Draft Pharmaceutical Needs Assessment 2018

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Pharmaceutical Needs Assessment 2018 Suffolk Health and Wellbeing Board

This Pharmaceutical Needs Assessment has been produced for Suffolk Health and Wellbeing Board by Suffolk County Council in conjunction with Soar Beyond Ltd. Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Contents Executive summary ______6 Section 1: Introduction ______14 1.1 Background ...... 14 1.1.1 Essential Small Pharmacy Scheme (ESPS) ...... 15 1.1.2 Influenza vaccination advanced service ...... 15 1.1.3 NHS Urgent Medicine Supply Advanced Service (NUMSAS) ...... 15 1.1.4 Pharmacy Access Scheme (PhAS) ...... 16 1.1.5. Quality payment scheme ...... 16 1.1.6. Pharmacy consolidations ...... 16 1.2 Purpose of the PNA ...... 17 1.3 Scope of the PNA...... 17 1.3.1 Pharmacy contractors ...... 18 1.3.2 Dispensing Appliance Contractors (DACs) ...... 21 1.3.3 Local Pharmaceutical Service (LPS) providers ...... 21 1.3.4 Dispensing GP practices ...... 22 1.3.5 Other providers of pharmaceutical services in neighbouring HWB areas ... 22 1.3.6 Other services and providers in Suffolk out of scope of the PNA ...... 22 1.4 Process for developing the PNA ...... 24 1.5 Localities for the purpose of the PNA ...... 25 Section 2: Context for the PNA ______27 2.1 Joint Strategic Needs Assessment (JSNA) ...... 27 2.2 Health and Wellbeing Strategy ...... 28 2.3 Population characteristics ...... 28 2.3.1 Overview ...... 28 2.3.2 Age ...... 29 2.3.3 Predicted population growth ...... 31 2.3.4 GP-registered population ...... 31 2.3.5 International migration ...... 33 2.3.6 Life expectancy ...... 34 2.3.7 Specific populations ...... 35 2.3.8 Deprivation ...... 47 2.3.9 Premature mortality ...... 48

1 Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.4 Causes of ill health ...... 49 2.4.1 Cardiovascular disease (CVD) ...... 49 2.4.2 Cancers ...... 50 2.4.3 Diabetes ...... 52 2.4.4 Chronic Obstructive Pulmonary Disease (COPD) ...... 53 2.4.5 Depression and mental health...... 54 2.4.6 Accidental injuries ...... 56 2.4.7 Asthma ...... 58 2.4.8 Excess weight and obesity ...... 59 2.4.9 Palliative care ...... 61 2.4.10 Influenza ...... 61 2.4.11 Coronary heart disease ...... 62 2.4.12 Strokes and Transient Ischaemic Attacks ...... 62 2.4.13 Hypertension ...... 62 2.5 Lifestyle ...... 63 2.5.1 Drug and alcohol misuse ...... 63 2.5.2 Alcohol and related disease ...... 64 2.5.3 Sexual health and teenage pregnancy ...... 65 2.5.4 Smoking ...... 67 2.5.5 Oral health ...... 68 Section 3: NHS pharmaceutical services provision – currently commissioned ___ 71 3.1 Community pharmacies ...... 71 3.1.1 Choice of community pharmacies ...... 72 3.1.2 Weekend and evening provision ...... 72 3.2 Dispensing Appliance Contractors (DACs) ...... 73 3.3 Dispensing GP practices ...... 73 3.4 Distance-selling pharmacies ...... 75 3.5 Access to community pharmacies ...... 76 3.5.1 Routine weekday daytime access to community pharmacies and dispensing GP practices ...... 76 3.5.2 Routine weekday evening access to community pharmacies and dispensing GP practices ...... 79 3.5.3 Routine Saturday daytime access to community pharmacies ...... 83

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

3.5.4 Routine Sunday daytime access to community pharmacies ...... 90 3.5.5 Routine bank holiday access to community pharmacies ...... 93 3.6 Advanced service provision from community pharmacies ...... 93 3.7 Enhanced service provision ...... 94 3.8 Pharmaceutical service provision provided from outside Suffolk HWB area .. 95 3.9 Locally-commissioned services ...... 95 Section 4: Other services which may impact on pharmaceutical services provision 96 4.1 Other services provided by dispensing GP practices ...... 96 4.2 Healthy Living Pharmacy ...... 96 4.2.1 Healthy Living Pharmacy enablers ...... 97 4.2.2 Healthy Living Pharmacy and local priorities ...... 97 4.3 Collection and delivery services ...... 100 4.4 Provision of services to nursing and residential care homes ...... 100 4.5 Out-of-hours GP service and Extended Hours ...... 100 Section 5: Findings from the public questionnaire ______102 Section 6: Analysis of Health Needs and Pharmaceutical Service Provision ____ 104 6.1 Localities within Suffolk ...... 104 6.2 Babergh locality...... 104 6.2.1 Necessary services: current provision ...... 104 6.2.2 Necessary services: gaps in provision ...... 104 6.2.3 Other relevant services: current provision ...... 105 6.2.4 Improvements and better access: gaps in provision ...... 105 6.3 Forest Heath locality ...... 106 6.3.1 Necessary services: current provision ...... 106 6.3.2 Necessary services: gaps in provision ...... 106 6.3.3 Other relevant services: current provision ...... 106 6.3.4 Improvements and better access: gaps in provision ...... 107 6.4 Ipswich locality ...... 108 6.4.1 Necessary services: current provision ...... 108 6.4.2 Necessary services: gaps in provision ...... 108 6.4.3 Other relevant services: current provision ...... 108 6.4.4 Improvements and better access: gaps in provision ...... 109 6.4.5 Other services ...... 109

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

6.5 Mid Suffolk locality ...... 109 6.5.1 Necessary services: current provision ...... 109 6.5.2 Necessary services: gaps in provision ...... 110 6.5.3 Other relevant services: current provision ...... 110 6.5.4 Improvements and better access: gaps in provision ...... 110 6.6 St Edmundsbury locality ...... 111 6.6.1 Necessary services: current provision ...... 111 6.6.2 Necessary services: gaps in provision ...... 111 6.6.3 Other relevant services: current provision ...... 111 6.6.4 Improvements and better access: gaps in provision ...... 112 6.7 Suffolk Coastal locality ...... 112 6.7.1 Necessary services: current provision ...... 112 6.7.2 Necessary services: gaps in provision ...... 112 6.7.3 Other relevant services: current provision ...... 113 6.7.4 Improvements and better access: gaps in provision ...... 113 6.8 Waveney locality ...... 114 6.8.1 Necessary services: current provision ...... 114 6.8.2 Necessary services: gaps in provision ...... 114 6.8.3 Other relevant services: current provision ...... 114 6.8.4 Improvements and better access: gaps in provision ...... 115 Section 7: Summary and conclusions ______116 Appendix A: List of pharmaceutical service providers in Suffolk HWB area _____ 118 Appendix B: PNA Steering Group Terms of Reference ______150 Appendix C: Public questionnaire ______152 Appendix D: Pharmacy contractor questionnaire ______160 Appendix E: Dispensing GP practice questionnaire ______168 Appendix F: Commissioner questionnaire ______171 Appendix G: PNA Project Plan ______176 Appendix H: Consultation plan and list of stakeholders ______179 Appendix I: Travel access to pharmacies and dispensing GP practices for Suffolk residents ______182 Appendix J: New housing and care homes planned in Suffolk ______183 Babergh locality ...... 183

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Forest Heath locality ...... 183 Waveney locality ...... 184 Suffolk Coastal locality ...... 184 Mid Suffolk locality ...... 185 Ipswich locality ...... 185 St Edmundsbury locality ...... 186 Appendix K: Results of the dispensing GP practice questionnaire ______189 Appendix L: Results of the commissioner questionnaire ______195 Appendix M: Results of the public questionnaire ______199 Appendix N: Results of the pharmacy contractor questionnaire ______210 Appendix O: Equality Impact Assessment ______225 Abbreviations ______233 Map A: Suffolk pharmacies and population density by output area ______235 Map B: Suffolk pharmacy and dispensing GP practice locations ______236 Map C: GP practice locations in Suffolk (April 2017) ______237 Map D: Ipswich GP practices (April 2017) ______239 Map E: Suffolk GP practices by locations and codes (April 2017) ______240 Map F: Suffolk 1.6 km buffers around pharmacies ______243 Map G: Suffolk pharmacy opening hours ______244 Map H: Suffolk pharmacies and deprivation by LSOA ______245 Map I: Suffolk pharmacies and Black and Minority Ethnic levels by LSOA _____ 247 Map J: Suffolk off-peak drive time to nearest pharmacy ______248 Map K: Suffolk peak drive time to nearest pharmacy ______249 Map L: Suffolk public transport time to nearest pharmacy, Tuesday, 9am to 1pm 250 Map M: Suffolk public transport times to nearest pharmacy, Tuesday, 1pm to 5pm ______251 Map N: Suffolk walking times to nearest pharmacy ______253 Map O: Suffolk pharmacies, dispensing practices and Standard Mortality Ratio (SMR) for all-cause mortality under 75 (2010-2014 inclusive), July 2017 __ 255

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Executive summary Every Health and Wellbeing Board (HWB) is now required to produce a Pharmaceutical Needs Assessment (PNA). After it has published its first PNA, each HWB must publish a statement of revised assessment within three years of its previous publication. However, the HWB must make a revised assessment as soon as it is reasonably practicable after identifying any changes that have occurred since the previous assessment which may have an effect on the needs of the pharmaceutical services. The responsibility of producing a Pharmaceutical Needs Assessment (PNA) was transferred from Primary Care Trusts (PCTs) to the Health and Wellbeing Board (HWB) of the local authority in 2013 and each HWB had a statutory duty to produce an updated PNA by 1st April 2018. The PNA is a statement of needs for pharmaceutical service provision within the HWB area. This mapping of pharmaceutical services against local health needs will be used by NHS England in its determination as to whether to approve applications to join the pharmaceutical list, under the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, as well as applications to change existing services. It will enable local pharmaceutical service providers and commissioners to: • understand the pharmaceutical needs of the population • gain a clearer picture of pharmaceutical services currently provided • make appropriate decisions on applications for NHS pharmacy contracts • commission appropriate and accessible services from community pharmacies • clearly identify and address any local gaps in pharmaceutical services • target services to reduce health inequalities within local health communities The PNA was developed by a steering group. The group consisted of a wide range of stakeholders including representatives from Suffolk County Council, Suffolk Local Pharmaceutical Committee (LPC), Suffolk Local Medical Committee (LMC), Clinical Commissioning Groups (CCGs) and NHS England. Views on the current and potential future provision of pharmaceutical services were sought from residents of Suffolk and current pharmaceutical service providers in Suffolk, through the use of questionnaires. NHS Pharmaceutical Services in England NHS Pharmaceutical Services are provided by contractors on the pharmaceutical list held by NHS England. Types of provider are: • community pharmacy contractors, including distance-selling pharmacies • dispensing appliance contractors • local pharmaceutical service providers • dispensing doctors

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Community pharmacies operate under a contractual framework agreed in 2005 which sets three levels of service: Essential services: Negotiated nationally. Provided from all pharmacies. Advanced Services: Negotiated nationally. Community pharmacists can choose to provide advanced services as long as they meet the requirements set out in the Secretary of State Directions. Enhanced services: Negotiated locally to address local health needs. Provided from selected pharmacies, specifically commissioned. This contractual framework enables NHS England to commission services to address local needs, while still retaining the pharmacies' traditional role dispensing medicine and access to support for self-care. Other commissioners such as CCGs and local authorities may also use this document to commission services, known as locally- commissioned services. Health in Suffolk Suffolk is a rural county in eastern England. It has borders with the counties of Cambridgeshire, Essex and Norfolk and a coastline facing the North Sea. Main urban areas in Suffolk include the county town of Ipswich and the large towns of Bury St Edmunds and Lowestoft. Elsewhere in Suffolk, the population is located in smaller towns and villages and in more isolated settlements in the countryside. The population The current estimated population is 741,895 (mid-year estimate 2015). The population of Suffolk has grown by 3.1% since 2010 and is expected to increase 11% by 2039. This number is projected to rise to: • 777,900 by 2025 • 823,000 by 2039 The ageing population is an important feature of the demography of Suffolk and the proportion of older people in the county is rising. Those aged 65 to 84 will make up the largest proportion of the population by 2026. This group will continue to increase to 2039, when it is forecast to make up almost 25% of the population of Suffolk. In England, approximately 18% of the population is aged 65+ compared with 22.4% in Suffolk. Between 2015 and 2039, there are projected to be an additional 39,393 people aged 65 and over. This will undoubtedly have an impact on health and care services. A number of housing developments are planned for Suffolk and neighbouring areas, which will impact on the demand for health services. Of particular note are the current and planned developments in Stowmarket in the Mid Suffolk locality, Martlesham in the Suffolk Coastal locality, Ipswich Garden Suburb in the Ipswich locality and several sites in Bury St Edmunds in the St Edmundsbury locality.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

The growing communities created by these neighbouring developments will require detailed and phased service-planning. The precise phasing of new housing is difficult to predict accurately. As this PNA will be reviewed within three years, considerations have been made into new housing growth planned until 2021/22. Suffolk has a number of care homes spread throughout the county. Due to the generally increased health needs of the elderly, consideration has also been made for future planned care home developments. The general increasing and ageing population will require flexible service delivery, particularly in rural communities. Provision from distance-selling pharmacies, prescription delivery services from existing community pharmacies and dispensing GP practices are current examples of this flexible service delivery. Health inequalities Suffolk has become relatively more deprived compared to other local authority areas in England since 2010. Only three counties/unitary authorities fell more places in the rankings than Suffolk. However, Suffolk continues to experience below-average levels of deprivation. Ipswich remains the most deprived local authority in Suffolk, being ranked 71st out of 326 Local Authorities (LAs) in England. It is also facing the greatest health inequalities and therefore the greatest health need. Particular populations which may have specific health needs include traveller populations, prisoners, minority ethnic communities and disabled people. The Gypsy and Traveller communities have a life expectancy rate that is 10 years lower than the rest of the population, and they have specific health problems and needs associated with respiratory disease, anxiety and depression. The first hidden report was published in 2011, and was updated in 2016. The new report includes data from the 2015 Index of Multiple Deprivation and the Social Mobility Index published in 2016 as well as the other indicators. The report highlights that Suffolk, on average, has lower rates of multiple deprivation than England but it includes some of the country’s most deprived neighbourhoods. Over 14% of neighbourhoods in Ipswich and 12% in Waveney are ranked among the most deprived 10% in England. The report also highlights areas of more rural deprivation that are bordered by areas or relative affluence. http://suffolkcf.org.uk/2016/09/hidden-needs- 2016/ Health in rural areas People living in rural areas tend to score higher on standard measures of health such as life expectancy and infant mortality. However, the distances patients have to travel to reach health services are greater and public transport may be limited. Much of the population has access to a car but certain groups, such as the economically disadvantaged and the elderly living alone, are less likely to have independent mobility.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

The cost of providing services in rural areas is estimated to be significantly higher than the cost of providing services in urban areas. Suffolk’s rural population is older than its urban population and the proportion of older people in Suffolk’s rural population is increasing faster than the proportion of older people in urban areas. This trend, combined with the higher cost of providing services in rural areas, housing stock which is often difficult to heat and maintain, poor transport and more limited social networks, is likely to lead to high and increasing needs and costs for Suffolk’s rural population now and in the future. Health and illness Suffolk is generally a healthy place to live. The average life expectancy for Suffolk overall is higher than the national average for both males (80.7 compared with 79.5 years) and females (84.1 compared with 83.1 years). However, at PNA locality level there are two areas where life expectancy is lower for both males and females when compared with the Suffolk average: Ipswich (male 78.8, female 83.2 years) and Waveney (male 79.4, female 83.2 years). The mortality rates from Chronic Obstructive Pulmonary Disease (COPD), Coronary Heart Disease (CHD), stroke / Transient Ischaemic Attack (TIA) and cancer are generally lower than in England as a whole. Forest Heath, however, has a higher mortality rate associated with injuries in the under 75 years’ age group, with directly standardised rates per 100,000 population which are significantly higher (20.4/100,000) than the national average (12.2/100,000). The prevalence of asthma across the HWB area was on average 6.7% and all the CCGs had a significantly higher prevalence of asthma when compared to England overall (5.9% prevalence). There is a higher prevalence of hypertension (15.2%) when compared to the East of England (14.1%) and England (13.8%). However, modelled estimates at local authority level indicate this figure could be much higher, and there may be a large proportion of Suffolk residents with undiagnosed hypertension. Finding people with high blood pressure is arguably the most effective way to prevent heart attacks, strokes, cognitive decline and premature death and disability. There could be scope for community pharmacies to help with screening the population and helping to identify those with need of follow-up and treatment. Lifestyle Lifestyle issues are of concern in some of the areas in Suffolk. These include: • drug and alcohol use • sexual health and teenage pregnancy • smoking These are more of an issue in certain areas rather than Suffolk as a whole. Locally- commissioned services, through the local authority, are provided by many community pharmacies to address these issues.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Pharmaceutical service providers in Suffolk To appreciate the definition of pharmaceutical services as used in this PNA, it is firstly important to understand the types of providers of NHS pharmaceutical services comprised in the pharmaceutical list maintained by NHS England. They are: • pharmacy contractors, including distance-selling pharmacies • dispensing appliance contractors • local pharmaceutical service providers • dispensing doctors For the purposes of this PNA, pharmaceutical services have been defined as those which are/may be commissioned under the provider’s contract with NHS England. Other providers of pharmaceutical services include hospitals, prisons and military bases. Suffolk HWB covers the geographical area of West Suffolk CCG, Ipswich and East Suffolk CCG and part of Great Yarmouth and Waveney CCG. Suffolk has 146 community pharmacies (as of 28th April 2017). This equates to an average of 19.7 community pharmacies per 100,000 population, which has decreased from 22 in 2012- 13. If we include dispensing GP practices, then the figure rises to 25.4. Table 1 below shows the data for the average number of community pharmacies for the HWB, the region and England, and compares the data from the previous PNA with 2015-16. Suffolk is currently well-served with community pharmacies, having numbers between England and East of England region averages. Table 1: Average number of community pharmacies per 100,000 population

Community pharmacies per 100,000 population

England East of England Suffolk HWB 2015-16 21.5 18.8 19.7* 2012-13 21 20 22 *In addition to community pharmacy pharmaceutical services are also provided by dispensing practices.

A number of community pharmacies in Suffolk are open weekday evenings, Saturday and Sunday. NHS legislation allows for GPs in certain areas to dispense NHS prescriptions for defined populations (controlled localities) not having reasonable access to a community pharmacy. In addition to 146 community pharmacies, Suffolk has 43 dispensing GP practices providing pharmaceutical services. Combining these, Suffolk has an average of 25.4 community pharmacies and dispensing GP practices per 100,000 population. This is a decrease of 0.5 per 100,000 population compared to the 2015 PNA.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Feedback on pharmaceutical services The views of pharmacy service users were gained from a questionnaire circulated for comments from the general public. From the 500 responses received from the public questionnaire: • 77% use a regular or preferred pharmacy • 89% visit the pharmacy for their own needs and 54% for a family member • 62% indicate that they use their pharmaceutical service provider(s) once a month or more • 69% rated ‘close to home’ as most important reason for choice of pharmacy; 55% rated ‘close to GP Practice’; friendly staff and efficiency were also highly rated • 62% of respondents report normally travelling by car, 31% walk, 3% use public transport and 2% use a bicycle • 80% of respondents can get to their pharmacy within 15 minutes and only 1% report having a travelling time of over 30 minutes • Of the 8% who report they have difficulties when travelling to a pharmacy, 48% indicate this is due to parking difficulties • 38% prefer to visit the pharmacy Monday-Friday, 50% said their preferred date varied, 10% prefer to visit on a Saturday and just 1% prefer Sunday • 42% of respondents prefer to visit the pharmacy between 9am and 6pm; 7% prefer early evening and less than 1% prefer to visit after 8pm; 50% however said their preference varied • 59% indicate they purchase over-the-counter medicines up to once a month or more. • Only 10% of respondents indicated that they have used an internet pharmacy; of those who did, 85% rated the service as excellent or good *In some cases, respondents were able to give more than one answer, and so responses may add up to more than 100%. Suffolk HWB has identified necessary services as essential services and advanced services, as required by Paragraphs 1 and 3 of Schedule 1 to the Pharmaceutical Regulations 2013. Suffolk HWB has identified enhanced services as pharmaceutical services which secure improvements or better access, or which have contributed towards meeting the need for pharmaceutical services in Suffolk. Suffolk HWB has identified locally-commissioned services which secure improvements or better access, or which have contributed towards meeting the need for pharmaceutical services in the area in Suffolk.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Conclusions Routine access Respondents to the pharmacy questionnaire indicated that the most important issue when choosing access to pharmaceutical services is having the pharmacy 'close to home'. Travel analysis shows that 100% of the Suffolk population has an average drive time not exceeding 25 minutes to their nearest provider of pharmaceutical services and the responses to the public questionnaire identified 62% of respondents use their car to travel to their pharmacy. Use of public transport to reach their pharmacy could be an issue, as between 7% and 8% of the population take over 30 minutes to reach their nearest pharmacy. However, the public questionnaire identified only 3% of respondents use public transport to travel to their pharmacy. It is recognised that a large proportion of the population of Suffolk live in a rural area and have rights to dispensing from their dispensing GP practice. There are 146 community pharmacies in Suffolk, 21 (14.4%) of which are open for 100 hours a week or more. The majority of dispensing GP practices are also open at least one evening a week and some are also open on Saturdays. There are only community pharmacy providers open on Sundays, mostly situated in towns and large villages. Access to pharmaceutical services in the weekday evenings and weekends is therefore generally good, however there is only provision from four pharmacies on Sunday evenings and none through the night. Provision on some bank holidays in some locations is varied and often for limited hours. NHS England review provision after each Christmas, New Year and Easter bank holiday rota. Based on the results and feedback received, NHS England will make any changes necessary to provide adequate access for the county for the next bank holiday period. Based on the results and feedback from: • the public and contractor questionnaires • provision of 100-hour pharmacies in Suffolk compared to nationally and regionally • access to pharmacies across Suffolk or in neighbouring HWB areas There is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this HWB. It is understood that commercial factors often dictate many pharmacies' decision to open (or not) during bank holidays. Therefore, if there was a need it would be met by existing providers. Suffolk HWB will monitor the uptake and need for necessary services. It will also consider the impact of any changes in the future which may provide evidence that a need exists.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Improvements and better access The PNA Steering Group recognises that there are potential opportunities to commission services from community pharmacy or other healthcare providers, which would promote health and wellbeing, address health inequalities and reduce pressures elsewhere in the health system. Where the potential exists for community pharmacies to contribute to the health and wellbeing of the population of Suffolk, this has been included within the document. Suffolk HWB recognise that the burden of health needs in Suffolk will increase as the population grows and ages and would welcome proactive proposals from commissioners, including NHSE and all CCGs to commission pharmacy services that meet local needs but are beyond the scope of the PNA.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Section 1: Introduction 1.1 Background The Health Act 20091 made amendments to the NHS Act 2006, requiring each Primary Care Trust (PCT) to assess the needs for pharmaceutical services in its area and publish a statement of its assessment and any revised assessment. The regulations required the Pharmaceutical Needs Assessment (PNA) to be published by 1 February 2011. There was also a requirement to re-write the PNA every three years or sooner if there were significant changes to the pharmaceutical needs of the area. Suffolk PCT and Great Yarmouth and Waveney PCT produced their first PNAs in 2011. These were subsequently updated in 2015 by Suffolk (Health and Wellbeing Board (HWB. The responsibility for the development, publishing and updating of PNAs became the responsibility of Health and Wellbeing Boards (HWBs) as a result of the Health and Social Care Act 2012.2 This Act reformed the NHS from 1st April 2013. PCTs were abolished and Health and Wellbeing Boards, Clinical Commissioning Groups (CCGs) and NHS England were formed. • CCGs are clinically-led NHS bodies responsible for planning, purchasing and monitoring the majority of local health services including hospital, community, emergency and mental health care. • NHS England oversees the operations of the CCGs, as well as commissioning primary and specialist services (such as cancer care). Along with CCGs, it has the responsibilities of improving health outcomes and reducing health inequalities. • Health and Wellbeing Boards (HWBs), hosted by each ‘upper tier’ local authority, have their membership drawn from local leaders (often NHS England, CCGs and local government) and are responsible for the continual improvement of the health and wellbeing of the local population. Suffolk HWB covers Suffolk County, which includes the geographical area of West Suffolk CCG, Ipswich and East Suffolk CCG and part of Great Yarmouth and Waveney CCG. The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (SI 2013/349),3 hereafter referred to as the ‘Pharmaceutical Regulations 2013’, came into force on 1st April 2013. Unless required to be produced earlier, the Pharmaceutical Regulations 2013 permitted HWBs a temporary extension of the PNAs previously produced by the PCT. HWBs were required to publish their first PNA by 1st April 2015.

1 Health Act 2009 - http://www.legislation.gov.uk/ukpga/2009/21/part/3/crossheading/pharmaceutical-services-in- england?view=plain 2 Health and Social Care Act 2012 - http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted 3 Pharmaceutical Regulations 2013 - http://www.legislation.gov.uk/uksi/2013/349/contents/made

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

The Regulations require each HWB to publish a statement of its revised assessment within three years of its previous publication, and this document fulfils that regulatory requirement. The Pharmaceutical Regulations 2013 were updated to the National Health Service (Pharmaceutical and Local Pharmaceutical Services) (Amendment and Transitional Provision) Regulations 2014 on 1st April 2014. This PNA has considered these amendments, but the Pharmacy Regulations 2013 have been referenced throughout. Since the 2015 PNA there have been a number of changes to the contractual framework for community pharmacies and these are briefly described below. 1.1.1 Essential Small Pharmacy Scheme (ESPS) Financial support for the Essential Small Pharmacy Scheme (ESPS) came to an end on 31st March 2015. Arrangements had existed for many years which provided modest financial support for small pharmacies in areas where they were needed for patients, but where the level of business was otherwise too low for a pharmacy to be viable. At the time, it was estimated there were no more than 100 such pharmacies in England. Those pharmacies that remained low volume and more than 1 km from the next nearest pharmacy had a number of options: • Cease to provide pharmaceutical services. • Return to the pharmaceutical list and receive standard funding. • Agree a new LPS contract with the local NHS England team. There are no pharmacies within Suffolk on LPS contracts. 1.1.2 Influenza vaccination advanced service On 20th July 2015, as part of the 2015-16 community pharmacy funding settlement, NHS England agreed to allow community pharmacies in England to offer a seasonal influenza (flu) vaccination service for patients in at-risk groups. This became the fifth Advanced Service in the English Community Pharmacy Contractual Framework (CPCF) and provision of the service commenced from 16th September 2015. The service has continued to be recommissioned for subsequent flu seasons. Those pharmacies which provided the service for the 2015-16 flu season are listed in Appendix A. 1.1.3 NHS Urgent Medicine Supply Advanced Service (NUMSAS) On 20th October 2016, the Department of Health (DH) and NHS England announced that as part of the 2016-17 and 2017-18 community pharmacy funding settlement, money from the Pharmacy Integration Fund (PhIF) would be used to fund a national pilot of an NHS Urgent Medicine Supply Advanced Service (NUMSAS). The pilot service has been commissioned as an Advanced Service and it will run from 1st December 2016 to 31st March 2018, with a review point to consider progress in September 2017. The service can only be accessed via a referral from an urgent care provider, e.g. NHS 111, who holds a list of providers of the service.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

There is no publicly-available list of providers of the service. The PNA recognises that a funded service which supports the supply of urgent medicines from pharmacies would reduce the burden on urgent care services and GPs and improve patient care. Consideration will be given to the type of commissioned service that would be most beneficial once the NUMSAS service evaluation is complete. A commissioned service had been running in Waveney since December 2015 and this had the additional benefits of an IT platform which facilitated service delivery and audit, as well as direct access for patients without the need for referral via NHS 111. 1.1.4 Pharmacy Access Scheme (PhAS) At the same time, the DH confirmed the introduction of a Pharmacy Access Scheme (PhAS). The aim is to ensure that a baseline level of patient access to NHS community pharmacy services is protected. The PhAS will protect access in areas where there are fewer pharmacies with higher health needs and ensure no area is left without access to NHS community pharmaceutical services. Qualifying pharmacies receive an additional payment which will protect them from the full effect of the reduction in funding which was imposed from December 2016. There are 32 pharmacies who qualify under the PhAS. A full list of those pharmacies can be found in Appendix A. It is uncertain whether this scheme will continue after March 2018. 1.1.5. Quality payment scheme The Government also introduced a 'quality payment scheme'. To qualify for payment, pharmacies have to meet four gateway criteria: • provision of at least one advanced service • NHS Choices entry up to date • staff able to send and receive NHS email • ongoing utilisation of the Electronic Prescription Service (EPS) Fulfilling the gateway criteria does not earn the pharmacy the quality payment in itself. Payment depends on how many of the quality criteria the pharmacy meets and the criteria are weighted based on how difficult they are to meet. At each review point, pharmacies need to make a declaration to NHS Business Services Authority (NHS BSA) and payment will be based on how many criteria are met. It is uncertain whether this scheme will continue after March 2018. 1.1.6. Pharmacy consolidations On 5th December 2016, an amendment to the Pharmaceutical Regulations 2013 came into effect affecting 'pharmacy consolidations'. This allowed NHS pharmacy businesses to apply to consolidate the services provided on two or more sites into a single site. Applications to consolidate are dealt with as 'excepted applications' under the Pharmaceutical Regulations 2013, which means in general terms that they will not be assessed against the PNA. Instead, consolidation applications will follow a simpler procedure, the key to which is whether or not a gap in pharmaceutical service provision would be created by the consolidation.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Some provision is also made in respect of continuity of services. For example, if NHS England intends to commission an 'enhanced service' from the applicant that has been provided at or from the closing premises, then the applicant is required to provide undertakings to continue to provide those services following consolidation. If NHS England is satisfied the consolidation would create a gap in service provision, it must refuse the application. If the Health and Wellbeing Board (HWB) does not consider that a gap in service provision is created as a consequence, it must publish a supplementary statement alongside its PNA recording its view. 1.2 Purpose of the PNA NHS England is required to publish and maintain pharmaceutical lists for each HWB area. Any person wishing to provide NHS pharmaceutical services is required to be listed on the pharmaceutical list. NHS England must consider any applications for entry onto the pharmaceutical list. The Pharmaceutical Regulations 2013 require NHS England to consider applications to fulfil unmet needs determined within the PNA of that area, or applications for benefits unforeseen within the PNA. Such applications could be for the provision of NHS pharmaceutical services from new premises, or to extend the range or duration of current NHS pharmaceutical services offered from existing premises. As the PNA will become the basis for NHS England to make determinations on such applications, it is therefore prudent that the PNA is compiled in line with the Regulations and with due process, and that the PNA is accurately maintained and up to date. Although decisions made by NHS England regarding applications to the pharmaceutical list may be appealed to the NHS Family Health Services Appeals Unit, the final published PNA cannot be appealed. It is likely the only challenge to a published PNA will be through application for a judicial review of the process undertaken to conclude the PNA. The PNA should also be considered alongside the Local Authority’s Joint Strategic Needs Assessment (JSNA).4 The PNA will identify where 'necessary' NHS pharmaceutical services (as detailed in Section 1.3) are required to address public health needs identified in the JSNA as a current or future need. In many cases, public health needs may be addressed through locally-commissioned services which has not been considered within the scope of this PNA. Through decisions made by the Local Authority, NHS England and the CCGs, these documents will jointly aim to improve the health and wellbeing of the local population and reduce inequalities. 1.3 Scope of the PNA The Pharmaceutical Regulations 2013 detail the information required to be contained within a PNA.

4 Current JSNA - https://www.healthysuffolk.org.uk/jsna

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

A PNA is required to measure the adequacy of pharmaceutical services in the HWB area under five key themes: • necessary services*: current provision • necessary services*: gaps in provision • other relevant services, current provision • improvements and better access: gaps in provision • other services *Necessary services are services that the PNA has identified as services inside and outside of the HWB area which are necessary to meet the need (or contribute to meeting the need) for pharmaceutical services in its area. In addition, the PNA details how the assessment was carried out. This includes: • how the localities were determined • the different needs of the different localities • the different needs of people who share a particular characteristic • a report on the PNA consultation As already mentioned, the PNA is aligned with the Suffolk JSNA. To appreciate the definition of 'pharmaceutical services' as used in this PNA, it is firstly important to understand the types of providers of NHS pharmaceutical providers comprised in the pharmaceutical list maintained by NHS England. They are: • pharmacy contractors, including distance-selling pharmacies • dispensing appliance contractors • local pharmaceutical service providers • dispensing doctors For the purposes of this PNA, 'pharmaceutical services' has been defined as those which are/may be commissioned under the provider’s contract with NHS England. A detailed description of each provider type, and the pharmaceutical services as defined in their contractual framework with NHS England, is set out below. 1.3.1 Pharmacy contractors Pharmacy contractors operate under the CPCF, initially agreed in 2005 with additional amendments since that time. See section 1.1 for the main changes in regulations affecting community pharmacy since the publication of the previous PNA. The Regulations set three levels of service under which community pharmacies operate. Essential services – these can be found in Schedule 4 (Part 2) of the Pharmaceutical Regulations 2013.5

5 Pharmaceutical Regulations 2013, Sch 4 (Part 2) http://www.legislation.gov.uk/uksi/2013/349/schedule/4/part/2/made

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

These are nationally negotiated and must be provided from all pharmacies: • dispensing of medicines • repeat dispensing • safe disposal of unwanted medicines • promotion of healthy lifestyles • signposting • support for self-care • clinical governance Advanced services – these can be found in Parts 2 and 3 of the NHS Act 2006 and in the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013, the ‘2013 Directions’.6 These are negotiated nationally; any contractor may provide them, as long as they meet the necessary criteria: • Medicines Use Reviews (MURs) • New Medicine Service (NMS) • Flu Vaccination Service • NHS Urgent Medicines Supply Advanced Service (NUMSAS) • Appliance Use Reviews (AURs) • Stoma Appliance Customisation (SAC) A full list of provision of advanced services provided by pharmacies in Suffolk (correct as of 1st June 2017) can be found in Appendix A. Enhanced services – these can be found in Part 4 of the 2013 Directions. They are negotiated locally by NHS England Area Teams and may only be provided by contractors directly commissioned by NHS England. • anticoagulant monitoring service • care home service • disease-specific management service • emergency supply service • gluten-free supply service • independent prescribing service • home delivery service • language access service • medication review service • minor ailment service* • needle and syringe exchange service*

6 The 2013 Directions and amendment - https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/193012/2013-03-12_- _Advanced_and_Enhanced_Directions_2013_e-sig.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/266023/pharmaceutical_services_ directions_amendment_2013.pdf

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

• on-demand availability of specialist drugs service • out-of-hours service • patient group direction service • prescriber support service • schools service • screening service* • stop smoking service* • supervised administration service* • supplementary prescriber service *These are services which are often commissioned by local authorities or CCGs. The responsibility for public health services transferred from PCTs to local authorities with effect from 1st April 2013. Where these services are currently commissioned by local authorities, they are not considered enhanced or pharmaceutical services. The 2013 Directions, however, permit NHS England to commission them from pharmacy contractors if asked to do so by a local authority. In this case, if commissioned by NHS England, they are enhanced services and fall within the definition of pharmaceutical services. In Suffolk, NHS England, as part of their emergency planning responsibilities, commission a provision of potassium iodate tablets service to help manage any radiation leak from Sizewell power station. A number of public health services are commissioned locally from community pharmacies by Suffolk County Council. These can be found listed in Appendix A. Great Yarmouth and Waveney CCG commission a palliative care medicines service from local community pharmacies. They also commission an emergency supply of medicines service, which is available from all pharmacies in the CCG area. Pharmacy contractors comprise both those located within Suffolk listed in Appendix A, those in neighbouring HWB areas and remote suppliers, such as distance-selling pharmacies. Although distance-selling pharmacies may provide services from all three levels as described above, and must provide all essential services, they may not do so face-to-face. Additionally, they must provide services to the whole population of England. There was one distance-selling pharmacy located within Suffolk in 2015, but this has now closed: • Blackbay Ventures Limited, Unit 12, Acorn Business Centre, Oaks Drive, Newmarket, CB8 7SX However, it should also be noted that distance-selling pharmacies throughout England (there were 266 in 2015-167) must provide services to anyone in England who requests them.

