[George Howarth in the Chair] — Local Pharmaceutical Services

– in Westminster Hall at 12:00 am on 3rd March 2015.

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Motion made, and Question proposed, That the sitting be now adjourned.—(Damian Hinds.)

Photo of George Howarth George Howarth Labour, Knowsley

Before I call the first speaker, it might be helpful if I point out that the time display has been the subject of a technology failure. Although it is telling the correct time, it is saying that the speech time is already 7 minutes 29 seconds. I say that not because I anticipate any pressure on time, but to prevent anybody who is wondering how long they have been speaking from thinking it is 7 minutes 29 seconds longer than they had anticipated.

Photo of Caroline Nokes Caroline Nokes Conservative, Romsey and Southampton North 9:30 am, 3rd March 2015

It is, as ever, a pleasure to serve under your chairmanship, Mr Howarth. I appreciate your pointing out the clock to me. I might have thought I had got stuck in some sort of time warp and was forever on 7 minutes 29 seconds.

I want to put on the record my thanks to Mr Speaker for granting this debate on the essential small pharmacy local pharmaceutical services scheme, which has played and continues to play an important role in supporting small community pharmacies up and down the country. Pharmacies are an essential part of our health care system, and pharmacists play a key role in providing quality health care. They are experts in medicines and they use their clinical expertise and practical knowledge to ensure that medicines are safely supplied to and used by the public.

Over the past few years, a much greater emphasis has been placed on the role of the pharmacist. People have been encouraged to use their local pharmacy as the first port of call for the minor ailments—coughs, colds and skin rashes—that afflict us all from time to time. Pharmacists also play a significant role in programmes such as smoking cessation and emergency contraception, and they do great work with medicine reviews and in ensuring that people use their medicines properly and effectively. They play a huge role in the winter by providing flu jabs efficiently and cost effectively. If I recall correctly, my hon. Friend the Minister supported Westminster flu day last year. Your interest in diabetes is well known, Mr Howarth, and you will be aware of the important role that pharmacists play in helping those with long-term conditions to manage their diseases.

Photo of Andrew Stephenson Andrew Stephenson Conservative, Pendle

I congratulate my hon. Friend on securing this important debate. I am a huge supporter of the role of local pharmacies, and I am kept regularly updated about developments by a number of Pendle pharmacists, including Mark Collins of the Barkerhouse road pharmacy in Nelson and Matthew Leedam of Leedams’ pharmacy in Colne.

Does my hon. Friend agree that expanding the crucial role of pharmacies to enable them to better care for patients with long-term conditions, help people to get the best from medicines and offer people the support and advice they need to live independently and stay healthy would benefit not only patients but our local communities and our NHS?

Photo of Caroline Nokes Caroline Nokes Conservative, Romsey and Southampton North

I absolutely agree with everything that my hon. Friend said. Small community pharmacies often know their patients well, so they are at the forefront of helping people to manage their conditions and know whether they are taking the right amount of medicine. They are often a useful place for people to go for an informal chat about the conditions that affect them.

Community pharmacies are at the heart of our communities. They dispense advice as regularly as medicine, and they help people to make healthier lifestyle choices. Pharmacy Voice, the organisation formed from the three largest community pharmacy associations, strongly advocated the role of the community pharmacy as part of the solution to pressures on accident and emergency and GP services. It has encouraged people to think, “Pharmacy first”, and it has described community pharmacy teams as being perfectly placed to care for patients with common winter ailments. We are coming out of winter and into spring, but pharmaceutical services are there all year round. They are just as adept at dealing with allergies, stings and hay fever as they are at dealing with winter colds.

Last year, Pharmacy Voice identified that up to 8% of A and E visits could have been dealt with by a high street pharmacy, and approximately one fifth of GP visits could have been avoided by visiting the pharmacist. Last year, NHS England reinforced the role of the community pharmacy with the “Feeling under the weather?” campaign. Many Ministers, including my hon. Friend the Minister, have emphasised in responses to written and oral questions that pharmacists have a great role to play in helping people to manage long-term conditions and in helping people with their medication.

None of the pharmacists I spoke to prior to this debate is sure when the role of the essential small pharmacy was first recognised, but I can say with certainty that the essential small pharmacy in the village of Wellow in my constituency has benefited from support, reflecting its small scale and relative remoteness from other pharmacies, since it opened in 1990. The national contract for such pharmacies was first introduced in 2006, and it has been extended a number of times since then. About 100 pharmacies receive support from the essential small pharmacy local pharmaceutical services scheme. Many are located in relatively remote rural areas, but some operate in inner-city communities. Over the years, they have provided services that have been relied upon by residents for their health care as well as their dispensing needs.

