Pharmacies and Integrated Healthcare: England

Wednesday 11th January 2017 Westminster Hall

00:00

[Mrs Anne Main (St Albans) (Con)]

I beg to move,

That this House has considered pharmacies and integrated healthcare in England.

It is a delight to serve under your chairmanship, Mr Bailey. In the light of the extreme pressures on our health services, particularly in the winter months—much has been made of this recently in the media, although it is not dissimilar to many other years—with our over- burdened frontline services, clogged up A&E departments and congested GP services, I believe it is vital that we explore new models of delivering patient care, particularly an integrated model of patient care.

In 2016, there was an average of 2,500 more attendances at major A&Es a day compared with 2015, which is a 6% increase. People aged 80-plus have the highest rates of A&E attendance. As a country, compared with only a few decades ago, we are now fortunate enough to benefit from innovative drug treatments, greater survival rates from complex surgery, better nutrition and better education; but, as a population, many of our residents are living longer. For example, in my constituency of St Albans, the average life expectancy for a pensioner is over 89 years—it is nearly 89 and a half years. However, for far too many of our constituents, the latter part of their lives brings a prolonged period of frail health, with dementia and diabetes on the rise and an increased incidence of ill health linked to lifestyle choices such as lack of exercise, alcohol, obesity and smoking. That period at the end of our lives is often not characterised as a period of good health.

We need to come up with a seamless, flexible model that makes the best use of precious resources and benefits patients. It is therefore timely to explore in this debate the role that local pharmacies play in local health services and the potential role that they might play to ease the strain on more congested frontline services. I also want to make the Government aware of the continuing importance of pharmacies in communities and their potential to do so much more.

In an ever-changing world, we have a duty continuously to challenge the old models of health delivery systems. In October, the Government proposed to reallocate money to NHS frontline services. We all accept that the NHS is labouring under huge financial pressures, so any areas in which precious resources are dissipated due to inefficiencies or duplications ought to be considered. It is important to integrate community pharmacies into the NHS urgent care system and GP services. We need to promote a pharmacy-first culture for minor ailments to take pressure off frontline services.

Community pharmacies currently see some 1.6 million people a day in the UK. It is worth noting that the recent standard patient experience report for the East of England Ambulance Service NHS Trust in 2016 showed that 0% of respondents in my county of Hertfordshire had contacted a walk-in service, an out-of-hours GP service or a pharmacy service before contacting the ambulance service. I think we can agree that a lot more can be done to take the pressure off emergency frontline services.

Pharmacies are the most accessible health services in most communities: they are found on high streets, in supermarkets and in shopping centres. In St Albans, we have some great independent local pharmacists who want to get more involved and we even have the headquarters of the National Pharmacy Association, which supports independent pharmacies and helps them grow their businesses. We need to look at the current pharmacy model. In St Albans, patients can choose from five dispensing pharmacies within a half-mile area of the high street. Some pharmacies are just over the road from each other, and some have only yards between them. Given the Government’s financial support of £25,000 for those dispensing 2,500 prescriptions per annum, which comes directly out of our NHS budget, it is easy to see why we need to look at the model of provision and ask how we can get a better bang for the NHS buck.

I accept the Government’s assertion that a balance must be struck to ensure that pharmacies remain accessible but are not excessive in number and, importantly, that we have a range of offering. All the local pharmacies on the high street in St Albans are closed on Sunday, whereas the big supermarket pharmacies are open, in line with their shopping experience. It is worth noting that Sunday is the busiest day for most A&E services. However, a recent survey showed that 50% of people prefer, for a variety of reasons, not to use a pharmacy in a supermarket, particularly the retired, the elderly and other frequent pharmacy users. We therefore need to examine the model of opening hours, as well as location and the type of provision on offer. Given that many supermarkets are located outside the town centre, their pharmacies are not accessible to everyone, particularly the most vulnerable in society. Diversity and accessibility of provision are key to integrating pharmacy and health services.

Let us explore what pharmacies could do. Pharmacies should be capable of providing general health services. They could increasingly work beyond the traditional role and offer services to promote sexual health, increase physical wellbeing and give advice on flu immunisations and drug-harm prevention, for example. However, if we expect pharmacies to do more, we need the funding formula to reflect the quality of service they provide. That is what the pharmacies want. Local pharmacists in St Albans believe that they should be the first point of contact for advice on medicines, minor illnesses, healthy living and wellbeing. To facilitate that, the Quadrant pharmacy in St Albans has undertaken a major refit, with a brand new consulting room, and invested heavily in technology, including an expensive automated robot for dispensing medicine.

I visited the Quadrant—I am sure that many hon. Members made similar visits after the Government’s pronouncements in October—in November last year to discuss the opportunities and challenges facing small independent pharmacies. The pharmacy is a friendly, attractive place to pop into and is well regarded by local people. It has the potential to do so much more, but that extra service does not come without a cost. If people spend time talking to their local pharmacist, the pharmacy gains nothing if they then walk out of the door and go off to see their GP. It is important that we recognise the role pharmacies are being asked to play in giving advice, holding consultations and, potentially, dispensing services. There must be some reflection of the cost involved in the staff time that it takes to do those things.

Rachel Solanki, the director of the Quadrant pharmacy, told me:

“General Practice will need to continue to be the gate keeper of referral to secondary care.”

However, she helpfully suggested

“a whole raft of services and support for self-limiting and long-term conditions”,

such as dealing with uncomplicated urinary tract infections in women, impetigo and bacterial skin infections; managing non-complex patients with high blood pressure; performing healthy heart and cholesterol checks; and supporting patients diagnosed with diabetes. The list was quite exhaustive. She proposed that pharmacies could and should act as wellbeing hubs for the communities they serve. She went on to say:

“The community pharmacist, a highly-skilled and trained individual, is the most accessible healthcare professional and is available without an appointment. If a mechanism could be found to incentivise and remunerate, we are confident the mutual agendas would be achieved.”

That is her view, and that of many other local pharmacists. There is a mutual agenda for providing good healthcare for patients that could be achieved if pharmacies were brought into play.

The Government’s proposals in October last year were a step in the right direction, but we need more detail. I want to ask the Minister a series of questions, and hopefully he will be able to answer some of them. How can the Government make smaller and local pharmacies more attractive and accessible for everyone? How can the Government encourage GPs to offload services such as flu jabs on to pharmacies? In saying “offload”, I recognise that where there is a cost to the pharmacy and the GP is in receipt of payment for that flu jab service, that needs to be considered, but I would like to hear the Minister’s views on that. How can the Government promote the pharmacy as an alternative local health provider that can be trusted and deliver a quality service? This is not just about having a shop that you take your prescription to and maybe pick up a few aspirin; it is about the pharmacy being a health provider. How can the Government increase pharmacy capacity to provide a broader range of health services and ensure the correct remuneration for the service provided?

Responding to an oral question on 2 March 2016, the then Health Minister, Lord Prior, stated:

“The big driving force going through healthcare and community pharmacy today is one of integration, which means that community pharmacies must in future work more closely with their local hospitals and GPs.”—[Official Report, House of Lords, 2 March 2016; Vol. 769, c. 817.]

That is the point of today’s debate. The Government have pursued several polices that are intended to lead to better integration of community pharmacies, including the introduction of a pharmacy integration fund as part of the 2016-17 community pharmacy settlement.

