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Holly Lynch (Halifax) (Lab)
I beg to move,
That this House has considered the role of community pharmacies.
May I say what a pleasure it is, Sir David, to serve under your chairship this morning, and to have you join us for this important debate?
Between the ages of 14 and 18 I worked in a local chemist shop two evenings a week and some Saturday mornings. There were the usual first job responsibilities: restocking shelves, cleaning, and meeting and greeting customers and patients who were not always well, for a variety of reasons. I loved it, because there is never a dull moment in a pharmacy. I remember a frantic mother handing me dead headlice taped to a piece of cardboard, and someone asking me to run a pregnancy test on a bottle of cough medicine, before discreetly letting me know that it was actually a urine sample rather than cough medicine and that that was the only secure way she could find of transporting it to the chemist shop.
The shop was exactly what it said on the tin. It was a community pharmacy, and the whole community would walk through those doors for advice, medication and reassurance. I remember the older people, whose relationship with the pharmacist was the longest-standing and most trusted relationship they had with a clinical professional. I remember a long-term recovering addict, who would bring his daughter with him every day. We watched her grow up, and supported him as he worked hard to stay the course on his journey to recovery.
That is why community pharmacies matter, and it is why they work. However, it appears from the community pharmacy contractual framework announced in October 2016 that that was not appreciated. There was a reduction from £2.8 billion in 2015-16 to £2.68 billion in 2016-17 and £2.59 billion in 2017-18. That represented a 4% reduction in funding in 2016-17 and a further 3.4% reduction in 2017-18. When inflation is factored in, as well as all the services that pharmacies already offer free and whose costs they absorb, that was a near fatal blow to the service nationwide. The then Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told the all-party parliamentary group on pharmacy that he expected between 1,000 and 3,000 pharmacies to close, as they would no longer be viable in the face of the cuts, with multiples and chains of pharmacies best placed to survive, and independent and more rural chemists left at a disadvantage.
In March this year the Pharmaceutical Services Negotiating Committee found that 233 community pharmacies have closed in England since the Government funding cuts were introduced. Sixty-nine were independent pharmacies and a further 22 were independent multiples. The number of closures anticipated by the right hon. Member for North East Bedfordshire has not yet been reached. However, I have spoken to people in pharmacies, and others contacted me ahead of the debate, and many are operating at a loss, clinging to the hope that the funding arrangements will improve, but with a business model that, as the right hon. Gentleman predicted, is not viable.
The impact that the funding cuts have had on patients is really difficult to justify. The cost of delivering prescriptions to those who find it hard to leave the house was previously absorbed by local chemists, but that is no longer possible. Boots was the last of the big four chain pharmacies to start charging for delivery over the summer, with all patients having to pay £5 for delivery, or £55 for a 12-month delivery subscription, by the end of the year. All have some exemptions for particularly vulnerable customers, but Boots, LloydsPharmacy, Rowlands Pharmacy and Well have all reduced free deliveries, or started charging for delivery.
There is no funding for arranging drugs in trays. When I worked in a pharmacy, it was a big undertaking to arrange medicines in trays by time and day, predominantly for older people who needed that degree of support if they were to live well for longer by taking their medication at the right time and in the right doses. Pharmacies were delivering a degree of invaluable social care, and that is no longer possible in the present financial climate. We can all see what the consequences will be. Ultimately the result will be more costly clinical interventions.
In addition to the financial pressures that pharmacies face, drugs shortages are now becoming debilitatingly resource-intensive across the NHS. Pharmacies have no ability to absorb the costly hours spent sourcing drugs or speaking to GPs about possible alternatives. A Bristol GP, Zara Aziz, recently wrote in The Guardian of her experience of medicines shortages. She explained that EpiPen users in Bristol are now being told to use their old EpiPens up to four months after the expiry date. She also tells the story of a patient in acute distress from arthritis pain when a commonly used anti-inflammatory, Naproxen, suddenly became unavailable. Eventually, a very small quantity was found, but the patient was forced to use it sparingly, not as she had been prescribed, as none of the alternative anti-inflammatories would have been suitable for her.
My hon. Friend the Member for Redcar (Anna Turley) shared with me a photo of a poster from Pharmacy Magazine, which has gone up in her local hospital. It says, “Please don’t blame us for the NHS medicine shortages. It is a nationwide problem. Please ask your local MP to help.” The poster included contact details of local MPs handwritten on the bottom. We very much hear those concerns, and we are here to ask the Minister to get a grip on this problem.
Shortages are caused by a combination of different issues. The implications of Brexit are inevitably a factor that will play out over the coming weeks and months. However, we know that the NHS and the UK are potentially losing out to more profitable and attractive markets. In addition, the stockpiling, as a precaution, of certain drugs that are harder to source, coupled with the deliberate and more alarming manipulation of the markets by some wholesalers to deliberately push up prices, is having a detrimental effect. New regulations are also having an impact on manufacturing processes.
On top of that, cash flow is a massive challenge in community pharmacies. Community pharmacies pay out for drugs and are reimbursed by the Government the following month. The situation is made even tougher still, however, because they are not always reimbursed what they have paid out for drugs, particularly for drugs that are in short supply. By law, pharmacies have to do everything in their power to source a drug and dispense it, even where prices have become inflated due to a shortage. Let us take Naproxen as an example. One of my local pharmacies tells me that earlier this year the cost of a box shot up from about 26p to about £15. The tariff price paid by the Government to reimburse pharmacies for Naproxen peaked around February, at £12.50 a box. The medicines shortage is having the perverse effect of forcing pharmacies to dispense at a loss. In previous budgets, there might have been just enough for the pharmacy to absorb this cost. Those days are long gone. The system is clearly no longer fit for purpose.
Earlier this year, the Government introduced the serious shortage protocol in the Human Medicines (Amendment) Regulations 2019. It was intended to be a safety mechanism to help cope with any serious national shortage. It gives pharmacists the ability to dispense a reduced quantity, alternative dosage form or generic equivalent to that stated on the prescription. There would be a small payment to pharmacies for undertaking that process. Despite pharmacists and GPs feeling that they are spending unprecedented amounts of time sourcing medicines or researching alternatives, not a single drug has appeared on the list, which means that pharmacies and GPs do not get paid any extra to compensate them for the time they now have to dedicate to that element of dispensing.
Although there are no drugs on the serious shortage protocol, there is a separate concessions list, which acknowledges that, due to a shortage of a drug, the price has changed. At the end of September, there were 45 drugs on that concessions list. Again, inclusion on that list does not acknowledge the time involved in having to source the drugs, which is becoming the largest part of the pharmacist’s day. Nor is there any attempt to fund that work.
There was some hope for community pharmacies more broadly in the community pharmacy contractual framework published in July, which takes effect from October 2019 through to 2023-24. The five-year deal commits to not cutting the budget any further. However, when inflation is taken into account, it will still see pharmacies unable to meet costs, for all the reasons I have outlined.
Strangely enough, what the framework does do is realise the potential for pharmacies to alleviate pressures on the wider NHS, paving the way for a much more integrated approach. The 111 service is now able to refer a patient directly to a pharmacy for an appointment. The framework seeks to expand the delivery of clinical services in pharmacies. It is all great stuff, which is very welcome, but I return to the clear warning given by the then Minister back in 2016 that between 1,000 and 3,000 pharmacies will not be viable and will be forced to close if overall funding does not increase.
