Clause 24 - Requirements about supervision

Health Bill – in a Public Bill Committee at 3:00 pm on 20th December 2005.

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Photo of Jane Kennedy Jane Kennedy Minister of State, Department of Health 3:00 pm, 20th December 2005

I beg to move amendment No. 90, in clause 24, page 21, leave out lines 10 to 14 and insert—

‘(7B)Conditions prescribed under subsection (7A) may relate to supervision in the case where the pharmacist is not at the place where the thing is being done, and in that case the thing is not to be so considered if no such conditions are prescribed.

(7C)In any case, compliance with any applicable conditions is sufficient for the thing to be so considered.” ’.

Photo of Eric Illsley Eric Illsley Labour, Barnsley Central

With this it will be convenient to discuss Government amendment No. 91.

Photo of Jane Kennedy Jane Kennedy Minister of State, Department of Health

My habit in Committee is usually to move relatively quickly in order to make progress and to answer briefly at the end of a debate any concerns raised.

The clause seeks to make clear our intention to set out in regulations the requirements as to the conditions that must be complied with before a pharmacist may discharge his duty to supervise from another location, which is what we are introducing as part of the clause. As originally drafted, the measure provided simply that regulations could be made to specify what would constitute adequate supervision. If no regulations were made, the measure as originally drafted did not clarify whether or not the use of remote technology was otherwise acceptable. The provision is fairly straightforward, so I will sit down and see whether there is further debate on it.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

We have some concerns about the clause, which I hope that you will allow us to express in a clause stand part debate, Mr. Illsley. We seek clarification of the Minister’s expectations of pharmacists in respect of telemedicine and remote supervision of the sort that she mentioned. It is important that she understands the limitations of those media, and it is not clear from what she briefly said that she does. I would be grateful for further clarification about exactly what she is getting at by tabling the amendments.

Photo of Jane Kennedy Jane Kennedy Minister of State, Department of Health

The amendment will clarify the pharmacist’s obligation and will make provision for the appropriate use of new technologies that enable pharmacists to supervise dispensing activity safely when away from pharmacy premises. The hon. Gentleman is right that we must consider what those technologies are. We intend to set out in regulations where the pharmacist is required to be personally involved in the preparation, sale and supply of medicines, or the supervision of those activities, and the conditions for use of new technologies.

For example, the conditions might include the use of technologies such as robotics or a video link, which can help the pharmacist meet their supervision obligations from another location. That is what we mean by remote supervision. With the aid of appropriate technologies, the pharmacist may continue to meet his or her responsibilities, through the ability to remain in contact, to provide professional advice to staff and patients.

In most circumstances, use of a telephone alone would be insufficient to meet the pharmacist’s supervision requirements. It would not allow the pharmacist to check the prescription being dispensed, and he would be reliant on information from pharmacy staff. Effectively, we are tightening the provisions.

However, there are technologies that allow the pharmacist to see a prescription electronically. Also, video links can support face-to-face contact with both staff and patients. We want new technologies to be used in a way that maintains patient safety. We intend to consult key stakeholders on the regulations, including conditions that could support remote   supervision through the use of new technologies. That way, the regulations will reflect the rapid pace of change in this area. I hope that that brief comment reassures the hon. Gentleman. I appreciate the spirit in which he raised his concerns.

Amendment agreed to.

Amendment made: No. 91, in clause 24, page 21, leave out lines 23 to 27 and insert—

‘(3)Conditions prescribed under subsection (2) may relate to supervision in the case where the pharmacist is not on the premises, and in that case the transaction is not to be so considered if no such conditions are prescribed.

(4)In any case, compliance with any applicable conditions is sufficient for the transaction to be so considered.’.—[Jane Kennedy.]

Question proposed, That the clause, as amended, stand part of the Bill.

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health

I am grateful for the opportunity for a brief stand part debate, because we are now on a new chapter of the Bill. It would be helpful if the Government could put on record a bit more of their thinking, because the clause gives them power to make various regulations. The pharmacists of Britain want to know a bit more about what is intended, so that they can plan ahead. I hope that the Minister will take our questioning in that spirit. We just want to understand a bit more about what is planned.

It is my understanding of the clause and this chapter of the Bill that the Medicines Act 1968 contained the concept of personal control by a pharmacist, to the extent that if the pharmacist pops over the road to a shop, or something like that, certain things cannot be sold. We are moving from that situation to one in which the pharmacist has to ensure that things are done under the supervision of a “responsible” pharmacist, not necessarily one on the premises. We have just heard the beginnings of a discussion about whether that would mean having a pharmacist on the other end of a video link, or that the pharmacist had put in place some other alternative arrangement.

I admit that I have an open mind on the subject. Certainly, it seems a reasonable assumption that there may be people working in pharmacies other than fully qualified pharmacists who have skills that have not so far been tapped. I am all in favour of using the talents of those who have already had some training and could do some things. The problem is the all-or-nothing nature of the provision. In one way, I am more relaxed about a pharmacist being on the other end of a video link in another pharmacy than about a pharmacist simply being off the premises and therefore uncontactable in some sense.

