Community Pharmacies — [Sir Mark Hendrick in the Chair]

Part of Backbench Business – in Westminster Hall at 3:00 pm on 14 September 2023.

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Photo of Peter Aldous Peter Aldous Conservative, Waveney 3:00, 14 September 2023

I beg to move,

That this House
has considered community pharmacies.

It is a pleasure to serve with you in the Chair, Sir Mark. I thank the Backbench Business Committee for granting this debate, the purpose of which is threefold. The first is to thank community pharmacists for the great work that they have been carrying out in towns and cities for around 175 years. It was in 1849 that John Boot opened his first shop in Nottingham. More recently, the sector stepped up to the plate and was a key player in delivering the covid vaccination roll-out.

Secondly, I wish to acknowledge and support the Government for recognising in their delivery plan for recovering access to primary care, published in May, the key role that community pharmacists have been asked to play in the future of planning care.

Thirdly, and probably most urgently, there is a need to address the enormous pressures that community pharmacists currently face. If that is not done, the sector could cease to exist in large swathes of the country and will be in no fit state to perform the role for which it has successfully auditioned. There are clear comparisons to be drawn with the current state of NHS dentistry, and it is vital that action is taken to prevent a repeat of that particular nightmare.

A community pharmacy, previously known as the chemist’s in the UK and still known as the drugstore in the US, is a retail shop that provides pharmaceutical drugs as well as other personal products. There will be a qualified pharmacist available to issue medical prescriptions and to provide advice and guidance to customers on prescriptions and over-the-counter drugs, as well as on general health problems. Community pharmacies should be distinguished from the solely dispensing pharmacies located in medical practices and hospitals.

In my research for the debate I noted, as I have over the years, that in some places and at some times, relationships between GPs and community pharmacists can be fraught and strained. That needs to be addressed if the Government’s plans for improving access to primary care are to be successfully delivered.

In preparing for the debate I visited the Kirkley pharmacy at Kirkley Mill in Lowestoft and Boots in Beccles. I thank them both, as well as Tania Farrow and Kristina Boulton from Community Pharmacy Suffolk, for their advice, information and support.

Community pharmacies are made up of privately run businesses and corporate chains. It is important to emphasise that both those groups are going above and beyond what any business could reasonably be expected to do to keep their shops open. It is the framework within which they have to operate that is at fault, not them. The private businesses often work ridiculously long hours for no reward in the service of their local communities, and the corporate chains use retail sales to subsidise the pharmacy side of their operation. It is clear that if reform is not carried out urgently, the steady stream of closures will turn into a torrent.

On 19 July, my hon. Friend the Minister—it is great to see him in his place—confirmed, in answer to a written question that I had submitted, that in the first six months of this year, the number of pharmacies in England reduced by 222. Yesterday, I was advised that Boots has announced that its shop in Orwell Road in Felixstowe, in the constituency of my right hon. Friend Dr Coffey, will close on 18 November.

While their number is falling by the day, there are approximately 10,800 community pharmacies in England. As I have mentioned, they do great work, and it was in recognition of that that the Government announced on 9 May that community pharmacies will play a central role in the delivery plan for recovering access to primary care, with £645 million being provided to support a pharmacy-first service.

That will include expanded treatment options for seven common ailments, including earache, sore throats and urinary tract infections. Community pharmacists will also be able to assess patients and supply certain prescription-only medicines without a prescription from a GP. That vote of confidence is welcome, but there is a concern that, due to a real-terms reduction in funding, about which I shall go into more detail shortly, there is an element of robbing Peter to pay Paul.

We now need the detail of how pharmacy-first will work, so that integrated care boards such as the Norfolk and Waveney ICB can set about its implementation. There have been no further details since May, and I will be grateful if my hon. Friend the Minister can advise us when further information will be published.

An important part of the future of community pharmacy is for pharmacists to be independent prescribers. By 2026, newly qualified pharmacists will be able to start work having received the necessary training to become independent prescribers as part of their qualification. There is a need to ensure enough support to enable existing community pharmacists also to be trained as independent prescribers.

