Pharmacies and Integrated Healthcare: England

Oliver Colvile Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Main]

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Will my hon. Friend recognise that some innovative things are taking place in the west country, especially in my constituency?

[Mrs Main]

I am happy to acknowledge that some fabulous things are happening in the west country. That list was given to me. I make no excuse for the fact that I thought it seemed fairly long already, but I am certain that there are a lot more services that hon. Members do not realise are out there—perhaps even in pharmacies in their own constituency or the one next-door that they go shopping in or visit with their families. The fact that we do not know about them shows that there is no integration in the system. We should be aware of it if these services are being rolled out. Perhaps there should be a directory that we could consult to find out what is going on in certain areas.

That list shows hon. Members the exciting possibilities that could be open to pharmacies, including those in the west country that were just referred to, if we just gave them the chance to embrace them. Rachel, the director of the Quadrant pharmacy, ended her observations with a positive endorsement of the “Community Pharmacy Forward View”. She told me that it has

“been developed and signed up to by all national community pharmacy organisations about the types of services that either need to be commissioned at a national level or pressure put on Sustainable Transformation Plans (STP) leaders locally to commission a service package to patients”.

My hon. Friend the Member for York Outer (Julian Sturdy) said that there is reluctance in some areas to embrace this. We need a strong steer from the Government that this is where we are going and that they had better wise up, get around the table and come up with a suitable model.

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[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

May I say what a pleasure and a delight it is to serve under your chairmanship, Mr Bailey? I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing the debate. I should warn the House that I am the Government’s pharmacy champion. I have been following this issue quite closely for about the last 20 years —not that I have been in the House of Commons for the last 20 years, but I have followed it consistently since being involved in the community pharmacy group action campaign, which was to do with resale price maintenance on non-prescription medicines in the 1990s, when I was doing a commercial job. I became a vice-chairman of the all-party pharmacy group when I was elected to the House, so this is an issue I feel quite strongly about and have been very involved in.

To put things in context, Plymouth, Sutton and Devonport is, uniquely for a Conservative constituency, an inner-city seat. Indeed, I am one of very few Members of Parliament outside London to represent a totally inner-city seat. The only countryside I have in my constituency is the Ponderosa pony sanctuary, which is a rather muddy field. How we can integrate pharmacies is a really important issue. There is an 11-year life expectancy difference between the north-east of my patch—I could probably walk from one end to the other in a couple of hours or so—down to the south-west in Devonport, which is a very deprived community that has real issues with homelessness, drug taking and smoking. People certainly need to be referred to pharmacies for smoking cessation too.

There are several areas of the debate that I am particularly interested in exploring, and I hope the Minister will respond on them. The first is summary care records. A lot of pharmacies want to be able to access the care records for their patients. They also want to be able to populate those records, so that they can review the medicines given to patients. We need to make sure that happens throughout the whole of England. I was very concerned by something I discovered over the Christmas recess. I did not take masses of time off over Christmas, but I did speak to a number of GPs; needless to say, I also did a surgery, with one of my local GPs in the Devonport ward. He told me that GPs—and, I suspect, pharmacies too—cannot access the medical records at Derriford hospital, because it uses a completely different system from the GPs and the pharmacies. The Minister needs to look at that.

The second issue we should look at is using pharmacies much more for minor ailments—a point that my hon. Friend the Member for St Albans made very clearly—so that people are signposted to the pharmacy rather than necessarily going to the GP. I was watching breakfast television this morning while I was getting ready to come and speak in this debate—I think it was Sky television, so I should declare an interest, because my brother is the cricket correspondent for Sky television and I do not want to be accused of doing anything wrong. I was interested to hear the person reviewing the newspapers say that she was doing a programme tomorrow evening on Radio 4 at 9 o’clock—I am giving her a plug—on how, rather than having lots of patients come to see them, some GPs in Plymouth have ended up talking to patients on the phone. Patients do not necessarily always need physically to go to a GP to seek help, which is a useful way of taking some of the pressure off GPs.

