Community Pharmacies
(1 year, 10 months ago)
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Peter Dowd (Bootle) (Lab)
I beg to move,
That this House has considered the future of community pharmacies.
It is a pleasure to see you in the Chair this afternoon, Sir Gary. As a member of the all-party parliamentary group on pharmacy, I am pleased to introduce the debate and glad to see so much support from Members who obviously, like me, recognise the huge value that our pharmacies bring to the NHS, patients and the public generally. I hope everyone here agrees that England’s 11,200 pharmacies play a crucial role in providing important healthcare, life-saving medicines and an increasingly wide range of clinical services to their local communities. Not only that, but as the most accessible providers of healthcare, pharmacies are key to reducing health inequalities: 89% of the population are less than a 20-minute walk from their nearest pharmacy, increasing to 99.8% in the most deprived areas, such as mine. It is fair to say that pharmacies understand their communities to a significant extent—sometimes more than the traditional health services—and as such are ideally placed to engage with the most marginalised and vulnerable groups in our communities.
The wider public appreciate the easy accessibility of pharmacies, which by their very nature are located at the heart of every community throughout the country. Throughout the pandemic, not only did community pharmacies remain open and continue to offer their full range of services, but they played a huge role in the vaccination programme, delivering an astonishing 24 million jabs. They also distributed some 27.6 million covid lateral flow tests and initiated a pandemic delivery service that ensured that 6 million vulnerable patients could access their medicine.
I think I am correct in saying that all Members present today would like to put on record their thanks and express their appreciation for all pharmacists, pharmacy dispensers, pharmacy technicians, medicines counter assistants, delivery drivers and administrative teams, who worked so hard during that difficult time to maintain the public’s access to the pharmaceutical services that they relied on. We, and the whole country, owe them a debt of gratitude. But we must also recognise that it is not just about thanking staff; it is also about recognising that the conditions they work in are crucial to the maintenance of a good service, whether a member of staff works in a larger or a smaller pharmacy provider.
Sir John Hayes (South Holland and The Deepings) (Con)
I congratulate the hon. Gentleman on securing the debate. The point he is making appears to be twofold: first, as well as responding to need, pharmacies can have a role in preventive medicine; and secondly, we now need to shout louder about that. Pharmacies did a heroic job during the pandemic and they continue to do so, but I am not sure that everyone knows as much as he clearly does about what we can do with and at a community pharmacy, and this debate serves the purpose of telling them.
Peter Dowd
The right hon. Gentleman makes a really valid point, and I will talk about some of that later. We have to recognise that, despite pharmacists trying to help people, they sometimes got dreadful abuse. We have to help them and protect them from abuse. That is part of addressing their working conditions. Vacancies in the sector are not caused simply by a shortage of pharmacists. It is also about which part of the space pharmacists work in. In other words, if I were a pharmacist, I would ask, “Do I like the conditions, pay and terms of my work?” If the answer is no, people move on.
Pharmacies are not just a shop; they are a healthcare setting and should be treated as such. They are a crucial part of the NHS ecosystem. I suspect that that is why a pharmacist needs to be on site all the time—this is not just a shop operating within a transactional context. Aside from covid, pharmacies are doing an incredible amount of work for their local communities every single day. In the most recent flu season, in 2021, pharmacies mobilised to deliver the biggest flu vaccination campaign on record, administering 4.85 million doses—over 2 million doses more than in the previous flu season, representing a 75% year-on-year increase.
The recently commissioned NHS blood pressure check service has already meant that 100,000 people have had their blood pressure checked in a pharmacy. Anecdotally, pharmacy representatives say they are already hearing that these checks have picked up cases of extremely high blood pressure in patients, who have then been referred on for treatment. This is a very highly valued healthcare intervention, which will save the NHS money in the long run, because it is cheaper to prevent disease than it is to treat it. More than that, however, I am convinced that these interventions will save lives.
Those two services on their own demonstrate pharmacy at its best. PwC estimates that the sector contributes around £3 billion in net value to society as a whole, and it works every day to improve the health and wellbeing of our local communities and our constituents. That is surely why we have the NHS in the first place.
What is the current financial health of the sector? It is no exaggeration to say that the community pharmacy network is under huge strain and that pharmacy staff and businesses are coming under increasing and, indeed, unsustainable pressure. Pharmacy funding is currently flat, with the total available funding envelope fixed at £2.592 billion. In practice, the Pharmaceutical Services Negotiating Committee reports that this means that real-terms funding is decreasing year on year, as inflationary pressures, rising business costs and increasing workload are not taken into account in that funding deal. Despite all that, many pharmacies have remained open, albeit under extremely difficult economic conditions.
However, the PSNC says that some businesses are reaching the limits of what is possible in terms of remaining viable, and that is already having an impact on patients. A recent survey on pharmacy pressures, conducted by the PSNC, found that 90% of pharmacy businesses are now unable to spend as much time with patients as they did before. Perhaps more worryingly, 92% of respondents said that patients were beginning to be negatively affected by the current pressures on their pharmacy. Despite pharmacies being a significant part of the NHS family—on average, at least 90% of their income comes from the NHS—pharmacy funding has not received the annual funding growth of 3.4% per annum that the rest of the NHS has been afforded.
