Health Bill [HL]

When I was a Minister in the department, it was drummed into me that doctors prescribe and pharmacists dispense. The reason given was that it was good practice because it avoided the conflicts of interest that could arise when doctors were perhaps tempted to prescribe drugs that played into their financial interests. The exception to that has of course been in rural areas. That is absolutely right, and I take on board what the noble Lord, Lord Walton, and the noble Baroness, Lady Masham, said. We need some exceptions. However, I am confused about what a "rural area" is. I can certainly understand that, in the highlands of Scotland, on the top of Dartmoor and in the Yorkshire dales, where people have to travel considerable distances to a pharmacy, they need a dispensing doctor. But what are those distances? I seek the definition of "rural" from the Minister. Voltaire said: ""If you wish to converse with me, define your terms"," so I seek the terms of "rural". The Oxford English Dictionary describes it as "pastoral", which sounds a bit old fashioned to me, or "agricultural", which is also rather vague. The Minister might say that it is up to the PCTs to define what is rural. That is not good enough. This is a basic block of government policy and we need to know what we are talking about. The present system appears to define "rural" as one mile from a chemist shop, because GPs are allowed to dispense to patients who live more than one mile away from a pharmacy. This is a nonsense, especially when car ownership has increased considerably over the past few years and many pharmacists provide doorstep deliveries of medicines that they dispense. I have not found many GP practices that do that. Contrary to what the noble Lord, Lord Walton, was saying, I have seen pharmacies with much longer hours than GP practices. It is interesting that GPs talk about out-of-hours. Whose hours? It may be their out-of-hours but they are actually my in-hours. My in-hours are evenings and weekends, but that apparently is not what doctors have. We know that pharmacists are experts in their field and, unlike dispensing doctors, we know that a pharmacist is dispensing the medication. A dispensing doctor does not have to have a trained pharmacist. A young person with an NVQ, with perhaps just a year’s training, could do it. Where a pharmacist does it, you get a second view, a check. Certainly, in my area, that second check has proved to be very valuable. Pharmacists also do medicine-use reviews, which have been useful. The Government produced a very good White Paper, Pharmacy in England: Building on Strengths—Delivering the Future. I am an officer of the All-Party Pharmacy Group, from whose work quite a lot of that document arose. The document has 139 pages and a very interesting annexe, which is about health challenges and how pharmacy can contribute. The health challenges are healthy weight, healthy lives, smoking—which is of interest to this Committee—sexual health, alcohol use, an ageing population—which is perhaps also of interest to this Committee—long-term conditions, mental health, healthcare-associated infections, medication-related harm, drug misuse-related harm and health and work. Alongside every health challenge is a column on the long-term impact if it is not addressed. There is then a column which sets out how pharmacy can contribute, followed by one on the likely benefits and outcomes. It is very clear, very good and puts the whole matter into context. It is therefore clear that the Government feel that pharmacy has a future and that it has untapped potential. Having received the RCN’s briefing, I was interested to see how it welcomed the integration of pharmacy into primary care. It is wrong to confuse dispensing doctors and their service with the wide range of services that pharmacy provides, especially in health promotion. I receive the Pharmaceutical Journal weekly. On the front page of the issue of 28 February is a picture of a very large boot stamping on a packet of cigarettes beside the headline, "Stamping out smoking: are targets achievable?". In the document is an extremely good, comprehensive report on how to encourage smoking cessation. The author, Andrew McGeogh, gives tips on engaging more clients and re-engaging those who have failed in previous attempts to give up. He writes of the smokers that they say, "I tried to quit before" and that you say, "Not with me. This is our first attempt". So some very strong messages are going through that subject of smoking. Pharmacists provide over-the-counter medicines, which a dispensing doctor does not, and they give advice. Very often, the advice one receives in a pharmacy is much more accessible than in a doctor’s surgery. You are on neutral territory, as opposed to a doctor’s waiting room or consulting room, which feels like their territory.