Tuesday, 1 March 2016

My speech opposing government plans to shrink the UK pharmacy network



Many issues where raised during the debate last week which I agreed with so in my 8 minutes I focused on the future importance of Healthy Living Pharmacies (see my previous article on this in Hyndburn) and the trend towards warehouse pharmacies and the sharp practice (with reference to Hyndburn) which we may see in the future. I have been supported by many health professional in Hyndburn. But come on: it's obvious??


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Letter

Dear Mr. Jones,

I am a recently retired GP. I spent my entire GP working life in Hyndburn. 
Over this twenty five year period I liaised closely with a number of Community Pharmacists. Like them I am very concerned about Government plans to reduce the number of community pharmacies. I feel that this is a very risky strategy at a time when Government policy did seem to be to expand the role of the Community Pharmacist in order to help and advise patients locally and reduce the significant pressures on GP and A+E services.
Please do what you can to highlight this misguided approach. Once lost these community pharmacies will not be replaced.

Kind regards,
David
Dr David Woodcock
Retired GP Principal (formerly of Peel House Medical Practice, Accrington Pals Primary Health Care Centre, 1 Paradise Street, Accrington, BB5 2EJ)

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Speech

I congratulate Derek Thomas on securing the debate. It is somewhat of a rerun of the post offices debate mentioned earlier. Post offices provide a commercial service, but the key point is that they also provide a public service - [just as pharmacies do].

My view is that the UK’s pharmacy network must be protected. They are vital because they are accessible and have good geographical coverage: 95% of the population can currently get to a pharmacy on foot within 20 minutes. For deprived populations, the elderly and young families whose car may be taken to work, such services that can be reached by walking are essential.


Local pharmacies provide advice and reassurance.

Pharmacies are also vital because they are beginning to be part of a better national health service, providing a first point of contact; 1.8 million people visit a pharmacy each day. They are an essential part of the pyramid of care that has been mentioned. Accident and emergency departments are stretched, and the solutions that will bring about better healthcare must start further upstream, with pharmacies. A pharmacist wrote to me:

“Pharmacies need to evolve and we have always engaged with the governments in the past to deliver the targets, and greater use of pharmacies must be made to reduce the hospital attendances in the AE”.

There are 36,000 patient visits to my local walk-in centre, which is a fraction of the number of visits to GPs. Yet A and E, the walk-in centre and GPs are all stretched. Local pharmacies are vital for access and as part of a model of healthcare delivery in the UK that relieves some of the current pressures and dispenses advice that puts prevention rather than cure at the heart of healthcare.


My local pharmacy in Baxenden is part of an innovative model of care: the healthy living pharmacy framework is a tiered commissioning framework, aimed at achieving consistent delivery of a broad range of high-quality services through community pharmacies to meet local health needs, improving the health and wellbeing of the local population, and helping to reduce health inequalities. What that means in plain English is that those pharmacies are the first point at which healthcare and health advice is delivered. That includes workforce and workplace development—developing a skilled team who can proactively support and promote behaviour change and improve health and wellbeing. Work done by the healthy living pharmacy initiative has shown that 70% of people who visit pharmacies do not regularly access other healthcare services. Those pharmacies are well placed to support the health and wellbeing of people in the community by, as has been mentioned, providing improved choice, and access to early interventions on such issues as optimal use of medicines, obesity, alcohol and smoking. That should improve outcomes in the short and long term, and have an impact on the cost of care in the future.


The Pharmaceutical Services Negotiating Committee evaluations of HLPs to date found that they

“demonstrate an increase in successful smoking quits, extensive delivery of alcohol brief interventions and advice, emergency contraception, targeted seasonal flu vaccinations, common ailments, NHS Health Checks, healthy diet, physical activity, healthy weight and pharmaceutical care services.”

The report also indicates that the HLP model is working in areas with different demography and geography. I cannot vouch for the PSNCevaluations, but I welcome the actions taken by my local pharmacy to be available to local people and offer better health advice.

Across Lancashire, pharmacists such as Linda Bracewell at Baxenden pharmacy are keen to see HLP rolled out across Lancashire. That requires support from the Government and the NHS. All pharmacies, including HLPs, are a vital part of the healthier Lancashire agenda. Yet today pharmacies are under threat from two directions. Those threats are the reductions in Government support—the 6.1% cut by the Department of Health in community pharmacy funding, which comes to a total reduction in funding of £170 million—and market forces. I want to move on to consider that other threat.

My right hon. Friend Kevin Barron mentioned changes in the market, such as the growth of warehouse pharmacies that seek profit—this is the Amazon model—at the expense of both the public service element and geographical access points. That is a cause for concern. Not everyone is online, or comfortable with such remote arrangements. There is no guarantee that such a method of providing pharmacy services has a role in a healthy living environment, or a better healthcare delivery system. Will it engage with hard-to-reach communities?

Over Christmas I was shown a letter by Linda Bracewell that was sent to a constituent by Pharmacy4U, a mail order pharmacist. Worryingly, it was passed off as an official letter. People would feel obliged to fill it in and send it off. It was personalised, and, crucially, it redirected customers with repeat prescriptions to Pharmacy4U. Worse, Pharmacy4U is just one of several emerging online mail order warehouse companies—box shifters. It was not clear that the letter was not official but a marketing ploy. It is a matter of great concern that the letter was part of a mass mailing, sent specifically to people with existing prescriptions. Their GP practice was named on the letter as though it came from that practice. That is a worry for pharmacies.

How did Pharmacy4U get access to patient practice details? Is it right that the letter I saw was allowed to look like an official document and a request for detail, when in fact it was simply permission to transfer existing prescriptions—a huge business for local pharmacies—to a warehouse pharmacy? Even more worrying was the fact that all the patients of GP practices with electronic data systems had been mailed, while patients of GP practices without such electronic patient systems had not been mailed. Does Pharmacy4U have business connections to the data company that provides GPs with electronic patient data systems, and the patients of those practices? The Minister should be aware that those issues are serious, and that such sharp business practices and models threaten existing pharmacies. The presence of warehouse pharmacies operating on an Amazon model is of concern to me and, I am sure, our constituents, because it erodes the public service element of the current pharmacy network—particularly the healthy living pharmacies.

In conclusion, does the Minister recognise the public service element of pharmacies? Does he want to preserve the current pharmacy network? Does he see pharmacies as having an increasing role in healthcare delivery? Does he think that there will be more or fewer pharmacies after his review is implemented?