any further detail on that matter.

The hon. Member for Runnymede and Weybridge asked about the reference to ``coverage'', and whether it was geographical or service-based. As he said, it includes both those considerations. Where services are unavailable, LPS may well be the best vehicle for delivering new services. Last week we discussed the need to get more doctors into under-doctored areas. It is possible that an LPS scheme would be an appropriate way of working with the PMS measures to get new pharmaceutical services into deprived estates. There are other areas, such as new housing developments, where that might be the right way forward.

Geographical coverage is good in most of the country, but we want to improve the quality of pharmaceutical services in many places. That might mean coverage through measures such as medicines management, prescribing reviews or the development of better out-of-hours services. It could mean the development of targeted services. For example, under LPS a narrow and specific service could be provided for drug users. All of those services come under ``coverage''. It is a matter of delivering better services to new people.

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