Community Pharmacies

Derek Thomas Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House has considered community pharmacies.

It is a pleasure to serve under your chairmanship, Mr Streeter. In a letter to community pharmacies on 17 December, the Department of Health discussed the potential for far greater use of community pharmacies and pharmacists. The letter refers to the role of community pharmacists in preventive health, support for healthy living, support for self-care for minor ailments and long-term conditions and medication reviews in care homes, and as part of a more integrated local care model. That is exactly the right direction. As an MP representing a Cornish seat where every effort is being made to integrate health and social care, I see community pharmacists as essential players in a new national health service equipped to meet the demands placed on it by modern society.

Westminster Hall debates are rarely secured in order to praise the Government and celebrate all that is good. I would love to be able to do so, but—wait for it—in the same letter to which I just referred, the Department set out its plans to reduce its funding commitment to community pharmacists by £170 million. Therein lies the problem. We have a front-line NHS service that is valued and depended on and able to embrace new clinical responsibilities and meet the demands of an ageing population, but it is unsure about its future.

[Tom Brake (Carshalton and Wallington) (LD)]

Does the hon. Gentleman share my concern? As Members of Parliament, we all, I suspect, refer constituents to pharmacy services, because we know the impact that that has on reducing the pressure on the NHS. If we cannot refer them to smoking cessation services, cholesterol testing and blood pressure testing, the NHS and hospitals will have to pick up the burden.

[Derek Thomas]

I welcome that intervention. That is exactly the point that I hope to make, particularly for independent pharmacists in rural areas, where it is much more difficult to access acute services and GP practices.

[Mr John Spellar (Warley) (Lab)]

The hon. Gentleman ought to see that that is true across the whole country. In urban areas, people are finding it more and more difficult to get appointments with their GPs and are going to accident and emergency. The best way to relieve that pressure is to encourage more people to go to our well-resourced local community pharmacies, maybe even rather than chain pharmacies.

[Derek Thomas]

That is absolutely right. The community pharmacist is part of the solution, not part of the problem, in what we want to do for the NHS. I hope to make the point in my speech that we need to do all we can to support the development of community pharmacists rather than take away money that they need.

[Andy Slaughter (Hammersmith) (Lab)]

Urban and rural areas share those problems. It is because people will only wait for so long for GP appointments—my hospital has exceeded waiting times for more than a year—that there is pressure is on community pharmacists. They are stepping up to the plate. Does the hon. Gentleman agree that they are being let down by this cut, when they are trying to do their best?

[Derek Thomas]

I hope to make the point that we need clarity about how the money will be found, if it must be found. I believe that there are other ways to save money, particularly involving the use and waste of drugs.

Community pharmacists are unsure about their future and unclear what support they can expect from the Government. The letter sets out the £170 million reduction in support for community pharmacists and asks them to prepare for the cut, but gives little detail about where the money will be cut, who will lose and what services can no longer be funded.

[Paula Sherriff (Dewsbury) (Lab)]

Does the hon. Gentleman agree that local pharmacies are part of the fabric of local communities? That is particularly the case for independent pharmacies, which are embedded in communities and whose owners and staff often come from those communities. Perhaps the Minister can tell us what impact assessments have been undertaken in terms of health and economic and social wellbeing by individual constituency.

[Derek Thomas]

I welcome that intervention, but I am concerned that the hon. Lady might have read my speech, and I have not yet put it on my Facebook page. In my constituency, I have several community pharmacists, and I am not sure that I have too many. It is simply that my patch is large and includes areas of social deprivation, which has an inherent impact on health. A car journey from the north to the south of my constituency takes an hour. The journey from the most westerly point to the most southerly point takes an hour and nine minutes. In a rural area such as mine, community pharmacists provide invaluable access to the NHS and invaluable support to vulnerable people.

To follow on from the hon. Lady’s helpful intervention, over and above their obvious healthcare roles, I see community pharmacies’ input into society as comparable to that of post offices, police community support officers, libraries, local churches or chapels, local pubs, village shops and our postmen and women. They all play an important part in local communities. They are the glue that holds communities together, the people and organisations that know when things are not as they should be, and the people who look out for our elderly, the sick and the vulnerable. Although it is difficult to put a price on the work they do, without those people and institutions, society would be a poorer place and the added strain on public services would be significant. It is perverse that we judge reducing support for services such as community pharmacists to be a saving.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Gentleman on securing this timely debate. It is a pleasure to serve under your chairmanship, Mr Streeter. The loss of pharmacists’ expertise and experience and their knowledge of the people who come in and out could be enormous if pharmacies such as the Whitworth family pharmacy in my constituency are forced to close as a result of this initiative.

[Derek Thomas]

I think we all share those concerns. I am pleased to have secured this debate, so as to give people an opportunity to share their experiences in their own constituencies.

