That this House has considered the role of community pharmacies.
May I say what a pleasure it is, Sir David, to serve under your chairship this morning, and to have you join us for this important debate?
Between the ages of 14 and 18 I worked in a local chemist shop two evenings a week and some Saturday mornings. There were the usual first job responsibilities: restocking shelves, cleaning, and meeting and greeting customers and patients who were not always well, for a variety of reasons. I loved it, because there is never a dull moment in a pharmacy. I remember a frantic mother handing me dead headlice taped to a piece of cardboard, and someone asking me to run a pregnancy test on a bottle of cough medicine, before discreetly letting me know that it was actually a urine sample rather than cough medicine and that that was the only secure way she could find of transporting it to the chemist shop.
The shop was exactly what it said on the tin. It was a community pharmacy, and the whole community would walk through those doors for advice, medication and reassurance. I remember the older people, whose relationship with the pharmacist was the longest-standing and most trusted relationship they had with a clinical professional. I remember a long-term recovering addict, who would bring his daughter with him every day. We watched her grow up, and supported him as he worked hard to stay the course on his journey to recovery.
That is why community pharmacies matter, and it is why they work. However, it appears from the community pharmacy contractual framework announced in October 2016 that that was not appreciated. There was a reduction from £2.8 billion in 2015-16 to £2.68 billion in 2016-17 and £2.59 billion in 2017-18. That represented a 4% reduction in funding in 2016-17 and a further 3.4% reduction in 2017-18. When inflation is factored in, as well as all the services that pharmacies already offer free and whose costs they absorb, that was a near fatal blow to the service nationwide. The then Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told the all-party parliamentary group on pharmacy that he expected between 1,000 and 3,000 pharmacies to close, as they would no longer be viable in the face of the cuts, with multiples and chains of pharmacies best placed to survive, and independent and more rural chemists left at a disadvantage.
In March this year the Pharmaceutical Services Negotiating Committee found that 233 community pharmacies have closed in England since the Government funding cuts were introduced. Sixty-nine were independent pharmacies and a further 22 were independent multiples. The number of closures anticipated by the right hon. Member for North East Bedfordshire has not yet been reached. However, I have spoken to people in pharmacies, and others contacted me ahead of the debate, and many are operating at a loss, clinging to the hope that the funding arrangements will improve, but with a business model that, as the right hon. Gentleman predicted, is not viable.
The impact that the funding cuts have had on patients is really difficult to justify. The cost of delivering prescriptions to those who find it hard to leave the house was previously absorbed by local chemists, but that is no longer possible. Boots was the last of the big four chain pharmacies to start charging for delivery over the summer, with all patients having to pay £5 for delivery, or £55 for a 12-month delivery subscription, by the end of the year. All have some exemptions for particularly vulnerable customers, but Boots, LloydsPharmacy, Rowlands Pharmacy and Well have all reduced free deliveries, or started charging for delivery.
There is no funding for arranging drugs in trays. When I worked in a pharmacy, it was a big undertaking to arrange medicines in trays by time and day, predominantly for older people who needed that degree of support if they were to live well for longer by taking their medication at the right time and in the right doses. Pharmacies were delivering a degree of invaluable social care, and that is no longer possible in the present financial climate. We can all see what the consequences will be. Ultimately the result will be more costly clinical interventions.
In addition to the financial pressures that pharmacies face, drugs shortages are now becoming debilitatingly resource-intensive across the NHS. Pharmacies have no ability to absorb the costly hours spent sourcing drugs or speaking to GPs about possible alternatives. A Bristol GP, Zara Aziz, recently wrote in The Guardian of her experience of medicines shortages. She explained that EpiPen users in Bristol are now being told to use their old EpiPens up to four months after the expiry date. She also tells the story of a patient in acute distress from arthritis pain when a commonly used anti-inflammatory, Naproxen, suddenly became unavailable. Eventually, a very small quantity was found, but the patient was forced to use it sparingly, not as she had been prescribed, as none of the alternative anti-inflammatories would have been suitable for her.
