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Westminster Hall

Wednesday 12 March 2003

[Mr. Edward O'Hara in the Chair]

Community Pharmacies

Motion made, and Question proposed, That the sitting be now adjourned.—[Dan Norris.]

9.30 am

Mr. Deputy Speaker (Mr. Edward O'Hara): Before I call the initiator of the debate, may I point out that 16 hon. Members have expressed in writing their desire to speak in the debate, and they will have priority? Others may hope to make a contribution, so Members who speak should take that into account and tailor their speeches accordingly.

Mr. Anthony Steen (Totnes): The timing of this debate is critical, because the Government have to respond to the Office of Fair Trading report on "The Control of Entry Regulations and Retail Pharmacy Services in the UK" by 17 April. I thank the Speaker for selecting this morning's debate. The Government will have adequate time to hear from both sides of the house. In view of how many hon. Members wish to speak, would colleagues consider adopting a five-minute limit? I shall speak a little longer than that, but not much.

Mr. Deputy Speaker : Order. I should point out that the Deputy Speaker has no power to curtail contributions, but I am sure that hon. Members will take note of what the hon. Member said.

Mr. Steen : I was not suggesting that you should curtail contributions, Mr. Deputy Speaker, but I am sure that hon. Members will respond to that request.

What should the Government say in response to the Office of Fair Trading report, which in effect recommended the wholesale deregulation of pharmaceutical services in England and Wales? I like to think that I am a model of a modern deregulator: I dislike unnecessary rules and regulations, and I chaired the Conservative party's committee on deregulation in the 1990s. I believe that our business ethos has been hijacked by a culture of over-regulation, which has resulted in batteries of officials, all armed with handbooks and directives, justifying rigid adherence to a bureaucratic straitjacket in the name of public protection.

The purported liberation of the pharmacists by removing the sluice gate currently operated by the local primary care trusts is not deregulation at all. The Office of Fair Trading proposals are not deregulatory: they are more about competition and price considerations. The report concludes that the public will be better off if the primary care trust is no longer involved. I do not believe that. Although a balance is needed between a planned and centrally controlled NHS and locality pharmacists, an unrestricted free market is neither relevant nor desirable in this instance. We must consider whether the small amount of money saved by the consumer justifies the impact on existing Government policies. I cannot believe that the

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progressive closure of neighbourhood pharmacies will fit into the Government's aims of social inclusion, urban renaissance and sustainable development.

Mr. Adrian Sanders (Torbay): Will the hon. Gentleman give way?

Mr. Steen : Not quite yet.

Furthermore, the closure of neighbourhood pharmacies would be counter-productive to patient welfare, as I shall explain. About 80 per cent. of a pharmacist's income comes from their contract with the local primary care trust to dispense NHS medical prescriptions. They assume a satellite role in relation to the NHS. The remaining 20 per cent. of the income of most pharmacies comes from marketing and selling other goods in their shops.

Mr. Sanders : Will the hon. Gentleman give way?

Mr. Steen : No, not yet. I know that the hon. Member for Torbay (Mr. Sanders) is my next-door neighbour, but I should like just a little longer to get the argument going.

It must be made clear that NHS prescriptions will cost the consumer the same amount, wherever purchased. I want to ensure that hon. Members understand that. Wherever people buy their NHS prescriptions, whether in a supermarket or a high street chemist, they will cost the same. Supermarkets will not be able to undercut their competitors' prices for prescriptions. The Office of Fair Trading report argues that, if supermarkets provide the NHS prescription service, they will also attract unprescribed, over-the-counter sales of items such as aspirin or cough mixture. Although supermarkets can sell such general items without the presence of a qualified pharmacist, they cannot sell what is known as P-list medicines without a pharmacist on duty.

However, the OFT argues that supermarkets should automatically be able to supply NHS prescriptions with a pharmacist on duty, and that they should not have to be regulated by primary care trusts. Supermarkets can apply to the PCT for a contract to dispense NHS prescriptions, and their applications, like any others, are considered according to the desirability of having another chemist in the locality. Many pharmacists with NHS contracts are based in supermarkets. That is just one of the factors that the local PCT considers.

The OFT says that the consumer will be able to save some £30 million each year, but I am not quite sure why. The industry says that the figure is nearer £8 million, or 0.08 per cent. of the £8.6 billion drugs budget. I am told that, if supermarkets open up NHS-subsidised pharmacies, more than 50 per cent. of the 12,250 community pharmacies are likely to be phased out over the next five years.

Mr. Sanders : The hon. Gentleman has made the precise point that I was going to raise. He mentioned that there would be savings for the consumer, but rightly

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referred to the evidence that throws the figures into doubt. There may be no saving whatever for the consumer.

Mr. Steen : I expect such a sensible remark from the hon. Gentleman, as he is a next-door neighbour of mine and benefits from all the good sense that I put out at my end of the bay.

Mr. Patrick McLoughlin (West Derbyshire): If the Government accept the report, they will be doing to community pharmacies exactly what they have done to our rural post offices. It will be seen as yet another death nail in the coffin of village life and local shops. This situation is exactly the same, and it worries a great many people.

Mr. Steen : My hon. Friend is a clairvoyant, because he anticipates the closing lines of my speech. Having taken those interventions, I shall deal with the points that have been made. If community pharmacies go, some could relocate to health centres. That has already happened, but it would be detrimental to the high street, because they would cream off NHS prescriptions, taking away the 80 per cent. of business that high street chemists need to survive.

One concern is the extent to which NHS money could be saved by eliminating the contract with local pharmacists. That costs £18,000 per year per pharmacy. If that £18,000 retainer is to be extended to all new outlets as a result of the so-called deregulation, it must end up costing the NHS more. In fact, it could cost the NHS a fortune, because every time a new outlet opened, with no regulation to prevent that from happening, it would require another £18,000 per pharmacy. However, that is unlikely to happen. It is more likely that the £18,000 retainer will be discontinued. If it is discontinued or reduced, that will lead to the collapse of the local community pharmacy, so either way there will be a knock-on effect if the PCT no longer hands out licences. The Minister is in a Catch-22 situation: he cannot win either way.

Mr. David Drew (Stroud): I am sure that the hon. Gentleman is aware of the long-standing dispute between the British Medical Association and pharmacists over rural dispensing. My worry, which I am sure that he shares, is that that dispute, which I gather was close to being settled, is likely to break out again on the back of what we are discussing. What are his views on that?

Mr. Steen : I am quite sure that once the Minister has heard all the views of hon. Members this morning he will be able to say something that will prevent any further disagreement between the BMA and the local rural pharmacists. If he does not do so today, I am sure that he will do so very shortly.

That brings me to the nub of my speech. What is the role of local pharmacists and how do they protect the quality of life for the elderly, the poor, the handicapped and other vulnerable people in our society? I approach this issue as a representative of one of the most beautiful rural constituencies in England, according to the House

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of Commons Library. It is scattered with historic towns, market towns, villages and hamlets. The vagaries of public transport and the cost of private travel for an ever-increasing retired population, many of whom lack mobility and suffer from physical frailty, make neighbourhood pharmacies essential.

Given the current location of our pharmacists in the South Hams, people living in villages and hamlets can include their visit to the chemist as a part of their weekly trip into the nearby town. However, a journey to the supermarket is often a much more difficult manoeuvre, and hazardous to arrange if public transport is involved.

