I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings for debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate. I remind Members participating physically and virtually that they must arrive at the start of debates in Westminster Hall. Members are expected to remain for the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and before they leave the room. Members attending physically who are in the later stages of the call list should use the seats in the Public Gallery and move on to the horseshoe when seats become available. Members may speak only from the horseshoe, because that is where the microphones are.
Once we move on to Back-Bench contributions, I intend to begin with a time limit of three and a half minutes. Hopefully we will not need to make it shorter during the course of the debate.
1:31 pm
Jackie Doyle-Price (Thurrock) (Con)
I beg to move,
That this House has considered community pharmacies and the effect of the covid-19 outbreak.
It is good to have you in the Chair for this important debate, Sir Graham. It is an honour for me to chair the all-party parliamentary group on pharmacy, not least because so many colleagues are big fans of the pharmacy sector. I am pleased to be introducing this debate this afternoon and to see so much support from Members who recognise the huge contribution that our community pharmacists have made during the pandemic. They are the front door to the NHS, and their doors have never been closed throughout the last year. We are all very grateful to them.
That contribution has not been without consequences for pharmacists, both financially and in terms of their own personal wellbeing. This debate is a chance for me to make a plea that the Government and the NHS fully appreciate the contribution made by our community pharmacists and ensure that they are recompensed adequately for it. Pharmacists can play a much fuller contribution to primary care, as they have shown over the past year, and they should be supported to do so.
Let us look at some figures. According to the Pharmaceutical Services Negotiating Committee, community pharmacists dispense 1 billion prescription items every year. They deliver healthcare advice at a rate of 48 million consultations a year. To put that in context, that saves nearly half a million GP appointments and 57,000 A&E visits every single week. That, by any stretch, is a service that is offering good value for money, and it deserves better support from us.
Community pharmacies are part of the NHS family. We often talk about “our NHS,” but what do we actually mean by that? Quite often, people think of our hospitals, and the doctors and nurses who work in them. For me, the NHS is every single person who works in dispensing health services, be they a nurse or paramedic working in a hospital trust, or somebody working independently, either as a GP or a pharmacist. We must ensure that whoever they are and wherever they are employed, if they are delivering NHS services, the NHS should ensure that they are adequately recompensed for it.
I am pleased to see the Minister in her place. I am preaching to the converted, frankly, as she is a huge supporter of pharmacists. I know that the contribution made by the sector over the last year has not gone unnoticed by her. Those working in the sector have also felt well supported by the recognition they have received from the Secretary of State for Health and Social Care and the Prime Minister. It is a level of support they are not used to and they are grateful for it, but perhaps now is the time to look beyond words of thanks and see that reflected in deeds.
It is a pleasure to see you in the Chair, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for bringing this issue before us today. She is right to say that pharmacies need our support now. They have played a crucial role as an integral part of our health service, which is under stress and strain at the best of times, and that is all the more the case during the covid pandemic. Pharmacies continue to play an even more important role, if that is possible, during this crisis. They have been there to support our communities when people could not access GP services. We have heard so many times during the crisis that people did not seek advice from their GP, local walk-in centre or hospital because they did not want to put even more of a strain on those services. Of course, many of them got the help and support that they requested, and it was from pharmacies. On behalf of my constituency, I would like to thank all the pharmacies that have helped during this crisis.
As the hon. Lady says, all the warm words we express count for nothing if that is all we do. Words are meaningless without action to back them up. Pharmacists have had enough words to last them a lifetime, so I will cut to the chase. First, the Government should review the response from pharmacies during the pandemic and re-evaluate a clear vision of what we need from these undervalued and vital frontline healthcare workers. It is not good enough to take pharmacies for granted. If this pandemic has shown us anything, it is how hard-pressed yet responsive our pharmacies have been during the crisis.
Secondly, the NHS and the Government should enable pharmacists to do more, as the hon. Lady said, by giving additional resources for training and support for this vital sector. The Test and Trace system has been given £22 billion, with another £15 billion in the pipeline. That is almost £600 per person to run a system that, at best, has been mediocre in terms of its returns. Frankly, a fraction of that resource could be put back to pharmacies. That would have a higher rate of return, be more productive and have a better outcome for our constituents.
