Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016
(8 years, 10 months ago)
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Lord Prior of Brampton
That the Grand Committee do consider the draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, this order makes changes to the pharmacy regulators’ powers to regulate pharmacy premises. In broad terms, the intention is to remove the General Pharmaceutical Council’s duty to set standards in rules and, instead, turn them into code of practice-style obligations which are enforced through disciplinary committee procedures. The Northern Ireland regulator, the Pharmaceutical Society of Northern Ireland, will have a statutory duty to set standards for registered pharmacies and the order clarifies what those standards can cover.
The order also makes changes to the regulators’ ability to issue interim suspensions from the premises register. The General Pharmaceutical Council’s powers relating to improvement notices are amended. It is enabled to publish reports of pharmacy premises inspections, there are changes to its powers to obtain information from pharmacy owners, and a correction is made to the Pharmacy Order 2010 in respect of the notification of the General Pharmaceutical Council of the death of a pharmacy professional. All the changes have been developed with the agreement of the regulators, the Government and the devolved Administrations. Since the General Pharmaceutical Council’s pharmacy premises standards may relate to the regulation of pharmacy technicians, which is a devolved matter, this order has also been laid in the Scottish Parliament.
I should give the Committee some background. All pharmacists and pharmacy technicians who practise in Great Britain must be registered by the General Pharmaceutical Council. Pharmacists who practise in Northern Ireland are registered with the Pharmaceutical Society of Northern Ireland. Pharmacy technicians are not a registered healthcare profession in Northern Ireland. Unlike most other healthcare regulators, the pharmacy regulators are also responsible for the regulation of registered premises. The regulation of retail pharmacy premises is the subject of the order under debate today.
The key change for the General Pharmaceutical Council, and one of the Law Commission’s recommendations, is that it should no longer be required to set standards for registered pharmacies in rules. Instead, the standards should be aligned with other regulatory standards and be code of practice-style obligations enforced through disciplinary procedures. This supports the General Pharmaceutical Council’s approach, since its inception in 2010, to move to an outcomes-based approach to pharmacy premises regulation. Overall, it will align the legal status of registered pharmacies’ standards with the status of standards for individual registrants.
As a consequence of moving the standards out of rules, they will no longer be included in a statutory instrument that is subject to Privy Council approval. Increasing the autonomy of the General Pharmaceutical Council in this way is in line with government policy. However, the order includes an explicit requirement for the General Pharmaceutical Council to consult Scottish Ministers, as well as English and Welsh Ministers, on changes to pharmacy premises standards.
The General Pharmaceutical Council’s standard-setting powers are being extended to include associated premises; that is, premises at which activities are carried out which are integral to the provision of pharmacy services. This reflects the fact that, in some respects, the traditional model of pharmacy premises being entirely self-contained operations in which all aspects of the retail pharmacy business are carried out is, for some businesses, outdated. Integral parts of their business operations—for example, electronic data storage—may be elsewhere. Very similar changes are being made in relation to Northern Ireland.
The disqualification procedures for pharmacy owners and the procedures for removing premises from the premises register are being amended for both regulators; first, so they apply to retail pharmacy businesses owned by a pharmacist or a partnership, as well as bodies corporate; and, secondly, to clarify that the test to apply sanctions where premises standards are not met is whether or not the pharmacy owner is unfit to carry on the retail pharmacy business safely and effectively.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to the noble Lord for his careful explanation of the order. On the whole, the changes seem sensible, and I note that some of them follow the Law Commission’s recommendations. As the noble Lord will know, there has been disappointment that the Government did not bring forward a Bill or a draft Bill in relation to the whole package, and I know from our previous discussions that the Government are considering what further to do in relation to the regulation of individual health professionals. Is he able to update me on where the Government are on that?
On the detail of the order, I noted that overall the consultation outcome showed a great deal of support for the proposals, although perhaps less so in respect of the change in relation to standards for registered practices, which are no longer to be placed in legislative rules. I noted that some concerns were expressed, according to the Explanatory Memorandum,
“that removing the ‘black and white’ rules could lead to unhelpful variation for employee pharmacists in the way pharmacy owners choose to meet the standards”.
I assume that the proposal for an outcomes-based approach would ensure that there will be consistency about the standards themselves but leave more discretion for individual community pharmacies to decide how to meet them. Could the noble Lord confirm that for me?
The noble Lord made a very interesting comment at the end of his speech about the rapid change in the way community pharmacy services are provided. I certainly agree with that. I am sure he is aware that an estimated 1.6 million people visit a pharmacy every day. There is no question but that they have huge potential, not just in dispensing medicines but in many of the other services that are now available in community pharmacies, for example home delivery, compliance aids and other support to help old and frail people in particular live independently. There is also no question about the strong professional advice community pharmacies can give, particularly in relation to medicine management. We know, again, that older and frailer people in particular can be prescribed individual medicines without perhaps the GP or other doctors looking at the whole impact, whereas community pharmacies, through medicine management approaches, can have a very beneficial impact. For instance, this winter, NHS flu vaccines were available for the first time through community pharmacies. Again, that shows the benefit of recognising the professional expertise they have and of trying to ensure that they can relieve some of the load on other pressurised parts of the National Health Service.
