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Public Bill Committee Debates

Draft Pharmacists and Pharmacy Technicians Order 2007

The Committee consisted of the following Members:

Chairman: John Bercow
Cohen, Harry (Leyton and Wanstead) (Lab)
Drew, Mr. David (Stroud) (Lab/Co-op)
Flint, Caroline (Minister of State, Department of Health)
Gidley, Sandra (Romsey) (LD)
Hall, Patrick (Bedford) (Lab)
Jackson, Glenda (Hampstead and Highgate) (Lab)
Lepper, David (Brighton, Pavilion) (Lab/Co-op)
McIsaac, Shona (Cleethorpes) (Lab)
Moss, Mr. Malcolm (North-East Cambridgeshire) (Con)
Newmark, Mr. Brooks (Braintree) (Con)
O'Brien, Mr. Stephen (Eddisbury) (Con)
Pelling, Mr. Andrew (Croydon, Central) (Con)
Pugh, Dr. John (Southport) (LD)
Rosindell, Andrew (Romford) (Con)
Todd, Mr. Mark (South Derbyshire) (Lab)
Ward, Claire (Lord Commissioner of Her Majesty's Treasury)
Whitehead, Dr. Alan (Southampton, Test) (Lab)
Susan Griffiths, Committee Clerk
† attended the Committee
The following also attended, pursuant to Standing Order No. 118(2):
Wright, Jeremy (Rugby and Kenilworth) (Con)

Fourth Delegated Legislation Committee

Tuesday 30 January 2007

[John Bercow in the Chair]

Draft Pharmacists and Pharmacy Technicians Order 2007

10.30 am
The Minister of State, Department of Health (Caroline Flint): I beg to move,
That the Committee has considered the draft Pharmacists and Pharmacy Technicians Order 2007.
This is the first time I have spoken in a Committee under your chairmanship, Mr. Bercow, and I am sure that it will be a very pleasurable experience.
The order is about patient safety and public protection. I think I can say at this first opportunity that all parties support the regulations. More than anything else, they will allow pharmacists and pharmacy technicians to play a fuller role in the delivery of health services. That is important to every community, but particularly, I think it is fair to say, to rural communities, for whom the regulations have added bonuses.
Patients must be at the heart of any changes to regulations, whether for doctors, for nurses, or, as we are discussing today, for pharmacists and pharmacy technicians. The order fits that programme and is important in several respects. It follows the model used for dentists, nurses, opticians and other health professionals, and it is important to bring pharmacists and pharmacy technicians within that health family. However, the order also makes regulation more responsive to patients’ needs and better at protecting them.
Committee members may have received an e-mail from the Royal Pharmaceutical Society saying how much it supports the order and how the Government, the society and other key stakeholders have worked closely on it to “update, strengthen and clarify” the society’s powers to protect, promote and maintain the health and safety of the public. The order will improve the society’s powers to protect patients in a number of ways. It will make clearer the society’s responsibilities to protect the public and its accountability in doing so, it will reform the society’s registration process, and it will bring pharmacy technicians in England and Wales into statutory regulation for the first time, which is important to their delivery of increasingly common clinical services such as sexual health services, drug treatment services, the testing of blood pressure. The involvement of pharmacists from the wider health family has advanced the delivery of those health care services.
Pharmacists have long been involved in supplying medicines and in advising people on their use. However, we are entering a new era in which the direct clinical care of patients will become a core business. The prescribing of medicines is no longer just the domain of doctors, dentists and nurses. Since 2003, pharmacists have acted as supplementary prescribers as part of agreed clinical management plans and, as I speak, some pharmacists are completing additional training to become independent prescribers of a full range of medicines. That will become commonplace, and the new community pharmacy arrangements across Great Britain will for the first time contain all clinical services.