The Minister may say that the Government are asking pharmacists to put in place structures—that is, to train people, to have procedures and protocols, and to have feedback at the end of the day on what was prescribed and to whom, and so on. It seems an all-or-nothing issue, because currently we say that a person cannot be sold medication that is not on the general sale list unless the pharmacist is physically there, but clause 24 and succeeding clauses take away that   requirement. I guess the question is, if it has been necessary for the last 37 years to have a pharmacist present, what has changed? Have we been over-regulating for 37 years?

Jane Kennedyindicated assent.

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health

The Minister nods, which is interesting. So, have we been over-regulating, or are we reacting to a shortage by lowering standards? If we are saying, “Actually, we never really needed the pharmacists to be there, and 37 years on, we have just realised it,” then that is a strange argument. The regulatory impact assessment says that the provisions in the 1968 Act were unclear in that respect, which is interesting. We have got by with them for 37 years, and only now do we seem to need to clarify them. That is surprising.

What sorts of requirements are we talking about? The Royal Pharmaceutical Society has suggested that the regulations should include provisions for the responsible pharmacist to be contactable when absent and in a position to return without undue delay. It would be helpful if the Minister could clarify whether that is the sort of thing that the Government have in mind.

For example, if simply being on the other end of a video link is good enough, why should not a qualified pharmacist be in charge of not one or two but 10 or 15 pharmacies? He or she could sit in front of their video link all day, dispensing—if that is the right word—wisdom. In respect of clause 24 and later clauses, once we have agreed that someone does not physically have to be present, there is no obvious reason why the number should be restricted to two or three. There is the potential to go a long way from where we are now. The Minister may say, “No, we don’t mean that, we just mean they can pop out to meetings with local GPs for half an hour,” but either pharmacists need to be there or they do not. If they do not need to be there, but just to be accessible, the powers given by the clause could be far-reaching.

However, unless the Government intend to specify in regulations that pharmacists can be responsible for, say, only two premises simultaneously, or if no limit is specified in regulations, the change could be far more radical than we have been led to believe.

I have misgivings about the view that we have been wrong for 37 years and now we need to change, that the regulations so far have been unduly restrictive and that it is safe to relax the restrictions. The Committee must therefore know far more about what the Government plan to put in the regulations that the clause gives them the power to introduce. I have a number of reservations and anxieties and I look forward to hearing what the Minister has to say.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health) 3:15 pm, 20th December 2005

What has changed in the past 37 years are the expectations we put on pharmacists. The hon. Member for Northavon (Steve Webb) made an interesting point: he asked why limits were being imposed and why there could not simply be a central pharmacists’ bureau—“Pharmacy Direct” or something like that—from which someone sitting   centrally could dispense advice with the aid of telemedicine and the telephone. A case could be made for that being okay in terms of patient safety. If someone can read the prescription on the computer screen and electronically accept that it is appropriate, it should be all right. Indeed, because it provides an audit trail, theoretically such a system might even be better than someone just giving the nod and the wink to a prescription in a pharmacist’s shop.

What seems to have changed in the past few years is what we expect of pharmacists. What Ministers expect, and what Conservative Members would support, is the extended role of the pharmacists, which means face-to-face contact. I do not know the intention of the limits that the Minister wishes to set on the absence of pharmacists from their premises, or what drives it. It is said to be safety, but I suspect, and hope, that it might be more than that. I hope that it is a desire to increase the extended role of the pharmacist in respect of the services that they offer, not just in the community, which is stated in the guidance note, but also in their premises. That means face-to-face contact; giving authoritative, credible advice to patients who visit those highly accessible premises.

We have probably all visited pharmacists in our constituencies who are expanding their role—they measure blood pressure, do tests for diabetes and a range of other things—and pushing the boat out in terms of the responsibility that they are prepared to accept, the sort of advice they give to people and the autonomy with which they practise. For that to work, there must be an accessible pharmacist in the practice. If they are not accessible, they are nothing at all.

In recasting their image of pharmacists, people are looking for someone who is there, and accessible. The advantage that pharmacists have over GPs is that they are in the high street and behind fewer barriers than is traditionally the case with general medical practitioners. I hope that such thinking lies behind the Minister’s intention that there should be a limit on the number of practices that pharmacists are able to supervise. If that is not the case, I am inclined to agree with the hon. Member for Northavon that all that would be needed was some superintendent pharmacist, remotely located, sitting behind a computer screen and fielding calls from the periphery put in by people with a basic level of training perhaps not that much greater than that of anybody who is engaged in selling a product. If that is the case, the safety case for restricting the number of premises pharmacists can supervise has not yet been made to my satisfaction. I know that it has been cited by representative bodies of the pharmaceutical profession, and they may be right. However, to date, I have been less than convinced that they are.

I am wholly signed up to the idea that if the role of pharmacists is to be extended and people are to have confidence in pharmacists in their new role, which is what we all want to see, then it has to be conducted one to one and face to face rather than one conducted at arm’s length from some remotely located office.

