Examination of Witnesses (Questions 120-139)
THURSDAY 3 APRIL 2003
MS SUE
SHARPE, MS
LIZ COLLING,
MR JOHN
D'ARCY, MR
JOHN EVANS,
MR JONATHAN
MAY AND
MR MATTHEW
JOHNSON
120. The OFT report suggests that they are very
well located.
(Mr Evans) No, 90% of people feel that their pharmacies
are in locations that they can get to; 10% say they cannot; but
the location of a pharmacy, opening hours and accessibility when
open is the issue. We are saying, let the market choose a level
first of all; then let the PCT subsidise areas where it needs
pharmacies. That is what we are saying.
Dr Naysmith
121. Mr D'Arcy almost argued that the proposals
are incompatible with the Government's plans for changing and
improving pharmacies. Is that a fair summary?
(Mr D'Arcy) Yes.
122. You want to stay as you are now, basically.
(Mr D'Arcy) No, we do not want to stay as we are,
we want to build on what we have got. We are saying that we have
a system that does work. Where there are deficiencies, let us
work within the existing system to plug those gaps and work on
those deficiencies.
123. But you think the proposals are basically
incompatible with that.
(Mr D'Arcy) Yes.
124. Is that what Liz Colling and Sue Sharpe
think?
(Ms Colling) I think so. Increasingly, pharmacists
are becoming part of the wider healthcare agenda and engaging
in provision of primary care health rather than retailers. We
all want to move the profession along that route, and that would
address some of the concerns Mr Evans has about pharmacies leaving
the profession. They are a valuable resource; they want to be
healthcare professionals—but we also need to preserve the
diversity of the areas which they can service and the accessibility
and relationships they have with their local communities. The
regulations are not perfect by any stretch of the imagination,
but they do however allow some new openings. We have opened new
pharmacies, but we can build on them and we can use the PCTs and
work with them to identify real health needs; and then find solutions
to local issues.
(Ms Sharpe) I agree entirely. In essence, community
pharmacy is an NHS primary care service, closely allied to primary
care medical services. It must make sense for community pharmacy
services to be planned.
125. Mr Evans, you obviously disagree profoundly
with what has just been said by all three community pharmacy organisations.
(Mr Evans) We are also a community pharmacy organisation
as well. We have 81 community pharmacies working in there, so
we offer a service to our customers too. It is just a bit more
to one side. We think PCTs should control where pharmacies are
needed, but what we are asking you boys—give us the chance
to look after our 11 million customers a week to have pharmacies.
That is all we are after: that is what they want and that is what
we are after. We will do that for PCTs. Then let the PCTs identify
where that is lacking and—
126. But that is not a free market, is it?
(Mr Evans) Exactly. We are not after a free market;
we are after deregulation. Let the PCTs choose where the services
are needed. We are not after a free market.
127. No, but the PCTs choosing is a form of
regulation. It is deregulation, but if the PCTs do that, then
it is a form of regulation. They might say to you, "we are
going to have pharmacy here, and we do not think you should have
one there". They do not have that power at the moment, but
they might do if things get developed along the suggested lines.
Julia Drown
128. Is there not a problem with this in that
of course you recognise customers want pharmacies everywhere and
would like a pharmacy on every single street corner so that wherever
you happen to be you can pop in with a prescription: but the problem
is that this is not something where the consumer just pays for
the product; we have a lot of taxpayers' money going in to support
pharmacy services. As I understand it, the argument of the supermarkets
and the OFT is that you let the market decide, which would naturally
move the market to a fairly stable level where profits are reasonable
for the supermarkets, and they are where the consumers want them;
and there will be some gaps, where a subsidy scheme would be put
in. That would be fine if there was not any taxpayer subsidy going
in to the mainstream, the market bit. As long as taxpayers' money
is going in to the mainstream market bit, we have to have some
sort of regulation. Would not any economist say that if you are
going to have to regulate a part of the market, you want the regulator
to have all the economic power possible to get the best service
for everyone across the board? You do not want to have to create
a whole new extra subsidy and only be able to operate within the
bit of the market that is unviable—once the market had settled
itself on a commercial basis. Is that not a problem with this?
