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Rachel Gilmour (Tiverton and Minehead) (LD)
I beg to move,
That this House has considered Government support for community pharmacies in Devon and the South West.
I am delighted to have secured my first Westminster Hall debate. It is an honour to speak under your chairmanship, Mr Betts. At a time such as this, when we repeatedly hear from the Government and our communities that the national health service is under strain, is heading into yet another winter crisis and is struggling with capacity, community pharmacies need the greatest consideration for further Government support. I will start by focusing on the role of pharmacies in our society, and then I will outline the challenges and end on what we might be able to do with the right support and engagement.
I wish to thank all pharmacists and their staff in Tiverton and Minehead for the invaluable work they do day in, day out. In particular, I commend Neil and Anna, who have run Bampton pharmacy in my home village for decades, and have, along with the owners of Wiveliscombe pharmacy and Alcombe pharmacy, provided me with first-hand, real-life insights into the challenges they face.
The 15 pharmacies in my constituency of Tiverton and Minehead provide a vital service to their communities —something they share with every pharmacy across Devon, Somerset, the south-west and, indeed, the whole of the United Kingdom. As I am sure we will hear from other hon. Members, pharmacies are under threat from the economic environment in which they now operate. Core pharmacy funding has decreased in real terms by more than 30% since 2016, and costs have gone in exactly the opposite direction. The number of pharmacies open in England is lower than it has been in any year since 2008-09, even though their workload is 40% higher, in terms of annual prescriptions.
Sarah Dyke (Glastonbury and Somerton) (LD)
I thank my hon. Friend for securing this really important debate. As she was laying out, community pharmacies face large funding gaps, but the rate of pharmacy closure is Glastonbury and Somerton is nearly double the national average. Does she agree that the Government should commit to publishing the independent economic analysis commissioned by NHS England in early 2025, when the work is concluded? Does she also agree that we must reform community pharmacy funding and put in place a sustainable, long-term funding model?
Rachel Gilmour
I agree with both courses of action, and I thank my hon. Friend very much for that important and interesting contribution.
The increase in workload is not sustainable, but that workload is too important not to receive proper backing from central Government as they make headway on their ambition to create what they have referred to, on occasion, as a neighbourhood health service.
Being a Devonian, I would like to go through things logically. First, I will talk about prescriptions. In Tiverton and Minehead, each pharmacy dispenses an average of 7,540 prescriptions every month. Across all 15 pharmacies, that is an average of 113,175 prescriptions each month across the constituency. That is 20,000 more prescriptions each month than the House of Commons Library says there are people in the entire constituency. Prescriptions that provide life-altering medications for constituents are the front door to the work of pharmacies. They are what most people think pharmacies do most often, but our pharmacies do a lot more work in our villages, towns and cities.
Ann Davies (Caerfyrddin) (PC)
It matters not whether the community pharmacy is in Devon or my constituency of Caerfyrddin; drug tariffs, which put such a strain on our pharmacists, need to be reviewed, and an uplift is long overdue. Would the hon. Member agree that we need to highlight that financial shortfall to the Government, and that something needs to be done immediately?
Rachel Gilmour
I agree that we need to do that as often as possible. I will move on to the workload. This is not a typical example: along with prescriptions, in Tiverton and Minehead each pharmacy conducted 398 flu vaccines on average during the 2023-24 season, higher than the national average of 355.
If Members are unfortunate enough to need their blood pressure checked, they can go to a pharmacy. Across the UK, 930,000 hypertension blood pressure checks are undertaken in just one year. With public health as a driving mission for the Government, I would hope that this was something they could support wherever it takes place. Pharmacies also offer a range of other clinical and public health services, including providing flu and covid-19 vaccinations, and if further services were to be commissioned from community pharmacies in the context of sustainable core funding, the sector could do even more to improve access to primary care.
Jim Shannon (Strangford) (DUP)
I thank the hon. Lady for bringing this debate forward. She has touched on the issue of funding. In Northern Ireland, we have already made that commitment as it is a devolved matter; an additional £15 million has been set aside for community and GP pharmacies, with extra money beyond April 2027. We all want to achieve what the hon. Lady wants, but does she agree that to achieve that the Government and the Minister have to invest accordingly?
Rachel Gilmour
I do agree. In addition to delivering formally commissioned services, pharmacies provide an alternative point of contact for the public for informal clinical advice. The 2024 pharmacy advice audit found that the average pharmacy carries out around 22 informal consultations per day, which is the equivalent of 1.3 million informal consultations taking place in community pharmacies every week.
Steve Race (Exeter) (Lab)
I congratulate the hon. Member on securing the debate. From the first day we met we have talked about getting this debate, so I am very pleased that it is happening. I am the chair of the all-party parliamentary group on pharmacy. Does she agree that community pharmacies have a huge amount of potential to support patients with a range of services, which will support the NHS ten-year plan to move more care into the community and help prevent ill health in the first place? That is one of the main roles they can play in the future.
Rachel Gilmour
As the hon. Member knows, I am keen on strategies, particularly the one that he has just mentioned.