It is an honour to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Thurrock (Jackie Doyle-Price) for securing this important debate.
The pandemic has shone a light on some of the more extreme challenges that we face as a society, but it has also highlighted the role of some of the institutions that support our communities—quietly, day in and day out. They are there for advice and support and offer a friendly and welcome face to those who are not reassured by going through online channels. Some people want a relationship but do not want to trouble their GP, and community pharmacies fill that role. These institutions have long been at the heart of all our constituencies, offering so much more than just prescriptions.
It would be remiss of me not to mention a few of the local pharmacies in my community and the incredible work that they have done and continue to do as part of the NHS family. Cohens, Coward’s and Murray’s, among others, are Furness institutions that have been remarkable in the support they have offered the community over the past year. Not only have pharmacies remained open over the past year; they are now supporting the vaccination programme.
A local pharmacist, Ben Merriman, was out vaccinating in Millom yesterday. I was told this morning of one pharmacist who was doing the same and, at the end of a very long day, found that their final patient was needle-phobic. It took an hour of gentle persuasion to get that final needle into the patient’s arm, which shows in one simple act the generosity and forbearance of the community pharmacist. This is a sector that we need to nurture and support, especially now.
Let us be honest: community pharmacies are struggling. While they have never been busier—significantly busy at the moment—90% of their business is pharmacy work and not retail, and that part of their business has dropped off. They have also seen a significant increase in their workload as the number of consultations they have taken on has increased since the start of the pandemic. Some of that is due to the approachability of community pharmacies, and some of it is due to word of mouth. If someone has had a good service, they are more than likely to tell their friends and family.
It is a pleasure to serve under your chairmanship, Sir Graham. I feel there will be a great deal of consensus over the course of this debate.
I have shared my experiences of my first job working in my uncle’s community pharmacy on numerous occasions in Parliament. Indeed, I secured a Westminster Hall debate on the role of community pharmacies in October 2019. I spoke of how there was never a dull moment in a pharmacy. I recalled the time a frantic mother handed 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 it was actually a urine sample and the bottle was the most secure way that she could think of getting it to the shop.
The lighter moments aside, what has always stayed with me from my time working evenings and weekends in a local chemist shop was that so often, particularly for older people, someone’s relationship with the pharmacist was the longest standing and most trusted relationship they had with any clinical professional. When we think about the pandemic, we think what an invaluable community asset pharmacies are, and I take this opportunity to thank all those who have worked so hard to keep pharmacy doors open during the most difficult times of this crisis.
Prior to the crisis, pharmacies had their budgets cut back in 2016, with a reduction from £2.8 billion in 2015-16 to £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 of charge—costs that they absorb—it dealt an almost fatal blow to pharmacies. The then Minister told the all-party parliamentary pharmacy group that he expected between 1,000 and 3,000 pharmacies to close as a result, because they would simply no longer be viable, with multiples and chains of pharmacies best placed to weather the cuts, and independent and more rural chemists left at a disadvantage.
2:06 pm
Andrew Jones (Harrogate and Knaresborough) (Con)
It is always a pleasure to serve under your chairmanship, Sir Graham. I congratulate my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on securing this debate.
We all know that the pandemic has put unprecedented pressure on our health services. That, for me, includes pharmacies. I consider pharmacies to be frontline medical services and a really important part of patient care. I emphasise that view, which is clearly shared among those of us in this debate, but I do not think it is a view universally held across the health sector.
Before going any further, I should declare an interest. Many years ago, I worked for Kingfisher and I had responsibility for pharmacy marketing and Superdrug, among other things. As a result, I spent considerable time with pharmacists and understood the value that people place on them. I saw at first hand the expertise and care, and have had much respect and affection for the sector ever since.