The demand for clinical services from pharmacists continues to grow. In England, we will introduce pharmacists with a special interest who, when suitably accredited, will specialise in a particular clinical area, just like GPs with a special interest. Pharmacists will also continue to play a huge part in educating, advising and supporting other health care professionals, including doctors and non-medical prescribers, on the prescription, supply and administration of medicines. Pharmacy technicians are also starting to provide more direct clinical care for patients, and the trend is likely to continue as health reforms progress with the more flexible use of staff who are properly trained to undertake roles that increase safe access to medicines and care.
The downside is that there is great scope for pharmacists to do harm if they do not perform properly and if they are not properly regulated. In recognition of that, pharmacists were the earliest health care professionals to be statutorily regulated. However, the most recent legislation to do so was the Pharmacy Act 1954. It is agreed that the legislation has served the profession well, but compared with that of other health profession regulators, it is out of date and limited in scope.
We wish to ensure that people who use the services of pharmacists and pharmacy technicians can benefit from the same safeguards as those recently introduced for doctors, nurses, allied health professions, opticians and dentists. To bring pharmacist regulation in line with that of other professions, the main provisions are the requirement to undergo continuing professional development so that registrants keep their knowledge, skills and aptitude up to date as long as they practise, and a wider range of powers and sanctions relating to investigating and dealing with allegations of impaired fitness to practise. Impaired fitness includes ill health as well as performance and conduct.
To protect the public, new sanctions include the ability to suspend registrants, when necessary, while their fitness to practise is investigated and adjudicated. Currently, that cannot happen. The sanctions also include the ability to restrict the practice of those unfit practitioners to areas where they are safe to practise, by attaching conditions to their registration. Members of the public may find it strange that the society does not currently have the flexibility to do that.
The order introduces new powers enabling the society to disclose fitness-to-practise information when that is in the public interest, and to require others to disclose information to it about fitness-to-practise matters. There is a new duty to co-operate with other public authorities and bodies with an interest in pharmacy matters and there are new powers to require practising registrants to be covered by an adequate and appropriate indemnity arrangement, although the implementation of that provision will be delayed while we, in conjunction with the other regulatory bodies, consider further the implications of a court judgment, handed down in the summer, about indemnity arrangements.
The order also contains provisions specific to the world of pharmacy. As I said, it is an opportunity to extend statutory regulation to pharmacy technicians, in recognition of how their role has developed. For example, in some hospitals, pharmacy technicians will take the medication history of a newly admitted patient. It is entirely right that those who use such a service be protected by safeguards appropriate to those technicians’ skill, knowledge and responsibility.
Hon. Members will have noticed that the provisions on the regulation of pharmacy technicians relate only to England and Wales. That is due to the separate powers of the Scottish Parliament to enact its own legislation on devolved health care professions, which are those not subject to statutory regulation at the time of the Scotland Act 1998. However, I have agreed in principle with the Minister for Health and Community Care in Scotland that later this year we will introduce an amending order, needing approval from both the United Kingdom and Scottish Parliaments, that will extend the scope of the order to encompass Scottish pharmacy technicians.
To make sure that the regulation of the profession happens consistently across Great Britain, we do not propose to commence the provisions of the order that relate to the regulation of pharmacy technicians until the amendments to its scope are in place. Another provision, peculiar to the professions involved, is the introduction of a division of the regulator’s registers to distinguish between those registrants—the vast majority—in practice and the very few who do not actively practise, such as those who have retired or are on a career break, or who, although they have qualified as pharmacists, work in other fields and do not practise as a pharmacist or pharmacy technician.
For those people, it will not be practical or relevant to keep up with continuing professional development or to be covered by indemnity insurance arrangements. I am satisfied that the definition in the order of what is meant by “practising” is broad enough to ensure that anyone whose work may have a direct or indirect impact on those using pharmacy services will be required to meet the requirements for practising registrants. That includes those working in academic research, management, journalism and industry who give advice on pharmacy matters and hold themselves out to be pharmacists or pharmacy technicians. The order contains provisions in the form of offences and the provision of guidance that will support that.
