Community Pharmacies

Oliver Dowden Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Oliver Dowden (Hertsmere) (Con)]

As we have already heard in the debate, many of us have seen the considerable value that local community pharmacies provide in our constituencies. I have seen that myself with the Manor pharmacy in Elstree, which is run by Graham Philips, to whom my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) paid tribute. I would urge the Minister to meet him; he really is a pool of expertise on this issue. The same is true of those at the Crown pharmacy at Borehamwood and Shenley.

What we see time and time again in these places is that the commitment to the customers goes way beyond what we would see from a normal retailer. There is a genuine understanding of the needs, health and wellbeing of the people who use such pharmacies. The services range from dementia-friendly services, picking up the early stages of the disease; healthy living advice, including assistance with drugs and weight management; and smoking cessation services.

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

Would my hon. Friend add to his list Nick Kaye in my constituency? He is carrying out some excellent work to collaborate with local GPs and to find innovative ways to deal with patients. Does my hon. Friend agree that pharmacies are particularly important in tourist areas, as the frontline that can deal with tourists who have health problems, and take pressure off the other health services?

[Oliver Dowden]

My hon. Friend is absolutely right that pharmacies play a crucial role in relieving the frontline of NHS services. However, that does not mean that reforms are not necessary. Of course we need to incentivise the kind of advantageous behaviour we have talked about; but we also need to recognise some of the problems with the provision of pharmaceutical services.

We know the basic problem; it has been referred to by other Members. The pharmacy budget has increased by 40% over the last decade. Even taking into account all the changes that the Government are proposing, funding for community pharmacies will still be 30% higher than when this Government first came to office in 2010. Equally, we have the problem of excessive clustering—a situation where there are many pharmacies within a short distance of one another.

Those who argue that there is no need for reform really need to explain where the money will come from. If we are not recycling these services to the frontline, we need to look for other savings, or we need to look at lower levels of service in the frontline of the NHS, whether that is services for diabetes or for cancer. There is no magic money tree. We have to take these difficult decisions in order to provide for the frontline, so I completely agree with the overall thrust of Government policy.

We can take an intelligent approach towards this issue. As we have heard, there is a big difference between various types of pharmacies. At one end of the scale, there are the very large pharmacies that are often in large retail outlets such as supermarkets and sit at the very back of the store. They are there, in essence, to encourage customers to go through the rest of the store to purchase other goods. They could easily take a larger cut than is being proposed, because they are just operating as loss leaders for those stores to get customers in the door in the first place.

[Maria Caulfield]

My hon. Friend is making an excellent point. I was slightly disappointed that the shadow Minister did not really understand the principle of vertically integrated pharmacies. Some big national companies are making a lot of money out of pharmacy at the moment.

--- Later in debate ---

[Oliver Dowden]

I thank my hon. Friend for that intervention. Equally, many such pharmacies do not provide any of the wider community health benefits. In essence, they are just dispensing services.

[Dr Philippa Whitford]

Is it not estimated, however, that those will be the ones that survive, purely because they are big, while the small, high-service pharmacies in communities are more vulnerable?

[Oliver Dowden]

That is precisely the point that I am coming to. As we proceed with these reforms, hon. Members need to recognise that we will need further savings in this area. I am not attacking large retailers because of their size; it is because of the lack of such wider provisions. We need to look at ways of securing further savings from them which we can plough back into the community pharmacies that are providing the services on which all our constituents rely. I completely accept that pharmacies that are purely dispensing services are very inefficient as such. They are highly labour-intensive; it is just a very expensive way of delivering drugs. We need to identify ways in which we can bifurcate the two different types of providers.

I pay tribute to what the Minister has announced so far. He clearly demonstrates an understanding of the situation, as we have seen in relation to the protection of key local pharmacies through the community access scheme. For example, in my constituency, the services in places such as Elstree and Shenley, where we have small, rural communities, often with an elderly population, will be protected. Equally, the quality payment scheme recognises some of these wider community benefits.

However, I urge the Minister to do more in that area. Let me make two brief suggestions. First, we need more detailed recording of the sorts of services that are provided by pharmacies which take pressure off the NHS. As I understand it, there is no systematic way in which these additional benefits are recorded, and we are all working on the basis of estimates. We could have a system whereby the community pharmacies systematically recorded the benefit that they provided, and then they could be better rewarded for those benefits. At the same time, there would be a means by which we could penalise, or find further cuts from, the pharmacies that did not provide those additional services.

Secondly, the hon. Member for Central Ayrshire (Dr Whitford) rightly commented on the common ailments scheme that operates in Scotland. The Minister indicated that the Government are moving down that route. I urge the Government to go further on this. There is absolutely no reason why patients suffering from things such as common cold and flu symptoms or head lice could not be referred directly from their GPs to pharmacies, thereby saving money for GPs and providing additional income for those pharmacies.

I support the overall direction of reform, but as the Government proceed with these reforms, they could do with engaging more in looking at ways of supporting what is best in community pharmacies while providing further savings from the services that do not provide them.

[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.