Dispensing Doctors (Rural Areas)
The final item of business is a members' business debate on motion S3M-4047, in the name of John Lamont, on dispensing general practitioner practices in rural communities. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises the important role of dispensing GP practices in remote and rural communities across Scotland; acknowledges the high level of patient satisfaction with these practices; is concerned about the process of the community pharmacy application in Chirnside, which has failed to properly involve the affected GPs or take account of the views of the local population; is aware of the current inquiry on dispensing under consideration by the Public Petitions Committee, and therefore welcomes the British Medical Association's calls for the pharmacy regulations to be reviewed.
I am grateful to have the opportunity to debate an important motion. I acknowledge the presence in the public gallery of a number of residents of Berwickshire, together with one of the Chirnside general practitioners. However, I know that the debate has much wider significance and involves many communities throughout Scotland.
The focus of the debate and the point of concern is the suitability and robustness of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 1995, which provide the framework against which NHS boards consider pharmacy applications. The issue is not whether community pharmacists should be allowed to operate at all, or whether in every case a dispensing GP practice is better than a community pharmacy. The question is how the regulations operate and their ability to produce the best outcome for each individual community.
It is important to understand how we have arrived at the present situation. Changes to the pharmacy contract in 2006 allowed community pharmacies to provide additional services over and above the traditional dispensing activities. In general, that has made community pharmacies much more profitable as businesses. The result is that more pharmacy applications are being made in smaller communities such as Chirnside that were not previously a viable business location and in which patients are currently served by a dispensing practice. Under the current regulations, dispensing practices are not allowed to offer the same breadth of services as pharmacies can. The regulations, which control the pharmacy application process, were to be updated with the introduction of the new pharmacy contract in 2006, but so far they have not been altered since 1995, despite the considerable changes that have been introduced by the new contract. A review of the regulations is therefore long overdue. I will return to that point later.
One of the greatest failures of the regulations is that dispensing practices are excluded from the NHS boards' pharmaceutical care services planning process. A GP's right to dispense has no legislative protection and can be withdrawn by the NHS board at any time. When a pharmacy application is accepted, the dispensing practice can lose its right to dispense with immediate effect. That sudden impact on income can have a considerable effect on the practice and its patients.
When a practice loses its right to dispense, the patients in the community will gain access to a community pharmacy service, but that could come at the cost of losing valuable GP services or, in some cases, a branch surgery, leaving the population without a comprehensive GP service. The Minister for Public Health and Sport has disputed that point in the past. However, I have spoken to a pharmacist who is also a GP, and she is clear that if the dispensing income goes, it is very likely that staff will lose their jobs and the practice infrastructure could be in danger. At a time when many rural communities have already lost many services, such as their local post office, it is important that other vital services are not lost.
What needs to be done to address the concerns that exist? The Scottish Government has announced that it intends to review the regulations. I welcome that, but a number of points need to be addressed in that review. I am sure that other members will deal with that matter, so I will deal with three principal issues in the limited time that is available to me.
First, it is essential that patients and dispensing doctors are allowed to participate in the pharmacy applications process. In Chirnside, there was great frustration that the views of local residents were not actively considered. More than 1,100 people signed a petition and more than 600 people wrote letters to NHS Borders about the application. The failure to address those concerns adequately completely undermined the decision-making process. The Government has acknowledged that problem in the consolidated regulations by putting a duty on NHS boards to take reasonable steps to consult on applications, but more needs to be done.
Secondly, the regulations must more clearly dictate the applications process. I will not dwell too much on that point in relation to Chirnside because of the possibility of a judicial review, but it was clear to me that there was considerable uncertainty throughout the process at the highest levels in the health board about how the process was to be managed. For example, why can only one application be considered at any one time when nothing in the regulations requires that? That approach was adopted in the Borders. When that point was tested, the GPs were told that it was due to custom and practice. With so few applications under the regulations, it is hard to know what custom and practice were being relied on. Surely there is no reason why competing applications cannot be considered at the same time. Indeed, in 1995, NHS Borders heard two pharmacy applications on the same day in respect of Greenlaw, which is also in my constituency. However, that precedent was not followed.
Thirdly, there is confusion about whether the regulations prevent the dispensing GPs from continuing to dispense even once a community pharmacy application has been successful. The British Medical Association has recommended that once a practice has lost its right to dispense, there should be a transition process to allow practices to plan for future service provision. However, in correspondence with me, the minister stated:
"the decision to allow a pharmacy to open does not of itself require the dispensing practice to cease dispensing".
