[Mr Gary Streeter in the Chair]
I beg to move,
That this House has considered community pharmacies.
It is a pleasure to serve under your chairmanship, Mr Streeter. In a letter to community pharmacies on 17 December, the Department of Health discussed the potential for far greater use of community pharmacies and pharmacists. The letter refers to the role of community pharmacists in preventive health, support for healthy living, support for self-care for minor ailments and long-term conditions and medication reviews in care homes, and as part of a more integrated local care model. That is exactly the right direction. As an MP representing a Cornish seat where every effort is being made to integrate health and social care, I see community pharmacists as essential players in a new national health service equipped to meet the demands placed on it by modern society.
Westminster Hall debates are rarely secured in order to praise the Government and celebrate all that is good. I would love to be able to do so, but—wait for it—in the same letter to which I just referred, the Department set out its plans to reduce its funding commitment to community pharmacists by £170 million. Therein lies the problem. We have a front-line NHS service that is valued and depended on and able to embrace new clinical responsibilities and meet the demands of an ageing population, but it is unsure about its future.
Does the hon. Gentleman share my concern? As Members of Parliament, we all, I suspect, refer constituents to pharmacy services, because we know the impact that that has on reducing the pressure on the NHS. If we cannot refer them to smoking cessation services, cholesterol testing and blood pressure testing, the NHS and hospitals will have to pick up the burden.
The hon. Gentleman ought to see that that is true across the whole country. In urban areas, people are finding it more and more difficult to get appointments with their GPs and are going to accident and emergency. The best way to relieve that pressure is to encourage more people to go to our well-resourced local community pharmacies, maybe even rather than chain pharmacies.
That is absolutely right. The community pharmacist is part of the solution, not part of the problem, in what we want to do for the NHS. I hope to make the point in my speech that we need to do all we can to support the development of community pharmacists rather than take away money that they need.
Urban and rural areas share those problems. It is because people will only wait for so long for GP appointments—my hospital has exceeded waiting times for more than a year—that there is pressure is on community pharmacists. They are stepping up to the plate. Does the hon. Gentleman agree that they are being let down by this cut, when they are trying to do their best?
I hope to make the point that we need clarity about how the money will be found, if it must be found. I believe that there are other ways to save money, particularly involving the use and waste of drugs.
Community pharmacists are unsure about their future and unclear what support they can expect from the Government. The letter sets out the £170 million reduction in support for community pharmacists and asks them to prepare for the cut, but gives little detail about where the money will be cut, who will lose and what services can no longer be funded.
Does the hon. Gentleman agree that local pharmacies are part of the fabric of local communities? That is particularly the case for independent pharmacies, which are embedded in communities and whose owners and staff often come from those communities. Perhaps the Minister can tell us what impact assessments have been undertaken in terms of health and economic and social wellbeing by individual constituency.
I welcome that intervention, but I am concerned that the hon. Lady might have read my speech, and I have not yet put it on my Facebook page. In my constituency, I have several community pharmacists, and I am not sure that I have too many. It is simply that my patch is large and includes areas of social deprivation, which has an inherent impact on health. A car journey from the north to the south of my constituency takes an hour. The journey from the most westerly point to the most southerly point takes an hour and nine minutes. In a rural area such as mine, community pharmacists provide invaluable access to the NHS and invaluable support to vulnerable people.
To follow on from the hon. Lady’s helpful intervention, over and above their obvious healthcare roles, I see community pharmacies’ input into society as comparable to that of post offices, police community support officers, libraries, local churches or chapels, local pubs, village shops and our postmen and women. They all play an important part in local communities. They are the glue that holds communities together, the people and organisations that know when things are not as they should be, and the people who look out for our elderly, the sick and the vulnerable. Although it is difficult to put a price on the work they do, without those people and institutions, society would be a poorer place and the added strain on public services would be significant. It is perverse that we judge reducing support for services such as community pharmacists to be a saving.
I congratulate the hon. Gentleman on securing this timely debate. It is a pleasure to serve under your chairmanship, Mr Streeter. The loss of pharmacists’ expertise and experience and their knowledge of the people who come in and out could be enormous if pharmacies such as the Whitworth family pharmacy in my constituency are forced to close as a result of this initiative.
I think we all share those concerns. I am pleased to have secured this debate, so as to give people an opportunity to share their experiences in their own constituencies.
Reform of community pharmacies is not something that we can afford to get wrong. Many of the community pharmacies in my constituency are independent businesses that have been established for decades. A wrong move by the Government now might make those community resources unviable. We all know that community pharmacists provide important services, including the safe dispensing of medicines. They are often the first port of call for people with minor ailments and health concerns, and are a key support for elderly and vulnerable patients in the community.
General practitioners in my constituency are under significant strain. Although no one is against sensible savings, does my hon. Friend agree that nothing should be done to undermine the excellent job done by community pharmacists in diverting patients from primary care, or to add to the burden on hard-pressed GPs?