Mr. Adrian Bailey (West Bromwich, West) : Will the hon. Gentleman give way?

Mr. Steen : If I must.

Mr. Bailey : I concur with the hon. Gentleman's judgment about his constituency. I understand the particular problems that arise in rural areas. Would he not agree that the problem of accessibility is equally great in some inner-city constituencies with a disproportionate number of elderly people on low incomes and low car ownership?

Mr. Steen : I am glad that I gave way. As the hon. Gentleman may know, I represented an inner-city seat in Liverpool for nine years. I am familiar with the points that he makes. The major supermarkets are on the outskirts of Liverpool, and to get there from the inner city is a day's job. The hon. Gentleman's point is extremely valid.

Mr. Paul Tyler (North Cornwall) : Will the hon. Gentleman give way?

Mr. Steen : Once more.

Mr. Tyler : I am extremely grateful. I entirely endorse the hon. Gentleman's view that this is an inner-city, outer-city and rural problem. Would he have time to address my concern that the professional pharmacist in a community pharmacy often gives a whole range of free advice, particularly to elderly people, that simply would not be available in a supermarket?

Mr. Steen : I know that Conservatives are clairvoyant, but I did not know that Lib Dems were too. The point I was making is that if the convenience of the old, the infirm and the handicapped is regarded as important by the Government—I do not know whether it is—especially in rural areas but not exclusively, supermarket shopping is not the answer. In my area of south Devon, the major towns of Totnes, Kingsbridge, Dartmouth and Brixham are all convenient, whereas the outer town supermarkets are extremely difficult to get to. They may be more convenient for city dwellers. I often wonder why reports tend to liberalise regulations for the people who live in urban areas rather than concentrate on the mainstream needs of rural England.

Mr. Mark Todd (South Derbyshire) : Will the hon. Gentleman give way?

Mr. Steen : Not at the moment. I should just like to finish this point.

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Lord Borrie, the former director general of the Office of Fair Trading, said:

How is the service provided by high street chemists different from that which could be provided by the supermarkets? First, it is personal. John Burkimsher's pharmacy on Bolton street in Brixham has a continuity of staff and delivers medication free of charge to elderly and housebound NHS patients. He is familiar with his local customers, and is able to provide a weekly medicines management system if they find it too difficult to control their own medicine intake. He offers a whole range of services that sadly are increasingly rare in today's world. Pharmacists such as Karen O'Brian in Torbay, who has been of great assistance in preparing this speech, work closely with local doctors, forming a bond of trust and reliability. She will go out at unsociable hours to supply crucial medicines in difficult circumstances.

Mr. Mark Francois (Rayleigh): That is a very important point. There is a national shortage of general practitioners, as the Minister well knows. Community pharmacists can provide a valuable service by dealing effectively with minor ailments, so that people do not need to see their doctor. That eases pressure on our already hard-pressed GPs. Surely we should bear that important point in mind when discussing this subject?

Mr. Steen : The problem about giving way is that my speech is being undermined by the tremendously insightful interventions of my colleagues.

There is a shortage of pharmacists. If supermarkets provide pharmacists with a national health contract, two pharmacists will be needed because of supermarket hours, thus taking them away from the high street.

The Office of Fair Trading suggested that access to pharmacies would be enhanced by the removal of the primary care trust's involvement in the entry regulations. It claimed that supermarket pharmacies were open more regularly and for longer than high street stores, so more of them would mean greater convenience.

Linda Gilroy (Plymouth, Sutton): Will the hon. Gentleman give way?

Mr. Steen : Plymouth will have to wait a moment.

Strangely, the Office of Fair Trading's own findings dispute the supermarkets' claim about opening hours. Its polling showed that 90 per cent. of respondents had no difficulty accessing pharmacies when required, largely because the current regulations allow for a good distribution of pharmacies. Community pharmacies keep irregular hours. They co-ordinate their hours with local GPs, and ensure that they are open up to an hour and a half after the surgery closes, so that patients can pick up their prescriptions straight away.

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Linda Gilroy : Will the hon. Gentleman give way on that point?

Mr. Steen : On that point.

Linda Gilroy : I am most grateful to the hon. Gentleman.

Mr. Steen : The hon. Lady should be.

Linda Gilroy : I hope that the hon. Gentleman does not have experience of this, but some of Plymouth's inner-city pharmacies play a key role in supervising the self-administration of methadone and other drug substitutes. Does he believe that such a service could continue in a deregulated market?

Mr. Steen : That is a rhetorical question, to which I am sure that the hon. Lady knows the answer. Clearly, that service will not continue in a deregulated market. [Interruption.] I shall not repeat what my hon. Friend the Member for East Devon (Mr. Swire) just said, as it would be totally unparliamentary.

Pharmacies are not just distributors of NHS prescriptions. My hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a distinguished dental surgeon, told me that his local pharmacies also provide other essential services, such as running a grocery store or even a post office, which are maintained solely because the pharmacist has a guaranteed income retainer.

The Government's strategy document "Pharmacy in the Future" suggests that the Department of Health is considering radical options for innovation. The pharmaceutical industry has proved willing to support and work alongside the Government in trying to achieve such objectives. When considering that report, the Department of Health should examine the system on the continent or the pilot schemes in Scotland, where community pharmacists have been allowed to treat minor ailments and have responsibility for repeat prescriptions. If the Government want to save money, those reforms should do just that.

The regulatory impact unit of the Cabinet Office calculated—I do not know how—that transferring responsibility for repeat prescriptions could save GPs up to 2.74 million hours. Perhaps that is why there are so many civil servants: they have been counting the number of hours that GPs could save if the responsibility for repeat prescriptions were transferred.

Estimates suggest that the NHS could save £380 million each year if only a quarter of all patients went to see their local pharmacist about their ailments instead of their doctor. I agree with the Office of Fair Trading report that competition, innovation and quality improvements are important measures of progress and desirable objectives, but the question is whether abolishing the current control of entry regulations in favour of an unregulated market will be more conducive to achieving those objectives. I do not believe that it will be.

Pharmacies are committed to providing health care to all at the point of delivery. The NHS is a centrally controlled body. Therefore, pharmacies cannot be

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based on a free market model, as that would clash with NHS objectives and the principle of delivering access to all who need it when they need it.

Mr. Swire : That is precisely the point in a rural area such as ours in Devon. There is a disproportionate number of elderly people in Devon, and they need to get to their local pharmacies but can do so only on foot. They might need transport to get to a supermarket, and we all know the state of the transport system in Devon.

Mr. Steen : I am grateful for that comment. Some of my constituents live in far-flung areas such as East Prawle, which is three-quarters of an hour by car to the nearest town. It takes some people living on Dartmoor up to an hour to get to a supermarket, and the cost of doing so is prohibitive. I agree entirely with my hon. Friend.

An important point about prescriptions is that 85 per cent. are free of charge; they are free of charge to the elderly, so the fact that there are cheaper over-the-counter medicines available at supermarkets is not a great help to many people compared with the advantages of location and access to pharmacies. It is not relevant to elderly people to know that aspirin is 2p less in a supermarket than in their chemist.

Mr. Todd : Will the hon. Gentleman give way?