It would be useful if the minister were to clarify that point in her closing remarks. It would also be useful to know why the market for pharmacy services needs to be restricted in the way that the regulations anticipate. In the Chirnside case, which I know most about, why cannot the GPs continue to dispense either as dispensing GPs or with their own community pharmacy in competition with the new operator? Why should the market be restricted by the way in which the 1995 regulations are being interpreted?
Although any review may not be able to unpick the questionable decisions that have already been made, a review can deal with some of the on-going issues that face GPs in my constituency to ensure their long-term survival and the continuation of the tremendous medical services that are provided in the district of Chirnside. I look forward to hearing other members' views on this important issue.
I congratulate John Lamont on securing the debate. I know that he has in-depth knowledge of the particular instance in Chirnside, and I note that Richard Simpson has been persistent in asking a series of questions about the matter.
It would be easy to say that this is simply an example of a further turf war between pharmacists and GPs. To some extent, members of the Health and Sport Committee have witnessed that turf war in evidence sessions. Whether or not we put things in such blunt financial terms as pharmacists' income versus GPs' income, at the heart of the matter is the professional delivery of the best of both worlds, particularly in rural communities. Therefore, it would be crass to say that there is simply a turf war.
The problems to which John Lamont alluded are to do with the historical legacy and contractual changes, which have overlapped with previous practices. My understanding is that GPs have no statutory right to dispense, although they have been doing so—I think that there are 130 dispensing practices in Scotland. However, there is a requirement on the NHS board to have a GP dispense if there is no other dispensing service in a community.
As John Lamont said, the introduction of the community pharmacy contract in 2006 extended the services that can be provided over and above what we used to see in the pharmacy. I offer the example of the Romanes pharmacy in Duns, which was mentioned in the context of the Chirnside situation, where there is a patient examination room and a super-duper dispensing machine—which is made in Germany, of course—rather than the traditional model that we used to see, where the combs and deodorants and so on were sold at the front of the shop and the dispensing was done at the back. Pharmacies have moved on, as have GP practices, with community health centres. There has been a bit of exchange and overlap.
However, the procedures for processing applications have been unchanged since the regulations in 1995. Refereeing in such circumstances—if I may put it bluntly—is done by the NHS board, with the assistance of the pharmacy practice committee, but the community is not involved. That should not be the case when we are talking about delivery for the patients. As I understand it, the community can get involved only at the appeals process, when things appear to be done and dusted, which is far too late. There were examples of that in the Borders when the local cottage hospitals closed and the communities could not take part in the process until the stage where they were fighting a losing battle.
There is obviously a bit of a democratic deficit, as well as a process guddle that ends up putting professionals at odds with one another, which is wrong. The public are left out in the cold; they have no part in the decision making until the appeals process, which is not good for anybody, including the boards. It is not often that I defend NHS boards, but it is not good for them either.
Like John Lamont, I note that the Government has laid new regulations before the Parliament, part of which would provide for the introduction of a duty on NHS boards to take reasonable steps to consult everybody involved and those who want to go on the pharmaceutical lists. That includes the public—and about time, too. I also understand that the control of entry arrangements for the pharmaceutical list might be under review—a consultation on that is under way.
I realise that members from other areas are present, but the Chirnside example demonstrates that we have to play catch-up with the reality out there in the delivery of health services to rural communities. We must not end up with a fight-out between the pharmacists on one side and the GPs on the other, with the public in the middle and the NHS boards taking the blame. That is an unhappy situation. I am sure that we are capable of resolving it if we remember that there are particular solutions to rural problems. The NHS board should look at the whole picture in the area and say, "This is working here, so we won't tamper with it." That is an excellent idea.
I will try not to repeat what has been said, but I congratulate John Lamont on obtaining the debate, which is important not just for Chirnside but for all dispensing GP practices and, more important, as Christine Grahame said, the communities in which they are sited. The communities, and the services that are provided to them, must be paramount in our minds.
The situation arose partly because of the 2003 Office of Fair Trading report that recommended the deregulation of dispensing. At the time, the Scottish Executive decided, partly in response to a petition that was lodged, that deregulation would not be appropriate for Scotland, so we have continued to have regulations.