That is absolutely superb—my next line is: “Community pharmacies have a vital role in giving advice and in diverting patients from GPs and emergency departments,” exactly as my hon. Friend said. In tourist areas such as Cornwall, they take their share of the extra demand during the height of the season. Most recently, my local community pharmacists administered flu jabs to increase uptake. Pharmacies regularly get prescriptions to patients out of hours when no alternative is otherwise available, and Cornwall has led the way, with ground-breaking work in enhanced services. That is an example of how community pharmacists are very much part of the solution to integrated community health provision.
Healthwatch Cornwall recently surveyed Cornish residents about access to community pharmacies. Some 69% of participants said that they regularly visit their pharmacy, and 74% of those felt comfortable talking to the pharmacist about their health, while 78% felt well informed by their pharmacists when taking new drugs and 93% said that the pharmacist was polite and helpful.
One constituent of mine, a retired doctor, Professor Dancy, wrote to me as follows:
“I am a warm supporter of Nigel, our local pharmacist, and proud to be so. He is always ready to help when I forget (as one does at the age of 95) to re-order a medicament, and when my doctor is unavailable, or just pushed for time, I do not hesitate to ask Nigel for advice, which I follow with a confidence that is always rewarded.”
Community pharmacists are highly trained and trusted healthcare professionals, qualified to masters level and beyond. Their knowledge base covers far more than just drugs, making them the ideal healthcare professionals to relieve pressure on GPs and other areas of the NHS. Equally importantly—perhaps even more importantly—community pharmacists are welcoming change and embracing new clinical opportunities.
However, the proposed funding cut will not sustain the transition from a supply-based service to the more clinically focused service that the Government desire and our patients deserve. Cuts will discourage progress and can only result in small, independent and much-loved businesses failing, at the expense of patients, the public and the wider NHS.
In York, the local authority has made cuts to smoking cessation services, as well as NHS health checks, and the community pharmacists I have spoken to have said that they see their future role as filling some of those gaps. However, with further cuts to community pharmacy itself, where are people meant to go—back to queues in GP surgeries?
I thank the hon. Lady for that intervention. That is exactly why we are having this debate. I want the Government to examine the value of community pharmacists and to consider how they can do some of the work—in fact, a large part of the work—that would save money for NHS acute services.
I am well aware that there is a need to secure better value for money in areas of the NHS. Over the weekend, I met four community pharmacists and they all talked of the opportunities to make savings that they have identified. They are willing and able to see more patients. Pharmacists give free, over-the-counter advice to thousands of people every day, promoting self-care and diverting patients from GP and urgent care services. However, it is estimated that £2 billion-worth of GP consultations a year are still being taken by patients with symptoms that pharmacists could treat.
Pharmacists want to have a greater role in prescribing drugs, so as to reduce waste. Last year in Cornwall alone, £2 million-worth of unused drugs were returned to community pharmacists to be destroyed. Pharmacists are best placed to reduce this waste. They want to do more to support people with mental illnesses; they are keen to provide continued care of people with diabetes and other long-term conditions; and my local community pharmacists want to work with the Department of Health to improve services, engage in health and social care integration, reduce drug waste and improve access to records, in order to support the giving of prescriptions.
On that point, does the hon. Gentleman agree that what is needed is a joint, co-ordinated approach to planning investment and implementing change, in partnership with national and community pharmacy bodies, rather than pushing things through at a great pace?
I thank the hon. Gentleman for that intervention. In my experience so far of looking at this subject, I have found that those in the pharmacist community do not feel that they have been properly consulted or engaged with. Pharmacists believe that they have many of the solutions that the Government wish to see.
Before I conclude, I will read one final letter that I received on Monday from a GP in my constituency. Dr Rebecca Osbourne writes:
“As you will no doubt be aware, General Practice is facing a crisis with too few GPs managing an ever-growing demand. Demand for appointments outstrips availability of doctors and allied surgery staff, and patient needs are increasingly complex with an ageing population with multi-morbidity.
A good Pharmacist helps to take some of the pressure off a local surgery—offering advice about self-limiting conditions, and prescribing over the counter medications for presentations that do not need to be taken as ‘on the day’ appointments with a GP; patients who are on complex medications can receive education and advice from their pharmacist regarding their regime, including the importance of compliance, which can further reduce the burden elsewhere in the system; vulnerable patients, whether elderly or experiencing mental ill-health, have an extra professional keeping watch over them, and a pharmacist may be better placed than a GP”—
it was a GP who wrote this—
“to see a trend developing or a change that requires further attention.”
I do not know whether the hon. Gentleman is aware from the conversations he has had with pharmacists that they often do things that are outside the terms of their contract. A couple of examples were cited to me. First, a pharmacist was involved in spotting someone who was having a cardiac arrest in their pharmacy, and then in helping someone else who had fallen outside the pharmacy and damaged their face quite severely. If we lost pharmacists and their extra input, that would have a significant impact on patients in a way that has really not been explained so far.
I thank the right hon. Gentleman for that intervention. What I have learned from many patients and from the pharmacists themselves is that patients see pharmacists as the first port of call for health, so there is no doubt that there will be times when pharmacists are picking up things that otherwise would have to be picked up in A&E.
Does my hon. Friend agree that it is important not to confuse the role of pharmacists with the number of pharmacies? It is vital that we protect the pharmacists, who are very important in delivering in the national health service.
