Community Pharmacies

Stephen Pound Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Stephen Pound (Ealing North) (Lab)]

As ever, it is a pleasure to serve beneath your firm but benevolent eye, Mr Streeter. I congratulate the hon. Member for St Ives (Derek Thomas) on bringing this important, relevant and timely matter before us. It is similar to an Adjournment debate I secured in the previous Parliament, to which the right hon. Member for North Norfolk (Norman Lamb) responded, and to a question I put to the Minister the week before last on this very subject. In both cases, the response I received was one of warm words but few concrete proposals and little reassurance for the community pharmacies.

Like everyone else in this Chamber, I happen to believe that the Minister is a good and decent man, but I fear I can see the handcuffs of the Treasury holding him tight. I feel that he is beneath the terrifying thrall of the Treasury. The proposals are nothing to do with improving patient service. They are nothing other than a pathetic attempt to balance the books on the backs of one of the most productive, hard-working, positive and excellent groups of people in our society: the modern community pharmacist. Every day, they perform a miracle on the high street. They have changed from the old-fashioned world of the dispensing retail chemist to the modern world of preventive medicine. In fact, in many ways pharmacies are multi-speciality community providers. It will not have escaped your notice, Mr Streeter, that we have here Members representing the highlands and islands, the Isles of Scilly, the Isle of Wight, Southend-on-Sea, and Members from Armagh to Ealing. This issue is one that the whole nation is concerned about.

[Mr George Howarth]

I am sure it was an oversight by my hon. Friend that he did not include Knowsley in that long list. I hope that the high street pharmacies are not depending on miracles. I rather hope that they are dependent on science.

--- Later in debate ---

[Stephen Pound]

Not for the first time in my life, I have been corrected by my right hon. Friend. When I referred to a miracle on the high street, I was referring to the contrast between the traditional chemist that we have known in the past and the modern community pharmacist. To go into the modern community pharmacy is to see a treatment room or an interview room, to get a blood pressure test or travel advice or to get advice on smoking cessation, healthy eating or obesity. Those are all things that we would never have thought of before with a pharmacy. To my mind, that is miraculous, mostly because it has been organic and has not come about by Government diktat. As a great believer in state centralism, I find that quite shocking, but that is all the more reason for this area to be nurtured, supported and not threatened.

The point that greatly concerns me is that the proposals go against the grain of all current thinking—not just the Carter review and the “Five Year Forward View”, which is the NHS document that talks about an enhanced role for the community pharmacist—and against every single professional body. That is not just Pharmacy Voice and the royal colleges. Everyone seems to feel that the proposals are a retrogressive step that will not only make the situation worse, but that cannot be justified because the knock-on costs to overcrowded GPs, A&E departments and urgent care centres will ultimately end up costing us so much more.

This issue concerns me greatly. One cannot imagine a more different constituency from that of the hon. Member for St Ives than mine in west London. I represent a tightly knit urban community. People are close together and tightly packed, as opposed to the great rural beauty of the Isles of Scilly. We are, however, what is known as an under-doctored area, which is typical of the big cities. The typical GP in my constituency is a single-handed elderly practitioner, often operating out of a terraced house. That is changing, but as it is changing there is a period in which a great many of my constituents—many of them are transient constituents who are moving in and moving out, and cannot register with a GP nor wait two or three weeks to see a GP, and they queue up at the A&E department or the urgent care centre and cannot be treated—are asking, “Where can we go?” The answer is that they can go to a source of good, sound advice that is both responsive and preventive. They can go to a person who is qualified and skilled. In many cases in my part of the world, we have community pharmacies with two or three pharmacists who are experts in their area. We can even do minor injuries. There is no reason why we should not expand the community pharmacies.

There is much talk of the seven-day NHS, and the model exists before our eyes. The NHS can be a seven-day service in the community pharmacies and, I profoundly hope, everywhere else. The opening hours of the community pharmacies—they are sometimes found in hospitals and supermarkets—are a great model that we should be working to support. I know that the Minister’s heart is in the right place. I know that he wants to stand up and say, “I will resist the Treasury diktat and support the community pharmacists for the sake not just of all our constituents, but of future generations, too.” Community pharmacists deserve that, and they are certainly entitled to it.

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

May I say what a pleasure it is to serve under your chairmanship, Mr Streeter. I have been involved in the whole business of pharmacies since 10 to 15 years ago, when I worked commercially on the campaign for resale price maintenance. Members may remember that the then Government were seeking to get rid of resale price maintenance on many prescription medicines. So I have been following the area closely.

I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing the debate. Members should be aware that I am the Government’s pharmacy champion, as well as the vice-chairman of the all-party pharmacy group. The right hon. Member for Rother Valley (Kevin Barron) is the chairman.