As Christine Grahame said, I have asked six parliamentary questions on this topic, and my colleague James Kelly asked the minister an oral question. The helpful responses to all those questions are welcome, so I take the opportunity to thank the minister for the responses, which indicate that a review of the regulations is to be considered, stakeholders are now being consulted and, in the meantime, matters of public consultation are to be proceeded with, which is welcome. I hope that that will apply to the Drymen practice, because there has been an application for a pharmacy in that area. The answers to the questions that I asked revealed that no board had consulted the Scottish health council about the changes that would occur as a result of the introduction of a pharmacy. In small communities, the introduction of a pharmacy that might destabilise a practice is important—I would regard it as a significant change—so we need to examine the consultation process carefully.
It is clear that the current regulations lack transparency. Those regulations are pre-devolution; they reflect an older health service and an older system. Given the Government's view of a mutual NHS, I know that the minister will want to make the new regulations transparent and fair to all.
Practices are independent contractors, although not in quite the same way as pharmacists are. Practices plan their business—they plan the buildings and the services that are provided from them, which cannot be changed overnight. John Lamont said that the BMA wants a transition period, but it is more than that. If dispensing facilities in purpose-built premises are closed while rent continues to have to be paid on them, that is an unfair imposition on practices that were, after all, required by the regulations to provide dispensing services. We need a set of regulations that reflects the fact that GPs run businesses. That is important.
I suggest that the effects on a practice of the introduction of a local pharmacist should be independently evaluated. The benefits and risks should be assessed by a health board committee, if that continues, but we need an independent evaluation of whether a practice will be destabilised. I say with due respect to my GP colleagues that, if they say that their practice will be destabilised, it is easy to put together a petition with as many signatures as the number of people who are registered with the practice, because no patient wants to lose their practice. We need independent evaluation that will allow effective consultation.
I have said repeatedly in many debates that pharmacists are highly skilled health professionals. Until recently, their skills were massively underused in the health service. The new contract and the developing role of pharmacists are welcome. In assessing the benefits and risks of a new pharmacy, it is important that we acknowledge that, in their new role, pharmacists provide an extended service that some general practitioners cannot provide.
I welcome the minister's replies to my questions and the review that will be conducted. I ask her to look carefully at all the issues. When she sums up, perhaps she could list all the issues that will be considered and discussed with stakeholders before the review is completed and give us a timetable for completing the review.
I, too, congratulate John Lamont on securing the debate. I was happy to support his motion and I associate myself with his speech. I also acknowledge the amendment that Dr Simpson lodged, which helps by expanding on some key changes that might need to be considered to address the shortcomings in the regulatory environment.
John Lamont set out the concerns in Chirnside about an application to open a community pharmacy there. As Christine Grahame said, such concerns are echoed elsewhere—not least in my constituency of Orkney, where a similar application in Dounby has caused widespread anxiety about the potential impact on primary health care services throughout the west mainland.
I will focus on the situation in Dounby, but I recognise the important role that community pharmacists play in our urban and rural areas. Their expertise and the service that they provide—often alongside GPs and other medical professionals—are highly valued. As Dr Simpson said, following the 2003 OFT report on pharmaceutical services, the Scottish ministers sensibly resisted calls for widespread liberalisation, which would have seriously undermined the position and development of community pharmacies.
The position and development of dispensing GP practices also merit close attention. As members have said, such practices are particularly prevalent in remote and rural areas. That is in no way surprising. In parts of the country where the population's size and dispersal make delivering public services difficult and therefore costly, bringing services together in a single location can be the only way of making them sustainable.
The Dounby GP practice has been built up over three decades from its start as a single-handed practice in cramped premises. The surgery now provides local residents with access to a one-stop shop where patients can see one of two doctors, as well as a nurse, a physiotherapist and a chiropodist, all under the same roof. At a single sitting, patients can pick up any medication that they need, which is often ready by the time they leave the consulting room.
As an integrated primary care team, working closely with the community nurse team that is based at the surgery, the staff understand their patients' social and family relationships; in the case of more dependent patients, they know who the patients' carers are and who supervises their medication.
In no sense has the application to open a community pharmacy in Dounby village, directly opposite the surgery, been driven by demand from patients—quite the contrary. I accept Dr Simpson's remarks about the ease with which petitions can be struck up, but around 1,500 letters have already been sent to me, from a patient list of 2,300. Petitions have secured even more signatures.
