Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Motion to Approve

That the draft Order laid before the House on 28 April be approved.

My Lords, since the outbreak of the coronavirus pandemic, the country has faced its greatest health and economic challenge for decades. Community pharmacies have proven once again that they sit at the centre of our communities and are a vital first port of call for healthcare advice. It is therefore important that we have a strong and flexible governance framework in place to meet the challenges of modern pharmacy and to deliver safe and effective services to patients, for patients.

The purpose of the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022 is to define and clarify the core purpose of the responsible pharmacist, who is the person in charge of a particular retail pharmacy premise, and the superintendent pharmacist, who is the person responsible for all retail pharmacies across a retail pharmacy business. The draft order also gives powers to the General Pharmaceutical Council and the Pharmaceutical Society of Northern Ireland to define in professional regulation how the purpose of these roles is fulfilled.

These regulators already have powers to set rules around professional standards. It therefore makes sense that these powers sit with the regulator rather than with the Minister. In doing so, we are putting in place a more flexible regulatory framework and the necessary system governance framework to support maximising the potential of community pharmacy and to make better use of the skill mix of pharmacy teams to deliver more clinical services in the community and support wider NHS capacity. The draft order will apply across the United Kingdom, and I draw your Lordships’ attention to two provisions specific to Northern Ireland, which aim to align the law in Northern Ireland with that in the rest of the UK.

At the request of the Department of Health in Northern Ireland and the Pharmaceutical Society of Northern Ireland, it is proposed to give the Department of Health in Northern Ireland the power to appoint a deputy registrar in respect of duties set out in the Pharmacy (Northern Ireland) Order 1976. This will essentially mean that there is no disruption to maintaining the register of pharmacists and pharmacies in the absence of the registrar, and secondly, it will extend the requirement that a superintendent pharmacist must inform the relevant pharmacy regulator when they stop holding the role in a pharmacy business to include Northern Ireland and the Pharmaceutical Society of Northern Ireland.

Moved by

At end insert “but that this House regrets that the Order does not make provision about the wider workforce challenges facing the community pharmacy sector”.

My Lords, I certainly have no objection to this statutory instrument, which, as the Minister said, requires a strengthening of the governance that relates to superintendent and responsible pharmacists. My complaint is that this could have been so much more. My principal purpose in tabling my amendment and allowing us to debate this is to talk about the potential of community pharmacy and my frustration that the Government are doing so little to support the sector. I find that quite extraordinary.

As the Minister said, the NHS is going through an incredibly tough time. We have a huge backlog of patients waiting for treatment, workforce pressures, scary ambulance waiting times, and there is a real sense of demoralisation in primary care. You would think that the Government would have welcomed with open arms the contribution that community pharmacy can make. Instead, however, it seems that the sector continues to be undervalued and starved of investment.

The contribution that community pharmacies made during the pandemic was really extraordinary. As noble Lords will know, hospitals were very much focused on Covid. They were taking great precautions and were sometimes unable to deal with patients needing routine and sometimes urgent treatments. In primary care, it was very difficult for patients to obtain face-to-face appointments. Through all this, the only reliable, accessible part of the NHS that you could go to see, face to face, were the community pharmacists. We should pay great tribute to them. It is noticeable that there was an increase of nearly 40% in the number of people visiting community pharmacists during the pandemic.

I also pay tribute to the role of community pharmacies when it came to the rollout of the vaccine. The Company Chemists’ Association reckons that they have delivered more than 24 million vaccines to date, which is a tremendous feat. The Pharmaceutical Services Negotiating Committee estimates that around 1.6 million people visit a community pharmacy every day in England, and say that that saves about 32 million appointments per year to general practitioners.

As the PDA says, we now understand that the pharmacy can provide a much more comprehensive contribution to health care than was ever contemplated in years gone by. Thinking about the future, and how pharmacies could play a central role in new multi- disciplinary working in primary care, this could be a real game-changer for co-ordinated primary care, given the silo working that we have seen consistently in that sector over the years.

