NHS Salford. Pharmaceutical Needs Assessment

Transcription

1 Made in accordance with the National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendment) Regulations 2010 Date of preparation: 13 th January

2 1. EXECUTIVE SUMMARY Summary of the assessment Conclusions Next steps INTRODUCTION Background CONTEXT FOR THE PNA The duty on the PCT Circumstances under which the PNA is to be revised or updated The scope of the pharmaceutical needs assessment What is excluded from scope of the assessment PROCESS FOLLOWED IN THE DEVELOPMENT OF THE PNA Governance and steering group Regulatory consultation process and outcomes How the PCT areas has been divided into localities for the purposes of the PNA Salford Context HEALTH NEED IN SALFORD Population Age profile Population structure by locality Population forecast Forecast change in population structure Ethnicity Disability Proposed, commenced or completed reassignment of gender Sexual Orientation Religion or belief Deprivation Life expectancy Infant mortality Disease prevalence Hospital admissions Smoking Alcohol Exercise and obesity Teenage pregnancy Sexual health

3 6. CURRENT PROVISION AND ASSESSMENT Future matters Pharmacy contractor questionnaire Essential services Current provision of essential services Analysis of distribution of pharmacies relative to population Analysis of opening hours Choice Dispensing services Advanced Services Enhanced pharmaceutical services Stop Smoking Service Emergency hormonal contraception service Head lice treatment service Prescription interventions service Drug Misuse Services Palliative Care Advice to Care Homes service Bank Holiday rota services Chlamydia & Gonorrhoea screening service Appendix 1: Policy context and background papers APPENDIX 2: MEMBERSHIP OF THE STEERING GROUP APPENDIX 3: NHS SALFORD STATISTICAL PEER GROUP APPENDIX 4: MAPS OF SALFORD PNA LOCALITIES APPENDIX 5: DISEASE PREVALENCE RATES BY LOCALITY APPENDIX 6: PHARMACY CONTRACTORS IN SALFORD APPENDIX 7: OPENING HOURS OF SALFORD PHARMACY CONTRACTORS APPENDIX 8: SERVICES PROVIDED BY PHARMACY CONTRACTORS APPENDIX 8: REPORT OF THE CONSULTATION ON THE DRAFT PNA APPENDIX 9: ABBREVIATIONS AND GLOSSARY

4 1. Executive Summary NHS Salford has a diverse network of 55 pharmacy contractors who ensure that our population receives a safe and effective pharmaceutical service. Over the last five years pharmacy services have changed considerably through the development of a new national contract and through local commissioning here in Salford, as a result patients can access a wider range of services from pharmacies than ever. Pharmacies in Salford now provide a range of national and locally commissioned services to the population including; stop smoking advice, emergency contraception, needle exchange and supervised drug treatment, in the near future they will begin offering Chlamydia and Gonorrhoea testing This document describes our assessment of the need for pharmaceutical services in Salford. It has been developed through a steering group with stakeholders and has also been informed by the views of local people who responded to our pre consultation questionnaire about their local pharmacies. The purpose of a (PNA) is: To inform and support NHS Salford s commissioning plans for pharmaceutical services To inform and support NHS Salford s decision making process in relation to market entry; this function requires further enabling regulation which is expected later in The PNA has been prepared at a time of significant change in the NHS and two important strands will influence the future; The recent White Paper, Equity and Excellence: Liberating the NHS (Department of Health, July 2010), has set in motion a significant programme of change which will have an impact on how we plan and use pharmaceutical services in the future. At this time the government is consulting on its plans and it is too early to say how the proposed changes will affect the PNA or pharmaceutical services. While we expect that some aspects of pharmaceutical services will be managed by an NHS commissioning board we see an opportunity for greater local commissioning through public health and GP consortia in the future. At the same time the NHS is being asked to reduce costs and find savings, following a period of sustained growth in spending. As a result all areas of NHS spending, including pharmaceutical services, will continue to be scrutinised to ensure that money is spent to deliver the outcomes expected by patients and the public in a cost effective manner. We expect to find that there are ways in which we can harness the work of pharmacists and their staff to deliver efficiency and better outcomes for our patients. The duty on the PCT is to ensure that it has in place a robust PNA by 1 st February 2011; this document is intended to meet that requirement. 4

5 1.1. Summary of the assessment In making this assessment we have tried to balance the need for a high quality, accessible network of pharmacies with the needs of our patients for services when and where they are needed. The PNA regulations require the PCT to consider whether current services are: Necessary services these are pharmaceutical services that the regulations describe as necessary to meet a current need Relevant services these are services which while not necessary they secure improvements, or better access to pharmaceutical services Essential Services e.g. Dispensing Services The core function of our pharmacies is to ensure a safe and accessible dispensing service is available to our population. Essential Services, which includes dispensing of NHS prescriptions is commissioned nationally by the NHS and provides a network of pharmacies through which our population can obtain prescribed medicines in a safe and reliable manner. Consequently, the PCT considers that access to essential services, specifically dispensing services, is a necessary service the current need for which is secured through our existing pharmacy contractors. Our analysis of opening hours has shown that the people of Salford have good access to our pharmacy network across an extended period of time. We have also considered choice available to our population when obtaining pharmaceutical services. We have conclude that there is adequate choice of provision of pharmaceutical services within and across localities for our population. We have concluded that there are no current gaps in Essential Services. Advanced Services e.g. Medicines Use Review Since 2005 community pharmacies have been able to provide medicines use reviews / prescription interventions (MUR/PIS) which is an Advanced Service within the community pharmacy contract and which pharmacy contractors may choose to provide. We have concluded that MUR is a necessary service for our population. We will work to develop and focus MUR services in order to improve the link between MUR and outcomes for patients. We believe that Salford residents should have the opportunity to have a MUR where it is appropriate. However more could be done to tell patients that this service is available from pharmacies, we have also identified a need for the PCT to communicate to local people to inform them of the locally commissioned services that are available from pharmacies. Stop Smoking Service NHS Salford commissions a Stop Smoking Service from community pharmacies. Pharmacies are seen as key providers of stop smoking services due to their opening hours, accessibility and ability to advise prospective quitters and supply Nicotine Replacement Therapy (NRT). 5

6 This service is an important strand of our efforts to reduce smoking rates among the population. Half of our pharmacies provide this service and the PCT has a commissioning process for identifying and filling gaps in provision. Given the priority placed on reducing smoking rates in Salford we consider the smoking cessation service to be a necessary service. We have concluded that there are no gaps in provision. Emergency Hormonal Contraception Service NHS Salford commissions an Emergency Hormonal Contraception Service (EHC) from community pharmacies. The EHC service is available free of charge to women using the service and provides important access to EHC for our population. The service is part of the PCT s programme to reduce teenage conceptions. Consequently, the PCT considers the EHC service is a necessary service. We have concluded that there are no gaps in provision. Head lice treatment service NHS Salford commissions a head lice treatment service. This service helps to free up resources in GP practices by using community pharmacies as source of advice and treatment for head lice. The service removes the need for patients to attend a GP appointment for a diagnosis and prescription. The Head Lice service through pharmacies makes good use of the accessibility and flexibility of pharmacies and frees up resources in general practice. The service works well and consequently, the PCT considers the head lice service is a necessary service. We have concluded that there are no gaps in provision. Prescription intervention service NHS Salford commissions a prescription intervention service which is intended to support the safe and effective use of medicines and provide value for money for the NHS. The Prescriptions Interventions service engages community pharmacists in reducing waste and securing value for money in the use of prescribed medicines. These are priority areas for the PCT and consequently we have concluded that this is a necessary service. The service is currently under review and will be refreshed to ensure that it remains focused on its intended outcomes. Needle Exchange Service and Supervised Consumption Service NHS Salford commissions two services to support drug treatment services: A needle exchange service which is focused on ensuring that injecting drug users have access to clean injecting equipment, are able to safely dispose of used equipment and have access to advice from pharmacists. 6

7 A supervised consumption service which is focused on ensuring that clients in drug treatment programmes take and use their treatment as prescribed and to provide an opportunity for the pharmacist to make relevant interventions The provision of needle exchange and supervised consumption from pharmacies is a service that we consider necessary to secure the access that our population needs to these services. The current provision is consistent with the needs of our population and we have concluded that there are no gaps in provision. The supervised consumption service performs a critical role in supporting drug users in treatment to manage their treatment programme while minimising the diversion of drug treatment onto the streets. The PCT has concluded that the supervised consumption service from pharmacies is a necessary service. The pattern of provision is consistent with the needs of the population and the PCT has concluded that there are no gaps in provision. Palliative Care Access Service NHS Salford commissions an important service for patients and healthcare professionals which ensures that there is ready access to supply of palliative care drugs for end of life care. The palliative care access service performs an important function in ensuring there is a network of strategically placed pharmacies in Salford which clinicians and carers can access when required. We have concluded that this is a necessary service and that the current provision meets the needs in Salford. Bank Holiday Rota service The rota service which is commissioned by the PCT provides access at times when our extended hours pharmacies would otherwise be closed, this service ensures that there is access in Salford at these times. We will be working to ensure that patients and the public are aware of this service. We have concluded that this is a necessary service and that the current provision meets the needs in Salford. Advice to Care Homes service NHS Salford commissions a care homes advice service from community pharmacies. The purpose of the service is to provide care home owners and staff with advice on the safe storage, management and disposal of medicines. This service helps to reduce waste and improve the safe use of medicines. The Care Homes service has been in place for many years, this service now needs to be reviewed in the light of the recent alert from the Department of Health. The current service is a necessary service the need for which is met by existing providers. 7

8 Chlamydia & Gonorrhoea screening service NHS Salford is preparing to roll out a Chlamydia & Gonorrhoea screening service from pharmacies which is part of the R U Clear initiative. The aim of the service is to promote screening for Chlamydia & Gonorrhoea in the year old age group and to provide advice and signposting to services for at risk people. This service will perform an important function in improving access for the target population to screening. At this time, we have concluded that the Chlamydia screening service is a necessary service and that the proposed commissioning will meet the needs of our population Conclusions This is our first PNA under the new regulations. The PCT conducted a consultation on a draft of the PNA with a broad cross section of stakeholders. The consultation built on the PCT s significant engagement activity with patients and the public during the development of the PNA. A report of the consultation is provided at Appendix 8. We have reviewed the services available from our pharmacies and our plans for future services, looking at the needs of our population and their experiences of current provision. Our assessment has found that our population currently enjoys good access to pharmaceutical services with a broad range of services available when and where they are needed. We have concluded that there is no requirement for additional pharmacies in Salford at this time Next steps We expect new regulations to be published in 2011 telling us how PNAs will be used to manage market entry. These regulations will then shape how our PNA is used and developed for the benefit of the population of Salford. 8

9 2. Introduction NHS Salford is the local NHS organisation responsible for health services for the population of the City of Salford. We are responsible for commissioning and planning services for the people who live in our area. This includes responsibility for ensuring that our population can obtain safe, effective and personal pharmaceutical services. This document sets out our first pharmaceutical needs assessment (PNA) under the pharmaceutical regulations 1 governing the development of PNA Background The pharmaceutical needs assessment (PNA) is a document that records our assessment of the need for pharmaceutical services in our area. This assessment is then used to help us to plan pharmaceutical services for our population by identifying where we should focus our efforts to commission services for our population. At this time PCTs are under a duty to prepare a pharmaceutical needs assessment which must be published by 1 st February Further legislation is expected to require PCTs to make commissioning decisions using the PNA, in particular in relation to market entry 2. The PNA will also help us to shape the future of pharmaceutical services for our population by providing a single point of reference for all of the information about pharmaceutical services in Salford. The PNA differs from other needs assessments in that the contents and manner of preparation are set out in regulations, in some ways this is similar to the requirement on PCTs to prepare JSNAs. However the PNA differs in that there is a PNA specific consultation process, the PCT is asked to consider the need for a specific type of service (e.g. pharmaceutical services) and the PNA is being prepared in order to support future market entry decisions. 3. Context for the PNA PNAs were first developed in 2005 to assist PCTs in preparing for changes to market entry. Since that time PNAs have been used to support market entry decisions but are not a requirement. The White Paper Pharmacy in England: Building on strengths delivering the future 3 was published by the Department of Health in April It highlighted the variation in the structure and data 1 SI 2010 No.914. The National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendment) Regulations Available at: 2 Market entry is the system that controls where pharmacies may open to provide NHS services