Such concerns are shared by the wider medical community in Orkney. The secretary of the local medical committee wrote in March:
"The resultant substantial and immediate reduction in funding to the Dounby practice, which would occur should this pharmacy application become successful is likely to seriously destabilise it and significantly reduce the service to West Mainland patients which they currently receive".
He went on to ask how provision would be provided to patients in the area if the pharmacy were set up but subsequently failed. A letter in much the same terms was sent by the secretary of the NHS Orkney area medical committee.
I acknowledge and welcome the Government's consultation on the National Health Service (Pharmaceutical Services) (Scotland) Regulations 1995, which, as Dr Simpson said, predate devolution. However, there appears to be a strong case for suspending consideration of current applications until the consultation process is complete. John Lamont, in his speech, and Dr Simpson, in his amendment to the motion, have highlighted a number of ways in which the consultation could be taken forward and improvements made; I will not repeat those suggestions now.
The Dounby practice has invested heavily in the development and expansion of the services that it offers to patients. As part of that development, it has secured the services of a highly skilled dispensing practitioner. It seems inconceivable that that is being put at risk. I urge the minister to take on board the points that members from all parties have made this evening and to respond positively to their concerns.
I, too, thank John Lamont for securing this debate and for the excellent points that he has made on an issue that affects constituents not only in the Borders but, as Liam McArthur said, in communities across the Highlands and Islands, including Appin, Lismore and Glensanda in Argyll, Dounby in Orkney, Lochaline and many others.
Although the minister has stated that the extra remuneration that GPs receive to cover the dispensing service is not intended to be used to cross-subsidise general medical services and should have no impact on the GP services that are provided, the fact is that additional income from dispensing makes some rural GP practices viable and helps them to exist. One doctor from Argyll stated:
"I can confidently say that 40% of rural practices in remote and rural Scotland would disappear if dispensing income was taken from them".
He continued:
"the reality is that the dispensing income is essential to maintain General Medical Services in many practices in rural Scotland."
I hope that I am not repeating what Liam McArthur has said, but a letter from Dounby states:
"The granting of an application to open a pharmacy would have devastating consequences on the level of service the GP practice provides".
Concerns have also been expressed in Drymen and various other parts of Scotland. The BMA confirms that one dispensing GP has a part-time partner, a half-time nurse and an extra receptionist as a result of dispensing.
For the reasons that I have outlined, I support Richard Simpson's call for the process to include
"independent evaluation on the effects upon the stability and service provisions by that practice",
as well as the other points in his amendment.
Like Christine Grahame, I would like to raise some topical issues relating to the Tobacco and Primary Medical Services (Scotland) Bill that is currently at stage 1 in the Health and Sport Committee. In its written evidence, Community Pharmacy Scotland expresses concerns about whether the current model of GP practices will even be in existence in 10 years' time.
It would appear from the organisation's evidence that community pharmacies would be willing to employ doctors to provide general medical services. In some cases, in particular areas, that might be the best and preferred approach, but I am aware that staff in some newly built and existing health centres who have been working towards providing a one-stop shop for patients to see the doctor, nurse, allied health professionals or mental health staff have found that when they propose the inclusion of a pharmacy the local pharmacist is first in the queue to complain. Like Christine Grahame, I do not want the debate to be a pitch against GPs or pharmacists. Instead of considering only the loss of the dispensing facility to GP practices, the Government might wish to consider the inclusion of dispensing in larger, as well as smaller, health centres and GP practices.
There is no doubt that GP practices in some remote and rural areas are sustainable only as a result of their dispensing facility. Let us look more widely, in this changing environment, to different models that put patients first and foremost and at the heart of the health service rather than have a turf war between pharmacists and GPs.
I, too, congratulate John Lamont on securing this important debate on an issue that is of some concern in my constituency, where we have a number of dispensing GP practices.
Last summer, I spent a day with a group of rural GPs who operate three surgeries in rural Clydesdale. They have recently lost the ability to dispense at Coalburn, which directly contributed to their decision not to build a new surgery. The process that led to the removal of dispensing there was without doubt wholly unsatisfactory: it was remote and it did not involve patients in a meaningful way. I and other elected representatives were made aware of the proposal only because of the GPs' lobbying, so we, too, were able to undertake only limited consultation with patients. That is neither open nor transparent.
