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Health and Social Care Committee 

Oral evidence: Pharmacy, HC 140

Monday 19 February 2024

Ordered by the House of Commons to be published on 19 February 2024.

Watch the meeting 

Members present: Steve Brine (Chair); Mrs Paulette Hamilton; Rachael Maskell; James Morris.

Questions 123 - 177


I: Janet Morrison, Chief Executive, Community Pharmacy England; Mike Dent, Director of Pharmacy Funding, Community Pharmacy England; Helen Kirrane, Head of Policy, Campaigns and Mobilisation, Diabetes UK.

II: Mark Samuels, CEO, British Generic Manufacturers Association; Dr Rick Greville, Director (Wales, and the Distribution and Supply Chain), Association of the British Pharmaceutical Industry.


Written evidence from witnesses:

– [Add names of witnesses and hyperlink to submissions]

Examination of witnesses

Witnesses: Janet Morrison, Mike Dent and Helen Kirrane.

Q123       Chair: Good afternoon. This is the Health and Social Care Committee live from the Palace of Westminster after half-term recess. The House is back today, and we are upstairs in Committee Room 16 with our public evidence session as part of our pharmacy inquiry. This is the third oral evidence session of this inquiry, and the main focus today will be the impact and causes of medicine shortages, although of course there are other issues in community pharmacy, which we want to discuss. We have the right people in front of us, as always, to help us discuss that.

We have Janet Morrison, who is the chief executive of Community Pharmacy England and has been since March 2022. We have Mike Dent, who is the director of pharmacy funding at Community Pharmacy England. He has worked for CPE and, presumably, the PSNCor the Pharmaceutical Services Negotiating Committee, which it was beforesince 2004. Between you both, you have a few miles on the clock, in the nicest possible way, in the area of community pharmacy. Helen Kirrane will be joining us as well. She is the head of policy and campaigns at Diabetes UK. She has just been held up, but she will hopefully make it and slot into the spare seat next to you.

This is a cross-party Committee, as you know. You know what the inquiry is all about. We are interested in community pharmacy. We are interested in the pharmacy workforce. We are also interested in hospital pharmacy. We have done some field visits in respect of that. We all, as constituency MPs, have community pharmacies in our constituencies, which we visit all the time, both professionally and personally. One of our members has visited it professionally during the half-term break and will be bringing that experience to bear during the questioning.

I will start off with you, Janet, if I may. You said in your written evidence to the inquiry something we have discussed before, which is that there needs to be “a fundamental review of the community pharmacy contractual framework”. What do you mean by that? That is pretty central to this conversation and therefore this inquiry.

Janet Morrison: I am sure you are very aware from the evidence that you have received so far of the pressures that are affecting community pharmacy. That is a direct result of the contractual framework that we are operating with, which has been going for five years and has resulted in 30% real-terms cuts in funding. We can see the strain being felt in the pharmacy sector in terms of permanent closures. We have seen 1,600 since 2017. We have seen an increase in activity and demand for our work, with an 11% increase in dispensing, and new services introduced under that contract. Yet we are seeing increasing numbers of temporary closures and real strain on the workforce and capacity.

It is clear that there is a problem with the overall quantumthis ironclad ringfence around our fundingwhich means that, however well we do, if we overdeliver on any part of the contract, it will get clawed back and taken back. We can end up with activity that is either paid less or not funded at all. That means that there is a real question. It is quite hard to distinguish between the challenge of the overall quantum, that increase in activity that we have to meet out of that overall quantum, and the actual structure of the contractual framework.

More recently, there has been a lot of pressure about the margin and the delivery of margin, and questions about whether people are really able to operate within the margin that we get now. We have been doing quite a lot of work to look at the ways in which we could incrementally improve the measurement of margin or, indeed, look at alternative funding mechanisms. We will also be looking at alternative means to fund the sector. We cannot do that on our own. We have to do that, obviously, in conversation with the Department of Health and NHS England to have some shared goals.

The principles that underpin what we think a funding system needs to deliver are sustainability and the ability for pharmacies to invest for the future. We need some indexation to take account of the increase of activity and inflationary pressures in fees. We need to ensure that there is more benefit sharing and reward for pharmacy businesses, that we reduce the risk in terms of the caps and clawbacks that are taken away from them, and that there is simplicity. My colleague Mike spends an awful lot of time explaining to pharmacies what to expect from the contract. Most do not find it very easy to navigate and it is not very transparent to what they can expect to earn.

The overall quantum is the problem, but some of the individual elements feel like they are creaking. We need to have that conversation to agree goals for a different contractual framework.

Q124       Chair: This Committee talks a lot about NHS dentistry and, obviously, just before half-term we had the NHS dentistry recovery plan. You could encapsulate it in funding and reform, the short-term measures and then the longer-term reform measures. Many people despair about the very long term, a destination we never seem to reach on reform of that contract. Obviously, reform of the pharmacy contractual framework could take a long time. As far as I know, unless you are going to tell us anything different today, negotiations for the 2024-25 framework have not yet begun. Maybe you are going to tell us differently. You are always dealing with the here and now versus the long term. What this inquiry is interested in is probably more the latter than the former.

Janet Morrison: Just to clarify that point about the contract for 2024-25, it is not expected to be a five-year deal. We did a five-year deal. We would probably feel a bit hesitant about another one.

Q125       Chair: Do you expect it to be a one-year rollover?

Janet Morrison: It would be a one-year. We have had the opening letter from the Department of Health just arrive, but we have not had any discussions or further detail in terms of working papers from the Department. As part of that, I would not be able to discuss it anyway. That is about to begin, but it will be for one year. From more informal discussions with the Department of Health and NHS England, they do think it would be worthwhile us having a broader scope of conversation outside of those negotiations to ask, “How should the funding mechanism work in future?” Alongside that, we would be very keen to talk to the Department about what it is we could deliver.

We would like to build on Pharmacy First and see a build in more clinical services, because we believe we can do a lot more, but obviously it would have to be underpinned by the right investment model. In a sense, I would not want to treat funding separately to the strategy for the development of pharmacy services.

Q126       Chair: True, but you have to try to focus Ministers minds on the short term as well as the long term. We are moving towards the end of a Parliament and, almost regardless of the outcome of the election, you are looking at a different ministerial team. Reforming the contract is great, but what recommendations would you say we can make for short-term actions the Government can take to improve the funding situation? By all means bring in Mike.

Janet Morrison: I might ask Mike to say a bit more about what we submitted. It is in the public domain about what we have said to the Department that we would like to see in terms of our asks for the future.

