Bexley Care Trust Pharmaceutical Needs Assessment
Bexley Care Trust
Pharmaceutical Needs Assessment
1 Bexley Care Trust Pharmaceutical Needs Assessment
Version control
Version Date Author
1.0 17th December 2010 Gianpiero Celino
Supplementary statements
Statement number Date of publication Comments Author
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1. EXECUTIVE SUMMARY ...... 5 Summary of the assessment...... 6 Conclusions...... 8 Next steps ...... 8 2. INTRODUCTION...... 9 Definition of a pharmaceutical services ...... 9 What is excluded from scope of the assessment ...... 12 Process followed in the development of the PNA...... 12 Governance and steering group ...... 14 Consultation during the development of the PNA...... 14 Regulatory consultation process and outcomes ...... 14 Circumstances under which the PNA is to be revised or updated...... 14 3. BACKGROUND TO PHARMACEUTICAL NEEDS ASSESSMENTS...... 15 Regulatory changes...... 15 The duty on the Care Trust...... 15 How the Care Trust has been divided into localities for the purposes of the PNA...... 16 Presentation of data in the PNA document ...... 17 4. THE CONTEXT FOR PHARMACY SERVICES IN BEXLEY...... 18 Bexley JSNA ...... 19 Population characteristics ...... 19 Population forecast ...... 20 Population change...... 20 Forecast change in population structure ...... 21 Population structure by ward...... 22 Ethnicity ...... 23 Access...... 24 Deprivation...... 25 Teenage pregnancy ...... 28 Infant mortality...... 29 Burden of disease and ill health...... 30 Hospital admissions...... 31 Disease prevalence – QoF data...... 33 Lifestyle factors ...... 35 5. BEXLEY’S FIVE YEAR STRATEGY...... 38 6. INSIGHTS FROM PATIENTS AND THE PUBLIC...... 42 Summary of responses ...... 42 General Demographics...... 43
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Use of Pharmacies...... 44 Most Recent Visit to a Pharmacy ...... 45 Access to Pharmacy Services...... 46 Consultations with Pharmacists ...... 47 Experiences of Getting a Prescription...... 49 Problems Experienced with Long-term Medicines...... 50 Getting New Medicines...... 51 Advice-giving by Pharmacists on Public Health Issues ...... 52 The Range of Pharmacy Services...... 53 Rating of Pharmacy Service Elements ...... 53 Conclusions...... 54 7. THE ASSESSMENT ...... 56 Essential services...... 56 Distribution of pharmacies by locality...... 56 Benchmarking distribution of pharmacy services ...... 56 Essential Small Pharmacies Scheme...... 58 Local Pharmaceutical Services (LPS)...... 58 Opening hours ...... 58 Access to pharmacy services ...... 58 Dispensing services ...... 61 Repeat dispensing...... 62 Advanced services ...... 64 Enhanced pharmaceutical services...... 70 APPENDIX 1: POLICY CONTEXT AND BACKGROUND PAPERS ...... 80 APPENDIX 2: MEMBERSHIP OF THE STEERING GROUP ...... 85 APPENDIX 3: PHARMACIES AND GP PRACTICES IN BEXLEY...... 86 APPENDIX 4: OPENING HOURS OF PHARMACIES...... 91 APPENDIX 5: SERVICES PROVIDED BY COMMUNITY PHARMACIES ...... 94 APPENDIX 6: BENCHMARKING OF PHARMACY SERVICES IN BEXLEY...... 97 APPENDIX 7: MAP SHOWING BEXLEY CARE TRUST PHARMACIES ...... 100 APPENDIX 8: ABBREVIATIONS AND GLOSSARY...... 101 APPENDIX 9: REPORT OF THE CONSULTATION ON THE DRAFT PNA...... 103
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1. Executive Summary
Bexley Care Trust has a diverse network of 45 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 a new national contract and through local commissioning here in Bexley, as a result patients can access a wider range of services from pharmacies than ever. Pharmacies in Bexley now provide a range of national and locally commissioned services to the population including; stop smoking advice, emergency contraception, Chlamydia testing, needle exchange and supervised drug treatment.
This document describes our assessment of the need for pharmaceutical services in Bexley. It has been developed through a steering group with stakeholders and has also been informed by the views of over 1,000 patients who responded to our questionnaire about their local pharmacies.
The purpose of a Pharmaceutical Needs Assessment (PNA) is: To inform and support the Care Trust’s commissioning plans for pharmaceutical services
To inform and support the Care Trust’s decision making process in relation to market entry, this function requires further enabling regulation which is expected in the autumn of 2010.
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, Liberating the NHS, 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. Here in Bexley practice based commissioning (PBC) is alive and kicking, we have already made significant progress in developing clinical leadership and devolving commissioning to GPs. We see great potential to extend this philosophy to pharmacy services in the future. While we expect that some aspects of pharmaceutical services will be managed by the 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 be scrutinised to ensure that money is spent to deliver the outcomes expected by patients and the public. 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. We have been in discussions with local pharmacists on how we can redesign services here in Bexley to achieve this.
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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.
This assessment is informed, in part, by the views of over 1,000 Bexley residents who took the time to tell us about their experience of using pharmacy services in Bexley.
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. In the pharmacy contract, dispensing services are a sub set of essential services.
Our PNA has found that our population has good access to dispensing services. The distribution of pharmacies in Bexley is as good or better when compared to our peers. Access in Bexley has improved recently as a new 100 hour pharmacy has opened in the last 5 years.
We have decided that dispensing services are a necessary service. Dispensing is a core service that we need to ensure our population can obtain with reasonable ease. We have concluded that there are no gaps in this service.
Advanced Services e.g. Medicines Use Review 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. Evidence for the effectiveness of MUR/PI is not yet well developed although some early studies show that the service can improve self-reported rates of adherence among patients.
At this time we do not believe that Advanced Services are a necessary service, however the service is relevant to the needs of our population and we will continue to work with our pharmacies to ensure that it is delivered where and when patients need it.
Emergency Hormonal Contraception Service The Care Trust commissions an Emergency Contraception Service from community pharmacies. The EHC service is available to women aged 14 - 24 resident in Bexley. The EHC service through pharmacies provides important access to EHC for women in Bexley and is a key part of the Care Trust’s aims to reduce teenage conceptions.
We consider the EHC service to be a necessary service; we will work with our willing providers to ensure there is comprehensive provision across Bexley.
Chlamydia screening service Bexley commissions a Chlamydia Screening service from pharmacies. The service allows pharmacies to offer the option of a Chlamydia test to the target population.
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Uptake of the service has been patchy, and the number of screens through pharmacy is low.
We have concluded that the Chlamydia screening and treatment service is a necessary service for our population. We will work with our pharmacy contractors to improve the uptake of this service in the future.
Smoking Cessation Service Bexley Care Trust 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 and supply smoking cessation therapy (SCT).
The stop smoking service through pharmacies is an important strand of the Care Trust’s efforts to reduce smoking rates among the population. One in three of our pharmacies provide a stop smoking counselling service, however we could improve access through pharmacy in areas where smoking rates are highest by involving pharmacies that are willing to provide this service in these areas in the service.
Pharmacy is a unique provider with a high quit rate and the ability to provide access to SCT at the point of care. Given this and the priority placed on reducing smoking rates in Bexley we consider the smoking cessation service to be a necessary service.
Needle Exchange Service and Supervised Consumption Service Pharmacies in Bexley provide 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.
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.
Informing our commissioning intentions Our recently published strategic plan provides a framework for reviewing pharmacy services and identifying how pharmacy services could contribute to delivering our vision in Bexley for excellent healthcare, locally delivered.
What our assessment has shown is that our pharmacies provide many local services which are intended to address the challenge of reducing ill health through screening and prevention, this is of course important in tackling the onset of disease and avoiding the development of diseases linked to lifestyle factors. However we could do more to use
7 Bexley Care Trust Pharmaceutical Needs Assessment pharmacies to deliver services which help us to tackle the challenge of long term conditions and hospital admissions which will become increasingly pressing as our population grows and ages. We have identified themes which could be explored as part of our future commissioning including:
Making the most of the existing essential services, particularly sign posting and public health campaigns Using the Electronic Prescription Service (EPS) and Repeat Dispensing (RD) to provide a more streamlined medication service for patients with the long term conditions which feature among our Bexley initiatives e.g. COPD, Diabetes, CHD and Mental Health Using Medicines Use Review (MUR) to target patients that are a high priority for the Care Trust Developing Enhanced services that are focused on supporting long term conditions, discharge and transfer of care and reducing errors and readmissions
Clearly the ability of pharmacy to deliver these initiatives will depend on building capacity and redesigning services, this fits well with our current and ongoing discussions with pharmacy contractors to identify how we can free up resources and capacity in the pharmacy network while developing new ways to utilise the pharmacists’ skills and expertise.
We will use this and the PNA more generally to inform our commissioning intentions as we progress with our strategy over the next five years. Conclusions This is our first PNA under the new regulations. The CT conducted a consultation on a draft of the PNA with our stakeholders. The consultation built on the significant engagement activity with patients and the public during the development of the PNA. A report of the consultation is provided at appendix 9.
We have reviewed the services available from our pharmacies and our plans for future services, looking at the needs of our population and the current provision from our pharmacies.
Our assessment has found that our population enjoys good access to pharmaceutical services with a broad range of services available when and where they are needed.
We have identified areas where our current commissioning could be improved and where there are opportunities to use our pharmacists and pharmacy network in the future to deliver our vision for Bexley of excellent healthcare, locally delivered. We hope that this PNA will help to inform and debate the future of pharmacy services in Bexley and we encourage you to tell us your views as we consult on this document.
Next steps This is our first PNA under the new regulations. We expect new regulations to be published in the autumn of this year 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 people of Bexley.
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2. Introduction Bexley Care Trust is the local NHS organisation responsible for health services in the borough council area of Bexley which is located within the South East of Greater London. We are responsible for commissioning and planning services for the people who live in our area. This includes responsibility for ensuring that our population has access to safe, effective and personal pharmaceutical services.
This document describes Bexley Care Trust’s pharmaceutical needs assessment (PNA). This document has been prepared to meet the requirements of the National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendments) Regulation 2010. These regulations require PCTs to prepare and publish a PNA by 1st February 2011. The purpose of the PNA is: To inform and support the Care Trust’s commissioning plans for pharmaceutical services To inform and support the Care Trust’s decision making process in relation to market entry, this function requires further enabling regulation which is expected in the autumn of 2010.
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 our information about pharmaceutical services in Bexley.
We have developed this PNA through a process of engagement and collaboration with our stakeholders, particularly our community pharmacy contractors who provide pharmaceutical services to our population.
The PNA differs from other needs assessments in that the contents and manner of preparation are all 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, in developing the PNA, the Care Trust 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 the market entry decisions.
Definition of a pharmaceutical services 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 Care Trust’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.
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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 dispensing practices the scope of the service to be included 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 other services dispensing GPs may provide. There are no dispensing practices in Bexley at this time and patients registered with Bexley GPs may not access dispensing services from GPs outside our area.
For appliance contractors the scope of the service to be included in the PNA is the dispensing of appliances and the provision of the recently introduced Appliance Use Review (AUR) service. 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 or AURs where they is undertaken by an appliance contractor but not concerned with other services appliance contractors may provide. There are no appliance contractors in Bexley but our population does access specialist appliance dispensing providers outside Bexley so we will need to take this into account when thinking about the needs of our population.
For community pharmacy contractors the scope the services to be included in the PNA includes the essential, advanced and enhanced services whether provided under the terms of services1 for pharmaceutical contractors or under Local Pharmaceutical Services 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: Dispensing and actions associated with dispensing (e.g. keeping records) Repeatable dispensing ETP Disposal of unwanted drugs Promotion of healthy lifestyles Prescription linked interventions Public health campaigns Signposting Support for self care
All 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: Advanced Services, specifically: Medicines Use Review and Prescription Interventions (MURs) Appliance Use Reviews (this is a new service introduced from April 2010)
1 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”.
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Any contractor may choose to provide this service and must notify the Care Trust of their intention to do so, at this time a pharmacy contractor may undertake a maximum of 400 MURs per annum Enhanced Services, specifically: Anticoagulant monitoring service Care home service Disease specific medicines management service Gluten free food supply service Home delivery service 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 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 services should be commissioned, its scope and method of delivery.
Each PCT must make arrangements for the provision of these services in its area. In the case of Bexley Care Trust arrangements are in place for the provision of:
Needle syringe exchange service The Care Trust commissions a needle exchange service whereby the pharmacy provides clean injecting equipment to drug users and takes in used injecting equipment for safe disposal Patient group directions service The Care Trust commissions a service whereby some pharmacies provide access to emergency contraception under patient group directions Screening service The Care Trust commissions a Chlamydia screening service, whereby the pharmacy provides screening kits to the target population. Stop smoking service The Care Trust 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.
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Supervised administration service The Care Trust 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 pharmacist.
Community pharmacy contractors also provide services directly to patients which 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 Care Trust.
In making its assessment the Care Trust 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 Bexley. We have identified dispensing appliance contractors and pharmacies outside Bexley which play a significant role in providing a service to our patients. These are discussed later in the PNA in more detail.
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 Care Trust has an interest but are excluded from this assessment. These include prison pharmacy and secondary care services 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 Care Trust or prison authorities. NHS Bexley has no prisons within its area.
Secondary care pharmacy Patients in Bexley have a choice of provider for their elective hospital services. Most of our hospital services are provided by the South London Healthcare Trust. Mental Health services are provided by the Oxleas NHS Trust
The PNA makes no assessment of the need for pharmaceutical services in secondary care; 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.
Process followed in the development of the PNA NHS Bexley’s PNA has been developed using a mixture of methods drawing on a range of information source and reinforced through consultation with patients and pharmacy providers. The process was divided into five steps which are illustrated using Figure 1, below.
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The development process combines PNA development process the PCT’s strategic plans, draws on the Step 1 Step 1: PCT priorities, health needs JSNA which describe the health needs of Step 2 Step 2: Pharmacy profile and audit Pharmaceutical our population and links this to the Needs Step 3 Step 3: Patient experience commissioning of Assessment pharmacy services. Step 4 Step 4: Synthesis and assessment
Step 5 Step 5: Consultation and consensus The PNA provides a foundation for further work to develop a Pharmacy commissioning strategy pharmacy commissioning strategy for the PCT. Figure 1: Bexley PNA development process
Each step has a specific function and / or source of data which is described in Figure 2, below.
These data have been combined to provide a picture of our population, their current and future health needs and how our pharmacy network can be used to support the Care Trust to improve the health and wellbeing of our population.
Step Data source(s) Activity Strategic Plan 2008 - 13 Analysis and synthesis of relevant data for the Step 1 JSNA 2008 PNA.
Routine contracting and activity data which is held by the Care Trust A postal survey of pharmacy contractors in Step 2 Bexley National benchmarking using NHS Information Centre data
A postal survey of Bexley residents Step 3 Further consultation with stakeholder groups
Drawing together and synthesis of emerging themes and ideas Step 4 Drafting of the PNA and synthesis of the assessment and recommendations PCTs are required to consult on their PNA Step 5 before publication.
Figure 2: Bexley PNA development data sources and activity
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Governance and steering group The development of the PNA was overseen by a steering group whose membership was drawn from the Care Trust’s commissioning, primary care and public health departments. The steering group also had representation from the Local Involvement Network (LINKs), LPC, PBC groups and community pharmacy contractors. The membership of the steering group is described in Appendix 2.
Consultation during the development of the PNA The Care Trust has engaged in a process of consultation throughout the development of the PNA, this has included: A postal survey of Bexley residents which achieved a response from approximately 1,000 persons Engagement with community pharmacy contractors through the LPC and a postal questionnaire Consultation with community and voluntary groups through the Care Trust’s engagement team
Regulatory consultation process and outcomes The Care Trust conducted a consultation on a draft of the PNA with its stakeholders between 5th October 2010 and 6th December 2010. The consultation built on the PCTs significant engagement activity with patients and the public during the development of the PNA. A report of the consultation is provided at appendix 9.
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 Bexley, where the Care Trust becomes aware that a change may require the PNA to be updated then a decision to revise the PNA will be made.
Not all changes to pharmaceutical services will result in a change to the need for services, where required the Care Trust will issue supplementary statements to update the PNA as changes take place to the provision of services locally.
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3. Background to Pharmaceutical Needs Assessments The development of the policy which has led to the implementation of PNA has its roots in over seven years of policy making which are described in more detail in Appendix 1. Today, the drive to develop PNAs and to make PNAs part of market entry come from the recent Pharmacy White Paper Pharmacy in England: Building on strengths – delivering the future2.
Regulatory changes The Pharmacy White Paper was published by the Department of Health in April 2008. It highlighted the variation in the structure and data 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 regulations3 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 2010.
The duty on the Care Trust
The regulations place a statutory duty on each PCT to develop and publish their first PNA by 1 February 2011. The regulations set out the minimum requirements for the first PNA produced under this duty, and these include such things as data on the health needs of the Care Trust’s population, current provision of pharmaceutical services, gaps in current provision and how the Care Trust 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 the regulations list those persons and organisations that must be consulted e.g. the Local Pharmaceutical Committee, Local Medical Committee, LINKs and other patient and public groups.
Further reading on the policy and guidance in relation to pharmaceutical services is set out in Appendix 1.
2 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083815 3 http://www.opsi.gov.uk/si/si2010/uksi_20100914_en_1
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How the Care Trust has been divided into localities for the purposes of the PNA The PNA regulations require that the Care Trust divide its area into localities which are then used a basis for structuring the assessment. For the purposes of the PNA the steering group decided that the PNA should adopt the locality structure used to plan and deliver services in Bexley. This structure is based on three localities comprising between six and eight electoral wards.
The relationship between the wards and localities is shown below:
Figure 3: Division of Bexley into localities
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The three localities into which the Care Trust is divided range in size from 61,000 population in Frognal up to 85,000 in North Bexley.
Locality Ward Population Clocktower Brampton 10,134 Christchurch 10,394 Danson Park 10,365 East Wickham 10,186 Falconwood and Welling 10,420 Lesnes Abbey 10,809 St. Michael's 10,454 Clocktower Total 72,762 Frognal Blackfen and Lamorbey 10,242 Blendon and Penhill 10,206 Cray Meadows 10,295 Longlands 9,656 Sidcup 10,256 St. Mary's 9,950 Frognal Total 60,606 North Bexley Barnehurst 10,057 Belvedere 10,885 Colyers 10,412 Crayford 10,321 Erith 10,721 North End 10,417 Northumberland Heath 10,427 Thamesmead East 11,211 North Bexley Total 84,451 Bexley Care Trust 217,819 Figure 4: Population distribution in Bexley by ward and locality Based on GLA Round 2009 Borough Population Projections PLP Low 2010
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 to 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: Bexley, locality and Ward or SOA level.
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4. The context for pharmacy services in Bexley
Bexley Care Trust is located on the South East periphery of Greater London which also forms the SHA area in which the Care Trust is located. Within greater London the Care Trust borders the Thames in the north, Greenwich PCT in the west and Bromley PCT to the south west. The Care Trust borders West Kent to the south east. The Care Trust has a relatively small population of around 218,0004 residents.