10 requirements of PCT PNAs and confirmed that they required further review and strengthening to ensure they are an effective and robust commissioning tool which supports PCT decisions. The Health Act 2009 amended the National Health Service Act 2006 to include provisions for regulations to set out the minimum standards for PNAs. The regulations 4 were consulted on in late 2009 and early 2010 and were laid in Parliament on 26 March 2010 and came into force on 24 May Appendix 1 has a detailed description of the policy background and references to further reading on PNAs The duty on the PCT These regulations place a statutory duty on each PCT to develop and publish their first PNA by 1 February The regulations set out the minimum requirements for the first PNA produced under the regulations, and these include such things as data on the health needs of the PCT s population, current provision of pharmaceutical services, gaps in current provision and how the PCT proposes to close these gaps. The PNA should also consider the future needs for services. The regulations require PCTs to undertake a consultation on their first PNA for a minimum of sixty days, and list those persons and organisations that must be consulted e.g. the Local Pharmaceutical Committee, Salford pharmacy contractors, the Local Medical Committee, LINKs and other patient and public groups. The regulations also require the PCT to define localities around which the PNA will be structured so that the comparative needs of different populations can be taken into account Circumstances under which the PNA is to be revised or updated It is important that the PNA reflects changes that affect the need for pharmaceutical services in Salford, where the PCT becomes aware that a change may require the PNA to be updated then a decision to revise the PNA will be made by the pharmacy panel. There are two mechanisms by which the PNA may be updated: Where there has been a change which, in the opinion of the pharmacy panel, has not affected the need for pharmaceutical services then the PCT will issue a supplementary statement describing the change

11 Where there has been a change which, in the opinion of the pharmacy panel, has affected the need for pharmaceutical services then the PCT will revise the PNA and consult with stakeholders on a revised PNA It is likely that the PNA will be updated as changes take place, however an annual review will be conducted to ensure that any changes that have taken place are reflected in the PNA or its supplementary statements. The PNA must be reviewed every three years The scope of the pharmaceutical needs assessment A pharmaceutical needs assessment is defined in the regulations as: The statement of the needs for pharmaceutical services [in its area] which each Primary Care Trust is required to publish It follows, therefore, that we must understand what is meant by the term pharmaceutical services in order to assess the need for such services in the PCT s area. Pharmaceutical services are defined by reference to the regulations and directions governing pharmaceutical services provided by community pharmacies (which may be LPS providers), dispensing doctors and appliance contractors. Whether a service falls within the scope of pharmaceutical services for the purposes of PNA depends on who the provider is and what is provided. For the purposes of this PNA we have adopted the following scope: For dispensing practices the scope of the service to be assessed in the PNA is the dispensing service. This means that, for the purposes of the PNA, we are concerned with whether patients have adequate access to dispensing services, including where those services are provided by dispensing GPs but not concerned with assessing the need for other services dispensing GPs may provide as part of their national or local contractual arrangements. There are no dispensing practices in Salford. For appliance contractors the scope of the service to be assessed in the PNA is the dispensing of appliances and the provision of the recently introduced Appliance Use Review (AUR) service and Stoma Appliance Customisation Service (SAC). This means that, for the purposes of the PNA, we are concerned with whether patients have adequate access to dispensing services, including dispensing of appliances, AURs and SACs where these are undertaken by an appliance contractor but not concerned with other services appliance contractors may provide. There is one dispensing appliance contractor in Salford, and our population also uses dispensing appliance contractors outside the Salford area so we will need to take this into account when assessing the needs of our population. 11

12 For community pharmacy contractors the scope the services that need to be assessed is broad and comprehensive. It includes the essential, advanced and enhanced services elements of the pharmacy contract whether provided under the terms of services 5 for pharmaceutical contractors or under Local Pharmaceutical Services (LPS) contracts. Pharmaceutical services in relation to community pharmacy contractors are defined as: Essential Services which are set out in the 2005 NHS Regulations, these include: o Dispensing and actions associated with dispensing (e.g. keeping records) o Repeatable dispensing o Disposal of waste medicines o Promotion of healthy lifestyles o Prescription linked interventions o Public health campaigns o Signposting o Support for self care All pharmacy contractors must provide the full range of essential services. Advanced and Enhanced Services which are set out in the Directions made subsequent to the 2005 Regulations, these include: o Advanced Services, specifically: Medicines Use Review and Prescription Interventions (MURs) Appliance Use Reviews (AUR) Stoma Appliance Customisation Service (SAC) Any contractor may choose to provide Advanced Services, there are requirements which need to be met in relation to premises, training or notification to the PCT. At this time a pharmacy may undertake up to 400 MURs per annum, a limited number of AURs linked to the dispensing of appliances and as many SACs as required. o Enhanced Services, specifically: Anticoagulant monitoring service Care home service Disease specific medicines management service Gluten free food supply service Home delivery service 5 Pharmacy contractors do not have a contract in the legal sense with primary care trusts, they operate under terms of service set out in regulations. These are often referred to as the community pharmacy contract. 12

13 Language access service Medication review service Medicines assessment and compliance support service Minor ailments service Needle syringe exchange service On demand availability of specialist drugs service Out of hours service Patient group directions service Prescriber support service Schools service Screening service e.g. for undiagnosed long term conditions Stop smoking service Supervised administration service Supplementary prescribing service The regulations are intended to be permissive and allow PCTs to interpret how any of the above Enhanced Services should be commissioned, its scope and method of delivery. Each PCT may make arrangements for the provision of these services in its area. In the case of NHS Salford arrangements are in place for the provision of: Care Homes Service Head lice service Prescriptions interventions service Needle syringe exchange service Palliative care service Emergency contraception service The PCT commissions a care homes service which provides advice to care home operators on the safe storage, administration and disposal of medicines. The PCT commissions a head lice service which provides patients with treatment and advice for head lice without charge if the patient is exempt from prescription charges The PCT commissions an interventions service where pharmacy contractors review and assess prescriptions against locally agreed criteria in order to reduce waste and simplify dosage. The PCT commissions a needle exchange service whereby the pharmacy provides clean injecting equipment to drug users and takes in used injecting equipment for safe disposal The PCT commissions a palliative care service from selected pharmacies, these pharmacies hold stock of an agreed list of medicines for use in end of life care The PCT commissions a service whereby some pharmacies provide access to emergency hormonal contraception under patient group directions to women 13

14 Chlamydia & Gonorrhoea screening service Stop smoking service Supervised administration service The PCT is about to commission a Chlamydia & Gonorrhoea screening service from pharmacies which is part of the R U Clear initiative. The PCT commissions a service for the supply of nicotine replacement therapy (NRT e.g. patches, gums, inhalers) and advice and counselling to support smokers to give up. The PCT commissions a service whereby patients prescribed drug treatments for addiction can obtain their treatment on a frequent basis, often daily and that this treatment is taken in the presence of the pharmacy staff Community pharmacy contractors also provide services directly to patients that are not commissioned by the primary care trust, for example some pharmacies provide a home delivery service but this is not commissioned or paid for by the PCT. In making its assessment the PCT needs to take account of any services provided to its population which may affect the need for pharmaceutical services in its area. This could include services provided across a border to the population of Salford by pharmacy contractors outside the PCT, or by GPs, or other health services providers including where these are provided the NHS trust staff What is excluded from scope of the assessment The PNA has a regulatory purpose which sets the scope of the assessment. However pharmaceutical services and pharmacists are evident in other areas of work in which the PCT has an interest but are excluded from this assessment. These include prison and secondary and tertiary care sites where patients may be obtaining a type of pharmaceutical service that is not covered by this assessment Prison pharmacy Pharmaceutical services are provided in prisons by providers contracting directly with the PCT or prison authorities. HM Prison Forest Bank is located on the site of the former Agecroft Power Station and is a 1064 place category B Male local prison serving the courts of the North-West, accepting remand and sentenced adults and remand young offenders. The pharmaceutical services to the prison are currently contracted to Boots Pharmacy. This arrangements is commissioned by the Prison Service Secondary care pharmacy Patients in Salford have a choice of provider for their elective hospital services. Most of our patients choose to be treated at one of the following NHS Trusts. 14

15 Salford Royal Hospitals NHS Trust North Cheshire Hospitals NHS Foundation Trust Trafford Healthcare NHS Trust Central Manchester University Hospitals NHS Foundation Trust Greater Manchester West Mental Health NHS Foundation Trust Pennine Acute Hospitals NHS Trust Royal Bolton Hospital NHS Foundation Trust The PNA makes no assessment of the need for pharmaceutical services in secondary care settings, however we are concerned to ensure that patients moving in and out of hospital have an integrated pharmaceutical service which ensures the continuity of support around medicines. 15

16 4. Process followed in the development of the PNA NHS Salford s PNA has been developed using a mixture of methods drawing on a range of information source and reinforced through consultation with patients and pharmaceutical services providers. This has included: An online questionnaire completed by 60 Salford residents A postal questionnaire of community pharmacy contractors A review of PCT held commissioning data The table below lists the main data sources used to develop and inform the PNA. Data source(s) Health need and priorities Current pharmaceutical services Patients and the public NHS Salford Strategic Plan Salford JSNA (2010) Routine contracting and activity data which is held by the PCT A postal survey of pharmacy contractors in Salford, 49 of our 55 pharmacy contractors responded National benchmarking using NHS Information Centre data Feedback from patients obtained through an online questionnaire Feedback from local groups and organisations through a facilitated discussion guide Figure 1: NHS Salford PNA development data sources and activity These data have been combined to provide a picture of our population, their current and future health needs and how pharmaceutical services can be used to support the PCT to improve the health and wellbeing of our population Governance and steering group The development of the PNA was overseen by a steering group whose membership was drawn from the PCT s pharmacy, public health, commissioning and communications departments and community services. The steering group also had representation from the Local Pharmaceutical Committee (LPC). The membership of the steering group is described in Appendix Regulatory consultation process and outcomes The PCT conducted a consultation on a draft of the PNA with a broad cross section of stakeholders. The consultation built on the PCT s engagement activity with patients and the public during the development of the PNA. Responses to the formal consultation were received from the LPC, five 16

17 pharmacy contractors (representing 23 pharmacy premises), five members of the public, three neighbouring PCTs and one commissioner. A report of the consultation is provided at appendix How the PCT areas has been divided into localities for the purposes of the PNA The PNA regulations require that the PCT divide its area into localities which are then used a basis for structuring the assessment. The PCT is divided into eight neighbourhoods which are co-terminous with ward boundaries. We have adopted these areas as localities for the PNA. Each of these localities is made up of between 2 and 3 electoral wards. The term neighbourhood has a special meaning in the current pharmaceutical regulations, to avoid confusion we have used the term locality in the PNA document. The resident population according to ONS projections is approximately 221,253, this population is distributed across the eight localities as shown in the table below. With populations between 17,000 and 40,000 in each locality. Locality Number of ward Population (2008) Claremont & Weaste 2 21,971 East Salford 3 39,524 Eccles 3 35,069 Irlam & Cadishead 2 20,086 Little Hulton & Walkden 3 33,786 Ordsall & Langworthy 2 17,511 Swinton 3 33,108 Worsley & Boothstown 2 20,198 Salford ,253 Table 1: Population by locality Source: ONS 2008 mid-year estimate 17