My hon. Friend the Member for Redcar (Anna Turley) shared with me a photo of a poster from Pharmacy Magazine, which has gone up in her local hospital. It says, “Please don’t blame us for the NHS medicine shortages. It is a nationwide problem. Please ask your local MP to help.” The poster included contact details of local MPs handwritten on the bottom. We very much hear those concerns, and we are here to ask the Minister to get a grip on this problem.
Shortages are caused by a combination of different issues. The implications of Brexit are inevitably a factor that will play out over the coming weeks and months. However, we know that the NHS and the UK are potentially losing out to more profitable and attractive markets. In addition, the stockpiling, as a precaution, of certain drugs that are harder to source, coupled with the deliberate and more alarming manipulation of the markets by some wholesalers to deliberately push up prices, is having a detrimental effect. New regulations are also having an impact on manufacturing processes.
On top of that, cash flow is a massive challenge in community pharmacies. Community pharmacies pay out for drugs and are reimbursed by the Government the following month. The situation is made even tougher still, however, because they are not always reimbursed what they have paid out for drugs, particularly for drugs that are in short supply. By law, pharmacies have to do everything in their power to source a drug and dispense it, even where prices have become inflated due to a shortage. Let us take Naproxen as an example. One of my local pharmacies tells me that earlier this year the cost of a box shot up from about 26p to about £15. The tariff price paid by the Government to reimburse pharmacies for Naproxen peaked around February, at £12.50 a box. The medicines shortage is having the perverse effect of forcing pharmacies to dispense at a loss. In previous budgets, there might have been just enough for the pharmacy to absorb this cost. Those days are long gone. The system is clearly no longer fit for purpose.
Earlier this year, the Government introduced the serious shortage protocol in the Human Medicines (Amendment) Regulations 2019. It was intended to be a safety mechanism to help cope with any serious national shortage. It gives pharmacists the ability to dispense a reduced quantity, alternative dosage form or generic equivalent to that stated on the prescription. There would be a small payment to pharmacies for undertaking that process. Despite pharmacists and GPs feeling that they are spending unprecedented amounts of time sourcing medicines or researching alternatives, not a single drug has appeared on the list, which means that pharmacies and GPs do not get paid any extra to compensate them for the time they now have to dedicate to that element of dispensing.
Although there are no drugs on the serious shortage protocol, there is a separate concessions list, which acknowledges that, due to a shortage of a drug, the price has changed. At the end of September, there were 45 drugs on that concessions list. Again, inclusion on that list does not acknowledge the time involved in having to source the drugs, which is becoming the largest part of the pharmacist’s day. Nor is there any attempt to fund that work.
There was some hope for community pharmacies more broadly in the community pharmacy contractual framework published in July, which takes effect from October 2019 through to 2023-24. The five-year deal commits to not cutting the budget any further. However, when inflation is taken into account, it will still see pharmacies unable to meet costs, for all the reasons I have outlined.
Strangely enough, what the framework does do is realise the potential for pharmacies to alleviate pressures on the wider NHS, paving the way for a much more integrated approach. The 111 service is now able to refer a patient directly to a pharmacy for an appointment. The framework seeks to expand the delivery of clinical services in pharmacies. It is all great stuff, which is very welcome, but I return to the clear warning given by the then Minister back in 2016 that between 1,000 and 3,000 pharmacies will not be viable and will be forced to close if overall funding does not increase.
I congratulate the hon. Lady on securing the debate. Given the pressures all our A&Es and acute hospitals face, does she agree that the community pharmacies in many areas across the UK do a magnificent job—particularly those specialised pharmacists who relieve the pressure on A&Es? If community pharmacies are put at risk and we lose them, there will be even more pressure on our A&Es and acute hospitals at a most awkward time for our society.
I could not agree more. I thank the hon. Gentleman for making that important point. It was very welcome that in the community pharmacy contractual framework—for the first time, I think—the Government really did understand that. However, the funding to allow pharmacies to survive long enough to deliver those services has not been forthcoming. For all its aspirations to deliver more clinical services, a pharmacy that has been forced to close can deliver diddly-squat. Does the Minister accept that community pharmacies’ potential will be realised only when they are funded to survive?
