Pharmacists (Hansard, 20 July 1984)

§ The Minister for Health (Mr. Kenneth Clarke)
I beg to move, That this House takes note of European Community Documents Nos. 4692/81 and 4465/84, draft proposals for Directives and a Decision on the right of establishment for certain activities in the field of pharmacy, and the Explanatory Memorandum from the Department of Health and Social Security dated 16th July 1984; endorses the view that the instruments are necessary; and welcomes the United Kingdom's endeavours to encourage the adoption and implementation of these measures which will give pharmacists the same freedom of movement within the Community already afforded to the other health professions. This debate was recommended by the Select Committee on European Legislation, which was apparently of the opinion that the draft instruments raised questions of political importance and should be further considered by the House before decisions were taken in the Council of Ministers. There probably is some political importance in the proposals but I hope that I shall discover that they are completely devoid of controversy. We are asking the House to take note of securing freer movement for qualified pharmacists within the EC of the kind that is already afforded to the other health professions.
There have been occasions in the past when proposals for the free movement of pharmacists in the Community were controversial. The House may recall earlier proposals that were published in 1969 and 1972 but they were eventually withdrawn by the Commission. Those proposals covered only self-employed pharmacists. They were wide-ranging in their implications and that is why they gave rise to so much debate.
The proposals now before us are much more modest in scope than their predecessors and are better adapted to the present state of Community integration. They are confined to measures necessary to facilitate the free movement of pharmacists within the Community and to provide for the definition of the standard minimum requirements for the exercise of the profession with regard to the pharmacist's field of activity and to the conditions of his education and training.
There are two directives. The first is known as the co-ordination directive and requires the approximation of national laws in order to give the necessary confidence among member states about the qualifications and competence of professional people engaged in pharmaceutical activities. It defines not only the characteristics which pharmaceutical training must have in all member states but the common core of the pharmacist's field of activity.
The second proposed directive is known as the mutual recognition directive and it has two objectives. First, it draws the logical conclusions from the approximation of the laws of member states — required by the first directive—by ensuring the recognition in all member states of the training courses in each country which meet the minimum criteria that will be laid down. Secondly, apart from the field of training, the proposal in the second directive contains a number of provisions intended to facilitate the exercise in practice of the right of establishment of people who wish to move to countries to practise their profession.
The amendment to the second directive proposed by the Commission in January 1984 — document 4465/84 — 685 contains an important safeguard which the House will welcome. It is designed to limit the scope for unbalanced movement between countries by pharmacists suddenly going to practise in one of the member states. That safeguard will permit host member states not to recognise diplomas recognised by other member states so far as they are relied upon for the establishment of new pharmacies open to the public or the takeover of such pharmacies which have been in operation for less than two years. The draft council decision is designed to establish a committee responsible for ensuring a high level of training in pharmacy. Similar committees have already been established for other health professions.
The Government have carefully considered the package that is now beginning to unfold. In our opinion if the proposals are adopted they will present no serious policy or financial implications for the United Kingdom. The provisions in the co-ordination directive preserve the comparability of pharmacy diplomas throughout the United Kingdom. They also ensure that, irrespective of whether those diplomas are awarded by English, Welsh, Scottish or Northern Irish educational establishments, they will be recognised by other member states in precisely the same way as they are recognised in the United Kingdom, as being equivalent one to the other. Therefore, there is no question of any United Kingdom country having to meet the expense of extending or modifying its first degree courses as a result of implementing the proposals.
With the freedom of movement gained under the proposals some pharmacists from other member states might seek to practise in the United Kingdom but they would have to compete with our nationals for situations in pharmacies, whether retail pharmacies or hospital pharmacies.
We do not expect that any substantial flow of people who wish to come to Britain is likely or that they would succeed in coming if they tried. If at any time we should wish to prevent any immigration of self-employed pharmacists or to control the numbers of such pharmacists coming in, that can be done by using the safeguard provisions that I have already mentioned.
We have discussed the matter with the professional and academic organisations and, in general, they do not oppose the proposals. They regard them as an improvement on the earlier proposals and find nothing controversial in the provisions dealing with the mutual recognition of qualifications. The professionals and the academics both welcome the plan to set up the advisory committee on training.
The Pharmaceutical Society of Great Britain is the primary representative body of the profession and the statutory registration authority for pharmacists. The society is reasonably satisfied that the proposals reflect the policies that it has evolved in recent years as a result of its involvement with other member states.
Therefore, the Government are satisfied that the United Kingdom's interests are adequately protected and that implementing the changes suggested by the Commission and the Council working party will not have any adverse effects on our NHS pharmaceutical services. Our main anxiety throughout has been to make sure that our very high standards of pharmaceutical service are not damaged or even threatened. It is an important safeguard for patients that they should know that the dispensing or prescribing 686 of medicines is carried out by fully qualified professionals who guard to the maximum possible extent against mistakes or errors and against dangerous medicines being wrongly dispensed.
We feel that the proposals meet that test and, having satisfied ourselves of that, we think that it is no more than fair that pharmacists should have the same freedom of movement and right of establishment throughout the Community as is already available to doctors, nurses, midwives, dentists and veterinary surgeons.

