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Mr. David Hinchliffe (Wakefield): There may be confusion in the Department of Health, but I think that the Conservatives chose today's debate. Is the hon. Lady surprised that there is one Conservative Back Bencher in the Chamber, making a total of three Tories present, which is disgraceful for an Opposition day debate?
The need to preserve access to local health services is of fundamental importance to our constituents and, for many, that means preserving access to local pharmacies. I referred earlier to the fact that I was a pharmacist before I came to the House, and I should state at the outset that I am probably the villain of the piece, as for a few years I was that hated figure, the supermarket pharmacist. Prior to that, I had experience in small and medium-sized family businesses, and did locum work for independent pharmacies. I have therefore worked in pharmacies of almost every size.
It is invidious to depict the supermarket pharmacist or a pharmacist in a large Boots as someone who does not provide a full servicea point that I shall return to later. All pharmacists receive the same training, and are highly qualified. The problem is making sure that they provide the range of services that are needed. I fully accept that there is probably a positive bias in favour of small, independent pharmacies that provide a wider range of services, which is often the only way that they can add value to their business.
I want to deal with the historical context of the problem. As has been mentioned, pharmacies increased at a rate of approximately 130 a year in the early 1980s, which was unsustainable. The Secretary of State for Trade and Industry rightly said that the Treasury responded to that growththe big problem was the method of payment, which favoured small, low-volume pharmacies.
Nobody has mentioned another problem, which made that change easier to achieve at the time: the problem of leapfrogging. There was a firm, which I shall nameLloyds Chemiststhat used to open branches between an existing pharmacy and a doctor's surgery and cream off half the business. Many independent pharmacies were threatened, and many people in the pharmacy profession felt that something had to be done about Lloyds, so it was relatively easy to accept the control of entry proposals at that time. The villain of the piece then was not supermarkets, but Lloyds. We do nobody a favour by pretending that only supermarkets could benefit from a relaxation of entry controls. The large firms on the high street, such as Boots and Superdrug, are also looking to expand, and their expansion poses just as much of a problem to existing pharmacies.
Some of the knock-on effects of control of entry were not predicted. The pharmacy profession noted that Lloyds was not stopped in its tracks. Where it was prevented from opening, it simply bought out all the very small firms. I used to work for a small family business with five shops. The owner died, and there was a piece about the business in The Pharmaceutical Journal. People phoned the family asking to buy the shops, not realising that that gentleman had three sons who were pharmacists and who clearly wanted to continue the family business. It was an aggressive time, and Lloyds is now one of the largest chains in pharmacy.
Sandra Gidley: The cost of the good will of a pharmacy business increased dramatically, making it almost impossible for somebody without financial backing to open an independent pharmacy. Such a person had to be very cute about a new opportunity opening upthere were people who regularly trailed housing estates to see where a doctor's surgery might open, to try to get in there. Another problem was that many contracts were sold to supermarkets or other large companies that could offer large premiums. That had a
Because supermarket pharmacies were offering so much money, nobody else could get in. In my locality there were two independent pharmacies. Both wanted to sell to an independent purchaser, but both were forced to sell to chains because nobody else could afford to pay.
Mr. Peter Pike (Burnley): Is it not a fact that every time a small local pharmacy sells on to a superstore, the service is removed from the most dependent elderly people, people without transport and those who cannot get to the superstore, who depend on the pharmacy not only for their prescriptions, but for the wider primary care service that pharmacies are now supposed to provide?
Sandra Gidley: The hon. Gentleman has a point, but the two pharmacies that I referred to still look like small pharmacies. They are just branded with a firm's logo. However, there is no longer 24-hour access to the person above the shop who, if somebody knocked on his door, would go down and provide the emergency inhaler mentioned earlier. That provision has gone. If people do not own their businesses, it is much more difficult to find any who are motivated to provide delivery services. Generally, such services are not paid for by the Department of Health, so they represent an added value that a business subsidises out of its profits.
The new contract has been mentioned. I know that many pharmacists are apprehensive about it because they fear that they will be given the same amount of money, but asked to do a lot more. Will the Minister give some reassurance that extra funding will be available if extra services are being provided? I am sure that that would put many people's minds at rest.
Mr. Steen: The hon. Lady will remember that I initiated the first Westminster Hall debate about this matter on 12 March this year, to which she made a very useful contribution as a pharmacist. As I said then, pharmacists in my constituency are concerned about the £18,000 contract that she mentioned. I believe that every pharmacist has such a contract for national health service prescriptions. Does she agree that that is what we want the Minister to deal with? I got the impression from the Secretary of State's speech that the Government were going to play around with that £18,000 and that some pharmacists will get more, but many will get less. Does she agree that it is crucial that that amount is high and that, if it is not, community pharmacists will not be able to survive?
Sandra Gidley: The hon. Gentleman makes a useful intervention, and he has a point. I am not necessarily saying that £18,000 is the level that must be set for only the dispensing part of the business. Clearly, he is right that a sustainable level is needed, but the concern is that some of the roles that pharmacists take on require much time and energy and cannot be funded out of any small amount that is left over, so new money is needed.
I admit that the status quo is not perfect. Everyone who gave evidence to the Select Committee on Health agreed that some change was necessary, but there appeared to be an emerging consensus that distribution should definitely take into account local health needs. As part of the reforms, we need to establish exactly what services should be available at every pharmacy, in addition to the core business of dispensing.
Various services can be available. Some pharmacies provide oxygen services, supervised dispensing of methadone and monitored dose systems for old people's homes allowing people to keep a check on their medications, and delivery, prescription collection and 24-hour services. I have provided all those services in my time, and I provided all but the 24-hour availability service in some role in working for a supermarket pharmacy. However, I fully accept that provision in supermarket pharmacies is patchy.
John Mann: On supervised consumption of methadone and other blockers, and in relation to drugs, does she accept that the problem of supermarket pharmacies is that the people on supervised consumption will often have a track record of shoplifting and will have been banned from supermarkets where they have previously stolen? That can also be a problem in some of the larger and wider product chains such as Boots.