Like many colleagues, I am incredibly concerned about the impact of medicine shortages, both on the NHS and on patients themselves. It is contributing to the mix of factors that are piling unbearable financial pressure on our local chemist shops. I hope the Government have a plan to respond and keep our trusted, effective community pharmacies open.
Several hon. Members rose—
Sir David Crausby (in the Chair)
Order. I will call the three Front Benchers at 10.30 am. Several Back Benchers wish to speak. I will not put a time limit on speeches, but if hon. Members keep them to about seven minutes or less, everybody will get an opportunity to speak.
9:41 am
Liz McInnes (Heywood and Middleton) (Lab)
It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing this important and pertinent debate and for giving me an opportunity to raise an issue of great concern to residents of Heywood and Middleton.
We know that community pharmacies have struggled with the funding cuts that the Government have introduced since October 2016. As my hon. Friend pointed out, figures compiled in March by the Pharmaceutical Services Negotiating Committee show that 233 community pharmacies in England have had to close since those cuts were introduced. Evidence from local pharmaceutical committees across England supports the picture of community pharmacies struggling financially. Independents are being hit the hardest and have been forced to cut hours or staff as a result.
A consequence of that was highlighted to me last week by my constituent Karen, who told me that her local independent community pharmacy was to start charging £5 for the home delivery of medicines. As my hon. Friend said, the same measure has already been adopted by the four multiples: LloydsPharmacy, Rowlands, Well and—the latest to join—Boots, which recently announced that it would charge a one-off fee of £5 or a 12-month subscription fee of £55 for delivery of prescriptions ordered in branch.
The actions of those multiples seem to be having a knock-on effect on our local independent community pharmacies as they struggle to cope with year-on-year funding cuts. With the cost of a prescription now at £9, the additional charge bumps up the total cost to a hefty £14 for those who pay for their prescriptions and makes an absolute mockery of free prescriptions for those who qualify. If someone is on free prescriptions but cannot get to their local pharmacy because of illness or disability, the delivery charge means that their prescription is no longer free.
As a result of these decisions, some of the most vulnerable people in our communities will suffer, including many who rely on the delivery service to access much-needed and essential medication. Sadly, many people in our communities suffer from chronic loneliness and simply do not have the social contacts to ask someone to collect their medicine for them. I would be interested to hear the views of the hon. Member for Eastleigh (Mims Davies), the Minister for loneliness, on this draconian measure; I will write to her after this debate, when I hope I will have received some response from the Minister who is present.
I urge the Minister to look carefully and seriously at this really important issue, which appears to be a growing problem. The Association of Independent Multiple Pharmacies says that continuing challenges to pharmacy funding are not helping the situation, with the five-year funding cap not covering
It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing the debate. I have a non-financial interest to declare: I chair the all-party group on pharmacy.
Community pharmacies play a major role in supporting the prevention agenda, which is a key development in the NHS long-term plan. As an integral part of the NHS, they are also a valued community facility with a positive track record of improving access to healthcare services. Compared with GP surgeries, there are more than 11,600 community pharmacies across England, and 89% of the population are estimated to have access to one within a 20-minute walk. That percentage rises to 99% in the most deprived areas of our country. We should recognise that community pharmacies are crucial.
There is still much more that could be done to unlock the huge potential of pharmacies and to further integrate them with emerging local healthcare networks. For example, service commissioning is patchy across the country, meaning that not all patients can access the same services from their local community pharmacies. More than 95% of community pharmacies now have a private consultation room from which they can offer advice to patients and a range of nationally commissioned services, such as the flu vaccination service. In 2018-19, 1.4 million flu vaccinations took place in community pharmacies. Two years ago, when the service was first introduced, other parts of the medical profession did not like the idea of pharmacies moving into that area, but the figures show that it was a good idea.
