Pharmacies

My Lords, I thank the noble Lord, Lord Clement-Jones, for raising this debate and other noble Lords for the usual array of interesting and informative contributions. I am pleased to have this opportunity to emphasise the important contribution that we believe pharmacy makes in the NHS and how we are keen to build on that. The noble Lord referred to the reform of the pharmacy sector. I absolutely agree. Our vision for pharmacy is that we want to transform it and place it at the heart of pharmaceutical care. We were pleased that our White Paper Pharmacy in England: Building on Strengths—Delivering the Future was so well received. We think that it set out an exciting vision. We hope that it raised the profile of pharmacists and how they can support quality improvements in health and well-being, as well as treatment. It anticipated the next-steps review final report of my noble friend Lord Darzi—High Quality Care for All—which emphasised quality in terms of effective, safe and personal services. I think that we are making good progress in implementing our programme. Of course this cannot be achieved overnight, but we are progressing incrementally to establish the infrastructure necessary for the transformation. We expect PCTs to be world-class commissioners of pharmaceutical services, just as they should be for other NHS services. We expect PCTs to develop their own vision, building on ideas in the White Paper, such as pharmacies as healthy living centres, promoting health and helping people to take better care of themselves, and improving the way in which medicines are taken, increasing repeat dispensing and strengthening medicine use reviews. I shall come back to those points. I take the point made by the noble Earl about the need to have good publicity; it was a point very well made. I undertake to find out and inform the House what we are doing about that. He asked a good question: what proportion of NHS health checks are being undertaken by pharmacists? The answer is not in my brief, but I undertake to find that out, too. We want pharmacists to be the first port of call for minor ailments, which would, as noble Lords have mentioned, free up GPs’ time for more complex needs. We want pharmacists to support people with long-term conditions, such as asthma or diabetes. I was particularly struck by the point made by my noble friend Lady Gale, who outlined exactly what we are talking about in terms of the importance of the work of pharmacies in helping people to manage their long-term conditions. Indeed, we want pharmacists to provide NHS health checks. Discussions are progressing between NHS Employers and the Pharmaceutical Services Negotiating Committee to explore the changes needed in the contractual framework to effect this, but I took the point made by the noble Baroness, Lady Murphy, when she said that this is not just about contracts but about people’s attitudes and historical regard and respect for one another’s professions. This House has already debated the measures in the Health Bill to improve quality by reforming market entry. PCTs will capture local needs through individual pharmaceutical needs assessments and then use these to determine service provision. I know that the noble Earl has raised many points about the capacity of PCTs to undertake to do this and I hope that we have taken that on board in the way in which we are proceeding. We plan to have these in place by 2011 alongside quality accounts, with new powers to take effective action against the minority of poor performers. The current financial climate is a concern, but we have acted to support pharmacies’ stability. An additional investment of £150 million in 2008-09 is being continued in 2009-10. We have also agreed to fund one-off infrastructure investments to sustain effective delivery of services, such as release 2 of the electronic prescription service, information governance and business continuity. Many noble Lords referred to the relationship between GPs and pharmacists. Better relationships mean better care, benefiting both patients and the professions. Importantly, NHS employers have established a professional relationships working group bent on improving relationships between GPs and pharmacies. The group has already developed and produced guidance on medicine use reviews and repeat dispensing to build GP understanding, and issued a letter on joint working, co-signed by all parties, to promote better, closer working relationships between pharmacists and GPs. Work is under way to develop guidance for GPs and pharmacists, to help to build a better understanding of their respective professions and practice. We welcome the joint initiative of the Royal College of GPs and the Royal Pharmaceutical Society of Great Britain on closer working, which is expected to complete its work this year. The pharmacy profession is transforming. The new General Pharmaceutical Council is expected to be in place next year, and this will strengthen professional responsibility and accountability. We are transforming the skills mix of the pharmacy workforce, with provisions relating to responsible pharmacy coming into effect on 1 October. We are underpinning the future of pharmacy by increasing preregistration pharmacists’ training places in hospitals. The modernising pharmacy careers programme board will make sure that the pharmacy workforce is fit for purpose. As part of medical education in England, it brings together consideration of medical and pharmacy workforce issues, which will aid better professional relationships. Pharmacies provide more services for their communities than ever, so it is important that people know about them. Pharmacy is already part of the It’s Your Choice campaign, running in 24 PCTs. We are developing a communications programme to make patients and the public aware of what is available. It would not be right to have this debate without also mentioning the very valuable contribution that pharmacy is making in responding to the flu pandemic. We should all applaud the speed and professionalism with which pharmacy has responded to the challenge. Noble Lords raised some specific points. The noble Lord, Lord Clement-Jones, mentioned the harmonisation of accreditation standards. We are keen to encourage the harmonisation of accreditation standards for pharmacy services commissioned by PCTs locally. NHS North West has already developed common standards for certain pharmacy services, and we are exploring how to build on this nationally. The noble Lord also mentioned pharmacy education and training. As I have said, we have established the modernising pharmacy careers programme as part of medical education in England. The noble Lord mentioned the programme of pharmaceutical needs assessment. This is subject to the parliamentary process. New regulations to be derived from powers in the Health Bill will set out the requirements for how and when pharmaceutical needs assessments should be carried out, including a deadline for completing them and requirements for consultation, including with pharmacy stakeholders. The noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Murphy, raised the issue of community pharmacy access to summary care records. I have a long answer, which they have been busy writing in the Box. We outlined in our pharmacy White Paper last year that we want pharmacists to provide increasing services, and we recognise that to do this they need access to information sources, both patient-specific and on updated clinical practice, to be able to make effective, safe decisions and support patient care. Community pharmacies already have a wealth of information available on their dispensing systems through their patient medical records. However, we are looking to pilot community pharmacy access to the SCR to see how this may further help and also to ensure that strict information governance regarding patient information requirements can be maintained in the community pharmacy. We will learn from this pilot and look to roll it out if it seems to be working. My noble friend Lady Gale made a very important speech about medicine use reviews and Parkinson’s disease. We agree that pharmacists are an integral part of the multidisciplinary team for people with Parkinson’s disease. Medicine use reviews are an ideal way for pharmacists to support people in taking their medicines. Pharmacists who undertake medicine use reviews have to be accredited and have the necessary training to practise competently. Although the uptake of medicine use reviews was initially slow, more than 950,000 reviews were undertaken in the past year—70 per cent more than in the previous year. I agree that patients need to know about the new services provided by pharmacists—a point which again touches on the communications issue raised by the noble Earl. As ever, the noble Lord, Lord Selsdon, treated your Lordships’ House to a contribution that was not only entertaining but had a very serious sting in its tail. He asked what the future holds for modern pharmacies. I fear that tonight I cannot take the House into the realm of the future of the industry but I thank the noble Baroness, Lady Murphy, for her help and can say that 99 per cent of people are within 20 minutes of a pharmacy, on whose door there will almost certainly be information about where the nearest open pharmacy is located. We want to build on pharmacists’ five-year training and are very keen that they should take the additional accreditation to be able to prescribe. The noble Baroness, Lady Murphy, rightly pointed out what a national asset our pharmacies are. She drew attention to the important part that they play in primary healthcare and the need to break down what she called the "social distance" between pharmacists and doctors. The noble Earl, Lord Howe, continued to voice his concerns about PCTs commissioning pharmacy. I share many of his concerns and have a desire for the best examples to become general practice. He is absolutely right about that. Finally, I hope that I have touched on the main themes in this short debate. I know we all agree that quality pharmacy services and providing better care and better choice are at the heart of the transformation that we are seeking. Sitting suspended.