Draft Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024
(6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)
I beg to move,
That the Committee has considered the draft Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024.
It is a pleasure to serve under your chairmanship, Mr Hollobone. The Government are proposing changes that would improve patient access to medicines in both dental practices and pharmacies.
First, hon. Members will know the vital role that pharmacies play in communities across our country, and I am sure that they will join me in expressing enormous gratitude and appreciation for the incredible work of brilliant pharmacists up and down the country. Of course, pharmacists dispense prescription medicines to the public, but for many people they are also the first port of call for healthcare advice. Pharmacies can provide a number of different services, including vaccinations, blood pressure checks and contraception, and that takes pressure off hospitals and GPs while playing an essential role in safeguarding the nation’s health. Pharmacists are fully trained and qualified, and pharmacies in hospitals are a key source of advice for doctors, nurses and other clinical staff. As well as supplying basic healthcare products, they support the management of complex medication regimes.
Pharmacies are a priority for this Government, and of course for the Prime Minister personally. Indeed, I do believe that the Prime Minister’s own mother was a pharmacist—colleagues may have heard that. [Interruption.] Have they? I think they have. I thank her for her lifetime of service, and pay tribute to every pharmacist who is helping us to deliver for the British people by taking NHS appointments, day in and day out. In recognition of the clinical expertise and knowledge that pharmacists have to offer, this Government have invested in pharmacy as part of our primary care recovery plan. We have made significant funding available for more blood pressure checks and more contraception consultations, as well as for Pharmacy First, which launched in January 2024, enabling community pharmacies to supply prescription-only medicines for seven common conditions without a prescription from a GP. Together with the investment in more blood pressure checks and oral contraception consultations, Pharmacy First will save around 10 million GP appointments once fully rolled out. The sector has embraced Pharmacy First, with over 125,000 consultations delivered in February, which was the first month of the service. Data on Pharmacy First delivery will start to be published from the end of this month.
Secondly, hon. Members will be only too aware of how important dental practices are in local communities. Dentistry is a top priority for this Government, and that is why we published our dental recovery plan in February. I am delighted that the plan is already delivering results on the ground, with nearly 500 more dental practices now open to new NHS patients. Dentists not only deal with emergencies, of course, but play a critical role in prevention.
Although the draft statutory instrument covers two very distinct professions, it will enable both to use their full range of skills to supply patients with the medicines they need in a timely manner. Legislation already allows some registered healthcare professionals to supply or administer certain medicines as part of their usual clinical practice. These are called exemptions. Our proposed changes will put exemptions in place for dental therapists and dental hygienists to supply or administer a range of medicines that are already a part of their day-to-day jobs. The changes will mean that they can supply or administer those medicines to patients without first having to refer to a dentist, so that they can deliver care without the need to organise additional appointments or interrupt dental colleagues who are already busy with other patients. These sensible, common-sense measures will free up precious time for clinicians and patients alike. The medicines are listed in the draft regulations. Seven of them are topical or local anaesthetics, three are fluoride products, and there is one antibiotic gel and one antifungal medicine.
Healthcare professionals have a responsibility to carry out care only where it is safe to do so and they are competent to do so. Many already have extensive experience of using these medicines, but of course we will not be compromising on safety one inch. Dental practices will continue to be responsible for making sure that clinicians undertaking the procedures have the knowledge, qualifications and skills to carry them out safely, and training will be made available for all those who want to make use of the exemptions. That will help dental practices to safely deliver more care for their patients as part of our dental recovery plan.
Our proposals will allow pharmacy technicians to supply or administer medicines to patients using mechanisms called patient group directions, or PGDs, which are written instructions that allow some healthcare professionals to supply or administer specified medicines to patients with certain conditions, without the need for a prescription. They are developed by experts from a range of fields, who thoroughly kick the tyres of every PGD before they are passed. Pharmacy technicians will be responsible for assessing whether patients fit the criteria. Once implemented, PGDs are carefully monitored to check they are being used appropriately on the ground. It is up to local healthcare organisations to decide, following national guidelines, whether a PGD route is appropriate for a clinical service. Local clinical managers are responsible for permitting healthcare professionals to work under PGDs, while making sure they are trained to use them safely.
Hon. Members might have come across pharmacy technicians in their local hospitals without necessarily realising who they are or what they do. However, pharmacy technicians are well placed to take on these roles. In fact, they already carry out a wide range of tasks in many healthcare settings, including hospital and community pharmacies, GP practices, care homes, prisons, our armed forces and the pharmaceutical industry. In recent years, their roles have given them opportunities to work face to face with patients, making them highly adept at answering questions about medicines.
