Members will have seen media coverage over the weekend about our consultation on the community pharmacy contractual framework. I shall 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 general practitioner sector.
We proposed ways in which to make a reduction to the £2.8 billion currently paid to the sector. Part of the rationale was the increase of 40% in the budget and an increase of 18% in the number of establishments in the past decade or so. Each establishment now receives an average £220,000 of margin over and above the cost of drugs disbursed. Many of the 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 that we need to deliver. We are confident that the changes proposed will not jeopardise the quality of services required or patient access to them, but 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 in GP practices.
The Government have consulted on the reforms since December 2015. On 13 October this year, the Pharmaceutical Services Negotiating Committee 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.
Thank you, Mr Speaker, for granting this urgent question. Community pharmacies play a vital role in frontline healthcare. Nearly 12,000 communities in England provide free advice to patients, and more than 1 billion items were dispensed in the community last year—an increase of 50% on 2005. Reports in recent days, however, make it clear that the Government are determined to press ahead with massive cuts to community pharmacies in this and the next financial year.
Serious questions remain about the impact of those cuts. When will Ministers finally publish an impact assessment of the proposed plans? How many pharmacies will close? Which regions will lose the most? Will they be in clusters or not? What will be the rate of loss in urban, as opposed to rural, areas? Will the Minister confirm that only about one in 10 community pharmacies will be helped by the pharmacy access scheme?
Community pharmacies and the cuts to them are a complete false economy for the NHS. They can only add further pressures to our already overstretched A&E units and GP surgeries. What is the Minister’s assessment of the downstream costs to other parts of the NHS as a result of cuts to the community pharmacy budget, especially given the evidence from Pharmacy Voice that one in four people who would usually visit a pharmacy for advice would instead make a GP appointment if their local pharmacy was closed? In areas of higher deprivation, such as those in my constituency, the numbers are much higher.
We have seen massive opposition to these cuts, not just from pharmacies and voices on both sides of the House, but from the 2.2 million people who have signed the biggest petition in healthcare history. To conclude, Ministers have, to be frank, been all over the place. We have had mixed messages and false hope. The Government announced a pause to the cuts. Is not there now a compelling case for that pause to be made permanent?
The hon. Gentleman has not had any mixed messages from me. A pause was announced because the original consultation gave the intent to go ahead with this on 1 October. Given the change of Government and of Prime Minister, and given the new Chancellor and new Ministers, we took the opportunity to look at it again, to make sure that we get it right for patients, the NHS and the pharmacy sector itself, and that is what we intend to do.
The hon. Gentleman asked several questions, but first he said that the pharmacy sector is vital, and we agree with him. In some instances, however, there are as many as a dozen pharmacies within half a mile of each other. That is not an isolated occurrence. Each of those pharmacies receives £25,000 per annum, and it is our job to consider whether that money could be better spent in other parts of the NHS.
I am not in a positon today to announce the final format or shape of the GP access scheme.
That is speculation. We continue to look at the most recent communication that we have received from the negotiating body of the PSNC. I remind the House that 60% to 65% of these pharmacies are owned by public companies or private equity. The fact of the matter is that the Government have a responsibility to make sure that that money is spent effectively, and that is what we are going to do.
Finally, the hon. Gentleman said that GP access needs to remain good. I confirm and repeat the point that I made earlier: 1,500 additional pharmacists will be recruited into the GP sector by 2020. That is a massive investment, and it will make a big difference.
I should declare that Boots has its headquarters partly in my constituency and partly in Nottingham South. May I gently say to the Minister that there is great concern about the proposals? If there was ever a time to argue to increase the role of pharmacies, it is now. They perform a hugely powerful job in making sure that people do not, to be frank, bother their GPs and A&E with matters that are best dealt with by pharmacies because they are of a minor nature. The Minister makes a good point about clustering, but he has to get this right, because, if he damages pharmacies, there will be fewer of them, not just in poorer areas, but in remote rural areas. I urge the Government to take a hard good look at the issue, to make sure that this is the right approach as the pressures on the NHS increase.