That is exactly right: it is pharmacists’ skills that we must be careful to maintain and develop.
I know that you have concerns about this matter as well, Mr Streeter, especially concerning the pharmacy in Modbury in your constituency, so I appreciate your support on this issue and the way you are chairing this wonderful Westminster Hall debate.
I congratulate the hon. Gentleman on securing this debate. The letter that he read out hits a lot of the points. Removing the funding will make waiting lists longer, when GPs are already under pressure; in fact, we are losing hundreds of GPs every year, as they go to other countries. Pharmacies can see people at the point in time that they would usually see GPs; sometimes people have to wait two or three weeks to get an appointment with the GP. So this proposed cut seems to defeat the purpose of the planned change.
I am pleased that we are so supportive of the community pharmacists, and hopefully we will get a good result from this debate.
I have three straightforward questions and a personal plea to put to the Minister, if you will bear with me, Mr Speaker—[Interruption.] Sorry, Mr Gary Streeter. [Laughter.]
Have the Government made any impact assessment in relation to their position of reducing community pharmacy numbers and the impact that this change might have on the health, and economic and social wellbeing of people living in our area? What assessment have the Government made of the impact that such a reduction would have on the workload of GPs, those in A&E and those providing out-of-hours services, if patients cannot access their regular pharmacy and then visit these other services?
I congratulate my hon. Friend on securing this timely debate on an important issue that could have far-reaching consequences, should the decision go through. Equally, I join him in urging the Minister to ensure that during the consultation—we understand that there is still to be consultation with patient groups—we will take, to echo a comment by a former Member, a constituency-by-constituency approach. I am sure that everybody will bring to the fore the particular characteristics of their own constituency. My constituency has the record number of octogenarians in the country and the fastest growing town in the south-east, and it routinely hosts tourism-driven events such as Airbourne, when 600,000 people come into the town. Pharmacies are a sometimes uncelebrated and unseen force that we rely on.
I thank my hon. Friend for her intervention and she is absolutely right to say that in a tourist area, where the population increases dramatically at times, we need to be careful that the core services are available for everyone who needs them.
My second question is: what assurances can the Government give to independent community pharmacists? The third question is: what consultation has been conducted with pharmacy patients, and what would their concerns be if community pharmacies were to close?
My personal plea to the Minister is please not to write pharmacies off until they have been given the resources to realise their full potential in society. I feel excited about the potential opportunity that exists for the NHS through the proper use of community pharmacists. While reforms to NHS services are essential and the way that community pharmacists are utilised needs to be reviewed, a blanket removal of funds to pharmacies will only hinder progress and limit this opportunity.
I congratulate the hon. Member for St Ives (Derek Thomas) on securing this debate.
I am the chair of the all-party group on pharmacy in Parliament and I have been for more than five years. I have a keen interest in public health and lifestyle issues, and I have quite enjoyed chairing the group. After the letter of 17 December, the all-party group—three Members of this House and one from the other place—met the Minister, on 13 January. We had what I described afterwards as “straightforward talking” about the letter—a letter that posed more questions about the future of pharmacy than it gave answers. The Minister was straightforward, and he said that one issue was that, in October of this year—so just for the second half of the financial year—£170 million will be taken out of the community pharmacy budget. That leaves a number of questions to be answered, including that of what will happen in a full financial year.
The Government make great claims about putting an extra £8 billion into the national health service, but the truth is that that £170 million, which is part of the £22 billion of efficiency savings, is being taken out of the NHS, so it is hardly new money. It is not the £8 billion—that comes in a few years’ time. We are talking here about major cuts to vital services.
Since the publication of that letter, it has become clear that as many as 3,000 community pharmacies could close in England alone—a quarter of them. How would that happen? Would it be by stealth, which is suggested in the letter and in the consultation currently coming out of the Department, or is there some sort of plan? We have seen in the letter, and in others, that if there is a 10-minute walk between pharmacies, that might be looked into, but there seems to be no plan whatsoever.
What we have to accept—I put to this to the Minister in that meeting on 13 January—is that pharmacists do not work for the national health service, yet more than 90% of community pharmacies’ income comes from the NHS. The idea that we could change that mechanism and close community pharmacies is outrageous. The pharmacists may not work for the national health service, but their income depends massively on it—I wish it did not.
For many years I have been promoting lifestyle issues and the idea of pharmacists getting paid for doing things other than just turning scrips over, but that is how it works at the moment and there needs to be some serious talking. What happens if someone who has a 10-year lease on a property they took over to run the local pharmacy is forced out of business? All those questions remain unanswered, yet there is the threat of up to 3,000 pharmacies in England closing.
I am following the argument that my right hon. Friend is putting forward. Does he agree that, instead of cutting services, we should be looking at opportunities for community pharmacies to extend healthcare further into their communities? It should be about investment at this time, particularly in prevention, which is all about saving money further down the line.
I agree with my hon. Friend. That is one of the reasons I took over as chair of the all-party group more than five years ago. I believe that our pharmaceutical services should be taking that route of travel.
