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As we have heard, community pharmacies have developed from being the main source of prescribed and over-the-counter medicines to providing a range of services designed to promote the health and well-being of the population. As the noble Lord mentioned, many pharmacies now offer vascular checks, heart disease management and prevention, diabetes screening and management, weight management programmes and smoking cessation services, and that is by no means an exhaustive list. For the individual, the advantage of going to a pharmacist for any of these services is that they are highly convenient and you do not usually have to make an appointment. For the NHS, the advantages are twofold: they are extremely cost-effective in comparison with the cost of delivering the same services via general practice; and potentially they also enable the coverage of such programmes to be extended to a larger population. Minor ailments are much better dealt with at pharmacist level because to the extent that patients can be encouraged to go to the pharmacist for advice about minor ailments, GPs are freed up to deal with more serious and complex conditions. It is estimated that every year GPs have to deal with more than 50 million minor ailment consultations, which represent about 20 per cent of their working time. That is not a cost-effective use of the medical profession.
In fact, the 2008 White Paper contained a lot that had already been said previously. The new community pharmacy contractual framework, which was introduced in the spring of 2005, was designed to encourage PCTs to use community pharmacy services more effectively. That did not work, as the Government have since admitted. In fact, it was worse than that, because when the framework was published, many pharmacists invested quite heavily in order to meet the opportunities they thought would be available, only then to be let down.
So, what is holding us up? Why are we making such slow progress in the take-up of these new pharmacy services? To answer that, I think one has to look at what is happening with the commissioning process; and in particular what is happening, or not happening, with the world class commissioning programme.
In March this year, the first panel reports about that programme were published. From those reports, the Company Chemists' Association and the Association of Independent Multiple Pharmacies conducted an analysis of the 30 PCTs which were ranked as being "most competent" in the league table produced by the Health Service Journal. The purpose of the analysis was to determine how well or badly PCTs were
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On the other hand, some examples of best practice were given. I will mention a couple. Eastern and Coastal Kent was shown to be creating patient choice across all care settings, including the use of pharmacy in undertaking tasks normally done in hospitals. City and Hackney PCT is investing £1.2 million a year in a vascular check programme aimed at reducing inequalities on those who are screened and increasing the proportion of hypertensive patients on GP registers from 48 per cent to 80 per cent. These are simple, cost-effective ways for a PCT to reach world-class commissioning standards, yet it would seem that the majority of PCTs simply have not hoisted this fact in. The average GP surgery consultation lasts 11.7 minutes and costs £32. The same 11.7-minute consultation in a pharmacy would cost just over half that. The potential savings to the budget are very great.
They are particularly great when we look at the rollout of NHS health checks. Typically, a health check will consist of some questions about lifestyle combined with some standard physical tests. It is clear that unless pharmacists are used in the delivery of these checks, the idea will fail, because it is the hard-to-reach groups and the people who are not frequent users of healthcare for whom the checks are especially necessary. Can the Minister say what proportion of NHS health checks are being delivered by pharmacists? We know that some are: in Islington PCT, for example, community pharmacies are screening almost 1,000 people every six weeks.
So, what ought we to do? One idea would be to incorporate NHS health checks into the community pharmacy contract as a standard feature. Another would be to require PCTs which are planning new vascular services, weight-management programmes or the like to factor in to their pharmaceutical needs assessments the contribution that community pharmacies are able to make to service delivery. There could be a greater emphasis on pharmacy in the next round of world-class commissioning. But I feel in my bones that this will not be enough. After all, we have been here before in 2005 with the contractual framework for community pharmacy-a document which was laden with good intentions but which came to very little in practice.
There are surely two things above all that need to happen if the aspirations we have all been talking about are to be met. The first is publicity. Patients and members of the public have got to know that these services are there to be had. Most people, I think, do not know. The White Paper contained a mention of publicity, but I am not sure how far this thought has been developed. It has to be tackled, and money and effort have to be spent on it. The second is that doctors
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With any luck, some useful pointers for both doctors and the pharmacy profession, as well as for PCTs, will have emerged from this short debate. The subject is important and I hope that the Minister will be able to reassure us that it is high on her department's agenda.
8.45 pm
Baroness Thornton: 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.
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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
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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 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
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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.
8.57 pm
Apprenticeships, Skills, Children and Learning Bill
Main Bill Page
Copy of the Bill
Explainatory Notes
Amendments
Supplementary Amendments to the Marshalled List
8th Report Delegated Powers Committee
Committee (6th Day)(Continued)
9.03 pm
149A: Clause 59, page 43, line 44, at end insert-
"( ) The YPLA must also ensure that it has an appropriate committee structure to oversee financial provisions for capital building projects for further education and sixth form colleges."
Baroness Perry of Southwark: I do not think that we are in love with the YPLA, at least not on this side of the Committee. Nevertheless we are now moving to the clauses on its structure and how it should go about its business. The amendment attempts to lay down one element in its committee structure. I wondered for a while whether this amendment might not have been more appropriate in the third schedule to the Bill, but I decided that I would move it here as it covers such a
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I think that not only because we have seen with the Learning and Skills Agency a fairly disastrous handling of capital building projects, but because over long experience of funding bodies of various kinds-we have had an awful lot in recent years-it is easy for them to become obsessed with the revenue aspects, which is understandable in a way. They have to decide who gets how much this year and whether somebody gets a bit more, or a bit less; whether they approve this scheme or that scheme; and all the things that we talked about in earlier clauses. It is easy for the capital projects to be tucked away with nobody responsible or, worse, a cabal of two or three of the most senior officers taking the decisions by themselves.
I know that the Association of Colleges feels strongly about this amendment. It has suffered badly from what happened with the LSC and is keen to have a structure in place with the YPLA that ensures that capital projects are properly considered, that there is a committee in place with sole responsibility to ensure that the building projects for both further education and sixth-form colleges are considered carefully and in some detail, and that the budget for them is monitored with somebody making sure that the money is there. I understand that that did not quite happen with the LSC.
It is very important that it is in the main part of the Bill that that is one of the two main streams of finance for which the YPLA will be responsible-the revenue and the capital-and therefore, rather than tucking it in as part of the committee structure, I want it up here in the main body of the Bill. I propose that at the end of the clause that describes the YPLA's financial responsibilities we should add provision for a committee to oversee provision for capital building projects. I beg to move.
Baroness Sharp of Guildford: My Lords, I support the amendment. As the Minister will know, colleges have been much embarrassed by the developments in the college capital building programme this year. I believe that I am right in saying that because the colleges span both 16 to 19 and adult provision, the capital programme for colleges will be split between the YPLA and the SFA. Therefore, it is important not only that the YPLA ensures that it has an appropriate committee structure but that there is a committee structure to bring the two together to run a coherent programme. In many senses, that poses a bigger challenge than the YPLA itself. One may despair about what happened with the LSC, but when two separate authorities are trying to run a single capital budget, many difficulties may arise.
As I understand it, once the basic funding for Building Colleges for the Future was allocated some four or five years ago, the initial bids were very low. That led the LSC to more or less send out messages to its local arms to see whether they could drum up some bids. That is not surprising, given that if you were going to put in a bid, you had to have at least outline
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