The practice dispenses at Rigside, too. Like Coalburn, Rigside is a community with many challenges. It is a former mining community, and many residents have diseases such as emphysema, asthma and lung disease. There are higher-than-average rates of heart disease and depression in the area, and there is a high incidence of many cancers. The GPs provide an invaluable local service, delivering a very holistic approach to health care. I witnessed that myself as I sat in on the consultations that took place on the day I spent at the surgery. Surgeries frequently overrun as a result of that, and it is unlikely that a pharmacy would be able to stay open to respond to such changes. However, with local dispensing, people are still able to get their medicine. Similarly, people with long-term conditions can be more easily and carefully monitored by the practice—and there are a lot of people in the communities concerned who have serious, long-term conditions. Patients to whom I have spoken like the service they receive and they have no appetite for change.
I am genuinely concerned that if a pharmacy were to apply to open in Rigside and was successful, the surgery would no longer be viable and the practice would withdraw from both Rigside and Coalburn and operate one surgery from Douglas, which is 4.5 miles away and has very limited access by public transport. That would have a seriously detrimental impact on patients. It is to their advantage to have a local GP surgery in their village.
I have been in discussion with GPs in Carstairs, which is also in my constituency, who have operated a dispensing practice for more than 40 years and are considering purchasing new and improved premises in the village. I am concerned that if that dispensing income were removed, that practice too would no longer be viable.
I appreciate that, when the minister stands up to wind up the debate, she is most likely going to say that dispensing should not be integral to the viability of the practice. That would be the case in an ideal world, but in the real world dispensing allows practices to keep open satellite surgeries, such as we have at Rigside, or to provide additional services such as additional GPs and practice nurses, as happens at Carstairs. If there were no dispensing, such activity would not be viable.
I support amendment S3M-4047.1, which Richard Simpson lodged. We need a balanced debate; this is not about pitting one side against the other, as members have said. GPs, like people in every other sector, are not immune to the temptation to overegg the pudding or to use change as an opportunity to do something that they wanted to do but did not want to take a popularity hit for doing. We need independent evaluation, to ensure that what happens is in the interests of the community.
I passionately believe that access to high-quality local primary care is crucial if we are to end health inequalities in Scotland, treat long-term conditions effectively and reduce the incidence of protracted periods of ill-health in the population. A reduction in access to GPs in communities such as Clydesdale, where rural deprivation is undoubtedly a factor, could only be a backward step in tackling health inequalities.
Mary Scanlon was right to say that we must find a solution that is right for Scotland and for the communities we serve. There should be no reason why we cannot have integrated local health care facilities such as the facility at Lanark, where a pharmacy sits alongside the health centre and the GP practice in a health campus. I urge the minister to do everything she can to ensure that as we develop the right solution we do not lose GPs from fragile rural settings.
I congratulate John Lamont on securing the debate. I wanted to speak in the debate because the petition to which the motion refers was submitted by my constituent, Alan Kennedy, from Leuchars.
The petition—PE1220—was lodged as a result of an application to establish a community pharmacy in the post office at Leuchars. Dispensing services are currently provided by a GP practice that covers Leuchars and Balmullo. There was considerable public concern about the application, not because anyone was against the co-location of pharmacies and post offices in principle but for a number of reasons.
Not least of those reasons was concern about the loss of GPs' particular knowledge of patients in dispensing essential drugs and equipment. More significant, there was genuine fear that the loss of income to the GP practice would result in a reduction in the service that the practice could provide. Dispensing income does not go into the GPs' pockets but is ploughed back into services, which allows the GPs to run two surgeries—one in Leuchars and one in Balmullo—and to provide additional nurses and services that they would not otherwise be able to provide, much as happens in practices in Karen Gillon's constituency.
People were also seriously concerned about the adequacy of the proposed premises. The premises are suitable for the purposes of a post office, but in the context of the application there was concern about accessibility, space and, in particular, the ability to provide a confidential consultation area, which is a requirement.
I attended a public meeting in Balmullo hall, which was attended by a large number of patients from the practice. I received a huge number of representations from constituents and it was quite difficult to establish what to do—I hope that the new regulations will set out how decisions are taken. I was eventually able to establish who was the chair of the local pharmacy practices committee, which meant that I could pass on my constituents' concerns. However, the committee could not take account of the wider health care issues that concerned my constituents, such as the potential loss of services. The committee could consider only whether the applicant was a fit person and whether the premises would be fit for purpose.