Pharmacies are not paid for the informal advice sessions. In over half of such occasions, if the patient had not been able to access their local community pharmacy they would have instead visited their GP surgery. That suggests that we have freed up 37.7 million GP appointments over the course of a year simply by patients having access to their local community pharmacy, which speaks to the point that the hon. Member just made.
Such a workload is commendable, but it is not sustainable in the current funding model. That has meant that over the autumn the National Pharmacy Association found that pharmacies are overwhelmingly willing to reduce services in order to protect patient safety and preserve access to pharmacies, if funding is not provided to protect the network. Pharmacies do not want to do that; they know the impact that reducing their services can have on a community, but if the other option involves continuing in an overstretched, under-supported environment, for pharmacists and anyone committed to delivering health and health-related services to vulnerable people, it is not a real choice.
Sir Ashley Fox (Bridgwater) (Con)
I thank the hon. Lady, my neighbour, for securing the debate. Does she agree that the many benefits that community pharmacies provide are in danger, because in many cases the pharmacist is not reimbursed even for the cost of prescription drugs? Will she, with me, ask the Minister to reply specifically on that point?
Adam Dance (Yeovil) (LD)
I congratulate you on securing this vital debate. In my constituency of Yeovil, pharmacies provide vital services, including more than 6,700 prescriptions per month—not quite as many as in your constituency, Rachel.
Adam Dance
Sorry, Mr Betts. Since the launch of the Pharmacy First service this year, it is estimated that pharmacies in Yeovil have saved at least 556 GP appointments. However, a lack of investment and the rise in national insurance contributions threaten the amazing work done by pharmacies in Yeovil and across the country. I understand from the response I received to a parliamentary question—
Mr Clive Betts (in the Chair)
Order. Interventions should be brief and to the point for hon. Members to respond to. They should not be another speech.
Adam Dance
Will my hon. Friend join me in urging the Minister to provide a clear timeline for the consultation to start?
Rachel Gilmour
I thank my hon. Friend for his not particularly concise, but erudite, intervention.
I will turn briefly to the funding model of pharmacies. Some 90% of a pharmacy’s income is derived directly from NHS funding, but when it comes to how that funding is allocated, the system is broken. Community pharmacies across the UK dispense more than 1.1 billion items a year and deal with shortage issues on a daily basis. The Department of Health and Social Care sets reimbursement prices in our system, but due to the reimbursement prices being so low and pharmacies being unable to compete on the international stage, the global market is now a safer bet for pharmaceutical companies than the UK. That means that people in the UK sometimes are not able to get the right medication due to shortages and that even when the DHSC puts together a price concession and allows for a greater reimbursement rate to allow UK pharmacies to compete for those life-aiding medications, there are extraordinary pressures on the NHS and the taxpayer. The realities of the funding model mean that community pharmacies are trying to push up water uphill using tools riddled with holes—in other words, sieves.
Claire Young (Thornbury and Yate) (LD)
Does my hon. Friend agree that in addition to the issues with the cost of drugs, the funding model for providing all the other services that pharmacies are expected to provide, including the Pharmacy First approach to avoiding GP appointments, needs addressing?
Rachel Gilmour
I will come on to Pharmacy First at the end of the debate, because I see it as the solution, rather than the problem.
The sector is trying its hardest, but without a fundamental overhaul of the system these NHS services, which are much-needed by patients and the public, may fall by the wayside into one of the following pits. There are the hours lost. When the money is not there, pharmacies cannot operate. As we see in many areas across the south-west and the UK, including in Tiverton and Minehead, hundreds of hours have been lost to temporary closures of pharmacies. According to the Company Chemists’ Association, pharmacies across the south-west have cut opening hours to the tune of 130,400 hours over just more than a year and a half by reducing their opening hours. According to Community Pharmacy England, from October 2021 to May 2024, in my constituency alone, more than 520 hours of pharmacy time were lost due to temporary pharmacy closures.
Although pharmacies operate all the services that I mentioned in the first part of my speech—and more, but I do not have time to go through them all—the closures take a toll on the GPs and A&E staff who might be someone’s next port of call if they cannot see their pharmacist. They take a toll on the NHS 111 line if the individual calls in, and they take a toll on the people who might not have any other free time in that day to take care of their health needs. Those lost hours add up. When pharmacies cannot provide those appointments or other services, it leads to bottlenecks elsewhere in the system.
Over the first three months of Pharmacy First, to which I will come shortly, pharmacies took 234 appointments out of the GP system simply by offering consultations for the seven applicable conditions. Pharmacies have fantastic potential to relieve pressure and provide new ways for people to access medical services, receive advice and so much more. Pharmacies cannot fulfil their potential if they are closed. The prospect of local pharmacies closing really does scare people. In a recent poll, 83% of respondents reported that they would be concerned about their local pharmacy closing. Data shows that closures are disproportionately taking place in the most deprived areas, with 50% of the pharmacy closures recorded in areas in the lowest three deciles of deprivation.
Andrew George (St Ives) (LD)
Further to the point made by the hon. Member for Exeter (Steve Race), is that not the nub of the argument? If the Government are to make the three shifts—including, importantly, the shift from hospital to community—they must not only stem the loss of pharmacies, but build them up.