The Care Trust is grouped with eight other PCTs with similar characteristics by the Office of National Statistics (ONS), namely:
East and North Hertfordshire Havering Medway Teaching Milton Keynes Peterborough South West Essex Teaching Swindon West Essex
This group is described by the ONS as the “New and Growing Towns” cluster group. More information about clusters and their construction can be found here: http://www.statistics.gov.uk/about/methodology_by_theme/area_classification/ha/cluster_su mmaries.asp). We have used the ONS cluster to compare and benchmark pharmacy services in Bexley with similar PCTs.
Bexley Care Trust 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 other is our Strategic Commissioning Plan, which covers a five year period and describes our plans for investment and outcomes in Bexley.
4 GLA Borough Population Projections Round 2008 Low
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Bexley JSNA This section describes the health profile of Bexley drawing on the most recent version of the JSNA (2008) which is available at: http://www.bexley.nhs.uk/docimages/676.pdf and other sources of data, including ONS and GLA data.
To set the scene for the PNA we describe the key characteristics of our population and their health and social care needs here. This section is informed by our JSNA and our Strategic Plan; it provides the context for pharmacy services and underlines the challenge we face to improve the health and wellbeing of our population.
Population characteristics Bexley has a younger population than the rest of England with a higher proportion of people aged 20 – 44 and a lower proportion of people overall aged over 65; this reflects its position on the periphery of London with a higher proportion of economically active people.
Figure 5: Bexley population age profile Data Source: Office for National Statistics mid-2007 estimates. Bexley: Columns / England: Line
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Population forecast Population forecasts by the GLA predict that the population of Bexley will grow from its current level of 218,000 people to almost 223,000 over the next 15 years.
Area 2010 2015 2020 2025 England 52,296,600 54,319,200 56,354,500 58,310,800 ONS Cluster 3,203,700 3,329,200 3,458,300 3,579,600 London 7,745,503 8,023,665 8,285,898 8,540,229 Bexley Care Trust 217,819 217,911 219,419 221,712 Figure 6: Bexley Population growth 2010 - 2025 Data Source: Office for National Statistics. Based on ONS mid-2006 population estimates for England and ONS group. London and Bexley projections based on GLA Round 2009 Borough Population Projections PLP Low.
Population change The growth in population in Bexley will be slower and more consistent than that predicted for England and London – the GLA projects that in the next five years the population change will be flat and then over the following two five year periods grow by approximately 1% each period.
Area Change 2010 - 2015 Change 2015 - 2020 Change 2020 - 2025 England 3.9% 3.7% 3.5% ONS Cluster 3.9% 3.9% 3.5% London 3.6% 3.3% 3.1% Bexley Care Trust 0.0% 0.7% 1.0% Figure 7: Bexley population growth, projected change Data Source: Office for National Statistics based on mid-2006 population estimates for England and ONS group. London and Bexley projections based on GLA Round 2009 Borough Population Projections PLP Low.
The projected changes for Bexley, which are moderate, hide larger changes are ward level as the chart below illustrates, the populations in some wards will rise while in others there will be a fall in population.
Figure 8: Ward population changes 2010 – 2016 GLA Round 2008 Ward Population Projections PLP Low 2001 -2031
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Forecast change in population structure The growth in population is also going to change the structure of the population, increasing the proportion of older people with a consequent increase in demand for support for long term conditions and escalation in the complexity of care. There will also be growth in the population aged under 16 years, the combined effect of these changes is to reduce the size of the population of working age.
2010 % 2015 % 2020 % 2025 % 2010 % 2015 % 2020 % 2025 % Name U16 U16 U16 U16 O65 O65 O65 O65 Bexley 19.5% 19.9% 20.4% 20.3% 15.1% 15.6% 15.5% 15.9% England 19.8% 19.8% 20.1% 20.0% 16.4% 17.9% 18.7% 19.9% ONS Cluster 21.1% 21.0% 21.3% 21.1% 14.9% 16.3% 17.1% 18.3% London 20.1% 20.3% 20.2% 19.6% 11.1% 11.2% 11.3% 11.8% Figure 9: Bexley population age profile change Data Source: Office for National Statistics. Additional Information: Data used based on ONS mid-2006 population estimates. London and Bexley projections based on GLA Round 2009 Borough Population Projections PLP Low.
There will be a marked growth in our population aged over 90 years of age.
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Population structure by ward Bexley has a larger proportion of its resident population in the younger (u 16) and older (0 60/65) age groups than London and the ONS cluster group. Frognal has the population with the oldest profile, it is generally older with most wards exceeding the Bexley average for residents over 60/65. The population in North Bexley is younger with North End and Thamesmead wards having significantly younger populations than the other wards in Bexley.
% Males over 65 Area % Under 16 and Females over 60 Brampton 17.6% 23.5% Christchurch 17.3% 20.6% Danson Park 18.2% 20.6% East Wickham 18.5% 20.9% Falconwood and Welling 19.6% 18.6% Lesnes Abbey 21.1% 17.9% St Michael's 22.6% 16.1% Clocktower Locality 19.3% 19.7% Blackfen and Lamorbey 19.1% 19.8% Blendon and Penhill 19.3% 20.8% Cray Meadows 18.9% 21.2% Longlands 16.6% 26.5% Sidcup 16.5% 22.4% St Mary's 17.9% 24.1% Frognal Locality 18.1% 22.4% Barnehurst 18.6% 21.0% Belvedere 21.6% 15.9% Colyers 21.4% 16.5% Crayford 22.3% 17.4% Erith 22.6% 13.5% North End 24.8% 12.7% Northumberland Heath 21.2% 17.3% Thamesmead East 25.2% 10.0% North Bexley Locality 22.3% 15.5% Bexley LA 20.1% 18.8% London SHA / GOR 19.3% 13.8% ONS Cluster (New and Growing Towns) 20.1% 17.2% England 18.9% 18.9% Figure 10: Population age profile by ward Data Source: Office for National Statistics mid-2007 estimates. Original data is split for males over the age of 65 and females over the age of 60. All data aggregated from LSOA level. Figures highlighted in red show wards with above Bexley average figures.
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Ethnicity Bexley’s population is less diverse (8.9% from a minority ethnic group, 2001 census) than that of London (28.8%) or England (13%). There are discrete areas in the Care Trust where there are high levels of diversity, particularly in parts of North Bexley (Erith and Thamesmead wards) and in Clocktower (Lesnes Abbey ward). There is a correlation between diversity and the age of the population with more diverse areas tending to also have a younger population with more families with children.
% non-white % non-white Area under 16 over 65 Brampton 9.1% 3.4% Christchurch 9.8% 2.3% Danson Park 10.7% 4.2% East Wickham 10.0% 2.4% Falconwood and Welling 7.7% 3.1% Lesnes Abbey 26.2% 6.1% St Michael's 9.0% 3.5% Clocktower Locality 12.1% 3.5% Blackfen and Lamorbey 6.4% 1.2% Blendon and Penhill 6.6% 2.0% Cray Meadows 8.7% 1.2% Longlands 7.1% 1.6% Sidcup 8.5% 3.0% St Mary's 7.1% 1.5% Frognal Locality 7.4% 1.8% Barnehurst 6.7% 2.0% Belvedere 18.0% 4.2% Colyers 8.6% 1.3% Crayford 6.2% 1.2% Erith 17.1% 5.2% North End 9.3% 3.0% Northumberland Heath 9.4% 1.0% Thamesmead East 33.2% 12.2% North Bexley Locality 13.9% 3.2% Bexley LA 11.7% 2.9% London SHA / GOR 40.6% 12.0% ONS Cluster (New and Growing Towns) 9.7% 2.4% England 13.6% 2.9% Figure 11: Population ethnicity by ward Data Source: NOMIS, 2001. All data aggregated from ward level
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Access Car ownership in Bexley is higher than the average for the ONS cluster, Greater London and England. Ownership is lowest in Frognal locality (particularly North End and Thamesmead wards).
More than Name No car One car Two cars 2 cars Brampton 19.2% 46.6% 27.9% 6.4% Christchurch 21.4% 47.2% 24.4% 7.0% Danson Park 22.4% 46.8% 24.4% 6.3% East Wickham 23.5% 46.9% 23.3% 6.3% Falconwood and Welling 20.2% 46.6% 26.4% 6.8% Lesnes Abbey 26.4% 46.4% 22.0% 5.2% St Michael's 18.1% 46.2% 28.5% 7.2% Clocktower Locality 21.7% 46.7% 25.2% 6.5% Blackfen and Lamorbey 17.0% 48.5% 27.2% 7.3% Blendon and Penhill 15.7% 45.2% 30.4% 8.6% Cray Meadows 24.1% 47.3% 22.8% 5.9% Longlands 23.7% 48.1% 22.7% 5.6% Sidcup 24.0% 44.1% 23.8% 8.1% St Mary's 15.4% 45.5% 31.0% 8.1% Frognal Locality 20.1% 46.4% 26.2% 7.2% Barnehurst 21.7% 46.2% 25.3% 6.7% Belvedere 28.2% 49.6% 18.7% 3.6% Colyers 29.3% 45.4% 20.3% 5.1% Crayford 27.5% 47.6% 20.7% 4.1% Erith 29.1% 49.0% 17.9% 4.0% North End 33.7% 47.8% 15.4% 3.0% Northumberland Heath 20.0% 46.2% 27.2% 6.5% Thamesmead East 34.1% 47.7% 15.2% 3.0% North Bexley Locality 28.1% 47.5% 20.0% 4.5% Bexley LA 23.7% 46.9% 23.5% 5.9% London SHA / GOR 37.5% 43.1% 15.8% 3.7% ONS Cluster (New and Growing Towns) 22.7% 45.1% 25.8% 6.3% England 26.8% 43.7% 23.6% 5.9% Figure 12: Car ownership at ward level Data Source: Office for National Statistics, 2001. All data aggregated from OA level
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Deprivation The Care Trust is sub-divided into discrete areas for the purposes of national statistics and census analysis. These areas (called super output areas) 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.
The national 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.
Figure 13: Bexley IMD by LSOA. Source: Commissioning Support for London (June 2010)
Analysis of the IMD for the lower level super output areas in Bexley shows that each of our localities has some levels of deprivation. However North Bexley has, by comparison to the rest of the Care Trust, the highest concentration of deprivation with more than half of all LSOAs in the 40% most deprived LSOAs in England. The converse is true of Frognal where 80% of LSOAs are in the least deprived 40% nationally.
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Figure 14: Distribution of LSOAs by quintile of deprivation in Bexley. Source IMD 2007
We can also draw on other measures of deprivation available including: Under 18 conception rates Children in low income families Rates of economic activity Qualifications
The table overleaf highlights some of the wards with indicators that are consistent with health inequalities and reduced socioeconomic opportunity.
The wards highlighted in blue are those wards where across the range of indicators there is a consistently poor picture of deprivation, inequality and social mobility.
Cells highlighted in gray show individual indicators which are worse than the Bexley average.
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% % children in unemploy Minimum Average Maximum low % ed % no IMD IMD IMD Minimum Maximum income economic economic qualificati Name Score Score Score IMD Rank IMD Rank families ally active ally active ons Brampton 4.28 8.27 18.57 15,049 30,652 18.5% 68.3% 2.1% 27.6% Christchurch 8.80 12.86 17.34 16,027 25,382 22.4% 71.3% 2.5% 24.5% Danson Park 9.52 13.93 29.52 8,389 24,470 30.3% 69.3% 2.5% 28.8% East Wickham 6.22 15.56 25.42 10,351 28,576 29.6% 68.3% 2.6% 32.7% Falconwood and Welling 6.30 10.64 18.82 14,848 28,480 19.1% 70.7% 2.0% 29.4% Lesnes Abbey 6.77 18.91 38.19 5,209 27,916 39.7% 67.0% 3.9% 31.3% St Michael's 6.68 11.09 17.82 15,653 28,017 23.2% 71.2% 2.7% 29.0% Clocktower Locality 4.28 13.04 38.19 5,209 30,652 26.3% 69.4% 2.6% 29.1% Blackfen and Lamorbey 5.78 8.81 12.89 20,396 29,056 19.3% 70.2% 2.2% 28.6% Blendon and Penhill 4.38 8.32 14.04 19,180 30,534 18.6% 70.3% 1.8% 27.1% Cray Meadows 7.87 19.92 34.50 6,470 26,540 38.1% 65.8% 3.1% 31.4% Longlands 3.97 10.51 21.63 12,709 30,931 19.9% 70.5% 1.9% 21.8% Sidcup 3.59 9.10 15.85 17,392 31,265 15.5% 71.1% 2.0% 20.7% St Mary's 3.54 7.98 16.28 17,005 31,309 15.5% 67.9% 1.9% 23.3% Frognal Locality 3.54 10.77 34.50 6,470 31,309 21.5% 69.3% 2.2% 25.5% Barnehurst 6.57 13.54 25.89 10,103 28,161 27.3% 70.5% 2.4% 28.1% Belvedere 15.29 23.00 32.37 7,235 17,921 44.2% 69.8% 3.6% 29.7% Colyers 10.34 24.11 41.34 4,320 23,390 46.1% 68.3% 4.1% 33.2% Crayford 8.44 20.19 36.13 5,861 25,840 37.9% 70.7% 2.9% 31.2% Erith 16.99 25.87 36.87 5,609 16,337 48.4% 70.7% 4.0% 28.8% North End 19.22 31.17 39.46 4,816 14,549 56.4% 66.5% 4.6% 35.9% Northumberland Heath 5.98 14.59 24.56 10,866 28,833 27.7% 71.1% 2.6% 29.6% Thamesmead East 17.75 28.51 37.95 5,271 15,711 55.8% 71.6% 5.6% 30.6% North Bexley Locality 5.98 22.62 41.34 4,320 28,833 43.8% 69.9% 3.7% 30.9% Bexley LA 3.54 16.04 41.34 4,320 31,309 32.4% 69.6% 2.9% 28.7% London SHA / GOR 1.71 25.61 70.59 221 32,352 46.8% 67.6% 4.4% 23.7% ONS Cluster 0.70 17.79 62.36 685 32,479 36.6% 71.1% 3.0% 29.2% England 0.37 18.36 85.46 1 32,482 40.5% 66.9% 3.3% 28.9% Figure 15: Socioeconomic data. Data Source: ONS, NOMIS and End Child Poverty. Employment and Qualifications, 2001. Child Poverty, Aug 2005. Qualifications data aggregated from MSOA level. For IMD data: Rank 1 is the most deprived and rank 32,482 the least deprived.
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Teenage pregnancy
Teenage pregnancy rates in Bexley are below the London and England rates and compare favourably to neighbouring PCTs in South East London. However within the Care Trust there are “hotspot” wards where rates are high.
The recently published Health Profile 2010 for Bexley give a provision rate for 2006- 08 of 39.8 per 1,000 population which compares with an England average of 40.9.
The wards where teenage pregnancy rates exceed the rate for Bexley are shows in the table below. The top three wards (North End, East Wickham and Colyers) are considered “hotspots” for teenage pregnancy and the focus of efforts by the Care Trust to address this challenge.
Locality Ward Quintile North Bexley North End 1 Clocktower East Wickham 1 North Bexley Colyers 1 Clocktower Falconwood and Welling 2 North Bexley Belvedere 2 North Bexley Erith 2 Frognal Blendon and Penhill 2 Figure 16: Ward ranking for teenage conception rates as a percentage of all conceptions 2005-2007, ONS 2009
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Figure 17 Teenage conception rates as a percentage of all conceptions 2005-2007, ONS 2009
There are a total of 19 pharmacies providing this service in Bexley. There are 4 in Frognal locality, 5 in Clocktower and 10 in North Bexley.
Infant mortality Reducing rates of infant mortality is a national and local priority; it is influenced by a range of factors which can be used as a proxy for child and maternal health.
Infant mortality rates are generally higher in deprived urban areas and among women from minority groups. Bexley Care Trust has a lower rate of infant mortality than the ONS cluster, London SHA and England, data for infant mortality is not available at ward level.
Perinatal Mortality Rate Neonatal Mortality Rate Infant Mortality Rate (1 Name (1 week) (4 weeks) year) England 2.62 3.41 4.94 ONS Cluster 2.14 2.80 4.21 London 2.45 3.29 4.83 Bexley Care Trust 2.02 2.61 4.16 Figure 18: Infant mortality rates Time period: 2005-07Data Source: The Information Centre for Health and Social Care. Additional Information: Data not available at ward level. Mortality per 1000 births
The recently published Health Profile 2010 for Bexley showed that for the period 2006 – 08 Bexley had an infant mortality rate of 4.02
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Burden of disease and ill health Bexley has lower levels of self reported long term limiting illness (LTLI) and self reported good health (both census measures). Male and Female life expectancy are better than comparative averages for the ONS cluster, London and England.
Looking at specific wards we can see this overall “good” picture has pockets were there are marked differences. The gap in life expectancy is 5.3 for men years between Colyers ward in North Bexley and Blendon and Pelhill in Frognal. The gap for women is 3.4 years between North End in North Bexley and Brampton in Clocktower. This correlates with the Standardised Mortality Ratio (SMR) which give us a measure of the impact of disease on a population (lower is better) with men in St Mary’s having an SMR of 76 versus men in North End with an SMR of 123. For women in Blackfen and Lamborey with an SMR of 71 and women in North End of 134.
Female % Male Life Life % reporting Expectan Expectan reporting poor cy at cy at Male Female Name LTLI health Birth Birth SMR SMR Brampton 15.7% 7.0% 78.5 84.2 84 78 Christchurch 15.9% 7.7% 76.5 79.5 104 114 Danson Park 15.9% 7.4% 78.0 81.4 83 91 East Wickham 16.9% 7.5% 78.3 81.2 85 102 Falconwood and Welling 13.7% 6.5% 78.4 81.8 86 90 Lesnes Abbey 16.4% 8.2% 77.1 81.8 96 87 St Michael's 13.2% 7.0% 78.4 82.8 84 89 Clocktower Locality 15.4% 7.3% 77.9 81.8 Blackfen and Lamorbey 14.0% 6.6% 78.7 82.8 83 71 Blendon and Penhill 13.6% 5.7% 79.4 82.4 77 87 Cray Meadows 18.1% 9.0% 77.3 80.9 91 94 Longlands 16.8% 7.5% 77.5 81.4 86 89 Sidcup 16.1% 6.8% 74.7 79.5 110 122 St Mary's 15.0% 6.7% 78.5 82.5 76 81 Frognal Locality 15.6% 7.0% 77.7 81.6 Barnehurst 15.3% 7.9% 77.6 82.5 87 91 Belvedere 15.9% 8.4% 77.6 80.3 96 106 Colyers 16.3% 8.2% 74.1 79.6 116 105 Crayford 17.0% 8.5% 76.7 83.2 91 93 Erith 15.3% 7.9% 75.6 80.0 107 106 North End 16.2% 8.4% 72.8 78.8 123 134 Northumberland Heath 14.9% 6.5% 77.7 81.1 83 97 Thamesmead East 15.6% 8.0% 74.9 79.1 113 117 North Bexley Locality 15.8% 8.0% 75.9 80.6 Bexley LA 15.6% 7.5% 77.1 81.3 92 94 London SHA / GOR 15.5% 8.3% 75.8 80.9 94 92 ONS Cluster 15.8% 7.7% 76.4 81.3 England 17.9% 9.0% 76.4 81.3 99 100 Figure 19: Male and female life expectancy and SMR by ward. Data Source: ONS. Time period: Life Expectancies - 1999-2003, Ward SMR data - 1999-2003, Other SMR data – 2008, other data – 2001. Life expectancies have been averaged to give higher level summaries. General Health and LTLI aggregated from OA level.