Those in the sector feel that it is time to put things right. Indeed, the PSNC recently submitted a funding bid to the Department, making the case for extraordinary economic circumstances to be taken into account. When the Minister responds to the debate, I hope she will update Members on whether a funding increase will be granted to the sector.
The PSNC also estimates that the sector has had to make efficiency savings of between 37% and 50% in order to manage the funding squeeze and to keep providing the services it is contracted to deliver, but how much more pressure should we expect it to operate under? Do we want a bare-bones network that delivers only the very basics for patients, or do we want a vibrant, innovative sector that is constantly looking to the future to find new ways of working and providing a personalised and consistently high-quality service for patients, and that is fully integrated with other areas of healthcare and able to be consistently relied on in the future, as millions of people relied on it during the pandemic? Members can certainly guess what my preference is.
One thing is for certain: maintaining the status quo is not an option. So what does the future of community pharmacy look like? I would like to see pharmacies evolve into the go-to healthcare settings for help with minor ailments. There is no need for otherwise healthy patients with minor conditions to continue to see their GP. The truth is that they can get the same expert advice from their local pharmacist, who can exercise their clinical judgment and sometimes even prescribe medicines or offer an over-the-counter treatment at half the cost to the NHS. Indeed, the PSNC estimates that if this policy was rolled out nationwide, the NHS could save a staggering £640 million.
What is more, there would perhaps be no need for people to queue in a waiting room or to visit multiple locations. Pharmacies could be a single go-to place for diagnosing, advising on and supplying medicines for the treatment of minor ailments. As we all know from when we go abroad, that system works in Europe and much of the developed world, so why not here? It would be potentially game-changing for the future of pharmacy and more widely for primary care. I hope the Minister will comment on what plans, if any, the Government have to commission a service of that nature.
Aside from minor ailments, pharmacies are well placed to deliver much of the prevention agenda set out in the NHS long-term plan. They could and should be at the forefront of promoting and supporting self-care. Future services could include a national emergency contraception service, or even the treatment of minor injuries. Pharmacies could also offer help and support to manage long-term conditions. For instance, they could offer a whole host of valuable services for supporting patients with asthma, such as an inhaler technique service or annual asthma reviews. Community pharmacies could do even more than they already do to review patients’ medication and ensure that it is being taken appropriately. That is all extremely important, from a patient perspective.
For the population that is otherwise healthy, pharmacies could play an increased role in promoting health and wellbeing, and in preventing and reducing further healthcare demand in the first place. After all, healthy people do not often visit hospitals or GPs, but they probably pass by pharmacies on the high street regularly. I certainly do. Pharmacies could conduct NHS health checks with enhanced patient follow-up, and they could use personalised wellbeing plans to help people to make healthy lifestyle choices. Pharmacies could also replicate their success with the flu and covid vaccination programmes by expanding into the provision of others such as the shingles and pneumococcal vaccine and NHS travel vaccinations.
When it comes to what pharmacies can do to improve patient outcomes, the possibilities are endless. I know at first hand that, given the capacity and a good working environment, pharmacists and their teams are ready and willing to take on and promote all those new services, but that has to be put into the context of wider deliverability. Let me use one example. Amanda Pritchard, the NHS chief executive, recently announced funding for high street pharmacies to identify signs of early cancer, and for subsequent referrals and follow-up by clinical radiologists. That is a good initiative. Nonetheless, as Anne Brontë wrote,
“there is always a ‘but’ in this imperfect world”.
Workforce and equipment issues are obstacles to a successful roll-out, given that the radiology system is already under pressure. What about an audit and a replacement programme for our increasingly outdated and, in some cases, obsolete imaging equipment? There are no plans to tackle the annual 7% increase in complex imaging demand and no plan to meet the workforce demand, with a 30% shortfall in clinical consultant radiologists. That figure is going up, and there are backlog issues.
The only question is whether the Government will now enable the community pharmacy sector to fulfil its potential by supporting the range of possible services, and by providing it with appropriate support and funding. I sincerely hope that the answer will be yes.
Several hon. Members rose—
Sir Gary Streeter (in the Chair)
Order. The Front-Bench spokespersons are due to begin at 5.10 pm. There are four other Members who wish to speak, so you each have six minutes.
Sir John Hayes (South Holland and The Deepings) (Con)
I will be mercifully brief, given the overture you have just offered the whole gathering, Sir Gary.
I want to do three things. The first is to endorse the comments of the hon. Member for Bootle (Peter Dowd) about the significance of community pharmacies. As I said in my brief intervention, that was drawn into sharp focus during the covid pandemic, when people began to realise quite the extent to which pharmacies and pharmacists are among the unsung heroes of the NHS. They provide services that are both proactive, in preventive medicine, and also reactive. They are often the first port of call when people seek medical advice.