I agree with my right hon. Friend. Boots makes a big contribution. It owns 1,724 pharmacies and is the biggest of the big four, which between them own 40% of all pharmacies. The Government’s position is that community pharmacists make a big contribution, but I repeat that the number of locations has increased by nearly 20% over the past decade, and each one gets £25,000 per annum just for being open and for being a pharmacy. One consequence is that we have seen a great deal of clustering, and 40% of pharmacies are within half a mile of three others. It is right that the Government look at that and make a judgment.
I congratulate my hon. Friend the Member for Barnsley East (Michael Dugher) on securing this urgent question and on his exceptional campaigning on the issue. He is, no doubt, as disappointed as I am by some of the Minister’s replies.
Ministers appear to be intent on pushing ahead with the cuts that have been outlined, under which thousands of community pharmacies could close and patients could lose out on essential medical services. The Pharmaceutical Services Negotiating Committee has described the Government’s proposals as “founded on ignorance” and warned that they will do “great damage”. The National Pharmacy Association says that the proposal is a “dangerous experiment” that
“shows a complete disregard for the well-being of patients.”
Is that not an absolute indictment of the Government’s handling of this matter? The Minister has said that he will make an announcement shortly. Given the concern among Members from across the House, including Conservative Members, can he be more specific and tell us when he will give us a final decision? Will he also be negotiating a solution with the Pharmaceutical Services Negotiating Committee? As the Minister knows, his predecessor talked of the potential for up to 3,000 pharmacies to close. Is that correct, in the Minister’s judgment? If not, can he tell us how many pharmacies he thinks will close, and how many of those will be in deprived areas?
Has the Minister had a chance to study the PwC report that describes the cash savings that community pharmacies bring to the NHS? What will be the financial impact on the NHS of more patients presenting themselves at A&E departments and GP surgeries because pharmacies have closed?
Is not the real reason why Ministers are pressing ahead with these cuts the complete mismanagement of NHS finances? Hospitals ended last year £2.45 billion in the red. We have had continual warnings from experts in the NHS, and over the weekend we learned from the Prime Minister that there is no more money for the NHS. The Secretary of State and the Prime Minister would be wrong to continue to ignore the advice of experts and pretend that everything is going to be okay. Unless the Government get a grip of the funding crisis facing the NHS, I fear that these cuts are just the start and that there is worse to come.
The Government spend more than the OECD average on the NHS. We spend more than the commitments made by the Labour party before the last election. That does not mean that we do not have a duty to spend that money as effectively as we can, however, and that is exactly what we intend to do. The money that may be saved by the measures we are consulting on will not go to the Treasury; it will be recycled back into NHS England. That is what NHS England wants to happen.
The hon. Gentleman mentions the excellent PwC report, which reaffirmed the value of community pharmacists to this country. PwC did not consider whether that same value could be still provided after some savings to the network. That is what we are looking at, and it is reasonable and responsible for the Government to do so. To say that that is not the case is simply incorrect.
The hon. Gentleman mentioned that the previous Minister talked about 3,000 pharmacies closing. We do not believe that the number will be anything like that big. In some areas, there are 10 or 11 pharmacies within half a mile of each other. [Hon. Members: “Where?”] Leicester, Birmingham—we can talk more about this. It is quite possible that at the end of the review, some of those pharmacies will merge. If that happens, it will not mean that provision has been reduced. We do not believe that patient provision will suffer at all from the changes that we are considering.
Community pharmacies play a very important role locally. Many of them have taken on useful services, such as eye tests and hearing tests, which definitely help to reduce the workload of GPs and of the NHS. Does my hon. Friend agree that we need a community pharmacy service that is better integrated with primary care and public health in line with NHS England’s five-year forward view?
It will not surprise the House to learn that I agree. Last Thursday night, I announced to over 1,000 pharmacists at their annual dinner that we are moving ahead with an urgent access scheme. From the beginning of December, all 111 calls for repeat prescriptions will go directly to pharmacists, not to the out-of-hours GP service. That is a tangible difference. We will do just the same with a minor ailments scheme, which will be commissioned right across the country so that, by April 2018, pharmacists will be paid—over and above any money that comes out of this settlement—for minor ailments work on things such as earache and so on. Those are exactly the sort of sensible steps that need to be taken to integrate pharmacy more closely into GP practice, and that is what we are doing.
