Community Pharmacies

Taiwo Owatemi Excerpts

Thursday 14th September 2023 Westminster Hall

[Taiwo Owatemi (Coventry North West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark. I thank the hon. Member for Waveney (Peter Aldous) for securing this important debate and highlighting the challenges faced by the pharmacy sector. He spoke with great knowledge about many of the challenges around funding, and the opportunities for the pharmacy sector to address some of the primary care challenges faced by the NHS. I highlight the points made by the Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), who has been very supportive of the pharmacy sector and has played a key role in pushing for the Committee to publish a report on the role of the sector and the challenges it faces.

I declare an interest as a registered pharmacist, the chair of the all-party parliamentary pharmacy group, and a member of the Health and Social Care Committee. I apologise to Members present, as I might end up repeating some of the points that have already been made, but I will try my best not to focus on them.

The first challenge I will highlight is the massive issue of the medicine supply chain. Every time I speak to pharmacy owners and pharmacists they raise the impact that uncertainty has on their profit margins. I recently started engaging with the pharmaceutical sector to understand the issues. There are issues around medicine distribution in this country, and there are middlemen supply chain distributors who keep hold of medicines and who are sometimes involved in driving up the prices, but we also have challenges around the manufacturing of generics, which account for about 80% of medicines used by the NHS.

About 2.2 million generic drugs are prescribed every single day in this country and used by the NHS. Despite that, it seems there were some oversights in this area when we negotiated our exit from the EU. Currently, legislation allows EU generics to be recognised in the UK but does not allow the EU to recognise UK generics. That means that British manufacturers are unable to submit their marketing authorisation applications easily within the EU. Therefore, they have no incentive to produce these medicines, or increase their manufacturing of these medicines, in the UK. It also means that they are unable to compete with their European competitors.

A great example of what is happening is that the EU has started investing about £20 billion in the manufacturing of generics since we left. So far, the UK, according to figures that I have seen recently, has invested nothing. Essentially, our UK manufacturers are being left at a competitive disadvantage. Aside from that, the Medicines and Healthcare products Regulatory Agency is facing significant challenges. It has lost a large amount of its workforce and is currently unable to process the regulatory applications coming through its doors—again, making it difficult for generic drugs to enter the UK. Essentially, there are regulatory difficulties and there seem to be limited financial incentives.

Secondly, I want to address the challenges of finance, which have been a massive issue facing the pharmacy sector. The sector has not been adequately funded in line with inflation for a very long time. That has led to many high street pharmacies closing down. In my constituency, Boots in Jardine Crescent had to close down because it was not financially viable for the business to continue. That has had a significant impact in an area of great deprivation and high health inequality.

Despite the challenges that community pharmacies face, there are also wonderful opportunities, which I have to admit the Government have started to recognise. I welcome their more than £600 million investment in the Pharmacy First programme, but there is a long way to go to fully take advantage of the potential that community pharmacies can offer.

Community pharmacies play an important role because they are the first point of call for patients, but they can play a bigger role in healthcare. Not only can they deliver the Pharmacy First scheme—I hope that will be rolled out and that the Government will add more clinical conditions to the list—but they can play an important role in other primary care services, such as vaccination, sexual health and the management of conditions such as cardiovascular disease.

I have always found it weird how a patient will come up to me in the pharmacy and say, “I have high blood pressure. I’m a bit concerned.” I say, “Sit down. Let’s check your blood pressure” and then I have to message the doctor to let them know. Then I will tell the patient to go to their GP to get a medication. In reality, that could have started and ended in a community pharmacy. That is something that hospital pharmacists easily do, and we regularly do it, so I encourage the Minister to look into the wider roles that community pharmacists can play in supporting GPs and primary care and in reducing some of the challenges it currently faces.

Many Members have spoken about the workforce crisis. To be able to fully take advantage of the potential of community pharmacy, we have to acknowledge the fact that, like many other healthcare professions in this country, pharmacies face a significant workforce crisis. We do not have enough pharmacists, and we are struggling to recruit and train more and to retain the community pharmacists we have.

Again, I welcome the Government’s workforce plan, but unfortunately it lacks the finer details of how community pharmacy will be supported in the long term. An integrated and funded workforce plan for pharmacy is needed if we are to enable pharmacies to support the community as well as the rest of the NHS. A larger number of designated prescribing practitioners is needed if community pharmacies are to assist with the provision of primary care. A clear pathway to ensure that that happens is important.

