Pharmacies and the NHS

Dan Poulter Excerpts

Wednesday 20th November 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have had a wide-ranging debate today on issues such as the deregulation and regulation of pharmacies, the local provision of pharmaceutical services and the extension of the role of pharmacists and what they do in our communities. Importantly, we have also discussed pricing and behaviour that, if not fraudulent, is certainly very irregular on behalf of some pharmacists and drugs companies. I hope that I will have time to deal with all those issues, but I will write in more detail to any Member here today who feels that more points need to be answered.

Before I go any further, may I say that it is a pleasure, as always, to serve under your chairmanship, Dr McCrea? We took part in many sittings together when the Health and Social Care Act 2012 was considered in Committee, and it is always a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer), my constituency neighbour, on securing today’s debate. It is important to recognise that our NHS is not only about doctors and nurses, but about midwives, physiotherapists, occupational therapists, heath care assistants and all the other people who contribute to the health of the nation every day, including pharmacists, who play an increasingly important role in delivering high-quality local health care and who are embracing the enhanced role that they have been offered under the 2012 Act. It is right that we put on record our thanks for the work that pharmacists do every day.

The right hon. Member for Rother Valley (Mr Barron), in an excellent, considered speech, made some very good points. In particular, he said that community pharmacists are the face of our NHS in many communities. He is absolutely right in saying that because, particularly in more deprived areas of the country, pharmacists are often the first point of call for advice—whether on simple details about medications or for important primary health care advice. Pharmacists perform that role every day. We should be grateful to them for what they do, and I put on record my thanks for that work.

It is important to put on record that pharmacies are in robust health. Although we debate deregulation and difficulties, we know that there are more NHS community pharmacies than ever before—more than 11,400 in England—and they are offering health care, treatment and healthy lifestyle advice and support throughout the country. They dispensed more than 900 million prescription items last year, which is up 53% from 10 years ago, and about 2 million prescriptions are handed out every day by pharmacists. Therefore, we have an industry, as part of our NHS and in its commercial activities and other work, that is in robust health and is performing a valuable service for our NHS.

Of course, we could get into the issues that the right hon. Gentleman rightly raised on the appropriateness of prescribing medication. The chief medical officer talked in some detail in a report about the need for GPs to look sometimes at the appropriateness of the antibiotics that they prescribe and about how we need to look at antimicrobial resistance in this country. The right hon. Gentleman made his points very well, but I hope that he will forgive the fact that I shall not address them directly in today’s remarks. However, he was right to make them and the chief medical officer certainly agrees with him, as do I.

I shall deal with other points that have been made, but initially, I would like to address the important points made by my hon. Friend the Member for Ipswich. We rightly value the innovation and the opportunities that pharmacists have to innovate and support their local communities in different ways. Because they are centred in the community, only pharmacists are able to use such methods. I had the pleasure of attending the annual pharmacy awards and looking at some of those ways. I saw pharmacies, embedded in local communities, making a real difference in providing health and lifestyle advice and improving the quality of care available to local patients.

At the same time, although we want to encourage and support innovation—the pharmaceutical price regulation scheme, or the PPRS, was recently renegotiated and enhanced to give pharmacists the opportunity to innovate exactly as I have described—we also need to recognise that we have a publicly funded national health service, which is a point that has been made across the Chamber today, and we are very proud of it. It is free at the point of need, and it is important to ensure that the money that is given to the health service, whether to pharmacies or to other parts of the NHS, is properly spent, and there is also a role in ensuring that services are provided in a safe and effective way. I shall come on to some of those points later.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) has been a consistently strong advocate for the role of pharmacists, and he made his points very well today. The hon. Member for Strangford (Jim Shannon) also made a useful and powerful contribution, which was picked up by the hon. Member for Copeland (Mr Reed) a few moments ago, about the importance of ensuring that there is no fraud in the system and that pharmacists always behave appropriately. I am sure that the majority of the time pharmacists behave appropriately and make a very valuable contribution. When there may be fraudulent behaviour, it is right to pick up on that and investigate it. I will come back to that in a moment, because we all want to see high value for money from our NHS and to make sure that the money is spent on patients and not wasted. I think that that is something that we all agree with and believe in across the House.

I turn to the important issue of pricing. The vast majority of drugs that are prescribed are either covered by the PPRS or are generics, where competition helps to keep the price down. We recently introduced a price for common specialists, but a small number of prescriptions, as has been mentioned in the debate, fall outside the pricing mechanisms that are in place. We are working with the Pharmaceutical Services Negotiating Committee to find a better mechanism to encourage pharmacists to seek lower prices.

Where there may be cases of fraud, it is right that we investigate them, and they are investigated. NHS Protect exists to safeguard—to protect—against fraud in the NHS. That has been a consistent policy; it was followed by the previous Government, and it has been followed by the current Government. The reason why we need services such as NHS Protect is to ensure that if there is fraudulent practice—in this case, potentially in the behaviour of a small number of pharmacists in dealing with small, unique areas of pricing—it is investigated properly. I will ensure that either I or Earl Howe, who is the Minister responsible, writes to the hon. Member for Copeland to inform him of where we have got to with the investigation.

The other point, which was made by the hon. Member for Strangford and is very important, is that we want to ensure that money goes on patients. There is increasing demand for drugs. It is very good that the NHS is continually innovating and developing more treatments, better surgical techniques and improved drugs and mechanisms. Of course, when drugs are used in the NHS, they need to be evidence-based, but I hope that he will agree that it is good that we have set up the cancer drugs fund, which has helped to increase the speed at which people with cancer receive drugs. More than 30,000 people have benefited from the cancer drugs fund and received cancer drugs. We should all be pleased about that and proud of it.

[Jim Shannon]

I thank the Minister for that positive response. I outlined in my contribution a couple of examples of people who did not access the cancer drugs fund, but in my mind clearly should have qualified. Is he prepared to look at that issue to satisfy those people who need drugs urgently because of the time they have left on this earth?

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.

[Mr Jamie Reed]

I am grateful to the Minister for giving way; he is being typically generous. On pharmacy numbers, does he think that we have too few or too many, or is the number about right?

[Dr Poulter]

The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.

Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.

It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.

Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.

I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.

We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.

[Dr William McCrea (in the Chair)]

I thank Members for the courteous manner in which they conducted the debate.