Budget for Community Pharmacies

Business of the House (Private Members’ Bills) – in the House of Commons at 6:59 pm on 24th May 2016.

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Motion made, and Question proposed, That this House do now adjourn.—(Stephen Barclay.)

Photo of Michael Dugher Michael Dugher Labour, Barnsley East 7:00 pm, 24th May 2016

I am grateful for the selection of this debate on the budget for community pharmacies, which the Government announced in December would be cut by £170 million in 2016-17—a cut of 6%.

I thank all right hon. and hon. Members, from both sides of the House, who attended the parliamentary event today organised by the Pharmaceutical Services Negotiating Committee, Pharmacy Voice, the National Pharmacy Association and the Royal Pharmaceutical Society to stress the importance of safeguarding a strong community pharmacy sector. I also thank the cross-party delegation of Members of this House and the other place, as well as patients and pharmacists, who came together to deliver a petition to 10 Downing Street today against the Government’s planned cut. The petition was signed by more than 1.8 million people, making it the most signed petition on any health issue in history.

It is clear, therefore, that there is massive opposition out there to the Government’s planned cuts, and it is entirely right, given the huge public interest, that we should have this debate today. The Government must now listen to the public and consider the mounting evidence showing that the cuts will be bad for many of our local communities, the pharmacy sector, public health and the wider NHS. Just yesterday, Pharmacy Voice published a comprehensive analysis of the merits of community pharmacies. The report, “Dispensing Health Equality”, found that community pharmacies

“are not just an invaluable community asset, dispensing medicines and vital public health services, they are potentially a key to unlocking deep-rooted health inequalities.”

Photo of Keith Vaz Keith Vaz Chair, Home Affairs Committee, Chair, Home Affairs Committee

I congratulate my hon. Friend on securing this debate. Instead of cutting the budget for pharmacies, we could use them much more effectively—for example, in combating diabetes. Rather than getting GPs to test patients for diabetes, pharmacies could do it more efficiently and effectively.

Photo of Michael Dugher Michael Dugher Labour, Barnsley East

My right hon. Friend is absolutely right. Given the success of community pharmacies, we should be doing far more with them, not cutting them. I shall come to some of the arguments for that during my remarks.

In the course of this campaign, I have been lucky enough to visit some excellent community pharmacies in almost every part of my constituency, campaigning with local councillors, listening to residents who rely greatly on the services these pharmacies provide and meeting staff who are among the very best healthcare professionals in the country.

Photo of Bill Esterson Bill Esterson Shadow Minister (Business, Innovation and Skills)

I congratulate my hon. Friend on securing this debate. Like him, I have visited several pharmacies in my constituency. They make the point that we are short of GPs and that, in that environment, it makes no sense to cut a service that can provide the support necessary to make up for the challenging circumstances that GPs face. Pharmacists can often provide advice and support to those who otherwise would go to their GP. In the absence of those GPs, pharmacies are essential.

Photo of Michael Dugher Michael Dugher Labour, Barnsley East

My hon. Friend is of course absolutely right. One of the successful community pharmacy operators in my own constituency, Lo’s pharmacy, which has 20 community pharmacies across Yorkshire, was set up by a fantastic individual, Mr Steve Lo, who was brought up in Hoyland Common in my constituency and remains the firm’s managing director. Of the Government’s proposals, he told me:

“There is a real and present danger that these cuts will make many pharmacies unviable. That can only mean a longer trip, not just for your prescription, but for free advice on minor ailments or medicines as well as a number of other NHS led services, and is only going to put more pressure”, as my hon. Friend just said,

“on GP surgeries and Accident and Emergency departments.”

I wholeheartedly endorse his comments.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

I congratulate my hon. Friend on securing this timely debate. Pharmacists have become very much like GPs—they are part of the community. This Government are always telling us all how they are taking big government out to the communities, but here they are again cutting another community facility, as well as cutting local government facilities.

Photo of Michael Dugher Michael Dugher Labour, Barnsley East

My hon. Friend is right. A modern community pharmacy of the type he referred to has so much to offer patients—from free medical advice and dispensing prescriptions to, crucially, reducing strain on other NHS primary care services.

