Warwickshire PNA FINAL DRAFT

119 Pages·2015·1.64 MB·English

WARWICKSHIRE
HEALTH & WELLBEING BOARD’S
PHARMACEUTICAL NEEDS ASSESSMENT
April 2015
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DOCUMENT INFORMATION
Document Name: Warwickshire HWB’s Pharmaceutical Needs Assessment
Published Date: 25-Mar-15 Version: 2 Release Final
:
Author: NHS Arden &GEM CSU on behalf of Warwickshire HWB
Owner: Warwickshire Health & Wellbeing Board
This document is only valid on the day it was printed.
The source of the document will be found at this location:
/http://hwb.warwickshire.gov.uk/2011-2/pharmaceutical-needs-assessment/
REVISION HISTORY
Previous
Revision Date Summary of Changes Change Marking
Revision
Changes detailed in consulation
11-Feb-15 6-Nov-14 See appendix 6b
responses
APPROVALS
This document requires the following approvals.
N.B. Signed approval should be filed appropriately in the project filing system.
Date of
Name Signature Title Version
Issue
Warwickshire Health
Health & Wellbeing Board 25-Mar-15 V2
and Wellbeing Board
Document developed on behalf of Warwickshire Health &
Wellbeing Board by NHS Arden&GEM Commissioning
Support Unit
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CONTENTS
Page
Document Information 2
Contents 3
Executive Summary 4
Introduction 6
Guidance on how to use the Pharmaceutical Needs Assessment 15
Part A: Necessary Services and Current Provision 17
 Community Pharmacy 17
 Dispensing doctors 27
 Dispensing appliance contractors 28
 What are pharmaceutical lists? 28
 Current provision of pharmaceutical services by pharmacy contractors 29
 Current provision of pharmaceutical services by dispensing doctors 38
 Public and service user views on pharmaceutical services 40
Part B: Local Need - Health Priorities and Targets 44
 Demography of Warwickshire 44
 Health and wellbeing in Warwickshire 49
 Warwickshire Joint Strategic Needs Assessment 53
 Warwickshire Health and Wellbeing Strategy 66
Part C: Necessary Services: Assessment to Determine Gaps in Provision 74
 Public & service user assessment of current access to pharmaceutical services 74
 How can the current range of services provided adapt to the HWB needs and priorities? 85
 Summary of access to pharmaceutical services by locality 94
Recommendations and Conclusions 114
Appendices
 Appendix 1 - PNA Working Group membership
 Appendix 2 - PNA Working Group Terms of Reference
 Appendix 3 - Pharmacy contractor questionnaire
 Appendix 4 - Dispensing GP questionnaire
 Appendix 5a - Public & Patient questionnaire
 Appendix 5b - Public engagement programme report
 Appendix 5c - Public & Patient questionnaire responses map
 Appendix 5d - Public & Patient questionnaire profile
 Appendix 6a, 6b - Consultation report
 Appendix 7a - Seasonal ‘flu vaccination service providers
 Appendix 7b - Minor Ailment Scheme providers
 Appendix 7c - Smoking cessation service providers
 Appendix 7d - Supervised consumption service providers
 Appendix 7e - Needle exchange service providers
 Appendix 7f - EHC service providers
 Appendix 7g - Chlamydia screening and treatment service providers
 Appendix 7h – Healthy Living Pharmacies
 Appendix 8a - Pharmacy contractor opening hours
 Appendix 8b - Dispensing GP practice hours
 Appendix 8c - Locality Map – Pharmacies in North Warwcikshire
 Appendix 8d - Locality Map – Pharmacies in Nuneaton & Bedworth
 Appendix 8e - Locality Map – Pharmacies in Rugby
 Appendix 8f - Locality Map – Pharmacies in Warwick
 Appendix 8g - Locality Map – Pharmacies in Stratford-upon-Avon
 Appendix 8h - Map of Dispensing Doctors
 Appendix 8j - Key to maps of service provision
 Appendix 9 - Template for assessment of current service provision
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EXECUTIVE SUMMARY
The Pharmaceutical Needs Assessment (PNA) is an assessment of the
pharmaceutical services that are currently provided in Warwickshire, including
dispensing of prescriptions by community pharmacies, dispensing GPs and other
providers, as well as other services available from community pharmacies. The PNA
aims to ensure that the NHS pharmaceutical services currently provided meet the
needs of the local population and also to guide decisions about commissioning of
future services, including whether new pharmacies should be allowed to open.

