§ 3.30 p.m.
§ Mr. Arthur Palmer (Bristol, North-East)
I wish to raise the question of the decline of chemists' shops in Bristol. I realise that this matter is of wider national concern even if I refer to it mainly in a Bristol context. National figures have been supplied to me by the Pharmaceutical Society of Great Britain which show that the number of separate pharmacies in this country has declined from 15,300 in 1955 to a little over 11,000 this year.
I have no exact figures for closures for the whole of Bristol, but the Bristol Community Teaching Health Council states that in its area, which would embrace a considerable part of the city, 16 pharmacies have closed in the last five years. I have perhaps rather more precise figures for my constituency, where investigation shows that in the area, which has an electorate of about 52,000, nearly half of 13 pharmacies have disappeared in the last 10 years.
I wish to consider the reason for this national and local trend. First, competition from large multiple stores and multiple chemists in cosmetics, toilet articles, fancy goods, and so on, has left the independent chemist with a profit that is insufficient to subsidise the making up of prescriptions.
Then, secondly, inflation hits every business, particularly the small business. It is, however, extremely costly for the pharmacist. It affects him in replacing his stock of drugs. Chemists are paid by the Government—who are never in a hurry to pay anybody if they can avoid it—three months in arrears. This means that the small men are driven to obtaining expensive bank loans in order to maintain their businesses. Sometimes they do not succeed in doing so.
There is a third point here which has not received so much publicity. I am obliged to a friend of mine in Bristol who told me of it. It concerns the methods of the drug firms which supply the small chemists. I am referring to the 991 major wholesalers, such as Gibbs, a subsidiary of Glaxo, and Evans Gadd, a subsidiary of Sanger. The wholesalers once had the policy of granting chemists three months' credit, particularly if companies were anxious to obtain the business. In this way they secured the allegiance of those chemists by getting them to establish or maintain themselves in business with expensive stock. I regret to say that the practice of some of these firms afterwards is to squeeze the chemist by reducing the period of credit to two months or even less.
I have no doubt that it may be regarded as good accountancy practice in large firms that they should not have too much money outstanding. But it is often a body blow to small people, resulting, once again, in their withdrawal from the pharmacy business and even their financial failure. My information is that some of these big firms are reticent even to enter into correspondence with pharmacists on this point, but they still demand their payments.
I turn now to the relationship between the National Health Service and the local chemist. It is not unfair to say that successive Governments have never regarded pharmacists as professional people, despite their long training and the examination standard demanded. I need hardly say that the need for safety in the dispensing of drugs is vital. These men and women have to be highly trained and well-educated in their job. I am told that even with the factory medical product—the ready-made medicine, which is far more prevalent today than in the past—it is important that the pharmacist should be able to check the general practitioner's prescription. This is no reflection on general practitioners, but, apart from their reputed bad writing, mistakes have been known to be made. It is important that the dispensing chemist should be able to check the dose and related aspects of administering it.
I am afraid that the attitude of Governments has often been that the pharmacist is just another shopkeeper, hiring out his services to the community as at best a kind of medical auxiliary. There was an article dealing with this point some time ago in The Sunday Times. I shall quote one paragraph, which refers to the pharmacist: 992As his professional organisation, the Pharmaceutical Society represents conflicting sectional interests of independent pharmacies, public companies, co-ops, industrial and hospital pharmacists, etc., it is disunited, feeble and fair game for division and rule by Government, big business, and any other powerful string pullers.These are strong words, but perhaps they are not unjustified.
The system of remuneration for pharmacists is very complicated. I do not profess for one moment to understand it fully. The present system is the result of an agreement made in 1964, I think, between the rulers of the National Health Service and the representatives of the profession. No doubt the agreement was freely entered into, but it was some time ago. It seems to be based on a system that fees are calculated from a notional salary which, at present, I think, is fixed at £5,000 per annum. No doubt his Department will have supplied my hon. Friend with the exact figure.
When we compare that figure with the average national wage, which must now be between £3,000 and £4,000 a year, there does not seem to be a great differential. There are additional payments for the maintenance of the shop, and so on, of course. Nevertheless, we can hardly say that the pharmacist is over-rewarded.
Although I am obviously sympathetic to this important group in the community who give devoted service, high standards of skill and knowledge and work long hours, my principal concern is with the interests and the convenience of the public generally and my constituents in particular. A reduction in the number of chemists' shops to about half the number of a decade ago in my constituency of Bristol, North-East will mean that pensioners, the disabled, and mothers with children will have to walk long distances to get prescriptions made up unless they possess cars.
The problem in my constituency—this aspect is rather special to this part of the country—has been aggravated by the construction of motorways which have sliced through what were formerly integrated communities. Motorways can be crossed only by underpasses—for elderly people they often turn out to be the mugger's delight—or bridges overhead, again with many dangers of accidents to the elderly.
