Community Pharmacies

Jo Churchill Excerpts

Wednesday 2nd October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir David. I thank each and every right hon. and hon. Member who has contributed. Most importantly, I thank the hon. Member for Halifax (Holly Lynch) for securing this debate and allowing us to discuss the challenges and celebrate the opportunities that lie ahead in community pharmacies, as well as how we best deliver to patients. The right hon. Member for Rother Valley (Sir Kevin Barron) and the hon. Members for Scunthorpe (Nic Dakin), for York Central (Rachael Maskell), for Heywood and Middleton (Liz McInnes), for Great Grimsby (Melanie Onn), for Strangford (Jim Shannon), for East Londonderry (Mr Campbell) and for Westmorland and Lonsdale (Tim Farron) all made excellent speeches that gave food for thought, as did the contributions from the hon. Members for Motherwell and Wishaw (Marion Fellows) and for Washington and Sunderland West (Mrs Hodgson). They celebrated exactly what community pharmacies can do if they are embedded in the heart of their communities and what untapped potential there is for moving forward.

I am pleased to have the opportunity to set out the vision for community pharmacy at a pivotal time for the pharmacy sector. As we have discussed, the past three years have been challenging, but there is a new pharmacy sector agreement. I am continually inspired, as everybody has been—we heard about the experience of the hon. Member for Halifax of working in a pharmacy—by the compassion, dedication and commitment of those who work in the NHS family. I saw that myself last week when I met pharmacists and the chief exec of the Pharmaceutical Services Negotiating Committee at the local pharmaceutical committee conference. That underlined to me again what an essential part of the NHS the pharmacy is, working day in and day out on improving outcomes for patients and for the community, which lies at the heart of what they do.

We have heard about the challenges of different communities. The hon. Member for Westmorland and Lonsdale made his point very well, as did other Members who represent rural constituencies. The hon. Members for Strangford and for Motherwell and Wishaw mentioned that the challenges are slightly different in rural, dispersed communities. We hope that the new contract will not be one size fits all but will give additional help to rural pharmacies to help them deliver, because we know that they are an important and integral part of their local community. Ensuring that we maintain a good level of access in England and support pharmacy where there are fewer pharmacies is important and built in.

Community pharmacy always has been an integral part of our communities. We have 11,500 community pharmacies delivering. I pay tribute to the right hon. Member for Rother Valley for his work in chairing the all-party group on pharmacy. He explained clearly how pharmacies are close to 96% of people, who can get to one by foot or on public transport in 20 minutes. The key thing for me was when he said that the majority were in areas of high deprivation. That is hugely important as the contract moves forward, because we are determined to double down on health inequalities, and we know that the pharmacist is a key frontline expert who can help deliver in those communities. Pharmacy can play a greater part in helping people to stay well in their communities.

Today’s debate is timely because the new landmark arrangements for pharmacy—a five-year deal for pharmacies—came into force yesterday. I have heard the deal criticised as flat, but the PSNC said that it wanted certainty; it wants to be able to use its skills better and further, and we have determined the deal in collaboration with it. The deal is the beginning of a programme to transform the sector and to see community pharmacies play a much expanded role in the delivery of health and care across prevention, urgent care and medicine safety. Those new arrangements will support the pharmacy team to utilise all its extensive clinical expertise, further developing new roles and providing the community with the knowledge, skills and support to prevent ill health, manage minor conditions and stay happy and healthy for longer. We have heard from virtually every Member who has spoken about how much that goes on. The hon. Member for Great Grimsby told a moving story of how intimate the relationship is between the community pharmacist and the community that he serves.

The deal sets a programme of work that the Department, NHS England, NHS Improvement and the PSNC have collaboratively developed and agreed—we have worked together to get there. Our direction of travel is clear, and we will continue to work together on the detail, strengthening the role of community pharmacy and the delivery of health and care year on year for the next five years and beyond.

[Nic Dakin]

The Minister is setting out the aspiration well, but does she recognise that having no increase—even by inflation—for five years is a desperately big challenge for community pharmacies?

[Jo Churchill]

On the matter of reimbursement, which was also raised by the hon. Members for York Central and for Westmorland and Lonsdale, we seek to ensure a fairer system of reimbursement for pharmacy contractors and value for money for the NHS. I am sure we would all agree that that is the challenge that we face the whole time. That is why, in July, we launched a consultation on community pharmacy drug reimbursement. We have engaged widely with pharmacy stakeholders and have had an excellent response. We will consider all those responses fully and set out plans for the fairer system in due course. I appreciate that the response will be, “But it’s needed now,” but a pharmacy is a private business, and reimbursement is not pharmacies’ only form of income. What I am talking about will take a shift. There is an acknowledgment that that shift—that transition—will need to be assisted. There is also an independent funding stream from the flu vaccine, for example. I would like to see—and have been discussing with officials—whether a broader vaccine programme could be rolled out through pharmacies as well, and reimbursed. We know we need to do better.