We are making changes to training for pharmacists that will soon mean they can graduate as fully qualified prescribers.
Richard Fuller (North East Bedfordshire) (Con)
I fully support what the Minister proposes, but I have a maths question for her. I know that she did not prepare the impact assessment herself, but she probably reviewed it. It states:
“We have discounted benefits to patient health and the NHS at 1.5% per annum and all other benefits at 3.5% per annum.”
Of course, that lower discount rate has the effect of making the later benefits look better—they are not discounted to a lower level now, so we can spend more money for the same amount of benefits later on. Is the Minister comfortable with those discount rates? Given where interest rates are now, will she put some questions to the people who made the impact assessment about why those particular discount rates were used?
Dame Andrea Leadsom
As always, my hon. Friend makes a very good point about the finances. I cannot answer his question immediately—I would have to refer back to the impact assessment—but perhaps I can write to him on that point. It is vital that we look at the longer-term impact of any change that we make. Without addressing his specific point, I can say more generally that in introducing these further flexibilities for pharmacy technicians, we are increasing capacity in the very important sectors of dentistry and pharmacy, and doing so will benefit patients and the national health service alike.
Let me conclude by pointing out that, together with the proposals we are debating, all these measures will expand capacity in pharmacies for the prescribing, supply and administration of medicines, providing patients with access to a wider range of clinical services delivered by healthcare professionals with the right skills, at the right time. That supports the Government’s ambition to improve outcomes for patients while reducing demand on other parts of the service. I commend the regulations to the Committee.
Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I want to start by echoing the Minister’s comments about pharmacies and pharmacists; I will even go so far as to thank the Prime Minister’s mother. We rely on our pharmacists to do an awful lot and Labour supports the concept of Pharmacy First. We think that pharmacies could and should play an even greater role in providing healthcare services in the closest places where people can most easily access them. In our towns, cities and villages, that is often on the high street, in our pharmacies. We would roll out more services to pharmacies and have proposals to do that, should we be fortunate enough to form the next Government.
I have to say, though, that the least said about NHS dentistry the better. I do not recognise the Minister’s description of her dentistry recovery plan. It does not go far enough for us. We want to see a proper, concerted effort in dentistry and in getting NHS dentistry back to where it should be. Even the professional bodies say that the dentistry recovery plan does not go far enough, and we echo their concerns. We can and should do more.
We support the overall terms of the draft regulations, particularly the measures on pharmacy technicians and dental hygienists. In particular, we think that dental hygienists are a useful tool to deliver timely and quality care to patients where it is safe and suitable for them to do so. The dental profession is supportive of the intention to enable dental hygienists and dental therapists to supply and administer the vast majority of the medicines listed in the regulations.
However, the inclusion of two medicines on the list—minocycline and nystatin—was not supported by the British Dental Association or the College of General Dentistry. These bodies tell me that for a number of reasons, including antimicrobial resistance and, in the case of minocycline, efficacy, they are not recommended in any national clinical guidelines and their use in dentistry is no longer accepted practice. Will the Minister be able to explain whether the concerns of key dental stakeholders were taken into account when the decision was made to retain these two drugs on the list? Will she also assure us that there has been full and proper consultation with both the British Dental Association and the College of General Dentistry on ensuring that the regulations are compliant with both national practice and existing clinical guidelines?
Efforts to increase the skill mix in our NHS dentistry workforce and across pharmacy more generally are welcome, but the Minister will forgive me for thinking that we need to go much further than technical tweaks if we are to reverse the crisis in which NHS dentistry finds itself. I know that she wants to do more—I want her to do more—but it will likely be left to the next Labour Government to fix NHS dentistry. We will support the regulations, and I hope that the Minister can reassure us about the medicines that are included in the list when they perhaps should not be.
Dame Andrea Leadsom
I thank the hon. Gentleman for his support for the measures. He is absolutely right to highlight that we all want to see greater capacity and more depth in these sectors, as well as more access for patients. It is a good thing to do and I can absolutely assure him that there has been full consultation, with views taken into account. I can also assure him that it is for professionals to decide which particular medicine can be used by which particular technicians and therapists in each case, so I do not think he needs to be concerned. Should there be views that a particular medicine is not effective or that it should not be used because of considerations of antimicrobial resistance, its inclusion does not necessarily mean that it must be used. I hope that I can reassure him that all views have very much been taken into account and the regulations are permissive, not compulsory, if I may put it like that.
Question put and agreed to.