§ Mr. Frank Dobson (Holborn and St. Pancras)
I am grateful for the Minister's lucid explanation of the documents. When I received a note about the debate, it was headed "Established Pharmacists" and I pondered why we were to talk about chi-chi chemist shops in Jermyn street. It was a relief to discover that the proper title was: Right of establishment for pharmacists. The Minister has explained that the professionals and the professional examining body are satisfied with the proposal. However, having browsed through the documents and the related EEC documentation, I am not sure whether a pharmacist who wishes to come here will need to have a grasp of English, which would seem to be a useful qualification for a pharmacist wishing to serve people in this country. I hope that somewhere in the maze of documents there is an obligation on pharmacists to be able to speak and to understand English. We would not want drugs to be dispensed by people who did not understand what was being said to them or could not make themselves understood when dispensing those drugs.
Although pharmacists from this country or any other member state can in theory establish pharmacies in France, Belgium, Holland and Denmark, they will, in practice, find it difficult, because there is strict control on the location of pharmacies in those countries. Many pharmacists in this country regard that system as superior to our freedom-to-go-where-you-like arrangement. If there is a surplus of pharmacists in an EEC country, their opportunites for establishing themselves in France, Belgium, Holland or Denmark will be negligible and their opportunities for establishing themselves here will be greater because we do not put restrictions on where people can set up a pharmacy.
The Minister told me during the Committee stage on the Health and Social Security Bill that in the past year or so there had been an increase in the number of pharmacies in this country, which had previously been declining. However, I think that most people are worried about the areas where there are no pharmacies. I have since been given some detailed statistics showing that in the last six months for which figures are available, well over half of the 237 pharmacies that opened in England were within 400m of an existing pharmacy. Thus, they were not filling a geographical blank but were rather doubling up with facilities that were already in existence. However, of the 108 pharmacies that closed, 81 were within 400m of an existing pharmacy. Therefore, the bulk of new pharmacies in this country have been established close to existing ones and they may be undermining each other's incomes. Very shortly—perhaps incited by the changes that the House is likely to endorse today—we may have to contemplate some restriction on the right of establishment of pharmacies to ensure that there is a good spread of them.
687 Having said that, I do not think that we—looking at the Benches behind me, I see that I overstate—I, have any violent objections to the EEC document. I certainly shall not vote against it.

§ Mr. Roger Gale (Thanet, North)
The future of community and rural pharmacies in this country will be the subject of an Adjournment debate on Monday or perhaps a debate in the small hours of Tuesday 31 July. I do not wish to pre-empt that debate, or to go too far down the road of parallel imports or generic prescribing, but I should like to trail it.
I hope that my right hon. and learned Friend will bear in mind that drugs that are prescribed and manufactured in this country, and that are understood by our chemists, are not necessarily the same as those carrying the same name that are imported into Britain. If we are going to allow people from other countries to practise pharmacy here, we must also exercise rigid quality controls over the drugs that they are enabled to prescribe.

§ Mr. Kenneth Clarke
I am grateful to my hon. Friend the Member for Thanet, North (Mr. Gale) for trailing his Adjournment debate. I know that my hon. Friend the Parliamentary Under-Secretary of State is very much looking forward to replying to his main points on rural pharmacies. I accept the force of what he said about drugs that are imported into this country—whether they are parallel imports or otherwise. I know that my hon. Friend has followed the steps that we have recently taken that have satisfied us that we are now importing only drugs that in every way come up to the safety standards that we require, and that are correctly identifiable by those who prescribe and dispense them here. However, we shall, of course, continue to take an interest in that subject.
The hon. Member for Holborn and St. Pancras (Mr. Dobson) bears the whole burden of representing the Opposition today. I accept the relevance of the point about proficiency in the English language. There is a maze of subordinate legislation, including Orders in Council and regulations, that will be required if we reach agreement on the directive and have to implement it here. Again, I think that it will all be non-controversial, but it will include 688 changes that will enable family practitioner committees to seek satisfactory evidence of proficiency in the English language from pharmacists who want to enter into a contract with them. That will be in line with measures that have already been taken following the adoption of a similar directive relating to doctors. Thus the hon. Gentleman made an entirely valid point.
The hon. Gentleman also asked about the distribution of pharmacies, and I accept that there is a genuine issue at stake, to which we must continue to address ourselves. However, I do not think that any significant number of people will come from Europe to have any effect on that. We take pleasure from the fact that there has been some increase in the number of pharmacies in recent years. However, they tend to be clustered in very popular places, close to each other, and that is not always in anyone's interest. We have a problem in ensuring that there is a satisfactory spread of the service, across rural areas in particular. However, we have the essential small pharmacy scheme at the moment which endeavours to do just that.
At present we are in negotiations with the representatives of the pharmacists—for this purpose, the Pharmaceutical Services Negotiating Committee—about the whole nature of the pharmacists' contract. Coupled with those negotiations are further discussions with them about how far we can ensure in a contract, and in our other dealings with the profession, that we get the spread of service that the patient and public require. I am not altogether satisfied that we have got that at present.
Subject to that, I think that the directive has desirable and not undesirable consequences for all our problems in the pharmaceutical world, and I am glad that those who have spoken in the debate have welcomed it.