Contents
- Attendance
- Current Petition
- New Petitions
- Tackling Child Sexual Exploitation in Scotland
- Current Petitions
Current Petitions
Pernicious Anaemia and Vitamin B12 Deficiency (Understanding and Treatment) (PE1408)
I move on to PE1408 by Andrea MacArthur on the updating of pernicious anaemia and vitamin B12 deficiency understanding and treatment. Member have a note by the clerk and submissions.
There are a number of ways forward. I suggest that we ask the Scottish Government to clarify exactly what action is taking place following the publication of the British Committee for Standards in Haematology’s guidelines and what its timescale will be.
Could we ask the Scottish Government as well as clinicians how the information will be disseminated to GPs? For many patients, it is the treatment by a GP or practice nurse that raises questions about B12 deficiency.
That is a fair point. Are we agreed?
Members indicated agreement.
Alzheimer’s and Dementia Awareness (PE1480)
The next petition is PE1480, by Amanda Kopel, on Alzheimer’s and dementia awareness, on behalf of the Frank Kopel Alzheimer’s awareness campaign. Members have a note by the clerk. I am sure that all members will wish to send their condolences to Amanda Kopel following the death of Frank Kopel.
I invite contributions from members, but also suggest that, as the Scottish Government has indicated that it will look into the provision of personal care for under 65-year-olds who have complex needs, the committee might wish to ask for more details on the scope and timescale of the work. Is that agreed?
Members indicated agreement.
Thank you for that.
Co-location of General Medical Practices and Community Pharmacies (PE1492)
Yes, I have. I welcome the fact that the Government has undertaken a fresh consultation. Members will remember that we thought that we had solved this problem during the previous parliamentary session, but clearly we have not. There is considerable anxiety among remote and rural practices about the development of pharmacy. The committee will appreciate that we are therefore faced with the dichotomy of wanting to provide good and full pharmacy services to communities on the one hand and, on the other, wanting not to disrupt or in any way to reduce the general medical services that are being offered by GPs.
The new regulations have been lodged and will be considered by the Health and Sport Committee at its meeting next week. I do not propose to seek to annul the instrument because the regulations are a considerable advance on what we have had until now. However, there are some questions that I want to raise for the committee’s information as much as anything, so I invite the committee to consider keeping the petition open a little longer to see what the minister’s response is next week.
First, there is the new concept of protecting rural and remote practices by designating them as practices where there should not be a pharmacy. That is new and it is very welcome. However, there is not a very clear definition of that concept, and the status of the practices concerned is to be reviewed every three years.
I declare an interest as a fellow of the Royal College of General Practitioners and a member of the British Medical Association. Frankly, when you are running a business, which is what GPs are doing, a three-year review is not adequate. You need certainty over a longer period, so I am slightly concerned about the three-year review, as well as about the vagueness of the definition. The regulations say that the practices will be designated as protected, but we do not know what the definition of that status is.
I also have some concerns about the consultation process, which is now to be agreed between the applicant and the board. There does not appear to be any role for either the GP or the community in agreeing the consultation process. Moreover, there is no external agency looking at this, as there is with the rest of the health service through the Scottish health council. There is something lacking when it comes to ensuring that consultation follows a process. We have no idea what the process is, because it is not defined in the regulations.
There is no requirement on the practice and the health board jointly to agree specifically any changes to services that might occur following loss of dispensing. Members will know that Millport is the worst example—the GPs there have all resigned. It is costing us as taxpayers and it is costing the Government and the health board a huge amount of money to provide locums, because the board cannot get GPs. There has also been a reduced service in Leuchars. In Methven, in my constituency, the GMS was previously a full-day service and is now a half-day service, so patients have to travel from Methven to Perth. None of that came out in the licensing process.
Three other practices in my area also have issues: Aberfoyle, Killin and Drymen. In Drymen, the GPs have both resigned as of 31 July. In Killin, there are particular problems, which I will not go into, but it looks like a diminished number of GPs will be present. In Aberfoyle, an appeal has just been upheld despite the fact that in the initial consideration by the local pharmacy board—the appropriate board—the pharmacy was regarded as being potentially unsustainable, which is one of the criteria under the new regulations.
There is also the question whether there should in the future be redress for practices that are affected by licensing. That has not been the practice in the past, and I would not argue for GPs to be in a position to sell goodwill. They never have been and they never should be. Their dispensing rights are given to them by the board and they are required to dispense by the board—they should not have the right to sell that goodwill. Nevertheless, GPs make an investment. I will give the committee another example. About two years ago, the Drymen practice invested £3,500 or £4,000 in software to improve the safety of its dispensing. However, it gets no recompense for that for losing its licence and the requirement to dispense. There should at least be an assessment of the effect on the practice of the loss of dispensing, in terms of both its software and the premises.
Are there arrangements for redundancy of dispensing staff? Are there Transfer of Undertakings (Protection of Employment) Regulations arrangements? That again does not come up under the regulations.
Finally, nothing in the new regulations promotes co-location of GPs and pharmacists. Indeed, I understand that pharmacists locally can currently object to co-location on the basis that it would give someone an unfair advantage and therefore it may not occur.
I am sorry to go on at length, convener—I know that the committee has a long agenda—but we are having yet another shot at this, so we need to get it right. I wonder whether the committee would consider keeping the petition open at least until the minister has answered the questions, which the minister now has notice of as a result of your having courteously allowed me to speak to the committee.
I will repeat a point that I made earlier. Dr Simpson has vast experience in medical practice, but I am not sure whether he is in favour of GPs having a financial interest in a co-located pharmacy. My major concern is that GPs do their core activities and that there is no bias as a consequence to select particular prescriptions and no financial benefit to GPs. How is that going to be overcome?
