Pharmacies and Integrated Healthcare: England

Jo Churchill Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Main]

My hon. Friend is absolutely right and completely backs up the point I was making. There is evidence of good practice but other areas could do much better. Without bringing pharmacies to the table and into the ongoing dialogue about this issue, we risk not having the new model that we would all like to see—one that operates consistently wherever people go.

There must be a consistent model in the drop-in pharmacy service that we are envisaging. Of course, people often use pharmacies away from where they live, such as where they work or when they are on holiday or visiting friends. If the model is patchy, as my hon. Friend says, the system will not improve and we will end up with a situation like the one that is found in many holiday towns. A few years ago, the Select Committee on Communities and Local Government looked into the fact that many seaside and holiday towns have enormous pressures on their frontline services. If something goes wrong when people are on holiday, although what happens is not necessarily catastrophic, they all end up at the local A&E services in hospitals. That huge problem was recognised, I think, in the 2006 seaside towns report by the CLG Committee. This is all part of evening out the stresses and strains on the system, which for many seaside holiday and tourist destinations are often huge.

[Jo Churchill (Bury St Edmunds) (Con)]

Does my hon. Friend agree that that was largely the point of the Murray review, which she alluded to earlier? Integration throughout the whole of the NHS is vital, so that everybody knows what everybody else is doing and so that there are seamless pathways that everybody knows how to follow. That will ultimately give us benefits not only in pharmacies, but right across the NHS.

[Mrs Main]

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

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[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I add my congratulations to my hon. Friend the Member for St Albans (Mrs Main) on securing not only a timely debate, given the current circumstances, but one that is important because we need to look at the whole system and integration, rather than at each specific service.

Interestingly, on 6 December, Lord Prior said:

“The Government recognise the vital importance of community pharmacy.”—[Official Report, House of Lords, 6 December 2016; Vol. 777, c. 593.]

It is from that positive stance that I wish to make my points. Pharmacists have been identified as one of the professions that are highly qualified and not in short supply. Some very advanced GPs are bringing pharmacists into their surgeries to help to alleviate some of the pressure. Some clever thinking is going on out there. I hope the Minister can tell us how we are capturing that innovative thinking and how it is being spread throughout the system.

The “Five Year Forward View” identified that the British public need to be made more aware of what pharmacies can do and how they can help people keep healthy. However, the Government need to give a steer and ensure that people with minor ailments understand that the pharmacist should be their first port of call.

When I visited my pharmacist there was concern about the 111 service, which was my hon. Friend the Member for St Albans mentioned. We need to keep an eye on that so that we do not unintentionally put pressure on different parts of the service. We need to look at it in the round and incorporate all key roles into pharmacies in order to provide additional services. I had my flu jab at a pharmacy this year, which is a useful use of resources within the system and within the community. We could make that more available and perhaps incentivise individual pharmacists to go out into care homes, which have a proliferation of need because of age and comorbidities, and give flu jabs and so on. Moving our workforce around, rather than driving ever-greater demand into smaller places such as hospitals, must be a consideration.

The Murray review, which has been mentioned, found that poor integration with other parts of the NHS was a significant barrier, and the Royal Pharmaceutical Society agreed. I like to think that the Government are taking a good look at what was said in the review and taking the issues on board.

I love the term “pharmacy-first culture”, which is a good motto for everybody to live by. I want to concentrate on my Bury St Edmunds constituency for a couple of minutes. We have 21 pharmacies and a cluster of Superdrug and Boots shops, which are volume providers that have other things such as make-up and lunches; they have optical services and Boots has audiology services. They provide everything needed from the cradle to the grave and they have considerably greater footfall than my excellent independent pharmacist, who puts more prescriptions through than any other pharmacist in the town. The 100-hours rule meant that I got local surgeries with pharmacies dispensing in them. We need to take a little bit of care, step back and get the right things in the right place. The last thing my local community wants is my independent pharmacy not being able to survive through these important transitions.

