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Committees
Mr. Deputy Speaker (Sir Alan Haselhurst): With the leave of the House, I shall take motions 2 and 3 together.
That Mr Rob Wilson be discharged from the Procedure Committee and Mr Mark Field be added.
That Mr Nick Clegg be discharged from the Joint Committee on Tax Law Rewrite Bills and Mr Colin Breed be added .—[ Mr. Nic holas Brown , on behalf of the Committee of Selection .]
Petition
Family Courts (Reform)
10.28 pm
John Hemming (Birmingham, Yardley) (LD): This petition is an interesting one, because the driving force behind it was a great grandfather, Mr. Phil Thompson, who was bewildered as to why his great grandchildren were taken out of the family. After some difficult effort, we found out the low level of threshold that was required, and hence we have the following petition:
The Petition of the O’Gorman Family,
Declares that a case in the Family Court has highlighted an injustice in the current system. The three children of Philip O’Gorman have been put up for adoption because it is alleged one of them missed some days in school, some medical appointments were missed, they were seen to be dirty and unkempt and that they would not cooperate with social services. The family contest the allegations, and believe that neither of these allegations is sufficient to warrant children being forcibly adopted into another family. The petitioners further believe that these actions were driven by a desire to increase the numbers of children adopted rather than to protect the children concerned. The petitioners believe that the response of the authorities was totally disproportionate in this case.
The Petitioners therefore request that the House of Commons urges the Government to legislate to prevent courts from accepting these arguments as sufficient cause to forcibly remove children from their birth families and ensure that parents are facilitated to contest the allegations made by the authorities
And the Petitioners remain, etc.
General Practitioner Dispensing
Motion made, and Question proposed, That this House do now adjourn. —[Liz Blackman.]
10.30 pm
Tony Baldry (Banbury) (Con): I have given the Minister prior notice of exactly what I intend to say to enable him better to respond directly to the points that I shall raise.
I need to put my concerns about the future of GP dispensing into the context of two broader points. The first is that my constituents are becoming increasingly angry and frustrated about what they see as a persistent attack by this Government on local services. Locally, we have seen post office closures, and we have been spared the closure of our local, consultant-led maternity unit and 24/7 children’s wards at the Horton hospital thanks only to the intervention of the independent reconfiguration panel. Not surprisingly, my constituents are constantly asking what next public or community service will be taken away from them.
One of my constituents wrote to ask me to oppose the pharmacy White Paper, asking
“why is this Government so determined to destroy all quality of life for rural inhabitants? This village has lost its Post Office, and consequently its shop, is shortly to lose our next nearest Post Office, now our dispensary service is under threat. What will they destroy next?”
Secondly, this debate has to be seen in the context of the Government’s professed commitment to give NHS patients greater choice. After all, the Government have spent considerable amounts of money on ensuring that GPs have choose and book systems, the better to allow patients choice as to where they are treated. Indeed, last week, the Prime Minister in his statement on the draft legislative programme said:
“It is right to make it”—
“more accountable to local people, giving patients real power and control over the service they receive.”—[ Official Report, 14 May 2008; Vol. 475, c. 1387.]
If the Government genuinely want to give patients real power and control over services they receive, the least the Government could do is to allow people the freedom to decide where they would like their prescriptions dispensed.
At the moment, there are some 5,872 dispensing doctors in the UK in 1,365 practices. Overall, they look after more than 8 million patients, of whom 3.5 million are dispensing patients. For reasons that I shall explain, these GPs mainly have rural practices. They provide the enormous benefit that patients can visit their GP and, at one and the same place, have their drugs both prescribed and dispensed. That service is being threatened by the Government.
Mr. Colin Breed (South-East Cornwall) (LD): I wish to reinforce the point that the hon. Gentleman is making. This debate has come to the attention of doctors in Cornwall and today I received an e-mail from Dr. Mark McCartney, who says:
“A new issue has arisen with the Pharmacy Bill which aims to end GP dispensing, another threat which may harm rural practices and services to patients, including small chemist shops as well as the GP’s own dispensaries.”
His whole practice, in Pensilva in my constituency, is very concerned.
Tony Baldry: There are dispensing practices throughout England that are very concerned because it would seem that the Government wish to give pharmacies a monopoly on dispensing.
There is, I suspect, some history that needs to be understood. When the NHS was set up, its establishment was a huge undertaking and no doubt required a number of political compromises with a range of groups involved in health care including GPs and pharmacists. I suspect that the big retail chemist chains such as Boots said that they would co-operate with its establishment only if they were given a monopoly of prescribing drugs in urban areas. Almost from the NHS’s inception, therefore, pharmacies had a monopoly on dispensing drugs in urban areas.