Mr. Steen : I will give way to the hon. Gentleman, but I will not take any more interventions.

Mr. Todd : Would the hon. Gentleman be surprised to know that the OFT report provides the data to back him up? In the survey, 89 per cent. of people said that they found it easy to get to a community pharmacy from their home and 86 per cent. said that they found it easy to get there from their GP's surgery. The report addresses the point of access, but does not follow it through in its conclusions.

Mr. Steen : I said that a moment ago, but I am grateful for the hon. Gentleman's confirmation of the point.

Change for change's sake has little merit. I do not believe that most consumers aspire to shop in out-of-town shopping malls, nor do they want to see skyscrapers where there are now supermarkets, with one-stop shops providing every facility. That would lead to the collapse of the high street and the high-street chemists, and would result in deteriorating, soulless neighbourhoods.

It may sound as if I am pleading for a return to the past, but that is not the case. I am a moderniser and I recognise the need to move forward and respond to the times in which we live. However, not everything new is better, and innovation is not always progress. The existing arrangement gets the balance right. We are talking not about deregulation but about the destruction of the high street as we know it and the quality of life of existing neighbourhoods. Destroying a community and neighbourhood facility, a network for people's care and health, and replacing it with an impersonal, off-the-shelf facility in a supermarket will bring little comfort and solace in an increasingly uncaring world.

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9.52 am

Dr. Howard Stoate (Dartford): I congratulate the hon. Member for Totnes (Mr. Steen) on securing the debate. All credit to him for doing so; it is an extremely important issue.

I met the Minister in the Library last night when I was preparing for the debate. He said that I was the parliamentarian whom he seemed to run into more than any other. That is a reflection of how seriously he takes his role as the Minister responsible for pharmacy, given that it is a small part of his wide brief. He regularly attends meetings with me to discuss these issues. It is also a reflection of how seriously I, as chair of the all-party pharmacy group, take the OFT report on an issue that affects many people.

The fact that so many hon. Members wish to speak in the debate also reflects how important this matter is, and it must not be underestimated. It hinges on three issues: first, whether any changes are necessary to the control of entry regulations for pharmacies; secondly, whether the OFT report is the way to go if such changes are necessary; and, thirdly, and most importantly, the role of community pharmacies in an ever-changing world. The fast-developing NHS needs to become much more consumer-responsive, to deliver more front-line patient services and to develop in a way that improves patient access to vital services.

The first thing that the all-party group on pharmacy did when the report was published was to hold an inquiry. There was a proper debate and consideration was given to all aspects of the report to see whether we could enlighten Ministers in their decision making. The debate was extremely well attended: more than 200 people turned up, including a large number of parliamentarians. There was a first-class discussion, and we examined both sides of the argument in as much detail as possible to see what, if anything, the OFT report could do for pharmacy. We found that changes in the control of entry regulations were needed. We are not opposed to change, because it is often an important way of improving service. I want briefly to read from some of the conclusions in the report that we produced, which has been circulated widely. If anyone who has not seen a copy of the all-party pharmacy group report speaks to me after today's debate, I will ensure that they get one.

The report says:

Pharmacists are very much in favour of improving choice, quality and access for patients. The report continued:

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Pharmacists are currently in negotiation on their contract to see how they can improve their services and access for patients. This is a critical time in the history of pharmacy, because such wide issues are being discussed at the same time. It is important that any changes take place in the context of the overall changes to pharmacy arrangements needed to ensure that patients get the best possible access.

In the meeting, there was an interesting contribution from Dr. Peter Fellows from the British Medical Association. He made an impassioned plea, which has not been fully recognised but which adds to the debate, about the relationship between pharmacists and GPs. We are not just talking about large supermarkets opening shops in out-of-town centres and sucking the high street dry, although that is an important issue. There is another, even more important, issue.

I have been a GP for more than 20 years, and the relationship between pharmacists and GPs has changed immeasurably in that time. When I first started, it was unusual for GPs to have much respect or time for pharmacists. There was certainly little contact between the two. Pharmacists were seen as just the shopkeepers who handed out the drugs that we prescribed. However, we have developed a much closer relationship over the years. They regularly come into my practice to look at patient notes and suggest how we can improve access to medicine, medicines management and concordance with patients. They make proposals about rational prescribing, improved drug regimes to make it simpler for patients to take medicines and so on. There is wide interaction.

The BMA representative said that that relationship could be put at severe risk by the regulations. It has not been mentioned that many GPs may decide to open pharmacies in their GP practice. That may be good news for them and, on the surface, for their patients, but it would not be good news for their relationship with pharmacists. It would have many unpleasant repercussions, and the damage could be immeasurable. That has not been significantly brought out in this debate, and it is important to put that on the record. I would hate to see the return of the days when GPs were suspicious of pharmacists and vice versa. That would be counter-productive.

A measure of how seriously pharmacists took that view was the large round of applause for Dr. Fellows when he made that comment. As I said at the time, I never thought that I would see the day when 200 pharmacists applauded the BMA. That is a reflection of how times have changed and how important it is for the relationship between pharmacists and GPs to be fostered and improved.

That brings me on to my third point, which is to ask about the future role of community pharmacists. I travel round the country and meet many pharmacists. I contact them in my constituency, and they come to many meetings of the all-party pharmacy group. It is clear that there is an enormous amount of good will and professional expertise to improve patient services. In meeting after meeting, I am made aware that pharmacists have set up patient group directions and are dealing with emergency hormonal contraception, anti-smoking mechanisms, lipid management and watering clinics, which takes some of the strain off GPs and front-line hospital services. That is to be welcomed. We are

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only just beginning to tap the role of the pharmacist. They have huge expertise, as they are highly qualified and dedicated. They do an enormous amount for the NHS, and we must ensure that that is not damaged.

The debate hinges on whether the Office of Fair Trading sees the pharmacy as a high street shop or a front-line NHS primary care service. Unfortunately, as the hon. Member for Totnes said, the OFT is far more interested in retail competition than professionalism and the front-line delivery of NHS services. I shall give a few examples of what might happen if the pharmacy becomes nothing more than a high street shop.

How many high street shops would telephone patients on a Sunday to make sure that they are okay? How many would deliver an oxygen cylinder late on a Saturday night to someone dying of lung disease? How many would tell a GP, "We are worried about Mrs. Smith, she is not a good colour today"? How often does that happen? It does not happen with retailers, but it does with pharmacists.

The level of service could easily be put under threat. We have already heard that as many as 6,000 of the nation's 12,000 pharmacies could theoretically be threatened. That may be slightly alarmist, but even a small proportion is not acceptable. As we have heard, access for people living in inner cities and in rural areas is difficult, and it is much more problematic for people who are housebound—the elderly, the frail and the infirm.

I agree that we need changes in control regulations, but pharmacy services are already being improved and there is already market competition between pharmacies. However, we must not undermine the close relationship between pharmacists and GPs. The report deals only with competition but, for the reasons highlighted by the hon. Member for Totnes, competition is far less important than in other retail sectors, because as much as 80 per cent. of a pharmacy's income comes from the NHS. For all the reasons that I and the hon. Gentleman have outlined, it would be dangerous to follow the report.

