Community Pharmacies (Hansard, 30 July 1984)

§ Mr. Roger Gale (Thanet, North)
I am grateful for the opportunity, even at this late hour, to raise the subject of the future of community, and especially rural, chemists. I am glad that so many of my hon. Friends have stayed to hear what I have to say. The debate springs from a recent meeting with the Isle of Thanet branch of the Pharmaceutical Society of Great Britain. I was most impressed by its arguments, and I hope to represent it well and faithfully tonight. I am sorry that my hon. Friend the Member for Thanet, South (Mr. Aitken) is unable to be here, but I am grateful for his fullest support for the arguments that I shall introduce. His constituent, Mr. Milne, in the village of Ash, is as concerned as are my constituents, Mrs. Brook of Garlinge and David Randall and Brian Bond of Margate; and they in turn have the support of the many members of the Isle of Thanet branch.
Our fear is that the future livelihood, and therefore the whole future, of the community and rural pharmacist is at risk. That poses a serious threat to our necessary services —as serious a threat as that posed by the passing of the corner shop or the village post office. The remedy is the same. We must either pay for it and use it, or lose it.
The timing of the debate is opportune, as for once we are not too late. Last week saw the publication of the pharmacist's charter—a 10-point schedule designed not only to maintain but to enhance the service provided by chemists. The Pharmaceutical Services Negotiating Committee, representing the 9,600 pharmacists in England and Wales, is now discussing with the Department of Health and Social Security the future of the chemist's contract. So the time is exactly right for the subject to be aired in the House.
What do the chemists offer, what do they need and what do they want? Aside from the obvious—the dispensing of National Health Service and, sometimes, private prescriptions—the chemist offers much advice, and at present he offers it without reward. It may surprise the House to learn that only about 15 per cent. of ailments are estimated to be taken to the doctor's surgery. The remainder — about 6 million a week — are treated elsewhere and by other means. I do not suggest that anything like all the 85 per cent. take their problems to the chemist, but many do. The lady with the pain in her back may spend 20 minutes discussing her difficulties with the chemist before purchasing a suitably efficacious liniment. The young man with sunburn will call at the chemist to ask for something for it. The catalogue of the counselling is almost endless, the value to the Health Service considerable, and the reward to the chemist, in cash terms, precisely nil.
It is true that the DHSS takes account, in the chemist's contract, of advice given relating to NHS prescriptions; thus, the, "Take three times daily and do not drive while you are taking them", information earns some small reward. But the vast wealth of assistance given—the assistance that often keeps the patient out of the surgery and so keeps the waiting room queue much shorter—is not recognised by the DHSS.
The chemist is reimbursed on a cost-plus basis. Essentially, that means in theory that the DHSS pays his 197 overheads plus a bit of profit. The practice is rather different. The chemist receives, for his professional skill, the service he provides to the NHS, and the advice given on NHS prescriptions only, a basic practice allowance of just £2,400 a year. He is reimbursed for the cost of his drugs, and any discounts negotiated with the suppliers are, as we now know, clawed back by the Department, so there is no profit there. He is allowed, on a sliding scale, a percentage on-cost that averages at about 11 per cent. to pay his overheads, a container allowance of 3.8p and a professional fee, per prescription, of a new rate—47p. The average pharmacist now reckons that up to 80 per cent. of his business is done with the NHS compared with below 70 per cent. in 1979. Why that increase?
Traditionally and historically, the chemist has been a brewer, manufacturer and purveyor of lotions and potions to the community. He supplied, in addition, their hairbrushes and combs, their flannels and sponges, their soaps and toothbrushes, their scents, their bathsalts and their contraceptives and many other items both mentionable and, less so, beside. It was called the counter trade, and much of it has gone. Where the pharmacist used to mix the medicine, it now comes in proprietary bottles, tablets and capsules. The home-medicaments, the aspirin, paracetamol, lemon drinks and vapour rubs, together with all the domestic and bathroom essentials that I have referred to, are now sold by supermarkets, sweetshops, tobacconists, ironmongers and probably, given the current trend, by most respectable filling stations as well. It is called competition and it is, no doubt, to be encouraged. But if we want the small chemist to survive, we must pay for him. It is no good Mrs. Jones bewailing the fact that she now has to walk 3.5 miles to get her prescription made up because the local chemist has closed, if she has not been inside the place for seven years.
