Pharmacies

My Lords, I first need to declare an interest and the reason why I have initiated today’s short debate, and, despite appearances, not as a Front Bencher, I may add. Last year I took up the role of chairman of the Council of the School of Pharmacy, University of London. The school achieved outstanding results in the research assessment exercise published last December and is top of the so-called power rankings for research among the pharmacy schools and faculties. We are also making a global contribution to pharmacy education through the Global Pharmacy Education Taskforce and having a major input into the future of pharmacy education and regulation here in the UK. Today, however, I want to highlight the unexploited opportunities for improved care with the further development of pharmacy services in the community. Let us have a quick look at the figures. There are 12,000 pharmacies in the United Kingdom and 32,000 registered pharmacists. They dispense some 1 billion items annually across the UK. The nature of pharmacy is changing rapidly. It has traditionally focused on dispensing medicines. However, if we invest wisely in community pharmacy now and build intelligently on the heritage of NHS community pharmacy and GP practice, it can help achieve better public health and more cost effective delivery of clinical care. The recent White Paper, Pharmacy in England: Building on Strengths and Delivering the Future, set out some of this landscape. The regulatory context is changing significantly, too, with the creation of the General Pharmacy Council, which comes into being next year. Growing demands from people recovering from acute interventions after short stays in hospital and others living with long-term health problems are putting new strains on GPs and their practice colleagues. Extended care by community pharmacists can help patients of all ages to obtain and use the medicines as productively as possible and can free GPs to focus more of their time on patients with the highest levels of need and enable more members of the public, particularly older people, to obtain good quality care and advice closer to their homes and workplaces and help them stay healthier for longer. Examples of extended pharmacy care—some foreseen in the White Paper and included in the current range of enhanced services—include diagnostic and preventive screening; the identification and reduction of vascular disease related risks; other preventive services such as smoking cessation support and the provision of emergency contraception; common ailments treatment and obesity management; the management of long-term chronic conditions; improved repeat medicine dispensing services and the targeted provision of home and other medicines’ use reviews; and improving health outcomes in areas such as diabetes through integrated care delivery, as experienced in Hackney and in Tower Hamlets. Every political party recognises that the future public spending climate will be difficult and that there needs to be a rebalancing towards primary care. But we have to make sure that it really happens in practice. Pharmacists will, with the right support, be increasingly capable of helping us all to treat risk rather than disease, but there are real challenges to be overcome if lasting progress is to be achieved. These include pressures on PCTs which are leading some to fail to invest in community pharmacy developments. It seems that current local and national arrangements for funding community pharmacy in England and the other nations of the UK are not adequate to deliver necessary cost-effective developments. The pharmaceutical needs assessments are a recommended commissioning tool for primary care trusts, but lack of pharmacy involvement in their execution, as the RPSGB says, has hindered their effectiveness and the provision of services. Then we have the issue of enhanced services: the evidence from pharmacists is that they form less than 3 per cent of income but 7 per cent of pharmacists’ activity on average. Should there not be a set of non-discretionary services—call them advanced or nationally arranged, if you like—provided in each area? We need to standardise accreditation by PCTs: each PCT has a different accreditation system. In larger companies pharmacists move from one store to another, but each PCT has a different system to accredit them. We also need to standardise service specification and commissioning. This is not incompatible with devolved decision-making and service delivery. Needless variations and access to services confuse and disempower the public and add to the cost of delivery. To deliver the full potential of their health improvement promise, pharmacists will also need to secure access to patient records—summary care records, as they are called. This is vital in a great number of cases. There is another challenge: relations between GPs and the pharmacy profession are not constructive and close enough. For example, although this year some 2 million medicines’ use reviews will be carried out by pharmacists, this is not matching their potential; GPs are not making full use of them and the chances we have for benefiting patients most in need are being missed. Above all, there is insufficient encouragement for doctors and pharmacists to work together. We need to provide incentives for GPs under the quality and outcome frameworks to work with pharmacists; and pharmacists should be as proactive as possible in seeking to work with GPs and their staff in increasingly complementary ways. We must encourage more co-location in practices, too, not only in GP practices but within the larger community pharmacies. I shall finish with some remarks about education and training for the future. The pharmacy profession, like every other, needs the constantly improving education and training tools to do better. Despite all the opportunities for better, more cost-effective healthcare, the quality and depth of pharmacy education in this country is under threat. The danger is that, just when pharmacy is in a position to add further value, funding for necessary improvements in undergraduate and postgraduate education will be insufficient to support the changes needed. We need radically to change and reform the M Pharm degree. Pharmacy degrees are not classed as clinical qualifications. If we are to achieve the desired clinical role for pharmacists, we need to put students in front of patients and give them more of a chance to learn in the way that doctors and nurses do. At least for one year, undergraduate pharmacy education should be funded at a clinical level. I could not discuss pharmacy education without mentioning the ELQ issue. As a result of the new policy to exclude those with first degrees from being eligible for funding for an M Pharm, my own school of pharmacy is losing £600,000 in fees each year. Pharmacy education as a whole has lost £2 million in fees as a result. More seriously, the public are being deprived of professional practitioners who in many cases would be exceptionally committed and able. Surely pharmacy should be put on the same basis as medicine and dentistry so that those with first degrees can take it up later and acquire a professional qualification. These are exciting times. There are real opportunities for living healthily for longer. Better pharmacy services are an opportunity for all of us. Given the right conditions, the appropriate investment and the opportunity to go on improving their knowledge and skills, community pharmacists can play a progressively more important role in meeting changing public health needs, preventing and treating illnesses and containing service costs. We must not let this opportunity slip.