Mr.
Mike O'Brien: I am grateful to the hon. Gentleman for
raising this issue in such detail. The EPS system would mean that PCTs
need to be satisfied that an application is EPS-compliant when
considering whether it would be granted on the basis that it secures
improvements or provides better access to pharmaceutical
services—at least, that is the intention of the
amendment.
I do not
accept that the amendment would be helpful or particularly improve the
available services. Let me take a few moments to explain the background
information to the EPS. I am grateful to the hon. Gentleman for the
points he has made, but to use the EPS, pharmacy contractors must have
IT systems that have gone through Connecting for Health’s
rigorous assurance process. Connecting for Health leads on the delivery
of the national programme for IT, and its assurance process is made up
of a number of key stages, including clinical safety testing and
initial implementation in limited numbers of GP and pharmacy sites.
Patient safety is obviously paramount. We do not want suppliers to cut
corners in order to reach the start of the assurance process faster,
only to lose time in the longer term as they fail to meet Connecting
for Health’s exacting standards.
Authority to
deploy Release 1 and Release 2 of the EPS is given separately. While
much progress has been made on deploying across the country Release 1
of the EPS, which releases technical infrastructure, I know that
Release 2 will be of greater interest as it brings a number of
functional changes and associated benefits for patients, prescribers
and dispensers. Those include the option for patients to select or
nominate a dispenser for their electronic prescription to be sent to
their chemist and electronic repeat dispensing produced.
[Interruption.] Just a moment—let me run
through some of the benefits.
What are the
benefits of Release 2 for patients? The first benefit is a more
convenient service, with a reduction in trips to the GP practice just
to collect a paper prescription—a point particularly relevant to
patients on repeat medication. Some 70 per cent. of prescriptions
nationally are issued for repeat medication. The second benefit is
greater freedom of choice, making it simpler for patients to use a
pharmacist convenient to them. The third benefit is potentially
reducing pharmacy waiting times, as, with a phone call, prescriptions
can be prepared in advance of a patient arriving. In effect, the
information is already there, and they do not have to wait for the
piece of paper.
However, what
are the benefits for GPs and pharmacies? First, there will be a
reduction in the work load in GPs’ practices generated by
patients collecting individual prescriptions from surgeries,
particularly repeat
prescriptions. Secondly, the ability to sign
prescriptions electronically is much more efficient for GPs. Thirdly,
GPs will be able to cancel prescriptions electronically at any point
until they are dispensed, leading to greater confidence in GPs to use
repeat dispensing. Fourthly, there will be a reduction in the need for
pharmacy staff to re-key prescription information into pharmacy
systems, which is quite a problem in bureaucracy terms—I had to
get that point in. In time, this will remove the need for pharmacy
staff to collect prescriptions where they offer a prescription
collection service. Those developments provide significant
benefits. Mr.
Stephen O'Brien: I appreciate the list of benefits, but
what is interesting in the Minister’s answer so far is that he
accepts that we have only managed to get to Release 1 implementation at
this stage, and he was relying on where we will get to with Release 2.
That said, if Release 2 delivers to that degree and soon, that is a
partial answer. Given the track record to date of the progress of the
programme’s delivery and implementation, particularly Release 2,
the Minister might at least want to think about—this could be a
compromise—postponing implementation of this element until after
Release 2 has taken place and proven
itself.
Mr.
Mike O'Brien: Much progress has been made on
delivering Release 1 against the background of competing priorities for
IT systems suppliers. EPS Release 1 deployment is virtually complete.
All GP and pharmacy suppliers have completed the compliance process.
The cumulative prescription volume is 207,195,907 as of 11
June—a relatively up-to-date figure. Some 95 per cent. of GP
services are technically enabled to deploy the EPS, and 80 per cent. of
GP practices are business-enabled. Some 92 per cent. of community
pharmacies are technically enabled to deploy the EPS, and 82 per cent.
are
business-enabled. On
Release 2, all central components have been delivered. There are eight
pharmacy systems suppliers delivering nine pharmacy systems for
community pharmacies in England. Currently, seven pharmacy systems
suppliers are developing EPS Release 2 systems. Initial implementation
commissioning is under way at a GP and independent pharmacy, using
synthetic patients to conduct technical and clinical assurance
activities. We expect nearly all suppliers to have full roll-out
approval by the end of 2009, according to the information given to us
by systems suppliers.