Community pharmacies are of growing importance. Figures from the Health and Social Care Information Centre show that since 2005, the number of prescriptions dispensed has risen by 50%, with over a billion items dispensed in the community last year. There have been increases in the number of items dispensed every year for the last decade, as community pharmacies have become more important for public healthcare. Staff at community pharmacies, trained pharmacists, technicians, dispensers and counter assistants are often the first port of call for an unwell patient or indeed a carer. Some 1.2 million health-related visits are made to community pharmacies across the country every single day—more than to any other primary care provider. The average person visits a pharmacy 14 times a year, and there are 11,500 community pharmacies across England.

Photo of Holly Lynch Holly Lynch Opposition Whip (Commons)

Where we have seen quite serious reorganisations of NHS services and A&E departments downgraded, part of the justification for it has been the role of pharmacies in delivering the “care close to home” agenda. If we see anything in the region of 3,000 pharmacies close across the country, that will raise very serious questions about how we have reorganised our existing NHS structures.

Photo of Michael Dugher Michael Dugher Labour, Barnsley East

My hon. Friend is exactly right. I know what a formidable campaigner she has been on this issue in her local community. I pay tribute to her, and not simply because she is also my Whip and occasionally allows me to go home—though I would not rule it out as a contributing factor!

The community pharmacy network is made up of trusted local chemists who are rooted in the communities they serve. I do not doubt that the Minister and his Department share with me an understanding of the vital importance of community pharmacies. Indeed, in the Government’s own letter last December to the Pharmaceutical Services Negotiating Committee, which announced the cut, it was stressed that community pharmacies must be at the “heart of the NHS”. The letter went on to praise the excellent work of community pharmacies

“in prevention of ill health;
support for healthy living;
support for self-care for minor ailments and long-term conditions;
medication reviews in care homes;
and as part of more integrated local care models.”

That is all true, so why on earth are the Government pressing ahead with a massive arbitrary budget cut for community pharmacies that will, by the Minister’s own admission at a meeting of the all-party pharmacy group in January, potentially force up to 3,000 local chemists to close?

A properly funded and well-resourced community pharmacy sector is vital for enhancing public health, reducing risk to the public and mitigating downstream costs to the NHS. This is the key argument. In his response, the Minister will no doubt rightly draw on the financial pressures facing the NHS, but is not this cut in the community pharmacy budget a false economy? By contributing to improved public health—frankly, by heading off some people at the pass—our community pharmacies prevent patients from resorting to visits to the GP surgery or the local hospital.

The Government’s timing could not be worse We need our community pharmacies more than ever, given that we have an NHS that is so self-evidently in crisis. A&E departments are under enormous pressure on the Government’s watch. In the three months to March this year, only 87.9% of patients visiting them were seen within four hours, which missed the Government’s own target of 95%. Despite the brilliant efforts of NHS staff in my own area—which was visited recently by my hon. Friend Justin Madders, in his capacity as shadow Minister—the figures were even worse, and, indeed, were going backwards. Just 86.7% of patients were seen within four hours in Barnsley Hospital’s A&E department, down from 87.2% in February and 89% in January.

Cutting the budget for community pharmacies will do nothing to alleviate the crisis. In fact, Ministers risk deepening the problems that face our A&E departments by removing access to the medical advice that those pharmacies offer before patients feel the need to go to hospital.

Photo of Sue Hayman Sue Hayman Opposition Whip (Commons)

Allison’s chemist in Cockermouth, which is in my constituency, provided a very important resource for local people after the floods. Rather than people going to hospital because they needed care, Allison’s visited them in their homes or where they were staying. This cut means that we shall risk losing that kind of important support.

Photo of Michael Dugher Michael Dugher Labour, Barnsley East

My hon. Friend has given a compelling example of the contribution made by community pharmacies—not just those in her constituency, for there are similar stories in many other parts of the country.

Another argument for arguing against the proposed cuts is the crisis relating to GP access. Millions of people are waiting longer for appointments: 14.2 million patients had to wait for a week, or were not given an appointment at all, when they last tried to see their doctors in 2015. The truth is that the GP access crisis can only be made worse by the Government’s plan to cut the community pharmacy budget.

