Community Pharmacies

Steve Brine Excerpts

Thursday 14th September 2023 Westminster Hall

[Steve Brine (Winchester) (Con)]

It is nice to see you in the Chair, Sir Mark. Well done to my hon. Friend the Member for Waveney (Peter Aldous), my dear friend with whom I entered Parliament in 2010: as always, he has set out the issues beautifully, with the forensic ability for which he is known. The people of Waveney are very lucky to have him, as is this House. It was my hon. Friend who inspired me to speak in this debate: he collared me in the corridor, as he often does. I am only too pleased to do so, both as MP for Winchester and Chandler’s Ford and as Chair of the Health and Social Care Committee.

When I was pharmacy Minister, I spent many happy hours where the Minister is sitting today, answering debates on the subject. We have moved on a lot, and I give credit to the Minister, the Secretary of State and this Prime Minister of all Prime Ministers—if they had not understood community pharmacy, we were never going to get there. All credit to them for the investment and the work that has gone on. As somebody once said, “Much done, more to do.”

My fellow Committee members, one of whom is here today, and I are all too aware of the challenges facing community pharmacies in all our constituencies. Nevertheless, there is great cause to be positive. In my opinion, pharmacies have huge untapped potential to transform the way patients access and receive healthcare services, and to support the building of a preventive healthcare approach, which the Minister knows I am passionate about and which I suggest is central to the future sustainability of the NHS itself.

Earlier this year, the Select Committee launched an inquiry into pharmacy. It will look broadly at pharmacy services including hospital pharmacy, which is often overlooked but is very important, but community pharmacy will form the largest part of it. The terms of reference include specific questions about funding, which my hon. Friend the Member for Waveney and the right hon. Member for Knowsley (Sir George Howarth) both mentioned; the commissioning arrangements for community pharmacy, which I know we will come on to; the locations of community pharmacies; and, of course, achieving the ambitions of Pharmacy First in the primary care recovery plan. I trialled Pharmacy First in the north-east when I was pharmacy Minister; I am a great believer in it, so it is great to see how the Minister has taken it forward.

A key question that our inquiry seeks to answer is, “What does the future of pharmacy look like, and how can the Government ensure that it is realised?” We will be very forward-looking, considering how the challenges of today can be addressed to ensure that the potential is realised. However, we will also look at the services that community pharmacies are already offering or are set to offer through the pharmacy-first approach. Crucially, we will also consider the areas in which there is a chance to go further.

Community pharmacists are highly trained clinical professionals. They are not retailers; they are clinical professionals. They want to do more, they can do more and we should trust them to do more. We will also consider some of the innovations in the sector—for example, how automation and hub-and-spoke arrangements, which we have not talked about much today, will come in and help. We will also look at the workforce challenges, which we have heard about, including issues around the retention of pharmacists in the community pharmacy sector and around training.

The inquiry will be wide ranging. We are looking forward to getting started with oral evidence, hopefully in November. There is no shortage of enthusiastic people in the community pharmacy sector who are willing to share their experiences with us. We are incredibly grateful to all those organisations and individuals who sent in their written evidence, and we hope to continue seeing that positive engagement from the sector when we start the oral evidence sessions.

The Committee has the benefit of drawing upon the work of our expert panel, which is chaired by Professor Dame Jane Dacre, whom the Minister will know. The panel, set up by my predecessor, now the Chancellor of the Exchequer, evaluates the Government’s progress on meeting their commitments on an area that I ask it to look at. It delivers a Care Quality Commission-style rating as to where we are, which can range from “outstanding” to “inadequate”. I asked the panel to look at the pharmacy sector, based on its own members’ expertise and research and submissions by stakeholders, as well as some roundtable events with patients, people in receipt of social care, and pharmacy professionals.

The panel recently published a report on its evaluation of Government commitments in the pharmacy sector. It was assisted by several pharmacy professionals and leaders who steered its decision on which commitments to evaluate. Community pharmacies were an obvious area to focus on. The panel looked at two specific community pharmacy-related commitments, rating the position on both as “requires improvement”. I take a glass half-full perspective. There are good things in the report; I know that the Minister will look carefully at it. The first commitment was to maintain the pharmacy access scheme, which aims to protect access to local, physical NHS pharmaceutical services in areas where there are fewer pharmacies. The chemist may be the only shop in town—that is often the case in coastal communities.

