Meeting of the Parliament

Meeting date: Thursday, May 16, 2019

Official Report 1002KB pdf

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Community Pharmacy Scotland

 

The next item of business is a members’ business debate on motion S5M 16544, in the name of Alexander Stewart, on Community Pharmacy Scotland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes the work of Community Pharmacy Scotland (CPS) in representing independent community pharmacy owners in Mid Scotland and Fife and across the country; acknowledges that it provides information and advice to over 1,200 pharmacies, engages with MSPs, NHS boards and other relevant national bodies and negotiates its members’ terms and conditions of service; considers that, because of their skills and professional expertise, community pharmacists are increasingly important front line healthcare providers, working as educators, primary care campaigners and experts in the most effective use of medicines; understands that CPS is keen to build its presence among the public by promoting the role of modern pharmacy care at a time of major change; believes that it is doing this by taking a proactive, open-door approach to better reflect the changing and developing role of its members, whom it considers are at the heart of every community, and acknowledges CPS’s work in the drive to ensure that its members can provide the services that communities need and deserve.

12:43  

I am delighted and grateful to have the privilege of opening my members’ business debate in recognition of the work of Community Pharmacy Scotland. I extend a warm welcome to guests from CPS who have joined us in the public gallery: Matt Barclay, the director of operations, and Caroline Rooks, the public affairs officer.

The debate is highly significant, as CPS is the organisation that represents community pharmacy contractor owners in every aspect of their lives. CPS is the voice of those healthcare professionals, as they deliver pharmaceutical care to people and their communities across Scotland. CPS is empowered to represent the owners of Scotland’s 1,257 community pharmacies and to negotiate on their behalf with the Scottish Government. That negotiation would normally cover all matters to do with their terms of service and the national health service activities that they provide.

CPS works on the development of new pharmaceutical care services and ensures that the framework exists to allow the owners of Scotland’s community pharmacies to deliver those services. Their contracts put the care of the individual right at its centre, with its focus on pharmaceutical care and improving clinical outcomes for everyone.

Community pharmacy contractors and their employee pharmacists play an integral and increasingly important role in maximising therapeutic outcomes and achieving improvements in medical safety and care. Community pharmacy is at the heart of every community; it works at the front line of healthcare in cities, towns and villages across Scotland to dispense medicines and offer patients advice and practical help with health and wellbeing. Community pharmacy plays an important part in the drive across the country to ensure that health professionals provide the service that meets patients’ treatment and care requirements.

By kind invitation and because of my support for community pharmacies, I recently had the opportunity to visit Bannerman’s pharmacy in Dunblane, in my region. I experienced at first hand the truly excellent service that it provides and saw what the variety of well-structured private contractors that operate in such facilities can achieve.

Services include the pharmacy first initiative, which was rolled out in 2017 to enable patients to access treatment in pharmacies. Pharmacists have been taking on more medical and clinical roles, which is vital. They already monitor asthma and diabetes and review other medical conditions, which is a step forward.

The scheme aims to improve patient access to GP appointments by encouraging those with certain minor ailments to use pharmacies for treatment rather than make an appointment at their surgery or attend accident and emergency. Community pharmacists carry out consultations with patients and provide advice and treatment under locally agreed patient group directions, which stipulate the medicines that can be prescribed to patients and in which circumstances. I am pleased that NHS Forth Valley, which covers part of my region, piloted that excellent service; it also operates a more advanced version of the nationwide service.

Community pharmacies also face challenging times. Unfortunately, there is a shortage of qualified technicians and pharmacists across Scotland. The new GP contract enabled pharmacists to be employed in GP clinics directly, and regional health boards can make such arrangements, which is to be welcomed, because that spreads the load and gives individuals the opportunity to participate.

The new approach could provide a great deal of benefit to the day-to-day running of GP clinics and give GPs time. There is the opportunity for a huge number of new posts to be created, but that creates issues, because we have a finite number of trained individuals. In my opinion and that of CPS, the issues have arisen because the new services were implemented without the impact on other healthcare professionals being taken into account. Much more consultation is required. To that end, NHS Education for Scotland has undertaken a comprehensive workforce survey, which will be published shortly. That will quantify the extent of this rather concerning development.