The findings of new research carried out by YouGov, commissioned by Pharmacy Voice and published in the report yesterday, show that one in four people who would normally visit a pharmacy for advice on common ailments would instead make an appointment with their GP if their local pharmacy faced closure. The report also states that the impact of the cut would be much more severe in areas of higher deprivation, such as my constituency, and that as many as four in five people would visit their GP if their local pharmacy closed. According to the National Pharmacy Association, that would mean approximately 1 million extra people per month using GP and alternative local NHS services.

In a recent letter to the Pharmaceutical Services Negotiating Committee, the Government said that they wanted

“a clinically focussed community pharmacy service that is better integrated with primary care. That will help relieve the pressure on GPs and Accident and Emergency Departments”.

I could not agree more, but how can an arbitrary cut—because that is what it is—in community pharmacies on such a scale possibly do anything other than make a bad situation in our NHS even worse, and how do the Government plan to introduce a “hub and spoke” dispensing model against a backdrop of thousands of closures in the sector?

Particularly in recent days and weeks, the Government have tried to argue that this is not the arbitrary cut that we all know it to be, and that it is not a raid on the community pharmacy budget in the Department. They now say that it is all about making the pharmacy sector stronger by eliminating what Ministers call “clusters” of chemists. However, in response to a written question on 4 May in which I asked the Government to

“make an assessment of the effect of the budget reduction for community pharmacy in 2016-17 on high street vacancy rates”, the Government conceded that they could not accurately assess the impact of the cut. They could not say how many community pharmacies would close, or, indeed, where they would close. The Minister said that the Government were

“not able to assess which pharmacies may close or what the effect on high street vacancy rates might be because we do not know the financial viability of individual businesses or the extent to which they derive income from services commissioned locally by the NHS or local authorities or have non-NHS related income.”

As I have already highlighted, the Minister previously said that he estimated that up to 3,000 community pharmacies—a quarter of all those in the country—could close as a result of this cut. However, with no planning, no strategy and no impact assessment, it is painfully obvious that the Government have not the faintest idea which community pharmacies are at risk of closure. It could be a chemist that is located in a so-called cluster, but it might well not be.

Photo of Kevin Barron Kevin Barron Chair, Committee of Privileges, Chair, Committee on Standards, Chair, Committee of Privileges, Chair, Committee on Standards

Does my hon. Friend agree that the petition that went to Downing Street today was not just about 1.8 million people being concerned about their local pharmacy? Those 1.8 million people are also taxpayers who feel that this efficiency drive is going to have a negative effect on what they believe to be an important part of their communities.

Photo of Michael Dugher Michael Dugher Labour, Barnsley East

My right hon. Friend makes an interesting point. I have seen the cuts to community pharmacies described as a Treasury-led process. A lot of people are paying their taxes, including the 1.8 million who have already signed the petition. I pay tribute to my right hon. Friend for the leadership he has shown as chair of the all-party parliamentary pharmacy group.

This is not a clear, well-thought-through strategy. It is a reckless leap into the unknown, and it is the NHS, patients and every community in the country that will pay the price. For those of us who were here during the last Parliament, this is painfully reminiscent of the process involved in the passing of the Health and Social Care Act 2012, with the Government making things up as they go along and ending up in a situation where things are worse for the NHS and more money is once again wasted.

I implore the Minister to listen to Members from both sides of the House and from the other place who have voiced their real and sincere concerns. I urge the Government carefully to consider the overwhelming body of evidence from our healthcare professionals who do so much to serve our local communities and our NHS. The Government must now listen to the unprecedented 1.8 million people who have signed the petition, which states:

“We, the undersigned, believe that local pharmacies are a vital frontline health service and part of the fabric of communities across England. Under new Government proposals, many pharmacies could be forced to close—depriving people of accessible medicines, advice and other valuable support from trusted professionals. It would also put more pressure on GPs and hospital services. In the interests of patient care, we urge the Prime Minister and the Health Secretary to abandon plans that put pharmacy services at risk.”

The Government must now think again.