Last month, Richard Murray of the King’s Fund published a paper looking into the role of community pharmacies in the NHS. In December 2016, the Minister described that review as

“an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well.”—[Official Report, 20 December 2016; Vol. 618, c. 1301.]

When can we expect a response to that incisive review?

The NHS “Five Year Forward View”, which was published in 2014, recognised that GPs are “under severe strain”, and many of us will have met GPs locally who have restated that view to us. It also states that steps will be taken to:

“Build the public’s understanding that pharmacies and on-line resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit.”

I urge the Government to listen to pharmacists when considering how to take that integration forward, as we do not want to lose what is good in the system, especially where it works well for our local patients. For example, I know that the Government are piloting an urgent medicine supply service. Rachel Solanki, the director of the Quadrant pharmacy, tells me that in Hertfordshire there is a local scheme that is so well regarded that it has now been rolled out again. Her concern is that the proposed national service does not necessarily promote a pharmacy-first culture. The Minister may wish to clarify that that is not the case, but that was the view she expressed to me. She was worried that there might be a perverse incentive to encourage patients to phone NHS 111 in order to get a referral to the pharmacy service.

In an email Rachel wrote to me recently, her view was that the change could have the unintended consequence

“of actually increasing NHS 111 calls for emergency medicines when they should be directed to community pharmacies first. Our local service offers both the facility to help the patients get their medicine but, more importantly; also offers incentivisation of the community pharmacy to promote ordering medicines in a timely way to reduce medicines waste, and hopefully therefore preventing a further incident of need.”

She thinks it unlikely that the proposed 111 service will operate both the services that we have locally and the new model, and she worries about losing the existing local scheme. Will the Minister reassure me by saying whether schemes such as the one operating in my county of Hertfordshire could still operate in tandem, or will they be mutually exclusive?

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a very powerful speech. Does she agree that although we must encourage clinical commissioning groups to work closely with community pharmacies—she has highlighted some good examples of that—the practice is patchy across the country? There is reluctance in some areas for clinical commissioning groups to engage with their local pharmacies. We have had that problem in York, where the CCG has been very reluctant to talk to local pharmacies. Local MPs, across parties, have written to it and finally got it to engage but it has been very slow, and we have to speed that up. We have great examples in some parts of the country, but poor examples in others.

[Mrs Main]

My hon. Friend is absolutely right and completely backs up the point I was making. There is evidence of good practice but other areas could do much better. Without bringing pharmacies to the table and into the ongoing dialogue about this issue, we risk not having the new model that we would all like to see—one that operates consistently wherever people go.

There must be a consistent model in the drop-in pharmacy service that we are envisaging. Of course, people often use pharmacies away from where they live, such as where they work or when they are on holiday or visiting friends. If the model is patchy, as my hon. Friend says, the system will not improve and we will end up with a situation like the one that is found in many holiday towns. A few years ago, the Select Committee on Communities and Local Government looked into the fact that many seaside and holiday towns have enormous pressures on their frontline services. If something goes wrong when people are on holiday, although what happens is not necessarily catastrophic, they all end up at the local A&E services in hospitals. That huge problem was recognised, I think, in the 2006 seaside towns report by the CLG Committee. This is all part of evening out the stresses and strains on the system, which for many seaside holiday and tourist destinations are often huge.

[Jo Churchill (Bury St Edmunds) (Con)]

Does my hon. Friend agree that that was largely the point of the Murray review, which she alluded to earlier? Integration throughout the whole of the NHS is vital, so that everybody knows what everybody else is doing and so that there are seamless pathways that everybody knows how to follow. That will ultimately give us benefits not only in pharmacies, but right across the NHS.

[Mrs Main]

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Will my hon. Friend recognise that some innovative things are taking place in the west country, especially in my constituency?

[Mrs Main]

I am happy to acknowledge that some fabulous things are happening in the west country. That list was given to me. I make no excuse for the fact that I thought it seemed fairly long already, but I am certain that there are a lot more services that hon. Members do not realise are out there—perhaps even in pharmacies in their own constituency or the one next-door that they go shopping in or visit with their families. The fact that we do not know about them shows that there is no integration in the system. We should be aware of it if these services are being rolled out. Perhaps there should be a directory that we could consult to find out what is going on in certain areas.

That list shows hon. Members the exciting possibilities that could be open to pharmacies, including those in the west country that were just referred to, if we just gave them the chance to embrace them. Rachel, the director of the Quadrant pharmacy, ended her observations with a positive endorsement of the “Community Pharmacy Forward View”. She told me that it has

“been developed and signed up to by all national community pharmacy organisations about the types of services that either need to be commissioned at a national level or pressure put on Sustainable Transformation Plans (STP) leaders locally to commission a service package to patients”.

My hon. Friend the Member for York Outer (Julian Sturdy) said that there is reluctance in some areas to embrace this. We need a strong steer from the Government that this is where we are going and that they had better wise up, get around the table and come up with a suitable model.

[James Cartlidge (South Suffolk) (Con)]

My hon. Friend is making an excellent point and I congratulate her on securing this debate. I have discovered the same thing as my hon. Friend the Member for York Outer (Julian Sturdy) in Suffolk. It is about trying to get the CCG to talk to the pharmacists. The interest of the NHS is our interest—it is a national interest—and not that of acute hospitals, the primary care sector or any particular sector. The NHS must operate in the national interest, and if that means involving pharmacists much more heavily and that we have to be the ones pushing for innovation, it is our job to do that.

[Mrs Main]

My hon. Friend is absolutely right. I shall conclude my remarks soon, because I know that other hon. Members want to take part in this debate. If there is resistance in the system, I ask the Minister to find out what can be done to sort that out. How aware is he of resistance in the system? How much input have pharmacies had into highlighting what they would be prepared to do and their concerns about the fact that they are sometimes not being listened to in this debate? There seems to be broad agreement in the NHS “Five Year Forward View”, the “Community Pharmacy Forward View” and at the King’s Fund that the integration of pharmacies into NHS healthcare is the direction of travel.

[Margaret Greenwood (Wirral West) (Lab)]

The hon. Lady is making a really interesting speech. I have had such a big postbag on this issue because of the threats to pharmacies in my constituency. The fact that local community pharmacies are facing cuts is threatening the level of healthcare that people receive, particularly elderly people who cannot drive, people with children who need to be able to pop in with them after school and people with mobility issues. The cuts imposed by the Government are threatening the quality of the service that is being delivered. They need to address that before they look at further integration.

[Mrs Main]

I agree that there are concerns. As I mentioned earlier, there are five dispensing pharmacies within half a mile in St Albans. Some are literally over the road from each other, although I know that model is not repeated everywhere. None of them is open on a Sunday and the only pharmacy that is open is in a big out-of-town superstore. We need to look at a model that addresses their proximity to the populations that need to use them and the hours that people are looking for pharmacies to be open. It is no good if people can access the seven-day-a-week pharmacy service only by getting in their car and driving two or three miles out of town. It is all part of the same thing.

That is why I support the point made in the Government’s proposals in October about models such as the one in St Albans, although this is not the case everywhere, where there are the big boys and smaller independents all in the same area. If the hon. Lady were to walk into Boots in my constituency—I have nothing against Boots, which is one of the pharmacies on my high street, as on many others—she could pick up sandwiches for her lunch, as well as a variety of health and beauty products, perfumes and so on. It is a one-stop shop for many things, a bit like a supermarket.