I acknowledge that some of that is recognised by the Government. The Minister himself paid tribute to community pharmacies today. I should say that the NHS Long Term Plan promised to make greater use of community pharmacists’ skills, and new clinical services have been introduced. I particularly welcome the Community Pharmacist Consultation Service, where staff in general practice and NHS 111 can refer patients to community pharmacies for advice on and treatment of minor illnesses. That is very welcome indeed, but we need to build on it. We must recognise that, at the same time, community pharmacy is absolutely hamstrung by workforce pressures and budgetary austerity, which threatens the viability of some parts of the sector, and certainly its ability to take on a much greater workload in future.

On funding, the Company Chemists’ Association reckons that the last increase in funding was in 2014. However, it was then cut by around £200 million a year in 2016, and the current contractual framework agreed in 2019 has not been adjusted, despite the pandemic and rising inflation. An analysis by the CCA shows that per capita spend in the community pharmacy sector decreased by nearly 10.7% from 2014 to 2019. As the PSNC says, it is clear that pharmacies are proving themselves, time and again, to be the most accessible healthcare locations, helping patients with a wide range of increasingly complex conditions and needs. It is astonishing that this work is all being done without specific funding.

The Minister was a little unsympathetic when it came to workforce issues. He seemed to be saying that because community pharmacies are essentially commercial businesses, workforce issues are their responsibility. Given that the great majority of income for community pharmacies comes from their work on NHS dispensing, you cannot divorce the viability of community pharmacies from the funding that the Department of Health makes available—and of course that impacts on the workforce.

The Minister said that the situation is being monitored and suggested that this was more a geographical disparity than a general problem. However, there are a record number of pharmacy vacancies, and we know that many of the businesses are struggling to recruit because of a number of related issues, such as a reduction in the number of students, Brexit and pharmacists choosing to work elsewhere. I am not opposed to this. The movement of some community pharmacies into GP surgeries and primary care networks is a good thing, but there is still a huge role for the community pharmacy sector on the high street as well.

There is a risk here. We have seen during the pandemic that community pharmacies can do more. They certainly have the professionalism and skills to take on more responsibility. However, the combination of funding and workforce pressures makes it unlikely that they can take on these new roles to the extent that would be extremely desirable in an NHS which is very hard-pressed and which will continue to be hard-pressed over the next few years.

My main message to the Minister is this: surely there is now a case for Ministers setting out a long-term vision for community pharmacies, placing them at the heart of primary care and ensuring that there is funding and workforce support to enable this to happen. Given the tremendous pressure on the health service, we have a huge untapped resource which we must fully encourage to do all it can to support patients at a very difficult time. I beg to move.

My Lords, I congratulate my noble friend on bringing forward the order before us today. I am interested to understand the background to why we are moving from ministerial discretion to regulated control. I think my noble friend will assure the House this afternoon that the concerns raised by the Secondary Legislation Scrutiny Committee have been addressed and that any changes will be brought forward by statutory instrument, in which case the committee and the House will have the opportunity to look at them.

I join the noble Lord, Lord Hunt, and my noble friend, in paying tribute to community pharmacies for the work that they have done throughout the years, and particularly during the Covid pandemic.

What will the position of dispensing doctors be, who fulfil a role where community pharmacies do not reach? Quite a large network of rural areas is served by dispensing doctors. As the daughter and the sister of dispensing doctors, and as someone doing outside work with dispensing doctors, I think it is appropriate that we look at how they are potentially being asked, for example, to deliver a booster jab this autumn at the same time as the flu jab. That will pose enormous logistical challenges for community pharmacies, dispensing doctors and others. How do my noble friend and his department expect to address those challenges so that the rollout will go as smoothly in the autumn—particularly if it is combined with a flu jab—as it did in the previous three or four rounds?

My Lords, the health or otherwise of independent community pharmacies can be judged by the rate of closures, which has been increasing over the last few years for a number of reasons, not least the overall deal with the NHS. That deal requires, for example, an individually owned community pharmacy to be deemed to have received the same discount on the purchase of drugs that Boots and the other big chains get on volume discounts. There is a serious crisis in this sector. Can my noble friend the Minister give us some idea of the rate of closure? If he does not have the statistics today, perhaps he could place them in the Library. Closure is an upward trend.

The noble Baroness, Lady Brinton, will be taking part remotely and I call her now.