Mike Dent: The first thing will be to close the gap on funding, because it is so enormous. The pressure through not having an inflationary rise for so long and through increased volume of activity is the first thing. We have accrued some retained margin that we could owe back to the Government and the Government wish to recover that. We are suggesting that there is so much pressure on the system that it is almost impossible to recover it. Also, the process of trying to recover it would damage the supply chain even further. It would be wise to say that that excess, which occurred during Covid and Brexit, was effectively an insurance policy, because you rightly kept the drug tariff quite generous, so it would be inappropriate to claw it back.

We are also talking about calling for a review of supply chain and retained margin, because there are challenges with delivering critical funding to contractors using something like retained margin. They are the key things.

Q127       Chair: Welcome to Helen Kirrane, who is the head of policy, campaigns and mobilisation of Diabetes UK. Thanks for joining us.

We might just move on to Pharmacy First with you first, Janet, and then we will bring in Helen. Pharmacy First launched at the end of January, so it is very early. Well, is it early days? It is not early days in terms of the concept of Pharmacy First, which, to declare my interest, I did the pilot for when I was the Pharmacy Minister in the north-east of England. It has now been rolled out, as of the very last day of January, across the whole of England. It is pretty much universal sign-up among pharmacists. I think 96% of pharmacists signed up for it. Why do you think sign-up was so high?

Janet Morrison: We did a lot of work with pharmacies to explain what was being launched and what was going to happen. The words that came out of the people who participated in those webinars and events were optimism and ambition. Pharmacies felt that it was the first big development in the role of pharmacy and that it was foundational for the future. It is the first significant investment pharmacy has had in a long time. It maps quite closely to work pharmacies had already been doing during the pandemic, in terms of giving more information and advice to people who perhaps cannot get access to GPs. It tied in with that. There was a lot of ambition in the sector to make more use of the clinical skills of pharmacists and the pharmacy team to more fully meet the needs of patients. There was a lot of enthusiasm.

The feedback that we have had since it started has been very positive. We know that there were about 3,000 consultations in the first three days. In some of the anecdotal evidence, people were saying it felt so satisfying. I had one pharmacist say to me, “It felt so satisfying to be able to resolve a problem for a parent and a child who needed eardrops. The father had been trying to ring a GP for the last five days, and I could resolve the issue there and then.” I have had a pharmacist who was consulting someone on sinusitis and then took their blood pressure, realised that they were dangerously high on their blood pressure, and sent them straight to A&E. They felt a lot of satisfaction that they had been able to serve that.

On Friday, I was visiting a pharmacy, which is co-located right next door to a GP’s, and it is open door between the two. The GP’s had had no GP turn up that day. There were no GPs on the premises. They had had at least seven consultations come through by 9.30 in terms of, “Can you help these people with minor ailments?” That feels like a really massive resource in terms of meeting pharmacists’ professional satisfaction and using all of their skills, not having to refer people away, meeting patient and public need, and being able to relieve that pressure on primary care.

Q128       Chair: There is a limit to those professional clinical skills, is there not, because there is a limit to what you can do as an independent prescriber, or someone who is not yet an independent prescriber? Then there is a limit, even if you are, to what you can do. This session, as I said at the start, is about medicine shortages and the impact that is having on the sector. As you know, I very much see pharmacy as part of primary care. The example you just gave shows it literally being part of primary care.

I spent some time a few weeks ago in a community pharmacy as a customer in a queue, and I was watching. During the 20 minutes I was in there, three people came in to redeem a prescription, only to be told they did not have it. Their options were to go and shop around to different pharmacies to find that item, which I know is a very familiar scenario to you, or, “While there is an alternative for the medicine you have been prescribed, I cannot give it to you. You will have to go back to your GP.” This is happening all the time. In 20 minutes, it happened three times in the one that I was watching.

While Pharmacy First is saving primary care time in general practice, medicine shortages, I would put to you as my thesis, are therefore cancelling that out, because they are going back the other way through the door to have to get another prescription for a different medicine for the same condition. Discuss.

Janet Morrison: The first point I would make is that Pharmacy First is going in the right direction. The use of patient group directions is helpful, but the direction of travel should be towards more independent prescribing and therefore being able to make more of those dispensing decisions that meet the needs of patients and the public there and then. That is the right direction of travel. We still have an issue, even when all of the graduates from pharmacy school are independent prescribers coming out in two years’ time, that we need to bring the rest of the workforce up to speed. We do need to have clinical services to make best use of those independent prescribers. It is a direction of travel that is useful.

I personally believe that we should be making more use of the pharmacists’ skills to be able to allow them to make substitutions for alternative, appropriate medication or formularies. That would relieve some of the pressure, because it stops people having to go back to the GPs, as you described. It stops that frustration for patients not being able to get what they need. It also prevents overreliance on one or two products when there is a range of products that would do the same job. I would personally like to see that.

Q129       Chair: The impact was the opposite of what you were saying about that satisfaction pharmacies feel, because I watched the pharmacist deflate and I watched the patient leave without what they wanted, equally frustrated, and then the GP was about to get another visit. What do we need to recommend to get the rest of the workforce up to speed? Even when you are an independent prescriber, what are the limits to what you can do in what is called generic substitution?

Janet Morrison: We need to look at the regulations to say what a pharmacist could do now, and then we need to look at independent prescribers as well. I am not an expert on workforce, so that is not our main concentration. We would need to look carefully at that, because obviously independent prescribers specialise in particular areas, so it would not be appropriate in all cases. We should start with the regulatory freedom to allow pharmacists to make more substitutions. Then that is creating the circumstances where independent prescribers in the future can do more of that.

You are right. There is a risk with Pharmacy First that we are deflecting the public and patients to pharmacies. If they cannot resolve all of those issues, some of that frustration is just in a pharmacy rather than at the door of the GP. We need to make sure that the regulatory freedoms are there to make more use of the pharmacists.

Also, the movement that has been shown in Pharmacy First towards being able to use pharmacy technicians is important. Therefore, we need to look at the supervision and skill mix proposals to make sure that the direction of travel is there to make better use of the whole team. Currently, as you will know when you have been in a pharmacy, the pharmacist is incredibly busy juggling: getting hold of the drugs, overseeing queries about dispensing and dealing with Pharmacy First queries.

Q130       Chair: Helen, the scenario that I report is, I suspect, very familiar to Diabetes UK.

Helen Kirrane: Absolutely, yes. Over the last six to eight months we have been hearing from many people calling into our helpline, reporting issues and challenges in accessing GLP-1 medications in particular. People have been writing to us and sharing their experiences about how this is impacting on them and their management of their condition, in really quite significant and severe ways. Yes, it has been having a huge impact on people with type 2 diabetes over the last six to eight months.

Q131       Chair: Would you say that people are getting sicker as a result of these shortages?

