Community Pharmacies

Luciana Berger Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

The hon. Gentleman talks of efficiencies; he will presumably have seen the research that says if people cannot get to a pharmacy one in four will go to a GP. We will see greater demand on GP surgeries and A&E departments. That is not efficient. It is a false economy, which is why the Pharmaceutical Services Negotiating Committee has said the proposals are

“founded on ignorance of the value of pharmacies to local communities, to the NHS, and to social care, and will do great damage to all three. We cannot accept them.”

It is why the chief executive of Pharmacy Voice described the decision as

“incoherent, self-defeating and wholly unacceptable”,

and it is why charities such as Age UK have said the plans are

“out of step with messages encouraging people to make more use of their community pharmacists, to relieve pressure on overstretched A&E departments and GP surgeries.”

Age UK has hit the nail on the head: these cuts to community pharmacies completely contradict everything we have been told by Ministers over recent years and will lead to increased pressures and increased demands on GP surgeries and A&E departments.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

My hon. Friend has made some crucial points about how the funding has been allocated across our country. There are 129 community pharmacies across the whole of Liverpool, yet just two of them will be eligible for this payment. Does my hon. Friend agree that that is absolutely outrageous and will impact on the entire population of Liverpool?

[Jonathan Ashworth]

My hon. Friend is right, and even after this scheme is in place pharmacists who are eligible for the mitigating funds are still saying that they will have to close despite them.

We believe in the importance of community pharmacies, because

“pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy”—[Official Report, 25 February 2014; Vol. 576, c. 162.]—

and:

“Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits.”—[Official Report, 23 October 2014; Vol. 586, c. 1049.]

Those are not my words: they are the words of the Health Secretary, said from that Dispatch Box over the last two years.

If the message the Health Secretary has been giving at that Dispatch Box is that community pharmacies are a way of relieving pressure on A&Es and GP surgeries, why is he now coming to the House to support cutting community pharmacies? It is a complete false economy. I will give way if he wants to explain that. He does not, probably because he knows it is a completely false economy.

--- Later in debate ---

[David Mowat]

When one takes into account the £112 million that we are spending on getting more pharmacists into GP practices, the right hon. Gentleman’s point is incorrect.

[Luciana Berger]

Will the Minister give way?

[David Mowat]

I will give way to the hon. Lady in a moment.

Finally, I want to talk about the work that we are doing to ensure that everyone in the country has access to a community pharmacy. We have developed a scheme with two components. First, all pharmacies that are more than 1 mile from another pharmacy will be eligible for additional funding, which will almost entirely mitigate the impact of the changes. That component is specifically designed to protect areas where current provision is quite spread out. In total, it will apply to around 1,400 locations—roughly half urban and half rural. Pharmacies that are in the highest 25% by prescription volume, and therefore most profitable, will not be eligible for the scheme. Secondly, there is a near-miss scheme under which pharmacies that are located up to 0.8 miles from each other and in the 20% most deprived areas in the country can apply to be reviewed by NHS England as a special case. The final safeguard is that NHS England has a continuing duty to ensure the adequate provision of services. Its role is to commission a new pharmacy in any area where it believes access is inadequate. That duty will continue.

[Luciana Berger]

I thank the Minister for very kindly giving way. Will he correct the record on something? Pharmacies are not all private enterprises. Many co-operatives across our country provide community pharmacies, often in rural and isolated areas. For the purposes of this debate, will he clarify his understanding of the distinction between a community pharmacy and a GP pharmacy? That has not been clear in his remarks so far.

[David Mowat]

The distinction is that a community pharmacy is part of a privately owned business that dispenses and is paid in that way. The ones that we are hiring into GP practices will leverage GP time and do medicine reviews, and I expect them to enable the pharmacy network in an area to work more cohesively. It is a welcome and, frankly, overdue step forward.

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[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I rise to speak in support of the Opposition motion. I put on record my thanks for the extremely hard work that has been done on this campaign by a number of my hon. Friends, particularly my hon. Friend the Member for Barnsley East (Michael Dugher).

Community pharmacies play a really crucial role in my constituency and, indeed, right across the country. We know from the many statistics, and the surveys and inquiries that have been done, that they are trusted. When I speak and listen to my constituents, it is clear that they trust the community pharmacies that they engage with, and also develop very close relationships with the people who work in them. I see that for myself when I go to collect my prescriptions locally. They are enormously busy places. I note that the hon. Member for Hertsmere (Oliver Dowden) said that they just deliver drugs, but they do so much more than that within our communities.