In Scotland, we already have a national minor ailments scheme within our community pharmacies, and it has had a huge impact. The Scottish Pharmacy Board estimated at the beginning of the project that 10% of those making GP visits and 5% of those making A&E visits could be seen in community pharmacies, so our investment has been in completely the opposite direction—in that of developing and strengthening such pharmacies. On top of minor ailments, one of the big areas that has made a difference is in chronic disease management. For people on repeat prescriptions, the pharmacist requests their next prescription and has it ready, while for housebound people, they deliver it, as they do with blister packs.
The concern about these changes is that pharmacists are afraid it will be a case of cutting and then seeing who survives. If it is felt that there are too many pharmacies in one place, reducing their number needs to be done in a planned way, otherwise rural and deprived areas will end up without one. The Government should be making sure that community pharmacy is a real part of the NHS, not slashing it.
The hon. Lady made several points. On her last point, the access scheme on which we are currently consulting will protect pharmacies in rural and deprived areas. That is precisely the point of the scheme.
The hon. Lady’s first point was that Scotland has moved ahead on minor ailments, and we agree. I am on the record as saying that the pharmacy first scheme in Scotland is a good model. We want the profession to move away from just dispensing towards more value-added activities, such as services. That is precisely why we are putting into effect the minor ailments scheme that has been piloted. It will be implemented right across the UK—right across England, I should say—from April 2018.
In the lee of Watership down in my constituency, the village of Kingsclere was so alarmed by the Government’s plans that it raised a petition, possibly for the first time in its history, in support of its precious local pharmacy. Will the Minister confirm that, notwithstanding the consultation, the idea of protecting the dwindling number of rural pharmacies will come out at the end of the consultation as part of the access scheme?
Yes, I will confirm that. I am not in a position to announce today precisely how the access scheme will work, but I agree with my hon. Friend that a central part of it will be to make sure that everybody has a baseline distance to travel to get to a pharmacy and that everybody in the country will be able to access pharmacies within a reasonable time.
NHS England’s five-year forward view stresses how important prevention is. Community pharmacies, which are anchored in the communities they serve, are vital in keeping people out of their GP surgeries and out of accident and emergency. The Minister talks about distance. What will the distance be? If I reflect on my own constituency, where the millionth signature of the petition was signed, my constituents really value each and every one of our community pharmacies. How many will he be cutting and how far does he expect people to travel to access one?
The hon. Lady mentions the five year forward view. If she reads the “General Practice Forward View”, she will see that central to it is the recruitment of 2,000 pharmacists into GP practices across the country by 2020. That is how we will embrace the pharmacy profession and link it much more closely to GPs. I am not in a position, because we have not yet announced it, to discuss in detail today the final form of the access scheme and how it will work. Let us be very clear, however, that we do not expect people to have appreciably more of a journey to any pharmacy. We are talking about tens of metres, if any. The fact is that we will protect the pharmacies that need to be protected, so that everybody in the country has access within a reasonable time.
Where sensible savings can be made, it is absolutely right that they should be explored, particularly if they are ploughed back into the health service. However, at a time when people in Cheltenham are turning increasingly to expert pharmacists for minor ailment support, can the Minister assure me that no changes will take place that undermine the welcome trend of going to pharmacies and not GPs?
We do not believe that any community pharmacies will necessarily close as a result of these cuts. That will depend on a number of factors. [Interruption.] I will answer the question, which is fair. It depends on the margin they make from their pharmacy activities and on the additional margin they make from their retail activities. Given that 65% of all pharmacies are owned by public companies or private equity, it depends on the position those organisations take to their businesses. That is very hard to predict.
Will the Minister say a little more about how he sees these plans tying in with the agenda to better integrate health services? In Weldon in my constituency, GP and pharmacy services work very well together for local patients under the leadership of Dr Sumira. What best practice is out there, and what attention is the Government giving to it?