7 General Pharmaceutical Services in England – NHS Digital 2015-16 - http://www.content.digital.nhs.uk/catalogue/PUB22317

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

1.3.2 Dispensing Appliance Contractors (DACs) Dispensing Appliance Contractors (DACs) operate under the Terms of Service for Appliance Contractors as set out in Schedule 5 of the Pharmaceutical Regulations 2013.8 They can supply appliances against an NHS prescription such as stoma and incontinence aids, dressings, bandages etc. DACs must provide a range of essential services, such as dispensing of appliances, advice on appliances, signposting, clinical governance and home delivery of appliances. In addition, DACs may provide the advanced services of Appliance Use Reviews (AURs) and Stoma Appliance Customisation (SAC). Pharmacy contractors, dispensing doctors and local pharmaceutical service (LPS) providers may supply appliances but DACs are unable to supply medicines. Table 2: List of DACs in Suffolk

Name Address Opening hours

Charles S Bullen 60 St Matthew's Street Ipswich Mon-Fri 09:00-17:00 Healthcare Ltd IP1 3EP Sat 09:00-13:00

25 Lower Brook Street, Ipswich Fittleworth Medical Ltd Mon-Fri 09:00-17:00 IP4 1AQ

1.3.3 Local Pharmaceutical Service (LPS) providers A pharmacy provider may be contracted to perform specified services to their local population or a specific population group. This contract is locally commissioned by NHS England, and provision for such contracts is made in the Pharmaceutical Regulations 2013 in Part 13 and Schedule 7.9 Such contracts are agreed outside the national framework, although may be over and above what is required from the national contract. Payment for service delivery is locally agreed and funded. In Suffolk there are no LPS pharmacies. Data gathered from 2015-16 shows that there was a total of 77 LPS pharmacies in England, which is a reduction of 80 since 2013-14. Of these, only ten are Essential Small Pharmacies and there are only two in the whole East of England region. Essential Small Pharmacies were under contract until 31st March 2015, at which time they were invited to either: • cease to provide pharmaceutical services • return to the pharmaceutical list and receive standard funding • agree a new LPS contract with the local NHS England team

8 Pharmaceutical Regulations 2013, Sch 5 - http://www.legislation.gov.uk/uksi/2013/349/schedule/5/made 9 Pharmaceutical Regulations 2013, Part 13 - http://www.legislation.gov.uk/uksi/2013/349/regulation/102/made; Sch 7 - http://www.legislation.gov.uk/uksi/2013/349/schedule/7/made

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

1.3.4 Dispensing GP practices The Pharmaceutical Regulations 2013, as set out in Part 8 and Schedule 6, permit GPs in certain areas to dispense NHS prescriptions for defined populations. These provisions are to allow patients in rural communities, who do not live within a 1.6 km radius of a community pharmacy, to have access to dispensing services from their GP practice, where the GP practice has dispensing rights. Dispensing GP practices therefore make a valuable contribution to dispensing services, although they do not offer the full range of pharmaceutical services offered at community pharmacies. GP premises for dispensing must be listed within the pharmaceutical list held by NHS England and patients retain the right of choice to have their prescription dispensed from a community pharmacy if they wish. In Suffolk there are 43 dispensing GP practices. Dispensing GP practices may dispense NHS prescriptions for their own eligible patients who live more than 1m/1.6km (as the crow flies) from their nearest community pharmacy. These can be found listed in Appendix A and identified on Map A. 1.3.5 Other providers of pharmaceutical services in neighbouring HWB areas There are three other HWB areas which border the Suffolk HWB area: Essex, Cambridgeshire and Norfolk HWBs. Therefore, in determining the needs of, and pharmaceutical service provision to, the population of Suffolk, consideration has been made to the pharmaceutical service provision from the neighbouring HWB areas. Maps A and B provide a detailed analysis of pharmacy contractors which lie across the Suffolk HWB border but are within easy reach of the Suffolk HWB area. 1.3.6 Other services and providers in Suffolk out of scope of the PNA As mentioned earlier, for the purpose of this PNA, 'pharmaceutical services' have been defined as those which are, or may be, commissioned under the provider’s contract with NHS England. The following are providers of pharmaceutical services in Suffolk, but commissioned by organisations other than NHS England and therefore out of scope of the PNA. Prisons – in Suffolk there are three male prisons: HMP Highpoint (North and South), c1,323 operational capacity for Category C adult males; HMP and YOI Hollesley Bay, 471 operational capacity for Category D adult males; and HMP Warren Hill, 257 operational capacity for Category C adult males. As of December 2016, prison populations in Suffolk were at or just over operational capacity. A pharmaceutical service is provided to the prisoners of these prisons and is directly contracted by the Health and Justice Team of NHS England (Midlands and East of England region). HMP Highpoint (North and South) has an on-site pharmacy, whereas external providers supply all medications to HMP and YOI Hollesley Bay and HMP Warren Hill.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Hospitals – Suffolk has two main NHS Hospitals – West Suffolk Hospital NHS Foundation Trust and Ipswich Hospital NHS Trust, providing services to the Suffolk and neighbouring populations. James Paget Hospital in Great Yarmouth is the main hospital used by the Waveney population. There are also a number of smaller community hospitals: Newmarket Community Hospital, Felixstowe Community Hospital, Aldeburgh Community Hospital and Bluebird Lodge Community Hospital. Pharmacy services are provided by Suffolk hospitals to both inpatients and outpatients from these sites. There are plans for Ipswich Hospital NHS Trust and Colchester Hospital University NHS Foundation Trust to reconfigure services. Minor injury units and walk-in centres – Felixstowe Community Hospital and Beccles and District War Memorial Community Hospital provide an assessment and treatment service for minor illness and minor ailments. There are no walk-in centres in Suffolk. Other commissioned services The following are services provided by NHS pharmaceutical providers in Suffolk, commissioned by organisations other than NHS England or provided privately and therefore out of scope of the PNA. It should be noted, while the following services fall outside the scope of the PNA, they are important services that in conjunction with the PNA create a strategic plan to address unmet health needs. Local authority public health services – Suffolk County Council commissions the following services from community pharmacies in Suffolk: • needle and syringe exchange service • supervised administration of opiates • chlamydia screening and treatment services • support to stop smoking services • emergency hormonal contraception services • NHS Health Checks Local CCGs – Great Yarmouth and Waveney CCG locally commission a palliative drugs service and emergency supply of medicines service from community pharmacies. The emergency supply service is available from all contractors so no separate reference is made in Appendix A to those who supply the service. Non-commissioned – many NHS pharmaceutical providers offer the following services privately: • care home service • home delivery service • patient group direction service • screening service

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Services vary between provider and in some cases may be provided free of charge. 1.4 Process for developing the PNA The Health and Social Care Act 2012 transferred responsibility for developing and updating of PNAs to HWBs. This meant that from 1st April 2013 the HWB assumed responsibility for the existing PNA – previously published by Suffolk PCT – and that the board must publish its first PNA by April 2015, with a revised assessment at least every three years thereafter. The last PNA for Suffolk was published in March 2015, and is therefore due to be re- assessed by March 2018. On 26th January 2017, the reassessment of the pharmaceutical needs of Suffolk was raised at the HWB meeting through the Information Bulletin. The Information Bulletin is a document that is made available to the public with the published agenda papers. It can include updated information requested by the board as well as information that a service considers should be made known to the board. Public Health Suffolk has a duty to complete this document on behalf of the HWB. Public Health Suffolk commissioned Soar Beyond to undertake the PNA. Soar Beyond was chosen from a selection of potential candidates due to their significant experience in providing services to assist pharmaceutical commissioning, including the production and publication of PNAs. Soar Beyond produced the first Suffolk HWB PNA in March 2015, and continued to support Suffolk County Council to maintain it. Step 1: Steering group and project group On 11th January 2017, a PNA Steering Group was established. The terms of reference and membership of the PNA Steering Group can be found in Appendix B. Step 2: Project management At its first meeting, Soar Beyond and the Local Authority presented and agreed the project plan and ongoing maintenance of the project plan. Appendix G shows an approved time line for the project. Step 3: Review of existing PNA and JSNA Through the project manager, the PNA Steering Group reviewed the existing PNA and subsequent supplementary statements10 and JSNA for Suffolk. It was agreed that the existing PNAs and subsequent supplementary statements were accurate and up-to- date and the public health team, supported by Soar Beyond, would be responsible for the on-going maintenance of the current PNA until this PNA was published.

10 Suffolk PNA, 2015 and supplementary statements - http://www.healthysuffolk.org.uk/joint-strategic-needs- assessment-jsna/reports/reports/pharmaceutical-needs-assessment-pna/PNA2015/

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Step 4a: Public questionnaire on pharmaceutical service provision A public questionnaire to establish views about pharmacy services was produced by the Steering Group, which was then circulated to all GP practices and community pharmacies in the Suffolk area. This was supported by a link to the questionnaire on the council’s website and advertised though posters in community pharmacies. A total of 500 responses were received, a summary of which can be found in Section 5. A copy of the public questionnaire can be found in Appendix C and results in Appendix M. Step 4b: Pharmacy contractor questionnaire The Steering Group agreed a questionnaire to be distributed to the local community pharmacies to collate information for the PNA. A total of 64 responses were received. A copy of the pharmacy contractor questionnaire can be found in Appendix D. The results of the questionnaire are found in Appendix N. Step 4c: Dispensing GP questionnaire A short questionnaire was agreed by the Steering Group which was distributed to the dispensing GP practices to inform the PNA on services provided. A total of 26 responses were received from the 43 dispensing GP practices in Suffolk. A copy of the dispensing GP practice questionnaire can be found in Appendix E. The results of the questionnaire are found in Appendix K. Step 4d: Commissioner questionnaire The Steering Group agreed a questionnaire to be distributed to all relevant commissioners in Suffolk to inform the PNA. A copy of the commissioner questionnaire can be found in Appendix F and the responses can be found in Appendix L. Step 5: Preparing the draft PNA for consultation The steering group, facilitated by the JSNA programme manager for Suffolk County Council, reviewed and revised the content and detail of the existing PNA, taking into account the JSNA and other relevant strategies, in order to ensure the priorities were identified correctly. 1.5 Localities for the purpose of the PNA The PNA Steering Group, at its first meeting, considered how the localities within Suffolk geography would be defined. The majority of health and social care data is available at district and local authority level and at this level provides reasonable statistical rigour. It was agreed that the district and borough council geographies would continue be used to define the localities of the Suffolk geography. These were the localities chosen in the previously published PNAs for Suffolk in 2015.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

The district and borough councils for Suffolk are: • Babergh District Council • Forest Heath District Council • Ipswich Borough Council • Mid Suffolk District Council • St Edmundsbury Borough Council • Suffolk Coastal District Council • Waveney District Council Appendix A shows a list of providers of pharmaceutical services in each locality. Primary care services are commissioned at CCG level. The CCG geographies do not match the district or borough council boundaries in all cases in Suffolk. Figure 1 below shows the geographical relationship between the borough or district council boundaries and the CCGs. Figure 1: Geographical relationship between CCGs and District or Borough Councils in Suffolk HWB

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Section 2: Context for the PNA Suffolk is a rural county in eastern England. It has borders with the counties of Cambridgeshire, Essex and Norfolk and a coastline facing the North Sea. Main urban areas in Suffolk include the county town of Ipswich and the large towns of Bury St Edmunds and Lowestoft. Elsewhere in Suffolk, the population is located in smaller towns and villages and in more isolated settlements in the countryside. The main roads A14 and A12 cross the county, as does the main railway line from London to Cambridge and Norwich. The East Suffolk railway line runs from Ipswich to Felixstowe and Lowestoft. Felixstowe is the largest container port in the UK and there are also small ports at Ipswich and Lowestoft. The RAF and USAF have airbases in Suffolk but there is no commercial airport in the county. Figure 2: Suffolk County, including geographical features and boundaries of local authority districts

2.1 Joint Strategic Needs Assessment (JSNA) The purpose of the Joint Strategic Needs Assessment (JSNA) is to accurately assess the health needs of a local population, to improve the physical and mental health and wellbeing of individuals and communities.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

The JSNA underpins the Health and Wellbeing Strategy. The HWB is responsible for both the JSNA and the Health and Wellbeing Strategy. A rolling programme of needs assessments, topic-based reports and data analysis all inform the overarching Suffolk JSNA. Suffolk’s first JSNA was published in 2008, with the 2015 State of Suffolk report being the latest major update, however this is being refreshed during 2018. The Suffolk JSNA is not a single document, it is a suite of dynamic resources to inform commissioning of health and social care and provide strategic direction. 2.2 Health and Wellbeing Strategy The vision of the Suffolk HWB is to enable people in Suffolk to live healthier, happier lives. The HWB want to narrow the differences in healthy life expectancy between those living in the most deprived communities and those who are better off. Suffolk’s Joint Health and Wellbeing Strategy 2012-22 sets the long term strategic framework for improving health and wellbeing in Suffolk. The Strategy was refreshed in 2016 to review and (where relevant) re-set the outcomes for the next three years to achieve the HWB's vision. The State of Suffolk 2015 informed the refresh of the Joint Health and Wellbeing Strategy, ensuring that the Strategy is evidence-based and focused on the relevant key issues including: inequalities, demographic pressures and redesigning services to meet needs and enhance opportunities for prevention. The refreshed outcomes for 2016-19 are shown below. Figure 3: Refreshed Health and Wellbeing Strategy outcomes, 2016-201911

2.3 Population characteristics 2.3.1 Overview The 2015 mid-year estimate of the resident population of Suffolk was 741,895, comprising 366,043 males (49.3%) and 375,852 females (50.7%). The population has increased by 3.1% since 2010, and is expected to increase 11% by 2039 to 823,000.12

11 Suffolk Health & Wellbeing Board. A Joint Health and Wellbeing Strategy for Suffolk: Refresh 2016-2019. 2016. 12 Office for National Statistics. Population Estimates for UK, England and Wales, Scotland and Northern Ireland: mid-2015. 2016.

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Suffolk is made up of seven districts and boroughs; Ipswich is the local authority with the highest population with 135,600 residents, Forest Heath has the lowest population (63,691 residents). Table 3: Local authority population estimates, 2015

Total Males Females Babergh 89,215 43,450 45,765 Forest Heath 63,691 32,174 31,517 Ipswich 135,600 67,647 67,953 Mid Suffolk 99,632 49,238 50,394 St Edmundsbury 112,523 56,386 56,137 Suffolk Coastal 125,052 60,913 64,139 Waveney 116,182 56,235 59,947

2.3.2 Age Suffolk has a higher percentage of adults in the older age groups compared to national figures. In the younger age bands, up to the age of 29, men outnumber women, however for the older age bands this is reversed. Figure 4: Suffolk population by age group, 201513

80-84

70-74

60-64

50-54

40-44

30-34

20-24

10-14

0-4 4 3 2 1 0 1 2 3 4 % of population F - Eng and Wales M - Eng and Wales F - Suffolk M -Suffolk

13 Office for National Statistics. Population Estimates for UK, England and Wales, Scotland and Northern Ireland: mid-2016. 2016. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/an nualmidyearpopulationestimates/latest

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

A breakdown of the population of Suffolk by district and borough shows that there is a great deal of variation around the county, with some local authorities having higher or lower proportions of each age group, compared to figures for the county overall. Those aged over 65 years comprise over 20% of the total population in five of the local authorities, but less than 20% in Forest Heath (17.6%) and Ipswich (16.0%). These authorities have higher proportions of their populations in the 0-15 age group. Table 4: Number of residents by age band for local authorities in Suffolk, 201514

Aged Aged Aged Aged Aged Total 0-15 16-29 30-45 45-64 65+ Babergh 15,539 11,795 14,028 25,490 22,363 89,215 Forest Heath 12,810 12,562 12,676 14,446 11,197 63,691 Ipswich 27,130 25,630 28,422 32,693 21,725 135,600 Mid Suffolk 17,333 13,890 16,382 28,869 23,158 99,632 St Edmundsbury 20,172 17,988 20,722 29,373 24,268 112,523 Suffolk Coastal 21,064 15,936 18,527 36,383 33,142 125,052 Waveney 19,982 16,943 17,964 30,788 30,505 116,182 Suffolk 134,030 114,744 128,721 198,042 166,358 741,895

Table 5: Proportion of total local authority population by age band in Suffolk, 201515 % % aged % aged % aged % aged aged 16-29 30-44 45-64 65+ 0-15 Babergh 17.4% 13.2% 15.7% 28.6% 25.1% Forest Heath 20.1% 19.7% 19.9% 22.7% 17.6% Ipswich 20.0% 18.9% 21.0% 24.1% 16.0% Mid Suffolk 17.4% 13.9% 16.4% 29.0% 23.2% St Edmundsbury 17.9% 16.0% 18.4% 26.1% 21.6% Suffolk Coastal 16.8% 12.7% 14.8% 29.1% 26.5% Waveney 17.2% 14.6% 15.5% 26.5% 26.3% Suffolk 18.1% 15.5% 17.4% 26.7% 22.4%

14 Suffolk HWB. A Joint Strategy: Refresh 2016-2019. 2016. 15 Suffolk HWB. A Joint Strategy: Refresh 2016-2019. 2016.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.3.3 Predicted population growth Population projections from the Office of National Statistics (ONS) suggest that the population of Suffolk is expected to increase to 777,900 by 2025 and 823,000 by 2039. The chart overleaf shows how the different age groups are predicted to change over the coming years. Some younger age groups are forecast to see a fall in numbers, however older age groups are set to increase, most notably those aged 65 to 84, who will make up the largest proportion of the population by 2026. This group will continue increase to 2039, the last year for which figures are currently available, when they are forecast to make up almost 25% of the population of Suffolk. Those aged over 85 are forecast to more than double by 2039, increasing from an estimated 24,000 in 2014 to 59,000. By contrast, the 35 to 49 population is forecast to reduce in number, from 139,000 in 2014 to 128,000 by 2039, a decrease of 3.1%. Figure 5: Population projections by age group 2014 to 2039, Suffolk16

250

200

150

100 No in 1,000sNo in

Year

0-19 20-34 35-49 50-64 65 -84 85+

2.3.4 GP-registered population In October 2016, 782,427 people were recorded as being registered with a GP in Suffolk, a small proportion of these may not be Suffolk residents, and will live just over the border in neighbouring counties.17 The following figures show GP practice list sizes by Clinical Commissioning Group (CCG).

16 Office of National Statistics. 2014-based National Population Projections. 2016. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/datasets/2 014basednationalpopulationprojectionstableofcontents 17 Suffolk County Council. Knowledge and Information Team, PCMD and GP Registration Data. 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Figure 6: Ipswich and East Suffolk CCG GP practice list sizes, October 201618

30,000

25,000

20,000 24,073 24,073

15,000 18,907 18,907 17,552 17,552 17,190 17,190 16,721 16,721

10,000 15,496 15,148 15,148 14,786 14,786 14,531 14,531 14,288 14,288 12,385 12,385 12,208 12,208 11,557 11,557 10,962 10,962 9,964 9,964 9,858 9,858

5,000 10,511 9,303 9,303 9,260 9,260 9,239 9,239 9,031 9,031 8,697 8,697 8,256 8,256 8,124 8,124 7,907 7,907 7,383 7,383 7,371 7,371 7,346 7,346 2,515 2,515 3,850 3,920 4,304 5,393 5,667 5,921 5,990 6,559 6,790 6,791 7,271 - STOW HEALTH STOW HAVEN HEALTH HAVEN WALTON SURGERY WALTON SURGERY LEISTON IXWORTH SURGERY IXWORTH COUNTRY PRACTICE COUNTRY EYE HEALTH CENTRE HEALTH EYE DEBENHAM SURGERY DEBENHAM DEBEN ROAD SURGERY ROAD DEBEN COMBS FORD SURGERY FORD COMBS MARTLESHAM SURGERY MARTLESHAM FRAMLINGHAM SURGERY FRAMLINGHAM CHURCH FARM SURGERY FARM CHURCH GROVE MEDICAL CENTRE MEDICAL GROVE THE PENINSULA PRACTICE PENINSULA THE HOWARD HOUSE SURGERY HOUSE HOWARD HADLEIGH HEALTH CENTRE HEALTH HADLEIGH ORCHARD STREET MEDICAL… STREET ORCHARD THE DERBY ROAD PRACTICE ROAD DERBY THE BILDESTON HEALTH CENTRE HEALTH BILDESTON HAWTHORN DRIVE SURGERY DRIVE HAWTHORN FRAMFIELD HOUSE SURGERY HOUSE FRAMFIELD CONSTABLE COUNTRY RURAL… COUNTRY CONSTABLE SURGERY ROAD BURLINGTON ORCHARD MEDICAL PRACTICE MEDICAL ORCHARD THE HOLBROOK AND SHOTLEY… AND HOLBROOK THE TWO RIVERS MEDICAL CENTRE MEDICAL RIVERS TWO THE NORWICH ROAD SURGERY ROAD NORWICH THE MENDLESHAM HEALTH CENTRE HEALTH MENDLESHAM THE BIRCHES MEDICAL CENTRE MEDICAL BIRCHES THE CENTRE HEALTH SAXMUNDHAM IVRY STREET MEDICAL PRACTICE MEDICAL STREET IVRY BARRACK LANE MEDICAL CENTRE MEDICAL LANE BARRACK FRESSINGFIELD MEDICAL CENTRE MEDICAL FRESSINGFIELD LITTLE ST JOHN STREET SURGERY STREET JOHN ST LITTLE RAVENSWOOD MEDICAL PRACTICE MEDICAL RAVENSWOOD THE BARHAM & CLAYDON SURGERY CLAYDON & BARHAM THE WICKHAM MARKET MEDICAL CENTRE MEDICAL MARKET WICKHAM THE CHESTERFIELD DRIVE PRACTICE DRIVE CHESTERFIELD THE FELIXSTOWE ROAD MEDICAL PRACTICE MEDICAL ROAD FELIXSTOWE Average practice Size for CCG

Figure 7: Waveney GP practice list sizes, October 201619

25,000

20,000

15,000 20,259 10,000 15,665 12,804 12,698 5,000 12,322 11,500 11,197 10,444 2,013 4,370 5,075 6,533 6,640 - SURGERY SURGERY CENTRE CENTRE SOLE BAY H/C SOLE CENTRE ALEXANDRA RD ALEXANDRA VICTORIA ROADVICTORIA BUNGAY MEDICAL BECCLES MEDICALBECCLES ANDAMAN SURGERY ROSEDALE SURGERY ROSEDALE KIRKLEY MILL HEALTH KIRKLEY MILL WESTWOOD SURGERY WESTWOOD HIGH STREET SURGERY HIGH BRIDGE ROAD SURGERYBRIDGE CUTLERS HILL SURGERY CUTLERS HILL LONGSHORE SURGERIES LONGSHORE Average practice Size for CCG

18 Suffolk HWB. A Joint Strategy: Refresh 2016-2019. 2016. 19 Suffolk HWB. A Joint Strategy: Refresh 2016-2019. 2016.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Figure 8: West Suffolk CCG GP practice list sizes, October 201620

25,000

20,000 23,000 15,000 17,805 10,000 14,877 14,215 13,946 13,758 13,499 11,844 11,650 11,309 10,870 10,608 9,552 5,000 9,367 9,055 7,926 7,270 7,036 4,530 4,962 5,024 5,051 5,272 5,456 - AVICENNA SIAM SURGERY SIAM SWAN SURGERY FOREST SURGERYFOREST VICTORIA SURGERYVICTORIA OAKFIELD SURGERY OAKFIELD ANGEL HILL SURGERY HILLANGEL GLEMSFORD SURGERYGLEMSFORD LAKENHEATH SURGERY LAKENHEATH MOUNT FARM SURGERY MOUNT FARM WHITE HOUSE SURGERY HOUSE WHITE WOOLPIT HEALTHWOOLPIT CENTRE MARKET CROSS SURGERYMARKET WICKHAMBROOK SURGERY WICKHAMBROOK HARDWICKE HOUSEHARDWICKE GROUP… CLEMENTS ANDCLEMENTS CHRISTMAS… ORCHARD HOUSEORCHARD SURGERY CLARE GUILDHALL SURGERY GUILDHALL CLARE BOTESDALE HEALTH BOTESDALE CENTRE THE GUILDHALL AND BARROW… BRANDON MEDICAL PRACTICE BRANDON MEDICAL THE LONG MELFORD PRACTICE THE LONG HAVERHILL MEDICAL PRACTICE HAVERHILL MEDICAL THE ROOKERY MEDICAL CENTRE THE ROOKERY MEDICAL Average practice Size for CCG

The average list size for GPs in Ipswich and East Suffolk CCG is 10,076, in Waveney (excluding Great Yarmouth element of the CCG) it is 10,117. West Suffolk CCG has the highest average list size at 10,581. 2.3.5 International migration ONS figures for 2015 show that although the rate of international migration to Suffolk is increasing, it remained below the rates for both the East of England and England until 2014, (when the rate exceeded that for the East of England). Data for 2015 shows that the rate of non-British nationals in Suffolk has reached 83.7 per 1,000 population, lower than the figure for England (93.2 per 1,000 population). Data from the Local Area Migration Indicators also shows that the proportion of live births in Suffolk to mothers born outside the United Kingdom increased from 13.9% in 2005 to 19.7% in 2015.21 The number of non-UK born residents in Suffolk increased from 44,000 (6.4% of the total population) in 2005 to 77,000 (10.6% of the population) in 2015.

20 Suffolk HWB. A Joint Strategy: Refresh 2016-2019. 2016. 21 Office for National Statistics. Local Area Migration Indicators Tool. 2016. [Accessed 1 April 2017]. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/migrationwithintheuk/datasets/lo calareamigrationindicatorsunitedkingdom.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Figure 9: Estimates of non-British nationals per 1,000 population, Suffolk 201522

100 90.4 93.2 90 83.5 84.1 85.1 83.782.4 80 73.1 70.1 72.7 73 72.1 70 61.2 63.7 60 54.4 50 40 30 20

No. per 1,000populationNo. per 10 0 2011 2012 2013 2014 2015

Suffolk East England

2.3.6 Life expectancy Life expectancy at birth in Suffolk for both males and females is significantly better compared to England. There is, however, variation within the districts and boroughs in Suffolk. In males, the highest life expectancy is 81.9 years in St Edmundsbury, the lowest is 78.8 years in Ipswich, this is significantly worse than the England value. For females, the highest life expectancy is 84.7 years in Suffolk Coastal, the lowest life expectancy for females is 83.2 years in Ipswich and Waveney. Table 6: Life expectancy at birth 2013-201523

Males Females Babergh 81.6 84.4 Forest Heath 80.5 83.3 Ipswich 78.8 83.2 Mid Suffolk 81.3 84.6 St Edmundsbury 81.9 84.6 Suffolk Coastal 81.4 84.7 Waveney 79.4 83.2 Suffolk 80.7 84.1 England 79.5 83.1

Benchmark = England

22 Office for National Statistics. Local Area Migration Indicators Tool 2015. 2016. [Accessed 1 April 2017]. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/migrationwithintheuk/datasets/lo calareamigrationindicatorsunitedkingdom 23 Public Health England. Public Health Outcomes Framework. March 2017. [Accessed 1 March 2017]. http://www.phoutcomes.info/public-health-outcomes-framework - page/3/gid/1000049/pat/6/par/E12000006/ati/101/are/E07000206/iid/90366/age/1/sex/1/nn/nn-1-E07000206

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.3.7 Specific populations 2.3.7.1 Ethnicity At the time of the last Census in 2011, 95.2% of the resident population in Suffolk identified themselves as White, around 5% above the rate for England and 10% higher than for the East of England. Consequently, Suffolk has lower percentages of the other ethnic groups compared to national figures. All local authorities within Suffolk have higher percentages of White residents compared to the county overall, except Forest Heath and Ipswich. Forest Heath is more ethnically diverse, largely due to the presence of American airbases at Mildenhall and Lakenheath. Table 7: Ethnicity by area in Suffolk, 201124

Usual Usual Usual Usual Usual residents residents residents residents residents Asian Black White Mixed other ethnic ethnic ethnicity ethnicity ethnicities groups groups

Babergh 97.8% 0.9% 0.8% 0.3% 0.2% Forest Heath 91.9% 2.9% 2.1% 2.2% 0.9% Ipswich 88.9% 3.6% 4.3% 2.3% 0.9% Mid Suffolk 97.9% 1.0% 0.7% 0.4% 0.1% St Edmundsbury 96.0% 1.3% 1.6% 0.8% 0.2% Suffolk Coastal 96.5% 1.2% 1.6% 0.5% 0.2% Waveney 97.7% 1.1% 0.8% 0.3% 0.1%

Suffolk 95.2% 1.7% 1.8% 0.9% 0.3% East of England 90.8% 1.9% 4.8% 2.0% 0.5% England 85.4% 2.3% 7.8% 3.5% 1.0%

2.3.7.2 Children 2015 population estimates indicate 167,186 Suffolk residents are aged between 0 and 19 years, making up 22.5% of the total population, slightly below the figure for England.

24 Nomis. 2011 Census Data. 2011. www.nomisweb.co.uk

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Table 8: Child population by age group, 201525

Suffolk England

% of total % of total Number Number population population Age 0-4 41,993 5.7% 3,434,680 6.3% Age 5-11 59,967 8.1% 4,587,326 8.4% Age 12-19 65,226 8.8% 4,983,721 9.1% Age 0-19 167,186 22.5% 13,005,727 23.7%

Population projections indicate that the proportion of children will decline over the next twenty years, and is forecast to be 22.0% in 2025, falling to 20.5% by 2039. Figure 10: 0-19 population projections by age group 2014 to 2039, Suffolk26

40 No. in 1,000sNo. in 38

Year

0-4 5-9 10-14 15-19

2.3.7.2.1 School Census The latest available data from the School Census shows 90% of school age children in Suffolk are White. Approximately 84% of these children are White British and 5% any other White background.27 14% of pupils are categorised as minority ethnic pupils, an increase of 1% from 2015.

25 Office for National Statistics. Population Estimates for UK, England and Wales, Scotland and Northern Ireland: mid-2015. 2016. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/an nualmidyearpopulationestimates/latest 26 ONS. 2014-based National Population Projections. 2016. 27 Suffolk County Council. Suffolk School Census. 2016.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

In addition, 8.9% of primary and 6.3% of secondary school pupils are known or believed to have a first language other than English. Both of these figures have increased since the 2015 School Census, where the percentages were 8.0% for primary schools and 5.6% for secondary schools.28 It is possible to compare the ethnic origin of school children in Suffolk with that of the population from the last Census, which remains the only current equivalent data source. There are around 5% fewer White children than in Suffolk overall, and the proportion of mixed-ethnicity children is 3.2% above that for the county as a whole. This suggests that the younger population of Suffolk is becoming more ethnically diverse. 2.3.7.2.2 Child poverty In 2014 child poverty in Suffolk affected 16.0% of children under the age of 16 equating to nearly 20,000 children. This is significantly lower than the figure for England (20.1%). At local authority level, Ipswich has a significantly higher proportion of children in poverty (21.3%), as has Waveney (22.7%) when compared to the England percentage. 2.3.7.2.3 Criminal justice In 2015, the rate of 10-17 year olds entering the criminal justice system was 303.8 per 100,000 population, significantly lower than the rate for England at 368.6 per 100,000.29 There were 1,636 first-time offenders of any age entering the criminal justice system in 2015, equating to a rate of 221.5 per 10,000 population, lower than the England rate (242.4 per 10,000).30 2.3.7.3 Children and adults in care The number of Children in Care (CiC) increased by 65 from 2015 to 2016, from 730 to 795. Prior to that, it had been slowly reducing, from 775 in 2012 to 725 in 2014. However, the rate per 10,000 children aged under 18 is still below the average for England, and has remained at 60 per 10,000 for the last four years.

28 Suffolk County Council. Suffolk School Census. 2016. 29 Public Health England. Public Health Outcomes Framework. March 2017. [Accessed 1 March 2017]. http://www.phoutcomes.info/public-health-outcomes-framework - page/3/gid/1000049/pat/6/par/E12000006/ati/101/are/E07000206/iid/90366/age/1/sex/1/nn/nn-1-E07000206 30 Public Health England. Public Health Outcomes Framework. March 2017. [Accessed 1 March 2017]. http://www.phoutcomes.info/public-health-outcomes-framework - page/3/gid/1000049/pat/6/par/E12000006/ati/101/are/E07000206/iid/90366/age/1/sex/1/nn/nn-1-E07000206

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Table 9: Number of children in care and rate per 10,000 children aged under 1831

Numbers Rate (per 10,000)

2012 2013 2014 2015 2016 2012 2013 2014 2015 2016

Suffolk 775 735 725 730 795 51 49 48 48 52

East of 6,420 6,300 6,350 6,140 6,330 51 50 50 48 49 England

England 67,070 68,060 68,810 69,480 70,440 59 60 60 60 60

The prevalence of those with learning disabilities who were registered with a GP was 0.42% for Suffolk in 2014/15 significantly lower than for England (0.44%).32 In 2014/15, 4.08 people per 1,000 population aged 18 to 64 were getting long-term support from the local authority due to learning difficulties, a significantly higher rate compared England (3.73 per 1,000).33 2.3.7.4 Older people ONS population estimates for 2015 indicate that 22.4% of Suffolk residents are aged 65 and over. Population forecasts suggest that this figure is set to rise to 26.1% by 2025 and 31.6% by 2039. In addition, the proportion of the population over the age of 85 is set to rise in the same period from 3.2% to 4.2%, then 7.1%. This will undoubtedly have an impact on health and care services. In 2015/16 the rate of emergency admissions to hospital due to dementia was 3,115 per 100,000 population, below the national figure. However, this has been steadily increasing since 2012/13 when the rate was 2,708 per 100,000 population. 2.3.7.5 Prison populations There are several prisons within Suffolk, they are all trainer prisons and the nearest remand prison is Norwich. Prisons within Suffolk are: • Warren Hill Prison – 257 operational capacity for Category C* adult males (18+). This is distributed with 32 in the Democratic Therapeutic Community; 20 in Psychologically Informed Planned Environment. The majority of the prison population are within the Progression Regime or in transit from open conditions. • Highpoint – c1,323 operational capacity for Category C* adult males (18+). These are across two distinct sites, Highpoint North and South. This training prison is located near Newmarket, Suffolk.

31 Department for Education. Children looked after in England including adoption: 2015 to 2016. 2017. [Accessed 1 March 2017]. https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption- 2015-to-2016 32 Public Health England. Learning Disability Profiles – March 2017. 2017. [Accessed 1 March 2017]. https://fingertips.phe.org.uk/profile/learning-disabilities 33 Public Health England. Learning Disability Profiles – March 2017. 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

• Hollesley Bay – 471 operational capacity for Category D** adult males (18+). This is an open prison in Woodbridge, Suffolk.34, As of December 2016, prison populations in Suffolk were at, or just over operational capacity.35 The operational capacity refers to the number of inmates the prison can safely hold. Prison populations are a high-risk group for cancer and heart attacks due to tobacco and alcohol use, poor diet and reduced physical activity.36

* Those who cannot be trusted in open conditions but who are unlikely to try to escape. ** Those who can be reasonably trusted not to try to escape, and are given the privilege of an open prison. 2.3.7.6 Less-abled populations The ONS has produced data comparing activity-limiting illness in local authority districts as recorded at the 2001 Census with that recorded at the 2011 Census. Data for local authority districts in Suffolk is shown below. Table 10: Changes in activity-limiting illness in Suffolk between 2001-201137

Activity limiting illness No activity limiting illness 2001 2011 2001 2011 Area Babergh 16.1% 17.4% 83.9% 82.6% Forest Heath 14.5% 15.1% 85.6% 84.9% Ipswich 18.0% 17.7% 82.0% 82.4% Mid Suffolk 15.5% 16.6% 84.5% 83.5% St. Edmunsbury 15.6% 16.4% 84.5% 83.6% Suffolk Coastal 17.2% 18.5% 82.8% 81.5% Waveney 20.7% 22.3% 79.3% 77.7%

Suffolk County 16.5% 18.0% 83.5% 82.1% East of England 16.2% 16.7% 83.8% 83.3% England 17.3% 17.6% 82.7% 82.4%

34 Independent Monitoring Board. Annual Report of the Independent Monitoring Board HMP Warren Hill 1 June 2015 – 31 May 2016. 2016. [Accessed 1 March 2017]. https://www.justice.gov.uk/contacts/prison-finder/hollesley- bay. 35 Ministry of Justice. Prison Population Figures 2016. 2017. [Accessed 1 March 2017]. https://www.gov.uk/government/statistics/prison-population-figures-2016 36 Office for National Statistics. Where do we commute to? 2011. [Accessed 1 April 2017]. http://www.neighbourhood.statistics.gov.uk/HTMLDocs/dvc193/#sty=true&flow=flow0&period=0&fix=E07000200& view=357.5,118.75,315,317.5&tr=-2008.3097074030588,-1459.1367882681975&sc=3.784230586902382 37 Nomis. 2011 Census Data. 2011. www.nomisweb.co.uk

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Between 2001 and 2011, the percentage of usual residents in local authority districts in Suffolk reporting activity-limiting illness increased in all areas except Ipswich. As with general health, these increases are likely to be in part related to population growth and ageing of the population between 2001 and 2011. Table 11: Limitation of daily activities as recorded at 2011 Census – residents of local authority districts in Suffolk County and higher geographies – persons aged 16-64 years38 Limitation of daily activities

(% of all usual residents aged 16-64 years) All usual residents Day to day Day to day Day to day aged 16-64 activities activities activities years limited a lot limited a little not limited number % % % Area Babergh 4.3 6.9 88.8 53,065 Forest Heath 3.9 5.8 90.2 38,990 Ipswich 5.5 7.6 86.9 87,566 Mid Suffolk 3.7 6.8 89.5 59,436 St. Edmunsbury 4.1 6.4 89.5 69,693 Suffolk Coastal 4.4 7.1 88.5 73,596 Waveney 6.9 8.4 84.7 67,876

Suffolk County 4.8 7.1 88.1 450,222 East of England 4.6 6.8 88.6 3,714,151 England 5.6 7.1 87.3 34,329,091

At the 2011 Census a total of 4.8% of usual residents of working age in Suffolk reported that their day-to-day activities were limited a lot. This compared with 4.6% in East of England and 5.6% in England as a whole. In local authority districts in Suffolk, the percentage of usual working age residents reporting that their day-to-day activities were not limited ranged from 84.7% in Waveney to 90.2% in Forest Heath. Percentages reporting that their day-to-day activities were limited a lot ranged from 3.7% in Mid Suffolk to 6.9% in Waveney. The percentage of usual residents of working age reporting that their day-to-day activities were limited a little was also highest in Waveney (8.4%).

38 Nomis. 2011 Census Data. 2011. www.nomisweb.co.uk

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Table 12: Long term illness or disability, Suffolk39 Time East of Indicator Suffolk England period England People aged 18-64 registered deaf 2009-10 22.4 120.9 172.8 or hard of hearing per 100,000 People aged 65-74 registered deaf 2009-10 48.6 290.2 620.4 or hard of hearing per 100,000 People aged 75+ registered deaf 2009-10 140.2 1,512.4 3,089.3 or hard of hearing per 100,000 People aged 18-64 registered blind or partially sighted per 2013-14 155.8 188.3 214.1 100,000 People aged 65-74 registered 2013-14 419 465 569 blind or partially sighted (number) People aged 75+ registered blind 2013-14 4,293.8 3,969.8 4,255.4 or partially sighted per 100,000 Adults with physical disabilities supported throughout the year per 2013-14 411.3 450.1 461.7 100,000 Adults with learning disabilities supported throughout the year per 2013-14 393.7 432.0 414.0 100,000 Adults with mental health problems supported throughout 2013-14 175.8 352.6 391.3

the year per 100,000 Approximately 22 people in every 100,000 aged 18-64 are registered deaf or hard of hearing in Suffolk. This is very low compared to the England average. Caution should be taken when interpreting this data, as registration is voluntary and therefore this indicator is not a good proxy for the prevalence of hearing impairments. People who are deaf or hard of hearing and also blind or partially sighted are recorded on the Register of Blind and Partially Sighted Persons, and are excluded from the count of people who are deaf or hard of hearing. Data indicates that approximately 156 of every 100,000 working age people (18-64) were registered as blind or partially sighted in 2013-14.40 The numbers of adults with physical difficulties or adults with mental ill health were significantly lower than England. Adults with learning disability were significantly lower in Suffolk than nationally. They are also lower than the East of England region which, although on a declining trajectory, remains higher than England.

39 Public Health England. Adult Social Care Profile. 2017. [Accessed 1 March 2017]. http://fingertips.phe.org.uk/adultsocialcare#gid/1000105/ati/102 40 Public Health England. Adult Social Care Profile. 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.3.7.7 Maternities In Suffolk in 2015 there were 7,933 maternities and 8,028 live births.41 A maternity is a pregnancy resulting in the birth of one or more children. This figure includes stillbirths and therefore represents the number of women giving birth rather than the number of babies born. Suffolk has a higher rate of maternities compared to England, and areas within Suffolk exhibit variation in maternity rates. Mid Suffolk has the lowest maternity rate (55.9 per 1,000 women), Forest Heath has the highest (80.1 per 1,000 women). In terms of absolute numbers, Ipswich had the highest number of maternities (1,956), this represented 25% of all maternities in Suffolk. The age of the mother at birth was slightly lower in Suffolk compared to England. Live birth rates were highest in the 25- 29 age group for Suffolk mothers, whereas England rates were highest in the 30-34 age group. Figure 11: Maternities per 1,000 women aged 15 to 44, 201542 100.0 80.0 60.0 40.0 women 20.0 rate per 1,000rate 0.0 Babergh Forest Heath Ipswich Mid Suffolk St Suffolk Waveney Edmundsbury Coastal Area Suffolk England 2.3.7.8 Homeless populations In 2015-16 the rate of statutory homelessness in Suffolk was lower than the national average at 1.7 per 1,000 households compared with 2.5 for England (1.9 for England excluding London). In Suffolk, this equates to 545 homeless households. The rates of statutory homelessness are highest in St Edmundsbury, Forest Heath and Ipswich. Figure 12: Statutory homelessness rate per 1,000 households, 2015-16 43 4.0

3.0

2.0

1.0 households rate per 1,000rate 0.0 Babergh Forest Heath Ipswich Mid Suffolk St. Suffolk Waveney Area Edmundsbury Coastal Suffolk England

41 Office for National Statistics. Births by mothers’ usual area of residence in the UK. 2016. [Accessed 1 April 2017]. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birth sbyareaofusualresidenceofmotheruk 42 ONS. Births by mothers’ usual area of residence in the UK. 43 Public Health England. Common Mental Health Disorders. 2016. http://fingertips.phe.org.uk/profile- group/mental-health/profile/common-mental- disorders/data#page/3/gid/8000026/pat/6/par/E12000006/ati/102/are/E10000029/iid/90556/age/164/sex/4

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

There is no available total number of homeless households in Suffolk. Those in priority need for whom there is a Local Authority statutory duty are recorded, but these are only a proportion of the total. The vast majority of single homeless people are not considered statutorily homeless (for example those ‘sofa surfing’ or residing with friends), and of these there is no record. 44 2015-16 data indicates that there were 155 households recorded as residing in temporary accommodation across Suffolk local authorities, with the highest rate in Babergh (0.9 per 1,000 households) and the lowest rate in Mid Suffolk (0.2 per 1,000 households)*.45 The rate for England during the same period was 3.1 per 1,000 households (1.0 excluding London).