The current pharmaceutical needs assessment, published in 2011, supports the continuation of the scheme. It states:

“ESPLPS pharmacies are used to ensure that access to pharmaceutical services is achieved in certain locations in line with the model of access to pharmacy services in ‘Healthy Horizons in Primary Care’.”

Rural bus services are being reduced and it is increasingly difficult to access other pharmacies by public transport, so small pharmacies can easily be described as essential to local communities. Certainly, that is true of Wellow pharmacy.

What is the problem, and why have I requested this debate? These arrangements have existed for many years and have provided modest support for small pharmacies, where they are needed for patients, but where they might not otherwise be economically viable. The national contract was introduced in 2006, and negotiations by the Pharmaceutical Services Negotiating Committee have seen it extended a number of times. But what is an essential small pharmacy? The criteria for eligibility are that the pharmacy must be dispensing fewer than 26,400 items a year and must be more than 1 km from the next nearest pharmacy. Their benefit to communities was deemed to be so great that a minimum level of remuneration was set. It is currently just under £80,000 a year. From the pharmacy global sum, a top-up payment would be permitted to ensure the continued viability of the pharmacy. However, NHS England confirmed last autumn that it is not possible to continue national arrangements, leaving individual pharmacies to negotiate with their own NHS area teams. Support has been available from the PSNC, but many local pharmacists have found those negotiations difficult, time consuming and stressful. Although some have been successful, other area teams have not been able to provide certainty.

Photo of Sarah Newton Sarah Newton Conservative, Truro and Falmouth

I am grateful to my hon. Friend for securing this important debate. She is describing the situation faced by an essential small pharmacy in St Mawes in my constituency. We had a public meeting on 5 February with NHS England local area teams, and hundreds of people showed their support for that pharmacy, which is vital in serving the Roseland peninsula. We have not yet heard from NHS England about whether that funding is secure, but the pharmacy applied for an LPS contract. My hon. Friend is right to highlight the continuing uncertainty that the situation is causing for pharmacists and the communities that they serve.

Photo of Caroline Nokes Caroline Nokes Conservative, Romsey and Southampton North

My hon. Friend has accurately outlined the situation in her constituency, which I am sure is mirrored across the country. I have received representations from community pharmacists, who have said that they are struggling with short time scales and no certainty from their NHS area teams.

Photo of David Simpson David Simpson Shadow DUP Spokesperson (Communities and Local Government), Shadow DUP Spokesperson (Business, Innovation and Skills)

I think Sarah Newton may need to go to the pharmacy. Is the main problem for smaller pharmacies purely the finance, or is it the facilities that they have?

Photo of Caroline Nokes Caroline Nokes Conservative, Romsey and Southampton North

I thank the hon. Gentleman for that intervention. I will move on to finance, but it is not my contention that finance is the problem; we just require the local area teams to manage these contracts and get them in place before the deadline of 31 March is reached.

As I was about to say, the contract for Wellow pharmacy, in line with those for every essential small pharmacy across the country, will expire on 31 March. When the contract comes to an end, my constituent Mr Sharma is gravely concerned that his pharmacy will not be able to continue providing these services, unless the local NHS area team decides to renew it, making specific arrangements under the local pharmaceutical services scheme. As yet, he has not received a decision.

Many other pharmacies are similarly affected, and I know that the Secretary of State for Education, my right hon. Friend Nicky Morgan, who cannot be here today, has expressed concerns about the pharmacy at Loughborough university and the one in the village of Wymeswold. I think that perfectly illustrates the diverse localities that these pharmacies serve. It is not just small village pharmacies under threat, but one serving a university campus, where young people are living away from home for the first time and might be in a position to benefit most from the sage, experienced advice of a pharmacist for their front-line health care needs.

I completely understand the need for NHS England to have devolved these contracts to local area teams, but the reality is that 31 March is now exactly four weeks away and for many pharmacists, there is still no certainty. According to Pharmacy Voice, had NHS England renewed the contract, there would have been procurement and tendering issues, so it was devolved to the areas, but we now face a problem where few have confidence that when we get to the end of this month, they will have a new contract.

What are their options? Well, they are pretty stark. They can close immediately, with no notice to the local community, because the contract will have expired and therefore no notice period is necessary. They can try to struggle on, returning to the pharmaceutical list but facing an immediate drop in income, which was previously agreed by all to be necessary to enable them to provide essential services. Or, and I am sure that this is the option most will follow, they can continue to pursue the NHS area teams to prove their value and worth, when in fact that was already established a long while ago.

For small pharmacies, there is a real challenge in viability. Using Wellow pharmacy as an example, it currently issues in the region of 2,200 prescriptions a month. That is pretty close to the 2,400 prescriptions a month that would trigger what is known as an establishment payment, but it is not quite there. It has worked hard to increase business, but in small communities it is incredibly difficult to push numbers above that threshold. My constituent Mr Sharma describes the additional prescriptions needed as a gulf that he has been struggling for years to cross and has never yet achieved.