As I said, we are recruiting an additional 2,000 pharmacists into general practice by 2020. We will also link community pharmacists into the NHS 111 system in a way that has never been done in England, so that repeat prescriptions will go direct to pharmacists and not to out-of-hours GPs. By 2018, pharmacists will receive additional payment for looking after minor ailments.
I declare an interest as the chair of the all-party pharmacy group. In February this year, the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said there would be an impact assessment. In answer to a parliamentary question I tabled last week and the Minister answered, you also said that an impact assessment will be published, so that it would inform the final decision. Can the Minister tell us when that will be published? Will it be shared with representatives of community pharmacists?
On Thursday, my local clinical commissioning group will announce whether it is going to press ahead with plans to downgrade A&E at the Huddersfield royal infirmary. Can the Minister not see that when our A&Es are under so much pressure, we need community pharmacies and GP surgeries to see patients on the front line? I appreciate what he says about clustering, but having seen the last bank branches close in my rural communities, I am sorry but I just do not have confidence in it.
All I can do is repeat the point that I made earlier. The Government completely agree that we need community pharmacies. The Government completely agree that they have a vital role to play in keeping patients away from GPs and, potentially, from A&E as well. That, however, is not the same as saying that the 11,800 pharmacies that we have at the moment are precisely the right number, or that the clustering is at precisely the right number as well. It is right for the Government to review this and to establish whether or not the £25,000 of NHS money that every pharmacy receives every year is money well spent.
As we have heard, pharmacies have the potential to help the NHS become more efficient and community based. Community pharmacies are an integral part of the integrated care communities that the Success regime in Cumbria is promoting in order to take the pressure off our overstretched GPs and A&Es. We are really struggling to recruit doctors in Cumbria, so any loss of community pharmacies is a serious loss to our community. Can the Minister assure me that these wider health challenges are being taken into account?
Yes, I can assure the hon. Lady that we fully understand the issues in places such as Cumbria. To an extent, the access scheme is designed to make sure that large rural communities are properly protected. I can only repeat that we value the services that pharmacies provide and that we do not believe that there will be a substantial detriment to them as a result of a bit less clustering.
Given that as part of the Greater Manchester devolution deal, the Greater Manchester health and social care partnership has taken control of the £6 billion a year health budget, will Greater Manchester be treated differently? If not, is there not a case for the area to be allowed to determine for itself how best to make use of community pharmacies?
It is my belief that the devolution deal does not include pharmacists, so the responsibility for that sector remains in the Department of Health. The proposals that we shall shortly outline will therefore include proposals for pharmacies that will apply equally to Greater Manchester.
The Minister may not know how many pharmacies are going to close, but Reena Barai, an award-winning community pharmacy in my constituency, estimates that one out of four pharmacies in the London borough of Sutton, which is 11 pharmacies in total, will be closed. These will predominantly be the independents—not Boots or Superdrug. Why does the Minister think that, for years, successive Governments have encouraged people to visit their pharmacies for certain conditions or tests, instead of GP surgeries and A&E? Was it not because it was better for their health and cheaper?
I can only repeat that we value and can see the value in community pharmacies. We do not believe that any reductions will be skewed towards the independent sector; nor do we believe that the sector’s position overrides our duty to look at clustering and to make sure that the money we spend in this sector—£2.8 billion—is spent most effectively and cannot be spent better on other parts of the NHS.
As far as residents in the Kettering constituency are concerned, community pharmacies are a good thing. They relieve the pressure on the overburdened A&E at Kettering general hospital, and they are the only place to go when people cannot get an appointment at their local GP surgery. Can we please make more use of the community pharmacies that we have? If the Minister is right, and he suspects that not many community pharmacies will close, let me tell him in all candour that the process he is going through is completely cack-handed, because it is spreading fear among the community pharmacy community up and down the country?
The current process began in December last year, and will be brought to an end shortly. I do not know about the specifies of the pharmacy scene in Kettering, but I repeat that we regard pharmacies as vitally important to the NHS. One of the proposals that we shall announce shortly is a proposal for an integration fund of £300 million, which will be used entirely to provide services and pay for pharmacies to provide them. It will be informed by the review that is being conducted by Richard Murray of the King’s Fund, and Kettering will benefit from those services in just the same way as other parts of the country.