Helen Kirrane: We are certainly concerned about the potential harm that is being caused by the disruption to access to these important type 2 medications. It is often only over time that we will see the serious consequences come to light. That is one of the aspects of diabetes: the complications that can arise from diabetes are not immediately apparent sometimes but do develop over time. Yes, there is serious concern about the harm that could be caused and not just from uspatient organisationsbut from professional associations.

For example, the Primary Care Diabetes Society and the Association of British Clinical Diabetologists have both raised concerns about this issue: not only the harm to patients in not being able to access their medication, but the bigger impact it has on the system in general. Individuals might need to spend a lot more time with clinicians reviewing alternative courses of treatment. The time that will take to initiate patients on new treatments is all taking away time for people being able to access their regular, routine care, which over the last couple of years has still been really piecemeal across the country and very hard for many people to access.

Chair: It is a concern.

Q132       James Morris: On Pharmacy First, I visited a local pharmacy in Halesowen on Friday and, as you say, the general reception was that implementation had been pretty positive. There were reasonably high volumes of referrals coming in, the IT system was working, and payments were being made. Quite a lot of the practicalities seemed to be working quite well in that particular place. What do you think are some of the key challenges around the implementation? Anecdotally, we have evidence that the pharmacy estatethe consultation rooms and some of the ITrequires upgrading. How extensive do you think that is as an issue?

Janet Morrison: You have touched on several of the key challenges there. One of the challenges I would like to address at the moment is the issue about IT. I have been really impressed by NHS England Digital’s ambition for interoperability of the Pharmacy First service with GP systems. However, in order to get launch and go-live at the date Ministers wanted it, we agreed a minimum viable product. It has been a little glitchy, as you can imagine with a new service. The ambition is that pharmacies will be able to access the full patient record, to update the full patient record and to make referrals across the whole of the NHS.

Q133       James Morris: In this particular pharmacy, it looked as though that was happening.

Janet Morrison: The other side of it is that the GP system is not fully up and running, so they may have a list of emails that will not be satisfactory to GPs. Until that is all updated and automated at their end, and payment mechanisms are working, that is one issue on which we need to make sure that the ambition is driven through. I am very confident that the ambition is there. I hope that will work.

The second issue you highlighted is about estate. The vast majority of pharmacies and those who have registered will have a consultation room, but it is very variable. Let us be honest about that. Some of the pharmacies and the consultation rooms they have built are amazing; some are less so.

The problem is, with our underlying funding, we get paid nothing towards our premises and our facilities. At the moment, given the huge squeeze on finances, any business would be hard-pressed to be able to refurbish its premises and build even better facilities. Many of them did prior to the pandemic, during the pandemic and all of that, but there is more that could be done. We do not get any funding and assistance to do that, so we would like to see that. Again, the pharmacy I was visiting on Friday had some amazing premises, but it also had some that it is waiting to refurbish until it has the cash to do so. That is an issue.

Another key issue for us will be marketing. Marketing has gone out today by NHS England. It was really important for it to drive public knowledge and understanding of the availability of the service, but also to do it about the seven conditionsnot everything. They have done that very well. They have plans for further campaigns later in the year, but that will need to be a continuous commitment to make sure the public are aware of it and have confidence in it. We are talking about a public behaviour change. That will be very important, so that is one of the challenges. We will follow through.

Q134       James Morris: Can I ask you about one specific thing, just because we are pressed for time, that was raised by the pharmacy in Halesowen? There is a process by which the pharmacists self-certify themselves as capable of delivering the service. They raised some issues about the online materials that are available from NHS England, and they thought there could be some improvements there. Is that something you are picking up on?

Janet Morrison: If they feed back to us at CPE, we will always pick that up. There are a lot of resources out there, I would say. We have put out a huge amount of resource for pharmacy owners; so have local LPCs and so have NHS England and CPPE, which provide the training. There is a lot of resource, but anything that can be improved we would like to hear.

Finally, I would just like to say that a challenge is capacity. It is the staffing issue. Because of the funding pressures, we do see an increase in temporary closures. Particularly we have seen peaks in the summer, when pharmacists might dare to go on holiday. Then you cannot get a pharmacist and a locum. Therefore, that could be a pressure point, but we are two weeks in. We are yet to see how it pans out.

Q135       James Morris: Mike, Janet said earlier that part of your thinking around contract reform was more benefit sharing and building on the Pharmacy First approach. What would we mean by benefit sharing?

Mike Dent: This is a difficult question. There are examples of cases where the kind of incentives that business owners could benefit from feel quite counter-cultural to people in the NHS. People are commissioning in a certain way from businesses. It is different talking to different types of providers. There are occasions where we need to make sure that everyone’s incentives are aligned. For example, with retained margin, the system worked really well until about 2012, 2013 or 2014, when we went to a fixed amount of retained margin. Then, if we earn more, it has to be paid back and then you have all these adjustments going on.

Q136       James Morris: It is overcomplicated.

Mike Dent: It becomes very overcomplicated. It means you cannot predict. It means you cannot invest. You might have earned something, but you do not know if you can keep it until later. There are a few areas.

Q137       James Morris: With the evolution of Pharmacy First, more services are coming in that are being paid for. There is a consultation fee. There are additional fees on top. Do you think in the medium term that that changes the model about how pharmacies work? The traditional business model is dispensing drugs, and that is the core business, which is all about your margin. Is this alignment of Pharmacy First with the contract, which Janet talked about, going to change the business model to some extent?

Mike Dent: It could change it a lot. It is really important that everyone recognises that contractors dispense over a billion items a year and that needs to be paid for. There should not be a cross-subsidy between service payments, for example around dispensing payments and vice versa. That is really important. It is also important that that funding is transparent. Our contract, for example, is different to the GPs’ contract, because they get stuff paid directly and we do not, so that needs to go into the funding.

The other way of thinking about it is that, when Monitor in the old days was doing some work about urgent and emergency care, it recognised that there needed to be payments for being there and payments for activity, then a layer of benefit sharing, because it puts the right incentives in the system to make sure that everything works effectively. Yes, it is quite a transformation.

Q138       James Morris: You want to put these things on the table in the new round of negotiations. Is that what I am hearing?

Mike Dent: Yes, absolutely.

Q139       James Morris: In terms of the future, would you like to see pharmacies playing a greater role in diabetes care more generally?

Helen Kirrane: That has great potential. In the context of challenges accessing primary care, that would be really welcome to many people, to be able to get easy access to support in the community.

Q140       James Morris: We saw today these figures about underdiagnosis. We were talking about a million people who might have type 2 diabetes who are going undiagnosed. Do you think pharmacies have a role in the prevention agenda there?

Helen Kirrane: Absolutely, they definitely do have a role. There is a huge role there potentially. Yes, the ONS figures today showed that there was an estimated 1 million people living with type 2 diabetes undiagnosed and one in nine of all adults in England living with pre-diabetes. There is a real potential for equipping, skilling up and training community pharmacy to understand more about prevention of type 2 diabetes, as well as the care and support signposting that could make a huge difference to people who are developing type 2 diabetes.