I do not intend to delve into the issue of dispensing GPs and what is often perceived as a conflict between pharmacies and those GPs who can dispense. That is quite separate from the immediate time pressure faced by these pharmacies, which have already been deemed essential. What my constituent and the other pharmacists who have contacted me have emphasised is the chasm between the number of prescriptions that they routinely issue and the number that they would have to reach in order to receive the establishment payment. For some, the gap is greater than others, which means that the impact of losing the essential scheme will be felt differently by various pharmacies and that some might be forced out of business faster than others.

Most members of the scheme are already doing significant work to make sure that they are as accessible as possible to patients, including collection of prescriptions from nearby surgeries and free delivery of medicines to patients. As Mr Sharma puts it:

“This pharmacy is the only health care provider in the area of any type, and the nearest other pharmacies are over five miles away in Romsey. If a patient was to need an over-the-counter medicine, require a medicine free of charge for a child, need support for self-care, or have a minor injury, there is a significant risk that without the availability of my pharmacy, they would attend either the GP surgery in Romsey or the accident and emergency department of Southampton general hospital.”

What he wants, in common with pharmacists from across the country who have been in touch with me, is some certainty going forward.

As Has Modi, of Deanshanger in the constituency of the Economic Secretary to the Treasury, my hon. Friend Andrea Leadsom, has said:

“These contracts have been left to the discretion of the area team of NHS England, to whom we are required to make a formal proposal.”

The primary care contracts manager of the area team is adamant that the proposal will not be supported unless it can be proved “value for money”. Without the financial support that that entails, this small pharmacy will undoubtedly have to close because the normal funding mechanisms are massively staked against small pharmacies. It does not even receive various basic fees—which can be substantial—that are available to average and larger pharmacies. This is why the ESPLPS arrangements were put in place to safeguard small but essential pharmacies in the heart of the community.

I appreciate that the current arrangements cannot continue, and that because the Secretary of State has devolved the contracting of primary care services to NHS England, a further extension to the scheme is not possible. He has already extended it once, from 2013 to 2015, and he cannot devolve responsibility for commissioning and then interfere with how that same commissioning operates. Therefore, no extension will be forthcoming and I accept that.

As my hon. Friend Sarah Newton has said, many pharmacies are actively negotiating with their area teams, but concerns have been raised about the responses they are receiving, including time-limited support, and requirements to demonstrate that they are providing value for money. However, those area teams with an essential small pharmacy service are receiving a top-up on their allocations, so the funding is already there and is ongoing from the global pharmacy sum. Any amounts allocated have to be spent on pharmacy services and cannot be redistributed to any other purpose.

Effectively, if the essential small pharmacies are not supported, the moneys will simply go to other pharmacies in locations that have not been deemed to be of such an essential nature. Presumably, they might be redistributed to the larger existing pharmacies, many in high street locations, some distance from the village where there once was a supported, critically important pharmacy.

Essential small pharmacies are working hard to ensure that their “pitch” to the area teams is as robust as possible. Many, such as Wellow pharmacy, are garnering support from the local community, from appreciative patients and from borough, county and parish councils. Local residents are filling in surveys, outlining the services that they use at the pharmacy and identifying what impact closure would have on them personally.

It seems to me a relatively simple proposition: if these pharmacies are essential, and successive Governments have agreed they are, what more can we do to make sure they are retained? I have three things that I wish to ask of the Minister today. First, we need some clarity over what constitutes an essential small pharmacy. Some 90 pharmacies historically receive payments under the scheme. It would be helpful if they could point to an incredibly robust set of criteria, so that it would be easy for the pharmacists then to identify to the area teams why they need the support that has been forthcoming for, in at least the case of Wellow, 25 years.

Secondly, we need some encouragement to NHS England area teams to ensure that the outstanding contracts, which are believed to be the majority of them, are resolved before 31 March, so that pharmacy services are not simply forced to stop in these communities. I know that some are resolved and that others are working very actively to make sure that they are in place before the contracts—and therefore the payments—expire, but from my e-mail inbox, I am acutely aware of how many are simply in a state of limbo, having no idea whether their business will be viable 28 days from now. I would welcome the Minister considering how best she might convey that urgency to NHS area teams.

Finally, we need closer investigation of what role NHS England could play in making sure, within the procurement rules, that pharmacies deemed over decades to be essential can continue to receive support, via the pharmacy global sum, so that there is no additional cost to the NHS area teams and that the top-ups that area teams receive remain in place. However, it should also be made very clear that those can only be used for pharmacy services and not distributed among the wider health care community.

