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Baroness Miller of Hendon: We fully understand the aim of this amendment in seeking to ensure that directions given to health authorities do not cut across professional standards already extant within the pharmacy profession. However, a Secretary of State in making such directions would need to consider any existing code of practice before making any such decision and would not wish to undermine professional standards in the way contemplated. We therefore think this amendment is not necessary. While we want health authorities to have flexibility in how much of a service to purchase and the features it contains, I can assure the noble Baroness that professional standards--for example, those laid down by the Royal Pharmaceutical Society of Great Britain--would certainly be something that the Secretary of State would wish to consider when issuing directions for additional pharmaceutical services. I therefore hope that the noble Baroness will be able to withdraw her amendment.

Baroness Jay of Paddington: I am grateful to the Minister for that reply. Again, it seems to fall into the category which I described earlier as being good intentions rather than precise regulation and understanding on the face of the Bill. However, I understand that she says that nothing which is to be regarded as a successful pilot scheme would go outside the understandings about professional standards that have already been agreed. For the moment at least, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Jay of Paddington moved Amendment No. 43:

Page 20, line 12, at end insert ("but may not add the name of any person to such a list whose name is not on any such list").

The noble Baroness said: With Amendment No. 43, I wish to speak to Amendments Nos. 44, 45, 46,49 and 50. All the amendments are designed to improve the mechanics of maintaining quality at a local level in new pharmaceutical provisions under the pilot schemes and to ensure that pharmacists, who, as we have agreed in several debates this afternoon, play an enormously important part in primary care services, are dealt with--to use the awful cliche--on a level playing field with other primary care professionals who operate in the pilot schemes.

Amendments Nos. 43 and 44 deal with the issue of pharmacists on a pharmaceutical list and how narrowly or broadly the conditions are drawn to include people on that list. The situation at the moment is that in order for pharmacists to practise within a health authority, that authority must keep a list of registered pharmacists. Only someone on that pharmaceutical list can practise

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within the health authority area. In fact, this is a somewhat narrowing provision in the existing legislation which is changed by Clause 24. It can enable the Secretary of State to alter the definition of the pharmaceutical list. That means, for example, that someone could be on a pharmaceutical list but not necessarily on the pharmaceutical list for any particular health authority. He could therefore, for example, provide a service between London boroughs in a health authority borough or area which was not the primary area of his pharmaceutical registration.

That seems to be precisely the kind of flexibility that the Bill seeks to encourage and it is indeed welcome. But the additional problem about extending that definition of the way in which the list should be organised is that it could include people who are not on the pharmaceutical list and who are not pharmacy contractors appearing on an existing list. It could go beyond that to other people whom the health authority might decide to include within the list as it exists.

That would mean that people other than persons who are already initially included as NHS pharmacy contractors could, under the pilot schemes, be contracted to provide services. It is well understood within the profession that, although happy with the idea that there will be additional flexibility around the lists based on a geographical qualification, it is less happy that it is drawn so widely that it might make it possible for health authorities in pilot schemes to include people who were not already on a pharmaceutical list within that health authority.

Amendments Nos. 45 and 46 deal with the issue--a vexed issue between the professions--of the relative authority of doctors and pharmacists in prescribing. One matter which concerns many pharmacists is that GP dispensing is on the increase. In view of many of the professionals involved in pharmacy that does not necessarily provide the best service. The amendments as they stand would have a simple effect. At the moment health authority lists of registered pharmacists are required to include the address from which the pharmacists dispense their services. In a sense that keeps some kind of regulatory control on the way in which pharmacies are distributed within a health authority area. The purpose of the amendments would be simply to include doctors who are also dispensing, in the sense of having to include their address on a pharmaceutical list. It is to extend the requirement at present made to pharmacists to GPs who are prescribing within a particular health authority area.

The purpose of Amendments Nos. 49 and 50 is equally mechanical but, in the view of many pharmacists practising at a local level, equally important. Again, it tries to establish a level playing field between doctors and pharmacists in these areas. As it stands at the moment, Clause 26 requires pharmacists providing Part I services to be the subject of an NHS contract. The amendments would give the pharmacists a choice of whether to be subject to an NHS contract or a so-called ordinary contract. That again would put them on a par with doctors and dentists under the pilot schemes. In the Second Reading debate the Minister spoke of the advantage of that choice. Although she was

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more happy with the idea of people being under NHS contracts, she said that the option of ordinary contracts would be available for those providers who preferred them. The object of those two amendments is simply to include pharmacists with GPs and dentists in having that choice. I beg to move.

Baroness Miller of Hendon: We do not believe that Amendments Nos. 43 and 44 are necessary. The existing draft of Section 41B(2) makes it perfectly clear that additional pharmaceutical services can only be provided by someone whose name is already included in a pharmaceutical list. The noble Baroness may be concerned that the Secretary of State's power of direction in Sections 41B(6) and 27B(6) might be used to redefine a pharmaceutical list more broadly. If so, I am happy to reassure her that we have no intention of using this new power to extend the definition of a pharmaceutical list, even were it possible to do so. The power of direction is necessary so that we can limit the pharmaceutical lists from which a health authority or board can draw when making an arrangement for additional pharmaceutical services. For example, we might wish an individual health authority or board to be able to arrange such provision only with people on its own or adjacent health authorities' or boards' lists. We would perhaps do this so that patients could conveniently access the pharmacy closest to their homes, in which case there would be no need to open the service to providers from further afield.

The noble Baroness suggested that perhaps the Secretary of State could alter the definition of a pharmaceutical list to include new people. That is certainly not our understanding. I am very happy to reassure the noble Baroness that that would just be National Health Service pharmacy contractors.

So far as concerns Amendments Nos. 45 and 46, we have considered them carefully. I have to say that the Government cannot accept them. I should point out that the main purpose of the clause as drafted is to ensure that all dispensing doctors, including those who in future elect to provide personal medical services under our new Part I arrangements, who continue to provide dispensing services under Part II, will be subject as far as their dispensing activities go to the National Health Service tribunal arrangements. The suggested amendment is not relevant to that position in any way.

Doctors are allowed to dispense medicines to their patients in limited circumstances, the most common of which is where their patients are living in a rural area more than a mile from the nearest community pharmacy. The health authority in allowing the doctor to dispense makes no specification as to where the dispensing should take place--it may be from the main surgery or a branch surgery, and in some instances the medicines will be handed over in the patient's home--and we consider that not only would it be impractical, but irrelevant, to include addresses in the proposed list. The jurisdiction of the National Health Service tribunal will apply so long as the doctor is included on the list. That is what we want.

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As for Amendments Nos. 49 and 50, I understand why the noble Baroness wishes to create flexibility here. Our view at present is that effectively making National Health Service contracts for the additional services which pharmacists and optometrists might provide would be more attractive to health authorities and boards. Indeed, we thought it might be overcomplicated to open up a new question on the type of contract for health authorities or boards and their potential providers to consider when negotiating. We certainly would not wish this to be a point of dispute, over which service opportunities might be missed. However, we are sensitive to the professions' views. If, in light of what I have said, their general feeling is that the advantages of flexibility outweigh the disadvantages, we are willing to reconsider this provided we can find a simple mechanism for deciding what sort of contract is to be used.

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