Mr Gregory Campbell (East Londonderry) (DUP)
I congratulate the hon. Lady on securing the debate. Given the pressures all our A&Es and acute hospitals face, does she agree that the community pharmacies in many areas across the UK do a magnificent job—particularly those specialised pharmacists who relieve the pressure on A&Es? If community pharmacies are put at risk and we lose them, there will be even more pressure on our A&Es and acute hospitals at a most awkward time for our society.
Holly Lynch
I could not agree more. I thank the hon. Gentleman for making that important point. It was very welcome that in the community pharmacy contractual framework—for the first time, I think—the Government really did understand that. However, the funding to allow pharmacies to survive long enough to deliver those services has not been forthcoming. For all its aspirations to deliver more clinical services, a pharmacy that has been forced to close can deliver diddly-squat. Does the Minister accept that community pharmacies’ potential will be realised only when they are funded to survive?
Like many colleagues, I am incredibly concerned about the impact of medicine shortages, both on the NHS and on patients themselves. It is contributing to the mix of factors that are piling unbearable financial pressure on our local chemist shops. I hope the Government have a plan to respond and keep our trusted, effective community pharmacies open.
Several hon. Members rose—
Sir David Crausby (in the Chair)
Order. I will call the three Front Benchers at 10.30 am. Several Back Benchers wish to speak. I will not put a time limit on speeches, but if hon. Members keep them to about seven minutes or less, everybody will get an opportunity to speak.
Liz McInnes (Heywood and Middleton) (Lab)
It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing this important and pertinent debate and for giving me an opportunity to raise an issue of great concern to residents of Heywood and Middleton.
We know that community pharmacies have struggled with the funding cuts that the Government have introduced since October 2016. As my hon. Friend pointed out, figures compiled in March by the Pharmaceutical Services Negotiating Committee show that 233 community pharmacies in England have had to close since those cuts were introduced. Evidence from local pharmaceutical committees across England supports the picture of community pharmacies struggling financially. Independents are being hit the hardest and have been forced to cut hours or staff as a result.
A consequence of that was highlighted to me last week by my constituent Karen, who told me that her local independent community pharmacy was to start charging £5 for the home delivery of medicines. As my hon. Friend said, the same measure has already been adopted by the four multiples: LloydsPharmacy, Rowlands, Well and—the latest to join—Boots, which recently announced that it would charge a one-off fee of £5 or a 12-month subscription fee of £55 for delivery of prescriptions ordered in branch.
The actions of those multiples seem to be having a knock-on effect on our local independent community pharmacies as they struggle to cope with year-on-year funding cuts. With the cost of a prescription now at £9, the additional charge bumps up the total cost to a hefty £14 for those who pay for their prescriptions and makes an absolute mockery of free prescriptions for those who qualify. If someone is on free prescriptions but cannot get to their local pharmacy because of illness or disability, the delivery charge means that their prescription is no longer free.
As a result of these decisions, some of the most vulnerable people in our communities will suffer, including many who rely on the delivery service to access much-needed and essential medication. Sadly, many people in our communities suffer from chronic loneliness and simply do not have the social contacts to ask someone to collect their medicine for them. I would be interested to hear the views of the hon. Member for Eastleigh (Mims Davies), the Minister for loneliness, on this draconian measure; I will write to her after this debate, when I hope I will have received some response from the Minister who is present.
I urge the Minister to look carefully and seriously at this really important issue, which appears to be a growing problem. The Association of Independent Multiple Pharmacies says that continuing challenges to pharmacy funding are not helping the situation, with the five-year funding cap not covering
“inflation, volume increases and national minimum wage increases.”
The five-year period will be increasingly painful for many pharmacy businesses already under heavy financial pressure. It is only to be expected that many pharmacies will reassess all their existing costs, including the costs of services that they currently deliver for free. The financial model is simply unsustainable for the next five years. I ask the Minister to think about the impact that the changes will have on vulnerable, lonely and housebound people, and to consider approaching the Chancellor to request funding for this vital service and bring an end to this tax on the sick.
Sir Kevin Barron (Rother Valley) (Lab)
It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing the debate. I have a non-financial interest to declare: I chair the all-party group on pharmacy.
Community pharmacies play a major role in supporting the prevention agenda, which is a key development in the NHS long-term plan. As an integral part of the NHS, they are also a valued community facility with a positive track record of improving access to healthcare services. Compared with GP surgeries, there are more than 11,600 community pharmacies across England, and 89% of the population are estimated to have access to one within a 20-minute walk. That percentage rises to 99% in the most deprived areas of our country. We should recognise that community pharmacies are crucial.
There is still much more that could be done to unlock the huge potential of pharmacies and to further integrate them with emerging local healthcare networks. For example, service commissioning is patchy across the country, meaning that not all patients can access the same services from their local community pharmacies. More than 95% of community pharmacies now have a private consultation room from which they can offer advice to patients and a range of nationally commissioned services, such as the flu vaccination service. In 2018-19, 1.4 million flu vaccinations took place in community pharmacies. Two years ago, when the service was first introduced, other parts of the medical profession did not like the idea of pharmacies moving into that area, but the figures show that it was a good idea.
The new medicine service allows pharmacies to provide support for people with long-term conditions who have been newly prescribed a medicine to help improve medicine adherence. My hon. Friend mentioned it in relation to the elderly. I am sure we all know that more than 70% of NHS expenditure in the UK is on people with long-term conditions in the acute or primary sector. It is important to recognise that. Many pharmacies are commissioned to offer public health services by local authorities and the NHS.
On the new national services in 2019-20, my hon. Friend mentioned the community pharmacist consultation service, which is something we should look forward to, with the community pharmacists as the first port of call for minor illness or for the urgent supply of medicines. Pharmacies will offer patients a consultation to help manage their minor illnesses or provide an emergency supply of medicine. The service will take referrals from NHS 111, but in years to come such referrals could come from other settings such as GP practices and the NHS online. That is a progressive move so that we can access services far better than we can at the moment. We will see how it goes.
The other national service is hepatitis C testing. Pharmacies will offer testing for people using pharmacy needle and syringe programmes to support the national hepatitis C elimination programme. There will, however, be an extension of the reach of the six mandated public health campaigns that community pharmacies have to take part in, and many community pharmacies will also choose to take part in the pharmacy quality scheme. This year, that might involve preparing for engagement with primary care networks, which is crucial. When I first talked to my local primary care network about where the pharmacy fits in with this, they were not at all sure. We also have: carrying out audits on prescribing safety for lithium, on pregnancy prevention for women taking valproate, and on the use of non-steroidal anti-inflammatory drugs; checking with patients with diabetes whether they have had annual foot and eye checks; reducing the volume of sugar-sweetened beverages; complete training and assessment on look-alike, sound-alike errors, which is crucial for us all; updating risk reviews; completing sepsis online training and assessment, along with risk mitigation; and completing the dementia-friendly environment standards.
