Norman Baker (Lewes) (LD): I am pleased to have the opportunity to deal with a matter of considerable importance to a large part of my constituency, namely the application by the doctors practice in Newick to dispense medicines from their Chailey surgery. The proposal may seem innocuous, but it has led to enormous objections in my constituency. There has been a huge furore and genuine and understandable concern about the implications of the application, should it to be approved.
Local parish councils, none of which were consulted about the proposals, have set out the concerns. That applies especially to Newick parish council, but Chailey and Fletching parish councils, as well as those in Barcombe, have also expressed concern. There is also a petition, which approximately 2,000 people have signed. That equates roughly to the entire population of NewickI hope that that demonstrates to the House the seriousness of the matter. If I may, I will hand the petition to the Minister when we have concluded the debate.
There are two reasons for the major anxieties about the proposal. The first is a genuine concern that the move will drive out of business the existing Lloyds pharmacy in Newick, which is well respected, performs a useful public function, is well liked and is used by people not just in Newick but in nearby villages. The view in the village, which I share, is that if the proposal goes ahead, it will fatally undermine the viability of the chemist. Not only would the village then lose the chemist, but there would be a knock-on effect on the remaining nearby shops, thereby potentially removing all retail outlets from the village, as people use the other outlets when they use the chemist. That is a genuine concern, which perhaps explains why there is such opposition to the proposals in Newick.
The second reason is a medical reason. In the view of many peopleagain, I share their viewthere will be a diminution of service if the chemist closes. The proposal for the doctors surgery to be able to dispense medicines from Chailey in no way compensates for the extremely good service currently provided by the chemist both onsite in Newick and remotely, through the free delivery service to nearby villages.
Let me turn to the comments that have been sent to me by residents, including Chailey parish council. I refer to Chailey in particular because the proposal, ostensibly to improve services, is to have the dispensing of pharmaceuticals at Chailey. One might therefore think, superficially, that people in Chailey would be in favour of it. However, they are totally opposed to the proposal, just as people in Newick are. It is not just those who have a chemists shop who are opposed, but those who value the remote service provided by Lloyds.
In Chailey parish alone, there is a residential home for disabled adults, a residential school for disabled
children and a development of 24 warden-controlled flats for older people. All those organisations are currently served by the Newick community pharmacy home delivery service. If that service were removed, the burden of arranging the collection of prescription drugs and appliances would fall on carers and wardens. That would obviously be highly regrettable, and in some cases not even possible, given the strains and stresses on those organisations.
Lloyds do an absolutely superb job and I wouldnt want to lose them. I dont know how I would get my prescriptions otherwise, especially repeat prescriptions. The Lloyds van is in our street nearly every day of the week.
Mrs. Stewart has lived in Barcombe for most of her life. She makes the point that the Chailey centre has no practice nurse service, so even if it is possible to get there for the first prescription, repeat prescriptions are still an important issue for many of my constituents.
For the last 10 years Lloyds pharmacy have offered us an excellent, efficient service. I have spoken to a number of our residents who are concerned about the impact it may have on their healthcare and like us feel that the service offered cannot be improved on.
A trustee of the Grantham trust, in Grantham close, Chailey, which operates 24 warden-controlled flats for the elderly, has reported that 36 of the residents in those flats currently receive deliveries via the community pharmacy home delivery service and that the system works well for all concerned. The Leyden trust, also in Chailey, operates a residential home for six disabled adults and relies on the delivery service for the supply of pharmaceuticals. The trust says that it would be difficult to release a member of staff to go on regular trips to a pharmacy to collect prescription items, in view of the intensive level of care required by the residents.
I would suggest that those are good medical reasons why the proposal causes such grave concern in my constituency and beyond. Indeed, a member of Fletching parish council, which is in the constituency of the hon. Member for Wealden (Charles Hendry), has also contacted me, writing:
I would make it clear that my Parish Council considered this matter at its last meeting and unanimously resolved to support Newick in its endeavours to resist any measures...that threatened the viability or existence of...a...valuable local resource.
Chailey parish council also submitted a thorough letter to the appeal process in Harrogate, making the point that 60 per cent. of the current dispensing business is for patients outside Newick and that 340 post codes are included in the application.
Chailey parish council has written to me to say that if the Newick community pharmacy were to close, residents would have to visit pharmacies in the surrounding towns, all of which are seven miles from the centre of Chailey. Interestingly, the council also notes that the Governments 2008 White Paper on pharmacies emphasisesrightly, I believethe importance of the development of a wide range of community services in the local pharmacy. If this decision were to be allowed, it would seem to run contrary to the Governments direction of travel, which most people support because they want to see greater use of pharmacies in their locality.