* Note: Suffolk coastal figures suppressed as too small to publish. 2.3.7.9 Daytime population (commuter flows) Data for Suffolk local authorities indicates that Ipswich has the highest net commuter inflow, increasing the overall population size during the working hours. Mid Suffolk has the highest net commuter outflow, resulting in a decreased working hours population. As well as workday movement, research by Visit England and Office of National Statistics estimated that in 2011 there were a total number of 31,228,000 day visitors to Suffolk. In 2010 there were 1,787,000 staying visitors in Suffolk, staying a total of 6,525,000 nights. The total number of day visitors was 24,808,375.46 Figure 13: Local authority commuter flow data, Suffolk, 201147

44 Suffolk County Council. Minutes of the Suffolk County Council Meeting held on 8 December 2016 at 2pm in the King Edmund Chamber, Endeavour House, Ipswich. 2016. [Accessed 1 April 2017]. https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwi3t8SP xK3TAhXFLsAKHYmUB1MQFgglMAA&url=http://committeeminutes.suffolkcc.gov.uk/LoadDocument.aspx?rID=0 900271181f36626&qry=c_committee~~County+Cou 45 Department for Communities and Local Government. Table 784: local authorities’ action under the homelessness provisions of the Housing Acts, financial years 2004-5 to 2015-16. 2016. [Accessed 1 March 2017]. https://www.gov.uk/government/statistical-data-sets/live-tables-on-homelessness 46 Office for National Statistics. Leisure and Tourism. 2011. [Accessed 1 March 2017]. https://www.ons.gov.uk/peoplepopulationandcommunity/leisureandtourism 47 Office for National Statistics. Where do we commute to? http://webarchive.nationalarchives.gov.uk/20160105224014/http://www.ons.gov.uk/ons/rel/census/2011-

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.3.7.10 Gypsy and Traveller population Gypsy and Traveller populations were counted at the 2011 Census for Suffolk. They numbered 604 (0.1%) people in Suffolk, however, this figure is likely to be an underestimate. Estimates suggest there are about 1,500 Gypsies and Travellers living in Suffolk in either trailers or houses based on an average of four persons per unit.48 Across Suffolk there are a number of council- and privately-owned Gypsy and Traveller sites. The Roma community come from Central and Eastern Europe and recently arrived in the UK, mostly after 2004. An estimate from the Roma community suggests there are about 1,000 Romanian Roma and 100 Bulgarian Roma living in Ipswich. School Census data for 2016 indicates a larger cohort of primary school age children in Suffolk are of Gypsy/Roma or Irish Traveller heritage, however this is still a relatively small number (400 pupils or 0.4% of all primary school pupils). The proportions are similar to England levels. Gypsies, Travellers and Roma have their own cultural health beliefs, and generally have a lower rate of GP registrations compared to the general population, as well as a life expectancy that is ten years lower.49 Significant health problems include long- term illness, respiratory disease (asthma and bronchitis), chest pain, chronic cough, higher maternal and neonatal death rates, high smoking rates, and anxiety and depression. Table 13: School pupils of Gypsy, Roma or Irish Traveller heritage, 201650

Gypsy / Roma or Traveller of Irish Heritage % of all pupils compulsory School type Area Number school age and above Suffolk 200 0.4% Primary England 16,788 0.5% Suffolk 65 0.2% Secondary England 8,034 0.3% Suffolk 4 0.4% Special England 435 0.4% Suffolk 269 0.3% Total England 25,257 0.4% census/origin-destination-statistics-on-migration--workplace-and-students-for-local-authorities-in-the-united- kingdom/sum---commuting-patterns-in-the-uk--2011.html. Published 2011. Accessed April 1, 2017. 48 Suffolk County Council. Groups At Risk of Disadvantage Needs Assessment. 2015. https://www.healthysuffolk.org.uk/jsna/reports/health-needs-assessments 49 Suffolk County Council. Groups At Risk of Disadvantage Needs Assessment. 2015. 50 Department for Education. Schools, pupils and their characteristics: January 2016. 2016. [Accessed 1 April 2017]. https://www.gov.uk/government/statistics/schools-pupils-and-their-characteristics-january-2016.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.3.7.11 Housebound populations There is no single indicator representing the number of housebound residents in Suffolk. However, the following data provides an overview of potential proxy for this indicator. For example, disabled populations may be less likely to leave their homes due to the severity of their disablement, carer populations may be indicative of a housebound resident being cared for, and the carer may be housebound due to their caring commitments. At the 2011 Census 0.8% of the Suffolk population was residing in medical/care communal establishment (just over 5,600 people).51 The numbers of people in medical/care communal establishment settings were highest in Suffolk Coastal (1,145) and lowest in Forest Heath (285). Working-age client group data indicates approximately 41,000 Suffolk residents of working age claim some sort of benefit: when expressed as a percentage this is lower than the East of England and Great Britain. When including older people and children, the total number of disability living allowance claimants was 25,000 in August 2016. Attendance allowance is given to those aged 65+ for personal care because an individual is physically or mentally disabled. Data for Suffolk indicates that in August 2016 20,440 residents were in receipt of attendance allowance.52 Table 14: Working-age client group claimants, 201653

51 Nomis. 2011 Census Data. 2011. 52 Department for Work and Pensions. Cases in Payment Aug 2016 – Stats Xplore. 2016. [Accessed 20 July 2004]. https://stat-xplore.dwp.gov.uk/webapi/jsf/tableView/tableView.xhtml. 53 Nomis. Labour market profile. 2016. [Accessed 1 April 2017]. Retrieved 10 March 2016 from https://www.nomisweb.co.uk/reports/lmp/la/1941962836/report.aspx.

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Table 15: Disability Living Allowance (DLA) cases in payment, August 201654

Aug 2016 Area Children Working age Over State Pension age Total Babergh 506 1,197 878 2,583 Forest Heath 299 751 647 1,694 Mid Suffolk 514 1,138 983 2,638 Ipswich 1,106 2,720 1,643 5,474 St Edmundsbury 621 1,639 1,150 3,415 Suffolk Coastal 688 1,584 1,421 3,692 Waveney 1,025 2,385 2,105 5,512 Total 4,761 11,416 8,829 25,008

Table 16: Indicator data relevant to more care-dependent population55

Time East of Indicator: 2013/14 Suffolk England period England Older people (65+) supported 2013-14 8,194 8,738 9,781 throughout the year per 100,000 Permanent admissions to residential and nursing care 2013-14 12.9 16.7 14.4 homes per 100,000 aged 18-64 Permanent admissions to residential and nursing care 2013-14 629.6 649.1 650.7 homes per 100,000 aged 65+ Adults who received home care 2013-14 1,580.2 1,132.1 1,110.0 during the year per 100,000 Adults who received meals 2013-14 130.0 79.1 75.4 during the year per 100,000 Adults who received professional support during the 2013-14 332.6 297.8 460.2 year per 100,000 Adults who received any community-based support 2013-14 2,323.2 2,347.3 2,482.4 during the year per 100,000 Adults receiving day care 2013-14 329.2 305.7 301.1 service per 100,000

54 Department for Work and Pensions. Cases in Payment Aug 2016 – Stats Xplore. 2016. 55 Public Health England. Adult Social Care Profile. 2017.

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2013-14 data indicates that the rate of older people (65+) supported year-round is significantly lower in Suffolk than nationally, however this still amounts to nearly 13,000 Suffolk residents. Data for the same period indicates that during the year there were 2,625 adults in residential care. The rate of Suffolk residents receiving home care during 2013/14 was significantly higher than England, and equated to 9,240 individuals. Contrary to a national decreasing trend, Suffolk data indicates that the number and rate of those receiving home care increased between 2012-13 and 2013-14. The rate of Suffolk residents receiving day care was significantly higher than England in 2013-14 although there has been a steady decline in rates both locally and nationally since 2006-07. 2.3.8 Deprivation The English Indices of Deprivation measure relative levels of deprivation in 32,844 small geographical neighbourhoods, called Lower-layer Super Output Areas (LSOAs), in England. It is important to note that these statistics are a measure of relative deprivation, not affluence, and to recognise that not every person in a highly-deprived area will themselves be deprived. Likewise, there will be some deprived people living in the least deprived areas.56 A range of economic, social and housing indicators is combined into a single deprivation score for each LSOA. The score is an absolute measure of deprivation. The score allows the 32,482 LSOAs in England to be ranked relative to one another. The overall Suffolk score for 2015 was 18.3, this is lower than England at 21.8. The indices of deprivation also provide ranking of local authorities, where the lower the rank, the more deprived the area. Ipswich remains the most deprived local authority in Suffolk, being ranked 71st out of 326 LAs in England. Ipswich has risen in the rankings from 99 in 2007, but still remains outside the top 20% of most deprived LAs nationally. It should be noted, that although Forest Heath appears to have dropped 100 places in the ranking, early data was generated using populations including United States military personnel based in the area. Suffolk has become more deprived compared to other local authority areas in England since 2010. Only three counties/unitary authorities worsened by more places in the rankings than Suffolk. However, Suffolk continues to experience below-average levels of deprivation.

56 Suffolk County Council. Suffolk Changes in the Index of Multiple Deprivation from 2010 to 2015. 2016. https://www.healthysuffolk.org.uk/uploads/SCC-Index-of-Multiple-Deprivation-2010-2015-FINAL.pdf

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Figure 14: Deprivation by LSOAs in Suffolk Comparative IMD distribution in 2010 and 2015

The impact of rurality and deprivation57: Despite these relatively low levels of overall rural deprivation in Suffolk, small distinct pockets of rural deprivation do clearly exist; these can be hidden by the Indices of Multiple Deprivation being calculated at LSOA level. The cost of providing services in rural areas is estimated to be significantly higher than the cost of providing services in urban areas. Suffolk’s rural population is older than its urban population, and the proportion of older people in Suffolk’s rural population is increasing faster than the proportion of older people in urban areas. This trend, combined with the higher cost of providing services in rural areas, housing stock which is often difficult to heat and maintain, poor transport and more limited social networks, is likely to lead to high and increasing needs and costs for Suffolk’s rural population now and in the future. 2.3.9 Premature mortality Premature mortality is a good high-level indicator of the overall health of a population, being correlated with many other measures of population health. The number of premature deaths in Suffolk from 2013-15 was 6,140, directly standardised rates of premature (under 75) mortality in Suffolk local authorities show variation. Rates are highest in Ipswich (364 per 100,000 population) equating to 1,114 premature deaths, and are significantly higher than England. Rates are lowest in Babergh (251 per 100,000 population) equating to 698 premature deaths during 2013- 15. Map O shows Standard Mortality Ratio (SMR) for all-cause mortality under 75 (2010-2014 inclusive).

57 Suffolk County Council. Rural Deprivation in Suffolk. 2016. https://www.healthysuffolk.org.uk/uploads/Rural- Deprivation-in-Suffolk-May-2016.pdf

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Figure 15: Directly standardised mortality rate for mortality from all causes, aged <75, 2013-1558

Overall premature deaths (Persons) 500 400 300 200 100 0 Ipswich England Babergh Suffolk Waveney region Mid Suffolk Forest Heath Forest Suffolk Coastal Suffolk East of England of East St. Edmundsbury

Key compared with England: 2.4 Causes of ill health 2.4.1 Cardiovascular disease (CVD) Cardiovascular disease (CVD) refers to all the diseases of the heart and circulation, including heart attack and stroke. CVD accounts for one in ten of all emergency admissions and is one of the highest causes of emergency hospital admission in Suffolk, with over 7,300 hospital admissions during 2013/14. In Suffolk, the premature mortality rate (age under 75) from cardiovascular disease was 62.2 per 100,000 population in 2013-15. This was significantly lower than the England rate of 74.6 per 100,000. When split by gender, Suffolk males had a higher mortality rate (62.2 per 100,000) compared to Suffolk females (35.4 per 100,000). However, these mortality rates were both significantly lower than England males and females. At local authority level, higher premature mortality rates were identified in males living in Forest Heath, Ipswich and Waveney. In 2013-15 in Suffolk there were 853 deaths from cardiovascular diseases in those aged under 75 that were considered preventable. During the same period the total cardiovascular disease deaths in those age under 75 totalled 1,317. In those aged 65 and over there were 5,617 deaths from cardiovascular disease in 2013-15. This number has been steadily declining since 2001-03, mirroring national trends. This figure equates to a rate of 1,116.6 per 100,000 population 65+, and is significantly better than the England rate of 1,191.9 per 100,000.

58 Public Health England. Public Health Profiles: Indicator Definitions and Supporting Information. http://fingertips.phe.org.uk/search/all%20cause%20mortality#page/6/gid/1/pat/6/par/E12000006/ati/101/are/E060 00055/iid/108/age/163/sex/4

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Figure 16: Under-75 mortality rate from CVD considered preventable, directly standardised rate per 100,000, 2013-1559

160

per 140 - 120 100 80 60 40

100,000 20 0 Ipswich Babergh Waveney Directly ratestandardisedDirectly Mid Suffolk Forest Heath Forest Suffolk Coastal Suffolk St. Edmundsbury

Males Females

2.4.2 Cancers Data from Public Health England indicates that compared to England, Suffolk CCGs have a higher rate of new cancer cases and a higher cancer prevalence overall. Table 17: Cancer summary statistics, by Suffolk CCG, mixed years60 Great Ipswich West Yarmouth and East Indicator Year Suffolk and England Suffolk CCG Waveney CCG CCG New cancer cases (Crude incidence 2013-14 605 639 664 515 rate: new cases per 100,000 population) Cancer: QOF % prevalence (all 2015-16 2.80% 3.10% 2.90% 2.40% ages) Number of emergency admissions with 2015-16 567 706 722 538 cancer (Number per 100,000 population)

59 Public Health England. Public Health Outcomes Framework. March 2017. 60 Public Health England. Cancer Services Profile. April 2017. [Accessed 1 April 2017]. https://fingertips.phe.org.uk/profile/cancerservices

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Data for cancer screening indicates that Suffolk has a higher percentage of the eligible population being screened for breast, bowel and cervical cancers compared to England. Table 18: Cancer summary statistics, for Suffolk, mixed years61

Indicator Date Suffolk England Cancer screening coverage – cervical cancer 2016 74.5% 72.7% Cancer diagnosed at early stage (experimental 2014 57.1% 50.7% statistics) Cancer screening coverage – bowel cancer 2016 62.0% 57.9% Cancer screening coverage – breast cancer 2016 78.9% 75.5% Under-75 mortality rate from cancer (persons) 2013-15 131.8 138.8 (per 100,000) Under-75 mortality rate from cancer (male) (per 2013-15 143.4 154.8 100,000) Under-75 mortality rate from cancer (female) 2013-15 121.0 123.9 (per 100,000) Under-75 mortality rate from cancer considered 2013-15 74.6 81.1 preventable (persons) (per 100,000) Under-75 mortality rate from cancer considered 2013-15 69.6 74.5 preventable (female) (per 100,000) Under-75 mortality rate from cancer considered 2013-15 80.1 88.4 preventable (male) (per 100,000)

Benchmark = England Ipswich and East Suffolk CCG had the highest number of recorded cancer deaths in 2015 (1,116).

61 Public Health England. Public Health Outcomes Framework. March 2017.

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Table 19: Cancer summary mortality statistics, for Suffolk CCGs, 201562

Ipswich and Great West England East Suffolk Yarmouth and Suffolk CCG CCG Waveney CCG Cancer deaths (%) % No. % No. % No. % Persons, all ages 27.4% 1,116 27.4% 580 27.5% 727 28.1% Persons, aged 0- 37.3% 196 43.0% 106 40.1% 120 38.7% 64 years Persons, aged 65- 44.2% 288 47.6% 150 45.1% 99 45.3% 74 years Persons, aged 75- 30.5% 366 32.8% 197 32.1% 239 32.3% 84 years Persons, aged 85 14.9% 266 14.0% 127 14.5% 169 15.4% years and over Note: percentage is the percentage of deaths within the age group. 2.4.3 Diabetes 2015-16 data for Suffolk indicates that the prevalence of diabetes in those aged 17+ is 6.3%, similar to the England prevalence of 6.5%.63 This equates to over 40,300 Suffolk residents with a diagnosis of diabetes. It is estimated that there may be approximately 7,500 people with undiagnosed diabetes in Suffolk.64 In terms of the control of diabetes, at CCG level, the figures for well-controlled blood glucose were 61.4% for Ipswich and East Suffolk CCG (better than the national average) and 61.3% in West Suffolk CCG (similar to the national average). However, cholesterol control in those with diabetes was poorer than the national average for Ipswich and East Suffolk CCG. West Suffolk CCG had a higher percentage of patients with diabetes with good blood pressure control compared to England. For all three indicators, the Great Yarmouth and Waveney CCG had significantly worse levels than the England average. Great Yarmouth and Waveney also has a higher prevalence of diabetes compared to other Suffolk CCGs and England as a whole.

62 Public Health England. End of Life Profiles. April 2017. [Accessed 1 April 2017]. http://fingertips.phe.org.uk/end-of-life 63 Public Health England. Fingertips Disease and Risk Factor Prevalence. 2017. [Accessed 1 April 2017]. http://fingertips.phe.org.uk/prevalence#gid/8000021/ati/102 64 Suffolk County Council. Suffolk Annual Public Health Report 2015. 2015. http://www.healthysuffolk.org.uk/assets/JSNA/Annual-Report/19673-APHR-2015-LR-20151209.pdf

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Table 20: Diabetes control in Suffolk CCGs, 2015-1665 Ipswich Great West and East Yarmouth Suffolk England Suffolk and Waveney CCG CCG CCG Prevalence of diabetes (17+) 5.9% 6.4% 7.7% 6.5% Good blood sugar control in 61.4% 61.3% 54.1% 60.1% people with diabetes Good blood pressure control 70.8% 72.0% 67.2% 70.4% in people with diabetes Good cholesterol control in 68.5% 69.2% 64.6% 70.0% people with diabetes

Benchmark = England 2.4.4 Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) is the name used to describe a number of lung diseases including chronic bronchitis and emphysema. The main cause of COPD is smoking, which accounts for about 75% of cases. In 2015-16 there were 1,567 emergency hospital admissions for COPD in Suffolk, and during 2013-15 there were 952 deaths from COPD. In Suffolk local authorities, mortality rates from COPD are higher than the Suffolk average in Forest Heath and Ipswich, and lower in Suffolk Coastal. Table 21: COPD indicators for Suffolk, 2013-2015, Directly Standardised Rates per 100,000 population66

Indicator (rate per 100,000) Year Suffolk England Under 75 mortality rate from respiratory disease considered preventable 2013-15 10.9 18.1 (persons) Under 75 mortality rate from respiratory 2013-15 12.1 20.3 disease considered preventable (male) Under 75 mortality rate from respiratory 2013-15 9.8 16.1 disease considered preventable (female) Under 75 mortality rate from respiratory 2013-15 21.2 28 disease (female) Under 75 mortality rate from respiratory 2013-15 23.7 33.1 disease (persons)

65 Public Health England. Diabetes Profile. April 2017. [Accessed 1 April 2017]. https://fingertips.phe.org.uk/diabetes 66 Public Health England. Public Health Outcomes Framework. March 2017.

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Indicator (rate per 100,000) Year Suffolk England Under 75 mortality rate from respiratory 2013-15 26.4 38.5 disease (male) Deaths from COPD 2013-15 37.7 52.6 Emergency hospital admissions for 2014-15 331 415 COPD Rate of deaths from respiratory disease 2013-15 547.5 646.2 among people aged 65 years and over

Benchmark = England Figure 17: Deaths from COPD, directly standardised rate per 100,000 population, 2013-1567

70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Ipswich St. Babergh Waveney per 100,000 populationper 100,000 Mid Suffolk Directly RateStandardisedDirectly Forest Heath Forest Edmundsbury Suffolk Coastal Suffolk

Suffolk England 2.4.5 Depression and mental health One in four Suffolk residents experience some form of mental ill health across a spectrum of severity levels in any given year.68 People with mental health conditions experience poor outcomes in terms of physical health and mortality rates.69 Conversely, people with long-term physical conditions experience high levels of mental ill health, as do informal and family carers supporting people at home.70

67 Public Health England. Local Tobacco Control Profiles. April 2017. [Accessed 1 April 2017]. http://www.tobaccoprofiles.info. 68 Suffolk County Council. Suffolk Minds Matter - Annual Public Health Report. 2016. http://www.healthysuffolk.org.uk/assets/JSNA/Annual-Report/APHR-2016/21991-APHR-2016-ONLINE.pdf. 69 The Mental Health Taskforce. The Five Year Forward View for Mental Health. 2016. https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf. 70 White C. 2011 Census Analysis: Unpaid care in England and Wales, 2011 and comparison with 2001. ONS 15 February 2013. http://webarchive.nationalarchives.gov.uk/20160109213406/http://www.ons.gov.uk/ons/dcp171766_300039.pdf

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Depression is a common and debilitating condition. Figures for 2015/16 indicate that around 9% people aged 18 and over in Suffolk have been recognised by their GP as having depression (over 55,000 people), with only small variation across the CCG areas:71 • Great Yarmouth and Waveney CCG: 9.2% • Ipswich and East Suffolk CCG: 8.7% • West Suffolk CCG: 8.7% These figures are significantly higher than the England prevalence (8.3%), however, they may underestimate the prevalence of depression, as many cases still remain unreported. In 2016, the rate of Employment Support Allowance (ESA) claimants for mental and behavioural disorders was lower in Suffolk compared with England. However, there was variation in Suffolk local authorities, with Ipswich and Waveney having significantly higher claimant rates compared with both Suffolk and England. Figure 18: ESA claimants for mental and behavioural disorders, crude rate per 1,000 working age population, 201672

45 40 35 30 25 20 15 10 population 5 0 Crude rate per 1,000 working age1,000 workingperCrude rate Ipswich Babergh Waveney Mid Suffolk Forest Heath Forest Suffolk Coastal Suffolk St. Edmundsbury Suffolk England

Benchmark = England

Approximately 1% of the population will be affected by severe mental ill health. 2015- 16 data indicates that 6,610 people registered at a Suffolk GP were diagnosed with schizophrenia, bipolar disorder or other psychoses (approximately 0.9% prevalence rate).73

71 Public Health England. Mental Health and Wellbeing JSNA. 2017. https://fingertips.phe.org.uk/profile- group/mental-health/profile/MH-JSNA/data#page/0 72 Public Health England. Mental Health and Wellbeing JSNA. 2017. 73 Public Health England. Mental Health and Wellbeing JSNA. 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

There were 187 deaths from suicide between 2012 and 2014 in Suffolk, the majority being men (137), although the age standardised suicide rate per 100,000 people is not significantly different from regional and national averages.74 Self-harming is considered to be a risk factor for the development of mental ill health in young people.75 In Suffolk over the period 2010-11 to 2012-13 there were 1,274 admissions to hospital for self-harm in young people aged 10 to 24. The overall rate of self-harm admissions in Suffolk is similar to the national average (375 per 100,000 people aged 10-24 years compared with 399 per 100,000 in England).76 Hospital admissions data for Suffolk indicates that for children and young people aged 0-19 years, rates of self-harm are three times greater amongst the most deprived Suffolk residents compared with the least deprived.77 2.4.6 Accidental injuries Suffolk has a lower rate of hospital admissions caused by unintentional and deliberate injuries in children and young people compared to England, and is similar to the East of England. Figure 19: Rate of hospital admissions caused by unintentional and deliberate injuries in children and young people by age group, per 10,000 resident population, 2015-1678

160.0 140.0 120.0 134.1 121.8 124.2 100.0 104.2 80.0 89.0 91.6 60.0 in age in group 40.0 20.0

Crude rate per 10,000populationperCrude rate 0.0 0-14 Years 15-24 Years

Suffolk East of England England

74 Suffolk County Council. Suffolk Minds Matter - Annual Public Health Report. 2016. 75 Saunders KE, Smith KA. Interventions to prevent self-harm: what does the evidence say? Evid Based Ment Health. July 2016. doi:10.1136/eb-2016-102420 76 Public Health England. Children’s and Young People’s Mental Health and Wellbeing Profile. 2016. http://fingertips.phe.org.uk/profile-group/mental-health/profile/cypmh 77 Suffolk County Council. Suffolk Minds Matter - Annual Public Health Report. 2016 78 Public Health England. Public Health Outcomes Framework. March 2017.

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Figure 20: Age-standardised rate of mortality from injuries in people under 75, per 100,000 population, 2013-1579

25 20 15 10 5 0 Ipswich Babergh Waveney Mid Suffolk 100,000 population under 75 underpopulation 100,000 Directly per RateStandardisedDirectly Forest Heath Forest Suffolk Coastal Suffolk St. Edmundsbury

Suffolk England

Benchmark = England The mortality rate for people under 75 is generally lower in Suffolk local authorities, the only exception being Forest Heath, where mortality rates are significantly higher than Suffolk and England. Figure 21: Rate of people killed or seriously injured on the roads, all ages, per 100,000 resident population, 2013-1580

60 50 40 30 20 10 0 population Ipswich St. Babergh Waveney Rate perresident 100,000Rate Mid Suffolk Forest Heath Forest Edmundsbury Suffolk Coastal Suffolk

Suffolk England

Benchmark = England During 2013-15, 740 Suffolk residents were killed or seriously injured (KSI) on the roads. Forest Heath had a significantly higher KSI rate. However, it is important to note that areas with low resident populations but which have high inflows of people or traffic may have artificially high rates because the at-risk resident population is not an accurate measure of exposure to transport.

79 Public Health England. Longer Lives. April 2017. http://healthierlives.phe.org.uk/ Babergh data not available 80 Public Health England. Public Health Outcomes Framework. March 2017.

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As people become older, they become increasingly likely to fall. About 1 in 3 people aged over 65 and 1 in 2 people aged over 80 will fall at least once a year. Women are more likely to fall than men. Falls can cause serious physical injury, for example, a fractured hip, and they can also make people fearful and anxious, which means that they restrict their activities and lose their independence.81 In 2014-15 in Suffolk there were 3,048 emergency hospital admissions for injuries due to falls in persons aged 65+; this equates to approximately 8 admissions per day. 71% of these admissions were for people aged 80+. Suffolk has a lower rate of falls compared to the East of England and England overall. None of the local authorities in Suffolk had a significantly higher rate of falls in those aged 65+ compared to England. Table 22: Age-sex standardised rate of emergency hospital admissions for injuries due to falls in persons aged 65+ per 100,000 population, 2014-1582 East of Indicator Suffolk England England Injuries due to falls in people aged 65 and 1,749 1,956 2,125 over Injuries due to falls in people aged 65-79 759 874 1,012 Injuries due to falls aged 80+ 4,618 5,096 5,351

2.4.7 Asthma 2015-16 data indicates there were 342 hospital admissions for asthma in those aged under 19 in Suffolk. This equates to a rate of 183.3 per 100,000 population, similar to the England rate (202.4 per 100,000), but worse than the East of England rate (160.0 per 100,000 population).83 The prevalence of asthma across the three Suffolk CCGs was on average 6.7%; all the CCGS had a significantly higher prevalence of asthma when compared to England overall (5.9% prevalence).

81 Suffolk County Council. Suffolk Annual Public Health Report 2015. 2015. 82 Public Health England. Public Health Outcomes Framework. March 2017. 83 Public Health England. Overview of Child Health. April 2017. http://fingertips.phe.org.uk/child-health-overview

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Figure 22: Asthma prevalence for Suffolk CCGs, all ages, 2015-1684

8 7 6 5

% 4 3 2 1 0 Great Yarmouth and Waveney Ipswich and East Suffolk CCG West Suffolk CCG CCG

England

Benchmark = England

2.4.8 Excess weight and obesity In Suffolk, nearly one in ten children aged 4-5 are obese (9.1%), one in five (19.8%) children aged 10-11 years are obese. In Suffolk, obesity in school children in reception year, measured under the National Child Measurement Programme, shows a downward trend over the last few years, from 8.7% in 2008-09 to 2010-11 to 8.2% in 2012-13 to 2014-15. The rate of obesity in this age group has been consistently around 1% below the rate for England. The percentage of obese school children in Year 6 is around twice that of reception year. The trend of this age group is upward, from 16.2% in 2008-09 to 2010-11 to 17% in 2012-13 to 2014-15. In spite of this increase, the rate of obesity in this age group continues to be around 2% below the rate for England. Approximately 2/3 of Suffolk adults are overweight or obese (66.1%), this is statistically worse than England levels (64.8%).

84 Public Health England. Inhale - INteractive Health Atlas of Lung conditions in England. 2017. https://fingertips.phe.org.uk/profile/inhale.

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Figure 23: Excess weight in Suffolk residents, 2015-1685

70.0% 60.0%

50.0% 66.1% 64.8% 40.0% 30.0% 20.0% 10.0% 9.1% 9.3% 13.1% 12.8% 17.6% 19.8% 13.8% 14.3% 0.0% Obese Overweight Obese Overweight Excess weight 4-5 Year olds 10-11 Year olds Adults

Suffolk England

Figure 24: The percentage of physically active Suffolk residents, 201586

70 60

63.8 Significantly higher than 50 57 59.9 58.5 58.2

57.4 England 54.8

40 51.9

30 Significantly similar to England 20 10 Significantly lower than 0 England Ipswich England Babergh Waveney Mid Suffolk Forest Heath Forest Suffolk Coastal Suffolk St. Edmundsbury The Active People Survey 2015 indicates that 57.8% of Suffolk residents achieve at least 150 minutes of physical activity per week in accordance with UK Chief Medical Officer's (CMO) recommended guidelines on physical activity. In addition, the survey results indicate that 28.3% of the adult population in Suffolk takes part in less than 30 minutes of physical activity a week, similar to the figure for England and slightly above the average for the East of England.87

85 Public Health England. Public Health Outcomes Framework. March 2017. 86 Public Health England. Public Health Outcomes Framework. March 2017. 87 Public Health England. Public Health Outcomes Framework. March 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.4.9 Palliative care In 2015, 3.9% of deaths occurred in hospices, compared to 5.6% in England. For those aged 0 to 64 years, the percentage rises to 10.1% in Suffolk, similar to England’s rate of 10.6%.88 Generally, the rate reduces as age increases, with older people (i.e. over the age of 65) people less likely to die in a hospice and more likely to die in hospital or a care home. Compared to England, a statistically higher percentage of Suffolk residents died in their home or in a care home in 2015. Table 23: Place of death for people of all ages, 201589

Number Suffolk East of England England Hospital deaths 3,276 42.6% 45.0% 46.7% Care home deaths 2,092 27.2% 24.7% 22.6% Home deaths 1,885 24.5% 23.4% 22.8% Deaths in other places 146 1.9% 2.2% 2.2% Hospice deaths 300 3.9% 4.7% 5.6%

2.4.10 Influenza Flu vaccination reduces the risk of seasonal flu and decreases hospital admissions for influenza, respiratory conditions and exacerbations of other conditions. The national flu vaccination programme for adults is targeted at people most at risk of harm from this: people aged 65 years and over, people under 65 in specific clinical risk groups, and pregnant women. The majority of vaccination is given between September and January each year by the GP practice with many pharmacists also offering the service. 71.2% of the population aged over 65 was vaccinated against influenza in 2015-16, similar to the England figure of 71.0% and the figure for the East of England of 70.9%. By contrast, only 42.4% of those under 65 considered at risk were vaccinated, below the England figure of 45.1% and the same as that for the East of England.90 Data indicates that the more deprived an area, the smaller the proportion of people vaccinated. 22% of the variation in influenza vaccine uptake by area can be explained by deprivation, rising to 26% for pregnant women. Residents in these localities are at greater risk of poor health compared with the county as a whole. The mortality rate from a range of specified communicable diseases (including influenza) was 6.8 per 100,000 population for 2013-15, lower than the rate for England at 10.5 per 100,000 and the East (8.7 per 100,000 population).

88 Public Health England. Fingertips - End of Life Care Profiles. 2017. [Accessed 1 April 2017]. https://fingertips.phe.org.uk/profile/end-of-life 89 Public Health England. Fingertips - End of Life Care Profiles. 2017. 90 Public Health England. Public Health Outcomes Framework. March 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.4.11 Coronary heart disease Data indicates that across the three Suffolk CCGs, on average 3.7% of the population is affected by coronary heart disease, compared with 3.2% in England and the East of England.91 Data for the three CCGs covering Suffolk shows that admissions to hospital (all ages) due to coronary heart disease are higher than the England figure of 539.7 per 100,000 population (2014/15): • Ipswich and East Suffolk = 558.5 per 100,000 (2,362 admissions) • Great Yarmouth and Waveney = 550.4 per 100,000 (1,353 admissions) • West Suffolk = 619.3 per 100,000 (1,420 admissions) However, the mortality rates of those under 75 years from coronary heart disease are lower in Suffolk than England, where the figure is 41.5 per 100,000 population (2012- 14).92 CCG data is provided below: • Ipswich and East Suffolk = 30.5 per 100,000 (341 deaths) • Great Yarmouth and Waveney = 40.9 per 100,000 (265 deaths) • West Suffolk = 35.1 per 100,000 (215 deaths) 2.4.12 Strokes and Transient Ischaemic Attacks 2015-16 QOF data indicates that 2.0% of the Suffolk population registered with a GP in Suffolk is recorded as having suffered a stroke or transient ischaemic attack, higher than both the East of England and England values (both 1.7%).93 Additionally, Atrial Fibrillation (AF) is one of the most common forms of abnormal heart rhythm affecting over 15,500 people in Suffolk.94 AF increases with age and is present in nearly a fifth of those aged 85 years and above. AF is a major cause of stroke – the annual risk of a stroke is five to six times greater for people with AF.95 2.4.13 Hypertension In Suffolk, 15.2% of patients registered with a GP are recorded as having hypertension (high blood pressure), a higher rate compared to the East of England at 14.1% and England at 13.8%.96

91 Public Health England. Fingertips Cardiovascular Disease Profiles. 2017. [Accessed 1 March 2017]. https://fingertips.phe.org.uk/profile/cardiovascular/data#page/0/gid/1938132736/pat/46/par/E39000030/ati/19/are/ E38000010 Great Yarmouth and Waveney CCG includes the Great Yarmouth local authority, which falls within the county of Norfolk. 92 Public Health England. Fingertips Cardiovascular Disease Profiles. 2017. 93 Public Health England. Disease and risk factor prevalence. http://fingertips.phe.org.uk/prevalence#gid/8000021/ati/102 94 Public Health England. Disease and risk factor prevalence. http://fingertips.phe.org.uk/prevalence#gid/8000021/ati/102 95 Suffolk County Council. Suffolk Annual Public Health Report 2015. 2015. 96 Public Health England. Disease and risk factor prevalence. http://fingertips.phe.org.uk/prevalence#gid/8000021/ati/102

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

However, modelled estimates at local authority level indicate this figure could be much higher, and there may be a large proportion of Suffolk residents with undiagnosed hypertension. Finding and treating people with high blood pressure is arguably the most effective way to prevent heart attacks, strokes, cognitive decline and premature death and disability. Table 24: Modelled estimates of hypertension in those 18+, 201597

Modelled estimate of Estimated prevalence of prevalence (%) undiagnosed hypertension (%) Babergh 23.2 13.3 Forest Heath 19.5 12.1 Ipswich 19.3 11.8 Mid Suffolk 22.1 13.2 St Edmundsbury 21.2 12.6 Suffolk Coastal 23.4 13.2 Waveney 26.4 13.5

The majority of people in Suffolk already diagnosed with high blood pressure are managing their condition well. However, over 25,000 people are not managing it to the levels recommended. Improvements in tackling blood pressure in the last decade have prevented or postponed many deaths. Standards are in place that describe good control of hypertension, however it is estimated that only four in ten adults in Suffolk with high blood pressure are both aware of their condition and are managing it properly.98 2.5 Lifestyle 2.5.1 Drug and alcohol misuse Prevalence estimates for 2011-12 (latest available) suggest there are 2,398 opiate and/or crack cocaine users resident in Suffolk, giving an estimated prevalence rate of 5.2 per 1,000 population. Not all of these individuals will be in substance misuse treatment services, and many will be unknown to treatment services.99

97 http://fingertips.phe.org.uk/prevalence#gid/8000021/ati/102 98 Suffolk County Council. Suffolk Annual Public Health Report 2015. 2015. 99 Suffolk County Council. Suffolk Minds Matter - Annual Public Health Report. 2016 https://www.healthysuffolk.org.uk/uploads/21991-APHR-2016-ONLINE.pdf

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Mental ill health is common among those in treatment for drug use,100 and in Suffolk 19.1% of all people entering specialist drug misuse services in 2014/15 were having treatment from mental health services for a reason other than substance misuse at the time of assessment.

2.5.2 Alcohol and related disease Although many people consume alcohol without damaging their health, excessive consumption can cause severe physical and mental health conditions. It is estimated that approximately 15% of the Suffolk population aged over 18 drinks above the advised limits and 3.8%, or 22,000 people, in Suffolk are alcohol-dependent.101 Rates of hospital admissions for alcohol and other substance misuse are lower in Suffolk than regionally or nationally, but in 2014-15 just over 8,000 people in Suffolk had an alcohol-related hospital admission. Suffolk has a significantly low figure for Years of Life Lost (YLL) due to alcohol-related conditions – 414 per 100,000 of population compared to the average in England at 552 per 100,000.102 Nevertheless, more than 2,000 people in Suffolk per year are in poor health related to alcohol. Suffolk rates of admissions related to alcohol are generally lower than in the East of England and England. Table 25: Admissions for alcohol related conditions, directly standardised rates per 100,000 population, Suffolk103

East of Suffolk England England Admission episodes for alcohol-related cardiovascular disease conditions (Broad) 967 1,014 1,077 (persons) (2014-15) Admission episodes for mental and behavioural disorders due to use of 238 266 390 alcohol condition (Broad) (2014-15) Admission episodes for alcoholic liver disease condition (Broad) (persons) (2014- 72.6 85.4 108.9 15) Incidence rate of alcohol-related cancer 36.85 36.07 38.04 (persons) (2012-14) Benchmark = England

100 Public Health England. Co-occurring substance misuse and mental health issues. 2016. http://fingertips.phe.org.uk/profile-group/mental- health/profile/drugsandmentalhealth/data#page/6/gid/1938132791/pat/6/par/E12000006/ati/102/are/E10000029/ii d/91294/age/168/sex/4 101 Suffolk County Council. Suffolk Annual Public Health Report 2015. 2015. 102 Public Health England. Local Alcohol Profiles for England. 2017. [Accessed 1 April 2017]. https://fingertips.phe.org.uk/profile/local-alcohol- profiles/data#page/3/gid/1938132848/pat/6/par/E12000006/ati/101/are/E07000200/iid/91411/age/1/sex/4 103 Public Health England. Local Alcohol Profiles for England. 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

2.5.3 Sexual health and teenage pregnancy Suffolk has lower rates of Sexually Transmitted Infections (STIs), HIV and teenage pregnancy compared to England, although there is variation at local authority level. In 2015, Ipswich had the highest rate of all new STI diagnoses at 744 per 100,000 population, similar to the England rate. Mid Suffolk had the lowest new STI diagnoses rate at 325 per 100,000, significantly below the England rate. Figure 25: All new STI diagnoses, rate per 100,000 population, 2015104

900 800 700 600 500 400 300 200 100 2012 2013 2014 2015 Suffolk 569 561 484 445 East of England 640 639 612 569 England 803 804 796 768

Figure 26: All new STI diagnoses, rate per 100,000 population for Suffolk local authorities, 2015105

900 800 700 600 500 400 300 200 100 385 358 744 325 427 374 386

Rate perpopulation 100,000Rate 0 Ipswich Babergh Waveney Mid Suffolk Forest Heath Forest Suffolk Coastal Suffolk St Edmundsbury Suffolk East of England England

Benchmark = England

104 Public Health England. Sexual and Reproductive Health Profiles. 2017. [Accessed 1 April 2017]. https://fingertips.phe.org.uk/profile/sexualhealth 105 Public Health England. Sexual and Reproductive Health Profiles. 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Table 26: Selected STI diagnoses, rate per 100,000 population for Suffolk local authorities, 2015106

Chlamydia Genital Genital New HIV Syphilis Gonorrhoea detection warts herpes diagnosis diagnostic diagnostic rate / diagnostic diagnosis rate / rate / rate / 100,000 rate / rate / 100,000 100,000 100,000 aged 15-24 100,000 100,000 aged 15+ Babergh 3.4 7.9 977.0 95.7 39.4 2.7 Forest Heath 6.4 17.5 595.0 79.6 31.8 9.7 Ipswich 3.0 40.0 1,699.0 114.8 60.0 4.5 Mid Suffolk 0.0 7.1 694.0 81.7 44.4 0.0 St Edmundsbury 3.6 11.6 1,139.0 108.0 41.0 4.3 Suffolk Coastal 2.4 16.0 986.0 83.3 45.7 6.6 Waveney 1.7 7.8 787.0 83.7 50.9 8.2

Suffolk 2.7 16.4 1,054.0 93.8 46.3 5.0 England 9.3 70.7 1,887.0 118.9 57.6 12.1 For Chlamydia: Benchmark = England 2.5.3.1 Teenage conceptions Suffolk has a lower teenage conception rate for females aged 15-17 when compared to England. In 2015 there were 196 conceptions in Suffolk females aged 15-17 years. Figure 27: Crude rate of conception for females aged 15-17 years, 2010-15107

- 40.0

35.0

30.0

25.0 17

20.0

15.0

10.0

Crude Rate per 1,000 females 15 1,000femalesperCrude Rate 2010 2011 2012 2013 2014 2015 Suffolk 26.1 26.0 24.8 19.6 17.4 15.6 East of England 29.1 26.6 23.2 21.0 20.2 18.8 England 34.2 30.7 27.7 24.3 22.8 20.8 Local authorities within Suffolk show variation, with Ipswich and Waveney having the highest conception rates. Although Waveney has a conception rate that is statistically similar to England, Ipswich has a significantly higher rate of conceptions.