This debate is focused on the current crisis. The way that the whole sector has responded—the NHS, pharmacies, the pharmaceutical companies; everybody—has been truly impressive. They have showed agility, which is not always what we expect in large organisations. Their working together has perhaps also taken them to new places.
Pharmacies have remained open and accessible places of advice and reassurance, and, above all, sources of vital medicines. Keeping that flowing was critical. Pharmacies have adapted to new rules and used their positions of trust and authority to really help patients.
I saw a little bit of that doing some volunteering for the Harrogate Easier Living Project. It has not been the quietest time for MPs or I would have done a little more. I helped deliver prescriptions to those who were shielding and visited a number of pharmacies across the constituency as a result. I was impressed by the actions they had taken to keep people safe and to continue their vital work.
When the NHS was rightly dealing with the immediate urgency of this crisis, pharmacies took a pace forward and helped with health advice. They took the pressure off other parts of the system. That is my key point: pharmacists are key frontline health workers. They are owed a debt of thanks and I put my thanks on the record.
The pandemic has shown what pharmacies can do. There is the work of the pharmacy-led vaccination centres. In Knaresborough in my constituency, we have a vaccination centre run by the local company, Homecare Pharmacy Services, at the former Lidl store. It is going great guns. It has the capacity to do 1,000 vaccinations a day, and I have heard nothing but positive reports.
It is a pleasure to serve under your chairmanship, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for securing this crucial debate. As a qualified pharmacist, I know the important role that community pharmacists play at the heart of communities, going above and beyond for their patients on a daily basis. I thank those in my constituency such as Allesley pharmacy and Rotherham Road pharmacy for their ongoing hard work. Since the start of the pandemic, much of our high street has shut up shop, faced with the unique threats that covid presents. Community pharmacies, on the other hand, have opened their doors to all those who need them. They quickly adapted their services to be covid secure, and offered face-to-face advice and healthcare on a walk-in basis when communities needed it most. They have been a shining light in the dark times for our high street and taken the strain off other sections of our health system.
We should celebrate the innovation shown by community pharmacists. Pandemic delivery services ensured that patients shielding at home were able to access their prescriptions without putting themselves at risk, and pharmacists reviewed the medication for those discharged from hospital, helping patients manage their medicines properly, reducing confusion and improving patient safety. They have used their expertise to support the national covid-19 vaccination programme, making it easier for many to receive the vaccination at their own convenience, from a familiar trusted face.
However, these changes have come at a huge cost, both financially and emotionally. Pharmacies have been left to fund the increased staffing costs, PPE, cleaning and social distancing measures that came with the effects of covid. Coupled with a reduction in over-the-counter sales and services, many are now facing serious financial challenges. Yet pharmacies have received no targeted funding for their efforts. Instead, this Government have taken advantage of the good will. From the ongoing effects of the devastating cuts of 2016, to the unforeseen cuts of the last year, pharmacies have been left in the lurch, forced to fend for themselves.
20 of 51 shown
I am sad to say that while the sector is getting that support from Ministers, it does not always get it from the machinery of the NHS or from the Department of Health and Social Care. The truth is that there are some people in our health establishment who view pharmacists as nothing more than glorified retailers. They are not. They are medical professionals who go through a substantial amount of training, and they do not all work for Boots and Lloyds. Most of them work independently, in small shops on our high streets, in the heart of our communities, and for those, 90% of their income comes from the NHS.
I am sad to say that I attended a discussion in which a DHSC representative asked, “Why can’t pharmacists earn money from other sources?” My answer to that is, “Why should they?” They are providing medical services. We have a contract with society that the NHS will meet the cost of those services, and the pharmacy sector should not be expected to go scrabbling around for other business to subsidise work that is done for the NHS. That is not the deal, and I think we need to properly take that on. Their fundamental business is the dispensing of prescriptions, which is an integral part of delivering an NHS that works for all patients. The NHS therefore has a duty to ensure that it is supporting a functional community pharmacy sector. It is not the job of independent providers in our pharmacy sector to be subsidising their NHS work through what they can sell. That is fundamentally not the ethos of our national health service.