Rachel Gilmour
I see it as a pyramid, with pharmacies at the bottom, right up to operations and A&E at the top.
According to the CCA, between September 2022 and June 2024 nearly 200,000 hours of pharmacy time was lost due to pharmacies closing their doors permanently. Over 1,000 pharmacies have closed since 2016, with a net loss of 136 pharmacies in the south-west over the last decade—including in Tiverton and Minehead, where we did not have many pharmacies to begin with. The number of pharmacies operating in England is now the lowest since 2008-09. There are reports across the sector of sustained difficulties in even staffing the pharmacies that remain open. The sector cannot sustain these exits, nor can communities where pharmacies are so vital. Pharmacies across the south-west and Devon need proper investment to safeguard and fix our broken pharmacy system, and to ensure that our health system is up to scratch and our social care system is supported.
Several hon. Members rose—
Mr Clive Betts (in the Chair)
Order. Given the number of Back Benchers who wish to speak, you will probably have to keep to less than five minutes each. Also, at some point we may have to suspend the sitting for 45 minutes to vote, so please do not speak unless you are prepared to come back when the debate resumes.
Sadik Al-Hassan (North Somerset) (Lab)
It is a pleasure to serve under your chairship, Mr Betts.
Over the past two decades I have had the privilege of working in a range of community pharmacies across the south-west and elsewhere. I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for the best birthday present I could ask for: an opportunity to talk about a passion that has defined my life and that I am still proud to practice today. I started my journey in community pharmacy studying at that pearl of south-west education, the University of Bath, more birthdays ago than I care to admit. From there, I went on to work in community pharmacies across the region, from Bideford in north Devon to the heart of Bristol, and even in Clevedon—a town I am honoured to represent as its Member of Parliament.
During my time working in village pharmacies, town pharmacies and even online pharmacies, I was witness to the irreplaceable value that pharmacies and their teams provide to some of the most vulnerable in our society. I am sad to say that I also experienced many of the challenges that the sector now faces. Indeed, it was living with those challenges and seeing the unnecessary suffering caused by the decline of community pharmacies that prompted me to run for Parliament earlier this year.
Over the past two decades working in community pharmacies across the south-west, I have seen at first hand the consequences of 14 years of pharmacy neglect by the previous Government, not least through their bad Brexit deal. By weakening our co-operation with our nearest neighbours, we have cut off the supply of pharmacists coming from Europe, we have greatly exacerbated our supply chain issues, resulting in medicine shortages, and we have contorted the Medicines and Healthcare products Regulatory Agency into a role it was never designed for and has since failed to live up to.
Undoubtedly the worst thing the previous Government did for our industry was freeze the funding settlement for 10 years, resulting in a 40% reduction in real terms. With ever-growing demands on prescribing and the introduction of the new role for pharmacists with Pharmacy First, the Conservatives prescribed pharmacy a tough pill to swallow and it will take years to undo the side effects. That is why we must not waste any more time. We must stabilise the sector today with a fair funding settlement while we begin the arduous task of reforming the role of pharmacy and the role it plays in our healthcare system.
Pharmacy First was a good step but, with only seven conditions eligible for treatment, it falls far short of Wales’s 27 and Scotland’s 30, with the scheme in England fraught with issues, not least in payment. Although the obvious priority is to expand Pharmacy First and relieve pressure on GPs, we must first expand pharmacies’ capacity, which can be done only by finally implementing the hub-and-spoke legislation that was inexplicably shelved in September without warning or explanation.
Hub-and-spoke model 1 would allow smaller independent community pharmacies finally to take advantage of the technologies that larger chains have been using for decades, thereby greatly increasing their efficiency and freeing up time previously spent on dispensing to be used for the delivery of clinical services to patients under an expanded Pharmacy First scheme.
I am eager to see this Government avoid the mistakes made during the past 14 years that have brought the sector to crisis point. I thank the hon. Member for Tiverton and Minehead for securing the debate, and the Minister for listening to our concerns. We have a once-in-a-generation opportunity to rewrite the story of pharmacy, which has a long and rich history of healthcare provision in this country but now faces an uncertain future, with some in the sector concerned that we might not survive past 2039.
The prescription for pharmacy is an immediate funding settlement for this year to stabilise the sector with a sticking plaster while we look at the longer-term changes the industry needs. Having been on the ground for the past 20 years, I am here to say that pharmacy has cut every ounce of fat that can be cut, and all that is left is bone. Without advancing the modernisation agenda, the sector has no more efficiencies to make. For that to happen, we need the Government to commit to implementing the hub-and-spoke model to increase capacity, and to expanding Pharmacy First to use that capacity. Pharmacy has an important future role to play in relieving pressure on other parts of our healthcare system, but it can play that role only if we proactively engage with the sector, rather than leave it out in the cold for another 14 years.
Steve Darling (Torbay) (LD)
It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) on securing this important debate.
A number of primary care providers, including GPs, dentists, opticians and pharmacists, spoke to Devon MPs a few weeks ago. They shared with us the crisis that the frontline of the NHS currently faces. They also shared another challenge that I ask the Minister to reflect on: how national operating framework 4 puts additional pressures on services in Devon, and how the integrated care board is challenged in respect of some decisions, perhaps where fewer prevention opportunities have been taken. That has increased pressures on primary care, with more money spent on acute services. The Government rightly highlight the fact that, in children’s services and adult social care, prevention is better than cure, and it is the same for this area of the NHS.
