New Petitions

I wish simply to make five main points for the committee to consider in conjunction with what you have already seen in the petition. First, I accept that, in November this year, the Cabinet Secretary for Health and Wellbeing agreed publicly, at last, that the current Scottish pharmacy application legislation is deeply flawed and will be revised. He has promised action soon. However, that process of review actually began in June 2013, following an MSP’s meeting with Michael Matheson, the Minister for Public Health, which identified serious problems with the legislation. We are still awaiting action, six months later.

Secondly, although the threat to Benbecula’s GP dispensing has been removed for now, two more practices are threatened with unwelcome applications—one in Drymen and one in Aberfoyle, and there may be a third one in Castletown. If a moratorium on further applications is not applied, other applications will follow; some 40 of 101 dispensing practices in Scotland are at risk. The problems and distress that those unwelcome applications are causing in communities and to staff should not be underestimated.

Thirdly, there is a belief in Government and the pharmaceutical industry that each and every existing pharmacist might be adversely affected by new start-ups. Thus, many pharmacists oppose new pharmacies even outwith their local area, whether they be independent or co-located with a medical practice. Government officials have admitted that the legislation is protecting pharmacists when application decisions are being made, regardless of community input. I have used freedom of information requests to determine dispensing income in every pharmacy in Scotland, and with input from an experienced dispensing practitioner, it is clear to me that rarely do such dangers exist. Some pharmacists will go to extraordinary lengths to protect their existing profit margins. Competition, as advocated by the Office of Fair Trading some years ago and rejected by the Scottish Government at that time could, I believe, save tens of millions of pounds in the Scottish national health service budget.

Fourthly, there is little evidence that those who are involved in negotiating and setting down the pharmacy legislation are prepared to take note of what patients in communities all over Scotland have been telling them for the past five years; namely, that patients demand a say on what they want locally, and having imposed upon them an unwanted pharmacy is definitely not part of that demand. Communities, including Whitlawburn, seek to have independent pharmacies; they should not be denied that choice by other pharmacists outwith the area.

Finally, at present, pharmacy legislation operates in a way that brings huge profits for a few and an impoverished health service for many people in the communities that are affected. It should not matter whether the dispensing and other services are provided by GPs, co-located GP surgeries and pharmacies, or independent pharmacies. Input that seeks to deny or restrain democratic choice must be rejected, whether it comes from Community Pharmacy Scotland or any other body that is associated with the NHS dispensing service to patients. It is time to change the legislation to support patient choice.

The Wilson and Barber report has been useful in that it has highlighted the problems. You will have noted that it calls for a moratorium. It is clear that reconsideration of the legislation is long overdue.

My reading of the situation from the information that comes in to me is that all GPs would welcome closer co-operation with pharmacies. What they do not welcome is the interruption to GP services that can be caused by a pharmacy coming into a dispensing area. That has to be looked at seriously.

What has happened in Millport is probably extreme. It has happened mainly because we are an island community. As a result of a pharmacy being imposed on us despite the fact that, in the consultation, patients were very much against a pharmacy coming in, we have lost a first-class service by three doctors who did all the out-of-hours work and their own surgeries, and we are now being serviced by locum doctors 24/7. We have had three adverts out for a doctor’s practice. We had one applicant who was refused interview or consultation to see whether anything could be done. We now face having temporary salaried doctors and our out-of-hours work is going to be serviced by advanced nurse practitioners, who are being trained specifically to deal with an island situation.

We have gone from having a superb service to having a poor service where we do not know the doctors and we never know who is coming. Once the salaried doctors come, it is a known fact that those people will be temporary. We have an elderly population who are extremely distressed about all this, and there will be no continuity for them. The situation has divided our community considerably, because the older ones are feeling the problems while the younger ones are quite happy because they only have minor illnesses and they get their free bits and pieces from the pharmacy.

As Alan Kennedy said, all that we are asking for is to get our dispensary back so that the money that is generated from it can pay for the full amount of doctors that we need. The general anecdotal evidence that we are getting is that the people who showed an interest when the adverts went out withdrew because they felt that the practice was unviable, given what was expected.

Yes. We asked that the dispensary remain open even though the pharmacy was coming in, but NHS Ayrshire and Arran refused that and closed the dispensary. We know that it has the authority to let the dispensary stay open, but it did not do that. As a result, we are unable to attract a GP practice that would be sustainable, safe and affordable.

I cannot speak for the doctors, but I note that they were there for almost 30 years and had built up a superb practice for us. We have not had a pharmacy on the island for 40 years. The doctors chose to put a great deal of the money that was generated from the dispensary into paying for a third doctor and their out-of-hours cover.

I add briefly that Millport is not alone in the doctors giving up. We have lost both our doctors in my community. Having started with a wooden shed, they ended up with two purpose-built surgeries, but now they can barely afford them.

I do not see why there should be a conflict, because the system has worked perfectly well for many years. Another myth that I should dispel is that pharmacies can provide services that dispensing doctors cannot provide. When we examine what happens in rural surgeries that are dispensing, we find that they mirror pharmacies in a certain way, and they are also cheaper. However, I am not here to defend dispensing doctors. I am here to point out that, when we look at the matter, more options are open than may at first appear.

Yes, but dispensing—

If you look at the clawback from dispensing income to GPs and to pharmacists, GPs are actually less costly than pharmacists. There is about a 1.5 per cent difference in the costs to the NHS.