My concern is that we must not lose community pharmacies such as the Quadrant, which is a single pharmacy in a small shopping precinct that many people walk to and use locally. We have to have a balance of availability and opening hours. If we are truly to embrace an integrated system, some pharmacies may need to consider their opening hours and sign up to being open when they would not normally be. They will have to be remunerated for that as well. We need to look at the whole model. I understand that there are concerns, but our current model cannot continue. I want integration, and I want more money and more services directed towards pharmacies to make them viable and to make them the first hub for the community.

There is broad agreement that the direction of travel we need is towards getting people to use the most accessible health provider, which is the local pharmacy. That would keep many smaller pharmacies going. They cannot compete with all the other offerings from supermarkets such as Sainsbury’s, which has a pharmacy in its out-of-town store in London Colney, so we need to ensure that they compete as health hubs.

I look forward to hearing what the Minister has to say about these issues. I am sure that many other Members will make contributions about their local models, because the provision and the pharmacies on offer vary throughout the country. I accept that, in areas such as mine, the current model cannot continue, particularly if it asks for NHS funding, but we must not throw out the baby with the bathwater. I ask the Minister to say what more the Government will do to ensure that pharmacies have a real role in the integrated health service.

09:51

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

May I say what a pleasure and a delight it is to serve under your chairmanship, Mr Bailey? I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing the debate. I should warn the House that I am the Government’s pharmacy champion. I have been following this issue quite closely for about the last 20 years —not that I have been in the House of Commons for the last 20 years, but I have followed it consistently since being involved in the community pharmacy group action campaign, which was to do with resale price maintenance on non-prescription medicines in the 1990s, when I was doing a commercial job. I became a vice-chairman of the all-party pharmacy group when I was elected to the House, so this is an issue I feel quite strongly about and have been very involved in.

To put things in context, Plymouth, Sutton and Devonport is, uniquely for a Conservative constituency, an inner-city seat. Indeed, I am one of very few Members of Parliament outside London to represent a totally inner-city seat. The only countryside I have in my constituency is the Ponderosa pony sanctuary, which is a rather muddy field. How we can integrate pharmacies is a really important issue. There is an 11-year life expectancy difference between the north-east of my patch—I could probably walk from one end to the other in a couple of hours or so—down to the south-west in Devonport, which is a very deprived community that has real issues with homelessness, drug taking and smoking. People certainly need to be referred to pharmacies for smoking cessation too.

There are several areas of the debate that I am particularly interested in exploring, and I hope the Minister will respond on them. The first is summary care records. A lot of pharmacies want to be able to access the care records for their patients. They also want to be able to populate those records, so that they can review the medicines given to patients. We need to make sure that happens throughout the whole of England. I was very concerned by something I discovered over the Christmas recess. I did not take masses of time off over Christmas, but I did speak to a number of GPs; needless to say, I also did a surgery, with one of my local GPs in the Devonport ward. He told me that GPs—and, I suspect, pharmacies too—cannot access the medical records at Derriford hospital, because it uses a completely different system from the GPs and the pharmacies. The Minister needs to look at that.

The second issue we should look at is using pharmacies much more for minor ailments—a point that my hon. Friend the Member for St Albans made very clearly—so that people are signposted to the pharmacy rather than necessarily going to the GP. I was watching breakfast television this morning while I was getting ready to come and speak in this debate—I think it was Sky television, so I should declare an interest, because my brother is the cricket correspondent for Sky television and I do not want to be accused of doing anything wrong. I was interested to hear the person reviewing the newspapers say that she was doing a programme tomorrow evening on Radio 4 at 9 o’clock—I am giving her a plug—on how, rather than having lots of patients come to see them, some GPs in Plymouth have ended up talking to patients on the phone. Patients do not necessarily always need physically to go to a GP to seek help, which is a useful way of taking some of the pressure off GPs.

I should also make a point about the decriminalisation of prescription errors. At the moment, GPs can get a slap on the wrist or be struck off, whereas pharmacists who fail to give prescriptions properly can face criminal charges. I had thought that the Government were very keen to address that. I was led to understand by the Minister that the matter might have been sorted out before Christmas, but that there were problems to do with the devolved Administrations needing to deal with it first. However, it seems very odd: here we are, at the beginning of the year, and we still have not dealt with it. I must warn my hon. Friend that I have tabled a parliamentary question about it.

My final point is that a great deal of pressure has been placed on the Government and the national health service, especially during the winter. There has been a great deal of discussion about how pharmacies need funding and so on, but in my opinion this is not just about money; it is about ensuring that we use the systems properly, so that we can deliver a better quality of care. We could get pharmacists to go into residential care homes for the elderly, too. It is not just about money; it is about the structure, too. We need to take that into account, because we need to ensure that budgets sweat.

09:58

[Steve Double (St Austell and Newquay) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing this debate on what I believe is a very important issue.

There is no doubt that our health service is currently under great pressure, as we have heard already. People are living longer and we are able to treat far more conditions than we could in the past, which adds to the demand on our health services. Although more money is always welcome, I am sure that many of us would agree that simply throwing more money at the health service is not the solution. We need to find better, smarter, more efficient and more effective ways of working to provide the healthcare that our growing population so desperately needs.

I have no doubt that pharmacies, particularly community pharmacies, can play an important role in finding better and smarter ways of providing healthcare to the people of this country. Community pharmacies continue to be an undervalued and underutilised section of our health service. As a country, we really need to embrace the role that community pharmacies can play in delivering health services. They have much more to offer than they are currently seen be to offering.

The Government have started to recognise that, with the current pilot scheme, started in 2015, to increase the presence of clinical pharmacists in general practice. That is clearly a step in the right direction, but I propose that we should also look the other way. We should not only look at integrating pharmacies into GPs’ surgeries; we should be looking to integrate GP services into our community pharmacies. It is quite clear that many of the routine services that people typically go to their local GP for could be provided by their local pharmacists in a much more cost-effective way.

[Oliver Colvile]

rose—

[Jake Berry (Rossendale and Darwen) (Con)]

rose—

[Steve Double]

I will give way to my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) first.

[Oliver Colvile]

I thank my hon. Friend for giving way. He makes a very powerful point. I have thought for some while that we should be trying to put GP surgeries into pharmacies, so that when someone goes to their GP and says, “I have got this ailment and I need some help,” he can say, “Don’t come and talk to me; go and talk to the pharmacist, because he or she can manage the thing properly.” To my mind, that seems a very clever way in which we could take some of the pressure off the finances of GPs, as they would not necessarily have their own lease, but could get the likes of Boots or others to provide facilities.

[Steve Double]

I thank my hon. Friend for that intervention and I agree with him. Clearly, part of the answer is getting GPs and pharmacies working much more closely together, and co-locating can often be one way to help with that.

[Jake Berry]

My hon. Friend is making an excellent speech. Does he accept that the demand for prescribing pharmacies can be demonstrated by the recent proliferation of adverts we have seen on television for “pay to see your GP” services, which I was very surprised to see so many of on TV over Christmas? For £20, someone can pay to have a Skype consultation with a GP, who will then email or contact the local pharmacy to issue them with a prescription. An NHS that is free at the point of use should be absolutely fundamental to us in this country, but the fact that people are now paying to see GPs rather than waiting to see them shows that there is huge demand for people to have minor ailments prescribed for by a pharmacist.

