Community Pharmacies: Devon and the South-west

Edward Morello Excerpts

Tuesday 17th December 2024 Westminster Hall

[Edward Morello (West Dorset) (LD)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this important debate.

Community pharmacies are indispensable to West Dorset, serving as essential health hubs for our communities. However, they face mounting challenges, including escalating financial pressures and critical workforce shortages that threaten their ability to continue to provide those vital services.

West Dorset, amazingly, is served by only 18 active pharmacies, for a population of more than 100,000. Data from the NHS Business Services Authority shows that the number of community pharmacies in England has declined by 6.7% since 2001. In the past year alone, a further 217 pharmacies have been lost, and startlingly it is those not offering in-person services—often called distance-selling pharmacies—that are the least likely to fail. That demonstrates that the new role that pharmacies are having to play in our healthcare system is actually hurting their viability due to the broken funding model.

Workforce shortages exacerbate the strain. In NHS Dorset, the integrated care system that covers West Dorset, there are 47 vacancies, equating to a vacancy rate above the national average of 19%. The impact of these staffing challenges is clear: a 2024 survey by Community Pharmacy England found that three quarters of pharmacy team members reported shop staff shortages, and approximately 10% of pharmacy owners had no choice but to temporarily close their doors as a result of those shortages.

For patients, that means longer waiting times, reduced services and less access to advice for urgent healthcare concerns. For staff, it translates to unsustainable workloads, difficulties in sourcing medicines and, most alarmingly, increases in patient abuse. Nearly all respondents—92%—reported struggling to cope with the pressure, highlighting the human toll of the pharmacy crisis.

The recent rise in national insurance contributions places an additional burden on pharmacies as employers, particularly in rural areas, where revenue streams are less predictable. I have one pharmacy in my constituency that made a six-figure loss last year, even before the increase in national insurance contributions came in.

[Sarah Dyke]

I thank my hon. Friend for giving way. As he is rightly pointing out, the employer national insurance contributions, alongside the national living wage, are increasing the pressure on our important community pharmacies. Does he agree that the Government must urgently exempt pharmacies, GPs and dentists from the tax hikes to avoid considerable damage to the sector?

[Edward Morello]

I thank my hon. Friend for the intervention. She will be pleased to know that there is, in fact, a Liberal Democrat amendment right now to do exactly that, which I am sure we will all be voting for, and which we would ask the Government to take the opportunity to support. Community pharmacies already face slim margins under the current community pharmacy contractual framework funding model, and while initiatives such as Pharmacy First have brought new funding streams into the sector, they are not sufficient to offset the rising costs of operation, including wages, rents and utility bills.

Community pharmacies are lifelines for rural constituents like those in West Dorset. They provide crucial access to healthcare services, especially for those who struggle to reach GPs or hospitals. They are also uniquely vulnerable due to small patient bases and higher operational costs, and the Government should recognise those disparities. That means revisiting the funding framework, addressing workforce shortages and offering targeted financial relief to offset rising costs, including the impact of national insurance contributions.

Community pharmacies are not just businesses; they help to support our strained healthcare systems and are a part of our communities. For the people of West Dorset, and for millions across the country, we cannot afford to let them falter. I urge the Government to prioritise this issue, undertake a comprehensive review of the funding model, work closely with Community Pharmacy England and provide the support necessary to secure the future of our pharmacies and the vital service that they deliver in rural communities.

[Richard Foord (Honiton and Sidmouth) (LD)]

It is an honour to serve under your chairship, Mr Betts. Growing up, people used to talk about going to the chemist, and at the time I saw that alongside going to the butcher or shoe shop—it was where we went to buy stuff. What I did not realise was how crucial pharmacies are to prescriptions and thus to people’s health and wellbeing, and I am ever so aware of that now that I represent a constituency in Devon.

Under the previous Government, in the last two years alone, Devon has seen the closure of nine pharmacies, leaving the county with just 133. For the people I represent in Honiton and Sidmouth, that translates to just 16 pharmacies per 100,000 people—even fewer than in West Dorset. That is partly because income for pharmacies has stagnated, particularly what they receive from the NHS, and that is combined with rising costs, including energy bills and wages, as well as the cost of medication. Altogether, it makes for an unsustainable financial model. Yet pharmacies provide over 1.3 million consultations each week for people’s health concerns, which is keeping people out of the NHS and saving 38 million GP appointments every year. Just last month, a pharmacist in Devon noted that his team spends over two hours per day providing free, unfunded clinical consultations, and those prevent health conditions from deteriorating, and prevent hospital visits and additional strain on the NHS.

[Edward Morello]

My hon. Friend raises a very important point: under the current funding model, pharmacists are reimbursed only if the consultation results in a prescription being issued. That results in a medicalisation of the process, which means that pharmacists are less likely to provide other sorts of solutions, such as community care. Does my hon. Friend agree that the model is fundamentally flawed and creates a medicalisation issue?

[Richard Foord]

It is flawed, particularly for those parts of the country that are rural and coastal, such as those represented by my hon. Friend and myself. In Honiton and Sidmouth, the average age of my constituents is 56. I went to a meeting of the all-party parliamentary group on ageing and older people last week, and we hosted Sir Chris Whitty, the chief medical officer for England. He described how, while in some societies people move away from the coast and rural areas to seek comfort and care in towns and cities, in England we do quite the reverse. That makes it even more crucial that we maintain our pharmacies in those rural and coastal communities.

In short, we are calling for the Government to provide funding to halt the closures and stabilise the sector, ensuring that rural communities such as those in Devon are not left behind. We want to see the role of pharmacists expanded to give them greater prescribing rights and allow them to take on bigger public health responsibilities.

Access to Primary Healthcare

Edward Morello Excerpts

Wednesday 16th October 2024 Commons Chamber

[Edward Morello (West Dorset) (LD)]

In my constituency of West Dorset, as across the country, community pharmacies are being asked to deliver more and more primary care services, increasingly acting as an alternative to GP surgeries. They are delivering vital healthcare services such as health consultations and vaccinations; however, the funding model for community pharmacies is outdated and insufficient, and does not reflect the expanded role that they now play in our healthcare system.

Community Pharmacy England reports that one sixth of pharmacies could close within a year, and the National Pharmacy Association estimates that the average pharmacy will lose £43,000 this year. This is being played out writ large in my constituency. Lyme Regis has recently lost its last remaining high street pharmacy. Our Beaminster and Sherborne pharmacies are reporting six-figure annual losses due to the unsustainability of the funding framework—a funding model that, as the Pharmaceutical Services Negotiating Committee suggests, does not account for the higher operating costs in rural areas, as well as wild fluctuations in medicine prices that can result in pharmacies losing money on every prescription issued of certain drugs.

Community pharmacies also have to operate within a system whereby they get compensated only for consultations that lead to prescriptions being issued. That leads to a perverse focus on patients where a medicalised outcome is most likely. I urge the Government to re-evaluate the funding model for community pharmacies. We need a system that recognises and rewards the broader role that pharmacies now play, particularly in rural areas. Pharmacies are delivering critical health services, yet they are being financially penalised because the funding system is still based on an outdated model. If we continue on this path, we risk losing these vital community assets.

Pharmacies in rural places such as West Dorset cannot survive on the current funding framework. They are a lifeline for many of my constituents, and without immediate action we could see further closures, which would leave vulnerable populations without access to vital healthcare services.