The Prime Minister recently paid the local area the honour of a visit to Leatherhead hospital. Sadly, I was unaware of his visit until after he returned to WestminsterI would have liked to join him at the hospital. No. 10 thoughtfully informed my hon. Friend the neighbouring Member for Epsom and Ewell (Chris Grayling), albeit too late for him to inform me. I was delighted 24 hours later to receive some apologies from
No. 10, which were accepted, but I used the opportunity to request an audience, along with some of my colleagues, with the Prime Minister about the issues that I would have raised if I could have joined them. To date, the silence from No. 10 is significant but not golden.
Both hospitals have evolved to meet the need to act as intermediaries between the GPs and their clinics and the three general hospitals. Both hospitals work closely with the many GP practices in their surrounding areas. For example, Leatherhead is run as an independent, not-for-profit unit giving services, including clinical assessment, especially for heart conditions, X-rays, audiology and dentistry for handicapped, abused and difficult children. I had hoped to use the opportunity to expand on the latter part by bringing in the private sector to pay for refurbishments and so on, and perhaps establish a charity to provide dentistryto put on my dental hatin the hospital if possible.
The hospital is effectively a polyclinic without GP servicesthe latter are not necessary, as the GPs are close by in Leatherhead and the surrounding villages. GPs in Mole Valley have coagulatedif I may use that medical termto form what I call mini-polyclinics. By forming partnerships with up to a dozen doctors, those clinics can offer the usual paramedical services as well as extras such as physiotherapy, minor surgery and, in the case of the Medwyn GP clinic in Dorking, dentistryas long as ones Polish English is effective. Several of those group practices can thus run satellite services in many villages. They are generally also dispensing practices, and that makes them just financially viable and means that the village patients do not have to travel into the bigger villages with their prescriptions. The towns and bigger villages are served by many excellent and modern pharmacies, which have encompassed new demands and requirements from patients, local GPs and the Government.
All those relationships of GPs, clinics, local hospitals and pharmacies have evolved co-operatively to meet evolving patient needs, and have encompassed developing medical science as well as requests from the Government. Any Government changes, such as polyclinics and changes in pharmacies that affect dispensing GP practices, may be applicable in inner-city areas such as the Minister's constituency, but must not be applied prescriptively to rural and semi-rural areas such as my constituency.
I guess that it may be convenient for the Minister and even the Prime Minister to call Leatherhead hospital a polyclinic. However, to expand that to include general medical practitioner services, when they are being provided close by, or to impose a full blown polyclinic anywhere else in or close to Mole Valley, would be short-sighted and deeply damaging to NHS services, Mole Valley towns and especially villages. To quote one of the many deeply worried doctors,
a polyclinic would act like a black hole drawing all in and forcing closure of GP clinics especially in the villages.
Surrey villages have been and are under great threatseveral village shops have gone. Recently, 25 per cent. of sub-post offices have closed and village halls have been hurt by the recent licensing legislation. Polyclinics and changes in the pharmacy rules could especially hurt GP services in satellite villages.
A recent speculative bid for a new pharmacy, ostensibly serving several villages east of Dorking, was carefully assessed and rejected by NHS regulators. The key reason for rejection was that the demand for prescription medicines
was being met by dispensing GPs in the village satellite clinics. The presence of a new pharmacy in the villages would have disturbed the financial balance of those surgeries. Some or all would either curtail their hours or force closure for economic reasons. To add to this, there was severe doubt whether the proposed pharmacy would have been viable. The end result would have been a pharmacy that would have killed off some of the GP services and GP clinics and then died itself for economic reasons. The result in a few short months would have been disaster for those villages. Fortunately, the decision was a refusal. It would be helpful if these dispensing pharmacies were able to provide over-the-counter medicines and other minor pharmacy additions such as first-aid supplies, and I understand that the Government are considering that.
I am asking the Minister to accept that a rigid application of the new distance parameters for pharmacies would be severely damaging in rural and semi-rural areas. Similarly, I hope she and her Department will accept that polyclinics with GP services in areas such as mine would damage a delicate and evolved environmental balance serving the national health service, and that that would result in poorer services for patients. My GPs will be keen to learn of the Ministers response, and if they are unhappy I suspect they will ask me to ask her whether I and one or two representatives might see her to expand on anything that comes out of todays debate.
These clinics are major employers, particularly in the villages, and they serve many who would find travelling for NHS care an enormous problem. I would be delighted if the Minister used this chance to reassure the concerned GPs and their patients, because if she does not do so she will be deepening an already deep fear among many people who loyally serve the NHS and who use it.
The Minister of State, Department of Health (Dawn Primarolo): I congratulate the hon. Member for Mole Valley (Sir Paul Beresford) on securing the debate. It is a pleasure to be present this evening. I shall go straight to the heart of his two major points on dispensing GPs and GP-led health centresor, as he called them and as they are often referred to in London, polyclinics. I hope that I will be able to reassure him, his constituents and those GPs who have been making representations to him that they should put aside their worst fears and instead embrace the agenda that he has outlined and that the Government are taking forward.
In his comments on dispensing GPs, the hon. Gentleman graphically laid out the complexities and differences in his constituency. Of course, if we compare it with, for example, my constituency of Bristol, South, his first proposition that one size does not fit all across the country is absolutely right, and that is precisely the Governments view. In looking at the provision of health services, it is important to take account of the needs and the location of the services in order to best serve patients in terms of quality and access to those services.
