My Lords, the current NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 continue an agreement reached between representatives of pharmacist and GP contractors setting out the circumstances under which patients living in designated rural areas are eligible to receive dispensing services from their GP. To make any significant change in the regulations would mean reopening complex and lengthy discussions. We believe that contractors’ representatives are satisfied with the current regulatory arrangements and would not support an extensive review.
My Lords, does the Minister agree that “no decision about me without me” and the freedom of patient choice have been pivotal to the Government’s NHS reforms? Does he not think it crazy that I, as a patient of a dispensing doctor, can either ask my doctor for a prescription which I can take to a pharmacist in the nearest town or have my prescription dispensed by his staff, whereas my neighbour, who might live just within that 1.6 kilometre boundary, is allowed to get his prescription dispensed only in a pharmacy in the town? Does the Minister agree that the reasons for this rule are now obsolete? It was created in 1911 when there could have been corruption between doctors and patients, and that possibility no longer exists because of the controls.
My Lords, there is a balance of interests here, not least the interests of the patient. We therefore need a set of rules which reflects those interests. Patients who live in a rural area can be dispensed to by their GP if there is no pharmacy within 1.6 kilometres of where the patient lives, or within 1.6 kilometres of the GP practice. Without these rules, it would rarely be viable for new pharmacies to open to serve rural areas. That would deprive people living in rural areas of the opportunity to benefit from the more comprehensive health service that a combination of a GP practice and a pharmacy can provide.
My Lords, can my noble friend say whether all elderly people who have difficulty over this matter are clearly informed that they can ask to have their prescription given by the doctor? For those who have no car and live in areas where buses are not frequent, it is sometimes extremely difficult to manage.
My noble friend makes a good point. There is a special provision that allows a patient who has serious difficulty in getting to a pharmacy by virtue either of the distance involved or lack of means of communication to receive dispensing services from a doctor. Any patient is eligible to receive these services; they do not have to live in a rural area to do so.
My Lords, the rules as they stand do not present a major obstacle for disabled patients. Many pharmacies, for example, offer a free prescription collection and delivery service if a patient encounters difficulty in getting into the pharmacy premises. Under that arrangement, the pharmacy collects the prescription from the surgery on behalf of the patient, dispenses it and delivers it to the patient. Patients can contact their local pharmacies to see whether they offer that service.
My Lords, I refer noble Lords to my health interests in the register. I well understand why the noble Earl does not want to reopen the issue, having chaired meetings at the department of the two representative bodies myself. However, I wonder whether the current arrangements are justifiable in 2013. Does the Minister not think that it might warrant his department asking an independent reviewer to look at the situation again, particularly from the point of view of the consumer and patient rather than of either the pharmacist or the dispensing doctors?
I am sure that the noble Lord is as aware as anyone of the balance that has to be struck here. A GP’s primary purpose is to provide comprehensive medical care and treatment to his or her patients. More than 90% of prescription items are dispensed by pharmacies, which is what most patients expect. However, we must have arrangements to enable patients who live in rural and more remote areas to access medicines more easily. I think the noble Lord will understand that the arrangement for some GPs to provide dispensing services has always been the exception rather than the rule. I do not think there is an appetite on anyone’s part among the professions to reopen these arrangements.
My Lords, these GP-dispensed services come at a cost, but as someone who lives in a rural area I am very glad of it, because it saves me a 12-mile round trip. However, the cost of a practice-based prescription will be apportioned to the CCG in two parts: the actual cost of the medicine itself and disbursement costs. Does my noble friend expect that the disbursement cost mechanism will be looked at again in the light of GPs running CCGs, where, of course, every penny will count towards the care of the patient?
My Lords, those particular technical matters will always be looked at very carefully to ensure that the right balance is struck. It is open to commissioners to propose a change in the arrangements. If a new pharmacy applies to open, and that could affect GPs dispensing to patients in a rural area, we would fully expect there to be consultation with patient groups and the public. There is a mechanism to ensure that that process can take place.