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Independent Pharmacies

Volume 678: debated on Monday 13 July 2020

Motion made, and Question proposed, That this House do now adjourn.(Maggie Throup.)

It is a pleasure to open this debate, which was prompted by a letter from an independent pharmacist in my constituency, Mr Tim Gibbs, who runs the Yarmouth pharmacy. Those who know it will know that it is not far from our beautiful harbour in Yarmouth and just opposite Yarmouth castle. I am delighted that this Minister is on the Front Bench, as I know she is a great supporter of pharmacies, pharmacists and indeed independent pharmacists. I am aware that the Health Secretary spoke at the National Pharmacy Association today. He spoke eloquently on the need for a major winter flu vaccination programme, which, clearly, we would welcome.

I will not speak for too long, as I am aware that one or two others wish to speak and it is getting late in the day, but I wish to cover some of the issues of concern to not only pharmacists, but independent pharmacists, who are especially important in isolated and rural communities, as other Members here, including those from places such as Cornwall, will testify. I have six independent pharmacists in my patch and all are highly valued. They include Tim in Yarmouth, Freshwater, Seaview, Ryde and Regent, which covers both East Cowes and Shanklin. I am grateful to Gary for taking the time to chat last week about some of the issues that have faced him.

Although many healthcare providers closed their doors during the covid pandemic, pharmacists stayed open, often at risk to themselves and their staff. For many people in our communities, NHS pharmacies were the visible face of healthcare on the high street. It is to their great credit that they stayed open and continued to serve their patients, often delivering medicines, at their own cost, to the homes of vulnerable and at-risk patients to make sure that those patients had what they needed. Pharmacy staff saw patients in person and ensured that the public—particularly vulnerable patients—had a consistent and safe supply of medicine. In doing so, they took considerable pressure off other elements of the health service, including GPs, who were often answering calls on the phone, and A&E.

However, I know from talking to Tim, Gary and other pharmacists in my patch that they face considerable financial insecurity on top of all the other problems. That is worse for pharmacists such as Tim who have to rely on over-the-counter trade. In Yarmouth, where there are a lot of yachts at weekends, he can usually make up the decline of income in other areas by selling soap and all the other good things that chemists sell, but in the covid period those sales took a significant hit. The same has been true for the independent pharmacies and many of the chemists in my patch. They have incurred many thousands of pounds in additional monthly costs from staying open and serving the community, and some of my independent pharmacists have even relied on volunteers.

Pharmacies have paid for the costs of installing screens, buying PPE—although I think the Isle of Wight Council helped Tim out after he requested it on a couple of occasions—hiring locums, paying overtime and absorbing the increases in the wholesale prices of medicines, which pharmacists are not allowed to pass on to their customers. That has created serious cash-flow problems.

I am very grateful, as we all are, that the Government provided £300 million in emergency loans to the sector at the outset of the crisis and have provided an additional £70 million since. Those are significant sums of money. The loans are, however, something of a sticking-plaster solution to cover the immediate covid costs that pharmacists have incurred and to make up for the longer-term shortfall. If pharmacists are left holding the bag for the costs that they have incurred through serving their communities in the past few months, many of them, including Tim, are worried that they will be forced to shut down in the next year or two. I believe that that would be a national shame. The ongoing uncertainty is an additional burden that pharmacists just do not need.

All pharmacists are valuable and they all play an important role. but because independent pharmacists are embedded in their community and represent a friendly, valued and, above all, trusted voice, they take pressure off A&E, GP surgeries and other areas of the NHS. On the Island, the number of GPs sits at roughly the average, but as the Minister well knows, we are struggling somewhat to make sure that there is an adequate supply of GPs to provide the primary care that this country needs.

I know that the Minister is a friend to pharmacists. Can she say something to reassure pharmacists—especially the independent ones—in my constituency and many others that the Government understand their valued and somewhat unique role, over and above chains of pharmacies, and that the Government wish to support them?