Just before Christmas, the Government announced that they wanted to review community pharmacies, and I very much welcomed that. The Government’s consultation process on community pharmacies needs to ensure that health service money is targeted better on where it can deliver the best results. The consultation process has highlighted that there is an oversupply or clustering of pharmacies in specific locations. The other day, I was driving back to London from my constituency, and I noticed that there were three or four pharmacies within two or three minutes’ walk of each other. To my mind, that has to be looked at.

The issue is how we ensure that the changes to the funding mechanism ensure the desired results, namely, the reduction of clusters while ensuring that we do not damage key parts of the pharmacy network. Using funding to make the changes is potentially a blunt instrument, and it will impact on smaller volume pharmacies in rural areas in particular. They are a part of the network that is desperately needed. What mechanisms are envisaged to achieve those goals? I understand that some large pharmacy groups might be willing to give up the leases on some of their shops, but they want to know whether the Government will give them an assurance that the leases will not be handed over to another chain of pharmacies. Perhaps my right hon. Friend the Minister will explain what approach the Government will take to ensure that that does not happen.

Pharmacies, particularly community pharmacies, are undergoing unprecedented changes. They want to expand and to assist in meeting primary care demand, diverting activity from A&E to support more patients with self-care and in the prevention of ill health. Pharmacy is increasingly seen as a large part of the solution to the shortage of doctors and nurses in primary care. We are watching the spiralling demand for practices and community pharmacies, which are about delivering that patient care.

We need to support the innovation in roles to facilitate change in the infrastructure: information exchange, organisation, and working practices. Current investment in the innovation fund will probably not provide the level of investment needed, and access to transformation funds for this purpose seems unlikely. The change is needed to manage demand more effectively, but, unless supported, we place the system and the patients it serves at high risk. Can we therefore ensure that higher priority is given to ensuring that the changes are effectively supported?

[Stephen Pound]

On the subject of changes, and bearing in mind that the increase in prescribing is about 2.5% per annum, does the hon. Gentleman honestly believe that the Government’s proposal for a hub-and-spoke prescribing model, breaking the link between the patient and the pharmacist, represents value for money, or even sanity?

[Oliver Colvile]

There are two things. First, it is important that the consultation process reaches a conclusion. For us to try to premeditate on that would be unhelpful. Secondly, there are examples of where the Government have been able to make sure that money is better focused and better used. They can make budgets sweat quite well, and we should certainly take that into account.

I very much welcome the review, as I believe that community pharmacies should have a much wider role than simply dispensing prescriptions. They can take the pressure off hectic GP surgeries and our hard-pressed accident and emergency units. Such venues should provide alternative services such as help with mental health conditions, smoking cessation and suchlike. The Government need to ensure that pharmacies are the first point of contact when patients are looking for minor help, such as flu jabs. We also need to make sure that patients in our rural villages have access to pharmacies, although in urban conurbations, such as my Plymouth, Sutton and Devonport inner city constituency, there should not be a plethora of chemists just for the sake of having them. We need to make sure that patients’ safety is paramount when pharmacies are dispensing medicines.

Over the past five years I have consistently campaigned for the Government to decriminalise dispensing errors made by pharmacies. At present, GPs can only be struck off if they make a prescription error, whereas pharmacists can be sent to prison for exactly the same thing. We need a level playing field. Despite being the Government’s pharmacy champion, I am going to be slightly critical of the Government over this issue. We hoped that it would be sorted through secondary legislation before the general election. During a debate on the Access to Medical Treatments (Innovation) Bill, which was promoted by my hon. Friend the Member for Daventry (Chris Heaton-Harris), I questioned the Department of Health’s decision to delay the necessary legislation until after the devolved Assembly elections and the new Executives and Governments had had a chance to introduce their own legislation. This means it is unlikely to be introduced before the summer, so English pharmacists are now dependent on legislation being passed for other pharmacists. So much for fair devolution. When my right hon. Friend the Minister sums up, will he explain why English pharmacies have to wait until the Welsh, Scottish and Northern Irish Assemblies have passed the necessary legislation?

I understand that the Government are keen for pharmacies to be able to share summary care records to ensure that they are fully informed of patients’ medical history when giving medical advice. What progress is my right hon. Friend’s Department making?

Yesterday, I met the General Pharmaceutical Council, the pharmacy regulator since 2010. Various issues were raised by the GPC, especially the Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016, which was in its Grand Committee stage in the House of Lords yesterday. I welcome this section 60 order, as it will bring much-needed transparency to the GPC’s reporting on inspections. There must be transparency. The section 60 would also allow the GPC to take proportionate action when pharmacies fail to meet essential standards. This is just one of the reasons why I support the section 60 order.

Pharmacy has the potential to play a huge part in community healthcare in Britain. However, we need to address the fundamental flaws in the system so that our communities are better served by pharmacy and our healthcare system is used responsibly.