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Hospital admissions Admissions (all causes) in Frognal (particularly in Cray Meadows, Longlands and St Marys) and Clocktower (particularly in Brampton, Danson Park and Lesnes Abbey) track above London and ONS levels. Consequently the rate of admissions per 1000 population in Bexley (188.4) is greater than the rate for London (184.3) and our ONS cluster (182.5).
Key contributors to these raised admission rates are Cancer in Clocktower (particularly in Brampton and Lesnes Abbey). Genitourinary admissions in Frognal (particularly in St Mary’s ward).
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-
pters
ss(H60 to
Admissionrates per 1000 population Cha All Infectiousand parasitic diseases (A00 B99) to Neoplasms(C00 to D48) Bloodand blood forming organs (D50 D89) to nutritional and metabolic diseases(E00 to E90) Nervoussystem to (G00 G99) Eyeand adnexa (H00 H59) to Ear andmastoid proce H95) Circulatory(I00 to I99) Respiratory (J00 to J99) Digestive (K00to K93) Skinand subcutaneous tissue(L00to L99) Musculoskeletal to (M00 M99) Genitourinary(N00 N08) to Brampton 199.2 2.0 60.7 5.0 1.6 5.1 9.9 0.8 17.9 11.9 27.2 5.3 19.7 32.1 Christchurch 172.1 3.5 38.0 6.5 2.6 4.5 6.9 0.9 23.9 13.2 24.5 4.8 13.4 29.3 Danson Park 198.5 3.0 47.0 4.8 3.4 3.7 9.5 1.0 20.5 13.2 26.8 3.9 15.3 46.6 East Wickham 184.0 3.3 50.1 6.5 3.1 4.3 7.4 1.2 20.9 15.1 31.3 6.6 16.1 18.1 Falconwood and Welling 186.0 2.5 45.4 4.2 4.6 3.8 6.7 1.3 18.0 10.9 29.4 6.9 12.5 39.8 Lesnes Abbey 202.2 4.2 57.0 6.7 3.3 4.5 9.3 1.5 20.3 17.4 28.0 6.9 12.1 31.0 St Michael's 175.3 2.0 45.0 5.8 7.4 4.4 8.0 0.8 16.1 10.9 23.5 5.7 19.0 26.5 Clocktower Locality 188.1 2.9 49.0 5.7 3.7 4.3 8.2 1.1 19.6 13.2 27.2 5.7 15.4 31.9 Blackfen and Lamorbey 188.7 2.4 45.2 8.3 2.0 3.6 7.6 1.8 15.8 10.7 31.2 4.1 16.0 39.9 Blendon and Penhill 175.2 2.1 47.3 3.3 3.0 3.3 6.4 1.8 17.3 10.7 24.9 5.5 18.9 30.7 Cray Meadows 219.3 3.8 49.5 9.9 4.6 5.8 8.6 1.0 23.9 13.2 38.7 4.5 20.1 35.5 Longlands 218.3 3.9 56.5 4.6 3.6 6.0 8.9 1.1 25.5 18.2 34.2 3.5 15.0 37.2 Sidcup 166.5 3.3 35.6 8.7 3.5 4.4 8.8 0.8 18.4 11.8 24.8 5.1 14.5 26.6 St Mary's 194.7 4.0 38.6 2.9 3.4 5.3 9.0 0.8 21.8 11.1 28.3 5.1 16.6 48.0 Frognal Locality 193.5 3.2 45.4 6.3 3.4 4.7 8.2 1.2 20.4 12.6 30.3 4.6 16.9 36.2 Barnehurst 180.4 3.2 49.6 3.8 3.4 5.4 6.9 1.1 19.3 12.7 29.5 4.0 18.8 22.8 Belvedere 192.7 4.2 38.3 3.6 3.1 3.1 6.8 1.5 17.2 16.3 26.1 7.0 16.1 49.5 Colyers 204.4 5.3 47.7 4.7 2.2 4.3 7.5 1.6 19.9 17.1 29.0 3.9 13.3 47.9 Crayford 187.4 5.0 46.8 2.9 3.8 4.9 5.9 0.9 21.1 18.7 31.3 5.5 16.8 23.7 Erith 199.2 5.1 30.2 5.0 2.6 5.7 7.1 2.3 23.3 18.5 33.8 6.0 15.1 44.4 North End 186.7 4.9 37.4 10.3 2.7 4.3 5.7 1.9 19.9 21.9 30.1 4.9 13.8 28.9 Northumberland Heath 190.0 3.4 43.4 4.8 2.5 3.8 5.8 1.9 20.6 11.4 29.4 5.3 16.9 40.8 Thamesmead East 134.8 4.2 22.8 5.3 2.0 3.5 4.3 1.9 13.4 13.1 25.4 6.1 11.4 21.3 North Bexley Locality 184.2 4.4 39.4 5.1 2.8 4.4 6.2 1.6 19.3 16.2 29.3 5.4 15.2 34.9 Bexley LA 188.1 3.6 44.3 5.6 3.3 4.5 7.4 1.3 19.7 14.2 28.9 5.3 15.7 34.3 London SHA / GOR 184.3 4.3 30.1 6.3 4.1 5.3 8.4 1.3 24.6 15.9 31.0 6.6 14.7 31.6 ONS Cluster 182.5 3.5 31.6 4.2 4.0 5.8 9.1 1.6 27.2 16.5 32.0 5.1 18.6 23.3 England 202.0 4.1 34.7 5.1 4.4 6.2 9.8 1.7 27.4 18.4 33.4 6.3 19.9 30.6 Figure 20: Hospital admissions by chapter and ward. Data Source: HES / IC, 2007/08. All data aggregated from LSOA level. Admissions have been grouped using ICD-10 code groupings. All Chapters' refers to the chapters presented here and excludes any other conditions
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Disease prevalence – QoF data Data collected by GP practices provides a measure of the prevalence of the disease on practice registers. Bexley Care Trust has relatively average prevalence for common long term conditions with compared with England, in all disease areas except diabetes where prevalence is markedly higher. Frognal and Clocktower exhibit raised prevalence of disease associated with ageing (shd, stroke and dementia. North Bexley exhibits higher prevalence in diabetes and respiratory disease.
Atrial Stroke & Hyperte Fibrillati Heart Diabetes Diabete Mental Dementi CKD CKD Practice code CHD TIA nsion on Failure COPD Asthma (QOF) s (17+) Health a (QOF) (18+) Clocktower 3.2% 1.5% 14.4% 1.2% 0.7% 1.3% 5.1% 4.2% 5.2% 0.54% 0.28% 4.2% 5.3% Frognal 3.3% 1.7% 14.0% 1.6% 0.7% 1.3% 5.1% 4.4% 5.4% 0.61% 0.61% 3.3% 4.1% North Bexley 2.8% 1.3% 12.1% 1.0% 0.6% 1.5% 5.2% 4.7% 6.2% 0.69% 0.39% 2.2% 2.9% Bexley 3.1% 1.5% 13.4% 1.2% 0.7% 1.4% 5.1% 4.4% 5.6% 0.62% 0.40% 3.2% 4.1% SHA 2.2% 1.0% 10.8% 0.8% 0.5% 1.0% 4.7% 4.0% 5.0% 0.93% 0.29% 2.0% 2.6% England 3.5% 1.7% 13.1% 1.3% 0.7% 1.5% 5.9% 4.1% 5.1% 0.75% 0.43% 3.2% 4.1% Figure 21: Disease prevalence by ward Data Source: Quality Outcomes Framework, 2007/08. All data aggregated from practice level. Diabetes register only includes patients aged 17+ and prevalence has been calculated for this age group. CKD register only includes patients aged 18+ and prevalence has been calculated for this age group
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Atrial Practice Stroke & Hyperte Fibrillati Heart Diabetes Diabetes Mental Dementi CKD CKD code CHD TIA nsion on Failure COPD Asthma (QOF) (17+) Health a (QOF) (18+) G83006 4.0% 2.0% 14.7% 1.7% 1.0% 1.3% 5.4% 4.4% 5.3% 0.55% 0.36% 3.3% 4.1% G83009 3.2% 2.1% 13.5% 1.4% 0.9% 1.1% 5.0% 3.3% 4.2% 0.37% 0.48% 5.7% 7.4% G83046 2.8% 1.2% 14.3% 1.0% 0.3% 1.2% 4.6% 4.2% 5.0% 0.69% 0.30% 3.5% 4.3% G83061 4.1% 1.9% 16.9% 1.1% 0.8% 1.4% 6.2% 4.3% 5.4% 0.85% 0.18% 4.4% 5.6% G83024 3.0% 1.2% 13.8% 0.9% 0.4% 1.2% 4.0% 4.0% 4.9% 0.49% 0.40% 1.8% 2.3% G83033 2.8% 1.1% 18.2% 1.2% 0.4% 1.0% 6.0% 4.7% 5.6% 0.30% 0.11% 3.3% 4.0% G83028 2.6% 1.0% 13.6% 0.7% 0.5% 1.4% 4.2% 4.1% 5.2% 0.45% 0.15% 6.6% 8.4% G83025 3.2% 1.2% 13.0% 1.4% 0.6% 1.3% 5.4% 4.6% 5.7% 0.47% 0.26% 3.5% 4.3% G83002 2.6% 1.6% 14.1% 1.3% 0.9% 1.4% 4.7% 3.5% 4.4% 0.69% 0.28% 4.3% 5.4% Clocktower 3.2% 1.5% 14.4% 1.2% 0.7% 1.3% 5.1% 4.2% 5.2% 0.54% 0.28% 4.2% 5.3% G83605 2.6% 0.9% 14.7% 1.4% 0.5% 1.6% 5.8% 3.5% 4.4% 0.49% 0.08% 1.1% 1.4% G83029 3.9% 1.8% 12.4% 2.2% 0.8% 1.2% 5.8% 3.3% 4.1% 0.45% 0.55% 1.7% 2.1% G83066 3.4% 2.0% 13.1% 1.8% 1.1% 1.5% 4.3% 5.1% 6.2% 1.06% 1.71% 5.9% 7.3% G83047 2.8% 1.6% 12.9% 1.0% 0.7% 1.0% 4.5% 3.9% 4.9% 0.68% 0.34% 4.3% 5.4% G83064 3.9% 1.0% 16.2% 1.3% 0.2% 0.2% 4.7% 4.3% 5.2% 0.41% 0.12% 3.0% 3.6% G83004 3.2% 2.0% 14.3% 1.9% 0.6% 1.4% 4.8% 5.1% 6.1% 0.58% 0.63% 3.1% 3.8% G83057 3.6% 1.8% 15.4% 1.6% 0.8% 1.7% 5.9% 4.6% 5.7% 0.41% 0.39% 2.7% 3.4% Frognal 3.3% 1.7% 14.0% 1.6% 0.7% 1.3% 5.1% 4.4% 5.4% 0.61% 0.61% 3.3% 4.1% G83052 2.5% 1.0% 11.7% 0.9% 0.6% 1.2% 5.7% 4.7% 6.3% 0.97% 0.16% 2.6% 3.5% G83053 3.2% 1.4% 13.4% 1.2% 0.4% 1.5% 4.5% 4.7% 6.1% 0.63% 0.31% 2.5% 3.2% G83037 2.8% 1.5% 13.0% 1.0% 0.3% 1.3% 4.1% 5.7% 7.3% 0.63% 0.14% 0.8% 1.0% G83005 3.0% 1.5% 13.2% 1.5% 0.9% 1.8% 6.0% 5.5% 6.9% 0.62% 0.20% 3.7% 4.7% G83621 3.5% 1.6% 13.0% 1.2% 0.9% 1.7% 4.8% 5.5% 7.3% 0.94% 0.07% 3.6% 4.9% G83642 2.2% 0.8% 14.9% 0.7% 0.4% 1.1% 6.2% 3.9% 5.3% 0.38% 0.07% 2.4% 3.4% G83630 1.6% 0.7% 10.5% 0.8% 0.4% 1.0% 4.5% 3.5% 5.0% 0.80% 0.12% 2.4% 3.5% G83018 2.2% 1.1% 9.8% 0.6% 0.6% 1.4% 5.6% 4.9% 6.7% 0.80% 1.02% 2.4% 3.3% G83049 3.6% 1.7% 14.4% 1.3% 0.8% 1.0% 5.1% 4.4% 5.3% 0.43% 0.73% 1.4% 1.7% G83672 3.7% 0.6% 9.1% 0.7% 1.0% 0.8% 4.0% 6.2% 7.9% 0.82% 0.19% 2.6% 3.4% G83010 3.7% 1.7% 11.3% 1.1% 0.7% 2.0% 5.8% 4.7% 6.0% 0.67% 0.29% 0.8% 1.0% G83043 3.0% 1.1% 14.7% 1.2% 0.7% 2.1% 5.5% 4.4% 5.5% 0.80% 0.27% 2.8% 3.5% G83062 1.8% 1.1% 10.1% 0.5% 0.6% 1.4% 4.3% 3.9% 5.5% 0.67% 0.26% 0.7% 1.0% North Bexley 2.8% 1.3% 12.1% 1.0% 0.6% 1.5% 5.2% 4.7% 6.2% 0.69% 0.39% 2.2% 2.9% Bexley 3.1% 1.5% 13.4% 1.2% 0.7% 1.4% 5.1% 4.4% 5.6% 0.62% 0.40% 3.2% 4.1% SHA 2.2% 1.0% 10.8% 0.8% 0.5% 1.0% 4.7% 4.0% 5.0% 0.93% 0.29% 2.0% 2.6% England 3.5% 1.7% 13.1% 1.3% 0.7% 1.5% 5.9% 4.1% 5.1% 0.75% 0.43% 3.2% 4.1% Figure 22: Disease prevalence by practice. Data Source: Quality Outcomes Framework, 2007/08. All data aggregated from practice level. Diabetes register only includes patients aged 17+ and prevalence has been calculated for this age group. CKD register only includes patients aged 18+ and prevalence has been calculated for this age group
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Lifestyle factors Data relating to lifestyle factors are drawn from the results of a small sample lifestyle survey undertaken with a cross section of the population. The size of the sample makes assessing the prevalence difficult; therefore the reported rates set out below provide a maximum, minimum and average figure. Generally these data are not available below PCT level, however model based estimates are available which attempt to estimate the prevalence at MSOA level (approx 7,200 persons). Estimates below this level are not available.
Smoking
The average estimated smoking rate in Bexley is slightly above the England and London average and below the average for our peer group.
Minimum Smoking Maximum Smoking Average Smoking Estimate Estimate Estimate Bexley Care Trust 15.8 38.8 24.9 England 7.3 54.2 24.2 ONS Cluster 12.1 44.1 26.2 London 8.9 42.0 23.4 Figure 23: Smoking estimate. ONS 2003-05
The map below shows that the highest rates of smoking are found in the north and east of the Borough with a pocket in the south east of the Borough.
Figure 24: Model based smoking estimates 2003-05. Commissioning Support for London.
More recent data published in the Health Profile for Bexley 2010 shows that smoking prevalence among adults was 20.5% in the period 2006-08, the average for England for the same period was 22.2%. Fifteen pharmacies are commissioned to provide a stop smoking service, five in Clocktower, four in Frognal and six in North Bexley.
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Binge drinking
The average estimated binge drinking rate in Bexley is below the average for England and our peer group and in line with that in London.
Minimum Binge Maximum Binge Average Binge Drinking Drinking Estimate Drinking Estimate Estimate Bexley Care Trust 11.2 16.7 13.3 England 5.2 63.9 17.9 ONS Cluster 10.0 36.4 16.6 London 5.2 22.7 12.6 Figure 25: Binge drinking estimate. ONS 2003-05
The map below shows that the highest rates of binge drinking are found in the north and east of the Borough with a pocket in the south east of the Borough.
Figure 26: Model based binge drinking estimates 2003-05. Commissioning Support for London.
More recent data published in the Health Profile for Bexley 2010 shows that binge drinking rates among adults was 12.8% in the period 2006-08, the average for England for the same period was 20.1%.
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Obesity
The average estimated obesity rate in Bexley is below the average for England and our peer group and above the rate for London.
Minimum Maximum Average Obesity Obesity Obesity Estimate Estimate Estimate Bexley Care Trust 15.6 25.3 21.8 England 5.4 35.7 23.5 ONS Cluster 15.6 32.8 25.1 London 5.4 32.0 18.5 Figure 27: Binge drinking estimate. ONS 2003-05
The map below shows that the highest rates of obesity are found in the north and west of the Borough.
Figure 28: Model based obesity estimates 2003-05. Commissioning Support for London.
More recent data published in the Health Profile for Bexley 2010 shows that obesity among adults in Bexley was 26.0% in the period 2006-08, the average for England for the same period was 24.2%.
% adults 3 hours exercise per week Bexley Care Trust 16.5% England 21.8% ONS Cluster 19.7% London 20.3%
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5. Bexley’s Five Year Strategy
Bexley Care Trust has set out its ambitions for the next five years in its Strategic Plan 2010. This document is underpinned by the JSNA and informed through consultation and engagement with local people, clinicians and partners.
The strategy sets out a programme of work to deliver the Care Trust’s vision for Excellent Healthcare, locally delivered. This vision is underpinned by five goals, these goals are:
Improving Health: Improve the health and wellbeing of the local population
Long-term conditions: Improve care for patients with long-term conditions
Sexual health: Empower the population of Bexley to make informed choices about their sexual health
Mental health: Greater focus on mental health and wellbeing
Child health: Improve the life chances of local children
To deliver these goals the Care Trust as indentified a number of Bexley Initiatives which represent the priorities for the next five years. These initiatives will have a significant impact on healthcare in Bexley and so, are an important consideration in the development of the PNA.
Bexley Care Trust has been working closely with local pharmacy contractors to prepare the ground for the changes that are likely to result from this plan. At the heart of this work is the proposition that more could be achieved, and patients would benefit from better use of our pharmacy network and the pharmacist and staff who work in Bexley.
This work is in its early stages, however local pharmacists have come together to form a partnership to work together to plan for these changes. One area on which we are focused is using technology to deliver change. Technology like the electronic prescription service to reinvent how prescribing, dispensing and repeat dispensing work in Bexley, so that patients receive a more flexible service and workload in pharmacy is reshaped to allow pharmacist and their staff to provide other services. This work has the potential to enable pharmacies and pharmacists to increase their contribution to our strategic plan initiatives.
The Bexley initiatives give us a framework for mapping where pharmacy is making a contribution to our goals through existing work programmes and where there is the potential to make a contribution through future commissioning. The table over leaf makes these links and invites a discussion on how we can take these ideas forward with local clinicians to realise this potential.