May I enthusiastically endorse the comments made by the hon. Member for Kettering (Mr Hollobone)? Community pharmacies are an underused resource. We currently spend £10 billion a year on diabetes treatment, 80% of which is spent on treating avoidable complications. Instead of cutting pharmacies, why do we not get them to do more to help with diabetes prevention, and to identify the 1 million people who have diabetes and do not know about it?
We intend to do more to help pharmacists to help with diabetes prevention. Diabetes is one of several long-term conditions that the Murray review is examining. There are ways in which pharmacies can be used to avoid repeat or ad hoc GP appointments, which is precisely what we want to happen, but that is not the same as not keeping under review the amount of money that we pay pharmacists for dispensing, and ensuring that we are getting a good deal.
The right hon. Gentleman said that he agreed with the hon. Member for Kettering (Mr Hollobone). The density of the United Kingdom’s pharmacy network is approximately double the density of networks in Holland, Sweden and Denmark. No one thinks that it should fall to the same level as theirs, but there are opportunities for us to review clustering and ensure that the NHS is receiving value for money, and that is our duty.
I congratulate the hon. Member for Barnsley East (Michael Dugher) on his urgent question, although I am slightly sorry for the excellent Minister, who is having to deal with the question before the Government are prepared to make an announcement. I agree with my hon. Friend the Member for Kettering (Mr Hollobone) that community pharmacies are very important in Northamptonshire, given that the rest of the national health service in our area is under such pressure. If the amount saved is really going to be so small, I urge the Minister to say, “Actually, let’s drop this. It is just not worth the battle.”
I can only repeat that we value the contribution that community pharmacies make, and that the savings that we shall propose shortly are needed for other parts of the NHS. We believe that provision will not be affected, and that other parts of the package, including the integration fund and the hiring of an additional 2,000 pharmacists for the GP sector, will make this sector work better than it does at present.
Community pharmacies play a vital role in primary care, and there is a very important relationship between them and our constituents and their patients and customers. My constituency contains a healthy living pharmacy that provides added value. Is not the Minister’s reductionist proposal about price rather than quality, and should we not be looking at the quality of pharmacy provision? Healthy living pharmacies in Hyndburn, and in Lancashire generally, provide an exceptional service, and should not be under the dark cloud that is hanging over them as a result of the Minister’s proposal.
The hon. Gentleman has made a good point. A large part of the value added from pharmacies is related to quality, and we need to reward the pharmacies that are trying harder than others to provide it. The hon. Gentleman mentioned healthy living pharmacies, and there are many examples. Part of our package will address the quality issue, which is one of the issues that the Pharmaceutical Services Negotiating Committee asked us to consider.
If the Minister wants to make the savings that he has talked about, he should work with the pharmacists and listen to what they have to say, because they have the ideas about how to make those savings. In my constituency, they talk to me about the potential for reducing repeat prescriptions, among other ideas. If he does that, he will play a role in looking after the heart of our community, which is what pharmacists are, and the heart of our NHS, which is also what they are. They also play an incredibly important role in every community in providing much needed footfall for other local businesses.
We have been talking to the Pharmaceutical Services Negotiating Committee for 10 months. We have tried to incorporate, in the proposals that we are going to make, some of the points it has put to us. I can only again tell hon. Members, as I have already said to many others, that we value the contribution that the pharmacy sector can make. We wish to see that move over and above what it is now, in terms of dispensing, into more value-added services dealing with minor ailments, repeat prescriptions and long-term conditions. We want to do all those things, and we will.
The Minister should tread with great care. I have visited many community pharmacies in my constituency, and in each and every one I saw lots of value-added activity—preparing medicine trays, delivering medicines or whatever—and a keenness to be involved in wider activities. There is a real danger that the Minister, in seeking savings, will cost the health service and communities more.