The new medicine service allows pharmacies to provide support for people with long-term conditions who have been newly prescribed a medicine to help improve medicine adherence. My hon. Friend mentioned it in relation to the elderly. I am sure we all know that more than 70% of NHS expenditure in the UK is on people with long-term conditions in the acute or primary sector. It is important to recognise that. Many pharmacies are commissioned to offer public health services by local authorities and the NHS.
Thank you, Sir David; it is a pleasure to speak in this debate. I congratulate the hon. Member for Halifax (Holly Lynch) on securing the debate and thank her for doing so. Community pharmacies are an important issue in my constituency, as they are in hers, and indeed in the constituencies of everyone who is here to contribute. Elected representatives who keep their ear close to the ground will know that community pharmacies have a critical role to play, why is why I wish to touch on them here.
It is a pleasure to see the Minister in her new post. This is only her second debate in Westminster Hall, and the first in which she is going to have to answer some hard questions, but I have no doubt that she is up to it.
I have spoken numerous times about the importance of community pharmacy funding, especially in rural areas, because it is absolutely essential. For people who are rurally isolated or ill, knowing that their local pharmacy will collect their prescription and have it ready to collect—or even deliver it, as they often do in my constituency—is very important. That point cannot be emphasised enough. It makes all the difference to an ill person and it is critical that we have that system in place.
I agree with the NHS protocol that does not allow GPs to prescribe annually, but I also know the strain that it puts people under to undertake to have a new prescription allocated, collected, left at the pharmacy and then further collected. It is time-consuming and means a lot of effort for those who are ill and rely on public transport. Community pharmacies take much of the legwork and stress out of this.
We all know the problems of getting community transport in rural areas, whether buses, taxis or even getting friends to help with collecting prescriptions. They are as important to our ill and vulnerable people as any other NHS service, and the funding cuts have put too much pressure on that service already.
It is a pleasure to see you in the Chair, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing today’s debate.
A couple of weeks ago, I went to visit a local community pharmacy in my constituency, and the superintendent pharmacist sat me down to tell me his tale of woe, which has been echoed across the Chamber this morning. He runs seven pharmacies across the city, serving 20% of the population, but he has seriously struggled over the past three years and is wondering whether he will be there next year. He has ploughed in tens of thousands of his own money just to keep the business afloat. That certainly highlights how many single-handed pharmacies have closed in the city.
Part of this is about the Government funding cuts, not least to the establishment payment, which covered things such as rent, regulatory registration and insurance. Part of it has also been about the loopholes for the clinical commissioning group and how it is now buying branded generics and not giving the headroom that pharmacies used to have. For instance, if people were purchasing a drug at, say, 60p and it had a value of 90p on tariff, there would be headroom of about 30p. That money was then ploughed back into the business to run other essential health services and to ensure that there could be free deliveries of pharmaceutical products to the community. Pharmacies just do not have that headroom any more.
The situation is made far worse by the multinational companies—we have heard about Boots, Lloyds and the others—which have the buying capacity and the space to be able to drive up the price at the wholesalers, which in turn means that the independents pay more when they go to purchase their pharmaceuticals. I have always called it the Walmart model, because that is how many of these companies operate. They try to push out the competition by making it impossible for the independents to participate in the market. That is certainly what we see here.
It is a pleasure to serve under your chairmanship, Sir David. I thank the hon. Member for Halifax (Holly Lynch) for bringing forward this issue, which is important for the whole country. Community pharmacies play a vital role wherever they are, but that is especially so in large dispersed rural communities such as mine.
As we have heard, many of those community pharmacies are in increasingly marginal positions and are at risk of closure—indeed, many have closed. That is tragic for them, their patients and the communities that they are at the heart of. It is also a tragic wasted opportunity. The Government should make far better use of our community pharmacies to secure their futures and to benefit patients. The Government could provide sufficient funding for pharmacies so that they can provide an agreed range of patient services to prevent ill health and to keep people who are living with chronic conditions from getting worse, as hon. Members have mentioned.
