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Community Pharmacy

Volume 774: debated on Monday 17 October 2016


My Lords, with permission, I will repeat an Answer given by my honourable friend the Parliamentary Under-Secretary of State to an Urgent Question in the other place on community pharmacy. The Statement is as follows:

“Members of the House will have seen there has been media coverage over the weekend about our consultation on the community pharmacy contractual framework. I will now set out the current position, the process going forward and how the final decision will be announced to the House.

In December 2015, 10 months ago, the Government set out a range of proposals for reforming the community pharmacy sector. Our intent was to promote the movement of the sector towards a future based on value-added services together with much stronger links to the GP sector. We also proposed ways to make a reduction to the £2.8 billion currently paid to the sector. Part of the rationale for this was the increase of 40% in the budget and 18% in the number of establishments over the past decade or so.

Each establishment now receives an average of £220,000 of margin over and above the cost of drugs disbursed. Many of these establishments are in clusters. The 2015 spending review reaffirmed the need for the privately owned community pharmacy sector to make a contribution to the publicly owned NHS efficiency savings which we need to deliver. We are confident that the changes proposed will not jeopardise the quality of services required or patient access to them. Some services will be delivered differently, which is why we have set aside £112 million to recruit a further 1,500 pharmacy professionals to be employed directly by the NHS and GP practices.

The Government have been consulting on these reforms since December 2015. On 13 October this year the PSNC rejected our proposed package and sent a list of remaining concerns. We are now in the process of considering its final response and expect to be in a position to make an announcement to the House shortly”.

My Lords, I thank the noble Baroness for repeating the Answer to the Urgent Question that was given in the other place earlier today. It is much appreciated by me and other Members. The stated aim of the Government has been to put pharmacies at the heart of the NHS. However, the proposals here will have serious and far-reaching consequences for patients, local communities and the NHS. Can the noble Baroness tell the House when we can expect to see the full impact assessment of these proposed cuts? What steps have been taken to ensure that the pharmacy access scheme is available to all community pharmacies based on the size and need of the population they serve? Does the noble Baroness see the contradiction in claiming to put pharmacies at the heart of the community while implementing arbitrary cuts? Finally, what steps is she taking to prevent the closure or the reduction of opening hours of community pharmacies?

I thank the noble Lord for those questions. The decision on the impact assessment has obviously not been made yet because the Government are thinking about the problems that have just arisen due to the PSNC not accepting the decisions that we thought had been made. There is no reason why this package should in any way affect the efficiencies of pharmacies at the moment. It is important to remember that the Government fund community pharmacies to the tune of £2.8 billion, and the average pharmacy receives £220,000 per year in NHS funding. We believe that the sector, which is made up of private companies that are often densely clustered together, can withstand this, and that the quality of services provided to patients will not be affected as a result. We know that 40% of pharmacies are in clusters of three or more, which means that two-fifths of pharmacies are within 10 minutes’ walk of two or more other pharmacies.

My Lords, the Minister will be aware of the report, commissioned for the Pharmaceutical Services Negotiating Committee and published last month, which showed that in 2015 community pharmacies provided 75 million minor ailment consultations and 74 million medicine support interventions. Does she not think that reducing the provision of community pharmacies may make it even harder for many people to see their GP and will add to the already considerable problems at many A&E units?

The Government are modernising the pharmacy sector and are investing £112 million to deliver a further 1,500 pharmacies in general practice by 2020. We are ensuring that no area is left without access to community pharmacy due to the pharmacy access scheme, and as the Minister for Community Health and Care announced on 13 October we are also introducing the pharmacy urgent care programme, a pilot scheme which will embed pharmacy into the urgent care pathway by expanding the service already provided by community pharmacies in England for those who need urgent repeat prescriptions and treatment for urgent minor ailments and common conditions. The move means that, in pilot areas, patients who need urgent repeat medicines will be referred from NHS 111 directly to community pharmacies. NHS 111 will develop and evaluate a new approach that will ultimately enable the service to refer patients with urgent minor ailments such as earaches to community pharmacies.