[Steve Double]

I thank my hon. Friend for that intervention; he clearly watches far more TV than I do, because I was not aware of that. However, he makes the point well that there has been a huge increase in the demand being placed on our GP services, and people are therefore looking for other ways to meet that demand when it cannot be met in the usual ways.

I applaud and support the Government in their desire to create a truly seven-day-a-week health service. Part of the way to achieve that is by making far better use of our community pharmacies. Many are already open for longer hours than GP surgeries, typically on a Saturday, and my hon. Friend the Member for St Albans made the point that maybe some need to consider opening for longer still. That is something the Government could certainly help with. If we are to achieve a truly seven-day-a-week health service, we need to make more effective use of our pharmacy services.

[Margaret Greenwood]

The hon. Gentleman is making a strong case for the importance of community pharmacies. Pharmacies in my constituency of Wirral West that will be unable to receive money under the planning access scheme have written to me to say they are very concerned that they face closure. Does the hon. Gentleman agree that it would make sense for the Government to pull back from those cuts while they consider the whole issue of integrating services?

[Steve Double]

I thank the hon. Lady for that intervention, and in many ways I share her concerns. While I respect the desire of Department of Health’s to ensure that money is well spent and delivers value for money, there are cases of over-duplication, as we have already heard. Some changes need to be made to the funding models. I agree that we need to do all we can to protect our community pharmacies, particularly in more rural areas such as my constituency in Cornwall, where they play such a vital role for rural communities. I was pleased that the Department was able to do something to help—certainly many pharmacies in my area benefited from the changes to the funding—but I respect the fact that that may not have been the case in her constituency, and I will be urging the Minister to do all we can to ensure that these vital services in our rural areas are protected as much as possible.

With the right support, and indeed the right funding streams, our pharmacies could play a role that would take pressure off the parts of our health service that are clearly under severe pressure, in particular primary care and acute and urgent care. We are all aware of the pressure that our A&E departments are under at the moment. I believe that many times, when people go to A&E—perhaps because they cannot get to see their GP as quickly as they would like or feel they need to—they could actually get what they need from their local pharmacy.

Part of this is about increasing people’s awareness of what our pharmacies can offer. Part of the learning curve that I have been on since becoming an MP has involved going to see our local community pharmacies and getting a better understanding of exactly what services they provide, which I was not aware of before. More could be done to promote the role that pharmacies can play and the services that they can offer by making the public more aware of those services. That in itself would take pressure off our GPs.

[Mrs Main]

I did not make this point in my speech, but my hon. Friend is almost making it for me—it is that our pharmacists are hugely qualified, but too often they are the most under-utilised highly qualified local health professional. It is nonsense that their expertise is not being used routinely, challenged or made available, because people do not seek to use it and are not even necessarily aware that it is there for them to utilise.

[Steve Double]

I thank my hon. Friend for making that point, which I completely agree with. There is much more we could do to increase the general public’s awareness of exactly how highly qualified our pharmacies’ staff are and of the excellent services that pharmacies can provide.

My hon. Friend the Member for Plymouth, Sutton and Devonport talked about the need to integrate IT systems better, which I believe is part of the solution we seek. My understanding is that community pharmacies can access summary care records, but on a read-only basis. Many pharmacists I talk to say that if they had read-write access to that information, so that they could input data about treatments they have given to patients, that would be better. For example, if they could take a patient’s blood pressure and input that reading into the patient’s care record, that would save the patient time as they would not then have to go their GP to have the same reading taken and put into their record. I urge the Government to consider carefully whether read-write access could be granted to pharmacies, because I believe it would save a huge amount of time and reduce what I believe is often duplication of work within our health system.

An interesting fact that I discovered in my discussions on this subject is that the average time that someone waits when they go to see their pharmacist—that is, the time between entering the pharmacy and actually getting to see the pharmacist—is eight minutes. Many people in this country would be absolutely delighted if they could see a health professional within eight minutes of asking to see one. I am sure that many hon. Members here today have in-boxes full of people’s complaints about how long it takes them to see their GP. If people were aware that if they went to see their local pharmacist they would only have to wait eight minutes on average to see a very well qualified health professional who has a good chance of providing them with what they are looking for, I believe they would be delighted. That is another example of how we can promote the work of pharmacists, which would provide a far better service to the people of this country and take pressure off the other parts of our health system.

[Bill Esterson (Sefton Central) (Lab)]

I am grateful to the hon. Gentleman for giving way and I apologise, Mr Bailey, for missing the start of the debate.

The excellent pharmacies in my constituency do much of the fine work that the hon. Gentleman and other speakers have described, but it struck me as I was sitting here listening to him that he is making a very powerful case for investment in our pharmacies, rather than the cuts that the Government have proposed. Does he accept that point? Will he and his hon. Friends take this opportunity to call on the Health Secretary to think again about pharmacies and the important role they play and to see them as an investment, so that they can play their part, particularly in taking pressure off A&E?

[Steve Double]

Although I agree with some of what the hon. Gentleman says, I believe the funding model for pharmacies needs to be looked at because there is a great deal of duplication. The money spent could be better utilised, so the funding model needs to be reviewed. Some of the recent changes are a step in the right direction, but I will always make the case that, particularly in our rural communities, we need to be careful how those changes are applied so that our local pharmacies continue to be viable and able to provide the services that are needed.

[James Cartlidge]

My hon. Friend is making an excellent speech. I understand why Labour Members want to focus on the potential savings that once again the Government are having to make, but I point out that the two pharmacies that I visited in Clare and Hadleigh in my constituency accept the changes, provided they are balanced by their having a more positive role in the healthcare system and doing more for our communities. That is what they want.

[Steve Double]

I agree absolutely. This is not only about money; it is about reviewing the way we provide our healthcare services, embracing a greater role for our pharmacies, and understanding and promoting the role that they can play.

I want to pick up on the point about tourist areas made by my hon. Friend the Member for St Albans. I represent the constituency of St Austell and Newquay in mid-Cornwall, and tourism is the biggest part of our economy. Hundreds of thousands of tourists come every year, which puts a great deal of pressure on our A&E and local GPs, because if people fall ill on holiday, they try to get to see a GP.

I commend the work of one of my local pharmacists, Nick Kaye, in Newquay. The Secretary of State visited a couple of years ago and saw the excellent work that he does working closely with the local GP surgery to provide a frontline service particularly for tourists. By doing so, he takes pressure off the other parts of the health service. We could see more of that if we supported pharmacists and promoted the excellent work that they can do.

We have already touched on my final point. We cannot have a one-size-fits-all approach. The services provided in urban metropolitan areas are very different from those provided in more rural parts of the country. As we have heard, there might be multiple pharmacies in a town, all falling over one another to compete for business—so different from the many rural villages that have one local pharmacy, which is struggling to make ends meet and to provide an ongoing service to the community. Another fact I have learnt is that there is an oversupply of qualified pharmacists in many areas, whereas in Cornwall we have a shortage. We cannot get enough into Cornwall to meet demand, so we cannot have a one-size-fits-all solution. I encourage the Minister to look carefully at the specific needs of different parts of the country, particularly with regard to pharmacies, to make sure that funding streams meet need and that we can sustain the vital role that community pharmacies play in our rural towns and villages.