I sat down with one of my local pharmacists in Kendal a few weeks ago. He told me that the Government have an opportunity to commission a national minor ailments service provided by community pharmacies. The key objective would be to use the talents and expertise of our pharmacists and, in doing so, to remove pressure from GPs and A&E departments in other parts of primary care in the NHS.
Pharmacists in my area serve communities as diverse and widespread as Sedbergh, Hawkshead, Ambleside, Staveley, Windermere, Milnthorpe, Kendal, Kirkby Lonsdale and many others. All the pharmacists I speak to fear that their numbers may be further whittled away by the Government, either by design or by attrition. The Government and people in the sector have talked about there being 3,000 fewer pharmacies. On behalf of local pharmacists and their patients, I say that that would be unacceptable. We want clarity from the Government on the number of pharmacies that they envisage, and we want a commitment to maintain the number that we have.
It is a pleasure to serve with you chairing today, Sir David. It is also a pleasure to speak in a debate in which the contributions so far have been full of knowledge and experience of the grassroots. I congratulate my hon. Friend the Member for Halifax (Holly Lynch) on securing it and on setting out at the start, from her own personal experience, the strength and importance of community pharmacies in their communities. They really are at the heart of communities.
My right hon. Friend the Member for Rother Valley (Sir Kevin Barron) spelled out clearly the potential of community pharmacies. I think the Government recognise that potential in their NHS long-term plan, but as my hon. Friend the Member for Halifax pointed out, they do not provide the funding to deliver on that potential.
Every day in this country, 1.6 million people visit a community pharmacy, so it is not surprising that the 2016 petition to save community pharmacies was one of the largest ever seen in this House. It demonstrated the commitment of communities across the country to their community pharmacies.
In visiting local community pharmacies across Scunthorpe, Bottesford and Kirton in Lindsey, I have seen the huge range of work that they do: dispensing medicines, dealing with minor injuries, administering flu jabs, and, as has already been said, being at the sharper end of drug shortages. Making sure that the drugs are there is a massive job and needs a lot of resource to ensure that it is done. As other colleagues have said, community pharmacies are a core part of the public health network, doing important work.
Community pharmacies are at the heart of communities and keep an eye on people, arranging their medicines in trays and delivering them free of charge to people’s doors. However, as my hon. Friends the Members for York Central (Rachael Maskell) and for Heywood and Middleton (Liz McInnes) have said, what is now developing is a drug delivery tax, which threatens the survival of this service. That is because the very people who most need it are the very people who will not use it—that is the nature of the loneliness and other challenges in these communities, as my colleagues have said.
10:17 am
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“inflation, volume increases and national minimum wage increases.”
The five-year period will be increasingly painful for many pharmacy businesses already under heavy financial pressure. It is only to be expected that many pharmacies will reassess all their existing costs, including the costs of services that they currently deliver for free. The financial model is simply unsustainable for the next five years. I ask the Minister to think about the impact that the changes will have on vulnerable, lonely and housebound people, and to consider approaching the Chancellor to request funding for this vital service and bring an end to this tax on the sick.
On the new national services in 2019-20, my hon. Friend mentioned the community pharmacist consultation service, which is something we should look forward to, with the community pharmacists as the first port of call for minor illness or for the urgent supply of medicines. Pharmacies will offer patients a consultation to help manage their minor illnesses or provide an emergency supply of medicine. The service will take referrals from NHS 111, but in years to come such referrals could come from other settings such as GP practices and the NHS online. That is a progressive move so that we can access services far better than we can at the moment. We will see how it goes.
The other national service is hepatitis C testing. Pharmacies will offer testing for people using pharmacy needle and syringe programmes to support the national hepatitis C elimination programme. There will, however, be an extension of the reach of the six mandated public health campaigns that community pharmacies have to take part in, and many community pharmacies will also choose to take part in the pharmacy quality scheme. This year, that might involve preparing for engagement with primary care networks, which is crucial. When I first talked to my local primary care network about where the pharmacy fits in with this, they were not at all sure. We also have: carrying out audits on prescribing safety for lithium, on pregnancy prevention for women taking valproate, and on the use of non-steroidal anti-inflammatory drugs; checking with patients with diabetes whether they have had annual foot and eye checks; reducing the volume of sugar-sweetened beverages; complete training and assessment on look-alike, sound-alike errors, which is crucial for us all; updating risk reviews; completing sepsis online training and assessment, along with risk mitigation; and completing the dementia-friendly environment standards.
