Health and Social Care Bill

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Sir George Young: I am not sure that I have fully understood the Minister. Is he saying that what can be provided under PMS is more restrictive than what is provided under LPS? The final sentence of paragraph 4.12.3 of ``The Health and Social Care Bill: Local Pharmaceutical Services'' implies that the same services can be provided under either PMS or LPS.

Mr. Denham: I confess that I am not quite sure to what the hon. Gentleman is referring.

Sir George Young: It is the document that has helpfully been provided called ``The Health and Social Care Bill: Local Pharmaceutical Services''. I will read out paragraph 4.12.3 in order to give the Minister's officials time to concoct a response. It says:

    ``The opportunity for innovation within a local contract therefore already exists, and it is likely simply to become confusing if the same services could be provided under either PMS or LPS.''

I took that to mean that it did not matter that a general practitioner was precluded from applying for a pilot scheme under LPS because he could apply under PMS and do exactly the same. However, in his response a few moments ago about the protection provided under clause 38, the Minster was unable to give me the assurance that I was seeking, that somebody who provided exactly the same services under PMS would receive protection under clause 38. I wanted an assurance that whichever door one knocked at to provide the services, one would receive clause 38 protection.

Mr. Denham: I set out in earlier discussions the distinction that we draw between dispensing doctor arrangements and pharmaceutical services and the reason why we do not apply the same entry criteria and competition criteria to the two. On the question of how that affects the PMS service, I accept that there is a contradiction between what I have just said and the document that I circulated previously. It may be helpful if I write to the right hon. Gentleman to clarify that point.

Question put and agreed to.

Clause 38 ordered to stand part of the Bill.

Clause 39

Assessing pilot schemes

Mr. Denham: I beg to move amendment No. 212, in page 33, line 21, at end insert—

    `(within the meaning of section 128(1) of the 1977 Act)'.

The amendment is purely technical. It simply corrects an oversight by adding a definition of the term ``health service'' used in subsection (1).

Amendment agreed to.

Clause 39, as amended, ordered to stand part of the Bill.

Clause 40 ordered to stand part of the Bill.

Schedule 3

LPS schemes

1Amendments made: No. 220, in page 62, line 11, leave out—

    `has such meaning as may be prescribed'

and insert—

    `means such services of a kind which may be provided under section 41 of this Act, or by virtue of section 41A of this Act (other than practitioner dispensing services) as may be prescribed; and

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

No. 221, in page 63, line 1, leave out from beginning to end of line 2.—[Mr. Denham.]

3 pm

Mr. Denham: I beg to move amendment No. 222, in page 63, line 19, leave out `of a prescribed description' and insert—

    `determined in accordance with the regulations'.

The Chairman: With this it will be convenient to take the following:

Government amendment No. 284.

Government new clause 12—Premises from which piloted services may be provided.

Mr. Denham: We are moving at such a rate that I am losing track.

Amendment No. 284 and new clause 12 deal with the movement of people from national arrangements to LPS and vice versa. New clause 12 deals with pilot schemes, while amendment No. 284 deals with the substantive, post-pilot arrangements, by adding further sub-paragraphs to paragraph 3 of schedule 3.

In both cases, the amendments provide powers to prevent people from providing services under both LPS and the national arrangements from the same premises. That is only sensible. In most cases it would be virtually impossible to tell when a prescription was being dispensed under LPS and when under the national contract. To let the two run side by side would be a recipe for confusion and—conceivably—fraud.

However, as with the equivalent provision for PMS, we do not think there should necessarily be a blanket ban. It is possible to imagine circumstances in which it might make sense for LPS to be provided from premises where services under national arrangements are also provided. For example, an LPS scheme might focus on out-of-hours services. In that case, there could be a clear distinction between LPS and the national arrangements, even though the same premises were used. Regulations will be able to make exceptions to the general rule.

The amendments provide a basis for regulations about transfer to and from pharmaceutical lists—the lists held by health authorities of the people with whom they have arrangements to provide services under the national contractual framework. When pharmacies move into LPS schemes, they will generally stop providing services under national arrangements, and so will need to be removed from pharmaceutical lists. The amendments provide for that.