Q141       Chair: Janet, you mentioned payment for buildings and facilities. Basically, you are harking back to the establishment fee, which of course died a death. We are in the business of making recommendations. Are you saying that is something that you would like to see return as part of this fundamental review that we talked about at the start?

Janet Morrison: It should certainly be considered as a return, because currently we would be relying on the margin portion and perhaps the prescription fee that we get in order to create the circumstances to invest in buildings, people, staffing, bills and running costs. At the moment, that is not sufficient. It is definitely something we would consider as an alternative that should be viewed. If you want those pharmacies to be in those areas, you should ensure that they can at least put the lights on, have the staff in place and have the facilities that are required for the future services we would like to see delivered.

Q142       Rachael Maskell: I am really interested in this model of Pharmacy First as well. We had walk-in centres, which obviously picked people up and could support them, being very much more nurse-led. They disappeared and we have Pharmacy First, which is pharmacist-led. Is there scope, do you believe, for greater collaboration between other disciplines to be able to get this model right, drawing on the professional skills of pharmacists around pharmacology in particular, but also other professions with their particular role? Adding into that, I particularly come to Helen for a response on the ability to look at that whole prevention agenda and work with public health, which also seems a very important partner in this.

Janet Morrison: I will try not to go on too long. Basically, there are quite a lot of areas we could see pharmacy providing more services in. Pharmacy First was accompanied by an expansion in blood pressure services and oral contraception services. Both of those could be built into wider services. Blood pressure could go into hypertension management, cholesterol management and atrial fibrillation. You could see the links to people with diabetes as well. That would make sense as a build in the future. It would also make sense, building on oral contraception, to look at other forms of contraception, HRT, women’s health, weight management, PrEP and those sorts of issues. You could see a range of additional services.

Ideally, pharmacies should not be viewed in isolation from other parts of the primary care system. One thing that frustrates us about the introduction of the additional roles reimbursement schemeARRSwas that they were recruiting people into GP surgeries, rather than working in partnership with the pharmacy that was right outside the door. That goes for wider professions, allied health professionals and community health that could all be working in a more integrated manner. Some pharmacies that have really pressed ahead have built a range of consultation rooms and do have other health professionals working within them, including physios, in some cases GPs and things like that.

There is huge scope to look at building, rather than these isolated pockets, interdisciplinary teams. We would love to see that. At the moment, we are quite a long way away from it. The question is, “Are you led by which services you would like to develop or by the infrastructure you want to create? It probably has to go hand in hand.

Helen Kirrane: I would echo a lot of that. Already, many pharmacies can help to provide some of the annual checks that people with diabetes need on a regular basis and might be able to get in a more accessible setting, such as tests like HbA1c checks, weight checks, blood pressure and cholesterol checks. There is a lot of potential for greater support and services in community pharmacy, but also for the role of pharmacy in primary care. Embedding pharmacists in a really multidisciplinary diabetes team within primary care is really important. I would agree that it depends on the infrastructure you are going to set up, but the role of pharmacists is key in diabetes management and could be really expanded upon.

Q143       Rachael Maskell: What I am hearing is that the element of delivering good first-line services to a community is a multidisciplinary team to which different elements and different health professionals can bring their strengths. There is a question about premiseswhether in NHS premises or private pharmacy premiseswhere that can be delivered under contracts. We need commissioners to think more widely about the opportunity.

Janet Morrison: That goes to the point about ICBs and the approach taken to primary care. Primary care always feels like a second-class citizen, and pharmacy within that is even further down the pecking order. It is that sense of integration in terms of what goals we are trying to achieve for population health in the community, where the most accessible places are for us to create that, and how we build on the skills and teams that already exist in different parts of this system to make them work better for patients.

I have worked for a lot of years with older people and people with long-term conditions. We are always asking, “Where can people go?” and then suddenly you realise on every high street, in every community, there is a pharmacy with an open door. They have huge potential as hubs in the community that are accessible and that could be built on to be a home for lots of professionals and teams.

Q144       Rachael Maskell: Mike, I want to come on to more gritty subjects, looking at leverage, medicine shortages, and also the contract again. The UK itself clearly has huge leverage. The NHS is the biggest organisation across the world. We have good mapping of data with what is happening around demand, ill health and the future. Do we use the UK leverage sufficiently in the global market of pharmacy in order to get the best deals possible? Is there more that can be done? How would we change contracting with wholesale to be able to achieve that?

Mike Dent: We did a little bit of research into category M products. These are the most commonly prescribed generics. There are just over 600 of them. We decided that 17% were less than £1 as a reimbursement price. I think it was 45% that were less than £2. Those products have probably been made in the Far East, shipped halfway across the world, been through pre-wholesale, wholesale, into community pharmacy and given out to a patient for £1. Leverage is an interesting question.

Manufacturers like the UK because it is a big market. It is a stable market. As you say, it is generally predictable. If you are setting up production runs, it is really helpful to have that core business. But, if there is a shortage, we are not going to be top of the list, because we are very cheap on an international basis.

In the way the procurement system works for community pharmacy, there is a relentless, downward pressure on real drug prices, so generics, but you see the brand prices come under pressure, effectively, with the VPAG and VPAS type systems. It feels like an addiction to cheap medicines, to me. I personally would prefer to feel like we had more medicine security. If this is the NHS’s primary means of treating people, we need to take them seriously and accept that. That costs money. That is an insurance policy.

Q145       Rachael Maskell: Other countries will be paying more for that security than the UK. As a result of that, in lines where we know there are particular challenges, as we have seen over the last few months, if the UK does not compete sufficiently in that global market, we are going to, effectively, continue to have these shortages.

Mike Dent: Lots of shortages are caused by lots of different reasons. In general and on average, that is correct. We will have problems.

Q146       Rachael Maskell: What opportunities are there for more streamlined, localised, regionalised manufacturing to provide that security? Are there other interventions that should be made to ensure that we have that medicine security?

Mike Dent: Can I defer that to the second half? You will get a more considered answer from the manufacturers. The only thing I would say, and we have touched on it, is that the hidden costs of shortages are absolutely huge. We talked a bit about patients. We have talked a bit about pharmacists and how much time they spend trying to find medicines that they could be spending doing other things. It applies to GPs as well. They spend an awful lot of time and effort. This hidden cost is not measured. It is not recognised. It is not part of the decision making. Actually, it would be really helpful if it was somehow.

Q147       Rachael Maskell: If I was to come to youmagic wand time—with an opportunity to write the policy, what changes would you bring about to achieve greater security but also to ensure that pharmacies themselves were able to stay afloat within that mechanism?