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Mapping strategic priorities to current and potential contribution of pharmacy
Initiative Current contribution Potential contribution Diabetes Essential services Essential services: Pharmacies provide prescription linked interventions and Focus on repeat dispensing and EPS to streamline medication signposting to services for patients. supply process for Diabetic patients
Advanced services Advanced services Medicines use review supporting Diabetic patients to manage their Targeted MUR through local MUR+ service treatment Enhanced Services: Diabetes screening, education and testing have all been developed as enhanced services for delivery through pharmacies by PCTs. Stroke Essential services Essential services Pharmacies provide health promotion campaigns to support local Focus on repeat dispensing and EPS to streamline medication and national information programmes. supply process for Stroke patients
Advanced services MUR post discharge to support transfer of care and reduce errors and re-admissions.
Enhanced services Post discharge medication support service to support patients and carers to manage medication. Mental Health IAPT Essential services Essential services Pharmacies provide health promotion campaigns to support local Use public health campaigns to improve uptake and referral to and national information programmes. mental health services
COPD Essential services Essential services Pharmacies provide health promotion campaigns to support local Focus on repeat dispensing and EPS to streamline medication and national information programmes to raise awareness of supply process for COPD patients services Advanced services Advanced services MUR post discharge to support transfer of care and reduce errors Medicines use review supporting COPD patients to manage their and re-admissions. treatment Enhanced services Post discharge medication support service to support patients and carers to manage medication. COPD early warning system to identify exacerbation in COPD 39 Bexley Care Trust Pharmaceutical Needs Assessment through monitoring treatment. Referral into COPD specialist / Community Matrons. Sexual Health Essential services Essential services Pharmacies provide health promotion campaigns to support local Use public health campaigns to improve uptake of sexual health and national information programmes to raise awareness of services services Enhanced services Enhanced services Broaden sexual health services to include long term contraception EHC service and Chlamydia screening service supply. Re-focus on Chlamydia to improve uptake of screens and extend to include treatment CVD Essential services Essential services Pharmacies provide health promotion campaigns to support local Focus on repeat dispensing and EPS to streamline medication and national information programmes to raise awareness of supply process for CHD patients services Advanced services Advanced services MUR post discharge to support transfer of care and reduce errors Medicines use review supporting CHD patients to manage their and re-admissions. treatment MUR+ to target CHD patients specifically
Enhanced services Enhanced services Smoking cessation services Post discharge medication support service to support patients and carers to manage medication.
NHS Health Checks through community pharmacy
Mental Health Home Essential services Essential services Setting Pharmacies provide health promotion campaigns to support local Focus on repeat dispensing and EPS to streamline medication and national information programmes to raise awareness of supply process for Mental Health patients services Advanced services Advanced services MUR+ to target Mental Health patients specifically Medicines use review supporting Mental Health patients to manage their treatment Enhanced services Medication support service to monitor adherence to medication in the community setting, reducing relapse and re-admission.
COPD Smokers Essential services Advanced services Pharmacies provide health promotion campaigns to support local Link MUR to smoking cessation advice and national information programmes to raise awareness of
40 Bexley Care Trust Pharmaceutical Needs Assessment services Enhanced services Focus service on at risk groups for future COPD exacerbation. Enhanced services Pharmacies provide advice and support to patients to give up smoking
Child Health Emotional and Essential services Wellbeing Pharmacies provide health promotion campaigns to support local and national information programmes to raise awareness of services
Child Health Obesity Essential services Enhanced services Pharmacies provide health promotion campaigns to support local Weight management, health eating and exercise support service. and national information programmes to raise awareness of services
This exercise has identified a number of ideas which could be developed and advanced through the Care Trust’s commissioning cycle to identify candidates for future commissioning.
There are some broad themes that emerge: Making the most of the existing essential services, particularly sign posting and public health campaigns Using EPS and Repeat Dispensing to provide a more streamlined medication service for patients with the long term conditions among our initiatives e.g. COPD, Diabetes, CHD and Mental Health Using Medicines Use Review (MUR) to target patients that are a high priority for the Care Trust Developing Enhanced services that are focused on supporting long term conditions, discharge and transfer of care and reducing errors and readmissions
Clearly the ability of pharmacy to deliver these initiatives will depend on building capacity and redesigning services, this fits well with our current and ongoing discussions with pharmacy contractors in order to free up resources and capacity in the pharmacy network.
We will use this and the PNA more generally to inform our commissioning intentions as we progress with our strategy over the next five years.
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6. Insights from patients and the public The development of this PNA was informed through a process of purposive research with patients and residents in Bexley in order to develop insights into the views of this important stakeholder group about community pharmacy.
Current and future commissioning needs to be informed by, and sensitive to the views of patients. However there is very little systematic collection of patient experience feedback or views about pharmacy services that is available to the Care Trust.
To provide some context for the PNA an in-depth postal survey was conducted with a sample of 4,200 (1.8% of the registered population) patients registered with Bexley GPs.
The questionnaire covered the current use of pharmacy services, satisfaction with services, prescription medicines use and access to pharmacies.
Summary of responses The responses to the questionnaire provide a valuable insight into the views of patients that can be used to inform the CARE TRUST’s plans for pharmacy services. Nine out of ten people use the same one every time or try to do so Two out of five choose a pharmacy because it is close to their GP and two out of five because it is close to their home Eight out of ten respondents had visited a pharmacy for a health related purpose in the last month Nine out of ten visited to get a prescription dispensed and one in twenty to buy a medicine Eight out of ten rated their experience of their last visit very good or excellent Nine out of ten rated the friendliness of the staff very good or excellent Seven out of ten rated their experience of getting their prescription very good or excellent Half rated the privacy during their last consultation very good or excellent One in ten respondents did not get their full prescription on their last visit Eight out of ten of these because the pharmacy did not have enough stock of the medicine Seven out of ten of those affected had their medicines within one day. Nine out of ten people are satisfied with the opening hours of their pharmacies One in five people had experienced a problem using their usual pharmacy in the last 12 months. Most problems were reported on evenings (Weekday, Sunday and Bank Holidays), Saturday mornings and Weekday lunchtimes One in six respondents had a consultation with the pharmacist on their last visit Half of all consultations took place in the pharmacy shop; one in five consultations took place in a separate room.
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Pharmacist’s consultations were highly rated, but patients would have preferred more privacy Nine out of ten respondents take regular medicines on repeat prescription One in five people stop taking the regular medication if they feel worse One in five sometimes forget to take their medicines
The results have provided a valuable insight into the views of patients which will be useful in developing the PNA and planning pharmacy services in the future. The results provide a foundation on which we can develop further work to explore the important themes that have emerged from the questionnaire.
Results Over 1,532 people responded to a survey exploring the frequency and nature of their visits to local pharmacies, and their wider experiences and opinions of pharmacy services. Most of the data are presented as percentages of the total number of respondents answering a particular question: some questions have also been subject to comparisons of groups (by gender, or by locality). Findings deemed ‘significant’ are all measured at the level p<0.05. This section summarises the results of the response rate, descriptive statistics and considers some further comparisons identified from the main survey data. The overall response rate was 36.5%. This was considerably greater than results of similar anonymous survey studies where no follow-up was possible. The sampling of the survey was intended to be randomly distributed across an age stratified sample; however the results show that the sampling was skewed towards older people, who are also higher responders to this type of questionnaire. Consequently the respondents were mainly people aged over 60 years (93%). However, this is apposite when we consider the nature of the aims and priorities of the Care Trust in relation to the management of long term conditions.
General Demographics In terms of general demographics, 41% of the respondents were male and 59% female. The vast majority of respondents (93%) were aged 60 years or over, and thus a similar number did not pay for prescriptions. Overall, the respondents rated their health as good, very good or excellent (34%, 27%, and 11% respectively), with 22% rating their health as fair and 6% rating their health as very poor or poor. A significant minority of the sample classed themselves as ‘carers’ of someone in their or another household (12%), and 15% as ‘cared for’ by someone who was not paid to do so. Almost all the respondents were white (99%).
Respondents were asked to provide their postcode; this was used to determine the electoral ward and locality where they live. A total of 1329 (86.8%) valid Bexley postcodes were identified, 54 (3.5%) had a Greenwich postcode, 149 (9.7%) did not provide a postcode or provided an invalid postcode.
Respondents % Resident population Respondents (n) from Bexley Bexley LA Clocktower wards 501 38% 33% Frognal wards 377 28% 28%
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North Bexley wards 451 34% 39% Respondents living in Bexley 1,329 100% 100% Figure 29: Patient questionnaire respondents by locality
The results show that the respondents were well distributed across Bexley LA area with responses from every ward. The respondents that could be identified as living in Bexley represent 0.6% of the resident population. Responses from individual wards ranged from 0.34% to 0.93% of residents.
The sample thus reflects the concerns of a key user group of pharmacies – older people. Younger people, parents and BME residents, however, are represented in much lower numbers than in the general population of the Care Trust. As a result, no comparisons of responses have been undertaken with respect to the age of the respondent. These groups will be purposively targeted in subsequent work.
Use of Pharmacies Almost two-thirds of respondents stated that they used the same pharmacy all the time (63%). In later analysis, this group will be referred to as ‘one-pharmacy users’. Only 3% of the sample indicated that they used different pharmacies, and none more frequently than any others. There were no differences by locality regarding the likelihood of being a ‘one- pharmacy user’.
Thirty-one per cent of respondents believed that the pharmacist knew a great deal about them and their care, another third (33%) indicated this to some extent, and the last third felt that the pharmacist was not engaged in their care (many of whom said that they did not usually see the same pharmacist). ‘One-pharmacy users’ were significantly more likely to report that the pharmacist knew ‘a great deal’ about them and their care (40.0% vs. 13.8%), and was more likely to see the same pharmacist was similar for both groups (11.4% vs. 21% for not seeing same pharmacist).
Does the pharmacist know about you and your care? % (n=1227) Yes, a great deal 31.2 Yes, to some extent 32.8 No 21.4 I don’t usually see the same pharmacist 14.5 Figure 30: The respondent’s perceived knowledge of the pharmacist about them and their care
‘One-pharmacy users’ were also significantly more likely to have been taking one or more prescribed medicines for 3 months or longer (96% vs. 81.8%).
When asked about location factors that influenced pharmacy choice, most respondents used a pharmacy close to their GP practice (40%), or close to their home (38%). ‘One- pharmacy users’ were less likely than other users to say that proximity to shops was a reason for choice (11.2% vs. 22.5%). People in Frognal were less likely to cite the GP practice location as a factor than other localities.
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Location factor important to respondent % (n=1299) It is close to my doctor’s surgery 39.9 It is close to my home 37.6 It is close to other shops I use 15.4 It is easy to park nearby 4.4 It is near to the bus stop / tube station / train station 0.7 It is close to my children’s school or nursery 0.2 None of these 1.8 Figure 31: Location factors influencing choice of pharmacy
When asked about service factors that influenced pharmacy choice, most respondents indicated that a quick service (37%) or the pharmacy stocking their medication (25%) were the most important to them. ‘One-pharmacy users’ were more likely than others to cite the pharmacist/staff knowing them (18.8% vs. 7.2%) and the collection-delivery service (13.8% vs. 8.7%) as important factors : other users were more likely than ‘one-pharmacy users’ to cite medicines in stock as a reason for use (28.5% vs. 22.3%). People in Frognal were more likely to cite the pharmacist/staff knowing them than other localities.
Service factor important to respondent % (n=1298) The service is quick 37.4 The pharmacy usually has my medicines in stock 24.5 The pharmacist or staff knows about me and my medicines 14.3 The pharmacy offers a prescription collection and delivery service 12.1 There is some privacy when I want to speak to the pharmacist 5.2 The pharmacy is open late or at weekends 3.1 None of these 3.4 Figure 32: Service factors influencing choice of pharmacy
Most Recent Visit to a Pharmacy Over 80% of respondents had visited a pharmacy within the last month for a health-related service, with 30% having visited in the last week: only 7% had not visited a pharmacy in the last six months. Seventy-seven percent of respondents had visited the pharmacy for themselves. The most frequent reason given for this visit was to obtain medicine/s on prescription (93%), and this was more likely to be the reason for ‘one-pharmacy users’ than other users (95.9% vs. 86.3%).
Reason for using the pharmacy % (n=1325) To get medicine(s) on a prescription 92.5 To buy medicine(s) from the pharmacy 4.4 To get advice at the pharmacy 2.6 Other 0.4 Can't remember 0.2 Figure 33: Reasons for which respondents most recently visited a pharmacy
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Most of the respondents had visited a pharmacy that they used regularly (90%). Most accessed the pharmacy by walking there (49%) or by car (30%).
Transport used to reach pharmacy % (n=1359) Walking 48.9 Car 30.4 Public transport 8.2 Taxi 0.7 Other 0.5 Figure 34: Transport used to reach the pharmacy on most recent visit
Access to Pharmacy Services In the last twelve months, only 2% of respondents reported problems finding a pharmacy to get a medicine dispensed, to get advice or buy medicines. There were no differences between ‘one-pharmacy users’ and other users. The majority of respondents (96%) were satisfied with the opening hours of their pharmacy: ‘one-pharmacy users’ were significantly more likely to be satisfied than other users. Respondents from North Bexley reported slightly higher access problems than the other two localities (2.5% reporting problems compared with 1.6% in both Frognal and Clocktower).
When asked, however, whether they had experienced problems accessing their usual pharmacy, or the pharmacy closest to them, 20% responded that they had, and for 7% of people it had happened on several occasions. ‘One-pharmacy users’ were significantly less likely to have a problem than other users.
Number of times unable to use regular or closest pharmacy % (n=1464) Not at all 80.0 Once or twice 12.2 Three or four times 3.6 Five or more times 2.7 Can't remember 1.5 Figure 35: Access problems with local pharmacies
Most respondents (43%) indicated that the problem was on a normal week day, and 30% had a problem over the weekend.
Day when unable to use regular or closest pharmacy % (n=367) A normal weekday (Monday to Friday) 43.3 Saturday 16.1 Sunday 15.3 Bank holiday 3.0 Can't remember 22.3 Figure 36: Access problem days for local pharmacies
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Most access problems (62%) were cited during normal opening hours 8am to 6pm, with fewer during the evening, and very few overnight.
Time when unable to use regular or closest pharmacy % (n=354) Midnight – 8am (overnight) 2.5 8am – 1pm (morning) 30.5 1pm – 6pm (afternoon) 31.6 6pm – Midnight (evening) 16.1 Can't remember 19.2 Figure 37: Access problem times for local pharmacies
Written comments associated with these questions revealed that people had difficulty getting access aligned with early or late GP appointments, or had longer working hours than the pharmacy was open, or wanted more weekend opening hours:
Closes at 5pm, I don’t get home from work before 6pm need longer opening hours. Doctors’ appointments can start before 9am - most pharmacies open at 9am, means a return journey if early appointment. I would like them to stay open longer and on weekends. If you have a late appointment at the Doctors my local chemist is shut so have I travel to late night 7 day chemist by taxi. Local pharmacies are open 9-5. I am not at home between 9-5 except on weekends. Open late in morning, shut for one hour lunch time. Opening hours OK but on many occasions pharmacist is not there so you will be able to get your medicine. Think there should be more flexibility so that people who go to work can collect prescriptions after work. Could do with more local 24 hour pharmacies.
Over three quarters (77%) of the sample needed the pharmacy visit for themselves, and most needed a medicine on prescription (73%). As a result, almost half (46%) went to another pharmacy, and a similar number (49%) waited until the pharmacy was open again.
In terms of how they found the alternative pharmacy, 79% said they already knew which one would be open: a very small minority called NHS Direct, looked on the Internet, or found out by either telephoning, driving around, or receiving information from a friend or family member.
Consultations with Pharmacists In the last twelve months, a minority of respondents (17.2%) had had a consultation with a pharmacist: Most of these had been medicine-related (14.4%). There was no difference in incidence between ‘one-pharmacy users’ and other users. Most were initiated by the patient (63%), rather than the pharmacist (27%). The pharmacist was more likely to have initiated the discussion for ‘one-pharmacy users’ than other users (30.0% vs 19.5%), perhaps
47 Bexley Care Trust Pharmaceutical Needs Assessment reflecting a degree of familiarity that encouraged the pharmacist to be more proactive. People in Frognal were more likely to report having a consultation than in other localities.
The varying subjects discussed, and the person initiating the consultation, were reflected in the associated written comments:
Concerning a change in the brand which is usually prescribed to my daughter. Checking for Lactose as I am intolerant. About my husband giving up smoking. Discuss support tights on prescription from my doctor. I was asked to talk to pharmacist about my medication. Pharmacist told me it was required by law. Wanted to check if I needed tablets, but they had been prescribed by hospital. I take warfarin, and the pharmacist wanted to know the reading of my last blood test. Allergic to wasps - going to Egypt - do I need to take my epi pens? Blood pressure check. Run out of blood pressure tablets. To order my drugs. I had no idea I could have a consultation.
Over half of consultations (54%) were carried out at the pharmacy counter, 19% in a separate room, and 17% in a quiet part of the pharmacy shop.
Location % (n=408) At the pharmacy counter 54.2 In a separate room 18.9 In a quiet part of the pharmacy shop 17.4 In the dispensary 5.1 Over the telephone 2.9 Other 1.5 Figure 38: Location of the consultation
Respondents rated the pharmacist highly in the consultation in terms of listening, time spent, confidence and trust, and being treated with dignity and respect – although a significant minority felt this ‘to some extent’.
% Question (n=) Yes, definitely Yes, No to some extent Did the pharmacist listen carefully to 88.7 10.5 0.7 you? (n=408) Were you given enough time with 84.0 14.3 1.7 the pharmacist? (n=407) Did you have confidence and trust in 84.9 13.0 2.2 the pharmacist? (n=416) Did the pharmacist treat you with 92.5 7.0 0.5 dignity and respect? (n= 414)
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Figure 39: Perceptions of the consultation
Most respondents (79%) said the pharmacist definitely provided useful information, 16% said it was useful to some extent and 2% considered the advice or information not to be useful. ‘One-pharmacy users’ were significantly more likely to indicate it useful than other users (83.6% vs 68.3% ‘definitely’ useful). Ninety-five percent of respondents believed that they felt able to ask as many questions as they wanted. Eighty-two percent said the pharmacist answered all of the questions they asked, but 11% indicated the pharmacist had answered only some of their questions, and one person felt that none of their questions had been answered.
Experiences of Getting a Prescription As stated earlier, most respondents had made their most recent visit to a pharmacy to get medicine/s on prescription. The majority (77%) said that a member of staff had explained how long their prescription would take: 18% said that they were not told, and did not mind, but 4% were not told how long their prescription would take, and they would have liked to have been informed. ‘One-pharmacy users’ were more likely to have been told than other users (81.3% vs 70.8%), again perhaps reflecting the familiarity of their relationship with the pharmacy staff.
Two thirds of respondents (66%) waited in the pharmacy for their prescription. Of those who waited, 83% waited up to ten minutes: only 4% had to wait more than twenty minutes. One- third of ‘one-pharmacy users’ reported waiting less than 5 minutes, as opposed to one- quarter of other users.