More than one Minister is involved. The lead Department is the Department of Trade and Industry, but the Department of Health will of course have an input. However, I gather that the final decision rests with the DTI. When Ministers meet to deliberate the Government's response, will the Minister ensure that the main point to be raised—it is the main reason for having community pharmacies—is the professionalism and the delivery of front-line NHS services? The competition issue, although important, is not paramount. Above all, patients want first-rate, front-line NHS services, as the hon. Gentleman said, rather than tuppence off the cost of aspirin.

10.2 am

Mr. Robert Syms (Poole): I congratulate my hon. Friend the Member for Totnes (Mr. Steen) on making a compelling case in his own particular style. I shall not repeat the arguments that he adduced. Instead, I shall concentrate on a few points. Most of my constituents have pretty good access to pharmacies, but they are worried about the impact that the changes may have. As the hon. Member for Dartford (Dr. Stoate) said, it may be alarmist to say so, but if 6,000 of our 12,000

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pharmacies close, my constituents will not have access to a local pharmacy. I have received many petitions, letters and telephone calls on the subject. Attendance at today's debate by Members from all parties proves that there is genuine concern.

Many of us have seen the closure of local post offices, the removal of public telephones, and the diminishing of general services for our constituents. This is the one area in which most of us are determined to do our best to ensure that our constituents, many of whom are elderly or not mobile, have access to that very important service.

As my hon. Friend the Member for Rayleigh (Mr. Francois) said in an earlier intervention, the key to the future is innovation. It is important that pharmacists are given more responsibility for treating minor ailments, and a number of tests have proved successful. Another question is the issuing of repeat prescriptions. Various assessments have been made of the savings, but we all know about the tremendous shortage of GPs. The Government have a number of targets for recruiting and training people, but it seems sensible, when possible, to relieve some of the burden on GPs and to provide a greater service.

Mr. James Gray (North Wiltshire): My hon. Friend comes from an urban constituency, but does he agree that in a rural constituency such as mine repeat prescriptions are particularly important? The GP's surgery may be some miles away from the patient's home, and it would be a huge help if the patient could nip down to the local pharmacy—for instance, in Box, a village in my constituency. The argument on repeat prescriptions is one of the most important in the debate.

Mr. Syms : My hon. Friend reinforces what I said. It is a very important point. Many measures could be taken to improve the service that pharmacists provide to integrate them into the NHS without necessarily going down that route. We have already heard about the close relationship between many GP practices and pharmacists, who sometimes go the extra mile if people need oxygen or additional help. That service might not be offered by a supermarket.

There is also concern because the pharmacies that have been opened in several supermarkets are not necessarily open during the same hours as the supermarkets, sometimes for the understandable reason that they have difficulty recruiting pharmacists. We have already heard that there is a shortage of pharmacists.

I want to put on record the concern of my constituents in Poole, who are determined to fight substantial change. If the Minister is unable to give us a full answer, I hope that he will give us substantial reassurance. This issue will become very important for my constituents over the next year.

10.5 am

Mr. Tom Cox (Tooting): All of us here today know from our correspondence of our constituents' deep concerns about the future of the typical pharmacy shop that we have in our constituencies. I totally reject the Office of Fair Trading's proposal that the regulations

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that control pharmacies should be abolished. On issues of fair trading, I always want proposals to be for the benefit of the consumer. Should these proposals be introduced, in my view they would most certainly not be for the benefit of the general public.

As we know, the general public very soon understand if a proposal meets with their approval, and these proposals most certainly do not meet with the approval of our constituents, from whichever part of the country. All of us have used and still use our local pharmacist. I stress the word "local", because that is what they are. They operate in the area where most people live. We get to know, trust, respect and listen to the people who run pharmacies. Opening up such services to supermarkets would, without doubt, present several concerns and problems.

Mr. Swire : Will the hon. Gentleman give way?

Mr. Cox : No, I do not intend to give way.

Many people do not shop in supermarkets. As we have heard, many retired people do not drive, so what has been a local service often becomes a service that is nowhere near where the person who needs it actually lives. The personal relationship no longer exists. As people have said to me in letter after letter, "I know my pharmacist, and they know me. They know who my doctor is, and I can talk to them in confidence about myself and my health. I would not feel confident trying to do that in a large supermarket." Pharmacists know their area and community, but I doubt that that knowledge would still be found if services were transferred to large supermarkets.

I also believe that the proposals would lead to many shop closures in our communities. As all of us have seen over the years, when large supermarkets open up, local shops, many of which have been in the local community for years and have been very popular, can no longer survive and compete against the supermarkets, given the opportunities and trade that they develop. That is what would happen to pharmacists in many areas of the country. Is that what the Government and the Department of Trade and Industry want? I do not want that to happen, and neither do the general public.

When the Minister replies to the debate, it would be very interesting to hear about the thinking behind the Department's policy on the issue. It would also be interesting to find out what the Department of Trade and Industry thinks. What complaint is made against local pharmacists? I get many letters of complaint about many issues, but I must say to my hon. Friend that, despite many years in the House, I have never received even one letter from a constituent complaining about the service that their local pharmacist provides. The control of entry regulations have been in force for some years. Why seek to change them now? I am not opposed to change when it is of clear benefit to the consumer who wants it. However, these proposals for change are being strongly opposed across the country by the people who use pharmacies every day. The Government have enough problems already, and I do not mean Iraq. Like me, the Minister is a London

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Member, and he knows his constituency as I know mine. He knows that the Government will face problems if they push ahead with these proposals against the will of the people whom we represent, be it in London or in any part of the country.

10.11 am

Mrs. Annette L. Brooke (Mid-Dorset and North Poole): I, too, congratulate the hon. Member for Totnes (Mr. Steen) on securing the debate. Judging by the size of our mailbags, this is a most pressing issue.

I should like to start by considering the motivation for change. It is worth while considering the arguments for removing the barriers to entry: excessive profits is the obvious one. However, there is no evidence that pharmacists make excessive profits. There is a claim that consumer choice is restricted. The difficulty with that argument is identifying the consumer. In a sense, the national health service is the main consumer, but the front-line consumer is the patient, and one must distinguish between the two.

How would the patient benefit if the barriers to entry were removed? There would be changes; there may not necessarily be fewer pharmacists, but they would be in different places. There is no evidence that removing the barriers to entry would lower prices, because, as the hon. Gentleman pointed out, many elderly people are exempt from prescription charges. We must consider whether there would be net gains from removing the barriers, and we must admit that that is very difficult to establish. It is significant that the former director of the Office of Fair Trading, Lord Borrie, opposes the change. He spent many years introducing more competition so that there would be more choice and lower prices, and he says that it is not appropriate to remove the barriers.

An argument for retaining the barriers to entry is to create a climate for investment, and this is an instance of when we need a climate for investment. The NHS plan proposes a greater role for pharmacists, which we all welcome. In fact, some of us would like pharmacists to do even more. For example, when one goes to one's GP for a blood test one is often sent to hospital. Many believe that, given our lifestyles nowadays, it would be better if such minor matters could be dealt with by a nurse based in a pharmacy.

