HL Deb 03 June 1992 vol 537 cc887-8

Lord Hatch of Lusby asked Her Majesty's Government:

Whether they consider that applications by pharmacists to dispense National Health Service prescriptions in rural areas already served by dispensing doctors should be approved when the local community objects to the change.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, the present arrangements for rural dispensing are designed to ensure that people have access to a comprehensive range of both medical and pharmaceutical services. It would therefore be wrong to reject an application from a pharmacist to dispense simply because there is already a dispensing doctor in the area.

Lord Hatch of Lusby

My Lords, I thank the noble Baroness for that Answer. Is it the case that if a pharmacist gets a licence to dispense, patients living within one mile of that pharmacist are bound to take their prescriptions to that pharmacist even if it means, as it often does, that they are no longer able to use the facilities of the surgery dispensary?

Baroness Cumberlege

My Lords, the noble Lord is correct in that assumption. When the family health service authorities make a decision on an application they have to bear in mind the crucial policy of separating diagnosis and prescribing from dispensing because that reduces the conflict of interest which potentially exists when one person both prescribes and dispenses.

The Countess of Mar

My Lords, does the noble Baroness agree that under the Clothier regulations a doctor can be compelled to dispense? Does she also agree that when a patient signs on with a dispensing doctor he has to sign a form? If he agrees to have his prescriptions dispensed by the doctor he can also ask that doctor for a prescription to take to a chemist. However, once he has said that he does not want the doctor to dispense for him he can only go to a pharmacy, despite the fact that the doctor is dispensing on the premises. Can the noble Baroness say what has happened to freedom of choice in these circumstances, or is it simply a matter of protecting the pharmacist?

Baroness Cumberlege

My Lords, when we have both doctors and pharmacists prescribing it is important that we have an integrated service. Primary care is often criticised for not being integrated. This question is taken carefully into account when the family health services authorities make their decisions.

Lord Mackay of Ardbrecknish

My Lords, will my noble friend resist any campaign organised by dispensing doctors to keep a pharmacist out of any area into which that pharmacist wishes to go? Does she recall that the reason why we have dispensing doctors in this country is to cover those areas which are without a pharmacy service? Will she therefore resist the temptation to agree to keeping doctors dispensing in a community which could in fact get a pharmacy which would give a far wider range of services than any dispensing doctor could ever give?

Baroness Cumberlege

My Lords, my noble friend, as a former Scottish Office Minister with responsibility for health, is correct in the views that he expresses. I should like to make the position clear. In the past year three-quarters of the population received advice on medication from pharmacists. The pharmacist is often the first port of call.

Lord Desai

My Lords, leaving aside the possibility of the conflict of interest, will the noble Baroness confirm that the pharmacist not only gives a wider range of service but also performs it more economically? Is it not better that we get value for money as well as choice in the National Health Service?

Baroness Cumberlege

My Lords, I very much agree with those views.

Baroness Robson of Kiddington

My Lords, is the position of the pharmacy in relation to the doctor's surgery taken into account? If a patient in a rural area goes to the surgery and then has to travel a mile or two to go to the pharmacy he faces enormous difficulties because of a lack of transport.

Baroness Cumberlege

My Lords, geography and proximity as well as choice are very much considered by the authorities when reaching their decisions. They also try to ensure that people using the NHS have available the widest range of facilities.

Lord Hatch of Lusby

My Lords, I wish to press the issue of choice that was raised by the noble Countess, Lady Mar. Even if a pharmacy is given a licence to dispense, is not choice maintained only by removing this prohibition on patients still getting their prescriptions from the doctor's surgery? I am concerned in particular about old people and mothers with children who at present may well make one visit to the doctor and get the prescription at the surgery but under the new circumstances will have to make two visits—one to the doctor and one to the pharmacist. Could not this prohibition be removed in the light of the need for choice?

Baroness Cumberlege

My Lords, it is important that the pharmacy is made viable. It is also in the interests of the National Health Service to reduce the conflict of interest which potentially exists when one person both prescribes and dispenses.

Back to