Covid-19: Community Pharmacies

Jim Shannon Excerpts

Thursday 11th March 2021 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for setting the scene, as she always does on such issues. I am very pleased to speak on this matter, because it is essential for me. I have often referred to pharmacies in my constituency, and I have often sent questions to the Minister here, and to the Minister whose responsibility they are back home as well.

Those pharmacies have reported much of the concern that has already been outlined by others, and they are in need of Government support. I have a good working relationship with pharmacies in my area and I visit them fairly regularly, but they are under additional pressure because of the recent strains relating to the Northern Ireland protocol. I know that the Minister is not responsible for the Northern Ireland protocol, but this debate is about pharmacies and the Northern Ireland protocol becomes part of that, as it always does with everything, for us in Northern Ireland anyway.

I was in contact with one of my local pharmacies, who spoke with other members of Community Pharmacy Northern Ireland and outlined the following:

“Community Pharmacy NI has been in on-going local and national discussions in respect of matters relating to the supply of medicines to Northern Ireland, and has highlighted the continuing concerns in respect of continuity of supply from a Northern Ireland perspective in 2021/22 and beyond. There is a 12-month derogation in place and Mr Gove has requested that this be extended to 2023.”

That is good news because it helps us in the short term, but we need a long-term solution as well. It goes on:

“there is work being undertaken at policy and operational levels to resolve anticipated supply issues before they impact on contractors and patients here.”

So, we are seeing some conciliation and help for us in Northern Ireland, and we appreciate that.

Community Pharmacy NI continues:

“However, additional regulatory requirements post 2021 may put a significant burden on manufacturers for a small NI market”—

it might be small, but it is crucial for us in Northern Ireland and for our constituents—

“and the fear is that this may force them to withdraw altogether from supplying here and that there may be significant disruption to the supply chain which will result in shortages.

There are also looming implementation dates for full compliance with HMRC and EHC requirements, which may impact on medicines movement. The potential shortage issue could be managed to a large degree by ensuring that the licensing status quo is retained as far as possible to allow the unfettered use of GB packs in Northern Ireland.

Community pharmacies in Northern Ireland provided a vital role in supporting patients, the health service and by maintaining medicines supply to patients during COVID.”

We have all said that.

“As we go forward now in 2021 can Government provide details/give assurances that work is ongoing to identify and quantify any possible medicines shortages and to put in place sufficient measures and contingencies to deal with any anticipated issues in respect of medicines supplies to Northern Ireland?”

Can the Minister respond to that today? If not, can she respond to it further down the line?

Local pharmacies are a focal point of villages and communities across my constituency. Throughout the pandemic, the community pharmacies have battled through as a lifeline for people. In the same way that we owe a debt to the NHS, I believe we also owe a debt to local pharmacies, who did their utmost to keep it together and keep going. There must be a better use of them to relieve the pressure on the NHS. I believe that pharmacies are at the frontline to do that. They could be addressing issues to do with diabetes, minor ailments or small medication problems.

I end by putting on record my sincere thanks to all the pharmacists, technicians and staff who kept making the packs, were available for assistance, and kept their doors open and medication flowing. We could not have done it without them, and now is the time to do right by them.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Graham. I am incredibly grateful to my hon. Friend the Member for Thurrock (Jackie Doyle-Price), not only for securing the debate today, but for her work as chair of the all-party parliamentary group on pharmacy, and across the health space more generally.

All those who have participated today have shown how important pharmacy is to every one of us. The voices of my hon. Friends the Members for Barrow and Furness (Simon Fell), for Harrogate and Knaresborough (Andrew Jones), for Bolton West (Chris Green), for Carshalton and Wallington (Elliot Colburn), for Henley (John Howell), for Winchester (Steve Brine), for Isle of Wight (Bob Seely) and for Southend West (Sir David Amess) joined those of the hon. Members for Strangford (Jim Shannon), for Birmingham, Selly Oak (Steve McCabe), for Coventry North West (Taiwo Owatemi), for Halifax (Holly Lynch) and for Bootle (Peter Dowd). Everyone recognised how important community pharmacy is in their community, and I want to join in the thanks given to that community today and say how much I value what it does on the frontline. As my hon. Friend the Member for Harrogate and Knaresborough said, pharmacy workers are key, skilled frontline workers and deliver over and above, every day, to our communities. I repeat the thanks of the Prime Minister and the Secretary of State for Health and Social Care, and add my gratitude.

The fact that pharmacy workers are a key part of our NHS family, as my hon. Friend the Member for Thurrock said, and have risen unfailingly to the many, varied and enormous challenges of the pandemic should not go unnoticed. There are 11,210 pharmacies sitting at the heart of our communities. They are easily accessible: 80% of them are within 20 minutes for someone walking there. They are highly rated, as many hon. Members have said, and highly trusted. Throughout the pandemic they have stayed open and served their communities. They have provided vital pharmaceutical services. Medicines are not something that people can choose to have or not have.

