NHS: Essential Small Pharmacy Allowances (Hansard, 8 July 1992)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, the Government have no plans to increase the essential small pharmacy allowances.

§ The Countess of Mar
My Lords, I thank the noble Baroness for that reply. But how does she equate her reply with the one given to the noble Lord, Lord Hatch, on 3rd June? At col. 887 of the Official Report she stated: When the family health service authorities make a decision on an application they have to hear in mind the crucial policy of separating diagnosis and prescribing from dispensing because"— and she stated this twice in answer to the noble Lord, Lord Hatch— that reduces the conflict of interest which potentially exists when one person both prescribes and dispenses". In the noble Baroness's reply to me on the same day she stated: When we have both doctors and pharmacists prescribing it is important that we have an integrated service". If pharmacists are to prescribe as well as dispense one will have a potential conflict of interest. Have Her Majesty's Government any plans to eliminate the present conflict of interest between pharmacists and dispensing doctors and the often bitter territorial disputes which there are at present under the Clothier regulations and which indeed existed prior to them?

§ Baroness Cumberlege
My Lords, the Government have no such plans.

§ Lord Mackay of Ardbrecknish
My Lords, is my noble friend aware that the position in Scotland seems perfectly satisfactory? Prescribing doctors operate only in areas which could not possibly sustain pharmacies. That seems a perfectly sensible way to conduct affairs in those rural areas. Will my noble friend further assist me by explaining why doctors who live in areas where there could be pharmacies appear to wish to become pharmacists as well as doctors? At present many doctors say that they are so overworked as doctors that they do not wish to give their patients a 24-hour service.

§ Baroness Cumberlege
My Lords, in answer to my noble friend's first question, I believe that in many areas, including this area, England has a lot to learn from Scotland. As regards my noble friend's second question, I agree with his sentiments. However, I believe that there are particular rural areas where it is essential to try to provide a pharmacy. I am surprised that some general practitioners feel that they should be in on this service where there is no necessity for that.

§ Lord Hatch of Lusby
My Lords, is the Minister aware that the passage from the Answer that she gave me on 3rd June, quoted by the noble Countess, Lady Mar, namely, the conflict of interest which potentially exists when one person both prescribes and dispenses", has been bitterly resented by the Dispensing Doctors' Association, which has written to me about the matter? Will the noble Baroness take this opportunity to withdraw what was, after all, at least a slur on the honesty of doctors? Furthermore, will she say whether 1137 the Government still believe in a maximum of choice for patients in dispensing? If so, should not dispensing by either pharmacists or doctors be carried out without any preference for one or the other?

§ Baroness Cumberlege
My Lords, the question of a conflict of interest arises because part of the income of dispensing doctors is related to the level of drugs that they prescribe and dispense. I am not saying that general practitioners are not providing a good service —in some areas they are absolutely essential —but I believe that in this case there is a potential conflict of interest.

§ Lord Carter
My Lords, will the Minister tell the House what is the relative income of the dispensing doctor and the non-dispensing doctor? She referred to their income so presumably she has the figures available. Secondly, will she say whether the freedom to provide services given to GP fundholders extends to providing dispensing services?

§ Baroness Cumberlege
My Lords, in some cases general practitioners can double their income from dispensing. With regard to GP fundholders, it would depend entirely on the area in which they were practising and on whether there was no possibility of a pharmacy in that rural area.

§ Lord Hatch of Lusby
My Lords, may I quote to the Minister from the letter which I received from the Dispensing Doctors' Association—

Noble Lords
No. Order!

§ Lord Hatch of Lusby
My Lords, I received it following the Answer given to me on 3rd June. As I have told the noble Baroness, the Dispensing Doctors' Association bitterly resents the slur which her words cast upon its members. Cannot she now remove the slur, or does she maintain that certain doctors are dishonestly dispensing in order to line their own pockets?

§ Baroness Cumberlege
My Lords, I have never claimed that there is dishonesty among dispensing doctors and in the practices under which they operate. I refute that suggestion. However, I hold to the tenet that where one person is diagnosing, prescribing and dispensing there is a potential conflict of interest.

Lord Winstanley
My Lords, will the noble Baroness clarify a previous answer that she gave? She told the House that some dispensing doctors could double their income as a result of dispensing. Does she mean their gross or net income? Does she mean that their profit on the dispensing is equal to their income from practising?

§ Baroness Cumberlege
My Lords, that is the case.

§ Lord Mackie of Benshie
My Lords, will the noble Baroness resolve the question by simply stating whether the amount spent on drugs where the doctor prescribes is larger or smaller than the amount spent when the pharmacist prescribes?

§ Baroness Cumberlege
My Lords, there is an issue here as regards value for money. It certainly costs the state more when a GP prescribes and dispenses. The total cost per item is greater for dispensing doctors. More items per person are prescribed by dispensing doctors, and in terms of remuneration the total cost —and that includes allowances and fees per item—is greater for dispensing doctors.

§ The Countess of Mar
My Lords, will the noble Baroness say why dispensing doctors' salaries are often clawed back so that they may be equated with prescribing doctors if she says that dispensing doctors make so much more money than prescribing doctors?

§ Baroness Cumberlege
My Lords, that is an extremely technical point and I shall write to the noble Countess on it at a later date.