Photo of Alistair Burt Alistair Burt The Minister of State, Department of Health 7:18 pm, 24th May 2016

I congratulate Michael Dugher on securing this debate and on the excellent way in which he put one side of the equation as we discuss pharmacy. His timing is of course impeccable. Over the past few months, we have been consulting on our proposals for the future of community pharmacy. The consultation closes today, as he said, although it is important to note that the confidential part of the consultation with the Pharmaceutical Services Negotiating Committee and other key stakeholders will continue. Today is also the day on which the National Pharmacy Association has handed over its “Support Your Local Pharmacy” campaign petition, signed by 1.8 million people, to No. 10. Colleagues might have also attended today’s “Pharmacy health checks and speed briefing” event. All of this is testament to the very high regard in which community pharmacies are held by patients and the public, and the hon. Gentleman will get no argument from me or the Government that that is not the case.

I said that the hon. Gentleman had addressed one part of the equation. He has indicated clearly what the state of pharmacy is today, but he said very little about what pharmacy could become. I understand that, and it is in fact my job to do that. I shall set that out in a few minutes.

If I may be forgiven for saying so, the hon. Gentleman presents a case that suggests that no Labour Government or local council has ever reduced the money for any service and he gives us the clear impression that, were it left up to him, there would be money for absolutely everything. There is not. In a perfect world in which money is no object, a service can be developed and extra money can be added. In the real world, in which we have to operate, it is rather different, so let me explain exactly how we are going to do that.

Several hon. Members:


Photo of Alistair Burt Alistair Burt The Minister of State, Department of Health

Mr Howarth approached me before, so I will take one intervention from him; I will not get through my answer otherwise.

Photo of George Howarth George Howarth Labour, Knowsley

I am grateful to the Minister for giving way. I want him to take two things into account. First, there is a correlation between clusters of community pharmacies and areas of high deprivation and associated ill health, as my hon. Friend Michael Dugher said. Secondly, small, independent, local community pharmacies do not have the ability of the big multiples to negotiate bulk discount deals. Will he take those two factors into account as he moves forward?

Photo of Alistair Burt Alistair Burt The Minister of State, Department of Health

I thank the right hon. Gentleman for his intervention. He has made representations in the past, and I know how keenly he understands the matter. I will come on to discuss access to funds in due course. It will not be based purely on location, but it will take into account what he says about areas of deprivation. We recognise that these are small businesses, and I understand exactly what he says.

The proposed funding cut has understandably created uncertainty and concern. I assure the House that I see a bright future for community pharmacy and pharmacists, so I urge colleagues to see the opportunity that the consultation presents, as well as the inevitable and understandable concern around funding.

The background to the matter lies in the NHS’s five-year forward view. One of its key strategic aims is to break down the traditional barriers between different primary care services, wider out-of-hospital care services and other sectors, such as social care, to deliver a more cohesive, community-based care model that is focused on keeping people healthy and helping people to manage long-term health conditions. Our vision is to achieve a transformation in primary care and out-of-hospital care more widely as we continue to move towards a seven-day health and care service. We want to empower primary care health professionals to take up opportunities to embrace new ways of working with other health professionals to transform the quality of care that they provide to patients and the public. In particular, we want to free up pharmacists to spend more time delivering clinical and public health services to patients and the public in a range of settings.

I have seen at first hand the fantastic work that pharmacists are doing from within community pharmacies, such as in healthy living pharmacies and other settings, and colleagues have also paid tribute to that work. Pharmacy-led services, such as the recently recommissioned community pharmacy seasonal influenza vaccination programme, can help to relieve pressure on GPs and A&E departments and ensure better use of medicines, better health and better patient outcomes. There are real opportunities for pharmacists and their teams to play an even greater role in helping people with long-term conditions and helping people to make better choices to improve their health and to get the maximum benefit from their medicines.

It is not a zero-sum game of accepting the reduction in funding of £170 million—from a budget of £2.8 billion—and ending this degree of high street care and having nothing in its place. I strongly believe that we can still have a network of high street pharmacies based on a financial regime that rewards quality as well as volume while moving pharmacy into different settings. To that end, we have consulted pharmacy bodies and others, including patient and public representatives, clinical commissioning groups and health and social care providers, on how best to introduce a pharmacy integration fund from 2016-17. The fund will help us to transform how pharmacists and their teams operate in the community, bringing clear benefits to patients and the public. The fund is set to rise by an additional £20 million a year. By 2020-21, we will have invested £300 million in addition to the £31 million that NHS England is investing in funding, recruiting and employing clinical pharmacists to work alongside GPs to ease current pressures in general practice and improve patient safety. The integration fund will help to move pharmacy in a direction that supplements what is already done on the high street and in a way it might not otherwise have done.

