Clause 38 - Control of entry regulations
Health and Social Care Bill
2:45 pm
Mr Desmond Swayne (New Forest West, Conservative)
In many respects, my constituency is patchy with respect to the coverage that can be had from pharmacists—we are certainly talking about many more than the three miles that were mentioned this morning by the hon. Member for Isle of Wight (Dr. Brand). That position would be much worse if one or two strategically placed independent pharmacists were to find themselves in greater difficulty because of current trading conditions.
My constituency is served by independent pharmacists. Although the total number of chemist shops in the United Kingdom has remained stable at approximately 10,000, the composition of those shops has changed significantly. Over the past 10 years, the proportion of chemist shops that are part of a chain of more than five shops has risen from approximately 25 per cent. to 40 per cent. There has been quite a concentration in the market with the growth of chains at the expense of independents.
The smaller independents inevitably face various disadvantages, such as the fact that a flat fee is paid as part of the system, whereas in the past, fees took account of the low volumes used by smaller independent outlets. The national health service expects pharmacies to negotiate discounts with wholesalers, and reimbursement is based on that. It does not take account of the differential ability of small independents to negotiate significant discounts with wholesalers. There is the additional question of the high-cost item for which the fee fails to reimburse the small independent for the cost of his borrowing while he waits 90 days to be reimbursed for the cost of the item.
It is for those reasons that many independent chemist shops have disappeared. I believe that the change in the structure of the market because of the disappearance of the independent can profoundly alter the relationship with the pharmacist. It is precisely because of the informal circumstances in which people meet their independent local pharmacist that they are able to obtain more information from the pharmacist than from their doctor. I would argue that local pharmacists provide a different quality and level of service.
The provisions in the Bill offer greater opportunities for independents. There is every prospect that the LPS arrangements will play to the strengths of the independents in the quality of the service that they offer. It would be tragic if at the same time, the control of entry criteria were changed to the extent that competition knocked many of those independent suppliers over the edge and drove them out of business. I am essentially seeking reassurance from the Minister. Will he describe the circumstances in which the control of entry criteria will be changed or removed in their entirety so as not to bring about a faster change in the structure of the market, with the disappearance of independents, than has already been the case, most regrettably, over the past 10 years?