[Oliver Dowden]

That was not my point; I was saying that many large-scale dispensaries, particularly in supermarkets, do little more than deliver drugs, but we need to focus on the community pharmacies that provide the wider services.

[Luciana Berger]

The hon. Gentleman has just spoken in support of the Opposition motion.

When we had an urgent question on this subject, I listened closely to the Minister, who talked particularly about how far he expected people to travel and said that lots of community pharmacies were not very busy. Over recent weeks, I have made a point of looking through the windows of my local community pharmacies to see whether any of them are in fact empty, and it is fair to say that none of them are at any point. The statistics show how busy our local community pharmacies actually are. The figures speak for themselves. The average community pharmacy sees, on average, 137 people every single day. They dispense 87,000 prescription items over the course of a year. They support, on average, 250 people with diabetes, 389 people with asthma, 463 unpaid carers, 805 older people, 1,317 with a mental health condition, and 1,416 people discharged from hospital. The last figure is particularly important. I will not presuppose what the Health Committee report that comes out tomorrow might say about pressures on our winter A&E services, but it is fair to say that many people are expecting, following a summer crisis in the A&Es in our hospitals, that our local hospital services will be under enormous amounts of pressure. Our community pharmacies already do a really important job in supporting our constituents who have been discharged from hospital.

I have had the opportunity to listen to members of my local pharmaceutical committee. When I asked them what the local stats and figures were so that I was equipped for this debate, I was very struck by what they said. Hon. Members have already mentioned to the Minister—it is regrettable that he is no longer in his place—the pharmacy assessment scheme and how it has been put together. It is enormously regrettable, to put it politely, that it does not take account of deprivation. That means that the pharmacies in the most deprived areas of our country, where patients have greater health needs, are not entitled to claim the payment. I made this point earlier, and I make it again: in Liverpool, we have some of the highest levels of deprivation; Kensington ward is in the top 20 in the country. No pharmacies in my constituency are eligible for the pharmacy assessment scheme payment, and just two across the whole of Liverpool are eligible—one in Croxteth and one in Netherley. That means that all the other 129 community pharmacies across Liverpool, and six distance-selling pharmacies, face the full funding cut. That puts at risk the very vital service that they offer to my constituents and people across Liverpool.

The funding cut in this financial year has already had an impact on our local pharmacies. Some have already curtailed their free, but unfunded, delivery service to patients. My hon. Friend the Member for Barnsley East highlighted the hours in which those services are often provided. They are a lifeline for house-bound and vulnerable patients across our country.

Other pharmacies are already in the process of making staff redundant, so they will have to survive on fewer staff. Pharmacists in some of our community pharmacies will, therefore, inevitably be tied more to the dispensing bench rather than undertaking the enhanced clinical role that NHS England, the Department of Health and Ministers expect them to deliver under the five year forward view.

The point about deprivation is so important. As my hon. Friend the Member for Leicester South (Jonathan Ashworth) said in his important opening remarks, it is outrageous that the pharmacy assessment scheme will further widen health inequalities in our country. We will have a specific debate about that issue next Tuesday, so I ask the Minister to reflect on it. In 2016, we have a responsibility to close the gap, not promote schemes that will widen it. I note in particular that the scheme makes no provision for patients and communities with protected characteristics under the Equality Act 2010.

I know that many other hon. Members wish to speak, so I will make a very brief point in the 13 seconds that I have left. Some Members, including the Minister, keep calling community pharmacies “private enterprises,” but there are many co-operatives that provide these services, often in rural and isolated areas across the country.

[Several hon. Members rose—]

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to follow the hon. Member for Burnley (Julie Cooper). I was interested to learn of her personal experience in the sector. She gave a well-informed speech that was in stark contrast to that of her boss, the hon. Member for Leicester South (Jonathan Ashworth). She was generous to contributions from Opposition Members, but it is only fair to say that Members on both sides of the House expressed considerable support for the work done by community pharmacies up and down the country. There is unanimity in the House on the importance of not only pharmacies’ current work, but their increasing role in supporting the NHS and providing services in future.