Pharmacists may not administer flu vaccinations for the NHS, although they are highly qualified and able to do so. CPS’s view is that that means that Scotland’s hard-working GP services are coming under even greater pressure in their battle to balance demands. Pharmacists maintain that allowing them to administer flu jabs would help significantly in getting closer to the target levels for vulnerable populations—we know that the elderly, pregnant women and people with specific conditions require the vaccination.

Last year, the number of people who suffered flu doubled from the previous year’s figure. Scotland’s vaccination rates fall well short of the World Health Organization’s targets, and we have never managed to vaccinate more than 61 per cent of at-risk adults who are under 65. As I said, we have 1,257 pharmacies, which are open six days a week and could do much more to support and assist us. We need to look at legislation; south of the border, pharmacists gave out 1.17 million flu vaccinations between September and January.

Community pharmacies provide a truly excellent range of patient care from privately owned and run businesses, and I commend and congratulate them on all the work that they do. They offer much more and could offer even more to our communities if they were given the opportunity, which would save costs for the NHS. We all want to see the NHS providing services, but we want to see it doing so collaboratively with the support of others. If CPS did not have its hands tied, it would be able to do so much more to support us.

I wish CPS continued success, and I look forward to seeing the organisation go from strength to strength because that is exactly what we should be seeing in our communities.

12:50  

I congratulate Alexander Stewart on securing the debate. I am delighted to speak on the importance of Scottish community pharmacies.

I welcome the opportunity to praise the work that pharmacists around Scotland do to support not only the people who live and work in their areas but GPs and other healthcare providers. Indeed, Scotland’s hard-working community pharmacists, who are independent contractors, and who supply pharmaceutical services to NHS Scotland, play a vital role in helping to alleviate pressures on local doctors’ practices and in supporting members of the community to access advice and guidance on health problems and medications before a doctor’s appointment is necessary.

The Scottish Government has a vision of providing more care closer to people’s homes. With 1,257 pharmacies all over Scotland, community pharmacies are the most accessible primary care provider. They play a vital role in helping the Scottish Government to meet that ambition, particularly through innovative programmes such as the minor ailments service, which is an NHS service that allows people to be assessed by a pharmacist and given advice, treatment or an onward referral as appropriate. That service, which is presently available to children, students aged under 19, and people aged 65-plus, has been very well received.

NHS Dumfries and Galloway in my South Scotland region serves a population of over 148,000 in a large geographical area of over 2,400 square miles. Dumfries and Galloway stretches from Langholm in the east to Drummore in the west, and from Kirkconnel and Carsphairn in the north down to Sandyhills on the Solway coast, as well as to Gretna at the border. The health board employs around 4,500 staff, excluding GPs and dentists. With one main hospital servicing such a large area, the pressure on local GP surgeries is high, and pharmacists play an integral part in alleviating that strain.

Community Pharmacy Scotland, the recognised body that represents Scotland’s community pharmacists, published research highlighting the success of the minor ailment service that shows that 60 per cent of those who used the service said that it saved them from making an appointment to see the GP. CPS is also working with the Scottish Government on an extension of the minor ailment service, which it aims to launch in April 2020. That expanded service will be free to all people who are registered with a Scottish GP. The existing pharmacy first programme will be merged with the minor ailment service, in line with the recommendations set out by CPS, to increase the breadth of conditions that pharmacists can prescribe for.

Currently, the pharmacy first programme allows pharmacists to prescribe for uncomplicated urinary tract infections and impetigo, as well as localised skin infections, conjunctivitis and vaginal thrush, and to provide antibiotics in a rescue pack for patients with chronic obstructive pulmonary disease .

On top of the minor ailments scheme and the present pharmacy first programme, community pharmacies play a role in helping members of their communities to battle debilitating addictions and substance abuse problems. The Boots pharmacy in Dumfries, for example, offers nicotine replacement therapy and supervised methadone supply, as well as emergency contraception.

NHS Dumfries and Galloway stretches over a large geographical area. I want to pay particular tribute to one scheme that has been pioneered there: an initiative to train pharmacy staff across the region, which was recognised in the Scottish pharmacy awards last year. The scheme was launched in Wigtownshire three years ago with finance from the health and social care integration fund. After receiving the award, locality prescribing adviser Amy Robinson, who originated the idea, said:

“It’s well known that we have a need to recruit people to work within the primary care pharmacy team ... As a result, we joined forces with Whithorn Pharmacy, which is an independent community pharmacy, and pharmacist Fiona McElrea.”