I am grateful to the hon. Gentleman, who is making a powerful speech, and I congratulate him on securing this Adjournment debate. Having worked in an independent pharmacy while I was at school, I recognise the trusted relationship that he describes between the pharmacist and the community that they serve. When the funding formula for pharmacies changed in 2016, the then Minister told the then all-party group on pharmacy that between 1,000 and 3,000 pharmacies were expected to close because they would no longer be financially viable in the face of the cuts, so the outlook for pharmacies was already tough and bleak. A significant number of the pharmacies that have closed have been independent pharmacies. Does he agree that that is a real shame, and a real loss to those communities?

I thank the hon. Member for making that point. I was just about to quote those statistics myself, but I thank her for teeing up the next bit of what I would like to say.

As I understand it, the budget for community pharmacies is £2.6 billion—a significant amount of money but quite a small proportion of the NHS’s total budget. It stretches to cover some 11,500 community pharmacies, serving the majority of the population of the United Kingdom—about 56 million people. On average, each one serves about 5,000 people per month and dispenses 7,300 prescriptions.

In the last four years, as the hon. Member says, the funding for pharmacies has shrunk by a significant amount; I am quoted a figure of approximately £200 million. Tim and other pharmacists in my patch are concerned that there is now going to be significant additional pressure, and we have seen statistics to suggest that up to 3,000 pharmacies could close for good. That has not happened yet; these are threats. Some have closed, but the majority are still struggling on.

I believe that would be short-sighted in the extreme. I am sure the Minister agrees that a sustainable pharmacy sector is a critical part of the NHS network in this country because, as I said, it takes pressure off both A&E and GPs. We badly need it. Having used an independent community pharmacy myself, I know the added value of having somebody trusted to talk to, whether about a bunged-up ear because I swim too much—well, not at the moment—or about more serious concerns.

NHS pharmacies are ready and willing to support the test and trace programme—something I have knowledge of in my patch due to our experience trialling the app, which sadly was not taken further. They could help to ensure support for test and trace, for home testing kits, and certainly for the winter vaccination programme, which is likely to be of increased significance this year because of the potential for phase 2 of covid, which clearly we all hope does not happen.

There is strong public support for community pharmacies. A recent opinion poll showed that 81% hold a favourable view of pharmacies, 78% value a face-to-face relationship—I wish Members of this House had those sorts of approval ratings; we live in hope—and more than half want to see emergency covid funding turned into a permanent grant versus the significantly smaller amount who want to see it repaid.

Crucially, the public are ahead of the health bureaucracy in seeing the benefit of having this network of highly trained healthcare professionals in many communities in Britain; 84% say that the NHS should do more to make use of pharmacists’ skills. It does seem to be a bit of a wasted resource when we have people with so much skill and ability in dispensing medicine and in being the first port of call for many when they are feeling under the weather.

Some 71% of people think pharmacies should be able to expand their offering to take pressure off the NHS. I completely agree. I wonder how we can work towards that betterment, which is certainly in all our interests considering the relatively small amount of money compared with the overall NHS budget that goes towards pharmacies, specifically community pharmacies.

I will round up and let other Members speak, but may I tempt the Minister to talk about how she can support community pharmacies—the six in my patch but also the 11,500 across Britain? What can she say to reassure us that the financial support will be there? Losing independent pharmacies would be much more expensive in the long run than providing modest additional sums to ensure that we help keep their pharmacy businesses viable, especially during the covid period, when other elements of their business—the cash trade of the chemist—have clearly been declining. I very much look forward to her response.

I congratulate my hon. Friend the Member for Isle of Wight (Bob Seely) on securing this important debate, and I am grateful to him for allowing me to participate.

This has been an extraordinary period. Despite its challenges, the coronavirus emergency has revealed many of the strengths of our health and social care systems. One of the most important—a system that extends into the community well beyond our fantastic doctors and nurses—is, of course, the pharmacy sector. Community pharmacists are a vital part of the frontline. For example, the Newborough pharmacy was crucial to that village’s response to covid, and I want to place on the record my thanks to Meb Datoo, his wife and their team at Newborough village pharmacy.

Just as the role of care workers has become better appreciated in the last few months, I believe it is time to value our pharmacists. They have been an essential face-to-face part of our response. According to the latest research, more than 60% of the public visited a pharmacy during lockdown. Three quarters agree that the NHS should make more of pharmacists’ skills, both in the ongoing covid-19 situation and more broadly.