Weighing the arguments for and against barriers to entry, one comes down in favour of retaining them. We may not want to keep them in exactly the same form; that could be an issue for future debate. The important thing is that there would be a net welfare loss if they were swept away. I concur with other hon. Members that there does not seem to be much evidence that patients want the change, and that is the critical point. The statistical survey that was mentioned showed that over 80 per cent. of patients do not want a change. I am sure that other hon. Members have, like me, received petitions, letters and surgery visits on the matter.

I represent a diverse constituency with pharmacies in many settings—supermarket, village, market town and neighbourhood urban shopping centre. I have been receiving representations from all quarters. In the village, the petition has been signed by nearly every resident, because for elderly people and mothers with young children, for example, the GP's surgery will be very far away. The pharmacy is their first stop-off and it

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is vital to them. Devon is a similar case. Dorset is renowned for having exceedingly poor public transport outside its conurbation, and, in contrast to some areas, our senior citizens' concession is only for half-price, rather than free, travel, so any savings that they make will soon be swallowed up by the costs and difficulties of travelling.

At my surgery on Saturday I met a pharmacist who works in Upton, an area attached to the main conurbation. I asked him what he does that supermarket pharmacies may not do. We should not suggest that supermarket pharmacists are in any way less qualified. He ran through a long list of what really amounted to voluntary work: home deliveries after 6 pm, which is an excellent service; making up the weekly medicine dosage tray; visiting a home if a doctor rings to suggest a change to a prescription; and taking oxygen out to people.

Sandra Gidley (Romsey): As the only pharmacist present I have listened to the debate with interest. I am the villain of the piece, having worked as a pharmacist in a supermarket, when I provided all those services—they are not unique to community pharmacies. However, that does not mean that we should deal with supermarkets in a way that enables them to deprive community pharmacies of the opportunity to do that work.

Mrs. Brooke : I thank my hon. Friend. The point that we are making is that the relationship with the pharmacist in the community is a much closer one, involving continuity of contact with people. People prefer their local service to that provided in a supermarket, which may not be so near to them.

As time is short, I conclude with a summary provided to me by the Dorset local pharmaceutical committee. It argues that the change

which is an important point. In addition, it would

A whole neighbourhood centre can be affected, as we know, which is why the supermarket issue is cause for concern. The summary continues:

Several hon. Members rose—

Mr. Deputy Speaker : Order. Before I call the next hon. Member to speak, it may be helpful if I point out that it would be desirable for the first of the three Front-Bench spokespersons to be called not later than 10.30.

10.18 am

Linda Perham (Ilford, North): I congratulate the hon. Member for Totnes (Mr. Steen) on securing this timely debate. I am interested in the issue as a member of the

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Trade and Industry Committee and of the all-party group on pharmacy. I am motivated also by the concerns of pharmacists in my constituency, who were among the first groups to contact me when I was elected. I met them in June 1997 and have remained in contact with them ever since.

My hon. Friend the Member for Ilford, South (Mike Gapes) received a petition last week with 20,000 signatures from our area alone. I expect one to be delivered today. A key issue for community pharmacists and patients in my constituency is access and convenience of location. That point has been well made by other hon. Members. Elderly people and those without access to private transport do not want to travel to supermarkets for their prescriptions.

Community pharmacists are not afraid of competition. For many years two pharmacies have been practising successfully opposite the health centre in my constituency, and another, closer to where I live, is just 10 or 15 minutes' walk from those two. Those pharmacies have been thriving for many years. Local pharmacists are approachable and knowledgeable, and they have forged a key role in delivering NHS services. As the Secretary of State said at the Labour party conference in October, pharmacists are clinicians, not shopkeepers. I would say that they are not retailers but rigorously trained professionals.

Marshall Davies, the president of the Royal Pharmaceutical Society, said in January:

Community pharmacists play a vital part in treating a range of illnesses, in managing chronic diseases and in complementing and alleviating the work of GPs. My hon. Friend the Member for Dartford (Dr. Stoate) made that point and it was also highlighted by the King's Fund, with which I spent a year on a National Council for Voluntary Organisations secondment. The fund's report, "Developing Community Pharmacy", found that community pharmacists were keen to play a greater role in the NHS.

I cannot emphasise enough the importance of community pharmacists in providing for the health and social needs of local communities. Today, on national no-smoking day, I pay tribute to their work in combating the scourge of smoking. Many community pharmacists work in partnership with smoking cessation services, and they can train to become community smoking cessation advisers, of which there are 18 in the boroughs of Redbridge and Waltham Forest. Some 260 people were helped last year, with a 50 per cent. success rate. For national no-smoking day today, pharmacists in my constituency are putting up posters and displays in their windows offering nicotine replacement therapy.

The help given to people to overcome that addiction and all the other vital services that pharmacists provide reinforce the crucial role that pharmacists play in their local communities.

Mr. Gareth Thomas (Harrow, West): My hon. Friend has, like me, the good fortune to represent a suburban constituency in outer London. Given that we have heard

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much about the impact of the proposed change in regulations on rural and inner-city areas, is it not also important to recognise the impact that the implementation of the Office of Fair Trading report would have on secondary shopping centres that provide a crucial sense of community in such constituencies?

Linda Perham : My hon. Friend is right. That affects us all. Other hon. Members have made that point and will continue to reinforce it for the Minister. I am sure that the Minister, to whom I pay tribute for his willingness to listen, will consider carefully the representations from hon. Members today on the necessity of encouraging community pharmacists to continue their positive contribution to primary care services and to the improvement of the nation's health.

10.23 am

Mr. Roy Beggs (East Antrim): I congratulate the hon. Member for Totnes (Mr. Steen) on securing this debate, which enables many of us to convey our views and those of our constituents to the Minister before the Government act on the report.

The proposal of the Office of Fair Trading to deregulate pharmaceutical dispensing is vigorously opposed by all my hon. and right hon. Friends. We believe that the OFT report is entirely misguided, and that its recommendations will impede access to, and the provision of, pharmaceutical services.

The New Economics Foundation recently raised the prospect of Britain as a nation of ghost towns. In its report "Ghost Town Britain: A lethal prescription", the foundation highlighted the negative impact that supermarkets, hypermarkets and out-of-town shopping centres have had on local services in our towns and villages. That might still be a relatively new phenomenon in Northern Ireland. The development of stores previously seen only on mainland Britain has occurred largely from the peace process of the last decade, yet our villages and towns are already witnessing the virtual disappearance of the high street. Our corner shops, post offices and banks are finding it increasingly difficult to compete with the large one-stop-shop supermarkets in out-of-town venues.

Clearly, such supermarkets provide many advantages to the consumer, such as greater choice and more competitive prices—not to mention the convenience of being able to buy all one's necessities in one place. However, people must be able to get to such facilities if they are to take advantage of them. What about the elderly, the disabled, single parents, young mothers and those without access to private transport? The high street is their lifeline. In a country such as Northern Ireland, whose economy and geography are predominantly rural, the local high street remains vital.

Mr. Swire : Is not there an inherent contradiction between the Government's sponsorship of the legislation, which will lead to more people having to use cars, and their attempts to persuade people not to use them?

Mr. Beggs : The hon. Member takes a keen interest in Northern Ireland affairs. He makes a valid point, which the Minister will have noted.

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The community pharmacy will become unsustainable in the face of competition from the pharmacies that spring up in our supermarkets. The Office of Fair Trading estimates that deregulation will result in 900 new pharmacies in large supermarkets and a further 2,127 in medium-sized stores across the United Kingdom. I sincerely hope that that does not happen.