From April 2020, all pharmacies will be required to be able to process electronic prescriptions and to have attained healthy living pharmacy level 1 status. Accreditation will mean the pharmacies are local hubs for promoting health, wellbeing and self-care, and providing services to prevent ill health. That is the real move we should be seeing in community pharmacy now, to promote population health and reduce health inequalities. Pharmacies have a major role to play in that.
With regard to other future pharmacy service developments, as part of the five-year deal community pharmacies may also be able to support the appropriate use of medicines through the expansion of the new medicine service to other conditions. In addition, the NHS will use the national pharmacy integration fund to pilot services for potential roll-out. These include a model for detecting undiagnosed cardiovascular diseases and smoking cessation referrals from secondary care. That is crucial—this is a matter for another day—when we see the reduction in smoking cessation services here in the UK, yet still more than 85,000 of our fellow citizens are dying prematurely each year from smoking-related disease.
Further services include: the use of point-of-care testing around minor illnesses to support efforts to tackle antimicrobial resistance; routine monitoring of patients, such as those taking oral contraception, under an electronic repeat dispensing arrangement; activity to support primary care network priorities, such as early cancer diagnosis and tackling health inequalities; and a service to improve access to palliative care. These are the ideas that the community pharmacy has got and where it is going to move in the next five years. That is crucial.
Once again, I thank my hon. Friend the Member for Halifax for securing the debate and providing this opportunity. The issue of expenditure has been mentioned, although I will not go into the history of it now. The Minister will be acutely aware that when we had the pharmacy integration fund, it was set aside after the cut. In fact, it was not used very well and lots of money was left in there. We are now moving into areas where that money should have been used. It is crucial that we get the money now on the table into frontline pharmacy services.
Jim Shannon (Strangford) (DUP)
Thank you, Sir David; it is a pleasure to speak in this debate. I congratulate the hon. Member for Halifax (Holly Lynch) on securing the debate and thank her for doing so. Community pharmacies are an important issue in my constituency, as they are in hers, and indeed in the constituencies of everyone who is here to contribute. Elected representatives who keep their ear close to the ground will know that community pharmacies have a critical role to play, why is why I wish to touch on them here.
It is a pleasure to see the Minister in her new post. This is only her second debate in Westminster Hall, and the first in which she is going to have to answer some hard questions, but I have no doubt that she is up to it.
I have spoken numerous times about the importance of community pharmacy funding, especially in rural areas, because it is absolutely essential. For people who are rurally isolated or ill, knowing that their local pharmacy will collect their prescription and have it ready to collect—or even deliver it, as they often do in my constituency—is very important. That point cannot be emphasised enough. It makes all the difference to an ill person and it is critical that we have that system in place.
I agree with the NHS protocol that does not allow GPs to prescribe annually, but I also know the strain that it puts people under to undertake to have a new prescription allocated, collected, left at the pharmacy and then further collected. It is time-consuming and means a lot of effort for those who are ill and rely on public transport. Community pharmacies take much of the legwork and stress out of this.
We all know the problems of getting community transport in rural areas, whether buses, taxis or even getting friends to help with collecting prescriptions. They are as important to our ill and vulnerable people as any other NHS service, and the funding cuts have put too much pressure on that service already.
I assume that all the elected representatives here today have received letters similar to those that I have received outlining the difficulties facing community pharmacies in Northern Ireland. I will highlight those that frighten me the most—I use the word “frighten” because that is exactly what they did. They hail from a rural constituency with stretched service provision. One such letter states:
“The results illustrate the cumulative impact of the funding and the workforce crisis as stark.”—
these are strong words—
“Aside from pharmacy staff leaving by choice, a significant proportion of pharmacy owners, 39%, have been forced to reduce their workforce as they can no longer afford to cover the salary costs. To try to compensate for staff losses, 95% of pharmacy owners have increased their own working hours”.
In other words, they are now working longer hours just to ensure that their pharmacies cope. Some report regularly working 80 to 100 hours a week, which I suggest is above and beyond the call of duty. In addition, the letter states that
“93% of contractors report being forced to reduce the level of additional services they can offer, with 41% reducing or applying to reduce their pharmacy opening hours.”
Those figures illustrate the issues: 30% of staff are leaving by choice; 41% of pharmacies are reducing their staff; and those in charge of the pharmacies are working almost 100 hours a week. Against this demonstrable crisis in workforce, the core workload continues to increase. Dispensing activity over the past nine years has risen by almost 40%—again, pharmacies are doing more work with fewer staff, which compounds the issue—to a level of around 55 million dispensing episodes in 2018-19 alone. That is a colossal number of prescriptions handled and dispensing episodes.
Over the same period dispensing fees have been reduced by around 30%, which is an example of marked underinvestment in an essential service, where safety and accuracy are critical to the public and the health service. I am not saying for one minute that things are going wrong, but we want to ensure that the general public’s safety is always at the forefront. For that to happen, pharmacies need to be assisted financially, and they must have the opportunity to get the staff they need.
The community pharmacy workforce survey contains a number of recommendations for turning things around in the sector. I have no doubt that the Minister’s response will help make these things happen before it is too late. I ask her to be cognisant of the recommendations, because if they are applicable to Northern Ireland, then they are applicable to the UK mainland. The thrust of the recommendations is that there must be better communication. How often do we say that there should be better communication? There must be better communication between Government Departments, elected representatives and their constituents on new legislation coming through. It is critical that we have better communication between the Department and pharmacies, because they need to know what is happening. The Government and the Department need to be responsible to them too.
We have TV campaigns outlining when it is appropriate to seek a pharmacist’s attention, rather than to see a GP. That is all good stuff. People can now visit their pharmacist to ask about minor ailments, taking some of the pressure off A&E departments. That is part of what they are trying to achieve over the next period of time. Yet the information about what can be treated and how to get that help is not communicated. Better communications are a way of doing things just that wee bit better.
Over the years I have suggested to Government Departments, including the Department of Health in Northern Ireland—health is a devolved matter—and to Health Ministers here that we could perhaps do things a lot better. For example, we could let pharmacies take on responsibility for some minor things, such as checking for glaucoma or diabetes. It would be helpful if those things could be checked for in pharmacies.
In conclusion, with this body of trained professionals we have the potential to ease the burden on GPs and enable better surgery efficiency, yet that has not been tapped into. We have the potential to make people’s lives a lot simpler with an appropriately funded community pharmacy. By not doing that, we are losing highly trained professionals and adding more strain to an already overburdened GP system. If we do not help the pharmacies, we do not help the GPs or the A&E departments. This needs an overhaul, and who better to feed into that than those operating the service at present? I look forward to hearing the Minister’s response and, hopefully, some positive replies.
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to see you in the Chair, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing today’s debate.
A couple of weeks ago, I went to visit a local community pharmacy in my constituency, and the superintendent pharmacist sat me down to tell me his tale of woe, which has been echoed across the Chamber this morning. He runs seven pharmacies across the city, serving 20% of the population, but he has seriously struggled over the past three years and is wondering whether he will be there next year. He has ploughed in tens of thousands of his own money just to keep the business afloat. That certainly highlights how many single-handed pharmacies have closed in the city.