Together, Amy Robinson and Fiona McElrea worked to ensure that participants could train for 15 hours a week in a community pharmacy to meet the necessary regulations, with the remaining time spent with the team in general practice. They received funding initially to train one pharmacy technician, Eilish Bell, who has now qualified. The initiative will be built on to provide more trainees with more qualifications. The award was well deserved, and the initiative shows the innovation in this area and the vital work that community pharmacists do.

12:55  

I thank my colleague Alexander Stewart for bringing this important debate on community pharmacies to the chamber. He is rapidly becoming known within our group as the MSP for members’ business debates.

I pay tribute to the people who work in community pharmacy across Scotland for the vital work that they do in assisting patients and advising them on health needs. I also acknowledge Scotland’s pharmaceutical sector and industry, which is important to our economy.

The Scottish Conservatives launched our pharmacy plan last summer, to look towards enhancing the capabilities of community pharmacy in Scotland. Community pharmacists across Scotland already play a vital role in supporting local patients, but we believe that they can do even more in the future, and we want to empower them to achieve that. By expanding the services that are offered by pharmacists, we can remove pressures from general practice.

In my region of Lothian and, as we have heard, in other regions across Scotland, there are growing demands on our GPs and other primary care services. Many GP practices are operating closed or restricted lists, and people often face a wait of weeks for routine appointments with a doctor. Demand for A and E services continues to grow, with people not being able to access information, and out-of-hours services are also being reduced.

Pharmacists are well placed to help reduce the ever-increasing demands on primary care. As has been mentioned, there are 1,257 pharmacies all over Scotland, which means that community pharmacies represent the most accessible primary care provider, and there is a higher concentration of pharmacies in deprived and more highly populated areas.

Pharmacists are highly trained healthcare professionals, and maximising their knowledge and expertise will increase their capacity to deliver effective primary care to all our communities. Before she became a minister—when, perhaps, she lost her ability to speak out—Maree Todd, who was here at the beginning of the debate, often highlighted in the Health and Sport Committee just where she thought community pharmacy could go in the future. That is important, and I am sure that her views on that are being heard in the Government.

The Scottish Conservatives want community pharmacies to become health hubs that will provide a wide range of services to people in the community. We therefore believe that community pharmacists should have appropriate access to patient records. I know that the Scottish Government is working on that proposal and that the Health and Sport Committee has been updated on it. In addition, we want all community pharmacists to have the opportunity to become trained prescribers, to allow more common ailments to be treated in a pharmacy setting. Our community pharmacies have the potential to assist more patients in more ways, such as by taking a lead in travel health services. For example, the Barnton pharmacy in Edinburgh has an in-built travel clinic, which is a one-stop shop for all travel-related healthcare needs.

As Alexander Stewart said, pharmacies could also play a much greater role in flu prevention. Providing more community-based opportunities for pharmacists to administer flu vaccinations would take pressure off GPs and significantly improve the rates of people being vaccinated. Taking someone's blood pressure is a service that some pharmacies already provide, but expanding that service and improving knowledge of its availability could make a real difference to heart health in Scotland.

Our pharmacists have huge untapped expertise, and their knowledge is a critically important part of our wider Scottish NHS. By giving them the ability to assist more patients in more ways, we can improve patient care and alleviate the ever-growing pressures on our overstretched GP services. I hope that the Scottish Government will take that work forward on a cross-party basis.

12:59  

I, too, congratulate Alexander Stewart on securing this important debate and on giving a comprehensive and well-researched speech.

As we have heard, community pharmacies are a vital cog in Scotland’s NHS and increasingly act as the first point of access to the NHS for many patients with ailments that can be big, small, long-term, short-term, one-off or chronic. I will flag up two initiatives that are not as well known as they should be: the 3 before GP campaign and the minor ailment scheme, which we have heard about from Joan McAlpine. Both are excellent.

Pharmacists are best known for dispensing medicines and offering patient advice, but they are now taking on more clinical roles including managing and monitoring long-term conditions such as asthma and diabetes and conducting medicine reviews. They also help people to give up smoking, provide drug misuse services and advise on sexual health matters. Like other members, I express my thanks and gratitude to community pharmacists for all their tireless hard work.

