Clause 25
Health Bill [Lords]
4:30 pm
Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)
Amendment 34 would place a duty on PCTs to take into account the services of dispensing doctors in their assessment of local pharmaceutical needs. We have now moved on to the clause dealing with pharmaceutical services in England and the needs assessments as they are proposed in the Bill. Amendment 35 would ensure that patients are consulted as part of each pharmaceutical needs assessment. Amendment 33 proposes pilot schemes for PNAs.
Amendment 35 would ensure that each PNA includes patient consultation. The principal purpose of the PNA should be to enhance local pharmaceutical services for patients and ensure that the area covered by the PCT is adequately provided for. We agree with the concept of giving PCTs local control over the provision of pharmaceutical services, but we want to make sure that patient choice is enhanced rather than overruled. At present, the Bill does not make any provision for patients to express their views in the assessment—an odd omission, given that patients are the users of the services provided under a PNA. Will the Minister confirm that the regulations will make provision for patient consultation? My amendment would ensure that PCTs include the results of such a consultation in their published PNAs, so that patients can be assured that their views were taken into account. If a PCT goes against the wishes of patients, the general public will be able to see that that is the case by examining the consultation.
Accounting for the views of patients in PNAs is particularly relevant in rural areas, where pharmaceutical services are less abundant. Many patients have to travel long distances to access services, and consequently people make extensive use of dispensing doctors, so that they can combine their visit to the doctor and the collection of their medicines. There is nothing in the Bill to prevent PCTs from cutting those services. As my noble Friend Lord Howe argued in the other place, many of the pharmacy community are concerned that the current PNAs are
“disproportionately focused on cost-effectiveness and not enough on health need”.
That means that these services face a real risk of being axed.
I have already fought a real battle on the subject in my constituency—with some success, I am glad to say. It revolved to some extent around the definition of what is rural and what is associated with an urban or suburban environment. Having said that, if any sort of assessment militates against the extension of dispensing doctors, it would be a very real threat to the rural community. Amendment 34 would ensure that the services of dispensing doctors are taken into consideration in PNAs, along with the views of patients, the majority of whom want to keep the services of dispensing practices.
On the management of dispensing practices, I am sure that the Minister will come back to me with the same assurance that his colleague the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope), gave in December 2008: that the Government do not intend to make any changes to the current arrangements for the dispensing of medicines to patients by GPs. However, I am slightly less inclined to trust the good will of the Government, given that they made that pledge last year before the publication of the Bill but they have clearly left a gaping hole in the legislation on that matter.
It is of more concern that the Government appear to be ignoring the wishes of NHS patients. Some 62,675 patients registered with a dispensing practice responded directly to the pharmacy White Paper consultation to express their support for no change to GP dispensing. However, the Bill makes no provision for PCTs to consider the services offered by dispensing doctors in their needs assessment. What firm and evidence-based assurance can the Minister give that patients who are registered with dispensing practices will not see those services axed by their PCTs?
It is fair to say that many of the satellite surgeries of doctors’ practices are, particularly in rural areas, cross-funded because they have a dispensing practice. Far from doctors seeking to increase the drawings from their own practice, it is cross-subsidy that enables them to have a satellite service to reach out into the more remote rural areas. The dispensing practice enables that.
Amendment 33 proposes pilot schemes, which would enable the PCT and the Government to investigate whether the local assessment of pharmaceutical needs results in adequate provision of services. It would also give PCTs a chance to experiment with the format and content of the PNA to ensure that any complications are addressed and that the assessment is wide ranging enough to be taken into account when a provider applies to the pharmaceutical list.
The Government’s own White Paper on pharmacy concedes that
“there is considerable variation in the scope, depth and breadth of PNAs”.
It also states:
“The structure of and data requirements for PCT PNAs require further review and strengthening to ensure they are an effective and robust commissioning tool which supports PCT decisions.”
Although I realise that the Government see the Bill as the occasion for review and strengthening, a pilot programme would be the opportune moment to examine and trial the content of PNAs in a practical setting. PCTs would also be able to adapt to producing more rigorous PNAs. Examples of best practice could be disseminated before the scheme is rolled out across the country.
Anne Galbraith’s 2008 review of NHS pharmaceutical contractual arrangements, which was published alongside the White Paper, made the point that
“Pharmaceutical Needs Assessments...should have a consistent structure across all PCTs and have national comparability in breadth and depth.”
One potentially negative consequence of localisation is that there will no longer be a framework for ensuring that PCTs maintain that comparability across the country. Of course, the regulations will seek to qualify the information contained in the PNA and the manner in which it is conducted. However, we have not had sight of those regulations, so we do not know the extent to which they guide PCTs on the form and content of a PNA. If the Government were to run a pilot scheme and report back to Parliament with the results in 12 months’ time, they would have a solid evidence base from which to move forward. In addition, PCTs would have increased knowledge of how best to utilise the PNA to gain the best possible access to pharmaceutical services for their patients.