Dr Luke Evans

It is a pleasure to serve under your chairmanship, Ms Jardine, and I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for securing this important debate. It is important that we discuss community pharmacies, given their place not only in the health landscape but in the hearts of many of my constituents and people across the nation. I, too, have visited multiple pharmacies, both in my shadow role and as an MP, and I, too, went to my local pharmacy for my flu jab, back in Newbold Verdon. I am very grateful to them because I found the system very easy to use and to get into. It is really important to see that system change that makes it more accessible and easier for people to make the choice to improve their own health and protect others. There are positives in this debate that we must celebrate. Community pharmacies are one of the most accessible parts of our health service. For millions of patients, particularly older ones, those with long-term conditions or those living in rural communities, the local pharmacy is often the front door to the NHS. They provide expert advice, dispense vital medicines, support prevention and increasingly deliver clinical services that help to reduce pressure on GPs and hospitals—as a former GP, I am very grateful for that—and that is why this debate is so important. Ministers want community pharmacies to do more, but I worry that, at the same time, they are actually making it harder for pharmacies to survive. This debate is timely, given that the Government agreed the community pharmacy contractual framework for 2026-27 last Friday. I expect that the Minister will reference that, but I will let Community Pharmacy England’s response speak for itself: “Accepting this deal does not mean we think it is enough—for this year or the future.” It went on to say: “It means the opposite…the sector is in a critical position, and that we now need urgent work on a sustainable long-term solution, including reform of the contract, funding and reimbursement model.” Given the Government’s enthusiasm for reviews and long-term plans, I would be grateful if the Minister updated us on what meetings he will have to work on the framework and the wider funding model, along with what changes we can expect and in what kind of time. The reality is that pharmacies continue to face mounting financial pressures, many related to the Government’s tax rises. Over the last two years, the Government have made a conscious choice not to exempt community pharmacies from their taxes and have even voted against that. In the first year of this Labour Government, pharmacies faced higher employer national insurance contributions alongside increases in the national living wage. In the second year, they have lost the temporary business rates support that they relied on, with the replacement not matching the rise in their costs. The sector is clear that much of the additional funding announced through the new framework will simply be absorbed by those rising costs. The headline findings from Community Pharmacy England’s latest “Pharmacy Pressures” survey, due to be published later this month, show that 100% of pharmacies report that costs are higher than at this time last year and that three quarters are losing money, while 86% say that it is taking longer to procure medicines and 76% say that patients are already being directly impacted by the pressures on their businesses. The National Pharmacy Association put it plainly last Friday when it said it was concerned that much of the funding increase will need to be spent on increased costs, including national living wage contributions, inflation and business rates rises, “rather than addressing chronic under-funding”. Those figures tell a simple story. The Government are asking pharmacies to do more while making it more expensive for them to keep their doors open. What discussions has the Minister had with the Chancellor regarding business rates for community pharmacies? Has he even raised the sector’s concerns with the Chancellor, and if so, what response did he receive? Will he press for a package of support similar to that made available to other sectors such as pubs, to help with those pressures? The rising costs also cast a shadow over the Government’s plan to expand independent prescribing through community pharmacy. We can all see that independent prescribing has enormous potential. It could improve patient access to care, make better use of pharmacists’ clinical expertise and help to deliver the Government’s ambition of shifting care from hospitals into the community. But the sector itself is not convinced that the necessary investment is in place. Community Pharmacy England has said: “we are not persuaded that sufficient investment is being made to enable the full and effective introduction of IP…given the workload, enhanced clinical responsibility, clinical governance and infrastructure requirements that it will entail.” It went on to warn that “the addition of IP to the CPCF risked being set up to fail.” That should concern us all in this Chamber. If pharmacies are expected to become a cornerstone of neighbourhood healthcare, as set out in the NHS 10-year plan, what steps are the Government taking to ensure that the necessary workforce, governance and infrastructure are in place to support that ambition? What response does the Minister have to those concerns, and what steps will he take to ensure that independent prescribing is the success we all want it to be? Alongside the financial pressures, pharmacies continue to face significant challenges in the medicine supply chain. Analysis by the National Pharmacy Association earlier this year highlighted rising prices for a number of cancer medicines and concerns about the impact on availability. At the same time, the number of medicine price concessions has reached record levels. There were 204 concessions agreed in April, surpassing the previous record set only a month earlier. Community Pharmacy England has now confirmed a new record of 219 concessions for May, with further requests still under negotiation. Behind those numbers are real patients facing delays, uncertainties and difficulties accessing the medicines that they need. Community Pharmacy England has warned that those figures reflect the continuing fragility of medicine supplies in the supply chain and that the wider instability from the middle east crisis is adding pressure. Of course, I cannot hold the Government responsible for that, but it is their duty to look at that volatility and to reassure patients and the sector that resilience is being put in place and measures are being looked at. I would be grateful for an update from the Minister on what that looks like. Before I conclude, I will raise an important point that is affecting dispensing practices. We have not talked about those today, but they are part of the real fabric of the community network. Dispensing GPs provide essential primary care medicine supplies to 10 million patients in remote, rural and coastal communities, where access to a community pharmacy is limited. For many patients, they are the primary point of access to medicines. Earlier this year, dispensing practices were informed that the central NHS England funding for the EMIS web dispensing module would cease and that the costs would instead be passed directly to the practices. The proposal generated significant concern among dispensing practices, the British Medical Association and the Dispensing Doctors’ Association. Concerns centred on the lack of consultation, the timing of the changes and the potential impact on the sustainability of dispensing services. Following representations from the sector, implementation has now been paused and central funding has continued. I welcome that decision. However, the uncertainty created caused understandable concerns for practices, their patients and the planning of future services, particularly for those in rural communities. When I wrote to the Minister to raise that issue, he responded that an assessment will take place this year of the long-term provision of dispensing modules and that NHS England will consult relevant bodies such as the Dispensing Doctors’ Association as part of that. Will the Minister provide further details on that assessment today? What criteria will be used? Who else is being consulted? If NHS England is going, who will take that work on? When can dispensing practices expect greater certainty about future arrangements? I would also be grateful if the Minister addressed concerns about the discount abatement—what is called the clawback system. Dispensing practices continue to argue that the current arrangement creates inequalities for them compared with community pharmacies. Equally, community pharmacies are upset about the clawback, so there is an obvious tension. Given that the Government are looking at the long-term structure, I would be grateful if the Minister took that away and considered how we can modernise that aspect to ensure that there is equity in the system as well as an understanding from both sides. Ministers have made it clear that they want pharmacies to play a greater role in prevention and neighbourhood healthcare and in reducing pressures elsewhere in the NHS. We in the Opposition agree, yet throughout this debate we have heard concerns from across the sector about rising costs, medicine supplies, independent prescribing and dispensing services. The question is whether Government policy is keeping pace with the expectations being placed on pharmacies, or whether Ministers are making it harder for the sector to deliver the growth and innovation they say they want to see. Community pharmacies have repeatedly demonstrated their value to patients in the wider health service. I therefore look forward to hearing from the Minister how he intends to address those concerns and provide greater confidence to a sector that remains vital to communities up and down this land.