106 Public Health England. Sexual and Reproductive Health Profiles. 2017. 107 Public Health England. Sexual and Reproductive Health Profiles. 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Figure 28: Crude rate of conceptions for females aged 15-17 years, Suffolk, 2015108

30.0 25.0 17 -

20.0 28.2 15.0 20.8 10.0

5.0 12.9 females 15 females 9.0 10.4 11.7 11.6 0.0 Crude Rate per 1,000perCrude Rate Suffolk Ipswich Coastal St Babergh Waveney Mid Suffolk Mid Forest Heath Forest Suffolk England Edmundsbury Benchmark = England

In Suffolk in 2015, 44.4% of teenage conceptions lead to abortion, lower than the rates for both the East of England (50.0%) and England (51.2%). As with the conception rate, there is variation around the county: 71.4% of conceptions in Mid Suffolk resulted in abortion in 2015, compared to only 27.0% in Ipswich. 2.5.4 Smoking 2015 data indicates that 16.1% of the adult population in Suffolk smokes, a similar proportion to both the East of England (16.6%) and England (16.9%).109 However, for those in routine and manual occupations the smoking prevalence rises to 23.1% in Suffolk, compared with 26.4% for the East of England and 26.5% for England. Figure 29: Smoking prevalence in local authorities in Suffolk, 2015110

35 Smoking Prevalence 30 %

25 Smoking Prevalence 20 % Routine and

% Manual Occupations 15 Suffolk Smoking 10 Prevalence 5 Suffolk Smoking 0 Prevalence Routine and Manual Occupations Ipswich St. Babergh Waveney Mid Suffolk Mid Forest Heath Forest Edmundsbury Suffolk Coastal Suffolk

108 Public Health England. Sexual and Reproductive Health Profiles. 2017. 109 Suffolk County Council. Suffolk Changes in the Index of Multiple Deprivation from 2010 to 2015. 2016. 110 Public Health England. Local Tobacco Control Profiles. April 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Between 2012 and 2014, 3,351 deaths were attributable to smoking, equating to approximately 3 deaths every day. In 2014/15 there were 7,635 smoking-attributable hospital admissions.111 2014-15 data indicates that 8.6% of 15 year olds in Suffolk were current smokers, and 17.6% of 15 year olds used or had tried e-cigarettes.112 Figure 30: Smoking-attributable mortality by local authority, directly standardised rate per 100,000 population, 2012-2014113

300.0 250.0 200.0 150.0 100.0 50.0 0.0 Suffolk Ipswich Coastal St. Babergh Waveney per 100,000 populationper 100,000 Mid Suffolk Forest Heath Forest Directly RateStandardisedDirectly Edmundsbury

Suffolk England

Benchmark = England

Smoking-attributable mortality varies across Suffolk local authorities, although none of the areas in Suffolk have significantly higher rates than England. 2.5.5 Oral health Data from oral health surveys indicates that 93.2% of children aged 3 years are free from obvious dental decay in Suffolk, significantly higher than the national average of 88.4%. Surveys also suggest that the proportion free from obvious dental decay is lower in those age 5, although Suffolk’s figure of 79.1% is still significantly higher than that for England at 75.2%.114

111 Public Health England. Local Tobacco Control Profiles. April 2017. 112 Public Health England. Local Tobacco Control Profiles. April 2017. 113 Public Health England. Local Tobacco Control Profiles. April 2017. 114 Public Health England. Oral Health Profile. April 2017. [Accessed 1 April 2017]. https://fingertips.phe.org.uk/profile/oral-health

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Figure 31: Children aged 3 and 5 years free from obvious dental decay, 2013-15115

93.2% 100% 91.9% 88.4% 79.1% 79.7% 80% 75.2%

60% % 40%

20%

0% 3 years 5 years

Suffolk East of England England

(Note: data for 3 year olds is from 2012-13, data for 5 year olds is 2014-15) There is some variation around the county, although for 3 year olds the figures for all local authorities in Suffolk are all over 90%; the highest figure is 95.5% in Babergh, the lowest 91.4% in Forest Heath. Figure 32: Children aged 3 years free from obvious dental decay (2012-13) 116

100%

90% 95.5% 94.7% 94.6%

80% 93.6% 92.9% 91.5% 91.4% % 70%

60%

50% Ipswich Babergh Waveney Mid Suffolk Forest Heath Forest Suffolk Coastal Suffolk St Edmundsbury

Suffolk England

Benchmark = England

For five year olds, the variation is more marked; figures range from 74.9% in Ipswich to 88.4% in Mid Suffolk. For this age group, only two Suffolk local authorities have a significantly higher percent of decay-free children compared with England (Babergh and Mid Suffolk).

115 Public Health England. Oral Health Profile. April 2017. 116 Public Health England. Oral Health Profile. April 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Figure 33: Children aged five years free from obvious dental decay (2014-15)117

100% 95% 90% 85%

% 80%

75% 88.4%

70% 83.8% 80.2% 78.0% 65% 76.5% 74.9% 75.6% 60% Ipswich Babergh Waveney Mid Suffolk Forest Heath Forest Suffolk Coastal Suffolk St Edmundsbury

Suffolk England

Benchmark = England

117 Public Health England. Oral Health Profile. April 2017.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Section 3: NHS pharmaceutical services provision – currently commissioned

3.1 Community pharmacies There are 146 community pharmacies in Suffolk, compared to 148 in 2015 PNA, serving a population of 741,895. This equates to an average of 19.7 pharmacies per 100,000 population, which has decreased slightly from the 2015 figure of 20.1 pharmacies. The figure is lower than the England average (2015/16 data) which is 21.5 pharmacies per 100,000 population. Given that over 50% of the population of Suffolk lives in areas defined as rural, the density of community pharmacies varies significantly between each locality (Map A). Table 27 provides a breakdown, by locality, of average number of community pharmacies per 100,000. This table should be used as a guide only, as it does not give any indication of the pharmacies' opening hours. Table 27: Breakdown of average community pharmacies per 100,000 population118 Average Average number of number of Number of community community community Mid 2015 pharmacies pharmacies Locality Pharmacies population per 100,000 and dispensing (as of 21st predictions population GP practices April 2017) (as of mid per 100,000 2015) population Babergh 17 89,215 19 26.9 Forest Heath 11 63,691 17.3 28.2 Ipswich 33 135,600 24.4 24.4 Mid Suffolk 14 99,632 14.1 24.1 St Edmundsbury 19 112,523 16.9 24.1 Suffolk Coastal 24 125,052 19.2 24 Waveney 28 116,182 24.1 27.6 Suffolk HWB 146 741,895 19.7 25.4 area England 11,688 - 21.5* - (2015-16 data) *Figure includes distance-selling pharmacies Section 1.3 lists the essential services of the pharmacy contract. It is anticipated that provision of all of these services is available from all contractors.

118 General Pharmaceutical Services in England – NHS Digital 2015-16

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Map A shows population densities, community pharmacies and dispensing GP practices. With a high proportion of the population of Suffolk living in a rural area, inevitably residents in some less densely populated areas will incur increased travel times to access community pharmacy or dispensing GP practice services. 3.1.1 Choice of community pharmacies Table 28 shows the breakdown of community pharmacy ownership, as provided by the Health and Social Care Information Centre (HSCIC). This data shows that the ownership of pharmacies by multiples was less than the national average in Suffolk. For clarity, an Independent contractor is not a member of the Company Chemists' Association (CCA) or Association of Independent Multiple Pharmacies (AIMp), whereas those considered multiples are a member of the CCA or AIMp. Table 28: Community pharmacy ownership, 2015-16119

Area Multiples (%) Independent (%) England 62 38 East of England SHA 60 40 Suffolk HWB 49 51

Three pharmacies have closed since the 2015 PNA including one distance-selling pharmacy – see section 3.4: • Your Local Boots Pharmacy, 34 St Matthew's Street, Ipswich IP1 3EP • Howells and Jolley Ltd, 100 High Street, Southwold, Suffolk IP8 6DP • Blackbay Ventures Ltd (T/A Chemistree), Unit 12, Acorn Business Centre, Oaks Drive, Newmarket CB8 7SX (this was not included in total number of pharmacies in 2015) One pharmacy opened since the 2015 PNA: • Glemsford Pharmacy, The Surgery, Lion Road, Glemsford CO10 7RF 3.1.2 Weekend and evening provision In 2014, it was estimated that community pharmacies in England were open for 150,000 hours per week more than the 10 years previously.120 This has mainly been driven through the opening of ‘100-hour’ pharmacies. There are now 1,161 pharmacies in England open for over 100 hours per week, which has risen from 773 in 2014. In Suffolk there are 21 community pharmacies open for 100 hours per week or more. This has increased from 20 in 2015, with the additional 100-hour pharmacy being located in Waveney.

119 General Pharmaceutical Services in England – NHS Digital 2015-16 120 Pharmacy Voice. Who do you think we are? Community Pharmacy: dispensers of health. Dispensing Health. 2014. http://www.dispensinghealth.org/wp-content/uploads/2014/01/DH-Launch-FINA1.pdf

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Table 29 shows that Suffolk has a much greater percentage of its pharmacies open for 100 hours or more when compared nationally and regionally. All 100-hour pharmacies in Suffolk are open late-night midweek and at the weekends. Table 29: 100-hour pharmacies

Locality Number (%) of 100-hour pharmacies England (2015-16 data) 1,157 (9.9%) East of England (2015-16 data) 90 (11.2%) Suffolk HWB 21 (14.4%) Babergh 3 (17.6%) Forest Heath 1 (9.1%) Ipswich 5 (15.1%) Mid Suffolk 1 (7.1%) St Edmundsbury 5 (26.3%) Suffolk Coastal 2 (8.3%) Waveney 4 (14.3%)

3.2 Dispensing Appliance Contractors (DACs) There are two dispensing appliance contractors (DACs) in Suffolk: • Charles S Bullen Healthcare Ltd, 60 St Matthew's Street, Ipswich IP1 3EP • Fittleworth Medical Ltd, 25 Lower Brook Street, Ipswich IP4 1AQ Appliances may be dispensed from community pharmacies and dispensing GP practices. As part of the essential services of appliance contractors, a free delivery service is available to all patients. It is therefore likely that patients will obtain appliances delivered from DACs outside the HWB area. There were 112 DACs in England 2015-16.121 3.3 Dispensing GP practices NHS legislation allows for GPs in certain areas to dispense NHS prescriptions for defined populations within rural communities. Geographical areas permitting dispensing by a GP practice are known as controlled localities. NHS England must define controlled localities as areas which are rural in character and therefore suitable for the provision of dispensing services by GP practices. It is the responsibility of NHS England to maintain controlled locality maps for Suffolk.

121 General Pharmaceutical Services in England – NHS Digital 2015-16

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Currently NHS England is assessing the controlled locality maps with a view to ensuring that the maps are published in a consistent manner across the country. While this assessment is being undertaken, any enquires regarding the map should be directed to the contract manager for pharmaceutical services in the East of England Area Team. There have been no changes to the controlled locality map since the publication of the last PNA in January 2015 and that is reproduced below. Figure 34: Map from previous PNA (2015) for Suffolk showing determined controlled localities. A map for Great Yarmouth and Waveney was not available.

There are 77 GP practices in Suffolk (April 2017), of which 43 provide dispensing services. This figure hasn’t changed since the previous PNA produced in 2015. Provision of pharmaceutical services by a GP to a registered patient is only permissible by a GP practice, previously granted rights to dispensing, to a patient who is able to prove one of the following: • that the patient would have serious difficulty in obtaining any necessary drugs or appliances from pharmacy premises because of distance or inadequacy of means of communication • that the patient lives in a controlled locality at a distance of more than 1.6 km from any pharmacy premises (with the exception of distance-selling premises) and the doctor has outline consent and premises approval for the premises from which they would provide services • if the doctor or the practice has historic rights and the patient needs to rely on those. As well as living in a controlled locality at a distance of more than 1.6 km from any pharmacy premises (with the exception of distance-selling premises) the patient must meet other defined criteria.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Table 30 lists the numbers of patients eligible for dispensing from a dispensing GP practice. West Suffolk CCG and Ipswich and East Suffolk CCG lie entirely within Suffolk, while Great Yarmouth and Waveney CCG lies partly in Suffolk. Using the combined total of these three CCGs as a proxy measure, approximately 15% of the total population of Suffolk is eligible for dispensing from their GP practice. Further detail is provided in Table 30. Table 30: List of patients eligible for dispensing services from a dispensing GP practice122

Number of patients % of total eligible for dispensing CCG registered CCG services from a population dispensing GP practice (2013 ONS estimates) Great Yarmouth and Waveney 17,747 7.9% West Suffolk 100,282 14.1% Ipswich and East Suffolk 85,640 22.3% Total 203,669 15.4%

A list of GP dispensing practices in Suffolk can be found in Appendix A. NHS Choices website was accessed on 19th May 2017 to confirm GP practice opening hours and the information can be seen in Appendix A. In Suffolk, 43 dispensing practices (98%) are open after 6pm for at least one evening per week and 12 (27%) are open on Saturdays. No dispensing practices in Suffolk are open on Sundays. There has been no change from 2015. 3.4 Distance-selling pharmacies A distance-selling pharmacy provides services as per the Pharmaceutical Regulations 2013. It may not provide essential services face-to-face and therefore provision is by mail order and/or wholly internet. As part of the terms of service for distance-selling pharmacies, provision of all services offered must be provided to anyone in England who requests them. It is therefore likely that patients within Suffolk will be receiving pharmaceutical services from a distance-selling pharmacy outside the HWB area. The public questionnaire identified that just over 10% of respondents do report using an internet (distance-selling) pharmacy. The one distance-selling pharmacy that used to be in Suffolk has now closed:

114 NHS Business Services Authority, Reports Portal. 2014. https://www.report.ppa.org.uk/ActProd1/iportal/activePortal/viewer/viewframeset.jsp?name=%2fCommon%20Info rmation%20Requests%2fQuarterly%20Patient%20List%20Size%20and%20GP%20Count%2fPatient%20list%20 size%20and%20GP%20count2014-04- 01%2eroi&repositoryType=Enterprise&userid=ciruser&serverURL=http%3a%2f%2factprod1%3a8000&volume=a ctprod

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

• Blackbay Ventures Ltd (T/A Chemistree), Unit 12, Acorn Business Centre, Oaks Drive, Newmarket CB8 7SX Figures for 2015-16 identify that there were 266 distance-selling pharmacies in England. 3.5 Access to community pharmacies The majority of community pharmacy providers in Suffolk are sited in areas co-located with shops, GP practices or other routine destinations; many also provide extended opening hours. The White Paper, ‘Pharmacy in England: Building on strengths – delivering the future’,123 noted that 99% of the population – even those living in the most deprived areas – can get to a community pharmacy within 20 minutes by car and 96% by walking or using public transport. A previously published article124 suggests that over 89% of the population of England has a maximum 20-minute walk to a community pharmacy, however this figure falls to as low as 14% in rural areas. The same study found that access is greater in areas of high deprivation. Higher levels of deprivation are linked with increased premature mortality rates. Populations are generally denser in urban areas. Map A describes the population density of Suffolk and location of community pharmacies and dispensing GP practices. The most densely populated local authority areas are Ipswich and north-eastern parts of Waveney. A high concentration of community pharmacies can also be found in these areas. A list of community pharmacies in Suffolk and their opening hours can be found in Appendix A. 3.5.1 Routine weekday daytime access to community pharmacies and dispensing GP practices Average drive time, walking and public transport travel times to community pharmacies and dispensing GP practices for Suffolk population can be found in Appendix I. Travel analysis data, as shown in Appendix I, shows that 100% of the population of Suffolk has an average drive time to a community pharmacy or dispensing GP practice within 25 minutes. Around 86% have access within a 20-minute public transport journey, while just over 69% have a maximum 20-minute walk. Almost 25% have a walk of over 30 minutes to their nearest pharmacy.

123 Department of Health. Pharmacy in England: Building on strengths – delivering the future. April 2008. http://www.official-documents.gov.uk/document/cm73/7341/7341.pdf 124 Todd A, Copeland A, Husband A et al. The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England. BMJ Open 2014; Vol. 4, Issue 8. http://bmjopen.bmj.com/content/4/8/e005764.full.pdf%20html

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

From the results of the public questionnaire (Appendix M), 77% of respondents’ report using a regular or preferred community pharmacy, 69% report their choice as it is ‘near to home’, while 55% report as it is ‘near to their GP surgery’. 62% of respondents travel by their own transport, 31% walk, 2% by bike and 3% by public transport. 80% report their travel time to their community pharmacy or dispensing GP practice takes less than 15 minutes. Only 8% of respondents report a difficulty in travelling to their pharmacy. For some residents, the nearest provider of pharmaceutical services may be across the border in the neighbouring HWB areas. Given the largely rural nature of this HWB area many residents will be familiar with significant travel times, particularly in the evenings and at weekends, to access other services such as a supermarket. A sample of some of the community pharmacies within easy access of Suffolk locality borders providing services are listed in Table 31. Table 31: Community pharmacy providers in neighbouring HWB areas* Opening hours HWB area Pharmacy name and address (excl. bank holidays) Tesco Pharmacy, The Square, Great Mon-Sat 08:00-20:00 Notley, Braintree, CM77 7WW Sun 10:00-16:00 Boots, Century House, Station Road, Mon-Fri 08:30-19:00 Manningtree, CO11 1AA Sat 08:30-17:30 Tesco Pharmacy, Highwoods Square, Mon-Sat 08:00-20:00 Colchester, CO4 9ED Sun 10:00-16:00 Mon 08:00-23:00 Asda Pharmacy, Unit 9 Turner Rise, Tue-Fri 07:00-23:00 Petrolea Close, Colchester, CO4 5TU Sat 07:00-22:00 Essex Sun 10:00-16:00 Mon-Fri 07:00-23:00 Queen Street Pharmacy, 12 Queen Sat 07:00-21:00 Street, Colchester, CO1 2PJ Sun 10:30-16:30 Cavalry Road Pharmacy, 15 Cavalry Mon-Sat 07:00-22:00 Road, Colchester, CO2 7GF Sun 08:00-18:00 Borno Chemists, Fryatt Hospital, Mon, Wed, Thurs, Fri 419 Main Road, Dovercourt, Harwich, 08:30-18:30 CO12 4ET Tues 08:30-20:30

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening hours HWB area Pharmacy name and address (excl. bank holidays)

Mon 08:00-22:30 Tesco Pharmacy, Angel Drove, Ely, Tue-Sat 06:30-22:30 CB7 4DJ (Sat closes 22:00) Sun 10:00-16:00 Cambridgeshire Mon 08:00-23:00 Sainsbury’s Pharmacy, Cresswells Tue-Fri 07:00-23:00 Lane, Ely, CB7 4AS Sat 06:30-22:00 Sun 10:00-16:00 St George’s Pharmacy, St George’s Mon-Sat 08:00-22:30 Medical Centre, Parsons Lane, Sun 08:00-21:00 Littleport, Ely, CB6 1JU Staploe Pharmacy, The Staploe Mon 08:30-21:00 Medical Centre, Brewhouse Lane, Tue-Fri 08:30-19:00 Soham, Ely, CB7 5JD Sat 08:30-16:30 Boots, 28 Petty Curry, Cambridge, CB2 Mon-Sat 08:00-20:00 3ND Sun 11:00-17:00 Mon, Tues, Weds, Boots, Grafton Centre, Cambridge, CB1 Fri, Sat 08:30-18:00 1PS Thurs 8:30- 20:00 Sun 11:00-17:00 Asda Pharmacy, Beehive Centre, Mon-Sat 09:00-21:00 Cambridgeshire Coldhams Lane, Cambridge, CB1 3ER Sun 10:00-16:00 Mon–Fri 7:00-23:00 Lloyds Pharmacy (Sainsbury’s), Brook Sat 07:00-22:00 Road, Cambridge, CB1 3HP Sun 10:00-16:00 Tesco Pharmacy, Cambridge Road, Mon-Sat 08:00-20:00 Milton, Cambridge, CB24 6AY Sun 10:00-16:00 Mon 08:00-22:30 Tesco Pharmacy, Yarrow Road, Tue-Sat 06:30-22:30 Fulbourn, CB1 9BF (Sat closes 22:00) Sun 10:00-16:00 Boots, Cambridge Retail Park, 320 Mon-Sat 09:00-23:59 Newmarket Road, Cambridge, CB5 Sun 10:00-23:590 8WR Hopton Pharmacy, 1 Warren Road, Mon-Fri 09:00-18:00 Hopton on Sea, Great Yarmouth, NR31 Sat 09:00-13:00 6JU Mon-Weds 08:30- Norfolk Boots, Unit E, Gapton Hall Retail Park, 00:00 Gapton Hall Road, Great Yarmouth, Thurs 08:30-00:00 NR31 0LZ Fri-Sat 08:00-00:00 Sun 10:30-16:30

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening hours HWB area Pharmacy name and address (excl. bank holidays) Mon 08:00-22:30 Tesco Pharmacy, Pasteur Road, Tue-Fri 06:30-22:30 Southtown, Great Yarmouth, NR31 Sat 6:30-22:00 0DW Sun 10:00-16:00 Town Pharmacy, 171 King Street, Great Mon-Sat 07:00-22:00 Yarmouth, NR30 2PA Sun 10:00-20:00 Mon-Fri 07:00-22:00 Greyfriars Pharmacy, 5 Greyfriars Way, Sat 08:00-21:00 Great Yarmouth, NR30 2QE Sun 08:00-20:00 Mon-Sat 08:30-20:00 Asda Pharmacy, Acle New Road, (Thurs and Fri open Vauxhall, Great Yarmouth, NR30 1SF until 21:00) Sun 10:00-16:00 Mon-Fri 07:00-23:00 Hado Pharmacy, 66 Mount Street, Diss, Sat 07:00-20:00 IP22 4QQ Sun 10:00-17:00 Tanner Street Chemists, 1 Tanner Mon-Fri 07:00-23:00 Court, Tanner Street, Thetford, IP24 Sat 08:00-20:00 2BQ Sun 10:00-18:00 Norfolk Lloyds Pharmacy, 10 King Street, Mon-Fri 09:00-19:00 Thetford, IP24 2AP Sat 09:00-17:30 Mon-Fri 07:30-23:00 Lime Pharmacy, Grove Surgery, Grove Sat 08:00-20:30 Lane, Thetford, IP24 2HY Sun 08:00-18:00 Mon-Fri 07:00-23:00 Lloyds Pharmacy (Sainsbury), London Sat 07:00-22:00 Road, Thetford, IP24 EQL Sun 10:00-16:00 Tesco Pharmacy, Norwich Road, Mon-Sat 08:00-20:00 Thetford, IP24 2HT Sun 10:00-16:00 *This list is not exhaustive, and many more (in some cases, closer) providers may exist, though often with lesser opening hours. NHS Choices website accessed 9.5.17 to confirm opening hours.

3.5.2 Routine weekday evening access to community pharmacies and dispensing GP practices The number, location and opening hours of community pharmacy and dispensing GP practice providers open beyond 6.30pm, Monday to Friday (excluding bank holidays) varies within each locality; they are listed in Table 32 below. Please note that some providers and GP practices are only open beyond 6.30pm on certain days and only the opening times for those days are given below. These providers will be open on other weekdays but not beyond 6.30pm. Full details of opening times for all community pharmacies and GP dispensing practices can be found in Appendix A. Considering ‘average’ access is difficult given the variety of opening hours and locations, access is therefore considered at locality level.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Table 32: Community pharmacy and dispensing GP practice* providers open Monday to Friday (excl. bank holidays) beyond 6.30pm Opening hours Type of Locality Provider name and address (Mon-Fri, excl. provider bank holidays) 06:30-22:30 Community Tesco, Springlands Road, Babergh (Mon open from pharmacy Sudbury CO10 1GY 08:00) Lloyds Pharmacy, Armes Mon- Fri Trading Estate, Sudbury CO10 7.00-23.00 2XB 06:30-22:30 Tesco, Springlands Road, (Mon open from Sudbury CO10 1GY 08:00) Lloyds Pharmacy, Armes Mon- Fri Trading Estate, Sudbury CO10 Community 7.00-23.00 Babergh 2XB pharmacy Mon 08:00-Tues 06:00 (non-stop), Parade Pharmacy, 6 North Tues 08:00-Wed Street Parade, Sudbury CO10 06:00 (non-stop), 1GL Weds, Thurs, Fri 08:00-22:00 Tesco, Copdock Interchange 08:00-13:30 London Road, Ipswich IP8 3TS 14:30-20:00 Lord’s Pharmacy, Guineas Shopping Centre, Newmarket 07:30-22:30 Community CB8 8EQ pharmacy Tesco, Fordham Road, Forest Heath 08:00-20:00 Newmarket CB8 7AH Market Cross Surgery, 7 Tues 08:30-20:00 Dispensing Market Place, Mildenhall IP28 Thurs 08:00- GP practice 7EG 20:00 Kew Pharmacy, 4 Ellenbrook 07:00-22:00 Green, Ipswich IP2 9RR Morrisons Pharmacy, 08:30-20:00 Sproughton Road, Ipswich Aqua Pharmacy, 52 Duke 08:00-20:00 Street, Ipswich IP1 5AS Community Lloyds Pharmacy, Hadleigh Ipswich 07.00-23:00 pharmacy Road, Ipswich IP2 0BX M and M Pharmacy, 14 St. Matthew’s Street, Ipswich IP1 07:00-22:00 3EU Wellbeing Pharmacy, 29 Chesterfield Drive, Ipswich IP1 07:00-22:00 6DW

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening hours Type of Locality Provider name and address (Mon-Fri, excl. provider bank holidays) Tesco Pharmacy, Cedars Link 08:00-13:00 Road, Stowmarket IP14 5BE 14:00-19:00 Community Mid Suffolk 07:00-23:00 pharmacy Asda Pharmacy, 8-9 Wilkes (Mon open from Way, Stowmarket IP14 1DE 08:00) Woolpit Medical Services, Community (Mon only Woolpit Health Centre, Heath pharmacy 07:00-19:45) Road, Woolpit IP30 9QU Mid Suffolk Drs Lewis, Partridge & Ahmed, Dispensing Tues only The Health Centre, Eye IP23 GP practice 08:30-19:30 7DD Fressingfield Medical Centre, Mon only 08:00- Fressingfield, Eye, IP21 5PJ 19:25 Needham Market Country Mon only 08:30- Practice, Barking Road, Dispensing 20:00 Mid Suffolk Needham Market IP6 8EZ GP practice Stowhealth, Violet Hill Road, Mon only 08:00- Stowmarket, IP14 1NL 20:15 Woolpit, The Health Centre, Mon only 07:00- Bury St Edmunds IP30 9 QU 20:00 Mon 07:00- Tesco Pharmacy, Cangle Road, 23:00 Haverhill CB9 0BQ (Mon open from 08:00) Lloyds Pharmacy, Bedingfield Way, Bury St Edmunds IP32 07:00-23:00 7EJ 06:30-22:30 Tesco, St Saviour’s Exchange, (Mon open from Bury St Edmunds IP32 7JS 08:00) Community Lloyds Pharmacy, Haycocks pharmacy 08:00-22:00 St Road, Haverhill CB9 7YL Edmundsbury 07:00-23:00 Asda Pharmacy, Western Way, (Mon open from Bury St Edmunds IP33 3SP 08:00) Swan Pharmacy, Swan Surgery, Northgate St, Bury St Edmunds 08:00-22:00 IP33 1AE Haverhill Pharmacy, Christmas Maltings Surgery, Camps Road, 08:30-23:00 Haverhill CB9 8HF Tues and Weds Dispensing Victoria Surgery, Victoria Street, only 08:00- GP practice Bury St Edmunds IP33 3BB 20:00

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening hours Type of Locality Provider name and address (Mon-Fri, excl. provider bank holidays) Felixstowe Pharmacy, Grove Med Centre, Grove Road, 07:00-22:30 Suffolk Community Felixstowe IP11 9GA Coastal pharmacy Waterton pharmacy, Framfield Med Centre, Ipswich Rd, 08:00-19:30 Woodbridge IP12 4FD Morrisons Pharmacy, Grange 08:00-14:00 Farm Avenue, Felixstowe IP11 15:00-20:00 2XD Your Local Boots Pharmacy, 31 Mon and Tues Orwell Road, Felixstowe IP11 08:30-20:00 7DD 08:00-20:00 Community Tesco Pharmacy, Anson Road, (Fri closes at pharmacy Martlesham Heath IP5 3RU 21:00) Lloyds Pharmacy, Felixstowe 08:00-21:00 Road, Warren Heath IP3 8TQ Hado Pharmacy, 135 Hamilton 07:00-23:00 Suffolk Road, Felixstowe IP11 7BL Coastal Tesco, Ropes Drive, Kesgrave 08:00-13:30 IP5 2FU 14:30-19:00 Framfield House Surgery, Mon and Tues Ipswich Road, Woodbridge IP12 only 07:00- 4FD 19:00 Framlingham Medical Centre, Mon only 08:00- Ipswich Road, Woodbridge IP13 Dispensing 19:30 9HA GP practice The Birches, Twelve Acre Mon only 08:00- Approach, Kesgrave 20:30 Wickham Market Medical Tues only Centre, Chapel Road, Wickham 08:00-20:00 Market IP13 0SB 07:00-23:00 Asda Pharmacy, Horn Hill, (Mon open from Lowestoft NR33 0PX 08:00) 08:30-19:30 Beccles HCC Ltd, St Mary’s (Fri closes Road, Beccles NR34 9NQ Community 18:30) Waveney pharmacy Rosedale Pharmacy, 3 Ashburnham Way, Lowestoft 07:00-22:30 NR33 8LG Tesco Pharmacy, George 06:30-22:30 Westwood Way, Beccles NR34 (Mon open from 9EJ 08:00) * Dispensing GP practices may only provide pharmaceutical services to patients eligible for dispensing, registered with that practice.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

There is access to pharmaceutical services in the evening in all localities, although in some areas greater distances are required to be travelled and/or access is provided from cross-border providers. The public questionnaire provided generally very positive feedback about access to pharmaceutical services. 3.5.3 Routine Saturday daytime access to community pharmacies The number, location and opening hours of community pharmacy providers open on a Saturday vary within each locality. A number of pharmacies are open only for Saturday mornings, while a small number are open until late evening. A full list of community pharmacy and dispensing GP practices and their opening hours can be found in Appendix A. Table 33: Community pharmacy and dispensing GP practice* providers open Saturday Opening Type of Locality Provider name and address hours provider Saturday Tesco, Springlands Road, Sudbury 06:30-22:00 CO10 1GY Lavenham Pharmacy, 3 High Street, 09:00-17:30 Lavenham, Sudbury CO10 1PX Boots Pharmacy, 5 Applegate Mews, Poplar Road, Great Cornard CO10 09:00-13:00 0GL Lloyds Pharmacy, Armes Trading Estate, Cornard Road, Sudbury 07:00-22:00 CO10 2XB Boots Pharmacy, 91 High Street, 08:45-10:00 Hadleigh, Ipswich IP7 5EA Glemsford Pharmacy, The Surgery, 09:00-12:30 Lion Road, Glemsford CO10 7RF Community Babergh Mill Pharmacy, Hadleigh Health pharmacy Centre, Market Place, Hadleigh, 09:00-18:00 Ipswich IP7 5DN Parade Pharmacy, 6 North Street 09:00-18:00 Parade, Sudbury CO10 1GL Tesco, Copdock Interchange, London 08:00-13:30 Road, Ipswich IP8 3TS 14:30-20:00 Day Lewis Pharmacy, The Street, 09:00-13:00 East Bergholt CO7 6SE Boots UK Ltd, 13-14 Market Hill, 08:30-17:30 Sudbury CO10 2EA Clare Pharmacy, 31 High Street, 09:00-13:00 Sudbury CO10 8NY 14:00-17:00 Superdrug Pharmacy, 8 North Street, 08:30-17:30 Sudbury CO10 1RB

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening Type of Locality Provider name and address hours provider Saturday Lloyds Pharmacy, 29 North Street, 09:00-17:30 Sudbury CO10 1RB Boots Pharmacy, 31 High Street, 09:00-17:00 Hadleigh, Ipswich IP7 5AF The Pharmacy, Richmond House, Hall Street, Long Melford, Sudbury 09:00-17:30 CO10 9JL Community The Surgery, The Street, Holbrook, 08:30-10:30 pharmacy Ipswich IP9 2QS Bildeston Health Centre, High Street, Babergh 08:30-12:30 Dispensing Bildeston IP7 7EX GP The Surgery, The Street, Holbrook, practice 08:30-10:30 Ipswich IP9 2QS Lord’s Pharmacy, Unit 61, The Guineas Shopping Centre, 07:30-22:30 Newmarket, CB8 8EQ Boots UK Ltd, 82 High Street, 08:30-18:00 Newmarket, Suffolk CB8 8JX Lloyds Pharmacy, Units 1 and 2, The New Rookery, Shopping Centre, 09:00-17:30 Newmarket CB8 8HT Day Lewis Pharmacy, Unit 3, 09:00-13:00 Community Bellflower Crescent IP28 8JU pharmacy Boots Pharmacy, 32-34 High Street, 08:30-13:30 Forest Heath Brandon IP27 0AQ 14:30-17:00 Boots Pharmacy, 1 Bury Road, 09:00-13:30 Brandon IP27 0BU 14:00-17:00 Superdrug, Unit 11, The Rookery, 08:30-17:30 Newmarket CB8 8HT Tesco, Fordham Road, Newmarket 08:00- CB8 7AH 20:00 Lloyds Pharmacy, 27 Market Place, 09:00-17:30 Mildenhall IP28 7EF Dispensing The Rookery Medical Practice, The GP 08:30-12:00 Rookery, Newmarket CB8 8NW practice Kew Pharmacy, 4 Ellenbrook Green, 8:00-22:00 Ipswich IP2 9RR Community Barbour Pharmacy, 119 Branford Ipswich 09:00-13:00 pharmacy Road, Ipswich IP1 2LW Delta Pharmacy, 57-59 Foxhall Road, 09:00-13:00 Ipswich IP3 8JU

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening Type of Locality Provider name and address hours provider Saturday Asda Pharmacy, Goddard Road, 09:00-13:00 Ipswich IP1 5PD Day Lewis Pharmacy, 26 Hening Avenue, Ravenswood, Ipswich IP3 09:00-13:00 9QJ Welch Stoke Park Pharmacy, 51 09:00-12:00 Stoke Park Drive, Ipswich IP2 9TH Your Local Boots Pharmacy, 58 09:00-17:00 Queens Way, Ipswich IP3 9EX Your Local Boots Pharmacy, 58 09:00-17:00 Queens Way, Ipswich IP3 9EX Lloyds Pharmacy, 204 Hawthorn 09:00-17:00 Drive, Ipswich IP2 0QG East of England Co-operative Society, 310 Sheldrake Drive, 08:45-17:30 Ipswich IP2 9LF Morrisons Pharmacy, Sproughton 09:00-18:00 Road, Ipswich IP1 5AS East of England Co-operative Society 08:45-17:30 145 Fircroft Road, Ipswich IP1 6PT East of England Co-operative Society, 8 Cox Lane, Ipswich IP4 08:30-17:30 1HT Aqua Pharmacy, 52 Duke Street, 08:00-20:00 Ipswich IP3 0AQ Community Burlington Pharmacy, 14 Burlington Ipswich 09:00-13:00 pharmacy Road, Ipswich IP1 2EU Boots UK Ltd, 5 Tavern Street, 08:00-18:00 Ipswich IP1 3AA Rushmere Pharmacy, 428 09:00-13:00 Woodbridge Road, Ipswich IP4 4EL Gainsborough Pharmacy, 13 09:00-13:00 Reynolds Road, Ipswich IP3 0JL Lloyds Pharmacy, Hadleigh Road, 07:00-22:00 Ipswich IP2 0BX Your Local Boots Pharmacy, Two Rivers Medical Centre, 32 09:00-12:00 Woodbridge Road East, Ipswich IP4 13:00-17:30 5PB Lloyds Pharmacy, 159 Felixstowe 09:00-17:00 Road, Ipswich IP3 8EB Spring Road Pharmacy, 203 Spring 09:00-17:30 Road, Ipswich IP4 5NQ

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening Type of Locality Provider name and address hours provider Saturday M and M Pharmacy, 14 St Matthew’s 07:00-22:00 Street, Ipswich IP1 3EU Wellbeing Pharmacy, 29 Chesterfield 08:00- Drive, Ipswich IP1 6DW 22:00 East of England Co-operative Society 08:45-17:30 350 Nacton Road, Ipswich IP3 9NA Rainbow Pharmacy, 289 Norwich 09:00-13:00 Road, Ipswich IP1 4BP Boots UK Ltd, Unit 5 Buttermarket 08:30-14:00 Shopping Centre, Ipswich IP1 1DT 15:00-17:30 Tesco Pharmacy, Cedars Link Road, 08:00-13:00 Stowmarket IP14 5BE 14:00-19:00 Claydon Pharmacy, 1 Station Road, 09:00-13:00 Calydon, Ipswich IP6 0HS Boots UK Ltd, 21 Ipswich Street, 08:30-17:30 Stowmarket IP14 1AH Boots UK Ltd, Stowmarket Health Centre, Violet Hill Road, Stowmarket 08:30-12:00 IP14 1NL Asda Pharmacy, 8-9 Wilkes Way, 07:00-22:00 Stowmarket IP14 1DE Woolpit Medical Services, Woolpit Health Centre, Heath Road, Woolpit 08:00-11:00 IP30 9QU Community Needham Market Pharmacy, Barking pharmacy 09:00-13:00 Road, Needham Market IP6 8EZ Mid Suffolk The Pharmacy, 1 Little Back Lane, 09:00-13:00 Debenham, Stowmarket IP14 6RB Station Pharmacy, Unit 1 Cattlepens, 09:00-13:00 Station Road, Elmswell IP30 9HD Thurston Pharmacy, Thurston Granary, Station Hill, Thurston IP31 09:00-13:00 3QU Botesdale Health Centre, Back Hills 09:00-11:00 Botesdale, Diss IP22 1DW East of England Pharmacy, Combs 08:30-17:30 Lane, Stowmarket IP14 2DA Eye Pharmacy, 5 Broad Street, Eye 09:00-13:00 IP23 7AF Botesdale Health Centre, Back Hills, 08:30- Dispensing Botesdale, Diss IP22 1DW 12:00 GP Combs Ford Surgery, Combs Lane, practice 08:00-11:00 Stowmarket IP14 2SY

