National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Lord Hunt of Kings Heath Excerpts

Monday 26th April 2021 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

That this House regrets that the National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021 (SI 2021/169) do not address the underlying funding problems faced by the pharmaceutical sector, which may affect the capacity of local pharmaceutical services to respond to future emergencies.

Relevant document: 47th Report from the Secondary Legislation Scrutiny Committee

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I welcome and support this statutory instrument. In fact, it is an excellent example of the contribution and innovation that community pharmacies make. Disappointingly, this has not always been recognised by the NHS, nor financially supported by the Government. As the Pharmaceutical Services Negotiating Committee has pointed out, community pharmacies have remained open throughout the Covid-19 pandemic; they have adapted to provide services in a Covid-secure way for their local communities, and they are offering face-to-face advice and healthcare on a walk-in basis. As well as delivering more than 1 billion prescription items a year, they have delivered healthcare advice at the rate of more than 48 million consultations a year. They have been a buffer for the NHS, helping their local communities and reducing pressure on other NHS healthcare providers.

The PSNC audit earlier this year, to be published this week, is fascinating. It says that 1.1 million informal consultations are taking place in community pharmacies in England every week. That comes to more than 58 million consultations a year. Every week, pharmacies provide advice on symptoms to more than 730,000 people. Nearly 38 million people per year—76% of pharmacy advice consultations—are people who have self-referred into the community, and 8.6% of those people seeking such advice said that they had been unable to access another part of the healthcare system. One in four informal consultations in pharmacies also involves advice and support relating to Covid-19. That means that 270,000 patients every week are seeking advice from pharmacies on Covid. Pharmacies giving advice save more than 2 million GP appointments every month, or 24 million every year. An additional 70,000 people would go to A&E or an NHS walk-in centre every week if they could not get advice from their local pharmacy.

Pharmacies, therefore, make a huge contribution. They can also make a contribution to the national Covid-19 vaccination effort. Some community pharmacies are already doing so, but all of this impressive work is at risk if they are not given adequate financial support. They cannot be expected to subsidise the NHS.

Work by the Company Chemists’ Association has shown that the community pharmacy sector is facing a real-terms cut in funding of more than 25% during the period 2014 to 2024. In 2016-17, funding for pharmacies was cut by more than £200 million a year, and, as a direct consequence, community pharmacies of all sizes have closed. We are now two years into the current five-year community pharmacy contractual framework, which was due for an annual review last year but which did not take place due to Covid. So the sector has been left, after those cuts, with a flat funding position for five years in a row, when the cost of service delivery continues to rise and the NHS prescribes more medicines year after year. We know that the additional cost of providing Covid-safe care has been significant. The sector has spent more than £400 million extra—out-of-pocket expenses—to sustain the service. The Government have provided some extra funding, but this falls way short of covering the full costs incurred.

The systematic underfunding of the community pharmacy sector, combined with the pressures to which I have referred, is putting many pharmacy businesses in a critical position. Many pharmacy owners are having to reduce services, opening hours or staff levels to cut down on costs. Large pharmacy chains have also announced significant cost-cutting and reorganisation measures over the past year. A study of independent community pharmacies found that 28% to 38% were in financial deficit already, and that this would rise to 64% to 85% without a funding uplift.

Already, we have also seen more than 400 net closures of pharmacies since funding cuts were introduced in 2016; 327 of them have been in the 30% most deprived areas. This has a knock-on effect on local high streets and potentially contributes to growing health inequalities. It is surely counterintuitive that we should have pharmacies closing in the middle of a pandemic—but without funding support, we expect more closures, which means more communities losing their primary link to the NHS.

The Government did provide £370 million in emergency funding loans to help pharmacies to stay open during the pandemic, in 2020. As I have explained, that money has been spent on covering the more than £400 million of NHS costs. Cash-flow modelling suggests many pharmacies cannot afford to pay back these emergency moneys. In summer 2020, HM Treasury made an initial offer on reimbursing pharmacy costs throughout the pandemic, but this was very constrained. Will the Minister tell us today whether the Government will write off the £370 million in advance payments that were made to pharmacies at the beginning of the crisis? I hope that he can bring a positive message. This would go some way to bridging the cost gap. Importantly, any shift to claw back this advance money from an already underfunded network will lead to further financial difficulties and potential closures.