Part of this is about the Government funding cuts, not least to the establishment payment, which covered things such as rent, regulatory registration and insurance. Part of it has also been about the loopholes for the clinical commissioning group and how it is now buying branded generics and not giving the headroom that pharmacies used to have. For instance, if people were purchasing a drug at, say, 60p and it had a value of 90p on tariff, there would be headroom of about 30p. That money was then ploughed back into the business to run other essential health services and to ensure that there could be free deliveries of pharmaceutical products to the community. Pharmacies just do not have that headroom any more.
The situation is made far worse by the multinational companies—we have heard about Boots, Lloyds and the others—which have the buying capacity and the space to be able to drive up the price at the wholesalers, which in turn means that the independents pay more when they go to purchase their pharmaceuticals. I have always called it the Walmart model, because that is how many of these companies operate. They try to push out the competition by making it impossible for the independents to participate in the market. That is certainly what we see here.
There is a toxic combination of cuts, CCGs facing tough financial lines—the CCG in York is always struggling—and, on top of that, the wider market pressures. Of course, the multinationals can spread their risk. They sell other products, and they are owned by multinational corporates, which gives them a further cushion in their operations. The impact is that, where some of those big companies have bought up independents, they are then closing them in crucial communities.
Clifton in my constituency is an area of high deprivation, with one of the lowest ages of mortality in the city and a real need for a community pharmacist, but Lloyds has pulled out of that community. That means that while people are waiting, say, three weeks to go and see their GP, they cannot just pop down the road to their community pharmacy as an alternative, because it is simply not there.
That is building more pressure on the independents, because people go to them to get the free delivery now that, as we have heard, the big companies have seen a gap in the market—surprise, surprise—and are charging their drug delivery tax to get more resource. That means that the independents, which are trying to provide that community service, are delivering further and further afield, which is costing them more, and they have less resource to do that with. We need to address the drug delivery tax to ensure that, as my hon. Friend the Member for Halifax set out, we get these products to those people in our communities who are incredibly vulnerable.
I draw the Minister’s attention to one other scandal in the industry, which is that companies such as Boots are paying only 9% corporation tax. As a result, the Government are losing out on £1 billion a year. If we think about the scale of the cuts and the £200 million that has been removed, it does not take long to realise that, if Boots was forced to pay its corporation tax, we would not see pharmacies struggling and going to the wall, or communities suffering and losing those essential community services.
I ask the Minister to go back to the Treasury and make sure that those tax loopholes are closed. Boots moved into a multinational company, which I believe is 49% American-owned, and it is now registered in Switzerland, so it does not have to pay the same overheads. That is another inequality built into the market that must be addressed. The pressure cannot continue, or we will lose our community pharmacies. As I said, one pharmacist, who oversees seven pharmacies, does not think he will be there next year. That is seven communities across my constituency and York Outer that will not have a community pharmacy on the street corner.
It is vital, therefore, that the new Minister gets to grips with this issue. She must make sure that the right investment goes into our communities, that those loopholes are closed for the CCGs and for tax, and that the drug delivery tax is not put on pharmaceutical products.
Tim Farron (Westmorland and Lonsdale) (LD)
It is a pleasure to serve under your chairmanship, Sir David. I thank the hon. Member for Halifax (Holly Lynch) for bringing forward this issue, which is important for the whole country. Community pharmacies play a vital role wherever they are, but that is especially so in large dispersed rural communities such as mine.
As we have heard, many of those community pharmacies are in increasingly marginal positions and are at risk of closure—indeed, many have closed. That is tragic for them, their patients and the communities that they are at the heart of. It is also a tragic wasted opportunity. The Government should make far better use of our community pharmacies to secure their futures and to benefit patients. The Government could provide sufficient funding for pharmacies so that they can provide an agreed range of patient services to prevent ill health and to keep people who are living with chronic conditions from getting worse, as hon. Members have mentioned.
I sat down with one of my local pharmacists in Kendal a few weeks ago. He told me that the Government have an opportunity to commission a national minor ailments service provided by community pharmacies. The key objective would be to use the talents and expertise of our pharmacists and, in doing so, to remove pressure from GPs and A&E departments in other parts of primary care in the NHS.
Pharmacists in my area serve communities as diverse and widespread as Sedbergh, Hawkshead, Ambleside, Staveley, Windermere, Milnthorpe, Kendal, Kirkby Lonsdale and many others. All the pharmacists I speak to fear that their numbers may be further whittled away by the Government, either by design or by attrition. The Government and people in the sector have talked about there being 3,000 fewer pharmacies. On behalf of local pharmacists and their patients, I say that that would be unacceptable. We want clarity from the Government on the number of pharmacies that they envisage, and we want a commitment to maintain the number that we have.
In the past, Health Ministers have expressed admiration for the French community pharmacy model, which pays for community pharmacies across the board to provide more patient services, such as conditions tests, smoking cessation and blood tests. Will the Minister commit to commissioning such services from community pharmacies across England comprehensively, not just case by case?
Community pharmacies would also be aided by having greater flexibility to dispense authorised medication when the pharmacist is away for a short time, perhaps visiting a local care home. The Government should also consider allowing big national pharmacy chains to share their automation platforms for prescription assembly with smaller independent community pharmacies to reduce costs across the board.
There is also the issue of fair payments. Many independent pharmacies in the south lakes are in danger of going out of business because of reductions in payments for prescriptions by NHS England. Often, the money that pharmacies receive from the national health service does not even cover the cost of the drugs being dispensed. In one shocking case, a pharmacist in my constituency in a relatively small Lake district village, who I have visited regularly, received in one single month £5,000 less in NHS payments than they had to pay out in wholesale drug payments. And that is on top of that pharmacy losing on average 10% of its NHS income each year over the last three years. That is utterly unsustainable, but it is replicated across our communities. So I ask the Minister to intervene personally to put this matter right.
We see a picture of a community pharmacy network that is full of wonderful, talented, highly skilled and dedicated professionals, who provide vital services to patients and their families, and that is part of the glue that holds communities—particularly rural communities—together, but it is being let down by an unambitious approach to community pharmacy from Government, which undervalues what these pharmacies do and, even more importantly, undervalues what they could do.
Therefore, I ask the Minister to consider the proposal in my early-day motion—which, thanks to the non-Prorogation, is still alive—for an essential community pharmacy scheme, to support community pharmacies in rural areas such as mine and to keep them open and thriving. Moreover, will she heed the calls from pharmacists across the country, who are merely calling for fairness in payments and for the ability to use their skills to serve their patients and communities, removing debilitating pressure from other parts of the NHS?
Nic Dakin (Scunthorpe) (Lab)
It is a pleasure to serve with you chairing today, Sir David. It is also a pleasure to speak in a debate in which the contributions so far have been full of knowledge and experience of the grassroots. I congratulate my hon. Friend the Member for Halifax (Holly Lynch) on securing it and on setting out at the start, from her own personal experience, the strength and importance of community pharmacies in their communities. They really are at the heart of communities.
My right hon. Friend the Member for Rother Valley (Sir Kevin Barron) spelled out clearly the potential of community pharmacies. I think the Government recognise that potential in their NHS long-term plan, but as my hon. Friend the Member for Halifax pointed out, they do not provide the funding to deliver on that potential.
Every day in this country, 1.6 million people visit a community pharmacy, so it is not surprising that the 2016 petition to save community pharmacies was one of the largest ever seen in this House. It demonstrated the commitment of communities across the country to their community pharmacies.