I am a member of the Health and Social Care Committee, and I am sure that in the future we will look at the value of pharmacies. The Chancellor of the Exchequer is the son of a pharmacist—that is perhaps not well known—so I am confident that the sector is appreciated not only by the Minister and her Department, but in Downing Street. That appreciation is needed.

Although the role and potential of pharmacies is now obvious, many are struggling to keep their doors open. The five-year financial deal for community pharmacies came into effect last summer, but I fear that it is not sufficient to keep the sector going, at least by itself. The Government have increased funding for the NHS by a record amount, and I am proud of that. I am also proud of the huge additional support to tackle coronavirus and deal with its consequences. Pharmacists deal with those consequences every day, and they deserve their fair share. We cannot let them shoulder greater responsibilities without the associated funding.

I agree with my hon. Friend that the sector needs to know whether it is, in effect, being asked to pay for the costs of covid—whether it is being asked to pay back the £370 million in Government loans. I do not necessarily expect the Minister to provide that answer tonight. I am sure she is sympathetic to the points that have been made, and I therefore hope that she agrees that, although our pharmacies are an excellent place to acquire a sticking plaster, they deserve a lot more than a sticking-plaster solution.

I am grateful to my hon. Friend the Member for Isle of Wight (Bob Seely) for securing the debate and to the hon. Members who contributed to it. We are all pretty much in agreement about the value of our pharmacies. Our community pharmacies are an integral part of our healthcare system. We have often spoken in this Chamber and elsewhere about how assiduously my hon. Friend looks after the health needs of those on the Island, with its unique ecosystem.

As has been said, community pharmacies across the country, including those on the Isle of Wight, are at the very heart of our community. Everyone agrees that they play a vital role in providing medicines and health advice to all those who cross their threshold—the hon. Member for Halifax (Holly Lynch) said she did that while at school. Many pharmacists have told me that during lockdown they have had to develop a different relationship with their customers, because the whole setting and how they advise has changed. Rather than having a friendly chat, they have had to help many of their older customers navigate their way through the new system. The role of pharmacies is more important than ever in the covid-19 pandemic. Their sensible approach has helped to spread the public health message. They are integral to the prevention agenda.

I say that because, although the pandemic continues to challenge all parts of the health and care system, local pharmacies have remained open throughout. They have truly been the frontline. They have adapted to the pandemic by making their businesses covid-secure. They have innovated and shown immense resilience in responding to the challenges brought about by the pandemic.

The Health and Social Care Secretary and I—indeed, all colleagues in Government—are hugely grateful for the unequivocal commitment shown by community pharmacies. I am immensely proud to be the pharmacy Minister. I want to take this opportunity, as I have done before, to thank all those who have gone above and beyond during this crisis, helping those in our community who have walked through the shop door because they are frightened or require assistance. Pharmacies have always been there.

As the House may recall, last July we agreed a landmark five-year deal, the community pharmacy contractual framework, which committed almost £13 billion to community pharmacy or about £2.6 billion a year. It is the joint vision for how community pharmacy will support delivery of the long-term plan. Community pharmacists are part of our community life, and independent pharmacists account for almost 40% of the market. They are integral to the success of delivering the five-year deal and supporting the NHS. As we have heard this evening, patients value the diversity of pharmacies and the different settings in which they interact with their communities.

Maintaining access to NHS pharmaceutical services continues to be a key priority for the Government. The pharmacy access scheme protects access in areas where there are fewer pharmacies and higher health needs, so that no area is left without access to local, physical NHS pharmaceutical services.

During this crisis, the Government have put in place a financial package to provide support to all businesses, including independent pharmacies. Under the NHS contractual arrangements, we have made available £370 million in advance payments to help pharmacies with their cash flow. We have also provided additional funding for the new medicine delivery service for shielded patients to ensure that the vulnerable get their medication, and covered the cost of bank holiday opening. We are increasing the reimbursement prices for the most commonly prescribed generic medicines by £15 million a month from June.

