Amendment to the Motion

Part of Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022 - Motion to Approve – in the House of Lords at 3:45 pm on 28 June 2022.

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Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care 3:45, 28 June 2022

My Lords, I thank all noble Lords for their contributions and once again apologise for the delay in bringing this matter before the House. I welcome the essential role that your Lordships play in scrutinising measures. I experienced that during the passage of the Health and Care Bill, and I think we have a better Act as a result of the scrutiny from across the House. I will try to address as many as possible of the points raised before I conclude. I will try to cover most of the points but I pledge to write to noble Lords if I have missed any specific points.

If we look at the overall picture of the NHS, I am sure noble Lords recognise that we seem to have more doctors, nurses and pharmacists than ever before. As someone said to me the other day, that is all very well but the supply is not keeping up with the demand. If we consider our whole understanding of health, some of the things we ignored many years ago are now things we deem as needing treatment. For example, the whole area of mental health was ignored for many years. PTSM, which people talk about now, was officially recognised only in the 1980s. I know that we will probably talk about that in the next debate.

Before a debate the other day about neurological conditions, I asked my officials to give me a list of all the conditions. They said, “Minister, there are 600 of them.” Let us think about this. We were not even aware of that previously. It shows the great complexity as we become more aware of conditions and issues, putting even more pressure on our health service and health professionals, even though we have more health professionals than ever before.

The Secretary of State recently pledged to start with pharmacies when it came to overall primary care. The community pharmacy contractual framework, to which the noble Baroness, Lady Wheeler, referred—the 2019 to 2024 five-year deal—set out a joint vision for the sector, and an ambition for community pharmacies to be better integrated in the NHS and provide more clinical services. We saw this during the pandemic when pharmacies provided vaccines and we have seen recently that they will be providing more initial advice on issues such as cancer—and they welcome this.

At the same time, we are seeing an overhaul of the overall model. It is time to move away from the old model, in which you see your GP for five minutes and then hope for a referral somewhere else. Services previously considered part of secondary care are now being taken over by primary care centres. Areas previously considered the work of GPs are now being taken over by nurses and physiotherapists, as well as by pharmacists in the community.

Despite the challenges of the last few years, we have jointly delivered the introduction of a new range of clinical services at the community level. These are important in their own right and we are negotiating with the Pharmaceutical Services Negotiating Committee on the expansion of additional services to be introduced in the fourth year of the five-year deal. I very much hope that my right honourable friend the Secretary of State will be able to make an announcement soon. Longer term, we want to build on what has already been achieved and make better use of existing skill sets and those that are developing; for example, the prescribing and assessment skills that all pharmacists graduating from 2026 will have acquired during their training.

I turn to some specific points. We now have more pharmacists than ever before. Data from Health Education England shows that we now have an additional 4,122 pharmacists employed in the community compared with 2017, and the number of registered pharmacists has increased year on year. The number of primary care pharmacy education pathway trainees coming from community pharmacy increased by nearly 2,500. Reforms to initial education and training of pharmacists means that pharmacists qualified from 2026 will be qualified to prescribe at the point of registration. On top of the £2.5 billion that we are spending on the sector, Health Education England is investing £15.9 million over the next four years to support the expansion of front-line pharmacy staff in primary and community care.

We are also supporting a significant expansion in primary care capacity through the additional roles reimbursement scheme, enabling primary care networks to recruit clinical pharmacists and pharmacy technicians, two of 15 roles that PCNs can choose to recruit to. We saw the strength and potential of community pharmacies —many noble Lords referred to it—during the Covid vaccination campaign and the role that community pharmacies played in it. It is not yet known whether recurrent boosters will be required annually. We are looking into that and whether pharmacies will be once again called on.

Noble Lords will recognise—we had this debate many times during the stages of the Health and Care Bill—that to support long-term workforce planning, we are looking first at the long-term strategic drivers of workforce demand and supply. Building on this work, we have commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. Once this work is ready, we will share the conclusions and start to home in on what it means for recruitment, skills needed and skill gaps.

A number of noble Lords raised fears or concerns about what the regulators will do with their new powers. This is understandable: community pharmacies are private businesses and increased regulatory burden will be a concern for many of them. However, once again, we have to get the right balance between regulation and making sure of safety. The proposals include safeguards to ensure that any changes the regulators make are subject to full consultation, in much the same way as is expected from the Government. This will ensure that patients, the public, pharmacy professionals and the pharmacy sector have their say on what the standards should say.

There were some concerns about remote supervision. It is important to emphasise that a lot of the issues raised today do not affect this legislation, but I completely understand the point about taking advantage of the situation to debate the wider issues.

Many noble Lords have asked about the role of primary care networks. One of the tensions that we have is that in some parts of the network we have seen an expansion in primary care capacity through additional roles, but there are accusations—or tensions—that PCNs are poaching community pharmacies, and we are asked what the Government can do. We want to make sure that we address that tension to ensure that the approach is appropriate. Of course PCNs need pharmacies, but at the same time what pressure does that put on community pharmacies? At the end of the day, it is important that patients and others have access to a pharmacy within a close distance.

I turn to issues raised by other noble Lords. My noble friend Lady McIntosh talked about dispensing doctors. I apologise: I should have foreseen that question, and I commit to writing to my noble friend. On the rate of closures, I commit to writing to more than one noble Lord who asked about that, and I will get that data.

On the timeline, even I find this slightly unhelpful, but I will read out what I have been advised: the timeline has been brought forward by regulators and they are going to outline the programme of work, but I do not yet have specific dates. As soon as I have specific dates from the regulators and the timeline, I commit to writing to noble Lords.

In closing, I am grateful for the contributions from noble Lords today. Introducing the order will give pharmacy regulators the necessary powers to set standards and rules on pharmacy practice matters and the core roles of responsible pharmacists and superintendent pharmacists. We hope this will allow the rules better to keep pace with the changes in modern pharmacy services. We recognise what was highlighted by the Secondary Legislation Scrutiny Committee’s first report, and any subsequent draft rules produced by the regulators will require full public consultation and scrutiny by Parliament. We look forward to discussing these matters in debate.

I turn to the amendment in the name of the noble Lord, Lord Hunt. Of course I have sympathy with the issues that he has raised. Strictly speaking, they are not matters that can be addressed by the legislation before your Lordships’ House today, so while I understand the frustrations, I do not support the noble Lord’s amendment. I thank Members for their interest and for the positive debate today and I commend the order to the House.