Rev. Martin Smyth (Belfast, South): Is my hon. Friend aware that GPs in Northern Ireland have said that they will be unable to give their attention to the anti-smoking campaign, which will therefore depend largely on community chemists? Given that today is no-smoking day, should not that issue be borne in mind?

Mr. Beggs : I thank my hon. Friend for that valid contribution, which highlights the fact that pharmacists' activities involve much more than just dispensing.

Research conducted by Lloyds Pharmacy at the beginning of the year estimated that more than half the pharmacies are in the catchment areas of two or more supermarkets, so the potential for many of them to fall by the wayside is high. Northern Ireland may be predominantly rural, but it is also small, and our pharmacies will inevitably be within the catchment areas of supermarkets. The number of community pharmacies lost could therefore be huge.

Why should we make people who are disadvantaged suffer increased inconvenience by forcing them to travel further to see their local pharmacist? Many people already have to wait a week or 10 days to get an appointment with their doctor. However, they can get instant access to the local pharmacist, who can often prescribe something for their ailment. Is the creation of such problems what the Government have in mind when they speak about access to health care for everyone?

The proposals will have an enormous impact on the delivery of health care. The OFT report fails to acknowledge that pharmacies provide much more than daily necessities. They are not there just to sell toiletries—they are more than a convenience store. According to the National Pharmaceutical Association, 80 per cent. of a typical pharmacy's turnover comes from providing NHS services, particularly from dispensing NHS prescriptions. The community pharmacy cannot be regarded as a typical high street shop. We cannot realistically subject health care to the free market.

Community pharmacists do more than dispense drugs. Many provide a very personal delivery service for prescribed medication, and often respond to patients' requests outside normal working hours. They are almost part of the family. They are trusted members of the local community, and provide health advice for those who cannot or will not see their GP. People are much more likely to seek advice from someone they know, trust and see often than from an unknown individual sitting behind a busy supermarket counter.

Face-to-face contact with patients, and the delivery of primary health care, encourage many young students into the pharmaceutical profession in the first place. Northern Ireland is already facing a shortage of qualified pharmacists, and students who decide to study in other areas of the United Kingdom invariably do not return. If we replace the essential caring element of the

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profession with a concern for profit margins over consumer health, it will be even more of an uphill struggle to entice young people into pharmacy in Northern Ireland and elsewhere in the United Kingdom. My party urges the Government to reject the proposals and to continue to support the present network of community pharmacies as an essential mechanism in the provision of health care and a vital part of community life.

10.29 am

Dr. Evan Harris (Oxford, West and Abingdon): I pay tribute to the hon. Member for Totnes (Mr. Steen) who introduced the debate in his typically clear way and was generous in giving way to interventions by hon. Members from all parties.

I do not have time to comment on all the points that have been made, and I have others of my own to add. There is a great deal of interest in the subject, as evidenced by the record numbers present from all political parties—13 Labour Members, nine Conservatives and nine Liberal Democrats, or 3, 5 and 17 per cent. of each party's respective parliamentary strength. On occasion, among all its disadvantages, the first-past-the-post system works to our advantage.

The hon. Gentleman pointed out, rightly, that there is a difference between deregulation and the need for increased competition. I was pleased to hear him say that a free market is not always appropriate, even in the retail environment. The Liberal Democrats strongly support deregulation if it means that every effort will be made to reduce the burdens on business. However, that does not mean having completely free competition.

Mr. Michael Weir (Angus): On deregulation, does the hon. Gentleman accept that the original reason for introducing regulations was to avoid the situation in which pharmacies clustered around doctors' surgeries and health centres and to ensure a wide spread of pharmacies throughout the community? The OFT report would reverse that process.

Dr. Harris : That is a fair point. It should be borne in mind that even if the OFT report were implemented, there would be other restrictions that none of us would want to lose. For example, planning restrictions impact on the number of retail outlets, especially supermarkets. The OFT seems to consider that, in the name of advantage to consumers, there is automatically a good argument for the abolition of any regulation. However, we should consider planning. To give just one example, removal of regulation would mean the abolition of controls on out-of-town supermarkets. In paragraph 1.11 of its summary, the OFT claims that

Even having read the report and the responses to it, I do not think that the case has been made.

Brian Cotter (Weston-super-Mare): Does my hon. Friend agree that it is striking that the OFT report says that there is clear evidence that the current system works

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well in terms of locality? The OFT itself draws attention to the importance of the fact that there are local pharmacists where people actually want them.

Dr. Harris : Yes, indeed. I pay tribute to my hon. Friend, who is probably more in touch with small business interests than any other hon. Member. He has done a huge amount of work to protect the interests both of consumers and of those who run small businesses.

It is argued that there are lower prices in supermarkets. However, where that is so—and it does not exist everywhere—it is not clear that it is anything other than loss-leading intended to increase footfall for the much wider range of goods that supermarkets can offer in comparison with pharmacies. Those goods include—even today, on national no-smoking day—cigarettes. Supermarkets want people to buy cigarettes and other products whereas community pharmacies, which do not sell such products, do not have that need.

The abolition of resale price maintenance has not necessarily and invariably led to maintained reductions in prices of over-the-counter medicines. I am concerned about the way in which the OFT report deals with international comparisons. It states, almost parenthetically, that Britain does better than average in the number of pharmacies per head of population—which counters its own case—and then lists only those countries that do better than this country. If one claims that an investigation is impartial, one should set out both sides of the argument.

There is inadequate consideration of work force issues, which are important. There is not a free labour market in the area, because it is comprised of professionals, and it does not follow that there should be a free market in retail if the work force does not have that freedom.

Throughout, the report refers to the people who rely on pharmacies as consumers. Many of us are concerned about the increasing redefinition of patients as consumers. Not all consumers and their interests should be considered equally. There are equity issues. It is not simply a matter of consumer choice but of ensuring that we give sufficient regard to those who are especially vulnerable. We must ensure that choice for the many is not increased at the cost of choice for the vulnerable few, such as low-income groups, the elderly and the sick. We should bear that principle in mind, although it is not endorsed by the OFT, which says that there should be no barrier to entry that does not best serve the interests of consumers.

The OFT mentions that it wants to be mindful of the public policy objectives of health departments. That will mean having regard for access by elderly people. The report found no sign of profiteering, although that usually follows when there is an inadequate market. The failure to find evidence of profiteering is a strong argument against the report's recommendations.

I want to say one word in defence of pharmacists who work in supermarkets, as did my hon. Friend the Member for Romsey (Sandra Gidley), because they, too, are professionals. They know local people, can assist with medicines management and do all the other

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things that we want them to do. The question is not about the professionalism of pharmacists employed by supermarkets, but the impact that greater competition in our supermarkets will have on the viability of local stores. I want all pharmacists to take part in medicines management work.

Finally, I want to offer the Government some better ways to reduce costs than those suggested in the OFT report. Clearly, more intervention by pharmacists actively to manage the way in which patients—consumers, if it wants to use that word—take their medicines will reduce costs, because there is much waste in prescribing. Increasing the supply of pharmacists will also ensure that there is more and better medicines management.