A growing and ageing population in Warwickshire puts increasing pressure on health
and social care. Dementia rates are increasing, 1 in 4 people smoke, 1 in 4 people
are obese and around 1 in 3 people live with at least one long term condition.

There are 111 community pharmacies in Warwickshire. It is important to ensure that
there are an appropriate number of pharmacies in the right locations and offering an
appropriate range of services. The PNA helps to achieve this.

The pharmaceutical services provided in Warwickshire have been evaluated. This is
presented in Part A. Key documents such as the Joint Strategic Needs Assessment
(JSNA) have been referenced and it is important to ensure that any developments of
services support the priorities in the Health and Wellbeing Strategy (HWBS). This is
presented in Part B. A county wide survey of the views of the public and service
users has also been completed. Part C considers Parts A and B together and aims
to identify any gaps in service where there is a need to be met.

NHS Regulations state that Health and Wellbeing Boards (HWBs) must produce
their first PNA by no later than 1st April 2015.

Findings and Conclusions

Pharmaceutical Needs and Provision
The PNA has concluded that the level of access to, range of, level of choice and
delivery of pharmaceutical services currently commissioned is adequate and
generally meets the needs of the population. The service is provided by
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appropriately located contractors, delivering services at appropriate times to allow
reasonable access. No significant gaps have been identified that constitute
pharmaceutical needs warranting new providers.

Views of the Public, Patients and Service Users
The views and opinions of the public and patients revealed a generally high level of
satisfaction.
 94% of respondents are very or fairly satisfied with opening hours
 Over 93% find it easy or fairly easy to access pharmaceutical services
 Almost half of respondents need to travel less than one mile to reach a
pharmacy or dispensing GP and 75% need to travel less than 2 miles
 Over 80% of respondents travel for less than 15 minutes to reach a
pharmacy

Opportunities to Enhance the Future Role of Community Pharmacy
Pharmacies can maximise their contribution to improving healthcare, by utilising to
the full the current service profile available under their contract. The developing
public health advisory role offers further opportunity for community pharmacies to
support the wider delivery of the HWB priorities by enhancing the use of current
services and the development of additional pharmacy services in the future.

A number of survey respondents reported difficulties accessing information about
pharmaceutical services - where is the nearest pharmacy that is open at a particular
time, late at night, at the weekend or a bank holiday? There is a need for such up-to-
date information to be made more easily accessible to the public.

The PNA presents an opportunity for local representatives of community pharmacy
contractors to engage with service commissioners to further explore how the
development of services provided by pharmacies can help to deliver the priorities of
the HWB in Warwickshire.

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INTRODUCTION
What is a Pharmaceutical Needs Assessment (PNA)?
A PNA presents a comprehensive picture of pharmaceutical service need and
provision. It also reviews access, range and adequacy of services and choice of
provider for service users.

The main aim of the PNA is to establish and review the current NHS pharmaceutical
services provided to the local population ensuring that current and future services
are of good quality, are easily accessible, meet local health and pharmaceutical
needs and provide good use of NHS financial resources.

PNAs are used to guide decisions concerning which NHS funded services need to
be provided by local community pharmacies and other providers. The PNA is also an
essential tool for deciding if new pharmacies are needed when dealing with
applications for entry onto the pharmaceutical list.

In summary a PNA is an important commissioning tool.

PNA History and Legislative background
In 2009 responsibility for PNA development rested with Primary Care Trusts (PCTs).
All PCTs were required to prepare a PNA, for publication by February 2011. The
NHS Warwickshire PNA (v 1.0) was published in January 2011.

