Community Pharmacies

Alistair Burt Excerpts

Tuesday 23rd February 2016 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

As others have said, it is a great pleasure to serve under your chairmanship, Mr Streeter. Thank you for chairing this debate. I also thank my hon. Friend the Member for St Ives (Derek Thomas) for bringing this debate to Westminster Hall and giving colleagues the opportunity to make such a range of comments. They all have a good knowledge of things in their areas, and some have more specialised knowledge. We heard from the right hon. Member for Rother Valley (Kevin Barron), my hon. Friend the Member for Bexhill and Battle (Huw Merriman), the hon. Member for Ealing North (Stephen Pound), my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), the hon. Member for Ceredigion (Mr Williams), the hon. Member for Hyndburn (Graham Jones) and, not least, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in whose constituency I have spent many happy hours—my father was born in Auchterderran, so I know the area very well. Although the hon. Gentleman is from Scotland, his contribution was welcome, and he made some pertinent points.

Before I make some prepared remarks, I want to put some things on the record. I would be foolish if I did not understand the widespread interest in this debate. I would also be naive if I believed that this is the last time we will discuss this issue. Many questions were asked, so this will run for a while. Let me set out the background before I make my prepared remarks.

First, we are having this debate at a relatively early stage of the negotiations between the Government and the Pharmaceutical Services Negotiating Committee, which is handling matters on behalf of the pharmacy profession. Many of the questions and issues raised by colleagues on both sides are at the heart of those discussions. What sort of services will there be? Where is pharmacy going? How exactly will the reduction in finance be handled and distributed? Not all the answers are available at this stage because a proper negotiation process is being undertaken. Understandably, colleagues will look at the most adverse potential consequences to make a point when representing their constituents. I understand that, and the points have been perfectly fair. We are at that point in the process. We think we know what the worst may be, but we do not know the outcome or what changes there will be for the better.

Secondly, on finance, we are all realists here. We would love to work in a world where the status quo is not changed except for improvements, where the only issue with money is where more can be spent and where change, if there is to be any, takes forever to bring in. Life is not like that. The Government’s spending commitment for the national health service—an extra £10 billion a year by 2020—has to start being found early. It is not only about extra money, but about the efficiencies that the NHS chief executive identified, which are to be found across the board and could partly come from the pharmacy sector’s £2.8 billion of funding, which the Government propose to reduce. It may be an appropriate place. Again, we often approach such matters with the view that no possible reduction could ever improve services anywhere. That is not true, as we know from the experience of successive Governments.

The third bit of the background is where we are in relation to where pharmacy is going. The Royal Pharmaceutical Society’s November 2013 report, “Now or never: shaping pharmacy for the future”, states that the traditional model of community pharmacy needs to change due to

“economic austerity…a crowded market of local pharmacies, increasing use of…automated technology to undertake dispensing, and the use of online and e-prescribing”.

The Nuffield Trust’s report, “Now more than ever: Why pharmacy needs to act”, states:

“Community pharmacy is subject to a particularly complex set of commissioning arrangements, which appear to support the status quo and inhibit innovation at scale.”

We would love to be in a situation where, as the hon. Member for Ealing North described, everything is absolutely great and every pharmacy offers all the services and delivers them marvellously, but that is not necessarily the case. Accordingly, change is sometimes inspired by necessity and can be for the better. That is part of the background to where we are.

[Graham Jones]

The Minister makes the point that, to pay for the £10 billion increase in NHS funding, funds are being shifted from other sources, including the £2.8 billion spent on pharmacies. However, the principle should not be to shift funding from primary care to secondary care. Our fundamental principle should be to shift—if we have to—money from secondary care to primary care, which is preventive and will cut costs in the long term.

[Alistair Burt]

The hon. Gentleman makes a fair point, and that is indeed being done in the NHS, but we are looking at where efficiencies can be made and at what different parts of the health sector can contribute. In doing so, we can see what changes are inspired in the service provided to patients.

