HC Deb 01 April 1968 vol 762 cc130-4
Mr. Snow

I beg to move Amendment No. 5, in page 18, line 24, at end insert: () A local health authority shall not, in the performance of the duty imposed on them by subsection (2) of the said section 21 to provide staff for health centres, employ registered pharmacists at a particular health centre for the purpose of providing pharmaceutical services under the said Part IV, unless they were doing so on the 22nd March, 1968; and, if they were doing so on that day, they shall not employ registered pharmacists at that centre for that purpose to a number greater than that to which they employed them there for that purpose on that day.

Mr. Deputy Speaker

I suggest that with this Amendment the House can also consider Amendment No. 6, in line 24, at end insert: (3) In subsection (2) of section 21 of the 1946 Act (duty of local health authorities to provide, maintain and equip health centres at which facilities for various purposes shall be available) the proviso (which prohibits local health authorities from employing medical or dental practitioners at health centres for the purpose of providing general medical services or general dental services under Part IV of the Act) shall be amended as follows:

  1. (a) after the words 'dental practitioners' there shall be inserted the words or registered pharmacists';
  2. (b) for the words 'or general dental services' there shall be substituted the words 'general dental services or pharmaceutical services'.

Mr. Snow

Except in one case, the two Amendments are largely the same. The purpose of my Amendment is to preclude local health authorities from employing registered pharmacists for the provision of pharmaceutical services under Part IV of the National Health Service Act, 1946, while safeguarding the existing arrangements at eight health centres in England and Wales. It seeks to amend the Clause with the object of qualifying Section 21(2) of the 1946 Act, which provides: A local health authority shall to the satisfaction of the Minister provide staff for any health centre provided by them: Provided that a local health authority shall not employ medical or dental practitioners at health centres for the purpose of providing general medical services or general dental services under Part IV of this Act. It has been felt by some pharmacists that their position was somewhat invidious. The Amendment which the Opposition moved in Committee aimed at precluding the employment by local authorities of registered pharmacists That Amendment was defective, in our judgment, in that it did not include any saving provision to allow existing arrangements to continue; and it was withdrawn on my assurance that I would consult the local authority associations and the associations representing the pharmaceutical profession and bring forward an Amendment on Report if any consultations showed this to be desirable.

8.15 p.m.

The pharmaceutical professsion has reiterated its strong support for a change in the law along the lines of my Amendment. It points to the specific provision in the proviso to Section 21(2) of the 1946 Act precluding the employment of doctors and dentists at health centres by local health authorities for the provision of medical … or … dental services under Part IV of the Act. The associations also instance the fact that a Government Amendment to Clause 18 was accepted in Committee so as to preclude local health authorities from employing opticians as well as medical practitioners at health centres for the provision of general ophthalmic services.

The pharmaceutical associations contend that, as professional contractors providing services under the Act, they should be treated like other professions in this respect. My right hon. Friend has a great deal of sympathy with this attitude. The other arrangements for a pharmacist would, it is thought, be inequitable. In the view of the pharmacists, the present position of the local health authority employed pharmacist in a health centre is invidious and not very desirable. If the present service is to be the best possible, there must be provided at a health centre where there is a local agreement a pharmacist who can play his full part in the medical, dental and pharmaceutical team.

The pharmaceutical profession does not object to the continuation of the existing arrangements at those health centres where pharmacists are already employed by local health authorities for the provision of pharmaceutical services, but it has expressed the hope that it may be possible to establish a chemist-contractor relationship at these centres at some date.

It became clear from my right hon. Friend's consultations that the local authority associations were not very enthusiastic about the proposed change. They are, naturally, concerned at the prospect of any curtailment of the existing powers of local health authorities. One of the major associations takes the view that, although very little use has been made of the power of the local authority to employ health centre pharmacists—it has been used only once since 1948—there may be occasions in the future when such a power would be useful. It thinks that it is not impossible to envisage circumstances where the local health authority may find that the only way to provide the pharmaceutical service under the Act at a health centre is for an authority to employ pharmacists itself. Although it is not in favour of the proposed change, I do not think that it will press this opposition to a change very hard, because it feels that existing arrangements should be safeguarded.

The pharmacists, on the other hand, apparently feared that it was intended to take advantage of the present development of health centres—which, incidentally, are rapidly increasing in number—and of the wording of Section 21 of the Act to develop services in health centres through salaried pharmacists employed by the local health authority, against the wishes of and at the expense of local retail chemists.

As my right hon. Friend said in Committee, in the discussion on Amendment 58, it seemed that the profession's fears were based on a misunderstanding. I do not disagree with the view that the interests of the public can often best be served by the traditional retail pharmacist. It is an extremely fine form of retail distribution which serves the public well. Also, pharmaceutical services should, I think, be provided at a health centre only when these needs are not being satisfactorily met by conventional retail pharmacists. It seems to me that consultation with the executive council and the local pharmaceutical committee should tidy up any possible misunderstandings or inequities. Any question of a local health committee employing a pharmacist at a health centre is, in the first place, a matter for local consultation and agreement, and pharmacists have full opportunity to express their views when the issue is discussed with the executive council or is referred to the Focal pharmaceutical committee in respect of any particular project.

However, although we feel that the pharmacists' fears in this respect are not well based, it is true that, under Clause 18(3)(b) as amended in Committee, a situation would arise in which pharmacists alone of the professions providing services under Part IV could be employed by local authorities at health centres for the purpose of these services. The House will, no doubt, accept that there is an anomaly here which ought to be removed and that the 1946 Act should be further amended so as to ensure that in this respect the pharmacist is treated on a par with the doctor, the dentist and the optician.

At the same time, it is necessary to ensure that existing arrangements are not disturbed. There are still in operation seven pre-National Health Service health centres with pharmaceutical services pro-sided by a salaried pharmacist employed by the local health authority—five in Wales and two in England—together with another health centre opened in 1956. In each case these arrangements have been found suitable to meet local circumstances, and both the profession and the associations agree that they should be permitted to continue until such time as there is local agreement for their modification. Existing arrangements have been taken to be those existing at the date of the publication of the Amendment.

In the circumstances, I hope that the House will accept that we are trying to make a small alteration in the law which will give pharmacists some comfort in the knowledge that they are being treated exactly the same as any other profession providing services under the Act.

Mr. Dean

The House is obliged to the Parliamentary Secretary for his explanation of the Amendment and for meeting substantially the point which we made in Committee. It was a fair point. Pharmacists feared that, under the Bill as then drafted, they were being treated differently from doctors, dentists and opti- cians; but this Amendment would bring them into line and substantially meet that point.

However, I should be grateful if the hon. Gentleman would clear up one question. Were there to be local agreement to discontinue the present arrangements in any of the eight health centres where a pharmacist is now employed on a salaried basis, the Amendment would, I take it, in no way prevent a local agreement operating in that way? That is the only point we should like cleared up.

Mr. Snow

I confirm that, subject always to the retention of power in my right hon. Friend, in the case of particular projects, to determine a matter, the hon. Gentleman's construction is correct.

Amendment agreed to.

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