The majority of respondents (90%) got all the medicines they needed on their last visit to the pharmacy. ‘One-pharmacy users’ were more likely to report full completion than others (91.8% vs 85.8%): this is likely to reflect the advantage of regular patronage in that the pharmacy knows what they need. Of those who did not, 77% said the main reason for incomplete prescriptions was stock shortage at the pharmacy, and 11% said that their prescription had not arrived at the pharmacy.
Reason for not getting all medicines needed % (n=135) The pharmacy had run out of my medicine 77.0 My prescription had not arrived at the pharmacy 11.1 My GP had not prescribed something I wanted 4.4 Some other reason 7.4 Figure 40: Explanations for not getting all medicines needed on the day
The overwhelming reason for multi-pharmacy users was a stock shortage (89.3% vs 70.1%): ‘one-pharmacy users’ reported relatively more problems in prescriptions not arriving at the pharmacy or some other problem. Most respondents had received their owing medicine within a day of the visit (69%), but a significant minority of 7% waited more than a week for their prescription to be completed.
The ‘other’ reasons given for not getting all the medicines needed included the following written explanatory comments:
3 Prescriptions. Only 2 passed to me until I asked for the third one which they had
49 Bexley Care Trust Pharmaceutical Needs Assessment overlooked! Dr has not signed prescription - had to wait till surgery resumed hours later. Another and inappropriate brand was substituted and had to be changed on the doctor’s orders. Has to be specially ordered. It was a new drug the pharmacy had not yet stocked. Told my prescription was very expensive, also, not enough space in shop to store a larger stock of what had been prescribed for me.
Problems Experienced with Long-term Medicines Most of the respondents (87%) had been taking prescribed medicines for three months or more. Most (70%) stated that they had had no problems with their medicines, and 85% did not report any problems, but a significant minority of 233 people (15%) reported up to six problems. The most common medication problems were changes to colour or shape of the medicine, and getting medicines out of the packaging.
Problem experienced with a medicine % (n=1533) Changes to colour or shape of the tablet 7.7 Getting a medicine out of the packaging 6.1 Confused by medicines that look similar 2.7 Swallowing or using my medicines 1.8 Reading the label or instructions 1.6 Taking my medicines the way the doctor wants me to 1.2 Figure 41: Types of problems experienced with long-term medicines
Number of problems experienced per Number % (n=233) respondent One 171 73.4 Two 39 16.7 Three 20 8.6 Four 1 0.4 Five 1 0.4 Six 1 0.4 Figure 42: Number of medication problems experienced by respondents
Over half of the respondents (58%) stated no medication adherence problems with their medicines, and 66% did not report any problems, but a significant minority of 513 people (34%) reported up to four problems. The most common adherence problems were discontinuing medicines if they made them feel worse, and forgetting to take medicines sometimes. ‘One-pharmacy users’ were significantly less likely to stop the medicine if feeling worse than other users (21.4% vs 27.5%), but there were no significant differences for the other adherence problems.
Adherence problem reported % (n=1533) Stopping the medicine if it made them feel worse 18.2 Forgetting to take medicines sometimes 18.1 Careless at times about taking the medicine 6.4 Stopping the medicine when they feel better 5.3 Figure 43: Types of adherence problems reported with long-term medicines
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Number of adherence problems experienced Number % (n=513) per respondent One 364 30.0 Two 123 10.1 Three 10 0.8 Four 16 1.3 Figure 44: Number of adherence problems experienced by respondents
Respondents reporting instances of being careless at times about taking medicines were significantly more likely than others to report having had a consultation with the pharmacist in the past year (p<0.05), but it is unclear why this might be from the survey.
Getting New Medicines Almost half of the respondents (42%) stated that they had had a new medicine on prescription in the last 12 months. The extent to which respondents felt that the pharmacist had explained different aspects of use of the new medication is reported in Figure 45.
Did the pharmacist Yes, Yes, to No Did not need explain...... in a way you completely some it could understand? (n=) extent What the medication was for 33.1 8.0 18.2 40.8 (n=677) Possible side-effects of the 19.2 8.2 32.6 39.9 medication (n=691) How to use this medication 30.2 7.0 17.7 45.1 (n=683) When to use this medication 31.9 4.9 15.8 47.5 (n=678) What other medicines, drinks or 21.4 6.1 28.8 43.6 foods you should avoid (n=683) Figure 45: Perception of explanations about new medicines
The table shows that, in each case, around 40% of respondents felt that they did not need an explanation of this aspect of use. Of those who did, about half felt that the pharmacist gave a complete explanation about what the medication was for, how to use it, and when to use it. Respondents felt more strongly that the pharmacist had not given a clear explanation of side-effects and other medicines, drinks or foods to avoid.
Most respondents (81%) felt able to ask as many questions as they wanted about the new medication. ‘One-pharmacy users’ were significantly more likely to feel able than other users (86.7% vs 70.1%), again perhaps reflecting the quality of their relationship with the pharmacist. On this occasion, a third (33%) of respondents felt the pharmacist answered all of their questions, but 60% had stated that they had not asked any questions. ‘One-
51 Bexley Care Trust Pharmaceutical Needs Assessment pharmacy users’ were more likely to report the pharmacist answering all their questions (41.8% vs 20.7%), and more likely to have asked questions (51.4% not asking any questions vs 68.2%).
Advice-giving by Pharmacists on Public Health Issues The survey asked respondents whether the pharmacist had ever discussed four important public health issues with them: stopping smoking; weight control; alcohol consumption; and risk of heart disease.
Has the pharmacist ever Yes No, and I No, and I Can’t talked to you would like don’t need remember about...... ? (n=) advice advice Stopping smoking (n=1420) 4.2 4.2 91.1 0.6 Drinking alcohol (n=1442) 2.1 3.4 94.2 0.3 Weight control (n=1453) 1.9 7.9 89.5 0.7 Your risk of heart disease 3.4 9.9 84.9 1.8 (n=1451) Figure 46: Reports of the pharmacist discussing public health issues
The table shows that most respondents did want to advice from the pharmacist about these health issues, and a very low level of such discussions taking place. Comparison of groups showed that pharmacists had spoken to significantly more men than women about smoking, alcohol and heart disease (p<0.05). There was some interest in getting advice about weight control (8%) and risk of heart disease (10%) from the pharmacist. Respondents from North Bexley seemed more interested than those from other localities in such advice.
There were notable differences in the responses of ‘one-pharmacy users’ and others. Previous results have indicated a strong trend for more proactive advice-giving and general discussion between ‘one-pharmacy users’ and their pharmacists and staff. This was again reflected here as modest increases in the number who reported that the pharmacist had discussed these issues with them, but then balanced out against the number who said No, and they would like advice. For all 4 areas, the proportion of one-pharmacy and multi- pharmacy users feeling that they did not need advice was similar. The only significant difference between one-pharmacy and multi-pharmacy users was on the topic of heart disease (p<0.05). All differences are small, but may become significant when extrapolated to larger populations and thus represent a possibly small but significant impact on local population health.
Comparison % of One-pharmacy Users and Multi-Pharmacy Users (OPU / MPU) Has the pharmacist ever Yes No, and I No, and I Can’t talked to you would like don’t remember about...... ? advice need advice Stopping smoking 5.3 / 3.3 4.7 / 4.0 89.6 / 91.8 0.4 / 2.7 Drinking alcohol 3.2 / 1.3 4.0 / 3.1 92.3 / 95.6 0.5 / 0.0
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Weight control 2.4 / 1.9 8.2 / 9.7 88.4 / 87.9 1.1 / 0.4 Your risk of heart disease 5.0 / 2.2 9.3 / 13.1 83.1 / 83.4 2.5 / 1.3 Figure 47: Reports of the pharmacist discussing public health issues with one- and multi-pharmacy users
The Range of Pharmacy Services In a final question regarding respondents’ perception of the range of pharmacy services, only 6% of respondents stated that they wished pharmacies could provide more services, and 90% were satisfied with current service provision. One-pharmacy users were more likely to report satisfaction with the range than multi-pharmacy users (4.5% vs 10.0%).
Rating of Pharmacy Service Elements Respondents were asked for rating of different aspects of pharmacy services within the survey. Figure 48 combines the answers to these questions to explore and compare results across these elements of the pharmacy service.
Politeness
Using Pcy
Excellent Getting Rx Very good Wait Good Fair
Service Element Service Privacy Poor Very Poor Access
Comfort
0% 20% 40% 60% 80% 100% % of Respondents
Figure 48: Respondent rating of pharmacy service elements
When this analysis was run with ‘one-pharmacy users’ only, ratings of ‘excellent’ increased for each aspect.
Politeness and Welcome: The majority of respondents reported that the staff had made them feel welcome (94%). Forty-six percent rated the staff as ‘excellent’ in terms of politeness, and 36% rated them ‘very good’. People in Frognal gave slightly higher ratings of politeness than others.
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Using a Pharmacy: Overall, 84% of the sample rated their most recent experience of using a pharmacy as ‘excellent’ or ‘very good’. Only 1% rated their last experience of using a pharmacy as ‘very poor’ or ‘poor’.
Getting a Prescription: Overall, 72% of the respondents rated their experience of getting their prescription as either ‘excellent’ or ‘very good’ on their last visit. Only 3% rated their experience as ‘poor’ or ‘very poor’.
Privacy in the Pharmacy: Although 46% of the sample rated the level of privacy as ‘excellent’ or ‘very good’, over one-quarter of respondents (28%) rated the privacy of the consultation as ‘fair’ or worse. Only 30% of respondents were offered the choice of having the consultation somewhere where they could speak privately. Written comments from respondents reflect their feelings about this issue:
For the discussion we had it was adequate. It is not a private matter but I do prefer privacy most times. Would have preferred not to have had the consultation - the same thing had happened before.
It was notable that respondents from the Frognal locality rated privacy either better or worse than other localities, being less likely to take the middle ground.
Waiting Time and Comfort: Almost 87% of respondents found the wait acceptable (rated ‘excellent’ to ‘good’). People in North Bexley gave slightly worse rating of waiting time than people in other localities: they were also more likely not to wait in the pharmacy for their prescription. Most respondents who waited (93%) indicated that there was sufficient waiting room in the pharmacy, but over one-quarter (27%) rated the comfort as ‘fair’ or worse. People in Frognal were less likely than others to rate the comfort as ‘poor/very poor’.
Access to a pharmacy: When people had found their normal pharmacy closed and had to find an alternative, they were still positive in their rating of the experience. 16% rated it ‘excellent’, two-thirds ‘very good’ or ‘good’, and 15% rated it ‘fair’ or worse. People in Clocktower were less likely to rate the experience ‘poor/very poor’ than others.
Cleanliness: Regarding pharmacy cleanliness, 87% of the sample rated the pharmacy as ‘very clean’, but a significant minority of 13% perceived the pharmacy cleanliness as ‘fair’ or worse.
Opinion of cleanliness of pharmacy visited % (n=1306) Very clean 86.8 Fairly clean 12.7 Not very clean 0.3 Not at all clean 0.2 Figure 49: Opinions of pharmacy cleanliness
Conclusions The results show that there is good satisfaction with pharmacy services among respondents. This positive rating extends across the factors assessed in the questionnaire;
54 Bexley Care Trust Pharmaceutical Needs Assessment however respondents that had a consultation with the pharmacist rated privacy lower than other service factors. This presents a challenge to pharmacists and pharmacies when they deliver services that require a consultation to ensure that patients have the privacy that they require.
Access to pharmacies was generally considered good and most respondents were satisfied with the opening hours of their pharmacies.
A significant minority of patients taking prescribed medicines reported problems in using or taking medicines. This suggests that there is a silent, but significant group that is not fully realizing the benefits of their prescribed medication. The WHO estimates that between 35 and 50% of all prescribed medication is not taken as intended. The challenge of non- adherence is evident in Bexley and merits active consideration.
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7. The assessment
The regulations governing the development of pharmaceutical needs assessments require the Care Trust 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 are relevant but do not constitute “necessary services”. Services not currently commissioned that will be necessary in specified future circumstance Services not currently commissioned that would secure improvements or better access to pharmaceutical services In reaching these conclusions the Care Trust is expected to explain where it has taken account of other services which have influenced its assessment.
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, 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.
Distribution of pharmacies by locality Bexley Care Trust has 45 community pharmacy contractors and 29 GP practices with 12 branch practices associated with these GP practices. The tables in Appendix 3 show the address of each pharmacy and GP practice, the ward into which the address falls and the neighbourhood. For GP practices the table shows the registered population which is approximately 4,000 larger than the resident population of the Care Trust
The pharmacy contractors include one “100 hour” pharmacy. This type of pharmacy contractor must open for at least 100 hours each week and may be required to provide certain specified local services by the Care Trust.
Benchmarking distribution of pharmacy services Using the comparative indicators that are available we can see that access to pharmacy services in Bexley is better than in other, comparable PCTs. This is demonstrated by the slightly higher number of pharmacies per head of population (Bexley: 20.6 per 100,000) when compared with our ONS cluster group (ONS: 20 per 100,000 population).
56 Bexley Care Trust Pharmaceutical Needs Assessment
Figure 50: Distribution of pharmacies in Bexley compared to ONS cluster group The closure of one pharmacy in Bexley in 2009 (after the NHSIC figures were prepared) would bring the number of pharmacies per head of population down to 20.1 per 100,000 population which would bring Bexley into line with the peer group average.
Pharmacies Population Prescriptions Pharmacies per per pharmacy 100,000 resident (monthly population average) 2009/10 Clocktower 14 73,994 19 5,418
Frognal 14 61,418 23 5,074
North Bexley 17 86,719 20 5.743
Bexley 45 222,131 21 5,434
SHA 23 4,253
ONS cluster 20 5,966
England 20 5,856 Figure 51: Pharmacies per head of population by locality Source: NHS Bexley, June 2010 *Locality level figures are derived from data collected by the Care Trust and may not correlate with the NHS Information Centre statistics presented previously.
Patients views Patients prefer pharmacies located close to their GP (39.9%) and close to their home (37.6%). Most important in choosing a pharmacy was the speed of the service provided (37.4%) and having the medicines in stock (24.5%). Only 2% of respondents to the questionnaire had reported a problem finding a pharmacy when they needed one in the last 12 months.
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Conclusions on distribution Bexley Care Trust has a level of pharmacy provision which is in line with comparable peer PCTs and appropriate for the size of our population. Our population is able to access pharmacy services and has a reasonable choice of provider in each locality localities.
Essential Small Pharmacies Scheme Three pharmacies in Bexley have been granted ESPLPS (Essential Small Pharmacies Local Pharmaceutical Services) status. This scheme provides pharmacy contractors located more than 1km from the nearest pharmacy with a guaranteed minimum income where their dispensing volume falls below a threshold. The purpose of the scheme is to secure provision in areas were a pharmacy would otherwise not be viable. Of the three ESPLPS pharmacies in Bexley one now falls out with the scheme as the number of prescriptions dispensed by this pharmacy has grown to exceed the threshold. The two pharmacies that fall within the scheme are:
Soka Blackmore Chemist in Erith, and Southcott Chemist in Sidcup
These pharmacies are located more than 1km from the nearest pharmacy. Soka Blackmore provides a broad range of enhanced services to its population and is an active provider of MUR services. Southcott pharmacy is located in an isolated part of Sidcup and serves a community which would otherwise have considerable difficulty accessing pharmaceutical services.
Local Pharmaceutical Services (LPS) The Care Trust has designated the three localities in Bexley for the purposes of LPS; this designation expires in November 2010. The purpose of the designation was to allow the Care Trust to work up plans for LPS services to support the planned Polysystems programme.
Opening hours Pharmacies are required to open between specific times by their terms of service. A detailed breakdown of pharmacy opening hours by ward and locality is provided in Appendix 3. .
Access to pharmacy services Opening hours of community pharmacies adapt to the demands of the local population and are influenced by the opening hours of GP services.
Current supplementary pharmacy opening hours held by the Care Trust show that there is good access throughout the week and at weekends across Bexley which reflects both the urban nature of the localities and the presence of a supermarket pharmacy in North Bexley and a 100 hour pharmacy in Clocktower.
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Pharmacies Weekday Saturday Sunday Open Close Open Close Open Close Clocktower 14 08:30 23:00 08:30 23:00 08:30 23:00
Frognal 14 08:30 19:30 09:00 18:00
North Bexley 17 08:00 22:00 07:00 21:00 10:00 16:00 Figure 52: Pharmacy opening hours in Bexley by locality
Very few pharmacies close for a half day during the week.
Pharmacies Mon Tue Wed Thu Fri Clocktower 14 - - 1 - - Frognal 14 - - - 1 - North Bexley 17 - - 2 - - Figure 53: Pharmacy half day closures in Bexley by locality
All but three pharmacies in Bexley open on a Saturday, more than half remaining open until 5pm. Very few pharmacies open on a Sunday and there are no pharmacies open on a Sunday in Frognal.
Remaining open at...on Saturday Open on Open on Locality Pharmacies Saturday Sunday 1pm 2pm 3pm 4pm
Clocktower 14 14 11 9 9 9 3
Frognal 14 14 12 12 11 9 0
North 17 16 12 9 8 8 2 Bexley
Bexley 45 44 35 30 28 26 5
Figure 54: Pharmacy weekend opening in Bexley by locality
Access 8am – 8pm The Healthcare for London programme has focused efforts on securing access to a broader range of services in primary care and on provision between 8am and 8pm. It is important to ensure that there are also pharmaceutical services available at the same time to the population. Currently there is good provision in the traditional core pharmacy hours, however provision is poor between 8am and 9am and between 7pm and 8pm. Frognal has no pharmacies open after 7.00pm, Monday to Friday, however residents of Frognal have access to pharmacies across the border with Bromley (to the south) which are open extended hours and in Clocktower (to the north).
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Open Open Open at Open Open Open at Open at after after Locality Pharmacies 9am after after 8am 8.30am 5pm 6pm 7pm 8pm
Clocktower 14 0 3 14 14 8 2 2
Frognal 14 0 1 115 14 6 1 0
North 17 1 2 166 17 10 1 1 Bexley
Bexley 45 1 6 41 45 24 4 3
Figure 55: Monday to Friday access 8am – 8pm
Access on Saturday reflects the provision during the working week with good provision between 9am and 5pm but poor provision between 8am and 9am and 6pm and 8pm. Provision in Frognal is from neighbouring pharmacies in Bromley and in Clocktower.
Open Open Open at Open Open Open at Open at after after Locality Pharmacies 9am after after 8am 8.30am 5pm 6pm 7pm 8pm
Clocktower 14 1 5 14 10 3 3 2
Frognal 14 11 7 1 0 0
North 17 1 1 14 7 3 1 1 Bexley
Bexley 45 2 6 39 24 7 4 3
Figure 56: Saturday access 8am – 8pm
Patients views In the last twelve months, only 2% of respondents reported problems finding a pharmacy to get a medicine dispensed, to get advice or buy medicines. The majority of respondents (96%) were satisfied with the opening hours of their pharmacy.
100 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 is one 100 hour pharmacy in Bexley which is located in Falconwood and Welling which is in Clocktower locality.
