Health Bill

These amendments seek to amend clause 32, which deals with application for provision of pharmaceutical services. It may be worth spending a little time on the context of these amendments. As the House knows, following the Office of Fair Trading consultation a couple of years ago, new pharmacies are controlled by something called the control of entry regulations. Any application to open a new pharmacy has to go before the primary care trust or the Assembly in Wales and has to pass certain tests. It is also worth remembering that pharmacies are private contractors which have a contract with the national health service. Historically, that has been to deliver dispensing services, but that has recently changed with the introduction of the new pharmacy contract. That seeks to extend the role of pharmacists, which is widely regarded as a good thing. Instead of just relying on dispensing, the contract is divided into levels of service. The standard services are those that all pharmacies should supply, and include services such as dispensing and health promotion. Advanced services are developing gradually and the first, which has been successful so far, is the medicines use review—or MUR—which has benefited many patients. So far, so good. The potential exists for enhanced services, such as smoking cessation—I had to mention that tonight—and monitoring the progress of disease or providing services to care homes. Commissioning of such enhanced services has been very patchy. Some primary care trusts have been very good and tried to embrace new services, but others have ignored the opportunity completely. Some of the evidence shows that the future of the enhanced services next year looks shaky, to say the least. However, that is probably a debate for another day. Clause 32 applies only when a primary care trust has two applications before it to provide pharmaceutical services in a similar locality. Each pharmacy must pass the existing test as to whether it is necessary or desirable. As drafted, clause 32 would mean that an NHS contract could be awarded according to promises made in relation to the commercial part of the business. That is wrong and unenforceable, and various problems arise. I admit that the Government have consulted on the proposal, but most respondents rejected it. All the contractors who were consulted did so, regardless of whether they represented single, independent contractors or large multiples. The contractors’ objections revolved around a few simple propositions. They said that no request for a certain level of medicine pricing could be enforced, as no price could be guaranteed in the long term. Contractors could promise the earth, but how could that be monitored by the PCT on a regular basis? What would happen if circumstances changed? For example, a certain price for over-the-counter medicines might be allowed, but the company or pharmacist involved could renege on the deal. The best analogy that I can come up with is with the contracts awarded to NHS dentists. Such dentists spend two or three years building up their patient lists, but then decide that they do not want to provide dentistry on the NHS. In those circumstances, the PCT has no control over what happens, and it is the question of control that is important here. Also, it is difficult to see how a PCT can balance different offers in different applications. For example, one pharmacy might offer a certain price for over-the-counter medicines, while another offers an enhanced delivery service. How can the first offer be compared with the second? Who decides what is best for patients? During the consultation, the concern was raised that the proposal could lead to more application refusals being contested, and therefore to a possible increase in the number of judicial reviews. What happens if a pharmacy is sold, quite legitimately, to an independent contractor or a different group? The buyer might have different marketing or pricing policies, or want to offer a different range of services. How will that be dealt with? It has been argued that the proposal will help disadvantaged communities, as they would have access to cut-price medicines. I have worked in such communities, and my experience is that that is not really a consideration. People who live in such areas know that they can get free prescriptions from their GPs, and are happy to do so. As a result, that argument is something of a red herring. Very often, businesses in disadvantaged communities are run by independent contractors. At first, they might not be able to offer big attractions in respect of cut-price medicines, but their commitment to the community can mean that they choose to plough some of the profits back into developing future services. Traditionally, that is what has happened in pharmacy, but the clause could put a stop to pharmacists’ very realistic desire to do the best that they can within the constraints of their budgets. In short, the clause is unworkable as it stands, being difficult both to monitor and sustain. If the Minister is committed to proceeding with it, I hope that she will at least review the new system after it has been in place for a year or 18 months. In that way, she will be able to see whether any of the problems that I have highlighted are based in reality rather than in fear.