Pharmacies and Integrated Healthcare: England

Debate between Anne Main and Julian Sturdy

Wednesday 11th January 2017 Westminster Hall

[Mrs Anne Main (St Albans) (Con)]

I beg to move,

That this House has considered pharmacies and integrated healthcare in England.

It is a delight to serve under your chairmanship, Mr Bailey. In the light of the extreme pressures on our health services, particularly in the winter months—much has been made of this recently in the media, although it is not dissimilar to many other years—with our over- burdened frontline services, clogged up A&E departments and congested GP services, I believe it is vital that we explore new models of delivering patient care, particularly an integrated model of patient care.

In 2016, there was an average of 2,500 more attendances at major A&Es a day compared with 2015, which is a 6% increase. People aged 80-plus have the highest rates of A&E attendance. As a country, compared with only a few decades ago, we are now fortunate enough to benefit from innovative drug treatments, greater survival rates from complex surgery, better nutrition and better education; but, as a population, many of our residents are living longer. For example, in my constituency of St Albans, the average life expectancy for a pensioner is over 89 years—it is nearly 89 and a half years. However, for far too many of our constituents, the latter part of their lives brings a prolonged period of frail health, with dementia and diabetes on the rise and an increased incidence of ill health linked to lifestyle choices such as lack of exercise, alcohol, obesity and smoking. That period at the end of our lives is often not characterised as a period of good health.

We need to come up with a seamless, flexible model that makes the best use of precious resources and benefits patients. It is therefore timely to explore in this debate the role that local pharmacies play in local health services and the potential role that they might play to ease the strain on more congested frontline services. I also want to make the Government aware of the continuing importance of pharmacies in communities and their potential to do so much more.

In an ever-changing world, we have a duty continuously to challenge the old models of health delivery systems. In October, the Government proposed to reallocate money to NHS frontline services. We all accept that the NHS is labouring under huge financial pressures, so any areas in which precious resources are dissipated due to inefficiencies or duplications ought to be considered. It is important to integrate community pharmacies into the NHS urgent care system and GP services. We need to promote a pharmacy-first culture for minor ailments to take pressure off frontline services.

Community pharmacies currently see some 1.6 million people a day in the UK. It is worth noting that the recent standard patient experience report for the East of England Ambulance Service NHS Trust in 2016 showed that 0% of respondents in my county of Hertfordshire had contacted a walk-in service, an out-of-hours GP service or a pharmacy service before contacting the ambulance service. I think we can agree that a lot more can be done to take the pressure off emergency frontline services.

Pharmacies are the most accessible health services in most communities: they are found on high streets, in supermarkets and in shopping centres. In St Albans, we have some great independent local pharmacists who want to get more involved and we even have the headquarters of the National Pharmacy Association, which supports independent pharmacies and helps them grow their businesses. We need to look at the current pharmacy model. In St Albans, patients can choose from five dispensing pharmacies within a half-mile area of the high street. Some pharmacies are just over the road from each other, and some have only yards between them. Given the Government’s financial support of £25,000 for those dispensing 2,500 prescriptions per annum, which comes directly out of our NHS budget, it is easy to see why we need to look at the model of provision and ask how we can get a better bang for the NHS buck.

I accept the Government’s assertion that a balance must be struck to ensure that pharmacies remain accessible but are not excessive in number and, importantly, that we have a range of offering. All the local pharmacies on the high street in St Albans are closed on Sunday, whereas the big supermarket pharmacies are open, in line with their shopping experience. It is worth noting that Sunday is the busiest day for most A&E services. However, a recent survey showed that 50% of people prefer, for a variety of reasons, not to use a pharmacy in a supermarket, particularly the retired, the elderly and other frequent pharmacy users. We therefore need to examine the model of opening hours, as well as location and the type of provision on offer. Given that many supermarkets are located outside the town centre, their pharmacies are not accessible to everyone, particularly the most vulnerable in society. Diversity and accessibility of provision are key to integrating pharmacy and health services.

Let us explore what pharmacies could do. Pharmacies should be capable of providing general health services. They could increasingly work beyond the traditional role and offer services to promote sexual health, increase physical wellbeing and give advice on flu immunisations and drug-harm prevention, for example. However, if we expect pharmacies to do more, we need the funding formula to reflect the quality of service they provide. That is what the pharmacies want. Local pharmacists in St Albans believe that they should be the first point of contact for advice on medicines, minor illnesses, healthy living and wellbeing. To facilitate that, the Quadrant pharmacy in St Albans has undertaken a major refit, with a brand new consulting room, and invested heavily in technology, including an expensive automated robot for dispensing medicine.