The Health and Social Care Act 2012 established Health and Wellbeing Boards
(HWBs). The Act transferred responsibility to develop and update PNAs from PCTs
to HWBs.

The NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations
2013 (The 2013 Regulations) state that HWBs must produce their first PNA by no
later than 1st April 2015. Warwickshire HWB has commissioned the services of NHS
Arden Commissioning Support (ACS) to help develop the PNA.

Responsibility for using PNAs as the basis for determining Market Entry to a
pharmaceutical list, transferred from PCTs to NHS England from 1 April 2013.
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Under the Act, the Department of Health has powers to make Regulations.
Regulations 3-9 and Schedule 1 of the NHS (Pharmaceutical Services and Local
Pharmaceutical Services) Regulations 2013 set out the legislative basis for
developing and updating PNAs and can be found here:
http://www.legislation.gov.uk/uksi/2013/349/contents/made

What is a Health and Wellbeing Board ?
Health and Wellbeing Boards (HWBs) became statutory bodies from April 1, 2013.
Each Local Authority (LA) has a HWB which oversees the new system for local
health commissioning. They have a wide remit across the health and care system,
providing strategic oversight and bringing together all the local commissioners.
HWBs do not commission services; this is undertaken by the LA. LAs and Clinical
Commissioning Groups (CCGs) have equal and joint responsibility for producing the
Joint Strategic Needs Assessment (JSNA), through the HWB. The JSNA and the
Joint Health and Wellbeing Strategy (JHWS) informs the preparation of the PNA.

What information does this PNA contain?
The content of PNAs is set out in Regulation 4 and Schedule 1 of the 2013
Regulations. This outlines the minimum content requirements for PNAs:
 The pharmaceutical services provided that are necessary to meet needs in the
area
 The pharmaceutical services that have been identified by the HWB that are
needed in the area, and are not provided (gaps in provision)
 Other services which are provided, which are not needed, but which have
secured improvements or better access to pharmaceutical services in the area
 The services that the HWB has identified as not being provided, but which would,
if they were to be provided, secure improvements or better access to
pharmaceutical services in the area
 Other NHS services provided by a local authority, NHS England, a CCG or an
NHS Trust, which affect the needs for pharmaceutical services
 Explanation of how the assessment has been carried out (including how the
consultation was carried out)
 Map of providers of pharmaceutical services. Weblink to the PNA Mapping tool:
http://maps.warwickshire.gov.uk/Pharmaceutical_Needs_Assessment/
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Timelines for publication of first and revised assessments
 The National Health Service (Pharmaceutical Services and Local Pharmaceutical
Services) Regulations 2013 came into force on 1 April 2013
 HWBs are required to produce their first PNA by 1 April 2015
 HWBs will be required to publish a revised assessment within three years of
publication of their first assessment
 HWBs will be required to publish a revised assessment as soon as is reasonably
practical after identifying significant changes to the availability of pharmaceutical
services since the publication of its PNA unless it is satisfied that making a
revised assessment would be a disproportionate response to those changes
 If it is determined a full revised assessment is disproportionate, then a
supplementary statement will be produced. A supplementary statement is
essentially a statement of fact and does not change the need. These statements
can and should be produced as necessary

Stakeholders involved in the development of the Warwickshire PNA
The HWB delegated responsibility for the development of the PNA to a working
group and Terms of Reference were established. (Appendix 1 and Appendix 2).

Warwickshire County Council (WCC): WCC is run by elected Councillors who are
responsible for ensuring that services the Council provides meet the needs of
residents and those who work within the county. They set policies and strategies for
the Council and monitor the way in which these are implemented. The day-to-day
work of the council is carried out by employees working within directorates.
Warwickshire County Council's HWB oversees the new system for local health
commissioning. It leads on the strategic planning and co-ordination of NHS, Public
Health, Social Care and related Children's Services.