The second commitment was to review the community pharmacy funding model and the balance between the spend on dispensing and new services within the community pharmacy contractual framework, which is negotiated between Community Pharmacy England—formally the Pharmaceutical Services Negotiating Committee—the Government and NHS England. The panel concluded that community pharmacies are struggling to meet increased demand. It is a good thing that demand is increasing, because it means that people are increasingly turning to the chemist, but they are struggling to meet that demand, to deliver services, and even to remain open with the current funding model, which was set in 2019 for five years and has not been reviewed significantly during that time.

As my hon. Friend the Member for Waveney suggested, pharmacies are also struggling as their staff are encouraged to take up roles in primary care, funded by the additional roles reimbursement scheme. The right hon. Member for Knowsley touched on the fact that IT systems can make it difficult for patient information to be shared between community pharmacies, hospitals and general practices. Taken together, those challenges can negatively impact community pharmacies’ ability to deliver services and support other parts of the health and care system.

The National Pharmacy Association does great work in this space and has been in touch with us. It commissioned an EY report, which found that almost three quarters of pharmacies in England face a risk of closure if a serious funding shortfall is not addressed, with 72% of them forecast to be loss-making within the next four years. The Minister will be aware of that report. It is sober reading, but it would be wrong to overlook it. It is a serious piece of work.

Going back to the expert panel, members also raised concerns about the lack of data collected on the performance of schemes designed to improve community pharmacy services, especially whether they were delivering the positive outcomes that we want for patients and people in receipt of social care. There is a lot for the Government to consider in the panel’s report. We still await their response, which, I hasten to add, has not timed out yet. We look forward to that.

I want to touch on a couple of other points. First, I co-chair the all-party parliamentary group on HIV and AIDS. We are calling for the HIV prevention pill, PrEP—pre-exposure prophylaxis—to be available through community pharmacies, with clear financial accountability for its provision. I think that would be a game changer for HIV prevention. It would be a critical part of ending new cases of HIV by 2030, urged by the HIV Commission, which I commissioned as the Minister and, after leaving Government, became a commissioner on, along with the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). The Opposition Front Benchers have signed up to that 2030 ambition, and the Government have committed to it too.

Community pharmacies are well placed to prescribe PrEP. They carry out medicine use reviews for patients, and I think that they would be well placed to counsel on PrEP and to manage the prescriptions alongside other medications, because it is critical that medicines are prescribed in conjunction with each other. Community pharmacies are well connected to other parts of the health service, where integrated care boards have ensured that the IT is right and that the relationships are right. Furthermore, services provided by pharmacies act as a bridge between secondary and primary care, so that would complement sexual health prevention and treatment services and the advice that goes on. Will the Minister, in his summing up, touch on what progress has been made towards the commitment to make PrEP available beyond sexual health services and when it will be available in community pharmacies?

On the supply side, we have talked a lot about the bricks and mortar and the workforce, but the medicines supply chain, also mentioned by both previous speakers, is in need of serious love from Ministers. Pharmacies often have no idea of the prices being charged by wholesalers for some key generics, so they have no idea what is short, while pricing of products is often much higher compared with other European countries; consequently, margins in community pharmacies are often being eroded by uncertainty in the supply chain. I urge the Government to look at a robust system to plan for future pandemics and address shortages of key pharmaceuticals, because that undermines the sector and some of its great work.

There are so many things we could talk about, such as the ill-health prevention inquiry by the Select Committee, where I see pharmacies playing a key role. Much has been achieved. When I walked into the Department, I asked the special advisers what should be on my worry list, and they said: “General practice, Minister.” Some things never change. However, I passionately believe that community pharmacies are part of primary care, or pre-primary care as I used to call it. When I talked to parts of the primary care sector as the Minister, they would say to me: “We want to do more. We can do more. We are trained clinical professionals who can be trusted to do more.” The Government have picked up the mantle of that through the reform of, and new investment in, the contract, with the Prime Minister putting his personal authority behind the sector.

There is therefore much to be proud of, but we have to be careful that we do not end up losing community pharmacies. If we lose them, once they have gone, they will not come back, and we will have a supply-side problem in the bricks and mortar, as well in some of the pharmaceuticals. I thank my hon. Friend the Member for Waveney for securing the debate—it is, as always, an excellent subject for the House to discuss—and thank you, Sir Mark, for calling me to speak.