The second point I want to make is that we should be saying much more about pharmacies. Indeed, it is important that we do, so that people know they can access those services. The point about celebrating the role of community pharmacists is not just to congratulate them on all they do, although that is worthy in and of itself, but to spread the word and evangelise about what they do to people who are not taking advantage of those services. I think particularly of the preventive services that the hon. Gentleman highlighted, which deal with things such as diabetes and blood pressure. We must ensure that there is early detection and diagnosis of conditions, so that people can be referred to other elements of the NHS and dealt with promptly. These are all aspects of the role of pharmacies, which deserve to be better known for the good that they can do.
My third and final point is informed by my visit to Holbeach community pharmacy, where I met staff in anticipation of the consideration of these matters, which I know the House takes seriously. Last week, I also met a pharmacist to discuss what more can be done. As the Government’s long-term health plan says, NHS England and the Government need to work together to see how the advantages of community pharmacies can be cemented and expanded. In saying that, I offer a word of warning: we should not see pharmacies as an alternative to GP services. We are having a debate in the main Chamber—almost as we speak—on those pressures, and I do not think that any of us would want to say that pharmacies should replace GP services. There is an overlap, but they are distinct aspects of healthcare. I know the Minister will want to reflect on that, and perhaps she could comment on it today. That is my caveat, but it is none the less important that the Government and NHS England look at how the services provided by community pharmacies can be cemented and built on.
The secret of this debate, if I may put it that way, can be expressed in two words: “pharmacies” and “community”. These pharmacies must be sufficiently accessible and plentiful—particularly in areas such as the ones that you and I represent, Sir Gary—so that people can gain all the benefits I have described, as close to home as is reasonable. There has been a trend in public services during my lifetime, including my political lifetime, towards centralisation and obliging people to travel further for the things they need to service their wellbeing. It needs to be reversed by the Government, who need to think much harder and more clearly about this issue. We need public services to be accessible to those who need them. That is particularly salient for the most vulnerable of our constituents, who find travelling more challenging.
Let us have more community pharmacies, more distributed services and more cottage hospitals—more things happening within communities. Community is the second part of what the hon. Gentleman has drawn to our attention today. It is the lifeblood of a healthy society that services the wellbeing of all, thereby adding to the common good.
Taiwo Owatemi (Coventry North West) (Lab)
It is an honour to serve under your chairmanship, Sir Gary. I thank my hon. Friend the Member for Bootle (Peter Dowd) for securing this important debate. He gave a detailed opening speech, so I will aim not to repeat the points that he has made.
I thank all pharmacists, pharmacy technicians and assistants for their hard work and dedication, and for their contribution to delivering first-class patient care in the community. As right hon. and hon. Members have said, community pharmacists are not just an integral part of our healthcare system; they are at the heart of our communities. After all, 1.6 million people visit around 11,400 pharmacies in England every day.
I would like to take the time to make two brief points on the future of community pharmacists. Before being elected as the Member of Parliament for Coventry North West, I worked in the NHS as a full-time cancer pharmacist, and I still regularly volunteer locally at University Hospitals Coventry and Warwickshire as a pharmacist in cancer care. In my role, I have seen and experienced at first hand the vital role that pharmacists play in their communities.
Community pharmacists can dispense medication, deliver vaccinations, write prescriptions and consult on medication, to name just a few responsibilities. Above all, they are dependable and dedicated individuals who are excellent at providing medical knowledge and support for the communities that they work in. It is therefore deeply frustrating to hear about the steady erosion in the availability of community pharmacies.
Data from the Pharmaceutical Services Negotiating Committee, which will be providing constituency-based information at a drop-in event in Parliament on Tuesday 5 July, paints a very grim picture. Since 2016, 639 pharmacies have closed across England, and nine of them were lost in my city of Coventry. All the while, communities have needed quick medical support more than ever. We have heard in today’s Opposition day debate, and time and again from our constituents, about the crippling difficulties facing GP services.
The Government claim that they are doing all they can about the rising crisis in accessing GP appointments. However, that cannot be the case, as they have been ignoring the roles that community pharmacists can play in combatting this escalating crisis. Those were evident throughout the covid-19 pandemic, when pharmacists played a substantial role in the vaccine roll-out and in providing advice and support to patients during the three lockdowns. The pharmacy sector boasts a highly trained and clinically skilled workforce, who, according to the PSNC, could free up up to 40 million GP appointments each year. The Government need to make full use of that potential. Ministers should take another look at the role that pharmacists can play in supporting our GP services, rather than simply allowing pharmacies across the country to close for good. Smarter thinking here has the potential to make a massive difference; it could help to reduce waiting times, clear backlogs in the NHS and improve the availability of GPs. It would certainly make a big difference in my constituency of Coventry North West.
