HL Deb 29 March 1983 vol 440 cc1453-5
Lord Kilmarnock

My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government whether they will implement the recommendation contained in paragraph 24 of the Greenfield Report on Effective Prescribing, whereby doctors would be required to indicate a positive preference for the proprietary version of a drug and, in the absence of such indication, the pharmacist would be expected to dispense the "generic" version when this exists.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)

My Lords, my right honourable friend the Secretary of State for Social Security has asked for comments on the report from interested organisations by 15th April. We shall not be making any decision on this or the report's other recommendations until we have had time to consider the comments we receive.

Lord Kilmarnock

My Lords, while I thank the noble Lord for that Answer and I am glad to hear that the Secretary of State is taking the report seriously, may I ask him whether he is aware of an experiment which has been operating at Abbots Langley for the last four years, in which the generic system was run on a voluntary basis and where it was calculated that the saving to the National Health Service was over £6,000 in one pharmacy alone, and that this, extrapolated nationwide, would produce a saving of some £40 million?

Lord Trefgarne

My Lords, it is very unwise to extrapolate the results of such very limited experiments as the one to which the noble Lord refers, because the results of wide-spread generic substitution, as it is called, would certainly result in an upward trend in the prices of drugs covered by patent for which no generic substitute exists. Therefore I hope the noble Lord will not take too much guidance from the kind of information that he has given to your Lordships. Having said that, we are, as the noble Lord recognises, considering this matter carefully and will announce our conclusions in due course.

Lord Wallace of Coslany

My Lords, while it is true that considerable savings can be made on drugs in the National Health Service, would not the noble Lord agree that it is somewhat dangerous to leave the responsibility to pharmacists when doctors should have the responsibility of prescribing either the proprietary drug or its equivalent? That responsibility should not be left to pharmacists, because in some instances it would be a tremendous risk to take.

Lord Trefgarne

My Lords, that is a perfectly respectable point of view but it is not necesssarily one which is universally shared. It is worth saying that pharmacists are highly qualified in their own profession. If some way forward along these lines were to be decided upon, pharmacists would be well qualified to follow that course.

The Earl of Onslow

My Lords, is my noble friend aware that pharmacists in hospital dispensaries are entitled to make the substitution from proprietary to generic drugs? Is my noble friend further aware that there was a television programme on the National Health Service, hosted by Brian Walden, which showed not just figures of savings from an extrapolation of £6,000 but figures of savings very similar to those given by the noble Lord, Lord Kilmarnock, which could be made to the National Health Service drugs bill?

Lord Trefgarne

My Lords, I have seen some of the programmes to which my noble friend refers and I have to say that these calculations rely upon a number of assumptions which are not necessarily proven in practice. As for hospitals, the position is that by agreement between doctors and medical staff in hospitals, generic substitution is practised to a considerable extent. But the circumstances are rather different. For example, doctors in hospitals are aware of precisely which generic substitute is to be dispensed in any particular case.

Lord Elwyn-Jones

My Lords, is a wary eye also kept on the prices charged by drugs manufacturers?

Lord Trefgarne

Yes, indeed, my Lords, We are at present reviewing the Pharmaceutical Prices Regulation Scheme.

Lord Wells-Pestell

My Lords, may I ask the noble Lord the Minister if he is in a position to say whether the profit to the pharmacist is greater on proprietary brands than on generic drugs?

Lord Trefgarne

My Lords, this tends to vary from pharmacy to pharmacy. It depends upon the price at which the pharmacist purchases his supplies. Generally speaking, he is reimbursed at a standard rate and is free to buy his supplies, provided they are from a reputable source, at the best price he can get.

Lord Mackie of Benshie

My Lords, does the noble Lord know of any case where the prioprietary version is superior to the generic version?

Lord Trefgarne

My Lords, the whole purpose of this system is to establish a range of generic substitutes which are just as good as and, indeed, identical to the standard version. But the difficulty is that the standard versions are generally covered by patent. The generic substitutes cannot come into use until the patent expires.

Lord Kilmarnock

My Lords, is the noble Lord fully aware of the commercial pressure on doctors which exists? May I ask him whether he has read the minutes of a meeting on 14th October, 1982 of the Association of British Pharmaceutical Industry in which the industry itself showed considerable signs of acute embarrassment about its own promotional excesses?

Lord Trefgarne

My Lords, I am aware of some anxiety on the point which the noble Lord raises. This is a matter for the pharmaceutical companies themselves. It is also for the doctors to ensure that they are not misled by any excessive or misleading advertising.

Lord Ferrier

My Lords, would my noble friend agree that on many occasions doctors welcome visits from pharmaceutical salesmen since they are the source of information about the latest developments?

Lord Trefgarne

My Lords, I am sure that is true, but I guess there is a difference between the sort of informative visits to which my noble friend refers and the excessive advertising and publicity junkets which have recently been the source of some publicity.

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