The Health and Social Care Committee’s Inquiry into the Contribution of Community Pharmacy to Health Services in Wales

“To propose that the National Assembly for Wales:”

“Notes the report of the Health and Social Care Committee on its Inquiry into the contribution of community pharmacy to health services in Wales, which was laid in the Table Office on 17 May 2012.”

Mark Drakeford: Cynigiaf y cynnig.

Yn ystod etholiadau diwethaf y Cynulliad, ychydig dros flwyddyn yn ôl, cyhoeddodd pob plaid yn y Siambr hon ymrwymiad maniffesto, ar ryw ffurf neu’i gilydd, i roi mwy o rôl i wasanaethau fferylliaeth gymunedol yng ngwasanaethau iechyd Cymru yn y dyfodol. Cam naturiol, felly, oedd i’r Pwyllgor Iechyd a Gofal Cymdeithasol newydd neilltuo lle yn ein rhaglen waith i archwilio’r cynnig hwn yn fanwl. Y canlyniad yw’r adroddiad sydd o’ch blaen heddiw.

Mae’r adroddiad hwn yn seiliedig, fel y buasech yn ei ddisgwyl, ar dystiolaeth arbenigol nifer fawr o unigolion a sefydliadau yng Nghymru a’r tu hwnt. Mae’n elwa o’r cymorth a gafodd y pwyllgor gan ei staff ei hun, a nododd y prif faterion ac a ddaeth i gasgliadau ynglŷn â nhw. Rydym yn parhau i fod yn ddiolchgar iawn iddynt. Rydym yn ddiolchgar hefyd i’r Gweinidog am ei hymateb adeiladol i’r adroddiad. 

Roedd rhan o’r broses o grynhoi’r cynnwys wedi’i seilio ar y ffaith bod y pwyllgor yn parhau i fod yn benderfynol o gynhyrchu adroddiad sy’n canolbwyntio ar nifer fechan o gasgliadau ac argymhellion gwirioneddol allweddol. Mae corff yr adroddiad yn cynnwys set ehangach o faterion sydd, fe gredwn, yn haeddu ystyriaeth bellach gan Lywodraeth Cymru, Mae’r crynodeb ar y ddwy dudalen gyntaf, fodd bynnag, yn nodi’r materion hynny yr ydym yn credu y bydd yn rhaid canolbwyntio arnynt i ddatblygu rhaglen gynhyrchiol ar gyfer fferylliaeth gymunedol yn y dyfodol.

Ein prif gasgliad yw bod rhagor y gallai, ac y dylai, fferylliaeth gymunedol ei wneud i gyfrannu at wasanaethau iechyd Cymru yn y dyfodol. Wedi dweud hyn, y mae set o faterion mwy penodol y mae angen rhoi sylw iddynt os yw gwir botensial fferylliaeth gymunedol am gael ei wireddu, ac at y materion hyn yr wyf am droi yn awr.

I move the motion.

At the last Assembly elections, just over a year ago, every party in this chamber provided a manifesto commitment, of one sort or another, to expanding the part to be played by community pharmacy services in future health provision in Wales. It seemed a natural step, therefore, for the newly formed Health and Social Care Committee to identify an early place in our work programme to subject this proposition to detailed examination. The result is the report you have before you today.
It is the product, as you would expect, of the expert evidence provided by a large number of individuals and organisations, from Wales and beyond. It draws on the assistance that the committee received from our own staff in identifying key issues and coming to conclusions about them. We were, and remain, very grateful to them all. We are grateful, too, to the Minister for her constructive response to the report.
Part of the process of distillation was sharpened by the committee’s continuing determination to produce a report that focuses a small number of really key conclusions and recommendations. The body of the report includes a wider set of issues that, we believe, deserve further consideration by the Welsh Government. The two-page summary at the start, however, identifies those issues that we believe are inescapable, if a productive agenda for community pharmacy is to be developed for the future.
Our central conclusion is to endorse the proposition that there is more that community pharmacy could, and should, contribute to future health services in Wales. Having said that, there is a set of more detailed matters that require attention if the real potential that these services possess is to be realised, and it is to these matters that I now turn.
 