I should also make a point about the decriminalisation of prescription errors. At the moment, GPs can get a slap on the wrist or be struck off, whereas pharmacists who fail to give prescriptions properly can face criminal charges. I had thought that the Government were very keen to address that. I was led to understand by the Minister that the matter might have been sorted out before Christmas, but that there were problems to do with the devolved Administrations needing to deal with it first. However, it seems very odd: here we are, at the beginning of the year, and we still have not dealt with it. I must warn my hon. Friend that I have tabled a parliamentary question about it.

My final point is that a great deal of pressure has been placed on the Government and the national health service, especially during the winter. There has been a great deal of discussion about how pharmacies need funding and so on, but in my opinion this is not just about money; it is about ensuring that we use the systems properly, so that we can deliver a better quality of care. We could get pharmacists to go into residential care homes for the elderly, too. It is not just about money; it is about the structure, too. We need to take that into account, because we need to ensure that budgets sweat.

[Steve Double (St Austell and Newquay) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing this debate on what I believe is a very important issue.

There is no doubt that our health service is currently under great pressure, as we have heard already. People are living longer and we are able to treat far more conditions than we could in the past, which adds to the demand on our health services. Although more money is always welcome, I am sure that many of us would agree that simply throwing more money at the health service is not the solution. We need to find better, smarter, more efficient and more effective ways of working to provide the healthcare that our growing population so desperately needs.

I have no doubt that pharmacies, particularly community pharmacies, can play an important role in finding better and smarter ways of providing healthcare to the people of this country. Community pharmacies continue to be an undervalued and underutilised section of our health service. As a country, we really need to embrace the role that community pharmacies can play in delivering health services. They have much more to offer than they are currently seen be to offering.

The Government have started to recognise that, with the current pilot scheme, started in 2015, to increase the presence of clinical pharmacists in general practice. That is clearly a step in the right direction, but I propose that we should also look the other way. We should not only look at integrating pharmacies into GPs’ surgeries; we should be looking to integrate GP services into our community pharmacies. It is quite clear that many of the routine services that people typically go to their local GP for could be provided by their local pharmacists in a much more cost-effective way.

[Oliver Colvile]

rose—

[Jake Berry (Rossendale and Darwen) (Con)]

rose—

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[Oliver Colvile]

I thank my hon. Friend for giving way. He makes a very powerful point. I have thought for some while that we should be trying to put GP surgeries into pharmacies, so that when someone goes to their GP and says, “I have got this ailment and I need some help,” he can say, “Don’t come and talk to me; go and talk to the pharmacist, because he or she can manage the thing properly.” To my mind, that seems a very clever way in which we could take some of the pressure off the finances of GPs, as they would not necessarily have their own lease, but could get the likes of Boots or others to provide facilities.

[Steve Double]

I thank my hon. Friend for that intervention and I agree with him. Clearly, part of the answer is getting GPs and pharmacies working much more closely together, and co-locating can often be one way to help with that.

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[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing this debate on a very important subject. It is pleasing to hear so much agreement around the room; I hope that the Minister is listening. I agree with most of what hon. Members have said.

This subject is very dear to my heart. My husband is a community pharmacist, and I worked with him for 24 years in our own community pharmacy in my constituency of Burnley; I have to add that we no longer have any financial interest in community pharmacy, but what I retain is a very deep understanding of the value of community pharmacy to patients, the community and the wider NHS, so I appreciate the hon. Member for St Albans securing this important debate.

I cannot think of a better way to demonstrate the value of community pharmacies than to talk about my experience. Coopers chemist in Burnley—a deprived constituency in many ways, where life expectancy is closer to 80 than 90—serves a community along with four other pharmacies in very close proximity, all of which are really busy and serve a big demand. On a typical day, we dealt with 600 prescriptions and 100 minor ailments, and ran many other services—forgive me if I forget some, because there were so many—including medication use reviews designed to maximise our use of medication, make sure patients understood it, encourage compliance and save money on wastage; smoking cessation programmes; dietary advice; emergency hormonal contraception; methadone programmes; and support for diabetics and asthmatics. It was an ever-increasing list. Those are the kinds of services that are at risk if the Government pursue their plans.

