Community Pharmacies

Holly Lynch Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Holly Lynch (Halifax) (Lab)]

I beg to move,

That this House has considered the role of community pharmacies.

May I say what a pleasure it is, Sir David, to serve under your chairship this morning, and to have you join us for this important debate?

Between the ages of 14 and 18 I worked in a local chemist shop two evenings a week and some Saturday mornings. There were the usual first job responsibilities: restocking shelves, cleaning, and meeting and greeting customers and patients who were not always well, for a variety of reasons. I loved it, because there is never a dull moment in a pharmacy. I remember a frantic mother handing me dead headlice taped to a piece of cardboard, and someone asking me to run a pregnancy test on a bottle of cough medicine, before discreetly letting me know that it was actually a urine sample rather than cough medicine and that that was the only secure way she could find of transporting it to the chemist shop.

The shop was exactly what it said on the tin. It was a community pharmacy, and the whole community would walk through those doors for advice, medication and reassurance. I remember the older people, whose relationship with the pharmacist was the longest-standing and most trusted relationship they had with a clinical professional. I remember a long-term recovering addict, who would bring his daughter with him every day. We watched her grow up, and supported him as he worked hard to stay the course on his journey to recovery.

That is why community pharmacies matter, and it is why they work. However, it appears from the community pharmacy contractual framework announced in October 2016 that that was not appreciated. There was a reduction from £2.8 billion in 2015-16 to £2.68 billion in 2016-17 and £2.59 billion in 2017-18. That represented a 4% reduction in funding in 2016-17 and a further 3.4% reduction in 2017-18. When inflation is factored in, as well as all the services that pharmacies already offer free and whose costs they absorb, that was a near fatal blow to the service nationwide. The then Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told the all-party parliamentary group on pharmacy that he expected between 1,000 and 3,000 pharmacies to close, as they would no longer be viable in the face of the cuts, with multiples and chains of pharmacies best placed to survive, and independent and more rural chemists left at a disadvantage.

In March this year the Pharmaceutical Services Negotiating Committee found that 233 community pharmacies have closed in England since the Government funding cuts were introduced. Sixty-nine were independent pharmacies and a further 22 were independent multiples. The number of closures anticipated by the right hon. Member for North East Bedfordshire has not yet been reached. However, I have spoken to people in pharmacies, and others contacted me ahead of the debate, and many are operating at a loss, clinging to the hope that the funding arrangements will improve, but with a business model that, as the right hon. Gentleman predicted, is not viable.

The impact that the funding cuts have had on patients is really difficult to justify. The cost of delivering prescriptions to those who find it hard to leave the house was previously absorbed by local chemists, but that is no longer possible. Boots was the last of the big four chain pharmacies to start charging for delivery over the summer, with all patients having to pay £5 for delivery, or £55 for a 12-month delivery subscription, by the end of the year. All have some exemptions for particularly vulnerable customers, but Boots, LloydsPharmacy, Rowlands Pharmacy and Well have all reduced free deliveries, or started charging for delivery.

There is no funding for arranging drugs in trays. When I worked in a pharmacy, it was a big undertaking to arrange medicines in trays by time and day, predominantly for older people who needed that degree of support if they were to live well for longer by taking their medication at the right time and in the right doses. Pharmacies were delivering a degree of invaluable social care, and that is no longer possible in the present financial climate. We can all see what the consequences will be. Ultimately the result will be more costly clinical interventions.

In addition to the financial pressures that pharmacies face, drugs shortages are now becoming debilitatingly resource-intensive across the NHS. Pharmacies have no ability to absorb the costly hours spent sourcing drugs or speaking to GPs about possible alternatives. A Bristol GP, Zara Aziz, recently wrote in The Guardian of her experience of medicines shortages. She explained that EpiPen users in Bristol are now being told to use their old EpiPens up to four months after the expiry date. She also tells the story of a patient in acute distress from arthritis pain when a commonly used anti-inflammatory, Naproxen, suddenly became unavailable. Eventually, a very small quantity was found, but the patient was forced to use it sparingly, not as she had been prescribed, as none of the alternative anti-inflammatories would have been suitable for her.