I visited the Quadrant—I am sure that many hon. Members made similar visits after the Government’s pronouncements in October—in November last year to discuss the opportunities and challenges facing small independent pharmacies. The pharmacy is a friendly, attractive place to pop into and is well regarded by local people. It has the potential to do so much more, but that extra service does not come without a cost. If people spend time talking to their local pharmacist, the pharmacy gains nothing if they then walk out of the door and go off to see their GP. It is important that we recognise the role pharmacies are being asked to play in giving advice, holding consultations and, potentially, dispensing services. There must be some reflection of the cost involved in the staff time that it takes to do those things.

Rachel Solanki, the director of the Quadrant pharmacy, told me:

“General Practice will need to continue to be the gate keeper of referral to secondary care.”

However, she helpfully suggested

“a whole raft of services and support for self-limiting and long-term conditions”,

such as dealing with uncomplicated urinary tract infections in women, impetigo and bacterial skin infections; managing non-complex patients with high blood pressure; performing healthy heart and cholesterol checks; and supporting patients diagnosed with diabetes. The list was quite exhaustive. She proposed that pharmacies could and should act as wellbeing hubs for the communities they serve. She went on to say:

“The community pharmacist, a highly-skilled and trained individual, is the most accessible healthcare professional and is available without an appointment. If a mechanism could be found to incentivise and remunerate, we are confident the mutual agendas would be achieved.”

That is her view, and that of many other local pharmacists. There is a mutual agenda for providing good healthcare for patients that could be achieved if pharmacies were brought into play.

The Government’s proposals in October last year were a step in the right direction, but we need more detail. I want to ask the Minister a series of questions, and hopefully he will be able to answer some of them. How can the Government make smaller and local pharmacies more attractive and accessible for everyone? How can the Government encourage GPs to offload services such as flu jabs on to pharmacies? In saying “offload”, I recognise that where there is a cost to the pharmacy and the GP is in receipt of payment for that flu jab service, that needs to be considered, but I would like to hear the Minister’s views on that. How can the Government promote the pharmacy as an alternative local health provider that can be trusted and deliver a quality service? This is not just about having a shop that you take your prescription to and maybe pick up a few aspirin; it is about the pharmacy being a health provider. How can the Government increase pharmacy capacity to provide a broader range of health services and ensure the correct remuneration for the service provided?

Responding to an oral question on 2 March 2016, the then Health Minister, Lord Prior, stated:

“The big driving force going through healthcare and community pharmacy today is one of integration, which means that community pharmacies must in future work more closely with their local hospitals and GPs.”—[Official Report, House of Lords, 2 March 2016; Vol. 769, c. 817.]

That is the point of today’s debate. The Government have pursued several polices that are intended to lead to better integration of community pharmacies, including the introduction of a pharmacy integration fund as part of the 2016-17 community pharmacy settlement.

Last month, Richard Murray of the King’s Fund published a paper looking into the role of community pharmacies in the NHS. In December 2016, the Minister described that review as

“an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well.”—[Official Report, 20 December 2016; Vol. 618, c. 1301.]

When can we expect a response to that incisive review?

The NHS “Five Year Forward View”, which was published in 2014, recognised that GPs are “under severe strain”, and many of us will have met GPs locally who have restated that view to us. It also states that steps will be taken to:

“Build the public’s understanding that pharmacies and on-line resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit.”

I urge the Government to listen to pharmacists when considering how to take that integration forward, as we do not want to lose what is good in the system, especially where it works well for our local patients. For example, I know that the Government are piloting an urgent medicine supply service. Rachel Solanki, the director of the Quadrant pharmacy, tells me that in Hertfordshire there is a local scheme that is so well regarded that it has now been rolled out again. Her concern is that the proposed national service does not necessarily promote a pharmacy-first culture. The Minister may wish to clarify that that is not the case, but that was the view she expressed to me. She was worried that there might be a perverse incentive to encourage patients to phone NHS 111 in order to get a referral to the pharmacy service.

In an email Rachel wrote to me recently, her view was that the change could have the unintended consequence

“of actually increasing NHS 111 calls for emergency medicines when they should be directed to community pharmacies first. Our local service offers both the facility to help the patients get their medicine but, more importantly; also offers incentivisation of the community pharmacy to promote ordering medicines in a timely way to reduce medicines waste, and hopefully therefore preventing a further incident of need.”

She thinks it unlikely that the proposed 111 service will operate both the services that we have locally and the new model, and she worries about losing the existing local scheme. Will the Minister reassure me by saying whether schemes such as the one operating in my county of Hertfordshire could still operate in tandem, or will they be mutually exclusive?