I know that the Government aim to ensure that we get as many prescribers as possible by 2026, and that is something I welcome. I am really happy that pharmacists are able to graduate with the ability to prescribe. However, there are many pharmacists in the workforce for whom there is no clear plan as to how they can become prescribers by 2026. I have spoken to many different pharmacy schools and they do not know how that is going to happen.

As the hon. Member for Waveney has explained, the process for getting sign-off is not easy. People have to ensure that they have found the right healthcare professional to shadow, as well as take time off work to do all the documentation and paperwork that is needed. Changes therefore need to happen, and further funding needs to be made available to incentivise healthcare professionals to take on more pharmacists and to mentor them and train them to become prescribers.

I also want to address areas that have not been mentioned in the debate so far. The first is technology, which has played a significant and positive role in the provision of the healthcare system. Since covid, technology has played an important role in allowing patients to have easy access to healthcare and allowing them to feel empowered. That is the reason we have seen an increase in the number of online pharmacies that are available, which has been quite positive.

However, I have some concerns. Figures recently published by the General Pharmaceutical Council, which is responsible for inspecting community pharmacies and online pharmacies, show that at least one in five of the online retailers it inspected in the past year did not meet at least one standard. If that was a community pharmacy, the store would be put on a clear supervision pathway to ensure that patients’ health was not put at risk. I would like to see the same happen to online pharmacies to ensure that they are better regulated as they continue to provide better access to medicines for patients.

I welcome the fact that the Government are looking at the supervision rules, which are outdated and were created at a time when we were making medicines in pharmacies and playing around with different active pharmaceutical ingredients. Pharmacy has changed since then, and the information available and the regulation around drug manufacturing has significantly improved. I welcome the consultation that is being carried out, and I encourage as many pharmacists as possible to give their feedback and engage with the consultation.

Lastly, I want to turn to the regulation of non-clinical managers. Community pharmacies either have a pharmacist as a manager or have non-clinical managers leading them. In the light of the Lucy Letby case, which highlighted the important role that non-clinical managers play, it is important that community pharmacists are also considered. Any new regulatory framework for unregulated management and leaders in healthcare should apply to not only those working in the NHS but those who have direct involvement in the provision of healthcare in our communities, such as community pharmacy.

Before I end, I would like to ask the Minister a few questions, which I hope he can answer today or respond to in a letter. Has any consideration been given to the generic industry, which, as I said earlier, accounts for a large amount of medicine supplies within the NHS? Can he direct me to the Minister who is responsible for drug manufacturing in this country, the changes in EU legislation and how we can bring about positive changes for our generic manufacturing industry? Do the Government have any plans to prevent future medicine shortages? I am already hearing pharmacies expressing concerns about the fact that winter is coming and they are expecting to have further shortages.

Are there any updates on the mutual recognition of medicines within the EU, and are any negotiations happening? Can the Minister provide an update on the prescribing scheme for healthcare professionals and whether any steps have been taken to address the issues I have raised? On funding, it would be helpful for many pharmacists to know whether there are any plans to help address some of the financial challenges they face. Lastly, as the chair of the all-party parliamentary pharmacy group, I wonder whether the Minister could spare some time to come and speak to key stakeholders in the sector, who would love to meet him and share some of their experiences.

[Sir Mark Hendrick (in the Chair)]

I thank Members for keeping to time. I call the shadow Minister.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Sir Mark, and I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. I start by echoing his thanks to our hard-working pharmacists, who do such a brilliant job. He raised six main points in his speech, and I can confirm that we are working on all of them.

Community pharmacies play a crucial role in our health system and a greater role in looking after people’s health than ever before. Pharmacies are easily accessible, and about nine in 10 people who visit one are positive about the advice they receive. The Government are investing in pharmacy to do much more. The delivery plan for recovering access to primary care announced an investment of up to £645 million in a new Pharmacy First service—a whole new NHS service will be created—as well as an expansion of the existing blood pressure check and contraception services. Pharmacy First will enable patients to see a community pharmacist for seven common conditions and be supplied with prescription-only medicines without the need for a GP. We are consulting Community Pharmacy England on the proposals in that delivery plan, with the aim of starting Pharmacy First this winter.