We have responded to concerns from the sector by pausing some work in order to prioritise day-to-day activities and enable an environment that provides space to do the day job safely and, importantly, supports the health and welfare of staff. That is particularly important given the high proportion of community pharmacy staff from black, Asian and minority ethnic backgrounds. For example, 43% of registered pharmacists come from such backgrounds. We need to provide the right environment to keep everybody working at their optimum level.

This year’s pharmacy quality scheme comprises of two parts: an essential element that focuses solely on covid-19 activities, including individual covid-19 risk assessments, and a second part that will be in the usual spirit of the scheme. I urge all community pharmacists to participate in this year’s pharmacy quality scheme, especially the essential element, which will reward community pharmacies for undertaking steps to keep patients and staff safe during the pandemic.

As my hon. Friend the Member for Isle of Wight will appreciate, we are in regular conversation with the pharmacy contractors’ negotiating body, the Pharmaceutical Services Negotiating Committee. We have met stakeholders regularly throughout the pandemic to ensure we have that ongoing dialogue that is so important. We will continue to work closely with the PSNC, NHS England and NHS Improvement to consider what further support and funding contractors will need during the pandemic and as we move into the recovery phase.

We have just entered discussions on firm proposals for additional funding put forward by the Government to meet the extra costs incurred by pharmacists at the peak of the pandemic. To respond to this crisis, we have a need to reprioritise certain community pharmacy contractual framework services. The immediate challenge will be to restore those services and programmes planned for the 2020-21 period where we can do so and where it remains the right thing to do. I stress that we will work by talking to the profession, because this has been an extremely difficult time and, as everybody has said, pharmacists have responded amazingly to the demands that have been put on them.

There is also an opportunity to learn from the pandemic and facilitate changes that may have been more difficult previously. We will continue to build capacity and capability, test new services for potential future commissioning, and focus services on the areas that have the most impact on the population’s health. Community pharmacies have demonstrated how they can increase the uptake of flu vaccinations, as my hon. Friend the Member for Isle of Wight said. That will be particularly important this winter, when we know that there will be increased uptake. I am keen for community pharmacies to do more in partnership with GPs in their local area and for them to be as one with their colleagues and treated like other members of the entire NHS family that we value so much. I sometimes feel that those in community pharmacies feel that perhaps we could go a little further in saying a big thank you to ensure that they feel part of the valued broader primary care network.

Isle of Wight community pharmacists are exceptional; indeed, in the past they have won awards for their work on the administration of hepatitis B and hepatitis C vaccines. We want to consider the role of community pharmacists in future vaccination programmes to maximise access.

The hon. Member for Halifax mentioned the anticipated loss of some 3,000 pharmacies; on this morning’s Zoom call with the National Pharmacy Association, the Secretary of State was clear that that would not happen on his watch and that any loss of pharmacies stopped when he arrived. Like me, he sees the value of community pharmacists. There are now 11,500 pharmacies throughout England, which is an uplift of some 12% since 2010.

I agree with my hon. Friend the Member for Peterborough (Paul Bristow) that this period has shown how vital pharmacists are and the importance of the role that they play for us all.

The Medicines and Medical Devices Bill, which goes to the Lords next week, will introduce legislation that will pave the way for further consultation on what more the Government can do to support dispensing arrangements and a better skill mix in community pharmacy. With such a highly skilled workforce, if we can free up pharmacies to better use their skills for patient-facing services, helping to alleviate pressures not only on pharmacies but in primary care, that will help the whole sector and be a recognition of the high skill level that we have. We will help people, including those on the Isle of Wight, to adopt innovative practices, including the greater use of digital and technology. We will of course engage with the sector on any proposals that we make. Any regulations in this policy area would come before Parliament.

I thank my hon. Friend the Member for Isle of Wight again for securing this important debate. I know that the coming months will continue to be challenging for Tim and the other community pharmacists that my hon. Friend mentioned, but it is really important that they know quite how much they are valued by Members from all parties, but mostly by their communities. I am personally committed to continue to do all that I can to support community pharmacies, which are an essential part of our lives, our high streets and our NHS family.

Question put and agreed to.

House adjourned.