[Jim Shannon]

The Minister has so far given a comprehensive response to our concerns. I suggested in the debate that, when it comes to medical attention, pharmacies could do more to oversee small things such as the flu vaccination that she referred to and diabetes and glaucoma. As other hon. Members have mentioned, there are small things that pharmacists could do to take the pressure off GPs. Is that something the Government would consider—giving more responsibility to the pharmacist and taking pressure off GPs and accident and emergency?

[Jo Churchill]

If the hon. Gentleman will just bear with me for a second, he will hear me largely repeating what the right hon. Member for Rother Valley said when he so beautifully laid out the skills and expertise that lie in the pharmacy sector, and how they can be utilised better.

As I said, the deal sets out a programme of work we shall be working on. Our aim is that collaborative working across the system will deliver an integrated and accessible community health service for all. I want to name-check the hon. Member for Strangford here because, as he articulated, communication lies at the centre of this issue. One instance might be the digital expertise that the hon. Member for Washington and Sunderland West said exists in Gateshead, where people’s greater readiness to get services from pharmacists, and the fact that pharmacists can do more, is having a positive effect for patients.

First, pharmacists told us that we must utilise and unlock the potential of the highly skilled pharmacy teams that are embedded in communities throughout the country, including in the constituency of the hon. Member for Halifax, with everyone celebrating what pharmacists can deliver. That is why the settlement aims to deliver more fulfilling, patient-facing careers for community pharmacists and technicians, as highly valued members of the NHS team. Additionally, populations will be helped by much better services.

Secondly, pharmacists told us that they wanted continuity. The settlement funding over five years gives certainty, and gives community pharmacists the confidence to invest in their business. However, there is no one size fits all. Being in the centre of a town is not the same as being in a rural village. Looking at these things in the round is why we want this to be collaborative.

[Rachael Maskell]

How will the Minister measure the impact of the settlement, particularly on independent pharmacists? If more of them close or are struggling financially, what other interventions does she plan to make?

[Jo Churchill]

As I said, there is no one size that fits all. As the hon. Lady articulated in her speech, the difficulty is that we are not looking at a system where businesses are run on the same scale model. At any one point, there are single pharmacists. She stated that the pharmacy she visited was part of a seven-strong business. Then there are the multiples. We need to look at what is the best scheme. However, I would argue that independents have a much higher footfall from their local population, because they are more trusted than many of the multiple pharmacies due to the continuity that comes from their having been in their communities for longer. There are opportunities there for independents.

We know we will need to design new ways of working to make a success of this, and we will need patients to be confident in how they use the services. The enhanced role for community pharmacy will support patients in getting access to help where required and in using the NHS in the best possible way. When people are suffering from minor conditions such as earaches or sore throats and need health advice, we want them to think “Pharmacy First”.

We want to build on that, with other parts of the NHS proactively signposting to local pharmacists. We want everyone to recognise the high-level skills held by pharmacists and to get people to understand that we need them as a first-line service to go to. That will grow trust in the system and spread the load. We will, of course, need to reform the way we work to free up pharmacists’ time so that they are able to deliver these new services.

[Liz McInnes]

I am sorry to interrupt, but the Minister has not referred to delivery times yet, and we have only two and a half minutes to go. Will she mention what she is going to do about those?

[Jo Churchill]

I thank the hon. Lady, but I would like to push through and to come on to the supply of medicines, which the hon. Member for Halifax spent much of her speech discussing.

We must recognise that we need to work in partnership and that this is not only about treating ill health. One of the first services to come online under the new arrangements will be the community pharmacist consultation service, which will start on 29 October. It will establish the first ever national triage system, which will look at community pharmacies referring patients into pharmacy directly from NHS 111 for minor illnesses, wellbeing support and self-care advice, as well as urgent problems. It is important that everybody involved makes this work a success, because we want this to be a two-way process. Over the next five years, we want to include referrals from GPs, urgent treatment centres and NHS Online, but we want to do that based on evidence, sensibly and in collaboration with those in the sector. Registration opened only last month, and more than 2,000 pharmacies have been signed up.

Additionally, by 2020, being a level 1 healthy living pharmacy is expected to be an essential requirement, so that pharmacies can give advice. Integration across primary care is hugely important; the new contractual framework is about not moving minor illness, but about using the whole system better. Community pharmacies are a vital part of the picture if we want to think “Pharmacy First”.

Coming on to the question of medicine supply and shortages, I appreciate the issues that the hon. Member for Halifax mentioned, but, as recognised in last week’s National Audit Office report, we have done an enormous amount in collaboration with pharmaceutical and medical device companies. There are always ongoing shortages, but the Department works all the time to ensure that they are mitigated and that a proper supply of medicine can be got to people. With the issues of Brexit, we know that that is doubly important, and that is what the Department has been doubling down on.

[Sir David Crausby (in the Chair)]

I do not think there is really time for Holly Lynch to wind up.

Question put and agreed to.

Resolved,

That this House has considered the role of community pharmacies.