Community Pharmacies

John Hayes Excerpts

Tuesday 21st June 2022 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered the future of community pharmacies.

It is a pleasure to see you in the Chair this afternoon, Sir Gary. As a member of the all-party parliamentary group on pharmacy, I am pleased to introduce the debate and glad to see so much support from Members who obviously, like me, recognise the huge value that our pharmacies bring to the NHS, patients and the public generally. I hope everyone here agrees that England’s 11,200 pharmacies play a crucial role in providing important healthcare, life-saving medicines and an increasingly wide range of clinical services to their local communities. Not only that, but as the most accessible providers of healthcare, pharmacies are key to reducing health inequalities: 89% of the population are less than a 20-minute walk from their nearest pharmacy, increasing to 99.8% in the most deprived areas, such as mine. It is fair to say that pharmacies understand their communities to a significant extent—sometimes more than the traditional health services—and as such are ideally placed to engage with the most marginalised and vulnerable groups in our communities.

The wider public appreciate the easy accessibility of pharmacies, which by their very nature are located at the heart of every community throughout the country. Throughout the pandemic, not only did community pharmacies remain open and continue to offer their full range of services, but they played a huge role in the vaccination programme, delivering an astonishing 24 million jabs. They also distributed some 27.6 million covid lateral flow tests and initiated a pandemic delivery service that ensured that 6 million vulnerable patients could access their medicine.

I think I am correct in saying that all Members present today would like to put on record their thanks and express their appreciation for all pharmacists, pharmacy dispensers, pharmacy technicians, medicines counter assistants, delivery drivers and administrative teams, who worked so hard during that difficult time to maintain the public’s access to the pharmaceutical services that they relied on. We, and the whole country, owe them a debt of gratitude. But we must also recognise that it is not just about thanking staff; it is also about recognising that the conditions they work in are crucial to the maintenance of a good service, whether a member of staff works in a larger or a smaller pharmacy provider.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I congratulate the hon. Gentleman on securing the debate. The point he is making appears to be twofold: first, as well as responding to need, pharmacies can have a role in preventive medicine; and secondly, we now need to shout louder about that. Pharmacies did a heroic job during the pandemic and they continue to do so, but I am not sure that everyone knows as much as he clearly does about what we can do with and at a community pharmacy, and this debate serves the purpose of telling them.

[Peter Dowd]

The right hon. Gentleman makes a really valid point, and I will talk about some of that later. We have to recognise that, despite pharmacists trying to help people, they sometimes got dreadful abuse. We have to help them and protect them from abuse. That is part of addressing their working conditions. Vacancies in the sector are not caused simply by a shortage of pharmacists. It is also about which part of the space pharmacists work in. In other words, if I were a pharmacist, I would ask, “Do I like the conditions, pay and terms of my work?” If the answer is no, people move on.

Pharmacies are not just a shop; they are a healthcare setting and should be treated as such. They are a crucial part of the NHS ecosystem. I suspect that that is why a pharmacist needs to be on site all the time—this is not just a shop operating within a transactional context. Aside from covid, pharmacies are doing an incredible amount of work for their local communities every single day. In the most recent flu season, in 2021, pharmacies mobilised to deliver the biggest flu vaccination campaign on record, administering 4.85 million doses—over 2 million doses more than in the previous flu season, representing a 75% year-on-year increase.

The recently commissioned NHS blood pressure check service has already meant that 100,000 people have had their blood pressure checked in a pharmacy. Anecdotally, pharmacy representatives say they are already hearing that these checks have picked up cases of extremely high blood pressure in patients, who have then been referred on for treatment. This is a very highly valued healthcare intervention, which will save the NHS money in the long run, because it is cheaper to prevent disease than it is to treat it. More than that, however, I am convinced that these interventions will save lives.

Those two services on their own demonstrate pharmacy at its best. PwC estimates that the sector contributes around £3 billion in net value to society as a whole, and it works every day to improve the health and wellbeing of our local communities and our constituents. That is surely why we have the NHS in the first place.

What is the current financial health of the sector? It is no exaggeration to say that the community pharmacy network is under huge strain and that pharmacy staff and businesses are coming under increasing and, indeed, unsustainable pressure. Pharmacy funding is currently flat, with the total available funding envelope fixed at £2.592 billion. In practice, the Pharmaceutical Services Negotiating Committee reports that this means that real-terms funding is decreasing year on year, as inflationary pressures, rising business costs and increasing workload are not taken into account in that funding deal. Despite all that, many pharmacies have remained open, albeit under extremely difficult economic conditions.

