Community Pharmacies

Anna Turley Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Dr Whitford]

If this is introduced badly, the cost will be greater in the long term. When the Minister talks about a more service-based approach, I think that he aspires to something more like the Scottish model, which I would commend. I just feel that this is being done “backside forward”.

[Anna Turley (Redcar) (Lab/Co-op)]

rose—

[Dr Whitford]

I need to make a bit of progress.

We need to design the services with the people who work in them. Some 18% of Scotland’s population—nearly 1 million people—are registered with and do access the minor ailment service, which takes pressure off accident and emergency, because there is availability out of hours, and GPs. The fourth service that we have is the public health service, with 70% of all smoking cessation work in primary care being carried out in our community pharmacies. These four services together—minor ailments, chronic medication, acute medication and public health—represent a huge breadth of service for a community. It is important that pharmacies in England that are currently just retail and dispensing pharmacies are encouraged to go in that direction, because it brings benefit for the NHS.

My biggest concern is the random nature of how this process might develop. If the Government simply cut and let the dice fall where they will, the problem is that they will not end up with an integrated service. Scotland still has health boards, so if a community pharmacy is to open there, an application needs to be made to the health board. When the project started, the boards decided which places got to become community pharmacies, and they decide whether there is a need to open a new community pharmacy. The biggest mistake in this scheme is its randomness.

One issue raised by the hon. Member for South West Wiltshire (Dr Murrison) was the profits made when drugs are sold on. The Government could look at the vertically integrated wholesalers—the big chains. In the mid-2000s, they were not considered. The Government do not know how much profit they make or where that profit is made, and the system is totally unregulated. These chains control about 40% of the pharmacy market. One of the biggest chains, Walgreens Boots Alliance, has declared profits of almost £1 billion, yet it has somehow been able to reduce its tax bill by more than £1 billion in this country. We are talking about people who are make almost half their profit from taxpayers yet do not pay their full share of tax. I absolutely agree that under this proposal the big chains will survive and the small, independent, very community-based pharmacies will be lost.

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

I should say that I am chair of the all-party pharmacy group. I am sure that many of my colleagues will today talk about the savings and services that community pharmacies provide to the national health service. Although that is an important point, it is also essential that we highlight the good that they provide to patients. They do so much more than just deliver prescriptions to people. Let me just highlight the scale of their operations. Some 11,800 community pharmacies dispensed more than 1 billion prescription items in 2015.

Community pharmacists are well prepared to adapt to many different problems with which they are presented. They help people to give up smoking, alter their diets, become healthier and manage their cholesterol. Effectively, they are on the frontline as far as the health of the public is concerned.

[Anna Turley]

My right hon. Friend makes an extremely important point. Pharmacies are right at the heart of their communities. As has already been mentioned today, access to those services is vital. In some areas—such as our two constituencies—bus services are being cut and people are finding it increasingly difficult to access services. It is nonsense for the Minister to say that it is a matter of seconds between pharmacies. Will my right hon. Friend comment on how important access to pharmacies is to our communities?

[Kevin Barron]

It is very important, and the mechanism that has been put in place will not solve everything. We may get Boots in Gatwick airport supporting it, but there is the potential that others may drop off the line because they are just outside the geographical area. We need to look at that.

Let me turn to population health. This cannot be done by central distribution centres or a pharmacy based miles away, as they have no link with the locality. I am pleased that the idea of major companies getting involved in prescribing has been dropped. Pharmacists know their customers well and are familiar with their medications and, consequently, the customers feel confident in asking them for their advice.

The Government’s figures show that the £170 million cut could force up to 3,000 community pharmacies—one in four across the country—to close their doors to the public, so people would have to travel a lot further to their pharmacist and not have the local connection that I mentioned previously. Community pharmacy is the gateway to health for some 1.6 million patients each day. If anything, that is something we need to get a grip on.

A core component of current pharmacy services supports the public to stay well, live healthier lives and self-care. Pharmacists play a central role in the management of long-term conditions. They carry out medicines use reviews, for example. We must remember that more than 70% of expenditure on our national health service at both primary and acute level is spent on people with long-term conditions. There could not be a better gateway for those people to get the assistance they need to manage those conditions than through local pharmacies.