In visiting local community pharmacies across Scunthorpe, Bottesford and Kirton in Lindsey, I have seen the huge range of work that they do: dispensing medicines, dealing with minor injuries, administering flu jabs, and, as has already been said, being at the sharper end of drug shortages. Making sure that the drugs are there is a massive job and needs a lot of resource to ensure that it is done. As other colleagues have said, community pharmacies are a core part of the public health network, doing important work.
Community pharmacies are at the heart of communities and keep an eye on people, arranging their medicines in trays and delivering them free of charge to people’s doors. However, as my hon. Friends the Members for York Central (Rachael Maskell) and for Heywood and Middleton (Liz McInnes) have said, what is now developing is a drug delivery tax, which threatens the survival of this service. That is because the very people who most need it are the very people who will not use it—that is the nature of the loneliness and other challenges in these communities, as my colleagues have said.
As the hon. Member for Westmorland and Lonsdale (Tim Farron) said, pharmacies are very important in rural areas, but they are also crucial in areas such as Westcliff, which is in the heart of the urban part of my constituency. There, the community pharmacy is the only health service that is close to the local community, which has many health needs.
A local community pharmacist contacted me recently, and I will use his words to describe what it is like at the sharp end. He points to
“Huge shortages and price hikes by suppliers of generic drugs from July 2017 onwards”,
and says that the Department of Health is
“not reimbursing us for even the cost of drugs, let alone giving us a purchase margin”—
something my hon. Friend the Member for York Central talked about in great detail and with great clarity. He says his pharmacy has been losing £10,000 a month since July 2017. He has not been able to afford to replace the two dispensers who have left in the past three months, so local people are losing their jobs as a result of the cuts, and the pressure on those remaining, although they continue to work really hard—I know because I visited them recently—is beginning to take its toll.
He says:
“The government has agreed to a five year funding package with no annual increase to the funding package. I would have at least expected an index linked funding package with index linking to NHS pay rises. The DHSC has given pay rises to all the other sectors of healthcare like GPs and Dentists but has chosen to effectively give a 9% cut over 5 years to community pharmacies.
As you know, community pharmacies are still struggling from the impact of the £250 million cut announced in December 2016. Since then, I have struggled…and…I have had to borrow hugely just to keep afloat. The net result is that my business is in danger of defaulting on the bank loans/overdrafts and might be potentially looking at bankruptcy. I have 20 employees who are mostly Scunthorpe residents and they are unlikely to find any work quickly if we were to go under.”
That pharmacist asks me to ask the new pharmacy Minister, who I congratulate on her appointment—she has shown since she came into this House her commitment to this area of work, and I can see from the way she is listening to the debate that she wants to make a difference—several questions. They are:
“why the Government chose not to give community pharmacy a pay rise given to other primary care health sectors…why the funding was not index linked…how the Government expects us to invest in our staff and premises with what is essentially a cut”
and
“how community pharmacy is expected to be part of Primary Care Networks when our sustainability is in jeopardy.”
That is from the frontline, from a man who is delivering excellent service to my local community and to patients locally and who wants to carry on doing so. The Government recognise the value of community pharmacies. If they want community pharmacists to continue to deliver, they need to give them the ability to do that, and not to speak nice words, without delivering. As well as talking the talk, the Government need to walk the walk on community pharmacies.
Melanie Onn (Great Grimsby) (Lab)
It is a pleasure to serve under your chairmanship, Sir David, and I congratulate my hon. Friend the Member for Halifax (Holly Lynch) on securing this important and timely debate on community pharmacies. Those are critical resources at the heart of all the communities in our constituencies and the first port of call for many of us who experience common or low-level health complaints.
In the North East Lincolnshire clinical commissioning group area, there are no fewer than 30 pharmacies, ranging from branches of Boots—we have already heard some discussion about that this morning—and pharmacies operating out of supermarkets to companies such as Periville, which runs three pharmacies on Cromwell Road, Wingate Parade and Ladysmith Road, two of those out of medical centres. Day Lewis Pharmacy, in Scartho medical centre, gave me my flu jab last year—thanks very much—while Cottingham Pharmacy on Wellington Street in the East March area has been run by the family for 60 years.
We talk about the community element of pharmacies, and Tim Cottingham recently joined me and the Labour campaign for drug reform in a community event hosting about 150 people to talk about the development of drug treatment, the lack of community drug and alcohol support, and the essential role played by pharmacists. Tim knows so many of his customers and provides an incredibly intimate service, working with them to improve their health and move them further away from the trappings of addiction. The tales he told the audience, with compassion and empathy for the human being behind the addiction story, were quite remarkable. That was something I had not seen or heard before, and I was not necessarily expecting it. It was very eye-opening, and we should recognise the important role that pharmacists play in people’s day-to-day lives. Pharmacists provide vital services to residents in Grimsby, and not only do they dispense medicines to those who need them, but they provide residents with advice and guidance to ensure they make a rapid recovery.
North East Lincolnshire pharmacies also take pressure off GPs by providing a minor ailment scheme for anyone who does not pay for their prescriptions, and by providing free advice and treatment for illnesses such as colds, coughs, flus, hay fever, dry eyes, athlete’s foot, conjunctivitis and many other complaints that might end up at a GP’s door without the presence of such an amenity. Given how important our pharmacies are to our health system, it seems counterproductive for the Government to say that they want to develop sustainability and transformation plans for the long-term needs of local communities, and then to cut nearly £300 million from the community pharmacy budget, thus harming those amenities that sit at the heart of our communities.
The impact of the cuts has been severe. The Pharmaceutical Services Negotiating Committee found that in the two years since the cuts were introduced in October 2016, more than 200 pharmacies across the country closed their doors. That includes E A Broadburn of Scartho, which operated and moved into a medical centre, but ended up closing due to loss of footfall.
Lloyds Pharmacy on Dudley Street is part of a much larger corporate structure, but presumably it was not making the returns from that site and decided to close. It sits right on the edge of the West Marsh, which is one of the most deprived communities in Great Grimsby, and that closure meant the loss of another service, including out-of-hours provision.
Independent, stand-alone stores are not necessarily inside medical centres, hospitals or supermarkets, and they can provide 24-hour pharmacy services much more easily than those that are co-located in medical centres. Such closures therefore mean the loss of another service and emergency access pharmacy on which communities rely. Both those shopfronts remain empty, which means another hole in the small parades of shops in which they sat. They were not quite on the high street, but they were certainly on community high streets, and such things make people feel that their communities are not being properly invested in.
In 2017, Ian Strachan, then chair of the National Pharmacy Association, pointed to pared-back services, reduced opening hours and lower morale in the pharmacy workforce as evidence of the pressure that all pharmacies are experiencing. Will the Minister confirm that the extra investment in primary and community care that was announced by the Government last month will not only cover the costs of any extra service that pharmacies might be expected to provide, but will reverse the cuts in real terms?
Great Grimsby contains a number of good medical centres that include multiple GP centres and often contain pharmacies. However, there are also an awful lot of empty spaces, and for a number of years the intention has been for some services to be offered in those community settings. Some things that are done in hospital could be done in the heart of the community, which would be much easier—and there is space available. If that happened, and if some of those services were to operate out of those community-based centres, that would increase footfall and aid some of those pharmacies by giving them the opportunity to reach more people who would otherwise go to hospital.