It would help if the Government provided details of how they will ensure access to pharmacy services in remote or deprived communities. If the market will drive closures, there will be chaos, and something substantial needs to be in place.
My right hon. Friend makes a powerful case. He mentioned the market. Does he agree that one difficulty that smaller independent pharmacies, such as John Davey in my constituency, have is that unlike the big chains they are unable to negotiate favourable deals on the drugs they dispense and, therefore, they are already at a disadvantage in market terms? Before the Government go any further with the programme they need to address that important issue.
I do not disagree with my right hon. Friend. I will not use the name of the company, but I can go into the store of one of the major chains, which is not in my constituency but not far away, and it takes me a minute to walk to the prescription counter, whereas in most of the pharmacies in my constituency I can get there in two or three seconds. We must recognise that, at constituency level, we are not comparing like with like.
Another thing is that key payments for pharmacies will be phased out, and there might be a drive towards a commoditised medicine supply service with an increased focus on warehouse dispensing and online services. Again, the possibility of added value in a local pharmacy regarding lifestyle issues potentially goes out of the window, and we really need to look at that. I have no direct experience, but I am told that they have that in the United States.
As well as dispensing medicines, community pharmacy teams help people to stay well and out of GP surgeries, to get the most benefit from their medicines and to manage their health conditions. The NHS spends £2 billion a year on GP consultations for conditions that pharmacy teams could treat. Community pharmacy can and should do more. A national community pharmacy minor ailments service could save the national health service some £1 billion a year. In some of the pharmacies in my constituency, there is already a minor ailments service. I understand that the Government recently changed their mind about developing such a service at a national level, and I would like to know why. Such a service makes great sense to me. It keeps pressure off not only GP surgeries but the local A&E.
In 2014-15, pharmacies delivered more than 3.17 million medicines use reviews, to increase people’s understanding and help them to take their medicines correctly. We get a lot more from our pharmacies than their just turning scrips over. Our communities and our constituencies need that, and if there are to be any changes, they should be carried out in a sensible and planned way, and not in the chaotic way of some of the suggestions of recent weeks.
It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on introducing this important debate.
Some 28% of my constituents, across our 200 square miles of East Sussex, are over the age of 65. Losing our pharmacies would affect all my constituents, but I am particularly concerned about the impact on the elderly and vulnerable. I spoke today with a pharmacist in the village of Ticehurst in my constituency, who told me about his concerns. First, he is concerned that the Government might cut 6% from his dispensing fees. Secondly, he is concerned that they might withdraw the £2,500 that all pharmacists are paid annually. Thirdly, he is concerned that the Government might impose a clawback, meaning that if a budget is overspent, pharmacists might be required to reimburse their fees. Fourthly, he is concerned that the pharmacy will have to cover the welcome introduction of the national living wage and the cost of new pension arrangements.
I understand that it is essential for the NHS to make savings—£22 billion over this term—and it therefore seems reasonable to expect the £2.8 billion pharmacy budget to contribute to that. The Government rightly point out that many of our pharmacies are situated in walking distance clusters, but I am concerned that the proposed funding changes, if not sensibly targeted, could affect not just pharmacies in clusters but the rural pharmacy that is miles from another one and more than just a dispensing chemist. Because a pharmacist knows his or her customers, he or she is able to advise them on solutions more cost-effectively than if they were to utilise the wider NHS, including GPs and A&E.
In an unscientific Twitter survey, which I kicked off at the beginning of the debate, 62% of respondents say they would prefer to see a community pharmacist first. Does my hon. Friend agree that the Government should be clear when making their funding allocation about the extent to which people would prefer to make use of community pharmacists before they see GPs?
My hon. Friend is making a powerful argument about rural pharmacies. A pharmacist in my constituency contacted me. He said that, if the proposed cuts go through, he will have to cut staff and the apprentices he is training, as well as reduce opening hours and stop the free services, such as the deliveries to housebound patients. The cuts would not just stop the important services that my constituents and many others get from rural pharmacies; it would also deeply impact on skills, and on skills going back into the services that we have to protect.
I very much agree with my hon. Friend’s point, and I can give another two reasons why pharmacists are so important. Like the post offices, our pharmacists also act as the eyes and ears for the welfare of certain vulnerable constituents. As a staple part of our village and town centres, pharmacies provide the footfall that allows our pubs, restaurants and shops to survive in an increasingly difficult environment.
I am not a deficit denier, and it would be hypocritical to be elected on the platform of balancing the Government books by 2020 and then to refuse to countenance savings in this area. It strikes me, however, that a better focus for efficiency is not the fees for dispensing, but the volume of drugs wasted by over-dispensing. For example, some drugs may be dispensed for a period of three months, only for the individual to change a course of treatment or stop treatment altogether. As soon as those drugs leave the pharmacy, they have to be used or destroyed. I wonder exactly how much money could be saved by dispensing for shorter periods of time.