18 Figure 2: Salford localities and wards 18

19 4.4. Salford Context The City of Salford sits to the west of Manchester and is bounded by the River Irwell to the east, the Manchester ship canal to the south and the city of Manchester to the west. The City has both densely populated areas and areas of open land. In recent years there has been significant development and regeneration, including the development of Salford Quays area to provide new housing, shopping and employment areas. The PCT boundaries are co-terminous with the boundaries of Salford City Council. Salford has a resident population of approximately 222,000 and a registered population of 235,000, it is the registered population that NHS Salford is responsible for commissioning services. The PCT shares a border with six other PCTs: Bury PCT Manchester PCT Trafford PCT Warrington PCT Ashton Leigh and Wigan PCT Bolton PCT The PCT is also grouped with seven other PCTs with similar characteristics by the Office of National Statistics (ONS). This group is a subgroup of the Regional Centres group. Appendix 3 provides more information on the ONS peer group which is used to compare and contrast the characteristics of Salford with other areas of a similar nature. NHS Salford is responsible for planning and buying services for our population, to support the decisions we take we regularly review the needs of our population and then prioritise how we invest in the services we are responsible for. There are two key documents which support this process. The first is the JSNA which is prepared with our local authority partner, this holds the detailed information about the needs of our population, some of these data have been used in our PNA. The JSNA can be found here: The other is our Strategic Commissioning Plan, which covers a five year period and describes our plans for investment and outcomes in Salford. The latest version of our plan can be found here: 19

20 5. Health need in Salford This section explores a summary of relevant data which informs the PNA, the information presented here is informed by the JSNA and draws upon data from the JSNA and other sources of data relevant to the provision of pharmaceutical services Population The resident population according to ONS projections is approximately 221,253, this population is distributed across the eight localities and the electoral wards as shown in the tables below. Locality Number of ward Population (2008) Claremont & Weaste 2 21,971 East Salford 3 39,524 Eccles 3 35,069 Irlam & Cadishead 2 20,086 Little Hulton & Walkden 3 33,786 Ordsall & Langworthy 2 17,511 Swinton 3 33,108 Worsley & Boothstown 2 20,198 Salford ,253 Table 2: Population by locality Source: ONS 2008 mid-year estimate Population by ward Locality Name Ward Name Population Claremont & Weaste Claremont 12,429 Claremont & Weaste Weaste and Seedley 9,250 East Salford Blackfriars 9,721 East Salford Broughton 8,638 East Salford Kersal 12,503 East Salford Pendleton 10,084 Eccles Barton 10,469 Eccles Eccles 11,830 Eccles Winton 12,770 Irlam & Cadishead Cadishead 9,614 Irlam & Cadishead Irlam 10,472 Little Hulton & Walkden Little Hulton 10,462 Little Hulton & Walkden Walkden North 11,291 Little Hulton & Walkden Walkden South 15,433 Ordsall & Langworthy Langworthy 6,006 Ordsall & Langworthy Ordsall 7,198 Swinton Pendlebury 14,893 Swinton Swinton North 11,801 Swinton Swinton South 12,759 Worsley & Boothstown Worsley and Boothstown 13,630 Table 3: Population by ward Source: ONS 2008 mid-year estimate 20

21 5.2. Age profile Salford s population is younger than that of England. As the chart below shows men and women aged between 15 and 35 make up a larger proportion of the population than England. The population aged between 50 and 70 years is smaller when compared to England. Figure 3: Population pyramid Data Source: Office for National Statistics mid-2008 estimates Salford: Columns / England: Line 21

22 5.3. Population structure by locality Irlam & Cadishead and Little Hulton & Walkden have a younger population profile, while the population in Claremont and Weaste, Swinton and Worsley & Boothstown is older. Localities above Salford s average for the relevant age groups are highlighted in the table below. Name % Under 16 % Males over 65 and Females over 60 England 18.8% 19.1% ONS Cluster 17.0% 17.9% North West GOR 18.9% 19.4% Salford LA 18.4% 17.8% Claremont & Weaste 16.4% 20.3% East Salford 18.6% 13.8% Eccles 18.7% 17.7% Irlam & Cadishead 20.5% 18.3% Little Hulton & Walkden 20.0% 18.4% Ordsall & Langworthy 15.0% 14.1% Swinton 18.0% 19.5% Worsley & Boothstown 16.8% 22.2% Figure 4: Population age profile by locality Data Source: Office for National Statistics mid-2008 estimates Some wards within our localities have particularly high proportions of younger or older people, for example Irlam ward has above average populations aged under 16 and over 60/65, consequently the population of working age will be smaller. This is also the case for Swinton and Worsley & Boothstown wards. Locality Name Ward Name % Under 16 % Males over 65 and Females over 60 Claremont & Weaste Claremont 16.9% 19.4% Claremont & Weaste Weaste and Seedley 15.7% 21.6% East Salford Blackfriars 11.3% 9.9% East Salford Broughton 24.0% 16.0% East Salford Kersal 26.4% 16.0% East Salford Pendleton 11.4% 13.0% Eccles Barton 18.8% 15.7% Eccles Eccles 15.6% 21.2% Eccles Winton 21.5% 16.0% Irlam & Cadishead Cadishead 20.6% 17.6% Irlam & Cadishead Irlam 20.4% 19.0% Little Hulton & Walkden Little Hulton 22.6% 17.5% Little Hulton & Walkden Walkden North 20.2% 17.7% Little Hulton & Walkden Walkden South 18.1% 19.5% Ordsall & Langworthy Langworthy 17.2% 17.2% Ordsall & Langworthy Ordsall 13.3% 11.5% Swinton Pendlebury 17.1% 17.6% Swinton Swinton North 18.3% 21.3% Swinton Swinton South 18.8% 20.0% Worsley & Boothstown Worsley and Boothstown 16.8% 22.2% Table 4: Population age structure by ward. Source ONS

23 What this means for our PNA NHS Salford Older people and children are higher uses of pharmacy services and are more likely to need regular access to pharmacies. A nationally representative survey of the population in England showed that those aged over 55, women and those with long term conditions were more likely to visit pharmacies once a month or more. Men, younger adults and those in employment were less likely to visit pharmacies regularly Population forecast Salford s population is forecast to grow from its current estimated level of 222,200 (2010) people to approximately 248,400 by This growth is slower than projected for our peer group and for England but faster than projected for the North West region. Name Salford LA (% Growth from 2010) ONS Cluster (% Growth from 2010) North West SHA (% Growth from 2010) England (% Growth from 2010) % 3.96% 2.54% 3.87% % 7.75% 5.19% 7.76% % 11.50% 7.67% 11.50% % 15.27% 9.87% 14.91% Data Source: Office for National Statistics. Based on ONS mid-2008 population estimates What this means for our PNA The forecast periods described in this section exceed the scope of the PNA which is expected to be updated regularly and completely refreshed every 3 years. However it is important to note the predicted trend in Salford which will be towards moderate overall growth, this will gradually increase demand for services, including services from community pharmacy. Pharmaceutical services in Salford will need to reflect the need for public health interventions focused on delaying the onset of disease and promoting years of healthy life and the need to anticipate and support the needs of an growing older population with long term conditions Forecast change in population structure The growth in population is also going to change the structure of the population, there will be an increase in the population at both ends of the age spectrum, with the proportion of the population aged under 16 rising from 19.35% in 2010 to 20.52% by 2020 and then declining to 19.81% by 2030 while the older population will increase more rapidly from 15.03% to 17.11% in The net effect of these changes is that the population of working age will decline by around 2.7% in the same period. When this change is compounded with the predicted population growth then the number of persons aged over 65 will increase by 9,105 people (27%) from our current estimated base of 33,

24 Name Salford LA ONS Cluster North West SHA England 2010 % U % 17.96% 19.95% 19.83% 2015 % U % 18.06% 19.81% 19.77% 2020 % U % 18.74% 20.17% 20.11% 2025 % U % 18.87% 20.00% 19.95% 2030 % U % 18.39% 19.39% 19.40% Data Source: Office for National Statistics Additional Information: Data used based on ONS mid-2006 population estimates Name Salford LA ONS Cluster North West SHA England 2010 % O % 15.27% 16.64% 16.41% 2015 % O % 15.88% 18.21% 17.88% 2020 % O % 16.20% 19.16% 18.74% 2025 % O % 16.92% 20.37% 19.87% 2030 % O % 17.94% 22.03% 21.43% Data Source: Office for National Statistics Additional Information: Data used based on ONS mid-2006 population estimates What this means for our PNA The forecast periods described in this section exceed the scope of the PNA which is expected to be updated regularly and completely refreshed every 3 years. However the trend in Salford will be towards increasing demand for services prompted by significant growth of our older population compounded by the decline of our working population. 24

25 5.6. Ethnicity Salford s has a less diverse population than England, the non-white ethnic groups make up 8% of our population which compares to 11.8% in England and 7.9% in the North West. % Chinese or % non-white % Asian % Black Name other % mixed England 11.8% 5.7% 2.8% 1.5% 1.7% ONS Cluster 9.5% 3.9% 1.8% 2.1% 1.7% North West SHA 7.9% 4.4% 1.1% 1.1% 1.2% Salford LA 8.0% 3.0% 1.5% 2.1% 1.4% Table 5: Estimated ethnicity, all ages Source: ONS 2007 The ethnic minority community is younger, making up a larger proportion of our population aged under 16, this reflects the higher birth rates among this population. Name % non-white % Asian under 16 % Black under 16 % Chinese or other under 16 % mixed under 16 England 15.80% 7.2% 3.4% 1.1% 4.1% ONS Cluster 11.80% 4.8% 1.8% 1.3% 3.9% North West SHA 11.20% 6.4% 1.1% 0.8% 2.9% Salford LA 9.20% 3.2% 1.5% 1.5% 3.0% Table 6: Estimated ethnicity, under 16 Source: ONS 2007 Whereas the older population is predominantly white with less than 2% being from non-white ethnic minority groups. Name % non white over M65 F60 % Asian over M65 F60 % Black over M65 F60 % Chinese or other over M65 F60 % mixed over M65 F60 England 4.20% 2.2% 1.3% 0.4% 0.3% ONS Cluster 2.60% 1.2% 0.7% 0.4% 0.3% North West SHA 2.30% 1.3% 0.5% 0.3% 0.2% Salford LA 1.90% 0.8% 0.3% 0.5% 0.3% Table 7: Estimated ethnicity, over 60 (female), 65 (male) Source: ONS 2007 Estimated ethnicity is not available at ward level, the last actual measure of ethnicity we have at ward level is from the 2001 census. At that time the percentage of the population from non-white ethnic groups in Salford was measured at 3.9% (it is now estimated to be 8.0%). While the proportion of our population from non-white ethnic minority groups is small when compared to England it has doubled in the six year period between the census and the 2007 ONS estimates. In the same period the percentage of the population in England from the non-white ethnic minority groups is estimated to have increased from 9.0% to 11.8%. 25

26 The table below shows the wards with the highest percentage of population from non-white ethnic minority group in Salford as measured at the last census. Locality Ward % population non-white East Salford Broughton 9.3% East Salford Blackfriars 8.5% East Salford Pendleton 7.9% Ordsall & Langworthy Ordsall 6.9% Eccles Eccles 6.5% East Salford Kersal 5.6% Claremont & Weaste Weaste and Seedley 4.3% Claremont & Weaste Claremont 3.8% Ordsall & Langworthy Langworthy 3.8% Eccles Barton 3.7% Table 8: Ethnicity at ward level Source: Census 2001 What this means for our PNA There is correlation between health inequalities and the levels of diversity in the population. Ethnic minority communities are exposed to a range of health challenges, from low birth weight and infant mortality through to higher incidence of limiting illnesses like diabetes and cardio vascular disease. Our pharmaceutical services need to reflect the needs of these populations while providing a broad range of services to the entire population of Salford. In addition to age, gender and ethnicity the PCT is also asked to consider the needs of population groups which share one or more of the following characteristics: 5.7. Disability All pharmacy contractors are required to comply with the provisions of the Disability Discrimination Act. Many pharmacy users will, as a consequence of the impact of disease and illness, be considered disabled. However not all services provided in pharmacies are equally accessible, for example, of the 42 pharmacy premises with consultation areas we found that 9 did not have a consultation areas that was wheelchair accessible. In some areas patients with a disability may be able to exercise choice to choose a pharmacy that is better able to address their needs, however we would expect all pharmacies to make significant progress towards exceeding the minimum legislative standards Proposed, commenced or completed reassignment of gender 26