I am grateful for the contributions made today by 24 hon. Members, in addition to the Front-Bench speakers. I wish to start my remarks by referring to the impact that these proposals will actually have on the typical pharmacy, because I am sorry to say that there has been considerable confusion, mostly among Opposition Members, about what the proposals deliver. The average pharmacy will see a reduction in taxpayer subsidy of £16,000 a year. The largest element of that is a reduction in the establishment payment, which is a fixed payment of between £23,000 and £25,000 that most pharmacies receive just for being there. It will be reduced by 20% from 1 December, which equates to a reduction of just over £400 per month, or £100 a week. From April, it will decrease by a further £400 per month, to £200 a week. Those are not huge reductions for private businesses. This element is a 40% reduction in the only fixed taxpayer subsidy that I am aware of that is paid to private businesses up and down retail high streets in England.

Meanwhile, pharmacies will still receive £1.13 for every prescription item they dispense, with the average pharmacy dispensing 87,000 items a year, as was said by the hon. Member for Liverpool, Wavertree (Luciana Berger), who is, sadly, not in her place.

[Luciana Berger]

I am here.

[Mr Dunne]

Oh, she is—I apologise. We are also introducing a new quality payment scheme worth up to £6,400 a year, so that the amount of NHS funding community pharmacies will be receiving will remain very significant.

In addition to payments from the NHS, pharmacies can earn extra income from a range of sources other than dispensing fees. About half the clinical commissioning groups in England already commission minor ailment services from pharmacies. These services include: flu vaccinations, which are topical today; stop-smoking schemes, which were topical last month, in Stoptober; and emergency hormonal contraception. All of those provide an additional source of income for community pharmacies. I believe the right hon. Member for North Norfolk (Norman Lamb) referred to healthy living pharmacies, and they will now qualify for this new quality payment, whereas they have not in the past—I hope he will welcome that. The Local Government Association’s briefing ahead of this debate echoed that fact, saying that

“there are significant opportunities for councils to commission public health services from community pharmacies as a key element of their health improvement strategies.”

In addition to those two alternative sources from NHS and non-NHS public bodies, in many cases pharmacies get a whole section of private sector income from non-publicly funded elements. That has not been referred to at all, but it is a significant element in the profitability of many pharmacies.

The Government’s vision in these reforms is to bring pharmacy into the heart of the NHS. The Opposition spokesman, the hon. Member for Leicester South, gave what appears, from his early outings at the Dispatch Box, to be becoming a trademark speech in his new role, seeking to scare the public about the proposals without demonstrating a genuine understanding of how community pharmacies are funded or owned, or of what is proposed by the measures. Since 2005-06, there has been an 18% increase in the number of pharmacies, so that today some 1,800 more operate in England than did so 10 years ago. Next year, pharmacies in England will receive £2.6 billion in funding from the NHS. NHS England supports the developments that we are proposing. The suggestion is that we will decimate NHS services because we will push a large number of people out of community pharmacies to their GP, but that is not the belief of NHS England. This is not about pharmacy closures—the point made by almost every Opposition Member who spoke—but about securing better value from the funding that we provide, modernising the way in which we do it so that pharmacies are not the only sector in the country that receives direct taxpayer subsidy for opening premises on the high street, and encouraging them, through increasing payments in the future, to provide more services to help patients in every community.

Community pharmacies are already much more than the place to which we go to get our medicines. They are an essential front-line service, providing care direct to patients and increasingly advising on a wide range of public health issues, for which, as I have indicated, they are paid separately from their dispensing fees. In doing so, they can relieve, and are relieving, pressures on other parts of the NHS.

Our package of reforms are about advancing that agenda, by rewarding quality for the first time, and moving to an enhanced role for the community pharmacy network in providing value-added services, as well as dispensing prescriptions. Yes, it does include making efficiencies in the way that these pharmacies are funded—I am talking about a reduction of £200 a week from next April—but those savings can be made within community pharmacies without compromising the quality of services or the public’s access to them. A key element of our proposals is that we will protect those pharmacies on which communities depend the most through the pharmacy access scheme, which has been supported by many hon. Members. A review of eligibility will assess the impact on those pharmacies in 20% of the most deprived areas, close to the one-mile test. That review opened yesterday and lasts for six weeks.

The hon. Member for Sedgefield (Phil Wilson) referred to the pharmacy access scheme. He admitted that, by his calculation, 40% of the pharmacies in his constituency will benefit from the scheme. I can update him on that. Nine out of the 20 pharmacies—or 45%—in his constituency will benefit. Indeed, his constituency will be one of the biggest beneficiaries of this scheme.

In summary, the reforms are what the NHS needs and what patients and taxpayers expect. I am confident that we will see a community pharmacy sector that is more efficient and better integrated with the rest of the healthcare system and delivering better services for patients as a result. I urge colleagues to support the amendment to this motion.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.