‘(1)The Secretary of State may give directions to a Primary Care Trust requiring it to charge a fee to persons who make an application referred to in section 42(2)(c)(i) or (ii) to the Primary Care Trust.
(2)The Secretary of State shall in the directions specify the fee to be charged, which may vary according to the type of application being made but not according to the place in England where it is made.
(3)Before determining the amount of any fee to be charged the Secretary of State must consult such organisations as he thinks fit that appear to him to represent persons providing pharmaceutical services and such organisations as he thinks fit that appear to him to represent Primary Care Trusts.
(4)The Secretary of State must publish in such manner as he thinks fit any directions he gives under this section.’.
We are powering ahead, which is great, and we come now to part 4, which deals with pharmaceutical services. The clause relates to the power for charges to be levied in respect of a chemist’s application to a pharmaceutical list. I hope that at some point we discuss the broader issues of entry and control of entry in respect of pharmaceutical supply. A number of us are concerned about the position of community pharmacies and the small local pharmacist as distinct from a pharmacist in a supermarket or something similar. I hope that we will discuss some of those issues in due course, but amendment No. 121 is much more specific. It would replace lines 20 to 40 on page 26 of the Bill, which contain provisions on the power to charge relating to England. The amendment is essentially a reformulation of those provisions.
Subsection (2) of the amendment would ensure that when the Secretary of State determines what fee can be charged, variation of the charge for any given type of application in different parts of England will be precluded, although there could be variation according to the nature of the application. This is an England-only clause, and we are trying to get consistency in the charges that might be levied, rather than allow charges that might vary according to primary care trust.
Beyond that, many of the reformulations in our amendment are similar to the original clause. For example, subsection (3) of the amendment is about consultation, and consultation provisions are in the original clause. The amendment would not much change the spirit of what is already in the Bill, but it would avoid some unnecessary variation in fees across the country. We think that it would tidy things up a bit, although that might be going a bit far. That is the spirit behind the amendment.
I think we are grinding to a conclusion, although not before we consider a couple of helpful amendments, the second of which is our amendment No. 21. It is quite simple and has to do with our concern that the determinations should be made in a timely fashion.
I am afraid that businesses constantly tell us that they are frustrated by bureaucracy failing to deliver within a reasonable time frame. Amendment No. 21 would insert words that allow the fee to be refunded if the matter is not determined within 28 days. That seems entirely reasonable to us, and I hope that the Minister, in a spirit of trying to ensure that business is dealt a fair hand, will consider it carefully.
Very few commercial organisations would consider our amendment unreasonable. Given that we are dealing with the interface between the NHS and commercial organisations, both working together to provide a service to patients, it seems appropriate to ensure that any requirements of the regulations are discharged within a reasonable time. Twenty eight days seems reasonable to us and would give an incentive for things to be determined speedily and in a timely fashion.
Clause 31 introduces a power to charge fees, as has been described. Primary care trusts will be required to levy such charges, which applicants will have to pay. We envisage that the Secretary of State, rather than primary care trusts, will determine the level of fee to ensure consistency. Fees would be determined only after consultation with appropriate bodies. However, a facility for primary care trusts to set the charges may be desirable in future, in line with our general policy of devolving decision making to the local level as far as possible. Subsections (2)(b) and (3)(b) of proposed new section 42A will require primary care trusts to determine and undertake local consultations on such fees in accordance with national requirements set out in the directions. That is the background.
The amendments pose an interesting set of challenges. I cannot support amendment No. 121, and shall explain why. First, Although the hon. Member for Northavon said that it would apply only in England, it would introduce different charging regimes in England and Wales. That is not what the measures intend.
Secondly, the amendment would prevent differential fee levels from being set for different types of application between different primary care trusts. In other words, there would be only one fee level for a particular type of application, and that would be determined nationally. That determination would only ever be for the Secretary of State to make, but we do not envisage that the Secretary of State is likely to want to determine fees differentially, according to which primary care trust decides an application. However, should the Secretary of State decide that that power is needed, the amendment would prevent that from occurring.
Thirdly, the amendment would mean that the Secretary of State could not, at any time he or she might choose, devolve the decision about fees to primary care trusts. As I made clear, such devolution of powers would be subject to whatever national requirements the Secretary of State chose to set out in directions, including in relation to whatever consultations the PCT must first undertake locally.
The amendment would make the determination of fees always the responsibility of the Secretary of State and would mean that they could never be devolved to PCTs. That does not sit well with the Prime Minister’s principle for public sector reform, which makes it clear that there is a need to devolve decision making to the lowest level wherever appropriate. We had some fun at the expense of the hon. Member for Northavon about the centralising nature of Liberal Democrat policy, but in the spirit of bonhomie I resist the temptation to go down that route.
I assure the Committee that we do not envisage directing PCTs simply to set whatever fees they think appropriate, but the Secretary of State might want to set out in directions a maximum fee that PCTs may charge for each type of application and leave it to them to consult on the fee levels that they wish to set up to that maximum level. The amendment would prevent that. I reassure the Committee that we have no intention of allowing PCTs to set extortionate or excessive fee levels. We would always ensure that they were reasonable, proportionate and fair in relation to the work involved for the NHS. For those reasons, I cannot support or accept the amendment.
Amendment No. 21—it is confusing to have amendments Nos. 121 and 21; I keep having to remind myself which one I am referring to—would give the Secretary of State powers to require PCTs to do as the amendment describes. There is undoubtedly a need for pharmacy applications to be dealt with as quickly as possible. That concern was acknowledged in the reforms of pharmaceutical services that we made earlier this year. The NHS (Pharmaceutical Services) Regulations 2005 introduced new time limits for the determination of applications.
With applications for inclusion in PCT pharmaceutical lists, the regulations require PCTs to reach decisions
“as soon as is practicable, and in any event within ... four months ... of receipt” unless there is “good cause” to extend that time limit. There are several stages to go through before a PCT can reach a decision, one of which involves notifying interested parties about the application and giving them 45 days in which to comment. Interested parties include the local pharmaceutical and medical committees, persons on the PCT’s pharmaceutical list who are likely to be significantly affected and the patient’s forum for the PCT area. We do not want to reduce that consultation period, because the organisations concerned need time to respond meaningfully. I know from comments made by the hon. Member for Westbury in previous discussions how important he views consultation to be. Therefore, we would never want to exercise a power such as that proposed in the amendment, as it would mean PCTs refunding fees charged on new applications every time.
Other types of application are more straightforward, such as one from a chemist who wishes to move a short distance or ones involving a change of ownership. Those are dealt with administratively by PCTs, and the regulations require them to reach a decision within 30 days either to grant the application or to determine that the normal procedure should apply. Therefore, the PCTs must still check the details; they must still prepare reports and reach their decision. Although many such applications will be clear cut, we will have to build in contingencies to allow for circumstances in which a PCT quite reasonably and through no fault of its own takes longer than 28 days to decide. For example: a PCT might have to clarify details with the applicant; an application might contain factual inaccuracies; or a PCT might have to carry out other checks on the applicant, such as into their fitness to provide NHS services.
It would be difficult to capture in directions the potential range of circumstances that might reasonably apply in such cases, and it would be unreasonable to require a PCT to make a refund if it has simply followed the correct legal procedures and processes. The current regulations make sufficient provision for applications to be dealt with efficiently and effectively. PCTs do not need any greater incentives to act speedily under the regulations.
I appreciate the reason behind the amendment, but I ask the hon. Member for Northavon to withdraw it, given my explanation of Government policy.