Pharmacies are often on the frontline when patients encounter wider problems in the NHS. For example, when the contraceptive Microgynon 30 went out of stock earlier this year, it was the pharmacists who spent time informing patients and trying to find solutions to get around the scarcities. All that takes far more time than simply dispensing the drug and can have an impact on pharmacies’ bottom line. The Operation Yellowhammer report told us that we might face many more drug shortages in the event of a no-deal Brexit, so have the Government involved pharmacies in no-deal planning and taken into account the pressures that pharmacies might experience due to drug shortages in the event of no deal?
Marion Fellows (Motherwell and Wishaw) (SNP)
It is a pleasure to serve under your chairmanship, Sir David, and I congratulate the hon. Member for Halifax (Holly Lynch) on bringing forward this important debate. I do not want to spend too much time summing up and repeating what has already been said by other Members—I have a list of them here—because I want to leave time for the hon. Member for Washington and Sunderland West (Mrs Hodgson) to make her case and for the Minister to answer the many questions that have been asked—I know she will appreciate that.
As everyone here should know, the NHS operates differently in Scotland. There are many plus points to being a patient and a user of community pharmacies in Scotland, not least of which are free prescriptions for all and the way the Scottish Government value and support local pharmacies. As we are all aware, pharmacists are in a unique position to improve medication safety. They have the time and clinical expertise to make a difference to how patients manage chronic conditions, for which they might be taking multiple medications.
For many patients, it is probably much easier to consult a pharmacist than a GP. The community pharmacy often becomes the de facto community health centre, and most of us know the value of what those centres do. They can be the first point of care, and how many of us here have just popped into the chemist for a bit of advice when we did not feel well, taking some strain off our GPs?
I pay tribute to my local pharmacy, because I could not have managed the last year and a half of my husband’s life without the help and support of its staff. They provided help, advice and reassurance in equal measure and took a real interest in how I was doing. I saw them do exactly the same for other people who visited what is an invaluable point of help.
In Scotland, pharmacists already play an active role in coaching patients on the potential side effects of medication, going out of their way to say why it is important to take medicines exactly as prescribed. Unfortunately, due to this Tory Government’s disastrous handling of Brexit, there is a real possibility that community pharmacies and their customers will be left without an adequate supply of medicines. The Operation Yellowhammer documents gave us a real insight into how that will affect our communities. The threat remains significant and, with just 30 days to go until the Brexit deadline, information about medicine supplies and stockpiling is lacking. Pharmaceutical companies tried to stockpile for the 29 March deadline, but warehousing space is much reduced at this time of year, especially as warehouses fill up with Christmas goods.
Of the 12,300 medicines licensed for use in the UK, around 7,000 come to Britain either from or through the EU. According to the Government’s reasonable worst- case scenario, the flow of goods could be cut by 40% to 60% on day one following a no-deal break, taking a year to recover. As we have already heard, that would play havoc with our local community pharmacies, because they are very much on the frontline. They are where our communities turn when they need help with medication.
Jim Shannon
I declare an interest as a type 2 diabetic who is on tablet medication. Over the past few weeks, I have been contacted by type 1 diabetics who depend on insulin. The hon. Lady refers to the need to ensure that medication such as insulin is available after Brexit. I understand from my discussions with the Government that they have assured us that it will be. Does she agree that it is important for the public record that we say that in this Chamber today?
Marion Fellows
I thank the hon. Gentleman for his intervention. I am not standing here to cause panic; I have spent a long time not trying to cause panic, but I have been wondering what will happen if the medications that people rely on do not arrive, because that really is a critical concern for lots of people. I know that community pharmacies and pharmaceutical companies are doing their very best to make sure that it does not happen.
Because the NHS in Scotland is different, I have had my eyes opened to a number of things that I did not realise were happening. I had assumed that what happens in my own country would happen in England, but it very much does not; I have had that experience in my dealings with Vertex Pharmaceuticals with respect to cystic fibrosis drugs as well.
I have to say that the SNP Scottish Government really do recognise the importance of community pharmacies and are taking action to ensure that they remain properly resourced. In April, the Scottish Government announced that community pharmacies will receive an extra £2.6 million in funding this financial year. We must compare that with the cuts in spending that this UK Tory Government have made to community pharmacies’ funding over a number of years, with absolutely no provision being made for inflation, as we have heard.
The package announced by the Scottish Government includes confirmation that the Pharmacy First scheme has been integrated with the national Minor Ailment Service, so there is a real drive for people to consult their pharmacist first. People who can register with the Minor Ailment Service, such as those who are over 60 or in full-time education up to the age of 19, can see a pharmacist and be given medication there and then without having to see their GP. The scheme has recently been extended; it now covers not just things such as diarrhoea, but treatment for uncomplicated urinary tract infections and impetigo. All those things reduce the strain on GP services—we know that across the country, with its ageing population, they are under strain.
The increases in funding have been welcomed by the Royal Pharmaceutical Society in Scotland, which states:
“The RPS supports the Scottish government’s vision for more people to use their community pharmacy as a first port of call.”
The Scottish Government have reviewed pharmaceutical care of patients, and they really want to understand how community pharmacies can be better supported. They are putting their money where their mouth is.
I do not always get to stand here and tell an even better story, but in Scotland we care about how our communities can be better treated and have better health outcomes. To my knowledge—I need to verify this—a local pharmacy in Scotland does not charge for delivery to patients because, as the hon. Member for Heywood and Middleton (Liz McInnes) pointed out, people who qualify for a free prescription service are really hammered if they then have to pay for the delivery of their drugs. I ask the Minister to look at that. As hon. Members all know, I frequently stand here and say, “Can you look at how things are done in Scotland and see whether that can be adapted for better use here?” I plead with the Minister to look at that again.
The Scottish Government really do recognise the vital role that community pharmacies play in Scotland, in rural and in urban areas. I will sit down now and leave the hon. Member for Washington and Sunderland West to sum up for the Opposition.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing the debate, and for her excellent opening speech. For their contributions early on this cold Wednesday morning, I also thank my hon. Friend the Member for Heywood and Middleton (Liz McInnes), my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for York Central (Rachael Maskell), the hon. Member for Westmorland and Lonsdale (Tim Farron), my hon. Friends the Members for Scunthorpe (Nic Dakin) and for Great Grimsby (Melanie Onn), and the hon. Member for Motherwell and Wishaw (Marion Fellows), who speaks for the Scottish National party.
It is clear that community pharmacies are valued across all our constituencies. On Friday I will be visiting Davy Pharmacy in Castletown in my constituency. I will hear once again at first hand how my constituents benefit from community pharmacies, and the impact that their services are having.
I welcome the new Minister to her role. I look forward to hearing from her today and to shadowing her in the months to come. I know that health is very important to her, and that it is one of the reasons why she stood to be a Member of Parliament. We previously worked together as officers of the all-party parliamentary group on breast cancer.
I will begin with one of the first things that springs to all our minds when we think about community pharmacies: prescriptions. As my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Secretary of State for Health, announced in Brighton last week, the next Labour Government will introduce free prescriptions for all. We believe that prescription charges are a tax on sickness. When as few as 5% of patients actually pay for their prescriptions and many of them struggle to pay, surely it is time that the charge was scrapped.