My second point, which has been raised briefly, is that we must put in place stronger protections for pharmacists in the workplace. Community pharmacists have reported that they do not feel safe in their workplace because of increasing levels of violence and abuse. A survey conducted by the Pharmacists’ Defence Association demonstrated the scale of the problem, with only two in 10 pharmacists reporting that they feel safe all the time at work. A follow-up survey in April showed that 44% of responding pharmacists have experienced physical or violent abuse in the past month, and that 85% have experienced verbal or racial abuse in the past month. That is disgraceful. Nobody should face that level of abuse in their place of work. Pharmacists and pharmacy teams need to feel safe. The Government must do all they can to ensure that adequate risk assessments and preventative safety measures are put in place, as well as taking a zero-tolerance approach when incidents occur.
I hope that the Minister takes into consideration the points I have raised today. The maintenance of community pharmacies and the wellbeing of pharmacists and their staff must be top priorities for this Government. Pharmacists play a crucial role in keeping their communities healthy, and the Government must do everything they can to ensure that they are protected and supported. I therefore hope that the Minister will look at how to better utilise community pharmacists to address the wider problems facing the NHS, and take immediate steps to protect pharmacists who are facing unacceptable abuse in the workplace.
Anna Firth (Southend West) (Con)
It is a pleasure to serve under your chairmanship this afternoon, Sir Gary. Community pharmacists have long been one of the unsung heroes of our NHS. Indeed, I would go as far as to say that they are a keystone species of the NHS, serving as a minor injuries unit and providing a vital prescribing service and essential healthcare out of hours for so many people around the country. They are also our most accessible form of healthcare. Their contribution throughout covid-19 was perhaps the best example of their heroic and accessible work. Community pharmacies were the first to step forward during our world-beating vaccine roll-out programme. Millions of people, just like me, had both their first and second jab from their local community pharmacy. Many of us regularly visit our pharmacies for covid tests, travel jabs, flu vaccines and a plethora of other essential healthcare services.
One of the less well known but most inspirational initiatives that community pharmacies have been involved in during the covid pandemic is their support for women experiencing domestic abuse. The Government-backed, pharmacy-led Ask for ANI scheme was a lifeline for many abused women. They could go into a pharmacy and ask for “ANI”, which was the codeword for getting a safe space to raise this important and personal issue.
It is their community nature that makes those pharmacies so valuable. Being on every high street, and having a smaller number of patients than a GP or medical centre, means they can be truly local and embedded in the area. In my constituency of Southend West, we have 18 brilliant pharmacies, each serving an average of 5,162 people. They thus serve a whopping 93,000 people a year. I am delighted that the Government have already recognised the important role that pharmacies play. Earlier this month, the NHS chief executive announced that community pharmacies will be funded to spot early signs of cancer and trained to refer people directly for scans and checks without seeing their GP. That is so welcome and important. Every Member of Parliament will be receiving a welter of emails complaining about access to GP appointments. The Valkyrie surgery, in my constituency, is clearly struggling to cope with the demand for appointments, and it is certainly not the only one struggling in Southend West.
Enabling people to access specialist services without going through a GP will massively ease pressure on GP services. It will also ease the pressure on our beleaguered accident and emergency services, which are crumbling under the pressure. Southend Hospital is safe for around 50 people going through A&E every day, but it is, on occasion, having to cope with 150 people. The obvious solution to those twin problems is to upskill our community pharmacies and ensure they have the funding and training they need to take the burden off our GPs, ambulances and hospitals.
Pharmacies already save 619,000 GP appointments every week; that is 32 million every year. The services they provide also save around 3.5 million people every year from visiting A&E and walk-in centres. We must go further to transform our pharmacies into an even more vital community resource. In Southend West we have the brilliant Belfairs pharmacy, run by an inspirational pharmacist called Mr Mohamed Fayyaz Haji—known locally as Fizz. Fizz provides a great range of services, including cholesterol and blood pressure checks, health advice and prescribing. He has recently acquired further premises so that he can expand into even greater levels of primary and community care, from ear syringing through to community phlebotomy, and to earlier diagnosis measures such as measuring prostate-specific antigen levels for prostate cancer, as well as electrocardiograms and ultrasound screening for sports injuries and pregnant women. That is exactly the sort of care that we want to be championing and supporting to ease the pressure on our other services. I am sure that my hon. Friend the Minister would like to join me in applauding Fizz’s efforts in Belfairs. That is a model for community pharmacy care around the country.
That sort of expansion is obviously not free. I applaud the fact that the Government are already investing in this area. I welcome the community pharmacy contractual framework, which will provide £2.5 billion annually. It is providing clarity and certainty about funding for the first time. I also welcome the new commitment for an additional £15.9 million to support the expansion of frontline pharmacy staff, providing people like Fizz with the training that they need to develop the skills of their staff for the benefit of everybody in the local community. I want to see this continue and for our pharmacies to be able to offer routine medical check-ups and routine injections and to be able to spot the early signs of serious illnesses and refer patients straight on to specialist departments in our local hospital.
