National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness McIntosh of Pickering Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I start by declaring my interest with the Dispensing Doctors’ Association, as in the register of Members’ interests.

I welcome the regulations before us this afternoon; the instrument makes a permanent change to broaden the existing arrangements for the supply of prescription items for pandemic disease or in other serious emergencies. As indicated by the Secondary Legislation Scrutiny Committee, there really are no downsides to this. The instrument

“allows specified medicines to be issued free of charge either on prescription or in response to a patient group direction (PGD), a pandemic treatment protocol (PTP) or serious shortage protocol (SSP) authorised by the Department for Health and Social Care.”

I welcome the opportunity to discuss the regulations before us. I also pay tribute to the role that community pharmacies have played in this regard—both generally and particularly during the pandemic. I would link to the role of community pharmacies the particular role that dispensing doctors have played. I once again ask my noble friend the Minister if, in the course of the afternoon, we could focus particularly on delivering medical care and pharmaceuticals in a rural setting, and ensuring that all aspects of rural life, including health policy, are delivered in a way which has clearly been rural-proofed.

I am delighted to join the noble Lord, Lord Hunt, and the noble Baroness, Lady Barker, in paying tribute to the role that community pharmacies play. But I would also like to pause for a moment and set out, as is referred to in the Explanatory Memorandum, the role that dispensing doctors have played. This is something of a lifelong interest for me because my late father was a dispensing doctor and my brother is a retired dispensing doctor. Dispensing doctors exist in rural areas because a pharmacy is not commercially viable. They date back to the time of Lloyd George and the National Insurance Act 1911.

It is important to appreciate that the income from dispensing cross-subsidises the medical service. Dispensing doctors do not have access to EPS—electronic prescription services—for their dispensing patients, over a decade since the system was introduced. That would seem to be a sign that perhaps rural-proofing in England is not working as well as it is in Wales, where they will be included for dispensing patients. Pharmaceutical needs assessment can place a dispensary under threat if a pharmacy application is made, unlike in Wales, where dispensing doctors are a full part of the pharmaceutical service, thanks to the Welsh department listening to the actions requested by the Dispensing Doctors’ Association.

Dispensing doctors are buying drugs in the same marketplace as pharmacies, yet their system of reimbursement and fees are different from community pharmacy. Despite this, as I understand it, NHS England and the department exclude dispensing doctors—in particular the DDA—from discussions on these matters. I ask my noble friend: why is that the case? The noble Lord, Lord Hunt, also mentioned that community pharmacies are excluded from these decisions as well. It strikes me that, immediately, the DDA, representing dispensing doctors and community pharmacies, should be at the table when these matters are discussed.

Most dispensing practices have vaccinated their patients against Covid as there is no scope for large centres in remote and rural communities. It is extremely difficult in areas such as sparsely populated parts of north Yorkshire for patients to access any such urban remote centre. Also, a lack of rural proofing harms rural communities. Primary care networks are being set up yet most dispensing practices are, in effect, their own primary care network given the large practice areas and dispersed populations that they serve.

As I mentioned previously, dispensing doctors are NHS GPs who are permitted to dispense medicines in designated rural areas where a community pharmacy is not economically viable. As I also said previously, dispensing practices use any profits that they make from the purchase of the drugs that they dispense to cross-subsidise the provision of the medical practice. That is often overlooked. There has never been any formal acknowledgement of this in England, although I understand that Scottish officials have done so before the Scottish Parliament.

In making the specific request to have regard the role of dispensing practices as well as community pharmacies in the dispensing of drugs under the regulations before us this afternoon, may I make a more general request to my noble friend that his department practise proper rural proofing? This will ensure that the work of, and reimbursement of, dispensing doctors in dispensing to their patients—often in rural, remote and sparsely populated areas—is properly addressed in the terms I have set out.

In that regard, I shall support the Motion to Regret before us this afternoon if the noble Lord, Lord Hunt, presses it to a vote. I hope that my noble friend the Minister will look sympathetically on the arguments I have made in favour of dispensing doctors specifically and the rural proofing of health policy more generally.