Pharmacy First builds on the community pharmacy contractual framework 2019 to 2024 five-year deal. That deal commits £2.592 billion a year to the sector and sets out how community pharmacy will be more integrated into the NHS, delivering more clinical services and effectively becoming the first port of call for minor illness. Under that deal, we have introduced minor illness referrals from GPs to community pharmacies, which have been a great success. A&E and NHS 111 can also now refer patients for an urgent medicine supply without a prescription from their GP. More than 2.8 million consultations have been provided at community pharmacies for a minor illness or urgent medicine supply since the start of those services.

We also introduced blood pressure checks, and community pharmacies have delivered 1.4 million checks since October 2021 and more than 150,000 in May 2023 alone. Huge numbers of potentially life-saving checks are being done. NHS England estimates that in 2023, more than 1,300 heart attacks and strokes will be prevented thanks to those checks, so I repeat my thanks to this fantastic sector.

In April this year, we introduced an oral contraception service, making it easier for women to access contraception.

In addition, community pharmacies now support and advise more than a quarter of a million people a month when they start new medicines, through the new medicine service, and 10,000 patients every month who have had their medicines changed following a visit to hospital, through the discharge medicines service. That supports medicines adherence, prevents GP visits and hospitalisations, and gives people a much better sense that they are taking the right medicines.

Community pharmacies are also playing a growing role in our vaccination programmes. Last winter, they administered 29% of adult flu vaccinations and more than a third—36%—of covid-19 vaccinations.

We have talked about the funding issue. In addition to the £2.592 billion a year, we added an extra £50 million last and this financial year, and we have made the additional sum of money that I mentioned available for Pharmacy First and the expansion of existing services. On top of that, we pay separately for flu and covid vaccinations, which, as I suggested, provide an increasingly important income stream for pharmacies.

The current five-year deal is of course coming to an end, and we will need to consider what comes next for pharmacy. As part of that, NHS England has committed to commissioning an economic study to better understand the cost of delivering pharmaceutical services. That study will feed into any future funding decisions on community pharmacy.

Several hon. Members raised the issue of the number of pharmacies, and we monitor that very closely. Our data shows that despite a number of pharmacies closing since 2017, there are about 10,800 pharmacies today, which is still more than in 2010. Despite the things that have happened to other high street businesses, we still see that there are more pharmacies and there are an awful lot more pharmacists—I will come on to that when we talk about the workforce.

However, rather than focusing merely on numbers, we should look at access. We know that 80% of the population live within 20 minutes’ walk of a pharmacy, and that there are twice as many pharmacies in more deprived areas. The right hon. Member for Knowsley (Sir George Howarth) is right that they play a crucial role in providing access in deprived areas. We ensure that that continues to be the case. Proportionally, the closures that we have seen reflect the spread of pharmacies across England.

We are seeing changes in the market, with some of the large pharmacy businesses divesting. That has an impact on the make-up of the sector: we are seeing the number of small independent pharmacies increase, while the number of pharmacies that are part of bigger businesses decrease. We are monitoring the market very closely as it evolves.

As my hon. Friend the Member for Waveney mentions, through the pharmacy access scheme, we are financially supporting pharmacies in areas where there are fewer pharmacies and where there might be a challenge in getting access. To address the disproportionately high rate of closures of pharmacies that must be open for a minimum of 100 hours—the so-called 100-hour pharmacies—legislation was amended in April to allow those pharmacies to reduce their hours to a minimum of 72, which is still a huge number of hours to be open. That will support those pharmacies to remain open, providing extended hours, particularly for weekend access.

The same legislation gave integrated care boards the possibility of introducing local hours plans. That enables the local co-ordination that will ensure that there is something available locally at all times when people need it. It allows temporary closures in an area if there are significant difficulties with access and ensures that a pharmacy is always open somewhere in an area.

Some pharmacies struggle to find staff, and in some instances they have had to close temporarily, because a pharmacy cannot open without a pharmacist. There is more demand than ever for pharmacy professionals—an issue raised by various hon. Members, including the hon. Member for Bradford South (Judith Cummins) and my right hon. Friend the Member for Tatton (Esther McVey). Since 2010, the number of registered pharmacists in England has increased by 82%, from 28,984 to 52,780. That means nearly 24,000 more pharmacists registered in England this year than in 2010. It is a huge increase, even compared with the huge increases elsewhere in the NHS.

