Community Pharmacies

Rebecca Harris Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Graham Jones (Hyndburn) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) on securing the debate. It is somewhat of a rerun of the post offices debate mentioned earlier. Post offices provide a commercial service, but the key point is that they also provide a public service. My view is that the UK’s pharmacy network must be protected. They are vital because they are accessible and have good geographical coverage: 95% of the population can currently get to a pharmacy on foot within 20 minutes. For deprived populations, the elderly and young families whose car may be taken to work, such services that can be reached by walking are essential.

Local pharmacies provide advice and reassurance.

[Rebecca Harris (Castle Point) (Con)]

Will the hon. Gentleman give way?

[Graham Jones]

No, I will not; I am sorry, but there is not enough time.

Pharmacies are also vital because they are beginning to be part of a better national health service, providing a first point of contact; 1.8 million people visit a pharmacy each day. They are an essential part of the pyramid of care that has been mentioned. Accident and emergency departments are stretched, and the solutions that will bring about better healthcare must start further upstream, with pharmacies. A pharmacist wrote to me:

“Pharmacies need to evolve and we have always engaged with the governments in the past to deliver the targets, and greater use of pharmacies must be made to reduce the hospital attendances in the AE”.

There are 36,000 patient visits to my local walk-in centre, which is a fraction of the number of visits to GPs. Yet A&E, the walk-in centre and GPs are all stretched. Local pharmacies are vital for access and as part of a model of healthcare delivery in the UK that relieves some of the current pressures and dispenses advice that puts prevention rather than cure at the heart of healthcare.

My local pharmacy in Baxenden is part of an innovative model of care: the healthy living pharmacy framework is a tiered commissioning framework, aimed at achieving consistent delivery of a broad range of high-quality services through community pharmacies to meet local health needs, improving the health and wellbeing of the local population, and helping to reduce health inequalities. What that means in plain English is that those pharmacies are the first point at which healthcare and health advice is delivered. That includes workforce and workplace development—developing a skilled team who can proactively support and promote behaviour change and improve health and wellbeing. Work done by the healthy living pharmacy initiative has shown that 70% of people who visit pharmacies do not regularly access other healthcare services. Those pharmacies are well placed to support the health and wellbeing of people in the community by, as has been mentioned, providing improved choice, and access to early interventions on such issues as optimal use of medicines, obesity, alcohol and smoking. That should improve outcomes in the short and long term, and have an impact on the cost of care in the future.

The Pharmaceutical Services Negotiating Committee evaluations of HLPs to date found that they

“demonstrate an increase in successful smoking quits, extensive delivery of alcohol brief interventions and advice, emergency contraception, targeted seasonal flu vaccinations, common ailments, NHS Health Checks, healthy diet, physical activity, healthy weight and pharmaceutical care services.”

The report also indicates that the HLP model is working in areas with different demography and geography. I cannot vouch for the PSNC evaluations, but I welcome the actions taken by my local pharmacy to be available to local people and offer better health advice.

Across Lancashire, pharmacists such as Linda Bracewell at Baxenden pharmacy are keen to see HLP rolled out across Lancashire. That requires support from the Government and the NHS. All pharmacies, including HLPs, are a vital part of the healthier Lancashire agenda. Yet today pharmacies are under threat from two directions. Those threats are the reductions in Government support—the 6.1% cut by the Department of Health in community pharmacy funding, which comes to a total reduction in funding of £170 million—and market forces. I want to move on to consider that other threat.

My right hon. Friend the Member for Rother Valley (Kevin Barron) mentioned changes in the market, such as the growth of warehouse pharmacies that seek profit—this is the Amazon model—at the expense of both the public service element and geographical access points. That is a cause for concern. Not everyone is online, or comfortable with such remote arrangements. There is no guarantee that such a method of providing pharmacy services has a role in a healthy living environment, or a better healthcare delivery system. Will it engage with hard-to-reach communities?

Over Christmas I was shown a letter by Linda Bracewell that was sent to a constituent by Pharmacy4U, a mail order pharmacist. Worryingly, it was passed off as an official letter. People would feel obliged to fill it in and send it off. It was personalised, and, crucially, it redirected customers with repeat prescriptions to Pharmacy4U. Worse, Pharmacy4U is just one of several emerging online mail order warehouse companies—box shifters. It was not clear that the letter was not official but a marketing ploy. It is a matter of great concern that the letter was part of a mass mailing, sent specifically to people with existing prescriptions. Their GP practice was named on the letter as though it came from that practice. That is a worry for pharmacies.

How did Pharmacy4U get access to patient practice details? Is it right that the letter I saw was allowed to look like an official document and a request for detail, when in fact it was simply permission to transfer existing prescriptions—a huge business for local pharmacies—to a warehouse pharmacy? Even more worrying was the fact that all the patients of GP practices with electronic data systems had been mailed, while patients of GP practices without such electronic patient systems had not been mailed. Does Pharmacy4U have business connections to the data company that provides GPs with electronic patient data systems, and the patients of those practices? The Minister should be aware that those issues are serious, and that such sharp business practices and models threaten existing pharmacies. The presence of warehouse pharmacies operating on an Amazon model is of concern to me and, I am sure, our constituents, because it erodes the public service element of the current pharmacy network—particularly the healthy living pharmacies.