Equally, it will be no good the Minister and his Department regretting increasing queues at the surgery and greater demands for more doctors and more health centres because the service is clogged with the work that was once done by chemists. The time to get it right is now—not when it is too late.
The chemists offer the provision of information and advice. Their job is not to diagnose — that is, quite properly, the doctor's task — but they can prescribe within limits and they can, and do, dispense both on and off prescription. That service to the nation's health can, and should, be rewarded in the basic practice allowance. The chemist can offer, within his pharmacy, basic health advice and health education—at a possible saving to our health bill of many millions.
Given that pharmacists are properly distributed and not simply allowed to proliferate in every high street at the expense of the side street and rural areas, it should then be possible to extend the home visit service already offered by some chemists and of particular value to areas such as my own constituency with a high elderly population. Repeat prescriptions, obtainable from the chemist, would result in a saving of more millions from the current NHS drug bill of £1.3 billion a year: If there is any doubt that millions are wasted, I challenge any Member of this House to examine his or her own bathroom cabinet and to view there the unused pills.
Above all else, let the second pharmacist's allowance be paid not, as al present, as a portion of the fee from every prescription, but to those chemists actually employing a second qualified chemist and, as a result, offering a faster, 198 better, more efficient service to the patient. Pharmacists, like doctors, vary widely. It is quite wrong to suggest that they cannot and should not be offered an individual contract and I hope that my hon. Friend the Minister will not bring that argument here tonight. In case he is tempted to do so, let me remind him that there are, within the Health Service, 29,000 doctors on individual contracts; there is no reason why 9,600 pharmacists should not be treated equally fairly.
The burden of this debate is, as I have said, quite plain. The public and the Government have both a responsibility and a choice: we either support the local chemist, or we lose him. If we do not support him, we shall have no right to complain when he is gone. My right hon. and learned Friend the Minister for Health has indicated his desire to see the pharmacist's service developed to the full benefit of the community. The publication of the pharmacist's charter and the current re-negotiation of the chemist's contract provide the ideal opportunity for that develop-ment to take place and that benefit to accrue.
We have the chance to recognise the value to the whole community of the small chemist and I hope that my hon. Friend the Minister, in his reply, will indicate that the matters of the individual contract, the basic practice fee and the second pharmacists allowance will all be approached sympathetically and with an open mind.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
I am pleased that my hon. Friend the Member for Thanet, North (Mr. Gale) raised this important matter on behalf of himself, our hon. Friend the Member for Thanet, South (Mr. Aitken) and the pharmacists in Thanet with whom he has been in discussion recently. I hope that my hon. Friend will take a message to chemists and pharmacists in Thanet from myself and my right hon. and learned Friend the Minister for Health—this Government have no intention of ignoring the needs of local pharmacists; we have no intention of abandoning support schemes for essential small pharmacies. Although I cannot be as forthcoming as my hon. Friend would like because negotiations are still continuing, I hope that he will accept my undertakings.
I can assure my hon. Friend that my ministerial colleagues and I are fully aware of the important role that the community pharmacist plays. He—and increasingly, she — dispenses general practitioners' prescriptions skilfully and promptly and offers readily accessible and knowledgeable health care advice. My hon. Friend is right to draw attention to the fact that wide health care advice is provided by pharmacists who also provide other important services, including the sale of a wide range of non-prescription, health care products. All in all, community pharmacists are an essential component of health care in both urban and rural areas.
My right hon. and learned Friend the Minister for Health, at the launch of the National Pharmaceutical Association's "Ask your local pharmacist" campaign, said: It does seem to me that the general public do not make sufficient use of the professional skills of pharmacists. They are probably not aware of the full extent of the professional skills and qualifications of the pharmacist and the help he could be, and I think a campaign that helps to make people more aware of that will be of very great advantage. Pharmacists are professional men and women, very highly trained and qualified. 199 My right hon. and learned Friend's words stand. Indeed, if everyone who felt unwell went to his or her doctor the GP system simply could not cope. Studies by my Department suggest that nine out of 10 adults feel unwell at least once during any four-week period, but only a small minority consult their GP. Many rely on self-medication or rest, or take to their beds, and the pharmacist's advice can be invaluable. Advice is given in both town and countryside.