993 Before turning now to the remedies for this serious state of affairs, I should like to attempt to clear the subject of group medical practices. I am in favour of the development of group practices which provide pharmaceutical services at health centres or by special arrangement with a nearby chemist. But the immediate result of that policy, good and rational as it is, is to concentrate dispensing in or around a health centre, leaving other areas in the same city further denuded of facilities. Therefore, one could say that it was common sense, to use a much abused term, that there should be a properly planned service by pharmacists not only for health centres and group practices but on an evenly spread independent basis as well. I suggest that this remedy needs to be investigated very closely.
I understand that the Department, which has been rather slow-moving on this matter in the past, as I shall show, in co-operation with the working party set up by the Pharmaceutical Society, is now looking at the possibility of carrying out this idea. I am glad to hear that, because I put a Question to my hon. Friend's predecessor—now the Minister of State, Foreign and Commonwealth Office—askingif he will take steps to increase the number of chemists' shops and other centres for the dispensing of medical prescription in Bristol.The reply was:I am not aware of exceptional circumstances in Bristol which might justify the intervention of my right hon. Friend, but I should be glad to receive details of any special dfficulties which patients have in getting prescriptions dispensed."—[Official Report, 27th April 1976: Vol. 910, c. 81–2.]I assure my hon. Friend that there are exceptional circumstances in Bristol, as elsewhere. This problem must be taken seriously by the Department.
I have had correspondence on the issue with interested local community health councils, local representatives of pharmacists and Labour ward councillors and members.
All stress the need for action. As a result of publicity which the famous Bristol Evening Post has given to this Adjournment debate, only this morning I received a letter from the vicar of a parish in my St. Paul ward expressing the concern of his church council on be- 994 half of the elderly regarding yet another threatened closure in North-East Bristol.
But I think that the most pungent comment that I have received so far has come from a lady, who writes:There is another elderly person's dwelling in my area almost completed. Is it really fair to site buildings like this in a place where the local shops sell only aspirins and castor oil?That is a very penetrating question, and I shall be glad to hear my hon. Friend's answer.
§ 3.45 p.m.
§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)
I am very grateful to my hon. Friend the Member for Bristol, North-East (Mr. Palmer). By initiating this Adjournment debate he has given me a chance to talk about pharmaceutical provision in relation to the National Health Service generally. As I shall seek to show, although the debate is couched in terms of Bristol and we shall be touching on the Bristol situation, it is a reflection of a national problem which needs discussing, and I hope that it will produce some action.
Those in the House who take an active interest in these services will be aware by now that my right hon. Friend the Secretary of State and I have recently spoken to members of the pharmaceutical profession on various issues concerning pharmacists, including the question of the decline in the number of pharmacies, which I readily admit. Incidentally, in the Department these days we tend to use the term "pharmacist" rather than "chemist". That is the modern fashion.
In view of some of my hon. Friend's remarks, I should place on record the fact that I have the highest possible regard for the professional services that pharmacists contribute to the running of the NHS; indeed, I should like to see them enhanced. I am sure that they are generally in a position to do that.
In Bristol, the local community health council, as well as the local ward branches of the Labour Party, has done much to draw attention to the number of local pharmacy closures in the last few years. Indeed, we have a letter from the community health council setting out its views on the situation, a copy of which I am sure my hon. Friend has also received. I welcome the way in which 995 these councils alert their local area health authorities and family practitioner committees to the problems that are occurring in this field, because it is these bodies that are responsible for providing or administering the services locally and they express public concern to the health authorities and family practitioner committees about the adequacy of particular local services.
I ought to mention the statutory responsibilities of my right hon. Friend in this matter. He is responsible for the provision of a NHS dispensing service—that is, the supply of medicines on a NHS doctor's or dentist's prescription by a pharmacist who has contracted with the NHS to do that. Of course, I recognise that some medicines that do not require a prescription can be obtained only at a pharmacy, that pharmacists stock a wide range of other products, and that the accessibility of the pharmacist is very important to the consumer for other purposes besides NHS dispensing. In other words, it is generally a combined commercial operation and a dispensing service.
I stress that my right hon. Friend and I would not be empowered to spend money except, obviously, in pursuit of NHS dispensing arrangements.
My hon. Friend gave some figures of closures nationally and in Bristol during the last few years. I have figures for periods of time different from those that he gave, but, if anything, I think that my figures are slightly more gloomy than those that he gave. My figures show that in the former area of the county borough of Bristol, since 1973 there have been 29 closures, and these have been balanced by the opening of only eight new pharmacies. This is part of a wider picture, which shows an overall decline in the number of pharmacies in England from 9,700 to just below 9,000.
The main reason seems to be a change in shopping habits and preferences, following closely what has been happening to many other types of small neighbourhood shops. Lack of custom has led to the closure of old-fashioned corner shops, whose former users are making more of their purchases in main shopping centres. This may be a growing trend, or perhaps increasing travel costs will alter or reverse it.