Additionally, I find it extraordinary that pharmacists deliver NHS prescriptions free of charge to all who want that service. I understand why those who cannot collect their prescriptions should get them delivered, but to provide free delivery, effectively on the NHS, appears to be an area that is ripe for efficiency savings. I welcome the Government’s proposal for a pharmacy access scheme. That would provide more NHS funds to certain pharmacies based on factors such as location and the health needs of the population. To that end, I ask the Government to distinguish and make a special case for rural pharmacies and to focus their efficiencies on those pharmacies that are within closer proximity to each other. If difficult choices are to be made, let us ensure that our constituents can still access a pharmacy within their locality.
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.
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.
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?
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?
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.
I note the time, Mr Streeter, and your stipulation about when Front-Bench speeches will start. I thank the hon. Member for St Ives (Derek Thomas) for initiating this important debate. As I look around the Chamber today, I see that Members from Wales, Scotland and Northern Ireland are outnumbered, which is appropriate, given the letter that was sent and the cuts that pharmacists might endure. In Wales, the issue of health is almost entirely devolved, so much of what is being discussed today will be different in Wales from in England. However, the community pharmacy contractual framework is an England and Wales arrangement, so what happens in England could impact on Wales.
The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) mentioned the issue of devolved Administrations and delays. Our understanding is that the consultation will conclude, the Minister will reflect, and an announcement will be made during the Assembly election campaign period. We will not have a health Minister in Wales if decisions made in Whitehall impact on the delivery of services in Wales. I think that it has something to do with the respect agenda and waiting for a health Minister to be in place.
The hon. Gentleman should address that question to the Minister. The timing represents an unfortunate mismatch, for which pharmacists in England might pay the price. The timetable is of the Government’s making, not mine, so the Minister needs to reflect on that.
I want to talk about two facets of this debate that have been touched on by the hon. Members for St Ives and for Bexhill and Battle (Huw Merriman): the issue of rurality and the impact of the cuts. The consultation document stated:
“40% of pharmacies are in clusters of 3 or more meaning that two-fifths of pharmacies are within 10 minutes walk of 2 or more other pharmacies”.
I am sure that the hon. Gentleman is going to make an excellent point about rural pharmacies, but there is another element in my constituency, where I met my local pharmacist, Mike Maguire of Marton Pharmacy. Two of our minor injury units have closed and there is a proposal to close another walk-in centre, after the last one was closed. The collateral impact of the withdrawal of those services reduces the ability of the average patient and customer to access services. There is not only the rural aspect but the specific need at the time.
The hon. Gentleman is right. That has been the message of many contributions. The work of our community pharmacies complements the work of the national health service. When the hon. Gentleman’s constituency is hit in the way that it has been, that represents the proverbial nail in the coffin of decent community-based services for his constituents.
On the urban point, to reiterate the point made by the right hon. Member for Rother Valley (Kevin Barron), we are talking about well-established community businesses that impact on many people in the locality. Two or three businesses clustered in the same area doing a generally good job will have an impact on the local economy, but the rural point is fundamental. We have heard about the pressures on GPs and the difficulties in getting appointments. In my vast rural constituency of Ceredigion, we have a district general hospital in Aberystwyth: Bronglais hospital. We have a good many GPs throughout the county. We also have a network of very effective pharmacists, and it is a jigsaw that works in providing good services. There are 716 community pharmacies in Wales—in high streets, villages and towns—with 50,000 people visiting those facilities every single day, proving the efficiency of the much-maligned Welsh national health service and bridging the real difficulty that people have in visiting the closest hospital or a GP for something as routine as blood pressure or cholesterol checks. It is really important that the outcome of the debate is that we support community pharmacies. That is fundamental.
In Wales we have developed our services. I visited the pioneering pharmacy of Mr Richard Evans in the town of Llandysul 11 years ago. He was clearly of the view that we could develop services much more, to relieve pressure on the national health service, and he achieved that. In Wales pharmacies have offered NHS flu jabs for at-risk groups for the fourth winter running. Almost 20,000 people in Wales benefited from that last winter. After four years of that provision in Wales, the NHS in England introduced the same service for the first time. Community pharmacies in Wales can treat about 30% of the common ailments that people would normally go to a GP for. That is a huge saving for the national health service. Pharmacies also promote meaningful public health campaigns. I visited the pharmacy in Borth, where there is a campaign on Parkinson’s disease. The staff are doing a good job talking with victims of Parkinson’s disease about their medication, and promoting awareness in the community.
Finally, having praised what is being done in Wales, in a rural area, I want to seek an assurance from the Minister that if his consultation has an effect on the three levels of services in the framework, there will be meaningful consultation with Assembly Ministers in Cardiff, and that any negotiations on changes to the contract will involve Welsh Government officials at the negotiating table. This is one of the small areas where health is not devolved, and that is particularly relevant on the Welsh border; it requires the respect agenda, on anything that the Minister concludes.
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.
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?
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.
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.
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.
It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate. I join the Scottish National party spokesperson, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in sending good wishes to Pauline Cafferkey, which I am sure we all wish to do. It is very disturbing to hear that she has become ill again.