We recognise the important role of the rural pharmacy. The immediate health resource of a pharmacy in a small village where a doctor lives a distance away is valuable to the whole village. That is why we are determined to ensure that a viable network of pharmacies is maintained in rural and urban areas.
There can be financial problems with rural pharmacies, as with other rural services. My hon. Friend pointed them out in his references to the village shop and to other parts of a village community—one might add the village pub and its important role from time to time.
Because of their location, rural pharmacies can have a relatively small dispensing turnover and some may have such a low turnover that their financial viability is in doubt and on the edge. That is why the present system of remuneration for community pharmacists gives special support to essential small pharmacists.
It is important to remind ourselves of exactly what that support scheme does. To qualify, a pharmacy must dispense fewer than 24,000 National Health Service prescription items a year. That compares with a national average dispensation of NHS prescription items of 30,000 a year. As I say, to qualify, a pharmacy must dispense fewer than 24,000 but more than 6,000 items. It must also be more than two kilometres from any other pharmacy.
The main effect of the scheme is felt in rural areas. Such is our support that in 1983 more than £375,000 was distributed among 404 essential small pharmacies in England and Wales. Very small pharmacies received over £1,300 each. The sums paid out reduce as the dispensing volume increases. Pharmacies dispensing between 23,500 and 24,000 prescriptions, for example, received only £350 on average. All in all, the average payment was just under £1,000 in 1983. The amount for distribution this year will be somewhat larger, at £381,000.
Those of us who have had to study the pharmacists' remuneration system recognise that it is complex——

§ Mr. Gale
indicated assent.

§ Mr. Patten
——and I am glad to see my hon. Friend assenting because I know that he, too, has struggled with the complexities of the system on behalf of his constituents who are interested in this subject.
My right hon. and learned Friend the Minister for Health and myself are committed to producing a new NHS contract for community pharmacists which will, I hope, be 200 somewhat simpler. In saying that, I assure my hon. Friend again of what I said at the beginning, which is that in the production of a new contract, the Government have no intention of ignoring the needs of rural pharmacies and abandoning support schemes for essential small pharmacies.
Negotiations on the new contract have now begun. My hon. Friend will know that, as part of the build-up to these negotiations, the pharmaceutical services negotiating committee has put forward a package of proposals for service developments. I assure my hon. Friend, and my hon. Friend the Member for Thanet, South, that we shall consider carefully all the points that they have made. In addition, we intend to produce a Green Paper on primary health care—that will represent a great bench mark in this area—later in the year, and the Nuffield Foundation has established a committee of inquiry into pharmacy. Much is happening in the pharmacy sphere. All the help and advice that we can get is welcome, and my hon. Friend's contribution tonight has been a significant addition to the consultation process that is taking place over a whole range of ideas.
One idea that has received professional support is the so-called "rational location" of community pharmacies. My hon. Friend will agree that an implication of that is that new pharmacies should be established only where they are necessary. At present, the decision on where any new pharmacy should open is settled by the commercial judgment of the contractor. While we have by no means made up our minds, we must be sure that in going down that road, were we to do so, we would be acting in the patients' interest.
I accept that the medical practices committee exercises detailed control over entry into medical, practice. But, equally, opticians and dentists are free to practise where they will. We need to strike a balance which is right for the circumstances of the profession, for at present, any pharmacist can begin anywhere in an urban area. There is absolute right of entry into a NHS contract. The position is somewhat more complex in rural areas and rather more delicate. I reassure my hon. Friend the for third and last time of the Department's respect for the complexities and the delicacy of the situation in rural areas.
I hope that I have said enough to make clear the Government's support for and commitment to community pharmacy, especially our support for essential rural pharmacies. The Government recognise their responsibil-ity to ensure that there is an adequate dispensing service for the public. We shall continue to discharge that responsibility and I pay tribute to the work of all the individual pharmacists in rural areas who help to provide a service in my hon. Friend's area of Thanet and elsewhere.