I am pleased to have been able to contribute to this important debate. As we continue down the path of integrating pharmacies into the health service, we must value and promote the role they play and make sure they are able to provide a service. They are part of the solution that we need to make sure our health service is fit for purpose.

[Mr Adrian Bailey (in the Chair)]

I intend to bring the Front-Bench spokesperson in at 10.30.

10:14

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I add my congratulations to my hon. Friend the Member for St Albans (Mrs Main) on securing not only a timely debate, given the current circumstances, but one that is important because we need to look at the whole system and integration, rather than at each specific service.

Interestingly, on 6 December, Lord Prior said:

“The Government recognise the vital importance of community pharmacy.”—[Official Report, House of Lords, 6 December 2016; Vol. 777, c. 593.]

It is from that positive stance that I wish to make my points. Pharmacists have been identified as one of the professions that are highly qualified and not in short supply. Some very advanced GPs are bringing pharmacists into their surgeries to help to alleviate some of the pressure. Some clever thinking is going on out there. I hope the Minister can tell us how we are capturing that innovative thinking and how it is being spread throughout the system.

The “Five Year Forward View” identified that the British public need to be made more aware of what pharmacies can do and how they can help people keep healthy. However, the Government need to give a steer and ensure that people with minor ailments understand that the pharmacist should be their first port of call.

When I visited my pharmacist there was concern about the 111 service, which was my hon. Friend the Member for St Albans mentioned. We need to keep an eye on that so that we do not unintentionally put pressure on different parts of the service. We need to look at it in the round and incorporate all key roles into pharmacies in order to provide additional services. I had my flu jab at a pharmacy this year, which is a useful use of resources within the system and within the community. We could make that more available and perhaps incentivise individual pharmacists to go out into care homes, which have a proliferation of need because of age and comorbidities, and give flu jabs and so on. Moving our workforce around, rather than driving ever-greater demand into smaller places such as hospitals, must be a consideration.

The Murray review, which has been mentioned, found that poor integration with other parts of the NHS was a significant barrier, and the Royal Pharmaceutical Society agreed. I like to think that the Government are taking a good look at what was said in the review and taking the issues on board.

I love the term “pharmacy-first culture”, which is a good motto for everybody to live by. I want to concentrate on my Bury St Edmunds constituency for a couple of minutes. We have 21 pharmacies and a cluster of Superdrug and Boots shops, which are volume providers that have other things such as make-up and lunches; they have optical services and Boots has audiology services. They provide everything needed from the cradle to the grave and they have considerably greater footfall than my excellent independent pharmacist, who puts more prescriptions through than any other pharmacist in the town. The 100-hours rule meant that I got local surgeries with pharmacies dispensing in them. We need to take a little bit of care, step back and get the right things in the right place. The last thing my local community wants is my independent pharmacy not being able to survive through these important transitions.

An ageing population is a challenge in rural areas such as Bury St Edmunds. Within the next decade, 40% of Suffolk’s population will be over 85. We know that that age group lives with comorbidities that need a degree of monitoring. That can be done most effectively in the pharmacy and in the GP’s surgery, but out of the big NHS pie the GPs get only about 8% and the acute sector gets about 92%. We need to show that we are spreading the money throughout the system, because a lot of the pressure will be coming down on the pharmacies, the GPs and the care sector.

Pharmacists are often not used to their full value. Delayed discharge from hospital often comes about because people do not get their meds, and pharmacies in some hospitals are not available throughout the weekends. There could be more joined-up thinking.

[Bill Esterson]

I do not think I disagree with anything the hon. Lady has said. She is making a very good case for the excellent practice in her constituency and for pharmacists more generally. Does she agree that the logic of her argument is that money is saved by investing in pharmacies? That is a strong argument. She is arguing that cuts should not be made and that the Government should invest in pharmacies to support the whole health system, which is what this debate is about.

[Jo Churchill]

I thank the hon. Gentleman for his intervention and agree with his final point. This is about the whole system and making efficiencies. We are talking about evolution. We are no longer looking at the service as it was perceived in 1948. There was a private element to it even back then, because that is what GPs wanted. We need a 2017 solution to the challenges of a larger population, an ageing population and so on. Pharmacists must play their part in that. They are really keen to step up and deliver more for the Government and more for the patients and people in their communities.

There are issues in the town, but there is an interesting rural situation, where there are rural payments for Elmswell and Thurston, but the GP surgery in Woolpit, which dispenses more scripts, does not get one. There seems to be a bit of discrepancy. I echo the point made by my hon. Friend the Member for St Austell and Newquay (Steve Double): looking at rural constituencies is a very different thing from looking at the whole ecosystem.

There is a Day Lewis pharmacy in my town. An exceptional local resident, Ernie Broom, is keen to note that that pharmacy, because of its location, cannot offer a lot of peripheral things. The local residents are largely mature or on lower incomes, which means that the pharmacy is vital to the community. We also have really poor bus services into town—it would take a young mum or an elderly person nearly an hour and a half to cross town. I want the Government to look at a weighting system, which takes into account what local pharmacies can deliver. They would get points for being in certain areas, or incentives for delivering more. I know that is something that is being looked at.

My questions are similar to those posed by my hon. Friend the Member for St Albans. What more can pharmacies be incentivised to do? How much more capacity can they provide? With people living longer and with comorbidities, how can we remunerate for services? How can we ensure that that is included as part of sustainable transformation plans? It is not something that should be added at the end as an afterthought, but is a hugely integral part of how we make our NHS better and more able to look after the health of us all.

10:19

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing the debate. I found much that I agreed with in her contribution, and I echo her call for a pharmacy-first culture.

It is a pleasure to take part in the debate, although I must admit to feeling a bit of an observer, as the debate is about pharmacies and integrated healthcare in England. We have heard from a number of speakers about the different practices that affect their parts of England; I hope that my observations from Scotland may also be of interest to Members. I have commented in a few debates that there are often lessons that we can learn from one another and good practices that can be shared. This issue provides an excellent case in point.

Community pharmacies were developed in Scotland 10 years ago and are there for minor ailments, chronic medication and public health services. The Scottish Pharmacy Board has stated that more than one in 10 GP consultations and more than 1 in 20 accident and emergency attendances could be managed by community pharmacists using the minor ailments service; that represents huge potential for the future. Although we await the full evaluation of the minor ailment service later in the year, estimates suggest that as much as £110 million could be saved. Further expansion of the MAS is planned.

[Mrs Main]

I do not often agree with what is said by Scottish National party Members, but I looked at the Scottish service, and one of the key things, which I think other hon. Members have raised, is the software functionality that in Scottish pharmacies are obliged to have. That is something we do not have in England—I do not know about Wales—and I wonder if the hon. Gentleman could let the Minister know about that. The ability to input into scripts and the remuneration that comes through that software functionality in Scotland is something that I found very interesting.

[Martyn Day]

The hon. Lady has emphasised the point very well. There is a considerable degree of integration in the Scottish service. It has been around for 10 years and is a fairly mature service.

