Community Pharmacies

Jim McMahon Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jim McMahon (Oldham West and Royton) (Lab)]

Here we are again, debating more slash-and-burn cuts to vital public services. Generations and decades of investment are being eroded in just a few short years. What will be left?

I think we all accept that if we can make savings in the public sector, we should do so, because we should use the money to the best possible effect. But it is short-sighted to take money away from community services when the accepted logic is that those services save money in the long run. It beggars belief that we are debating this again.

[Conor McGinn (St Helens North) (Lab)]

In my constituency, local pharmacies and GPs are working collaboratively to build an integrated health centre in Haydock. Does my hon. Friend agree that although the Government say they want to encourage such working, their actions, as usual, do not match their words, because they are cutting the funding that would make that long-term, sustainable investment worthwhile?

[Jim McMahon]

I share that view entirely. My preferred option would be to devolve that power with fair funding to local areas, so that they can decide. The Government have proved time and again that they do not understand or value the public services that our communities rely on.

Let me tell Members what it is like in Oldham. We have 57 community pharmacies, nine of which have 100-hour contracts and four of which offer delivery services. That is about 25 pharmacies per 100,000 residents. Ask the public how they perceive those pharmacies, and 93% say that those pharmacies are doing a good job, while 88% of people in Oldham use those pharmacies. They are respected, and they are used by the community. When asked, the main reason people gave for using those pharmacies was their proximity and location. People could get to those pharmacies to access the services that they needed.

The truth is that we do not need fewer pharmacies; we need more, because demand is going up. I am not the only one who says so. The local health and wellbeing board says so in a 90-page review of pharmaceutical support in Oldham. It says that we have enough pharmacies to meet current demand, but that demand is going up because people are living longer, because the population is increasing and because new homes are—as the Government want—being built in the area to support new families. That requires the infrastructure to be in place.

Many wards in the borough do not have pharmacies that are open at weekends, so it is not as though we have a gold-plated service. We are just about getting by. It is not as though pharmacists are twiddling their thumbs behind the counter waiting for somebody to walk through the door. The average number of prescriptions dispensed by those outlets is 7,000 a month. We really need to think about what we are doing, whether the money is in the best possible place and whether we are valuing the real saving that can be derived further down the line.

I am not the only one who says that pharmacies can help us to achieve savings. PwC, which is hardly a standard bearer for public services, has said that pharmacies in the community save £3 billion a year. Why? Because people do not have to go to the GP or present to A&E, and because prevention is far better than cure. That is exactly what community pharmacists are there to do.

I really worry about what we are going to do to the industry and to the profession—that community service—which people aspire to be part of. I can tell Members what community pharmacists are saying, because I have a letter from a local pharmacist who lives in the Werneth area of my constituency. Mr Khan studied hard through school, sixth-form college and university to set up his own pharmacy. He works very long hours; although he is funded to work 40 hours a week, he actually works 50 hours a week—10 hours a week free of charge to the NHS—because he believes in a community service. He provides a delivery service, which is not paid for by the NHS, where he takes prescriptions out to the public. For a lot of the people he meets, he might be the only person they see during the week. According to the estimates in the report that I referred to, 15,000 more people in my borough will be living alone by 2017. Loneliness and isolation are real issues, and such community infrastructure is an important way of combating them.

I want to read out an important quote from the pharmacist I have mentioned. He said:

“Many of us, however, feel betrayed, angry and confused right now because the government who promised to make Pharmacy at the heart of the NHS; has ripped the very heart out of Pharmacy.”

It is not me or the Labour party saying that, but a pharmacist. They have studied hard and worked hard to set up their own business, and they work hard every day for their community, but they are being let down by this callous Government.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

I will not go through the many arguments made by hon. Members, but the reason I do not support the Opposition motion is that I do not agree with their argument about funding. The current funding system for pharmacies in this country is not working. Pharmacies have grown organically in a haphazard way, not necessarily meeting the needs of patients or the changing demands of healthcare.

I find it extraordinary that Opposition Members are satisfied that big national companies such as Sainsbury’s, Boots and Asda, many of which make profits of £1 billion a year, are being funded with NHS money, which goes to each and every one of their branches. That is completely unacceptable. [Interruption.] I will not give way because there is not enough time. I agree with the hon. Member for Central Ayrshire (Dr Whitford) that the money that is saved through these changes must go to community pharmacies and away from big business.

I have severe concerns about the proposals on the table, however, and I have met the Minister to raise them. The first is my fear that the role of the pharmacist is not properly understood. As a practising nurse, I see at first hand every day the role that pharmacists play in safeguarding patients. Doctors often make out prescriptions that are wrong or do not take into account current medications a patient is on. That is where the pharmacist comes in. Thinking that pharmacists simply stand at a counter, pick a box off a shelf and put a sticker on it is misguided; they do a huge amount more.