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health

I follow with interest what the hon. Gentleman is saying and have some sympathy with it. However, would it not be possible for that to happen now with no legislative change at all? Presumably, we could just say to pharmacists that we want them to be more face to face, out at the counter chatting to people and not behind the scenes. This is about spreading pharmacists more thinly, which is perhaps the opposite of what the hon. Gentleman wants to see.

Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health)

The hon. Gentleman makes a good point. We have to face the difficulty with making pharmacists more accessible. By putting them out in to the community, and sending them into general practitioner’s surgeries to do smoking cessation clinics and the rest of it, we are spreading them very thinly. That, of course, creates a problem. When someone goes to collect their prescription or for some health care advice, as they have been encouraged to expect to be able to do in their high-street chemist, they will find that the pharmacist is not there and they are faced by a very nice but relatively unskilled person who is simply retailing items. Next time, they will not have the same level of confidence in their high-street chemist.

The Minister will have to decide to what extent she will push pharmacists out into the community to do outreach and to what extent she will have them in the high street, where they are a reliable point of contact for people who seek health care advice. We are expecting pharmacists to spread themselves relatively thinly, so we cannot necessarily reconcile those two things. That is absolutely correct.

I hope that the Minister will be able to reassure us that she is not stretching pharmacists too thinly and that she will pursue the model of high-street pharmacy that she and her colleagues have been encouraging these past few years. I hope that she will focus heavily on the idea that people should have confidence that in their high street there will be a reliable, regular pharmacist with whom they will be able to have face-to-face contact and to discuss the increasing range of health care conditions that I believe the Minister intends should be the province of pharmacy.

Photo of Jane Kennedy Jane Kennedy Minister of State, Department of Health

Clause 24 deals only with the supervision of the sale and supply of prescriptions and pharmacy medicines, including remote supervision, not the personal control of a pharmacy by a pharmacist. We will be dealing with that in later clauses. There are variations in the interpretation of the pharmacist supervision requirements in section 10 and section 52 of the Medicines Act 1968. For example, the degree to which the pharmacist must personally supervise the preparation, assembly, sale and supply of medicines from the pharmacy, and the degree to which he must be involved in those activities, is unclear. Consequently, that often has to be determined by the courts. The aim is simply to remove the confusion about precisely what level of involvement a pharmacist must have in an individual transaction to be properly regarded to have supervised it personally.

We are not pushing pharmacists out into the community in the way that the hon. Member for Westbury (Dr. Murrison) suggests. Pharmacists—particularly those working in a communal pharmacy—are constrained from making better use of non-pharmacist staff by the supervision requirements in the Medicines Act 1968. Those provisions tie the pharmacist to the dispensing bench. They are restricted from making wider use of their clinical training to offer other services from the pharmacy, such as advice on the effective use of medicines.

I am sure that all parties would want pharmacies and pharmacists to be better able to use non-pharmacist staff, and to improve the use of their different skills and experience. We are introducing new arrangements that allow the pharmacist to delegate certain preparation-dispensing and supply activities to non-pharmacist staff. For example, the pharmacist may clinically check the prescription, and then instruct a suitably trained dispensing assistant to select the appropriate pre-packaged medicine from the pharmacy shelves, to cross-check that with another member of pharmacy staff, and to hand it over to the patient, without the further direct involvement of the pharmacist. Let me offer another example: a dispensing assistant may select the medicine from the shelves and make it ready for handing to the patient after the pharmacist has checked it.

Where suitably trained staff support the pharmacist, both of those practices are acceptable and can be done perfectly safely. The clause allows us to make the law clear on that point through regulations. We would have to legislate to make that change; we would need to do that. I sometimes look to find ways in which we can ease the regulatory burden while retaining and reinforcing safe practices, and this is a straightforward and sensible way to do that. The pharmacist does not need to supervise personally at all times suitably qualified and trained staff, such as pharmacy technicians, who are working to written procedures for safe working set down by the pharmacist in charge of the pharmacy.

At the same time as exercising this new power, we intend to use existing powers in the Medicines Act 1968 to enable suitably trained and registered pharmacy technicians, or other suitably trained health professionals, to supervise the dispensing or sale of medicines, except for certain activities that must be undertaken by the pharmacist. There will always be things that the pharmacist does that they will be required to do.

Photo of Steve Webb Steve Webb Shadow Secretary of State for Health

The Minister says that there will always be some things that only the qualified pharmacist can do. Can she give the Committee a flavour of what she means by that? What can be legitimately delegated to the technicians, and what can the pharmacists alone do, and what does that imply for the physical presence of the pharmacist?

Photo of Jane Kennedy Jane Kennedy Minister of State, Department of Health

I am cudgelling my brain, but at this moment I cannot think of an example. However, I will get examples, and I will write to the hon. Gentleman to   explain them, so that he has a picture of exactly what we envisage taking place. At present, however, I cannot offer such an example without inspiration.

Without the amendments and the clause, the pharmacist would be tied in a way that would not enable us to achieve the development of their role and fully exploit their skills.

Question put and agreed to.

Clause 24, as amended, ordered to stand part of the Bill.