5 Three pharmacies in Frognal open at 9.30am (Source: total contractual hours) 6 One pharmacy in North Bexley opens at 9.30am (Source: total contractual hours)
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In addition some pharmacies choose to open extended hours; these pharmacies may vary their hours by giving the Care Trust 3 months notice. There is one extended hours pharmacy (Sainsbury’s) located in Crayford ward in North Bexley.
Out of hours services The Carson Review (2004) of out of hour’s 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 out of hour’s provider and not on the patient. Out of hours provision in Bexley is commissioned from GRABADOC which provides a telephone, clinic and home visiting service. Arrangements are in place to ensure that patients seen out of ours are able to get the medicines they need or are able to obtain these medicines in the in hours period.
Conclusions on opening hours Analysis of the opening hours of our pharmacies has identified some areas for future work. It is reassuring to note that our two most deprived localities (North Bexley and Clocktower) have the better access and extended opening hours of pharmacies. While opening hours in Frognal, which is relatively less deprived, are shorter, there is access to pharmacies in Bromley and Clocktower available to residents.
Dispensing services Dispensing services are provided by our 45 community pharmacies. Pharmacies in Bexley dispense fewer prescription items (Bexley: avg. 5,104 items per month) when compared to our ONS cluster group (ONS: median. 6,049 per month).
Figure 57: Prescription items dispensed by pharmacies in Bexley compared to ONS cluster group. Source: NHSIC 2009
The average prescription volume per pharmacy in each of our localities is consistent with the number of pharmacies observed per head of population. These data suggest that in Bexley there is capacity in our community pharmacy network to absorb additional work as our population grows without adding additional pharmacy contractors.
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Patient views The majority of respondents (90%) got all the medicines they needed on their last visit to the pharmacy. Of those who did not, 77% said the main reason for incomplete prescriptions was stock shortage at the pharmacy, and 11% said that their prescription had not arrived at the pharmacy. Most respondents had received their owing medicine within a day of the visit (69%), but a significant minority of 7% waited more than a week for their prescription to be completed.
There is a current and known issue with the supply of common medicines which is related to supply chain changes taking place nationally. This is the subject of a national focus involving the Department of Health, pharmaceutical manufacturers, wholesalers and pharmacy owners. We will monitor the outcome of these discussions to understand if there is any local action that could be taken to improve the supply of medicines to our patients.
Analysis of cross border dispensing Patients are free to choose where to have their prescription dispensed, this means that in some areas there is can be significant cross border movement of prescriptions to pharmacies outside Bexley. In 2009-10 2.95 million prescription items were issued by Bexley GPs, of these 2.54 million (86%) were dispensed by Bexley pharmacies.
EPACT data shows that there are 555 pharmacies outside Bexley dispensing Bexley prescriptions. Of these just five pharmacy contractors account for one third of all non- Bexley dispensing. It is these pharmacies that we will take account of in considering services provided across the border to our population.
The top five non-Bexley pharmacies dispensing prescriptions of Bexley patients are shown below:
Pharmacy contractor Address Postcode PCT Stevens RW (Chemists) Ltd 379 Footscray Road SE9 2DR Greenwich Boots UK Limited 48-52 High Street DA1 1DE West Kent Browne AF Ltd 16 Wilton Road SE2 9RH Greenwich Wm Morrison Supermarkets Plc 2 Twin Tumps Way SE28 8RD Greenwich Pring W & Co 40 Chatterton Road BR2 9QE Bromley Data Source: EPACT, 2009-10
Repeat dispensing Essential services include repeat dispensing. Repeat dispensing allows GPs to issue a long term supply of medication which the patient obtains at regular intervals from their pharmacy. The patient does not need to return to the GP each month to obtain a new prescription. At each supply the pharmacist reviews with the patient whether they require the medication and may choose not to dispense an instalment. Repeat dispensing has the potential to reduce waste and to improve adherence to medicines by creating a regular interaction between pharmacist and patient.
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Uptake of repeat dispensing has been slow in Bexley, only 0.027% of prescriptions are issued via repeat dispensing in Bexley.
Essential services – conclusions We consider that access to essential services, specifically dispensing services, is a necessary service the need for which is secured through our existing pharmacy network. The opening hours of pharmacies provide our population with goods access to services across the week.
We have not found any evidence of a gap in this service.
Essential services – future improvements We could also improve the uptake of repeat dispensing by working with GPs and pharmacists to encourage more practices to issue repeat dispensing prescriptions to stable patients.
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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 Care Trust 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.
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.
Pharmacy contractor questionnaire A questionnaire was developed by the Care Trust and agreed with the LPC, this questionnaire was distributed to each pharmacy contractor in Bexley. Some pharmacy contractors did not return the Care Trust approved questionnaire, opting, instead, for a template questionnaire produced by the PSNC (version 3). The resulting data for analysis represents the best fit combination of the two datasets obtained from contractors.
Responses were received from 39 of the 45 pharmacy contractors (87%)
Clock Frognal North BCT Tower Bexley Number of pharmacies 14 14 17 45 Returned BCT questionnaire 12 11 13 36 Returned PSNC questionnaire 0* 1 2 3 All responses 12 12 15 39 No response 2 2 2 6 Figure 58: Responses to questionnaire by locality
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Premises and consultation areas Of the 39 pharmacies in Bexley that returned a questionnaire, 35 have a consultation area (90%) providing good access generally to pharmacies with the facilities to undertake confidential consultations with patients.
Clock Tower Frognal North Bexley BCT n % n % n % n % Consultation area meeting 11 92% 11 92% 13 87% 35 90% the requirements of advanced services Figure 59: Pharmacies with consultation areas
Two pharmacies said they planned to introduce a consultation area in the future – one in November 2010 and one in July 2011. One in Frognal and one in North Bexley.
Three pharmacies reported access to a consultation area off the pharmacy premises which meets the MUR standard but these all already had an on-site consultation area. Two in Clock Tower and one in Frognal.
Two pharmacies had 2 consultation areas, one in Frognal and one in North Bexley.
Almost all (90%) are a closed room, 59% of the consultation areas have wheelchair access, with approximately similar percentages across the three localities, just under half (46%) have toilet nearby that customers can use and 38% are suitable for an appliance use review.
Clocktower Frognal North Bexley BCT n % n % n % n % Closed room 12 100% 10 83% 13 87% 35 90% Wheelchair access 7 58% 7 58% 9 60% 23 59% Toilet that patients can use nearby 7 58% 6 50% 5 33% 18 46% Suitable for appliance use review 5 42% 3 25% 7 47% 15 38% Figure 60: Consultation area facilities
The Care Trust questionnaires asked for additional information about the consultation area, the responses below are based on the 36 pharmacies that returned the Care Trust questionnaire. The most common additional attributes of consultation areas were having a computer terminal in the area (75%), with access to the internet (72%).
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Clocktower Frognal North Bexley BCT n % n % n % n % Computer terminal 8 67% 9 82% 10 77% 27 75% Internet access from computer 9 75% 9 82% 8 62% 26 72% Sink 7 58% 7 64% 7 54% 21 58% PMR access from computer 7 58% 7 64% 6 46% 20 56% Telephone 4 33% 4 36% 7 54% 15 42% Hot water supply 5 42% 5 5 38% 15 42% Examination couch 1 8% 0% 3 23% 4 11% Figure 61: Consultation area facilities (BCT questionnaire detail)
Future work The presence of consultation areas in many pharmacies presents an opportunity to the Care Trust to use pharmacies in new and different ways to deliver services. In some respects the Care Trust is already doing this through commissioning of local enhanced services.
Benchmarking Looking specifically at MUR/PI which has been provided since 2005 we find that median for provision of MUR among pharmacy contractors in our ONS cluster group was 84% (2008/097) of pharmacies, Bexley (70%) was significantly below this level at that time; however provision has now risen into line with the ONS median.
Figure 62: MUR uptake in ONS peer group
7 This is the latest data which is available from the NHSIC.
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The maximum number of MURs that a pharmacy may provide is 400 in any one financial year. Pharmacies in Bexley provided 167 MURs in 2008/09 on average; this is in line with the median of 166 MURs for our ONS peer group.
Figure 63: MUR activity in ONS peer group
Current provision The provision of Advanced Services in 2009/10 in Bexley based on BCT payment data is shown below, no comparator data for the ONS peer group is available for this period at this time. We have shown 2008/09 data to show how provision has developed over time with provision growing from 66% of pharmacies to 84% of pharmacies.
Mapping provision at locality level shows that there is some inequality of provision with fewer active pharmacies in Clocktower when compared with Frognal and North Bexley. The pharmacies that are active in Clocktower also undertake fewer reviews.
Number Number Percentage Average actively actively Number of actively MURs/ Neighbourhood providing providing pharmacies providing Provider (2008/09)8 (2009/10)9 (2009/10) (2009/10
Clocktower 14 8 12 85.7% 124 Frognal 14 10 11 78.6% 153 North Bexley 17 12 15 88.2% 152 Bexley 45 30 38 84.4% 143 Figure 64: Pharmacy provision of advanced services by locality Data source: PPD MI data supplied by Bexley Care Trust (Feb 08 – Jan 09)
8 Active provision is defined as claiming for at least one MUR in the 12 month period 9 ditto
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Provision of MUR is good when mapped against indicators of need, for example the table below shows, by ward, the number of pharmacies accredited to provider MUR. Ward names shaded in red are those in the highest quintile for older people and those highlighted in blue are wards in the top quintile for residents with LTLI.
Locality Ward Inactive Active Grand Total Clocktower Brampton 3 3 Christchurch 3 3 Danson Park 2 2 East Wickham 2 2 Falconwood and Welling 2 1 3 St Michael's 1 1 Clocktower Total 2 12 14 Blackfen and Frognal Lamorbey 3 3 Blendon and Penhill 2 2 Cray Meadows 1 1 Longlands 1 1 Sidcup 1 3 4 St Mary's 1 2 3 Frognal Total 3 11 14 North Bexley Barnehurst 2 2 Belvedere 3 3 Colyers 1 1 2 Crayford 3 3 Erith 2 2 North End 1 1 Northumberland Heath 1 2 3 Thamesmead East 1 1 North Bexley Total 2 15 17 Grand Total 7 38 45 Figure 65: MUR provision by ward with wards with high LTLI and older population highlighted
Responses to the pharmacy questionnaire correlate well with the Care Trust data, however not all pharmacies responded to the questionnaire so a precise comparison cannot be made. The data show that all current providers plus some pharmacies that are not currently able to provide the service would be willing to do so in the patient’s home or other suitable site.
Three pharmacies reported that they do not currently provide the MUR service, two intend to begin providing in the next year, one intends to begin providing but had no timescale.
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Clocktower Frognal North Bexley BCT n % n % n % n % Currently provide MUR service 11 92% 11 92% 14 93% 36 92% Willing to provide MURs in patient’s homes or other suitable site Yes 12* 100% 11* 92% 13 87% 36 92% No 1 8% 1 3% Plan if not currently providing service Intend to provide in next year 1 1 2 5% Intend to provide – no timescale 1 1 3% Do not intend to provide Figure 66: Advanced services currently provided and willingness to provide / expand (n=39)
*Two pharmacies indicated they would be willing to provide service outside the pharmacy although they were not currently providing it in the pharmacy.
The two pharmacies intended to provide the service in the next year were waiting for a suitable consultation area to be installed. The one pharmacy who was unsure when they might provide the service cited staffing issues as the barrier to providing the service.
Patient’s views Patients taking long term medication reported problems using their medicines, particularly dealing with changes to the presentation (7.7%) and getting medicines out of the packaging (6.1%). These percentages are small but significant. However a far higher proportion reported adherence problems including remembering to take their medication (18.1%), stopping their medicine when they felt worse (18.2%), being careless about taking their medicine (6.4%) or stopping taking their medicine when feeling better (5.3%). These patients also reported wanting more information from the pharmacist about their medicines, particularly about possible side effects (32.6%) and what the medicine was for (18.2%).
Advanced services – conclusions The stated purpose of advanced services fits well with the Care Trust’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 self-reported rates of adherence among patients. At this time we do not believe that Advanced Services are a necessary service, however the service a relevant service and we will continue to work with our pharmacies to ensure that it is delivered where and when our patients need it.
Advanced services – other matters We will continue to work with our pharmacy contractors to develop MUR services to widen access and target provision with high priority patient groups.
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Enhanced pharmaceutical services We commission the following local enhanced services from our pharmacy contractors: Emergency Contraception Service Chlamydia Screening and Treatment Smoking Cessation Service Needle Exchange Service Supervised Consumption Service
Emergency Hormonal Contraception Service The Care Trust commissions an Emergency Contraception Service from community pharmacies. The EHC service is available to women aged 14 – 24 resident in Bexley. To provide this service the pharmacy must be commissioned by the Care Trust to provide the service. Each pharmacy must have at least one pharmacist trained and accredited to provide the service. Pharmacies also sell EHC over the counter.
The enhanced service addresses the need to provide easy and convenient access to emergency contraception to women. The impact that the service seeks to make is to address the rates of teenage pregnancy in Bexley.
There is good evidence for pharmacy’s role as an effective, acceptable and accessible outlet for emergency contraception. The service is commissioned by over 70% of PCTs in England.
Current commissioning The service is provided in 19 pharmacies (42%) across Bexley. Provision is focused in areas where young women are more likely to access the service, like town centre pharmacies. The table below shows the provision by ward in Bexley with the three teenage pregnancy hotspot wards highlighted.
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Locality Ward EHC providers All pharmacies Clocktower Brampton 1 3 Christchurch 2 3 Danson Park 2 East Wickham 2 Falconwood and 1 3 Welling St Michael's 1 1 Clocktower Total 5 14 Blackfen and 1 3 Frognal Lamorbey Blendon and Penhill 1 2 Cray Meadows 1 Longlands 1 Sidcup 2 4 St Mary's 3 Frognal 4 14 Total North Bexley Barnehurst 2 2 Belvedere 3 3 Colyers 1 2 Crayford 1 3 Erith 1 2 North End 1 Northumberland Heath 1 3 Thamesmead East 1 1 North Bexley Total 10 17 Grand Total 19 45 Figure 67: Provision of EHC enhanced service with “hotspot” wards highlighted.
Our contractor questionnaire showed that a further 20 of the 39 contractors that responded would be willing to provide the EHC service in the future.
All those willing to provide each Clocktower Frognal North BCT service Bexley n % n % n % n % EHC service 7 58% 7 58% 6 40% 20 51% Figure 68: Willing to provide enhanced services not currently commissioned
Future plans The Care Trust has recently concluded a sexual health needs assessment; this has highlighted the need for pharmacy services provision in the East Wickham hotspot ward. There are two pharmacies in East Wickham, both have consultation areas. The Care Trust is working with the two pharmacy contractors in East Wickham to secure provision in this area.
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EHC Service Conclusions The EHC service through pharmacies provides important access to EHC for women in Bexley and is a key part of the Care Trust’s aims to reduce teenage conceptions. Without this service access would only be available via a GP appointment or sexual health service clinic, this would limit access considerably. Community pharmacies offer extended access, without an appointment in a relatively anonymous setting.
We consider the EHC service to be a necessary service; we will work with willing providers to ensure there is comprehensive provision.
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Chlamydia screen and treatment Bexley commissions a Chlamydia Screening and Treatment service from pharmacies. The service allows pharmacies to offer the option of a Chlamydia test to the target population and to then offer treatment if the test is positive.
Increasing screening, education and treatment are key priorities for the Care Trust, the target age group is young people aged 16 – 24 years, however there is also evidence that STI rates are rising in our older population. Current commissioning The service is commissioned in 14 pharmacies across Bexley.
The table below shows the provision by ward in Bexley with wards with above average younger populations highlighted.
Chlamydia Screen and All pharmacies Locality Ward Treat Provider Clocktower Brampton 1 3 Christchurch 1 3 Danson Park 2 East Wickham 2 Falconwood and 3 Welling St Michael's 1 Clocktower Total 2 14 Blackfen and 3 3 Frognal Lamorbey Blendon and Penhill 1 2 Cray Meadows 1 1 Longlands 1 Sidcup 4 St Mary's 3 Frognal 5 14 Total North 2 2 Bexley Barnehurst Belvedere 2 3 Colyers 2 2 Crayford 3 Erith 1 2 North End 1 Northumberland 3 Heath Thamesmead East 1 North Bexley Total 7 17 Grand Total 14 45 Figure 69: Chlamydia screen and treat commissioning
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Our contractor questionnaire showed that a further 23 of the 39 contractors that responded would be willing to provide the Chlamydia screening service in the future.
All those willing to provide each Clocktower Frognal North BCT service Bexley n % n % n % n % Chlamydia screening & treatment 8 67% 7 57% 8 53% 23 59% Figure 70: Willing to provide enhanced services not currently commissioned
Chlamydia Screen and Treat Service Conclusions The Chlamydia screen and treat service has yet to fully develop, our experience is mirrored in other PCTs where uptake, generally has been low, however in areas where pharmacy is a destination for young people the service works well.
We have concluded that the Chlamydia screening and treatment service is a necessary service for our population and one which pharmacy, alongside other providers, makes a valuable contribution to delivery.
We will review the uptake and commissioning of this service to ensure the best fit with our objectives and to fit with other screening programmes.
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Smoking Cessation Service Bexley Care Trust commissions a Stop Smoking Service from community pharmacies. The service includes the provision of advice on stopping smoking and supply of smoking cessation therapy (SCT), which is a key differentiator of pharmacy stop smoking services from other providers of stop smoking services. Pharmacies are seen as key providers of stop smoking services due to their opening hours, accessibility and ability to advise and supply SCT.
The stop smoking service directly addresses a key outcome measure for the Care Trust. Stopping smoking is the single most effective health care intervention that can be made. Wards with the highest rates of smoking are: Erith, North End, Northumberland Heath, Colyers and Crayford in North Bexley, East Wickham in Clocktower and Cray Meadows in Frognal.
Current commissioning The table below shows the provision by ward in Bexley with wards with rates in the top two quintiles in Bexley highlighted. Stop smoking All Locality Ward providers pharmacies Clocktower Brampton 1 3 Christchurch 2 3 Danson Park 2 East Wickham 2 Falconwood and 1 3 Welling St Michael's 1 1 Clocktower Total 5 14 Blackfen and 1 3 Frognal Lamorbey Blendon and Penhill 1 2 Cray Meadows 1 Longlands 1 Sidcup 2 4 St Mary's 3 Frognal 4 14 Total North Bexley Barnehurst 1 2 Belvedere 2 3 Colyers 2 Crayford 1 3 Erith 2 North End 1 Northumberland Heath 1 3 Thamesmead East 1 1 North Bexley Total 6 17 Grand Total 15 45 Figure 71: Provision of stop smoking enhanced services with wards in top two quintiles for smoking rates highlighted.
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Our contractor questionnaire showed that a further 18 of the 39 contractors that responded would be willing to provide the Smoking Cessation service in the future.
All those willing to provide each Clocktower Frognal North BCT service Bexley n % n % n % n % Smoking cessation service 3 25% 7 58% 8 53% 18 46% Figure 72: Willing to provide enhanced services not currently commissioned
Patient views Patients responding to the questionnaire were asked whether the pharmacist had ever spoken to them about stopping smoking. 4.2% could recall having a discussion with the pharmacist and a further 4.2% would have like to discuss this with the pharmacist. Bexley has an average smoking estimate of 24.9%, these data suggest that pharmacies have the potential to target one sixth of the smokers in Bexley simply through offering opportunistic advice.