From April 2020, all pharmacies will be required to be able to process electronic prescriptions and to have attained healthy living pharmacy level 1 status. Accreditation will mean the pharmacies are local hubs for promoting health, wellbeing and self-care, and providing services to prevent ill health. That is the real move we should be seeing in community pharmacy now, to promote population health and reduce health inequalities. Pharmacies have a major role to play in that.
With regard to other future pharmacy service developments, as part of the five-year deal community pharmacies may also be able to support the appropriate use of medicines through the expansion of the new medicine service to other conditions. In addition, the NHS will use the national pharmacy integration fund to pilot services for potential roll-out. These include a model for detecting undiagnosed cardiovascular diseases and smoking cessation referrals from secondary care. That is crucial—this is a matter for another day—when we see the reduction in smoking cessation services here in the UK, yet still more than 85,000 of our fellow citizens are dying prematurely each year from smoking-related disease.
Further services include: the use of point-of-care testing around minor illnesses to support efforts to tackle antimicrobial resistance; routine monitoring of patients, such as those taking oral contraception, under an electronic repeat dispensing arrangement; activity to support primary care network priorities, such as early cancer diagnosis and tackling health inequalities; and a service to improve access to palliative care. These are the ideas that the community pharmacy has got and where it is going to move in the next five years. That is crucial.
Once again, I thank my hon. Friend the Member for Halifax for securing the debate and providing this opportunity. The issue of expenditure has been mentioned, although I will not go into the history of it now. The Minister will be acutely aware that when we had the pharmacy integration fund, it was set aside after the cut. In fact, it was not used very well and lots of money was left in there. We are now moving into areas where that money should have been used. It is crucial that we get the money now on the table into frontline pharmacy services.
I assume that all the elected representatives here today have received letters similar to those that I have received outlining the difficulties facing community pharmacies in Northern Ireland. I will highlight those that frighten me the most—I use the word “frighten” because that is exactly what they did. They hail from a rural constituency with stretched service provision. One such letter states:
“The results illustrate the cumulative impact of the funding and the workforce crisis as stark.”—
these are strong words—
“Aside from pharmacy staff leaving by choice, a significant proportion of pharmacy owners, 39%, have been forced to reduce their workforce as they can no longer afford to cover the salary costs. To try to compensate for staff losses, 95% of pharmacy owners have increased their own working hours”.
In other words, they are now working longer hours just to ensure that their pharmacies cope. Some report regularly working 80 to 100 hours a week, which I suggest is above and beyond the call of duty. In addition, the letter states that
“93% of contractors report being forced to reduce the level of additional services they can offer, with 41% reducing or applying to reduce their pharmacy opening hours.”
Those figures illustrate the issues: 30% of staff are leaving by choice; 41% of pharmacies are reducing their staff; and those in charge of the pharmacies are working almost 100 hours a week. Against this demonstrable crisis in workforce, the core workload continues to increase. Dispensing activity over the past nine years has risen by almost 40%—again, pharmacies are doing more work with fewer staff, which compounds the issue—to a level of around 55 million dispensing episodes in 2018-19 alone. That is a colossal number of prescriptions handled and dispensing episodes.
Over the same period dispensing fees have been reduced by around 30%, which is an example of marked underinvestment in an essential service, where safety and accuracy are critical to the public and the health service. I am not saying for one minute that things are going wrong, but we want to ensure that the general public’s safety is always at the forefront. For that to happen, pharmacies need to be assisted financially, and they must have the opportunity to get the staff they need.
