Pharmacies and the NHS

Debate between Oliver Colvile and Kevin Barron

Wednesday 20th November 2013 Westminster Hall

[Oliver Colvile]

Plymouth, Sutton and Devonport.

[Mr Barron]

I am sure Hansard will put that right anyway—I could have said “somewhere in the south”. The hon. Gentleman mentioned the all-party group, and we had a session on pharmacies easing the burden of emergency care. We had several witnesses, one of whom—Paula Wilkinson—was the chief pharmacist at Mid Essex Clinical Commissioning Group. She showed us a publication that the CCG was sending round mid-Essex called “Why wait to see your doctor or nurse? See your pharmacist first!” It is part of the health care on the high street initiative that the CCG is running, and she focused the majority of her comments on that initiative, which she said nudged—that is very much Government-speak—people towards using the pharmacy first. Like another witness, she focused on the expanded role that pharmacies could play in serving patients with minor ailments.

Paula said—this is quite interesting, and I would be interested in the Minister’s comments—that for people on low incomes, prescriptions often provided a way of gaining free access to medicines that are otherwise available over the counter without a prescription. She said that meant that patients on low incomes were perversely incentivised to attend their GP or an A and E service to get prescriptions. She believed consideration should be given to providing some free medicines without prescription to those on low incomes. Clearly, if a patient has been on a medicine for a long time, that would not be that challenging, and a professional such as a pharmacist could extend the period without having to go through any rigmarole and clogging up the rest of the system.

The A and E report that came out last week showed that 40% of people who attend A and E have nothing whatever done to them, which is an extraordinary statistic. Indeed, 50% of people who are blue-lighted—an ambulance or paramedic goes out to them—are not admitted to hospital. We need to look at certain issues in primary care services and, to some extent, in the acute sector if we are to deal with such people.

Community pharmacy provides a common ailments service—we call it a minor ailments service in Rotherham —in 10% of England, and people are encouraged to go to the community pharmacy as part of that. A nationally commissioned service would reduce pressure on GP surgeries and, subsequently, on A and E. Recent reports suggest that 56 million to 57 million visits a year could be managed by pharmacists, freeing up GPs to manage more complex cases, and I agree.

Pharmacists support people with long-term conditions to manage their symptoms, improving access to care for people in the most deprived areas and increasing capacity to treat patients out of hours and in the community. The Minister will be well aware of this, but about 75% of NHS expenditure goes on people with long-term conditions. This winter, quite a lot of them are likely to end up going to A and E and clogging up the system because they have, for whatever reason—they may be forgetful as a result of other problems, such as dementia—not adhered to their drugs regime at home. Managing such people in the community using professionals such as GPs, nurses and pharmacists is a better way of caring for such people. We have few systems to deal with these things, although the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) will no doubt tell us what is going on in his constituency with healthy living pharmacies, so I will not go into that. These are, however, major issues, and the strengths of pharmacists should be used a bit more.

I mentioned the question of medicines adherence. Under the present general pharmacy contract, it is pharmacists’ duty—and they are paid for this—to take in unused medicines. It is extraordinary that every year medicines costing hundreds of millions of pounds are prescribed and then are unused, for whatever reason. It is a difficult situation. The 2010 report by the York health economics consortium and the school of pharmacy at the university of London suggested that up to £500 million could be generated in England in just five therapeutic areas—asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia—if medicines were used optimally. Those are all long-term conditions on which taxpayers’ money is spent. The report rightly said that sub-optimal use of medicines and waste undermine the £12 billion investment in medicines by the NHS.

Pharmacists do quite a lot of work which, although it is contracted to the NHS, is not always laid out nationally or used by local health partnerships. The hon. Member for Ipswich pointed out that pharmacists were not included in the publication that he cited. A medicines use review is a review of a patient’s medicines—prescribed and non-prescribed—to promote adherence and to support the optimal use of medicines; 2.8 million MURs were provided by community pharmacies in England in 2012-13. Since 2011, pharmacies have offered a new medicine service to provide additional support to patients who are starting to take certain medicines for long-term conditions. An evaluation of the effectiveness of the NMS is due soon, and more than 640,000 people starting to take new medicines have benefited. That is adherence —making sure that people do as their prescription sets out.

The York and London review, which is entitled “Evaluation of the Scale, Causes and Costs of Waste Medicines”, goes into the question in great depth, and clearly the problem will never be eliminated altogether. Nevertheless it is clear that in this country people sit and write out prescriptions and people take them away and effectively put them on the shelf. The patient might use the medicine for a couple of days. Perhaps they do not like the side-effects, and indeed that is unavoidable on occasion. However, some medicines are stored in bathroom cabinets, and when they are emptied the medicines are taken back to the pharmacist or thrown away, which costs the nation hundreds of millions of pounds. We must question whether some of those medicines, given that they are not used, should be prescribed in the first place. However, that is a wider issue for health professionals, not me.

More than 57 million GP consultations a year involve minor ailments. If we rolled out the scheme that currently covers about 10% of England, we could greatly reduce pressure on those services, and GPs could get on with more important things. The patients could be moved to pharmacies, and more than £812 million of GP capacity could be freed for other things.

In 2009-10, 140,000 people chose their community pharmacy to set a quit date and 62,000 had successfully quit smoking by the fourth week, which was a 13% increase on the previous year. Pharmacists give support in a wide variety of public health roles, including flu vaccinations, international normalised ratio-testing clinics—monitoring and adjusting the dose of the blood-thinning medicine warfarin—and asthma clinics.

There has been much debate in Parliament about changes in the Health and Social Care Act 2012. The Minister was on the Committee that considered the measure. Two things were writ large in that Act. First, we have now put into statute the need to reduce health inequalities—but they are not reducing. Everyone is living longer, but in terms of social class things are still going downwards. Pharmacists could work on reducing health inequalities in areas where there is known deprivation. That should be a major aim. Secondly, the Minister will remember the emphasis on population health. In view of the statistics that I have read out, I think pharmacy has a major role to play in improving population health.

Public health problems were very bad 150 years ago, and they involved the environment—bad housing, bad sanitation and bad water. The public health issues that this century will suffer from will be to do with individual lifestyles. I read out some statistics about smoking cessation and pharmacies, and I believe that community pharmacists are the gatekeepers to the national health service. Far more people visit them than any other part of the NHS and they have a major role to play. The sooner we alter the current mode of contact and move away from the situation where pharmacists get the bulk of their money just churning out prescriptions to one where they cover wider issues within communities and look after the health of the population, the better we shall be.