Budget for Community Pharmacies

George Howarth Excerpts

Tuesday 24th May 2016 Commons Chamber

[Alistair Burt]

The right hon. Member for Knowsley (Mr Howarth) approached me before, so I will take one intervention from him; I will not get through my answer otherwise.

[Mr George Howarth (Knowsley) (Lab)]

I am grateful to the Minister for giving way. I want him to take two things into account. First, there is a correlation between clusters of community pharmacies and areas of high deprivation and associated ill health, as my hon. Friend the Member for Barnsley East (Michael Dugher) said. Secondly, small, independent, local community pharmacies do not have the ability of the big multiples to negotiate bulk discount deals. Will he take those two factors into account as he moves forward?

[Alistair Burt]

I thank the right hon. Gentleman for his intervention. He has made representations in the past, and I know how keenly he understands the matter. I will come on to discuss access to funds in due course. It will not be based purely on location, but it will take into account what he says about areas of deprivation. We recognise that these are small businesses, and I understand exactly what he says.

The proposed funding cut has understandably created uncertainty and concern. I assure the House that I see a bright future for community pharmacy and pharmacists, so I urge colleagues to see the opportunity that the consultation presents, as well as the inevitable and understandable concern around funding.

The background to the matter lies in the NHS’s five-year forward view. One of its key strategic aims is to break down the traditional barriers between different primary care services, wider out-of-hospital care services and other sectors, such as social care, to deliver a more cohesive, community-based care model that is focused on keeping people healthy and helping people to manage long-term health conditions. Our vision is to achieve a transformation in primary care and out-of-hospital care more widely as we continue to move towards a seven-day health and care service. We want to empower primary care health professionals to take up opportunities to embrace new ways of working with other health professionals to transform the quality of care that they provide to patients and the public. In particular, we want to free up pharmacists to spend more time delivering clinical and public health services to patients and the public in a range of settings.

I have seen at first hand the fantastic work that pharmacists are doing from within community pharmacies, such as in healthy living pharmacies and other settings, and colleagues have also paid tribute to that work. Pharmacy-led services, such as the recently recommissioned community pharmacy seasonal influenza vaccination programme, can help to relieve pressure on GPs and A&E departments and ensure better use of medicines, better health and better patient outcomes. There are real opportunities for pharmacists and their teams to play an even greater role in helping people with long-term conditions and helping people to make better choices to improve their health and to get the maximum benefit from their medicines.

It is not a zero-sum game of accepting the reduction in funding of £170 million—from a budget of £2.8 billion—and ending this degree of high street care and having nothing in its place. I strongly believe that we can still have a network of high street pharmacies based on a financial regime that rewards quality as well as volume while moving pharmacy into different settings. To that end, we have consulted pharmacy bodies and others, including patient and public representatives, clinical commissioning groups and health and social care providers, on how best to introduce a pharmacy integration fund from 2016-17. The fund will help us to transform how pharmacists and their teams operate in the community, bringing clear benefits to patients and the public. The fund is set to rise by an additional £20 million a year. By 2020-21, we will have invested £300 million in addition to the £31 million that NHS England is investing in funding, recruiting and employing clinical pharmacists to work alongside GPs to ease current pressures in general practice and improve patient safety. The integration fund will help to move pharmacy in a direction that supplements what is already done on the high street and in a way it might not otherwise have done.

The chief pharmaceutical officer, Dr Keith Ridge, has commissioned an independent review of community pharmacy clinical services to make recommendations on future models for commissioning pharmacy-led clinical services. I am very keen that what we are doing is seen in the context of where pharmacy is going to go—not a snapshot of how good it is now, but what it can become. Clinical pharmacists will offer complementary skills to GPs, giving patients access to a multi-disciplinary skill set, and helping GPs manage the demands on their time and provide a better experience for patients. This is a great opportunity for pharmacists wanting to make better use of their clinical skills and develop them further.

Let me give a couple of examples. At the Wallingbrook Health Group in Devon, the work of the local pharmacist on all aspects of medicines optimisation has reduced the need for patient GP appointments by 20% to 30%, making a significant impact on GP workloads and patient outcomes. In Cambridge, Sandra Prater is working with patients to optimise their medicines and supporting patients to self-manage a range of conditions, including asthma, high blood pressure and atrial fibrillation.

The reduction in funding for community pharmacy that we have set out was a commitment in last year’s spending review. I want to emphasise that our aim is to secure efficiencies, make savings and improve quality. It is most definitely not our aim to close pharmacies. I accept that it was me who said to the meeting with the all-party group that up to 3,000 pharmacies could be affected. That was me extrapolating the figures. It is not the aim of the Government to close pharmacies and, as I said in answer to the question, we do not know exactly how the funding will fall, because we do not know yet the result of the negotiations and how this will be handled. I accept that I put that figure into the public domain, but it may not happen in that way at all.

I know that many people choose to access health services through community pharmacies, and I want to assure them that our aim is to ensure that those community pharmacies upon which people depend continue to thrive. That is why we are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, as the right hon. Member for Knowsley mentioned.

Let me deal with another theme that the hon. Member for Barnsley East mentioned. Hand in hand with that approach, we want to ensure that modern community pharmacies reflect patient and public expectations, and developments in technology. Large sections of the population are now accustomed to using digital services through their phones and tablets. Why not do this for people wanting to obtain their prescription medicines? That is why we want to help those patients to get their prescriptions in a way that fits their lifestyle, by promoting the use of online click-and-collect or home-delivery models. We have also consulted on amending legislation to allow independent pharmacies to benefit from hub- and-spoke dispensing models, which facilitate more use of automation and increase efficient dispensing processes. Officials are now carefully considering the responses received and the Government will respond in due course. These are things we want to encourage people to do, but they do not totally replace what is already being done. They might, however, free up more time for the pharmacists to spend on patient contact rather than on doing some of the other work.

The public phase of the community pharmacy consultation may now have ended, but that does not mean that we will stop listening and talking—the hon. Gentleman asked me to keep doing those things. The Department, supported by NHS England, will have further confidential negotiations with the PSNC, and there will also be a final round of confidential discussions with other key pharmacy stakeholders, who take a keen interest in the discussions in this House. Our aim is to communicate the final decisions early in July so that pharmacy contractors are fully informed in advance of the changes being implemented from October 2016.

Our proposals are informed by the discussions that have taken place and by what has been said by those involved in pharmacy in the past—the Royal Pharmaceutical Society and independent studies—about how pharmacy can move in a different direction but that the current funding structure rewards volume not quality and that changes could be made that would widen the reach of pharmacy. I believe that these ideas can be taken forward in the current context. Our proposals can truly place pharmacy at the heart of the NHS and provide a better, more integrated, service for patients and the public. I am confident that the efficiencies we have proposed can be made within community pharmacy without compromising the quality of services or the public’s access to them. I want to thank those in pharmacy, who are working so hard at the moment and making their case very well, and the public who support them. I think pharmacy can have a great future, as can pharmacists.

Question put and agreed to.