I want to suggest three better ways to increase access. The first is to freeze prescription charges, which, for many people who fall just outside the exemption, are a barrier to accessing medicines. The Government should ensure fair remuneration for pharmacists, so that they are able to do all the things that the Government want them to do without finding that they are unable to do the work that makes them viable. Pharmacists receive no money for making up dosage boxes, although that is time consuming, but we know that compliance with medicines is a critical factor in effective medical treatment—no medicine works if it is not taken.

The Government must do something to improve the supply of pharmacists and to ensure that supermarkets and independent pharmacists do not have to shop around for locums, because, in the current labour market, community pharmacists will always lose out against the wider multiples. Although the Liberal Democrats are in favour of greater deregulation, we do not believe that the OFT report makes an adequate case. The interests of vulnerable patients and consumers will not be safeguarded if community pharmacists are driven out of business by increasing competition from supermarkets and large multiples.

10.39 am

Chris Grayling (Epsom and Ewell): I, too, congratulate my hon. Friend the Member for Totnes (Mr. Steen) on securing this extremely important debate on an issue that is clearly of concern to hon. Members from all parties. The fact that he initiated the debate emphasises the Conservative party's concern about the future of community pharmacies. It comes at a time when local centres, stores and communities are, increasingly, under threat from the Government's policies. Thousands of post offices are already disappearing throughout the country. There is now the risk of local pharmacies doing the same, the consequence of which would be devastating for local communities. That is why I am extremely concerned about the impact of the OFT recommendations and why I believe that the Government should scrutinise them fully before they consider adopting them.

A local pharmacy is important for several reasons, which Ministers must not forget as they set about studying the detail of the OFT report. The first reason is access, to which many hon. Members referred. The elderly and the infirm have always relied on going to their local chemist to get the drugs and treatments that they need. They have also relied on a friendly and

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supportive word from their pharmacist, whose professional skills contribute significantly to health care in today's world, as several hon. Members have said. The hon. Member for Dartford (Dr. Stoate) made that point especially well. As chairman of the all-party group on health, he, perhaps more than most, recognises the importance of the role played by the local pharmacist in our communities.

Many families also need the local pharmacy for treatment for their children. The reality for many families is that one partner takes the family car to work, and the other is at home with the kids. He or she will walk to the local centre and pick up the necessary drugs from the local pharmacy. We must not run the risk of that disappearing. The damage that that would do to the fabric of local communities would be enormous.

Mr. Henry Bellingham (North-West Norfolk): My hon. Friend may be aware of a village in my constituency called Snettisham. It has an excellent pharmacist called Alan Stockley who does a superb job serving what is now a predominantly ageing community. That community is very worried about the report, and I am glad that my hon. Friend mentioned elderly people who need advice from their friendly local pharmacy.

Chris Grayling : I thank my hon. Friend for his comments, which speak for themselves. They reflect the strength of feeling across the House about the risk to our community pharmacies.

There is a practical point to be made about the viability and future of local centres. As I said, post offices and banks are disappearing, and local food stores have gradually moved out of local communities. In many places, the local pharmacy is the anchor store on a small parade. Its disappearance will not only cause a reduction in local services but kill other businesses. The consequences of that to the people who live in those areas could be very significant.

It is interesting that planning policy guidance 6 sets out to protect the local pharmacy and post office as an important part of the fabric of those local centres. In many ways, it seems, the OFT is arguing against established Government planning policy, and the Government should think carefully before they go against their own planning policy.

As many hon. Members have said, the local pharmacy has a role in supporting the national health service. Pharmacists have profound skills and years of experience with individual patients and the treatments that they dispense daily. Those skills can and must be an important part of the provision of health care in the future. There is a clear role for the pharmacist as our society looks to new ways to deliver health care closer to the communities that benefit from it. There is also a clear role for the pharmacist in providing more of a gateway to our over-pressed GPs by giving basic advice and guidance to people about ways to tackle their health problems. That role must not be undermined by local pharmacies in local communities disappearing as a result of these measures.

The OFT report will clearly open up the market. It will allow supermarkets to move into the market in a big way. I accept the professionalism of the pharmacists

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who work in our supermarkets. None the less, I was surprised to hear the two Liberal Democrat health spokesmen weighing into the debate in defence of supermarket pharmacies. We must be careful before we see significant additional provision of pharmacies in supermarkets. There is no doubt that supermarkets play an important role in our society, and there are places where supermarkets can and do provide good pharmacy services, but we must be careful about giving supermarkets the opportunity to have an additional and substantial presence in this market.

Sandra Gidley : Will the hon. Gentleman give way?

Chris Grayling : I have only a minute left, so I hope that the hon. Lady will forgive me if I do not give way.

Before I give the Minister a chance to wind up the debate, I shall refer to the nature of the market with which we are dealing. In recent months, we have had a debate on the over-the-counter market. Many pharmacists told hon. Members on both sides of the House that, if they lost the resale price maintenance that applies to over-the-counter drugs, they would lose an important part of their business. They said that there would be price cutting and that they would be unable to compete with supermarkets. To a significant degree, however, that has not happened. There was some crying of wolf in the pharmacy industry. I have talked to many local pharmacists who say that the situation has not proved to be as bad as they thought.

However, that experience does not justify deregulating the NHS prescription dispensing market, because that market does not depend on excellent service, innovation and competition. It is largely a fixed market. It is not as fixed as Ministers might like, given its escalating budgets, but we are talking about a fixed cake. If we allow new entrants into the marketplace to take a share of that cake, some of those who are there today will inevitably lose. That is basic economics; it cannot be any other way. Given the fixed or limited prescription market for those businesses to draw on, a significant expansion of the number of pharmacies, as the OFT envisages, cannot but ensure that pharmacies in local communities throughout the country will disappear. That must not happen. It would be a devastating blow to those communities, so the Government must think carefully about what lies ahead.

I know that the Minister is in the middle of consultation and likely to be reticent about anticipating the results of that consultation, but my message to him is that we have heard from hon. Members on both sides of the House who come from different backgrounds, persuasions and viewpoints. The views of the hon. Member for Tooting (Mr. Cox) are well known, and I respect him for his long service in his constituency. He made an impassioned plea from his political perspective about the importance of local pharmacies. My hon. Friend the Member for East Devon (Mr. Swire), who represents rural communities—small villages in the countryside—also saw as enormous the dangers that could result in those communities from the disappearance of local pharmacies.

As I have said, the Minister has heard views from hon. Members on both sides of the House, from different types of constituency and political perspective. I very

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much hope that he will take from the debate a clear understanding that the House does not want local community pharmacies to be undermined. He must not take decisions in the wake of the OFT report in a way that is likely to cause further damage to the people who most depend on the services that community pharmacies provide.

10.47 am

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy) : I congratulate the hon. Member for Totnes (Mr. Steen) on securing the debate and on the spirited way in which he made his contribution. A wide cross-section of Back Benchers have made quality contributions. I am particularly grateful for the views of my hon. Friend the Member for Dartford (Dr. Stoate), the work of the relevant all-party group and the powerful contribution from my hon. Friend the Member for Tooting (Mr. Cox).