Since then, almost every other similar professional monopoly has long been discarded. One only has to think of the revolution in eye care and opticians that occurred when opticians’ monopoly to sell spectacles was taken away. However, the Government not only intend to retain the pharmacies’ monopoly on dispensing, but are clearly intent on strengthening that monopoly, as evidenced in the White Paper “Pharmacy in England”, which the Department chose to publish during the Easter recess, so it did not get the publicity that it perhaps deserved.
The existing dispensing rules already lead to some fairly ludicrous results. Here, I declare some interests. I live in the village of Bloxham, in my constituency. It is some 4 miles from Banbury, dominated by the spire of its parish church. It is a self-contained village, surrounded by fields for some considerable distance. It is perhaps one of the few villages in England that is so much a village that the Warriner school in Bloxham even has its own school farm. The village has a very good GP practice and surgery, which also has a dispensary, so that patients who attend Bloxham surgery can also have their drugs dispensed there. I am a registered patient at that surgery, although I have to say that I am a very infrequent visitor, as whenever Dr. Martin Harris, my GP, sees me, he rightly tells me that I need to lose a couple of stone in weight.
A pharmacy chain has applied to open a chemist shop in Bloxham. I am sure that residents of Bloxham and the surrounding villages will be genuinely delighted if a chemist shop is opened in Bloxham. The village is fortunate in having a diverse range of local shops and a chemist shop would be genuinely welcome. However, under the existing rules, the application by a pharmacy to open in Bloxham was a trigger for the primary care trust to review whether Bloxham continues to be a rural area. If an organisation called the NHS Litigation Authority decrees it to be an urban area, any incoming pharmacist who sets up will be given a complete monopoly on dispensing and the GP practice will no longer be allowed to dispense drugs for Bloxham residents. That might also lead to the GP practice being forced to cease dispensing before the proposed new pharmacy has been established.
The definition of what is rural is left to the individual primary care trust, but it is usually considered to be an area surrounded by open land with a limited number of shops or other facilities and poor transport infrastructure.
The decision is subject to appeal, and an oral hearing has been scheduled by the NHS Litigation Authority in July. Once determined, there is no further appeal short of judicial review, and the decision stands for five years unless there is a major change in circumstances. Bizarrely, should it be determined that Bloxham is no longer rural, the GP practice will be allowed to continue to dispense drugs to patients in other villages such as Barford St. Michael or Milcombe, but not Bloxham—until the provisions of the Government’s White Paper in due course kick in.
Put shortly, under the existing rules GPs may not dispense to patients who live within 1.6 km of a pharmacy or who are deemed to live in a non-rural area. Almost everyone living in Bloxham considers that being told by the Government that they no longer live in a village is pretty crazy. But what really causes offence is the thought that they will no longer have any choice as to where their drugs are dispensed, and that they will be compelled, whether they like it or not, to go to a new chemist to get their drugs dispensed. Bloxham residents are concerned that they will no longer be able to get their drugs dispensed by their own GP, as in the past, notwithstanding that that is far more convenient and that they only need to park once—parking at the GP’s surgery is considerably easier than having to park near the shops in Bloxham. Why not give patients choice?
Mr. Edward Vaizey (Wantage) (Con): I congratulate my hon. Friend on securing the debate. I represent the south of Oxfordshire in Wantage and I have been inundated with letters on the matter. Does my hon. Friend agree that choice is the key issue? My constituents focus on the point that although it might be right to relax the rules regarding pharmacies so that they can dispense more drugs and give some medical advice, it is wrong as a quid pro quo to close down GPs’ dispensaries. My constituents simply want choice, and surely that is what they should be given so that they can continue to use the dispensary if they so choose.
Tony Baldry: I agree entirely with my hon. Friend. The Government say that they are keen to give NHS patients as much choice as possible, so why not give them choice about where they have their drugs dispensed? Why take away patients’ ability to have their drugs dispensed at their GP surgery if they so wish? It seems that the Government will allow choice in the NHS when it suits them, and will not when it does not. Is it simply that the Government wish to give the impression of choice, freedom and new regulation, when in reality they are being increasingly dirigiste?
One rationale given in the White Paper for the proposals was that present regulations do not take into account the distance that a patient must travel between the GP surgery and the chemist. The new proposals fail to address that, as the new regulations would still be unable to account for the distance a patient has to travel between their surgery, their home and the pharmacy. The solution proposed in the White Paper would simply result in fewer patients receiving the service.
I thought that the proposal to prevent the Bloxham GPs from dispensing drugs to local people was one of
the crazier decisions that I had come across during my 25 years as a Member of Parliament, and so I asked the Office of Fair Trading if it would investigate what on the face of it seemed to be simply a strengthening of the monopoly against the interests of consumers. [ Interruption. ] It may be for the convenience of the House— [ Interruption. ]
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I am sorry to interrupt the hon. Gentleman, but I must say to the hon. Member for Romsey (Sandra Gidley) that we do not usually accept interventions from Front Benchers during an Adjournment debate, and certainly not from a sedentary position.