My constituency has 22 pharmacists serving communities across Torbay. Sadly, we have lost seven pharmacists in recent years, significantly increasing the pressure on those that still trade, which is a grave concern. We have an older population, leading to greater footfall for our helpful pharmacists. I also reflect on the fact that 10 years ago the NHS spend on support for pharmacists was 2.4%, and it is now 1.6%. If our plan is prevention, that is going in the wrong direction. Colleagues have rightly raised the Pharmacy First approach, which has saved a little under 500 GP appointments in the Torbay constituency; we need to push harder on that agenda.
I would like to curry a little favour with the Minister by sharing with him the fact that the first manifesto I bought had a picture of his father on the front of it. I still have it up on my shelf, despite my wife regularly asking me to clear out my office. I would like the Minister to reflect on whether NOF4 is part of the problem rather than the solution for NHS services, and to ensure that we get the long-term funding for pharmacies that is the strength they need to build on.
Several hon. Members rose—
Mr Clive Betts (in the Chair)
Order. I am going to have to squeeze speeches down to no more than four minutes.
Anna Gelderd (South East Cornwall) (Lab)
It is a pleasure to serve under your chairmanship, Mr Betts, and I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for securing the debate.
After decades of Conservative Government, our NHS is on its knees, and we see that in our long waiting times, in GP services over capacity and in hospitals struggling to meet demand. In the middle of this, community pharmacies have been quietly stepping up and taking on more responsibilities to help NHS colleagues and to ensure that our communities are not disadvantaged further. However, underfunding, medication shortages and a reduction in the skilled workforce have left many pharmacies in crisis.
According to the Company Chemists’ Association, the south-west has lost more than 300,000 hours of pharmacy care a year, with 40% lost due to reduced opening times and 60% as a result of permanent closures. Behind the statistics are real people in our constituencies who are struggling to access the care they need. Community pharmacies are trusted pillars of our communities and a key part of the wider healthcare system. For areas such as my South East Cornwall constituency, where we have a large elderly population and constituents who often have to travel very long distances to access healthcare services, our pharmacies are vital lifelines.
This Government have a plan to rebuild our NHS, but it will take time and we need to do more in the interim to support our pharmacies so they can continue to support our communities. Great initiatives such as Pharmacy First have demonstrated that pharmacies can support our NHS and deliver for people when they are empowered to do so. Such schemes can help to free up GP capacity and improve patient access to treatments for common conditions. However, more could be achieved, so will the Minister outline what support will be made available for community pharmacies in my area of South East Cornwall and across the south-west?
Vikki Slade (Mid Dorset and North Poole) (LD)
It is a pleasure to serve under your chairmanship, Mr Betts, particularly because I speak after the hon. Member for North Somerset (Sadik Al-Hassan) indicated that it may be his birthday, which means that he and I share our birthday with the Pope.
Sadik Al-Hassan
I congratulate the hon. Member on having the best birthday.
Vikki Slade
I thank the hon. Gentleman for that intervention.
Like my colleagues, I get a lot of correspondence about community pharmacies, which comes from my constituents and also from the pharmacists of Mid Dorset and North Poole. One of my constituents, Ruth in Wimborne, visited Quarter Jack Pharmacy for me at the weekend to get some data. I asked her to get some examples of drugs for which the price differential between what was paid and what was reimbursed was particularly high. The pharmacist gave her a whole list of drugs for which the money received was substantially less than what he got. He said that the precise amount varied from week to week, including for apixaban, which is prescribed to prevent strokes and which presumably saves the NHS a lot of money. Does the Minister agree that that is unacceptable? What commitment will he give to update the contract urgently?
On the medicines shortfall, I cannot tell Members how many people have told me about having to go around the county to try to find the medication they need. Patients with epilepsy, attention deficit hyperactivity disorder, Parkinson’s and sight loss have all contacted me worried about their health. David explained his issue with epilepsy, which is that stress can increase the chance of seizures. I have a personal example: my husband Paul also has epilepsy, which is controlled by drugs, but if he has one seizure, he will lose his driving licence again. He has just got it back after two years and I really do not want to be driving him around. The idea of people being unable to work or drive is mad. The list of medicines available under prescription includes epilepsy, but not Parkinson’s. Does the Minister agree it is high time that the list was updated, given that it was last changed in 1968?
There has been a recent consultation on allowing non-pharmacists to give out bagged medication, and on pharmacists being allowed to give approved persons the right to issue medication. I wrote to the Minister to ask when we were going to get a result and was told that it was still being considered, so I really hope that, today, he might give us a timeline for when we can expect that for our pharmacists.
Finally, in one of my local villages the GP dispenses out of a side window of the surgery, with patients expected to wait in the cold. When I asked why they could not reduce this inconvenience for patients, who are often out there for 45 minutes, I was told it was because they cannot make up prescriptions for three months instead of one because they get paid per prescription and not for the drugs, so the GP would be out of pocket if they made the prescription for three months. That seems outrageous. If it is true, will the Minister urgently review how that works so that dispensing GPs and pharmacists are not out of pocket for providing a better service to their patients?