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening Type of Locality Provider name and address hours provider Saturday Stowhealth, Violet Hill Road, 8:30-11:45 Stowmarket, Ipswich IP14 1NL

Woolpit, The Health Centre, Bury St 08:00-11:00 Edmunds IP30 9QU Tesco Pharmacy, Cangle Road, 07:00-22:00 Haverhill CB9 0BQ Lloyds Pharmacy, Bedingfield Way, 07:00-22:00 St Community Bury St Edmunds IP32 7EJ Edmundsbury pharmacy Boots UK Ltd, 15 High Street, 08:30-17:30 Haverhill CB9 8AD Well Pharmacy, 2 Mill Road, Haverhill 09:00-13:00 CB9 8BD Boots UK Ltd, 11-13 Cornhill, Bury St 08:30-18:00 Edmunds IP33 1BX Abbey Pharmacy, Lower Baxter 09:00-13:00 Street, Bury St Edmunds IP33 1ET Superdrug Pharmacy, m37-39 08:30-17:30 Cornhill, Bury St Edmunds IP33 1DX Tesco Pharmacy, St Saviour’s Exchange, Bury St Edmunds IP32 06:30-17:00 7JS Ixworth Pharmacy, Peddars Close, 09:00-13:00 Ixworth, Bury St Edmunds IP31 2HD Lloyds Pharmacy, Haycocks Road, 08:00-22:00 Haverhill CB9 7YL Croasdale and Sons, 1 The Traverse, 08:30-17:30 St Community Cornhill, Bury St Edmunds IP33 1BE Edmundsbury pharmacy Asda Pharmacy, Western Way, Bury 07:00-22:00 St Edmunds IP33 3SP David Holland Pharmacy, Norton Road (Greenfields Way) Haverhill 09:00-12:30 CB9 8LU Day Lewis Pharmacy, 7 St Olaves 09:00-13:00 Precinct, Bury St Edmunds IP32 6SP Swan Pharmacy, Swan Surgery, Northgate St, Bury St Edmunds IP33 08:00-23:00 1AE Haverhill Pharmacy, Christmas 08:00- Maltings Surgery, Camps Road, 21:45 Haverhill CB9 8HF Barrow Pharmacy, Barrowhill, 09:00-12:00 Barrow, Bury St Edmunds IP29 5DX

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Type of Opening Locality provider Provider name and address hours Saturday Victoria Surgery, Victoria Street, Bury 08:00-9:30 Dispensing St Edmunds IP33 3BB Angel Hill, 1 Angel Hill, Bury St GP 08:30-12:00 practice Edmunds IP33 1LU The Swan Surgery, Norgate Street, 08:30-12:00 Bury St Edmunds IP33 1AE Felixstowe Pharmacy, Grove Med Centre, Grove Road, Felixstowe IP11 07:00-22:30 9GA Wickham Market Pharmacy, Unit 2, Suffolk Community 09:00-13:00 White Hart Court, Wickham Market Coastal pharmacy 14:00-17:00 IP13 0RA Waterton Pharmacy, Framfield Med Centre, Ipswich Rd, Woodbridge IP12 10:00-13:00 4FD Waterton Pharmacy, Framfield Med Centre, Ipswich Rd, Woodbridge IP12 10:00-13:00 4FD Lloyds Pharmacy, Unit 1, 11 09:00-17:30 Thoroughfare, Woodbridge IP12 1AA Kesgrave Pharmacy, 34a Penzance 09:00-13:00 Road, Kesgrave, Ipswich IP5 1JS Framlingham Pharmacy, 32 Market Hill, Framlingham, Woodbridge IP13 09:00-17:00 9AY Morrisons Pharmacy, Grange Farm 08:00-14:00 Avenue, Felixstowe IP11 2XD 15:00-18:00 Your Local Boots Pharmacy, 31 09:00-17:30 Suffolk Community Orwell Road, Felixstowe IP11 7DD Coastal pharmacy Tesco Pharmacy, Anson Road, 08:00-20:00 Martlesham Heath IP5 3RU Boots UK Ltd, 86 Hamilton Road, 08:30-17:30 Felixstowe IP11 7AD Lloyds Pharmacy, 277 High Street, 09:00-13:00 Walton, Felixstowe IP11 9DU Lloyds Pharmacy, Felixstowe 08:00-20:00 Road, Warren Heath IP3 8TQ Square Pharmacy, 696 Foxhall Road, 09:00-13:00 Ipswich IP3 8NQ Hado Pharmacy, 135 Hamilton Road, 07:00-20:00 Felixstowe IP11 7BL Martlesham Pharmacy, 9 The Square, Martlesham Heath, Ipswich 09:00-12:00 IP5 3SL

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Type of Opening Locality provider Provider name and address hours Saturday East of England Co-operative Society, 183-185 Hamilton Road, 08:30-17:30 Felixstowe IP11 7DT Aldeburgh Pharmacy, 125 High 09:00-17:00 Street, Aldeburgh IP15 5AR Rendlesham Pharmacy, Unit 7 Rendlesham Mews, Rendlesham 10:00-12:00 IP12 2SZ Lloyds Pharmacy, 62 High Street, 09:00-17:30 Leiston IP16 4BZ Boots UK Ltd, 58 Thoroughfare, 08:30-12:45 Woodbridge IP12 1AL 13:45-17:30 East of England Co-operative Society, 7 High Street, Saxmundham 08:30-17:30 IP17 1DF Leiston Pharmacy, 20 High Street, 09:00-17:00 Community Leiston IP16 4EW pharmacy Tesco, Ropes Drive, Kesgrave IP5 08:00-13:30 2FU 14:30-19:00 Suffolk Dr Taylor and Partners, 7 Little St Coastal John’s Street, Woodbridge, Suffolk 08:30-11:30 Dispensing IP12 1EE GP Wickham Market Medical Centre, practice Chapel Road, Wickham Market IP13 08:30-11:45 0SB Asda Pharmacy, Horn Hill, Lowestoft 07:00-22:00 NR33 0PX Beccles HCC Ltd, St Mary’s Road, 09:00-12:00 Beccles NR34 9NQ Boots UK Ltd, 5 New Market, 09:00-17:30 Beccles, Suffolk NR34 9HQ Boots UK Ltd, 4 St Mary’s Street, 08:30-12:30 Bungay NR35 1AX 13:00-17:30 Community Boots UK Ltd, 28 St John’s Road, 09:00-13:00 Waveney pharmacy Bungay NR35 1LP 14:00-18:00 Boots UK Ltd, 26 Market Place, 09:30-17:00 Halesworth IP19 8AY Boots UK Ltd, 78a London Road 08:30-17:30 North, Lowestoft NR32 1ET Boots UK Ltd, 120 St Peter’s Street, 09;00-13:30 Lowestoft, NR32 1UD 14:00-16:30 Boots UK Ltd, 2-4 Stradbrooke Road, 09:00-13:00 Pakefield, Lowestoft NR33 7HT 14:00-18:00

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Type of Opening Locality provider Provider name and address hours Saturday Cutlers Hill Pharmacy, Bungay Road, 08:30-12:30 Halesworth IP19 8SG Eastpoint Pharmacy, 216 London 09:00-13:00 Road South, Lowestoft NR33 0HF Hayden Chemist, Bridge Road, 09:00-13:00 Oulton Broad, Lowestoft NR32 3LL Kessingland Pharmacy, 70 High 09:00-17:00 Street, Kessingland NR33 7QF Queen Street Pharmacy, 18 Queen 09:00-17:30 Street, Southwold IP18 6EQ Raydon Pharmacy, Solebay Health Centre, Teal Close, Raydon IP18 09:00-13:00 6GY Rosedale Pharmacy, 3 Ashburnham 07:00-22:30 Way, Lowestoft NR33 8LG Superdrug Pharmacy, 14 The Britten 09;00-17;30 Centre, Lowestoft NR32 1LR Well Pharmacy, Unit 5,15 Ashburnham Way, Carlton Colville, 09:00-17:30 Lowestoft NR33 8LG Jhoots Pharmacy, 187 London Road 09:00-13:00 South, Lowestoft NR33 0DR Well Pharmacy, 55 Westwood Community 09:00-13:00 Waveney Avenue, Lowestoft NR33 9RW pharmacy Village Rise Pharmacy, Weston 09:00-13:00 Road, Gunton, Lowestoft NR32 4PT Worlingham Pharmacy, Woodland Avenue, Worlingham, Beccles NR34 09:00-17:00 7EF Tesco Pharmacy, George Westwood 06:30-22:30 Way, Beccles NR34 9EJ

The majority (87%) of community pharmacy providers are open for some hours on Saturday. Around 28% of dispensing GP practices also provide services for some hours on a Saturday. There is access to pharmaceutical services on Saturdays in all localities, although in some areas greater distances are required to be travelled and/or access is provided from cross-border providers. No issues regarding access to pharmaceutical services on Saturdays were raised from the public questionnaire. 3.5.4 Routine Sunday daytime access to community pharmacies The number, location, and opening hours of community pharmacy providers open on a Sunday vary within each locality.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Information received from the service provider questionnaires suggests that there are no dispensing GP practices providing services on a Sunday. Table 34 - Community pharmacy providers open Sundays Opening Locality Pharmacy name and address hours (Sundays) Tesco, Springlands Road, Sudbury, CO10 1GY 10:00-16:00 Mill Pharmacy, Hadleigh Health Centre, Market 10:00-14:00 Place, Hadleigh, IP7 5DN Parade Pharmacy, 6 North Street Parade, 10:00-15:00 Babergh Sudbury, CO10 1GL Tesco Pharmacy, London Road, Ipswich, IP8 3TS 10:00-16:00 Lloyds Pharmacy, Armes Trading Estate Cornard 10:00-16:00 Road, Sudbury, CO10 2XB Boots, 12-14 Market Hill, Sudbury, CO10 2EA 10:00-16:00 Lord’s Pharmacy, The Guineas Shopping Centre, Forest Heath 09:00-19:00 Newmarket, CB8 8EQ Tesco Pharmacy, Fordham Road, Newmarket, 10:00-16:00 Forest Heath CB8 7AH Boots, 82 High Street, Newmarket, CB8 8JX 10:00-16:00 Kew Pharmacy, 4 Ellenbrook Green, Ipswich, IP2 09:00-20:00 9RR Morrisons Pharmacy, Sproughton Road, Ipswich, 10:00-16:00 IP1 5AH Boots Pharmacy, Sailmakers Shopping Centre, 5 10:30-16:30 Tavern Street, Ipswich, IP1 3AA Ipswich M and M Pharmacy, 4 St Matthew’s Street, 08:00-18:00 Ipswich, IP1 3EU Wellbeing Pharmacy, 29 Chesterfield Drive, 09:00-20:00 Ipswich, IP1 6DW Lloyds Pharmacy, Hadleigh Road, Ipswich, IP2 10:00-16:00 0BX Tesco Pharmacy, Cedars Link Road, Stowmarket, 10:00-16:00 IP14 5BE Mid Suffolk Asda Pharmacy, Meadow Centre, 8-9 Wilkes Way, 10:00-16:00 Stowmarket, IP14 1DE Tesco Pharmacy, Cangle Road, Haverhill, CB9 10:00-16:00 0BQ Lloyds Pharmacy, Bedingfield Way, Bury St 10:00-16:00 Edmunds, IP32 7EJ St Boots Pharmacy, 11-13 Cornhill, Bury St Edmunds, 10:30-16:30 Edmundsbury IP33 1BX Tesco Pharmacy, St Saviours Exchange, Bury St 10:00-16:00 Edmunds, IP32 7JS Lloyds Pharmacy, Haycocks Road, Haverhill, CB9 10:00-16:00 7YL

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Opening Locality Pharmacy name and address hours (Sundays) Asda Pharmacy, Western Way, Bury St Edmunds, 10:00-16:00 IP33 3SP Swan Pharmacy, Swan Surgery, Northgate Street, 08:00-23:00 Bury St Edmunds, IP33 1AE Haverhill Pharmacy, Christmas Maltings Surgery, 08:00-21:45 Camps Road, Haverhill, CB9 8HF Felixstowe Pharmacy, Grove Medical Centre, 10:00-17:00 Grove Road, Felixstowe, IP11 9GA Waterton Pharmacy, Franfield Medical Centre, 10:00-12:00 Ipswich Road, Woodbridge, IP12 4FD Suffolk Morrisons Pharmacy, Grange Farm Avenue, 10:00-13:00 Coastal Felixstowe, IP11 2XD Tesco Pharmacy, Anson Road, Martlesham Heath, 10:00-16:00 IP5 3RU Boots Pharmacy, 86 Hamilton Road, Felixstowe, 10:00-16:00 IP11 7AD Lloyds Pharmacy, Felixstowe Road, Warren Heath, 10:00-16:00 IP3 8TQ Hado Pharmacy, 135 Hamilton Road, Felixstowe, 10:00-17:00 Suffolk IP11 7BL Coastal Aldeburgh Pharmacy, 125 High Street, Aldeburgh, 10:00-14:00 IP15 5AR Boots Pharmacy, 58 Thoroughfare, Woodbridge, 10:00-16:00 IP12 1AL Asda Pharmacy, Belvedere Road, Horn Hill, 10:00-16:00 Lowestoft,NR33 0PX Boots, 74 London Road North, Lowestoft, NR32 10:00-16:00 1ET 10:00-16:00 Queen Street Pharmacy, 18 Queen St, Southwold, Waveney (during busy Suffolk, IP18 6EQ periods) Rosedale Pharmacy, 3 Ashburnham Way, Carlton 10:00-17:00 Colville, Lowestoft, NR33 8LG Tesco Pharmacy, George Westwood Way, 10:00-16:00 Beccles, NR34 9QH

There are just over one in four community pharmacy providers in Suffolk open on Sundays. Access is generally good, although as would be expected of access to many services, residents in rural areas may experience additional travel time compared with weekdays and Saturdays. No issues regarding access to pharmaceutical services on Sundays were raised from the public questionnaire.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

3.5.5 Routine bank holiday access to community pharmacies Community pharmacies are not obliged to open on nominated bank holidays. While many opt to close, a number of pharmacies (often those in regional shopping centres, retail parks, supermarkets and major high streets) opt to open, often for limited hours. The number, location and opening hours of community pharmacy providers open on a bank holiday vary within each locality and on different bank holidays. Number of pharmacies open across the bank holidays for May and August in 2017 has ranged from 22 to 24. NHS England commission a Christmas Day and Easter Sunday service and review provision after each Christmas, New Year and Easter bank holiday. Commercial factors often dictate many pharmacies' decision to open or not during bank holidays. No issues regarding access to pharmaceutical services on bank holidays were raised from the public questionnaire. 3.6 Advanced service provision from community pharmacies Section 1.3 lists all advanced services which may be provided under the pharmacy contract. As these services are discretionary, not all providers will provide them all of the time. Data available from the NHS Business Services Authority and posted on the website of the Pharmaceutical Services Negotiating Committee (PSNC)125 has been used to demonstrate in Appendix A which pharmacies had claimed (and therefore provided) MUR, NMS and flu vaccination services in 2015/16. The data shows that around 98% of community pharmacies in Suffolk are providing the MUR service (an increase from 90% reported previously), around 95% are providing the NMS service and 63% provided the flu vaccination service (2015/16 season). Information on provision of AURs and SACs is presented at HWB level. The latest data available is for 2015-16 and is presented in Table 35. Table 35: Percentage of community pharmacies and dispensing appliance contractors by HWB, providing AURs and SACs, 2015-16126

Advanced service AUR SAC

Suffolk HWB 0.7% 3.4%

East of England SHA 0.7% 11.4%

England 1.2% 14.7%

125 NMS/MUR/Flu activity data per pharmacy, PSNC website: http://psnc.org.uk/funding-and-statistics/nhs- statistics/mur-statistics/ 126 General Pharmaceutical Services in England – NHS Digital 2015-16

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Demand for the appliance advanced services (SAC and AUR) is lower than for the other two advanced services due to the much smaller proportion of the population that may require the services. Pharmacies and DACs may choose which appliances they provide and may also choose whether or not to provide the two related advanced services. 3.7 Enhanced service provision Under the pharmacy contract, enhanced services are those directly commissioned by NHS England. Therefore, any locally-commissioned services commissioned by CCGs or the local authority are not considered here. The East of England Area Team of NHS England currently commissions the following services: • rota service – there is often a recognised gap in service provision on the following bank holidays: Christmas Day, Boxing Day, New Year’s Day and Easter Sunday. As part of its responsibility to ensure the ongoing provision of pharmaceutical services to support out-of-hours services, NHS England undertakes to commission rota services on these days when required. The link provides details of the rota service: https://www.england.nhs.uk/mids- east/our-work/pharm-info. Future commissioning is informed after a review of the previous commissioned rota service. • for the provision of potassium iodate – this service is commissioned as part of NHS England’s emergency planning responsibilities to help manage any radiation leak from the Sizewell power station. This is a very small pharmaceutical service and is provided from only two community pharmacies near to Sizewell, in Leiston. o Leiston Pharmacy, 20 High Street, Leiston IP16 4EW o Lloyds Pharmacy Ltd, 62 High Street, Leiston IP16 4BZ The following pharmacy services are included here for information only: Hospitals: West Suffolk Hospital NHS Foundation Trust, Ipswich Hospital NHS Trust, James Paget University NHS Hospital, Felixstowe Hospital, Aldeburgh Hospital, Newmarket Hospital and Bluebird Lodge Community Hospital all provide inpatient and outpatient dispensing services directly to the patient. Minor injury units: Felixstowe Community Hospital and Beccles and District War Memorial Community Hospital provide an assessment and treatment service for minor illness and minor ailments. Prisons: in Suffolk there are three male prisons: HMP Highpoint (North and South), HMP and YOI Hollesley Bay and HMP Warren Hill. A pharmaceutical service is provided to the prisoners of these prisons and is directly contracted with the Health and Justice Team of NHS England (Midlands and East of England region).

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HMP Highpoint (North and South) has an on-site pharmacy whereas external providers supply all medications to HMP and YOI Hollesley Bay and HMP Warren Hill. 3.8 Pharmaceutical service provision provided from outside Suffolk HWB area Suffolk is bordered by three other HWB areas: Cambridgeshire, Norfolk and Essex. Maps A, B and F show the cross-border pharmacies within easy reach of Suffolk HWB from which Suffolk residents may access pharmaceutical service provision. Suffolk residents may also access service provision from the 266 distance-selling (internet) pharmacies and 112 DACs in England. 3.9 Locally-commissioned services Appendix A provides a summary of locally commissioned services within Suffolk pharmacies. It is important to note the commissioning status of each service as this defines whether or not it is a locally-commissioned service. Please note data collection methods have changed since the 2015 PNA so activity data is not directly comparable. Locally-commissioned services are included within this assessment where they affect the need for pharmaceutical services or where the further provision of these services would secure improvements, or better access, to pharmaceutical services. Suffolk County Council currently commission the following locally-commissioned services from community pharmacies: • chlamydia screening • chlamydia treatment • Emergency Hormonal Contraception (EHC) • stop smoking support • needle exchange* • supervised consumption* • NHS Health Checks* *These services are not open for all community pharmacies. The selection of pharmacies is based on local commissioning decisions. The only CCG-commissioned services from community pharmacies currently are the palliative care drugs service and emergency supply of medicines in the Great Yarmouth and Waveney CCG. The CCG commission the palliative care service from only a small number of community pharmacy providers to ensure ongoing access to drugs. The emergency supply of medicines is open to all pharmacy contractors within the CCG so no separate list appears in Appendix A.

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Section 4: Other services which may impact on pharmaceutical services provision

Community pharmacies and dispensing GP practices provide a range of other services. These are not considered pharmaceutical services under the Pharmaceutical Regulations 2013 and may be either privately funded or commissioned by NHS England, the Local Authority or the CCG. 4.1 Other services provided by dispensing GP practices Although not listed as a pharmaceutical service within the Pharmaceutical Regulations 2013, Dispensing Review of Use of Medicines (DRUMs) may be provided by a dispensing GP practice which has opted to provide the Dispensing Services Quality Scheme (DSQS). The DSQS is an optional service commissioned by NHS England for dispensing GP practices to provide annually. A DRUM is a face-to-face review with the patient to find out their compliance and agreement with their prescribed medicines and to help identify any problems that they may be having. The dispensing GP practices in Suffolk were sent a dispensing GP practice questionnaire to complete in Spring 2017. All GP practices completed the questionnaire. A copy of the questionnaire can be found in Appendix E. The survey identified that 96% of dispensing GP practices confirmed that they are participating in the 2015/16 DSQS and 96% participate in DRUM. Other information provided from the dispensing GP practice questionnaire can be found in Appendix K. 4.2 Healthy Living Pharmacy The political intention and context for Healthy Living Pharmacies (HLPs) was set out in the 2008 pharmacy White Paper, ‘Pharmacy in England: Building on Strengths, Delivering the Future’.127 This called for community pharmacies to have a greater role and participation in public health provision as healthy-living hubs. This fuelled the pioneering work in Portsmouth to develop the HLP framework and subsequent high profile National Pathfinder Study in which Suffolk participated. In Suffolk, this programme continues to be led by Suffolk LPC, in collaboration with the public health team and large range of partner agencies and stakeholders. HLPs put their local community’s health and wellbeing at the core of everything they do. They consistently deliver a range of services to a high quality and are recognised with a HLP Quality Mark. The HLP framework involves a system-wide approach to support change across the profession and within the workplace, an organisational development tool and a brand that unites community pharmacy while changing public perceptions about what community pharmacy can offer in supporting their health.

127 Department of Health. Pharmacy in England: Building on Strengths, Delivering the Future. 2008. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/228858/7341.pdf

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4.2.1 Healthy Living Pharmacy enablers Important HLP enablers to support delivery include: • workforce development • engagement with the community and other providers • premises that are fit for purpose and support health promotion 4.2.2 Healthy Living Pharmacy and local priorities To date, significant benefits have been realised from HLPs by commissioners, contractors and employees and, imperatively, the public have fully welcomed the concept. Analysis of the National Pathfinder reports indicated the value of HLPs for: • commissioners showing that community pharmacies are able to deliver health and wellbeing services to meet local health needs • public health teams who understood the potential for HLPs to deliver these types of health services effectively • contractors – the results of the quantitative survey to assess the benefits of HLP status on contractors was positive for all contractor types. Implementation of the HLP concept was seen as worthwhile for the business by over 70% of contractors. Community pharmacies are a local asset and an important resource for Suffolk communities – especially for those that may not access other NHS services. The HLP framework was launched in September 2010, and in March 2011 the national pharmacy bodies started working with DH to launch the HLP pathfinder programme, which resulted in an evaluation being published in April 2013. Following this, Public Health England (PHE) adopted the concept and supported the roll-out in pharmacies across the country. Suffolk pharmacies have been involved with the project since 2011 when they were chosen as a Pathfinder Site for national roll-out.

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Table 36: The Healthy Living Pharmacy Framework

Since 2015, Suffolk County Council has supported the roll out of HLP Level 1 across the county and this has been project-managed by Suffolk LPC. This involved funding the provision of Health Champion Training for members of the pharmacy team and support for developing leadership skills in each pharmacy involved in the roll-out. Evidence folders were provided to each pharmacy and support was given to pharmacy teams to collect relevant information and to link with other organisations to better support the health of their communities. Pharmacies were assessed against the locally-agreed HLP standards which incorporated all the national guidance, and pharmacies achieved accreditation when all the standards had been demonstrated. In October 2016, HLP Level 1 became one of the Quality Payment criteria under the new funding model for the National Pharmacy Contract. At this point, pharmacies moved to the Public Health England Quality Criteria for HLP Level 1 Self- assessment128. Suffolk LPC, with the continued support of Suffolk County Council, has committed to provide training, materials and support to pharmacies as they engaged with the new process with a view to achieving Level 1 accreditation in all pharmacies. The HLP Quality Mark is a useful and important platform by which existing and new public health pharmaceutical services can be developed to target areas of local need, as well as services that can be made available for everyone.

128 http://www.gov.uk/government/publications/healthy-living-pharmacy-level-1-quality-criteria

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

This includes services that can assist with earlier identification, screening and management of risk factors for life-shortening diseases, reducing premature deaths and major morbidity, and targeting pharmaceutical support for patients with long-term conditions to enhance quality of life, reducing health inequity and health inequalities. This will be increasingly important as the NHS seeks to develop new models of care that are patient-centred and focus care in the community in a way that frees up GP time and reduces the burden on out-of-hours services and secondary care. Suffolk pharmacies are therefore well placed to support such services as they develop. At present, there is no published list of pharmacies which have achieved the HLP Quality Mark under the Quality Criteria, however the twenty pharmacies which achieved accreditation to HLP Level 1 through the initial Suffolk County Council scheme in 2015- 16 can be found in table 37. Additional pharmacies accredited by the Royal Society of Public Health are available https://www.rsph.org.uk/our-services/registration-healthy- living-pharmacies-level1/register/east-of-england.html Table 37: Pharmacies which have achieved HLP1 under the County Council scheme

Acer Road Pharmacy Boots Pharmacy Rendlesham IP12 2GA Sudbury CO10 2EA Aqua Pharmacy Boots Pharmacy Ipswich IP3 0AQ Lowestoft NR32 1ET Beccles HCC Ltd Clare Pharmacy Beccles NR34 9NQ Clare, Sudbury CO10 8NH Boots Pharmacy Day Lewis Pharmacy Hadleigh IP7 5EA Ipswich IP3 9QJ Boots Pharmacy Day Lewis Pharmacy Ipswich IP1 1DT Red Lodge, Bury St Edmunds IP28 8XQ East of England Co-operative Society, Lloyds Pharmacy Stowmarket IP14 2DA Ipswich IP2 OQG Queen Street Pharmacy Worlingham Pharmacy Southwold IP18 6EQ Worlingham, Beccles NR34 7EF Lloyds Pharmacy Tesco In Store Pharmacy Ipswich IP2 OQG Sudbury CO10 6GH Station Pharmacy Day Lewis Pharmacy Elmswell, Bury St Edmunds IP30 Colchester CO7 6SE 9HG Tesco In-Store Pharmacy Village Rise Pharmacy Stowmarket IP14 EBE Lowestoft NR34 7EF

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4.3 Collection and delivery services From both the pharmacy contractor questionnaire and dispensing GP practice questionnaire, 88% of community pharmacies and 74% of dispensing GP practices provided free home delivery services on request. Both groups often noted restrictions on areas and/or to which specific patient groups they offered free delivery. 100% of pharmacies who responded offer to collect prescriptions from GP surgeries on behalf of their patients. This is an increase from only 95% of respondents willing to provide this service in 2015. Free delivery is required to be offered without restriction by all distance-selling (internet) pharmacies to patients who request it throughout England. There is no distance-selling pharmacy based in Suffolk, but there 266 throughout England. Free delivery of appliances is also offered by DACs. There are two DACs based in Suffolk providing services nationally and there are a further 110 throughout England. 4.4 Provision of services to nursing and residential care homes Elderly patients require proportionally more medicines than younger people. Results from the pharmacy contractor questionnaire indicate that currently only 4% provide a service to care homes commissioned via the CCG or LA, but 64% indicate they would be willing to provide if commissioned. The dispensing GP questionnaire identifies 19- 25% of dispensing GP practices provide medicines to care home residents. The opening of a new care home may provide a significant increase in dispensing for a pharmaceutical service provider. Appendix J provides a list of larger new care homes planned. Care home pharmaceutical service provision is often a specialised function within community pharmacies. Community pharmacy provision to care homes is often centralised, therefore may not necessarily be provided by the nearest local provider. The information provided in Appendix J therefore should not be interpreted as an indication of need of pharmaceutical service provision within the locality of the planned care home. The impact on local pharmaceutical service providers should be monitored as new care home builds are completed. 4.5 Out-of-hours GP service and Extended Hours Ipswich and Suffolk CCG commission a GP-Plus service which aims to provide access to a GP appointment outside of normal GP practice working hours. The patients of all Ipswich and East Suffolk CCG practices can access this service. The table below identifies the locations where this service takes place and their opening times. Bank holiday openings are as Saturday.

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Table 38: Locations providing the GP-Plus service and opening times Location Mon-Fri Saturday Sunday Riverside, Ipswich 18:30-21:00 09:00-21:00 9am-9pm

MIU, Felixstowe 18:30-21:00 09:00-13:00 Closed

Stowhealth 18:30-21:00 09:00-13:00 Closed

Leiston Surgery 18:30-21:00 09:00-13:00 Closed Wickham Market 18:30-21:00 09:00-13:00 Closed Surgery

The amount of GP Plus appointments is likely to be extended as part of the winter planning, but exact information is not yet known. There is also a GP Out of Hours service which is available Monday to Friday from 6.30pm to 8.00am, and for 24 hours at weekends and during bank holidays. Table 39 identifies the locations where this service is available. Table 39: Locations providing the GP Out of Hours service Bury PCC Haverhill PCC West Suffolk Hospital Haverhill Health Centre Hardwicke Lane Camps Road Bury St Edmunds Haverhill Suffolk Suffolk IP33 2QZ CB9 8HF Mildenhall PCC Stowmarket Mildenhall Health Centre Stow health Centre Chestnut Close Violet Hill House Mildenhall Stowmarket Suffolk Suffolk IP28 7NL IP14 1NL Eye PCC Ipswich PCC Hertismere Hospital Ipswich Hospital (Entrance 5 – 26 Castleton Way Rheumatology) Eye Heath Road Suffolk Ipswich IP23 7BH Suffolk IP4 5PD Saxmundam Sudbury Community Health Centre Lambsdale Meadow Church Field Road Saxmundam Sudbury Suffolk Suffolk IP17 1AS CO10 2DZ In addition to the above two services, there is also a “GP in Accident and Emergency” service and this will operate in Ipswich Hospital between 1pm until 6.30pm and 9pm – 11pm Monday to Friday (excluding bank holidays).

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Section 5: Findings from the public questionnaire

A public questionnaire about pharmacy provision was developed (Appendix C) and compiled by Suffolk PNA Steering Group. This was circulated to the following groups including via a link on the Local Authority’s website: • community pharmacies in the Suffolk • GP practices • patient groups in Suffolk A total of 500 questionnaires were received from a range of Suffolk residents. This is down from 610 replies in 2015. A full summary of the results can be found in Appendix M. Of the respondents, 62% visit their pharmacy at least once a month, either for themselves or someone else, and just under 77% use a regular or preferred provider. Just under 69% of respondents rated ‘close to home’ as important, which is an 11% increase on the 2015 PNA; 55% rated ‘near to GP surgery’ as important, which has shown an increase from the 2015 PNA by 8%. Friendliness and efficiency were also highly regarded. The majority of respondents (89%) visit the pharmacy for their own needs, while 54% do so on behalf of a family member. Those that visit on behalf of someone else, state that the reason they visit the pharmacy is that it is the 'most convenient'. Provision of a collection and home delivery service was important to 84% of respondents. The most common form of travel to their chosen pharmacy is by car (62%). Walking is used by 31% of respondents, which is down from the 2015 PNA by 7%, and 3% use public transport, which is similar to 2015 PNA. The results indicate that 2% travel by bike. Only 1% of respondents have a journey of over 30 minutes to their pharmaceutical service provider, with 80% reporting less than 15 minutes, and 92% report no difficulties when travelling to a pharmacy. Of those who do report an issue with travelling to their pharmacy, 48% report parking difficulties, 14% availability of public transport and 11% the actual location of the pharmacy. The survey identifies that Monday to Friday are the most convenient days to visit a pharmacy, with only 10% preferring Saturday and 1% Sunday. Preferred visiting time varies for 50% of respondents, 42% prefer to visit between 9am and 6pm, 7% prefer early evening and less than 1% prefer to visit after 8pm. When asked about the buying of over-the-counter medications, 59% of respondents purchase items at least once a month or more. The questionnaire asked respondents to indicate if they had ever used an internet pharmacy to obtain medicines and 10% indicated they had done so. For those who did use an internet pharmacy, 85% rated the service as excellent or good.

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Of those respondents who made additional comments, the vast majority made positive comments about friendly, efficient staff and the service offered. However, a handful commented about services being inefficient, too busy, not enough helpful staff or having poor parking/location. When asked about which services respondents would like to see provided by their local pharmacy, 94% identified the routine services that are provided in all pharmacies as their preferred choices e.g. repeat dispensing, advice from pharmacist, buying OTC medication and disposal of unwanted medicines. However, there was also interest in seeing other services which are less commonly provided e.g. supervised consumption of methadone (53%), immediate access to specialist drugs (70%) and needle exchange (53%). Some of the questions permitted more than one answer, resulting in totals above 100%.

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Section 6: Analysis of Health Needs and Pharmaceutical Service Provision 6.1 Localities within Suffolk As described in Section 1.5, the PNA Steering Group decided that the Suffolk HWB PNA should be divided into seven localities, which are identical to those used in the 2015 PNA. These are the localities of Babergh, Forest Heath, Ipswich, Mid Suffolk, St Edmundsbury, Suffolk Coastal and Waveney. Most health data is available at this level. Suffolk HWB has identified the necessary services, described in Section 1.3, as essential services and advanced services as required by Paragraphs 1 and 3 of Schedule 1 to the Pharmaceutical Regulations 2013. Suffolk HWB has identified the enhanced services in Section 3.7 as pharmaceutical services which secure improvements or better access, or which have contributed towards meeting the need for pharmaceutical services in the area of Suffolk. Suffolk HWB has identified the locally-commissioned services in Section 3.9 which secure improvements or better access, or have contributed towards meeting the need for pharmaceutical services in the area of Suffolk. Other relevant services. - A change in service provision (see above in 3.) is due to local commissioning decisions. 6.2 Babergh locality 6.2.1 Necessary services: current provision The population of Babergh locality is 89,215: 12% of the Suffolk population. It is a relatively healthy area, recording amongst the lowest rates of all-cause mortality in England. However, rates of CVD and hypertension are higher than seen nationally. There are 17 community pharmacies and six dispensing GP practices in Babergh locality, which is an increase of one community pharmacy from the 2015 PNA. Three are open for 100 hours or more per week. The rate of community pharmacies (19 per 100,000 population) is less than national (21.5) and Suffolk rate (19.7) but, when the seven dispensing GP practices in Babergh are included, the rate increases to 26.9 pharmaceutical service providers per 100,000 population. There are six PhAS pharmacies in the Babergh locality. Access to pharmaceutical services in the evenings and weekends is good, with a number of providers in Babergh open. There are also a number of accessible providers open in neighbouring localities and HWB areas. All community pharmacies provide the MUR and NMS advanced services. 6.2.2 Necessary services: gaps in provision A number of new housing developments are planned for the Babergh locality.

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While a number of these are significant, it is considered that there are adequate pharmaceutical service providers locally with sufficient capacity to ensure a continuity of provision to these new developments.

No gaps in the provision of necessary services have been identified for Babergh locality.

6.2.3 Other relevant services: current provision Provision of local authority-commissioned services is described in Appendix A. There are six (35%) providers of the supervised consumption service and four (23%) providers of the needle exchange service. The sexual health service is provided by ten (59%) community pharmacies and the stop smoking service is provided by 11 (65%) providers. This figure has decreased significantly from 2015 when 94% of community pharmacies provided the stop smoking service. Babergh does however have the lowest smoking-attributed mortality rate compared to the other localities in Suffolk. 6.2.4 Improvements and better access: gaps in provision Figures for Suffolk indicate that 15.2% of patients registered with a GP are recorded as having hypertension, a higher rate compared to the East of England at 14.1% and England at 13.8%. However modelled estimates at locality level indicate the figure could be much higher, and there may be a large proportion of Suffolk residents with undiagnosed hypertension. Babergh has a modelled estimated prevalence of 23.2% for hypertension and a further 13.3% undiagnosed. It would therefore suggest there is scope for improvement in identifying and treating those with hypertension. Should this be a priority target area for commissioners, they may want to consider the current provision and uptake of screening services from community pharmacies, to help improve the identification of those with hypertension and direct them to appropriate treatment and follow-up. Consideration should be given to incentives for further uptake from current providers and extending provision through community pharmacies. There are no community pharmacies providing services overnight from Wednesday to Sunday inclusive in the Babergh locality. Based upon the results of the public and pharmacy contractor questionnaires, consultation on the draft PNA, provision of 100- hour pharmacies in Suffolk compared to nationally and regionally, and access to pharmacies across Suffolk or in neighbouring HWB areas, there is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this locality. Suffolk HWB will monitor the uptake and need for necessary services. It will also consider the impact of any changes in this locality in the future which may provide evidence that a need exists.

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No gaps in service provision have been identified for Babergh locality.

6.3 Forest Heath locality 6.3.1 Necessary services: current provision The population of Forest Heath is 63,691, which is 8.6% of the population of Suffolk. Forest Heath is the least populated locality in Suffolk. As demonstrated in Map A, large parts of Forest Heath are sparsely populated. There are 11 community pharmacies, a decrease of one from 2015, and seven dispensing GP practice providers, which has increased by one from 2015, in the locality. This results in an overall rate of 28.2 pharmaceutical service providers per 100,000 population. There is one community pharmacy open for 100 hours or more per week and two community pharmacies open in the evenings, which has remained unchanged from 2015. In addition, Thetford in the north, Cambridge in the west and Bury St Edmunds in the east are a short distance from the locality borders where there are a number of providers open late. There are three PhAS pharmacies in the locality. All the community pharmacies in Forest Heath locality provide the MUR and NMS advanced services. 6.3.2 Necessary services: gaps in provision A number of new housing developments are planned in the locality. Suffolk HWB will consider the change in health needs in Forest Heath locality as the housing developments listed in Appendix J progress through the three-year time horizon of the PNA. Suffolk HWB will consider the views from the public, pharmacy contractors and other stakeholders when considering the changing health needs of the residents of Suffolk.

No gaps in the provision of necessary services have been identified for Forest Heath locality.

6.3.3 Other relevant services: current provision There are eight (73%) providers of the supervised consumption service, and five providers (41%) of the needle exchange service. The sexual health services are now only provided by six providers (54%) from previous eight community pharmacies and the stop smoking service continues to be provided by nine (82%) providers.