A decision was taken in December that the premises would not be fit for purpose, for the reasons that I gave. The decision went to appeal, which was not determined until May. At that point there was a collective sigh of relief among constituents in Balmullo and Leuchars, but a couple of weeks ago a fresh application for a pharmacy on the same premises was made under a different name.
I ask the minister to comment on whether there should be a time bar on reapplication where an application fails, unless it fails for a particular reason that is then resolved or the circumstances in the area change significantly. It seems bizarre that a community can campaign successfully to resist the establishment of a pharmacy and be left having to start the process again from scratch just a couple of weeks after a national appeal was rejected.
Will the new regulations allow local pharmacy practices committees to take account of the wider health care issues in an area to ensure that allowing a community pharmacy to open and removing the dispensing services from a GP will not result in a significant loss of other services that are vital to local communities?
I welcome the opportunity to take part in the debate and congratulate John Lamont on securing it. It is clear from the way that he spoke that he has a lot of knowledge about the matter and cares deeply about the needs of his constituents.
I do not want to be drawn into the debate about GPs versus community pharmacists. My concerns are about pharmacy applications and the need to involve the public. From that point of view, I welcome the new regulations that the minister laid before the Parliament, which will come into effect on 1 July and secure greater public involvement. I also welcome the consultation that has been announced, which gives us the opportunity to amend the regulations and make the system fairer and more transparent.
I will relate an instance in my constituency in which an application is subject to appeal. It is an application that I support but do not believe has been treated fairly. Indeed, the applicants are now on their second attempt to set up a pharmacy, having strengthened their original application.
The area where they want to site their pharmacy has a high number of pensioners, a great deal of social housing and a limited number of car owners. The application was originally rejected on the basis that constituents could get to two pharmacies nearby, but a constituent who does not have a car would need to travel by bus to get to them. That situation is unacceptable, as is the reason for the rejection.
I have concerns about the transparency and openness of the process. My constituents, Mr Balmer and Mr Dryden, had difficulty at times acquiring information about the process as their application went through the pharmacy practices committee and the national appeal panel. I have specific concerns about the role of Community Pharmacy Scotland in the application. At the appeal on the original application, the organisation's chairman and a senior member of its executive committee both objected. They have pharmacies locally, but Community Pharmacy Scotland has representation on the national appeal panel and I submit that that is a conflict of interest. In this case, it was not declared. That is a problem, and it must be addressed in the consultation.
Mr Balmer and Mr Dryden have an excellent case for their application. I am running a survey in the area of the constituency that is affected. I have sent 1,200 letters and received more than 440 postcards in return supporting the application. In fact, more people have participated in that survey than voted at the European elections. That demonstrates support for the application and that, were a pharmacy to be set up in the area, it would be economically viable.
The debate has been excellent. Members have brought different views and experiences to it, and I am sure that the minister will reflect on them in her closing speech. We need a process that delivers better outcomes for the public. To achieve that, we need more transparency and greater public involvement.
I thank John Lamont for raising some very important issues.
Members will be aware that, over the past few months, there has been significant interest in the procedures by which decisions are made on applications to open community pharmacies—examples of which have been aired in tonight's debate. The issue is greater in remote and rural areas, where the viability of a community pharmacy might not be guaranteed. In areas where patients might have difficulty in accessing pharmaceutical services through a community pharmacy, an NHS board may require a GP practice in the area to dispense prescribed items for some or all of its patients. I agree with John Lamont that dispensing GP practices have an important role. I know that many patients who collect their prescriptions from their GP practice value the service very much indeed.
Although there are some overlaps in the knowledge and skills of the medical and pharmaceutical professions, their respective education and training complement each other. The best therapeutic outcome for patients comes from both professions working together for the benefit of the patient—a point captured by Christine Grahame—which is very much at the forefront of our thinking on where we want to get to. The Scottish Government will continue to explore innovative ways to allow patients to have access to independent advice on their medicines from pharmacists.
The new community pharmacy contract is designed to build on pharmacists' role in caring for patients by making full use of their clinical skills and expertise. The community pharmacy network across Scotland is well placed to provide accessible services in local communities in a way that enhances patient care and improves health outcomes, as Richard Simpson mentioned. Contracted services already in place include the minor ailment service, the public health service, and the acute medication service. The chronic medication service, which is currently undergoing early testing in Fife, will be rolled out across Scotland from October this year.