The Government have made clear in a number of publications how they value community pharmacies, so I have been puzzled by the reductions that are going to be made in the community pharmacy budget, which is the subject of an Oral Question next week. I am puzzled by the thinking behind that reduction, which I think will start in October 2016, according to a letter that the Department for Health and NHS England sent out to community pharmacies. I just wanted to ask two or three questions about this.
First, in the letter that was sent out to community pharmacists, or to their representative organisations, there was a clear implication that the Government think there are too many community pharmacies at the moment. The letter points out:
“In some parts of the country there are more pharmacies than are necessary to maintain good access. 40% of pharmacies are in a cluster where there are three or more pharmacies within ten minutes’ walk. The development of large-scale automated dispensing, such as ‘hub and spoke’ arrangements, also provides opportunities for efficiencies”.
The department is also looking at ways of online ordering, which will make it easier for the public. The letter also says it is looking at,
“steps to encourage the optimisation of prescription duration”,
which I assume means prescriptions for a lengthier period than currently.
The Pharmaceutical Services Negotiating Committee has told me that it feels that the cut in budget is incompatible with the Government’s ambitions in relation to the contribution of community pharmacy. It wants to know whether it is government policy to see a reduction in community pharmacy premises. It would be a brave Government who said that they wanted to see that, but clearly it would be helpful to know if that is a stated intention. The development of an online pharmacy service is clearly to be encouraged. The record of community pharmacy has been very good in relation to being able to adopt a digital approach. Will that be done in a way that does not bypass the actual value of the advice that pharmacists can give to individual patients, particularly about medicine management?
Finally, on the question of increasing the length of time of a prescription, we know that a lot of medicine is wasted. Often, patients give up the course before they reach the end, even though they are recommended to take the full course. I can see that making the length of a prescription longer will mean that they will need fewer visits to the community pharmacist, thereby reducing the money going to the community pharmacist. However, if it leads to a greater waste of medicine, it might be a false economy. Has the department undertaken any work on that?
Overall, the SI itself is eminently sensible, but it cannot be considered without looking at the context of where community pharmacy is going. When we debated the Health and Social Care Bill in 2012, we discussed whether community pharmacists should be represented, as of right, on the board of a CCG. The Government resisted that, but there is evidence that because community pharmacists are not around the table at CCG level, the contribution they can make is often missed when it comes to issues such as how you make a health economy work effectively together or how you can, say, reduce pressure on A&E. We may be missing a trick here in not embracing community pharmacy rather more than we have been for the past year or two.
Lord Prior of Brampton
My Lords, I had a feeling that we might stray beyond the order, and we duly have. The noble Lord raised three broad points. The first was to request an update on the Law Commission’s report into the regulators. I do not have much to say that we have not already said. We think that a lot of what was in the Law Commission’s report was absolutely right, but it was a long and fairly prescriptive approach to the matter. We are considering it and may return to it in this Parliament, but it is not a priority in the short term.
The noble Lord referred to the outcomes-based approach and raised concern about whether the standards will be consistent. The intention is that they will, but there will be more discretion in how the outcomes are achieved. We are at one on the intent that lies behind his question.
I turn to the much more difficult matter that the noble Lord raised, which does not relate directly to the order, although he is right to say that it provides some context. The first thing to say is that I agree wholeheartedly with what he said about the vital role of pharmacists not just in dispensing but in how we manage medicines, perform vaccinations and look after the old and frail. I was interested by his comment at the end about why pharmacists are not represented on the board of CCGs. When we come to debate our whole approach to community pharmacy in more detail, we will set out our views on how pharmacy should be more integrated with the delivery of health and social care. It may well be that we should revisit whether pharmacists should be on the board of CCGs. Perhaps I can take that away to think about it further.
I do not want to be taken down the route of the number of pharmacists, because we are out to consultation at the moment. It is a fact that 46% of pharmacists are located in very close geographic proximity to each other. That is one reason why we have been looking at the structure of delivery of community pharmacy. On the one hand, we absolutely recognise that in rural areas we must have community pharmacies close by, and we want them to be much more integrated with healthcare delivery; on the other, there must be a question mark about the structure of community pharmacy. The number of outlets has grown from 9,000 to 11,500 in the past seven or eight years, which is a huge increase. Much of that increase has come from people setting up shop in very close proximity to existing pharmacies. It is right that we look at the whole delivery of healthcare by pharmacies, and it will be interesting to see what emerges from the current consultation.