However, the PSNC says that some businesses are reaching the limits of what is possible in terms of remaining viable, and that is already having an impact on patients. A recent survey on pharmacy pressures, conducted by the PSNC, found that 90% of pharmacy businesses are now unable to spend as much time with patients as they did before. Perhaps more worryingly, 92% of respondents said that patients were beginning to be negatively affected by the current pressures on their pharmacy. Despite pharmacies being a significant part of the NHS family—on average, at least 90% of their income comes from the NHS—pharmacy funding has not received the annual funding growth of 3.4% per annum that the rest of the NHS has been afforded.

Those in the sector feel that it is time to put things right. Indeed, the PSNC recently submitted a funding bid to the Department, making the case for extraordinary economic circumstances to be taken into account. When the Minister responds to the debate, I hope she will update Members on whether a funding increase will be granted to the sector.

The PSNC also estimates that the sector has had to make efficiency savings of between 37% and 50% in order to manage the funding squeeze and to keep providing the services it is contracted to deliver, but how much more pressure should we expect it to operate under? Do we want a bare-bones network that delivers only the very basics for patients, or do we want a vibrant, innovative sector that is constantly looking to the future to find new ways of working and providing a personalised and consistently high-quality service for patients, and that is fully integrated with other areas of healthcare and able to be consistently relied on in the future, as millions of people relied on it during the pandemic? Members can certainly guess what my preference is.

One thing is for certain: maintaining the status quo is not an option. So what does the future of community pharmacy look like? I would like to see pharmacies evolve into the go-to healthcare settings for help with minor ailments. There is no need for otherwise healthy patients with minor conditions to continue to see their GP. The truth is that they can get the same expert advice from their local pharmacist, who can exercise their clinical judgment and sometimes even prescribe medicines or offer an over-the-counter treatment at half the cost to the NHS. Indeed, the PSNC estimates that if this policy was rolled out nationwide, the NHS could save a staggering £640 million.

What is more, there would perhaps be no need for people to queue in a waiting room or to visit multiple locations. Pharmacies could be a single go-to place for diagnosing, advising on and supplying medicines for the treatment of minor ailments. As we all know from when we go abroad, that system works in Europe and much of the developed world, so why not here? It would be potentially game-changing for the future of pharmacy and more widely for primary care. I hope the Minister will comment on what plans, if any, the Government have to commission a service of that nature.

Aside from minor ailments, pharmacies are well placed to deliver much of the prevention agenda set out in the NHS long-term plan. They could and should be at the forefront of promoting and supporting self-care. Future services could include a national emergency contraception service, or even the treatment of minor injuries. Pharmacies could also offer help and support to manage long-term conditions. For instance, they could offer a whole host of valuable services for supporting patients with asthma, such as an inhaler technique service or annual asthma reviews. Community pharmacies could do even more than they already do to review patients’ medication and ensure that it is being taken appropriately. That is all extremely important, from a patient perspective.

For the population that is otherwise healthy, pharmacies could play an increased role in promoting health and wellbeing, and in preventing and reducing further healthcare demand in the first place. After all, healthy people do not often visit hospitals or GPs, but they probably pass by pharmacies on the high street regularly. I certainly do. Pharmacies could conduct NHS health checks with enhanced patient follow-up, and they could use personalised wellbeing plans to help people to make healthy lifestyle choices. Pharmacies could also replicate their success with the flu and covid vaccination programmes by expanding into the provision of others such as the shingles and pneumococcal vaccine and NHS travel vaccinations.

When it comes to what pharmacies can do to improve patient outcomes, the possibilities are endless. I know at first hand that, given the capacity and a good working environment, pharmacists and their teams are ready and willing to take on and promote all those new services, but that has to be put into the context of wider deliverability. Let me use one example. Amanda Pritchard, the NHS chief executive, recently announced funding for high street pharmacies to identify signs of early cancer, and for subsequent referrals and follow-up by clinical radiologists. That is a good initiative. Nonetheless, as Anne Brontë wrote,

“there is always a ‘but’ in this imperfect world”.

Workforce and equipment issues are obstacles to a successful roll-out, given that the radiology system is already under pressure. What about an audit and a replacement programme for our increasingly outdated and, in some cases, obsolete imaging equipment? There are no plans to tackle the annual 7% increase in complex imaging demand and no plan to meet the workforce demand, with a 30% shortfall in clinical consultant radiologists. That figure is going up, and there are backlog issues.