Mike Dent: In terms of the second bit, which we are most able to answer, the £800 million that contractors get from retained margin has been the same figure for the last 10 years. Volume has grown. Inflation has happened. It is still exactly the same. Per box, that makes a huge squeeze. Answering the bigger question is a combination of UK manufacturing, possibly stockpiling, possibly paying more, and being seen as a better place to do business. It is a combination answer.

Q148       Rachael Maskell: Helen, if I can refer to you, obviously this has huge implications for patients with diabetes. Indeed, other people will be arguing their corner too. How would you respond to that policy question of how important it is for those people you represent?

Helen Kirrane: It is incredibly important for people living with conditions such as type 2 diabetesa really complex, relentless and serious conditionto be able to access the medication that they need and that they should be able to access. We have just been hearing devastating stories from people about the emotional toll of not being able to access vital medications, not being able to feel like they can continue, not being able to go to work and to live their daily lives, and not being able to manage their condition effectively.

The GLP-1 shortages have raised some different issues and possibly will raise some different policy questions. One of the key things that we have seen with GLP-1 shortages is the huge explosion of interest in this type of medication for weight loss globally over the last year or so and, particularly in the UK, the huge surge of off-label prescribing in the private sector. There have been measures taken and national patient safety alerts issued to mitigate some of these issues and try to ensure that off-label prescribing does not take place. We are not certain of the impact that that has had on private prescribing. There are questions remaining about scrutiny and enforcement of these measures, particularly in the private sector.

Rachael Maskell: Thank you ever so much. What you are all saying, essentially, is that these are not really hidden costs. They are costs that are picked up elsewhere in the service and they need to be brought into the calculations that are being made when looking at pricing.

Q149       Mrs Hamilton: My question was about how you would rate how the Government have been trying to promote this to the publicnot to each other, not to other pharmacists but to the public. As somebody who is a qualified nurse and uses pharmacists, no one has ever given me a leaflet. No one has ever said anything to me about it. If I was not on this Committee and had not read up about Pharmacy First, I am not sure I would know anything about it.

My last point is that you have people from communities where English is not their first language. They do not necessarily read. They are struggling. How is that information being put out there? Are the Government doing a fair job at the moment? Do you believe that more could be done in this area?

Janet Morrison: There were announcements, but I take your point that they are on the news programmes and things like that. That is not going to be picked up by everyone. The first publicity campaign is starting today. It was wise for them not to introduce it straight away, because we had to gear up to be ready on 31 January. To give it a couple of weeks seems wise to me in order to get it bedded into community pharmacies. I am not sure how long this campaign will go on. I am not sure of all of the formats. We have certainly been pushing for lots of everything—you name it: posters, leaflets, even stickersto show that we are Pharmacy First pharmacies and that service is available.

From my awareness, they are planning another campaign later in the year. That is important. We potentially have some seasonality at the moment in terms of the numbers we are dealing with. UTIs are the biggest number, I have heard informally. That should obviously be throughout the year. The other biggest numbers have been ears, throat and sinusitis. You would expect that is a winter issue. We need to keep pushing it. My concern is that I do not know whether there is commitment beyond this year to continue to market and promote it. That is incredibly important.

As you know, community pharmacies are at the heart of every community. Particularly during Covid and the pandemic, they were extremely effective in reaching harder-to-reach communities. They are part of those communities, so they also have a part to play in promoting the service. I have been scanning my local pharmacies and I have seen those who have been really advertising the service and making people aware of it. It is a shared endeavour, but they will have to continue to do a lot more to reach everyone, to let them know that this service is available, and to tell the good news stories about patient satisfaction and people feeling the relief of getting their issues resolved. There is lots more to do. We are only just starting now.

Q150       Mrs Hamilton: I am going to be awkward before I pass to Mike. What is a UTI?

Janet Morrison: Sorry, it is a urinary tract infection. As part of Pharmacy First, we can do uncomplicated UTIs. That is a really helpful service that is extremely valued. That has been the largest presentation that I have heard informally. These are not formal figures. In Scotland, I know it is a very significant part of the offer there as well. That is very valuable. There are quite a few of these common conditions that just fall between the cracks: you would not get a GP appointment for them, but you would not quite know where else to go. That is very important.

We could add other conditions to Pharmacy First. The next obvious thing would be chest infections, where it is a one-off minor ailment that you could deal with, but, if you need to be referred onwards, you would be.

Q151       Mrs Hamilton: Do you want to add anything to that, Mike? That is a very full answer. My last question goes to your last point. What would you like to see added on and after what period of time?

Janet Morrison: It is a good question. We need to monitor how the service goes and see the results. We plan to do that actively with the Department of Health and NHS England. As I said, chest infections are the most obvious next thing. I do not necessarily have lots of other conditions to add into the service. I do know that some locally commissioned services have closed now. On Friday when I was visiting a pharmacy, they were talking about a locally commissioned service that dealt with eye infections and with infected skin conditions. You could consider those as well.

The other element we included when we made our business case in March 2022 for Pharmacy First was to have free over-the-counter medicines for low-income people. That is available in Scotland. It is one of the drivers for people to get a GP appointment, because they cannot afford the prescription. We put that in, but it was not included. Since Pharmacy First has been introduced, I have heard of some local commissioning to provide that in some areas. Certainly, I have heard in north-east London they will be doing that. That might be an addition to the service if we are genuine about wanting to take the pressure off GP appointments.

Q152       Mrs Hamilton: My very last point is around the fact that a number of my colleagues talked about, which is pharmacy being integral in primary care. Who are you going to be evaluating this to? Who is going to evaluate what you are doing? Will it be the local ICBs? Will it be directly to Government? Who actually will you be feeding into to ensure that, if this is going well, we will know quickly and we will know what to do if things are not going so well?

Janet Morrison: As I said, we will be monitoring with the Department of Health and NHS England the statistics and the data that we have. We will also do some work with pharmacies to get feedback on what is going well or not. We will be looking at that. NHS England and the Department have commissioned independent evaluators to look at the efficacy of the service. There will be a particular focus on antimicrobial resistance, because of some of the concerns and reservations that were felt by clinical colleagues in NHS England about the propensity to prescribe antibiotics. That will obviously be an important check.

We feel quite confident about that, however, because we think the data shows pharmacists are actually more conservative about prescribing antibiotics than other professions. We will wait to see. There is quite a full structure of evaluation to go forwards. Being able to get the feedback from patients will be really important, because in the way that services are commissioned, unfortunately, patients do not have a full part to play in the design. We need to make sure that we pick up their feedback and understand the impact on them.

Q153       Chair: Does the evidence in other parts of the world where they are ahead of us on this suggest that there is overprescribing where pharmacists have those powers?