The chief pharmaceutical officer, Dr Keith Ridge, has commissioned an independent review of community pharmacy clinical services to make recommendations on future models for commissioning pharmacy-led clinical services. I am very keen that what we are doing is seen in the context of where pharmacy is going to go—not a snapshot of how good it is now, but what it can become. Clinical pharmacists will offer complementary skills to GPs, giving patients access to a multi-disciplinary skill set, and helping GPs manage the demands on their time and provide a better experience for patients. This is a great opportunity for pharmacists wanting to make better use of their clinical skills and develop them further.

Let me give a couple of examples. At the Wallingbrook Health Group in Devon, the work of the local pharmacist on all aspects of medicines optimisation has reduced the need for patient GP appointments by 20% to 30%, making a significant impact on GP workloads and patient outcomes. In Cambridge, Sandra Prater is working with patients to optimise their medicines and supporting patients to self-manage a range of conditions, including asthma, high blood pressure and atrial fibrillation.

The reduction in funding for community pharmacy that we have set out was a commitment in last year’s spending review. I want to emphasise that our aim is to secure efficiencies, make savings and improve quality. It is most definitely not our aim to close pharmacies. I accept that it was me who said to the meeting with the all-party group that up to 3,000 pharmacies could be affected. That was me extrapolating the figures. It is not the aim of the Government to close pharmacies and, as I said in answer to the question, we do not know exactly how the funding will fall, because we do not know yet the result of the negotiations and how this will be handled. I accept that I put that figure into the public domain, but it may not happen in that way at all.

I know that many people choose to access health services through community pharmacies, and I want to assure them that our aim is to ensure that those community pharmacies upon which people depend continue to thrive. That is why we are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, as the right hon. Member for Knowsley mentioned.

Let me deal with another theme that the hon. Member for Barnsley East mentioned. Hand in hand with that approach, we want to ensure that modern community pharmacies reflect patient and public expectations, and developments in technology. Large sections of the population are now accustomed to using digital services through their phones and tablets. Why not do this for people wanting to obtain their prescription medicines? That is why we want to help those patients to get their prescriptions in a way that fits their lifestyle, by promoting the use of online click-and-collect or home-delivery models. We have also consulted on amending legislation to allow independent pharmacies to benefit from hub and spoke dispensing models, which facilitate more use of automation and increase efficient dispensing processes. Officials are now carefully considering the responses received and the Government will respond in due course. These are things we want to encourage people to do, but they do not totally replace what is already being done. They might, however, free up more time for the pharmacists to spend on patient contact rather than on doing some of the other work.

The public phase of the community pharmacy consultation may now have ended, but that does not mean that we will stop listening and talking—the hon. Gentleman asked me to keep doing those things. The Department, supported by NHS England, will have further confidential negotiations with the PSNC, and there will also be a final round of confidential discussions with other key pharmacy stakeholders, who take a keen interest in the discussions in this House. Our aim is to communicate the final decisions early in July so that pharmacy contractors are fully informed in advance of the changes being implemented from October 2016.

Our proposals are informed by the discussions that have taken place and by what has been said by those involved in pharmacy in the past—the Royal Pharmaceutical Society and independent studies—about how pharmacy can move in a different direction but that the current funding structure rewards volume not quality and that changes could be made that would widen the reach of pharmacy. I believe that these ideas can be taken forward in the current context. Our proposals can truly place pharmacy at the heart of the NHS and provide a better, more integrated, service for patients and the public. I am confident that the efficiencies we have proposed can be made within community pharmacy without compromising the quality of services or the public’s access to them. I want to thank those in pharmacy, who are working so hard at the moment and making their case very well, and the public who support them. I think pharmacy can have a great future, as can pharmacists.

Question put and agreed to.

House adjourned.