Recent changes to the service The Care Trust has recently revised the therapies available through the Stop Smoking Service in order to ensure that the service performs within budget. A decision has been made to continue to allow the most consistent providers (the top 7 pharmacies) to continue to do so and that this would be capped at one patient per quarter.
Smoking Cessation Services Conclusions The stop smoking service through pharmacies is an important strand of the Care Trust’s efforts to reduce smoking rates among the population. One in three of our pharmacies provides a stop smoking counselling service, however we could improve access through pharmacy in areas where smoking rates are highest by involving pharmacies that are willing to provide this service in these areas in the service.
Pharmacy is a unique provider with a high quit rate and the ability to provide access to NRT at the point of care. Given this and the priority placed on reducing smoking rates in Bexley we consider the smoking cessation service to be a necessary service.
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Needle exchange & Supervised Consumption Service Pharmacies in Bexley provide 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. 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 Bexley has a multiagency Community Safety Partnership 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 Care Trust’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. Current commissioning The aim of commissioning these services is to ensure that there are strategically located needle exchange sites across the Care Trust area and to ensure that there is a comprehensive network of supervised consumption sites across the Care Trust to ensure that clients in drug treatment are able to use a service close to where they live or work.
The table overleaf show we have good provision of both services commensurate with these commissioning intentions. Sixteen of our pharmacies provide the supervised consumption service Two of our pharmacies currently provide the needle exchange service Needle exchange service can also be obtained at the following non-pharmacy sites: Queen Mary’s Hospital, which is located in Longlands Ward Erith Hospital, Outpatients Department, which is located in Erith Ward Signpost, Erith Health Centre, which is located in Erith Ward The wards where these sites are located are highlighted in blue on the table overleaf.
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Provides Provides supervised Needle All pharmacies Locality Ward administration Exchange Clocktower Brampton 2 3 Christchurch 2 3 Danson Park 2 East Wickham 1 2 Falconwood and 3 Welling St Michael's 1 Clocktower Total 5 14 Blackfen and 1 3 Frognal Lamorbey Blendon and Penhill 1 2 Cray Meadows 1 Longlands 1 Sidcup 3 4 St Mary's 3 Frognal 5 14 Total North 1 2 Bexley Barnehurst Belvedere 1 3 Colyers 2 Crayford 1 3 Erith 2 1 2 c North End 1 Northumberland Heath 1 3 Thamesmead East 1 1 North Bexley Total 6 2 17 Grand Total 16 2 45 Figure 73: Needle exchange and supervised administration commissioning
Our contractor questionnaire showed that a further 16 of the 39 contractors that responded would be willing to provide the supervised consumption service in the future and that 27 of the 39 contractors that responded would be willing to provide needle exchange services.
All those willing to provide each Clocktower Frognal North BCT service Bexley n % n % n % n % Supervised consumption service 5 42% 5 42% 6 40% 16 41% Needle exchange service 9 75% 8 67% 10 67% 27 69% Figure 74: Willing to provide enhanced services not currently commissioned
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Conclusion – Needle Exchange and Supervised Consumption Service 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.
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Appendix 1: Policy context and background papers National policy context influencing the development pharmacy and PNAs This Appendix provides some context for the policy influencing the development of community pharmacy and PNAs specifically. 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 proposal for the NHS.
A Vision for Pharmacy in the New NHS (July 2003) The recent pace of change for NHS community pharmaceutical services over 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. That is what was intended when the Department of Health launched A Vision for Pharmacy in the New NHS in July 2003. That 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 2004. 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 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 2005. It comprises three tiers of services – essential, advanced and local enhanced services.
Essential services are those which every pharmacy must provide, including dispensing. Advanced services are those which, subject to accreditation requirements, a pharmacy contractor can choose to provide. At present, there is one advanced service - the Medicines Use Review (MUR) - where a pharmacist discusses with a patient their use of the medicines they are taking and whether there are any problems which the pharmacist can help resolve. Essential and advanced services are determined nationally.
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Local enhanced services, such as help for substance misusers, are commissioned locally by PCTs 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 provide in providing services which support patients with long term conditions and make treatment for minor illnesses accessible and convenient.
NHS Next Stage Review The NHS Next Stage Review final report 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 PCTs, pharmacists and the 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 well-being 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 well-being and reducing health inequalities. These include proposals for how pharmacies will, over time:
become ‘healthy living’ centres – promoting health and helping more people to take care of themselves;
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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 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. For PCTs 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 world class commissioning of services from community pharmacy.
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Documents and reference papers for PNA
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. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida nce/DH_083815
PNAs as a part of world class commissioning guidance. This guidance sets out why Pharmaceutical Needs Assessments (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. http://www.nhsemployers.org/PayAndContracts/CommunityPharmacyContract/Pages/PNAs asapartofworldclasscommissioning.aspx
Developing pharmaceutical needs assessments guidance This guidance and individual supporting guides explain why Pharmaceutical Needs Assessments (PNAs) are important and how they fit into PCTs' planning cycles. It outlines how to produce a new PNA or revise an existing one. http://www.nhsemployers.org/PayAndContracts/CommunityPharmacyContract/Pages/PNA_ Guidance.aspx
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. http://www.nhsemployers.org/PayAndContracts/CommunityPharmacyContract/Pages/Phar macy-basedsmokingservices.aspx
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 2009/2205.
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.
83 Bexley Care Trust Pharmaceutical Needs Assessment http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida nce/DH_105361
World class commissioning: Improving Pharmaceutical Services This is a practical guide to support PCTs in commissioning pharmaceutical services. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_097408
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. http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Communitypharmacy/ Localpharmaceuticalservices/LPSPermanenceguidance/index.htm
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. http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/PharmacyWhitePaper/ RegulationsAdvisoryGroup/index.htm
The DH has now published the revised guidance and regulations. The regulations were laid in parliament on 23rd March 2010 and will come into force on 24th May 2010. The updated guidance and regulations can be accessed at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents /digitalasset/dh_114952.pdf
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Appendix 2: Membership of the steering group Name Role Organisation
Annie Gardner Patient Liaison Manager Bexley Care Trust Anton Glinski Interim Assistant Director of Systems & Bexley Care Trust Service Management Arvinder Gill Community Pharmacist Brownes Chemist Bipin Patel Pharmacy Contractor, LPC Chair Broadway Pharmacy Clare Fernee Head of Medicines Management Bexley Care Trust Elizabeth Ozogolu Community Pharmacy Contracts Bexley Care Trust Manager John Adeyemo Pharmacy contractor Praise pharmacy Jon Wood PEC pharmacist and Boots Area Boots the Chemist Manager and Bexley Care Trust Khushbu Lalwani Public Health Development Manager Bexley Care Trust Michael Boyce Assistant Director of Finance Bexley Care Trust Paul Cutler Non Executive Director / Pharmacy Bexley Care Trust Champion on the Board Peter Buck Assistant Director of Public Health Bexley Care Trust Raj Matharu Joint Chief Officer BBG LPC Sarb S Bansal Community Pharmacy Contracts Bexley Care Trust Manager
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Appendix 3: Pharmacies and GP practices in Bexley Clocktower
FCS Code Legal name Address 1 Postcode Ward Locality FH281 Lloyds Pharmacy 32 Pickford Lane DA7 4QW Brampton Clocktower FXK04 Praise Ltd 146 Long Lane DA7 5AH Brampton Clocktower FLK13 National Co-Operative Chemist 297 Brampton Road DA7 5QR Brampton Clocktower FA575 Broadway Pharmacy 172 Broadway DA6 7BN Christchurch Clocktower FMH33 Boots The Chemist Ltd 31-33 DA6 7JJ Christchurch Clocktower FH066 Crook Log Chemist 329 Broadway DA6 8DT Christchurch Clocktower FTM47 Boots The Chemist 109-111 Welling High Street DA16 1TY Danson Park Clocktower FCE42 National Co-Operative Chemists CWS Superstore DA16 1TU Danson Park Clocktower FE068 B R Lewis Chemists Ltd 62/64 Upper Wickham Lane DA16 3HQ East Wickham Clocktower FKV68 Bellegrove Pharmacy 225 Bellegrove Road DA16 3RQ East Wickham Clocktower FE097 Falconwood Pharmacy 3 Falconwood Parade DA16 2PL Falconwood and Welling Clocktower FXN89 Mistvale Chemist 175a Bellegrove Road DA16 3QS Falconwood and Welling Clocktower FYQ93 Mistvale Chemist 15 Bellgrove Road DA16 3QS Falconwood and Welling Clocktower FRM32 Hayshine Ltd 54 Wrotham Road DA16 1LN St Michael's Clocktower
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Frognal
FCS Code Legal name Address 1 Postcode Ward Locality Targett Chemist 172 Halfway Street DA15 8DJ Blackfen and Lamorbey Frognal FY261 Browne’s Pharmacy 252 Blackfen Road DA15 8PW Blackfen and Lamorbey Frognal FPX29 Day Lewis Pharmacy 253 Westwood Lane DA15 8PS Blackfen and Lamorbey Frognal FP029 Blackfen Olins Pharmacy 3 The Oval DA15 9ER Blendon and Penhill Frognal FHR27 Compact Chemist 137-139 Blendon Road DA5 1BT Blendon and Penhill Frognal FQ282 Hollytree Pharmacy 2 Hollytree Parade DA14 6JR Cray Meadows Frognal FLD66 Southcott Chemist 281 Main Rd DA14 6QR Longlands Frognal FD537 Boots The Chemist Ltd 56-58 High Street DA14 6EH Sidcup Frognal FE434 St Johns Pharmacy 16 High Street DA14 6EH Sidcup Frognal FQ835 Lloyds Pharmacy 23 High Street DA14 6EQ Sidcup Frognal FHN98 Roadnight Chemists 88 Station Road DA15 7DU Sidcup Frognal FED29 Warren Pharmacy 24 High Street DA5 1AD St Mary's Frognal FX373 Bourne Road Pharmacy 7 Bourne Parade DA5 1LQ St Mary's Frognal FTK01 Albany Pharmacy 24 Steynton Avenue DA5 3HP St Mary's Frognal FFL63
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North Bexley
FCS Code Legal name Address 1 Postcode Ward Locality Daysol Pharmacy 3 Parkside Parade DA1 4RA Barnehurst North Bexley FAQ24 Davidson Chemist 5 Midfield Parade DA7 6NA Barnehurst North Bexley FCG07 Lloyds Pharmacy 7 Nuxley Road DA17 5JE Belvedere North Bexley FR109 Knightons Chemist 36 Nuxley Road DA17 5JJ Belvedere North Bexley FTM56 Spadeground Ltd 11 Picardy Street DA17 5QQ Belvedere North Bexley FD280 Lloyds Pharmacy 89 BARNEHURST ROAD Colyers North Bexley FKG16 DA7 6HD Stelling Road Chemist 38 Stelling Road Colyers North Bexley FDT69 DA8 3JH Station Road Pharmacy 8 Station Road DA1 3QA Crayford North Bexley FKR09 Sainsbury’s Pharmacy Sainsbury’s Store DA1 4HW Crayford North Bexley FGQ05 Boots the Chemist Tower Retail Park Crayford North Bexley FA084 DA1 4LD Soka Blackmore Chemist 2 Pembroke Parade DA8 1DB Erith North Bexley FA554 Harrison’s Pharmacy 1 Town Square DA8 1RE Erith North Bexley FL579 National Co-Operative Chemist 41-49 Forest Road DA8 2NU North End North Bexley FK814 Day Lewis Chemists 5 The Pantiles DA7 5HH Northumberland Heath North Bexley FQA59 Erith Pharmacy 249-251 Bexley Road DA8 3EX Northumberland Heath North Bexley FER44 Ormay Chemist 224 Bexley Road Northumberland Heath North Bexley FPN89 DA8 3HD A F Browne Ltd 4 Tavy Bridge Thamesmead East North Bexley FR278 SE2 9UG
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General practices in Bexley
Code Practice name Postcode Ward Neighbourhood Type G83002 Westwood Surgery DA16 2HE Falconwood and Welling Clocktower Main G83006 Albion Surgery DA6 7LP Christchurch Clocktower Main G83009 Bellegrove Road Surgery DA16 3RE East Wickham Clocktower Main G83024 Ingleton Avenue Surgery DA16 2JZ Danson Park Clocktower Main G83024 Cumberland Drive Surgery DA7 5LB Brampton Clocktower Branch G83025 Welling Medical Practice DA16 2AU Falconwood and Welling Clocktower Main G83025 New Eltham Surgery SE9 2BD Eltham South Clocktower Branch G83028 Upper Wickham Surgery DA16 3AF St Michael's Clocktower Main G83028 Station Road Surgery DA17 6JJ Belvedere Clocktower Branch G83028 Nuxley Road Surgery DA17 5JG Belvedere Clocktower Branch G83033 Littleheath Surgery DA7 5HL Northumberland Heath Clocktower Main G83046 Bursted Wood Surgery DA7 6HZ Brampton Clocktower Main G83061 CROOK LOG SURGERY DA6 8DZ Danson Park Clocktower Main G83004 The Barnard Medical Practice DA14 4TA Sidcup Frognal Main G83029 Plas Meddyg Surgery DA5 1HU St Mary's Frognal Main G83047 Station Road Surgery DA15 7DS Sidcup Frognal Main G83053 Hurst Place Surgery DA5 3LH St Mary's Frognal Branch G83057 Woodlands Surgery DA15 8DF Blackfen and Lamorbey Frognal Main G83064 Thanet Road Surgery DA5 1AP St Mary's Frognal Main G83066 Sidcup Medical Centre DA14 6BU Sidcup Frognal Main G83066 Sidcup Medical Centre DA15 9BQ Blendon and Penhill Frognal Branch G83605 Bedside Manor DA15 9DX Blendon and Penhill Frognal Main G83605 Thwaites Clinic DA14 5BZ Cray Meadows Frognal Branch
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G83002 Pickford Surgery DA7 4RN Brampton North Bexley Branch G83005 Cairngall Medical Practice DA17 6EZ Belvedere North Bexley Main G83010 Northumberland Heath Medical Centre DA8 3DB Erith North Bexley Main G83018 Lakeside Medical Practice SE2 9LH Thamesmead East North Bexley Main G83028 Mayfair Medical Centre DA7 4TT Brampton North Bexley Branch G83037 Bullbanks Medical Centre DA8 1BJ Erith North Bexley Main G83043 Parkside Surgery DA7 6NW Barnehurst North Bexley Main G83049 Lyndhurst Medical Centre DA7 6DL Barnehurst North Bexley Main G83052 Belvedere Medical Centre DA17 5LQ Belvedere North Bexley Main G83053 Bexley Medical Group, King Harolds Way DA7 5RF Brampton North Bexley Main G83053 Erith Health Centre DA8 1RQ Erith North Bexley Branch G83062 Slade Green Medical Centre DA8 2HS North End North Bexley Main G83062 Colyers Lane Surgery DA8 3NZ Colyers North Bexley Branch G83621 Crayford Medical Centre DA1 4JL Crayford North Bexley Main G83630 Goodhealth PMS Erith Health Centre DA8 1RQ Erith North Bexley Main G83630 Barnehurst Surgery DA7 6HD Colyers North Bexley Branch G83642 Crayford PCT Medical Services DA1 4AN Crayford North Bexley Main G83672 Mill Road Surgery DA8 1HW Northumberland Heath North Bexley Main Data source: Bexley Care Trust
90 Bexley Care Trust Pharmaceutical Needs Assessment Appendix 4: Opening hours of pharmacies Clocktower
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code Name Ward Open Close Open Close Open Close Open Close Open Close Open Close Open Close FH281 Lloyds Brampton 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 17:30 FXK04 Praise Brampton 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 FLK13 NCC Brampton 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 FA575 Broadway Christchurch 08:30 19:00 08:30 19:00 08:30 19:00 08:30 19:00 08:30 19:00 08:30 18:00 FMH33 Boots Christchurch 08:30 17:30 08:30 17:30 08:30 17:30 08:30 21:00 08:30 17:30 08:30 17:30 10:00 16:00 FH066 Crook Log Christchurch 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 17:00 FTM47 Boots Danson Park 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 FCE42 NCC Danson Park 08:30 20:00 08:30 20:00 08:30 20:00 08:30 20:00 08:30 20:00 08:00 20:00 10:00 16:00 FE068 BR Lewis East Wickham 09:00 20:00 09:00 20:00 09:00 20:00 09:00 20:00 09:00 20:00 09:00 14:00 FKV68 Bellegrove East Wickham 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 FE097 Falconwood Falcon’d & Welling 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 13:00 FXN89 Mistvale10 Falcon’d & Welling 09:00 23:00 08:30 23:00 08:30 23:00 08:30 23:00 08:30 23:00 08:30 23:00 08:30 23:00 FYQ93 Mistvale Falcon’d & Welling 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 13:00 FRM32 Hayshine St Michael's 09:00 17:30 09:00 17:30 09:00 13:00 09:00 17:30 09:00 17:30 09:00 17:30
10 100 hour pharmacy 91 Bexley Care Trust Pharmaceutical Needs Assessment Frognal
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code Name Ward Open Close Open Close Open Close Open Close Open Close Open Close Open Close FY261 Targett Blackfen & Lamorbey 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 17:30 FPX29 Browne’s Blackfen & Lamorbey 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 18:00 FP029 Day Lewis Blackfen & Lamorbey 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 FHR27 Olins Blendon & Penhill 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:30 FQ282 Compact Blendon & Penhill 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 15:00 FLD66 Hollytree Cray Meadows 09:30 19:30 09:30 19:30 09:30 19:30 09:30 19:30 09:30 19:30 09:30 18:30 FD537 Southcott Longlands 09:30 18:00 09:30 18:00 09:30 18:00 09:30 18:00 09:30 18:00 09:30 17:00 FE434 Boots Sidcup 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 09:00 17:30 FQ835 St Johns Sidcup 09:30 18:00 09:30 18:00 09:30 18:00 09:30 18:00 09:30 18:00 09:30 16:00 FHN98 Lloyds Sidcup 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 FED29 Roadnight s Sidcup 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 13:00 FX373 Warren St Mary's 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 08:30 18:00 09:00 17:30 FTK01 Bourne Road St Mary's 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 16:00 FFL63 Albany St Mary's 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 17:00
92 Bexley Care Trust Pharmaceutical Needs Assessment North Bexley
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code Name Ward Open Close Open Close Open Close Open Close Open Close Open Close Open Close FAQ24 Daysol Barnehurst 09:00 18:00 09:00 18:00 09:00 13:00 09:00 18:00 09:00 18:00 09:00 14:00 FCG07 Davidson Barnehurst 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 FR109 Lloyds Belvedere 08:30 18:30 08:30 18:30 08:30 18:30 08:30 18:30 08:30 18:30 09:00 13:00 FTM56 Knightons Belvedere 08:45 18:30 08:45 18:30 08:45 18:30 08:45 18:30 08:45 18:30 08:45 17:30 FD280 Spadeground Belvedere 09:30 18:00 09:30 18:00 09:30 13:00 09:30 18:00 09:30 18:00 09:30 14:00 FKG16 Lloyds Colyers 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 13:00 FDT69 Stelling Road Colyers 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 10:00 13:00 FKR09 Station Road Crayford 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 15:00 FGQ05 Sainsbury’s Crayford 08:00 21:00 08:00 21:00 08:00 21:00 08:00 22:00 08:00 22:00 07:00 21:00 10:00 16:00 FA084 Boots Crayford 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 10:00 16:00 FA554 Soka Blackmore Erith 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 FL579 Harrison’s Erith 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:00 FK814 NCC North End 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 19:00 09:00 17:30 FQA59 Day Lewis Northumberland Heath 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 13:00 FER44 Erith Northumberland Heath 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 18:30 09:00 17:30 FPN89 Ormay Northumberland Heath 09:00 18:00 09:00 18:00 09:00 18:00 09:00 17:00 09:00 18:00 09:00 17:30 FR278 A F Browne Thamesmead East 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00 09:00 18:00
93 Bexley Care Trust Pharmaceutical Needs Assessment Appendix 5: Services provided by community pharmacies Clocktower
FCS Pharmacy Name Postcode Ward Locality traception Chlamydia Chlamydia Screening and Treatment Emergency Hormonal Con Stop Smoking Supervised Administration FH281 Lloyds Pharmacy DA7 4QW Y Y Brampton Clocktower FXK04 Praise Ltd DA7 5AH Y Y Y Brampton Clocktower FLK13 National Co-Operative Chemist DA7 5QR Brampton Clocktower FA575 Broadway Pharmacy DA6 7BN Y Y Y Y Christchurch Clocktower FMH33 Boots The Chemist Ltd DA6 7JJ Y Y Christchurch Clocktower FH066 Crook Log Chemist DA6 8DT Y Christchurch Clocktower FTM47 Boots The Chemist DA16 1TY Danson Park Clocktower FCE42 National Co-Operative Chemists Ltd DA16 1TU Danson Park Clocktower FE068 B R Lewis Chemists Ltd DA16 3HQ Y East Wickham Clocktower FKV68 Bellegrove Pharmacy DA16 3RQ East Wickham Clocktower FE097 Falconwood Pharmacy DA16 2PL Y Y Falconwood and Welling Clocktower FXN89 Mistvale Chemist DA16 3QS Falconwood and Welling Clocktower FYQ93 Mistvale Chemist DA16 3QS Falconwood and Welling Clocktower FRM32 Hayshine Ltd DA16 1LN Y Y St Michael's Clocktower
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Frognal
FCS Pharmacy Name Postcode Ward Locality Chlamydia Chlamydia Screening and Treatment Emergency Hormonal Contraception Stop Smoking Supervised Administration FY261 Targett Chemist DA15 8DJ Y Blackfen and Lamorbey Frognal FPX29 Browne’s Pharmacy DA15 8PW Y Y Y Y Blackfen and Lamorbey Frognal FP029 Day Lewis Pharmacy DA15 8PS Y Blackfen and Lamorbey Frognal FHR27 Olins Pharmacy DA15 9ER Blendon and Penhill Frognal FQ282 Compact Chemist DA5 1BT Y Y Y Y Blendon and Penhill Frognal FLD66 Hollytree Pharmacy DA14 6JR Y Cray Meadows Frognal FD537 Southcott Chemist DA14 6QR Longlands Frognal FE434 Boots The Chemist Ltd DA14 6EH Y Y Y Sidcup Frognal FQ835 St Johns Pharmacy DA14 6EH Y Y Y Sidcup Frognal FHN98 Lloyds Pharmacy DA14 6EQ Y Sidcup Frognal FED29 Roadnight Chemists DA15 7DU Sidcup Frognal FX373 Warren Pharmacy DA5 1AD St Mary's Frognal FTK01 Bourne Road Pharmacy DA5 1LQ St Mary's Frognal FFL63 Albany Pharmacy DA5 3HP St Mary's Frognal
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North Bexley
FCS Pharmacy Name Postcode Ward Locality ing and and ing Chlamydia Chlamydia Screen Treatment Emergency Hormonal Contraception Stop Smoking Supervised Administration FAQ24 Daysol Pharmacy DA1 4RA Y Y Y Barnehurst North Bexley FCG07 Davidson Chemist DA7 6NA Y Y Y Barnehurst North Bexley FR109 Lloyds Pharmacy DA17 5JE Y Belvedere North Bexley FTM56 Knightons Chemist DA17 5JJ Y Y Y Y Belvedere North Bexley FD280 Spadeground Ltd DA17 5QQ Y Y Y Belvedere North Bexley FKG16 Lloyds Pharmacy DA7 6HD Y Y Colyers North Bexley FDT69 Stelling Road Chemist DA8 3JH Y Colyers North Bexley FKR09 Station Road Pharmacy DA1 3QA Crayford North Bexley FGQ05 Sainsbury’s Pharmacy DA1 4HW Y Crayford North Bexley FA084 Boots the Chemist DA1 4LD Y Y Crayford North Bexley FA554 Soka Blackmore Chemist DA8 1DB Y Y Y Erith North Bexley FL579 Harrison’s Pharmacy DA8 1RE Y Erith North Bexley FK814 National Co-Operative Chemist DA8 2NU North End North Bexley FQA59 Day Lewis Chemists DA7 5HH Northumberland Heath North Bexley FER44 Erith Pharmacy DA8 3EX Y Northumberland Heath North Bexley FPN89 Ormay Chemist DA8 3HD Y Y Northumberland Heath North Bexley FR278 A F Browne Ltd SE2 9UG Y Y Thamesmead East North Bexley
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Appendix 6: Benchmarking of pharmacy services in Bexley This information is based on the NHS Information Centre’s 2008/09 statistical bulletin on pharmaceutical services which is the last year for which benchmarking data is available.