Janet Morrison: No.

Q154       Chair: It is quite the opposite, right?

Janet Morrison: As you know, we commissioned Nuffield Trust and the King’s Fund to produce a vision for community pharmacy last autumn. In their research, they included Pharmacy First as the right step forward. In their research, they showed that there is no evidence from around the world that pharmacists overprescribe antibiotics. In any new service, you have to overcome some professional concerns and prejudices from other parts of the system. I hope that this service will prove that.

Q155       Chair: Professional prejudices within the system—we have never heard of such things. On that happy note, we will thank you very much, Janet Morrison and Mike Dent from Community Pharmacy England, and Helen Kirrane from Diabetes UK. It has been really good evidence and much appreciated. We will just take a couple of minutes’ break while we change the panel. Then we will move on to our second panel. Thank you for your time.


Examination of witnesses

Witnesses: Mark Samuels and Dr Rick Greville.

Q156       Chair: Welcome back. This is the second panel of our third session of our pharmacy inquiry. We are looking at medicine shortages and supplies. We have just been talking to Community Pharmacy England and to Diabetes UK. We now have two more guests. We have Mark Samuels, who is the CEO of the British Generic Manufacturers Association—BGMA—and we have Dr Rick Greville, who is the doctor with responsibility for Wales and the distribution and supply chain at the ABPI, which is the Association of the British Pharmaceutical Industry. Thank you both very much for being here. You obviously heard the discussion in the first panel. Is it getting worse or it is getting better, in terms of the medicine shortages issues that we were discussing with our first set of guests?

Dr Greville: We certainly recognise the frustration. You heard the frustration earlier from the pharmacy and patient perspective. We certainly recognise that frustration. We also recognise that it is a very complex topic with no single solution. Companies invest heavily in business continuity plans, but shortages are a real risk for any supply chain, especially complex, global, highly regulated supply chains such as pharmaceuticals. To answer your question, Chair, the situation continues to be challenging in certain aspects. It is difficult to know as to whether it is increasing significantly. Certainly, it is a long-standing issue and those issues do remain. on occasions.

Q157       Chair: Mark, in the evidence that you sent us for this, which we agreed earlier to publish and will publish probably tomorrow, you said, “medicines shortages are among the top items of some integrated care boards’ risk registers”, which I am not surprised by at all. You also say, “On a strategic level, falling resilience within the supply chain has been worsened because the generic and biosimilar market has not been a priority for Government, despite the huge reliance the NHS has on these medicines”. That does not reflect particularly well on Ministers, current and past, does it? We are not in a great place here, are we, if you have risk registers putting medicine shortages quite near the top?

Mark Samuels: Yes, we have been monitoring it for several years now. As you saw in the written evidence, shortages have increased. They are around double what they were a year ago. You have the detailed figures. We have them at 101 shortages in February this year. We have been highlighting to Ministers since July 2021 the medicine shortage risk. We have raised it in letters to Ministers and in meetings. We are very concerned about it, as you have seen in the written evidence.

Q158       Chair: What should Ministers do? What should we recommend they do? When you answer that, tell us about the critical imports council. Tell those watching what the critical imports council does or is meant to do.

Mark Samuels: I will start with the critical imports council. That is a really good example of where our sector has been ignored. The first I heard about the critical imports council was when a journalist from The Guardian phoned me up to ask about it. We have obviously raised with the Government the importance of our sector being part of that council, as we supply four out of five medicines.

What should be done? We have five suggestions as to what should be done.

Chair: Hit us with them.

Mark Samuels: First, there is a huge backlog at the MHRA of licensing generic medicines. You have seen in the written evidence that it now takes between 24 and 30 months to license a new generic drug. That is wildly unacceptable. It should only be 12 months. It used to be 12 to 15 months. It must return to that. There are some very practical things that could be done around that. For example, last month I spoke to the MHRA. It said that half of its pharmaceutical assessors were new in post. That means that retention of knowhow is critical. Staff retention is an example of the sorts of practical things that could be done.

The second thing is domestic manufacturing, which you touched on in the previous session. The Chancellor in the autumn statement committed £520 million to support medicine manufacturing. That must have resilience as its top priority. There have been numerous schemes to support medicine manufacture in the UK. None of them has put resilience as its top priority. This one must.

In addition, through VPAG there is £75 million allocated to medicines manufacturing. Currently, we have no clue how that will be spent. That must also have resilience at its heart. It is important who manages that. If for example, it is Innovate UK that manages that, it will focus on new plants and new technologies that may be unrelated to the current resilience challenges.

You will have seen in the written evidence that we talked about the trade and cooperation agreement. I must stress when I am talking about this that it is not a Brexit discussion. This is merely a discussion about the agreement itself. We could have left the EU with a different agreement. The TCA as it currently stands is catastrophic for UK generic manufacturing. It substantially incentivises manufacturing in the EU. The current agreement hugely disincentivises investment in UK generic manufacturing. Since the TCA was formed, we have seen our members invest over £4 billion in new manufacturing facilities in the EU and around zero in the UK.

In secondary care, we need a couple of very practical and, I hope, uncontroversial changes that this Committee could recommend. The first of those is in hospital contracts. Those contracts must be issued with enough time for manufacturers to manufacture the stock. It takes at least 16 weeks to manufacture a new generic medicine, and often even more than that. Actually, manufacturers need that much notice to manufacture the stock.

The second recommendation for secondary care, which again I hope is uncontroversial and this Committee could recommend, is that currently, if you are a manufacturer supplying one region and there is a shortage in another region, the contract disincentivises you from sending supply to the other region because you will drop below your minimum buffer stock and you will be penalised for that. That would seem to me a non-controversial and entirely sensible fix that could be made quite quickly. Those would be our recommendations.

Q159       Chair: You have not minced your words.

Dr Greville, would you like to add in terms of what we can recommend to Ministers? The trouble with this issue is that it is quite complex. It is quite techy, not in the computer tech sense, but it is quite complicated. It is quite technical. For the patient at the pharmacy counter being told, “It is not available.” You have to go and visit another five pharmacies to be told it is not available there as well, then go back to the GP and get another prescription for the replacement item—that is where their frustration lies. They do not really need to get into the weeds of this, but we do. We need Ministers, present and future, to understand what you are saying.

Do you get a sense when you talk to Ministers, or even senior officials, in the Department that they understand this issue?

Dr Greville: They certainly understand the issue. We engage very heavily with the Department of Health and Social Care in this space. It has a supplier resilience directorate that we work very closely with. It is an important aspect. We were certainly introduced to the critical import strategy as a part of that engagement and regular discussions that we have with them. We certainly are very well aware of the critical imports council. We hope that the industry is fully represented there. We certainly worked with the Department of Health to ensure that medicines was recognised as a critical import to the UK.