I, too, have recently visited community pharmacies. A couple of Fridays ago, I visited the Lochardil pharmacy in Inverness, and, a couple of months ago, I went to KJ Macdonald’s excellent pharmacy on Cromwell Street in Stornoway—it was a beautiful day, Presiding Officer.

From the excellent briefing that I received from Community Pharmacy Scotland, I learned that community pharmacies are the most accessible primary care providers. As we have heard from the Conservative front bench, there are 1,257 pharmacies all over Scotland and there is a higher concentration of pharmacies in disadvantaged and highly populated areas.

As in all areas of the NHS, staffing is an issue at the moment—pharmacies are no different, given the challenges of recruitment and retention. Another pressure that pharmacists face relates to the lack of sharing of patient records. Not only do pharmacists not have access to patient records from GPs, but records that are held by pharmacists are not shared with other pharmacies or GPs. Where is the joined-up thinking? Perhaps the minister could concentrate on that issue in his winding-up speech. Working in silos could put patients at risk and prevent pharmacists from making informed decisions.

NHS Highland, which is one of the health boards in my region, has been developing innovative pharmacy services to deliver high-quality pharmaceutical care in more rural settings. From reviewing patient medicines in care homes via telehealth link to providing medication reviews in dispensing practices, pharmacists play a vital role in the NHS Highland team. Making medical services more accessible, alleviating the pressure on hard-pressed GPs and A and E departments, and offering advice and medication are all things that our community pharmacies can help with if we give them the support that they need.

In closing—unusually, I have kept to time—I will quote, for the second day in a row, from the founder of the NHS, Nye Bevan, who said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

I do not know whether Mr Stewart is looking for brownie points for that, but we will think about it.

13:03  

I welcome this debate on Community Pharmacy Scotland, and I thank Alexander Stewart for bringing it to the Parliament.

Pharmacists play a vital role in delivering healthcare to Scotland’s people, and I express my appreciation for the work that they do. I thank the organisations that provided a briefing for today’s debate, and I thank all those in the Carrick Knowe pharmacy with whom I spent an informative afternoon. The busy staff team helped me to learn more about the important work that they do.

As the Royal Pharmaceutical Society notes in its briefing, it is no surprise that community pharmacies are increasingly becoming the first point of access to the NHS for many patients. Community pharmacists are taking on more clinical roles and are offering smoking cessation and drug misuse services as well as providing sexual health advice. There is also the minor ailment service, which Community Pharmacy Scotland says saved 60 per cent of those who were treated from needing to see their GP.

As members are aware, I recently led a debate on GP recruitment and retention, during which my colleague Mark Ruskell and I spoke about the importance of developing the multidisciplinary team that would have the potential to reduce GPs’ unsustainable workloads. I welcome the expansion of community pharmacists’ role, but we must ensure that a sufficient workforce is in place. Community Pharmacy Scotland says that the new GP contract has resulted in hundreds of pharmacists being recruited to work in GP surgeries, which has created recruitment and retention challenges in the profession, because there has not been a corresponding increase in the pharmacy workforce.

The Royal Pharmaceutical Society is asking for direct investment in education and training to ensure that there are enough qualified pharmacists and for effective workforce planning to ensure the profession’s long-term sustainability. The Scottish Government must heed those calls. It is essential that we do not overburden other health professionals in an effort to assist Scotland’s struggling general practices.

Community Pharmacy Scotland has called for improved communication between healthcare providers. Currently, pharmacists cannot access patient care records, which hinders their ability to prescribe medication and places extra pressure on GPs, who are often asked to verify a patient’s history. Information sharing across the health service must be improved urgently if the multidisciplinary team is to operate effectively.

There is room for more collaborative working between professions—for example, in the promotion of pharmacists as clinical experts in medicine and prescribing. In December 2017, the Royal College of General Practitioners ran its 3 before GP campaign—David Stewart referred to that—which set out three steps that patients should consider before booking an appointment with their GP, one of which is:

“Seek advice from a pharmacist”.

I urge the Scottish Government to consider running or supporting similar campaigns in the future, as patients might simply not think to seek medical advice from their pharmacists. A culture change is required, which we can facilitate.