Underneath the headline of believing that more could and should be done through community pharmacies in the future, our report looks at a number of key advantages that we think this sector possesses, at a number of reservations that we have, arising from the evidence we received, and then at a number of key matters that we think need to be attended to for the future.

Among the advantages put to us, and which we endorse, is the accessibility of community pharmacies. There are 710 of them in Wales and, on average, the network will deal with more than 50,000 individual cases every single day. We believe that they also have an ability to serve hard-to-reach groups, as there are community pharmacists in rural towns and villages. They serve deprived populations, and they serve those who do not have a GP and those who struggle to see GPs during opening hours.

They offer a relatively anonymous service. The Family Planning Association, for example, told us that that was very important for receipt of the morning-after pill and other services in that field.

We were also convinced about the contribution that community pharmacists can make to the public health agenda. This is partly because, as Public Health Wales reported last year, there is a greater concentration of community pharmacists in areas of relative deprivation. The public health contribution of community pharmacy is an area where the committee was encouraged by evidence of what has already been achieved and also anxious that lessons should be learned to achieve even greater impact in the future. We think that the contribution of community pharmacy in this area is best realised when public health is pursued in an active and a campaigning way. We agreed with the Minister when she told us that the full impact of community pharmacy involvement in the public health agenda was yet to be captured. As a result, we recommended that consistent participation of the sector be secured for the next round of public health campaigns, both national and local.

If those are some of the key strengths of the sector, we had some reservations as well. We were not as convinced as some of the advocates of community pharmacy that pharmacists are routinely available out of normal working hours or at weekends. We accepted the evidence they gave us that there are cost benefits to be obtained from greater use of community pharmacists, but we thought that the case was oversimplified. It is not enough simply to say that if you move work from GPs to community pharmacies, that in itself will create savings—it does not. There are potential savings to be obtained further down the line if that means that GPs have more time to do the things that only GPs can do, but we thought that a more sophisticated sense of where those cost savings might be realised was needed in the future.

Also, we were concerned by evidence of differences in the level of service between different community pharmacies. It is one of the reasons we made a key recommendation that there should be an obligation on all community pharmacists to place a prominent notice in their premises identifying the range of services available at that pharmacy. There is more work to be done in ensuring that both the range and the quality of community pharmacy services across the sector are brought up to the level already achieved by the best.

Looking to the future, we echoed the conclusions reached by the task and finish group, set up by the previous health Minister, in that there is a need for a greater standardisation of services to meet needs that occur everywhere across Wales. The current Minister, in her evidence to us, equally made clear her preference for a greater number of services to be delivered against a single national specification. As a result, we emphasise in our report that the Welsh Government should take a lead in setting national priorities and ensuring their development. In that context, we warmly welcome the Welsh Government’s encouragement of all local health boards to consider community pharmacies as providers of flu vaccinations over the coming winter. We think that this could help to drive up vaccination rates and make good use of the professional abilities of pharmacists. It will also provide a testing bed for the generally agreed proposition that national leadership is needed to bring about local service change.

There are a number of other matters that we identified as important for the future. Remuneration is important. Currently, the remuneration of community pharmacists is based on volume as opposed to quality of service. All five LHBs that responded to our inquiry favoured a change in that area. Scotland has already introduced a banded capitation payment system. We took evidence from pharmacy representatives from Scotland, by which we were much impressed and which strongly endorsed the shift towards serviced-based rather than volume-based remuneration.