You mentioned the complexity of the supply chain, Chair. You are absolutely right. It is also important to recognise the global nature of that supply chain. Part of our messaging to Government is to ensure that there are very few disruptions to the movement of medicines around the world. We see that as absolutely critical for maintaining a supply resilience to the UK. In many ways, we see that as equally if not more important than the onshoring of specific manufacturing to the UK. It is the throughput of medicines across borders that we believe is highly critical to success here, recognising of course that we are looking at the issue from slightly different perspectives. Mark represents the generic manufacturers and we represent primarily the innovative, branded side of the market. There are subtle differences as well that are important to consider.

Q160       Chair: You seem to have different experiences of the critical import supply chain strategy and the critical imports council. You seem to have different lenses on that.

Dr Greville: I can only describe my lens.

Q161       Chair: I can see both lenses and I see a difference between you.

Dr Greville: I cannot comment as to why there are differences. We have certainly engaged very heavily with the Department of Health on the topic. We are aware that we are still awaiting information with regards to the council and representation of life sciences on that council. We were very aware that the strategy itself was being developed and contributed to its development.

Q162       Mrs Hamilton: In the notes, I read that China and India have, it is estimated, between 60% and 80% of the world’s active pharmaceutical ingredients market. It is suggested that the chain relies heavily on these two counties. How can we reduce that reliance? Listening to you speak, I am beginning to question: do we not want to reduce it, just stay out of the way and stop blocking it? How can we reduce the reliance from those two countries, so you have more choice? I will ask Mark, if that is your area.

Mark Samuels: We live in a world where security is increasingly fragile. We are all aware of conflicts around the world and the state actors who are perhaps less well disposed to the UK. National resilience is critical. We can look to what has done well in other countries. India, for example, has a special economic zone for generic manufacturing. We can look to see how effective that is. It is very effective. We should have a policy for that. As I put in the paper, the Government should have a strategy for both ingredients and generic, finished products. That would be helpful. A good start to that would be simply to engage with the sector globally.

To give an example, the global chief executive of one of our companies was coming to the UK and contacted the relevant Minister to say, “I am going to be in the UK. I would like to talk to you. I am considering investments, including in manufacturing”. No Minister would meet him. In contrast, he went to Slovakia. The Prime Minister would meet him. Slovakia got a $400 million investment in generic manufacturing. A good start would be better engagement with our sector and putting together a Government strategy for generic manufacturing, including the active pharmaceutical ingredients.

Q163       Mrs Hamilton: The final question I am going to ask, because this is not my area of specialism, is about this critical imports council. Would it help? I was shocked to hear that you did not even know about it, really. Would this council actually help with what you are asking for?

Mark Samuels: We are all patients at some point, and we all have family who are patients. We all go to pharmacies for medicines. What we all need is both Rick’s members’ new medicines and my members’ established medicines. Those are essential for all of us and, indeed, for the NHS. That means Government initiatives and Government policy must support both the ABPI members and our members alike. Currently, as you have heard, the gap is that there is a policy vacuum and therefore no supportive police for the generic medicines in the UK. That is something that we need to change. That includes the critical imports council currently.

Q164       Rachael Maskell: Clearly, a strategy is everything. As we look across different inquiries that we undertake, the need for a strategy and the current deficit of not having a strategy is really showing its light. I want to come on to a specific issue around shortages. The Department used to have a committee that would scan the horizon and see where shortages were occurring, and then was able to address that right at the heart of Government. The Government decided to end that committee and that process. What impact has that had on the ability to address the issue of shortages of medicine supply?

Mark Samuels: I would like to give some praise to the medicines directorate in the Department of Health. They work very hard to tackle shortages. Since the pandemic, we have all pulled together. That spirit of collaboration is still there. They are obviously a finite-sized team, but they do work very hard to look for alternatives, to contact suppliers where there are issues and so on. Some praise is due to the civil servants who are working on this. Obviously, even a team of effective and hardworking civil servants cannot resolve every shortage issue. That is why there needs to be some broader supportive policy.

Q165       Rachael Maskell: Sorry, I am dotting around a little bit today. The VPAG scheme is obviously new. It is looking at a variety of issues and particularly the affordability mechanism around the rebate. I would like to hear what you think the positive and the negatives are of the new VPAG scheme, what impact it will have, and what else you would want to see.

Dr Greville: In terms of VPAG itself, it has to be recognised that it was a very tough negotiation that the ABPI and the UK Government had last year. We ended up in a place that is challenging for industry. Nevertheless, it is a place that has benefits and opportunities for the industry and the NHS at the same time. It is never easy when you come out of a negotiation, certainly not one that introduces new policy areas. For example, the new VPAG arrangement does differentiate between newer and older medicines. Time will tell, I suppose, whether that approach is going to work to the benefit of everybody. We certainly see it as an untested approach. We are very interested in working with the Department of Health to make sure that any unintended consequences are resolved as quickly as possible in this space.

Q166       Rachael Maskell: Is there a mechanism for that resolution within the agreement?

Dr Greville: Indeed, there is a mechanism. There will be an ongoing six-monthly review of the impact of the VPAG negotiated outcome. We will be taking that very seriously and are assured that the Department of Health will take it equally seriously in its evaluation as to whether it has any impact.

In terms of the older medicines percentage rebate and payment, the jury is still out in terms of what those percentages are. The Department of Health will announce at the end of this month, I believe, or during the next, precisely what the rebate percentages will look like for a whole range of medicines. Until those resolve themselves, it is very difficult to comment.

We appreciate that part of the negotiation introduced a means by which exemptions can be raised if need be. If some medicines are found to be unviable under the current VPAG, there are arrangements by which those can be reconsidered. Again, we look forward to that mechanism becoming clearer and to our members engaging in that process and identifying as and when medicines become unviable for supply to the UK, if that is indeed the case.

Q167       Rachael Maskell: As a result of the mechanisms, do you think that we will see more generic medicines and fewer branded medicines? What impact will it have?

Dr Greville: It may well happen. The branded generics are a strange mixture in many ways. The regulator insists that some medicines, whether they are generic or before they lose their patent, are prescribed by brand. Those opportunities to change will not be available to companies unless the regulator advises that they can do so. You can imagine some scenarios where, for whatever reason, commercial reasons predominantly, companies decided to retain the brand, even though the product itself had lost its exclusivity. Under the current arrangement, there will perhaps be a fair number of de-branded opportunities taken up by pharmaceutical companies. Again, time will tell.

Rachael Maskell: Mark, do you have anything to add?

Mark Samuels: For us and our members, it has been a mixed picture. There are certainly things we like and some things we have concerns about. Last year we were very concerned about it and the direct impact of shortages.