As I said at the beginning, we all appreciate the very important role pharmacists play in our health care provision. They dispense advice and knowledge, as well as drugs. In those of our communities remote from other health care providers, 100 or so of them have been deemed to be essential—and we need to keep them.

Photo of Kevin Barron Kevin Barron Chair, Committee on Privileges, Chair, Committee on Standards 9:49 am, 3rd March 2015

I think that this is the first time I have spoken when you are in the Chair, Mr Howarth. I hope that I do not receive a yellow card from you, given the rumour that is going around at the moment that the refereeing system from soccer will be brought into this place.

I do not have a constituency interest to declare inasmuch as Caroline Nokes does. I thank her for securing this debate, but I represent urban Rotherham, which is a little different from some of the other constituencies represented here. My interest is that I chair the all-party pharmacy group, as I have done for nearly five years in this Parliament. I also have a personal interest in pharmacy and its development.

I am sure that most of us know that pharmacies provide services that are vital to some patients. Without financial support, we could lose them and patients would not be easily able to access other health services. The current system ensures that the benefits of access to pharmacy networks are spread widely. Furthermore, if small pharmacies have to close, local patients may find it harder to access and receive advice on medicines and support for healthy living services, such as stopping smoking or weight loss, that pharmacies have begun to offer.

The lack of a pharmacy in many areas could lead to additional strain on other parts of the NHS. The hon. Lady mentioned GP surgeries and A and E. We all know about the pressure on A and E: I think nationally 50% of people who attend A and E get no treatment whatsoever. Some of them may not need treatment, but what they should get could be provided by a pharmacy or dentist, not by the local hospital. I think last year we had 76 people turn up at Rotherham’s A and E with toothache. Quite frankly, we need to start educating the population a bit more about where they should go, but clearly the pharmacy has a major role to play.

Two of the four organisations who support the all-party pharmacy group are the PSNC and Pharmacy Voice, which have been highlighted by the hon. Lady, and I have talked to them briefly about this issue. The all-party group has not looked at that in the past four years, but we have looked at lots of issues and had many meetings with both Ministers and civil servants about pharmacy developments. Those organisations tell me that they certainly believe that sufficient funding is available in the NHS to support pharmacy, as has already been said, but they are concerned about the responses that some contractors have received locally.

PSNC has pressed NHS England to give this matter urgent attention, stressing the impact on contractor and patients of any delay. As was pointed out well, there are four weeks to go and there must be deep concern in areas where matters have not been settled that pharmacies may go under. Those two organisations also believe that NHS England needs to consider and confirm its position on each of the pharmacies urgently. The overwhelming majority have strong cases for continued funding.

There are many reasons why a pharmacy is a vital component of a community. Indeed, pharmacies lie at the heart of a community. Community pharmacies are the most accessible health care locations in the country: they are the more than 11,500 places in England where people can go to get their prescriptions dispensed and receive advice from experts on medicines and support to help them make lifestyle choices. Many community pharmacies offer extended opening hours and weekend services. Unlike many GP services, they are more available to the population than ever before.

In one of the last two meetings of the all-party group, we looked at the new medicine service that pharmacists are deeply involved in to help patients to adjust, if need be, to the medicines prescribed to them. Then, just last week, we had a round-table discussion with many organisations representing patients with mental health problems on whether issues such as mental health should come under that new service. That debate is ongoing, but it shows the potential for pharmacists to help people.

Community pharmacy also helps to prevent ill health and protect the public. The provision of smoking cessation services, which has already been mentioned, as well as health checks and, here in London, seasonal influenza vaccination programmes and emergency hormonal contraception are all examples of how pharmacies help to reduce public risk and mitigate potential downstream costs for the NHS.

This winter, the all-party group looked deeply at influenza vaccines. London is contracted to do that, unlike many other parts of the country, which is another area where we can take the burden off GP services. I have no doubt that we all read the e-mails we get constantly from the British Medical Association about the pressure on GP services, and measures such as professional pharmacists giving influenza jabs seem to be common sense to most people. We should look at expanding the London contract.

Committed, trained, competent pharmacists, pharmacy technicians, dispensers and counter assistants are often the first point of contact for the public. More than 1.6 million visits a day are made to community pharmacies, which is more than to any other primary care provider. Many years ago, I saw the real strength of pharmacies. I took my family of young children to Spain. One of them fell ill and I said in the hotel, “We may need a doctor,” and they said, “Well, just go up to the local pharmacist.” I have to say that I was impressed, not just that they could understand my Yorkshire accent—or English, if that is what it is—but by the advice we got, with no need to go and bother anyone else. It was clear that, years ago, other parts of Europe were using pharmacists as the great pillars of strength that they are. We now do that, but we should continue to do so. Indeed, that is one of that major reasons why I took over the chair of the all-party group.

