General Practitioner Dispensing

Part of the debate – in the House of Commons at 10:52 pm on 19th May 2008.

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Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services) 10:52 pm, 19th May 2008

I will not.

That is the nature of the health service that we seek to create. The idea that the Government have an agenda to impose polyclinics on a one-size-fits-all basis in every community in every part of the country is utter nonsense. That is disingenuous, because it is not the Government's position.

On behalf of his constituents, the hon. Member for Banbury has raised a number of valid and legitimate points, which I shall deal with. On Bloxham, the current regulations covering NHS pharmaceutical services have been in place since April 2005. They replaced previous systems, which existed in one form or another since 1948—indeed, I understand that the regulations on rural areas can be traced back to 1936. The latest regulations implement a series of measures that were agreed between pharmacy and medical representative bodies back in 2001. It is important for the House to bear in mind the fact that the regulations that gave rise to the local PCT's decision about which the hon. Gentleman is concerned are based on that accord between representatives of doctors and pharmacists.

It is a long-standing general precept, which all Governments have endorsed since the NHS came into being, that doctors prescribe medicines and pharmacists dispense them. In that way, patients receive the benefits of both professions' expert advice, intervention and care. I have used the term "general precept" very carefully. We all agree that both medical and pharmaceutical services have developed significantly since 1948. Our White Paper set out ways in which pharmaceutical services should and will grow in the future.

It is also possible that a community pharmacy is simply not a viable proposition in every part of the country, especially in rural areas. Patients need to receive their NHS-prescribed medicines promptly and efficiently, which is where dispensing doctors can play a vital role by allowing patients to collect their medicines from a surgery's dispensary without undertaking a lengthy journey to the nearest pharmacy. In the vast majority of cases, if the patient wishes to receive the services of a dispensing doctor, they need to live in a designated controlled locality—the hon. Gentleman has raised that point. The local PCT determines whether a particular area is rural or not. When it does so, it invites views from interested parties locally. Whatever the PCT decides, the decision can be appealed to an independent body, the NHS Litigation Authority, which is genuinely independent. As the hon. Gentleman knows, the question is whether Bloxham is rural in character. An appeal against the PCT decision has been lodged with the NHS Litigation Authority, and every opportunity will be given for people, including the hon. Gentleman, to make appropriate representations.

The hon. Gentleman has referred to the OFT. He has accused the Government of ignoring the OFT's recommendations on community pharmacy services, which we did not do. We responded in July 2003 and did not accept the case for full deregulation. We decided to move cautiously in the recommended direction, and we announced a balanced package of reforms to the regulatory system. We introduced those reforms in 2005 and reviewed their operation in 2006. Overall, we have found that they opened up the market as intended without destabilising it, but the impact was genuinely uneven. The tendency for pharmacies that are open for at least 100 hours a week to cluster near each other in some places is considered in the White Paper, which is why we have introduced proposals for further reform and why we did not fully deregulate as the OFT wanted.

On the reference by the OFT's chief executive to GP-led health centres, I cannot say what was intended by the reply that the hon. Gentleman received, and I am sure that the chief executive's office will be pleased to help him further. GP-led health centres are designed to extend choice and offer convenient services. Indeed, £250 million of additional funding is available, and I wonder whether the hon. Gentleman will bid for some of those additional resources on behalf of his constituents.

The White Paper was not, as the hon. Gentleman has claimed, published during the recess; it was published while Parliament was sitting. It has received broad support from all those involved—the NHS, health professionals and business. The hon. Gentleman has referred to chemists' shops, and I hope that the community pharmacy profession as a whole is not offended by the implication that its members are simply retailers. I am sure that the hon. Gentleman implied no such disparagement; pharmacists are, of course, highly trained and skilled professionals. However, not once has the hon. Gentleman mentioned his local pharmacist or referred to the comprehensive programme that we have set out to develop community pharmaceutical services.

It is absolutely right in a changing world that the Government should be prepared to engage in the reform of the NHS that most appropriately meets patients' needs. Of course, that has to be done in partnership with the local population, which will be given every opportunity to comment.

The motion having been made after Ten o'clock , and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Eleven o'clock.

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Jane Birkby
Posted on 27 May 2008 1:27 am (Report this annotation)

Ivan Lewis says "Patients need to receive their NHS-prescribed medicines promptly and efficiently, which is where dispensing doctors can play a vital role by allowing patients to collect their medicines from a surgery's dispensary without undertaking a lengthy journey to the nearest pharmacy. "
He is right, so why has our local PCT taken my GP practice's right to dispense away, when it inconveniences many elderly people.
They say it is because a pharmacy has been opened within a mile, but this pharmacy is connected to the other GP practice, and for those whose mobility is questionable, the walk is up and down hill, and for those who have trouble walking, it might as well be "a lengthy journey" even though I understand it is within the guidelines.
This is unacceptable, as it only benefit's the other surgery's patients and not my own GP's.
I insist the government find a way to reinstate my own GP's dispensing capability, as the new alternative is not prompt nor efficient in delivery of medication.
Medication prescribed for me on Friday 23rd May will not reach me until Tuesday 27th May because I have to have it delivered, instead of collecting it immediately at the surgery.
I have ME and the extra walk would cause my condition to worsen.

Paul Gowers
Posted on 12 Jun 2008 9:58 am (Report this annotation)

Slowly and surely our rural lives are being affected by all these changes... disappearing. Post offices and the demise of village shops... not to mention the appalling transport systems & the seeming lack of concern for the large elderly population here (highly dependent on GP dispensing).

Why should doctors who have dispensed for decades and provided a fantastic service for their patients be made to wind down and stop?

Surely it is up to the patient where they go for their prescriptions to be dispensed... ie what this government is always promoting. CHOICE!

The National Plan for Pharmacy contains not a word about dispensing by doctors but says that government wishes to offer pharmacy services which are fast and convenient, tailored to patients’ need and available when they need it at a consistently high standard.

However for some reason they would seem to decline choice on this occasion as no doubt it does not suit them politically.
The control of entry rules may well completely destroy our dispensing practices which will be devastating to patients.

Pharmacists have argued that simple dispensing under uses their skills; others claim there to be threats from other suppliers of medicines such as supermarkets. The government has announced its intention to extend the roles and activities whilst at the same time protecting their monopoly as dispensers. Interestingly,

The National Plan will dramatically alter the present separation of the roles of prescribing by doctors and dispensing by chemists.

Future pharmacists and pharmacies will:

One-stop centres of pharmacists, GPs and other NHS providers will be set up. In effect, dispensing practices with pharmacists. There will be 500 of these by 2004 mainly in inner cities. There are already over 2000 one-stop dispensing practices although GPC and the DDA Ltd are set on ensuring there will not be any more.

The main point of these are that patients will have better information about pharmacy opening times, better availability of medicines out-of-hours and that out-of-hours dispensing should be reliable. In other words, just like dispensing practices.

The national contract will be "renegotiated". The "control of entry rules" limiting the number of pharmacies in an area may change to encourage competition and to ensure more openness in "under provided, deprived areas". The dispensing doctor’s politicians should be anxious lest these include rural areas.