The Scottish Government work side by side with the medical professions in Scotland and recognise just how important community pharmacies are. They are interested in exploring new ways for pharmacies to offer primary care services to help deliver care across our communities. There are some 1,200 pharmacies throughout Scotland, providing a range of services on behalf of the NHS. As well as dispensing prescriptions, they offer four NHS pharmaceutical care services, which have been gradually introduced since 2006. These are the minor ailment service, which I have mentioned, the public health service, the acute medication service and the chronic medication service. Those new services involve pharmacists more in the community in the provision of direct, patient-centred care, with every community pharmacy in Scotland having patients registered for the minor ailment service by March 2015.

Patients register with a pharmacist in the same way as they register with a GP. The aim is for all people to be registered with their local pharmacist, wherever they consider that to be, by 2020, and for all our pharmacists to be independent prescribers by 2023. Approximately 18% of the population of Scotland are registered for the minor ailment service—a total of 913,483 people. More than 2.1 million items have been dispensed under the service, which is some 2.2% of all items dispensed by community pharmacies in Scotland. Almost 500,000 patients are registered under the chronic medication service.

It is important that retail and dispensing pharmacies in England be encouraged to go in a similar direction to Scotland, because that would bring great benefit for the NHS. In Scotland, we recognise just how important community pharmacies are. We are committed to supporting and developing local GP and primary care services and have recently announced a three-year, £85 million primary care fund to help develop new ways of delivering healthcare in the community, which will involve pharmacists delivering aspects of patient care.

Looking at pharmaceutical services across the two nations, one of the significant differences appears to be how the services have developed, partly as a result of the funding structures. In Scotland, pharmacists do not get a large payment merely for existing, such as the £25,000 in England. Instead, they receive a modest establishment payment of £1,730. However, payments are based on needs that reflect a population’s age, vulnerability and deprivation. That model will see funding in Scotland rise by approximately 1.2%, while it looks likely to decrease by around 4% in England.

Another difference is the almost random way in which pharmacies in England appear to have opened, as a result of anyone being allowed to do so if they open 100 hours a week. A concern must be that there could equally be unplanned random closures, if they are allowed to shut down simply because they can no longer afford to survive. In Scotland we have a system of controlled entry for those who want to open a community pharmacy. Need must be demonstrated and applications approved by health boards. Consequently, we find community pharmacies in areas of deprivation, serving those most in need. Often health boards refuse applications because demand is already met.

Pharmacists are located throughout communities in Scotland, from rural areas to deprived inner-city areas, providing pharmaceutical care on behalf of NHS Scotland. The Scottish Government policy remains that, wherever possible, people across Scotland should have local access to NHS pharmaceutical care. There is much in the Scottish model that is working well and may provide a useful example for study on this side of the border. It is imperative that this successful model of community pharmacies across Scotland should not be put under threat by UK Government health budget cuts, which would impact on the Scottish Barnett formula.

10:28

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing this debate on a very important subject. It is pleasing to hear so much agreement around the room; I hope that the Minister is listening. I agree with most of what hon. Members have said.

This subject is very dear to my heart. My husband is a community pharmacist, and I worked with him for 24 years in our own community pharmacy in my constituency of Burnley; I have to add that we no longer have any financial interest in community pharmacy, but what I retain is a very deep understanding of the value of community pharmacy to patients, the community and the wider NHS, so I appreciate the hon. Member for St Albans securing this important debate.

I cannot think of a better way to demonstrate the value of community pharmacies than to talk about my experience. Coopers chemist in Burnley—a deprived constituency in many ways, where life expectancy is closer to 80 than 90—serves a community along with four other pharmacies in very close proximity, all of which are really busy and serve a big demand. On a typical day, we dealt with 600 prescriptions and 100 minor ailments, and ran many other services—forgive me if I forget some, because there were so many—including medication use reviews designed to maximise our use of medication, make sure patients understood it, encourage compliance and save money on wastage; smoking cessation programmes; dietary advice; emergency hormonal contraception; methadone programmes; and support for diabetics and asthmatics. It was an ever-increasing list. Those are the kinds of services that are at risk if the Government pursue their plans.

I appreciate the value of community pharmacies. I am also a former private business owner. Let us not forget that that is what community pharmacies are; they are not provided for and paid for by the NHS.

[Oliver Colvile]

That is a very good example of how the private sector, working in the national health service, can deliver good-quality services.

[Julie Cooper]

I do not disagree with the hon. Gentleman’s point.

It is important that we recognise that community pharmacies provide their own premises and train their own staff. As a former business person, I totally get the point about value for money, but this is not just about money; it is about the efficient use of money. We all understand the pressures that our NHS face, and we have to look at that. There are a lot of myths floating around, so it is important that we clarify that.

There has been a lot of talk about the clusters. Again, because pharmacies are private businesses, they respond to demand in the community.

[Julian Knight (Solihull) (Con)]

The hon. Lady brings her expertise to the debate. Does she agree that we need more innovative approaches? The Grove surgery in Solihull has a symbiotic relationship with its local GP services, but in parts of the UK we seem to have run into the sand. We need greater public awareness and encouragement to take such innovative approaches forward.

[Julie Cooper]

I will come on to that very point in a moment.

To return to value for money, it is important that the Government take a responsible attitude and review funding for pharmacies, and I think that professional community pharmacists across the country accept that. Much has been made of the clusters. Pharmacies are independent businesses that arise and stay in business where there is demand. I do not know whether this is widely understood—hon. Members will have to forgive me if they already know this—but the global sum allocated to pharmacies is what pharmacies cost the Government. The Government know what community pharmacies are going to cost. If a new one opens, it does not cost the Government any more; it just means that the same amount of money is shared out more thinly. That is a bit of a red herring. We can be sure that if there is no demand for the services that a pharmacy provides, it will close.

Much has been made of the £25,000 payment, but that does not cover the cost of putting a van on the road and paying for a driver to deliver and administer a prescription delivery service. Those services are absolutely invaluable to communities with many elderly people. I had a conversation with practice managers and general practitioners in my constituency recently, and they were absolutely horrified because they use that service—there is a lot of repeat ordering—and if it were lost, they could not cope.

The Government are suggesting that in-surgery pharmacists are a substitute, but that is another red herring. I welcome the use of well-qualified pharmacists in GP surgeries, but that is a totally separate issue. It is like comparing hospital doctors with GPs. Community pharmacists are at the heart of the community and are accessible for many hours. The hon. Member for St Austell and Newquay (Steve Double) made the point very well earlier when he said that eight minutes is the average wait to see a qualified professional who can help with most things. We have got to embrace that and use what is already there.

I have had conversations with the National Pharmacy Association and the Royal Pharmaceutical Society, and just last night the chair of the English Pharmacy Board said, “We want to work with the Government. We want to sit down and look at how we can do more.” There is the idea that integration is a new thing waiting to happen, but we were proud as community pharmacists to be at the heart of the primary care team, working with GP surgeries, hospital discharge teams, community nurses and district nurses. They often came to us. GPs came and went—that is even more the case now, given the problems with retention in GP practices—so we provided the only continuity in healthcare for many chronically ill people. Particularly for the elderly, that was a vital part of the service, and we were really proud to provide it.

Many community pharmacies are proactive. When this business of moving towards a clinical approach was suggested, community pharmacies accepted it without it needing to be mandated. We invested in a purpose-built consulting room to provide a more clinical environment. That is the way forward, and most community pharmacies accept that.