NHS boards would tell you that they are applying the letter of the law, but the legislation is weighted so heavily in favour of pharmacy applications that the needs, wishes and expectations of communities are not recognised. Boards have always argued that dispensing should not continue because the service is inadequate. To be frank, that is wrong and takes no account of what patients consider to be an adequate service.

The ideal solution is a co-located pharmacy and GP surgery, but that is not permitted.

That is correct.

That is correct.

The Scottish NHS has never recognised that cross-subsidising from GP dispensing income to support other services is valid. Dispensing GPs are treated as contractors, which is quite different.

Let me explain, taking the example of Leuchars and Balmullo. When Leuchars was granted a pharmacy, dispensing in Balmullo had to cease because the Leuchars pharmacist objected. We have exchanged a dispensing practice that was purpose built for dealing with dispensing problems, as you have described, and we now have a poky little pharmacy sharing premises with a post office, with difficult disabled access and very limited privacy. We have exchanged an excellent one-stop service for another service that is considered unsatisfactory, not by me but by the local community. I think that the case is unique in that I got five community councils in the area to agree that what we have is unsatisfactory. Usually they barely talk to one another, but they are agreed on that.

Yes. It would be sensible, especially where it can be publicly demonstrated that the community wants a service. In my case, the community is not particularly rooting for a dispensing service to be brought back, but it would like a pharmacy service and it cannot get one, despite being the largest village in Scotland.

I do not entirely agree with Mr Carlaw. I apologise for that. During the past three and a half years, in which we have been fighting the closure, we have gone to great lengths to converse with NHS Ayrshire and Arran. When we and our local councillor met the chief executive and the chairman of the board on 25 November 2011, we asked them two simple questions. One was why the dispensary could not stay open as well as the pharmacy; we asked that question three years ago.

We emphasise that we are not anti-pharmacy but pro-dispensary. I have only recently gone back to live on the island, having been born there. The service that we were getting—and would like to get—is much more suitable for our community, which is where I agree with Jackson Carlaw. One service does not fit all, particularly in Scotland, where there are so many small and rural communities of people who are now having to travel.

Our pharmacy is in an unsuitable location as it is right beside a bus stop, there is no parking, especially in the summer, and there is a bicycle shop right beside it. The whole thing has not been considered properly—that was our argument with NHS Ayrshire and Arran. The only reason that the board gave us was that Mr Semple, who has the pharmacy, may choose to sue for breach of contract. We think that that is the reason why the board has definitely closed our dispensary, and we would like that to be taken into consideration.

I am saying that they are weighted against a pharmacy opening where other pharmacists oppose it. They have the privilege of defining the neighbourhood need with regard to such applications; it does not come from the community, whose view is not accepted.

I have looked at the evidence that was provided to me recently by a dispensing GP, who is aware of the discounts that are being achieved. Currently, the Scottish Government works with pharmaceutical firms to establish what the base price should be. It then deducts a certain amount in reimbursement to pharmacists and GPs, knowing that they will get a small discount. The problem is that the amount of discount that pharmacists are getting is not clear. That needs much more exploration. There was an example in London recently in which a pharmacy was marking up particular medicines by 500 per cent as well as getting a discount. There was a court case about it.

The amount of discount that pharmacies—even small ones—are achieving is in the order of 20 per cent. A larger firm operating in Scotland, such as Boots, can get up to 50 per cent. I am not an accountant, but I would have thought that somebody in Scotland should be picking up on that issue and asking whether we are examining in detail what discounts are being achieved. I am certain that there is money to be earned by doing that. When we consider the overall cost of prescriptions over the past two years—from memory, it is about £2 billion—we can see that there must be savings in there.

It almost has to be taken up as a separate matter. It is not something that the pharmaceutical directorate can consider.

Yes—there are 101 of them. Another example is Carstairs. It had a dispensing practice, and a pharmacy was allowed to open opposite. Two GPs left the practice because it was no longer viable. It was recently rescued from being closed thanks to an injection of £50,000 from—I think—South Lanarkshire Council to pay for repairs to the building and keep the place open. Without dispensing income, it would have gone.

I repeat that, in Scotland, cross-subsidising from dispensing income is not recognised, whereas in England it is.

There is a cost in time, a cost in convenience and a cost in money. Since our dispensing practice closed, people in Balmullo have had to get on a bus or into a car. We now have a situation where we have a pharmacist who is the pharmacist of choice for the community—who would have started in the GP practice in combination—and who is delivering to the surgery. It is a compromise that is working and a lot of people are taking it up, but it is not a pharmacy service; it is simply a delivery service of pre-prepared prescriptions. It is one way round the current impasse, but it is not what our local community would like. It would like to see the pharmacist set up shop.

Yes. In addition, you must remember that patients choose which pharmacist they want to supply them if they do not have one in their area. The patient should have the right of choice. In Millport, they would like the right of choice, but they are denied it. Because they choose not to use the island pharmacy, they have to travel to pick up dispensing products from a pharmacy on the mainland.

It is not purely a matter of choice because the pharmacy that has now opened is quite a considerable distance from the surgery, which is a particular issue for older people. The surgery has a lift, full disabled access and car parking. We have no public transport on the island, and when the ferry goes off, the ferry bus goes off. It costs our older people the minimum fare in a taxi to go and get their prescriptions collected and take them home.