Peter Aldous leads a debate to call on the Government to address the enormous pressures facing community pharmacists especially as the sector will play a key role in the Government’s delivery plan for recovering access to primary care.
Peter Aldous (Waveney) (Con)
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 the Member for Suffolk Coastal (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.
4.25pm
Peter Aldous
This has been a very informative and helpful debate. We clearly have an enormous challenge in this country in improving access to primary care, and the key role played by the community pharmacy in addressing that challenge will be vital. We have heard about the three shortages that the industry faces, and I urge the Minister to reflect on those: the shortage of funding and finance, the shortage of staff, and the shortage of medicines.
The right hon. Member for Knowsley (Sir George Howarth) highlighted the impact of community pharmacy closures on deprived areas. It is clear from the maps that have been produced that the impact is disproportionate, including in some coastal communities, such as the one I represent. He also highlighted the key role that community pharmacies play in treating the long-term health conditions found in such areas.
My hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, rightly showed that this issue is on its register. I looked at the registers in the Select Committee report and I look forward to the amber and red warnings turning into green notices in due course. He highlighted the importance of PrEP being available for community pharmacies—the Terrence Higgins Trust brought that to my attention—and I welcome the update that the Minister provided.
The hon. Member for Bradford South (Judith Cummins) clearly emphasised the importance of a prevention-first approach. We got the first-hand knowledge that is so important in forums such as this from the hon. Member for Coventry North West (Taiwo Owatemi). I was particularly struck by her emphasis on the importance of using technology and the specific problem with the manufacture of generic medicines—she made her point very well. The shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), reinforced the potential of the sector and what an alternative Labour Administration would do.
The Minister highlighted the whole range of work that community pharmacies can do. He touched on the closures but said that there are actually more community pharmacists now than in 2010. I just highlight, from talking to community pharmacists, that when there are closures, getting consolidation of the sector across the country, so there is an even spread and we retain community pharmacies within 20 minutes of people, is not straight- forward with the current regulations. I urge the Minister and his Department to look at that.
The Minister also said there has been an 82% increase in registered pharmacists since 2010, but a lot of that increase may have been in hospitals and medical practices.
The feedback that I get from community pharmacists is that they have challenges with recruitment and retention in their settings, and we need to address that. I was heartened by what the Minister said about regulatory reform; it appears that the Government are embracing that particular challenge.
Let me say, in the few seconds I have left, that this debate has served the purpose of highlighting the key role of community pharmacies and the challenges they face. I urge the Minister to continue to engage with the sector—I know he will—particularly when the extra report is produced on Tuesday.