I am immensely proud to stand here as the Minister for pharmacy, and I thank everyone involved in community pharmacy for their hard work, whether they talk to patients every day or are involved in the vaccine roll-out or the broader team. From the times I have spoken to them, I know that they are tired. They have worked unbelievably hard for the past year. I do not think that, when this started, anyone anticipated that it would go on week after week. They have been working evenings and weekends, and I would like to thank them for it.

Hon. Members might recall that we agreed a five-year deal back in July 2019, before the pandemic. It commits almost £13 billion to community pharmacy—just under £2.6 billion a year—and was the joint vision of Government, NHS England and the pharmaceutical negotiating committee, the PSNC, for how community pharmacy will support the delivery of the NHS long-term plan, and patients.

As we have heard from many, particularly my hon. Friend the Member for Southend West, there is so much more that pharmacies are saying they want to do for our communities. Having spoken to many pharmacists and their teams, I know that using their full skillset is something they would welcome. It is what they want to do and what they want to see happen.

Over the period of the five-year deal, community pharmacy will be more integrated into the NHS and will deliver more clinical services, taking pressure off other areas in the NHS, as the first port of call for minor illnesses. That recognises, importantly, the skill base in the sector. To that end, more than 2,800 pharmacists each year go into training at the current time; there are more than 10,000 in training at the moment. We are making sure that, as the current cohort come out, they are equipped to be part of that future high-skilled workforce, enhancing their skills for consultation and so on.

[Jim Shannon]

One of the advantages that I am sure the Minister is coming to is that GP surgeries and A&Es will potentially have fewer people to see if the pharmacies take over that role.

[Jo Churchill]

I thank the hon. Gentleman for that point.

We are already making good progress on the journey. The community pharmacist consultation service went live in November 2019, enabling NHS 111 to refer patients into community pharmacies for minor illnesses or the urgent supply of prescribed meds. We have had more than 750,000 referrals so far.

In November 2020, we expanded that service to GP surgeries, so GPs can now formally refer patients to community pharmacies for consultation. In February, we introduced the discharge medicines service, enabling hospitals to refer discharged patients into a community pharmacist for support with their medicines. There will be more services introduced over the financial year.

Those services are to do what pharmacists and their teams do best, and that is to help patients. My hon. Friend the Member for Southend West spoke about hepatitis C. I assure him that, as of last year, we gave access to hepatitis C testing to those pharmacies that chose to take up that option.

I agree with my hon. Friend the Member for Winchester that there is great potential in hub and spoke dispensing. I also agree with the hon. Member for Nottingham North (Alex Norris) that there is already experience to learn from in the sector.

As set out in the community pharmacy contractual framework five-year deal, we want to make dispensing more efficient and, by doing that, free up pharmacist time to provide more clinical services—they are highly skilled, and we know they want to do that. The Medicine and Medical Devices Act 2021 paves the way for us now to progress legislative change to enable the better use of skills in pharmacies, something that several Members this afternoon have alluded to. There is a large amount of will to make sure that the whole team can use their skills appropriately and perhaps free up the pharmacist a little more for him or her to concentrate on other areas.

We have already started informal engagement with stakeholders—that started this week—which will be followed by a formal consultation. I am afraid I cannot give hon. Members an exact date, but I will commit that I want that to be as soon as possible—I want us to get on with this. I thank my hon. Friend the Member for Winchester, who knows the sector extremely well, for his comments about the opportunities that lie therein. I am sure that many hon. Members will want to work to develop that.

New services will develop and expand the role of community pharmacy across three key areas. Several hon. Members alluded to the fact that pharmacies would be expert in helping with prevention, urgent care and medicine safety and optimisation. Those are all areas in which growth is envisaged in the short, medium and longer terms.

That brings us to the pressure. I am well aware of the pressures community pharmacies are under. Not only has the last year brought quite unprecedented circumstances, but it has not allowed some things to go on that we thought would be embedded by this point. Throughout the last year, we have had conversations with community pharmacy and stakeholders, and have tried to respond as best we can by putting in place a package of measures and support for the sector.

Most community pharmacies have been able to access some general covid-19 business support, including various rates reliefs and some retail, leisure and hospitality grants, and we estimate that there has been access to about £82 million in grants. There has been extra funding for bank holiday openings, when—particularly looking back to last Easter, for example—the sector has responded phenomenally by remaining open and giving patients access across long holiday periods; for a medicines delivery service for shielded patients, which has been mentioned and has been hugely appreciated; and for a contribution to ensure that social distancing measures can be in place in every pharmacy.