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6.3.4 Improvements and better access: gaps in provision Although in Suffolk the cardiovascular disease mortality rate overall is lower than the national average, there is a higher rate of mortality for males in Forest Heath. When considering COPD, Forest Heath has the highest rate of mortality when compared to the rest of Suffolk. If deemed a priority for commissioners, improved outcomes may be possible through a review of current service provision and providers to further increase access to related services. Forest Heath locality has a sizeable all year round visiting population due to the Centre Parcs holiday village in Elveden Forest. There are pharmacies in the surrounding villages of Brandon, Lakenheath and Mildenhall. Although none are open on Sundays or weekday evenings after 6:30pm, there are a number of pharmacies open in nearby Bury St Edmunds, Thetford (Norwich HWB area) and Newmarket. There is therefore sufficient and reasonable access to pharmaceutical services. However, there remains no commissioned service to provide for those visitors who have arrived at Centre Parcs forgetting to bring their prescribed medication. A private service may be offered from community pharmacies (patients have to pay at least the net cost of the medicines supplied), although some patients may access urgent care services under the NHS to have a prescription supplied to obtain their medication. Based upon the results of the public and pharmacy contractor questionnaires, there is no evidence to suggest there is a need for a new or improved service. There are no community pharmacies providing services overnight in the Forest Heath locality. Based upon the results of the public and pharmacy contractor questionnaires, consultation on the draft PNA, provision of 100-hour pharmacies in Suffolk compared to nationally and regionally, and access to pharmacies across Suffolk or in neighbouring HWB areas, there is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this locality. Suffolk HWB will monitor the uptake and need for necessary services. It will also consider the impact of any changes in this locality in the future which may provide evidence that a need exists.

No gaps in service provision have been identified for Forest Heath locality.

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6.4 Ipswich locality 6.4.1 Necessary services: current provision Ipswich is the most populated locality in Suffolk, providing residence to a population of 135,600, which is 18.3% of Suffolk. The BME population is the highest in Suffolk (11.1% versus 4.7% in Suffolk as a whole, and 14.6% in England). The population is amongst the most deprived in the country. Ipswich locality has the highest rates of new STI diagnoses. Latest published data (2015) indicates the Ipswich locality to have one of the highest prevalence rates of smoking overall and the third highest in routine and manual occupations. The population of Ipswich locality has 33 community pharmacies (24.2 per 100,000 population) which is higher than the average in England (21.5 per 100,000 population). Four of these community pharmacies are funded under PhAS. There are no dispensing GP practices in Ipswich. Five pharmacies (15%) are open for 100 hours a week or more. Six are open in the evenings, seven on Sundays and the large majority (27) open on Saturdays. All the community pharmacy providers provide the MUR service and 32 the NMS advanced service. 6.4.2 Necessary services: gaps in provision Ipswich locality will see a number of significant housing developments in the coming three years. A significant housing development (3,500 units) is planned within the Ipswich Garden Suburb, however, no commencement date is available at this time. Suffolk HWB will consider the change in health needs in Ipswich locality as the housing developments listed in Appendix J progress through the three-year time horizon of the PNA. Suffolk HWB will consider the views from the public, pharmacy contractors and other stakeholders when considering the changing health needs of the residents of Suffolk.

No gaps in the provision of necessary services have been identified for Ipswich locality.

6.4.3 Other relevant services: current provision There are 26 (79%) providers of the supervised consumption service and 15 providers (45%) of the needle exchange service, which is a decrease of seven providers from 2015. However, the service is not open to all pharmacies and the selection of pharmacies is based on local commissioning decisions and should not be seen as a drop in service. The sexual health service is provided by 22 (67%) community pharmacies and the stop smoking service is provided by 27 (82%) providers. No change from 2015 PNA. If deemed a priority by commissioners, there may be an opportunity to improve uptake through reviewing incentives to current providers and the current provider list.

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6.4.4 Improvements and better access: gaps in provision Although the control of blood sugar and blood pressure is similar or better than the national average for diabetes within the Ipswich and East Suffolk CCG, the control of cholesterol is worse than the national average. There may be scope for community pharmacies to help support patients and encourage them to undertake regular monitoring and compliance with medication. In addition, mortality rates from COPD are higher than the Suffolk average in Ipswich. If deemed a priority for commissioners, improved outcomes may be possible through a review of current service provision and providers to further increase access to related services. Premature mortality rate is highest in Ipswich locality. There are no community pharmacies providing services overnight in the Ipswich locality. Based upon the results of the public and pharmacy contractor questionnaires, consultation on the draft PNA, provision of 100-hour pharmacies in Suffolk compared to nationally and regionally, and access to pharmacies across Suffolk or in neighbouring HWB areas, there is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this locality. Suffolk HWB will monitor the uptake and need for necessary services. It will also consider the impact of any changes in this locality in the future which may provide evidence that a need exists. 6.4.5 Other services Consideration should be given as to how services are tailored to meet any specific needs of the BME populations, which account for 11.1% of the total population of this locality. An estimate from the Roma community suggests there are around 1,100 Romanian and Bulgarian Roma living in Ipswich.

No gaps in service provision have been identified for Ipswich locality.

6.5 Mid Suffolk locality 6.5.1 Necessary services: current provision Mid Suffolk locality has a total population of 99,632 which is 13.4% of the population of Suffolk as a whole. This locality has areas which are amongst the least 20% deprived in England and it has one of the highest life expectancy rates in Suffolk for males and females, both of which are higher than the national averages. Mid Suffolk had the lowest new STI diagnosis rate at 325 per 100,000, significantly lower than the England rate (2015 figures). Recently recorded teenage pregnancy rates show that Mid Suffolk has a below-average rate, when compared to the rest of Suffolk and the England average (2015 figures).

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However, 71% of teenage conceptions in Mid Suffolk resulted in abortion. The latest figures for smoking rates show that Mid Suffolk has the lowest prevalence of all the localities and one of the lower attributable mortality rates. Given its largely rural geography, there is the greatest number of dispensing GP practices (ten) in this locality. There are 14 community pharmacies, resulting in the lowest ratio in Suffolk of 14.1 pharmacies per 100,000 population. However, if we include GP dispensing practices, this figure rises to 24.1 pharmaceutical service providers per 100,000 population. One pharmacy is open for 100 hours or more per week and two open in the evenings which is a decrease of one from previous PNA. There are eight PhAS pharmacies in the locality. 6.5.2 Necessary services: gaps in provision A number of significant housing developments are planned or are being built in Mid Suffolk, particularly in and around Stowmarket (1,500 units). Suffolk HWB will consider the change in health needs in Mid Suffolk locality as the housing developments listed in Appendix J progress through the three-year time horizon of the PNA. Suffolk HWB will consider the views from the public, pharmacy contractors and other stakeholders involved in these developments when considering the changing health needs of the residents of Suffolk.

No gaps in the provision of necessary services have been identified for Mid Suffolk locality.

6.5.3 Other relevant services: current provision There are six (43%) providers of the supervised consumption service, and two providers (14%) of the needle exchange service. The provision of these two services are not open to all pharmacies and the selection of providers is based on a local commissioning decision. The sexual health services are provided by ten (71%) community pharmacies and the stop smoking services provided by 11 (78%) providers. 6.5.4 Improvements and better access: gaps in provision There are no community pharmacy providers providing services overnight in Mid Suffolk locality. Based upon the results of the public and pharmacy contractor questionnaires, provision of 100-hour pharmacies in Suffolk compared to nationally and regionally and access to pharmacies across Suffolk HWB area or in neighbouring HWB areas, there is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this locality. Suffolk HWB will monitor the uptake and need for necessary services.

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It will also consider the impact of any changes in this locality in the future which may provide evidence that a need exists.

No gaps in service provision have been identified for Mid Suffolk locality.

6.6 St Edmundsbury locality 6.6.1 Necessary services: current provision The population of St Edmundsbury locality is 112,523 which is 15.2% of the population of Suffolk. The locality has the highest rate of statutory homeless population in the HWB. In this locality, 19 community pharmacies provide services - an average of 16.9 providers per 100,000 population. There are 24.1 pharmaceutical service providers per 100,000 population when the eight dispensing GP practices are taken into consideration. Five community pharmacies (26.3% of the total for this locality) are open for 100 hours per week or more. Seven pharmacies are open in the evenings. There are four PhAS pharmacies in the locality. 6.6.2 Necessary services: gaps in provision There are a number of new housing developments planned in St Edmundsbury locality. Over 50% of which are planned for the Bury St Edmunds area. Suffolk HWB will consider the change in health needs in the St Edmundsbury locality as the housing developments listed in Appendix J progress through the three-year time horizon of the PNA. Suffolk HWB will consider the views from the public, pharmacy contractors and other stakeholders when considering the changing health needs of the residents of Suffolk.

No gaps in the provision of necessary services have been identified for St Edmundsbury locality.

6.6.3 Other relevant services: current provision There are 15 (79%) providers of the supervised consumption service, an increase of three from the previous PNA and five providers (26%) of the needle exchange service. The sexual health service is provided by 13 (68%) community pharmacies, which is an increase of three more pharmacies compared to 2015, and the stop smoking service is provided by 15 (79%) providers, which is an increase of four providers compared to the 2015 PNA.

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6.6.4 Improvements and better access: gaps in provision There are no community pharmacies providing services overnight in St Edmundsbury locality. Based upon the results of the public and pharmacy contractor questionnaires, consultation on the draft PNA, provision of 100-hour pharmacies in Suffolk compared to nationally and regionally, and access to pharmacies across Suffolk HWB area or in neighbouring HWB areas, there is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this locality. Suffolk HWB will monitor the uptake and need for necessary services. It will also consider the impact of any changes in this locality in the future which may provide evidence that a need exists

No gaps in service provision have been identified for St Edmundsbury locality.

6.7 Suffolk Coastal locality 6.7.1 Necessary services: current provision The population of Suffolk Coastal locality is 125,052 which is 16.8% of Suffolk population as a whole. Over one in four residents are over the age of 65 and the locality has the highest life expectancy for females in the HWB. Suffolk Coastal has the highest number of people in medical/care communal establishment settings. Pharmaceutical services are provided by 24 community pharmacies and eight dispensing GP practices. There are 19.2 community pharmacies per 100,000 population and 24 pharmaceutical service providers per 100,000 population, if dispensing GP practices are included. Two community pharmacies are open for 100 hours or more per week and eight are open in the evenings. There are five PhAS pharmacies in the locality. 6.7.2 Necessary services: gaps in provision Several housing developments are planned for the locality, the largest of which is planned for the Martlesham area (2,000 units). This could provide an issue with regard to pharmaceutical service provision and Suffolk HWB will consider the change in health needs in Suffolk Coastal locality as the housing developments listed in Appendix J progress through the three-year time horizon of the PNA. Suffolk HWB will consider the views from the public, pharmacy contractors and other stakeholders involved in these developments when considering the changing health needs of the residents of Suffolk.

No gaps in the provision of necessary services have been identified for Suffolk Coastal locality.

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6.7.3 Other relevant services: current provision There are 11 (46%) providers of the supervised consumption service, and six (25%) providers of the needle exchange service. The sexual health service is provided by 13 (54%) community pharmacies, a decrease of three providers, and the stop smoking service is provided by 18 (75%) providers, from the previous 22 (92%) in 2015 PNA. Two community pharmacies provide a locally-commissioned enhanced service to provide potassium iodate tablets to employees at Sizewell Nuclear power stations to limit exposure to ionising radiation in the unlikely event of an accidental release. 6.7.4 Improvements and better access: gaps in provision Suffolk Coastal has a large number of visiting tourists. Currently, visitors arriving without their prescribed medication can either, pay for a private supply from a community pharmacy at the discretion of the pharmacist, or make an appointment with a GP as a temporary resident to obtain a prescription. An opportunity exists, if deemed a priority by the commissioners, to make improvements and better access to the emergency supply of medicines through the commissioning of an emergency supply service from community pharmacies in tourist areas. Figures for Suffolk indicate that 15.2% of patients registered with a GP are recorded as having hypertension, a higher rate compared to the East of England at 14.1% and England at 13.8%. However modelled estimates at locality level indicate the figure could be much higher, and there may be a large proportion of Suffolk residents with undiagnosed hypertension. Suffolk Coastal has a modelled estimated prevalence of 23.4% and a further 13.2% undiagnosed. It would therefore suggest there is scope for improvement in identifying and treating those with hypertension. Should this be a priority target area for commissioners, they may want to consider the current provision and uptake of screening services, including health checks, that could be provided by local community pharmacies. Consideration should be given to incentives for further uptake from current providers and extending provision through community pharmacies. There are no community pharmacies providing services overnight in the Suffolk Coastal locality. Based upon the results of the public and contractor questionnaires, consultation on the draft PNA, provision of 100-hour pharmacies in Suffolk compared to nationally and regionally, and access to pharmacies across Suffolk HWB area or in neighbouring HWB areas, there is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this locality. Suffolk HWB will monitor the uptake and need for necessary services. It will also consider the impact of any changes in this locality in the future which may provide evidence that a need exists.

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No gaps in service provision have been identified for Suffolk Coastal locality.

6.8 Waveney locality 6.8.1 Necessary services: current provision The population of Waveney is 116,182, which is 15.6% of the total Suffolk population. This locality has the highest percentage of over-65s (26.3%). It has one of the lowest life expectancies for both males and females in the HWB. Prevalence of diabetes and depression are higher than the England average. It also has the lowest percent of physically active residents in the HWB. There are 28 pharmacies and four dispensing GP practices in this locality. This equates to 24.1 community pharmacies per 100,000 population and 27.6 pharmaceutical service providers per 100,000 population. Three community pharmacies are open for 100 hours or more per week, and four are open in the evenings. All dispensing GP practices are open weekday evenings up to 18:30, none are open on Saturday or Sunday (previously two were open on all or some Saturdays). There are two PhAS pharmacies in the locality. 6.8.2 Necessary services: gaps in provision There is only one housing development of 250 dwellings or more planned over the lifetime of this PNA. This is a development of 1,440 units in the Kirkley Waterfront and Sustainable Urban Neighbourhood. However, it is anticipated that there will be limited completion within the lifetime of this PNA. This will require consideration in future years beyond the duration of this PNA. Suffolk HWB will consider the change in health needs in the Waveney locality as the housing development listed in Appendix J progresses through the three-year time horizon of the PNA. Suffolk HWB will consider the views from the public, pharmacy contractors and other stakeholders involved in these developments when considering the changing health needs of the residents of Suffolk HWB area.

No gaps in the provision of necessary services have been identified for Waveney locality.

6.8.3 Other relevant services: current provision There are 16 (57%) providers of the supervised consumption service, and 16 pharmacy contractors (57%) provide the needle exchange service. The sexual health service is provided by 21 (75%) pharmacy contractors, this is a reduction from 26 (90%) previously. Stop smoking service is provided by 16 (57%) pharmacy contractors, again this is a reduction from 25 (86%) providers previously reported.

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6.8.4 Improvements and better access: gaps in provision Waveney locality has a large number of visiting tourists. Currently, visitors arriving without their prescribed medication can either pay for, pay for a private supply from a community pharmacy at the discretion of the pharmacist, or make an appointment with a GP as a temporary resident to obtain a prescription. However Great Yarmouth and Waveney CCG does commission an 'emergency supply service' which is available from all community pharmacy contractors in the CCG. Great Yarmouth and Waveney CCG is the poorest performing across all three measures for diabetes control. There may be scope for community pharmacies to help support patients and encourage them to undertake regular monitoring and compliance with medication. In addition, data from 2014/15 shows that admissions to hospital due to CHD are higher than the England average. There are no community pharmacies providing services overnight in the Waveney locality. Based upon the results of the public and pharmacy contractor questionnaires, provision of 100-hour pharmacies in Suffolk compared to nationally and regionally, and access to pharmacies across Suffolk HWB area or in neighbouring HWB areas, there is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours in this locality. Suffolk HWB will monitor the uptake and need for necessary services. It will also consider the impact of any changes in this locality in the future which may provide evidence that a need exists.

No gaps in service provision have been identified for Waveney locality.

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Section 7: Summary and conclusions When assessing the provision of pharmaceutical services in Suffolk HWB area and each of the seven PNA localities, Suffolk HWB has considered the following: • the map showing the location of pharmacies within Suffolk in relation to ward, locality and population density indicating that pharmacies are generally located within areas of higher population density (Map A) • the population densities • the Index of Multiple Deprivation and deprivation ranges within Suffolk across the seven PNA localities (Figure 13) and map H. • ethnicity levels (Table 7) across all seven PNA localities • the percentage of population of Suffolk and the average drive, public transport and walking times to nearest community pharmacy or dispensing GP practice (Appendix I) • using average drive time, all residents can access a pharmacy or dispensing GP practice by car within 25 minutes (Appendix I) • using average walking times, 69% of Suffolk residents can access a pharmacy or dispensing GP practice within 20 minutes (Appendix I) • the location of pharmacies and dispensing GP practices within each of the seven PNA localities and across the whole HWB area (Maps A to C) • the number, distribution and opening times of pharmacies and dispensing GP practices within each of the seven PNA localities and across the whole Suffolk (Appendix A) • the choice of pharmacies covering each of the seven PNA localities and the whole Suffolk (Appendix A) • results of the public questionnaire (Appendix M) • proposed new housing developments and care homes planned (Appendix J) • projected population growth (Section 2.3.3)

Suffolk has a current estimated population of around 741,895. The population rise between 2012 and 2037 is expected to be 13%. Suffolk has a high percentage of the population aged over 65 (20%). The population is generally affluent, compared to the England average, though pockets of significant deprivation exist. BME populations are lower than seen nationally and there are a number of small-to-medium traveller sites spread through the county. Over 15% of the population of Suffolk is eligible to have their prescriptions dispensed at their dispensing GP practice. From the public questionnaire, 77% of respondents report using the same provider for pharmaceutical services; 69% report that it is important their provider is ‘close to home’ and 55% report it is important they are ‘close to their GP practice’. Almost two thirds (62%) of respondents travel by car to their provider, while 31% walk.

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Dispensing GP practices play a significant role, in addition to community pharmacies, in the provision of pharmaceutical services in Suffolk. There are 146 community pharmacies and 43 dispensing GP practices. In addition, there are two appliance contractors. Community pharmacies are more densely concentrated in populated areas and this generally matches areas of higher all-cause mortality and deprivation. Community pharmacies are therefore well-placed to provide services specifically targeted to improve health outcomes. There are 19.7 community pharmacies per 100,000 population in Suffolk, compared with 21.5 per 100,000 in England. A higher percentage of community pharmacies in Suffolk are open for 100 hours or more (14.4% versus 9.9% in England). Many dispensing GP practices and the majority of community pharmacies are open on Saturdays. Access to pharmaceutical services on bank holidays, overnight and on Sunday evenings is limited. There is no evidence to suggest there is a gap in service which would equate to the need for access to essential services outside normal hours anywhere in the HWB area. The majority of community pharmacies and dispensing GP practices offer a free delivery service and many have extended opening hours on weekday evenings and Saturdays. As evidenced from the public questionnaire, the number of respondents currently accessing pharmaceutical services via distance-selling pharmacies has risen to 10%. This compares to only 1% in the 2015 PNA. Of those who do use this service, 85% rate it as either excellent or good. Areas of Suffolk are frequented by holidaying visitors. In some places, this significantly increases the local populations and may provide extra strain on healthcare resources. No gaps in pharmaceutical service provision have been identified. Suffolk HWB recognise that the burden of health needs in Suffolk will increase as the population grows and ages and would welcome proactive proposals from commissioners, including NHSE and all CCGs to commission pharmacy services that meet local needs but are beyond the scope of the PNA.

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Appendix A: List of pharmaceutical service providers in Suffolk HWB area

Ipswich locality

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

in 2016

s Supply

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs service ou h - Needle Exchange NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme Flu vac Flu vac AURs provided in 2016 Support to Stop Smoking Supervised Consumption

Electronic Prescription Service NHS UrgentNHS Med Chlamydia Screen and Treat Community Pharmacies 119 Bramford 09:00-13:00 Barbour Pharmacy Road, Ipswich IP1 09:00-13:00 Closed N N Y Y Y N N N N Y Y Y Y Y 14:15-17:30 2LW 57- 59 Foxhall 09:00-13:00 Delta Pharmacy Road, Ipswich IP3 09:00-13:00 Closed N N Y Y N N N N N Y Y Y Y Y 14:00-18:00 8JU Goddard Road, 09:00-13:00 Asda Pharmacy 09:00-13:00 Closed N N Y Y Y N N Y N Y Y Y N Y Ipswich IP1 5PD 14:00-17:30 Unit 4, Anderson House, Rapier 09:00-13:00 Vision Pharmacy Closed Closed N Y Y Y Y N N Y N Y Y Y Y Y Street, Ipswich 13:30-17:30 IP2 8JS 416 Norwich Road, Day Lewis Pharmacy 09:00-18:00 Closed Closed N N Y Y Y N N Y N Y Y Y N Y Ipswich IP1 5DX 26 Hening Avenue, Day Lewis Pharmacy Ravenswood, 09:00-18:00 09:00-13:00 Closed N N Y Y Y N N Y N Y Y Y N Y Ipswich IP3 9QJ

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NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

in 2016

s Supply

Electronic Prescription Service NHS UrgentNHS Med Chlamydia Screen and Treat Community Pharmacies 102-104 Lacey Woodbridge Road Street, Ground 09:00-13:00 Closed Closed N N Y Y Y N N N N N N N N N Pharmacy Floor, Ipswich 14:00-18:30 IP4 2PH 51 Stoke Park Welch Stoke Park 09:00-13:00 Drive, Ipswich 09:00-12:00 Closed N Y Y Y Y N N N N Y Y Y N Y Pharmacy 14:00-17:30 IP2 9TH 4 Ellenbrook 09:00- Kew Pharmacy Green, Ipswich 07:00-22:00 08:00-22:00 Y N Y Y Y N N N Y Y Y Y Y Y 20:00 IP2 9RR Your Local Boots 58 Queens Way, 09:00-17:30 09:00-17:30 Closed N N Y Y Y N N Y N N N Y N Y Pharmacy Ipswich IP3 9EX 204 Hawthorn Lloyds Pharmacy Drive, Ipswich 08:30-18:30 09:00-17:00 Closed N N Y Y Y N N Y Y Y Y Y Y Y IP2 0QG 310 Sheldrake East of England Co- Drive, Ipswich 08:45-17:30 08:45-17:30 Closed N N Y Y Y N N Y Y Y Y Y N Y Operative Society IP2 9LF Sproughton Road, 10:00- Morrisons Pharmacy 08:30-20:00 09:00-18:00 N N Y Y Y N N Y N N N Y N Y Ipswich, IP1 5AS 16:00 East of England 145 Fircroft Road, 08:45-17:30 08:45-17:30 Closed N Y Y Y Y N N Y N Y Y Y N N Co-Operative Society Ipswich IP1 6PT

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NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

in 2016

s Supply

Electronic Prescription Service NHS UrgentNHS Med Chlamydia Screen and Treat Community Pharmacies 8 Cox Lane, Wellbeing Pharmacy 08:45-17:30 08:30-17:30 Closed N N Y Y Y N N Y N Y Y Y Y Y Ipswich IP4 1HT 52 Duke Street, Aqua Pharmacy 08:00-20:00 08:00-20:00 Closed N Y Y Y Y N N Y N Y Y Y Y Y Ipswich IP3 0AQ 14 Burlington 09:00-13:00 Burlington Pharmacy Road, Ipswich IP1 09:00-13:00 Closed Y N Y Y Y N N N N Y Y Y N Y 14:00-17:30 2EU 5 Tavern Street, 10:30- Boots UK Limited 08:00-18:00 08:00-18:00 N N Y Y Y N N Y N Y Y Y Y N Ipswich IP1 3AA 16:30 428 Woodbridge 09:00-13:15 Rushmere Pharmacy Road, Ipswich IP4 09:00-13:00 Closed N N Y Y Y N N N N Y Y Y Y Y 13:45-17:30 4EL Orchard St Medical Centre, Orchard Lloyds Pharmacy 08:45-18:30 Closed Closed N N Y Y Y N N Y N N N Y Y Y Street, Ipswich IP4 2PU 46-48 Westgate 08:30-13:00, Welch Pharmacy Street, Ipswich IP1 Closed Closed N N Y Y Y N N N N Y Y Y N Y 14:00-17:30 3ED Gainsborough 13 Reynolds Road, 09:00-17:30 09:00-13:00 Closed N N Y Y Y N N N N N N Y N Y Pharmacy Ipswich IP3 0JL

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NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

in 2016

s Supply

Electronic Prescription Service NHS UrgentNHS Med Chlamydia Screen and Treat Community Pharmacies 14 St Matthew's 08:00- M & M Pharmacy Street, Ipswich IP1 07:00-22:00 07:00-22:00 Y N Y Y Y N N N N N N N Y Y 18:00 3EU 29 Chesterfield 09:00- Wellbeing Pharmacy Drive, Ipswich 07:00-22:00 08:00-22:00 Y N Y Y Y N N N Y N N N N N 20:00 IP1 6DW East of England Co- 350 Nacton Road, 08:45-17:30 08:45-17:30 Closed N N Y Y Y N N Y N Y Y Y Y Y Operative Society Ipswich IP3 9NA 289 Norwich Road, 09:00-13:00 Rainbow Pharmacy 09:00-13:00 Closed N N Y Y Y N N N N N N N N N Ipswich IP1 4BP 14:30-18:00 Unit 5, Buttermarket 08:30-14:00 08:30-14:00 Boots UK Limited Closed N N Y Y Y N N Y N Y Y Y Y Y Shopping Centre, 15:00-17:30 15:00-17:30 Ipswich IP1 1DT Hadleigh Road, 10:00- Lloyds Pharmacy 07:00-23:00 07:00-22:00 Y N Y Y Y N N Y Y N N Y N Y Ipswich IP2 0BX 16:00 Two Rivers Medical Centre, 32 Your Local Boots 09:00-12:00 09:00-12:00 Woodbridge Road Closed N N Y Y Y N N Y N N N Y N N Pharmacy 13:00-18:00 13:00-17:30 East, Ipswich IP4 5PB

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NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

in 2016

s Supply

Electronic Prescription Service NHS UrgentNHS Med Chlamydia Screen and Treat Community Pharmacies Two Rivers Medical Centre, 32 Your Local Boots 09:00-12:00 09:00-12:00 Woodbridge Road Closed N N Y Y Y N N Y N N N Y N N Pharmacy 13:00-18:00 13:00-17:30 East, Ipswich IP4 5PB 159 Felixstowe Lloyds Pharmacy Road, Ipswich 09:00-18:00 09:00-17:00 Closed N N Y Y Y N Y Y N Y Y Y N Y IP3 8EB 64 St Matthew's 08:30-12:00 Welch Pharmacy Street, Ipswich Closed Closed N N Y Y Y N N N N N N N N N 13:00-17:30 IP1 3EP Spring Road 203 Spring Road, 09:00-18:30 09:00-17:30 Closed N N Y Y Y N N N N Y Y Y Y Y Pharmacy Ipswich IP4 5NQ Pharmacy Dept, 19 East of England Co- Meredith Road, 08:45-17:30 08:45-17:30 Closed N Y Y Y Y N N Y N Y Y N Y Y Operative Society Ipswich IP1 6ED Dispensing Appliance Contractors 25 Lower Brook Fittleworth Medical Street, Ipswich IP4 09:00-17:00 Closed Closed Y N N Y Y Ltd 1AQ Charles S Bullen 60 Matthew's Street, 09:00-17:00 09:00-13:00 Closed Y N N N N Healthcare Ltd Ipswich IP1 3EP

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Mid Suffolk locality

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

eat

Name of Contractor Address Monday- pharmacy (Y/N)

Saturday Sunday EHC Friday NMS MURs Supply hour - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines Flu vaccination service AURs provided in 2016

Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Tr Community Pharmacies 1 Station Road, 09:00- Claydon Pharmacy Claydon, 09:00-18:30 Closed N Y Y Y Y N N N N Y Y Y N N 13:00 Ipswich IP6 0HS 21 Ipswich St, 08:30- Boots UK Limited Stowmarket 08:30-17:30 Closed N N Y Y Y N N Y N Y Y Y Y Y 17:30 IP14 1AH Instore Pharmacy, 08:00- Tesco Instore Cedars Link 08:00-13:00 13:00 10:00- N Y Y Y Y N N Y N Y Y Y N N Pharmacy Road, 14:00-19:00 14:00- 16:00 Stowmarket 19:00 IP14 5BE 8-9 Wilkes Way, 07:00-23:00 07:00- 10:00- Asda Stores Ltd Stowmarket (Mon - opens Y N Y Y Y N N Y N Y Y Y Y Y 22:00 16:00 IP14 1DE at 08:00) Stowmarket Health Centre, 08:30- Boots UK Limited Violet Hill Road, 08:30-18:30 Closed N N Y Y Y N N N N N N N N N 12:00 Stowmarket IP14 1NL

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NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

eat

Name of Contractor Address Monday- pharmacy (Y/N)

Saturday Sunday EHC Friday NMS MURs Supply hour - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines Flu vaccination service AURs provided in 2016

Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Tr Community Pharmacies Stowmarket Health Centre, 08:30- Boots UK Limited Violet Hill Road, 08:30-18:30 Closed N N Y Y Y N N N N N N N N N 12:00 Stowmarket IP14 1NL Woolpit Health 08:30-18:30 Woolpit Medical Centre, Heath 08:00- (Mon - 07:00- Closed N N Y Y Y N Y N N N N N N Y Services Ltd Road, Woolpit 11:00 19:45) IP30 9QU 5 Broad Street, 09:00- Eye Pharmacy 08:30-18:00 Closed N Y Y Y Y N N Y N Y Y Y N Y Eye IP23 7AF 13:00 Barking Road, Needham Market 09:00- Needham 09:00-18:30 Closed N N Y Y Y N N N Y Y Y Y N Y Pharmacy 13:00 Market IP6 8EZ The Pharmacy, Debenham 1 Little Back Pharmacy-Mid- Lane, 09:00-13:00 09:00- Closed N Y Y Y Y N N N N Y Y Y N N Suffolk Medical Debenham, 14:00-17:30 13:00 Supplies Ltd Stowmarket IP14 6RB

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

eat

Name of Contractor Address Monday- pharmacy (Y/N)

Saturday Sunday EHC Friday NMS MURs Supply hour - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines Flu vaccination service AURs provided in 2016

Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Tr Community Pharmacies 19 The Street, Green Cross 08:45-13:00 Bramford, Closed Closed N Y Y Y Y N N Y N Y Y Y N N Pharmacy 14:00-17:45 Ipswich IP8 4DU Unit 1, Cattlepens 09:00- Station Pharmacy Station Road, 09:00-18:00 Closed N Y Y Y Y N N Y N Y Y Y N N 13:00 Elmswell IP30 9HD Thurston 09:00-13:00 Granary, Station 09:00- Thurston Pharmacy 14:00-18:00 Closed N Y Y Y Y N N N N N N N N N Hill, Thurston 13:00 IP31 3QU Botesdale Health Centre Botesdale Health 08:30-13:00 09:00- Back Hills, Closed N Y Y Y N N N N N N N Y N N Centre Pharmacy 14:00-18:30 11:00 Botesdale, Diss IP22 1DW Combs Ford Pharmacy, East of England Co- 08:30- Combs Lane, 08:30-18:30 Closed N N Y Y Y N N Y N Y Y Y N Y Operative Society 17:30 Stowmarket IP14 2DA

125

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

eat

Name of Contractor Address Monday- pharmacy (Y/N)

Saturday Sunday EHC Friday NMS MURs Supply hour - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines Flu vaccination service AURs provided in 2016

Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Tr GP Dispensing Practices Back Hills, Botesdale Health 08:30- Botesdale, Diss 08:00-18:30 Closed N Centre 12:00 IP22 1DW Combs Lane, 08:00-18:30 08:00- Combs Ford Surgery Stowmarket (Tues open Closed Y 11:00 IP14 2SY from 07:00) Mon 08:30- 18:00 Tue 08:30- 20 Low Lane, 13:00 Debenham Group Debenham IP14 Weds and Closed Closed Y Practice 6QU Thurs 08:30- 18:30 Fri 07:30- 13:00 The Health 08:30-18:00 Drs Lewis, Partridge Centre, Eye (Tue open until Closed Closed Y and Ahmed IP23 7DD 19:30) 08:00-18:30 Fressingfield Medical Fressingfield, (Mon open Closed Closed N Practice Eye IP21 5PJ until 19:25)

126

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

eat

Name of Contractor Address Monday- pharmacy (Y/N)

Saturday Sunday EHC Friday NMS MURs Supply hour - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines Flu vaccination service AURs provided in 2016

Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Tr GP Dispensing Practices Norwich Road, The Barham & 08:00-13:00 Claydon IP6 Closed Closed Y Claydon Surgery 13:45-18:30 0DJ Chapel Road, Mendlesham Group Mendelsham 08:00-18:30 Closed Closed Y Practice IP14 5SQ Barking Road, 08:30-18:30 Needham Market Needham (Mon open Closed Closed Y Country Practice Market IP6 8EZ until 20:00) Violet Hill Road, 08:00-18:30 08:30- Stowhealth Stowmarket (Mon open Closed N 11:45 IP14 1NL until 20:15) The Health 08:00-18:30 Centre, Bury St Woolpit (Mon open 08:00-1100 Closed N Edmonds IP30 07:00-20:00) 9QU

127

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Forest Heath locality

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

Name of Address Contractor Monday- Saturday Sunday pply r pharmacyr (Y/N) EHC Friday NMS MURs Su ou h - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies Unit 61, The Lords Guineas Shopping 09:00- 07:30-22:30 07:30-22:30 Y N Y Y Y N N Y Y N N N Y Y Pharmacy Centre, Newmarket 19:00 CB8 8EQ 40 High Street, Lakenheath Lakenheath IP27 09:00-18:30 Closed Closed N Y Y Y Y N N N N N N Y N Y Pharmacy 9JS 08:30-13:30, Your Local 32-34 High Street, 14:30-18:00 08:30-13:30 Boots Closed N N Y Y Y N N Y N Y Y Y N Y Brandon IP27 0AQ (Wed - closes 14:30-17:00 Pharmacy at 17:00) Your Local 1 Bury Road, 08:30-13:30 09:00-13:30 Boots Closed N N Y Y Y N N Y Y N N Y Y Y Brandon IP27 0BU 14:00-18:30 14:00-17:00 Pharmacy Unit 11, The Superdrug Rookery, 08:30-17:30 08:30-17:30 Closed N N Y Y Y N N N N Y Y Y Y N Stores Plc Newmarket CB8 8HT

128

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

Name of Address Contractor Monday- Saturday Sunday pply r pharmacyr (Y/N) EHC Friday NMS MURs Su ou h - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 2 Manor Court, Lloyds High Street, 08:30-13:00 Closed Closed N N Y Y Y N N N N N N Y N N Pharmacy Mildenhall IP28 14:00-17:30 7EH Tesco Stores, Tesco Instore Fordham Road, 10:00- 08:00-20:00 08:00-20:00 N Y Y Y Y N N Y N Y Y Y N N Pharmacy Newmarket CB8 16:00 7AH 27 Market Place, Lloyds Mildenhall Suffolk, 09:00-18:00 09:00-17:30 Closed N N Y Y Y N Y Y Y N N Y Y Y Pharmacy IP28 7EF 82 High Street, Boots UK 10:00- Newmarket CB8 08:30-18:00 08:30-18:00 N N Y Y Y N N Y N Y Y N N Y Limited 16:00 8JX Units 1&2, The New Rookery, Lloyds Shopping Centre, 09:00-17:30 09:00-17:30 Closed N N Y Y Y N Y Y Y Y Y Y Y Y Pharmacy Newmarket CB8 8HT Day Lewis Unit 3, Bellflower 09:00-13:00 09:00-13:00 Closed N Y Y Y Y N N Y Y Y Y Y N Y Pharmacy Crescent IP28 8JU 14:00-18:00

129

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

Name of Address Contractor Monday- Saturday Sunday pply r pharmacyr (Y/N) EHC Friday NMS MURs Su ou h - Needle Exchange

130

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-commissioned

Opening hours

Pharmaceutical services services

Name of Address Contractor Monday- Saturday Sunday pply r pharmacyr (Y/N) EHC Friday NMS MURs Su ou h - Needle Exchange

GP Dispensing Practices Orchard House Newmarket CB8 08:00-18:30 Closed Closed Y Surgery 8NU Turnpike Road, 08:00- 18:30 Reynard Red Lodge, Bury St (Wednesday Closed Closed N Surgery Edmunds IP28 8LB 07:00-18:30)

131

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

St Edmundsbury locality

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs u Supply o rovided in 2016 h - Needle Exchange NHS HealthNHS Checks 100 SAC p SAC Pharmacy Access Scheme NHS urgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 07:00-23:00 Cangle Road, Haverhill 07:00- 10:00- Tesco Instore Pharmacy (Mon - opens at Y N Y Y Y N N Y Y Y Y Y Y N CB9 0BQ 22:00 16:00 08:00) 37-39 Cornhill, Bury St 08:30- Superdrug Stores Plc 08:30-17:30 Closed N N Y Y Y N N Y Y Y Y Y Y Y Edmunds IP33 1DX 17:30 Bedingfield Way, Bury St 07:00- 10:00- Lloyds Pharmacy 07:00-23:00 Y Y Y Y Y N N N N N N Y N Y Edmunds IP32 7EJ 22:00 16:00 Mount Farm Surgery, Croasdales Chemist Lawson Place, Bury St 09:00-18:00 Closed Closed N N Y Y Y N N Y N N N Y N Y Edmunds IP32 7EW 15 High Street, Haverhill 08:30- Boots UK Limited 08:30-17:30 Closed N N Y Y Y N N Y Y N N N N Y CB9 8AD 17:30 2 Mill Road, Haverhill CB9 09:00- Well Pharmacy 08:30-18:30 Closed N N Y Y Y N N Y Y Y Y Y N Y 8BD 13:00 11-13 Cornhill, Bury St 08:30- 10:30- Boots UK Limited 08:30-18:00 N N Y Y Y N N Y N Y Y N Y Y Edmunds, IP33 1BX 18:00 16:30 Guildhall and Barrow Surgery, Lower Baxter 09:00- Abbey Pharmacy 09:00-18:00 Closed N N Y Y Y N N N N N N N N N Street, Bury St Edmunds 13:00 IP33 1ET

132

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs u Supply o rovided in 2016 h - Needle Exchange NHS HealthNHS Checks 100 SAC p SAC Pharmacy Access Scheme NHS urgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 06:30-22:30 St Saviours Interchange, 06:30- 10:00- Tesco Instore Pharmacy (Mon - opens at Y N Y Y Y N N Y N N N Y N Y Bury St Edmunds IP32 7JS 22:00 16:00 08:00) Ixworth Surgery, Peddars 09:00- Ixworth Pharmacy Close, Ixworth, Bury St 08:30-18:30 Closed N Y Y Y Y N N N N Y Y Y N Y 13:00 Edmunds IP31 2HD Haycocks Road, Haverhill 08:00- 10:00- Lloyds Pharmacy 08:00-22:00 N Y Y Y Y N N Y Y N N N N Y CB9 7YL 22:00 16:00 Lloyds 17 Victoria Street, Bury St 08:30-18:30 Closed Closed N N Y Y Y N N N N Y Y Y N Y Pharmacy Edmunds IP33 3BB 1 The Traverse, Cornhill, 08:30- Croasdale & Sons Bury St Edmunds IP33 08:30-17:30 Closed N N Y Y Y N N Y Y Y Y Y Y Y 17:30 1BE 07:00-23:00 Western Way, Bury St 07:00- 10:00- Asda Stores Ltd (Mon - opens at Y N Y Y Y N N Y N Y Y Y N Y Edmunds IP33 3SP 22:00 16:00 08:00) David Holland Norton Road, (Greenfields 09:00-13:00 09:00- Closed N N Y Y Y N N N N N Y Y Y Y Pharmacy Way) Haverhill CB9 8LU 14:00-17:30 12:30 7 St Olaves Precinct, Bury 09:00- Day Lewis Pharmacy 09:00-18:00 Closed N N Y Y Y N N Y N Y Y Y N Y St Edmunds IP32 6SP 13:00

