Pharmacies: Rural Areas

Baroness Merron Excerpts

Tuesday 10th September 2024 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have to ensure that pharmacies are accessible to those living in rural areas.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, pharmacies are key to our plans to make healthcare fit for the future, as we shift healthcare out of hospitals and into the community. We will expand the role of pharmacies, including the introduction of prescribing services. People’s experiences of accessing pharmacies differ across the country; we will look closely at this. There are dispensing doctors in areas where pharmacies are not viable, and online pharmacies delivering medicines free of charge to patients.

[The Lord Bishop of St Albans]

I thank the noble Baroness for her response. However, analysis by the Independent Pharmacies Association has identified a £1.2 billion funding gap in this sector, which is leaving, in particular, pharmacies in rural and deprived areas very vulnerable indeed, at the very point when, as she said, we are looking for them to deliver more services. Given that 90% of their income comes from the NHS contracts and that most are unable to fill the funding gap through a retail outlet, what else can His Majesty’s Government do to ensure that we have adequate coverage in rural areas?

[Baroness Merron (Lab)]

I take on board the point that the right reverend Prelate makes. The analysis to which he refers shines a light on the fact that funding for community pharmacies was either cut or held flat over the last eight years, which amounted to a funding cut in real terms of some 28%. We are seeing the result of that. It is also worth saying that the consultation with Community Pharmacy England on the national funding and contractual framework arrangements for 2024-25 was not concluded by the previous Government, so I can say to your Lordships’ House that we are looking at this as a matter of urgency. We look forward, through my colleague Minister Kinnock, to how community pharmacy can be best set to deliver on the ambitions that I have already outlined.

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my role with the Dispensing Doctors’ Association; I am grateful to the Minister for paying tribute to it. The right reverend Prelate identified the problem of having equal funding in urban and rural areas, where the dispensing doctors she identified fulfil such a crucial role. Can she give the House a commitment that sufficient funds will be made available in the negotiation of the GP contract so that all the services that are available in urban areas will also be available in rural areas?

[Baroness Merron (Lab)]

I know that the noble Baroness understands that there are some services which cannot be provided—for example, online services do an excellent job, as do dispensing doctors, but although I regard the online option as a very creative one that I would like to see expanded further, there are some things that require in-person attention and that will not be possible. We of course take account of situations across the country, in all the discussions, and that includes rural areas.

[The Earl of Devon (CB)]

My Lords, I am chair of the Plunkett Foundation’s inquiry into the state of rural retail, in particular the loss of wholesale supply chains essential to the survival of rural communities. Will the Government please undertake to review this highly discriminatory circumstance, which hits the rural poor the hardest?

[Baroness Merron (Lab)]

I will be very happy to look at the work that the noble Earl refers to. If he would like to meet me to discuss it, I am sure that would be of great assistance as we look to the future.

[Lord Scriven (LD)]

My Lords, there is a crisis in community pharmacies, as the Minister will know. Two weeks ago, the industry brought out a report that predicted that one in six community pharmacies could close within the next year. What urgent action will the Government take to ensure that that does not happen?

[Baroness Merron (Lab)]

On the point that the noble Lord correctly raises, it is worth reflecting that there has already been a reduction in the number of pharmacies since 2017. There are now some 1,200 fewer pharmacies than we had in 2017 and 600 fewer than there were two years ago. This is a trajectory that we would rather was not the case. Support is available—for example, through the Pharmacy Access Scheme, which provides financial support to pharmacies in areas where there are fewer pharmacies. I can say that we are monitoring access to pharmacies. While it is the case that four in five people live within a 20-minute walk from a community pharmacy, we absolutely recognise that the experiences of patients differ. If we are to see pharmacies as key to future plans for the health services, we will have to address that.

[Lord Kamall (Con)]

My Lords, we recognise that the current access to healthcare is based on an outdated model, where far too many patients are unable to book GP appointments online or by telephone in advance. They have to join the 8 am lottery to try to get an appointment by phone, only to be referred later to a pharmacist or hospital. The Pharmacy First reforms introduced by the last Government attempt to unblock the GP surgery bottleneck by allowing patients to access treatment for common health conditions without the need for a GP appointment. To ensure that patients in rural communities equally benefit from the Pharmacy First initiative, is the Minister able to give the House a firm commitment that the Government will continue the Pharmacy First approach and look at how this could be accessed by more patients in rural areas?

[Baroness Merron (Lab)]

I am pleased to say that, as I am sure the noble Lord is aware, prescribing pilots are going on in NHS England. These will look at what more pharmacies could do in this regard, in particular asking whether more minor illnesses could be dealt with, and whether the long-term management of conditions could be better managed through pharmacies. We will be very interested in what those pilots come up with. They are across the entire country, so will of course include rural areas. This is something that we will want to ensure is available in rural and urban environments.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the Commons Health and Social Care Select Committee pharmacy inquiry found that, while most medicines are in good supply, medicines shortages have doubled since 2021. This means that pharmacists spend time dealing with medicines shortages every day—some as much as four and a half hours. The committee recommended an independent review into how to improve resilience of the medicines supply chain, including looking at pharmacists’ prescribing. Will the Minister commit to this, and if not, what will she do to improve the situation?

[Baroness Merron (Lab)]

The noble Baroness makes a good point about the shortage of medicines; this has been raised many times in your Lordships’ House. I will ensure that my colleague Ministers are aware of the points raised today, to build these into our consideration of how we support pharmacists and pharmacies to continue to do a good job and, indeed, expand their remit.

[Lord Foulkes of Cumnock (Lab Co-op)]

Does the Minister agree that part of the problem around access to rural pharmacies is the massive deterioration of bus services under the previous Government? Since our Government are going to give powers to local councils to run bus services more efficiently and effectively, will that not improve access to local rural pharmacies? Can the Minister ensure that that is done as quickly as possible?

[Baroness Merron (Lab)]

I welcome the announcement by the Secretary of State for Transport about ensuring that bus services can be more readily available, which will assist access to pharmacies. However, there are other options that we need to continue to look at. For example, there are 400 distance-selling pharmacies that deliver medicines which they dispense free of charge to patients, and provide other pharmaceutical services remotely, and, as we know, GP practices can dispense medicines to their patients. I mention those as examples of more creative ways in which we can support people in rural areas.

[Lord Swire (Con)]

Another creative way is to locate some of these pharmacies where we still have community or cottage hospitals up and down the country, which has been done successfully. Will the Minister therefore undertake to look at where this is common practice to see if it can be expanded?

[Baroness Merron (Lab)]

All these creative approaches will be considered as we look at what we will be doing to ensure that pharmacies are key to delivering on improved healthcare across the entire country.