Edward Morello (West Dorset) (LD)
It is a pleasure to serve under your chairmanship, Mr Betts. I thank my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this important debate.
Community pharmacies are indispensable to West Dorset, serving as essential health hubs for our communities. However, they face mounting challenges, including escalating financial pressures and critical workforce shortages that threaten their ability to continue to provide those vital services.
West Dorset, amazingly, is served by only 18 active pharmacies, for a population of more than 100,000. Data from the NHS Business Services Authority shows that the number of community pharmacies in England has declined by 6.7% since 2001. In the past year alone, a further 217 pharmacies have been lost, and startlingly it is those not offering in-person services—often called distance-selling pharmacies—that are the least likely to fail. That demonstrates that the new role that pharmacies are having to play in our healthcare system is actually hurting their viability due to the broken funding model.
Workforce shortages exacerbate the strain. In NHS Dorset, the integrated care system that covers West Dorset, there are 47 vacancies, equating to a vacancy rate above the national average of 19%. The impact of these staffing challenges is clear: a 2024 survey by Community Pharmacy England found that three quarters of pharmacy team members reported shop staff shortages, and approximately 10% of pharmacy owners had no choice but to temporarily close their doors as a result of those shortages.
For patients, that means longer waiting times, reduced services and less access to advice for urgent healthcare concerns. For staff, it translates to unsustainable workloads, difficulties in sourcing medicines and, most alarmingly, increases in patient abuse. Nearly all respondents—92%—reported struggling to cope with the pressure, highlighting the human toll of the pharmacy crisis.
The recent rise in national insurance contributions places an additional burden on pharmacies as employers, particularly in rural areas, where revenue streams are less predictable. I have one pharmacy in my constituency that made a six-figure loss last year, even before the increase in national insurance contributions came in.
Sarah Dyke
I thank my hon. Friend for giving way. As he is rightly pointing out, the employer national insurance contributions, alongside the national living wage, are increasing the pressure on our important community pharmacies. Does he agree that the Government must urgently exempt pharmacies, GPs and dentists from the tax hikes to avoid considerable damage to the sector?
Edward Morello
I thank my hon. Friend for the intervention. She will be pleased to know that there is, in fact, a Liberal Democrat amendment right now to do exactly that, which I am sure we will all be voting for, and which we would ask the Government to take the opportunity to support. Community pharmacies already face slim margins under the current community pharmacy contractual framework funding model, and while initiatives such as Pharmacy First have brought new funding streams into the sector, they are not sufficient to offset the rising costs of operation, including wages, rents and utility bills.
Community pharmacies are lifelines for rural constituents like those in West Dorset. They provide crucial access to healthcare services, especially for those who struggle to reach GPs or hospitals. They are also uniquely vulnerable due to small patient bases and higher operational costs, and the Government should recognise those disparities. That means revisiting the funding framework, addressing workforce shortages and offering targeted financial relief to offset rising costs, including the impact of national insurance contributions.
Community pharmacies are not just businesses; they help to support our strained healthcare systems and are a part of our communities. For the people of West Dorset, and for millions across the country, we cannot afford to let them falter. I urge the Government to prioritise this issue, undertake a comprehensive review of the funding model, work closely with Community Pharmacy England and provide the support necessary to secure the future of our pharmacies and the vital service that they deliver in rural communities.
Richard Foord (Honiton and Sidmouth) (LD)
It is an honour to serve under your chairship, Mr Betts. Growing up, people used to talk about going to the chemist, and at the time I saw that alongside going to the butcher or shoe shop—it was where we went to buy stuff. What I did not realise was how crucial pharmacies are to prescriptions and thus to people’s health and wellbeing, and I am ever so aware of that now that I represent a constituency in Devon.
Under the previous Government, in the last two years alone, Devon has seen the closure of nine pharmacies, leaving the county with just 133. For the people I represent in Honiton and Sidmouth, that translates to just 16 pharmacies per 100,000 people—even fewer than in West Dorset. That is partly because income for pharmacies has stagnated, particularly what they receive from the NHS, and that is combined with rising costs, including energy bills and wages, as well as the cost of medication. Altogether, it makes for an unsustainable financial model. Yet pharmacies provide over 1.3 million consultations each week for people’s health concerns, which is keeping people out of the NHS and saving 38 million GP appointments every year. Just last month, a pharmacist in Devon noted that his team spends over two hours per day providing free, unfunded clinical consultations, and those prevent health conditions from deteriorating, and prevent hospital visits and additional strain on the NHS.
Edward Morello
My hon. Friend raises a very important point: under the current funding model, pharmacists are reimbursed only if the consultation results in a prescription being issued. That results in a medicalisation of the process, which means that pharmacists are less likely to provide other sorts of solutions, such as community care. Does my hon. Friend agree that the model is fundamentally flawed and creates a medicalisation issue?