I thank Dr Simpson for his comments. You will probably know that I have had some regional interest in the matter in Benbecula and Caithness, so I know first hand how difficult it is. I am grateful to Mr Kennedy for lodging the petition.
Sorry to cut across you, but I remind members that Dr Simpson is not a witness here; he has just made a statement on the petition. I am reluctant to open up another philosophic discussion.
There is a dilemma, as Chic Brodie outlined. It was a serious dilemma 15 or 20 years ago because there was no control over GP prescribing, whereas now at least there are agreements between health boards and GPs on their prescribing budgets. They are now much more tightly supervised, and if practices prescribe in an inappropriate way—for example, by prescribing branded products instead of much cheaper generic products that possibly have less profit margin for the dispenser—the health board should be able to control that.
However, there might need to be something specific in the regulations that, on the one hand, encourages co-location where appropriate in order to introduce full pharmacy services in areas that might not have that benefit; and, on the other hand, ensures that there is a memorandum of understanding with general practitioners to ensure that co-location does not lead to any sort of abuse.
I move that we support Dr Simpson’s suggestion that we keep the petition open, in the expectation and hope that a copy of the Official Report will find its way to ministers in order that they can facilitate appropriate, fulsome responses to the questions that the committee intends to put to them next week. We can look at the petition again in the light of that.
Thank you for that. I ask for other members’ views. That is an option, but we could also refer the petition to the Health and Sport Committee, which is the lead committee for the regulations.
I am minded to refer the petition to the Health and Sport Committee. As that committee is examining the regulations, it would be more appropriate for us to pass on to it the information that we have on the petition.
Dr Simpson eloquently expressed the questions on the issue that he will no doubt ask the minister and the cabinet secretary next week. The difficulty for me is that I do not want this committee to be a back-up committee for an inquiry or work that is being done by another committee. We should respect the Health and Sport Committee’s ability to do its work. If all else fails, the petition can come back to this committee so that we can examine it further. If we refer the petition to the Health and Sport Committee, I am sure that Dr Simpson will make a very good job of raising all the questions and getting the answers that he requires.
Thank you. We have two proposals: to continue the petition or to refer it to the Health and Sport Committee. I invite members to say which one they support.
I would refer it on to that committee.
I am happy to refer it on.
Dr Simpson has made it clear that there are questions still to be answered. I would rather that we deal with them before moving the petition on.
I think that there is a strong argument for referring the petition to the Health and Sport Committee.
I thank colleagues for that. By a majority, we have agreed to refer the petition to the Health and Sport Committee, which is the lead committee for the regulations. I thank Dr Simpson for coming along today and for his expertise.
Thank you for allowing me to speak to the committee.
We greatly appreciate your comments.
The next petition is by Alan Kennedy on co-location of GP practices and community pharmacies. Members have a note by the clerk and submissions. I invite contributions from members.
The Government has now indicated its position on this. I have indicated to the cabinet secretary that we will need to be sure that there is no conflict of interests in future co-location of community pharmacies and GP practices. That will be a matter for further review.
Dr Simpson has an interest in the petition.
Group B Streptococcus in Pregnancy (PE1505)
The next petition is PE1505, by Jackie Watt, on awareness of group B streptococcus in pregnancy and infants. Members have a note by the clerk and the submissions on the petition.
I point out that Jane Plumb, the chief executive of Group B Strep Support, has provided an additional paper. In case members have not had time to read it, I point out that she is particularly keen that we write again to relevant bodies rather than defer further consideration of the petition. Again, though, it is up to members to decide on the next steps.
Having glanced through all the relevant papers, my view is that we should write to the Scottish Government and NHS Health Scotland to request that the petitioner and other stakeholders are consulted as part of the revision of the “Ready Steady Baby!” leaflet to include information on GBS. Does everyone agree to that?
Members indicated agreement.
A9 Average Speed Cameras (PE1503)
The fifth current petition is PE1503, by Mike Burns, on behalf of the average speed cameras on the A9 are not the answer campaign, on a review of the A9 speed camera proposals. Members have a note by the clerk and the submissions.
Members will remember that Mike Burns gave evidence to us on the petition. The Scottish Government’s view on the petition is quite clear. As a regular on the A9, I know that the cameras have already been constructed, are under trial and will be operational in October. Part of the trialling will involve increasing the speed limit for heavy goods vehicles from 40mph to 50mph. Members will know that I have a strong view on that. That aspect is not part of the petition, but I want to ensure that we have a balanced view on the issue.
In my view, Mike Burns has done a very good piece of work with his petition, but I do not see what more we can do on it with regard to the Scottish Government, because it has made its view absolutely clear. Before we consider whether to close the petition, though, I point out that Mr Burns has made two or three extra points in a paper that he would like us to consider. The first is that the Scottish Government should undertake an economic impact study of the effect of speed cameras on the Highland economy, but such a study has been commissioned, so that is not news to the Scottish Government. Mr Burns also proposes that the A9 safety group become more of a public forum and that the driver surveys that have been done are published.
Unfortunately, I cannot see that we have any choice other than to close the petition. However, it is important that we chase up Mr Burns’s points with the Scottish Government. As I said, the economic impact study proposal has already been enacted, as far as I am aware, and the driver surveys just need to be made public. The point on the A9 safety group becoming a public forum is a matter for the Scottish Government and Transport Scotland, but out of courtesy to the petitioner I think that we could ask for the minister’s views on that.
I am sorry to have gone on at length on the issue, but it is an important one in the Highlands and Islands. Do members agree to our closing the petition but chasing up the outstanding points?
Members indicated agreement.
Meeting closed at 12:17.