Hon. Members will appreciate that legislation of this size and scope will have been in production for some time. It has been suggested that it would be better to hold back issues such as the consideration of this order to amend the Pharmacy Act 1954 until after the release of the findings of the chief medical officer’s review of medical regulation and the parallel review of non-medical regulation in the light of the fifth report of the Shipman inquiry. However, the contents of the order are essentially a long-overdue overhaul of the regulation of pharmacists and the administration of the Royal Pharmaceutical Society of Great Britain. The extension of the statutory regulation of pharmacy technicians is also in the public interest. The issues covered by the order need to be addressed irrespective of the findings of those two reviews. They in no way pre-empt the reviews’ recommendations or the Government’s response to them.
The order has been well researched and has found broad favour and support from those most affected by it. It has been subject to full publication and public consultation as required by the Health Act 1999, under which the order is made. A copy of that is available on the Department of Health website, as is the report on the consultation itself.
I commend the order to the Committee.
10.39 am
Mr. Stephen O'Brien (Eddisbury) (Con): I am delighted to serve under your chairmanship for a second time, Mr. Bercow. I place on record my thanks to the Minister, whose introduction to the order summarised the overall position and the representations clearly and succinctly. As she rightly said, the order has our broad support. We are not dealing with anything contentious, although it is important to raise a few issues.
As the Minister said, the order updates the rules governing the regulation of pharmacists in Great Britain. For the first time, it puts in place arrangements to regulate pharmacy technicians in England and Wales under the supervision of the Royal Pharmaceutical Society. She said that she plans to make sure that those arrangements are extended through liaison with her counterparts in the Scottish Parliament. What plans, if any, has she to extend matters to Northern Ireland, given the current arrangements?
The order has been the subject of extensive consultation within the pharmacy profession and indeed outside it. As Lord McColl of Dulwich has said in another place, regarding the principle provisions of the order,
“we are satisfied that it reflects the society’s policy—which we very definitely share—to strengthen and clarify its powers to protect and promote the health and safety of the general public.”—[Official Report, House of Lords, 24 January 2007; Vol. 688, c. 418.]
We also note that the order completely replaces the Pharmacy Act 1954, although, as the Royal Pharmaceutical Society has said, many of the tried and trusted aspects of that Act are still to be found in the order. I am particularly grateful to Corinne Hunt of the RPS who took the trouble to make a special appointment and see me in my surgery in my constituency before Christmas, to make sure that I was fully briefed and aware of matters, in anticipation of today’s order.
As Her Majesty’s official Opposition, I am glad to confirm Conservative support for the concept of professional self-regulation and I welcome the fact that the Royal Pharmaceutical Society retains responsibility for regulating the profession. As we await the outcome of the Donaldson review and the Foster review, I seek the Minister’s assurance that the concept of professional self-regulation will not be eroded. In particular, does she expect the reviews to affect the order? When are they expected to be published?
In introducing the order in another place, Baroness Royall of Blaisdon specifically mentioned pharmacists with a special interest. She outlined the Government’s plans for pharmacists and their contribution in:
“education, advertising and supporting other health care professionals.”
However, figures released to us by the Department of Health reveal that PCTs are not using the range of services that can already be commissioned from pharmacies, with only a tiny percentage offering additional services. For example, only 0.21 per cent. offer anti-coagulant monitoring and, even worse, only 0.03 per cent. offer services to schools despite advice from the Department of Health. In addition, again despite Department of Health guidance, there has been a staggering 53 per cent. decline in pharmacies with extended weekday openings and a 21 per cent. decline in pharmacies with Sunday and bank holiday openings. Those were the new figures released by the Government themselves on 21 November 2006. To what does the Minister attribute that? Do I see yet another cut in front-line patient services due to the Government-made NHS cash crisis?
Finally, I reiterate for the record two concerns raised by Lord McColl in the other place. First, there is the matter of discretionary rather than mandatory notification to protect the reputation of pharmacists and pharmacy technicians in the case of false or malicious rumours—a suggestion made by the Royal Pharmaceutical Society but rejected by the Government. Second, under article 5(1), the Privy Council has a power to alter the size and composition of the council, subject to specified limitations, whereas the society’s charter provides for the Privy Council to do so only if it receives an application from the society in pursuance of a special general resolution. Baroness Royall of Blaisdon said that it would be “possible” that the Privy Council could vary the composition of the society’s council without a request, but gave an undertaking that:
“there are no plans to do so.”—[Official Report, House of Lords, 24 January 2007; Vol. 688, c. 422.].
