The noble Lord, Lord Faulkner, has very capably outlined some of the concerns which I am aware are current among members of the pharmacy profession in the community. In speaking to my own Amendment 112, which is grouped here, I should just like to add a few words to what he has said.
Life in rural communities has a number of features which need to be considered—almost automatically—whenever health services of any kind are planned. The distances that people have to travel to access services are greater than in urban areas; access to community services, including the voluntary sector, is more difficult because of the nature and sparseness of public transport links; and there can also be considerable degrees of social deprivation in rural areas, and hence greater health inequalities. It is for those reasons that there has been such support for the retention of dispensing GPs.
One worry that many people have is that the Bill now before us could have adverse consequences not only for dispensing doctors but also for rural communities more generally. The reason for that worry is the lack of clarity about how well PCTs are equipped to gauge the needs and preferences of those who live in less populated areas, and what information they will draw on as they make these assessments of need. Experience of PNAs to date suggests that their quality is generally mediocre to poor. The White Paper concluded that existing PNAs were highly variable in their, "scope, depth and breadth", which I read as a rather damning indictment.
This finding represented a number of concerns raised in the earlier consultation exercise. One concern of the pharmacy community was that PNAs, as they exist at present, are disproportionately focused on cost-effectiveness and not enough on health need. It seems to me that, if that concern is to be dispelled, ways have to be found of reconciling the duty on commissioners to be cost-effective with their duty to meet perceived health need and to do this in a transparent manner that will command public confidence. The prospect of bringing this about is by no means assured. We simply do not know enough about how the needs assessment will actually work, nor whether PCTs will be fully up to the task of carrying them out. In particular, there is a fear that the way in which needs assessments are translated into service delivery could once again cause dispensing GPs to be under threat, this time as a direct consequence of decisions taken which would permit new pharmacies to provide NHS services.
Additionally, there is concern about the ability of PCTs to adapt with sufficient speed to the changes that are needed in the commissioning of enhanced and advanced services. It is quite telling that the latest available data from the NHS Information Centre suggest that, between 2006-07 and 2007-08, the number of out-of-hours services commissioned by PCTs from community pharmacy declined by 9 per cent. In the same period, the number of home delivery services commissioned from pharmacy declined by 47 per cent, and only 138 community pharmacies out of more than 10,000 were commissioned to provide prescribing services to GPs. Those figures do not give one much confidence that enhanced services are currently high on the agenda of PCTs, whether for rural areas or for the country more generally.
Like the noble Lord, I would be grateful for any reassurance that the Minister is able to give on this set of concerns. The next group of amendments will provide an opportunity to debate the subject matter of these clauses in a more general way, but this is undoubtedly a useful lead-in to a topic which is perhaps less straightforward than it first appears.
Health Bill [HL]
Proceeding contribution from
Earl Howe
(Conservative)
in the House of Lords on Wednesday, 11 March 2009.
It occurred during Debate on bills
and
Committee proceeding on Health Bill [HL].
About this proceeding contribution
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2008-09Chamber / Committee
House of Lords Grand CommitteeSubjects
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