To emphasise where we are with pharmacy, there are 11,674 pharmacies in England, which has risen from 9,758 in 2003—a 20% increase—while 99% of the population can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. The average pharmacy receives £220,000 a year in NHS funding. On clusters, which my hon. Friend the Member for Plymouth, Sutton and Devonport mentioned, the Government contend that money can perhaps be saved in one place and used elsewhere for the delivery of new services. That is the reality of life. It would be great if new money was always coming from somewhere, but bearing in mind that the Government are dealing with an Opposition who could not commit to the extra £8 billion that the NHS was looking for, we have to make the changes that others were not prepared to make and still deliver services.

Let me move on to where we are going. Everyone in this room, Government Members included, recognises the quality of the best pharmacy services around the country. We are familiar with the valued role that community pharmacy plays in our lives and those of our constituents. I am grateful to my hon. Friend the Member for St Ives for giving me the opportunity to put on public record the high esteem that we hold them in and to set out our plans for the future.

I am a firm believer that the community pharmacy sector already plays a vital role in the NHS. I have seen at first hand quite recently the fantastic work that some community pharmacies are doing across a wide range of health services that can be accessed without appointment. Many people rely on them to provide advice on the prevention of ill health, support for healthy living, support for self-care for minor ailments and long-term conditions, and medication reviews. There is also real potential for us to make far greater use of community pharmacy and pharmacists in England. For example, I am due to speak at an event tomorrow that is looking at the role that pharmacy can play in the commissioning of person-centred care for vulnerable groups.

Our vision is to bring pharmacy into the heart of the NHS. We want to see a high quality community pharmacy service that is properly integrated into primary care and public health in line with the “Five Year Forward View”. I cannot answer all the questions that the hon. Member for Worsley and Eccles South (Barbara Keeley) asked, but she did at least mention the integration fund for the first time in the debate.

[Barbara Keeley]

There is a difficulty, in that funding for integration should recognise that the extra work needs to be done. The point of today’s debate has been about the Government using blunt instruments, such as a 6% cut in funding, reducing the number of pharmacies in clusters, changing dispensing charges, and the warehouse pharmacy that my hon. Friends mentioned. It is the use of those blunt instruments, not the working with the sector, that is the fault.

[Alistair Burt]

That working with the sector is ongoing. That is what the negotiations with the Pharmaceutical Services Negotiating Committee are all about. I take the hon. Lady’s point, but those discussions are under way. We are consulting with a wide range of groups, not just the PSNC, including patients and patient bodies.

As part of what we are doing for the future of pharmacy, we want pharmacists and their teams to practise in a range of primary care settings to ensure better use of medicines and better patient outcomes and to contribute to delivering our goal of truly seven-day health and care services. As part of that, I want to work with NHS England to promote local commissioning of community pharmacy within the health community, so that we can ensure the best use of this valuable resource. That is why we are consulting on how best to introduce a pharmacy integration fund to help to transform the way pharmacists and community pharmacy will operate in the NHS of the future. By 2020-21, we will have invested £300 million in the fund.

While it is understandable that the focus of most colleagues’ comments today was access to existing services, little was said about where pharmacy might be going and what new opportunities there will be. That is part of the overall development that we are hoping to achieve, which will include the work not only of the access fund, but of the integration fund.

Colleagues asked several questions about access. I want to provide some reassurance. We recognise that some of the Government’s proposals have caused concern, and that will take some time to distil as the negotiations are worked through. We are committed to maintaining access to pharmacies and pharmacy services. We are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, both of which were raised today. Qualifying pharmacies will be required to make fewer efficiencies than the rest of the sector. We certainly recognise that rural pharmacies will need to be considered in that, and we want to ensure that location matters in areas of sparsity. That work is ongoing.

In conclusion, the process has some way to run. I simply put it to colleagues that, in relation to good community services on the high street, there is more for modern pharmacy to do. Looking at the proposals of the past, we hope that the profession shares the Government’s determination to move pharmacy into a new future, and I am convinced that the future will be good.

[Mr Gary Streeter (in the Chair)]

Derek Thomas has 40 seconds in which to respond coherently.