27 Pharmacies are often part of the care pathway for people who undergo gender reassignment. Their role is typically to ensure that medicines which form part of the treatment are available and provided without impediment. We are not aware of any barriers to treatment through community pharmacies in Salford Sexual Orientation As part of the training for provision of the sexual health services in Salford pharmacists undergo training and awareness raising on providing services irrespective of sexuality or sexual orientation of service users Religion or belief Standards of conduct, ethics and performance set out the behaviours, attitudes and values expected of pharmacy professionals. Standard 3.4 of the pharmacists code of ethics enables a pharmacy professional to refer a patient to an alternative provider where the professional s religious or moral beliefs prevent them from providing a service. This can have implications for some services particularly in relation to provision of emergency hormonal contraception (EHC) treatment. The PCT when commissioning services, to which this conscious clause may apply ensures that there is choice for patients who may need to access these services irrespective of the beliefs of individual practitioners. 27

28 5.11. Deprivation The index of multiple deprivation (IMD) provides a comparative measure of the deprivation experienced by a population based on their circumstances which can then be applied to a geography. The index provides a score for each output area and ranks areas relative to each other. The relative level of deprivation experienced by a population has a direct correlation with health outcomes for that population. Overall Salford has a more deprived population when compared to England, analysis of the IMD for the lower level super output areas (LSOAs) in Salford shows that Ordsall & Langworthy, East Salford and Eccles have the most LSOA s in the 20% most deprived in England with none in the 20% least deprived LSOAs. All LSOAs in Ordsall & Langworthy are in the 40% most deprived. By contrast Worsley and Boothstown is the least deprived community. The chart below illustrates the extent of deprivation in Salford and compares this with England. The column for England shows the national distribution of deprivation and then compares this to Salford s localities. The darker the colour of the column the more deprived areas make up each locality. Figure 5: Distribution of LSOAs by quintile of deprivation in Salford. Source IMD

29 5.12. Life expectancy Life expectancy is a measure of how long a person born in an area would be expected to live by reference to current observed rates of mortality. The gap in life expectancy between the best and worst helps us to understand how inequalities affect our population differently. Life expectancy in England is 81.3 years for women and 76.4 years for men. In Salford the equivalent figures are 77.8 years and 72.6 years, both are worse than the national figure. The gap between our best and worst areas in Salford is a key measure of the challenge facing the PCT. Pharmacy has a role to play in addressing inequalities which create gaps in life expectancy. Locality Name Name Male Life Expectancy at Birth Female Life Expectancy at Birth East Salford Pendleton East Salford Broughton Ordsall & Langworthy Ordsall East Salford Blackfriars Ordsall & Langworthy Langworthy Little Hulton & Walkden Little Hulton Eccles Eccles Claremont & Weaste Weaste and Seedley Eccles Barton Eccles Winton East Salford Kersal Swinton Pendlebury Irlam & Cadishead Irlam Little Hulton & Walkden Walkden North Claremont & Weaste Claremont Swinton Swinton North Irlam & Cadishead Cadishead Little Hulton & Walkden Walkden South Swinton Swinton South Worsley & Boothstown Worsley and Boothstown Table 9Source: ONS. Life expectancy at ward level ( ) Men in East Salford (specifically Pendleton ward) can expect to live 10 years less than men born in Worsley & Boothstown ward. For women the gap is smaller, 8.7 years between Broughton ward in East Salford and Walkden South in Little Hulton & Walkden. Life expectancy is part of a complex problem linking social inequalities and health services, closing the gap in life expectancy requires efforts across the health and social care systems. 29

30 What this means for our PNA NHS Salford Closing the gap in life expectancy is a key outcome for the PCT, this requires targeted effort focusing on communities that have the worst outcomes. Examples of relevant pharmacy services which can impact on factors affecting life expectancy include: smoking cessation, vascular risk assessment, alcohol interventions healthy living advice, medicines use review. NHS Salford currently commissions a Smoking Cessation Enhanced Services from pharmacy contractors Infant mortality Infant mortality rates in Salford are better than England up to the four week measure (Perinatal & Neonatal), however rates at the one year measure (Infant) are worse in Salford than other comparator areas including England. Perinatal Mortality Rate (1 week) Neonatal Mortality Rate (4 weeks) Infant Mortality Rate (1 year) England ONS Cluster North West SHA Salford Table 10: Infant mortality. Infant mortality per 1000 live births Time period: Data Source: The Information Centre for Health and Social Care What this means for our PNA Infant mortality is linked to maternal health. Improving maternal health and providing appropriate antenatal care contribute to reducing infant mortality. Early access to antenatal care can also be secured through pharmacy pregnancy testing services linked to antenatal referral for women who are pregnant. For example, pharmacies in East London provide an early pregnancy testing service in order to encourage women who are pregnant into the antenatal care system as early as possible in the pregnancy. 30

31 5.14. Disease prevalence Data collected by GP practices provides a measure of the prevalence of the disease on practice registers. Due to the way these data are collected they can under represent actual prevalence. Salford has similar disease prevalence rates to England with the exception of Diabetes, and COPD. Most long term conditions are managed by using prescribed medicines; this presents an opportunity to ensure that pharmacists are in a position to support patients to get the most from their treatment. Data collected by GP practices provides a measure of the prevalence of the disease on practice registers. Due to the way these data are collected they can under represent actual prevalence; modelled prevalence estimates give an expected prevalence for our population based on the population characteristics. The absolute prevalence, and the gap between recorded and expected prevalence present an opportunity to use pharmacies and pharmacists. The gap between recorded and expected prevalence provides an opportunity to support case finding in our population of undiagnosed patients. We also know that patients recorded on disease registers in practices are more likely to have other important factors including smoking, BMI and testing for other comorbidities. This reinforces the importance of closing the gap. Disease Salford Salford Expected / Modelled England Hypertension Prevalence 13.1% 24.0%* 13.8% Asthma Prevalence 5.9% 6.3% CHD Prevalence 3.5% 5.1%* 4.3% Diabetes Prevalence 4.1% 7.2% # 4.1% CKD Prevalence 3.2% 2.9% COPD Prevalence 1.5% 4.2%* 2.6% Stroke & TIA Prevalence 1.7% 2.2%* 1.9% Atrial Fibrillation Prevalence 1.3% 1.3% Heart Failure Prevalence 0.7% 0.9% Mental Health Prevalence 0.75% 0.87% Dementia Prevalence 0.43% 0.41% Table 11: Disease prevalence in Salford. Source: QMAS 2008/09 * EPHO Modelled estimate of prevalence by GP practice. # APHO Diabetes Prevalence Model, June

32 Claremont & Weaste, Swinton and Little Hulton & Walkden have higher prevalence rates for most conditions including the top five LTCs in Salford. = % of practice population above Salford rate Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Hypertension Prevalence Asthma Prevalence CHD Prevalence Diabetes Prevalence CKD Prevalence COPD Prevalence Stroke & TIA Prevalence Atrial Fibrillation Prevalence Heart Failure Prevalence Mental Health Prevalence Dementia Prevalence Table 12: Disease prevalence by locality. Source: QMAS 2008/09 Swinton Worsley & Boothstown Hospital admissions This section looks at hospital activity in Salford which can help us to understand which diseases are responsible for causing admissions and how activity varies by locality. The rates in the tables below are finished consultant episodes (FCEs) per 1,000 population. A patient may have more than one FCE for a single admission. Rates in Salford are higher than for England and similar to rates in the North West. Rates in Ordsall & Langworthy, Claremont & Weaste and Eccles are the highest in Salford. All Area chapters England ONS Cluster (Regional Centres) North West GOR Salford LA Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown Table 13: Finished consultant episodes per 1,000 population Source HES 2008/09 32

33 The FCEs can be broken down according to the coding groups used by hospitals, these data show that Genitourinary (which includes kidney disease), Digestive disorders and Circulatory admissions account for 50%of all admissions in Salford. Salford England All Chapters Genitourinary (N00 to N08) Digestive (K00 to K93) Circulatory (I00 to I99) Respiratory (J00 to J99) Neoplasms (C00 to D48) Musculoskeletal (M00 to M99) Eye and adnexa (H00 to H59) Skin and subcutaneous tissue (L00 to L99) Endocrine, nutritional and metabolic diseases (E00 to E90) Nervous system (G00 to G99) Blood and blood-forming organs (D50 to D89) Infectious and parasitic diseases (A00 to B99) 5 4 Ear and mastoid process (H60 to H95) Table 14: FCEs per 1,000 population by ICD-10 group Source HES 2008/09 Analysis of admissions by locality shows that Ordsall & Langworthy, Claremont & Weaste and Eccles have the highest rates of admissions in Salford for the top five causes of admissions. = FCE rate above Salford rate Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown All Chapters Genitourinary Digestive Circulatory Respiratory Neoplasms Musculoskeletal Eye and adnexa Skin and subcutaneous tissue Endocrine, nutritional and metabolic diseases Nervous system Blood and blood-forming organs Infectious and parasitic diseases Ear and mastoid process Table 15: FCEs by locality Source HES 2008/09 33

34 What this means for our PNA NHS Salford Pharmacy services are an important, but often overlooked part of the long term conditions pathway. One in three people have a long term condition and most long term conditions are treated or managed using medicines. Ensuring that medicines are used safely and effectively improves outcomes and reduces the risk of hospital admission. It is estimated that around 20% of all admissions to hospital are medicines related, so while the above admissions categories may be disease specific one in five is likely to be related to a failure or unintended consequence of using prescribe medicines. Non-adherence is a silent but significant challenge in managing long term conditions, the WHO estimates that between one third and one half of all dispensed medication is not taken as intended. This has the double negative impact of denying the patient of the benefit of the treatment while costing the health system to drugs that are essential wasted as a result. Pharmacy has a role in ensuring patients, clinicians and carers can obtain the maximum benefit from medicines while reducing risks associated with treatment. This analysis takes account of prevalence rates but does not attempt to relate this to the cost of treatment or predicted future prevalence. There are diseases which have low prevalence rates (e.g. Dementia) where the prevalence rate is expected to rise and the cost of treatment is high in relation to other disease processed. There are also changes in the way some conditions are managed, where patients are being moved from secondary care into primary care. This will create the need for new services in the future. For example, HIV clinic services in Salford are based in the community but close to secondary care where drugs for HIV treatment are dispensed. In the near future this clinic will be relocating to a site which is a considerable distance from the hospital. This has precipitated a need to redesign the pathway for medicines dispensing to ensure patients and their carers are able to access the medicines they need. HIV prevalence is Salford is 3.5 per 1,000 population (2009). 34

35 5.16. Smoking One of the most important determinants of health is whether a person smokes. Rates of smoking have fallen in recent years, however it remains a focus for health services to reduce rates further, especially among harder to reach groups. Smoking prevalence is estimated from a small scale survey (the Health Survey for England) which is then used to develop estimates at Middle Super Output Areas (MSOA) level. The table below shows around one in three adults in Salford smoke, this compares to around one in four in England. However in some areas of Salford the prevalence of smoking rises to one in two adults. Average Smoking Name Estimate England 24.2 ONS Cluster 28.6 North West SHA 27.1 Salford LA 32.0 Figure 6: Synthetic smoking estimate (percentage of population) MSOA Data source: ONS What this means for our PNA Pharmacies already play an active role in providing support for smoking cessation. The role of community pharmacy is two-fold; providing access to nicotine replacement therapy and providing advice from pharmacists and staff trained as level 2 counsellors. Pharmacy is a unique provider, in that pharmacies have access to NRT at the point of care, they also provide a walk in service across extended hours of service. 35

36 5.17. Alcohol The methodology for estimating binge drinking 6 behaviour in the population is similar to that used in smoking. Salford has a higher binge drinking estimate that other comparators and in some areas around one in three adults report binge drinking. Average Binge Name Drinking Estimate England 17.9 ONS Cluster 22.2 North West SHA 23.2 Salford LA 25.7 Figure 7: Binge drinking estimate (percentage of population) Data source: ONS What this means for our PNA Pharmacies have a small but evolving role in providing brief interventions in alcohol use. For example, pharmacies in Merseyside provide a brief intervention service designed to identify, support and refer patients into alcohol services Exercise and obesity Estimates of the levels of physical activity among adults in Salford show that fewer adults in Salford report undertaking exercise. It should be noted that these estimates are based on a small sample of persons interviewed. % adults 3 hours Area exercise per week England 21.8% ONS Cluster 21.6% North West SHA 21.8% Salford LA 18.4% Figure 8: Adults reporting greater than 3 hours exercise per week (percentage of population) Data source: Sport England N /08 6 Binge drinking is defined as consuming more than twice the daily recommended limit on any day (more than six units for women and eight units for men). 36