On top of that, we have published the “NHS Long Term Workforce Plan”, backed by more than £2.4 billion to fund further additional increases and more training places over the next five years. The plan sets out the steps that the NHS and education providers will take to deliver an NHS workforce who meet the changing and growing needs of the population over the next 15 years. Our ambition is to increase training places for pharmacists by nearly 50%—building even further on what we have already done—to around 5,000 by 2031-32, and to grow the number of pharmacy technicians.

Employers clearly have a key role in retaining staff and making jobs in community pharmacy attractive. To support employers, we are investing in training to help private contractors to deliver high-quality NHS services. NHS England has provided a number of fully funded training opportunities for pharmacists and pharmacy technicians—the hon. Member for Coventry North West (Taiwo Owatemi) raised an interesting and important point on this matter. That is why we are providing 3,000 independent prescribing training places—applications for this year are now available to pharmacists—and, on top of that, another 1,000 fully funded training places for designated prescribing practitioners, or DPPs. As well as growing the number of people entering the workforce, we are making provisions to upskill those who are already in the workforce. We are as just excited as other hon. Members present about the huge potential of independent prescribing in pharmacy to build even more on what we are doing to grow the range of services in community pharmacies.

I have talked about what we are doing on funding and the workforce, but I also want to talk about structural reform and efficiencies, and enabling pharmacists to do more with the skills they have—an important point raised by a number of hon. Members. The plan for primary care sets out some of the things we are doing, including modernising legislation to make it clear that pharmacists no longer have to directly supervise all the activities of pharmacy technicians, who are, in fact, registered health professionals in their own right.

Hon. Members are right to point out that the nature of work in pharmacy has changed, and we must change the legislation to match that. We also plan to enable any member of the pharmacy team to hand out appropriately checked and bagged medicines in the absence of a pharmacist, remedying frustrating instances where patients are delayed, having to wait perhaps because the pharmacist has popped out for lunch. We are also consulting on changes to the legislation to enable pharmacy technicians to use patient group directions, which would enable pharmacy technicians to do more.

Last week, the House debated legislation to give pharmacists the flexibility to dispense medicines in their original packs, so that pharmacists use their high-end clinical skills rather than spending time snipping out blister packs, which is not a good use of their time. We are progressing legislation to enable hub-and-spoke dispensing—the Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine), rightly mentioned that—following public consultation on the changes.

Finally, we are also working with medicine suppliers to identify medicines that could be reclassified from being available only on prescription, known as “POM”, to being available in a pharmacy, known as “P”.

This is a huge package of structural reforms and a huge liberalisation of the structure of pharmacy, enabling pharmacists with ever-growing clinical skills to do more and not be caught up in bureaucracy.

The Government are thinking beyond that about what pharmacy can do in the longer term. Hon. Members are right that Pharmacy First, the fantastic new NHS service, could be added to over time. NHS England is also starting independent prescribing pilots, with a view to implementing pharmacy prescribing services in the future, based on what we learn from them. That has huge potential to take further pressure off GPs and make the best possible use of all the new skills in the pharmacy workforce.

The Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester, raised an important point about access to PrEP, as an example of an advanced service that pharmacies could provide. As he will know, partly because of his work in initiating this, the PrEP access and equity task and finish group was established in 2022 as a sub-group of the HIV action plan implementation steering group, to improve access to PrEP. That steering group is working to develop a PrEP road map based on the task and finish group’s recommendations. I can say today that the road map will be out before the end of the year, and it will deal with how we will work through all the knotty issues in enabling community pharmacy to provide PrEP.

I thank my hon. Friend the Member for Waveney for raising these hugely important issues, which are crucial to community pharmacy. The sector is doing more than ever before, seeing more people, providing a wider range of services and becoming more clinically advanced than ever. There are pressures in the sector, but we are injecting further funding. We have grown the workforce hugely. We will continue to build on what community pharmacists do to further improve community pharmacy across the country.

[Taiwo Owatemi]

Will the Minister give way?

[Neil O’Brien]

I will pause at the point of my peroration, because there is a question.

[Taiwo Owatemi]

There is a question: will the Minister return to my earlier question about whether he can come to the APPG to meet key pharmacy stakeholders?

[Neil O’Brien]

That is a brilliantly timed question, to which the answer is yes.