An ageing population is a challenge in rural areas such as Bury St Edmunds. Within the next decade, 40% of Suffolk’s population will be over 85. We know that that age group lives with comorbidities that need a degree of monitoring. That can be done most effectively in the pharmacy and in the GP’s surgery, but out of the big NHS pie the GPs get only about 8% and the acute sector gets about 92%. We need to show that we are spreading the money throughout the system, because a lot of the pressure will be coming down on the pharmacies, the GPs and the care sector.

Pharmacists are often not used to their full value. Delayed discharge from hospital often comes about because people do not get their meds, and pharmacies in some hospitals are not available throughout the weekends. There could be more joined-up thinking.

[Bill Esterson]

I do not think I disagree with anything the hon. Lady has said. She is making a very good case for the excellent practice in her constituency and for pharmacists more generally. Does she agree that the logic of her argument is that money is saved by investing in pharmacies? That is a strong argument. She is arguing that cuts should not be made and that the Government should invest in pharmacies to support the whole health system, which is what this debate is about.

[Jo Churchill]

I thank the hon. Gentleman for his intervention and agree with his final point. This is about the whole system and making efficiencies. We are talking about evolution. We are no longer looking at the service as it was perceived in 1948. There was a private element to it even back then, because that is what GPs wanted. We need a 2017 solution to the challenges of a larger population, an ageing population and so on. Pharmacists must play their part in that. They are really keen to step up and deliver more for the Government and more for the patients and people in their communities.

There are issues in the town, but there is an interesting rural situation, where there are rural payments for Elmswell and Thurston, but the GP surgery in Woolpit, which dispenses more scripts, does not get one. There seems to be a bit of discrepancy. I echo the point made by my hon. Friend the Member for St Austell and Newquay (Steve Double): looking at rural constituencies is a very different thing from looking at the whole ecosystem.

There is a Day Lewis pharmacy in my town. An exceptional local resident, Ernie Broom, is keen to note that that pharmacy, because of its location, cannot offer a lot of peripheral things. The local residents are largely mature or on lower incomes, which means that the pharmacy is vital to the community. We also have really poor bus services into town—it would take a young mum or an elderly person nearly an hour and a half to cross town. I want the Government to look at a weighting system, which takes into account what local pharmacies can deliver. They would get points for being in certain areas, or incentives for delivering more. I know that is something that is being looked at.

My questions are similar to those posed by my hon. Friend the Member for St Albans. What more can pharmacies be incentivised to do? How much more capacity can they provide? With people living longer and with comorbidities, how can we remunerate for services? How can we ensure that that is included as part of sustainable transformation plans? It is not something that should be added at the end as an afterthought, but is a hugely integral part of how we make our NHS better and more able to look after the health of us all.

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[David Mowat]

That is of course a valid concern. We are trying to make progress on having GP services open for much longer than they have been historically, including weekend opening. Several colleagues have made the point—the Murray review also addressed this—that there is occasionally a barrier between the attitudes of some GPs and what can be done by pharmacists. That is true. We must be conscious that it behoves us to try to encourage the breaking down of that barrier, and misplaced professional pride must not prevent us from doing things to the best extent. Putting some pharmacists in GP practices—particularly with new models of working in which more disciplines tend to work together and a GP does not just work on his own—is an important part of that.

[Jo Churchill]

There is a barrier, but again, those services are used in different ways. My independent community pharmacist in Bury St Edmunds dispenses around 18,000 or 19,000 prescriptions in the town and provides all these ancillary services. He also has a dispensing practice in a GP surgery, which he is looking to automate, to make it more streamlined and cost-effective. Those services are two slightly different things, and I would worry if there were too much of an idea that they service the same thing.

[David Mowat]

They are different, but my point was somewhat different: optimising the use of the pharmacist profession could facilitate the breaking down of barriers and some of the care home activities that have to happen.

I will leave a couple of minutes for my hon. Friend the Member for St Albans to respond, so I will not talk in detail about the value for money aspect, other than to repeat the point—Opposition Members made a couple of interventions about this—that overpaying for a dispensing service is not the way to facilitate a much more clinically-based and service-based approach. The way to facilitate that is to get the appropriate remuneration models and revenue streams in place, and that is what we are determined to do. In the end, that is what we expect to be judged on, and I hope that we will be judged on it. With that, I will let my hon. Friend summarise.