Pharmacists are also crucial to the integration of health and social care. In a recent report, the Royal Pharmaceutical Society highlighted the need for more pharmaceutical care in care homes and recommended that dedicated time with pharmacists and their teams be embedded in care home services. Scotland’s people are living longer and, as a consequence, we have an increasing number of frail elderly patients with complex conditions in care homes. Community pharmacists are well placed to support care homes in administering medical care to their residents, and it is essential that there is more collaboration between pharmaceutical and care services in the future.

The role of the community pharmacist is expanding, which will be of prodigious benefit to our health service and to patient care. It is vital that a sufficient workforce and appropriate funding are in place to facilitate that development.

13:07  

I congratulate Alexander Stewart on securing the debate.

I have supported community pharmacy throughout my term as an MSP—I am wearing my “20 years” badge today—and over that time I have seen some fantastic changes. I thank everyone who works in a community pharmacy—not just in my constituency, but throughout Scotland. I have visited numerous pharmacies, and their work is fantastic.

I agree with everything that members have said about community pharmacies’ role in treating minor ailments and so on.

I want to reiterate the point about access to patient records that Dave Stewart and Alison Johnstone, in particular, made. I know that information sharing is difficult, particularly in the context of the general data protection regulation, but it would be helpful to have some joined-up thinking on the matter, even if we are talking just about the emergency care summary.

Aside from the medical aspect of their work, community pharmacies are community hubs, with people of all ages using them.

Pharmacies also make bubble packs for home delivery. A couple of weeks ago, I visited the community pharmacy in Argyle Street in my constituency, where the staff were talking about having to cap the number of bubble packs that they provide because of the cost. Bubble packs are of great benefit to elderly and infirm people, and their use creates employment. That is another thing that needs to be looked at.

Pharmacists are very involved in their communities, to the extent that if someone does not turn up to pick up a prescription, or if staff have not been able to get into a house to deliver a prescription, the pharmacist knows that something is wrong. Community pharmacy is not just about medical care; it is also about looking after elderly and infirm people in the community. Community pharmacists have lots of knowledge about the people who come to their premises, and they do a fantastic job.

Alison Johnstone talked about pharmacists in care homes. Only two weeks ago I hosted an event on that and, as a member of the Health and Sport Committee, I have also raised the issue in a committee meeting. I am thankful that the committee will be carrying out an inquiry into care homes and is considering the report by the Royal Pharmaceutical Society Scotland entitled “Putting residents at the centre of pharmacy care home services”.

Community pharmacies are not just about medicine, they are about caring for communities and much more. I hope that they will be able to access people’s records from doctors.

Thank you for all the interesting contributions. I call Joe FitzPatrick to close for the Scottish Government.

13:10  

I add my congratulations to Alexander Stewart on having secured the debate, and I thank members from across the chamber for their contributions.

I welcome the motion not only because Community Pharmacy Scotland is an important stakeholder in our healthcare system, but because of the pivotal contribution that its members make to the multidisciplinary team that is at the heart of primary care, as a number of members mentioned. With more than 1,250 members, Community Pharmacy Scotland represents a diverse range of community pharmacies, from small independently owned pharmacies to large retail chains.

On a visit to Aviemore during the peak winter period earlier this year, I saw at first hand the vital role that a community pharmacy plays. The pharmacist, Gary Buchanan, and his team provide a range of NHS pharmaceutical care and advice services to the resident population and, because Aviemore is an all-year-round tourist destination, they provide pharmacy care and advice to United Kingdom and international visitors to the area.

I am very grateful for the minister’s visit to my region. I hope that he enjoyed his visit to that pharmacy. Did the pharmacist mention the problem about data? Many members have asked why patient data cannot be available to pharmacists.

David Stewart will not be surprised to hear that the pharmacist raised that issue and its being a barrier to the pharmacy’s being able to do more, as he would like it to do. Although data was mentioned, I was—from speaking to the team—impressed by the range of services that they already provide.

I was going to cover the data later, but I will talk about it now, given that David Stewart and other members have raised it. As Miles Briggs mentioned, work is progressing on providing access to the appropriate information from patient records that is needed to support community pharmacists in caring for their patient population. The Scottish Government is working with the Scottish general practitioners committee of the British Medical Association to put in place a framework for safe access to, and sharing of, electronic health information. It is an important matter, and clearly one that members are hearing about across Scotland, given that it has been raised by David Stewart, Alison Johnstone, Sandra White and Miles Briggs.