As the hon. Gentleman will be aware, the Governments White Paper, Pharmacy in England: Building on StrengthsDelivering the Future, published on 3 April, set out our future proposals for expanding high-quality pharmaceutical services and developing the role of pharmacists as a leading clinical profession within the primary care team. He will know from my written ministerial statement of 17 July that next month we intend to publish our further consultation on the structural changes for the pharmaceutical services, which will run through the autumn.
Regulations governing dispensing by GPs have been in place since 1912, and despite some changes in April 2005 to implement measures agreed between pharmacy and medical representative bodies, they have not substantially changed for almost a century. A general precept adhered to not only by this Government, but by all Governments, is that doctors prescribe medicines and pharmacists dispense them. However, the hon. Gentleman alluded to the fact that community pharmacy is not always viable in all parts of the country, particularly rural areas. Patients need to receive their NHS-prescribed medicines promptly and efficiently, and that is where dispensing GPs can play a vital role.
I say clearly to the hon. Gentleman that the Government recognise the importance of the role of the dispensing GP and do not propose to end it; there is no question of the Governments advancing an agenda that is about disposing of the services of dispensing GPs. I know that some dispensing GPs have expressed doubts about their future. I hope that my clear statements today will show that it is not, and never has been, the Governments intention to disband or remove the services of dispensing GPs.
However, I am sure that the hon. Gentleman recognises that the system of GP dispensing contains anomalies and inconsistencies, and we want to seek views on how to deal with that. I stress the words seek views,
because there is no predetermination involved, and we have made no suggestion that GP dispensing will cease. We have also made it clear that in examining some of the problems and anomalies, which GPs themselves identify, it will be vital to consult. That is the case precisely for the reasons that the hon. Gentleman so clearly and correctly identified in respect of understanding the geography and the services that are in place.
I move on to the question of super-surgeriespolyclinicsand GP-led services. I am told by Surrey primary care trust that there are no plans to have any major new primary care developments in the area. However, the hon. Gentleman will be aware that that might not please all his constituents, given that the public have told us that enabling them to see a GP at a time that is more convenient to themfor example, at weekends or in the eveningsis their No. 1 priority in improving the NHS further. It is also true that Surrey PCT has more patients who are dissatisfied with the office hours opening times than anywhere else.
Sir Paul Beresford: I thank the Minister for letting me respond to that specific point. Interestingly, the GPs in my constituency are clear about the fact that they have reacted positively by expanding their hoursthat includes weekend openings.
Dawn Primarolo: I agree with the hon. Gentleman, because, so far, 55 per cent. of the local GPs77 out of 139are offering extended opening hours. None the less, that leaves almost 50 per cent. of his constituents outside such arrangements. The point that he makes is that the investment in and the dialogue with the PCT and the GPs is about enhancing and developing services, not cutting back on the services that are available.
I confirm once more that the guiding principle behind GP health centres is the wish to provide additional ways of accessing GP servicesprecisely the sort of things that the hon. Gentleman mentioned in his contribution. I am more than happy to echo the point that he made that that is best planned and delivered by agreement and in co-operation with the health professionalsGPs and othersin his constituency. The most important thing is that his constituents get the best quality of care and the best access to care.
In response to the two points that the hon. Gentleman made, I repeat that, first, there will be no requirement or any forced solutions in the development of GP-led centres or polyclinics in his constituency, but there will
be continuing dialogue between the GPs, the PCT and other health professionals on how to deliver the best services; and, secondly, there is no predetermined conclusion and no desire to abolish GP dispensing. The White Paper raises questions about the accessibility of pharmacies and how we can iron out any problems in the current rules. It may not be a problem in the hon. Gentlemans constituency, but there are examples around the country of dispensing GPs being on the opposite side of the road to a pharmacy. Such anomalies need to be resolved.
Sir Paul Beresford: I accept the Ministers point about other areas. The difficulty in my villages is that a new pharmacy, on its arrival, will kill off the satellite dispensing pharmacies in the villageswe have seen some speculators try thatand then die off itself, leaving the villagers without pharmacy or GP services.
Dawn Primarolo: It is obviously not the Governments intention to drive GP services out of areas, given that we have announced that we will invest an extra £250 million in taking those services into areas that are under-doctored.
I am aware that applications have been made for two pharmacies, and those are under consideration. The White Paper attempts to ensure that we have the most appropriate services for the patient, delivered by the best-qualified provider. However, in encouraging that breadth of professionals in an area, we do not want to remove the GP service, for instance.
The hon. Gentleman is absolutely right to point out that, particularly in the areas represented by him and by some of my hon. Friends, it will be very important to consider the provisions for quality of care and for access. The White Paper says not that pharmacies offer all the solutions, but that they have the potential in certain parts of the country to open up the health service. We need to find a route whereby we can do that, where appropriate, without undermining quality provision where it exists. I know that he will agree that we need rules that are consistent and fair and that work to the best advantage of the patient and of the quality of care. That is what we are proposing to do and I see no reason why that should threaten the viability of GPs offering excellent medical services.
I hope that the hon. Gentleman will accept my reassurance and await the publication in the next month or so of the next stage of the consultation. If there are outstanding issues that he wants to raise with me, I will be happy to see him.