37 Obesity rates in Salford are also higher than England, around 27% of our adult population is categorised as obese. Average Obesity Area Estimate England 23.5 ONS Cluster 22.3 North West SHA 24.4 Salford LA 26.8 Figure 9: Obesity estimate (percentage of population) Data source: ONS What this means for our PNA Pharmacies provide advice and support for healthy lifestyles as part of their core contract. There are also examples of local enhanced services where pharmacies support patients with risk factors to reduce and manage their weight. For example, pharmacies in Coventry have offered a comprehensive weight management service since 2006 which includes a risk assessment and motivational interviewing to support people to lose weight. The service is successful in attracting men who are often more difficult to reach through traditional weight management services Teenage pregnancy Teenage pregnancy rates in Salford are higher than for England, at a locality level rates are higher in Ordsall & Langworthy, Claremont and Weaste and Swinton. All localities, except East Salford and Worsley and Boothstown have rates of teenage pregnancy higher than the average for England. Area % under 18 conceptions England 4.8% ONS Cluster (Regional Centres) 5.5% North West GOR 5.9% Salford LA 6.4% Claremont & Weaste 7.4% East Salford 4.4% Eccles 7.3% Irlam & Cadishead 6.1% Little Hulton & Walkden 7.1% Ordsall & Langworthy 7.7% Swinton 7.2% Worsley & Boothstown 3.3% Figure 10: Under 18 conception rates Source: ONS

38 The table below shows the wards in Salford arranged with the wards with the highest rates of teenage pregnancy at the top of the table (quintile 5) and the lowest rates (quintile 1) at the bottom. Locality Ward Quintile of teenage pregnancy rate Ordsall & Langworthy Langworthy 5 Little Hulton & Walkden Little Hulton 5 Eccles Winton 5 Swinton Swinton North 5 Claremont & Weaste Weaste and Seedley 4 Swinton Pendlebury 4 East Salford Blackfriars 4 Little Hulton & Walkden Walkden North 4 Eccles Eccles 3 Claremont & Weaste Claremont 3 Irlam & Cadishead Cadishead 3 Eccles Barton 3 Irlam & Cadishead Irlam 2 East Salford Pendleton 2 Swinton Swinton South 2 Little Hulton & Walkden Walkden South 2 Ordsall & Langworthy Ordsall 1 East Salford Broughton 1 Worsley & Boothstown Worsley and Boothstown 1 East Salford Kersal 1 Table 16: Teenage Conceptions Source: ONS What this means for our PNA Pharmacies in Salford provide access to Emergency Hormonal Contraception through a Patient Group Direction (PGD). The service is free of charge to women using the service. Pharmacies are seen as a safe, accessible and non-judgemental provider of EHC services, some women, particularly younger women prefer to use town centre pharmacies as these offer a sense of anonymity when compared to local pharmacies 38

39 5.20. Sexual health Salford has lower rates of sexually transmitted infections (STIs) among the population when compared to England and the North West. Name STIs - 15 to 19 STIs - 20 to 24 STIs - 25 to 34 STIs - 35 to 44 STIs - 45 to 64 England West Midlands Salford PCT Table 17: Sexually transmitted infection rates Source: Health protection agency Salford s rates of Chlamydia infection are also lower than both England and North West rates across all age groups. Name Chlamydia Infections - 15 to 19 Chlamydia Infections - 20 to 24 Chlamydia Infections - 25 to 34 Chlamydia Infections - 35 to 44 Chlamydia Infections - 45 to 64 England West Midlands Salford PCT Table 18: Chlamydia infection rates Source: Health protection agency What this means for our PNA Pharmacies are playing an increasing role in offering a range of sexual health services around the supply of emergency hormonal contraception. NHS Salford is preparing to commission a Chlamydia and Gonorrhoea screening service from pharmacies. This is part of the R U Clear initiative. The service is intended to build on pharmacy s accessibility and availability to provide a route to screening, particularly the younger population. 39

40 6. Current provision and assessment This section describes the current provision of pharmaceutical services from pharmacy contractors using the following sources of data: Results of a postal questionnaire of pharmacy contractors in NHS Salford which was conducted in August 2010, this was update by a telephone survey of pharmacies in October 2010 Benchmarking data from the NHS information centre, this information is published each November, the last published data set relates to 2008/09. Data collected or held by NHS Salford in relation to the planning and delivery of pharmaceutical services. It draws together relevant supporting data from the health needs section and any relevant data from our pre-consultation engagement with the public together with supporting national evidence. The regulations governing the development of pharmaceutical needs assessments require the PCT to consider the need for pharmaceutical services in terms of: Services currently commissioned that are necessary to meet a current need Services that are currently commissioned which secure improvements or better access to services these are referred to as relevant services in the regulations The PCT may also consider: o Services not currently commissioned that may be necessary in specified future circumstance o Services not currently commissioned that may be relevant in the future because they would secure improvements or better access to pharmaceutical services 6.1. Future matters The PCT has not identified services not provided in the localities that will, in specified future circumstances, need to be provided in order to meet a need for pharmaceutical services or to secure improvements or better access to pharmaceutical services Pharmacy contractor questionnaire A questionnaire was used to gather information about current pharmacy services from pharmacy contractors in August The PCT used a template questionnaire produced by the Pharmaceutical Services Negotiating Committee (PSNC). Responses were received from 49 (89.1%) pharmacy contractors in Salford. Following the preparation of the draft PNA a further telephone survey of pharmacy contractors was conducted in October 2010 to confirm the validity of data held by the PCT. 40

41 6.3. Essential services In order to assess the provision of essential services against the needs of our population we have looked at the distribution of pharmacies relative to our population, their opening hours and the provision of dispensing services. We consider these three factors to be the most important in determining the extent to which the current provision of essential services meets the needs of our population Current provision of essential services NHS Salford has 55 pharmacy contractors and one appliance contractor who together provide pharmaceutical services to our population. A schedule of these providers is set out in Appendix Distribution of pharmacies by locality The pharmacy contractors include three 100 hour pharmacy and two Local Pharmaceutical Services (LPS) pharmacies. 100 hour pharmacies must open for at least 100 hours each week and may be required to provide certain specified local services by the PCT. LPS pharmacies are contracted directly with the PCT and not through the national terms of service to provide pharmaceutical services in a specific way. For example one LPS pharmacy in Salford is based at Hope Hospital and provides unscheduled care access to medicines. The other is based within one of our new primary care centres and provides additional services around long term conditions (LTCs) to support patients and prescribers. LPS pharmacies 100 hour pharmacies PNA Locality All pharmacies Claremont & Weaste 5 East Salford 9 2 Eccles 11 1 Irlam & Cadishead 5 1 Little Hulton & Walkden 6 Ordsall & Langworthy 10 1 Swinton 6 Worsley & Boothstown 3 Salford Table 19: Distribution of community pharmacies by locality 41

42 6.5. Analysis of distribution of pharmacies relative to population We can set the provision of pharmacy services in Salford into context by comparing the provision using national benchmarks which are available. The data below is taken from the most recent statistical bulletin published by the NHS information centre. This covers the period to March Benchmarking provision of pharmacy services This chart shows that Salford had 24.4 pharmacies per 100,000 population this is more than is typical for our ONS peer group (21.4) and, more than England (20.4). These data relate to 2008/09, the ONS based the analysis on 54 pharmacies, however Salford now has 55 pharmacies which would give a ratio of 24.9 per 100,000 population. Figure 11: Pharmacies per 100,000 population in ONS peer group Source: NHSIC 2009 and NHS Salford The current pharmacy provision analysis shows that NHS Salford has more pharmacies in relation to our population than we would expect to find in a PCT of this size and type. 42

43 Analysis of distribution by locality, which is shown in the chart below, shows that there is considerable variation in distribution, however this reflects the concentration of destination centres and GP practices in some localities. Worsley and Boothstown has the lowest ratio of pharmacies to population, whereas Ordsall and Langworthy has the highest. Figure 12: Pharmacy distribution by locality Over the last four years the population of Salford has grown from approximately 218,000 to 222,000. Over the same period the number of pharmacies has increased from 53 to 55. The ratio of population to pharmacies has decreased over the same period from 4,114 people per pharmacy to 4,040 people per pharmacy. Access to pharmacy services in Salford has improved in the last four years. 2006/ / / /2010 (est) Population ( 000) Pharmacies Pop/Pharmacy 4,114 4,132 4,098 4,040 Source: NHS Information Centre (2009) and ONS 43

44 Map ref Pharmacy Map ref Pharmacy Map ref Pharmacy 1 Manor Pharmacy 19 Victoria Chemist 37 Tims & Parker (Coniston Ave) 2 Boots the Chemist (Salford Shopping Centre) 20 Rowlands Pharmacy (Littleton Road) 38 Tims & Parker (Hulton District Centre) 3 Boots the Chemist (Bury Old Road) 21 Rowlands Pharmacy (Douglas Green) 39 Tims & Parker (Boothstown) 4 Boots the Chemist (Regent Retail Park) 22 Lloyds Pharmacy (Broadwalk) 40 Tims & Parker (Manchester Rd, Walkden) 5 Boots the Chemist (Eccles) 23 Lloyds Pharmacy (Hankinson Way) 41 Tims & Parker (4 Hodge Road) 6 Boots the Chemist (Swinton) 24 Lloyds Pharmacy (Irlam Health Centre) 42 Tims & Parker (Ellenbrook) 7 Boots the Chemist (Walkden) 25 Lloyds Pharmacy (Irlam) 43 Co - op Pharmacy (Russel Road) 8 Boots the Chemist (Gt Cheetham St) 26 Lloyds Pharmacy (Cadishead) 44 Co - op Pharmacy (291 Bolton Road) 9 Boots the Chemist (Langworthy Road) 27 Lloyds Pharmacy (Langworthy Road) 45 Co - op Pharmacy (203 Eccles Old Road) 10 Rosenhead Chemist (Leicester Road) 28 Lloyds Pharmacy (Eccles) 46 Co - op Pharmacy (Tootal Road) 11 Church Street Chemist 29 Gatley Pharmacy 47 Co - op Pharmacy (512 Liverpool Road) 12 Peel Green Pharmacy 30 Ross Chemist 48 Clarendon Pharmacy 13 Co - op Pharmacy (Russel St) 31 Tims & Parker (295 Moorside Road) 49 Sainsbury's Pharmacy 14 Cohens Chemist (Seedley Road) 32 Tims & Parker (Health Centre, Bolton Road) 50 SRHT Unscheduled Care Pharmacy 15 Cohens Chemist (Eccles) 33 Tims & Parker (Chorley Road, Swinton) 51 Vincent Smith Pharmacy 16 Greencross Pharmacy 34 Tims & Parker (Sides Medical Centre) 52 Tesco Pharmacy (Irlam) 17 K's Chemist Ltd (Mocha Parade) 35 Tims & Parker (Partington Lane) 53 Tesco Pharmacy (Walkden) 18 K's Chemist Ltd (Ordsall Health Centre) 36 Tims & Parker (716 Bolton Road) 54 Thompson Crabtree Ltd 55 Zemmel Chemist Figure 13: Map of premises providing pharmaceutical services in Salford 44

45 6.6. Analysis of opening hours Pharmacies are required to open between specific times by their terms of service. A visual representation of pharmacy opening hours by neighbourhood is provided in Appendix hour pharmacies and extended hour pharmacies. 100 hour pharmacies are contracted to open for at least 100 hours each week, thereby guaranteeing access for around 14 or 15 hours each day. Opening 100 hours each week is a condition of their license to provide NHS services. There are three 100 hour pharmacies, one in Eccles, one in Irlam and Cadishead and one in Ordsall and Langworthy. There is one pharmacy which opens extended hours in Little Hulton and Walkden (Tesco Walkden) and there is a specialist out of hours pharmacy operated under an LPS contract by Salford Royal Hospitals Foundation Trust, this is described under the out of hours section later in the PNA. Pharmacy Name Postcode Locality Type Church Street Chemist M30 9AN Eccles 100 hour Tesco Instore Pharmacy M44 6BL Irlam & Cadishead 100 hour Tesco Pharmacy M28 3BT Little Hulton & Walkden Extended Sainsbury's Supermarkets Ltd M5 4QU Ordsall & Langworthy 100 hour Figure 14: 100 hour pharmacy and extended hours pharmacy locations It should also be noted that on our border with Manchester to the South and East that our population has good access to pharmacies in Manchester city centre which are open extended hours. 45

