Community Pharmacies

Debate between Neil Coyle and Philippa Whitford

Wednesday 2nd November 2016 Commons Chamber

[Dr Whitford]

I need to make a bit of progress.

We need to design the services with the people who work in them. Some 18% of Scotland’s population—nearly 1 million people—are registered with and do access the minor ailment service, which takes pressure off accident and emergency, because there is availability out of hours, and GPs. The fourth service that we have is the public health service, with 70% of all smoking cessation work in primary care being carried out in our community pharmacies. These four services together—minor ailments, chronic medication, acute medication and public health—represent a huge breadth of service for a community. It is important that pharmacies in England that are currently just retail and dispensing pharmacies are encouraged to go in that direction, because it brings benefit for the NHS.

My biggest concern is the random nature of how this process might develop. If the Government simply cut and let the dice fall where they will, the problem is that they will not end up with an integrated service. Scotland still has health boards, so if a community pharmacy is to open there, an application needs to be made to the health board. When the project started, the boards decided which places got to become community pharmacies, and they decide whether there is a need to open a new community pharmacy. The biggest mistake in this scheme is its randomness.

One issue raised by the hon. Member for South West Wiltshire (Dr Murrison) was the profits made when drugs are sold on. The Government could look at the vertically integrated wholesalers—the big chains. In the mid-2000s, they were not considered. The Government do not know how much profit they make or where that profit is made, and the system is totally unregulated. These chains control about 40% of the pharmacy market. One of the biggest chains, Walgreens Boots Alliance, has declared profits of almost £1 billion, yet it has somehow been able to reduce its tax bill by more than £1 billion in this country. We are talking about people who are make almost half their profit from taxpayers yet do not pay their full share of tax. I absolutely agree that under this proposal the big chains will survive and the small, independent, very community-based pharmacies will be lost.

[Neil Coyle]

The Minister accused those who highlight concerns of “scaremongering”. Atul, who runs St George’s pharmacy at the Elephant and Castle in my constituency, says:

“We may survive the first set of”—

in-year—

“cuts by compromising on our services. But the second set of cuts next April will most definitely place us at a real risk of closure.”

Does the hon. Lady agree with Atul that it is right for us to highlight our concerns, especially in constituencies such as mine, where we face losing 18 community pharmacies?

[Dr Whitford]

Losing that many pharmacies in any area would be a disaster. This is a bit like groundhog day, because this is our third discussion on this topic in as many weeks. The Minister said that there absolutely would be protection, but the pharmacy access scheme still largely comes down to the amount of dispensing that is done and the distances. It does not take account of which pharmacies are providing a good service, which ones are set up to provide a good service and how to encourage others to develop. This is what is completely wrong in the Government’s approach. They are just slicing money off and leaving individual businesses to decide whether they think they will be profitable. The danger would be that we get a whole lot of pharmacies deciding to sell out and walk, instead of someone saying for a particular area, “Eighteen is too many”—especially if they are all around one town square—“so which ones are best able to develop a service? Let them bid for it and let them be inspected, and let’s see how they take it forward.”

The Government could make a lot of savings by addressing the wholesalers. In Scotland, we have margin sharing, which means that a price control group looks at the profit that is made at various stages, and some of it has to be shared back. We do have people who are trading on the open market and moving drugs around, especially in the big chains. As we heard earlier, we would get a better result by sitting down with the profession and designing a service. STPs could provide the model within which to look at how many community pharmacies there should be and where they should be, and then it would be a case of working backwards.

The danger of the Government’s approach is that it is the wrong way round. Just calling something an “efficiency cut” does not make it efficient, and the danger is that we just slash something and it falls over. The pharmacy access scheme is not enough of a protection or of an intervention. There needs to be planning. I commend the idea of a proper services-based pharmacy system, but the aspiration should be not just that a few pharmacies choose to do it and others do not. It should be that a patient who walks into a community pharmacy will know what services they can get, and we should aim to have that right across the country.