Local Pharmaceutical Services

Jane Ellison Excerpts

Tuesday 3rd March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate colleagues on their contributions, and I particularly congratulate my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on securing the debate and highlighting some of the challenges facing local pharmacies. For me, as the Minister with responsibility for public health, the debate is also a welcome opportunity to place on record the wider contribution that pharmacies make. The right hon. Member for Rother Valley (Kevin Barron) singled out that contribution and emphasised the potential of pharmacies.

I hope that I can give some of the reassurances that the shadow Minister, the hon. Member for Copeland (Mr Reed), sought. Overall, the picture for pharmacy is positive, and it has the potential to play a greater role. I have talked about and, I hope, championed that on a number of occasions, and there is an awful lot more that we can do. I will talk a little bit about that wider point, but I will also address the specifics of the essential small pharmacies scheme and the challenges that face those pharmacies.

People understandably appreciate the ability to access pharmaceutical services near to where they live or work. Essential small pharmacies have, in the past, been valuable in securing and maintaining the community access that my hon. Friend the Member for Romsey and Southampton North has so ably described. NHS England’s five-year forward view makes it clear that our health services must evolve to cope with not only increasing demand but the different patterns of people’s lifestyles. Every part of the health system is now considering how best to engage with that challenge and how to allocate available resources most efficiently.

Although others have touched on it, it is worth revisiting the history of the essential small pharmacies scheme. It has been in existence since the 1960s as a way of ensuring access to services in local communities for patients and the public in locations where the viability of such pharmacies might have been uncertain. As others have said, that is often in isolated rural areas, but not exclusively; sometimes such pharmacies are in new residential developments, for example. The scheme operates against a backdrop that has changed a great deal since its inception in the 1960s, and I will perhaps touch on the ways in which the world around the scheme has evolved.

The scheme was reviewed as part of the new community pharmacy contractual framework, and became known by yet another snappy health service title: the essential small pharmacy local pharmaceutical services scheme. The contracts were not designed to be permanent; they were transitional arrangements. The shadow Minister mentioned transitional arrangements, and the scheme is coming to the close of quite a long transitional arrangement, as was flagged some years ago. Pharmacies admitted to the new scheme, which replaced the previous scheme in April 2006, had to be nominated by the then local primary care trust and agreed by the Department of Health. As in the previous scheme, pharmacies were required to meet certain conditions, the most important of which was that they had to dispense more than 6,000 and fewer than 26,400 prescription items per annum and be located more than 1 km from the nearest pharmacy by the nearest practical route available to the public on foot. There is no central definition of “essential” but, broadly speaking, it is as I have described. It is a case of considering the different schemes. Essentially, community access is at the heart of the definition of “essential.” The scheme closed, and no new pharmacies have been allowed to join since 2006.

The current scheme was intended to be temporary, but it was extended in 2012 for a further two years. That was done in the context of a new market entry system for pharmacies and the changes made to the NHS under the Health and Social Care Act, which the shadow Minister mentioned, with the objective of enabling NHS England to consider the options and to give adequate notice to affected pharmacist contractors. With four weeks to go, it is obviously a concern that we are debating the fact that some pharmacies do not quite know what is happening. I will address the efforts to resolve that, but hopefully this debate, if nothing else, will be a good spur to everyone engaged in those important discussions and negotiations, so that we can ensure that they are brought to a sensible resolution.

The end date of the scheme, as my hon. Friend the Member for Romsey and Southampton North mentioned, is 31 March 2015, which means that affected pharmacies have had two years to prepare for the changes since the scheme was extended. I stress that the ending of the scheme does not mean that affected pharmacies must close. It is obviously up to the individual contractor whether they wish to return to the pharmaceutical list and come under the terms of the community pharmacy contractual framework or submit a proposal to provide local pharmaceutical services. Many have done that, and I will touch on the numbers in a moment.

I appreciate that it has been a difficult time for contractors, such as the ones described by my hon. Friends the Members for Romsey and Southampton North and for Truro and Falmouth (Sarah Newton), because small businesses are often concerned with serving their communities and perhaps have a bit less time for protracted contractual negotiations. I hope and expect that they will receive appropriate support from local NHS teams. I give an assurance that, if a change in provision is needed, NHS England’s local area teams will work, and are working, with individual providers, but my hon. Friend the Member for Romsey and Southampton North has highlighted where she thinks that work needs a bit more energy to ensure that people in her community can continue to access services conveniently.

Of course, there are new ways of delivering dispensing services. We have internet pharmacies, and many pharmacies now offer delivery services to patients—members of my family have taken advantage of such services. People who are less mobile can have medicines delivered straight to their door, and I hope it reassures the House to know that 99% of the population can reach a pharmacy within 20 minutes by car, and that 96% of people can do so by walking or using public transport.

At the end of March 2014, there were 11,647 pharmacies in England providing NHS services, which is 18% more than in March 2006. That is a success story for pharmacies and not the opposite; it is definitely a growing story, and rightly so, for exactly the reasons that the right hon. Member for Rother Valley highlighted. Pharmacies have an essential role in supporting our public health system, as well as our NHS.