46 Saturday opening hours Of the 55 pharmacies in Salford 28 open on a Saturday, half of these (14) close between noon and 1pm for the day. After 1pm, 14 pharmacies remain open, with gradual closures over the remainder of the day. Worsley and Boothstown has no provision after 1pm, however there is an extended hours pharmacy in the adjacent locality (Little Hulton and Walkden) which is open until 8pm. After 5pm there is also no provision in East Salford, the nearest pharmacies are then in Ordsall and Langworthy and over our border with Manchester PCT. Locality Pharma cies Open on Sat Open after 1pm Open after 5pm Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown Salford Figure 15: Opening of pharmacies on Saturdays Open after 7pm Sunday opening hours Six pharmacies in Salford, open on a Sunday, most open for 6 hours to comply with Sunday trading regulations. Pharmacy Postcode Open Close Locality I J Rosenhead Ltd M7 4AS 09:30 13:00 East Salford Church Street Chemist M30 9AN 10:00 15:30 Eccles Tesco Instore Pharmacy M44 6BL 10:00 16:00 Irlam & Cadishead Tesco Pharmacy M28 3BT 10:00 16:00 Little Hulton & Walkden Sainsbury's Supermarkets Ltd M5 4QU 11:00 17:00 Ordsall & Langworthy Boots UK Ltd M5 3TP 11:00 17:00 Ordsall & Langworthy Figure 16: Opening of pharmacies on Sundays 46

47 Out of hours services The Carson Review (2004) of out of hours provision made recommendations relating to medicines supply in the out of hours setting. The review placed the responsibility for ensuring that patients receive medicines, if required, out of hours on the provider and not on the patient. Arrangements are in place in Salford to ensure that patients that have an unscheduled care consultation can obtain a full course of treatment (if that is what is required) or a prescription which can be dispensed in the next in-hours period Unscheduled care pharmacy NHS Salford currently commissions an unscheduled care pharmacy service under a Local Pharmaceutical Services (LPS) contract which is provided by Salford Royal Hospitals NHS Foundation Trust. The unscheduled care pharmacy is located close to the unscheduled care service based at Hope Hospital and supports the clinicians working from this site. The opening hours of the pharmacy are planned to provide services when other pharmacies are closed. The pharmacy opens from: 6pm 10pm Monday to Friday, 9am noon and 4pm 8pm on Saturday and 9am noon and 2pm 6pm on Sunday Choice We are asked to consider the benefits of having a reasonable choice with regard to obtaining pharmaceutical services in our PNA. PCTs are required to consider whether there is reasonable choice when assessing applications for pharmacy services. We do not know how PCTs will be required to deal with the concept of choice under market entry using PNAs however we can consider the question of choice in relation to our PNA using the current regulations. It is up to the PCT to determine what weight the choice factor should be given in any case, therefore there is no qualification that can be applied to the question of choice. Judicial reviews of decisions made by PCTs have helped to clarify the question of choice in determining application. We can conclude that choice can only exist where there is more than one provider available to the population. However we can also conclude that there is choice where some or all providers are located outside the area in question. In Salford all of our localities have multiple pharmacy providers with most centres of population having a choice of two or more providers. 47

48 6.8. Dispensing services Pharmacies in Salford dispense an average of 7,708 prescription items per month (NHS IC: 2008/09), this compares with a median of 6,129 in England and 6,361 in the ONS peer group. (Note, these data do not include Appliance Contractors). Table 20: Dispensing activity in ONS peer group The data below shows that variation in our peer group PCTs in relation to dispensing volumes. PCT Pharmacies Prescriptions dispensed ( ) ( 000) Prescriptions dispensed ( ) Monthly avg / pharmacy Brighton and Hove City 59 3,746 5,291 Bristol 87 6,612 6,334 Leeds ,420 6,389 Liverpool 125 9,020 6,013 Newcastle 61 5,348 7,307 Plymouth 50 4,251 7,085 Portsmouth City 38 2,651 5,814 Salford 54 4,995 7,708 Sheffield ,049 7,219 Southampton City 41 3,049 6,198 Table 21: Pharmacies and dispensing activity in ONS peer group Our analysis of pharmacy distribution showed that Salford has more pharmacies per head of population when compared to other similar PCTs and England as a whole. We would expect, therefore, that pharmacies in Salford would dispense fewer prescription items on average than other comparable PCTs. However we have found the opposite to be the case, pharmacies in Salford dispense more items per month than any other PCT in our ONS peer group. Salford pharmacies 48

49 dispense more prescription items per month due to a combination of factors including, shorter dispensing intervals, higher prevalence rates and a greater dependence on primary care Taking account of other providers: Dispensing of appliances The PCT is required to take account of other providers of dispensing services which may affect our assessment. We have concluded that we need to take account of dispensing by appliance contractors in Salford. Surgical appliances may be dispensed by a pharmacy contractor or an appliance contractor. There are three broad categories of surgical appliance; stoma appliances, incontinence appliances and dressings. Patients receiving prescriptions for appliances may choose to have their prescription dispensed by a dispensing appliance contractor (DAC). DACs are a specialist type of contractor who dispense and advise on the use of surgical appliances. Dispensing appliance contractors have a PCT in which they are based but provide services over a wider footprint, many DACs provide a national service through mail order or a network of stoma nurses. There is one DAC based in Salford which serves England from its based in Walkden. Community pharmacies are not required to dispense appliances, therefore it is important to understand if patients in Salford have adequate access to this type of service. Of the 49 respondents 46 (94%) reported that they dispense all types of appliances. This suggests that there is good provision of dispensing of appliances in Salford Essential services conclusions Essential Services, which includes dispensing of NHS prescriptions is a fundamental service, it is commissioned nationally by the NHS and provides a network of pharmacies through which our population can obtain prescribed medicines in a safe and reliable manner. Consequently, the PCT considers that access to essential services, specifically dispensing services, is a necessary service the current need for which is secured through our existing pharmacy contractors. Salford has a comprehensive network of pharmacies, which has developed over the last 5 years to include three new 100 hour pharmacies. As a result the ratio of pharmacies to population has improved from 4,114 persons per pharmacy in 2006 to 4,040 persons per pharmacy in Our analysis of opening hours has shown that the people of Salford have good access to our pharmacy network across an extended period of time. We have concluded that there are no current gaps in Essential Services. 100 hour pharmacies 49

50 In relation to our 100 hour pharmacy contractors we have considered the current provision from these contractors and the potential for these contractors to apply to reduce their hours in the future based on the PNA. We have concluded, that our current 100 hour contractors perform an important role in opening up access in the evening and at weekends Advanced Services Since 2005 community pharmacies have been able to provide medicines use reviews / prescription interventions (MUR/PI) under the Advanced Services within the community pharmacy contract. Contractors may choose to provide MURs and must make a declaration to the PCT of conformity with the requirements to provide. The MUR/PI service is intended to improve patients' understanding of their medicines; highlight problematic side effects & propose solutions where appropriate; improve adherence; and reduce medicines wastage, usually by encouraging the patient only to order the medicines they require. Some pharmacy contractors have referred to this as a Medicines MOT, this is a good analogy to convey the purpose, and frequency of the review. The provision of Advanced Services is linked to the provision of consultation areas within pharmacies, this was explored in some depth in the pharmacy contractor questionnaire Premises and consultation areas Of the 49 pharmacies that responded, 42 have a consultation area of these 33 have wheelchair access. One contractor plans to introduce a consultation area within 12 month and six do not currently have a consultation and have no immediate plans to introduce one. Available (including wheelchair access) Available (without wheelchair access) Planned within the next 12 months None Did not answer Total Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown Salford Table 22: Consultation area provision in pharmacies Source: PNA contractor questionnaire 2010 Combining the current and planned consultation areas in Salford gives a provision of 88% across the city with 100% provision in Eccles, Little Hulton and Walkden and Worsley and Boothstown. 50

51 Provision appears poorest in Claremont and Weaste, however there were two non-respondents in this areas (out of five pharmacies) which makes the data we have less reliable. Currently have a consultation area or Respondents % planned within 12 months Claremont & Weaste % East Salford % Eccles % Irlam & Cadishead % Little Hulton & Walkden % Ordsall & Langworthy % Swinton % Worsley & Boothstown % Salford % Table 23: Consultation area provision in pharmacies Source: PNA contractor questionnaire Characteristics of consultation areas Three quarters of consultation areas take the form of a closed room (74%), slightly more have wheelchair access (79%) and 43% have a toilet nearby that patients can use. Consultation area characteristics Salford % Closed door 74% Wheelchair access 79% Hand Washing facilities in consult area 62% Hand Washing facilities nearby 26% Toilet nearby 43% Table 24: Consultation area characteristics Consultation Wheelchair All Closed door Toilet area access respondents Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown Salford Table 25: Consultation area characteristics by locality 51

52 Consultation areas - future work The presence of consultation areas in many pharmacies presents an opportunity to the PCT to use pharmacies in new and different ways to deliver services. In some respects the PCT is already doing this through commissioning of local enhanced services Benchmarking MUR uptake by pharmacies in Salford is consistent with the rates in our peer group. In 2008/09 81% of pharmacies in Salford were active in providing MUR. This compares with an ONS median of 81%. Figure 17: Benchmark MUR provision. Source: NHSIC 2008/09 The maximum number of MURs that a pharmacy may provide is 400 in any one financial year. Pharmacies in Salford provided 183 MURs in 2008/09 on average; this is more than the median of 160 MURs for our ONS peer group. 52

53 Figure 18: Benchmark MUR uptake. Source: NHSIC 2008/ Current provision Forty-eight pharmacies in Salford provide the MUR service, this is around 88% of all pharmacies. Provide MUR All pharmacies Claremont & Weaste 4 5 East Salford 8 9 Eccles 8 11 Irlam & Cadishead 4 5 Little Hulton & Walkden 6 6 Ordsall & Langworthy Swinton 5 6 Worsley & Boothstown 3 3 Salford Table 26: MUR providers by locality Source: Contractor telephone survey Oct 2010 In addition 29 of the pharmacies responding were willing to undertake MUR in patient s homes. The map overleaf shows the provision of MUR by pharmacies against a background showing the proportion made up of older people. 53

54 Figure 19: Provision of MUR service mapped ward population aged 65 and over 54

55 Appliance Use Review (AUR) and Stoma Appliance Customisation Service (SAC) There are two new Advanced Services which were introduced in April 2010, these are not yet well established however we did ask contractors to tell us if they had begun to provide these services through the contractor questionnaire. At this time 18% of pharmacies in Salford have begun to provide the AUR service and 43% the SAC service. It is too early to evaluate the requirement for this service in our population, however these early data suggest there will be a number of providers in Salford Conclusion in relation to Advanced Services The stated purpose of advanced services fits well with the PCT s strategic aims, particularly improving outcomes for patients with long term conditions (LTCs). Evidence for the effectiveness of MUR is not yet well developed although some early studies show that the service can improve selfreported rates of adherence among patients. We have concluded that MUR is a necessary service for our population. We will work to develop and focus MUR services in order to improve the link between MUR and outcomes for patients. We believe that Salford residents should have the opportunity to have a MUR where it is appropriate. However more could be done to tell patients that this service is available from pharmacies, we have also identified a need for the PCT to communicate to local people to inform them of the locally commissioned services that are available from pharmacies. We will focus on making the most of MUR, to link this to our priorities and use our powers to improve the delivery of this service from contractors The AUR and SAC services are new services which are not yet well established, we have limited data on which to determine need and where pharmacy providers fit in to meeting this need. We will review the arrangements for these services in the future. 55