Reform of community pharmacies is not something that we can afford to get wrong. Many of the community pharmacies in my constituency are independent businesses that have been established for decades. A wrong move by the Government now might make those community resources unviable. We all know that community pharmacists provide important services, including the safe dispensing of medicines. They are often the first port of call for people with minor ailments and health concerns, and are a key support for elderly and vulnerable patients in the community.

[Alex Chalk (Cheltenham) (Con)]

General practitioners in my constituency are under significant strain. Although no one is against sensible savings, does my hon. Friend agree that nothing should be done to undermine the excellent job done by community pharmacists in diverting patients from primary care, or to add to the burden on hard-pressed GPs?

[Derek Thomas]

That is absolutely superb—my next line is: “Community pharmacies have a vital role in giving advice and in diverting patients from GPs and emergency departments,” exactly as my hon. Friend said. In tourist areas such as Cornwall, they take their share of the extra demand during the height of the season. Most recently, my local community pharmacists administered flu jabs to increase uptake. Pharmacies regularly get prescriptions to patients out of hours when no alternative is otherwise available, and Cornwall has led the way, with ground-breaking work in enhanced services. That is an example of how community pharmacists are very much part of the solution to integrated community health provision.

Healthwatch Cornwall recently surveyed Cornish residents about access to community pharmacies. Some 69% of participants said that they regularly visit their pharmacy, and 74% of those felt comfortable talking to the pharmacist about their health, while 78% felt well informed by their pharmacists when taking new drugs and 93% said that the pharmacist was polite and helpful.

One constituent of mine, a retired doctor, Professor Dancy, wrote to me as follows:

“I am a warm supporter of Nigel, our local pharmacist, and proud to be so. He is always ready to help when I forget (as one does at the age of 95) to re-order a medicament, and when my doctor is unavailable, or just pushed for time, I do not hesitate to ask Nigel for advice, which I follow with a confidence that is always rewarded.”

Community pharmacists are highly trained and trusted healthcare professionals, qualified to masters level and beyond. Their knowledge base covers far more than just drugs, making them the ideal healthcare professionals to relieve pressure on GPs and other areas of the NHS. Equally importantly—perhaps even more importantly—community pharmacists are welcoming change and embracing new clinical opportunities.

However, the proposed funding cut will not sustain the transition from a supply-based service to the more clinically focused service that the Government desire and our patients deserve. Cuts will discourage progress and can only result in small, independent and much-loved businesses failing, at the expense of patients, the public and the wider NHS.

[Rachael Maskell (York Central) (Lab/Co-op)]

In York, the local authority has made cuts to smoking cessation services, as well as NHS health checks, and the community pharmacists I have spoken to have said that they see their future role as filling some of those gaps. However, with further cuts to community pharmacy itself, where are people meant to go—back to queues in GP surgeries?

[Derek Thomas]

I thank the hon. Lady for that intervention. That is exactly why we are having this debate. I want the Government to examine the value of community pharmacists and to consider how they can do some of the work—in fact, a large part of the work—that would save money for NHS acute services.

I am well aware that there is a need to secure better value for money in areas of the NHS. Over the weekend, I met four community pharmacists and they all talked of the opportunities to make savings that they have identified. They are willing and able to see more patients. Pharmacists give free, over-the-counter advice to thousands of people every day, promoting self-care and diverting patients from GP and urgent care services. However, it is estimated that £2 billion-worth of GP consultations a year are still being taken by patients with symptoms that pharmacists could treat.

Pharmacists want to have a greater role in prescribing drugs, so as to reduce waste. Last year in Cornwall alone, £2 million-worth of unused drugs were returned to community pharmacists to be destroyed. Pharmacists are best placed to reduce this waste. They want to do more to support people with mental illnesses; they are keen to provide continued care of people with diabetes and other long-term conditions; and my local community pharmacists want to work with the Department of Health to improve services, engage in health and social care integration, reduce drug waste and improve access to records, in order to support the giving of prescriptions.

[Peter Dowd (Bootle) (Lab)]

On that point, does the hon. Gentleman agree that what is needed is a joint, co-ordinated approach to planning investment and implementing change, in partnership with national and community pharmacy bodies, rather than pushing things through at a great pace?

[Derek Thomas]

I thank the hon. Gentleman for that intervention. In my experience so far of looking at this subject, I have found that those in the pharmacist community do not feel that they have been properly consulted or engaged with. Pharmacists believe that they have many of the solutions that the Government wish to see.

Before I conclude, I will read one final letter that I received on Monday from a GP in my constituency. Dr Rebecca Osbourne writes:

“As you will no doubt be aware, General Practice is facing a crisis with too few GPs managing an ever-growing demand. Demand for appointments outstrips availability of doctors and allied surgery staff, and patient needs are increasingly complex with an ageing population with multi-morbidity.