Quite a lot
of progress has therefore been made on Release 2, and we need to
continue to monitor it with great care. We know that deploying any
computer system has its problems. Over the years, Governments of all
persuasions have found that computer systems can cause difficulties.
That is also the case in the private sector where large-scale computer
projects have been introduced. However, with careful monitoring they
can also bring enormous dividends and benefits to
users. We
do not feel that the amendment would contribute significantly to
delivery leverage for EPS. EPS is an essential component of a modern
pharmacy service, and we intend that it should be provided by all NHS
community pharmacies. EPS is on everyone’s agenda—it is
not just an issue for applicants to pharmaceutical lists. We do not
agree with the amendment because a successful applicant to a
pharmaceutical list currently has up to 15 months to open. In that
time, the parameters
for EPS compliance may change, so a PCT’s compliance assessment
at the time of application may be out of date or irrelevant by the time
the pharmacy opens. If we find in
future that IT systems are compliant with Release 2 of the EPS but
pharmacies are still not delivering the service, we have scope in
clause 26 to make provision as to what matters the PCT must or must not
take into account for the purpose of determining whether to grant the
application. I therefore ask the hon. Gentleman to consider withdrawing
his
amendment. 5.45
pm
Mr.
Stephen O'Brien: I am grateful to the Minister for seeking
to address my point. I hope he realises that I raised it in a genuine
attempt to be constructive. In resisting the amendment, he prayed in
aid the 15-month time period between when the choice is effectively
made and implementation. He also prayed in aid the fact that due to the
nature of technology, the programming, the system and the compatibility
could change during that period.
This is one
area where we must be extraordinarily cautious. To the extent that I
have found myself dragged, somewhat reluctantly, towards the NHS IT
programme, I understand that one will never catch up with the leading
edge of technology. One must set a point at which one is trying to
achieve a certain standard and say, “That’s the standard
to be met,” and not always worry about things such as the
15-month period. The Minister is absolutely right: the technology may
well move forward. The issue is compatibility with a standard that will
work to deliver the
service. I
will not press the amendment, because I think that the issue requires
continuous careful and vigilant monitoring, as the Minister accepted.
We need to watch it carefully, as there are fantastic benefits to be
gained—he sought to highlight some—but it could easily
trip on the basis that implementation is flawed or time-lagged and
there is a lack of capacity for, let alone understanding of, the
standards to be applied to achieve compatibility. Although the
amendment is the sort that one might want to press to a vote in a
somewhat virile way, to demonstrate that one means it, on this occasion
I will withdraw it. However, we need to highlight the issue and ensure
that the Minister, the Department and the Minister’s advisers
keep it as a high priority in order to make it work. I beg to ask leave
to withdraw the
amendment. Amendment,
by leave, withdrawn.
Mr.
Stephen O'Brien: I beg to move amendment 37, in
clause 26, page 29, line 8, at
end insert ‘including
the impact that granting an application would have on existing
services.’. I
am delighted that somebody, in a sedentary position, regards it as a
signal victory to have reached amendment 37.
I intend to
consolidate some of the issues that have been raised so far. We have
discussed the need to consult patients and highlighted the potential
impact of the pharmaceutical needs assessment on the services that
dispensing doctors offer patients. We have also discussed the different
needs of rural and urban populations—however one wants to
describe them—and I have sought to ensure that the Minister
takes all those matters into account in setting regulations for the
PCTs.
In many
respects, amendment 37 would solve the problems raised by the
Dispensing Doctors’ Association with regard to offering patients
a choice of services. If PCTs were duty-bound to assess what impact
granting an application to the pharmacy list would have on existing
services, they would have to ensure that the new service would
complement and enhance existing services, thereby safeguarding patient
choice and potential patient preference for existing services,
such as those of dispensing doctors, be they in the Minister’s
PCT or my own. Hopefully, the PCT would then avoid cutting services
unnecessarily or granting applications to provide services that do not
add to patient choice or increase patient access to pharmacies or
dispensers. PCTs would, of course, still have the right to cut services
in circumstances where they breached a term of arrangements under new
section 150A of the National Health Service Act
2006. The
amendment is simple. I hope that the Minister’s thoughts will
turn towards accepting this worthwhile amendment to the
Bill.
Mr.
