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Given that a large number of polyclinics will be in urban areas, there can be no possible justification for the Government’s allowing them to dispense drugs when they are not allowing GPs to dispense drugs. Do the Government intend to rewrite the NHS (Pharmaceutical Services) Regulations 2005 to favour polyclinics?
There seems to be no end to the Government’s meddling in the NHS. There have been nine major reorganisations of the NHS since Labour came to power, at a cost of £3 billion. The NHS is an institution that binds our nation together. In cities, towns and villages up and down the country, family doctor surgeries are part of the fabric of our community. The Government seem intent on imposing a polyclinic on every primary care trust area, which will inevitably put a substantial number of smaller local family doctor surgeries at risk. Again, if the Prime Minister is serious about the Government wanting to give patients “real power and control” over the service that they receive, why will the Government not let my constituents vote on whether they want a polyclinic imposed on Banbury?
Well over 1,000 GP practices in England will be destabilised as a consequence of the proposals in the Government White Paper on pharmacy. More than 8 million patients are registered with dispensing practices and thus potentially affected, and huge numbers of them will in future be denied choice about where, and by whom, their prescriptions are dispensed. It is estimated that between 5,000 and 7,000 staff employed in the dispensary and ancillary service areas of dispensing practices will be made redundant. That is a crazy situation. Will the Minister provide assurances that the Department will re-examine the proposals for dispensing doctors, and will he ensure that those appalling plans are not put into practice? Patient choice is allegedly a constant driver in all other aspects of Government health policy. Why not in dispensing?
Dr. Laurence Buckman, the chairman of the general practitioner committee of the British Medical Association, tells me that the implications of the Government’s pharmacy White Paper
“could be very severe indeed. The result might well be to terminate the rights to dispense of a substantial number of practices who rely on their dispensing income to subsidise the rest of the practice’s work. We believe that this could well mean that a lot of practices would cease to be financially viable and thus affect the provision of NHS services to their patients. This would be a perverse result of proposals that are intended to provide greater choice and access to patients.
Paragraph 8.7.2 refers to ‘transitional rules’ being required in the event that the loss of dispensing income financially destabilises a practice. ‘Transitional’ implies that such resources would eventually be withdrawn and so practices are and will continue to be under the threat of closure as it is unlikely that existing NHS income could be increased to cover the loss of dispensing...dispensing practices are popular with patients and provide an excellent service. Given that there is no public demand for any changes to the current arrangements, we do question why the Government seem so determined to generate so much uncertainly and to potentially destabilise the provision of local services.”
“in just about every patient survey that has been undertaken, dispensing practices are shown to be highly popular with patients. Indeed, the decision to have medicines dispensed with a practice rests with the patients themselves.”
The Prime Minister and the Government purport to give patients real power and control over the services that they receive, but it is clear that in practice the Government have no intention of giving patients either power or control over services. I hope that Ministers will seriously reconsider their proposals for GP dispensing.
10.52 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Banbury (Tony Baldry) on securing this Adjournment debate, and point out that he has not given me much time to respond to the various points that he made. If I am not able to respond to them all directly, I will follow them up in writing. I thank him for giving me a copy of his speech in advance.
I should like to begin by responding to the challenge, “What next?” Record levels of sustained investment in the NHS—that is what is coming next for the hon. Gentleman’s constituents. Continued record levels of investment in his local schools—that is what is coming next. Measures that brought an end to mass unemployment will continue under this Government; that is what is coming next for his constituents. I assume that his constituents will benefit from free off-peak travel for pensioners, and from the winter fuel allowance, which was introduced by this Government.
Of course, the hon. Gentleman’s constituents, and those of the hon. Member for Wantage (Mr. Vaizey), will benefit from the extended opening hours in primary care that have come about as a consequence of the recent ballot of GPs, which was initiated by this Government. There will be evening and weekend opening; I am sure that the constituents of the hon. Member for Banbury will welcome that, too. It is interesting that he did not refer to the fact that there is a clear dividing line between the Government and Her Majesty’s Opposition on the issues. The Leader of Her Majesty’s Opposition has clearly stated that future decisions about primary care should be in the hands of the British Medical Association. The Government’s policy is that future decisions about primary care should be in the hands of patients. That is the nature of the health service that we seek—
Mr. Vaizey: Will the hon. Gentleman give way?