We can set the provision of pharmacy services in Bexley Care Trust into context by comparing the provision using national benchmarks which are available to the Care Trust. The table overleaf shows the data for Bexley Care Trust and together with all PCTs in Greater London using nine available indictors.
Guide to column headings
Number of community This is the number which was returned to the NHS Information Centre for 2008/09 pharmacies 2008-09 by the Care Trust
% Independent This is the number of contractors belonging to chains of 5 of fewer pharmacies as contractors determined by the Prescription Pricing Division (PPD) at 31st March 2009.
Households without This is the % of all households in the Care Trust that reported in the 2001 census access to a car (%) that they did not have access to a car
Population / Hectare This is the population density calculated using the ONS estimates of the area (2008/09) covered by the Care Trust and the ONS 2008 mid-year population estimates.
Pharmacies per This is the number of pharmacies at 31st March 2009 per 100,000 population 100,000 population using the ONS mid-year estimates for 2008 2008-09
Prescription items per This is the average of the number of prescription items dispensed by a pharmacy pharmacy (month) in the Care Trust calculated by the PPD in 2008/09
This is the percentage of all prescription items dispensed in 2008/09 which were % RD Items (2008/09) issued using repeat dispensing
This is the percentage of all contractors in the Care Trust that have claimed for Advanced services (%) Advanced services in 2008/09
MURs per provider This is the average number of MURs claimed per provider of Advanced services (2008/09) in 2008/09
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08 n
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PCT
08 -
Number of Number community 2007 pharmacies Independent % contractors without Households (%) to car a access / Population (2007/08) Hectare per Pharmacies populatio 100,000 2007 items Prescription pharmacy per (month) Items RD % (2007/08) services Advanced (%) provider per MURs (2007/08) Barking and Dag 35 57% 38% 46 21 4,914 1.11% 86% 194 Barnet 77 75% 27% 38 24 3,872 0.49% 68% 150 Bexley Care Trust 46 61% 24% 37 21 5,104 0.01% 70% 167 Brent Teaching 72 76% 37% 62 26 3,915 2.51% 74% 152 Bromley 59 51% 23% 20 19 5,000 0.28% 92% 166 Camden 63 59% 56% 106 27 2,794 0.64% 73% 159 City and Hackney 64 59% 56% 99 29 3,492 6.13% 84% 256 Croydon 69 58% 30% 39 20 4,812 0.18% 93% 207 Ealing 71 69% 32% 55 23 4,400 3.29% 85% 181 Enfield 60 52% 29% 35 20 4,879 2.50% 87% 166 Greenwich 52 65% 41% 47 23 4,784 0.65% 81% 108 H’smith & Fulhm 41 61% 49% 105 24 3,585 3.91% 71% 144 Haringey Teaching 56 68% 46% 76 25 3,789 2.11% 63% 149 Harrow 57 61% 23% 43 27 4,860 5.83% 72% 165 Havering 45 38% 23% 20 19 6,205 2.50% 91% 221 Hillingdon 64 59% 22% 22 25 4,381 3.81% 89% 221 Hounslow 55 55% 29% 39 24 4,519 9.87% 73% 218 Islington 45 84% 58% 127 24 3,644 2.44% 82% 150 K’gton & Chelsea 39 67% 50% 148 22 2,846 1.72% 59% 203 Kingston 30 53% 24% 42 19 4,967 0.81% 90% 225 Lambeth 60 63% 51% 102 22 4,441 9.72% 78% 155 Lewisham 55 64% 43% 73 21 5,241 4.03% 85% 141 Newham 63 73% 49% 69 25 4,794 7.83% 83% 168 Redbridge 52 48% 26% 45 20 5,078 0.44% 96% 207 R’mond & T 45 62% 24% 31 26 3,543 13.86% 73% 167 Southwark 62 61% 52% 95 23 4,016 1.78% 69% 194 Sutton & M 77 58% 27% 47 20 4,740 5.00% 84% 231 Tower H’lets 45 69% 57% 109 20 5,326 1.46% 87% 179 Waltham Frst 60 52% 39% 57 27 3,644 0.56% 87% 158 Wandsworth 65 66% 41% 82 23 4,262 4.90% 91% 191 Westminster 93 69% 56% 109 40 2,258 0.56% 44% 216 London 1,777 62% 37% 48 23 4,253 3.29% 79% 182 ENGLAND 10,475 38% 27% 4 20 6,129 1.58% 83% 161 Figure 75: Pharmacy characteristics in greater London SHA PCT’s Data source: NHS Information Centre 2008/09. Repeat dispensing data obtained using a FOI request to PPD. Note: at the time of the NHSIC report Bexley Care Trust had 46 pharmacies.
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PCT
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h) 08 -
Number of community 2007 pharmacies 08 % Independent contractors Households a to access without car (%) / Population Hectare (2007/08) per Pharmacies population 100,000 2007 items Prescription per pharmacy (mont % Items RD (2007/08) services Advanced (%) perMURs provider (2007/08) Bexley 46 61% 24% 37 21 5104 TBC 70% 167 E & N Herts 112 45% 18% 5 21 6077 TBC 91% 193 Havering 45 38% 23% 20 20 6512 TBC 91% 221 Medway 49 37% 23% 13 19 6049 TBC 84% 136 Milton Keynes 41 12% 19% 6 17 5760 TBC 95% 146 Peterborough 39 38% 26% 5 24 5731 TBC 79% 162 SW Essex 79 32% 21% 9 20 5595 TBC 85% 166 Swindon 39 33% 22% 8 20 6590 TBC 79% 185 West Essex 48 48% 18% 3 17 6410 TBC 79% 158 ONS Cluster 498 39% 21% 7 20 5966 TBC 85% 174 England 10,475 38% 27% 4 20 6129 TBC 83% 161 Figure 76Pharmacy characteristics in the New and Growing Towns ONS cluster group Data source: NHS Information Centre 2008/09. Repeat dispensing data obtained using a FOI request to PPD. Note: at the time of the NHSIC report Bexley Care Trust had 46 pharmacies.
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Appendix 7: Map showing Bexley Care Trust Pharmacies
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Appendix 8: Abbreviations and Glossary BMI Body Mass Index LPS Local Pharmaceutical Services BP Blood Pressure LTC Long Term Condition CHD Coronary Heart Disease LTLI Long Term Limiting Illness CKD Chronic Kidney Disease MDS Monitored Dosage System Chronic Obstructive Pulmonary Medicines Use Review / COPD Disease MUR/PI Prescription Intervention Community Pharmacy Patient CPPQ Questionnaire NHSIC NHS Information Centre CVD Cardio Vascular Disease NRT Nicotine Replacement Therapy Emergency Hormonal EHC Contraception ONS Office of National Statistics EPS Electronic Prescription Service PCT Primary Care Trust GLA Greater London Authority PMR Patient Medication Record GP General Practitioner PNA Pharmaceutical Needs Assessment HbA1c Glycosylated haemoglobin PWP Pharmacy White Paper HES Hospital Episode Statistics QOF Quality and Outcomes Framework HF Heart Failure RD Repeat Dispensing JSNA Joint strategic needs assessment SCP Strategic Commissioning Plan LMC Local Medical Committee SHA Strategic Health Authority LPC Local Pharmaceutical Committee SSP Strategic Services Plan
NHS appeals authority A special health authority that was responsible for determining control of entry appeals. Subsequently replaced by the NHS Litigation Authority. Community pharmacy contract The community pharmacy contract is made up of three service levels: Essential Services, Advanced Services and Enhanced Services. Consultation facilities / area Most community pharmacies now have an area in the pharmacy where the patient and pharmacist can have a private consultation. The design and specification of these facilities varies from pharmacy to pharmacy. Medicines Use Review A discussion between the pharmacist and patient with the aim of improving understanding and medicines use by patients ONS Cluster PCTs which are grouped according to local social and economic factors. Pharmacist A registered pharmacist has typically completed five years of training which includes a degree and post graduate training. Pharmaceutical Services These are services available from pharmacies and dispensing appliance contractors and dispensing GPs. Pharmacy A registered pharmacy premises that is regulated by the Royal Pharmaceutical Society and appears on the Care Trust’s list.
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Prescription item(s) Each medicine on a prescription is counted as one item. A prescription may have many items. Quartile One of four division which divide a series of data into four equal parts Quintile One of five division which divide a series of data into five equal parts Repeat Dispensing Repeat dispensing is a mechanism by which the patient’s GP may issue the pharmacist with a prescription to dispense at agreed intervals for on-going treatment. Secondary Care Hospital based care Tertiary Care Specialist residential care
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Appendix 9: Report of the consultation on the draft PNA Introduction This report provides a summary of the stakeholder consultation undertaken by Bexley Care Trust on its draft Pharmaceutical Needs Assessment (PNA).
Background BCT prepared a draft Pharmaceutical Needs Assessment (PNA), the draft PNA was prepared in order to satisfy the requirement in regulations which require each PCT to publish a PNA by 1st February.
A steering group was established to guide the development of the draft PNA which was published for consultation on 5th October 2010, the consultation ended on 6th December 2010.
Consultation process A list of stakeholders to be consulted on the PNA was developed with the PNA steering group and by following the regulations relating to the development of PNA which set out a minimum requirement for the individuals and groups that each PCT must consult.
Each stakeholder was sent a full copy of the draft PNA together with a covering letter and consultation questions.
The list of stakeholders consulted during the consultation is shown at Figure 1.
Respondents were asked to respond using a proforma provided by the PCT. Respondents could also submit their response by letter or email for consideration.
Results of the consultation Responses were received from nine pharmacy contractors and the Local Pharmaceutical Committee. The steering group met to consider the responses to the consultation and agreed changes which would be made to the draft PNA as a result of the comment received.
A summary of the responses and the proposed changes is set out below.
103 Bexley Care Trust Pharmaceutical Needs Assessment Response to the open questions
The grid below sets out the issues raised in consultation responses received by the PCT. The Care Trust’s response and any proposed change to the final PNA is then.
Issue raised Care Trust’s response Proposed change Concern that patients and the public whose The patient questionnaire results have been None first language is not English were not able to used to inform the development of the PNA, contribute due to use of a postal survey in the results have not been used in isolation, English nor has any conclusion relied solely upon the results of the questionnaire. The development of the PNA was also informed by engagement through Bexley’s PPE team with faith groups which included ethnic minority groups. Request for more detailed, smaller scale The map included meets the requirements of None maps the regulations. However, BCT will endeavour to revise the mapping in subsequent versions of the PNA. Concern that the PNA does not take account The regulations require BCT to assess the None of Bexley pharmacies dispensing for non- need for service in its area and for its Bexley patients (e.g. patients registered with population and to take account of services a neighbouring PCT. provided outside its area which may affect the need for services in its area. The PNA has met this requirement. Observation that in relation to the description Noted Drafting has been revised to reflect of opening hours in Frognal between 7pm this observation and 8pm. The CT should note that there is easy access to North of the locality and on the border with Bromley The Care Trust should assess MUR to be a BCT is not aware of any evidence to support None necessary service. The response asserts that the assertion in the response, and none was there is evidence for improved adherence provided. and reduced hospital admissions.
104 Bexley Care Trust Pharmaceutical Needs Assessment In relation to the smoking cessation service Noted. The Care Trust has recently revised Drafting has been revised to reflect the PNA does not mention that some the therapies available through the Stop this response. pharmacies may provide Champix to patients Smoking Service in order to ensure that the and that this service has recently been service performs within budget. A decision revised to limit availability of Champix. has been made to continue to allow the most consistent providers (the top 7 pharmacies) of Champix to continue to do so but that this would be capped at one patient per quarter. Drafting / accuracy - Figure 70 Noted Drafting will be updated to reflect the change. Drafting / accuracy - Page 75 Noted Drafting will be updated to reflect the change. Drafting / accuracy - Opening hours of Noted Drafting will be updated to reflect Browne Chemists the change. Noted that BCT is pursuing, with pharmacy Noted None contractors, a home delivery service for patients. Drafting / accuracy - Check whether Boots in Sarb? To check Sidcup provides Chlamydia screening Requested that the PNA include a table Noted This will be included as an appendix showing which pharmacies provide each service. Requested mapping of GP locations in Noted that this is not a requirement under This will be included as an appendix Bexley the regulations, however this map is available within the CT and will be included in the final version Drafting / accuracy – Opening hours of Drafting will be updated to reflect Lloyds Pharmacy (FK616) the change. The PNA does not take account of non-NHS This is out of the scope set for the PNA None (private) services provided by pharmacies BCT has not engaged with PBC and GP The LMC was consulted on the draft PNA. None groups in developing the PNA Drafting / accuracy - Data for Smoking etc in health profile out of date
105 Bexley Care Trust Pharmaceutical Needs Assessment Wording used in relation to meeting future Noted Wording to be revised to reflect any needs through existing pharmacy contractors willing provider approach to may be anticompetitive. commissioning services.
Drafting / accuracy - The description of the Noted Drafting will be updated to reflect EHC service should include that the service the change. is restricted to women aged 14 – 24 years Proposed that BCT combine EHC and The steering group was persuaded to revise Drafting will be updated to reflect Chlamydia into a single Sexual Health its assessment such that both services the change. service and that these be made necessary would be necessary. The design of the services services would be taken up with the relevant commissioners
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Figure 1: Distribution list for PNA
Bexley Bromley and Greenwich LPC Bexley LMC Pharmacy contractors in Bexley Bexley Council SLHT Oxleas NHS Foundation Trust Bexley, Bromley, Greenwich and West Kent PCT Bexley Link
108