Community Pharmacies

Norman Lamb Excerpts

Monday 15th April 2013 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate the hon. Member for Ealing North (Stephen Pound) not only on securing this debate on community pharmacies, but on entertaining us. At the end of a long day, it has been appreciated by the gathering before me, small though it might be. I can assure him that I am not often found talking about domains and the outcomes framework. He and I are at one on that. He talked about the quiet revolution he has witnessed in his constituency and the several fine pharmacies there. They do incredibly valuable work, and I can assure him absolutely that I see a critical role for community pharmacies. He talked about integrated care. They can play a central role in an integrated service for patients, particularly those with the long-term, chronic conditions he referred to, so I am completely at one with him on that.

Today, more NHS community pharmacies than ever offer health care treatment and healthy lifestyle advice and support in England. As I think the hon. Gentleman said, they dispensed 885 million prescription items last year—up 56% from 10 years ago, with nine in every 10 items prescribed. Pharmacies are also involving accessible. Research has shown that 99% of people can get to a pharmacy with relative ease, especially in more deprived communities, perhaps including parts of his constituency. Because of that, many people use their local pharmacy team as the first port of call for all sorts of health problems, both minor and major. Indeed, that might be the first point at which a serious condition is identified. For that reason, pharmacies are incredibly important. For example, many pharmacies now offer services that help patients to get the best from their medicines or provide support for patients with long-term conditions such as asthma who are starting a new medicine.

However, this goes beyond mere statistics. A graph or chart cannot represent the relief of an elderly person who gets help with a niggling cold or cough, the comfort that a pharmacist can provide a young mother worried about her child’s health or the benefits that people with diabetes or heart disease get from good lifestyle advice. This is all because people trust the community pharmacist. That trust is a vital commodity that should be very much valued. As the hon. Gentleman said, community pharmacies help people to live healthier day-to-day lives. I know he saw that for himself when he visited a pharmacy in his constituency recently. Indeed, I visited a pharmacy in my constituency in Sheringham recently. For a photo opportunity, I had a blood pressure test done on my arm. It came out that I had high blood pressure, so I was immediately referred to my GP. It happens that my blood pressure is all right, but that kind of reminder or shock to the system—in this case experienced by me—is of enormous value to many people, and he was right to highlight that.

The pharmacy that the hon. Gentleman visited has, like many others, helped thousands of people to quit smoking. He talked about his own experience. I am not sure whether he got help from a pharmacy, but I remember as his next-door neighbour over in Norman Shaw North that he used to smoke like a chimney and he has now stopped. That is an admirable achievement. Nearly three quarters of all pharmacies in England gave out quit kits last year, many as part of the Stoptober campaign, which was an enormous success.

Our pharmacies show how they can be proactive, not reactive places, genuinely improving people’s health and well-being on a daily basis, so I welcome the endorsement that the hon. Gentleman gave to the pharmacy’s history of good service. Demand for health care will increase. An increasing population, with people living longer and needing more treatment, means that we must harness every available resource to meet those needs. We want to see pharmacy’s contribution flourish in the future, very much as a central part of local health provision.

Only a fortnight ago, far-reaching changes to transform commissioning health care in England came into effect. Clinicians, not managers, are now in the driving seat. The NHS Commissioning Board—now NHS England—has responsibility for commissioning all NHS primary care services, including pharmaceutical services. We expect NHS England to involve clinical commissioning groups where appropriate, because they know the needs of their local populations best. To meet those needs, CCGs are free to commission further services over and above what NHS England commissions. If they want to, and if it is appropriate, CCGs can commission those services from pharmacies. Local authorities now have the powers and funding to commission public health services, such as stopping smoking or sexual health services, and are free to commission from pharmacies. That provides an enormous opportunity to pharmacies. There is an increase in the public health budget this year and next. It is important for pharmacies to get stuck in and make their case to local authorities about the service they can provide—accessible to all, on the high street and trusted, as we have agreed.

These are far-reaching and necessary developments. It is therefore important that new commissioners are fully aware of pharmacy’s potential. That is why the pharmacy and public health forum, chaired by Professor Richard Parish, has been working on how pharmacy can best enhance its role in public health, with more research into pharmacy’s contribution.