That is the nature of the health service that we seek to create. The idea that the Government have an agenda to impose polyclinics on a one-size-fits-all basis in every community in every part of the country is utter nonsense. That is disingenuous, because it is not the Government’s position.
On behalf of his constituents, the hon. Member for Banbury has raised a number of valid and legitimate points, which I shall deal with. On Bloxham, the current regulations covering NHS pharmaceutical services have been in place since April 2005. They replaced previous systems, which existed in one form or another since 1948—indeed, I understand that the regulations on rural areas can be traced back to 1936.
The latest regulations implement a series of measures that were agreed between pharmacy and medical representative bodies back in 2001. It is important for the House to bear in mind the fact that the regulations that gave rise to the local PCT’s decision about which the hon. Gentleman is concerned are based on that accord between representatives of doctors and pharmacists.
It is a long-standing general precept, which all Governments have endorsed since the NHS came into being, that doctors prescribe medicines and pharmacists dispense them. In that way, patients receive the benefits of both professions’ expert advice, intervention and care. I have used the term “general precept” very carefully. We all agree that both medical and pharmaceutical services have developed significantly since 1948. Our White Paper set out ways in which pharmaceutical services should and will grow in the future.
It is also possible that a community pharmacy is simply not a viable proposition in every part of the country, especially in rural areas. Patients need to receive their NHS-prescribed medicines promptly and efficiently, which is where dispensing doctors can play a vital role by allowing patients to collect their medicines from a surgery’s dispensary without undertaking a lengthy journey to the nearest pharmacy. In the vast majority of cases, if the patient wishes to receive the services of a dispensing doctor, they need to live in a designated controlled locality—the hon. Gentleman has raised that point. The local PCT determines whether a particular area is rural or not. When it does so, it invites views from interested parties locally. Whatever the PCT decides, the decision can be appealed to an independent body, the NHS Litigation Authority, which is genuinely independent. As the hon. Gentleman knows, the question is whether Bloxham is rural in character. An appeal against the PCT decision has been lodged with the NHS Litigation Authority, and every opportunity will be given for people, including the hon. Gentleman, to make appropriate representations.
The hon. Gentleman has referred to the OFT. He has accused the Government of ignoring the OFT’s recommendations on community pharmacy services, which we did not do. We responded in July 2003 and did not accept the case for full deregulation. We decided to move cautiously in the recommended direction, and we announced a balanced package of reforms to the regulatory system. We introduced those reforms in 2005 and reviewed their operation in 2006. Overall, we have found that they opened up the market as intended without destabilising it, but the impact was genuinely uneven. The tendency for pharmacies that are open for at least 100 hours a week to cluster near each other in some places is considered in the White Paper, which is why we have introduced proposals for further reform and why we did not fully deregulate as the OFT wanted.
On the reference by the OFT’s chief executive to GP-led health centres, I cannot say what was intended by the reply that the hon. Gentleman received, and I am sure that the chief executive’s office will be pleased to help him further. GP-led health centres are designed to extend choice and offer convenient services. Indeed, £250 million of additional funding is available, and I
wonder whether the hon. Gentleman will bid for some of those additional resources on behalf of his constituents.
The White Paper was not, as the hon. Gentleman has claimed, published during the recess; it was published while Parliament was sitting. It has received broad support from all those involved—the NHS, health professionals and business. The hon. Gentleman has referred to chemists’ shops, and I hope that the community pharmacy profession as a whole is not offended by the implication that its members are simply retailers. I am sure that the hon. Gentleman implied no such disparagement; pharmacists are, of course, highly trained and skilled professionals. However, not once has the
hon. Gentleman mentioned his local pharmacist or referred to the comprehensive programme that we have set out to develop community pharmaceutical services.
It is absolutely right in a changing world that the Government should be prepared to engage in the reform of the NHS that most appropriately meets patients’ needs. Of course, that has to be done in partnership with the local population, which will be given every opportunity to comment.
The motion having been made after Ten o'clock , and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.
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