133

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs u Supply o rovided in 2016 h - Needle Exchange NHS HealthNHS Checks 100 SAC p SAC Pharmacy Access Scheme NHS urgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies Swan Surgery, Northgate 08:00- 08:00- Swan Pharmacy Street, Bury St Edmunds 08:00-22:00 Y N Y Y Y N N Y N Y Y Y N N 23:00 23:00 IP33 1AE Christmas Maltings 08:00- 08:00- Haverhill Pharmacy Surgery, Camps Road, 08:30-23:00 Y N Y Y Y N N Y Y Y Y Y N Y 21:45 21:45 Haverhill CB9 8HF Barrow Hill, Barrow, Bury 08:00-14:00 09:00- Barrow Pharmacy Closed N Y Y Y N N N N N Y Y Y N N St Edmunds IP29 5DX 14:30-18:30 12:00 GP Dispensing practices 1 Angel Hill, Bury St 08:30- Angel Hill 08:00-18:30 Closed Y Edmunds IP33 1LU 12:00 Hopton Surgery The Chase, Stanton, Bury 09:00-17:00 Closed Closed N (Avicenna) St Edmunds IP31 2XA Christmas Maltings & Norton Road, Haverhill 08:00-18:30 Closed Closed N Clements Practice CB9 8LU Guildhall and Barrow Lower Baxter Street, Bury 08:00-18:30 Closed Closed N Surgery St Edmunds IP33 1ET Peddlers Close, Ixworth, Ixworth Surgery Bury St Edmunds IP31 08:00-18:30 Closed Closed N 2HD

134

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

135

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Babergh locality

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs Service ou edle Exchange h - Ne

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 06:30-22:30 Tesco Instore Springlands Road, 06:30- (Mon - opens 10:00-16:00 Y Y Y Y Y N N Y N Y Y Y N N Pharmacy Sudbury CO10 1GY 22:00 at 08:00) 36 The Street, Capel 08:30-13:00 Villapharm Ltd St Mary, Ipswich IP9 Closed Closed N N Y Y Y N N N N Y Y Y N N 14:00-18:15 2EE 3 High Street, 09:00- Lavenham Pharmacy Lavenham, Sudbury 09:00-18:00 Closed N Y Y Y Y N N Y N Y Y N N Y 17:30 CO10 9PX 5 Applegate Mews, Your Local Boots 09:00-13:00 09:00- Poplar Road, Great Closed N N Y Y Y N N Y N N N N N N Pharmacy 14:00-17:30 13:00 Cornard CO10 0GL Hadleigh Health Centre, Market 09:00- Mill Pharmacy 08:00-18:30 10:00-14:00 N N Y Y Y N N Y N Y Y Y N N Place, Hadleigh, 18:00 Ipswich IP7 5DN

136

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs Service ou edle Exchange h - Ne

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies Mon 08:00 - Tues 06:00 (non-stop), 6 North Street Tues 8:00- 09:00- Parade Pharmacy Parade, Sudbury Wed 06:00 10:00-15:00 Y N Y Y Y N N N N Y Y Y Y Y 18:00 CO10 1GL (non-stop), Wed, Thurs, Fri - 08:00- 22:00 09:00- 31 High Street, 09:00-13:00 13:00 Clare Pharmacy Sudbury, Suffolk, Closed N Y Y Y Y N N Y N Y Y Y N N 14:00-17:30 14:00- CO10 8NY 17:00 8 North Street, 08:30- Superdrug Pharmacy 08:30-17:30 Closed N N Y Y Y N N N N N N N N N Sudbury, CO10 1RB 17:30 Lloyds 29 North Street, 09:00- 09:00-18:00 Closed N N Y Y Y N N Y N N N Y Y N Pharmacy Sudbury CO10 1RB 17:30 31 High Street, Your Local Boots 09:00- Hadleigh, Ipswich 09:00-17:30 Closed N N Y Y Y N N Y N N N N N Y Pharmacy 17:00 IP7 5AF

137

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs Service ou edle Exchange h - Ne

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies Hall Street, Long 09:00-13:00 09:00- The Pharmacy Melford, Sudbury Closed N N Y Y Y N N Y Y Y Y Y N N 14:00-18:00 17:30 CO10 9JL Copdock 08:00- Tesco Instore Interchange, London 08:00-13:30 13:30 10:00-16:00 N Y Y Y Y N N Y Y N N Y Y Y Pharmacy Road, Ipswich IP8 14:30-20:00 14:30- 3TS 20:00 The Street, East 09:00-13:00 09:00- Day Lewis Pharmacy Closed N Y Y Y Y N N Y N N N Y N N Bergholt CO7 6SE 14:00-18:00 13:00 13-14 Market Hill, 08:30- Boots UK Limited 08:30-17:30 10:00-16:00 N N Y Y Y N N Y Y Y Y Y Y Y Sudbury CO10 2EA 17:30 Armes Trading Estate, Cornard 07:00- Lloyds Pharmacy 07:00-23:00 10:00-16:00 Y N Y Y Y N N Y N Y Y N N N Road, Sudbury 22:00 CO10 2XB 91 High Street, Your Local Boots 08:45-12:30 08:45- Hadleigh, Ipswich Closed N N Y Y Y N N Y N N N Y N N Pharmacy 13:30-17:30 10:00 IP7 5EA The Surgery, Lion 08:30-13:00 09:00- Glemsford Pharmacy Road, Glemsford Closed N Y Y Y Y N N N N Y Y N N Y 13:30-18:30 12:30 CO10 7RF

138

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

Name of Contractor Address Monday- Saturday Sunday r pharmacyr (Y/N) EHC Friday NMS MURs Service ou edle Exchange h - Ne

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Medicines AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat GP Dispensing Practices Bildeston Health High Street, 08:30- 08:00-18:30 Closed Y Centre Bildeston IP7 7EX 12:30 Lion Road, The Surgery Glemsford, Sudbury 08:00-18:30 Closed Closed Y CO10 7RF Hadleigh Boxford Market Place, 08:00-18:30 Closed Closed N Group Practice Hadleigh IP7 5DN Harwicke House, Hardwicke House Stour Street 08:00-18:30 Closed Closed N Group Practice CO10 2AY The Long Melford The Surgery, Long 08:00-18:30 Closed Closed N Practice Melford CO10 9EP Mon 07:00- 17:00 The Street, Holbrook, Tues, Wed, Fri 08:30- The Surgery Closed N Ipswich IP9 2QS 08:00-18:30 10:30 Thur 08:00- 12:30

139

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Suffolk Coastal locality

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

ice

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou enhanced serv

h - - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme AURs provided in 2016 NHS UrgentNHS Medicines Flu vaccination service Provision of Potassium

Iodate Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies Grove Medical Centre, Grove Road, Felixstowe Pharmacy 07:00-22:30 07:00-22:30 10:00-17:00 Y N Y Y Y N N Y N N Y Y Y N N Felixstowe IP11 9GA Unit 2, White Hart Wickham Market 09:00-13:00 Court, Wickham 09:00-18:00 Closed N Y Y Y Y N N Y N N Y Y Y N Y Pharmacy 14:00-17:00 Market IP13 0RA Framfield Medical Centre, Ipswich Waterton Pharmacy 08:00-19:30 10:00-13:00 10:00-12:00 N N Y Y Y N N Y N N N N N N N Road, Woodbridge IP12 4FD Unit 1, 11 Thoroughfare, Lloyds Pharmacy 09:00-18:00 09:00-17:30 Closed N N Y Y Y N N Y N N Y Y Y N Y Woodbridge IP12 1AA Grange Farm Avenue, Cavendish Park 08:00-14:0, 08:00-14:00, Morrisons Pharmacy 10:00-13:00 N N Y Y Y N N N N N N N Y N N Estate, Felixstowe 15:00-20:00 15:00-18:00 IP11 2XD

140

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

ice

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou enhanced serv

h - - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme AURs provided in 2016 NHS UrgentNHS Medicines Flu vaccination service Provision of Potassium

Iodate Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 34a Penzance Road, 09:00-13:00 Kesgrave Pharmacy Kesgrave, Ipswich 09:00-13:00 Closed N N Y Y Y N N N N N N N N N N 14:00-18:00 IP5 1JS 32 Market Hill, Framlingham Framlingham, 08:30-18:00 09:00-17:00 Closed N Y Y Y Y N N N N N N N Y N N Pharmacy Woodbridge, IP13 9AY 08:30-18:30 Your Local Boots 31 Orwell Road, (Mon & Tues - 09:00-17:30 Closed N N Y Y Y N N Y N N Y Y Y Y Y Pharmacy Felixstowe IP11 7DD closes at 20:00) Tesco Superstore, Tesco Instore Anson Rd, 08:00-20:00 (Fri 08:00-20:00 10:00-16:00 N N Y Y Y N N Y N N N N N N N Pharmacy Martlesham Heath, closes at 21:00) Ipswich IP5 3RU 86 Hamilton Road, Boots UK Limited 08:30-17:30 08:30-17:30 10:00-16:00 N N Y Y Y N N Y N Y Y Y Y N N Felixstowe IP11 7AD 277 High Street, Lloyds Pharmacy Walton, Felixstowe 09:00-18:30 09:00-13:00 Closed N N Y Y Y N N Y N N N N Y Y Y IP11 9DU Felixstowe Road, Lloyds Pharmacy Warren Heath, 08:00-21:00 08:00-20:00 10:00-16:00 N N Y Y Y N N Y N N N N Y N Y Ipswich IP3 8TQ

141

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

ice

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou enhanced serv

h - - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme AURs provided in 2016 NHS UrgentNHS Medicines Flu vaccination service Provision of Potassium

Iodate Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 6 Acer Road, 09:00-13:00 Acer Road Pharmacy Rendlesham IP12 Closed Closed N N Y Y Y N N N N N N N N N N 13:30-17:30 2GA 696 Foxhall Road, 09:00-13:00 Square Pharmacy 09:00-13:00 Closed N Y Y Y Y N N N N N N N N N N Ipswich IP3 8NQ 14:00-18:00 135 Hamilton Road, Hado Pharmacy 07:00-23:00 07:00-20:00 10:00-17:00 Y N Y Y Y N N N N N Y Y Y N N Felixstowe IP11 7BL 9 The Square, Martlesham 09:00-13:00 Martlesham Heath, 09:00-12:00 Closed N N Y Y Y N N N N N Y Y Y N Y Pharmacy 14:00-18:00 Ipswich IP5 3SL Pharmacy East of England Co- Department, 189 08:30-17:30 08:30-17:30 Closed N N Y Y Y N N Y N Y Y Y Y Y Y Operative Society Hamilton Road, Felixstowe IP11 7DT 125 High Street, Aldeburgh Pharmacy 09:00-18:00 09:00-17:00 10:00-14:00 N Y Y Y Y N N N N Y Y Y Y N N Aldeburgh IP15 5AR Unit 7, Rendlesham Rendlesham Mews, Rendlesham 09:00-17:00 10:00-12:00 Closed N N N Y Y N N N N N N N N N N Pharmacy IP12 2SZ Tesco Instore Ropes Drive, 08:00-13:30 08:00-13:30 Kesgrave, Ipswich Closed N N Y Y Y N N Y N N Y Y Y N N Pharmacy IP5 2FU 14:30-19:00 14:30-19:00

142

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

ice

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou enhanced serv

h - - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme AURs provided in 2016 NHS UrgentNHS Medicines Flu vaccination service Provision of Potassium

Iodate Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 62 High Street, Lloyds Pharmacy 08:30-18:00 09:00-17:30 Closed N N Y Y Y N N Y Y N Y Y Y Y Y Leiston IP16 4BZ 58 Thoroughfare, 08:30-12:45 08:30-12:45 Boots UK Limited Woodbridge IP12 10:00-16:00 N N Y Y Y N N Y N N N N Y N Y 13:45-17:30 13:45-17:30 1AL 7 High Street, East Of England Co- Saxmundham IP17 08:30-18:00 08:30-17:30 Closed N Y Y Y Y N N Y N Y Y Y Y Y Y Operative Society 1DF 20 High Street, Leiston Pharmacy 09:00-18:30 09:00-17:00 Closed N N Y Y Y N N Y Y Y Y Y Y Y Y Leiston IP16 4EW GP Dispensing practices 7 Little St John's Dr Taylor and Street, Woodbridge 08:00-18:30 08:30-11:30 Closed Y Partners IP12 1EE 08:00-18:30 Ipswich Road, Framfield House (Mon and Tues Woodbridge IP12 Closed Closed Y Surgery open until 4FD 20:00)

143

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

ice

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou enhanced serv

h - - Needle Exchange

NHS HealthNHS Checks 100 SAC providedSAC in 2016 Pharmacy Access Scheme AURs provided in 2016 NHS UrgentNHS Medicines Flu vaccination service Provision of Potassium

Iodate Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat GP Dispensing Practices The Surgery, Pembroke Road, 08:30-18:30 Framlingham Framlingham, (Mon open from Closed Closed Y Medical Centre Woodbridge IP13 07:00-19:00) 9HA 23 The Square, Martlesham Heath Martlesham Heath, 08:00-18:30 Closed Closed Y Surgery Ipswich IP5 3SL Lambsdale Saxmundham Health Meadows, 08:00-18:30 Closed Closed Y Group Saxmundham IP17 1DY Main Street, Leiston The Leiston Surgery 08:00-18:30 Closed Closed N IP16 4ES

Alderton Health 08:00-18:30 The Peninsula Centre, Mill Hoo, (Mon and Tues Closed Closed Y Practice Alderton, Woodbridge IP12 3DA closed at 14:30) Chapel Rd, Wickham 08:00-18:30 Wickham Market Market, Woodbridge (Tues open until 08:30-11:45 Closed N Medical Practice IP13 0SB 20:00)

144

Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Waveney locality

NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

icines

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou h - Needle Exchange

NHS HealthNHS Checks 100 Palliative Care Drugs SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Med AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 07:00-23:00 Horn Hill, Lowestoft 10:00- Asda Pharmacy (Mon opens at 07:00-22:00 Y N Y Y Y N N Y Y N Y Y Y Y Y NR33 0PX 16:00 08:00) St Mary's Road, 08:30-19:30 (Fri Beccles HCC Ltd 09:00-12:00 Closed N N Y Y Y N N Y N N Y Y Y N Y Beccles NR34 9NQ closes at 18:30) 5 New Market, 8:30-13:30 Boots UK Limited 09:00-17:30 Closed N N Y Y Y N N Y N Y Y N N Y Y Beccles NR34 9HQ 14:30-17:30 4 St Mary's Street, 08:30-12:30 08:30-12:30 Boots UK Limited Closed N N Y Y Y N N Y N N Y Y Y N Y Bungay NR35 1AX 13:00-17:30 13:00-17:30 28 St John's Road, 09:00-13:00 09:00-13:00 Boots UK Limited Closed N N Y Y Y N N Y Y N Y Y Y Y Y Bungay NR35 1LP 14:00-18:00 14:00-18:00 26 Market Place, Boots UK Limited 08:30-18:30 08:30-17:00 Closed N N Y Y Y N N Y Y Y Y Y N N Y Halesworth IP19 8AY 76a London Road 10:00- Boots UK Limited North, Lowestoft 08:30-17:30 08:30-17:30 N N Y Y Y N N Y N Y Y Y Y Y Y 16:00 NR32 1ET

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NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

icines

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou h - Needle Exchange

NHS HealthNHS Checks 100 Palliative Care Drugs SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Med AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies Oulton Village Medical Centre, 09:00-13:00 Boots UK Limited Closed Closed N N Y Y Y N N Y N N N N N N N Meadow Road, 14:00-18:00 Lowestoft NR32 3AZ 120 St Peter's Street, 09:00-13:00 09:00-13:30 Boots UK Limited Closed N N Y Y Y N N Y N N N N N Y Y Lowestoft NR32 1UD 14:00-18:00 14:00-16:30 2-4 Stradbroke Road, Pakefield, 09:00-13:00 09:00-13:00 Boots UK Limited Closed N N Y Y Y N N Y N N Y Y N N N Lowestoft 14:00-18:00 14:00-18:00 NR33 7HT Bungay Road, Cutlers Hill Halesworth IP19 08:30-18:30 08:30-12:30 Closed N N Y Y Y N N N N N N N N N N Pharmacy 8SG 216 London Road Eastpoint Pharmacy South, Lowestoft 09:00-17:30 09:00-13:00 Closed N N Y Y Y N N N Y N Y Y Y Y Y NR33 0HF Bridge Road, Oulton Hayden Chemist Broad, Lowestoft 09:00-17:30 09:00-13:00 Closed N N Y Y Y N N Y N Y Y Y Y Y Y NR32 3LL High Street High Street, 09:00-18:00 Closed Closed N N Y Y Y N N Y Y N Y Y Y Y Y Pharmacy Lowestoft NR32 1JE

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NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

icines

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou h - Needle Exchange

NHS HealthNHS Checks 100 Palliative Care Drugs SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Med AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies 1b Bridge Road, 08:30-13:00 Holly Pharmacy Oulton Broad, Closed Closed N N Y Y Y N N Y N N Y Y N N N 14:00-18:00 Lowestoft NR32 3LJ 70 High Street, Kessingland Kessingland NR33 09:00-18:00 09:00-17:00 Closed N N Y Y Y N N Y N N Y Y Y N Y Pharmacy 7QF 10:00- 18 Queen Street, 16:00 Queen St Pharmacy 09:00-17:30 09:00--17:30 N Y Y Y Y N N Y N N Y Y Y N N Southwold IP18 6EQ (Busy periods) Solebay Health Centre, Teal Close, Reydon Pharmacy 09:00-18:00 09:00-13:00 Closed N Y Y Y Y N N N Y N N N N N N Reydon, Southwold IP18 6GY 3 Ashburnham Way, 10:00- Rosedale Pharmacy 07:00-22:30 07:00-22:30 Y N Y Y Y N N Y N N Y Y Y Y Y Lowestoft NR33 8LG 17:00 14 The Britten Centre, Superdrug Pharmacy 09:00-17:30 09:00-17:30 Closed N N Y Y Y N N N N N Y Y Y Y Y Lowestoft NR32 1LR George Westwood 06:30-22:30 Tesco Instore 10:00- Way, Beccles NR34 (Mon open from 06:30-22:30 Y N Y Y Y N N Y Y N N N N N N Pharmacy 16:00 9EJ 08:00)

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NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

icines

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou h - Needle Exchange

NHS HealthNHS Checks 100 Palliative Care Drugs SAC providedSAC in 2016 Pharmacy Access Scheme NHS UrgentNHS Med AURs provided in 2016 Flu vaccination service Support to Stop Smoking Supervised Consumption Electronic Prescription Service Chlamydia Screen and Treat Community Pharmacies Unit 5, 15 Ashburnham Way, Well Pharmacy 08:45-18:00 09:00-17:30 Closed N N Y Y Y N N Y N N Y Y Y N N Carlton Colville, Lowestoft NR33 8LG 187 London Road Jhoots Pharmacy South, Lowestoft 08:30-18:30 09:00-13:00 Closed N N Y Y Y N N N N N N N N N N NR33 0DR 55 Westwood Av, Well Pharmacy 08:30-18:00 09:00-13:00 Closed N N Y Y Y N N N N N Y Y Y Y Y Lowestoft NR33 9RW Alexandra Road, Well Pharmacy 08:30-18:30 Closed Closed N N Y Y Y N N N N N N N N N N Lowestoft NR32 1PL 82 Victoria Road, 08:30-13:00 Victoria Pharmacy Oulton Broad, Closed Closed N N Y Y Y N N N N N Y Y N N N 14:00-18:00 Lowestoft NR33 9LU Village Rise Pharmacy, Weston 09:00-13:00 FP Cross Ltd 09:00-13:00 Closed N N Y Y Y N N N N Y Y Y Y N N Road, Gunton, 14:00-17:30 Lowestoft NR32 4PT Woodland Avenue, Worlingham Worlingham, Beccles 09:00-18:00 09:00-17:00 Closed N Y Y Y Y N N Y N Y Y Y Y N Y Pharmacy NR34 7EF

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NHS England Advanced Local authority-

Opening hours

Pharmaceutical services commissioned services

icines

Name of Contractor Address Monday-Friday Saturday Sunday r pharmacyr (Y/N) EHC NMS MURs Supply ou h - Needle Exchange

*A list of providers of NHS Urgent Medicines Service is expected to be available later in 2017

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Appendix B: PNA Steering Group Terms of Reference

1. Objective/Purpose To support the production of a Pharmaceutical Needs Assessment on behalf of the Suffolk County Council, to ensure that it satisfies the relevant regulations including consultation requirements. 2. Accountability The Steering Group is to report to the Director of Public Health for Suffolk County Council, who has received delegation from Suffolk Health and Wellbeing Board to produce the 2018 Pharmaceutical Needs Assessment for Suffolk. 3. Membership Core members: • Head of Knowledge and Intelligence, Public Health, Suffolk County Council • NHS England representative • Suffolk Local Medical Committee representative • Suffolk Local Pharmaceutical Committee representative • Suffolk Local Pharmaceutical Network Lead • Great Yarmouth and Waveney Clinical Commissioning Group Medicines Management representative • West Suffolk Clinical Commissioning Group Medicines Management representative • Ipswich and East Clinical Commissioning Group Medicines Management representative • Communications and Engagement Manager, Great Yarmouth and Waveney Clinical Commissioning Group • JSNA Programme Manager, Public Health, Suffolk County Council • Council – Consultant in Public Health, Suffolk County Council • Council – Commissioning Manager • Engagement Lead, West Suffolk Clinical Commissioning Group • Engagement Lead, Suffolk County Council • Health Watch representative (lay member)

Members are encouraged to provide a deputy if unable to attend. Soar Beyond members are not core members however will chair and collate minutes of the meetings. Each core member/deputy has one vote. Anna Crispe, the Head of Knowledge and Intelligence, Public Health, Suffolk Council will have the casting vote, if required. Core members may provide a deputy to meetings in their absence. The Steering Group shall be quorate with seven core members in attendance. Non- attending members are unable to cast a vote – that vote may otherwise sway the casting decision.

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Additional members (if required): • CCG Commissioning Managers • NHS Trust Chief Pharmacists • Dispensing Doctors representative

In attendance at meetings will be representatives of Soar Beyond Ltd who have been commissioned by Suffolk County Council to support the development of the PNA. Other additional members may be co-opted if required 4. Frequency of meetings Meetings will be arranged at key stages of the project plan. The Steering Group will meet in late 2017-early 2018 to sign off the PNA for submission to the Health and Wellbeing Board. 5. Responsibilities • Provide a clear and concise PNA process • Review and validate information and data on population, demographics, pharmaceutical provision, and health needs • To consult with the bodies stated in Regulation 8 of the Pharmaceutical Regulations 2013: o Any Local Pharmaceutical Committee for its area o Any Local Medical Committee for its area o Any persons on the pharmaceutical lists and any dispensing doctors list for its area o Any LPS chemist in its area o Any Local HealthWatch organisation for its area o Any NHS trust or NHS foundation trust in its area o The NHSCB o Any neighbouring HWB • Ensure that due process is followed • Report to Health & Wellbeing Board on both a Draft and Final PNA. • Publish a Final PNA by end 1st April 2018.

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Appendix C: Public questionnaire

Tell us what you think of pharmacy services in Suffolk We want to hear what you think of pharmacy services in Suffolk to help us develop services in the future. Your views will help us to develop our Pharmacy Needs Assessment (PNA) which will look at health needs in Suffolk, the level and accessibility of pharmacy services and how these will be maintained and developed in the future. We would be grateful if you would take a few minutes to answer some questions about your own experience and views. The information in the questionnaire you provide is confidential. Please be honest with your answers so we can accurately assess areas where pharmacies are already performing well and areas that need improvement. Information returned in the ‘A bit about you’ section will be recorded separately from your questionnaire response. If you would like to complete this online please go to: https://www.surveymonkey.co.uk/r/_SUFFOLK_Public Or scan the QR code below:

Closing date for this questionnaire is 31 March 2017. Please return the questionnaire to your pharmacist or GP practice or post back to: Natacha Bines, Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich IP1 2BX Please provide your postcode: ______Should you require this questionnaire in any other format or language, please call 08456 066 067

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N.B. All information supplied will be kept strictly confidential, held securely and used for the purpose of planning appropriate services for all communities. It will not be passed on to any third party. 1) How often have you visited the pharmacy in the last six months? For yourself: For someone else: Once a week or more Once a week or more Once a month Once a month Once every few months Once every few months Once in six months Once in six months 2) Do you have a regular or preferred pharmacy that you visit? Yes - if happy to do so, please provide the name and address No ______3) When considering a choice of pharmacy, which of the following helps you choose? (Please select all that apply) Close to home Close to GP surgery Close to work Efficiency They offer a specific service Expertise / quality of advice Friendly staff Other, please specify ______4) Who would you normally visit the pharmacy for? (Please select all that apply) Yourself A family member Neighbour / friend Someone you are a carer for All of the above Other, please specify ______5) If you visit a pharmacy on behalf of someone else, please give a reason why (you may select more than one answer) Opening hours of the pharmacy not suitable for patient Most convenient Access (for example disability / transport) All of the above Other, please specify ______6) How would you usually travel to the pharmacy? (Please select one answer) Car Taxi Public transport Walk Bicycle Other, please specify ______7) On average, how long does it take you to travel to a pharmacy? (Please select one answer) 0 to 15 minutes 16 to 30 minutes Over 30 minutes Varies Don’t know

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8) Do you have any difficulties when travelling to a pharmacy? Yes No If yes, please select one of the following reasons: Location of pharmacy Parking difficulties Public transport availability Other, please specify ______9) What is the most convenient day for you to visit a pharmacy? (Pleased select one answer) Monday to Friday Saturday Sunday Varies Don’t know 10) When do you prefer to visit a pharmacy? (Please select one answer) Morning (8am-12pm) Lunchtime (12pm-2pm) Afternoon (2pm-6pm) Early evening (6pm-8pm) Late evening (after 8pm) Varies Don’t know 11) How regularly do you typically buy an over the counter (i.e. non-prescription) medicine from a pharmacy? (Please select one answer) Daily Weekly Fortnightly Monthly Yearly Never 12) Which of the following pharmacy services are you aware that a pharmacy may provide? (Please select all that apply) Dispensing of prescriptions Repeat dispensing services Needle exchange Advice from your pharmacist Buying over the counter medicines Disposal of unwanted medicines Flu vaccination services Home delivery and prescription collection services Detailed discussion with your pharmacist – how you take your existing and newly prescribed medicines Stopping smoking / nicotine replacement therapy Sexual health services (chlamydia testing / treating, condom distribution, emergency contraception) Immediate access to specialist drugs e.g. palliative care medicines Supervised consumption of methadone and buprenorphine Emergency supply of prescription medicines Other, please specify ______

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13) What services would you like to see provided by your local pharmacy? Yes No Don’t know Dispensing of prescriptions Repeat dispensing services Home delivery and prescription collection services Needle exchange Advice from your pharmacist Buying over the counter medicines Disposal of unwanted medicines Flu vaccination services Detailed discussion with your pharmacist how - to take your existing and newly prescribed medicines Stopping smoking / nicotine replacement therapy Sexual health services (chlamydia testing / treating, condom distribution, emergency contraception) Immediate access to specialist drugs e.g. palliative care medicines Supervised consumption of methadone and buprenorphine Emergency supply of prescription medicines Other, please specify ______14) Is there a consultation room available where you cannot be overheard in the pharmacy you normally visit? Yes No 15) Have you ever used an internet pharmacy to obtain prescription medicines? Yes No 16) If yes, how would you rate your overall satisfaction with the internet pharmacy? Excellent Good Fair Poor Any other comments you would like to make about your pharmacy? ______Thank you for completing this questionnaire Your answers to this survey are private and will be kept in line with the Data Protection Act. If you wish to be kept informed about the Pharmaceutical Needs Assessment and the consultation we will be running, you can give us your contact details here: Name: ______Address:______

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Telephone number: ______Email:______Preferred method of communication: Telephone Email Post

A bit about you This information is being collected anonymously and will only be used for the purpose of improving Suffolk’s consultation service. Please note that this section is optional and you don’t have to complete these questions if you don’t want to. If you choose not to answer these questions, please tick the ‘Prefer Not to Disclose’ option so that we are aware of your choice. By providing this information it allows us to see which groups of people are responding to our consultations and which groups are underrepresented. We can then make extra efforts to reach underrepresented groups so that we can consider the views of all groups who may be affected by our plans. It also helps us ensure that everyone is treated fairly and equitably in everything we do. Without your information, we can't always spot trends and issues which enable us to make appropriate changes or improvements. All responses to these questions are anonymous; responses are added together and no individuals are identified. Any information provided is governed by the Data Protection Act 1998 which will be treated as strictly confidential. 1. If you choose not to answer any of these questions, please tick the ‘Prefer not to disclose’ option below so that we are aware of your choice. (Prefer not to disclose) 2. Are you: Female Male Prefer not to say Prefer to self-describe (please specify): ______3. Which age group do you fit into? Under 16 16-24 25-34 35-44 45-54 55-64 65-74 75+ Do not want to say 4. The provision for disability within Equalities legislation defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) and has an adverse effect on the person’s ability to carry out normal day-to-day activities. Do you consider yourself to have a disability according to the terms given in the Equality legislation? Yes No

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5. If you have answered yes to the above question, please indicate the type of impairment which applies to you from the list below. People may experience more than one type of impairment, in which case please select all that apply. If your disability does not fit any of these types, please mark ‘Other’. Mobility Hearing Vision Learning Mental Health Communication Long standing health condition Other (Please state below):

6. To which of these groups do you consider you belong? Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Any other Asian background - please specify in the box below:

Black or Black British: Caribbean Black or Black British: African Any other Black background - please specify in the box below:

Chinese Mixed: White and Black Caribbean Mixed: White and Black African Mixed: White and Asian Any other Mixed background - please specify in the box below:

White: English White: Irish White: Scottish White: Welsh White: British Gypsy or Irish Traveller Other white background - please describe:

Do not want to say 7. Your religion or belief - What group do you most identify with? No religion Baha'i Buddhist Christian Hindu Jain Jewish Muslim Sikh Any other religion or belief (specify if you wish)

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8. What is your sexual orientation? Bisexual Gay man Gay woman / lesbian Heterosexual No sexuality Prefer not to say Same-sex relationship with a man Same-sex relationship with a woman Other

Why do you want to know more about me? We are committed to building a community where everyone can flourish and achieve their full potential and the information you give us will help us achieve our commitment of being fair to all. We value diversity and acknowledge that our residents come from different backgrounds and have different needs, experiences and interests. It’s really important we get to know you better so that we can plan and deliver fair services that are tailored to residents’ needs. The information you give us will enable us to: • check whether or not our services are equally accessible to everyone who is entitled to them; • identify and address any barriers to accessing (information about) our services; • continually improve the services we deliver

What is an Equal Opportunities Form? Suffolk County Council monitors the age, disability, gender, race and preferred first language of our service users, as well as whether or not they have caring responsibilities for an adult or a child with a disability. Where relevant and appropriate to the service questionnaire, for example in relation to health or social care services, we also sometimes ask about the sexual orientation, marital or civil partnership status and religion or belief of service users. We collect this information by asking you to fill in an Equal Opportunities Form. The form is very straightforward to complete. Who chooses the questions listed on the Equal Opportunities Form? The questions in the Equal Opportunities Form are based on legislation (Equality Act 2010); advice from advisory bodies (Equality and Human Rights Commission) and best practice by other local authorities. Is it just Suffolk County Council that carries out equal opportunities monitoring? No. All local authorities across the country monitor characteristics such as the age, gender, disability and ethnic origin of those who use their services.

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Do I have to give you this information? No. All questions in the Equal Opportunities Form are voluntary. If you feel uncomfortable giving us this information, simply tick the ‘prefer not to say’ box or do not answer the question. However, we can’t get things right without your help so we ask you to help us by completing this form. I've already given you this information, why do you want it again? We recognise that people’s circumstances change all the time and we want to make sure that our services are reflective of people’s changing circumstances. Still have questions? If you have further questions or want more information about this form, please contact: Natacha Bines, Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich IP1 2BX. [email protected] or telephone 01473 260091.

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Appendix D: Pharmacy contractor questionnaire

PNA Pharmacy Questionnaire Suffolk Health and Wellbeing Board Soar Beyond are supporting Suffolk County Council to produce their 2018 Pharmaceutical Needs Assessment. We are undertaking a survey of all pharmacy contractors in Suffolk. We would therefore be grateful if you could spend a few minutes to complete the questions below. If you prefer, you may complete the survey online at: https://www.surveymonkey.co.uk/r/_SUFFOLK_Pharmacy_Contractor Please complete the questionnaire by 31 March 2017, and return any completed paper copies of the survey in the enclosed reply-paid envelope. Premises Details

Contractor Code (ODS Code) Name of contractor (i.e. name of individual, partnership or

company owning the pharmacy business) Trading Name Address of Contractor pharmacy Is this pharmacy one which is entitled to Pharmacy Access Yes No Scheme payments? Possibly Is this pharmacy a 100-hour pharmacy? Yes No Does this pharmacy hold a Local Pharmaceutical Services (LPS) contract? (i.e. it is not the ‘standard’ Pharmaceutical Yes No Services contract) Is this pharmacy a Distance Selling Pharmacy? (i.e. it cannot provide Essential Services to persons present at or in the Yes No vicinity of the pharmacy) Pharmacy email address Pharmacy telephone Pharmacy fax (if applicable) Pharmacy website address (if applicable) Can the LPC store the above information and use it to contact Yes No you?

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Core Hours of Opening

Day Open from To Lunchtime (from - to) Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Total Hours of Opening Day Open from To Lunchtime (from - to) Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Consultation Facilities There is a consultation area (meeting the criteria for the Medicines Use Review service) (tick as appropriate) None Available (including wheelchair access) On premises Available (without wheelchair access) Planned within the next 12 months Other (please specify) Where there is a consultation area, is it a closed room? Yes No

In the consultation area During consultations are there Close to the consultation area hand-washing facilities None

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Patients attending for consultations have access to toilet Yes No facilities

The pharmacy has access to an off-site consultation area (i.e. one which the former Yes No PCT or NHS England local team has given Off-site consent for use) The pharmacy is willing to undertake consultations in patient’s home / other suitable Yes No site

Access to the Pharmacy Ramped access Yes No The pharmacy is accessible Wide door Yes No for wheelchair users Electric door Yes No

Languages spoken (in addition to English)-please list

IT Facilities in the Pharmacy Electronic Prescription Service Release 2 enabled Yes No NHS mail being used Yes No NHS Summary Care Record enabled Yes No Up to date NHS Choice entry Yes No

Healthy Living Pharmacies (HLP) Select the one that applies. The pharmacy has achieved HLP status The pharmacy is working toward HLP status The pharmacy is not currently working toward HLP status

Services Does the pharmacy dispense appliances? Yes, all types Yes, excluding stoma appliances Yes, excluding incontinence appliances Yes, excluding stoma and incontinence appliances Yes, just dressings Other (please identify) None

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Advanced Services Does the pharmacy provide the following services? Intending to No - not Yes begin within intending to next 12 months provide Medicines Use Review Service New Medicine Service Appliance Use Review Service Stoma Appliance Customisation

Service Flu Vaccination Service NHS Urgent Medicine Supply

Advanced Service

Enhanced129 and Other Locally-Commissioned Services Which of the following services does the pharmacy provide, or would be willing to provide? Currently Currently Currently Willing to Not providing providing providing provide if able or under contract under under commissioned willing with the local contract contract with to NHS England with CCG Local provide Team Authority Anticoagulant Monitoring Service Anti-viral Distribution * Service* Care Home

Service Chlamydia * Testing Service* Chlamydia Treatment * Service* Contraceptive service (not * EC)*

129 ‘Enhanced Services’ are those commissioned by the local NHS England Team. CCGs and Local Authorities can commission Other Locally-Commissioned Services that are equivalent to the Enhanced Services, but for the purpose of developing the PNA are called ‘Other Locally-Commissioned Services’ not ‘Enhanced Services’

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Currently Currently Currently Willing to Not providing providing providing provide if able or under contract under under commissioned willing with the local contract contract with to NHS England with CCG Local provide Team Authority Disease-Specific Medicines Management Service: Allergies Alzheimer’s /

dementia Asthma CHD COPD Depression Diabetes type I Diabetes type II Epilepsy Heart Failure Hypertension Parkinson’s

disease Other (please state) Emergency Contraception * Service* Emergency

Supply Service Gluten Free Food Supply

Service (i.e. not via FP10) Home Delivery Service (not * appliances)* Independent Prescribing Service If currently providing an Independent Prescribing Service, what therapeutic areas are covered? Language

Access Service Medication

Review Service

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Compliance Support Service Minor Ailment

Scheme MUR Plus/Medicines * Optimisation Service* If currently providing an MUR Plus/ Medicines Optimisation Service, what therapeutic areas are covered? Needle and Syringe

Exchange Service Obesity Management - * adults* Obesity Management - * children Not Dispensed

Scheme On Demand Availability of

Specialist Drugs Service Out-of-Hours

Services Patient Group Direction Service Name the medicines covered by the Patient Group Direction Phlebotomy * Service* Prescriber

Support Service Schools Service Screening Service Alcohol Cholesterol Diabetes

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Other (please state) Seasonal Influenza * Vaccination Service* Other vaccinations* Childhood * vaccinations Hepatitis (at risk workers or * patients) HPV * Travel vaccines *

Other (please state) Sharps Disposal * Service* Stop Smoking

Service Supervised Administration Service Supplementary Prescribing Service If so, what therapeutic areas are covered? Vascular Risk Assessment * Service (NHS Health Check)* * These services are not listed in the Advanced and Enhanced Services Directions, and so are not ‘Enhanced Services’ if commissioned by the local NHS England Team. The local NHS England Team may commission them on behalf of the CCG or Local Authority, but when identified in the PNA they will be described as ‘Other Locally- Commissioned Services’ or ‘Other NHS Services’

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Non-commissioned Services Does the pharmacy provide any of the following?

Collection of prescriptions from GP practices Yes No Delivery of dispensed medicines – free of charge on request Yes No Delivery of dispensed medicines – selected patient groups - Yes No list criteria Delivery of dispensed medicines – selected areas – list areas Yes No Delivery of dispensed medicines – chargeable Yes No Monitored Dosage Systems – free of charge on request Yes No Monitored Dosage Systems – chargeable Yes No

Is there a particular need for a locally-commissioned service in your area? Yes No If so, what is the service requirement and why?