The £9 per item prescription charge results in some patients on low incomes reducing their medication or going without, which is dangerous and can impact on a patient’s long-term health. It can even be fatal, as in the heartbreaking case of 19-year-old Holly Warboys, who died of an asthma attack. Holly did not have a full inhaler because she could not afford one. Nobody should have to pay to breathe.
A large proportion of the 5% of people who pay for their prescriptions budget for them by taking advantage of prepayment certificates, to reduce what they have to pay to the equivalent of about one and a half prescriptions per month. When all the costs of administering the fines and prepayment certificates, and the whole kit and caboodle around charging, are taken into account, it seems eminently sensible, fair and cost-effective to extend free prescriptions to all.
Research backs that up. A study from the University of York has shown how beneficial free prescriptions can be as a means of prevention. When patients suffering with Parkinson’s disease, for example, were given free prescriptions, hospital admissions were reduced by 11.4%, patient day care was reduced by 20.4%, and accident and emergency attendances were down by 9%. I am sure that the Minister will see that the policy will improve patient outcomes and save precious NHS resources. I know that she is new to her post, so she might want to make a bold announcement today. Will she match Labour’s commitment to ending this tax on sickness? The subject was definitely on the radar of one of her predecessors on the health team, the hon. Member for Winchester (Steve Brine), as I had conversations with him about it.
As we have heard, filling prescriptions is only the tip of the iceberg of the services that our community pharmacies provide. There is the potential for the expansion and development of a whole range of services. For example, I would like to see an expansion of pharmacists being able to prescribe, especially basic medications, in order to relieve pressure on our GPs. I understand that that service is very successful where it currently happens. Community pharmacists are the most accessible healthcare professionals, and community pharmacies are a genuine hub for the delivery of a diverse range of health and wellbeing services. The Government’s television campaign advises people to ask their pharmacist, because it really is an easy thing to do. That is especially true for traditionally hard-to-reach people who benefit from the barrier-free access to healthcare that community pharmacists provide.
In some circumstances, if there is a high turnover of GPs in an area, the community pharmacist is the only one providing continuity of care, which builds invaluable trust and the capacity for important health interventions. It is therefore a natural and sensible progression to allow basic prescribing, especially if it is coupled with a sort of triage service that is linked to an ability to make appointments for people with more serious concerns directly with their GP.
As we have heard, community pharmacies have long provided a range of services in addition to the provision of medicines, including minor ailment schemes, smoking cessation services, blood pressure testing, support for asthmatics and diabetics, emergency hormonal contraception and monitored dosage systems. Despite that, community pharmacies are in many ways the NHS’s best kept secret. They are invaluable in a health service that is overwhelmed by increased demand.
There is so much untapped potential in community pharmacies, as well as some excellent examples of best practice across the country that could be rolled out nationwide. For example, when patients phone the Central Gateshead Medical Group with a minor illness such as earache or a sore throat, they may be offered a referral to one of 13 community pharmacists in the Gateshead area for a same-day booked consultation, which creates capacity for GP appointments for patients who need to be seen by a GP. The patient’s referral details are sent to the pharmacy using a secure NHS mail account. Patients are then sent a text message to confirm the details of the appointment with the community pharmacist. Community pharmacists are already doing some great work and they have a huge role to play at the heart of every primary care network. The Government are failing to recognise that if they do not try to roll that out.
I welcome the Government’s commitment to prevention, but they must put their words into action, for example by reversing the terrible cuts to local authority public health budgets and by recognising the importance of community pharmacists in particular and the role that they can play in prevention. As we have heard, thousands of people—millions, actually—visit their community pharmacy every day. Every one of those presents an opportunity for a positive health or wellbeing intervention. In the words of Simon Stevens, “Make every contact count”.
The profession and its representatives, the Pharmaceutical Services Negotiating Committee and the National Pharmacy Association, have offered to deliver more services. The recently negotiated new pharmacy contract begins to recognise what the NHS has been missing for so long. There are many welcome features, including the new community pharmacist consultation service, which will take patient referrals from NHS 111 and will be extended for referrals from other parts of the NHS, such as GPs and A&E. Similarly, the new Medicines reconciliation service will ensure that medicine prescribed in secondary care is appropriately implemented on discharge to the community, which will reduce the number of unnecessary hospital readmissions. Those changes will be not only convenient for patients, but enormously important in relieving pressure on GP surgeries and A&E departments, which is what we all want to do.
That is why we need a shift to service-based remuneration in the context of a five-year agreement. If community pharmacies, with their huge potential, are to remain viable, the remuneration must be adequate. Can the Minister tell us today what the new funding settlement will look like? I hope that, in her response, she will celebrate the work of community pharmacies—I am sure she will—and set out what the Government will do to utilise their potential.
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
It is a pleasure to serve under your chairmanship, Sir David. I thank each and every right hon. and hon. Member who has contributed. Most importantly, I thank the hon. Member for Halifax (Holly Lynch) for securing this debate and allowing us to discuss the challenges and celebrate the opportunities that lie ahead in community pharmacies, as well as how we best deliver to patients. The right hon. Member for Rother Valley (Sir Kevin Barron) and the hon. Members for Scunthorpe (Nic Dakin), for York Central (Rachael Maskell), for Heywood and Middleton (Liz McInnes), for Great Grimsby (Melanie Onn), for Strangford (Jim Shannon), for East Londonderry (Mr Campbell) and for Westmorland and Lonsdale (Tim Farron) all made excellent speeches that gave food for thought, as did the contributions from the hon. Members for Motherwell and Wishaw (Marion Fellows) and for Washington and Sunderland West (Mrs Hodgson). They celebrated exactly what community pharmacies can do if they are embedded in the heart of their communities and what untapped potential there is for moving forward.
I am pleased to have the opportunity to set out the vision for community pharmacy at a pivotal time for the pharmacy sector. As we have discussed, the past three years have been challenging, but there is a new pharmacy sector agreement. I am continually inspired, as everybody has been—we heard about the experience of the hon. Member for Halifax of working in a pharmacy—by the compassion, dedication and commitment of those who work in the NHS family. I saw that myself last week when I met pharmacists and the chief exec of the Pharmaceutical Services Negotiating Committee at the local pharmaceutical committee conference. That underlined to me again what an essential part of the NHS the pharmacy is, working day in and day out on improving outcomes for patients and for the community, which lies at the heart of what they do.
We have heard about the challenges of different communities. The hon. Member for Westmorland and Lonsdale made his point very well, as did other Members who represent rural constituencies. The hon. Members for Strangford and for Motherwell and Wishaw mentioned that the challenges are slightly different in rural, dispersed communities. We hope that the new contract will not be one size fits all but will give additional help to rural pharmacies to help them deliver, because we know that they are an important and integral part of their local community. Ensuring that we maintain a good level of access in England and support pharmacy where there are fewer pharmacies is important and built in.