In conclusion, pharmacies already provide a huge range of local services and they deserve greater recognition for the essential work that they do. The Government are already doing great work. I would like to see the Government go further with upskilling pharmacists, easing the pressure on our NHS and creating a healthier society all round. Pharmacies, especially in Southend West, are keen to be part of this mission and offer more to their local communities. I welcome every step to empower them to do just that.
Jim Shannon (Strangford) (DUP)
Thank you, Sir Gary. It is a pleasure to speak in this debate. First, I congratulate the hon. Member for Bootle (Peter Dowd) on setting the scene so very well. This subject is something that I am sold on. It is something that I fully endorse, as others have done. We all see the real benefits of it. I have a great interest in the topic. I believe that community pharmacies are an untapped resource that we need to unlock with clever funding and foresight. Over the years, I have worked closely with a number of pharmacies in my constituency of Strangford and have been impressed by the expertise and the potential that is ready to be unlocked.
Pharmacies were involved in covid-19 jabs. They do flu jabs, blood pressure tests and asthma checks, as the hon. Member for Bootle mentioned. Staff can look out for signs of illness and can, if necessary, refer people on—because they know the limitations of the service as well—and that is a good thing. I got the girl from the office to send through details of some of the things that they can do right there and then; people do not have to go to A&E to get these things done. Pharmacies can deal with athlete’s foot, diarrhoea, haemorrhoids, head lice, groin infections, threadworms, thrush, earwax, mouth ulcers, scabies and verrucas. Staff can deal with all those things, at the initial stage, in pharmacies. Although some of those things are probably fairly personal, pharmacies do have the ability to deal with them.
During my time in the Northern Ireland Assembly, I was a strong advocate for what was then called the minor ailment scheme. Although that may still be in operation to a small degree, the potential for more is at our fingertips. The enthusiasm and energy that local pharmacies have really excites me. I get extremely excited about the potential, about what could happen, when I speak to owners such as James McKay of McKay Pharmacy in Newtownards to hear of the schemes that he has ready to go—making space for community physio and nutritionist provision in tandem with the local GP surgery that has premises abutting the pharmacy. There is scope for a real community facility—with much more provision than perhaps pharmacies, with their space, can provide—and that needs to be progressed and replicated.
I was not surprised to read that, on average, pharmacies undertake more than 58 million informal consultations per year. I had to get malaria tablets for a trip to Nigeria just a few months ago. In the past that would have meant a trip to a Belfast private doctor to get a private script, at a large cost. But this was a matter of popping down to my local pharmacy, answering some questions and getting the malaria tablets. Last week, I had a bit of toothache. Again, I went down and spoke to the lady. She gave me the tablets; she gave me the gum rub, and there and then seemed to have solved the problem. Similarly, I believe that those informal consultations prevent an additional 70,000 people from needlessly attending A&E or an NHS walk-in centre every week. Yet community pharmacies receive no specific funding for holding such consultations. That needs to change. I look to the Minister, as I always do. She understands these issues extremely well and, more often than not, she has the answers to the questions we ask.
Delivering minor ailment care through community pharmacies rather than GPs could result in a 53% total cost reduction to the NHS. The cost of providing 40 million minor ailments GP appointments per year is £1.2 billion; it would cost just £560 million to transfer those appointments to pharmacies as a community pharmacy consultation service. Those significant savings cannot be ignored. In this day and age, when finances are important, it is important we look at these issues. It is not simple, straightforward maths and is more than just a number exercise.
We must understand that community pharmacies are ready and willing, and local GP practices are calling out for pressure on surgeries and treatment rooms to be relieved, as well as that on accident and emergency departments. This change makes sense. It has been shown to work in the past and will work again in the future. Let us make the most of the expertise we have and take the pressure off our GP practices where it is possible to do so. We need to get treatment and training in place and get the right people doing the right things.
The future of community pharmacies is intrinsically linked with that of the NHS. We need to work smart as well as expecting them to work hard, and get the minor ailments scheme in a funded and good position. This is a tremendous opportunity to do something good with our health service, in a way that we save money and also deliver better care across the whole community. Everyone of us here today is excited at the possibility of what could happen. I am sure when she responds the Minister will give us some encouragement. I know one thing: if this happens, we all gain.
Sir Gary Streeter (in the Chair)
We move to our Front-Bench speakers. I call Steven Bonnar.
Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)
It is a pleasure to see you in the Chair, Sir Gary. I thank the hon. Member for Bootle (Peter Dowd) for leading this debate, on a topic that is vitally important to every community across the four nations of the UK.
Local pharmacies are a lifeline for their communities and a vital part of our primary healthcare system. They are our most accessible point of contact with our NHS and are invaluable in keeping our constituents and our communities healthy and happy. In Scotland, community pharmacies are playing a commendable role in ensuring that millions of people can and do have their minor ailment needs addressed quickly without needing to go to their GP or a hospital.