For example, one of our members supplies a breast cancer drug, Herzuma. They were very open about the fact that the VPAS percentage last year made it loss-making. They spoke to the Department of Health and NHS England, were remarkably open book about it and said that, unless the VPAS situation changed, they could not continue to supply the product at a loss for much longer. That is not unusual for our members, because generics and biosimilars were on very thin margins. In the end, they had to withdraw the drug from the UK because they just could not supply it at a loss for any longer. That situation is terrible, and we clearly do not want to see that under the new scheme.

The new scheme is mixed. We are pleased that there is a recognition where prices are much reduced and a lower clawback tax paid. We welcome that. As Rick said, we are waiting to see what the benchmark is, because the Department has not yet calculated the rebates, but I know it is working very hard on that. It is recruiting staff and on the case for that. We will wait and see.

As is extremely public knowledge, we were gravely upset about being excluded from the negotiations, to the extent we went to judicial review around that. You will have seen the written evidence. It went all the way up. The global chief executive of virtually every generic manufacturer co-signed a letter to the Prime Minister expressing their disquiet. That is an incredibly unhelpful position for the UK to be in. It is the first time that all the world’s global generic manufacturers have co-signed a letter to the UK Government. That is not putting the UK in a good light in terms of market attractiveness. That is where a recommendation from this Committee to try to improve that situation and that relationship would be very helpful.

The last thing to say is about the investment facility. The investment facility, which amounts to £400 million by the end of the scheme, was sprung on us as a surprise. It was not mentioned at all prior to the agreement. Our members have significant disquiet with that situation.

That is a mixed picture. There is some good stuff and some stuff we have concerns about.

Chair: It is a curate’s egg, as they say.

Mark Samuels: It is a curate’s egg.

Chair: Anyway, we are going to conclude with a subject we have not yet touched on, with James Morris.

Q168       James Morris: Mr Samuels, you said earlier that one of the drivers around the MHRA was that its process for licensing of generic medicines was too slow. You cited one reason why you thought that was, talking about resourcing and the retention of staff. Is there something deeper going on, do you think? You other remarks about the general regulatory/strategic environment we are talking about here does not seem to be particularly positive. Does the MHRA reflect that?

Mark Samuels: It is not positive, but there are enormous opportunities. In biosimilar medicines, for example, the MHRA has been world-leading in streamlining those regulations. It deserves praise for that and that is a great opportunity, particularly given the enormous cost savings in the billions over the next few years for biosimilar medicines.

Q169       James Morris: The MHRA would say that it has been working on this backlog, there have recently been improvements and so on. Do you recognise that there is progress being made?

Mark Samuels: There has been progress for the MHRA in clinical trials. It has made improvements there. That did involve staff being taken off generic licensing and put on to clinical trials processes. The one has not helped the other. Really, the MHRA needs to do both; it needs to be effective and efficient for clinical trials and at licensing medicines.

Q170       James Morris: Is that a function purely of resource constraint?

Mark Samuels: The MHRA lost 20% of its budget when it lost its European funding, so that is unhelpful. As a consequence of that, it lost staff when it downsized. It is the loss of knowhow that goes with losing experienced staff that really matters. That is why, as I said earlier, it is really important that the MHRA retains its staff so that, as those new staff build up knowhow, it is not lost in a few years.

Q171       James Morris: Dr Greville, do you have any reflections on the MHRA in its current state?

Dr Greville: I very much agree with Mark. We always look to the regulator for predictable performance. At the moment, it is struggling to be predictable in different areas. It can prioritise areas. It can move resources from one to the other. In general, we would look to the MHRA for predictable performance. Perhaps that is what is lacking currently.

Q172       James Morris: Do you think it is having a significant erosion of competitive advantage for UK generic manufacturing?

Mark Samuels: Yes, it is, very directly. I will not name the company, but one of our members, who manufactures a significant volume of medicines in the UK with a UK manufacturing plant, is considering whether to continue to do that or whether to relocate overseas, entirely because of the MHRA delay situation.

Q173       James Morris: I get a sense, Mr Samuels, that you think there are some other things going on in terms of the lack of responsiveness of the UK Government. What is driving that?

Mark Samuels: We currently have a life sciences vision that is focused entirely on originator medicines. It should support originator medicines, of course. We all need new medicines, but we have a policy vacuum, therefore, when it comes to generic and established medicines, which leads to unresponsiveness. It leads to chief execs of multinational companies not being given time with Ministers when they are visiting the UK and other countries benefiting from investment. All those kinds of things are a natural consequence.

Q174       James Morris: You think that is driven by a choice the Government have made to say, “The Government’s life sciences strategy is focused on X; therefore, we do not want to spend so much time on Y”.

Mark Samuels: If I can speak as a citizen and as a patient, the Government should support new medicines, established medicines, medical devices, diagnostics and all the things that we all rely on for a working health service.

Q175       James Morris: Dr Greville, is there something else going on beyond the MHRA in terms of political responsiveness, Government responsiveness and strategy not being quite well enough aligned with what we need?

Dr Greville: From our sector, we have very strong engagement with the Government. We do not always have meetings with Ministers when our global members come to the UK either. Nevertheless, it has been a very workable relationship over recent times. I would not want to criticise that aspect.

Q176       Chair: Just to conclude, health is so high profile. Everything this Committee does is scrutinised, rightly so, and then we scrutinise Ministers. Media talk about waiting lists and NHS performance. The long-term workforce plan has productivity assumptions built right at the heart of it, which will be incredibly difficult to meet. We talk about Pharmacy First, which is out there today with a big new PR campaign, as you have heard us just talking about with the first panel. Yet we have this shortage issue, which is really drag weight on not just pharmacy but the NHS, given its reliance on good supply of medicine.

In everything that we have talked about this afternoon, how would you draw it together? Is there a grip from anyone on this, or is it just drifting? What do you think, Mark? Does anyone have a grip on this? Is there a plan or are we going back to square one, as somebody might say?

Mark Samuels: I do not see a plan currently.

Q177       Chair: We need a plan. Dr Greville, is there a plan?

Dr Greville: There are certainly gaps in current approaches. We would encourage a more collaborative approach. We would consider, similarly to some of the answers to questions earlier, whether the professions are stronger when they work together. Absolutely, they are. Could the NHS, the industry, suppliers and manufacturers work a bit better together? Yes, they could. The Department of Health’s medicine supply team, as Mark mentioned earlier, do what they can in pulling together these differing sectors. Could they do a little bit better? Perhaps they could. Could the sectors gain more from engagement with one another? Perhaps we could.

Chair: This is really good. We have some really good material to take forward into our inquiry. We will close it there. Dr Rick Greville from the ABPI and Mark Samuels from the British Generic Manufacturers Association, we are grateful, as ever, for your time. That concludes the session.