As such, I am very clear that we need to put our pharmacists on a more secure financial footing if we are to maximise the use of this sector in delivering good primary care services, and we need to look at how it is supported and how it sits with GP services in our primary care system. My challenge is for DHSC and the NHS to look properly at whether, and how, they can make sure that pharmacies get a fair deal. It is fair to say that our pharmacies are held in very high esteem by the patients who use them. That has been especially true during the pandemic, when patients often found that their pharmacy was the only ready source of advice.
Our 11,500 community pharmacies have been open every day for every single one of us, but that has not been without real costs, as I mentioned. Our pharmacists today are facing debts simply because they stayed open. They had to supply their own personal protective equipment. They had to invest in keeping their shops covid-secure. They had to deal with staff absence due to sickness or self-isolation, and they had to deal with the increased wholesale prices of medicines.
To be fair, like most of the NHS, community pharmacies did receive funding to ensure that they could remain operational, but that was only ever advanced as a loan that needs to be paid back. That is now threatening the operation of some of our pharmacy businesses—as many as one in five, as estimated by Ernst and Young. It simply cannot be right that, in stepping up to the challenge posed by the pandemic, some pharmacies have unwittingly crippled their businesses, as the additional costs are not being properly reimbursed.
The covid pandemic has highlighted that we are long overdue a conversation about the role of pharmacy and its place in the NHS, and the all-party group stands ready to play its part in having that debate. Central to this will be the following principles. First, pharmacies can play a fuller role in primary care. GPs will face additional pressures as we come out of the pandemic. Pharmacies can give that support, but they should be properly supported in doing so.
Secondly, we will be living with covid forever, and it looks as if regular vaccination will become as big a part of our lives as the flu vaccine. I really want to see pharmacists fully engaged in that. There has been disappointment with the number of pharmacists engaged so far, which I think is due to constraints on the supply of the vaccine, but I hope that will be properly addressed as we go forward.
Thirdly, we need a plan to deal with the £370 million loan to the sector. To be brutally frank, when we look at the sums given to other areas of the economy, and indeed to the NHS, our pharmacies can be forgiven for feeling a little hard done by. It will mean curtains for some businesses that acted in good faith after being promised that the NHS would receive all the money it needed to fight the pandemic. No pharmacist should be out of pocket for stepping up to this challenge, and we really do need to look very closely at this. Fourthly, we need to make this sector understand that it is valued, and we should encourage people to work in it.
To end, I can advise the House that the all-party parliamentary group on pharmacy held an inquiry in December in which we surveyed the opinions of pharmacists. We found an overstretched workforce responding heroically to the challenge of a pandemic, with an attitude of doing what needed to be done, and I salute them for that. The survey also told a story of businesses being saddled with debt for doing the right thing, and it found a workforce who felt undervalued and burnt out by the professional pressure they faced. Let us have a conversation about how we secure our finances for the future. Let us properly thank pharmacists for everything they have done to support us in the last year. If we do not, we will miss them when they are gone.
Thirdly, a reassessment of the value of pharmacies, especially by finance teams in the Department of Health and Social Care and the NHS, would be welcome. When was the last time any real assessment of the value of pharmacies was undertaken by the Department or NHS finance teams in a comprehensive fashion that has led to any real support for the sector?
Fourthly, the Government should write off the advance payments as an immediate way of providing relief. Additionally, they should re-evaluate the financial implications of asking pharmacies to pay back the £370 million advance. This is crucial, given that pressures are pushing many community pharmacies to the edge. Quite simply, payments have not been enough to cover the financial pressures brought on by covid-19.
Fifthly, and linked to the points above, the sustainability of pharmacies is crucial. That is why the all-party parliamentary group on pharmacy is giving them its support.
I urge the Government, before it is too late, to consider that current funding levels may already be causing irreversible damage. It is time for us to give our local pharmacists—for example, Dr Lisa Manning, the CEO of my local pharmaceutical committee—and their colleagues a shot in the arm. It is time to support them, and the time is now.