The Scottish Government know that good quality healthcare is the cornerstone of a decent society and we will always strive to provide that for the people of Scotland. That is proven by the fact that every single prescription in Scotland is free, unlike here in England where charges apply. Currently, the charge is £9.35 per item—not per prescription, but per item. I know the Minister has said before that prescriptions are free to those who need them, but if she thinks people are not choosing how sick they can become, because of their finances, she is mistaken. The UK Government should follow the lead of the Scottish Government and abolish prescription charges in England. I will continue to ask for that for as long as I am here.
The cost of living crisis is hurting working families more and more each day, and it is only right that the first step to a future of fairer, more equitable healthcare practices in our pharmacies is for the UK Government to remove the charge that is associated with entering a pharmacy in the first place. The SNP appreciate the huge effort that the pharmacy profession has shown in response to the covid-19 pandemic and recognise that it further emphasised the role of all pharmacy team members as a key part of the health and social care workforce.
In July 2020, the Scottish Government introduced the NHS Pharmacy First service. I know the Minister is a massive fan. It is part of our NHS recovery plan to look to expand the range of common clinical conditions that can be treated by community pharmacists, avoiding unnecessary GP appointments and backlogs. That removes huge pressures from our GPs and our accident and emergency services and allows the public, from rural areas to inner cities, to access treatments more easily.
I am proud to note that across my constituency of Coatbridge, Chryston and Bellshill a number of pharmacies have gone over and above to enhance their practices and strengthen their clinical workforce to meet the demands of local people. Mackie’s pharmacy in Moodiesburn recently won the pharmacy of the year award for its dedication and revolutionary contributions to the technological advancement of pharmacy services throughout the covid-19 pandemic. Stepps Pharmacy has implemented a fantastic robot dispensing tool, making it more convenient for my constituents to obtain their prescriptions at any time of the day, to suit their busy schedules. Robertson’s Pharmacy in Coatbridge has been serving the community for generations. The North Road pharmacy in Bellshill has created
“vital relationships with local GP practices to reduce the pressures on the appointment system, and ensure that small ailments are seen to quickly and easily with a walk-in service. This includes late-night and weekend openings, ensuring local people are able to access services at their convenience.”
I place on the record my sincere thanks to all of them, and to every pharmacy across the constituency, for their ongoing work in our communities.
The development of pharmacists as independent prescribers, for example, demonstrates their evolving role and how they can be better utilised in the future. We heard from the hon. Members for Coventry North West (Taiwo Owatemi) and for Bootle (Peter Dowd) about the difficult circumstances, including violence, that pharmacy staff often face. That is an important point, and it is why I am so proud of the Scottish Government’s Protection of Workers (Retail and Age-restricted Goods and Services) (Scotland) Act 2021. So far, this Government have resisted action in this area. I urge the Minister to think again about that, and to discuss it with the Justice team.
We also heard from the hon. Member for Southend West (Anna Firth) and the right hon. Member for South Holland and The Deepings (Sir John Hayes), who outlined the array of services on offer from pharmacies, such as treatments for asthma, diabetes and allergies, assistance with medication, and medical advice on minor injuries. I thank all Members for their excellent contributions to this valuable debate.
Empowering pharmacists to utilise their clinical skills benefits both patients and the overall health service, and it must always be encouraged. Community pharmacists have the skills and the desire to play a much bigger role in primary care delivery, and they need the support to be able to do so. Eight years of real-terms decreases in funding, coupled with the increasing demands of the last few years, have meant that instead of taking on more clinical services to relieve pressure on GPs and accident and emergency departments, many pharmacies have had to limit or even reduce their offerings. In some cases, pharmacies are closing down.
To ensure that our community pharmacies have a bright future, I ask the Secretary of State for Health and Social Care to take forward the recommendations of the all-party parliamentary pharmacy group, provide future-proofed funding against inflationary pressures and ensure that the level of support given to our pharmacies is always sustained. I also ask that the Pharmacy First approach is rolled out in England and Wales, and that the example of the Scottish Government in placing importance on primary care facilities is implemented here too.
Finally, to ensure the future of our community pharmaceutical practices, I ask that our healthcare professionals are given the pay increases that they deserve as recognition of their outstanding work during the pandemic and in the light of ever-increasing backlogs. The Scottish Government have been able to achieve much with less and less funding guaranteed through Barnett consequentials, so there is no excuse for the UK Government not to ensure the same for patients here in England. The future of our community pharmacies lies in the practices of responsible Governments. It is increasingly obvious that this UK Government need only look north to Scotland if they require inspiration.
Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to serve under your chairmanship, Sir Gary. I add my congratulations to my hon. Friend the Member for Bootle (Peter Dowd) on securing the debate, and I congratulate him and Members across the House on putting forward a compelling argument for supporting our community pharmacy sector and increasing its role in the provision of localised community healthcare.
We have heard from Members from across the House that community pharmacies are the cornerstone of our local areas. For many people, community pharmacists are the most accessible healthcare professionals in the NHS, and their work is invaluable. We have heard that more than 89% of the population is estimated to have access to a community pharmacy within a 20-minute walk, but, as my hon. Friend rightly pointed out, access is significantly higher, at 99%, in areas of the highest deprivation.