In what has been a wide-ranging debate, we have had heard from Members about the importance of community pharmacies to their constituents. I thank my hon. Friend the Member for Ealing North (Stephen Pound) for not only giving us an impressive list of the additional services available from community pharmacies but, importantly, discussing the role that they can play in under-doctored areas, which is an issue in my constituency. We must of course consider rural areas, but urban areas can also be very short of services. In my constituency, we have lost walk-in centres and other forms of community support, such as active case-management pilots. It is a pity that such excellent services that keep people away from GPs and hospitals are being cut.
As we have heard again and again in the debate, community pharmacies provide an essential service in dispensing both medication and the essential information and advice that can prevent people from having to visit their GP for common health problems. On 17 December, the day the House rose for the Christmas recess, the Government announced a £170 million cut to community pharmacy services, with further cuts to follow. That initial 6% cut in the funding for community pharmacies will put significant financial pressure on many of them and will result in closures and job losses. Can the Minister assure us that the service offered to patients will not suffer due to the cuts? It is hard to see how there will not be a loss to patients. Will he comment on the additional pressures that will be placed back on the NHS as a result of that loss?
As my right hon. Friend the Member for Rother Valley (Kevin Barron) said, the Minister had a meeting with members of the all-party parliamentary group on pharmacy. I understand from the note of that meeting that he estimated that between 1,000 and 3,000 pharmacies, out of the overall total of 11,700, could close. He also recognised that smaller pharmacies are likely to be squeezed. Such a significant number of pharmacy closures will have a substantial impact on the way that the pharmacy sector operates. The sector called the cuts a “profoundly damaging move”, so it is important that the Minister updates us on the number of pharmacies at risk of closure. The Government failed to outline funding plans for subsequent years, raising concerns that there could be even deeper cuts later in this Parliament. Will the Minister tell us what further cuts are planned?
Despite the cuts, the Government say they want
“greater use of community pharmacy and pharmacists: in prevention of ill health; support for healthy living; support for self-care for minor ailments and long term conditions; medication reviews in care homes; and as part of more integrated local care models.”
As with everything else to do with care, a letter from the Department for Health suggests that the reforms can be carried out by integrating community pharmacies into a range of primary care settings. Integration is fine in itself, but it will not be achieved through funding such as the pharmacy integration fund, which is set at £20 million and will rise to £100 million by year five. I understand that the majority of the funding will focus on providing pharmacy services at GP practices, but that overlooks the wider role that community pharmacies play, which hon. Members have talked about in the debate.
My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) passed me a note about the Windmill Pharmacy in his constituency. In a couple of hours on Saturday, its pharmacists dressed an elderly man’s superficial wound, gave advice on a fungal infection, advised on vaccines and malaria tablets for people travelling abroad, counted and sorted the tablets for many patients with multiple conditions, gave an antibiotic eye drop for a child with an infected eye, gave repeat blood pressure tablets to a patient whose GP was away, and, of course, had their technicians set up the dosette boxes for patients, including those with dementia, who rely on that service. All those services are freely provided in pharmacies. That is an excellent example from my hon. Friend’s constituency. How does the Minister expect community pharmacies to improve their services and continue to do all of those things when they face a significant decrease in funding and are simultaneously being asked to provide greater support to GP practices, care homes and accident and emergency units?
It has been suggested that we should facilitate hub-and-spoke arrangements, but there are real concerns about that system. My right hon. Friend the Member for Rother Valley said:
“Warehouse dispensing, or ‘hub and spoke’, raises questions around safety, quality and access. The supply of prescription medicines cannot be treated like buying clothes and DVDs. High quality, safe dispensing depends on the opportunity for a face-to-face discussion between the pharmacist and the patient. I don’t see how that can be done in a warehouse.”
I share those worries, which were expressed very well by my hon. Friend the Member for Hyndburn (Graham Jones), who asked some important questions about warehouse chemists’ practices and the data security implications of what they do. Most importantly, the Government must tell us how they will ensure that the essential face-to-face contact between pharmacists and patients is maintained.
Pharmacy Voice outlined the negative consequences of the cuts to community pharmacy services. It is concerned that the funding cuts will increase the risks to patient safety and will decrease patient access to medicines and vital support. The cuts risk job losses and will diminish community assets and the long-term potential of community pharmacies. Pharmacy Voice also warned that the cuts are likely to undermine existing health improvement plans and recent initiatives to integrate and develop community pharmacy services. We heard about some wonderful examples of integration and new ways of working in this debate, but all of that will be dashed.
Sue Sharpe, the chief executive of the Pharmaceutical Services Negotiating Committee, said that the plans
“can only impair pharmacies’ contribution to keeping people well and out of GP and urgent care settings.”
The Government are, in her words,
“proposing to drive ahead to radically change the market with a real paucity of knowledge essential for good decision making.”
We want decisions to be based on better information than we have heard about here.
In my constituency, I have been in contact with the chair of the Salford and Trafford local pharmaceutical committee, Varun Jairath, who is a board member of Community Pharmacy Greater Manchester. He believes that patient safety and welfare are at risk from the planned funding cuts, which means that the community pharmacy network will have to reduce staffing levels and the services it offers for free, such as the home delivery of medication, which has been referred to again and again. I went with a delivery driver from a local pharmacy to hand out information to carers in homes who receive medication. Vital extra things such as that can be done, but only with the existing service levels.