What is the alternative to what the Government are proposing? For a start, we need a proper assessment of what the cuts will mean. There has been no impact assessment of which pharmacies will close. I agree with the hon. Member for Bury St Edmunds (Jo Churchill) that it will not be the multiples that will close; it will be the independent pharmacies that rely on the £25,000 to provide their core services. That is an absolute fact. Not a single pharmacy in my constituency qualifies for access payments, and only three in the entire city of London do. I can say with absolute confidence that in my constituency it will not be Boots that closes or cuts its hours; because of the volume of business, it has other ways of covering its overheads.

I ask the Government not to throw money willy-nilly at pharmacies, but to look at their value and assess the impact of the cuts. If they think that the best way forward is for some pharmacies to close, they must ensure that the right ones close. We must do what the professional organisations are asking for and come to the table. Pharmacies are begging to take on extended roles. There is so much good will there. The minor ailment scheme, which we were privileged to provide, is an important service. Busy families who have children with minor ailments do not have time to be at the GP surgery. GPs accept that, without that service, they could not manage. We all know that GPs work hard and are overstretched. This is not about criticising the work they do; it is about supporting them, saving the NHS money and taking off pressure.

I ask the Minister not to reconsider the funding, but to look at the way he works with pharmacies in the NHS. I ask him to look at their role, as many Conservative Members have said, and at how they can work with the Government to support other areas of the NHS, thereby saving money. Let us avoid a knee-jerk reaction with no proper assessment of the impact. Let us deliver a better integrated service. The way to do that is not to make blind cuts with no proper assessment.

10:39

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on leading the charge on what we all agree is an important subject. We have heard some very useful speeches, although I would make the point in passing that the subject is apparently so important to the Opposition that there have been no speeches from their Back Benchers on any aspect of the reforms during the last hour and a half.

My hon. Friend used an important word in introducing the debate: integration. I will talk about that, because if we are to fulfil the potential of the sector, which we need to do, it needs to be integrated. We have heard other important words too. We have heard about “pharmacy first” and also the phrase “wellbeing hub”, which I think sums up where we want to be in time. I will try to address many of the points made in all parts of the Chamber, but I will also set out what the Government are planning. When we boil it down, however, there is a huge amount of agreement about where we need to get to and the direction of travel. We also heard about Scotland, which is not perfect—the Murray review made some points about IT integration in Scotland, which is not yet working as well as it might—but as I have said in the past, I think we have things to learn from Scotland.

Everyone in the Chamber, Government or Opposition, can agree on three things. First, we need to move funding and the profession from a model based principally on dispensing to one based much more on services. Of course it is true that, to an extent, we are already going in that direction, but the funding model is not facilitating that, and it needs to. The Government must address that and take it forward.

Secondly, we all agree that services are a good thing per se, but that they are better if integrated with the primary care pathway much more than has been the case historically, and that is about working much more closely with GPs. I do not agree that employing more clinical pharmacists in GP practices is a “red herring”; it is part of how we bring the professions together, although I accept historically there have been difficulties doing that.

The third thing we all agree on—this must apply to the Opposition as well—is that we need to get value for money for the £2.8 billion that we spend on dispensing around £8 billion-worth of drugs. It is right to look at doing that as efficiently and effectively as possible. For example, the existing funding model encourages clusters to develop. I note that the establishment payment in Scotland is £1,700 per annum—I think I heard that right—while ours is £25,000, which has encouraged clustering, so that NHS money is not being spent on frontline services.

It is worth reminding the House that none of the efficiency changes that we announced before Christmas represents a cut of money going back to Treasury; the money is being reallocated to other areas of the NHS. The impact analysis talks in some detail about how money can potentially be spent more efficiently. In parallel with that, we need to make progress on services. I completely agree with that, and I will talk about the pharmacy integration fund and the Murray report, an important piece of work which my hon. Friend the Member for St Albans talked about and which will inform our policy.

We all agree not only on those three things, but on others. For example, there is a big benefit in diverting activity away from GPs. Various reports have been produced by the sector itself, and the Government accept that up to 30% or 40% of GP appointments could possibly be handled by pharmacists. That is a massive number. If we can achieve that, it will be of great benefit to us all. More can be done in pharmacies, such as medicine reviews and medicine optimisation, let alone how they can help us with the public health agenda, which we have not covered in particular today. A lot could be done with smoking cessation, obesity and sexual health programmes.

[Julie Cooper]

The Minister is contradicting himself. Pharmacists are already planning to reduce the hours that they are available to provide these services—the very services that he tells us he values and wants to see more of. Does he accept that if he persists with the cuts, there will be less of them? Some pharmacies will close, while others will reduce services, and are already planning to cut opening hours and reduce staff.

[David Mowat]

What we are not reducing is the amount of money available for services, as opposed to dispensing. Some pharmacies use part of their dispensing money to provide services on a discretionary and ad hoc basis, but I make this point again: overpaying for dispensing is not a good vehicle for getting more and better services.

I want to talk about some of what is already happening. We have heard about flu jabs this morning—I, too, had a flu jab at a pharmacy—and at the end of last year, we had had more flu jabs in pharmacies by October than we had in all of the previous year. The money available for that and similar service-based allocations has not been affected by the changes we announced. The community pharmacy sector has received £10 million for flu jabs up to the end of October. We want to see more of that happening, and that direction of travel is important.

A number of hon. Members made the point, which I agree with, that the public need to understand that pharmacies represent an important first port of call—it should not always be GPs. The Government can do more to make that clear. When I was preparing for this debate last night, I saw a television advert from NHS England for its “Stay well this winter” campaign. The campaign is running TV and newspaper adverts, and its theme is for people to visit their pharmacy as soon as they feel unwell. The people running the campaign have told us they think the advertising campaign has generated about 1.2 million additional pharmacy visits that would not have happened otherwise. That was a good challenge and we need to do more of that.

We also need to go further with services. There are two approaches. I recommend that anyone interested in this subject—as everyone present clearly is—reads the Murray review, which was produced by the King’s Fund. NHS England commissioned the review to inform it and us on how to spend the integration fund, the budget available to drive services more deeply into the system. I will talk about some aspects of that and about some announcements that I made in October as part of the package we are discussing.

One of the announcements was about urgent or repeat prescriptions. At the moment, NHS 111 gets about 200,000 phone calls a year asking for a further prescription, and those callers are told to see an out-of-hours GP to issue a prescription, which in due course goes to the pharmacy. We are changing that so that people will be directed to a pharmacy immediately. That is a stream of revenue for the pharmacy, which will provide both a consultation, for which it will be paid, and then the drug or prescription, as necessary.

My hon. Friend the Member for St Albans asked whether that scheme would somehow affect a good local scheme in her area. There is no reason why that should be the case. The new scheme is supplementary to anything that might have been commissioned already. It sounds as if her scheme was commissioned by the CCG, and that is good, although it takes us to the fact that things are patchy—different CCGs do different things in different areas, which I will come to. However, that is an example of where we need to be.

Another example is the minor ailments scheme. As I have said, 30% to 40% of GP appointments could be dealt with in pharmacies. Parts of England already have minor ailments schemes, but the service is very patchy and it need not be. It is true that different CCGs and indeed different GPs have different attitudes to such schemes, but NHS England has made a commitment that by March 2018 it will have encouraged all CCGs to be commissioning minor ailment schemes in pharmacies across their patch.

