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Community Pharmacies

Volume 828: debated on Monday 20 March 2023


Tabled by

To ask His Majesty’s Government what plans they have for making the best use of community pharmacies.

My Lords, community pharmacies make a vital contribution to the provision of primary care. The Government and the sector continue to implement their vision, agreed in 2019, to make better use of the skills and expertise of community pharmacy teams. This aims to develop the role of community pharmacy in managing demand for urgent care, supporting optimal use of medicines and prevention and detection services. We continue to explore what else community pharmacy could be commissioned to do.

Is my noble friend aware that, since 2015, funding for community pharmacies has been cut by around 30% and around 720 pharmacies have closed? Many pharmacies have had to reduce their hours and provide prescriptions and other services at a loss. The NHS estimates that 6% of all GP consultations could be transferred to community pharmacies; however, this service is limited due to unnecessary bureaucracy, requiring patients to be referred by their GP. Can my noble friend please confirm whether the Government will enter into discussions with the Pharmaceutical Services Negotiating Committee to look at introducing a fairly funded “pharmacy first” service as soon as possible, to help to relieve GPs’ workload?

I thank my noble friend for that important question regarding pharmacies. Although we are yet to label our service offer as “pharmacy first”, we have already introduced and funded a range of services in community pharmacy that make use of the clinical skills of pharmacy teams and take the pressure off GPs and other parts of the NHS. We continue to discuss with the Pharmaceutical Services Negotiating Committee how the Government can best support community pharmacies and the sector to provide services to patients.

Due to government policy, primary care networks are recruiting pharmacists from community settings. In January 2023, it was confirmed that about 4,100 pharmacies have been recruited into PCNs, with a large proportion of those being recruited from community pharmacy. Community pharmacy owners are now becoming more dependent on locum pharmacists to fill vacancies, and the fees have gone up by 80%. What will the Government do to deal with this problem as a matter of urgency to support local community pharmacists?

Health Education England’s 2021 community pharmacy workforce survey identified an increase in the number of pharmacists from 23,284 in 2017 to 27,406. From 2026, all newly graduated pharmacists will have a prescription qualification, and we will upskill the existing workforce. This will provide further opportunity for the community pharmacy sector to better support the delivery of primary care.

Of the 720 permanent pharmacy closures since 2015, 41% are in 20% of the most deprived areas. I cannot see how this squares with the Government’s vision of using pharmacies to relieve pressures on GPs and primary care. Both large and small pharmacies are affected, including those in supermarkets such as Sainsbury’s, Asda and Tesco. Boots is reducing essential pharmacy services, such as the provision of blister medicine packs for the safe taking and administering of daily medicines by patients, domiciliary care workers and carers who look after elderly and disabled patients. How will the Minister address this issue, which stands to affect thousands of patients?

My Lords, 80% of the population live within 20 minutes’ walking distance of a pharmacy. There are twice as many pharmacies in more deprived areas. Despite a reduction in the network in recent years, there are still about the same number of pharmacies today as there were 10 years ago.

My Lords, in answer to my Written Question last November the noble Lord, Lord Caine, conceded that

“This Government has had no discussions with Community Pharmacy NI about funding for pharmacies in Northern Ireland.”

In the subsequent four months, the crisis facing community pharmacies in the Province, which rural communities are so reliant on, has continued, with the future of some clearly at risk. I urge the Minister to ensure that community pharmacies in Northern Ireland are given active support from His Majesty’s Government so that they do not become the latest casualties of the political vacuum in the Province.

Unfortunately, I was not in the House in November last year, but I hear very strongly what the noble Lord is saying about healthcare and pharmacies in Northern Ireland and I will certainly feed that back to the department.

My Lords, what has to happen in the independent pharmaceutical sector for the Government to realise that there is a crisis? This has been running for years. Independent pharmacies are closing at an alarming rate, as we have heard from other Members of this House. The Government seem to be in total denial. What has to happen for the Government to recognise and confront this issue? How many pharmacies have to close? Are they waiting for them all to close before they recognise the problem?

My Lords, there are more than 11,000 pharmacies in England. Some people know the true value of local pharmacies, but people do not always know just what pharmacies are able to do and how skilled pharmacists are at diagnosing minor illnesses. We want to continue to unleash the potential and make the best possible use of the skills and knowledge of community pharmacy teams to support the wider NHS. As I said earlier, from 2026 all newly graduated pharmacists will have a prescribing qualification: we are upskilling the existing workforce.

My Lords, do the Government recognise that local pharmacists may well be the people who know best of all who is seriously ill and potentially at the end of life in a particular area? They may have been involved in dispensing a just-in-case box for the family. They may know that that a patient is taking a lot of complementary therapies but, without access to the clinical record and a systematic way of feeding the information in, they become an add-on to the clinical service, rather than being able to contribute. They may also be unable to give really appropriate, targeted advice as part of the clinical team. Will the Government seriously look at ways of ensuring that community pharmacists can, with patients’ permission, access the clinical record, to really understand what is happening to these patients, who are very vulnerable and need good advice?

The noble Baroness raises several good points there. From my personal experience of pharmacies, they do have access to those records, but unfortunately that is not across the board and there is still more to be done on that front.

My Lords, would the Minister like to have another go at answering the question from the noble Lord, Lord Grade? I did not really get from him any sense of how the Government are dealing with the crisis in community pharmacy. There has been a 30% cut in real terms since 2015. As he said, many independent pharmacies are going to the wall. They are faced today with huge inflationary pressures, yet all we get are platitudes from the Government. When will they do something?

My Lords, they are private businesses and some close, some open and there are changes. As I said in an answer I gave earlier, there are still the same number of pharmacies as there were 10 years ago.

My Lords, we can anticipate that our Prime Minister understands something about pharmacy for obvious reasons. In my experience over some years, the opportunity lies in the hands of local NHS commissioners. The contract allows them to commission additional services such as minor illness services and, in the past, medicine use reviews, but they often did not do so. What steps might the Government now take with ICBs to encourage them to undertake more of the commissioning of additional services?

I thank my noble friend for that very good question. ICBs are encouraged to do exactly what he says. I refer to an answer I gave earlier: from summer 2023, NHS England will start piloting prescribing services in community pharmacies—exactly as he suggests.

My Lords, the best use of community pharmacies will come at a price. Can the Minister give us an indication of how much that will cost? Has anyone calculated how much it will save GPs? If he does not have the figures to hand, could he put them in the Library?

My noble friend is aware of the work I do with dispensing doctors and the fact that they have a role to play where there is no pharmacy. Is he as concerned as I am that routine procedures, such as syringing of ears, are being taken away from general practice? Why can general practitioners not continue to do such routine procedures?

My noble friend raises a very good point. I have experience in my own family of GP practice doing exactly that. I am not aware of that being deliberately taken away but, if she wants to speak to me about a specific case, I will certainly look into it.