In conclusion, does the Minister recognise the public service element of pharmacies? Does he want to preserve the current pharmacy network? Does he see pharmacies as having an increasing role in healthcare delivery? Does he think that there will be more or fewer pharmacies after his review is implemented?

[Roger Mullin (Kirkcaldy and Cowdenbeath) (SNP)]

It is a great pleasure to serve under your chairmanship, Mr Streeter. As this is a health debate, I hope you will not consider it inappropriate if I start by saying that my thoughts are very much with Pauline Cafferkey. Earlier today she was hospitalised in Glasgow for the third time after contracting the Ebola virus. She is being flown to London for treatment at the Royal Free hospital. I am sure that the whole House will join me in wishing her the very best.

The debate has been extraordinarily good, so I extend my thanks to the hon. Member for St Ives (Derek Thomas) for this timely initiative on his part. I had a standard speech prepared, but such has been the debate that I would like instead to reflect on the contributions we have heard so far. Some might be wondering why a Scot representing a Scottish constituency is here at all. At least some people present have emailed me to say, “Even though this debate is not about Scotland, we would very much appreciate hearing a Scottish voice.” What I bring to the debate is shared by everybody present: a concern to maintain community pharmacies because they are a vital part of all our communities.

When making his compelling case, the hon. Member for St Ives said that patients see pharmacists as the first port of call. They do indeed. My own wife, Barbara, has a condition known as post-polio syndrome, which means that she has to take a wide variety of medicines that often vary. It is essential for her that she is able to go along and talk to a pharmacist as her condition varies over time. If she always had to burden a GP when she needed such advice, that would put an unnecessary strain on local GP services.

[Rebecca Harris]

A lot of people who go to community pharmacies in my constituency such as Bharat Patel’s and Asif’s go there with problems that they would not wish to burden their GP with, but that are a burden to themselves, so it is a great relief for them to be able to talk things through with someone. Does the hon. Gentleman agree that sometimes people go to a pharmacist because they would be uncomfortable or embarrassed to go to their local, perhaps single-handed, GP? They might want to ask for alcohol advice or about something that they find embarrassing, or perhaps a young girl might want to ask for emergency contraceptive but not wish to see the receptionist, who is her mother’s friend whom she has known all her life.

[Roger Mullin]

I agree entirely with the hon. Lady’s point. Moving on a little, the right hon. Member for Rother Valley (Kevin Barron) described very clearly the long-term funding consequences of the Government’s proposals. As he indicated, they are planning to insert £8 billion more into the NHS while at the same time seeking to cut £170 million from pharmacies. The use of market forces to cull pharmacies does not really make any sense. The hon. Member for Bexhill and Battle (Huw Merriman) made a telling point that relates to the intervention that the hon. Member for Castle Point (Rebecca Harris) just made: he said that pharmacists can act as the eyes and ears of the vulnerable in our communities. That is the other side of the coin to the point she made about people who feel under stress or strain in their immediate circumstances very often seeing the pharmacist as their first port of call.

The hon. Member for Ealing North (Stephen Pound), in his typical style, with quiet presentation, pointed out that the proposals will affect every community, whether up in the highlands and islands or down in Ealing North. Indeed, he said that they will affect every community in terms of both the science and the magic that is involved. Everybody here is, I think, as one in our desire to develop pharmacies, yet, as he pointed out, the Treasury is seeking to put on the shackles for the sake of a £170 million saving. As I have previously spoken in Treasury debates, I made a note to point out that that saving would amount to less than half of what the Government could save if they simply closed the so-called Mayfair loophole. Pharmacists provide a service far beyond that supplied by many financial advisers in our society.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) discussed the need to reduce clusters. When he was talking, I immediately thought of the hon. Member for Ealing North, who would no doubt advise him that perhaps we would do better by going back to some old-fashioned central planning to do things more coherently, rather than using market forces. If we use only market forces, the people who are going to be served least well are those in the large rural communities, whether in Wales or many parts of England. The hon. Member for Ceredigion (Mr Williams) made an excellent case about the importance of such far-flung rural communities and the critical services provided by community pharmacies.

Finally, I was very taken by one of the statistics cited by the hon. Member for Hyndburn (Graham Jones) early in his speech. I have to say I was not aware that 1.8 million people visit pharmacies each day, not merely for the dispensing of drugs but to see someone from whom they can get advice and in whom they can place their trust. Everybody who has contributed to the debate has pointed out that pharmacists supply a service to our communities that goes far beyond that provided by what we used to call in the old days the local chemist. They are highly qualified people who can provide a range of expertise. As the hon. Member for St Ives pointed out, many have masters degrees in specialist areas. In all honesty, in some areas of medicine they can provide advice that goes beyond the expertise of a GP. To lose that in any way, particularly in the most vulnerable communities, would be a sad loss indeed. I am very aware of wanting to leave some time for the hon. Gentleman to say a few words at the end, so I simply congratulate him again on an excellent debate.