So I ask the Minister why the order does just that. Is she certain that the rights of the society will be upheld and not diminished by the order?
Although I hope that the Minister will address the concerns that I have raised, I recognise the concerns of the Royal Pharmaceutical Society that its ability to protect the public is already somewhat deficient, and will be further compromised by any delay in the order. With that in mind, the Opposition will not seek to hinder the order, and indeed will support it.
10.46 am
The order has clearly been the result of extensive consultation with the profession, which is to be welcomed. There is 99 per cent. agreement on what is proposed and I welcome the Minister’s positive words about pharmacy and what pharmacists can offer.
The timing of the document is interesting. The Minister herself alluded to it, and commented on the Foster review and the Donaldson review, which some people considered might be a reason for delay. Having said that, it has been made clear that the Royal Pharmaceutical Society wishes to proceed because its current powers are inadequate for a modern day regulator. For example, it has no power to suspend or to place conditions on registration.
The Minister may be aware of a recent case before the statutory committee in which the chair of the committee was attacked with an iron bar. It seems that there was an element of premeditation in the attack, as most of us do not carry such items around. There are no powers to suspend the pharmacist in question until the appeal procedure has been completed. In most cases, I would say that there has to be an appeal period and that public safety would not be compromised by that. However, it would be useful if the Minister could indicate the circumstances in which the powers in the order would be used, because if used extensively they would also have an effect on individual pharmacists. We hope that the procedures will be fully followed in all cases, but we would like some reassurance on the point.
I am aware of the growing backlog of disciplinary cases that are related to health and fitness to practise. Current provisions mean that there is very little that can be done if people have a health problem that may temporarily render them unfit to practise, without there yet being any behaviour that would justify suspension or striking off. I welcome a more humane way of tackling the problems that arise when people sometimes have problems and need help rather than censure.
I return briefly to the Foster review. There is concern that the review may recommend a split in the Royal Pharmaceutical Society’s functions. The society is unusual, because although it has a regulatory function, it has a representative one as well and there is a degree of conflict between those functions. Some in the profession think that the functions should be split completely. Others say that the Royal Pharmaceutical Society is working well and if it ain’t broke, don’t fix it. The reality of the Foster review is that we are potentially faced with the prospect of a lay majority on a council that also has a representative function. Some feel that that is incompatible.
I welcome the comments made by the hon. Member for Eddisbury. He referred to article 5 and the Privy Council. The Privy Council has the power to alter the size and composition of the council other than at the society’s request. As has been pointed out, that is not compatible with the society’s charter, which states that such a change can take place only at the request of the society.
If, following the Foster review, we reach a position where the society retains its dual role but the review recommends a lay majority, that is clearly not what many pharmacists would see as being in the best interests of representation of their profession. It would be useful if the Minister could clarify the matter and when we might hear more from Foster.
Most of the other points that I wish to query have been raised. The point about the regulation of Scottish technicians has been covered by the Minister. I was pleased to hear that the amending order will be in place later this year. Northern Ireland was mentioned: Foster suggests that the Pharmaceutical Society of Northern Ireland should consider a merger. That has to be considered in the long term.
That is the bulk of the points that I wish to make at this stage. Hopefully the Minister will be able to provide greater clarification when she sums up. The public and the profession alike welcome the proposals because they will improve patient safety. Although the Royal Pharmaceutical Society has so far done an exemplary job in protecting the patient, it is clear that as we move into the 21st century it needs some help in adopting a more flexible approach in what can and cannot be done.
10.53 am
Mr. Malcolm Moss (North-East Cambridgeshire) (Con): May I add my comments to those of my hon. Friend the Member for Eddisbury in saying what a pleasure it is to serve under your chairmanship for the first time, Mr. Bercow?