Arden, Herefordshire and Worcestershire Area Team (AT), NHS England: NHS
England is responsible for commissioning services under the national community
pharmacy contract, as well as the other primary care contracts for general practices,
dentistry and optometry. It is also responsible for some nationally commissioned
public health services. NHS England’s Area Teams (ATs) are the ‘local’ arms of the
organisation. There are 27 ATs nationally, the local team being Arden (incorporating
Coventry & Warwickshire), Herefordshire & Worcestershire Area Team.
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The aim is to achieve effective commissioning of services to improve outcomes for
people in the Arden, Herefordshire and Worcestershire area. This requires close
working with a very wide range of other organisations, such as clinical
commissioning groups, provider organisations, local authorities, health and wellbeing
boards, the NHS Trust Development Authority, Monitor, the Care Quality
Commission, Public Health England and Health Education West Midlands.

The ATs are responsible not only for determining applications for pharmacy
contracts but also commissioning of enhanced services for pharmacy, contract
monitoring, pharmacy opening hours and Electronic Prescription Service (EPS)
support.

Warwickshire Local Pharmaceutical Committee (LPC): This is the statutory local
representative committee (LRC) for the 111 community pharmacies in Warwickshire
(including 6 internet pharmacies). There are 13 members of the Committee who are
elected for a four year term. The Committee works with the NHS England Area
Team, CCGs and the Local Authority to develop community pharmacy based
services to support the residents of Warwickshire. The LPC also works closely with
the other LRCs in Warwickshire and neighbouring LPCs within the same area team
of Arden, Herefordshire & Worcestershire.

Warwickshire Local Medical Committee (LMC): LMCs are statutory representative
bodies of general medical practitioners elected by their peers at intervals of 3 years.
The Committee in Warwickshire has developed close links with many of the
stakeholders involved in planning and providing health care in the community and
fulfils an important role linking the views of general practitioners with these health
care organisations.

Clinical Commissioning Groups (CCGs): Groups of General Practitioners
known as NHS Clinical Commissioning Groups (CCGs) have responsibility for
planning and commissioning health services (as opposed to public health services).
All GP practices within the area of the CCG are ‘members’ of the CCGs. CCGs may
wish to commission services such as minor ailments services, palliative care
schemes, MUR+ and other medicines optimisation services from community
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pharmacies. The CCGs in Warwickshire are: South Warwickshire, Warwickshire
North and Coventry & Rugby CCG.

NHS South Warwickshire CCG consists of 36 member GP practices, serving a
population of approximately 270,000 whilst NHS Warwickshire North CCG comprises
28 practices with approximately 184,000 registered population. NHS Coventry &
Rugby CCG has a total registered population of approximately 460,000 patients
including approximately 103,000 registered with the 12 member GP practices in
Rugby.

Local Professional Networks (LPNs): Each AT has three LPNs covering
pharmacy, dentistry and optometry. The LPNs are intended to provide clinical input
into the operation of the AT and local commissioning decisions. They will also be the
focus for NHS England’s work on quality improvement for the three local services.
The Pharmacy LPN’s specific functions include supporting local authorities with the
development of the PNA, helping to develop the community pharmacy role in
supporting self care, managing long term conditions, promoting medicines
optimisation and developing services commissioned locally by local authorities and
CCGs, highlighting inappropriate gaps or overlaps.

NHS Arden Commissioning Support (ACS): NHS ACS delivers specialist support
for healthcare providers and clinical commissioners, providing expertise and
innovation to support clinical decision making to improve patient experience and
outcomes. NHS ACS works closely with local authorities and other partners to
provide integrated commissioning support across health and social care. The
organisation was created as result of the Health and Social Care Act 2012 and is
hosted by NHS England.

Methods used for identifying providers of pharmaceutical services
Details of providers of pharmaceutical services including community pharmacies,
dispensing GPs, Dispensing Appliance Contractors (DACs) and internet pharmacies
were preferentially obtained directly from contractors. Where information was not
provided by the contractor, this was sourced from NHS England AT.

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