Our network of community pharmacies plays a vital role in providing advice to communities about medicines and self-limiting illnesses. Through the acute medication service, community pharmacies dispense more than 100 million prescription items annually, with 98 per cent of prescription messages being electronically transferred between general practices and community pharmacies. That is all done alongside delivery of key person-centred services, including supporting more than 750,000 people who have stable long-term conditions through the chronic medication service; public health services for smoking cessation, which Joan McAlpine mentioned; provision of emergency contraception; and provision of advice and intervention.

Crucially, for many people their community pharmacy is the first port of call for advice and treatment for common and minor conditions, through the minor ailment and pharmacy first services, which were highlighted by Joan McAlpine, Alexander Stewart, David Stewart and Alison Johnstone. Those services help to reduce the burden on our busy general practices and open up access to primary care.

The chief pharmaceutical officer’s strategy, “Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland”, underlines the Government’s recognition of the important role that community pharmacy already plays in provision of NHS pharmaceutical care by providing highly accessible services for people both in and out of hours.

We want more people to use their community pharmacy, not only for treatment of self-limiting illnesses and for medicine-related matters, but for on-going support for self-management of long-term conditions.

“Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland” also makes a commitment to supporting engagement between general practices and community pharmacies. Data sharing is probably important, going forward, as part of that. There is an important role for practice-based pharmacists to work closely with community pharmacists to ensure seamless care and to reduce potential medication-related problems and errors.

Alison Johnstone touched on workforce planning and the fact that the GP contract will see pharmacists going into the GP setting. What future proofing is there to ensure that that will not be robbing Peter to pay Paul, and that we have a proper pharmacy strategy in the workforce plan?

The Scottish Government has provided specific funding of £416,000 to support community pharmacists to understand that work. In recognition of the need for us to have robust baseline data on the number of pharmacists and pharmacy technicians working across the network, last year, in partnership with CPS, NHS Education for Scotland undertook the first national community pharmacy workforce study in order to gain a better understanding of the numbers and the skills mix across Scotland. I hope that that will ensure that we have the right set of skills, going forward.

I will pick up on a number of the points that have been raised. The Cabinet Secretary for Health and Sport and I are keen that our positive partnership with CPS continues. We will continue in close collaboration to work towards delivering our programme for government commitments. The programme for government includes two specific commitments relating to community pharmacy—redesign of the minor ailments and common conditions service, which members mentioned, and a refresh of the chronic medication service. Work has started on the chronic medication service: we will strengthen, refresh and relaunch it this year as the medicines care and review service. That will improve how pharmacies provide personalised care for people with long-term conditions who are on medication long-term.

Preparatory work is under way to introduce a redesigned minor ailments and common conditions service, which will be available from April 2020 to all patients who are registered with a GP. It will bring together the existing minor ailments and pharmacy first services, which members have mentioned, and it will gradually extend the range of conditions that can be treated by community pharmacists, including some common conditions that would normally require a GP prescription. That will further reduce the burden on our GP practices.

Alexander Stewart mentioned vaccination, so I will say a little about our vaccination transformation programme. There is no doubt that community pharmacy will contribute to delivery of the vaccination programme. The programme supports NHS boards, and health and social care partnerships, to design solutions for delivering vaccinations in a way that best suits their needs. NHS boards are to be encouraged to consider the potential of different parts of the multidisciplinary team to ensure that patients receive the right care in the right place at the right time, which is why vaccination solutions must not focus only on community pharmacies. Ensuring that our pharmacy teams are delivering high-quality core pharmaceutical care services is the focus of our priorities, and we continue to discuss those with Community Pharmacy Scotland.

Alison Johnstone and Sandra White both mentioned care homes—Alison Johnstone mentioned particularly the recent contribution of the Royal Pharmaceutical Society on the support that community pharmacists provide to patients in care homes. Our “Achieving Excellence in Pharmaceutical Care” strategy document contains a commitment to improve pharmaceutical care of residents in care homes, as well as of people who are cared for in their own homes. Work must obviously continue on that, and we will work with the integration joint boards to identify how the approach will move forward. It is a very important matter.

I recognise and welcome the contribution that Community Pharmacy Scotland and its members make to pharmacy services in Scotland and the wider healthcare system, and I am very pleased to support the motion.

13:19 Meeting suspended.  

14:30 On resuming—