My hon. Friend the Member for Redcar (Anna Turley) shared with me a photo of a poster from Pharmacy Magazine, which has gone up in her local hospital. It says, “Please don’t blame us for the NHS medicine shortages. It is a nationwide problem. Please ask your local MP to help.” The poster included contact details of local MPs handwritten on the bottom. We very much hear those concerns, and we are here to ask the Minister to get a grip on this problem.

Shortages are caused by a combination of different issues. The implications of Brexit are inevitably a factor that will play out over the coming weeks and months. However, we know that the NHS and the UK are potentially losing out to more profitable and attractive markets. In addition, the stockpiling, as a precaution, of certain drugs that are harder to source, coupled with the deliberate and more alarming manipulation of the markets by some wholesalers to deliberately push up prices, is having a detrimental effect. New regulations are also having an impact on manufacturing processes.

On top of that, cash flow is a massive challenge in community pharmacies. Community pharmacies pay out for drugs and are reimbursed by the Government the following month. The situation is made even tougher still, however, because they are not always reimbursed what they have paid out for drugs, particularly for drugs that are in short supply. By law, pharmacies have to do everything in their power to source a drug and dispense it, even where prices have become inflated due to a shortage. Let us take Naproxen as an example. One of my local pharmacies tells me that earlier this year the cost of a box shot up from about 26p to about £15. The tariff price paid by the Government to reimburse pharmacies for Naproxen peaked around February, at £12.50 a box. The medicines shortage is having the perverse effect of forcing pharmacies to dispense at a loss. In previous budgets, there might have been just enough for the pharmacy to absorb this cost. Those days are long gone. The system is clearly no longer fit for purpose.

Earlier this year, the Government introduced the serious shortage protocol in the Human Medicines (Amendment) Regulations 2019. It was intended to be a safety mechanism to help cope with any serious national shortage. It gives pharmacists the ability to dispense a reduced quantity, alternative dosage form or generic equivalent to that stated on the prescription. There would be a small payment to pharmacies for undertaking that process. Despite pharmacists and GPs feeling that they are spending unprecedented amounts of time sourcing medicines or researching alternatives, not a single drug has appeared on the list, which means that pharmacies and GPs do not get paid any extra to compensate them for the time they now have to dedicate to that element of dispensing.

Although there are no drugs on the serious shortage protocol, there is a separate concessions list, which acknowledges that, due to a shortage of a drug, the price has changed. At the end of September, there were 45 drugs on that concessions list. Again, inclusion on that list does not acknowledge the time involved in having to source the drugs, which is becoming the largest part of the pharmacist’s day. Nor is there any attempt to fund that work.

There was some hope for community pharmacies more broadly in the community pharmacy contractual framework published in July, which takes effect from October 2019 through to 2023-24. The five-year deal commits to not cutting the budget any further. However, when inflation is taken into account, it will still see pharmacies unable to meet costs, for all the reasons I have outlined.

Strangely enough, what the framework does do is realise the potential for pharmacies to alleviate pressures on the wider NHS, paving the way for a much more integrated approach. The 111 service is now able to refer a patient directly to a pharmacy for an appointment. The framework seeks to expand the delivery of clinical services in pharmacies. It is all great stuff, which is very welcome, but I return to the clear warning given by the then Minister back in 2016 that between 1,000 and 3,000 pharmacies will not be viable and will be forced to close if overall funding does not increase.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Lady on securing the debate. Given the pressures all our A&Es and acute hospitals face, does she agree that the community pharmacies in many areas across the UK do a magnificent job—particularly those specialised pharmacists who relieve the pressure on A&Es? If community pharmacies are put at risk and we lose them, there will be even more pressure on our A&Es and acute hospitals at a most awkward time for our society.

[Holly Lynch]

I could not agree more. I thank the hon. Gentleman for making that important point. It was very welcome that in the community pharmacy contractual framework—for the first time, I think—the Government really did understand that. However, the funding to allow pharmacies to survive long enough to deliver those services has not been forthcoming. For all its aspirations to deliver more clinical services, a pharmacy that has been forced to close can deliver diddly-squat. Does the Minister accept that community pharmacies’ potential will be realised only when they are funded to survive?

Like many colleagues, I am incredibly concerned about the impact of medicine shortages, both on the NHS and on patients themselves. It is contributing to the mix of factors that are piling unbearable financial pressure on our local chemist shops. I hope the Government have a plan to respond and keep our trusted, effective community pharmacies open.

[Several hon. Members rose—]