I appreciate the value of community pharmacies. I am also a former private business owner. Let us not forget that that is what community pharmacies are; they are not provided for and paid for by the NHS.

[Oliver Colvile]

That is a very good example of how the private sector, working in the national health service, can deliver good-quality services.

[Julie Cooper]

I do not disagree with the hon. Gentleman’s point.

It is important that we recognise that community pharmacies provide their own premises and train their own staff. As a former business person, I totally get the point about value for money, but this is not just about money; it is about the efficient use of money. We all understand the pressures that our NHS face, and we have to look at that. There are a lot of myths floating around, so it is important that we clarify that.

There has been a lot of talk about the clusters. Again, because pharmacies are private businesses, they respond to demand in the community.

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[David Mowat]

What we are not reducing is the amount of money available for services, as opposed to dispensing. Some pharmacies use part of their dispensing money to provide services on a discretionary and ad hoc basis, but I make this point again: overpaying for dispensing is not a good vehicle for getting more and better services.

I want to talk about some of what is already happening. We have heard about flu jabs this morning—I, too, had a flu jab at a pharmacy—and at the end of last year, we had had more flu jabs in pharmacies by October than we had in all of the previous year. The money available for that and similar service-based allocations has not been affected by the changes we announced. The community pharmacy sector has received £10 million for flu jabs up to the end of October. We want to see more of that happening, and that direction of travel is important.

A number of hon. Members made the point, which I agree with, that the public need to understand that pharmacies represent an important first port of call—it should not always be GPs. The Government can do more to make that clear. When I was preparing for this debate last night, I saw a television advert from NHS England for its “Stay well this winter” campaign. The campaign is running TV and newspaper adverts, and its theme is for people to visit their pharmacy as soon as they feel unwell. The people running the campaign have told us they think the advertising campaign has generated about 1.2 million additional pharmacy visits that would not have happened otherwise. That was a good challenge and we need to do more of that.

We also need to go further with services. There are two approaches. I recommend that anyone interested in this subject—as everyone present clearly is—reads the Murray review, which was produced by the King’s Fund. NHS England commissioned the review to inform it and us on how to spend the integration fund, the budget available to drive services more deeply into the system. I will talk about some aspects of that and about some announcements that I made in October as part of the package we are discussing.

One of the announcements was about urgent or repeat prescriptions. At the moment, NHS 111 gets about 200,000 phone calls a year asking for a further prescription, and those callers are told to see an out-of-hours GP to issue a prescription, which in due course goes to the pharmacy. We are changing that so that people will be directed to a pharmacy immediately. That is a stream of revenue for the pharmacy, which will provide both a consultation, for which it will be paid, and then the drug or prescription, as necessary.

My hon. Friend the Member for St Albans asked whether that scheme would somehow affect a good local scheme in her area. There is no reason why that should be the case. The new scheme is supplementary to anything that might have been commissioned already. It sounds as if her scheme was commissioned by the CCG, and that is good, although it takes us to the fact that things are patchy—different CCGs do different things in different areas, which I will come to. However, that is an example of where we need to be.

Another example is the minor ailments scheme. As I have said, 30% to 40% of GP appointments could be dealt with in pharmacies. Parts of England already have minor ailments schemes, but the service is very patchy and it need not be. It is true that different CCGs and indeed different GPs have different attitudes to such schemes, but NHS England has made a commitment that by March 2018 it will have encouraged all CCGs to be commissioning minor ailment schemes in pharmacies across their patch.

[Oliver Colvile]

Is the Minister aware that in Devon about £5 million a year is apparently being wasted on unused medicines? Something needs to happen with that to ensure that the NHS has enough money with which to do things.

[David Mowat]

Yes. Throughout the country, the number is far more than £5 million—