Pharmacy First

Lord Allan of Hallam Excerpts

Tuesday 6th February 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I recognise that pharmacies already do far more than just dispense prescriptions and sell items. They are highly trained experts, easily accessible and approachable, with a reach across the entire country. As we saw during the pandemic, they are a highly trusted part of our communities and they are to be commended. But their skills and knowledge are often underutilised, even though pharmacists can take the pressure off GPs and encourage people to seek advice and services that they otherwise might not have sought. That is why we recently announced that we would want to bring NHS out-patient appointments closer to people, and through high street opticians as well.

This announcement will not make up for the 1,000 pharmacies that have closed or the 2,000 GPs that have been cut since 2015. Patients today can be waiting over a month to see a GP, if they can get an appointment at all. When I think back to 2010, I recall that people could get an appointment within 48 hours. Can the Minister update your Lordships’ House on what has happened to the Government’s pledge to deliver 6,000 more GPs this year? What is being done to support community pharmacies, which are already facing a perfect storm with inflationary pressures on running costs, recruitment challenges and an unstable medicines market?

As the Association of Independent Multiple Pharmacies chief exec said, we should not forget that pharmacies are seriously underfunded and that the

“stranglehold of chronic underfunding must be relieved … to ensure our community pharmacies continue to exist and can deliver”

what the Government are expecting. How will the Government ensure that GPs and pharmacies work closely together, given some of the fractured relationships that currently exist over their roles? On delivery, how long will it take to get up to the promised capacity? When will the promised IT systems go fully live across all pharmacies taking part, and how will the public be made aware of the services that they will now be able to get from their local pharmacy?

The Minister will know of concerns regarding the impact on the pharmacy workforce. The concern is that they will just be overwhelmed, which begs the question: why was Pharmacy First not phased in? What is being done to ease the inevitable extra pressure on pharmacies, including in the use of their premises? How will the Government ensure the privacy that we all need? It is not acceptable to be discussing personal matters for all to hear, nor to receive a vaccination that may require the removal or adjustment of clothing for all to see.

Turning to some of the specific services, I note that pharmacists will be able to treat urinary infections, which women suffer frequently, requiring urgent treatment as soon as the signs start to occur. But why is that only up to the age of 64? It is very welcome to get blood pressure checks routinely done at pharmacies, particularly for older people with long-term conditions. At present, many are asked to buy their own assessment machine and report in the results to the surgery, which they cannot do, and not having a blood pressure reading can lead to delays in getting medication. So how will the Government ensure that key data is safely, accurately and speedily exchanged between pharmacies and GPs?

Finally, what is the Government’s plan in the longer term to integrate the increase in independent prescribers, who are being trained as part of the long-term workforce plan? Does the Minister agree that we should accelerate the rollout of independent prescribing to establish a community pharmacist prescribing service, covering a wide range of common conditions? That would support patients with chronic conditions, which is one of the biggest challenges facing the NHS. Does he agree that community pharmacies will have an important role to play in supporting GPs in the management of long-term conditions, such as hypertension and asthma, and in tackling the serious issue of overprescribing, which is responsible for thousands of avoidable hospital admissions every year?

Bringing healthcare into the community means that patients will have greater control and be seen faster, while GPs will be freed up to see more complex cases. From these Benches, we have long argued for a greater role for pharmacists and pharmacies. The NHS should work as a neighbourhood health service as much as a National Health Service, and that is a development to which these Benches are wholly committed.

[Lord Allan of Hallam (LD)]

My Lords, the holy grail for health policy is a change which improves the service for patients at the same time as reducing the cost of delivering that service. I think we can all see the potential for Pharmacy First to be such a move, if executed well. I have a few questions for the Minister and his answers will help us to understand whether he is on the right path in this grail quest.

First, I understand that there will be a payment per consultation, if the consultation meets criteria that the Government have set, but that there will be a cap on the total budget. Can the Minister explain how this cap will work? Is it per pharmacy or per integrated care board, and what happens if it is exceeded? I do not think that we want people going back to more costly channels simply because of an accounting feature. Secondly, can he explain how the Government will assess value for money in comparing the cost of the Pharmacy First consultations with the estimated savings on the GP and A&E side?

Thirdly, while we are discussing urgent care today, can the Minister also say whether the Government are looking at using pharmacies for approving repeat prescriptions—this was raised by the noble Baroness, Lady Merron—for drugs such as statins that people may be on for many years? The current protocol requires them to go back to their GP for regular reviews. Are there any plans afoot to move some of that medicine review process for long-term conditions also into the Pharmacy First programme?

Can the Minister also explain how instructions will be given to NHS 111 services so that they can properly direct people, in light of Pharmacy First now being an available option? It could make a real difference to the pressure on A&E services if 111 moved appropriate cases over to pharmacies. There are concerns that 111 has a natural tendency to be risk averse and refer people to A&E. If we are going to ask it to refer people now to pharmacies, we need to understand how that shift in direction will take place.

