Community Pharmacies: Devon and the South-west

Rachel Gilmour Excerpts

Tuesday 17th December 2024 Westminster Hall

[Rachel Gilmour (Tiverton and Minehead) (LD)]

I beg to move,

That this House has considered Government support for community pharmacies in Devon and the South West.

I am delighted to have secured my first Westminster Hall debate. It is an honour to speak under your chairmanship, Mr Betts. At a time such as this, when we repeatedly hear from the Government and our communities that the national health service is under strain, is heading into yet another winter crisis and is struggling with capacity, community pharmacies need the greatest consideration for further Government support. I will start by focusing on the role of pharmacies in our society, and then I will outline the challenges and end on what we might be able to do with the right support and engagement.

I wish to thank all pharmacists and their staff in Tiverton and Minehead for the invaluable work they do day in, day out. In particular, I commend Neil and Anna, who have run Bampton pharmacy in my home village for decades, and have, along with the owners of Wiveliscombe pharmacy and Alcombe pharmacy, provided me with first-hand, real-life insights into the challenges they face.

The 15 pharmacies in my constituency of Tiverton and Minehead provide a vital service to their communities —something they share with every pharmacy across Devon, Somerset, the south-west and, indeed, the whole of the United Kingdom. As I am sure we will hear from other hon. Members, pharmacies are under threat from the economic environment in which they now operate. Core pharmacy funding has decreased in real terms by more than 30% since 2016, and costs have gone in exactly the opposite direction. The number of pharmacies open in England is lower than it has been in any year since 2008-09, even though their workload is 40% higher, in terms of annual prescriptions.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I thank my hon. Friend for securing this really important debate. As she was laying out, community pharmacies face large funding gaps, but the rate of pharmacy closure is Glastonbury and Somerton is nearly double the national average. Does she agree that the Government should commit to publishing the independent economic analysis commissioned by NHS England in early 2025, when the work is concluded? Does she also agree that we must reform community pharmacy funding and put in place a sustainable, long-term funding model?

[Rachel Gilmour]

I agree with both courses of action, and I thank my hon. Friend very much for that important and interesting contribution.

The increase in workload is not sustainable, but that workload is too important not to receive proper backing from central Government as they make headway on their ambition to create what they have referred to, on occasion, as a neighbourhood health service.

Being a Devonian, I would like to go through things logically. First, I will talk about prescriptions. In Tiverton and Minehead, each pharmacy dispenses an average of 7,540 prescriptions every month. Across all 15 pharmacies, that is an average of 113,175 prescriptions each month across the constituency. That is 20,000 more prescriptions each month than the House of Commons Library says there are people in the entire constituency. Prescriptions that provide life-altering medications for constituents are the front door to the work of pharmacies. They are what most people think pharmacies do most often, but our pharmacies do a lot more work in our villages, towns and cities.

[Ann Davies (Caerfyrddin) (PC)]

It matters not whether the community pharmacy is in Devon or my constituency of Caerfyrddin; drug tariffs, which put such a strain on our pharmacists, need to be reviewed, and an uplift is long overdue. Would the hon. Member agree that we need to highlight that financial shortfall to the Government, and that something needs to be done immediately?

[Rachel Gilmour]

I agree that we need to do that as often as possible. I will move on to the workload. This is not a typical example: along with prescriptions, in Tiverton and Minehead each pharmacy conducted 398 flu vaccines on average during the 2023-24 season, higher than the national average of 355.

If Members are unfortunate enough to need their blood pressure checked, they can go to a pharmacy. Across the UK, 930,000 hypertension blood pressure checks are undertaken in just one year. With public health as a driving mission for the Government, I would hope that this was something they could support wherever it takes place. Pharmacies also offer a range of other clinical and public health services, including providing flu and covid-19 vaccinations, and if further services were to be commissioned from community pharmacies in the context of sustainable core funding, the sector could do even more to improve access to primary care.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this debate forward. She has touched on the issue of funding. In Northern Ireland, we have already made that commitment as it is a devolved matter; an additional £15 million has been set aside for community and GP pharmacies, with extra money beyond April 2027. We all want to achieve what the hon. Lady wants, but does she agree that to achieve that the Government and the Minister have to invest accordingly?

[Rachel Gilmour]

I do agree. In addition to delivering formally commissioned services, pharmacies provide an alternative point of contact for the public for informal clinical advice. The 2024 pharmacy advice audit found that the average pharmacy carries out around 22 informal consultations per day, which is the equivalent of 1.3 million informal consultations taking place in community pharmacies every week.

[Steve Race (Exeter) (Lab)]

I congratulate the hon. Member on securing the debate. From the first day we met we have talked about getting this debate, so I am very pleased that it is happening. I am the chair of the all-party parliamentary group on pharmacy. Does she agree that community pharmacies have a huge amount of potential to support patients with a range of services, which will support the NHS ten-year plan to move more care into the community and help prevent ill health in the first place? That is one of the main roles they can play in the future.

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[Rachel Gilmour]

As the hon. Member knows, I am keen on strategies, particularly the one that he has just mentioned.

Pharmacies are not paid for the informal advice sessions. In over half of such occasions, if the patient had not been able to access their local community pharmacy they would have instead visited their GP surgery. That suggests that we have freed up 37.7 million GP appointments over the course of a year simply by patients having access to their local community pharmacy, which speaks to the point that the hon. Member just made.

Such a workload is commendable, but it is not sustainable in the current funding model. That has meant that over the autumn the National Pharmacy Association found that pharmacies are overwhelmingly willing to reduce services in order to protect patient safety and preserve access to pharmacies, if funding is not provided to protect the network. Pharmacies do not want to do that; they know the impact that reducing their services can have on a community, but if the other option involves continuing in an overstretched, under-supported environment, for pharmacists and anyone committed to delivering health and health-related services to vulnerable people, it is not a real choice.