--- Later in debate ---

[Michael Dugher (Barnsley East) (Lab)]

It is a pleasure to follow the right hon. Member for North East Bedfordshire (Alistair Burt), who tried to be extremely helpful to the current Minister—most ex-Ministers have ex-Ministeritis and tend to be extremely unhelpful to current Ministers, but not so the right hon. Gentleman. However, he did use that figure of 3,000 pharmacies—one in four—facing closure. He has attempted to qualify it now, and his defence seems to be that he made the estimate without properly thinking it through. To that extent, there is remarkable continuity with his successor, who makes a number of assertions without remotely thinking them through. However, if we are now told that we have to disregard what the previous Minister said, why on earth we should believe what the incumbent says? Who is to say that, in a year’s time, after some reshuffle, the Minister’s successor will not come to the House and tell us at the Dispatch Box, “You don’t want to pay any attention to what the fellow before me said. He never knew what he was talking about.”?

The Government’s impact assessment is worth closer examination, because it states:

“the potential impacts…are assessed on the basis that there is a scenario where no pharmacy closes”—

not one. That scenario is not shared by anyone else. Even the Minister, when asked how many would close, told the House, “I do not know.” The impact assessment goes on to concede:

“There is no reliable way of estimating the number of pharmacies that may close as a result of this policy.”

The Department literally has no idea. According to the impact assessment, the Department is officially clueless as to the impact on pharmacies.

[Anna Turley]

Does my hon. Friend agree that an impact assessment of the knock-on effects for the NHS more broadly would have been useful? One in four patients will probably seek with a GP an appointment they would have sought with a pharmacist. We have heard nothing from the Government about what the knock-on effect would be or what investigation they have done into that.

[Michael Dugher]

My hon. Friend makes an excellent point. It would have been helpful to have had an impact assessment as the basis for debate, rather than having something that was published on the day of the announcement.

My hon. Friend alludes to the fact that the impact assessment on community pharmacy says that cuts to community pharmacies will increase patient health benefits

“by reallocating savings from community pharmacy funding to other uses”—

a point the Minister made—

“ensuring that patient health is unaffected”.

Yet, polling commissioned by Pharmacy Voice shows that one in four patients would make an appointment at a GP if their local chemist was closed—a figure rising to four in five in more deprived communities such as my own in Barnsley.

There is no consideration whatever in the Government’s assessment of the potential downstream costs to other parts of the NHS budget, such as the pressure on GPs and A&E. The Department’s impact assessment does say that these cuts are

“expected to lead to reductions in the employment of pharmacists, pharmacy technicians and other pharmacy staff”,

so the Government are clear at least that local pharmacists—the people many of our constituents rely on—will go because of these cuts.

The impact assessment predicts that there will be a “corresponding increase” in other NHS employee numbers, so there will be “no net effect” on the NHS. That is completely without foundation. Are the Government really trying to tell us today that, for all their talk about the importance of community pharmacies and all the evidence about the pressures that will result on GPs and A&Es, which are already overstretched, the work of pharmacists in our local communities will, and should be, taken up by a corresponding increase in other NHS staff?

The impact assessment says:

“the modelling does not take any account of potential reduction in opening hours which may also affect access.”

You bet! New research published today and carried out by the National Pharmacy Association shows that, when faced with the Government’s budgetary cuts, 86% of community pharmacies are likely to limit or remove the home delivery of medicines to housebound patients; 77% of chemists say they will probably become more retail focused to deal with funding shortages—exactly the opposite of what the Minister hopes to achieve; and 54%—more than half—are likely to reduce their opening hours, which will limit patient access and put more strain on our already overstretched GP surgeries and A&E departments.

To sum up, the Government’s own impact assessment, which is well worth a read, if only for comedy value, reads as though it was written in haste on the back of a cigarette packet. The Government—rather like the Minister—are making up the policy as they go along. What Ministers are actually asking us to do today is to make a leap of faith: to turn a blind eye to all the evidence; to disregard all the warnings; to ignore the unanswered questions, the contradictory statements and the glaring omissions in the Government’s own case; to brush away expert opinion; and to dismiss the concerns of the public. Based on the Department’s own impact assessment, how can any right hon. or hon. Member possibly support the Government in the Lobby today?