The additional services provided by community pharmacies are at risk from the funding cuts. The minor ailments scheme, which was piloted in Eccles in my constituency, was shown to free up capacity and cash for other areas of primary care by allowing GPs to focus on the more complex patients. That service can continue at £3 per consultation only if community pharmacies continue to be funded at current levels. Such services, which improve quality and save cash, are under threat due to the proposed cuts.
As a number of right hon. and hon. Members said, one of the most worrying effects of the cuts is the potential reduction in rural pharmacy services. Access to pharmacy services should not be reduced for people who live in areas with widely dispersed populations. I ask the Minister—he has been asked this question already—what his assessment is of the impact that the funding cuts will have on rural pharmacies.
To reduce pressure on NHS services, the Government have repeatedly suggested that people should visit their local pharmacy for advice and the extra services we have talked about in the debate. Putting extra pressure on GPs through these funding cuts to community pharmacies is risky. GPs have warned that their workload is becoming unmanageable, which is likely to have an impact on patient safety. In a recent survey of about 3,000 GPs, 55% said that the quality of the service they provide has deteriorated in the past year, and 70% said they feel that their workload is unmanageable some or all of the time. I spoke to a local GP in my constituency recently in a practice whose list size had just been increased by 15%. The GPs at that practice cannot cope with that increase plus any extra that they gain from the losses that have been outlined in the debate.
We recognise the need to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve primary care outcomes. It will do the opposite. I fear that pharmacies will struggle to provide safe, good-quality services to patients. In proposing the cuts, the Government failed to recognise the value of community pharmacies and to put patients at the heart of their plans for pharmacy services. Patients will bear the brunt of these inappropriate cuts to an essential community service. A joint co-ordinated approach to planning and investment is needed across primary care to ensure that the pharmacy sector can play the important role it could fulfil, and, as I know from all the contacts I have had, wants to fulfil, and ensure that patients get the most out of both the NHS and pharmacies.
As others have said, it is a great pleasure to serve under your chairmanship, Mr Streeter. Thank you for chairing this debate. I also thank my hon. Friend the Member for St Ives (Derek Thomas) for bringing this debate to Westminster Hall and giving colleagues the opportunity to make such a range of comments. They all have a good knowledge of things in their areas, and some have more specialised knowledge. We heard from the right hon. Member for Rother Valley (Kevin Barron), my hon. Friend the Member for Bexhill and Battle (Huw Merriman), the hon. Member for Ealing North (Stephen Pound), my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), the hon. Member for Ceredigion (Mr Williams), the hon. Member for Hyndburn (Graham Jones) and, not least, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in whose constituency I have spent many happy hours—my father was born in Auchterderran, so I know the area very well. Although the hon. Gentleman is from Scotland, his contribution was welcome, and he made some pertinent points.
Before I make some prepared remarks, I want to put some things on the record. I would be foolish if I did not understand the widespread interest in this debate. I would also be naive if I believed that this is the last time we will discuss this issue. Many questions were asked, so this will run for a while. Let me set out the background before I make my prepared remarks.
First, we are having this debate at a relatively early stage of the negotiations between the Government and the Pharmaceutical Services Negotiating Committee, which is handling matters on behalf of the pharmacy profession. Many of the questions and issues raised by colleagues on both sides are at the heart of those discussions. What sort of services will there be? Where is pharmacy going? How exactly will the reduction in finance be handled and distributed? Not all the answers are available at this stage because a proper negotiation process is being undertaken. Understandably, colleagues will look at the most adverse potential consequences to make a point when representing their constituents. I understand that, and the points have been perfectly fair. We are at that point in the process. We think we know what the worst may be, but we do not know the outcome or what changes there will be for the better.
Secondly, on finance, we are all realists here. We would love to work in a world where the status quo is not changed except for improvements, where the only issue with money is where more can be spent and where change, if there is to be any, takes forever to bring in. Life is not like that. The Government’s spending commitment for the national health service—an extra £10 billion a year by 2020—has to start being found early. It is not only about extra money, but about the efficiencies that the NHS chief executive identified, which are to be found across the board and could partly come from the pharmacy sector’s £2.8 billion of funding, which the Government propose to reduce. It may be an appropriate place. Again, we often approach such matters with the view that no possible reduction could ever improve services anywhere. That is not true, as we know from the experience of successive Governments.
The third bit of the background is where we are in relation to where pharmacy is going. The Royal Pharmaceutical Society’s November 2013 report, “Now or never: shaping pharmacy for the future”, states that the traditional model of community pharmacy needs to change due to
“economic austerity…a crowded market of local pharmacies, increasing use of…automated technology to undertake dispensing, and the use of online and e-prescribing”.
The Nuffield Trust’s report, “Now more than ever: Why pharmacy needs to act”, states:
“Community pharmacy is subject to a particularly complex set of commissioning arrangements, which appear to support the status quo and inhibit innovation at scale.”
We would love to be in a situation where, as the hon. Member for Ealing North described, everything is absolutely great and every pharmacy offers all the services and delivers them marvellously, but that is not necessarily the case. Accordingly, change is sometimes inspired by necessity and can be for the better. That is part of the background to where we are.