Tony Baldry: It may be for the convenience of the House, and of the hon. Member for Romsey (Sandra Gidley), to listen to the response I received from John Fingleton, the chief executive of the OFT, which is dated 28 April 2008. It reads:
“Thank you for your letter of 28th March with enclosures...requesting that the OFT consider your concerns about the monopoly community pharmacies have under pharmaceutical regulations in dispensing drugs in ‘urban’ areas, which you consider is against consumers’ interests. You ask that the OFT refers the matter to the Competition Commission to investigate.
To be clear, the OFT does have powers to refer markets in which we consider competition problems to exist to the Competition Commission for investigation. But as an alternative, and where more appropriate, we can also make recommendations to the Government for changes in existing...regulations.
In fact it was using these powers that in 2003 we investigated the role of community pharmacies in dispensing drugs. Our Report ‘The Control of Entry Regulations and Retail Pharmacy Services in the UK’ recommended liberalising the pharmacy market to allow any registered pharmacy with qualified staff to dispense NHS prescriptions.
Our investigation concluded that deregulation would give consumers greater choice, provide more competition and better access to pharmacy services.
We note your concerns about the monopoly position of community pharmacies in urban areas and the situation which may arise in Bloxham where consumers previously using the General Practitioners’ surgery dispenser may have to travel a distance to access the nearest pharmacy. We strongly believe consumers, particularly the elderly and infirm, should be able to obtain their drugs with utmost convenience, whether that be from a surgery dispenser or a community pharmacy and we hope this continues to be so in your area.
The Government response to our Report did not feel deregulation as the best course of action and it decided to modify the entry control regulations rather than abolish them. It has since developed far-reaching plans for reshaping the NHS and as you know polyclinics are part of these plans...our view remains that the retail pharmacy market should be liberalised and the Government is aware of this.”
Let us be clear about what is being said. The Office of Fair Trading is the organisation established by Parliament, by statute, to protect the interests of consumers. The OFT has made recommendations to the Government that it believes would give consumers
“greater choice...more competition and better access to pharmacy services”.
The Government have ignored the OFT.
The OFT believes that consumers,
“particularly the elderly and infirm, should be able to obtain their drugs with utmost convenience, whether that be from a surgery dispenser or a community pharmacy”.
Not only have the Government ignored the OFT, but they are, as I shall explain, going in exactly the opposite direction.
The Government’s White Paper, “Pharmacy in England”, was published during the Easter recess, as I mentioned earlier. Proposals in the White Paper, if implemented, would mean that any GP surgery with more than about 3,000 registered patients would not be able to dispense drugs. No GP surgery with a chemist within a mile of the surgery would be allowed to dispense drugs. The opportunity for dispensing doctors to continue dispensing would be completely dependent on whether a pharmacist decided to open a shop within a mile of their surgery. For example, the Montgomery House surgery in Bicester has a considerable number of patients who live in the surrounding villages. At present, if they need drugs prescribed and dispensed after a visit to their GP, it can all be done conveniently at the surgery. In future, if the Government have their way, my constituents will no longer have that opportunity or choice; they will be obliged to go elsewhere to have their drugs dispensed. Why?
If doctors are prevented from dispensing, the resulting loss of income for the practice will in many instances also mean a reduction in patient services. At present, the income from dispensing subsidises other services—for example, branch surgeries. Dispensing practices have examined the plans and foresee that they will have to close branch surgeries or make salaried GPs redundant. Where doctors are near retirement and sole practitioners, the prospect of surgery closure looms.
Is it all a ruse whereby the Government hope to help fund polyclinics? Will polyclinics be allowed to dispense drugs? Why does the chief executive of the OFT say in his analysis of the Government’s failure to take on board the OFT’s recommendations that the Government have
“developed far-reaching plans for reshaping the NHS and as you know polyclinics are part of these plans”?
During a recent debate on family doctor services, I intervened on my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, who was pointing out that the introduction of polyclinics could threaten existing GP surgeries. I observed that communities were also losing their dispensaries, and asked:
“Is my hon. Friend aware that 8.5 million patients are in GP practices that dispense drugs? Under the Government’s White Paper on the future of pharmacy services it will be almost impossible for GPs to dispense drugs in the future. Why on earth remove patient choice in this way? This is yet another service that will be lost in villages in my constituency and colleagues’ constituencies.”
“Yes, I am interested in what my hon. Friend says because in one particular respect the effect of the pharmacy White Paper, which was published during the recess, may well be to undermine dispensing by dispensing doctors, and it may all be part of a common process by the Government. The polyclinics are expensive beasts; they cost about £800,000 each, so money has to be raised for them. I suspect that in many cases the Government intend to ensure that they have a large pharmacy, which will take the pharmacy profits, and the dispensing doctors in local surgeries will lose out and shut down as a consequence.”—[ Official Report, 23 April 2008; Vol. 474, c. 1317.]
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