At a time when the England’s high streets are under siege, it is important to remember that pharmacies employ local people and help to bring variety over and above betting and charity shops—another vital issue—with a network of premises reaching out into communities, especially deprived ones. There is no evidence to show that simply reducing the number of pharmacies will improve care for patients. Central to the future development of community pharmacies is supporting them to become hubs for health care in local communities, to be the first port of call for health advice to help people to manage their health and well-being, both in self-limiting common conditions and in supporting greater self-care in the management of long-term conditions.

We do have healthy living pharmacists up and down the land now. About 10% to 12% of pharmacists give people advice on lifestyle issues on a daily basis. I do not want to encourage the Front-Bench Members to start having a go at one another about the Health and Social Care Act 2012 that went through earlier in the Parliament. I did serve on the Bill Committee, and as the Minister has heard me say before, I supported some of the changes, particularly moving public health back into the community.

There are two things in that Act that have not been on people’s lips since. One was reducing health inequalities. It is essential to have local pharmacists, working in areas where we have known inequalities. The other one was population health. Again, we do not seem to be talking about not looking just at people who are ill. I have often said that the national health service has been a national ill health service in reality: it responds to people who are ill.

If we are to get public health right and improve health in this century, we must move away from the idea that the NHS is here as an ill health service and towards being proactive. Lifestyles are a bigger threat to public health than anything else. Population health is crucial and I see no better primary health care practitioners with better numerical access to the population than local pharmacists. Although that is not about the potential threat to pharmacies, which should be protected—quite right, too, in the circumstances—that will be a growing issue and pharmacies should become a proactive health service in years to come. To lose pharmacists through these changes, if they happen, will not help in any way whatsoever.

I will be interested to hear what the Minister has to say to some of the questions asked by the hon. Member for Romsey and Southampton North, particularly on the ticking clock, which stands at four weeks. If I was running a business such as a pharmacy now and I had got as close to that time as that, I would be deeply worried, as I would be for the people who work in the pharmacy with me.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health) 9:59 am, 3rd March 2015

It is a pleasure, as always, to serve under your chairmanship, Mr Howarth, and not for the first time. I extend my congratulations to Caroline Nokes on securing the debate. She made an excellent case, and I could not disagree with a word that she said. I thank my right hon. Friend Kevin Barron for his typical insight. He will be reassured to know that I understood every single word.

With access to treatments under increasing pressure, with more people waiting in A and E and with GP appointments fully booked, it is right that we devote parliamentary time to discussing how we can increase the role of local pharmacy services in our communities, so I commend the hon. Member for Romsey and Southampton North on bringing the matter to the House. If we were not four weeks away from a general election and on a one-line Whip, I am sure that the Chamber would be packed. It is a shame that we are discussing a matter of such importance to colleagues from all parts of the House in this environment, because the subject is important to everybody who understands and cares about what is happening in their local health economy.

On 31 March 2015, as we have heard, the Local Pharmaceutical Services (Essential Small Pharmacies) Directions 2013 will be revoked. As a result, on that date, the essential small pharmacies scheme will come to an end. In contract negotiations in 2004-05, the Department of Health and the Pharmaceutical Services Negotiating Committee agreed that essential small pharmacies should be contracted under the local pharmaceutical services provisions. In discussions, NHS England has confirmed that it and the PSNC cannot negotiate a new arrangement to replace the existing contracts. Instead, that must be done locally. An NHS England document published in January this year states that contractors have two options available to them:

“1. To rely on any right of return to a Pharmaceutical List maintained under Regulation 10 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (“the Regulations”); or

2. To submit a proposal to provide Local Pharmaceutical Services (“LPS”) under Part 13 of the Regulations.”

In effect, they can either receive standard pharmacy funding as set out in the drug tariff, which would result in reduced incomes, or they can agree a new local pharmaceutical service contract with the local area team. The report by NHS England neglects to mention a third possible outcome, which is that pharmacies may be left with no option. Pharmacies on reduced incomes may no longer be viable, and they would have to cease to provide pharmaceutical services. The PSNC states that pharmacies that face having to close down will not have to give notice, because NHS England is aware of the termination of the contract, although it recommends contacting local area teams. I am sure we all agree that that could have a devastating impact on local services. Many people rely on their local pharmacy, and I am genuinely concerned that as a result of the plans, those people could be left without the pharmaceutical services that they need and rely on.