56 6.10. Enhanced pharmaceutical services NHS Salford currently commissions the following enhanced services from some pharmacy contractors: Stop Smoking Service Emergency Hormonal Contraception Head Lice Interventions Drug Misuse Services, which include: o Needle exchange o Observed Methadone Palliative Care service Care Homes service Bank Holiday Rota service Services in development The PCT is preparing to roll out a Chlamydia and Gonorrhoea screening programme in pharmacies. Each of these services is reviewed in turn in this section of the PNA. Other services The PCT also commissions a minor ailments scheme from two pharmacies as part of their LPS contracts. 56

57 6.11. Stop Smoking Service NHS Salford commissions support for smoking cessation from community pharmacies who provide advice and support on stopping smoking and supply nicotine replacement therapy (NRT) at the point of care. Pharmacies are seen as key providers of stop smoking services due to their opening hours, accessibility and ability to advise and supply NRT as well as provide counselling. The stop smoking service directly addresses a key outcome measure for the PCT. Reducing smoking and exposure to smoke is the single most effective health care intervention that can be made Current commissioning The stop smoking service is commissioned from 45 pharmacies with provision in each locality. This service is commissioned by the PCT s smoking cessation service in areas of highest need, smoking cessation counselling services are also provided by other providers, including GPs and specialist smoking cessation advisers. Smoking cessation service available All pharmacies Claremont & Weaste 2 5 East Salford 7 9 Eccles Irlam & Cadishead 4 5 Little Hulton & Walkden 6 6 Ordsall & Langworthy 8 10 Swinton 5 6 Worsley & Boothstown 3 3 Salford Table 27: Summary provision of smoking cessation support by locality The map overleaf shows the current provision against the index of multiple deprivation (IMD) The map shows that there is good provision, with every locality having some or all of the pharmacies providing this service. 57

58 Figure 20: Provision of smoking cessation services by pharmacies mapped against IMD

59 Willingness to provide Pharmacy contractors were asked to consider if they would be willing to provide the smoking cessation service. Seven would be willing to provide this service, including one pharmacy in Monton. Willing to provide Need training Need premises adjustment Total willing to provide Claremont & Weaste 2 2 East Salford Eccles 1 1 Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton 1 1 Worsley & Boothstown Salford Table 28: Willingness to provide smoking cessation service Conclusions in relation to stop smoking service The stop smoking service through pharmacies is an important strand of the PCT s efforts to reduce smoking rates among the population. Pharmacy is a unique provider with the ability to provide access to NRT at the point of care. Given this and the priority placed on reducing smoking rates in Salford the PCT has concluded that the smoking cessation service is a necessary service. There is good provision from pharmacies in Salford, with all localities having some or all pharmacies providing this service. There are other providers of this service, including GP based services which the public can access. 59

60 6.12. Emergency hormonal contraception service NHS Salford commissions an Emergency Hormonal Contraception Service from community pharmacies. To provide this service the pharmacist must be accredited by the PCT. The aims of the EHC service are to provide a safe, and accessible route for women to obtain emergency contraception in a timely manner. The service is intended to contribute to avoiding unwanted pregnancy and reducing teenage pregnancy Current commissioning The EHC service is commissioned from 30 pharmacies with provision in each locality. Activity data for a recent six month period shows that there is most activity in the Eccles area. EHC Consultations (6m data) All pharmacies Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown Salford Table 29: Summary provision of EHC by locality and recent activity The map overleaf shows the current provision against teenage conceptions at ward level. 60

61 Figure 21: Map of EHC service provision with teenage conception rates 61

62 Willingness to provide Pharmacy contractors were asked to consider if they would be willing to provide the EHC service. Eighteen would be willing to provide this service; eleven of these would need training in order to provide the service. There is training planned to bring new providers into the service over the last quarter of 2010/11. Willing to Need premises Need training provide adjustment Total WTP Claremont & Weaste 2 2 East Salford 1 1 Eccles Irlam & Cadishead 2 2 Little Hulton & Walkden Ordsall & Langworthy Swinton 3 3 Worsley & Boothstown 1 1 Salford Table 30: Willingness to provide EHC service Conclusions in relation to the EHC service The EHC service through pharmacies provides important access to EHC for women in Salford. Without this service access would only be available via a GP appointment or clinic, this would limit access considerably when compared to including pharmacy as an outlet for EHC. Consequently, the PCT considers the EHC service is a necessary service. We have concluded that there are no gaps in provision. 62

63 6.13. Head lice treatment service NHS Salford commissions a head lice treatment service. This service helps to free up resources in GP practices by using community pharmacies as source of advice and treatment for head lice. The service removes the need for patients to attend a GP appointment for a diagnosis and prescription. This service is aimed at children and families with children who make up the largest numbers of head lice cases in primary care Current commissioning The Head Lice Service is commissioned from 46 pharmacies with provision in each locality. Activity data for a recent six month period shows that there is most activity in the Eccles area. Head Lice Consultations Service (6m data) All pharmacies Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown Salford Table 31: Summary provision of EHC by locality and recent activity The map overleaf shows the current provision against the population aged under 16 years at ward level. 63

64 Figure 22: Map of head lice service provision with population aged under 16 years. 64

65 Conclusions in relation to the Head Lice service The Head Lice service through pharmacies makes good use of the accessibility and flexibility of pharmacies and frees up resources in general practice. The service works well and consequently, the PCT considers the EHC service is a necessary service. We have concluded that there are no gaps in provision. 65

66 6.14. Prescription interventions service NHS Salford commissions a prescription intervention service which is intended to support the safe and effective use of medicines and provide value for money for the NHS. The prescription intervention service is a simple but effective way for pharmacy contractors to identify prescribing where there is an opportunity to reduce waste or costs through, for example synchronisation of quantities, dose optimisation, reconciliation and education of patients. The pharmacy is paid a fee for the intervention and completion of a record of the intervention. The patient s GP is informed of the intervention and changes may be made, if appropriate, to the patient s medicines profile. The service focuses on reducing waste and delivering value for money in prescribing Current commissioning The service is currently commissioned from all pharmacies in Salford, the service has been in place for many years and is currently being refreshed to refocus on priorities for the PCT and to ensure that the design and remuneration are appropriate Conclusions in relation to the Prescription Interventions service The Prescriptions Interventions service engages community pharmacists in reducing waste and securing value for money in the use of prescribed medicines. These are priority areas for the PCT and consequently we have concluded that this is a necessary service. The service is currently under review and will be refreshed to ensure that it remains focused on its intended outcomes. 66

67 6.15. Drug Misuse Services NHS Salford commissions two services to support drug treatment services: NHS Salford A needle exchange service which is focused on ensuring that injecting drug users have access to clean injecting equipment, are able to safely dispose of used equipment and have access to advice from pharmacists. A supervised consumption service which is focused on ensuring that clients in drug treatment programmes take and use their treatment as prescribed and to provide an opportunity for the pharmacist to make relevant interventions The local authority has a Drug and Alcohol Action Treatment (DAAT) team which co-ordinates the local strategy for drug and alcohol treatment. Drug treatment and harm minimisation services directly address an important strand in the PCT s strategic plan. Although the numbers of people affected are small the impact on the wider community can be significant if not properly managed. With consequences for blood borne disease, health and safety and drug related crime. Needle exchange services are commissioned by the DAAT from specific pharmacies, the supervision services are demand led, any pharmacy may provide these services on application to the DAAT. The needle exchange service is currently commissioned from 10 pharmacies and the supervised consumption service from 25 pharmacies. Needle Supervised Exchange Consumption All pharmacies Claremont & Weaste 1 5 East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown 1 3 Salford Table 32: Summary provision of drug misuse support services by locality The maps overleaf show the current provision for both in Salford mapped against the Index of Multiple of Deprivation (2007). The needle exchange service provision has recently been reviewed by the DAAT, no changes to provision were proposed as a result. In the course of developing the PNA we have discovered that pharmacy contractors are not aware that they can approach the DAAT to begin providing the supervision service if there is a client that requires the service using the pharmacy. We will be writing to pharmacy contractors to clarify this arrangement. 67

68 Figure 23: Map of needle exchange provision 68

69 Figure 24: Map of supervised consumption provision 69

70 Willingness to provide Needle Exchange Pharmacy contractors responding to the PCT questionnaire were asked to consider if they would be willing to provide the Needle Exchange service. Twenty-eight pharmacies were willing to provide this service if commissioned by the PCT, 12 would need training and nine would need premises adjustments to provide the service. Willing to Need premises Need training provide adjustment Total WTP Claremont & Weaste 1 1 East Salford 3 3 Eccles Irlam & Cadishead 1 1 Little Hulton & Walkden Ordsall & Langworthy Swinton 4 4 Worsley & Boothstown 3 3 Salford Table 33: Willingness to provide Needle Exchange Service Pharmacy contractors responding to the PCT questionnaire were asked to consider if they would be willing to provide the Supervised Consumption Service. Fifteen pharmacies were willing to provide this service if commissioned by the PCT, four would need training and four would need premises adjustments to provide the service. Willing to Need premises Need training provide adjustment Total WTP Claremont & Weaste 1 1 East Salford 2 2 Eccles 1 1 Irlam & Cadishead 1 1 Little Hulton & Walkden Ordsall & Langworthy 1 1 Swinton Worsley & Boothstown 2 2 Salford Table 34: Willingness to provide Supervised Consumption Service Needle exchange service is an important public health service which reduces the risk to drug users and the general population. Consequently the PCT has concluded that the provision of needle exchange service from pharmacies is a necessary service. The current pattern of provision is consistent with the needs of the population and the PCT has concluded that there are no gaps in provision. 70

71 The supervised consumption service performs a critical role in supporting drug users in treatment to manage their treatment programme while minimising the diversion of drug treatment onto the streets. The PCT has concluded that the supervised consumption service from pharmacies is a necessary service. The pattern of provision is consistent with the needs of the population and the PCT has concluded that there are no gaps in provision. 71

72 6.16. Palliative Care NHS Salford commissions an important service for patients and healthcare professionals which ensures that there is ready access to advice and supply of palliative care drugs for end of life care. Making these drugs available, and having a network of pharmacies that undertake to hold stock of these unusual, but urgently needed drugs, facilitates the choice of patients to die at home Current commissioning This service is commissioned from eight strategically located pharmacies some of which open extended hours to provide enhanced access to this service. The map below shows the pharmacies that provide this service and their location; this shows that we have provision in each of the main centres in Salford. Figure 25: Map of palliative care service provision against IMD Conclusions in relation to palliative care service The palliative care access service performs an important function in ensuring there is a network of strategically placed pharmacies in Salford which clinicians and carers can access when required. We have concluded that this is a necessary service and that the current provision meets the needs in Salford. 72

73 6.17. Advice to Care Homes service NHS Salford commissions a care homes advice service from community pharmacies. The purpose of the service is to provide care home owners and staff with advice on the safe storage, management and disposal of medicines. Community pharmacies providing the service are required to undertake regular visits to the care homes they advise and to document their advice and recommendations. This service helps to reduce waste and improve the safe use of medicines Current commissioning This service is commissioned by the PCT from 3 contractors that have relationships with the care homes concerned. The Department of Health has recently issued an alert to PCTs regarding the safe use or medicines in care settings, this stressed the roles and responsibilities of all stakeholders across secondary and primary care in relation to ensuring the safe and effective use of medicines. The service has been in place for some time and is due to be reviewed to ensure that it remains fit for purpose Conclusions in relation to the Advice to Care Homes service The Care Homes service has been in place for many years, this service now needs to be reviewed in the light of the recent alert from the Department of Health. The current service is a necessary service the need for which is met by existing providers Bank Holiday rota services NHS Salford commissions a rota service which operates on specific days e.g. Christmas Day, Boxing Day, New Year s Day and Easter Sunday. These are days when supermarket and pharmacies based in retail centres are not permitted to open. The PCT recently invited expressions of interest from pharmacies to provide this service. Four pharmacies located in Cadishead, Swinton, Little Hulton and Higher Broughton have come forward to express an interest. We have indentified the need to effectively promote this service to patients and the public to ensure that they know where they can obtain pharmaceutical services on these days Conclusions in relation to the rota service The rota service which is commissioned by the PCT provides access at times when our extended hours pharmacies would otherwise be closed, this service ensures that there is access in Salford at these times. We will be working to ensure that patients and the public are aware of this service. We have concluded that this is a necessary service and that there are no gaps in provision. 73

