Local Pharmaceutical Services

Debate between David Simpson and Caroline Nokes

Tuesday 3rd March 2015 Westminster Hall

[Caroline Nokes]

My hon. Friend has accurately outlined the situation in her constituency, which I am sure is mirrored across the country. I have received representations from community pharmacists, who have said that they are struggling with short time scales and no certainty from their NHS area teams.

[David Simpson (Upper Bann) (DUP)]

I think the hon. Member for Truro and Falmouth (Sarah Newton) may need to go to the pharmacy. Is the main problem for smaller pharmacies purely the finance, or is it the facilities that they have?

[Caroline Nokes]

I thank the hon. Gentleman for that intervention. I will move on to finance, but it is not my contention that finance is the problem; we just require the local area teams to manage these contracts and get them in place before the deadline of 31 March is reached.

As I was about to say, the contract for Wellow pharmacy, in line with those for every essential small pharmacy across the country, will expire on 31 March. When the contract comes to an end, my constituent Mr Sharma is gravely concerned that his pharmacy will not be able to continue providing these services, unless the local NHS area team decides to renew it, making specific arrangements under the local pharmaceutical services scheme. As yet, he has not received a decision.

Many other pharmacies are similarly affected, and I know that the Secretary of State for Education, my right hon. Friend the Member for Loughborough (Nicky Morgan), who cannot be here today, has expressed concerns about the pharmacy at Loughborough university and the one in the village of Wymeswold. I think that perfectly illustrates the diverse localities that these pharmacies serve. It is not just small village pharmacies under threat, but one serving a university campus, where young people are living away from home for the first time and might be in a position to benefit most from the sage, experienced advice of a pharmacist for their front-line health care needs.

I completely understand the need for NHS England to have devolved these contracts to local area teams, but the reality is that 31 March is now exactly four weeks away and for many pharmacists, there is still no certainty. According to Pharmacy Voice, had NHS England renewed the contract, there would have been procurement and tendering issues, so it was devolved to the areas, but we now face a problem where few have confidence that when we get to the end of this month, they will have a new contract.

What are their options? Well, they are pretty stark. They can close immediately, with no notice to the local community, because the contract will have expired and therefore no notice period is necessary. They can try to struggle on, returning to the pharmaceutical list but facing an immediate drop in income, which was previously agreed by all to be necessary to enable them to provide essential services. Or, and I am sure that this is the option most will follow, they can continue to pursue the NHS area teams to prove their value and worth, when in fact that was already established a long while ago.

For small pharmacies, there is a real challenge in viability. Using Wellow pharmacy as an example, it currently issues in the region of 2,200 prescriptions a month. That is pretty close to the 2,400 prescriptions a month that would trigger what is known as an establishment payment, but it is not quite there. It has worked hard to increase business, but in small communities it is incredibly difficult to push numbers above that threshold. My constituent Mr Sharma describes the additional prescriptions needed as a gulf that he has been struggling for years to cross and has never yet achieved.

I do not intend to delve into the issue of dispensing GPs and what is often perceived as a conflict between pharmacies and those GPs who can dispense. That is quite separate from the immediate time pressure faced by these pharmacies, which have already been deemed essential. What my constituent and the other pharmacists who have contacted me have emphasised is the chasm between the number of prescriptions that they routinely issue and the number that they would have to reach in order to receive the establishment payment. For some, the gap is greater than for others, which means that the impact of losing the essential scheme will be felt differently by various pharmacies and that some might be forced out of business faster than others.

Most members of the scheme are already doing significant work to make sure that they are as accessible as possible to patients, including collection of prescriptions from nearby surgeries and free delivery of medicines to patients. As Mr Sharma puts it:

“This pharmacy is the only health care provider in the area of any type, and the nearest other pharmacies are over five miles away in Romsey. If a patient was to need an over-the-counter medicine, require a medicine free of charge for a child, need support for self-care, or have a minor injury, there is a significant risk that without the availability of my pharmacy, they would attend either the GP surgery in Romsey or the accident and emergency department of Southampton general hospital.”

What he wants, in common with pharmacists from across the country who have been in touch with me, is some certainty going forward.

As Has Modi, of Deanshanger in the constituency of the Economic Secretary to the Treasury, my hon. Friend the Member for South Northamptonshire (Andrea Leadsom), has said:

“These contracts have been left to the discretion of the area team of NHS England, to whom we are required to make a formal proposal.”

The primary care contracts manager of the area team is adamant that the proposal will not be supported unless it can be proved “value for money”. Without the financial support that that entails, this small pharmacy will undoubtedly have to close because the normal funding mechanisms are massively stacked against small pharmacies. It does not even receive various basic fees—which can be substantial—that are available to average and larger pharmacies. This is why the ESPLPS arrangements were put in place to safeguard small but essential pharmacies in the heart of the community.

I appreciate that the current arrangements cannot continue, and that because the Secretary of State has devolved the contracting of primary care services to NHS England, a further extension to the scheme is not possible. He has already extended it once, from 2013 to 2015, and he cannot devolve responsibility for commissioning and then interfere with how that same commissioning operates. Therefore, no extension will be forthcoming and I accept that.

