Community Pharmacies

George Howarth Excerpts

Thursday 14th September 2023 Westminster Hall

[Sir George Howarth (Knowsley) (Lab)]

It is always a pleasure to take part in a debate when you are in the Chair, Sir Mark. I congratulate the hon. Member for Waveney (Peter Aldous) on the timeliness of this debate and on the typically thoughtful way in which he presented his case. If I repeat some of his arguments, it is not that I am gratuitously copying what he said; the themes need to be emphasised, and I will try my best to do so.

At Prime Minister’s questions on 26 April, I raised the need for a new pharmacy-first approach as a means of providing additional capacity to deal with minor medical problems and consequently help to relieve the pressures on GP and hospital A&E services. I was encouraged by the Prime Minister’s positive response: he declared himself

“a wholehearted champion of and believer in the role that community pharmacies can play.”—[Official Report, 26 April 2023; Vol. 731, c. 732.]

Two weeks later, on 9 May, as the hon. Member for Waveney said, the Health Secretary made a statement to the House that set out the Government’s primary care recovery plan. In the second part of that statement, he announced the adoption of a pharmacy-first approach as part of a new NHS service. Again, it was a potentially positive step forward. He pointed out

“the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so”.—[Official Report, 9 May 2023; Vol. 732, c. 219.]

As part of that approach, the Secretary of State committed to investing up to £650 million over the next two years, so that pharmacists can supply prescription-only medicine for common conditions such as ear pain, a urinary tract infection or a sore throat, without requiring a prescription from a GP. In the time available, I want to explore how that policy is developing and how the resources that the Government have earmarked meet the requirements for pharmacies to deliver such a service. I should add that the Secretary of State’s list could easily be added to, and I hope it will be.

I am grateful to the Company Chemists’ Association, Community Pharmacy England and Pharmacy2U for their comprehensive briefing for the debate, on which I will rely heavily. CPE points out:

“We are currently negotiating on how this funding commitment will be delivered to ensure that community pharmacies can meet patient needs and we welcome the confidence and additional investment in community pharmacy...Until those negotiations are complete, we do not know the extent to which this additional investment will help community pharmacies with these current pressures, but we do know that it will not address all of the pressures as outlined later in this briefing.”

Pharmacists refer to a funding black hole; I do not think the hon. Member for Waveney used that term, but he did use the figures involved. They point out that the recent announcement of funding is welcome but represents

“new money for new workers”.

They go on to say that there is currently an annual funding shortfall of at least £67,000 per pharmacy. Consequently, there is insufficient money in the system to deliver the services that they are already contracted for, let alone to take on new ones.

The CCA also draws attention to the trend between 2015 and 2022, which saw the permanent closure of 720 pharmacies. On a recent visit to Asda in Huyton in my constituency, I saw the consequences at first hand. The Asda pharmacy, which by the way is admirable, is having to fill the gap created by the loss of other smaller, independent local pharmacies, and the pressure on the dispensers while I was there was relentless. There was not a minute to pause for thought or have a conversation with people coming to pick up their prescriptions, because they were so busy.

Of the pharmacies that closed, 40% were in the 20% most deprived areas of England. That is worrying for me as the MP for Knowsley, which is one of the areas of greatest deprivation. One way in which high levels of deprivation are reflected is in the number of people in Knowsley living with long-term health conditions, which account for 70% of the total healthcare spend, 64% of hospital out-patient appointments and 50% of GP appointments. If community pharmacies could be deployed to deal with some of those cases where appropriate, that could help immensely in easing the burden on the NHS services that currently have to deal with them.

As the Minister will be aware, and as the hon. Member for Waveney referred to, there is a workforce crisis in community pharmacies in England. There is estimated to be a shortfall of 31,000 pharmacists. The Asda community pharmacy I visited had vacancies, one of which was for a pharmacist; I think they had been trying for a year, unsuccessfully, to fill the position.

I also want to raise the issue of medical supply chains. The current level of allowable margin is £800 million; it was first agreed in 2014 and has not been reviewed since. That amounts to an annual reduction in the margin available. In practice, all pharmacies are faced with diminishing resources for the purchase of medical supplies. On 18 May, with my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer), I held a roundtable event with local pharmacies. It was pointed out to us by independent pharmacies that they are unable to negotiate lower purchasing rates, as they cannot buy in bulk in the way that larger-scale national pharmacy companies can.

This problem will lead to more local pharmacy closures and reduced capacity to serve the new pharmacy-first policy. As CPE puts it, reforms are needed

“to the medicines market to avoid the situation we are now in, where pharmacies are dispensing some medicines at a loss and patients are facing delays for medicines.”

Pharmacy2U, which is a delivery service, has pointed out that stakeholders now have to deal with the issue. It notes the difficulty with the interoperability of IT systems and points out that

“there is significant variation in the systems used by GPs, and pharmacy services are often unable to easily access patient records, heavily restricting their ability to support patients with their medicines. Ensuring that pharmacists have swift access to this data is vital in empowering pharmacies to play a central role in a reformed and improved primary care system.”

It suggests that

“HSC and NHSE should consult with system-wide stakeholders to ensure all pharmacists are enabled to access and, where appropriate, update patient records in line with data privacy rights, ensuring that GPs and pharmacies have a complete picture of the patient they are caring for.”

I will make one final point before asking some questions. I wrote to the Secretary of State on 17 July, following some written questions that I had tabled concerning hub-and-spoke provisions and the use of third-party hub providers; the answers seemed to indicate a specific problem in Northern Ireland. I would be grateful if the Minister chased up my letter, which has had no response, and if he could give an indication in his speech as to how the issue can be resolved.

I will conclude with a few questions. First, how do the Government propose to address the funding black hole that I have referred to? Secondly, what is the Government’s strategy for halting the alarming number of pharmacy closures? Thirdly, how do the Government intend to address the workforce shortages? Fourthly, will the Minister agree to consult stakeholders on how to deal with the issue of interoperability of IT systems? Finally, how does the Minister propose to enable all pharmacies, including independent pharmacies, to fund the gap between the cost of acquiring medicines and the resources available?