Another concern is the proposal or recommendation that we move towards either GP dispensing or GP practices housing pharmacists. I know from talking to my GP practices that they are bursting at the seams. It is not as simple as installing a pharmacist at a practice; pharmacists need storage space for their medication, temperature-controlled rooms and space to make up that medication. I know that my GP practices do not have that space right now. I also have concerns about GPs’ taking on dispensing; as I have said, pharmacists have a crucial role in safeguarding patients. Who will pick up those mistakes, or look at patient medication or drug interaction if no pharmacist is there?

My biggest concern—again, this point was made by the hon. Member for Central Ayrshire—is that this is a huge missed opportunity. We are doing things the wrong way round. We should be looking at the system and at patients’ needs. We should follow the excellent model currently running in Scotland and learn from it, rather than thinking, “We need to save money. How can we best do that?”

As many Members have mentioned, there is some obvious stuff that pharmacists are doing now.

[Jim McMahon]

Will the hon. Lady give way?

[Maria Caulfield]

I will not—as I have said, time is short.

Right now, pharmacists are running clinics for asthma, blood pressure and thyroid issues. But we are not seeing what pharmacists could do. They are highly experienced and highly qualified. They should have registers of patients and be referring people to clinicians and hospitals themselves. They should be a second point of primary medical care. I cannot support the Opposition, because they are wrong that this is only about saving money. It is much bigger than that, and should be an opportunity to improve primary care overall.

--- Later in debate ---

[Graham Jones (Hyndburn) (Lab)]

As many colleagues have pointed out, not just today, but in previous Westminster Hall and other debates, cuts of £170 million to pharmacy funding will decimate NHS primary care. It could force up to 3,000 pharmacies to close their doors to the public. In Lancashire alone, 387 pharmacies are at risk. I am deeply concerned about that. It will put an intolerable amount of pressure on front-line NHS services. When we look at the evidence, we find that 25% of the 2 million people who normally seek advice from their community pharmacy would visit their GP instead if they could not get it from their pharmacy. Other NHS services, which are already facing sustained attack from the Health Secretary, will become even more stretched.

I am particularly concerned about the impact on innovative and pioneering models of primary care that are provided through pharmacies. My local pharmacy in Baxenden, for example, is a healthy living pharmacy, ensuring that its provision is localised and preventive. I believe that all pharmacies should look to achieve such added value. This tiered commissioning framework, of which healthy living pharmacies are part, has been praised by the Pharmaceutical Services Negotiating Committee for its successes in reducing smoking, alcoholism and obesity. The majority of users do not have to go elsewhere for their health advice; they can use their local pharmacy instead of their local GP. Indeed, 70% of people who visit pharmacies do not regularly access other healthcare services. The healthy living pharmacy framework should be rolled out across Lancashire and should be part of the primary care review.

[Jim McMahon]

Does my hon. Friend agree that the pharmacy access scheme is more about the Tories buying off their Back Benchers than delivering the services that he mentions?

[Graham Jones]

My hon. Friend makes a powerful point, which was also made by our Front-Bench spokesperson, who rightly observed that most of the cuts will fall in deprived areas, while the exemptions will be mostly in wealthy areas. The Government must address why they favour those who have the fewest health issues and are almost punishing those who face the greatest health challenges. The cuts will do precisely the opposite of what the Minister claims. The value-added local pharmacies in those areas will be undermined completely by the cuts. As a result, community centre provision in some of the most deprived areas might well be eroded, reduced or lost altogether. The personal relationship between patient and pharmacist will be lost, which brings me to my final point.

If these cuts go ahead, what will be the future of primary care? My right hon. Friend the Member for Rother Valley (Kevin Barron) has stated on several occasions that an Amazon model of delivery could take the place of community-centred pharmacies. Remote warehouses with box shifters driven by profit are proliferating. They are unable to provide a localised service and are unwilling to carry out primary care. They could be a dangerous replacement for community pharmacies, and that is on top of the cuts that the Government are making. This is a double whammy. Instead of promoting a primary care model that includes pharmacies at the centre, we are undermining it with these cuts.

Pharmacies in my constituency have expressed concern about this trend. They inform me that some of the warehouse pharmacies have already used patients’ personal data for marketing purposes. I have seen evidence from a company called Pharmacy4U—a mail order company—of feigned official NHS letters targeting repeat prescription users, many of whom were vulnerable. In reality, these letters were switch approval forms. This is a worrying sign of things to come if the cuts go ahead. I urge the Government to think again.