996 My hon. Friend mentioned the delay in Government payments to pharmacists. These are handled by the Prescription Pricing Authority, and the Government have recently mounted an exercise to improve its speed of reaction. I hope that there will be extensive consultation, to be followed by action in the not-too-distant future.
Pharmacies have been closing at a time when the number of prescriptions issued under the NHS has been rising steadily. So closures have combined with the opening of new pharmacies, but not to the same extent. This suggests a redistribution of pharmacy work and not simply a loss of existing facilities. But most of these closures have taken place in the inner city and urban areas rather than in rural areas. That is the source of my hon. Friend's worry, because his constituency covers just such an area.
At the moment, the development of health centres is not a serious cause of concern, although I agree that they concentrate doctors' practices by bringing them together with other primary health and sometimes social services, and we recognise that they may create problems for pharmacists. However, only 17 per cent. of the nation's doctors practise from health centres, and of the 634 centres operating only 13 contain pharmacies. I welcome the development of health centres, and there may be more of them with pharmacies. That will create some local problems.
§ Mr. Palmer
Before leaving that point, will my hon. Friend deal with the other point that I raised—the practice of the large wholesale drug firms and chemists of restricting credit or shortening the credit period?
§ Mr. Moyle
With the action of the Tricker Committee and what I hope will be the speedier response of the Prescription Pricing Authority to pharmacists' bills, that matter should be eased considerably. I hope to show that some other matters may contribute to solving the problem.
We always try to consider the problems of pharmacy closures from the point of view of people with no private transport. But this is an uneven business. The answer to the problem of a pensioner on a bus route is very different from the answer to that of a young woman with 997 children and a long walk to a bus stop. But we hope to solve the problem.
Most prescriptions are issued from doctors' surgeries. So far as I can judge from considering my hon. Friend's constituency, most doctors' surgeries are within half a mile or three-quarters of a mile of a pharmacy—although one or two may be a little further away. There we get to the point of inconvenience. When complaints are received which suggest that there is a local problem, we ask the family practitioner committee for details. These usually reveal a loss of convenience or individual personal difficulties rather than a serious dispensing problem for the whole community.
As a result of my hon. Friend's questions to my predecessor, now the Minister of State, Foreign and Commonwealth Office—my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen)—we have done our best to investigate the immediate problems in the Bristol area. My predecessor invited details of any difficulties that were being experienced in Bristol. There followed an article in the Bristol Evening Post publicising this invitation, but I regret that only three letters were sent to my Department as a result. The electors of Bristol probably had confidence in the ability of my hon. Friend to represent them without the need for further intervention on their own behalf. That did not deter us from following up the matter.
It is probably the trend rather than the actual situation in Bristol that is worrying—the fact that the number of pharmacies per head of the population is decreasing. If the situation remained as it is now there would still be 83 pharmacies in the city, and the ratio of pharmacies to population in the whole Bristol area would remain at about 1 to 5,000 people, which is still slightly better than the national average.
I realise that even here there are still problems of distribution. I recognise that some people cannot easily reach a pharmacy without using public transport. Concessionary fares—half fares—are available for the elderly and disabled in Bristol and they should make the cost of travelling for prescriptions somewhat less expensive.
I said that the Government were worried about the problem in Bristol and 998 in the whole country. We are keeping a close watch on it and taking action. To help solve the problems of elderly and handicapped people who find difficulty in getting about, relatives or neighbours should be mobilised. To that end, I should like to give further publicity to the "Good Neighbour" campaign that has been launched recently by my right hon. Friend. That is concerned not only with the collection of medicines. People in any community are urged to go out of their way to help those who are less fortunate. The collection of medicines for senior citizens, the handicapped and the less well supported is one way in which a good neighbour policy can be simply and effectively deployed by the local community.
We are watching closely the number of pharmacies, and their distribution. We are alert to identify any exceptional situation where arrangements for dispensing might be justified. We have to balance against that the fact that we cannot afford to spend money on facilities which involve highly-trained manpower if they are likely to be under-used. In any case, there would have to be extensive consultations with the local representatives of the professions before we could take action. There are already arrangements, under the system for remunerating pharmacists for National Health Service dispensing, to help isolated pharmacies, normally in rural areas, which dispense small numbers of prescriptions.
We have started to discuss with the Pharmaceutical Services Negotiating Committee the problems of small pharmacies in both urban and rural areas, to see what we can do to help them and to ensure that an essential dispensing service is maintained. The negotiating committee has put to my Department proposals for additional help for pharmacies of this type, and we are sympathetic to the idea, although I stress that in the present financial circumstances the solution must take the form of a reallocation of a small sum of the total sum of money due to pharmacists, rather than new money being put in by my Department. This is the main hope for retaining the existing number of pharmacies.
I hope that as a result of what I have said my hon. Friend will realise that we are doing our best to support the pharmaceutical service to the National Health 999 Service, that we recognise that there is a problem of the nature to which he has drawn attention, and that we shall continue to watch it closely at local level and endeavour to introduce national policies which will help to alleviate the situation.