Our goal is to allow the new commissioning arrangements to make people healthier. The hon. Gentleman referred to integrated care, which I also mentioned earlier. The Government intend to focus on trying to achieve an integrated care model across the country, moving away from the fragmented nature of health care delivery towards a much more integrated model, and pharmacies can play an absolutely central role in that approach. Pharmacy has an excellent reputation when it comes to integration. I know that pharmacies have a track record of providing quality services that people value, and that patients and consumers hold pharmacy in high regard, so all commissioners should recognise the potential of community pharmacies. It is also clear that the relationship should work the other way, too. Just as commissioners support pharmacies, pharmacies should also be ready to support commissioners by making available their professional experience and specialist clinical expertise. Pharmacies should make the case to commissioners as to why they should consider the role of community pharmacies.

The hon. Gentleman referred to community pharmacy’s concerns about the new commissioning arrangements, and I hope that I can address some of those concerns and reassure him. The first big concern involves the availability of senior pharmacy expertise and pharmacy’s role in commissioning. I want to assure the hon. Gentleman that the chief pharmaceutical officer for England is already part of the senior management team at NHS England. NHS England is looking at how its regional and area teams can make use of appropriate pharmaceutical advice.

The hon. Gentleman also pointed out that some pharmacists are concerned that they are not represented on CCGs. We deliberately did not prescribe set lists of other health professionals who should be on CCGs’ governing bodies. CCGs must be free to decide that for themselves, because it is they, not us, who know exactly what is suitable for their communities. If every single profession were represented on every single board, that would make for bloated and top-heavy organisations, which is exactly the opposite of what we want to achieve. However, CCGs have a duty to get advice from a broad range of health experts. CCGs can involve pharmacy, and I would expect that involvement to be commonplace, given the extent to which pharmacies are involved in people’s care. I am sure that the existing local pharmaceutical committees and the new local pharmacy networks will be more than willing to offer advice and support to commissioners. I hope that they will do so, and that they will make the case to the commissioners that they can improve care.

The second big concern involves the potential for pharmacy-led care to stop. I understand that concern—it is natural at a time of transition and significant change—but I do not share the apprehension. I see a potentially greater role for pharmacies, if they can make their case effectively. NHS England is legally required to commission pharmaceutical services that meet health care needs. It bases that on the assessments of pharmaceutical needs for which the health and wellbeing boards are now responsible. As I said, pharmacy’s reputation is well established. Commissioners are not going to stop effective and proven pharmacy services overnight. I can reassure the hon. Gentleman that, as CCGs have no power under the Health and Social Care Act 2012 to commission pharmaceutical services, they cannot cut or decommission those services either.

Will some things change? Yes, of course they will. We would not have embarked on our reforms of the NHS if there had been no need for change. For example, local authorities have already taken over responsibility for public health services such as smoking cessation services. Pharmacy absolutely has its place in the new NHS. Not only that, but in my view it must surely grow to meet the increasing needs of our communities. The reformed commissioning environment provides new opportunities for pharmacies. If they remain passive and do not seek to make their case, they will suffer, but if they go out and make the case for the central role that they can play, for their accessibility and for the trust that the community has in them, they will be able to thrive and prosper, particularly given the focus on a new integrated care model. They can demonstrate how they can improve health and improve people’s well-being.

The third big concern is that CCGs’ commissioning decisions will be unduly influenced by people with a vested interest in securing contracts and cutting pharmacies out of the equation. The Department’s view is that this is unlikely to happen. The idea that members of CCGs will secure all the profitable and lucrative services for themselves is a pretty negative view, and one that I do not share, but of course we have to be vigilant.

We will not allow a situation to develop where profits come before patient care or patient choice. That would be in direct contradiction of the founding principles of the NHS, and it must not happen. We have put robust governance arrangements in place and guidance was issued last year to all CCGs. Registers of interests must be maintained and available for public scrutiny. Members and employees must declare any conflict or potential conflict in relation to a decision to be made by the group, and there are effective sanctions if those principles are breached. In addition, the General Medical Council published updated guidance for doctors last month. It comes into effect a week from today, on 22 April. It includes a section on doctors’ financial and commercial arrangements and conflicts of interest. The GMC has provided supplementary guidance explaining how doctors can put those principles into practice.

I conclude by thanking the hon. Gentleman once again for the opportunity to discuss the crucial role of community pharmacies in the new health and care system. The new arrangements will allow commissioners and pharmacists to work closer together, not in opposition. There will be new opportunities for better and more flexible pharmaceutical care arrangements that are both relevant and accessible to local people. Underpinning these will be effective governance—