Health Bill [HL]

The amendment of my noble friend Lady Gibson, spoken to by my noble friend Lord Faulkner, would amend this clause in two ways. The noble Earl, Lord Howe, and the noble Baroness, Lady Cumberlege, seek to amend the clause in a slightly different way. My noble friend’s amendment would require, first, that regulations made provision so that the services provided by dispensing doctors were included by the primary care trusts in their pharmaceutical needs assessment along with the circumstantial needs of older and disabled patients everywhere, but with particular mention of rural areas. Secondly, they would enable the regulations to make provision so that the pharmaceutical services to which an assessment must relate would include in particular the services of dispensing doctors. The Government have always recognised the importance of dispensing services for those who cannot easily access a pharmacy, and recognise the value that patients put on them, as so eloquently expressed by the noble Baroness, Lady Masham. That is why, following consultation, my right honourable friend the Minister of State for Care Services Phil Hope made clear last December that there would be no change to the arrangements currently in place under which doctors are authorised to dispense to their eligible patients. Indeed, in response to a Question in the House, I repeated that. Like my noble friend, I fully accept that the needs of older or disabled people must form part of a comprehensive assessment of pharmaceutical needs locally. After all, we know that older people are far more likely to be frequent users of their pharmacies, as are those with long-term conditions, but important as these users are, they are not the only groups to be considered. The important thing must be that primary care trusts undertake comprehensive needs assessments that are specific to their areas. I am not convinced that we assist them in this task by laying down in the Bill the types of needs or the kinds of services that they must or must not take into account beyond what we have already proposed. We run the risk of undermining their work or of omitting some aspect of critical importance locally that we may be unaware of nationally. I would not wish to fetter their discretion in this way, but I reassure my noble friend that it would, in my view, be a very odd assessment that did not, for example, consider the needs of older or disabled people or did not include, where appropriate, the services of dispensing doctors. It might be appropriate to make specific provision for such matters in the regulations to come—it is certainly appropriate for the information and guidance now being produced for primary care trusts—but that is best decided by all interested parties when drawing up the detailed regulations that will support implementation rather than it being in the Bill. I turn now to the amendment tabled by the noble Earl, Lord Howe, and the noble Baroness, Lady Cumberlege, which is closely linked to that tabled by my noble friend. Their amendment adds a specific provision that the regulations require primary care trusts to have particular regard to the needs of rural populations when making their pharmaceutical needs assessment. Rurality is not defined by one mile. The rule is that patients in designated rural areas who live within one mile of a pharmacy should, with limited exceptions, use it. There is no intention to change the dispensing doctor arrangements. I am not sure that I am going to satisfy the noble Baroness in the definition of "rural" when I tell her that rurality—I am not sure that is a real word—is determined by PCTs. PCT decisions are appealable, and guidance has been issued to them on factors that they may consider. I will send it to the noble Baroness. I suspect that we will continue this discussion. I shall address the more general points raised by the noble Earl about the capabilities of PCTs in the next group of amendments, which relate specifically to them, and shall not go into detail here. As noble Lords may be aware, in 2004-05, all primary care trusts in England were advised to develop a pharmaceutical needs assessment in preparation for the community pharmacy contractual framework and the reform of the existing control of entry regulations. It was envisaged that these assessments would equip each primary care trust to deal with control of entry applications for their area, including urban, suburban and rural areas. Under this new power, we expect to require primary care trusts to include a full assessment of the needs of their area, whether it covers rural, urban or suburban areas, and the population mix. I thank the noble Baroness for referring to the report of the All-Party Pharmacy Group, because it helped to shape the pharmacy White Paper. The noble Earl, Lord Howe, made a point about out-of-hours services and home deliveries. PCTs commission according to their assessment of local needs. A decline in numbers might be an issue, or it might be attributable to more pharmacies opening with extended hours or to pharmacies voluntarily providing home deliveries. I am not sure we have evidence of what is behind the decline. I listened carefully to what noble Lords said, but I am not, at the moment, persuaded of the necessity of including in the Bill the consideration of the circumstances of the rural population. However, I reassure noble Lords that any pharmaceutical needs assessment will have to consider the overall needs of the whole population in the primary care trust’s area and be as comprehensive as possible. I stress that we expect primary care trusts that have rural populations to ensure that they take full account of their particular needs and circumstances. I hope I have been able to reassure the noble Lords sufficiently on these matters and ask them not to press their amendments.