We are still talking, however. We have provided personal protective equipment free of charge via the PPE portal, and have reimbursed community pharmacies for PPE purchased. We have also provided non-monetary support, such as the removal of some administrative tasks, flexibility around some of the opening hours, support through the pharmacy quality scheme for the sector’s response to covid-19, and the delay to the start of new services, all of which have been requested.

Between April and July 2020, an advance payment of £370 million was made to support community pharmacies with cash-flow pressures, which were extremely acute. Those were caused by several issues, including a sharp increase in prescription items in the March-April period, higher drug prices, delayed payments from the pharmacy quality scheme, and extra covid-related costs. Acting swiftly and providing those advance payments helped to alleviate immediate cash-flow concerns, but since then pharmacies have been paid for the increased items that they have dispensed, reimbursement prices were increased to reflect higher drug prices, and payments have been made under the pharmacy quality scheme.

We are still in discussions with the PSNC about the reimbursement of covid-19 costs incurred by community pharmacy, and I can reassure the House that the Government will take a pragmatic approach. I expect to deduct any agreed funding from the £370 million advance payments, and to discuss timescales around the advance separately with the PSNC, being very mindful of the pressures. We need to assure ourselves that community pharmacies are financially stable. Without that stability, they cannot deliver those services.

I am aware of the concerns that current funding is not enough, and I need to work with the sector to look at things in much more detail, because pharmaceutical services are complex, and there is a range of different providers. The hon. Member for Nottingham North mentioned that he has a Boots in his constituency, but that is a very different operation from many of the individual pharmacists, such as Tim, who has a pharmacy on the harbour in the constituency of the hon. Member for Isle of Wight.

Whether they are independent, small-chain or large-chain pharmacies, no two pharmacies are the same. The solution has to be one that we can tailor. A balanced and considered approach must be taken to maintain the variety and vibrancy that we all recognise as absolutely key in the pharmacy network. People and patients absolutely value the diversity that best suits them and their own needs. We need a sustainable funding model that works for all types.

I have heard the concerns about pharmacy closures, and I can assure Members we monitor the issue very closely indeed. Our data shows that, despite the number of pharmacies reducing since 2016, there are still more than there were 10 years ago. We have seen more closures in deprived areas, as many Members have said. However, importantly, there were more in deprived areas, so making sure that there are still more pharmacies in deprived areas is extremely important.

Proportionally, the closures reflect the spread of pharmacies across England, with closures tending to be where they are clustered. The most recent data shows that three quarters of the closures were part of large chains, and that aligns with consolidation announcements made before the pandemic. It is important that we protect access to pharmaceutical services. The pharmacy access scheme protects access in areas where there are fewer pharmacies and higher health needs so that no area is left without access to a local NHS pharmacy.

It is important to recognise that covid-19 is also an opportunity, which many Members have alluded to. The pandemic has shown across healthcare the value of our highly skilled community pharmacy teams, and how they can contribute and receive more funding. Commissioning community pharmacies to operate the medicines delivery service has been vital to ensure that vulnerable constituents have received their medicine. Community pharmacies have delivered the biggest flu vaccination programme ever, vaccinating more people than ever before.

There are currently around 200 pharmacy-led covid-19 vaccination sites, with a target to double that number by the end of this month, and there have been 60 more this week alone—on many of the questions around vaccines, I will defer to the Minister for Covid Vaccine Deployment. I expect more to follow, and NHS England is looking to designate more pharmacy-led sites, including sites that can deal with up to 400 vaccinations a week in areas where there were not sites that could deal with large quantities of vaccine, which initially put some sites off.

We are considering the important role of community pharmacy and how that can play out in future as we learn to live with covid-19 and having vaccinations. In addition, community pharmacies are taking part in pilots of antigen testing at lateral flow test collection sites. If those are successful, community pharmacies will be able to provide a valuable service to their local area and will be paid to do it.

The community pharmacy continues to be part of local PCNs, and I know it stands ready to take its full part in primary care as we learn to live with the disease. Those examples show how community pharmacy is helping the broader healthcare family fight covid-19. The Government are keen to make better use of the clinical skills, while giving pharmacies opportunities to generate more income above the £2.5 billion per year that the five-year deal went to—and there are opportunities.

Finally, I once again thank my hon. Friend the Member for Thurrock for this important debate. The past year has tested all pharmacies, and the following months will continue to be challenging. I am personally committed to doing everything I can to support all community pharmacies in what I view as their essential role as part of the NHS family, which, again, many have spoken of. This is a responsibility on all of us. Pharmacies bring incredible value to local communities and their patients. We are beginning to see the light at the end of a troubling tunnel, and we would not have made it this far without the contribution from community pharmacy. I look forward to having the conversation to ensure that we get a sustainable funding model not only with colleagues but, mainly, with the sector.