Ms Joan Walley (Stoke-on-Trent, North): Does my hon. Friend accept that many more hon. Members wished to contribute to the debate? We want him to take away the strong message that this issue is about public health. We want primary care trusts to consider health planning and community pharmacies, and we want a deal negotiated with the pharmacies for the new contract. We do not want medicine to be treated as an ordinary item of commerce.

Mr. Lammy : My hon. Friend is right to point out that many hon. Members have spoken on this subject in this Chamber, and many are concerned about the report and anxious to express their views. We heard from constituencies as far apart as those of the hon. Members for Mid-Dorset and North Poole (Mrs. Brooke), for Rayleigh (Mr. Francois), for East Antrim (Mr. Beggs), for Belfast, South (Rev. Martyn Smith) and for East Devon (Mr. Swire), and of my hon. Friend the Member for Harrow, West (Mr. Thomas). Hansard will also contribute to the Government's deliberations.

Much has been said about the contribution of community pharmacies in rural, suburban and inner-city areas. All Ministers, of whatever Government, are also informed by their constituency experiences. From the inner-city constituency that I represent, and in which I grew up, I know that people in deprived communities rely on three people in authority. They rely on the general practitioner and often on the local priest. However, they traditionally have to get an appointment to see the GP, and the priest is not to everyone's taste, so they most definitely rely, as my family did, on the work of the community pharmacist at the bottom of the road.

In preparing for a speech that I made to the pharmaceutical services negotiating committee eight days ago, I spent Saturday not only rushing to the bank and paying the bills as one does, but also incognito in north London in some of my community pharmacies.

Chris Grayling : The mystery shopper.

Mr. Lammy : The hon. Gentleman is right—I watched what was going on in our community pharmacies.

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During the day, I saw a desperate father rush in to get drugs for his epileptic son, a bus driver who was worried about shortness of breath, and many mothers, with children who had sticky fingers and runny noses, looking for cold medicines. What struck me was the fact that the community pharmacists knew the name of the epileptic son of the man, and that they came from behind the counter to help the mothers with their children and advise them what cold remedies to buy. Importantly, they knew people's histories—for example, the bus driver's grandmother had a history of high blood pressure.

Mr. Paul Truswell (Pudsey): Does my hon. Friend appreciate the concern shared by hon. Members throughout the House that when the Government come to take a decision, the Department of Trade and Industry tail will wag the Department of Health dog? Will he give a categorical assurance that he and his colleagues will do their utmost to ensure that patient care and public health take precedence over any considerations of commercial practice?

Mr. Lammy : My hon. Friend will know that the Government will deliberate on the issue in the usual way.

Mr. Eric Joyce (Falkirk, West): Further to that point, my hon. Friend will know that whether this matter is regarded as a health or consumer protection issue is important in Scotland, as one matter is devolved and the other is not. There is a Scottish health and medicines plan, called "The Right Medicine". A Health Minister is responding to a debate in Scotland today, and the argument deployed in Scotland is that we are discussing what is essentially a health matter. That is also the general view of hon. Members present today, so will my hon. Friend convey that fact to Ministers at the DTI? I appreciate that Ministers have to consider important competition points, but this is an important issue for the Scottish Executive and for people with the same interests.

Mr. Lammy : I am grateful for that, and as I have said, many Departments have a stake in the issue. We will deliberate and make our response as a Government in due course.

My ministerial portfolio is very diverse, but in the past few weeks and months, pharmacy has taken up the lion's share of my diary. With officials from both the DTI and the Department of Health, I have met a wide range of stakeholders and interest groups to listen to their points of view. I know that hon. Members have also been lobbied intensely, and for me, to go through a Division Lobby at the moment is to run the gauntlet.

Mr. David Lepper (Brighton, Pavilion): Does my hon. Friend acknowledge that the importance that so many of our constituents attach to maintaining community pharmacies is shown, for instance, in the petition that I received this week from Fields pharmacy in Eldred avenue in my constituency with 400 signatures and the petition that I received this morning from Stallion's pharmacy in Preston Drove in Brighton with 960

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signatures? That was received in one week, and I am told that other pharmacists have similar petitions awaiting collection.

Mr. Lammy : Democracy is alive in this place. I know that as I walk through the Lobby and receive advice from hon. Members of all parties.

It is important that I set out the course of events. The remit that the director general set himself was to examine the UK market for retail pharmacy services, and to consider whether consumers are best served by the current statutory controls under which pharmacies can dispense NHS prescriptions. His conclusion was that they are not. He therefore recommended abolition of controls to improve competition, to reduce prices for over-the-counter medicines and to improve access to and the quality of pharmaceutical services.

Ms Walley : Is my hon. Friend aware of studies made in Stoke-on-Trent by local pharmacists that show that the basket of different items is cheaper in independent pharmacies? Will he accept that even where the OFT report says that there are reductions, that is not necessarily the case, particularly when one takes transport issues into account?

Mr. Lammy : I am aware of that study. There are many studies in this area.

We recognise that the report marks a significant watershed, but its implications go wider than community pharmacy. They involve GPs, the NHS more widely and—most importantly—patients. We have therefore made it clear that we would study the report carefully, canvass views, and consider the impact on our plans to improve services. I wrote to all hon. Members in England and, as I said, I have met leading professional bodies to hear their reactions. Those include the pharmaceutical services negotiating committee, the National Pharmaceutical Association, private companies, the British Medical Association, the all-party pharmacy group and a cross-section of supermarkets.

Mr. Steen : Having met all those key people, what is the Minister's conclusion?

Mr. Lammy : As I have said, the Government will let their views be known in due course, as the hon. Gentleman knows very well.

My officials have also met representatives of patient, consumer and NHS groups. I understand that the

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Health Committee wants to undertake a one-day inquiry on 3 April into the possible impact of the OFT report on community pharmacy services, and I urge Members to feed into that very useful inquiry. We are giving the report and the many hundreds of responses careful attention. We have heard a wide range of views. I have listened keenly to all the arguments. I wish to assure the House today that I, my colleagues across Government and the devolved Administrations will give them the fullest attention when we consider our response to the report.

Mr. Tyler : In the final moments of his speech, will the Minister tell us whether he expects legislation to be required? What sort of legislation might it be, and what priority would it be given in view of all the other pressures should the Government eventually decide to activate the OFT recommendations?

Mr. Lammy : I am advised that if the Government accepted the report's recommendations in full, primary legislation would be required.

In the remaining time available I am not able to talk about the other important things that are taking place in pharmacy across the board. I should have liked to set my remarks in the context of pharmacy in the future, which includes local pharmaceutical services projects, medicines management, repeat dispensing and supplementary prescribing. I accept that the OFT report has an important bearing on all those issues. However, I encourage hon. Members to make their views known. I can tell them that the Government are taking the report, and their views, seriously.

Ms Walley : On a point of order, Mr. Deputy Speaker. In view of the obvious cross-cutting issues relating to the Department of Health and the Department of Trade and Industry in the light of the OFT report, what powers do you have to recommend a cross-cutting debate in Westminster Hall so that we can consider the issues in relation to both Departments?

Mr. Deputy Speaker : I have no such powers, but I am impressed by the amount of interest in the debate. I am concerned that so many Members wish to participate in the debate, but cannot, and I shall certainly draw that to the attention of the Speaker.

12 Mar 2003 : Column 93WH

12 Mar 2003 : Column 95WH

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