To become independent prescribers, pharmacists will need the support of a designated prescribing practitioner as part of their training. Sufficient investment is needed to ensure that that can happen, as designated prescribing practitioners will be required to support both those studying for their foundation pharmacist year in 2025-26 and the existing community pharmacists wanting to be trained as independent prescribers. Both will require 90 days in a prescribing environment.

Community pharmacists are under extreme pressure on multiple fronts—financial, workforce and regulatory, with many rules dating back to the 1930s. Medical supply instability is particularly acute. That puts operational pressures on pharmacists, imposes financial burdens on their businesses and creates worrying delays for their patients. Two of the biggest and interlinked challenges facing the sector, and indeed the whole of primary care, are access to services and the sustainability of the workforce. An increasing number of pharmacies are now providing core hours only, due to workforce challenges and financial sustainability. That means that fewer are offering services in the evening, at weekends and over bank holidays, and, in some cases, they are having to close much earlier during the day.

While the introduction of pharmacists working in general practice is to be welcomed, it has had the negative consequence of making it more difficult for community pharmacies to recruit pharmacists. A lack of access to pharmacy services cascades through other parts of the health system—to general practice, to the number of calls to NHS 111, to appointments to out-of-hours services and to visits to A&E.

Funding has been cut by 30% in real terms over the past seven years. As a result, so as to remain viable, community pharmacists are cutting back on the discretionary services that they provide. That ultimately leads to permanent closures—461 by Lloyds and 300 announced by Boots in June.

The 30% real-terms funding reduction, accompanied by inflationary pressures and workforce shortages, has driven up costs and has led to reduced hours and permanent closures. The £645 million for the new common conditions service announced in May is welcome, but it does not address the underfunding of existing core services. There is a need for a stable, long-term and sustainable funding commitment that can be delivered through a review of the community pharmacy contractual framework. This means not only additional funding, but alignment of care pathways and provision of incentives within primary care systems. The funding crisis has knock-on implications, including pharmacists being unable to spend as much time with patients as they would like, as well as the withdrawal of services such as free deliveries, particularly to care homes, and monitored dosage system boxes, which are important to many people.

To address these pressures and ensure that community pharmacies can realise their full potential, Community Pharmacy England has come forward with its own six-point plan. First, as I mentioned, pharmacy funding should be reformed to give pharmacies a long-term, economically sustainable funding agreement.

Secondly, a common conditions service should be developed and implemented so as to allow patients to have walk-in consultations for minor conditions. That would provide accessible care and ease pressure on general practice.

Thirdly, community pharmacies should look to build on other clinical service areas, such as vaccinations, women’s health and long-term conditions management for, say, asthma and diabetes, using independent prescribing rights. In this way, pharmacy can do a great deal in key NHS priority areas and will help to get the health service back on a sustainable footing.

Fourthly, the medicines market must be reformed so as to get out of the situation we are now in, where pharmacies are dispensing some medicines at a loss and patients are facing long delays for medicines.

Fifthly, regulatory burdens should be reviewed and where necessary removed, so as to make running community pharmacies easier and to limit the increasing cost of service provision.

Sixthly and finally, a long-term plan for the community pharmacy workforce should be produced to ensure that pharmacies can keep their doors open and to enable them to retain pharmacists in local pharmacies.

In many respects, this debate is a trailer for the main attraction next Tuesday, when Community Pharmacy England launches its vision for community pharmacy, as prepared by the King’s Fund and the Nuffield Trust. In the delivery plan for recovering access to primary care, the Government undertook to continue to engage with the sector, with specific reference to the piece of work that is being published next Tuesday. I urge the Government to adhere to that commitment, which is vital not only to rebuilding primary care but to giving community pharmacies a sustainable and viable future, thereby ensuring that after 170 years they can remain part and parcel of the fabric of our towns and cities.