Mike O'Brien: The amendment aims to oblige PCTs to
consider the impact that granting an application would have on existing
services. I can see the importance of doing so, but it is also a key
concern that the new arrangements for determining entry to a
pharmaceutical list should not be used simply as a basis for PCTs to
refuse all or any new applications without some clear, robust and
objective ground. Just as we saw when the matter was raised in the
other place, I am concerned that the consequence of the amendment would
be unwittingly to restrict new entries, so it would constrain
competition and could undermine new businesses’ ability to enter
the field. The hon. Gentleman looks quizzical, but if he looks at this
he will see that it could well be the consequence.
Each and
every application will have some impact and effect on contractors; that
is unavoidable, but how much is a question of degree based on local
factors and circumstances. It is impossible for us, from the centre, to
understand the exact impact in every case. We must strive to achieve
the right balance between adequate PCT controls and the freedom of
contractors to operate without creating disproportionate burdens or
costs. When we consulted on this proposal last autumn, we recognised
the need to strike that balance. We proposed to use existing factors
introduced in the 2005 regulations to the current control of entry
tests. These factors are the level of access, the choice and diversity
of providers, innovation in service delivery, the services available to
specific populations to meet specific health conditions or disease
needs and the overall longer-term impact of approving new
applications.
We intend to
include the criterion of longer-term impact that this amendment
proposes in the new regulatory regime. We have not determined that this
criterion should have pre-eminence above all other criteria. It is one
of a range of factors that PCTs need to consider when determining
whether, against its assessment of local needs, an application should
be approved or not. PCTs will have to weigh up the facts, look at the
evidence carefully and determine the plus and minus points accordingly
before reaching their decision.
I also make
the observation on the amendment that I think it is equally important
that PCTs should consider the longer-term impact when they are minded
to refuse an application, not just when they are minded to grant one.
Refusing an application may have implications for other businesses and
competition in the area. My concern is that the result of this
amendment would be to restrict competition, to inhibit business, to
prevent new entry of businesses into this area and, in effect, to
restrain the market in a way that I did not think the Conservative
party believed in. It seems that, in response to lobbying, it is
disposed to do that unless the hon. Gentleman decides, as I hope he
will, that he will not press this amendment to a
vote.
Mr.
Stephen O'Brien: We do not favour any kind of
protectionist approach. When the Minister suggested that I might be
quizzical—I was not quite sure who he was indicating as I had my
head down—I was writing a
note.
Mike
Penning: I think he was looking at me, but I was
yawning.
Mr.
Stephen O'Brien: I shall move on swiftly. The Minister has
over-egged his case. If one looks carefully at the wording of this
amendment, it says that, where primary care trusts have determined to
make any kind of recommendation, the regulations may make provision for
the manner in which they determine that grant and matters that the
primary care trust must and must not take into account for the purposes
of determining whether to grant the application, including the effect
that granting such an application would have on existing services. Far
from restraining competition or inhibiting new business, the fact that
they would have to acknowledge that they have taken into account the
effect that granting such an application would have on existing
businesses might result in their granting an application because it
increased competition. They might be concerned that a particular area
had no competition, and consider that granting the application would
ensure that an efficient service was delivered, prices were kept keen
and customers would receive first-class customer services.
The Minister
has overplayed his hand, as he has exaggerated what the amendment
actually states. It makes explicit what is set out and is referred to
in the justification by a primary care trust. A trust must ensure that
it has taken into account the effect that granting an application would
have on existing services. To be frank, in light of cases that have
arisen in my constituency and I dare say in others, the problems have
arisen precisely when it appears that there has been no explicit
justification to make a recommendation without reference to the effect
that it might have on existing services—not that it would
inhibit new business or restrain
competition.
Mr.
Mike O'Brien: I do not disagree with the point that the
hon. Gentleman has just made. When PCTs make these decisions, it is
important that they weigh appropriately the impact that a decision will
have on local services, and that means the impact on other pharmacies
in the area. He may well be right that, in some cases, PCTs have failed
to give the appropriate weight to that criterion when they make a
decision.
Mr.
Stephen O'Brien: I am grateful to the Minister, because
our dialogue has brought us back to where we need to be. We want to
ensure that that consideration is made explicit and that we do not end
up having unnecessary concerns, disputes or even campaigns locally
because there has not been a sufficiently explicit
explanation of what lies behind the thinking of a PCT and its
recommendations.
On that
basis, I do not need to press the issue to a vote. However, it was very
important to have clarity in terms of what the amendment was intended
to say and, given the way that the Minister provided the
counter-argument, I also wanted to make sure that the record was
absolutely straight.
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