Richard Foord
It is flawed, particularly for those parts of the country that are rural and coastal, such as those represented by my hon. Friend and myself. In Honiton and Sidmouth, the average age of my constituents is 56. I went to a meeting of the all-party parliamentary group on ageing and older people last week, and we hosted Sir Chris Whitty, the chief medical officer for England. He described how, while in some societies people move away from the coast and rural areas to seek comfort and care in towns and cities, in England we do quite the reverse. That makes it even more crucial that we maintain our pharmacies in those rural and coastal communities.
In short, we are calling for the Government to provide funding to halt the closures and stabilise the sector, ensuring that rural communities such as those in Devon are not left behind. We want to see the role of pharmacists expanded to give them greater prescribing rights and allow them to take on bigger public health responsibilities.
Lloyd Hatton (South Dorset) (Lab)
It is really important that we widen the discussion to talk about not only stemming the loss of pharmacies, but how we can put pharmacies back. In the south-west, community hospitals would act as an excellent venue for them. Does the hon. Member agree that we should be looking at community hospitals as a potential venue for new pharmacies, so that they are a bit of a one-stop shop where people can access healthcare and advice?
Richard Foord
I think the hon. Gentleman has come up with an absolutely brilliant idea. Community hospitals are potentially hubs where pharmacies might sit in the future. I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate; she has done a great thing by doing so.
Mr Clive Betts (in the Chair)
We now move on to the Front Benchers. The two Opposition spokespeople have no more than five minutes, and then the Minister will probably have about 10 minutes left.
Dr Danny Chambers (Winchester) (LD)
I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate, which is very timely because just yesterday the hospital in Winchester declared a critical incident. It has had so many infectious patients come in with various flus, the norovirus and other infectious diseases that it is short of beds. It has asked people to seek other healthcare arrangements, and has specifically mentioned pharmacies as a place to go for advice.
Alongside providing more social care packages to free up beds, one part of the solution to prevent the yearly NHS winter crisis is to increase the delivery of flu and covid vaccinations well before winter. We have seen that, with the right Government support, our community pharmacies are well placed to deliver vaccinations; they are not just accessible but convenient, and they deliver care right in the heart of a community.
I have been to many pharmacies in and around Winchester, including the Springvale pharmacy in Kings Worthy, the Wellbeing pharmacy on Winchester High Street and the Colden chemist in Colden common. I have spoken to the staff who work there and have heard at first hand that the NHS funding model really isn’t working for them. I was saddened to hear that, although those pharmacists are passionate about their work, they struggle to see how they will remain open for the next 12 to 24 months.
Caroline Voaden (South Devon) (LD)
Pharmacies in two of the major GP surgeries in my constituency, Leatside in Totnes and Compass House in Brixham, have closed in the past year because the private operators could not make a profit. Does my hon. Friend agree that it is urgent that we revise the funding model for prescriptions so that pharmacies, particularly in GP surgeries, can survive?
Dr Chambers
I completely agree. As other Members said, in some cases it costs pharmacies money to dispense NHS prescriptions. That is clearly not viable, especially given that the core NHS funding for pharmacies has been reduced by about 30% since 2015.
Some healthcare providers are really struggling and are on the brink of financial viability. They include pharmacies, hospices and some social care providers. The increase in national insurance contributions will cost the pharmacy industry approximately £50 million extra this year. Once again, we urge the Government to exempt some healthcare providers from the increase in national insurance or potentially repay that money through another mechanism, because it could be a death blow to social care providers, pharmacies and hospices that are on the brink of financial viability.
I thank hard-working pharmacists, such as the hon. Member for North Somerset (Sadik Al-Hassan), who really are part of the community. People come in; they trust them. Pharmacists have a really good personal relationship with their communities. Through the work they do and the hours they work, pharmacies are a lifeline for millions. They provide nearly a third of consultations outside normal working hours. They are often the only point of care for people living in rural areas. As our population grows older and faces increasingly complex health challenges, pharmacies must be empowered to step up and deliver the reliable, flexible care solutions that our communities desperately need.
As we talk about the strain on the public finances and the NHS budget, we cannot be tempted to see primary care—GPs, mental health provision, pharmacies or dentists—as a cost to be cut. We must invest in them and ensure we keep them viable, because it is always more cost-effective to treat people in their communities and prevent them from getting ill than it is to treat them when they end up in hospital.
Dr Luke Evans (Hinckley and Bosworth) (Con)
It is a pleasure to serve under your chairmanship, Mr Betts, and to speak across the Chamber from the Minister for the first time.
As a GP, I am grateful for the fact that 38 million GP appointments are saved each year. Although the temptation is to try to thank everyone—it can feel like doing a set of prescriptions again—I pay particular tribute to the pharmacists, because whenever I used to get a call from a pharmacist, I always knew that they were right and that I should listen carefully to what they said.
As of January 2024, there were more than 10,000 pharmacies providing NHS services, with 80% of the population living within 20 minutes’ walking distance of a pharmacy. We know that the number of registered pharmacists also grew consistently under the last Government, up 61% in 2024 compared with 2010. I am pleased to hear that the Government are still committing to the NHS workforce plan. As we have heard today, there are still difficulties in meeting recruitment needs.