I shall be brief. The order is welcome. As an ex-Minister for health in Northern Ireland—almost a decade ago—I can remember trying to encourage more work for pharmacists and more front-line services through that outlet. Here we are almost 10 years later still trying, it would seem, to encourage the same kind of involvement. It would be interesting if the Minister replied to my hon. Friend’s question about the statistics that we in the Conservative party have gleaned that show that pharmacy services are not being used at the level that we would like. Perhaps the Minister has some targets and can tell us how close the Government are reaching to the targets to use to the full the high standards of professionalism that pharmacists have to offer.
Looking at the order, I see a document that replicates closely some legislation that I had a hand in introducing back in 1993: I refer to the Osteopaths Act 1993, which was followed by the Chiropractors Act 1994. Those were milestones at the time. They were obviously Government-sponsored Bills, and I was lucky enough to be high in the order for private Members’ Bills and took the Osteopaths Act through. I can remember receiving some representations then from pharmacists saying, “Hey, what about us? We are still labouring under the Pharmacy Act 1954; we would like to be modernised.” Here we are some years later with the document that will, I think, give them the professional stature and basis that they asked for.
I have very few questions. The Foster and Donaldson reviews have already been mentioned twice. However, the Royal Pharmaceutical Society raised its concern with us in its briefing, so it would be helpful if the Minister could allay its fears that the findings of those two reports will in any shape or form jeopardise the excellent work and progress that has been made under the order.
10.55 am
Caroline Flint: There have been some thoughtful and constructive points and questions raised in this short debate.
To go through the questions, first, Northern Ireland has its own order, dating from 1976. Updating that is being considered as part of the White Paper review. Regulation in Northern Ireland is covered by the Pharmaceutical Society of Northern Ireland, but I take the point that we want to give pharmacists and pharmacy technicians throughout our islands the opportunity offered by the order within the scope and range of services that they can provide.
That brings me to the point about PCTs not using the range of services. In my area of work as the Minister with responsibility for public health, as well as in the various ministerial posts that I have had the privilege to hold, I have been reassured by and had my eyes opened to the sort of services that pharmacists can provide, whether they be national chains or community based. Such services include drug treatment and, as I said earlier, chlamydia testing, which is offered through a well-known chain of pharmacies. Good relationships are emerging between GP practices and their local pharmacies, particularly smaller pharmacies, to provide the extra care that we think is valuable. That is particularly important for those individuals who might more frequently pop into their pharmacy than go to see their GP.
The emphasis is very much on the health family and what we hope to achieve, although I am afraid to say that these things always take longer than we might want. By regulating as we are doing, we can give a greater sense of assurance about the reasons why people should support the partnership with that sector of the health family, rather than the reasons why not.
Sandra Gidley: I welcome the Minister’s positive words, but the commissioning of services from pharmacies is at a disappointing level, particularly compared with what was available before the new contract. Will she use her best efforts to ensure that there is an opportunity to include pharmacies in practice-based commissioning, and to allow them to tender for and be considered for services? The relationship with the GP is often there; it is often the PCTs that do not appreciate the benefits of the pharmacy.
Caroline Flint: I will certainly take back the points that have been raised today and raise them with my noble Friend Lord Hunt of Kings Heath, who is responsible for the issue. I have heard and noted what hon. Members have said and will take that back to the Department, because we are looking at strengthening commissioning. Our work on the sort of care that can happen outside the more traditional settings is about 21st-century health care, which includes both prevention and treatment. As Minister with responsibility for public health, I think that we should all welcome the opportunities for prevention that the involvement of pharmacies provide, but I will follow the point up. Clearly, we cannot dictate to PCTs what they should and should not do. We have to make the arguments and make it more difficult for people to say why they should not, rather than, “We should.”