Community pharmacy always has been an integral part of our communities. We have 11,500 community pharmacies delivering. I pay tribute to the right hon. Member for Rother Valley for his work in chairing the all-party group on pharmacy. He explained clearly how pharmacies are close to 96% of people, who can get to one by foot or on public transport in 20 minutes. The key thing for me was when he said that the majority were in areas of high deprivation. That is hugely important as the contract moves forward, because we are determined to double down on health inequalities, and we know that the pharmacist is a key frontline expert who can help deliver in those communities. Pharmacy can play a greater part in helping people to stay well in their communities.
Today’s debate is timely because the new landmark arrangements for pharmacy—a five-year deal for pharmacies—came into force yesterday. I have heard the deal criticised as flat, but the PSNC said that it wanted certainty; it wants to be able to use its skills better and further, and we have determined the deal in collaboration with it. The deal is the beginning of a programme to transform the sector and to see community pharmacies play a much expanded role in the delivery of health and care across prevention, urgent care and medicine safety. Those new arrangements will support the pharmacy team to utilise all its extensive clinical expertise, further developing new roles and providing the community with the knowledge, skills and support to prevent ill health, manage minor conditions and stay happy and healthy for longer. We have heard from virtually every Member who has spoken about how much that goes on. The hon. Member for Great Grimsby told a moving story of how intimate the relationship is between the community pharmacist and the community that he serves.
The deal sets a programme of work that the Department, NHS England, NHS Improvement and the PSNC have collaboratively developed and agreed—we have worked together to get there. Our direction of travel is clear, and we will continue to work together on the detail, strengthening the role of community pharmacy and the delivery of health and care year on year for the next five years and beyond.
Jo Churchill
On the matter of reimbursement, which was also raised by the hon. Members for York Central and for Westmorland and Lonsdale, we seek to ensure a fairer system of reimbursement for pharmacy contractors and value for money for the NHS. I am sure we would all agree that that is the challenge that we face the whole time. That is why, in July, we launched a consultation on community pharmacy drug reimbursement. We have engaged widely with pharmacy stakeholders and have had an excellent response. We will consider all those responses fully and set out plans for the fairer system in due course. I appreciate that the response will be, “But it’s needed now,” but a pharmacy is a private business, and reimbursement is not pharmacies’ only form of income. What I am talking about will take a shift. There is an acknowledgment that that shift—that transition—will need to be assisted. There is also an independent funding stream from the flu vaccine, for example. I would like to see—and have been discussing with officials—whether a broader vaccine programme could be rolled out through pharmacies as well, and reimbursed. We know we need to do better.
Jim Shannon
The Minister has so far given a comprehensive response to our concerns. I suggested in the debate that, when it comes to medical attention, pharmacies could do more to oversee small things such as the flu vaccination that she referred to and diabetes and glaucoma. As other hon. Members have mentioned, there are small things that pharmacists could do to take the pressure off GPs. Is that something the Government would consider—giving more responsibility to the pharmacist and taking pressure off GPs and accident and emergency?
Jo Churchill
If the hon. Gentleman will just bear with me for a second, he will hear me largely repeating what the right hon. Member for Rother Valley said when he so beautifully laid out the skills and expertise that lie in the pharmacy sector, and how they can be utilised better.
As I said, the deal sets out a programme of work we shall be working on. Our aim is that collaborative working across the system will deliver an integrated and accessible community health service for all. I want to name-check the hon. Member for Strangford here because, as he articulated, communication lies at the centre of this issue. One instance might be the digital expertise that the hon. Member for Washington and Sunderland West said exists in Gateshead, where people’s greater readiness to get services from pharmacists, and the fact that pharmacists can do more, is having a positive effect for patients.
First, pharmacists told us that we must utilise and unlock the potential of the highly skilled pharmacy teams that are embedded in communities throughout the country, including in the constituency of the hon. Member for Halifax, with everyone celebrating what pharmacists can deliver. That is why the settlement aims to deliver more fulfilling, patient-facing careers for community pharmacists and technicians, as highly valued members of the NHS team. Additionally, populations will be helped by much better services.
Secondly, pharmacists told us that they wanted continuity. The settlement funding over five years gives certainty, and gives community pharmacists the confidence to invest in their business. However, there is no one size fits all. Being in the centre of a town is not the same as being in a rural village. Looking at these things in the round is why we want this to be collaborative.
Rachael Maskell
How will the Minister measure the impact of the settlement, particularly on independent pharmacists? If more of them close or are struggling financially, what other interventions does she plan to make?
Jo Churchill
As I said, there is no one size that fits all. As the hon. Lady articulated in her speech, the difficulty is that we are not looking at a system where businesses are run on the same scale model. At any one point, there are single pharmacists. She stated that the pharmacy she visited was part of a seven-strong business. Then there are the multiples. We need to look at what is the best scheme. However, I would argue that independents have a much higher footfall from their local population, because they are more trusted than many of the multiple pharmacies due to the continuity that comes from their having been in their communities for longer. There are opportunities there for independents.
We know we will need to design new ways of working to make a success of this, and we will need patients to be confident in how they use the services. The enhanced role for community pharmacy will support patients in getting access to help where required and in using the NHS in the best possible way. When people are suffering from minor conditions such as earaches or sore throats and need health advice, we want them to think “Pharmacy First”.
We want to build on that, with other parts of the NHS proactively signposting to local pharmacists. We want everyone to recognise the high-level skills held by pharmacists and to get people to understand that we need them as a first-line service to go to. That will grow trust in the system and spread the load. We will, of course, need to reform the way we work to free up pharmacists’ time so that they are able to deliver these new services.
Liz McInnes
I am sorry to interrupt, but the Minister has not referred to delivery times yet, and we have only two and a half minutes to go. Will she mention what she is going to do about those?
Jo Churchill
I thank the hon. Lady, but I would like to push through and to come on to the supply of medicines, which the hon. Member for Halifax spent much of her speech discussing.
We must recognise that we need to work in partnership and that this is not only about treating ill health. One of the first services to come online under the new arrangements will be the community pharmacist consultation service, which will start on 29 October. It will establish the first ever national triage system, which will look at community pharmacies referring patients into pharmacy directly from NHS 111 for minor illnesses, wellbeing support and self-care advice, as well as urgent problems. It is important that everybody involved makes this work a success, because we want this to be a two-way process. Over the next five years, we want to include referrals from GPs, urgent treatment centres and NHS Online, but we want to do that based on evidence, sensibly and in collaboration with those in the sector. Registration opened only last month, and more than 2,000 pharmacies have been signed up.
Additionally, by 2020, being a level 1 healthy living pharmacy is expected to be an essential requirement, so that pharmacies can give advice. Integration across primary care is hugely important; the new contractual framework is about not moving minor illness, but about using the whole system better. Community pharmacies are a vital part of the picture if we want to think “Pharmacy First”.
Coming on to the question of medicine supply and shortages, I appreciate the issues that the hon. Member for Halifax mentioned, but, as recognised in last week’s National Audit Office report, we have done an enormous amount in collaboration with pharmaceutical and medical device companies. There are always ongoing shortages, but the Department works all the time to ensure that they are mitigated and that a proper supply of medicine can be got to people. With the issues of Brexit, we know that that is doubly important, and that is what the Department has been doubling down on.
Sir David Crausby (in the Chair)
I do not think there is really time for Holly Lynch to wind up.
Question put and agreed to.
Resolved,
That this House has considered the role of community pharmacies.