The Minister makes the point that, to pay for the £10 billion increase in NHS funding, funds are being shifted from other sources, including the £2.8 billion spent on pharmacies. However, the principle should not be to shift funding from primary care to secondary care. Our fundamental principle should be to shift—if we have to—money from secondary care to primary care, which is preventive and will cut costs in the long term.
The hon. Gentleman makes a fair point, and that is indeed being done in the NHS, but we are looking at where efficiencies can be made and at what different parts of the health sector can contribute. In doing so, we can see what changes are inspired in the service provided to patients.
To emphasise where we are with pharmacy, there are 11,674 pharmacies in England, which has risen from 9,758 in 2003—a 20% increase—while 99% of the population can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. The average pharmacy receives £220,000 a year in NHS funding. On clusters, which my hon. Friend the Member for Plymouth, Sutton and Devonport mentioned, the Government contend that money can perhaps be saved in one place and used elsewhere for the delivery of new services. That is the reality of life. It would be great if new money was always coming from somewhere, but bearing in mind that the Government are dealing with an Opposition who could not commit to the extra £8 billion that the NHS was looking for, we have to make the changes that others were not prepared to make and still deliver services.
Let me move on to where we are going. Everyone in this room, Government Members included, recognises the quality of the best pharmacy services around the country. We are familiar with the valued role that community pharmacy plays in our lives and those of our constituents. I am grateful to my hon. Friend the Member for St Ives for giving me the opportunity to put on public record the high esteem that we hold them in and to set out our plans for the future.
I am a firm believer that the community pharmacy sector already plays a vital role in the NHS. I have seen at first hand quite recently the fantastic work that some community pharmacies are doing across a wide range of health services that can be accessed without appointment. Many people rely on them to provide advice on the prevention of ill health, support for healthy living, support for self-care for minor ailments and long-term conditions, and medication reviews. There is also real potential for us to make far greater use of community pharmacy and pharmacists in England. For example, I am due to speak at an event tomorrow that is looking at the role that pharmacy can play in the commissioning of person-centred care for vulnerable groups.
Our vision is to bring pharmacy into the heart of the NHS. We want to see a high quality community pharmacy service that is properly integrated into primary care and public health in line with the “Five Year Forward View”. I cannot answer all the questions that the hon. Member for Worsley and Eccles South (Barbara Keeley) asked, but she did at least mention the integration fund for the first time in the debate.
There is a difficulty, in that funding for integration should recognise that the extra work needs to be done. The point of today’s debate has been about the Government using blunt instruments, such as a 6% cut in funding, reducing the number of pharmacies in clusters, changing dispensing charges, and the warehouse pharmacy that my hon. Friends mentioned. It is the use of those blunt instruments, not the working with the sector, that is the fault.
That working with the sector is ongoing. That is what the negotiations with the Pharmaceutical Services Negotiating Committee are all about. I take the hon. Lady’s point, but those discussions are under way. We are consulting with a wide range of groups, not just the PSNC, including patients and patient bodies.
As part of what we are doing for the future of pharmacy, we want pharmacists and their teams to practise in a range of primary care settings to ensure better use of medicines and better patient outcomes and to contribute to delivering our goal of truly seven-day health and care services. As part of that, I want to work with NHS England to promote local commissioning of community pharmacy within the health community, so that we can ensure the best use of this valuable resource. That is why we are consulting on how best to introduce a pharmacy integration fund to help to transform the way pharmacists and community pharmacy will operate in the NHS of the future. By 2020-21, we will have invested £300 million in the fund.
While it is understandable that the focus of most colleagues’ comments today was access to existing services, little was said about where pharmacy might be going and what new opportunities there will be. That is part of the overall development that we are hoping to achieve, which will include the work not only of the access fund, but of the integration fund.
Colleagues asked several questions about access. I want to provide some reassurance. We recognise that some of the Government’s proposals have caused concern, and that will take some time to distil as the negotiations are worked through. We are committed to maintaining access to pharmacies and pharmacy services. We are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, both of which were raised today. Qualifying pharmacies will be required to make fewer efficiencies than the rest of the sector. We certainly recognise that rural pharmacies will need to be considered in that, and we want to ensure that location matters in areas of sparsity. That work is ongoing.
In conclusion, the process has some way to run. I simply put it to colleagues that, in relation to good community services on the high street, there is more for modern pharmacy to do. Looking at the proposals of the past, we hope that the profession shares the Government’s determination to move pharmacy into a new future, and I am convinced that the future will be good.
Thank you, Mr Streeter, and I thank Members for their contributions, which have been really helpful. I thank my right hon. Friend the Minister for seeking to tackle the many issues that have been raised. We all agree that the NHS is a fantastic institution. Community pharmacists hold some of the keys to improving patient care in the community and reducing pressure on GPs and other NHS services. I hope that the debate has gone some way to empower pharmacists to offer the solutions that the Government are seeking in order to secure a modern-day NHS, but this is all about the best care for patients, which we all agree is what really matters.
Motion lapsed (Standing Order No. 10(6)).
[Mr Philip Hollobone in the Chair]