May I give some advice to the Minister? If he wants reforms—I think that the feeling on both sides of the House is that we need a high-performing, innovative pharmacy sector, which is at the heart of every community, urban and rural—and if he wants to generate enthusiasm in the workforce, he should not demoralise them at the very beginning. His predecessor was the person who said, “Let us cut 2,000 pharmacies.” That is the truth. The Minister should not just reach out to pharmacies at posh dinners—he should come to Huddersfield, which is more exciting than Kettering, and talk to our pharmacies.
The hon. Gentleman makes a good point: I should not just reach out to pharmacists at posh dinners. In the past three weeks, I have visited a number of pharmacists. I have even opened a new pharmacy. I bow to no one in my view of the value that they can add, but they agree, and I think most Members in the House agree, that the community pharmacy network must move from a model based on dispensing to a model based more on services. We are going to help pharmacies to do that, and these proposals in the round will achieve that.
As we have said, primary care is the cornerstone, indeed the foundation, of the NHS, and pharmacies represent a successful public-private model. This proposal does seem to be a totally counter-intuitive one. When I, on the Public Accounts Committee, questioned the chief executive of the NHS last month about the Department of Health accounts, he expressed surprise that there may be a reprieve for pharmacies, because the reality is that this is an in-year cut that is already happening; it is part of NHS England’s delivery of savings this year. Can the Minister clarify the reports over the weekend—what are the figures we are talking about? The reports were that the cuts would be £113 million in 2016-17 and £208 million in 2017-18. Are those the correct figures?
The figures to which the hon. Lady refers were announced in the consultation in December 2015. The only change since those figures were announced in that consultation in 2015 is that, because of the delay in looking at this again, the in-year saving this year is likely to be lower.
Those of us who wish the Minister well would probably best describe his performance at the Dispatch Box this afternoon as “courageous”. I feel that he has been sold a hospital pass on this one. He is responsible for a policy that lurches from the inchoate to the indefensible; that talks on the one hand about recruiting thousands of pharmacists and on the other about closing thousands of pharmacies. I am sorry, but we cannot keep loading, even on to the willing shoulders of the community pharmacies, more and more responsibility while we are draining away the financial lifeblood. Would the Minister care to become the most popular Minister on the high streets of our nation by saying that he is going to have another look at this nonsense?
I am always keen to be popular, but I am also keen to do the right thing. Nobody is talking about thousands of pharmacies closing and I do not believe that will happen, but we have talked about hiring 2,000 more pharmacies in the GP sector. That is true, but that is not incoherent; that is the right thing to do.
I just say this to the House: we all need to distinguish at times between the pharmacy profession, which we need and will nurture and help to grow and that can produce all these added values, and those people who own the pharmacy shops, 65% of which are public companies and private equity. The House should just reflect on that.
It really is possible that the centre-ground in British politics is changing. Here we have a Conservative Minister coming to the Chamber to say, “I’m going to put hundreds of small firms out of business, but don’t worry; I’m going to get them all working for the Government.” It is absolutely bizarre, and the Minister is now trying to convince us by saying, “Don’t worry, they’re all hedge funds anyway.” We know it is not the Boots in the centre of Chesterfield that is going to be shutting; it is the community pharmacies in each of our communities. So will the Minister at least give us the commitment that no community will be left without a pharmacy and that no doctors’ surgery will be allowed to have a pharmacy close on its doorstep?
I cannot impress strongly enough on the Minister the danger of these proposals. In my constituency the pressures on primary care are such that GP surgeries cannot recruit GPs and many practices are now not meeting Care Quality Commission standards because they are in old premises that are unsuitable. The thought that on top of that we would reduce the possibility for people to attend their local community pharmacy for simple healthcare needs is frightening. When the Minister publishes the impact assessment, will it provide any sort of reassurance and clarity that those complex primary care factors have been properly taken into account?
We have talked all afternoon about the need to protect access to GPs, and I repeat the point I made earlier: our proposals in the round should increase the degree to which pharmacists are linked into GP practices. The hon. Lady says that many practices are getting poor-quality assessments, but the fact is that over 80% of them are getting good-quality assessments, and we need that to continue.
The proposals we are setting out in the round are expected to make pharmacy access better than it is now, and the orientation of the pharmacy profession towards services and away from just dispensing should happen more quickly.