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It would clearly be a false economy if it resulted in losing pharmacies in areas where we need them. Equally, we would have to say to GPs, “I’m sorry. We can’t take the money off the pharmacies. We are taking it off you instead.” That would make it harder for them to deliver the services that they want to deliver. I do not think there are any easy answers. The system is under so much financial pressure that we must find savings wherever we can.
I have a few areas on which I want the Minister to comment when he winds up. The first is the hub-and-spoke model. Such a model would have been a complete disaster for community pharmacies. If the system is to work, we need pharmacists who know and are trusted by their patients so that they can deliver to patients the extra services that they need. If we moved to a hub-and-spoke model, in which the pharmacy knows almost nothing about the patients—the drugs are just prepared in a factory somewhere and then turn up for the patient—we would not have the community advantages from the pharmacy network that we all want. I hope that that idea, which may have been raised by some management consultants, can safely be binned—where most such ideas are probably worth sending.
The second area is the provision of services by pharmacists. I know that my local pharmacies are very keen to deliver more value-added services. They see that as right for the NHS and in the best interests of their patients. As I found out five years ago, when we went through the clinical commissioning group reform, they are not quite so sure that local GPs are keen on commissioning new services from pharmacies, rather than carrying out those services and taking the revenue themselves. We know that there is pressure in the GP sector, so we can see the point of that.
We need to have a vision throughout the country about what core services should be commissioned from pharmacies. I think the word the Government use about the minor ailments scheme, which I generally support, is that we should “encourage” all CCGs to commission such a scheme. I hope we can do something a little stronger than encourage, and that we can have a broader list of services for CCGs to commission from pharmacies. I have seen great work done on that in my constituency. Permission has been given for syringe driver services to be carried out by some pharmacies, rather than hospitals, so that they can be got to the patients needing them much more quickly and cheaply. Some pharmacies do warfarin testing, because it is much more convenient for patients to go to their local pharmacy than to have to trek to the nearest hospital or to their GP. Those services are very patchy and do not even cover a whole constituency, so I hope we will draw up a core list of services that can be done better by pharmacies and which will be used.
I will quickly touch on the third area, which is the variety of opening hours. Quite rightly, we are to start directing patients from the 111 service to their pharmacy rather than to out-of-hours doctors as the first port of call for emergency repeat prescriptions. However, there is an interesting mix in that some pharmacies open for 100 hours a week—perhaps opening at 6 am and closing at midnight—and other pharmacies open from 9 o’clock to 5 o’clock from Monday to Friday and may open for a couple of hours on Saturday morning. How will we commission all pharmacies to carry out such a service if some do not open out of hours? On the flipside, we still require many of them to open for 100 hours a week, even though it is not economic for them to do so during many of those hours. There is therefore scope for a review of the hours during which we expect pharmacies to open.