As my hon. Friend the Member for Truro and Falmouth (Sarah Newton) has said, many pharmacies are actively negotiating with their area teams, but concerns have been raised about the responses they are receiving, including time-limited support, and requirements to demonstrate that they are providing value for money. However, those area teams with an essential small pharmacy service are receiving a top-up on their allocations, so the funding is already there and is ongoing from the global pharmacy sum. Any amounts allocated have to be spent on pharmacy services and cannot be redistributed to any other purpose.

Effectively, if the essential small pharmacies are not supported, the moneys will simply go to other pharmacies in locations that have not been deemed to be of such an essential nature. Presumably, they might be redistributed to the larger existing pharmacies, many in high street locations, some distance from the village where there once was a supported, critically important pharmacy.

Essential small pharmacies are working hard to ensure that their “pitch” to the area teams is as robust as possible. Many, such as Wellow pharmacy, are garnering support from the local community, from appreciative patients and from borough, county and parish councils. Local residents are filling in surveys, outlining the services that they use at the pharmacy and identifying what impact closure would have on them personally.

It seems to me a relatively simple proposition: if these pharmacies are essential, and successive Governments have agreed they are, what more can we do to make sure they are retained? I have three things that I wish to ask of the Minister today. First, we need some clarity over what constitutes an essential small pharmacy. Some 90 pharmacies historically receive payments under the scheme. It would be helpful if they could point to an incredibly robust set of criteria, so that it would be easy for the pharmacists then to identify to the area teams why they need the support that has been forthcoming for, in at least the case of Wellow, 25 years.

Secondly, we need some encouragement to NHS England area teams to ensure that the outstanding contracts, which are believed to be the majority of them, are resolved before 31 March, so that pharmacy services are not simply forced to stop in these communities. I know that some are resolved and that others are working very actively to make sure that they are in place before the contracts—and therefore the payments—expire, but from my e-mail inbox, I am acutely aware of how many are simply in a state of limbo, having no idea whether their business will be viable 28 days from now. I would welcome the Minister considering how best she might convey that urgency to NHS area teams.

Finally, we need closer investigation of what role NHS England could play in making sure, within the procurement rules, that pharmacies deemed over decades to be essential can continue to receive support, via the pharmacy global sum, so that there is no additional cost to the NHS area teams and that the top-ups that area teams receive remain in place. However, it should also be made very clear that those can only be used for pharmacy services and not distributed among the wider health care community.

As I said at the beginning, we all appreciate the very important role pharmacists play in our health care provision. They dispense advice and knowledge, as well as drugs. In those of our communities remote from other health care providers, 100 or so of them have been deemed to be essential—and we need to keep them.

Dangerous Dogs

Debate between David Simpson and Caroline Nokes

Wednesday 6th July 2011 Westminster Hall

[Caroline Nokes]

That is valid. My hon. Friend makes a good point. Enforcement is certainly not consistent. However, I am seeking consolidation of the legislation to make it easier to enforce consistently across the country.

As I was saying, the problem is that Staffordshire bull terriers and pit bulls share many visual characteristics. Naturally affectionate Staffies are either mistaken for pit bulls by the authorities, resulting in seizure, kennelling and lengthy legal battles to prove that they are not one of the banned breeds, or—which is much worse, in my view—are deliberately selected for their status dog appearance and then trained to be aggressive, or not trained at all. As all of us who are dog owners know, any pet requires a reasonable level of training and discipline to become a pleasant, well-behaved member of the family.

I contend that much behaviour is learned rather than inherent, and that wrong handling or deliberate training to provoke aggression can turn any dog into a potential problem. The rise of so-called status dogs, which are often linked to antisocial behaviour, cannot necessarily be addressed by breed-specific legislation. The real cause of the problem is the owner’s actions rather than the breed of dog.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Lady on obtaining this important debate. I pay tribute to Banbridge high school in my constituency, which has taken a great interest in the matter and made it into a project. She has mentioned Northern Ireland. One blight on Northern Ireland is illegal dog fights for gambling and so on. Does she agree that if illegal dog fights are found to be occurring—we need the general public to provide information about them—the full rigour of the law must be brought to bear on the people who hold such fights? Those people train dogs to be vicious, while people who look after their pets properly are penalised.

[Caroline Nokes]

I thank the hon. Gentleman for raising the problem of illegal dog fighting. He is correct to say there has been a rise in such cases not only in Northern Ireland, but here in the capital, London, in particular. He is right that the full rigour of the law must be brought to bear.

One problem is that, while some dogs may have certain characteristics, it does not mean that they are fighting or status dogs, either by temperament or by upbringing. There is a fundamental problem with the assumption that one breed or type is dangerous and others are not. That misses the point that it is owners, not dogs, who pose the risk, and that a dog’s behaviour will be largely dependent on its upbringing, socialisation and home environment. Ultimately, the law should be targeted at individuals taking responsibility for their dogs, not at dogs for simply being dogs.

There is, however, a significant problem with aggressive and out-of-control dogs. I emphasise that much of the problem stems from irresponsible ownership, but we cannot get away from the fact that eight people have been killed in dog attacks in the past four years. According to the Communication Workers Union, 6,000 postal workers are attacked by dogs every single year. Attacks on farm animals cost in the region of £2.8 million a year, and there have been 74 reported attacks on horses in the past three years. Other dogs are certainly not immune. According to the Guide Dogs for the Blind Association, there are three attacks a month on guide dogs.