Can the Minister outline any transitional arrangements that have been made to ensure that pharmacies are not forced to close unnecessarily? Are any contingency plans in place to cope with difficulties? I would be grateful if she could outline the discussions that the Government had with industry representatives when the plans were drawn up. Notwithstanding any transitional issues, can she provide an estimate of how many pharmacies may be forced to close under the new arrangements? Pharmacies play a crucial role, especially in rural and remote communities such as mine. Pharmacies often provide key services, and the average person will visit their pharmacy more often than their family doctor—I certainly do. Such engagement is crucial in maintaining good health and well-being. My right hon. Friend the Member for Rother Valley spoke at length about the fact that community pharmacies provide services such as smoking cessation and dietary advice, and those services must be maintained.

I am sorry to disappoint my right hon. Friend, but I will mention the Health and Social Care Act 2012, because the Government’s NHS reorganisation has forced intense pressure on all parts of our NHS. That can clearly be seen, as I said at the outset, in the waiting rooms of our GP surgeries and in our A and E departments. According to the most recent GP patient survey, almost 6 million people could not get a GP appointment the last time they tried, and a further 7.8 million waited a week or more. GPs are under severe strain, and pharmacies can play a critical role in alleviating that pressure and expanding access. We also know from the GP patient survey that some 1 million patients went to A and E because they could not get a GP appointment.

More than 1 million people per day—I think the figure is 1.6 million—in England visit their local pharmacy, and the average person will visit their pharmacy 14 times a year. The GP patient survey has shown that GPs and A and E departments already struggle to cope with patient numbers, so they would simply not be able to manage if pharmacies were forced to turn patients away. The Government must make it clear that that will not happen under the new regime.

In a White Paper published in 2008, Labour made it clear how pharmacies can deliver more services to ease pressure on primary care. Pharmacies have a huge role to play in our NHS, and the service simply cannot afford for pharmacy not to play a key role. To address pressures in primary care, the Government should implement measures such as improving links between pharmacy and the NHS 111 service so that care is better co-ordinated. Can the Minister explain what steps the Government are taking to utilise pharmacy better within the NHS?

With those points in mind, I would be grateful if the Minister could outline how the Government will ensure that service coverage and access to pharmacies are not compromised by the upcoming changes. Further to that, will she explain how the Government will ensure that pharmacies provide more services to alleviate pressure on other parts of the system? That is a particular issue in remote, rural and isolated areas, as the hon. Member for Romsey and Southampton North has said, where there are no bus services worthy of the name and no other public transport. The hon. Lady made the case exceptionally well. Isolated health economies are already struggling and frequently achieving sub-optimal outcomes. Reducing access will only worsen those outcomes and increase acute service pressures. Many people rely on those services, and they will be worried that they could lose them. I hope that the Minister can address those concerns, and if my fears are misplaced, I hope that she will explain why.

I am reminded of the roll-out of NHS 111. That has nothing to do with the Minister, because she was not in post at the time, and she knows that I hold her in the highest regard. However, I ask the Government not to repeat the failings of the 111 roll-out when it comes to small pharmacies. Independent academic studies showed Ministers that 111 was not fit for purpose and not fit to be rolled out. Members from all parts of the House warned the Government that the 111 pilots had not worked. I warned the Government before the roll-out of NHS 111 that the scheme was not ready, but they ignored all the advice and rolled out a service that they knew was misfiring and that contributed to the worst A and E performance in more than a decade. That deterioration in patient care was avoidable. I urge the Minister not to repeat those mistakes, but to listen to, accommodate and respond to all the concerns raised today.

Photo of Jane Ellison Jane Ellison The Parliamentary Under-Secretary of State for Health 10:07 am, 3rd March 2015

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate colleagues on their contributions, and I particularly congratulate my hon. Friend Caroline Nokes on securing the debate and highlighting some of the challenges facing local pharmacies. For me, as the Minister with responsibility for public health, the debate is also a welcome opportunity to place on record the wider contribution that pharmacies make. Kevin Barron singled out that contribution and emphasised the potential of pharmacies.

I hope that I can give some of the reassurances that the shadow Minister, Mr Reed, sought. Overall, the picture for pharmacy is positive, and it has the potential to play a greater role. I have talked about and, I hope, championed that on a number of occasions, and there is an awful lot more that we can do. I will talk a little bit about that wider point, but I will also address the specifics of the essential small pharmacies scheme and the challenges that face those pharmacies.

People understandably appreciate the ability to access pharmaceutical services near to where they live or work. Essential small pharmacies have, in the past, been valuable in securing and maintaining the community access that my hon. Friend the Member for Romsey and Southampton North has so ably described. NHS England’s five-year forward view makes it clear that our health services must evolve to cope with not only increasing demand but the different patterns of people’s lifestyles. Every part of the health system is now considering how best to engage with that challenge and how to allocate available resources most efficiently.