If there was one issue that we, as a committee, felt ran as a thread through some of these issues for the future, it was a sense of disagreement between different professional interests that operate in and around the field of community pharmacy. Improvements need to be made for the future that lies in the hands of the professions themselves. There are other areas, however, where the greater contribution, which we believe is there to be realised, relies on securing agreement not only in the community pharmacy profession, but with other health professionals. Disagreements between the community pharmacy sector and doctors’ representatives were highlighted throughout the inquiry. Our view was that inter-professional disputes are holding back the resolution of some important issues, such as the extent to which community pharmacists should have access to patient information. The clear evidence that we took from the Welsh Government’s chief information officer was that there was no technological reason why pharmacists should not access relevant patient information via individual healthcare records. The barrier is not technological. It relies on the professions agreeing among themselves on what should be shared.

Positively, in that area, we believe that the decision to introduce a national minor ailments scheme, underpinned by a patient registration system, offers a real and practical opportunity for that information-sharing issue to be resolved. Our conclusion was that access to summary patient records by community pharmacists was the correct course to pursue in future. As regards addressing other inter-professional tensions that we identified as holding back the contribution that community pharmacists could make to the future of primary care teams, there is a job for the Government to do in bringing about the discussions necessary to their resolution. The key responsibility lies in the hands of the professions themselves and the bodies that represent them. In one of our recommendations, we say that it is a responsibility that they need to exercise more positively and with a greater sense of urgency.

To conclude, this is a report that provides a positive endorsement of the contribution that community pharmacy makes now, and the extended contribution that it could make in future. Our recommendations identify a set of practical actions that need to be taken to realise that potential in full. We are pleased that the Government’s response accepts all our recommendations, and we hope that the report will find favour with the wider Assembly this afternoon.
 

 

Closing debate:

Mark Drakeford: Briefly, I just want to pick up on the points that all contributors to the debate made that added to the points that I was able to make in the beginning. I will very quickly do that.

I thought that Darren Millar put his finger on something very important in the very beginning when he described community pharmacists as an underestimated service. In the past, they have been underestimated—sometimes by Government, sometimes by other professionals, and sometimes by people who use the service. Part our report is about trying to release their potential so that they are not underestimated in the future.

Lynne added to that point when she said that we need to ensure that we make full use of the services that community pharmacists already provide. There are things that they do now where that potential is not taken up properly. Lindsay Whittle emphasised the education role of community pharmacists in making sure that people know how to take their medicines in the best possible way and that they understand the treatments that they are being prescribed. He drew attention this afternoon—as he did regularly throughout the inquiry—to the importance of privacy within community pharmacies and having places where people can go to get the advice that they need without having to get it in front of other people who are using the pharmacy for other purposes.

Peter Black picked up that theme too and reminded us that community pharmacists have a new role as independent prescribers. That adds to their capacity to contribute to the health service in the future.

Diolch yn fawr i Keith am ein hatgoffa mai ‘gorau chwarae cyd chwarae’. Dyma ddywediad arall i chi, Keith: ‘nid da lle gellir gwell’. Mae honno’n thema yn yr adroddiad. Mae’r bobl sy’n gweithio ym maes fferylliaeth gymunedol ar eu gorau pan eu bod yn cydweithio.

I thank Keith for reminding us of the motto, ‘the best play is team play’. Here is another for you, Keith: ‘there is always room for improvement’. That is a theme in the report. The people working in community pharmacy are at their best when they collaborate.

William Graham drew an important point to the surface regarding the potential of community pharmacies to contribute to the long-term care of people with chronic conditions. Their status as high-street health centres makes them ideally suited to doing that in the future, as he said. Lastly, just to reiterate what Nick Ramsay said, we sometimes underestimate the stigma that some people with some conditions can experience in sitting in GP waiting rooms, with everyone else asking them, ‘What is wrong with you today, then?’ and ‘Why are you here?’, whereas there is greater anonymity of service in a community pharmacy.

Diolch yn fawr i bawb sydd wedi cyfrannu at y ddadl y prynhawn yma.

I thank everyone who has contributed to the debate this afternoon.

I thank the Minister in particular for the positive way in which she has responded to our report. We have said that we will return to this topic in the future and we look forward to seeing the gains that we think are there to be realised being reported to us then.