The Government’s support for this arm of the NHS is welcome, and the £370 million helped to deal with some of the immediate cash-flow issues at the start of the pandemic. I am sure my hon. Friend will continue to engage with the PSNC to ensure that this vital arm of the NHS has the support that it needs to stay afloat. Ultimately, if pharmacies close—that is what is happening now and it will continue at a faster rate if it is allowed to progress—the patients of Furness and those in constituencies around the country, along with the rest of the NHS, will suffer.
No one could have predicted the pandemic and the massive impact that it would have on the NHS, the Exchequer and the country as a whole, but pharmacies were already under massive financial strain before this. I have already lost one pharmacy in Barrow and several others have cut their hours because of financial cutbacks. It is worth looking at where the bulk of pharmacy closures have taken place in the past four years. The vast majority sit in the most deprived areas of our country, where we need to level up healthcare the most. Squaring that circle is the challenge that my hon. Friends in the Treasury face—one that they are no doubt alive to.
As my hon. Friend the Member for Thurrock said when she opened the debate, community pharmacies are the front door to the NHS. We need to make sure that that door stays firmly open.
That was in 2016 and it set the landscape going into the pandemic. When the pandemic started, these already underfunded pharmacies were called on to be a crucial element of the UK’s frontline response, dealing with a 20% rise in demand for medicines and a 35% increase in required prescriptions. They experienced a doubling in demand for home deliveries of medication and a tripling in calls from the public. According to the PSNC pharmacy advice audit, pharmacies have been providing healthcare advice to more than 600,000 people every week. We owe a great debt to these underfunded and overworked pharmacies and their teams, who went above and beyond to relieve pressures on our NHS.
I commend the work of the all-party parliamentary pharmacy group, under the leadership of the hon. Member for Thurrock (Jackie Doyle-Price), for its detailed work on this issue. I ask the Government to reflect on the ask within its recent flash inquiry report. We need pharmacists—that has to be the bottom line—so why are we putting these perverse financial barriers in their way? They are providing a great deal of care, as well as social care, to those who most need it. We have to find ways of looking after them into the future.
Looking ahead, I can see a role for pharmacies in helping with the likely winter covid booster jab, which is probably going to be part of all our futures, and a role in helping people who take several medicines as they manage what the NHS cheerfully calls “multiple comorbidities”, alongside their regular care and the community value that they bring, day in, day out.
My message is that pharmacies do a lot. They have shown us that, and that they could do more. They have the expertise and trust. They should be at the heart of how frontline health services are planned. A stable, secure pharmacy sector, planning and supported for the future, will be able to add a huge contribution to the health of our nation.
The systemic underfunding has put community pharmacies in dire straits and many owners have been left having to use their own money to keep these vital parts of our community afloat. A third of pharmacies and businesses in England are now in deficit and many have closed for good. It is counterintuitive that pharmacies are being forced to close in the midst of the pandemic. If we do not act now to stop the loss of community pharmacies, our high streets will be hit hard and many of the most desperate and deprived will lose their main link to NHS services. Only by picking up the extra costs faced by pharmacists and writing off the £370 million in emergency loans—that most will struggle to ever repay—can the Government ever hope to fulfil their promise to do whatever it takes.
Looking ahead, we need to understand the value and work that our community pharmacists do every day. Not only do they provide a key link between individuals and a wider NHS but they are a vital part of our plan to address the health inequalities that many in my constituency and across the country, are seeing grow more and more. Our pharmacists have a fantastic set of skills, and a broad knowledge and expertise that can take some of the burden from the overstretched primary care network. I hope the Minister will listen to what has been said, because now we need active steps to give community pharmacists guaranteed support grants and to fully fund the enhanced community and public healthcare and covid-19 booster vaccinations. The Minister and his colleagues in the Treasury should remember that the success of pharmacies does not simply keep our communities healthy. They also inject life into our high street—which themselves have been ravaged by the pandemic. An investment in pharmacists is an investment in public health, local economies and preventing future pandemics having the startling impact that we have seen in the past year. This is an investment that will pay for itself many times over.