Finally, I have a digital question. It is not the one about the joined-up records that we discussed earlier at Oral Questions, as I am confident that the Minister will tell us that the Government are on track for that. What I want to raise is, even when the pharmacy has issued a prescription and dispensed it, at present what happens is that it will then print it off and post it to the NHS Business Services Authority for payment. This happens with all the prescriptions in the pharmacy system at present. My understanding is that the business services authority will then scan them into its system to make the payments—which seems quite farcical in 2024. So I would be interested to hear from the Minister what plans the Government have to get rid of that piece of the equation or to make it more efficient, so that, when a prescribing process happens electronically, it happens all the way through, to the point at which the pharmacy is reimbursed for the work that it has done.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I thank both noble Lords for their general welcome of what we are trying to do here. My thoughts on this are that anything that we can do to expand supply should be a good thing in this context.

I will pick up on specific questions. As mentioned, we have not managed to achieve 6,000 additional GPs. To specifically answer the question, we have achieved about 2,799. However, through the use of additional staff, we have managed to achieve 50 million additional appointments in GP settings since 2019, so we actually hit our target on that earlier. I think that demonstrates—this goes back to the Question we had earlier today—that we are trying to use people to the top of their professional skills and supplement that with other skilled people coming in. In terms of output, 50 million appointments are a good example.

We are hoping that this will be a boost to community pharmacies. They are, as I mentioned earlier today, seen as a very important asset. They are often the first line in terms of health in the local community. This is intended to not only enhance the health service in an area but give community pharmacies a necessary boost. I think these figures have been reported, but for the sake of completeness I will say that we have had about 10,000 pharmacies sign up—about 95% of them—so clearly it has been welcomed. In the first three days we have had about 3,000 consultations. In answer to the question about pharmacies being overwhelmed, the early indications are that it has been managed well. You could say that the more business they get is a good thing in terms of their viability. Right now, we feel that it is so far, so good.

On privacy—I will try to group the app and IT questions together a bit later—part of the conditions for being available for Pharmacy First is that a pharmacy has a private treatment area available, so that there will not be privacy issues.

My understanding—I will definitely need to write on this—in terms of UTIs is that it applies only up to the age of 64, as they are less complex in those cases. For instance, as you get older UTIs can be a sign of other comorbidities. I think that is the thinking behind the age of 64, but I will follow that up in writing.

The general point was made by both the noble Baroness, Lady Merron, and the noble Lord, Lord Allan, about trying to expand provision. I would say that this is the first step. We have tried to pick the areas that we think suit the situation well. This gives us the ability to expand as the capability increases. Repeat prescriptions is obviously a very good example, as is managing cases such as hypertension and other similar areas. The direction of travel is very much: let us make sure that this works well and then build on that.

I will answer the questions on IT asked by the noble Lord, Lord Allan, together. The overall thinking on the cap is that we are trying to make sure that this does not run out of control—for want of a better word—in some respects, and that goes back to the value for money question. If you can really prove that it is enhancing and substituting for GP appointments, which we all want to boost the availability of, that has to be a good thing. As ever, you need to try to set up budgets at the beginning to make sure that they are sensible in terms of that control.

To give a sense of direction, it is very much the intention that 111—I include the app and other digital approaches in this—will point a person to the right pathway for them. If we then know that they have one of these seven conditions, such as a simple UTI, sinusitis, or something of that ilk, they will be guided towards Pharmacy First. That is very much the intention. I hope that that in some way answers the question. It is intended that more and more volume is put that way.

In terms of trying to make sure that there is a slicker system with the IT generally, obviously it has to be sensible—for example, not printing things off, and that there is an electronic payment mechanism. My understanding is that that is already occurring in some of the digital areas. Noble Lords will be aware of some of the digital pharmacies, which are paperless the whole way. Those sorts of mechanisms are being set up and it is a matter of expanding them, so that there is a complete digital service. I will come back with more detail on that, but I understand that it is happening.

On the IT systems and the holy grail of making sure that they are all connecting—to give everyone the benefit of our conversation in the Corridor—the idea is that it has to be two-way. You want to make sure that pharmacies have access to doctors’ records. That is not ready today, but it will be in the next few months. Likewise, you want to make sure that whatever the pharmacies do gets updated to GP records. Right now, that will be done by a simple PDF. This is not ideal because it involves a rekeying, but in a matter of weeks, it will update the GP records automatically. The value of that is that, obviously, while Pharmacy First is the forerunner, there are all sorts of circumstances it could be replicated for, whether appointments with physios or any other physician relevant to the patient records. I think that will be a positive when it comes in.

I have tried to answer most of the questions about execution. I think we will all freely admit that, as ever with these things, there is a certain amount of bedding in—it is something that I am glad to see everyone welcomes in principle. I hope that in a few months’ time I will be able to update the House on it; I will be happy to do so. If it is executed well, and we believe that this is working well, we will be looking to extend it to further services.