I congratulate the hon. Member for Tiverton and Minehead (Rachel Gilmour) on securing her first debate. As she rightly pointed out, there are many difficulties in the sector. I would like to take a quick canter through them. With five minutes, I have five questions to the Minister.
The first and most obvious issue is the community pharmacy contractual framework, which is so important to the financial agreement for 2024-25. This was a deal struck in July 2019 to provide £2.59 billion in annual funding to NHS pharmacy services. Under the last Government, in 2023, the NHS published a delivery plan for improving access to primary care, which included a £645 million investment over two years to expand community pharmacies. However, the delays in the negotiations are having an impact on pharmacies across the country. In a recent letter, Community Pharmacy England wrote that
“there will not be a community pharmacy sector left to deliver the Contractual Framework, let alone the future ambitions of the Government and the NHS.”
Question No. 1 is: can the Minister provide an update on the negotiations? When will it start, and will there be published terms of reference?
My next question relates to the impact of the increases in national insurance contributions and the national living wage—the Government’s choice to place a burden of about £50 million on the sector, as has been set out. The Government have exempted secondary care, but made no such commitment to community pharmacies. Question No. 2 is: was the Health Department aware of the Treasury’s decision, and did it raise concerns about pharmacies and the impact the changes would have? After all, it has led the National Pharmacy Association to vote in favour of collective action for the first time in their history, saying:
“The sense of anger among pharmacy owners has been intensified exponentially by the Budget, with its hike in national insurance employers’ contributions and the unfunded national living wage increase, which has tipped even more pharmacies to the brink.”
Question No. 3 is: what mitigations are planned and when for? As we have heard from the Prime Minister, the Chancellor and the Health Secretary, it will be done in the usual way. Decisions are being made now, so could they please set that out?
Let me turn to the evolving model of Pharmacy First. The programme has shown just how capable pharmacies are, and it has been welcomed. There is great potential for the service to benefit patients, yet recent data from NHS England identifies that GP referrals to Pharmacy First in England can vary quite significantly across integrated care boards. For example, in Greater Manchester, there were 11,683 referrals, whereas in Cornwall and Isles of Scilly, there were 612. There could be obvious reasons for that, such as demographics or locations, but question No. 4 is: can the Minister clarify what the Government are doing to promote Pharmacy First services, and share that data?
I was pleased to hear the hon. Member for Mid Dorset and North Poole (Vikki Slade) discuss the issue of dispensing GPs. There are 948 dispensing GPs, and they account for 7% of prescriptions, covering almost 9 million people, many of whom are in rural areas. Not much is mentioned about what they do, so I am keen to understand the Government’s position on dispensing GPs. Question No. 5 is: will the Minister set out how he perceives the landscape? Given the time constraints of this debate, perhaps he can write and give me an idea of what it would look like.
Finally, the pharmacies stepped up during the pandemic. They were the lightning rod not only for getting medications out but for providing the much-needed vaccinations that allowed us to relieve lockdown. Christmas is one of their busiest times—I have seen that at first hand. I would like to put on record our thanks, from both sides of the House, for the fantastic job that they do.
The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairship, Mr Betts. I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for ensuring that this really important debate can take place today. I start by acknowledging and paying tribute to the outstanding work of community pharmacy teams in Devon, the south-west and right across the country. I have heard so many examples, showing just how many patients and communities rely on pharmacy services, and the lengths to which they go to deliver care. I thank them for their professionalism, hard work and dedication in providing excellent standards of patient care.
It is a credit to them that surveys show that nine in 10 people who visit pharmacies feel positive about the experience. Community pharmacies are often the most accessible part of our NHS, allowing people to access professional healthcare advice right there on the high street. They are also vital in supporting rural communities and people living in remote locations. Furthermore, as community pharmacies provide more clinical services, they help to relieve pressure in other areas of the NHS. That includes freeing up GP appointments, preventing hospital admissions and reducing overall pressure on secondary care.
For far too long, however, Governments have failed to recognise the essential role of community pharmacies in safeguarding the nation’s health. On 4 July, we inherited a system that has been starved of funding, with a 28% cut in funding in real terms. In many ways, it is on its knees, with far too many closures happening across the country. Lord Darzi’s report laid bare the true extent of the challenges facing our health service. Even he, with all his years of experience, was truly shocked by what he discovered. His report was vital, because it gave us a frank assessment—a diagnosis—so that we can face the problems honestly and properly. It will take a decade of national renewal, lasting reform and a long-term plan to save our NHS. We have committed to three key shifts: from hospital to community, from analogue to digital, and from sickness to prevention. Our 10-year plan will set out how we will deliver these shifts to ensure that the NHS is fit for the future.
To develop the plan, we must have a meaningful conversation with the country and those who work in the system. We are therefore conducting a comprehensive range of engagement activities, bringing in views from the public, the health and care workforce, national and local stakeholders, system leaders and parliamentarians. I urge Members, their constituents, and staff across health and social care to tell us what is working and what needs to change. They should visit change.nhs.uk and make their voice heard.
