Limited List Prescribing (Hansard, 12 November 1985)

§ 3. Mr. Latham
asked the Secretary of State for Social Services whether he will make a statement on the operation of the limited list for prescribing drugs under the National Health Service.

§ The Secretary of State for Social Services (Mr. Norman Fowler)
The selected list scheme has been in operation since 1 April, and the scheme is running successfully.

§ Mr. Latham
Is my right hon. Friend aware that I am still receiving letters from constituents and their general practitioners complaining that they cannot get the drug that they need and saying that the National Health Service substitute is not satisfactory? Will he have another go at trying to persuade the British Medical Association to agree to a local appeal procedure?

§ Mr. Fowler
All the evidence that we have shows that the scheme has settled down. As my hon. Friend will be aware, we put forward proposals for an appeal mechanism for doctors. They were rejected by the General Medical Services Committee, which put forward no alternative. I shall, of course, bear in mind what my hon. Friend has said, but, on present evidence, I am not sure that any further action is required.

§ Dr. Roger Thomas
How many drugs has the Secretary of State allowed to be included on the limited list for each month since April 1985? What has been the reduction in the amount of savings expected? I appeal to him, once more, to place the new mucolytic drugs on the list.

§ Mr. Fowler
I cannot give the hon. Gentleman the detailed information that he requires. In general, we thought the savings on the drugs bill would be about £75 million a year, and that has proved to be the case. The hon. Gentleman will be aware that mucolytics were studied by the independent review committee. That committee made recommendations on two matters, but, in general, it said that they had no proven general therapeutic value in the treatment of chest conditions. We have accepted its independent advice.

§ Mrs. Virginia Bottomley
Does my right hon. Friend agree that to achieve continued improved patient care it is essential that we have an efficient and effective use of resources, such as the long overdue introduction of the limited list scheme?

§ Mr. Fowler
Yes. The scheme has proved to be a sensible way of saving money on the drugs bill and ensuring that extra resources go on the health services. The Government have sought to use the resources available to the National Health Service to the best effect. One of the results is that the NHS is now treating more patients that than at any time in its history.

§ Mr. Meadowcroft
Why does the Secretary of State allow the GMSC unilaterally to prevent other doctors from using the appeal procedure? Will he implement his offer to the doctors to allow those general practitioners who wish to prescribe by the appeal system to do so?

§ Mr. Fowler
In view of the history of the selected list and the controversy that it aroused in the medical profession, it seems rather foolhardy to seek to impose an appeal mechanism on the medical profession, which does not appear to want it.

§ Mr. Boyes
The Opposition said that the limited list would be a disaster, and that was an understatement. It is causing grave anxiety to patients, constituents and doctors. The Minister keeps saying that the list is working. Why does the lady at the other end of this Corridor keep sending letters to me saying that the Minister cannot reply to the complaints in less than three months because he is receiving too many letters about them? How can it be working in that case?

§ Mr. Fowler
The hon. Gentleman talks about statements that I have made. He has made a complete mis-statement of the position. Despite early controversy, the selected list has settled down, is working well and is producing sensible savings for the Health Service. I should have thought that that is what the hon. Gentleman would want to see.

§ Mr. Favell
Is my right hon. Friend aware that many general practitioners are delighted with the new selected list because they now find that the patients of their weak kneed brethren are no longer doing the prescribing? Instead, those doctors are prescribing the most cost-effective drugs.

§ Mr. Fowler
Opinion inside the medical profession on this issue has undoubtedly changed. Another benefit has been that some drug prices have come down appreciably as a result of the policy. Again, I should have thought that that was something that hon. Members on both sides of the House would want to see.

§ Mr. Pavitt
How many members of the limited list advisory and monitoring committee still have financial interests in the manufacture of drugs being prescribed? Is the Secretary of State satisfied that, with the number of members who have a financial interest, he is receiving disinterested advice?

§ Mr. Fowler
I am satisfied that it is an independent committee and that the advice being given is entirely disinterested and independent. I would not have set up the committee in any other way.