Rather more significant for pharmacy owners will be the question whether they will be able to return to the national arrangements if, for any reason, their LPS scheme does not work out. The arrangements will be similar to those for PMS. Before people start providing LPS, they will be told whether they will have a preferential right to return—or in the case of new providers, transfer—to the national arrangements. Such a right will mean that they do not have to go through the normal control of entry procedures when they apply to go back on to the pharmaceutical list. Decisions about rights of transfer and return will be taken by the Secretary of State for pilot schemes and by health authorities for the later substantive arrangements.

Amendment No. 221 removes a small inconsistency in the drafting of the regulation making powers in paragraph 3(3)(a) of schedule 3.

Amendment agreed to.

Amendments made: No. 284, in page 63, line 28, at end insert—

    `( ) prevent (except in such circumstances and to such extent as may be prescribed) the provision of both LP services and pharmaceutical services from the same premises;

    ( ) make provision with respect to the inclusion, removal, re-inclusion or modification of an entry in respect of premises in a list under section 42;'.

No. 223, in page 63, line 42, at end insert—

    `.—(1) Regulations may provide for the making and recovery, in such manner as may be prescribed, of charges for local pharmaceutical services.

    (2) The regulations may, in particular provide for—

    (a) exemptions from charges;

    (b) the liability to pay charges to be disregarded in prescribed circumstances or for prescribed purposes;

    (c) section 122A of this Act (recovery of certain charges and payments) to apply also in relation to local pharmaceutical services (with or without modification);

    (d) section 122B of this Act (penalties) to apply also in relation to local pharmaceutical services (with or without modification).

    (3) The regulations must secure that the amount charged for any service is the same as the amount that would be charged for that service if it were provided under Part II of this Act.'.—[Mr. Denham.]

Schedule 3, as amended, agreed to

Clause 41

Application of enactments

Mr. Denham: I beg to move amendment No. 281, in page 33, line 39, leave out from beginning to end of line 2 on page 34 and insert—

    `( ) The relevant authority may by regulations make, in relation to Schedule 8A arrangements or persons providing or assisting in the provision of services under such arrangements, provision corresponding (whether or not exactly) to enactments containing provision relating to—

    (a) arrangements made under section 28C of the 1977 Act (provision of personal medical or dental services); or

    (b) pilot schemes made under Part I of the National Health Service (Primary Care) Act 1997,

    or relating to persons who provide or perform services under them.'.

The Chairman: With this it will be convenient to take Government amendments Nos. 282 and 283.

Mr. Denham: The clause is intended to provide the power to make regulations so as to apply to local pharmaceutical services other aspects of the existing legislation about PMS and PDS that are not explicitly covered in the Bill. As there is already a well-established model to follow in the NHS (Primary Care) Act 1997 and elsewhere, it does not seem necessary to go into the same exhaustive detail in the Bill. The main elements of LPS arrangements are covered in the clauses with which we have already dealt. This regulation-making power will allow us to deal with the remaining details by applying the existing model, with modifications where necessary. For example, it will allow us to extend the role of local pharmaceutical committees to representing those LPS providers who want such representation.

On reflection, we concluded that the powers originally drafted did not meet our requirements. Government amendment No. 281 replaces subsection (1) with a more extensively drafted and clearer provision. Government amendments Nos. 282 and 283 make consequential changes to subsection (2). The resulting power will remain limited to mirroring legislation that applies to PMS and PDS, but it will be expressed rather differently. The amendments make it clear that the Bill covers provisions not only about PMS and PDS arrangements, but also about the people providing and performing them.

Amendment agreed to.

Amendments made: No. 282, in page 34, line 4, leave out `provision' and insert `such enactment'.

No. 283, in page 34, line 4, after `modifications', insert `, if any,'.—[Mr. Denham.]

Clause 41, as amended, ordered to stand part of the Bill.

Clause 60

Extension of prescribing rights

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