[Sir Ashley Fox (Bridgwater) (Con)]

I thank the hon. Lady, my neighbour, for securing the debate. Does she agree that the many benefits that community pharmacies provide are in danger, because in many cases the pharmacist is not reimbursed even for the cost of prescription drugs? Will she, with me, ask the Minister to reply specifically on that point?

[Rachel Gilmour]

I will of course do that.

[Adam Dance (Yeovil) (LD)]

I congratulate you on securing this vital debate. In my constituency of Yeovil, pharmacies provide vital services, including more than 6,700 prescriptions per month—not quite as many as in your constituency, Rachel.

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[Adam Dance]

Will my hon. Friend join me in urging the Minister to provide a clear timeline for the consultation to start?

[Rachel Gilmour]

I thank my hon. Friend for his not particularly concise, but erudite, intervention.

I will turn briefly to the funding model of pharmacies. Some 90% of a pharmacy’s income is derived directly from NHS funding, but when it comes to how that funding is allocated, the system is broken. Community pharmacies across the UK dispense more than 1.1 billion items a year and deal with shortage issues on a daily basis. The Department of Health and Social Care sets reimbursement prices in our system, but due to the reimbursement prices being so low and pharmacies being unable to compete on the international stage, the global market is now a safer bet for pharmaceutical companies than the UK. That means that people in the UK sometimes are not able to get the right medication due to shortages and that even when the DHSC puts together a price concession and allows for a greater reimbursement rate to allow UK pharmacies to compete for those life-aiding medications, there are extraordinary pressures on the NHS and the taxpayer. The realities of the funding model mean that community pharmacies are trying to push up water uphill using tools riddled with holes—in other words, sieves.

[Claire Young (Thornbury and Yate) (LD)]

Does my hon. Friend agree that in addition to the issues with the cost of drugs, the funding model for providing all the other services that pharmacies are expected to provide, including the Pharmacy First approach to avoiding GP appointments, needs addressing?

[Rachel Gilmour]

I will come on to Pharmacy First at the end of the debate, because I see it as the solution, rather than the problem.

The sector is trying its hardest, but without a fundamental overhaul of the system these NHS services, which are much-needed by patients and the public, may fall by the wayside into one of the following pits. There are the hours lost. When the money is not there, pharmacies cannot operate. As we see in many areas across the south-west and the UK, including in Tiverton and Minehead, hundreds of hours have been lost to temporary closures of pharmacies. According to the Company Chemists’ Association, pharmacies across the south-west have cut opening hours to the tune of 130,400 hours over just more than a year and a half by reducing their opening hours. According to Community Pharmacy England, from October 2021 to May 2024, in my constituency alone, more than 520 hours of pharmacy time were lost due to temporary pharmacy closures.

Although pharmacies operate all the services that I mentioned in the first part of my speech—and more, but I do not have time to go through them all—the closures take a toll on the GPs and A&E staff who might be someone’s next port of call if they cannot see their pharmacist. They take a toll on the NHS 111 line if the individual calls in, and they take a toll on the people who might not have any other free time in that day to take care of their health needs. Those lost hours add up. When pharmacies cannot provide those appointments or other services, it leads to bottlenecks elsewhere in the system.

Over the first three months of Pharmacy First, to which I will come shortly, pharmacies took 234 appointments out of the GP system simply by offering consultations for the seven applicable conditions. Pharmacies have fantastic potential to relieve pressure and provide new ways for people to access medical services, receive advice and so much more. Pharmacies cannot fulfil their potential if they are closed. The prospect of local pharmacies closing really does scare people. In a recent poll, 83% of respondents reported that they would be concerned about their local pharmacy closing. Data shows that closures are disproportionately taking place in the most deprived areas, with 50% of the pharmacy closures recorded in areas in the lowest three deciles of deprivation.

[Andrew George (St Ives) (LD)]

Further to the point made by the hon. Member for Exeter (Steve Race), is that not the nub of the argument? If the Government are to make the three shifts—including, importantly, the shift from hospital to community—they must not only stem the loss of pharmacies, but build them up.

[Rachel Gilmour]

I see it as a pyramid, with pharmacies at the bottom, right up to operations and A&E at the top.

According to the CCA, between September 2022 and June 2024 nearly 200,000 hours of pharmacy time was lost due to pharmacies closing their doors permanently. Over 1,000 pharmacies have closed since 2016, with a net loss of 136 pharmacies in the south-west over the last decade—including in Tiverton and Minehead, where we did not have many pharmacies to begin with. The number of pharmacies operating in England is now the lowest since 2008-09. There are reports across the sector of sustained difficulties in even staffing the pharmacies that remain open. The sector cannot sustain these exits, nor can communities where pharmacies are so vital. Pharmacies across the south-west and Devon need proper investment to safeguard and fix our broken pharmacy system, and to ensure that our health system is up to scratch and our social care system is supported.

[Several hon. Members rose—]

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[Rachel Gilmour]

The Health and Social Care Committee reported in May that

“the undoubted potential for pharmacy to improve access to health care, crucially including immunisations, and reduce pressure on general practice and other areas of the health system can only be realised with the right support and the right investment of public funding.”

Why, then, are we not hearing anything from the Government about support for pharmacies? In under a decade, the proportion of NHS funding for pharmacies has fallen from 2.4% to 1.6%. An average pharmacy relies on NHS funding for 90% of its income.

It does not have to be like this. The sector is ready, it just needs backing. We know that pharmacies across the country and the region, and especially in Tiverton and Honiton—whoops: Tiverton and Minehead—are willing to provide these services. Pharmacy First—