Although others have touched on it, it is worth revisiting the history of the essential small pharmacies scheme. It has been in existence since the 1960s as a way of ensuring access to services in local communities for patients and the public in locations where the viability of such pharmacies might have been uncertain. As others have said, that is often in isolated rural areas, but not exclusively; sometimes such pharmacies are in new residential developments, for example. The scheme operates against a backdrop that has changed a great deal since its inception in the 1960s, and I will perhaps touch on the ways in which the world around the scheme has evolved.

The scheme was reviewed as part of the new community pharmacy contractual framework, and became known by yet another snappy health service title: the essential small pharmacy local pharmaceutical services scheme. The contracts were not designed to be permanent; they were transitional arrangements. The shadow Minister mentioned transitional arrangements, and the scheme is coming to the close of quite a long transitional arrangement, as was flagged some years ago. Pharmacies admitted to the new scheme, which replaced the previous scheme in April 2006, had to be nominated by the then local primary care trust and agreed by the Department of Health. As in the previous scheme, pharmacies were required to meet certain conditions, the most important of which was that they had to dispense more than 6,000 and fewer than 26,400 prescription items per annum and be located more than 1 km from the nearest pharmacy by the nearest practical route available to the public on foot. There is no central definition of “essential” but, broadly speaking, it is as I have described. It is a case of considering the different schemes. Essentially, community access is at the heart of the definition of “essential.” The scheme closed, and no new pharmacies have been allowed to join since 2006.

The current scheme was intended to be temporary, but it was extended in 2012 for a further two years. That was done in the context of a new market entry system for pharmacies and the changes made to the NHS under the Health and Social Care Act, which the shadow Minister mentioned, with the objective of enabling NHS England to consider the options and to give adequate notice to affected pharmacist contractors. With four weeks to go, it is obviously a concern that we are debating the fact that some pharmacies do not quite know what is happening. I will address the efforts to resolve that, but hopefully this debate, if nothing else, will be a good spur to everyone engaged in those important discussions and negotiations, so that we can ensure that they are brought to a sensible resolution.

The end date of the scheme, as my hon. Friend the Member for Romsey and Southampton North mentioned, is 31 March 2015, which means that affected pharmacies have had two years to prepare for the changes since the scheme was extended. I stress that the ending of the scheme does not mean that affected pharmacies must close. It is obviously up to the individual contractor whether they wish to return to the pharmaceutical list and come under the terms of the community pharmacy contractual framework or submit a proposal to provide local pharmaceutical services. Many have done that, and I will touch on the numbers in a moment.

I appreciate that it has been a difficult time for contractors, such as the ones described by my hon. Friends the Members for Romsey and Southampton North and for Truro and Falmouth (Sarah Newton), because small businesses are often concerned with serving their communities and perhaps have a bit less time for protracted contractual negotiations. I hope and expect that they will receive appropriate support from local NHS teams. I give an assurance that, if a change in provision is needed, NHS England’s local area teams will work, and are working, with individual providers, but my hon. Friend the Member for Romsey and Southampton North has highlighted where she thinks that work needs a bit more energy to ensure that people in her community can continue to access services conveniently.

Of course, there are new ways of delivering dispensing services. We have internet pharmacies, and many pharmacies now offer delivery services to patients—members of my family have taken advantage of such services. People who are less mobile can have medicines delivered straight to their door, and I hope it reassures the House to know that 99% of the population can reach a pharmacy within 20 minutes by car, and that 96% of people can do so by walking or using public transport.

At the end of March 2014, there were 11,647 pharmacies in England providing NHS services, which is 18% more than in March 2006. That is a success story for pharmacies and not the opposite; it is definitely a growing story, and rightly so, for exactly the reasons that the right hon. Member for Rother Valley highlighted. Pharmacies have an essential role in supporting our public health system, as well as our NHS.

Some 226 pharmacies were accepted on to the ESPLPS pilot scheme in 2006 and, of those, 73 are still eligible to receive payments, which is less than 1% of pharmacies overall. Of those 73, 16 have reached an agreement or have a solution at a very advanced stage, and 47 have proposals under consideration, so the balance of around 10 are still working closely with area teams, which I hope gives Members at least some reassurance that the scale of the challenge is not huge. The challenge is important and serious for those who have not resolved the situation, and I urge area teams to work closely and give maximum support, but I reassure the House that this is not a large-scale problem across the country; it is a localised problem. None the less, it is important, particularly for local communities. People are probably most concerned about pharmacies where proposals are under consideration, because the clock is ticking. We want those proposals to be given serious and urgent consideration so that we can bring those discussions to some sort of conclusion.