Does my noble friend agree that the link between individuals and the pharmacy can be important, particularly for the elderly and those with long-term illnesses? On the whole, this may well be easier to facilitate in the case of small pharmacies rather than large ones in a larger shop that is engaged in other operations, not to in any way denigrate the important role which those shops may play. Does my noble friend agree that it is important that, in the course of this change, the position of the smaller pharmacies should not be undermined?

I absolutely agree with my noble friend. There is no reason why that should be the case. At the moment, as I am sure he is aware, there are sometimes up to three or four pharmacies on one high street. It is not necessary to say that with these proposals the pharmacies will close, because the majority of them are privately owned, but it is important to try to modernise the system as it is now. The integrated care fund is very much working towards joined-up thinking on this.

Will my noble friend take a message back to my right honourable friend the Secretary of State to say that if the reports are true that we could end up losing 1,500 or 1,400 small, independent pharmacies, these plans are barking mad and should have no part of Conservative government policy? It is right to save money on drugs, but can we target the big pharmas which rip off the Department of Health and have been doing so for years, and call the dogs off the little, independent pharmacies, which are vital for rural areas and are important small businesses? I do not want to see only Lloyds, Boots and the supermarkets on the high street—we need the little independents as well.

There is no reason why this should stop that happening. As I mentioned, the pharmacy access scheme absolutely ensures that no area will be left without access to community pharmacy, and that targets the rural areas in particular.

My Lords, I know that my noble friend will agree that community pharmacy has a tremendous reach in that 1.6 million people every day visit a community pharmacy. It can play a vital part in enhancing care in the community, particularly, as my noble friend said, looking after those who are older and/or with chronic conditions. It tries to ensure that people are diagnosed and looked after, and that their needs are met in the community, not defaulting to costly hospital admissions. In that respect, my noble friend said that value-added services are key to this. They are, and for years we have wanted pharmacies to be able to diversify out of reliance wholly on dispensing fees and the allowable profit margin, to raise resources themselves by services provided to the NHS locally. Can my noble friend say to that extent how far clinical commissioning groups themselves use the opportunity of local pharmacies to offset what would otherwise be the pressures of demand upon NHS services?

I thank my noble friend for that question. On the last part, I may have to get back to him, because I do not know the answer to that. It is important to remember that the proposals that the Government have been consulting on are part of a wider package of reforms to ensure that the NHS funds are allocated in the most efficient way possible, while promoting a high-quality community pharmacy service which is fully integrated with primary and urgent care and which makes better use of pharmacies’ valuable skills.

Does the noble Baroness agree that one of the most valuable services provided by pharmacies is the delivery of medicines to people who are elderly and housebound, and that it is vital that the funding proposals that the Government come up with do absolutely nothing to undermine that service?

The noble Lord is absolutely right. That service will not be undermined and it is extremely important that it carries on—again, particularly in rural areas.

My Lords, I echo the remarks made by my noble friend Lord Blencathra. Both of us represented rural constituencies: in my case for 31 years and in his case I think for nearly 30. The truth is that local pharmacies are terribly important in rural areas. I hope that my noble friend will have that in mind when the policies are addressed.

My noble friend is absolutely right. As I mentioned earlier, that is the point of the pharmacy access scheme, which is intended in particular to ensure that the right number of rural pharmacies are available in those areas.

I know that my local chemist is very upset about what may happen to him. He talks about areas where money is wasted by the NHS and where efficiencies could be effected. Has the Minister had discussions with the representatives of pharmacists who have opposed this proposal, to see whether they can come up with ideas on how efficiencies can be achieved?

Certainly everybody was consulted during the process and that is why we were very disappointed with the attitude that has been taken. We took particular care to endeavour to work collaboratively and we listened to their suggestions and proposals over quite a long period.

I have just been passed something by my inspiration, who is not far from my left-hand side. As I am on my feet, I hope that noble Lords will not mind if I answer the question put by my noble friend Lord Lansley. Roughly 50% of local areas currently commission community pharmacies to provide minor-ailment services. As the Minister announced last week, we are committed to increasing the coverage to all areas by April 2018. This shows how valuable a resource pharmacies are for patient care.