[Oliver Colvile]

Is the Minister aware that in Devon about £5 million a year is apparently being wasted on unused medicines? Something needs to happen with that to ensure that the NHS has enough money with which to do things.

[David Mowat]

Yes. Throughout the country, the number is far more than £5 million—

[Julie Cooper]

Will the Minister give way?

[David Mowat]

If I may answer the previous intervention, I will certainly give way again. I have talked about medicine optimisation and pharmacies doing reviews, in particular in people’s homes, for example, and they are part of that solution. Pharmacists in GP surgeries are part of the solution too, and a way of achieving that—as I said earlier, I do not agree that that is an irrelevancy.

[Julie Cooper]

I thank the Minister for giving way. A highly trained pharmacist, who often has a trusted relationship with his patients in the community, is better placed than any other health professional to lead on saving money on wasted drugs. Patients quite often say in a close conversation when they collect their prescription, “Actually, I’ve not been taking that,” but they quite often do not say that to their GP. The pharmacist will then take it upon themselves to say either, “Actually, do you realise you should be taking this?” or, “Let’s speak to your GP and, effectively, avoid waste.” The pharmacist is best placed to do that.

[David Mowat]

I completely agree. Pharmacists have a big role to play in saving money, and medicines optimisation is very important in that. NHS England has established an integration fund, which will provide £42 million—a significant amount, even in the context of the rebalancing that has occurred—of seed money between now and the end of the next financial year to address just those sorts of things and take that work further.

The Murray review, which was commissioned by Dr Ridge, the chief pharmaceutical officer at NHS England, and published in December, sets out in some detail what we believe the direction of travel should be. Someone asked earlier when the Government will respond to that review. I expect NHS England to respond this month—if I may put that on the record in that way. NHS England will respond, not me, but there is not a lot in the review that is controversial. There are a lot of very good points, many of them about IT integration and the care record. I agree completely that some of the progress we need to make with services involves the ability to both read and write to the summary care record. That will be part of where we have to get to. Frankly, technology is an area in which the NHS could improve. That is true in Scotland—it is true everywhere. I will not spend a lot of time talking about what we need to do, but we could facilitate an awful lot of progress on integration between pharmacy and primary care, and primary care and secondary care, if we had stronger technological and IT solutions.

Colleagues have talked about the need to have more pharmacy involvement in medicines optimisation, and care homes are part of that. Pharmacists could do an awful lot with a more structured approach to care homes. One strand of work that has come out of the integration fund is a care homes taskforce, which is chaired jointly by the Royal Pharmaceutical Society and NHS England and is setting out a direction of travel for doing the sorts of things we have talked about, such as medicines optimisation, in a more structured way in care homes right across the country. There are more than 50,000 qualified pharmacists across our country. There are also 23,000 qualified pharmacy technicians, who are part of this too. The pharmacist profession is not as short as some, and it can and needs to do more to make progress in this area.

One part of the Government’s approach to this whole area that has been mentioned and I do not think enough is made of is the GP forward view. Everyone understands how much pressure GPs are under. There are something like 400 clinical pharmacists working in GP practices. We have committed and budgeted £112 million to increase that to 2,000 clinical pharmacists, many of them dispensing pharmacists. Parts of the community pharmacy network, which we have heard a little about, regard that as potentially in conflict with what they do. I think that is wrong. It is not in conflict; it is a way of breaking down the barriers that I accept there have occasionally been between CCGs and GPs and the pharmacy profession. Those are not in anyone’s interests, and we need to get over them.

[Mrs Main]

The only concern I have about too much of a drift towards putting pharmacists in GP surgeries is that GP surgeries have limited opening hours. Many pharmacies have a drop-in service. My hon. Friend the Member for St Austell and Newquay (Steve Double) mentioned the average waiting time of eight minutes. Having a link between booking a GP appointment and going to the pharmacy would start to bring people back into GP services rather than keeping them outside those services. That is the only concern I have about that matter.

[David Mowat]

That is of course a valid concern. We are trying to make progress on having GP services open for much longer than they have been historically, including weekend opening. Several colleagues have made the point—the Murray review also addressed this—that there is occasionally a barrier between the attitudes of some GPs and what can be done by pharmacists. That is true. We must be conscious that it behoves us to try to encourage the breaking down of that barrier, and misplaced professional pride must not prevent us from doing things to the best extent. Putting some pharmacists in GP practices—particularly with new models of working in which more disciplines tend to work together and a GP does not just work on his own—is an important part of that.

[Jo Churchill]

There is a barrier, but again, those services are used in different ways. My independent community pharmacist in Bury St Edmunds dispenses around 18,000 or 19,000 prescriptions in the town and provides all these ancillary services. He also has a dispensing practice in a GP surgery, which he is looking to automate, to make it more streamlined and cost-effective. Those services are two slightly different things, and I would worry if there were too much of an idea that they service the same thing.

[David Mowat]

They are different, but my point was somewhat different: optimising the use of the pharmacist profession could facilitate the breaking down of barriers and some of the care home activities that have to happen.

I will leave a couple of minutes for my hon. Friend the Member for St Albans to respond, so I will not talk in detail about the value for money aspect, other than to repeat the point—Opposition Members made a couple of interventions about this—that overpaying for a dispensing service is not the way to facilitate a much more clinically-based and service-based approach. The way to facilitate that is to get the appropriate remuneration models and revenue streams in place, and that is what we are determined to do. In the end, that is what we expect to be judged on, and I hope that we will be judged on it. With that, I will let my hon. Friend summarise.

10:57

[Mrs Main]

This has been an excellent debate. I echo the Minister’s sadness about the fact that the two Opposition Members who made interventions did not stay for the whole debate. Unfortunately, some did not even arrive for the beginning of the debate, let alone stay for it all. That is disappointing, because this issue has filled my postbag and this debate is timely. There has been a lot of news about whether the NHS is under massive strain now more than ever. The reality is that we need a new model of working. Many hon. Members have put forward positive suggestions and have obviously been engaging with their local pharmacists. I am pleased that so many Government Members have made that effort and are so knowledgeable about their pharmacies.

The very fact that many private independent pharmacies like Quadrant have put money into their businesses—the hon. Member for Burnley (Julie Cooper), who leads for the Opposition, stressed her role in that—shows that there is a private model that can work with the NHS. It shows that those two models can be mutually beneficial and can learn from and give to each other. I am delighted that the Minister said that the emergency prescription system would not necessarily rule out the excellent system that Quadrant pharmacy operates, and I am delighted that we will soon hear the response to the Murray review, which contains many positive aspects about the way forward for pharmacies.

I am glad that there is so much consensus that keeping the model in which small, private independent pharmacies support the public NHS is an excellent way forward, and long may it reign. I am just concerned that we must ensure that small independent pharmacies in rural areas like the one that my hon. Friend the Member for Bury St Edmunds (Jo Churchill) represents are supported, perhaps with a weighting system. It is hard for them to compete with the big boys on the high street and the concessions in out-of-town supermarkets with parking and Sunday opening. I am glad that the Minister has been so frank with us, I am glad that there is so much consensus, and I am really looking forward to a great future for the NHS.

Motion lapsed (Standing Order No. 10(6)).