I opened by describing some of the fantastic work done by community pharmacies. They are a critical part of the NHS and they have much more to offer to benefit patients, local communities and local healthcare systems. They are working with local GPs to roll out referrals from general practice, so that patients can get quick and convenient access to advice on minor illness, but they could do so much more. Over the coming months and years, pharmacies could really help on prevention, on levelling-up health inequalities, on identifying people with undiagnosed high blood pressure and other cardiovascular diseases, and on helping to tackle obesity and other health factors that have contributed to the UK Covid-19 death rate. They could provide enhanced community and public healthcare. I have already said that they could boost our vaccination effort and provide a first port of call to support GPs to return to pre-Covid activities. The new community pharmacy consultation service has the potential to enable pharmacies to meet the currently unmet need in urgent care, but it is currently failing due to a lack of engagement by, and referrals from, GPs and NHS 111.

It is very important that, in addition to providing financial support to the sector, the NHS trusts patients to know when their pharmacy is the right place for them to receive their care. Patients should be allowed to choose pharmacy as a place to receive their urgent NHS care. Part of the problem is that community pharmacy does not have a place around the table when it comes to the decision-making bodies at local level. I give notice to the Minister that I expect the NHS Bill, which we will see in the next Session, to put this right. We argued when the Bill went through that removing pharmacy from the boards of CCGs was a mistake. My goodness me, it has been a mistake.

Surely we should all come together to unlock the potential of community pharmacies and help the NHS get back on its feet as quickly as possible. I come back to funding: the current funding envelope for the community pharmacy network is unsustainable. We need to do better. The NHS could learn and benefit hugely from the pharmaceutical sector. I hope that this debate will encourage the Minister to take a much more positive look at what the sector can provide. I beg to move.

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[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, this has been a very good debate. I am grateful to all noble Lords, and the Minister, for their interesting contributions. Although this was essentially about the funding of community pharmacy, the huge contribution that it makes—and can make in the future—became very apparent in this debate. I hope that this is what will draw us together.

The noble Baroness, Lady Barker, drew an interesting distinction between provision in south London and that in south Lancashire. The irony is that it looks as though community pharmacies are most vulnerable in the most deprived areas and we really have to deal with this.

I was interested in what the noble Baroness, Lady McIntosh, had to say about dispensing doctors. When I was the Minister responsible for community pharmacy 20 years ago, we established a joint committee, between the PSNC and the BMA, of community pharmacists and dispensing doctors, to try to resolve some of the tensions. I am not sure whether we succeeded in doing that, but I echo the noble Baroness’s comments about the role of dispensing doctors.

I also thought that the noble Baroness, Lady Wheatcroft, gave an interesting analysis of the financial challenge facing the sector. She and the noble Baroness, Lady Brinton, referred to the EY report. What she said about the general impact that community pharmacy has on high streets was very important and we should not forget it.

We should also not forget what the noble Baroness, Lady Brinton, said about the unsustainable financial framework for many community pharmacies at the moment and the Government’s consultation and recommendations for structural financial change. I also echo what she said about resources for training pharmacists in new services.

In her winding, my noble friend Lady Thornton made the important point that community pharmacies did not close; they carried on and were of huge benefit to us. That is why it is so frustrating that there are so many local examples of where the NHS does not see the potential of community pharmacy. I come back to what I said earlier about the need to ensure some kind of statutory provision for community pharmacy representation around board tables, at local level. You could say the same for opticians and dentists; all too often, they are neglected by the decision-making bodies. When we no doubt come to debate these matters on the Queen’s Speech, in a couple of weeks, I hope we come back to the structure of the future NHS that the noble Lord wishes to bring us.

The noble Lord, Lord Bethell, chided me a little, I think, about using this SI as a way of raising general issues, but what are we to do? We have largely been deprived of Questions for Short Debate over the last year, and I am afraid that this SI is an excellent vehicle to raise more general issues. I have no problem whatever with the SI before us. I am grateful to the Minister for saying that he has heard my concerns and that there are discussions and negotiations going on, and that he will report back to us. But—and it is a big “but”—there is a tremendous risk that we will undermine the very fabric of community pharmacy unless we take action, which is what I urge on the Government. Having said that, I beg leave to withdraw my Motion.

Motion withdrawn.