74 6.19. Chlamydia & Gonorrhoea screening service NHS Salford is preparing to roll out a Chlamydia & Gonorrhoea screening service from pharmacies, this is part of the R U Clear initiative. The aim of the service is to promote screening for Chlamydia & Gonorrhoea in the year old age group and to provide advice and signposting to services for at risk people. The service allows pharmacies to offer a testing kit to the target population future plans for the service include involving the pharmacy contractor in sending completed tests to the lab. Increasing screening, education and treatment are key priorities for the PCT, the target age group is young people aged years, however there is also evidence that STI rates are rising in the older population Current commissioning This service will be commissioned from 16 pharmacies with provision in each locality except Worsley & Boothstown locality. Chlamydia screening All pharmacies Claremont & Weaste 1 5 East Salford 1 9 Eccles 4 11 Irlam & Cadishead 2 5 Little Hulton & Walkden 3 6 Ordsall & Langworthy 4 10 Swinton 1 6 Worsley & Boothstown 3 Salford Table 35: Summary provision of Chlamydia screening service by locality and recent activity The map overleaf shows the current provision against the younger population at ward level. 74

75 Figure 26: Map of Chlamydia screening service provision against ward population aged

76 Willingness to provide Pharmacy contractors were asked to consider if they would be willing to provide this service if the PCT extended the commissioning in the future. Thirty-two would be willing to provide this service, eleven of these would need training in order to provide the service and two would need to make premises adjustments. Willing to Need premises Need training provide adjustment Total WTP Claremont & Weaste East Salford Eccles Irlam & Cadishead Little Hulton & Walkden Ordsall & Langworthy Swinton Worsley & Boothstown 3 3 Salford Table 36: Willingness to provide Chlamydia screening service Conclusions in relation to the Chlamydia Screening Service This service will perform an important function in improving access for the target population to screening. At this time, we have concluded that the Chlamydia screening service is a necessary service and that the proposed commissioning will meet the needs of our population. 76

77 6.20. Appendix 1: Policy context and background papers This Appendix provides some context for the development of the policy influencing the development of pharmacy and PNAs. At the time of writing we do not know how the trajectory set by this policy will change as the new government sets out its policy proposal for the NHS. A Vision for Pharmacy in the New NHS (July 2003) The pace of change for NHS community pharmaceutical services over the last 10 years has been more rapid than at any other time in the last 60 years. Community pharmacy has featured more prominently in the NHS s efforts to improve services and is increasingly recognised by the NHS and by other health professionals, and how its ability to respond innovatively and creatively can be better utilised. This was what was intended when the Department of Health launched A Vision for Pharmacy in the New NHS in July 2003, which identified and aligned the ambitions for pharmacy alongside the wider ambitions for the NHS as a whole. The current policy context shaping the direction of pharmacy services has its roots in the publication of a strategy for pharmacy Choosing Health published by the Government in In this White Paper, the Government set out a programme of action to provide more of the opportunities, support and information people want to enable them to improve their health. Choosing health through pharmacy As part of this programme, the Government made a commitment to publish a strategy for pharmaceutical public health (Choosing Health Through Pharmacy) which expanded the contribution that pharmacists, their staff and the premises in which they work can make to improving health and reducing health inequalities. This strategy recognised that pharmacists work at the heart of the communities they serve and they enjoy the confidence of the public. Every day, they support self care e.g. for minor illnesses and provide health messages, advice and services in areas such as diet, physical activity, stop smoking and sexual health. A new contractual framework for community pharmacy As part of the Vision for Pharmacy a new community pharmacy contractual framework was put in place in April It comprises three tiers of services essential, advanced and local enhanced services. Essential services are those which every pharmacy must provide, including dispensing and advice and self help Advanced services are those which, subject to accreditation requirements, a pharmacy contractor can choose to provide. At present, there are two advanced service: a) The Medicines Use Review (MUR) - and b) the Appliance Use Review / Stoma Appliance Customisation Service. Essential and advanced services are determined nationally. 77

78 Local enhanced services, such as help for substance misusers, are commissioned locally by PCT/CTs direct with contractors. Our health, our care, our say The White Paper Our health, our care, our say launched in January 2006 set out a new strategic direction for improving the health and well-being of the population. It focused on a strategic shift to locate more services in local communities closer to people s homes. This recognised the vital role that community pharmacies play in providing services which support patients with long term conditions and make treatment for minor illnesses accessible and convenient. NHS Next Stage Review High Quality Care For All The NHS Next Stage Review final report (June 2008) set out a vision of an NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart quality defined as clinically effective, personal and safe. The changes that are now being taken forward, locally and nationally, will see the NHS deliver high quality care for all users of services in all aspects, not just some. It will see services delivered closer to home, a much greater focus on helping people stay healthy and a stronger emphasis on the NHS working with local partners. Pharmacy has a key role to play in delivering this vision, particularly as a provider of services which prevent ill-health, promote better health for all and improve access to services within communities. The pharmacy White Paper, Pharmacy in England - Building on strengths delivering the future In April 2008 the government set out its plans for pharmacy in the Pharmacy White Paper Pharmacy in England: Building on strengths - delivering the future (PWP) subsequently a regulatory consultation was undertaken to consult on the proposed changes to the regulations for pharmacy. This White Paper sets out a vision for improved quality and effectiveness of pharmaceutical services, and a wider contribution to public health. Whilst acknowledging good overall provision and much good practice amongst providers, it revealed several areas of real concern about medicines usage across the country which it seeks to address through a work programme which will challenge and engage PCT commissioners, pharmacists and the wider NHS. It identifies practical, achievable ways in which pharmacists and their teams can improve patient care in the coming years. It sets out a reinvigorated vision of pharmacy s potential to contribute further to a fair, personalised, safe and effective NHS. This vision demonstrates how pharmacy can continue, and expand further, its role in an NHS that focuses as much on prevention as it does on treating sick people, helping to reduce health inequalities, supporting healthy choices, improving quality and promoting wellbeing for patients and public alike. This White Paper has put forward a broad range of proposals to build on progress over the last three years which has succeeded in embedding community pharmacy s role in improving health and wellbeing and reducing health inequalities. These include proposals for how pharmacies will, over time: 78

79 become healthy living centres promoting health and helping more people to take care of themselves; offer NHS treatment for many minor ailments (e.g. coughs, colds, stomach problems) for people who do not need to go to their local GP; provide specific support for people who are starting out on a new course of medicines treatment for long term conditions such as high blood pressure or high cholesterol; offer screening for those at risk of vascular disease an area where there are significant variations in access to services and life expectancy around the country; use new technologies to expand choice and improve care in hospitals and the community, with a greater focus on research; and be commissioned based on the range and quality of services they deliver increased involvement in screening, vaccination and sexual health. For PCT/CTs the PWP presents a timely opportunity to take stock of progress with the development and integration of pharmacy services and to prepare a strategy to deliver the PWP vision over the next 3-5 year period. High quality commissioning is a recurring theme throughout these documents. A robust Pharmaceutical Needs Assessment (PNA) is key to commissioning of services, consistent with world class commissioning principles, from community pharmacy. The following documents provide some background to the PNA development process, the relevant policy and guidance available to PCTs. Pharmacy in England: building on strengths - delivering the future This White Paper sets out a vision for building on the strengths of pharmacy, using that capacity and capability to deliver further improvements in pharmaceutical services over the coming years as part of an overall strategy to ensure safe, effective, fairer and more personalised patient care PNAs as a part of world class commissioning guidance. This guidance sets out why s (PNAs) are important, how they fit into the primary care trust (PCTs) planning cycle and how it can be used to drive intelligent, world class commissioning of pharmaceutical services. ldclasscommissioning.aspx 79

80 The Health Act 2009 NHS Salford The Health Act 2009 amended the National Health Service Act 2006 to include provisions for regulations to set out the minimum standards for PNAs. Advisory Group on the NHS (Pharmaceutical Services) Regulations Following the publication of the White Paper Pharmacy in England: Building on strengths - delivering the future, a consultation was held in the autumn 2008 on proposals for legislative change derived from the Health Act This work was taken forward by an advisory group established by the government. dvisorygroup/index.htm The DH has now published the revised guidance and regulations. The regulations were laid in parliament on 23 rd March 2010 and will come into force on 24th May The updated guidance and regulations can be accessed at: dh_ pdf Developing pharmaceutical needs assessments guidance This guidance and individual supporting guides explain why s (PNAs) are important and how they fit into PCTs' planning cycles. It outlines how to produce a new PNA or revise an existing one. px Pharmacy-based stop smoking services guidance This guidance covers the key areas for primary care trusts (PCTs) when commissioning 'world class' pharmacy-based stop smoking services. The NHS (Pharmaceutical Services) Regulations: information for primary care trusts - revised September 2009 This guidance has been produced to assist primary care trusts in the assessment and determination of applications to provide NHS pharmaceutical services. It incorporates reforms effective from 1 April 2005 to the regulatory system and amendments to the Regulations since. This includes the amendments which came into force on 17 September SI 2009/

81 It also incorporates supplementary information for primary care trusts on the NHS Pharmaceutical Services (Fees for Applications) Directions 2008 which give primary care trusts the ability to charge for certain applications for inclusion on their NHS pharmaceutical services lists World class commissioning: Improving Pharmaceutical Services This is a practical guide to support PCTs in commissioning pharmaceutical services. Local pharmaceutical services (LPS) LPS is a tool available to PCTs by which they may contract locally for provision of pharmaceutical and other services, including services not traditionally associated with pharmacy, within a single contract. ceuticalservices/lpspermanenceguidance/index.htm 81

82 Appendix 2: Membership of the steering group Name Alan Campbell (Chair) Role / Organisation Director of Commissioning & Deputy Chief Executive Officer Peter Jones PCT Pharmaceutical Adviser & Head of Medicine Management Fiona Reynolds David Lamb Gianpiero Celino Phillip Hammond Amanda Rafferty Alan Berry Bethan Pickup Public Health Consultant Public Health Analysis Project Lead Patient & Public Involvement Public Engagement Manager - deputy for Phillip Pharmacy Panel Representative Salford & Trafford LPC Gerry Haydock Varun Jairath Monica Roper Independent Pharmacy Contractor Community Pharmacy Contract Manager 82

83 Appendix 3: NHS Salford statistical peer group The PCT is grouped with eight other PCTs with similar characteristics by the Office of National Statistics (ONS): Brighton and Hove City Teaching Bristol Teaching Leeds Liverpool Newcastle Plymouth Teaching Portsmouth City Teaching Sheffield Southampton City This group is a subgroup of the Regional Centres group. More information about clusters and their construction can be found here: Presentation of data in the PNA document Throughout this document, where data is available, we refer to these localities in describing services or assessing the need for services. These localities can be subdivided into electoral wards or into Super Output Areas (SOAs). Electoral wards are political units of geography whose boundaries are managed by the electoral commission, ward boundaries change over time. SOAs are administrative units of geography which have been established by the ONS. SOA boundaries do not change and provide a consistent basis for tracking changes in the population over time. These areas can be aggregated up to ward level, however, ward boundaries do change occasionally as electoral boundaries are redrawn so links between any one SOA and a particular ward can be lost. SOAs exist at three levels: Lower Layer SOAs have a population of approximately 1,500 persons Middle Layer SOAs have a population of approximately 7,200 persons Upper Layer SOAs are not yet developed but are expected to have a population of approx 25,000 persons. Where data is available then the PNA describes the health needs and current provision of pharmaceutical services at all three levels: Salford, Locality and Ward or SOA level. 83

84 Appendix 4: Maps of Salford PNA localities NHS Salford The PCT area has been divided into eight localities for the purposes of the PNA. These correspond to the neighbourhoods used by NHS Salford to plan Primary and Community Services 84

85 Appendix 5: Disease prevalence rates by locality NHS Salford Source: QMAS 2008/09, All data aggregated from practice level 85

86 86

87 Diabetes register only includes patients aged 17+ and prevalence has been calculated for this age group 87 CKD register only includes patients aged 18+ and prevalence has been calculated for this age group

88 88