The community pharmacy workforce survey contains a number of recommendations for turning things around in the sector. I have no doubt that the Minister’s response will help make these things happen before it is too late. I ask her to be cognisant of the recommendations, because if they are applicable to Northern Ireland, then they are applicable to the UK mainland. The thrust of the recommendations is that there must be better communication. How often do we say that there should be better communication? There must be better communication between Government Departments, elected representatives and their constituents on new legislation coming through. It is critical that we have better communication between the Department and pharmacies, because they need to know what is happening. The Government and the Department need to be responsible to them too.
We have TV campaigns outlining when it is appropriate to seek a pharmacist’s attention, rather than to see a GP. That is all good stuff. People can now visit their pharmacist to ask about minor ailments, taking some of the pressure off A&E departments. That is part of what they are trying to achieve over the next period of time. Yet the information about what can be treated and how to get that help is not communicated. Better communications are a way of doing things just that wee bit better.
Over the years I have suggested to Government Departments, including the Department of Health in Northern Ireland—health is a devolved matter—and to Health Ministers here that we could perhaps do things a lot better. For example, we could let pharmacies take on responsibility for some minor things, such as checking for glaucoma or diabetes. It would be helpful if those things could be checked for in pharmacies.
In conclusion, with this body of trained professionals we have the potential to ease the burden on GPs and enable better surgery efficiency, yet that has not been tapped into. We have the potential to make people’s lives a lot simpler with an appropriately funded community pharmacy. By not doing that, we are losing highly trained professionals and adding more strain to an already overburdened GP system. If we do not help the pharmacies, we do not help the GPs or the A&E departments. This needs an overhaul, and who better to feed into that than those operating the service at present? I look forward to hearing the Minister’s response and, hopefully, some positive replies.
There is a toxic combination of cuts, CCGs facing tough financial lines—the CCG in York is always struggling—and, on top of that, the wider market pressures. Of course, the multinationals can spread their risk. They sell other products, and they are owned by multinational corporates, which gives them a further cushion in their operations. The impact is that, where some of those big companies have bought up independents, they are then closing them in crucial communities.
Clifton in my constituency is an area of high deprivation, with one of the lowest ages of mortality in the city and a real need for a community pharmacist, but Lloyds has pulled out of that community. That means that while people are waiting, say, three weeks to go and see their GP, they cannot just pop down the road to their community pharmacy as an alternative, because it is simply not there.
That is building more pressure on the independents, because people go to them to get the free delivery now that, as we have heard, the big companies have seen a gap in the market—surprise, surprise—and are charging their drug delivery tax to get more resource. That means that the independents, which are trying to provide that community service, are delivering further and further afield, which is costing them more, and they have less resource to do that with. We need to address the drug delivery tax to ensure that, as my hon. Friend the Member for Halifax set out, we get these products to those people in our communities who are incredibly vulnerable.
I draw the Minister’s attention to one other scandal in the industry, which is that companies such as Boots are paying only 9% corporation tax. As a result, the Government are losing out on £1 billion a year. If we think about the scale of the cuts and the £200 million that has been removed, it does not take long to realise that, if Boots was forced to pay its corporation tax, we would not see pharmacies struggling and going to the wall, or communities suffering and losing those essential community services.
I ask the Minister to go back to the Treasury and make sure that those tax loopholes are closed. Boots moved into a multinational company, which I believe is 49% American-owned, and it is now registered in Switzerland, so it does not have to pay the same overheads. That is another inequality built into the market that must be addressed. The pressure cannot continue, or we will lose our community pharmacies. As I said, one pharmacist, who oversees seven pharmacies, does not think he will be there next year. That is seven communities across my constituency and York Outer that will not have a community pharmacy on the street corner.
It is vital, therefore, that the new Minister gets to grips with this issue. She must make sure that the right investment goes into our communities, that those loopholes are closed for the CCGs and for tax, and that the drug delivery tax is not put on pharmaceutical products.
In the past, Health Ministers have expressed admiration for the French community pharmacy model, which pays for community pharmacies across the board to provide more patient services, such as conditions tests, smoking cessation and blood tests. Will the Minister commit to commissioning such services from community pharmacies across England comprehensively, not just case by case?