Mr. O'Brien: While the Minister is thinking about taking messages back, and about taking an example of what has been raised and stretching it beyond, strictly speaking, the public health field, I hope that she will take back the message that there has been serious concern about the absence of support for pharmacies in the change to the supply of domiciliary oxygen. That is serious and controversial issue. Pharmacists used to be brilliant at supplying the domiciliary oxygen within their communities, but the contracts have been changed and the service has often fallen apart. It has been the local pharmacists, not least Ian Littler in Tarvin in my constituency, who have come to the rescue and provided an excellent service. That message ought to be taken back to ensure that that contract does not undermine the great link between pharmacists and those who need oxygen in their homes.
Caroline Flint: That is noted. There were some changes in the provision of that service and some issues that had to be sorted out. As far as I am aware, on the whole it is working well. Services that have traditionally been provided by one part of the health family sometimes change over time. However, it is clear from our discussion that, although there have been changes to some of the traditional services that pharmacists have provided, there are plenty of opportunities to make other services, to which they have not been able to contribute, part of their future agenda. That is what the order and other work in the Department of Health are all about.
Moving on to the issues raised by the hon. Members for Eddisbury and for Romsey, a point was made about allegations and the notice that needs to be given. I would like to reassure the Committee that the registrar will weed out cases before they are referred to the investigating committee. Only on referral will disclosure be made. That is important because in any walk of life allegations can be made that, after some examination, do not stand up as what would rightly be considered cases for referral and further investigation. The society will make rules on which cases will be referred to the investigating committee. Given that that check is in the system, it can only be right that at the point where a referral is made, appropriate individuals, including the employer and so on, should know that a case is to be investigated further. That sort of transparency is only right.
Article 5 deals with the Privy Council’s power to alter the size and composition of the council. Lord McColl of Dulwich asked in the other place if the Privy Council could vary the council’s composition without a request. I understand that the straightforward answer to that is yes, it would be possible, but there are no plans to do so; it is simply possible. The hon. Member for Eddisbury asked why that potential is available. I understand that we have it purely because it is consistent with what other regulators do throughout the health care profession, and for no other reason. I suppose that the short answer is that that is how it works in other areas. It is a matter of having synergy between regulations. However, the inference of the discussion in the other place is that it is unlikely that the power would ever be used. I take on board the point made by the hon. Member for Romsey about a potential imbalance in the membership of the council, and will take it back to my noble Friend.
Sandra Gidley: The Minister has pre-empted my point. She mentioned consistency among health regulators, but does she accept that the Royal Pharmaceutical Society is different because of its dual role? We cannot necessarily apply a one-size-fits-all solution.
Caroline Flint: I have heard what the hon. Lady says about that. A question was asked about the dual role of the society during the consultation on preservation of the statutory link between registration of pharmacists and membership of the Royal Pharmaceutical Society of Great Britain. There was much discussion of that in response to the consultation on the order, and the majority favoured retention of the link. The review of non-medical regulation recommended that the functions of the RPSGB should be split to create a regulatory and a professional body, but that issue will be addressed in the White Paper and is, therefore, a matter for future discussion.
Going back to points made in the debate, the work that has been undertaken by the Department and the society has resulted in the good support that we have had for the order. The society’s involvement in defining the order has been helpful. Clearly, we want to encourage self-regulation in the profession, as it is extremely helpful. Of course, we need to get the order right in terms of public protection as opposed to a representative role, and that will be discussed further when the White Paper is produced.
I cannot say more about the White Paper, because we could end up having a discussion about it, which would be inappropriate today. The reason for introducing the order is that, regardless of the White Paper and the two reviews and the discussions that they will create, the order-making powers are required.
I commend the hon. Member for North-East Cambridgeshire for his patience in respect of regulation in this area. Unfortunately, as he will know only too well, progress in Government is sometimes much slower than we might wish. It is important to get the foundation right, and the order, on which I hope we all agree, will speed up the process in which pharmacists and pharmacy technicians can play a fuller role with the confidence of others who work in health care and certainly of the general public, which is the paramount priority.
Question put and agreed to.
That the Committee has considered the draft Pharmacists and Pharmacy Technicians Order 2007.
Committee rose at seven minutes past Eleven o’clock.

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