There is, and there will remain, a need for some GP practices to provide a dispensing service for their patients. There will continue to be some marginal cases in which a new pharmacy applies to a health board to open in a particular area. Boards must satisfy themselves that the provision of pharmaceutical services at the premises that are named in an application is necessary or desirable in order to secure provision of pharmaceutical services in the neighbourhood in which the premises are located. Such decisions must be a matter for the board concerned. As John Lamont will know—as the correspondence between us has confirmed—the Scottish Government is not involved in making those decisions.
What is the Government's view on whether a dispensing GP practice may be required to cease dispensing when a community pharmacy application has been successful?
I will come on to that point in a moment.
John Lamont is concerned that the application process does not allow the board to hear the views of GPs or of local people who might be affected by the board's decision. I am aware that other members, and members of the public, have raised similar concerns. We have listened carefully to those concerns.
As members will know, we laid replacement regulations on pharmacy applications before the Parliament on 18 May. Subject to approval by Parliament, those regulations will come into force on 1 July this year. The regulations will place a duty on health boards, when applications to the pharmaceutical list are made, to take reasonable steps to consult persons to whom pharmaceutical services might be provided as a result of the application. The regulations will replace the requirement on boards to consult local health councils—which were abolished in 2005—and will ensure that local people are consulted. However, how such local consultation should best be undertaken will remain a matter for boards.
In addition to those amendments, we intend to review the legislation further and to undertake a formal consultation exercise in the autumn. As I announced to Parliament on 21 May, the review process will begin before the summer recess through open discussion with stakeholders, including the BMA's Scottish general practitioners committee and Community Pharmacy Scotland. We will take that forward and complete the process as quickly as possible.
John Lamont's motion calls on the Parliament to be aware of the Public Petitions Committee's inquiry into PE1220. Members should note that the committee has been kept fully informed of our position. Indeed, the Scottish Government wrote to the committee on 21 May to advise it about the replacement regulations and about the review that I have mentioned. At its meeting on 2 June, the committee agreed to reconsider the petition once our review of the relevant legislation is completed, and I look forward to hearing its views at that time.
John Lamont raised the case of the application to open a community pharmacy in Chirnside, in which he has a strong interest and which he has represented extremely well. I am aware of the particular circumstances of the application, although, as he will appreciate, I cannot comment on the decisions that have been taken by the board's pharmacy practices committee or the national appeal panel. Ministers have no involvement in those decisions.
The Scottish Government has been called on—by, for example, the BMA—to suspend decisions on applications until the Public Petitions Committee has completed its consideration of the processes, and Liam McArthur made such a call earlier. As I indicated, the Scottish Government is not involved in those decisions. Moreover, we cannot suspend the operation of the current pharmaceutical services regulations, which are subordinate legislation, nor can we ask NHS boards to suspend their decisions, as that would not be compatible with the regulations.
I turn to the point that John Lamont made in his intervention. It has been claimed that a dispensing GP practice will be required to cease dispensing if an application to open a community pharmacy in the area is approved. I should point out that the relevant legislation does not require the dispensing GP practice to stop dispensing for all patients. Again, that is a decision for boards, which must take local circumstances into consideration. In such cases, boards are required to reconsider whether any patients would have serious difficulty in obtaining prescribed items.
In many cases, it will demonstrably not be the case that a patient would have "serious difficulty" in obtaining prescribed medications, but it is pretty unrealistic to expect a GP dispensing practice to continue to dispense a small part of what it previously dispensed, given the levels of investment that will have gone into developing the practice as a whole.
I was going to repeat that the extra remuneration that GP practices receive for providing dispensing services is intended only to cover the additional cost of providing those services; it was never intended to cross-subsidise their base general medical services provision. However, I recognise what has been said in the debate about the realities of the situation in some areas of the country.
I thank John Lamont and other members for raising important issues. I am grateful for the opportunity to reiterate the Scottish Government's position, which is that we take seriously his concerns, those of the Public Petitions Committee and those of the many others who have an interest in the issue. Although the review will be on the control-of-entry arrangements rather than pharmaceutical services as a whole—it is right and proper that we have restricted it in that way—I am confident that most of the issues raised by Richard Simpson, as well as Iain Smith's point about reapplications, will be considered as part of it.
I welcome tonight's input and encourage members to continue to contribute to the review process as we take it forward.
Meeting closed at 17:53.