The only question is whether the Government will now enable the community pharmacy sector to fulfil its potential by supporting the range of possible services, and by providing it with appropriate support and funding. I sincerely hope that the answer will be yes.

--- Later in debate ---

[Sir John Hayes (South Holland and The Deepings) (Con)]

I will be mercifully brief, given the overture you have just offered the whole gathering, Sir Gary.

I want to do three things. The first is to endorse the comments of the hon. Member for Bootle (Peter Dowd) about the significance of community pharmacies. As I said in my brief intervention, that was drawn into sharp focus during the covid pandemic, when people began to realise quite the extent to which pharmacies and pharmacists are among the unsung heroes of the NHS. They provide services that are both proactive, in preventive medicine, and also reactive. They are often the first port of call when people seek medical advice.

The second point I want to make is that we should be saying much more about pharmacies. Indeed, it is important that we do, so that people know they can access those services. The point about celebrating the role of community pharmacists is not just to congratulate them on all they do, although that is worthy in and of itself, but to spread the word and evangelise about what they do to people who are not taking advantage of those services. I think particularly of the preventive services that the hon. Gentleman highlighted, which deal with things such as diabetes and blood pressure. We must ensure that there is early detection and diagnosis of conditions, so that people can be referred to other elements of the NHS and dealt with promptly. These are all aspects of the role of pharmacies, which deserve to be better known for the good that they can do.

My third and final point is informed by my visit to Holbeach community pharmacy, where I met staff in anticipation of the consideration of these matters, which I know the House takes seriously. Last week, I also met a pharmacist to discuss what more can be done. As the Government’s long-term health plan says, NHS England and the Government need to work together to see how the advantages of community pharmacies can be cemented and expanded. In saying that, I offer a word of warning: we should not see pharmacies as an alternative to GP services. We are having a debate in the main Chamber—almost as we speak—on those pressures, and I do not think that any of us would want to say that pharmacies should replace GP services. There is an overlap, but they are distinct aspects of healthcare. I know the Minister will want to reflect on that, and perhaps she could comment on it today. That is my caveat, but it is none the less important that the Government and NHS England look at how the services provided by community pharmacies can be cemented and built on.

The secret of this debate, if I may put it that way, can be expressed in two words: “pharmacies” and “community”. These pharmacies must be sufficiently accessible and plentiful—particularly in areas such as the ones that you and I represent, Sir Gary—so that people can gain all the benefits I have described, as close to home as is reasonable. There has been a trend in public services during my lifetime, including my political lifetime, towards centralisation and obliging people to travel further for the things they need to service their wellbeing. It needs to be reversed by the Government, who need to think much harder and more clearly about this issue. We need public services to be accessible to those who need them. That is particularly salient for the most vulnerable of our constituents, who find travelling more challenging.

Let us have more community pharmacies, more distributed services and more cottage hospitals—more things happening within communities. Community is the second part of what the hon. Gentleman has drawn to our attention today. It is the lifeblood of a healthy society that services the wellbeing of all, thereby adding to the common good.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Bootle (Peter Dowd) for securing this debate. He is pushing at an open door, as I am a huge supporter of community pharmacists.

The evangelising of my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) is definitely working. Community pharmacies are front and centre of the changes we want when developing primary care. Of course, they are already a central part of the NHS, delivering vital primary care services at the heart of every community throughout the country and ensuring that patients have timely access to medicine. That is one of the lesser elements of the services we have talked about, but it is an important element that keeps patients well and out of hospital, enables them to get discharged safely and prevents readmission.

Community pharmacies are offering more services and they are accessible to all. They are key in providing self-care support, thereby allowing individuals to manage their own healthcare needs and, in turn, increasing capacity for the NHS overall. Community pharmacists are an easily accessible and trusted part of the NHS: a team of highly skilled, qualified, experienced healthcare professionals. There are more than 11,000 community pharmacies across England, 80% of which are around a 20-minute walk from most people’s homes. I am committed to making the best possible use of their resources and talent.

As many Members said, we saw the clear difference that community pharmacies made during the covid pandemic. They stepped up to implement a medicines delivery service for shielding and isolating patients. They implemented Pharmacy Collect, making lateral flow tests widely available to the public. At the height of the vaccination programme there were more than 1,500 community pharmacy-led covid vaccination centres. There is no doubt that they stepped up to the mark and showcased what they could offer.