A good Pharmacist helps to take some of the pressure off a local surgery—offering advice about self-limiting conditions, and prescribing over the counter medications for presentations that do not need to be taken as ‘on the day’ appointments with a GP; patients who are on complex medications can receive education and advice from their pharmacist regarding their regime, including the importance of compliance, which can further reduce the burden elsewhere in the system; vulnerable patients, whether elderly or experiencing mental ill-health, have an extra professional keeping watch over them, and a pharmacist may be better placed than a GP”—

it was a GP who wrote this—

“to see a trend developing or a change that requires further attention.”

[Tom Brake]

I do not know whether the hon. Gentleman is aware from the conversations he has had with pharmacists that they often do things that are outside the terms of their contract. A couple of examples were cited to me. First, a pharmacist was involved in spotting someone who was having a cardiac arrest in their pharmacy, and then in helping someone else who had fallen outside the pharmacy and damaged their face quite severely. If we lost pharmacists and their extra input, that would have a significant impact on patients in a way that has really not been explained so far.

[Derek Thomas]

I thank the right hon. Gentleman for that intervention. What I have learned from many patients and from the pharmacists themselves is that patients see pharmacists as the first port of call for health, so there is no doubt that there will be times when pharmacists are picking up things that otherwise would have to be picked up in A&E.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Does my hon. Friend agree that it is important not to confuse the role of pharmacists with the number of pharmacies? It is vital that we protect the pharmacists, who are very important in delivering in the national health service.

[Derek Thomas]

That is exactly right: it is pharmacists’ skills that we must be careful to maintain and develop.

I know that you have concerns about this matter as well, Mr Streeter, especially concerning the pharmacy in Modbury in your constituency, so I appreciate your support on this issue and the way you are chairing this wonderful Westminster Hall debate.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on securing this debate. The letter that he read out hits a lot of the points. Removing the funding will make waiting lists longer, when GPs are already under pressure; in fact, we are losing hundreds of GPs every year, as they go to other countries. Pharmacies can see people at the point in time that they would usually see GPs; sometimes people have to wait two or three weeks to get an appointment with the GP. So this proposed cut seems to defeat the purpose of the planned change.

--- Later in debate ---

[Derek Thomas]

I am pleased that we are so supportive of the community pharmacists, and hopefully we will get a good result from this debate.

I have three straightforward questions and a personal plea to put to the Minister, if you will bear with me, Mr Speaker—[Interruption.] Sorry, Mr Gary Streeter. [Laughter.]

[Mr Gary Streeter (in the Chair)]

It is okay, I will let you off.

[Derek Thomas]

Have the Government made any impact assessment in relation to their position of reducing community pharmacy numbers and the impact that this change might have on the health, and economic and social wellbeing of people living in our area? What assessment have the Government made of the impact that such a reduction would have on the workload of GPs, those in A&E and those providing out-of-hours services, if patients cannot access their regular pharmacy and then visit these other services?

[Caroline Ansell (Eastbourne) (Con)]

I congratulate my hon. Friend on securing this timely debate on an important issue that could have far-reaching consequences, should the decision go through. Equally, I join him in urging the Minister to ensure that during the consultation—we understand that there is still to be consultation with patient groups—we will take, to echo a comment by a former Member, a constituency-by-constituency approach. I am sure that everybody will bring to the fore the particular characteristics of their own constituency. My constituency has the record number of octogenarians in the country and the fastest growing town in the south-east, and it routinely hosts tourism-driven events such as Airbourne, when 600,000 people come into the town. Pharmacies are a sometimes uncelebrated and unseen force that we rely on.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Derek Thomas]

I thank my hon. Friend for her intervention and she is absolutely right to say that in a tourist area, where the population increases dramatically at times, we need to be careful that the core services are available for everyone who needs them.

My second question is: what assurances can the Government give to independent community pharmacists? The third question is: what consultation has been conducted with pharmacy patients, and what would their concerns be if community pharmacies were to close?

My personal plea to the Minister is please not to write pharmacies off until they have been given the resources to realise their full potential in society. I feel excited about the potential opportunity that exists for the NHS through the proper use of community pharmacists. While reforms to NHS services are essential and the way that community pharmacists are utilised needs to be reviewed, a blanket removal of funds to pharmacies will only hinder progress and limit this opportunity.

[Several hon. Members rose—]

--- Later in debate ---

[Derek Thomas]

Thank you, Mr Streeter, and I thank Members for their contributions, which have been really helpful. I thank my right hon. Friend the Minister for seeking to tackle the many issues that have been raised. We all agree that the NHS is a fantastic institution. Community pharmacists hold some of the keys to improving patient care in the community and reducing pressure on GPs and other NHS services. I hope that the debate has gone some way to empower pharmacists to offer the solutions that the Government are seeking in order to secure a modern-day NHS, but this is all about the best care for patients, which we all agree is what really matters.

Motion lapsed (Standing Order No. 10(6)).

[Mr Philip Hollobone in the Chair]

[Mr Philip Hollobone (in the Chair)]

Will those who are not staying for the next debate please leave quickly and quietly? We now come to a very important subject to be addressed by the Member for the sunniest place in the United Kingdom, Caroline Ansell.