We have always known that community pharmacies are important, but it was felt acutely during the pandemic. Community pharmacies helped to administer 24 million covid vaccines and were at the forefront of our response to the virus. In 2020-21, they delivered more than 4 million flu vaccinations—an increase of 75% on the year before. Indeed, as the hon. Member for Southend West (Anna Firth) pointed, community pharmacies carried us through the pandemic and reacted with extraordinary speed to a virus that shut down the rest of the country. It is therefore essential that we not only protect this vital community resource but equip it for the future.
As has been noted throughout the debate, there are two broad areas of concern within the sector, and I would appreciate the Minister’s assessment of them. The first relates to resources. Despite the additional demand for services, there has been no increase in funding for the pharmacy network since 2014, and there have been cuts of around £200 million since 2016. The current framework, agreed in 2019, has not been adjusted, despite the covid-19 pandemic, and we have seen central Government’s failure to adapt. This has resulted in pharmacies being unable to meaningfully invest in staff and has been detrimental to infrastructure development as well as innovation.
What is perhaps most worrying, however, is that an EY study in 2020 found that 40% of the large pharmacy chains sampled were operating at a loss. That is not sustainable, and unless action is taken, we could see pharmacies shut and that vital point of access for people close. I think there is consensus across all parties, including from the Minister, that we want to avoid that, so I would be grateful if she could outline what steps the Government are taking to better support community pharmacies and what assessment her Department has made of the potential impact of fiscal pressures on the sector. Furthermore, has the Department of Health and Social Care made any assessment of the additional pressures that the pandemic has placed on pharmacies? Will that inform the next community pharmacy contractual framework?
The second issue I would like to focus on is strategy and workforce. That will not come as a surprise to the Minister, given the Opposition day debate in the main Chamber earlier. There has been a distinct lack of overarching Government strategy when it comes to workforce planning over the past decade, including in relation to community pharmacies. The community pharmacy model that the NHS needs has drastically changed, as have the needs of patients. As far as I am aware, there has not been any strategy outlining the Government’s ambitions for the sector. Instead, we have seen short-term thinking, a real-terms funding decline and radio silence on the future of this vital resource. That needs to change, and I impress on the Minister the urgency of working with her DHSC colleagues to develop a strategy for community pharmacies that is fit for the future. Crucially, it needs to address the workforce issues that have been reported by parts of the sector, particularly in rural areas, where the increase in patient demand is putting pharmacies under more pressure.
I understand that the Government will argue that extra resource is going into the NHS, but we must not get into the trap of taking community pharmacies for granted, and we need to build a resilient, innovative and adaptive service for the future. We must utilise community pharmacies to tackle the key issues of our time. For example, many pharmacies already offer a range of services geared towards tackling health inequalities, but the local commissioning structures mean that access is not equal throughout the country. There is a real opportunity for central Government to step in and to ensure that no matter where people live, they can access weight-management services, emergency contraception, smoking-cessation services and much more.
Community pharmacies are already embedded in communities. They are trusted by local people. We need, therefore, to ensure that the Government give full support to the sector. Every Member who has spoken would wholeheartedly support the Minister to make sure that happens.
Sir Gary Streeter (in the Chair)
I kindly ask the Minister to leave 30 seconds for Mr Dowd to speak at the end.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Bootle (Peter Dowd) for securing this debate. He is pushing at an open door, as I am a huge supporter of community pharmacists.
The evangelising of my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) is definitely working. Community pharmacies are front and centre of the changes we want when developing primary care. Of course, they are already a central part of the NHS, delivering vital primary care services at the heart of every community throughout the country and ensuring that patients have timely access to medicine. That is one of the lesser elements of the services we have talked about, but it is an important element that keeps patients well and out of hospital, enables them to get discharged safely and prevents readmission.
Community pharmacies are offering more services and they are accessible to all. They are key in providing self-care support, thereby allowing individuals to manage their own healthcare needs and, in turn, increasing capacity for the NHS overall. Community pharmacists are an easily accessible and trusted part of the NHS: a team of highly skilled, qualified, experienced healthcare professionals. There are more than 11,000 community pharmacies across England, 80% of which are around a 20-minute walk from most people’s homes. I am committed to making the best possible use of their resources and talent.
As many Members said, we saw the clear difference that community pharmacies made during the covid pandemic. They stepped up to implement a medicines delivery service for shielding and isolating patients. They implemented Pharmacy Collect, making lateral flow tests widely available to the public. At the height of the vaccination programme there were more than 1,500 community pharmacy-led covid vaccination centres. There is no doubt that they stepped up to the mark and showcased what they could offer.