Unfortunately, that seems to run counter to some of the regulations, and I would welcome clarification from the Minister on this. I have dug out a similar case relating to an application made in 2000 in Robertsbridge, which is in the same primary care trust area. I understand that the 1992 regulations state that the committee
shall refuse an application to the extent that it is of the opinion that to grant it would prejudice the proper provision of general medical services or pharmaceutical services in any locality.
The fact that the granting of an application could lead to a reduction in the level or standard of general medical or pharmaceutical service does not, of itself, constitute prejudice to proper provision.
That is an important paragraph, because it seems to imply that, even if there is a diminution in service, that is not a reason in itself for rejection. That is from the 1992 regulations; it might well be that the 2005 regulations have overtaken those provisions. It would be helpful to learn from the Minister whether that is the case. However, if the regulations say that a facility for local people can be reduced from its present level if, for example, a doctors surgery applies to dispense medicines, that cannot be consistent with the Governments direction of travel. It would be useful to get an update on that point.
There is also uncertaintyperhaps it is welcomeas a result of responses that were received this week in another place. My constituent, Baroness Cumberledge, raised the matter with the Health Minister, Lord Darzi. The baroness is a doughty campaigner on these matters, and has a long history of activity in the health service. However, given her political allegiance, it is probably just as well that she does not have a vote at the general election. She asked Lord Darzi about these matters, and on 2 June he replied:
If a new pharmacy opens in a controlled locality, or if an area is no longer considered rural by the PCT, GPs are required to reduce their dispensing.
In other words, the hierarchy that the Government appear to supportwhich I think is absolutely rightseems to place the GP dispensing process in a secondary position to pharmacies. The GP process seems to have been designed to fill gaps rather than to be a rival to the pharmacies. If that is the hierarchy that the Government support, I entirely agree with it, but it seems inconsistent with the regulations that I have just quoted.
The principle of GPs dispensing has historically been seen as an exceptional measure, normally where there may not be a convenient community pharmacy and patients have no choice but to travel a considerable distance to the nearest pharmacy.
Again, I have no objection to that. No one wants to prevent patients from having access to pharmaceuticals if there are no chemists nearby. However, that is not the situation in Newick, where there is a chemist nearby that is well supported and provides a service that is second to none. Anything that threatens that provision cannot be in the interests of patients or of the health service generally.
White Paper Pharmacy in England: Building on StrengthsDelivering the Future we will be consulting on proposals making changes to the control of market entry for dispensing medicine that will examine options for improving services and patient access.[ Official Report, House of Lords, 2 June 2008; Vol. 702, c. WA13.]
It would be helpful if the Minister clarified how that fits in, although I understand that this is not part of her portfolio at the Department of Health. I am trying to understand the Governments direction of travel. Do they see GPs as a back-up to the pharmacies, as I think they should, or as potential rivals who shouldaccording to the 1992 regulationsbe allowed to damage the interests of pharmacies? That important point needs to be clarified, but if the Minister cannot deal with it or with any of my other points on this occasion, it would be useful if she helped me to arrange a meeting with the relevant health Minister.
I wrote to the family health service appeal unit in Harrogate on the basis of the narrow grounds on which I understand that the regulations allow appeals to be made. Some of the points that I have made to the Minister are fairly wide, but while I feel that account should be taken of those wider points, I see a case for rejecting the application even on the narrow grounds specified in the regulations.
In my letter I said that the proposal, if enacted, would prejudice the proper provision of pharmaceutical services for people in the Newick locality, including nearby communities such as Chailey. I noted that consideration was given to the viability of the chemists shop on the occasion of the Robertsbridge appeal. It was obvious to me that if that were taken into account, the case for allowing this application would disappear entirely. I hoped that the appeal committee would agree to undertake a proper economic assessment to establish whether the Newick chemist would be affected before making any irreversible decision on whether to allow the application.
The decision was flawed in another respect. No consultation whatever was conducted with the parish councils, with the district council or with me. Indeed, I was not even notified. The process appears to have taken place behind closed doors, with no reference to the local community. That is contrary to the Governments stated views on public participation, which I am happy to support. Although the regulations may not have been formally overridden, I think that, in the spirit of the regulations, consultation should have taken place. Indeed, a specific power to allow such consultation has not been used, and for that reason alone I feel that the matter deserves further consideration. If the appeal committee does consider the issue further, as I imagine it will have to, I think thatparticularly given the lack of consultation so farit should do so by means of an oral hearing either in Newick or in Lewes, the county town, so that local people can have their say.
Finally, let me return briefly to the issue of GPs dispensing pharmaceutical medicines. I understand that it was originally intended to benefit patients in areas where it was economically unfeasible for a chemist to operate. However, it seems to meand I say this advisedlyto have become a money-spinner for some practices. I fear there is a danger that the narrow financial benefits to be gained by general practices will override the health benefits to the population at large. That is a wider problem, which the Government must try to straighten out.