Some 226 pharmacies were accepted on to the ESPLPS pilot scheme in 2006 and, of those, 73 are still eligible to receive payments, which is less than 1% of pharmacies overall. Of those 73, 16 have reached an agreement or have a solution at a very advanced stage, and 47 have proposals under consideration, so the balance of around 10 are still working closely with area teams, which I hope gives Members at least some reassurance that the scale of the challenge is not huge. The challenge is important and serious for those who have not resolved the situation, and I urge area teams to work closely and give maximum support, but I reassure the House that this is not a large-scale problem across the country; it is a localised problem. None the less, it is important, particularly for local communities. People are probably most concerned about pharmacies where proposals are under consideration, because the clock is ticking. We want those proposals to be given serious and urgent consideration so that we can bring those discussions to some sort of conclusion.

I reassure members of the public that if their essential small pharmacy closes, they will still have access. I have given the assurance that many pharmacies will not close, but people nevertheless want to know that they will still have access. I have mentioned some of the ways in which people now have greater choice than in 2006, and NHS England has an absolute responsibility to ensure that communities can continue to access appropriate services and consider alternative local provision. That provision might be through new contractors, or through a service that is accessible as part of a larger retail offer somewhere nearby. That has become more popular in recent years, and it allows people to combine their weekly shop with a visit to the pharmacy, allowing them to take advantage of public health work through those outlets.

The closing of the scheme does not mean that affected pharmacies have to close; quite the opposite. The two available options have already been outlined. Pharmacies can return to providing NHS pharmaceutical services under the contractual framework and no longer receive the top-up payment, which I accept might be difficult for some, particularly very small businesses. Alternatively, pharmacies can make a proposal, and those proposals are now under consideration and being worked on. I cannot comment specifically on the case in West Wellow in the constituency of my hon. Friend the Member for Romsey and Southampton North, but the area team will know about this debate; we will follow up to ensure that the area team has a record of it and understands that Members were sufficiently concerned about the matter to bring it to the House’s attention today.

More broadly, on the subject of how much community pharmacies have changed since 2005-06, we now see pharmacies as places to go for much more than just getting a prescription dispensed and getting advice on medicines. Pharmacies are a valuable, and sometimes the most accessible, health resource in a local community. We have introduced new revenue streams, such as medicines use reviews and the new medicine service, which contractors can choose to provide to their local population, so there are other routes for local pharmacies.

Clearly, with my public health responsibilities, I am happy to take this opportunity to highlight the relevance of community pharmacies to providing public health services. The NHS document on its long-term sustainability, the five-year forward view, calls on the nation to get serious about public health as one way in which we can avoid spending billions of pounds on avoidable illness. Pharmacies have an important role to play. I have visited pharmacies that are rolling out pre-diabetes checks and other such things. It makes no sense for us, as a nation, to gear up to spend money to serve 4.5 million people with type 2 diabetes when we could do valuable preventive work to stop millions of them getting type 2 diabetes in the first place. Even if people can live with type 2 diabetes for a long time, we want people to live not only long lives but well lives. Living a long time with a number of co-morbidities is not a great quality of life, so there are all sorts of reasons for encouraging pharmacies to be on the front line of preventing illness and helping people to avoid such conditions.

As the right hon. Member for Rother Valley mentioned, there are now more than 1,000 healthy living pharmacies across the country, and there are many more in the pipeline. Those pharmacies utilise the skills of the whole team—not just the pharmacist, but those trained as health champions. I am conscious that the individuals who work in a pharmacy may be more approachable to many people, may understand the local community particularly well and may have insights to bring. I saw some good examples of that when I went around constituencies last Easter talking to pharmacists who knew their communities particularly well, many having grown up in them. They knew the individuals there and knew how to target leaders in the community. I am a great fan of pharmacists and their role in all public health promotion work.

More than 9,000 community pharmacies in England supported the smoke-free January campaign last month, giving out quit cards, and engaging with smokers in person, through their digital presence and on social media. More than 6,500 have signed up to support no smoking day later this month, and that number continues to grow. It is valuable work. Pharmacies have also delivered a large part of this year’s winter flu immunisation programme; more than 105,000 vaccinations have been provided through that route in London alone. Again, as the shadow Minister said, pharmacies are an important way to relieve pressure on other parts of the system, and they are recompensed for those services.

This debate has provided us with a valuable chance to put on record what tangible value pharmacies bring to our society, and particularly to our health system, of which they can sometimes be the unsung heroes. I applaud how they have supported and continue to support our public health ambitions. The five-year forward view had a whole chapter on prevention. Getting serious about public health is at the heart of the challenge of sustainability for our much-valued and much-loved NHS. We need pharmacies to play their part. Estimates suggest, as I think the shadow Minister mentioned, that 18% of GP consultations for common and minor ailments and about 8% of accident and emergency attendances could be dealt with by pharmacists, which emphasises their importance.

I appreciate the concerns that have been raised about this scheme. I hope that I have given the House some reassurance that although it is clearly a challenge for the pharmacy in the constituency of my hon. Friend the Member for Romsey and Southampton North and some others, we have now reduced the number of pharmacies with unresolved issues to a very small number. However, it is critical in these last few weeks before the transitional scheme expires that we resolve the remaining issues in a way that gives people a chance to plan for the future. Those essential small pharmacies have played an important role in the past, and NHS England area teams are ready to work with, and I hope are working with, any contractor who wants to continue providing a pharmacy service to their community. I will encourage them to continue to engage, to ensure that we can reach as many outcomes as possible, particularly for the benefit of local communities, which have been so ably championed by my hon. Friend.