Community pharmacies would also be aided by having greater flexibility to dispense authorised medication when the pharmacist is away for a short time, perhaps visiting a local care home. The Government should also consider allowing big national pharmacy chains to share their automation platforms for prescription assembly with smaller independent community pharmacies to reduce costs across the board.
There is also the issue of fair payments. Many independent pharmacies in the south lakes are in danger of going out of business because of reductions in payments for prescriptions by NHS England. Often, the money that pharmacies receive from the national health service does not even cover the cost of the drugs being dispensed. In one shocking case, a pharmacist in my constituency in a relatively small Lake district village, who I have visited regularly, received in one single month £5,000 less in NHS payments than they had to pay out in wholesale drug payments. And that is on top of that pharmacy losing on average 10% of its NHS income each year over the last three years. That is utterly unsustainable, but it is replicated across our communities. So I ask the Minister to intervene personally to put this matter right.
We see a picture of a community pharmacy network that is full of wonderful, talented, highly skilled and dedicated professionals, who provide vital services to patients and their families, and that is part of the glue that holds communities—particularly rural communities—together, but it is being let down by an unambitious approach to community pharmacy from Government, which undervalues what these pharmacies do and, even more importantly, undervalues what they could do.
Therefore, I ask the Minister to consider the proposal in my early-day motion—which, thanks to the non-Prorogation, is still alive—for an essential community pharmacy scheme, to support community pharmacies in rural areas such as mine and to keep them open and thriving. Moreover, will she heed the calls from pharmacists across the country, who are merely calling for fairness in payments and for the ability to use their skills to serve their patients and communities, removing debilitating pressure from other parts of the NHS?
As the hon. Member for Westmorland and Lonsdale (Tim Farron) said, pharmacies are very important in rural areas, but they are also crucial in areas such as Westcliff, which is in the heart of the urban part of my constituency. There, the community pharmacy is the only health service that is close to the local community, which has many health needs.
A local community pharmacist contacted me recently, and I will use his words to describe what it is like at the sharp end. He points to
“Huge shortages and price hikes by suppliers of generic drugs from July 2017 onwards”,
and says that the Department of Health is
“not reimbursing us for even the cost of drugs, let alone giving us a purchase margin”—
something my hon. Friend the Member for York Central talked about in great detail and with great clarity. He says his pharmacy has been losing £10,000 a month since July 2017. He has not been able to afford to replace the two dispensers who have left in the past three months, so local people are losing their jobs as a result of the cuts, and the pressure on those remaining, although they continue to work really hard—I know because I visited them recently—is beginning to take its toll.
He says:
“The government has agreed to a five year funding package with no annual increase to the funding package. I would have at least expected an index linked funding package with index linking to NHS pay rises. The DHSC has given pay rises to all the other sectors of healthcare like GPs and Dentists but has chosen to effectively give a 9% cut over 5 years to community pharmacies.
As you know, community pharmacies are still struggling from the impact of the £250 million cut announced in December 2016. Since then, I have struggled…and…I have had to borrow hugely just to keep afloat. The net result is that my business is in danger of defaulting on the bank loans/overdrafts and might be potentially looking at bankruptcy. I have 20 employees who are mostly Scunthorpe residents and they are unlikely to find any work quickly if we were to go under.”
That pharmacist asks me to ask the new pharmacy Minister, who I congratulate on her appointment—she has shown since she came into this House her commitment to this area of work, and I can see from the way she is listening to the debate that she wants to make a difference—several questions. They are:
“why the Government chose not to give community pharmacy a pay rise given to other primary care health sectors…why the funding was not index linked…how the Government expects us to invest in our staff and premises with what is essentially a cut”
and
“how community pharmacy is expected to be part of Primary Care Networks when our sustainability is in jeopardy.”
That is from the frontline, from a man who is delivering excellent service to my local community and to patients locally and who wants to carry on doing so. The Government recognise the value of community pharmacies. If they want community pharmacists to continue to deliver, they need to give them the ability to do that, and not to speak nice words, without delivering. As well as talking the talk, the Government need to walk the walk on community pharmacies.