The Government are committed to restoring the NHS to its founding promise that it will be there for all of us and our constituents when we need it. However, as identified by Lord Darzi’s review, primary care is under massive pressure and in crisis. I recognise that it is a really challenging environment for colleagues in all parts of the NHS, including in community pharmacy, but we remain resolute and determined to fix this situation.
Pharmacies are based in, and are a key part of, the communities that they serve. They are ideally placed to help to tackle inequalities and to increase the reach of and access to NHS services. This includes delivering a range of health advice and support services, helping to relieve pressure on and improve access to the wider NHS. Community pharmacies are a vital part of our NHS that must be recognised in the development of the Government’s 10-year plan. They are central to the three big shifts in healthcare that I outlined earlier. I know that pharmacies can and should play an even greater role in providing healthcare on the high street. This will be imperative if we are to deliver across the Government’s mission—not just on the health mission, but on growth and opportunity.
A healthy society and workforce are pre-conditions for prosperity and growth. We have a staggering 2.9 million people who want to work, but are unable to do so because they have been failed by our health and care system for the last 14 years. Community pharmacy has a pivotal role to play in getting our economy back on its feet and fit for the future, whether that is by identifying those with risk factors for disease such as high blood pressure, or ensuring that people can access and use their medicines to best effect. As a Government, we are fully committed to working with the sector to achieve what we all want: a community pharmacy service that is fit for the future.
I am keen to unlock the potential of the whole pharmacy team. We want pharmacists to be providing new and impactful clinical services, including our future pharmacies prescribing service. We want pharmacy technicians to have more responsibility in supporting the pharmacists, to help people to deliver the best possible health outcomes.
Every day, pharmacy teams facilitate the safe supply of medicines to patients, enabling them to manage health conditions as part of their daily lives in Devon, the south-west and right across the country. They also provide vital advice on prescriptions, over-the-counter medicines and minor ailments. But pharmacies do not just dispense medicines and offer advice. They do much more. They positively impact patients’ health and support the wider NHS by providing a wide range of clinical services. Many offer blood pressure checks, flu or covid-19 vaccinations, contraception consultations and many more locally commissioned services.
Dr Evans
The Minister is espousing brilliantly what community pharmacies do. That all comes under a contractual framework, and one of the key things that pharmacies are asking for is when the negotiations will start and what the terms of reference will be. Will the Minister address that point?
Stephen Kinnock
I thank the shadow Minister for that intervention. I am as frustrated as everybody else about the delay. The reason for the delay is that the negotiations did not get over the line before the general election. The general election came, and we have spent a lot of time now clearing up the disastrous mess that the previous Government made of the system. I can say that we are now very focused on getting these negotiations started early in the new year. I know that hon. Members across the House will be very interested in that, in terms of the contractual framework, the medicines margin and all of the funding. We have a statutory duty to consult with the sector before we can make any announcement, but we are confident that we will start the negotiations early in the new year.
We supported Pharmacy First in opposition, and we will build on that programme in the future. We look to create an independent prescribing service, where prescribing is an integral part of the services delivered by community pharmacies. We are also doing a lot of work on the IT infrastructure to make sure that the sector can more easily prescribe and refer through better IT. That is an important part of our shift from analogue to digital. We need pharmacies delivering services that help patients to access advice, prevention and treatment more easily—services that help people to make best use of the medicines they are prescribed and that ease some of the pressures in general practice and across parts of the NHS.
There are more than 10,000 pharmacies in England. They are busy dispensing medicines, offering advice and providing these services. Patients across the country can also choose to access around 400 distance-selling pharmacies that deliver medicines to patients’ homes free of charge. They play a vital role in reaching the most isolated members of our society.
I am very keen to ensure that the hon. Member for Tiverton and Minehead has a minute at the end of the debate to sum up. In the short time I have, I want to say a couple of words about her constituency, where there are 15 pharmacies. We are aware of the closure of one pharmacy in her constituency since 2017 and that the local population instead get their medicines from the neighbouring dispensing GP. I also note that, according to the latest data, there are 203 pharmacies in Devon; across the south-west, there are 916. Where closures have occurred across the south-west, the ICBs are working through the process of approving applications from new contractors. Some applications have already been granted. Following approval, the new pharmacy contractor has 12 to 15 months in which to open a pharmacy, so the ICBs are also working with GP practices and other contractors to minimise any temporary disruption for patients.
Community pharmacies are a vital part of the NHS and communities across our country. The Government are committed to supporting them now and into the future. I look forward to working with pharmacists across the country and hon. Members across this House as we progress our plans to embrace the skills, knowledge and expertise in pharmacy teams.
Rachel Gilmour
The Health and Social Care Committee reported in May that
“the undoubted potential for pharmacy to improve access to health care, crucially including immunisations, and reduce pressure on general practice and other areas of the health system can only be realised with the right support and the right investment of public funding.”
Why, then, are we not hearing anything from the Government about support for pharmacies? In under a decade, the proportion of NHS funding for pharmacies has fallen from 2.4% to 1.6%. An average pharmacy relies on NHS funding for 90% of its income.
It does not have to be like this. The sector is ready, it just needs backing. We know that pharmacies across the country and the region, and especially in Tiverton and Honiton—whoops: Tiverton and Minehead—are willing to provide these services. Pharmacy First—