Covid-19: Community Pharmacies — [Sir Graham Brady in the Chair]

Part of Backbench Business – in Westminster Hall at 2:46 pm on 11th March 2021.

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Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care) 2:46 pm, 11th March 2021

It is an honour to serve under your chairship, Sir Graham. I thank Jackie Doyle-Price for securing this important debate through the Backbench Business Committee, as well as for her leadership of the all-party parliamentary group on pharmacy. We are very lucky to have her commitment and her expertise in this area, and we can tell by how subscribed the debate has been and the high quality of it just how important community pharmacy is to Members of Parliament of all political persuasions. This is a very well-timed opportunity to talk about this important subject. As a Nottingham Member of Parliament, I know that Boots has been putting us on the map for 170 years now, so I am always very enthusiastic to talk about pharmacy.

The hon. Member for Thurrock made a number of important points, a couple of which I double-underlined. First, that sheer volume of work is indicative of the capacity, ability and creativity of our pharmacies, but also just how popular they are with our constituents. Secondly, she made a particularly important point about cross-funding, which is what pharmacy is built on at the moment. We have to get to a place where pharmacy, and the provision of what are, however we think about them, NHS services, is not cross-subsidised from selling Dairy Milks as well. That is the situation at the moment, and we need to do better.

The contributions from colleagues were really great, and it was really interesting to hear just how much commonality there is. I will start with my hon. Friend Taiwo Owatemi, because of her special expertise in the NHS as an oncologist pharmacist. The points she made about how pharmacies stayed open and the financial pressures that they face today were shared by my hon. Friends the Members for Bootle (Peter Dowd), for Halifax (Holly Lynch) and for Birmingham, Selly Oak (Steve McCabe), but they were also echoed across parties, in the contributions of the hon. Members for Bolton West (Chris Green), for Harrogate and Knaresborough (Andrew Jones), for Isle of Wight (Bob Seely) and for Southend West (Sir David Amess), as well as by Simon Fell, who left us with the sobering reality that his community has lost a pharmacy during this crisis. That is a big gap in the high street.

The hon. Members for Henley (John Howell) and for Carshalton and Wallington (Elliot Colburn) made very good points about vaccinations, which I will draw on shortly. Jim Shannon, as ever, brought his insight from Northern Ireland, which I thought was interesting. In particular, his points about medicine supply remind us that, without the right supply, we can have all the best services in the world but we will be unable to meet need. Finally, I was delighted that Steve Brine, the former Minister, raised the issue of hub and spoke. This is going to be such a seismic change to pharmacy that is going to affect all of our high streets, and I will make a couple of points about that in my conclusion in a moment.

Throughout this pandemic, we have had many heroes working on the frontline—doctors, nurses, dentists and other healthcare staff, as well as others in other professions, such as teachers, retail workers and many more. They have all adapted to fight the impact of the pandemic on the frontlines. They have had to adapt the way in which they operate, as has everybody in some way, whether it is working from home, working with social distancing measures or being on furlough. We ourselves are meeting in an extraordinary Chamber today, and we are very lucky to have the staff to deliver this for us.

However, one profession that has carried on very much as normal on the frontlines is community pharmacy. My local chemist in Bulwell has been open for me to pop in to pick up essentials, to get face-to-face advice and healthcare, and to pick up prescriptions. Now he is starting up as a vaccine centre—Raza, we are very lucky to have you. That has been the case all over the country, and although the hon. Member for Thurrock and I have obviously had similar briefings on this, I will reiterate the numbers, because they are really something. As well as dispensing the annual 1 billion prescription items, pharmacies have delivered healthcare advice at a rate of more than 48 million consultations a year. More than 600,000 people have sought advice from English pharmacies on medical symptoms each week, with a further 185,000 regularly needing help with an existing medical condition.

Pharmacies are acting as a buffer for the NHS, sharing the load when it has been most desperately needed. Thanks to community pharmacies, half a million GP appointments and 57,000 A&E walk-in centre appointments every week have been avoided. This has been a massive help for local communities and kept our NHS going. We should feel very fortunate to have these services available to us throughout the pandemic, but we must therefore show our gratitude in a meaningful way.