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a very powerful speech. Does she agree that although we must encourage clinical commissioning groups to work closely with community pharmacies—she has highlighted some good examples of that—the practice is patchy across the country? There is reluctance in some areas for clinical commissioning groups to engage with their local pharmacies. We have had that problem in York, where the CCG has been very reluctant to talk to local pharmacies. Local MPs, across parties, have written to it and finally got it to engage but it has been very slow, and we have to speed that up. We have great examples in some parts of the country, but poor examples in others.

Rural Broadband (North Yorkshire)

Debate between Anne Main and Julian Sturdy

Wednesday 8th January 2014 Westminster Hall

[Mrs Anne Main (in the Chair)]

I am informed by the Clerk that because the last debate ended early, an extra nine minutes of this sitting is allowed, should people wish to have it.

[Julian Sturdy (York Outer) (Con)]

It is a proud pleasure to serve under your chairmanship for the first time, Mrs Main. I am delighted to have been given this opportunity to debate rural broadband in north Yorkshire.

Before speaking specifically about York and north Yorkshire—the most beautiful area within God’s own county—may I touch briefly on the wider broadband roll-out? I am pleased that, as part of their long-term economic plan, the Government have recognised that the future of our economy rests on the ability of our infrastructure not only to cope with the demands placed on it, but to exceed those demands and facilitate new opportunities for growth. This is no less true of superfast broadband than it is of our rail, road and air infrastructure.

The Government’s investment in superfast broadband is, to my mind, one of their greatest and most important achievements in this Parliament, yet sometimes it does not get the plaudits that it deserves. It has by no means been an easy task. It has required huge investment from the Government, totalling roughly £1.6 billion, and some hard work from all those involved in organising the roll-out, including the people physically on the ground, upgrading the telephone cabinets with the fibre.

However, all the hard work and commitment has been worth it. The recent findings from the UK broadband impact study reveal that for every £1 the Government invest in broadband, the UK economy will benefit by £20. That represents fantastic value for money in the short term. In the short term, the network construction will add around £1.5 billion to the economy, creating 11,000 jobs this year alone. In the longer term, it will increase annual gross value added by £6.3 billion. Its benefits will be spread across the country, with approximately 89% of that in areas outside London and the south-east, such as York and north Yorkshire. That vindicates the Government’s commitment to investing so much in this programme and shows that all the hard work that is being put in on a local level is delivering real results.

The roll-out has not been without its problems and it has faced some public criticism for the degree to which one company has achieved a monopoly over the roll-out contracts. There is also some concern about the apparent shortcomings in the contracts, with BT being obliged only to upgrade telephone cabinets with their fibre-to-the-cabinet approach. Some of my constituents have expressed concern that, because they receive their telephone lines from an upgraded cabinet, they are being counted by BT as though they were part of the 90%, despite being too far away from the cabinet to receive the upgraded superfast internet speeds.

However, I have received assurances from the chief executive of BT Openreach that that is not the case, and that only those who receive superfast speeds are counted. Superfast North Yorkshire has subsequently clarified that, although there may be issues about how coverage is measured in other parts of the country, the north Yorkshire contract only counts those who are capable of receiving superfast speeds.

Locally, the roll-out so far has been a roaring success. The project, which has been overseen by Superfast North Yorkshire, has been run well. When it first set out on its mission, it had a total of 670 cabinets to be upgraded—I think the technical term is “deployed”—but, to date, 350 cabinets have been upgraded, which marks 52% of the total. However, it is expected that this figure will rise to 370 next week, ensuring that the project is well over halfway to completion.

In north Yorkshire, roughly one cabinet is updated per working day. As a result, phase 1 of the roll-out is expected to be completed by October 2014, well ahead of the national target, which originally intended to provide only 90% of all households with speeds of up to 25 megabits per second by the end of 2015. That target now appears to have been pushed back, and phase 1 might not be achieved nationally until the end of 2016. Will the Minister clarify that? What might that do to the expected release of phase 2 funding?

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Culture, Media and Sport (Mr Edward Vaizey)]

indicated assent.

[Julian Sturdy]

indicated assent.

[Mrs Anne Main (in the Chair)]

I call Nigel Adams.

Renewable Energy (The Humber)

Debate between Anne Main and Julian Sturdy

Wednesday 16th February 2011 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

I congratulate my hon. Friend on securing this important debate. I add my support to his campaign for the Humber, especially as I am a big supporter of wave and tidal. He makes a key point about bioethanol: it will be a huge economic driver for our region if we get it right. However, I add a note of caution, and would like to know what he thinks about it. Commodity prices are growing rapidly at present—

[Mrs Anne Main (in the Chair)]

Order. Interventions should be brief. The hon. Member for Brigg and Goole wants to hear the Minister’s response.

[Julian Sturdy]

The intervention is about commodity prices and the impact on food security.