We have a clear vision for community pharmacy. In 2019, we agreed the landmark five-year deal, the community pharmacy contractual framework, which commits to £2.592 billion of funding for the sector. It also sets out a joint vision for the Government, NHS England and the Pharmaceutical Services Negotiating Committee for how pharmacy services will support the delivery of the NHS long-term plan. We are in negotiations for year 4 of that deal, so I am limited in what I can say about the funding, but I can reassure Members that the PSNC is negotiating hard and we want to work with it to expand services. Obviously, it is keen for funding to be attached.

[Sir John Hayes]

It is vital that, as the Minister described, the service is integrated. GPs must continue to offer out-of-hours services, weekend services and, most salient of all, face-to-face encounters with their patients. Services do a great job but that does not mean that GPs should not do all those things.

[Maria Caulfield]

Absolutely—it is not an either/or situation. We have enough capacity and patients to expand community pharmacy services, but that does not mean that we do not also need to support GPs and other primary care providers.

I thank the team at the Department of Health and Social Care; often, their work is not recognised, but they are working hard to develop some of the services that we have talked about. The community pharmacy consultation service went live in November. Patients can dial 111 and be directed to a community pharmacist for help with minor ailments or medication. We have extended that to GP surgeries, so now a receptionist can make an appointment at the local pharmacist for minor illness consultations.

It has been estimated that 20 million appointments in general practice alone do not require a GP—that does not mean we do not need GPs—and pharmacists can look after those conditions. The introduction of the scheme has been slightly slower than we would have liked, so there is work being done to help to overcome some of the barriers to referrals, because once they see their community pharmacists, patients have a positive experience.

In addition, the discharge medicines service enables hospitals to refer discharge patients to community pharmacists for support with their medicine. The evaluation of this service indicates that for every 23 consultations, one readmission is prevented. Where patients are readmitted, their stays are reduced by six days on average, which I think we can all agree is of huge value. We also have the blood pressure check service, which enables people with high blood pressure to be managed by their local community pharmacist, offering blood pressure checks.

We also have the stop smoking service to enable patients who started their stop smoking journey in hospital to continue with a community pharmacist, and we are looking at developing the role of community pharmacy teams, because it is not just the pharmacist who has clinical knowledge and skills. We are working in a number of areas to upskill the whole community pharmacy team so that they can deliver more and use their skills in a better way.

As has been mentioned, we now have NHS Direct cancer referrals, which community pharmacists will be able to take. Just to reassure the hon. Member for Bootle, we have 160 community diagnostic centres, which will be increasing the capacity to do some of those diagnostic tests, and we have already had 1 million visits to those centres. We are not just expecting pharmacists to refer into existing services; we are expanding the routes for diagnosis as well.

My hon. Friend the Member for Southend West (Anna Firth) beautifully told the story of Ask for ANI. It is so vital that a woman can go into a pharmacist, just say those few words and get help—they might not be able to go to a GP practice, because sometimes the help they are asking for might be more obvious.

We also have the minor ailments service, which is being rolled out throughout the country, so pharmacies are delivering more and more. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) knows that I am a pharmacy first supporter. I hate to admit it, but Scotland has taken the lead in that, although we are not afraid to learn lessons if that means learning from what Scotland has done.

On the Fuller stocktake and the future of primary care, just to reassure colleagues, we are not just looking at how general practice looks in the future; community pharmacy will also play a key part in that model. With the integrated care system set to go live on 1 July, we are working with those who will be making commissioning decisions in local communities to set out how that future will look.

We are considering all options for community pharmacy and how we build on the progress we have already made. It is important to say that although we have made progress, there is a lot more that can be done. We are developing new standards for the initial education and training of pharmacists, which are set to be implemented shortly, so that from 2026 all newly qualified pharmacists will be able to be independent prescribers—an essential skill that will help to deliver and develop the service further. For those who are not currently prescribers but would like to be, Health Education England is supporting the existing pharmacy workforce to undertake the required training and upskilling, and £15.9 million of funding support has been made available.

We are also looking at the use of patient group directions, because pharmacists have specifically asked for that, so there are a number of measures in place. We are listening to the community pharmacy community, and where we can make changes quickly and easily, we will.

Just to touch on the issue of violence, I want to be really clear that there is zero tolerance for abuse and violence against community pharmacists—and, indeed, against all primary care staff, whether receptionists, GPs or community pharmacists themselves. I also want to put on the record our thanks to the hon. Member for Coventry North West (Taiwo Owatemi) for her work in the NHS as a pharmacist and the experience she has brought to this debate. I reassure hon. Members that we are on a clear journey and we will be supporting community pharmacy going forward.