I reassure members of the public that if their essential small pharmacy closes, they will still have access. I have given the assurance that many pharmacies will not close, but people nevertheless want to know that they will still have access. I have mentioned some of the ways in which people now have greater choice than in 2006, and NHS England has an absolute responsibility to ensure that communities can continue to access appropriate services and consider alternative local provision. That provision might be through new contractors, or through a service that is accessible as part of a larger retail offer somewhere nearby. That has become more popular in recent years, and it allows people to combine their weekly shop with a visit to the pharmacy, allowing them to take advantage of public health work through those outlets.

The closing of the scheme does not mean that affected pharmacies have to close; quite the opposite. The two available options have already been outlined. Pharmacies can return to providing NHS pharmaceutical services under the contractual framework and no longer receive the top-up payment, which I accept might be difficult for some, particularly very small businesses. Alternatively, pharmacies can make a proposal, and those proposals are now under consideration and being worked on. I cannot comment specifically on the case in West Wellow in the constituency of my hon. Friend the Member for Romsey and Southampton North, but the area team will know about this debate; we will follow up to ensure that the area team has a record of it and understands that Members were sufficiently concerned about the matter to bring it to the House’s attention today.

More broadly, on the subject of how much community pharmacies have changed since 2005-06, we now see pharmacies as places to go for much more than just getting a prescription dispensed and getting advice on medicines. Pharmacies are a valuable, and sometimes the most accessible, health resource in a local community. We have introduced new revenue streams, such as medicines use reviews and the new medicine service, which contractors can choose to provide to their local population, so there are other routes for local pharmacies.

Clearly, with my public health responsibilities, I am happy to take this opportunity to highlight the relevance of community pharmacies to providing public health services. The NHS document on its long-term sustainability, the five-year forward view, calls on the nation to get serious about public health as one way in which we can avoid spending billions of pounds on avoidable illness. Pharmacies have an important role to play. I have visited pharmacies that are rolling out pre-diabetes checks and other such things. It makes no sense for us, as a nation, to gear up to spend money to serve 4.5 million people with type 2 diabetes when we could do valuable preventive work to stop millions of them getting type 2 diabetes in the first place. Even if people can live with type 2 diabetes for a long time, we want people to live not only long lives but well lives. Living a long time with a number of co-morbidities is not a great quality of life, so there are all sorts of reasons for encouraging pharmacies to be on the front line of preventing illness and helping people to avoid such conditions.

As the right hon. Member for Rother Valley mentioned, there are now more than 1,000 healthy living pharmacies across the country, and there are many more in the pipeline. Those pharmacies utilise the skills of the whole team—not just the pharmacist, but those trained as health champions. I am conscious that the individuals who work in a pharmacy may be more approachable to many people, may understand the local community particularly well and may have insights to bring. I saw some good examples of that when I went around constituencies last Easter talking to pharmacists who knew their communities particularly well, many having grown up in them. They knew the individuals there and knew how to target leaders in the community. I am a great fan of pharmacists and their role in all public health promotion work.

More than 9,000 community pharmacies in England supported the smoke-free January campaign last month, giving out quit cards, and engaging with smokers in person, through their digital presence and on social media. More than 6,500 have signed up to support no smoking day later this month, and that number continues to grow. It is valuable work. Pharmacies have also delivered a large part of this year’s winter flu immunisation programme; more than 105,000 vaccinations have been provided through that route in London alone. Again, as the shadow Minister said, pharmacies are an important way to relieve pressure on other parts of the system, and they are recompensed for those services.

This debate has provided us with a valuable chance to put on record what tangible value pharmacies bring to our society, and particularly to our health system, of which they can sometimes be the unsung heroes. I applaud how they have supported and continue to support our public health ambitions. The five-year forward view had a whole chapter on prevention. Getting serious about public health is at the heart of the challenge of sustainability for our much-valued and much-loved NHS. We need pharmacies to play their part. Estimates suggest, as I think the shadow Minister mentioned, that 18% of GP consultations for common and minor ailments and about 8% of accident and emergency attendances could be dealt with by pharmacists, which emphasises their importance.

I appreciate the concerns that have been raised about this scheme. I hope that I have given the House some reassurance that although it is clearly a challenge for the pharmacy in the constituency of my hon. Friend the Member for Romsey and Southampton North and some others, we have now reduced the number of pharmacies with unresolved issues to a very small number. However, it is critical in these last few weeks before the transitional scheme expires that we resolve the remaining issues in a way that gives people a chance to plan for the future. Those essential small pharmacies have played an important role in the past, and NHS England area teams are ready to work with, and I hope are working with, any contractor who wants to continue providing a pharmacy service to their community. I will encourage them to continue to engage, to ensure that we can reach as many outcomes as possible, particularly for the benefit of local communities, which have been so ably championed by my hon. Friend.

Sitting suspended.