On 8 March last year, the Chancellor said that the NHS would have whatever it needs. Well, like Andrew Jones, I count community pharmacy very much as NHS—absolutely—and they should be covered by this too. That extra work and the extra costs of providing a safe environment have cost them money, and we have an obligation to meet those costs. That is not just my view, but the view of the Prime Minister on 10 February at the Downing Street press conference. He promised reimbursement as soon as possible, but pharmacies are still waiting. Those must not be empty words, to go along with empty claps for carers who have done so much for us but whose justice is a real-terms pay cut. We cannot see that happen again.

In a written answer to my hon. Friend Sarah Owen published on Tuesday, the Minister said that negotiations about this issue are ongoing. I hope the Minister can update us on progress and give us some good news. I am very mindful that, whatever we think about the recovery in dentistry, it was not satisfactory that negotiations between NHS England and the dentistry negotiating bodies collapsed before Christmas, meaning that the new arrangements were imposed on dentists. That has left a lot of ill feeling and anxiety. We should not repeat the same in pharmacy.

In that reply, the Minister also discussed advance payments as part of Government support for pharmacy, but we know now that the Government want those emergency cash-flow loans to be paid back. We should not be selling this as money given to the sector, when it is indeed a loan. That repayment of £370 million—an average of £32,000 per community pharmacy—is a real burden. I would be keen to know from the Minister what assessment she has made of the impact, because this could well harm patient care. It is impossible not to see, certainly because of the elegance of the figures, that that is exactly 1% of what we will spend on Test and Trace. Given what the Public Accounts Committee said about the effectiveness there, community pharmacies, which are getting a 100th of the funding, have probably had 100 times the impact.

This has been an ongoing situation in recent years. Pharmacy finances were marginal prior to this pandemic. A study by the National Pharmacy Association last year found that 28% to 38% were in financial deficit already, that this number would more than double without funding changes and that we have lost 400 pharmacies since 2016—disproportionally in the poorest communities, as the hon. Member for Barrow and Furness said. That has a significant impact on communities: patients travelling further, people waiting longer for appointments with overstretched GPs, and people suffering in pain with their minor illnesses and ailments or overloading our A&E departments. Communities lose the benefits of prevention, tackling health inequalities, early identification of disease, tackling obesity and other health conditions, and, of course, the vital administration of vaccinations.

Now is a good time to talk about the covid vaccine supply. With vaccine supply doubling this week, and with community pharmacy being so keen to do more, could the Minister tell us how we might get up from the few hundreds to perhaps the majority of the 11,500 pharmacies in England being part of the programme?

I want to finish by talking about hub and spoke dispensing. I am not against it, or particularly in favour of it. It still seems a bit like a solution in search of a problem to solve. I have met with pharmacy big and small—pharmacy representative bodies, independents and massive multiples—and everyone is always pretty nonplussed by it. It is never in the top few things that they want to talk about. That gives me some cause for concern. There will be thorny issues around the regulatory framework relating to the Medicines and Healthcare Products Regulatory Agency and the General Pharmaceutical Council over issues such as refrigeration and those differences that will need to be ironed out. Similarly, there are issues about finances and where risk and reward relating to the dispensing margin will lie in the system.

Despite the ambivalence on hub and spoke generally, there is a lot of interest in how it is going to proceed. I echo much of what the hon. Member for Winchester said. I hope the Minister will say today when we can expect the consultation on hub and spoke and critically— I have been asked this question multiple times—whether the Government see it happening before the NHS Bill, at the same time as the NHS Bill or after the NHS Bill. I understand that information sometimes cannot be shared, but knowing that would be of great importance to organisations that are planning their responses to both things and that want to know what their priority should be.

The Minister has made welcome commitments about consultation, but what is coming back to me from the sector is a desire for a really deep, proper technical consultation about this. I hope she can commit to that, because this is one of those strange circumstances where some people are already doing these things: we can build on their expertise and understand what hub and spoke does and does not do.

Pharmacy is a critical part of our health service. It has delivered for us in the most testing of times. We do not want to repeat the mistake that was made with dentists. We do not want broken commitments such as those that have been made to NHS staff. Pharmacy deserves better than that. I hope that today we can hear good news from the Minister about negotiations and get a sense of where we are going in the future.