We have a clear vision for community pharmacy. In 2019, we agreed the landmark five-year deal, the community pharmacy contractual framework, which commits to £2.592 billion of funding for the sector. It also sets out a joint vision for the Government, NHS England and the Pharmaceutical Services Negotiating Committee for how pharmacy services will support the delivery of the NHS long-term plan. We are in negotiations for year 4 of that deal, so I am limited in what I can say about the funding, but I can reassure Members that the PSNC is negotiating hard and we want to work with it to expand services. Obviously, it is keen for funding to be attached.
Sir John Hayes
It is vital that, as the Minister described, the service is integrated. GPs must continue to offer out-of-hours services, weekend services and, most salient of all, face-to-face encounters with their patients. Services do a great job but that does not mean that GPs should not do all those things.
Maria Caulfield
Absolutely—it is not an either/or situation. We have enough capacity and patients to expand community pharmacy services, but that does not mean that we do not also need to support GPs and other primary care providers.
I thank the team at the Department of Health and Social Care; often, their work is not recognised, but they are working hard to develop some of the services that we have talked about. The community pharmacy consultation service went live in November. Patients can dial 111 and be directed to a community pharmacist for help with minor ailments or medication. We have extended that to GP surgeries, so now a receptionist can make an appointment at the local pharmacist for minor illness consultations.
It has been estimated that 20 million appointments in general practice alone do not require a GP—that does not mean we do not need GPs—and pharmacists can look after those conditions. The introduction of the scheme has been slightly slower than we would have liked, so there is work being done to help to overcome some of the barriers to referrals, because once they see their community pharmacists, patients have a positive experience.
In addition, the discharge medicines service enables hospitals to refer discharge patients to community pharmacists for support with their medicine. The evaluation of this service indicates that for every 23 consultations, one readmission is prevented. Where patients are readmitted, their stays are reduced by six days on average, which I think we can all agree is of huge value. We also have the blood pressure check service, which enables people with high blood pressure to be managed by their local community pharmacist, offering blood pressure checks.
We also have the stop smoking service to enable patients who started their stop smoking journey in hospital to continue with a community pharmacist, and we are looking at developing the role of community pharmacy teams, because it is not just the pharmacist who has clinical knowledge and skills. We are working in a number of areas to upskill the whole community pharmacy team so that they can deliver more and use their skills in a better way.
As has been mentioned, we now have NHS Direct cancer referrals, which community pharmacists will be able to take. Just to reassure the hon. Member for Bootle, we have 160 community diagnostic centres, which will be increasing the capacity to do some of those diagnostic tests, and we have already had 1 million visits to those centres. We are not just expecting pharmacists to refer into existing services; we are expanding the routes for diagnosis as well.
My hon. Friend the Member for Southend West (Anna Firth) beautifully told the story of Ask for ANI. It is so vital that a woman can go into a pharmacist, just say those few words and get help—they might not be able to go to a GP practice, because sometimes the help they are asking for might be more obvious.
We also have the minor ailments service, which is being rolled out throughout the country, so pharmacies are delivering more and more. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) knows that I am a pharmacy first supporter. I hate to admit it, but Scotland has taken the lead in that, although we are not afraid to learn lessons if that means learning from what Scotland has done.
On the Fuller stocktake and the future of primary care, just to reassure colleagues, we are not just looking at how general practice looks in the future; community pharmacy will also play a key part in that model. With the integrated care system set to go live on 1 July, we are working with those who will be making commissioning decisions in local communities to set out how that future will look.
We are considering all options for community pharmacy and how we build on the progress we have already made. It is important to say that although we have made progress, there is a lot more that can be done. We are developing new standards for the initial education and training of pharmacists, which are set to be implemented shortly, so that from 2026 all newly qualified pharmacists will be able to be independent prescribers—an essential skill that will help to deliver and develop the service further. For those who are not currently prescribers but would like to be, Health Education England is supporting the existing pharmacy workforce to undertake the required training and upskilling, and £15.9 million of funding support has been made available.
We are also looking at the use of patient group directions, because pharmacists have specifically asked for that, so there are a number of measures in place. We are listening to the community pharmacy community, and where we can make changes quickly and easily, we will.
Just to touch on the issue of violence, I want to be really clear that there is zero tolerance for abuse and violence against community pharmacists—and, indeed, against all primary care staff, whether receptionists, GPs or community pharmacists themselves. I also want to put on the record our thanks to the hon. Member for Coventry North West (Taiwo Owatemi) for her work in the NHS as a pharmacist and the experience she has brought to this debate. I reassure hon. Members that we are on a clear journey and we will be supporting community pharmacy going forward.
Peter Dowd
I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes), my hon. Friends the Members for Coventry North West (Taiwo Owatemi) and for Denton and Reddish (Andrew Gwynne), and the hon. Members for Southend West (Anna Firth), for Strangford (Jim Shannon) and for Coatbridge, Chryston and Bellshill (Steven Bonnar).
I think we have reached a degree of consensus. I hope we can move forward with that consensus and that if we revisit this issue in six or 12 months, we will have made significant progress. I also thank the Minister for certain of the reassurances she gave. When we come back, let us review this and see how it is moving on, because that is our job, and I know that the Minister recognises that.