(Mr May) Our view is—and the Social Exclusion
Unit has come up with this, for example—that the existing
system means that a number of people are not served well.
129. Everybody is accepting that the system
could be improved; that is across the board.
(Mr May) Secondly, our view is that the control of
entry regulations actually stifle the provision of services. They
stop new people coming in offering new services.
130. There is some agreement to that.
(Ms Sharpe) We want to change and develop
them, yes.
(Mr May) In doing so, they cost both
the taxpayer and businesses money in certain respects, and we
also think there are consumer savings. We think that if you let
the market essentially let people come in, you will then have
provision. We also think that some of that new provision should
help to deal with some of the problems that currently exist. What
the PCTs and the health focus should be is looking at those areas
where there is not adequate provision, and using their powers
and subsidies for a targeted scheme for example, or using the
way they remunerate pharmacies—and this is very important—what
service are you getting from your pharmacy—to tackle those
issues. We think that would be a better use of public money and
everyone's time and effort.
131. Are you not forgetting the fact that a
lot of the taxpayers' money is going in to the bit that the market
is settling on its own? What about the economics argument that
if you are going to have to regulate the market, you want as much
buying power as possible?
(Mr May) But you would have plenty of buying power
because you would be remunerating the pharmacist as you choose
through the global sum, and you can change the way you do that
and put a different focus on different services.
132. So you would have to change that if you
were changing the market as well. Do others agree with that?
(Ms Colling) I am not sure I fully grasp the issue,
to be honest.
133. The point I am getting at is that it would
be fine if the supermarkets were going to open many more pharmacies
if that was not requiring use of taxpayers' money. The fact that
you are using taxpayers' money means that given we have to have
some sort of regulator dealing with the bits that—if you
were that regulator you would rather have the power over all of
the money.
(Ms Colling) Absolutely.
134. That is some regulation seen across everywhere,
rather than just having what one is left over with to deal with
the bits that are unviable.
(Ms Sharpe) I think under the proposed
new scheme, everybody would be providing a NHS community pharmacy
service, and whether in a supermarket or wherever would expect
to get their funding for the service they are providing. That
is where there is an incompatibility between this idea that you
do not plan and you do not ensure that you are getting the best
value in terms of location and quality of service. It does not
merely come through the planned regulator service.
135. You picked up earlier some issues that
the OFT is raising, that people who use pharmacies are proportionately
more amongst the elderly and people with disabilities, and that
is whether they are supermarkets or community pharmacies. The
OFT has argued that those groups would be disproportionately affected
by deregulation, and I wonder if you would agree with that.
(Ms Sharpe) It is interesting, if you look at parts
of the OFT's own study, that the over-sixties, and people who
are most likely to use pharmacies for their OTC purchases and
toiletries purchases—we know in answer to a parliamentary
question that was answered by the Minister responsible for pharmacy
very recently, that 56% of all prescriptions are for people over
sixty. It seems to me to be self-evident that these are the high
users of the local community pharmacy services, and therefore
by definition these people with local pharmacies are threatened
and will be the people to be affected.
136. Can we move on to the issues that we have
not touched on, for example social functions that pharmacies provide,
things like distribution of emergency contraception, controlled
Methadone distribution and so on, which are particularly important
in deprived areas? Did the OFT look at that at all?
(Mr May) No, we did not look at that. I come back
to the point that you can ensure that pharmacies provide these
things by making sure that when you are paying them from the global
sum, you say, "these are the things we expect you to provide
as a minimum" and you can force standards through that. Then
you can encourage people to provide more. We saw that as very
much a health policy issue. It is not really to do with the control
of entry system; it does not affect that at all.
137. It does not affect it, except if there
was deregulation you are hinting strongly that the whole of the
remuneration of pharmacies would have to be looked at alongside
it.
(Mr May) Only to the extent, if more people came in
and the global sum remained fixed.
138. Is not the whole reason you want to deregulate
it so that more people come in?
(Mr May) Yes, to provide an alternative.
139. So you are suggesting that deregulation
will lead to more people coming in, and therefore you would need
to look at the whole way the pharmacy—
(Mr May) I think it would be sensible to do so, and
that is my understanding of what Government intends to do. That
is essentially what the response to our report says. It makes
sense.
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