Details of the Person Completing this Questionnaire - if questions arise Contact name Contact telephone number

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Appendix E: Dispensing GP practice questionnaire

Suffolk Pharmaceutical Needs Assessment 2018: Dispensing Practice Questionnaire What is this questionnaire about? As you may be aware, Suffolk County Council has a statutory duty to develop and publish a revised Pharmaceutical Needs Assessment (PNA) at least every three years. The next PNA will be published by 1 April 2018. Work has been underway on the PNA for some time and I would like to update you on the process so far. A core Steering Group was established to lead the work. The Steering Group includes LMC representation. Information is being collated on the population and health needs of each of the localities in Suffolk. Alongside that, information is being collated on the pharmaceutical services that are currently available. The conclusions will start to be drawn leading to the draft PNA for consultation being completed by October 2017. All dispensing doctor contractors will be asked to comment as part of the consultation. To help us form a clearer picture of the services available to patients living in the more rural parts of the Health and Wellbeing Board area who may have problems accessing services, please can you answer the following questions by Friday 31 March 2017 at the latest, so that the information can be incorporated into the needs assessment. Who should complete the questionnaire? This questionnaire should be completed by the Dispensing Doctor / Practice Manager. The responses should be about the dispensary. If your practice offers dispensing services from several branch surgeries, please complete a return for each dispensing site. If you do not wish to answer a question for any reason, then leave it blank. If you would like to complete this online please go to: https://www.surveymonkey.co.uk/r/suffolk_dispensing

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1) Is the practice participating in the current Dispensary Services Quality Scheme (DSQS)? Yes No 2) What are the total number of hours each week when dispensing is available by the practice? ______2a) Do the dispensary hours match the surgery hours? If not what are the gaps. Yes No - the following hours are the gaps: ______3) Do you provide any of the following services outside the dispensing service? Please tick those that apply DRUMs NHS Health Checks commissioned by Public Health Sexual health services Home delivery (if yes, please complete sections 8-10) Compliance aids, please list ______Other, please specify ______No additional services 4) Is your practice planning to provide any of the following services? Please tick those that apply DRUMs NHS Health Checks commissioned by Public Health Sexual health services Home delivery Compliance aids, please list ______Other, please specify ______No Only complete the following questions if you provide a delivery service or are planning to do so in the future 5) Please tell us about your delivery / planned delivery service We currently offer a delivery service We plan to offer a delivery service from______(provide date / timescale if known) 6) If you provide a delivery service, or are planning to do so in the future, which of these groups do you offer free delivery to? Please select all that apply. All patients Older people Disabled people People that are housebound Nursing home residents Residential home residents Those specifically requesting delivery Requested by GP Other (please specify) ______

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7) Where do you offer, or plan to offer, free delivery to? Please select one answer. Any eligible patient within our practice inner boundary Any eligible patient within a smaller area than our practice boundary Any eligible patient wherever they live 8) Do you place any other restrictions on the free delivery (or planned free delivery) of dispensed medicine? ______9) In your opinion is the current provision of pharmaceutical services in Suffolk: Excellent Very Good Good Adequate Poor Very Poor 10) In your opinion do patients in your area have adequate access to the following services commissioned from, or provided by, some community pharmacies? Please select one answer for each row. Yes No Over the counter medicines Access to local services: • supply of emergency contraception • support to stop smoking • chlamydia screening and treatment • immediate access to emergecy medicines 11) Do you feel that local provision would be improved by: (select all that apply) Yes No Increasing the number of pharmaceutical service providers locally Increasing the opening hours of existing local pharmaceutical service providers Other (please specify) ______12) If your practice could be commisionned to provide similar services to those currently available under the additional services sections of the community pharmacy contract, would you be prepared to do so? Yes (please specify the type of service) ______No Thank you for your time completing this questionnaire Your answers to this survey are private and will be kept in line with the Data Protection Act. Please return any completed paper copies of the questionnaire in the reply-paid envelope enclosed.

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Appendix F: Commissioner questionnaire

PNA Commissioner Questionnaire Suffolk Health and Wellbeing Board Soar Beyond are supporting Suffolk County Council to produce their 2018 Pharmaceutical Needs Assessment. We are undertaking a survey of all commissioners who are responsible for commissioning services from community pharmacies in Suffolk (even if they do not commission services currently). We would therefore be grateful if you could spend a few minutes to complete the questions below. If you prefer, you may complete the survey online at https://www.surveymonkey.co.uk/r/_SUFFOLK_Commissioner Please complete the questionnaire by 31 March 2017. Which of the following services do you commission or may be considering commissioning from local community pharmacies? Currently Currently Currently May consider Not able or providing providing providing commissioning willing to under contract under under commission with the local contract contract NHS England with CCG with Local Team Authority Anticoagulant Monitoring Service Anti-viral Distribution Service Care Home Service Chlamydia Testing Service Chlamydia Treatment Service Contraceptive service (not EC)

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Which of the following services do you commission or may be considering commissioning from local community pharmacies? Currently Currently Currently May consider Not able or providing providing providing commissioning willing to under contract under under commission with the local contract contract NHS England with CCG with Local Team Authority Disease Specific Medicines Management Service: Allergies Alzheimer’s/ dementia Asthma CHD COPD Depression Diabetes type I Diabetes type II Epilepsy Heart Failure Hypertension Parkinson’s disease Other (please state) Emergency Contraception Service Emergency

Supply Service Gluten Free Food Supply

Service (i.e. not via FP10) Home Delivery Service (not appliances) Independent Prescribing Service Language

Access Service Medication

Review Service

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Currently Currently Currently May consider Not able or providing providing providing commissioning willing to under contract under under commission with the local contract contract NHS England with CCG with Local Team Authority Medicines Assessment and

Compliance Support Service Minor Ailment

Scheme MUR Plus/ Medicines

Optimisation Service Needle and Syringe

Exchange Service Obesity management adults Obesity management- children Not Dispensed

Scheme On Demand Availability of

Specialist Drugs Service Out of Hours

Services Patient Group Direction Service (name the medicines covered by the Patient Group Direction) Phlebotomy

Service Prescriber

Support Service Schools Service

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Which of the following services do you commission or may be considering commissioning from local community pharmacies? Currently Currently Currently May consider Not able or providing providing providing commissioning willing to under contract under under commission with the local contract contract NHS England with CCG with Local Team Authority Screening Service: Alcohol Cholesterol Diabetes Gonorrhoea H. pylori HbA1C Hepatitis HIV Other (please state) Seasonal Influenza

Vaccination Service

Which of the following services do you commission or may be considering commissioning from local community pharmacies? Currently Currently Currently May consider Not able or providing providing providing commissioning willing to under contract under under commission with the local contract contract NHS England with CCG with Local Team Authority Other Vaccinations: Childhood vaccinations Hepatitis (at risk workers or patients) HPV Travel vaccines Other (please state) Sharps Disposal

Service

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Service Supervised Administration Service Vascular Risk Assessment

Service (NHS Health Check)

Details of the Person Completing this Questionnaire - if questions arise Contact name Contact telephone number

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Appendix G: PNA Project Plan

Jul 2017 Oct 2017Oct Jan 2017 Apr 2017 Jan 2018 Feb 2017 Mar 2017 Jun 2017 Feb 2018 Mar 2018 Dec 2017 Nov 2017 May2017 Aug 2017 Sept 2017 Steering Group and Project Governance established • First Steering Group meeting conducted • Project plan shared and agreed

• Communications Plan and Terms of reference agreed • PNA localities agreed • Questionnaire templates shared and agreed Stakeholders identified • For dissemination of information • Contact details obtained and initial contact made • Share project plan and brief on what the pharmacy needs assessment is • Questionnaire circulation (e.g. patient groups, specific populations etc.) Data collection and stakeholder engagement • Distribution of pharmacy user questionnaire • Public webinar on the Suffolk PNA and feedback on current service provision • Distribution of pharmacy contractor questionnaire • Community pharmacy contractor webinar for engagement on PNA, feedback on current

service provision and future needs • Distribution of commissioner questionnaire • Distribution of dispensing doctor questionnaire • GP dispensing doctor webinar for engagement on PNA, feedback on current service provision and future needs Information collection • Review of planning and strategy documents e.g. JSNA, Housing Strategy, Commissioning Intentions, STP etc. • List of all providers of pharmaceutical services from NHS England e.g. pharmaceutical contractors, internet pharmacies etc. • List of any commissioned services by CCG e.g. minor ailment services, out of hours, local hospitals • Information from Public Health Team e.g. demographics, specific health needs and any commissioned services

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017

Jul 2 Oct 2017Oct Jan 2017 Apr 2017 Jan 2018 Feb 2017 Mar 2017 Jun 2017 Feb 2018 Mar 2018 Dec 2017 Nov 2017 May2017 Aug 2017 Sept 2017

Deadline for questionnaires to be completed Service provision mapping (maps to be agreed in advance with Suffolk CC) • Pharmacies categorised by type • Travel access • Opening times

• Demographics maps • Lifestyle maps • Housing developments • Pharmacies who provide advanced services including bordering areas • Pharmacies who provide enhanced/locally-commissioned services including bordering areas Second Steering Group Meeting • Agree data received as final (check no planned revisions in next 4 months)

• Commence consultation planning process • Share feedback from questionnaires Collation and analysis of all information collected • Triangulate information received from duplicate sources, identifying and resolving any

discrepancies and gaps (e.g. opening hours’ information) • Comparison with information and recommendations from 2015 PNA Review and identify gaps in service, current and future • Identification of any changes (service provision, current and future needs etc.)

• Identify potential gaps • Make recommendations Draft PNA completed • Complete the draft assessment, clearly articulating any gaps and propose recommendations • Compile specific consultation questions • Highlight any specific communities and/or providers identified as potentially affected by the analysis of gaps Third Steering Group Meeting • Agree Draft PNA for consultation • Agree consultation plan

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Jul 2017 Oct 2017Oct Jan 2017 Apr 2017 Jan 2018 Feb 2017 Mar 2017 Jun 2017 Feb 2018 Mar 2018 Dec 2017 Nov 2017 Aug 2017 May2017 Sept 2017

Consultation period (9 Oct-10 Dec 2017) • Host Draft PNA on Suffolk County Council website • ‘Advertise’ consultation through existing consultation channels (e.g. communications and engagements leads with CCGs, HealthWatch, Patient Participation Groups etc.) • Send links (or copies) of Draft PNA to consultees as required by the Pharmaceutical Regulations (listed within the Communications Plan), and any specific individuals, populations and stakeholder groups identified within the stakeholder engagement undertaken in the Spring • Hold direct stakeholder engagement events (face to face meetings, webinars, online surveys etc.) with specific populations/providers identified as potentially affected by the analysis of gaps Consultation findings report • Collate, analyse and make recommendations on the consultation responses • Share with Steering group Fourth Steering Group Meeting • Receive consultation findings report

• Agree and finalise proposed changes necessary to the draft PNA • Agree Final PNA Final draft PNA • Produce final document in pdf format and upload to Suffolk County Council website • Send links (or copies) of Final PNA to consultees as required by the 2013 Pharmaceutical Regulations (listed within the Communication and Engagement Plan), and any specific individuals, populations and stakeholder groups identified within the stakeholder engagement undertaken in the Spring PNA published ahead of time (due 23 Mar 2018) Maintenance through production of supplementary statements, annual review and provision of specialist advice • Ongoing receipt of changes in provision and needs from NHS England, LPC, Commissioners, Suffolk County Council Public Health Onwards • Analysis of changes and production of Supplementary Statements- provided to Suffolk

County Council to host on their website

• Annual refresh of the PNA to ensure validity of (for example) commissioned services and providers • Ongoing Pharmaceutical expertise provided to Suffolk County Council Public Health team in relation to the PNA

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Appendix H: Consultation plan and list of stakeholders

Stakeholder Engagement during PNA production Questionnaire (Pharmacy PNA Briefing Steering group contractor/ Public/ Disp Role letter sent representation practice/ (Y/N) (Y/N) Commissioner) LPC Representative Y Y Pharmacy questionnaire Dispensing GP practice LMC Representative Y Y questionnaire Pharmacy questionnaire, Pharmacy contractors on Suffolk pharmaceutical list Y Y public questionnaire egulations 2013, 2013, egulations Appliance contractors on Suffolk pharmaceutical list Y Y Pharmacy questionnaire Dispensing GP practice

Dispensing GP practices on Suffolk pharmaceutical list Y Y questionnaire, public questionnaire Local Healthwatch Y Y Public questionnaire Section 8 Pharmacy Local Professional Network Lead Y Y N/A

Suffolk Cancer Support Group N N Public questionnaire

West Suffolk Chronic Pain Group N N Public questionnaire

Ipswich Hospital User Group N N Public questionnaire Senior Development Officer, N N Public questionnaire Consultee as required by R Pharmaceutical Consultee as required Community Action Suffolk

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Sandy Park Traveller Site N N Public questionnaire

Kessingland Traveller Site N N Public questionnaire

Ace Advocacy Database members N N Public questionnaire

Public libraries in Suffolk N N Public questionnaire

Community centres in Suffolk N N Public questionnaire

Age UK Suffolk N N Public questionnaire Section 8

Ipswich Hospital NHS Trust N N Public questionnaire

West Suffolk NHS Foundation Trust N N Public questionnaire Public questionnaire, JSNA Programme Manager Y Y commissioner questionnaire Head of Knowledge and Information, Public Health, Suffolk Public questionnaire, Y Y Council commissioner questionnaire

Consultee as required by Pharmaceutical Regulations 2013, 2013, by Regulations Pharmaceutical Consultee as required Public questionnaire, Assistant Director of Public Health, Suffolk Council Y Y commissioner questionnaire

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Stakeholder Engagement during PNA production Questionnaire (Pharmacy PNA Briefing Steering group contractor/ Public/ Disp Role letter sent representation practice/ (Y/N) (Y/N) Commissioner) Engagement Lead West Suffolk CCG Y Y Public questionnaire Head of Medicines Management, Ipswich and East Suffolk Public questionnaire, Y Y CCG commissioner questionnaire

Public questionnaire, Chief Operating Officer, Ipswich and East Suffolk CCG N N commissioner questionnaire Public questionnaire, Chief Operating Officer, West Suffolk CCG N N commissioner questionnaire Public questionnaire, Head of Medicines Management, West Suffolk CCG Y Y commissioner questionnaire Public questionnaire, Medicines Management, Great Yarmouth and Waveney CCG Y Y commissioner questionnaire Senior Communications and Engagement Manager, Great Y Y Public questionnaire Yarmouth and Waveney CCG

Regulations 2013, Section 8 Regulations Section 2013, Community Engagement Group, West Suffolk CCG N N Public questionnaire Community Engagement Partnership, Ipswich and East Suffolk Y Y Public questionnaire Consultee as required by Pharmaceutical Consultee as required CCG Healthwatch Norfolk N N Public questionnaire

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Appendix I: Travel access to pharmacies and dispensing GP practices for Suffolk residents

Driving Times Public Transport Times Walking Times

Tuesday Tuesday Average Off-Peak Peak 9am to 1pm 1pm to 5pm

Number % Number % Number % Number % Number % Number %

0-5 425,793 57.4% 450,373 60.7% 401,213 54.1% 102,515 13.8% 104,909 14.1% 80,485 10.8% minutes 0-10 662,212 89.2% 676,039 91.1% 648,386 87.4% 448,796 60.5% 459,673 62% 283,788 38.3% minutes 0-15 730,566 98.5% 735,713 99.2% 725,420 97.8% 587,867 79.2% 596,694 80.4% 437,189 58.9% minutes 0-20 740,491 99.8% 741,895 100.0% 739,087 99.6% 630,618 85% 636,803 85.8% 514,010 69.3% minutes 0-25 741,895 100.0% 741,895 100.0% 741,895 100.0% 660,116 89% 667,885 90% 546,206 73.6% minutes 0-30 741,895 100.0% 741,895 100.0% 741,895 100.0% 680,421 91.7% 688,875 92.9% 559,090 75.4% minutes >30 741,895 100.0% 741,895 100.0% 741,895 100.0% 741,895 100% 741,895 100% 741,895 100% minutes

Note: Public transport times represent the best-case scenario for journeys by bus, train or coach on a Tuesday, 9am to 1pm and 1pm to 5pm.

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Appendix J: New housing and care homes planned in Suffolk Babergh locality Potential new housing growth (greater than 250 dwellings planned) No of planned Site name Area Comments dwellings (2017-21) Chilton Woods Sudbury 1,050 Allocated but no permission Direction of growth identified, no East of Sudbury Sudbury 500 allocation or permission Wolsey Grange Ipswich Fringe 475 Permitted Brantham Brantham 320 Permitted regeneration Former HMS Shotley 285 Permitted Ganges Hadleigh East Hadleigh 250 Allocated but no permission TOTAL 2,880

Forest Heath locality Potential new housing growth (greater than 250 dwellings planned). No of planned Site name Area Comments dwellings (2017-21) Land west of Not expected to commence Mildenhall 1,300 Mildenhall within three years Land east of Red Lodge 382 Permitted Red Lodge Proposed allocation (not Land at North Lakenheath 375 expected to commence within Lakenheath three years) Proposed allocation (not Land north of Red Lodge 350 expected to commence within Acorn Way three years)

Elms Road Red Lodge 295 Almost built out

TOTAL 2,702

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Waveney locality Potential new housing growth (greater than 250 dwellings planned). No of planned Site name Area Comments dwellings (2017-21) Kirkley Waterfront and Limited delivery within three Sustainable Kirkley 1,440 years Urban Neighbourhood TOTAL 1,440

Suffolk Coastal locality Potential new housing growth (greater than 250 dwellings planned). No of planned Site name Area Comments dwellings (2017-21) Adastral Park Martlesham 2,000 Current application Land north of Walton High Felixtowe 400 Allocated but not permitted Street Land off Howett St Martin 360 Allocated but not permitted Way, Trimley Western part of Purdis Farm 300 Permitted Trinity Park TOTAL 3,060

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Mid Suffolk locality Potential new housing growth (greater than 250 dwellings planned). No of planned Site name Area Comments dwellings (2017-21) Chilton Leys Stowmarket 800 Allocated and permission in part Former Masons Great 426 Full permission Cement Works Blakenham Ashes Farm Stowmarket 400 Allocated but no permission Union Road Stowmarket 300 Allocated but no permission Needham Needham 266 Full permission Chalks Market Castleton Way Eye 250 No permission TOTAL 2,442

Ipswich locality Potential new housing growth (greater than 250 dwellings planned). No of planned Site name Area Comments dwellings (2017-21) Ipswich Garden Allocated in total, part Not provided 3,500 Suburb permission Not expected to commence Helena Road Not provided 566 within three years Cranfields Mills Not provided 337 Permitted, almost complete Hayhill Road / Woodbridge Not provided 281 Permitted, almost complete Road Not expected to complete within Island Site Not provided 271 three years Regatta Quay Not provided 267 117 already built TOTAL 5,222

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St Edmundsbury locality Potential new housing growth (greater than 250 dwellings planned). No of planned Site name Area Comments dwellings (2017-21) North West Bury Bury St 950 Permitted St Edmunds Edmunds Bury St Westley (West) 450 Allocated, no permission Edmunds Bury St Moreton Hall 500 Permitted and underway Edmunds South East Bury Bury St 1,250 Allocated, no permission St Edmunds Edmunds NE Bury St Bury St 1,250 Allocated, no permission Edmunds Edmunds Bury St Station Hill 300 Permitted Edmunds NW Haverhill Haverhill 1,150 Permitted NE Haverhill Haverhill 2,500 Allocated TOTAL 8,350

New care home schemes planned in Suffolk New home Proposed Net Address Comments location development change Land adjacent to Three storey Commenced Beccles 54 Beccles Station Nursing Home 2nd Sept 2011 Grandora Hall Lane, Two-storey care Commenced Blundeston 4 Blundeston home annexe 30th April 2013 NR32 5BL Carlton Hall, Commenced Single-storey Carlton Chapel Road 4th Oct 2013 extension 4 Colville Carlton Colville

NR33 8AT Applicant Extension of time for confirmed Lound Hall further three years. commitment to Nursing Home, Two-storey proceed and is Lound Church Lane 17 extension and actively Lound refurbishment of pursuing NR32 5LH existing building funding options

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New home Proposed Net Address Comments location development change Land adjacent to Care home, plus Travelodge Hotel Lowestoft staff and ancillary 80 Leisure Way accommodation Lowestoft Former Roman Hill Primary Care home and School Commenced Lowestoft community well- 80 Love Road July 2013 being centre Lowestoft NR32 2NY 60A Kirkley Cliff ‘Change of Use’ Separate from Road from part Lowestoft -1 adjacent 'Orme Lowestoft Residential Care House' NR33 0DF Home to Flat Broadland Residential Care Extension and Home, alteration of Lowestoft 5 Borrow Road residential care Lowestoft NR32 home 3PW Applicant confirmed Oaklands Two-storey intention to Lowestoft Road Reydon extension to create 8 implement Reydon IP18 additional bedrooms permission 6RD before lapse date Care home (part of HealthEast Former Playing a ‘mixed use’ have Field scheme including confirmed Reydon Nightingale residential, healthy 60 commitment to Avenue living centre, delivery but no Reydon retail/commercial timescales units) Closure of SCC beds due to Stradbroke Court Beccles/ relocation to Britten / Blyford Court / -109 Lowestoft Court (former The Dell Roman Hill Primary School Great Heath Mildenhall Primary School, 60 Mildenhall

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New home Proposed Net Address Comments location development change Chalkstone Haverhill Middle School, 60 Haverhill Glastonbury Bury St Court, Bury St 80 Edmunds Edmunds Land east of 66 Great Cats Lane, Great 45 Cornard Cornard Change of use from care home to four units of sheltered Approved Ipswich Redan Street 4 accommodation for October 2012 the learning disabled Care home and Approved Ipswich Aster Road community well- 80 January 2013 being centre Mixed-use St George’s Approved redevelopment of Ipswich House, St 35 September site including very Matthew's Street 2013 sheltered housing Business Care home and Development Approved July Ipswich community well- 80 Land, 2013 being centre Ravenswood Total 646 Committed

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Appendix K: Results of the dispensing GP practice questionnaire Q1. Is the practice participating in the current Dispensary Services Quality Scheme (DSQS)?

Yes No

96%

Q2. What are the total number of hours each week when dispensing is available by the practice?

34.5 (2) 38 47.5 (2) 49 (2) 50 (4) 52.5 (3) 53 53.5 (2) 54 55 56 63.5 90.5

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Q3. Do the dispensary hours match the surgery hours? If not, what are the gaps?

27%

Yes

73%

Q4. Do you provide any of the following services outside the dispensing service?

50% No additional services 50% 0%

0% Other, please specify 50% 50%

0% Compliance aids, please list 11% 89%

0% Don't know Home delivery 18% 82% No Yes 0% Sexual health services 7% 93%

NHS Health Checks commissioned by 0% 0% Public Health 100%

0% DRUMs 4% 96%

0% 20% 40% 60% 80% 100% 120%

Dosette boxes (10) OTC products available to purchase Stoma, catheter, lymphoedema, managed repeats

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Q5. Is your practice planning to provide any of the following services? Please answer yes or no and provide further details where requested

20% No additional services 40% 40%

50% Other, please specify 50% 0%

17% Compliance aids (please list) 17% 67%

13% Don't know Home delivery 38% 50% No Yes 20% Sexual health services 20% 60%

NHS Health Checks commissioned by 0% 0% Public Health 100%

0% DRUMs 10% 90%

0% 20% 40% 60% 80% 100% 120%

Dosette boxes (2) Delivery service

Q6. Please tell us about your delivery / planned delivery service

We currently offer a delivery service

We plan to offer a delivery service from (provide date/timescale if known)

93%

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Q7. If you provide a delivery service, or are planning to do so in the future, which of these groups do you offer free delivery to? Please select all that apply

Other 13%

Requested by GP 75%

Those specifically requesting delivery 56%

Residential home residents 25%

Nursing home residents 19%

People that are housebound 69%

Disabled people 63%

Older people 56%

All patients 19%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Sheltered housing People in villages

Q8. Where do you offer, or plan to offer, free delivery to? Please select one answer

13%

Any eligible patient within our practice inner boundary 13% Any eligible patient within a smaller area than our practice boundary Any eligible patient wherever they live

74%

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Q9. Do you place any other restrictions on the free delivery (or planned free delivery) of dispensed medicine?

No (8) Controlled drugs unless GP requested We only deliver on Tuesdays and Need to be at home to receive Fridays medication

Q10. In your opinion is the current provision of pharmaceutical services in Suffolk:

45% 40% 40% 35% 30% 25% 25% 20% 20% 15% 15% 10% 5% 0% 0% 0% Excellent Very Good Good Adequate Poor Very Poor

Q11. In your opinion do patients in your area have adequate access to the following services commissioned from, or provided by, some community pharmacies?

Local Services - immediate access to 14% emergecy medicines 86%

Local Services - Chlamydia screening 15% and treatment 85%

5% Local Services - support to stop smoking No 95% Yes

Local Services - supply of emergency 9% contraception 91%

5% Over the counter medicines 95%

0% 20% 40% 60% 80% 100%

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Q12. Do you feel that local provision would be improved by: (select all that apply)

89% Increasing the opening hours of existing local pharmaceutical service providers 11%

No Yes

95% Increasing the number of pharmaceutical service providers locally 5%

0% 20% 40% 60% 80% 100%

Q13. If your practice could be commissioned to provide similar services to those currently available under the additional services sections of the community pharmacy contract, would you be prepared to do so?

35%

No Yes

65%

Anything (4) Asthma Care home service Weight management (2) Stop smoking (2) Emergency contraception

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Appendix L: Results of the commissioner questionnaire Q1. Which of the following services do you commission or may be considering commissioning from local community pharmacies?

67% 33% Contraceptive service (not 0% EHC) 0% 0%

33% 0% Chlamydia Treatment 67% Service 0% 0%

33% 0% Not able or willing to Chlamydia Testing Service 67% commission 0% May consider commissioning 0% Currently commissioned under contract with LA 50% 50% Currently commissioned under contract with CCG Care Home Service 0% 0% Currently commissioned under contract with NHSE 0%

50% 50% Antiviral Distribution Service 0% 0% 0%

50% 50% Anticoagulant Monitoring 0% Service 0% 0%

0% 20% 40% 60% 80%

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Q2. Which of the following services do you commission or may be considering commissioning from local community pharmacies?

50% Patient Group Direction… 100% Schools Service 100% Prescriber Support Service 50% Phlebotomy Service 50% Out of Hours Services 50% 50% On Demand Availability of… 50% Obesity management… 50% 50% Needle and Syringe… 50% MUR Plus/Medicines… 50% 100% Minor Ailment Scheme 50% Medicines Assessment… 50% 100% Medication Review Service 100% Not able or willing to commission Language Access Service 50% Independent Prescribing… 50% May consider commissioning 100% Home Delivery Service… Currently commissioned under 100% contract with LA Gluten Free Food Supply… Currently commissioned under 33% Emergency Hormonal… contract with CCG 50% Currently commissioned under Parkinson’s disease 50% contract with NHSE 50% Hypertension… 50% 50% Heart Failure… 50% 50% Epilepsy management… 50% 50% Diabetes type II… 50% 50% Diabetes type I… 50% 50% Depression management… 50% 50% COPD management service 50% 50% CHD management service 50% 50% Asthma management… 50% 100% Alzheimers/dementia… 100% Allergy management service

0% 20% 40% 60% 80% 100%

Out-of-hours pharmacies are Antibiotics for chlamydia commissioned on Christmas day and Easter Sunday in selected pharmacies

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Q3. Which of the following services do you commission or may be considering commissioning from local community pharmacies?

50% 50% HIV screening service 0% 0% 0%

50% 50% Hepatitis screening service 0% 0% 0%

50% 50% HbA1C screening service 0% 0% 0%

50% Not able or willing to commission 50% H. pylori screening service 0% 0% May consider commissioning 0% Currently commissioned under 50% contract with LA Gonorrhoea screening 50% 0% Currently commissioned under service contract with CCG 0% 0% Currently commissioned under contract with NHSE 50% 50% Diabetes screening service 0% 0% 0%

100% Cholesterol screening 0% 0% service 0% 0%

50% 50% Alcohol screening service 0% 0% 0%

0% 20% 40% 60% 80% 100%

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Q4. Which of the following services do you commission or may be considering commissioning from local community pharmacies?

50% Vascular Risk Assessment 0% 50% Service (NHS Health Check) 0% 0%

100% Supplementary Prescribing 0% Service (what therapeutic 0% areas are covered?) 0% 0%

50% Supervised Administration 0% 50% Service 0% 0%

50% 0% Stop Smoking Service 50% 0% 0% Not able or willing to commission 50% 0% Sharps Disposal Service 50% May consider commissioning 0% 0% Currently commissioned under 100% 0% contract with LA Travel vaccines 0% 0% Currently commissioned under 0% contract with CCG 50% 50% Currently commissioned under HPV 0% contract with NHSE 0% 0%

100% Hepatitis (at risk workers or 0% 0% patients) 0% 0%

50% 50% Childhood vaccinations 0% 0% 0%

0% Seasonal Influenza 0% 0% Vaccination Service 0% 100%

0% 20% 40% 60% 80% 100%

Flu vaccination is currently a national advanced service

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Appendix M: Results of the public questionnaire Q1. How often have you visited your pharmacy in the last six months?

60%

53%

50% 45%

40%

Once a week or more 30% Once a month 24% Once every few months 21% Once in six months 20% 18% 14% 12% 12% 10%

0% For yourself: For someone else:

Q2. Do you have a regular or preferred pharmacy that you visit?

23%

No Yes

77%

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Q3. When considering a choice of pharmacy, which of the following helps you choose?

Other 10%

Friendly staff 44%

Expertise / quality of advice 32%

They offer a specific service 10%

Efficiency 40%

Close to work 17%

Close to GP surgery 55%

Close to home 69%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Location (18) Opening hours (5) Parking (4) Reliability (4) Service (10)

Q4. Who would you normally visit the pharmacy for? Please select all that apply

Other 1%

All of the above 2%

Someone you are a carer for 7%

Neighbour / friend 6%

A family member 54%

Yourself 89%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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Q5. If you visit a pharmacy on behalf of someone else, please give a reason why

Other 21%

All of the above 10%

Access (for example disability / transport) 15%

Most convenient 51%

Opening hours of the pharmacy not suitable 15% for patient

0% 10% 20% 30% 40% 50% 60%

Carer (12) Child (21) Efficiency (15) Elderly (5) Transport (2)

Q6. How would you usually travel to the pharmacy?

70% 62% 60%

50%

40% 31% 30%

20%

10% 3% 2% 2% 0% 0% Car Taxi Public Walk Bicycle Other Transport

Wheelchair Powered wheelchair (2) Mobility scooter Suffolk Coastal’s connecting services transport system

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Q7. On average, how long does it take you to travel to a pharmacy?

Don't know 0%

Varies 2%

Over 30 minutes 1%

16-30 minutes 16%

0-15 minutes 80%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Q8. Do you have any difficulties when travelling to a pharmacy?

Yes No

92%

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Q9. If you answered yes to the previous question, please select one of the following reasons:

60%

50% 48%

40%

30% 27%

20% 14% 11% 10%

0% Location of pharmacy Parking difficulties Public Transport Other avaliability

Disability related issues (2) Condition of pavements Parking (3) Transport on weekends

Q10. What is the most convenient day for you to visit a pharmacy?

60%

50% 50%

40% 38%

30%

20%

10% 10%

1% 1% 0% Monday to Friday Saturday Sunday Varies Don't know

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Q11. When do you prefer to visit a pharmacy?

Don't know 2%

Varies 50%

Late evening (after 8pm) 0%

Early evening (6pm-8pm) 7%

Afternoon (2pm-6pm) 13%

Lunchtime (12pm-2pm) 5%

Morning (8am-12pm) 24%

0% 10% 20% 30% 40% 50% 60%

Q12. How regularly do you typically buy an over the counter (i.e. non- prescription) medicine from a pharmacy?

Never 13%

Yearly 28%

Monthly 47%

Fortnightly 7%

Weekly 5%

Daily 0%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

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Q13. Which of the following pharmacy services are you aware that a pharmacy may provide?

Other 3%

Emergency supply of prescription medicines 36%

Supervised consumption of methadone and 22% buprenorphine

Immediate access to specialist drugs e.g. 16% palliative care medicines Sexual health services (chlamydia testing / treating, condom distribution, emergency 26% contraception) Stopping smoking / nicotine replacement 47% therapy Detailed discussion with your pharmacist – how you take your existing and newly 63% prescribed medicines

Flu vaccination services 60%

Disposal of unwanted medicines 72%

Buying over the counter medicines 84%

Advice from your pharmacist 80%

Needle exchange 30%

Home delivery and prescription collection 63% services

Repeat dispensing services 85%

Dispensing of prescriptions 96%

0% 20% 40% 60% 80% 100% 120%

Cholesterol testing Dosette box filling Health checks Medication reviews (2) Monitored dosage MUR Palliative care Specialist medications Travel vaccinations

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Q14. What services would you like to see provided by your local pharmacy?

7% Emergency supply of prescription medicines 1% 91%

Supervised consumption of methadone and 35% 12% buprenorphine 53%

Immediate access to specialist drugs 25% 5% e.g.palliative care medicines 70%

Sexual health services (chlamydia testing / 23% treating,condom distribution, emergency 11% contraception) 66%

Stopping smoking / nicotine replacement 21% 7% therapy 72%

Detailed discussion with your pharmacist how 7% to take your existing and newly prescribed 3% medicines 90% 10% Flu vaccination services 7% 82%

4% Disposal of unwanted medicines 1% 94%

5% Buying over the counter medicines 1% 94%

5% Advice from your pharmacist 1% 94%

35% Needle exchange 12% 53%

Home delivery and prescription collection 11% 5% services 84%

5% Repeat dispensing services 1% 94%

6% Dispensing of prescriptions 1% 93%

0% 10%20%30%40%50%60%70%80%90%100%

Don't know No Yes

Travel clinic INR Testing Weight management Health assessments (2) Minor injuries treatment (2) Mental health

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Q15. Is there a consultation room available where you cannot be overheard in the pharmacy you normally visit?

27%

Yes No

73%

Q16. Have you ever used an internet pharmacy to obtain prescription medicines?

10%

Yes No

90%

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Q17. If yes, how would you rate your overall satisfaction with the internet pharmacy?

10%

51%

34%

Excellent Good Fair Poor

Q18. Any other comments you would like to make about your pharmacy? Bad location (2) Bad opening hours Consultation room too small Convenient (3) Efficient (2) Excellent service (12) Excellent staff (7) Friendly staff (9) Good advice Good location Helpful staff (6) Inappropriate pharmacist Inconvenient Inefficient (6) Lacking Need more helpful staff (2) Needs better access Poor parking Too busy (5) Valuable resource (9)

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Demographic analysis of respondents Sex (%) Male Female Prefer not to say 28.2% 71.5% 0.3% Age (%) Prefer not U16 16-24 25-34 35-44 45-54 55-64 65-74 75+ to say 0% 4.9% 10.3% 12.9% 23.9% 19.5% 17.5% 10.8% 0.3% Do you consider yourself disabled (%)? Yes No 19.1% 80.9% Ethnic origin (%) Asian / Asian British – Bangladeshi 0% Asian / Asian British – Indian 0.5% Asian / Asian British – Pakistani 0.3% Asian / Asian British – Chinese 0.8% Black / African / Caribbean / Black British – African 0.3% Black / African / Caribbean / Black British – 0.3% Caribbean Black / African / Caribbean / Black British – Other 0.3% White – English / Welsh / Scottish / Northern Irish / 91.5% British White – Irish 0.3% White – Gypsy or Irish Traveller 0% Mixed/multiple ethnic groups – White and Black 0.5% Caribbean Mixed/multiple ethnic groups – White and Black 0% African Mixed/multiple ethnic groups – White and Asian 0.3% Other ethnic group (please state) 0.8% Prefer not to say 2.9% Your religion or belief (%): Baha'i 0.3% Buddhist 0.5% Christian 48.1% Hindu 0% Jain 0% Jewish 0% Muslim 0.5% Sikh 0.5% No religion or belief 41.5% Prefer not to say 5.2% Other 3.3%

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Appendix N: Results of the pharmacy contractor questionnaire Responses to Q1-3 are omitted as they relate specifically to the individual contractor Q4. Is there a consultation area (meeting the criteria for the Medicines Use Review service)?

None 0%

Planned within next 12 month 0%

Available (without wheelchair access) 18%

Available (including wheelchair access) 82%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Q5. Where there is a consultation area, is it a closed room?

Yes No

100%

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6. During consultations are there hand-washing facilities?

In the consultation area Close to the consultation area 36% 56% None

Q7. Do patients attending for consultations have access to toilet facilities?

32%

Yes No

68%

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Q8. Off-site consultation areas

The pharmacy is willing to undertake 37% consultations in patient’s home / other suitable site 63%

The pharmacy has access to an off-site 98% consultation area (i.e. one which the former PCT or NHSE has given consent for use) 2%

0% 20% 40% 60% 80% 100%

No Yes

Q9. The pharmacy is accessible for wheelchair users

100% 93% 90%

80%

70% 64% 60% 52% 48% 50%

40% 36%

30%

20%

10% 7%

0% Ramped access Wide door Electric door

Yes No

Q10. Languages spoken (in addition to English) Polish (9) Chinese (4) French (2) Hindi (3) Spanish (3) Portuguese (3) Russian (3) Punjabi (7) Gujarati (3) Czech German Hungarian

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Q11. IT facilities in the pharmacy

12% Up to date NHS Choice entry 88%

10% NHS Summary Care Record enabled 90%

57% NHS mail being used 43%

Electronic Prescription Service Release 2 2% enabled 98%

0% 20% 40% 60% 80% 100%

No Yes

Q12. Please read the following statements and select the one that applies

The pharmacy is not currently working toward 5% HLP status

The pharmacy is working towards HLP status 75%

The pharmacy has achieved HLP status 20%

0% 10% 20% 30% 40% 50% 60% 70% 80%

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Q13. Does the pharmacy dispense appliances?

100% 90% 90%

80%

70%

60%

50%

40%

30%

20%

10% 3% 0% 2% 2% 2% 2% 0% Yes, all Yes, Yes, Yes, Yes, just None Other types excluding excluding excluding dressings stoma incontinence stoma and appliances appliances incontinence appliances

Any appliance dispensed via FP10

Q14. Does the pharmacy provide the following services?

120% 98% 98% 100% 81% 80% 70% 62% 60% 47%

40% 31% 22% 23% 22% 20% 15% 7% 10%9% 0%2% 2%0% 0% Medicines use New medicine Appliance use Stoma Flu NHS Urgent review service review service appliance vaccination Medicine services customisation service Supply service Advanced Service

Yes Intending to begin within next 12 months No - not intending to provide

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Q15. Which of the following services does the pharmacy provide, or would be willing to provide?

12% 75% Contraceptive service (not EHC) 2% 3% 8%

10% 37% Chlamydia treatment service 25% 5% 23%

7% 17% Chlamydia testing service 39% 8% 29%

33% 64% Care home service 2% 2% 0%

15% 85% Anti-viral distribution service 0% 0% 0%

10% 90% Anticoagulant monitoring service 0% 0% 0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Not able or willing to provide Willing to provide if commissioned Currently providing under contract with Local Authority Currently providing under contract with CCG Currently providing under contract with the local NHS England Team

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Q16. Which of the following Disease Specific Medicines Management Services does the pharmacy provide, or would be willing to provide?

28% Independent prescribing 72% service 5% Home delivery service (not 2% 74% appliances) 3% 16% Gluten free food supply 13% 2% 83% service (i.e. not via FP10) 2% 3% 55% Emergency supply service 2% 14% 26% 3% Emergency hormonal 29%34% contraception service 5% 29% 12% Parkinson’s disease 86% 2% Not able or willing to provide 10% Hypertension 88% 2% 10% Willing to provide if Heart failure 88% commissioned 2% 12% Currently providing under Epilepsy 86% 2% contract with Local Authority

8% 88% Diabetes type II 2% Currently providing under 2% contract with CCG 8% 88% Diabetes type I 2% 2% Currently providing under 12% contract with the local NHS Depression 86% 2% England Team

8% 88% COPD 2% 2% 10% CHD 88% 2% 9% 84% Asthma 2% 5% 12% 85% Alzheimers / dementia 2% 2% 14% Allergies 85% 2%

0% 20% 40% 60% 80% 100%

NHS Travel vaccination – currently Delivery is provided by the company provide private service Will consider any service that there is a demand for

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Q17. Which of the following services does the pharmacy provide, or would be willing to provide?

11% 89% Independent prescribing service 0% 0% 0%

3% 94% Home delivery service (not appliances) 3% 0% 0%

8% 92% Gluten free food supply service (i.e. not via 0% FP10) 0% 0%

0% 69% Emergency Supply service 0% 9% 23%

3% 35% Emergency Hormonal Contraception service 38% 3% 22%

0% 20% 40% 60% 80% 100%

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Q18. Which of the following services does the pharmacy provide, or would be willing to provide?

6% 87% MUR Plus / Medicines Optimisation Service 0% 2% 6%

4% 96% Minor Ailment Scheme 0% 0% 0%

4% 89% Medicines Assessment and Compliance 0% Support Service 2% 6%

0% 63% Medication Review Service 4% 6% 28%

17% 81% Language Access Service 0% 2% 0%

0% 20% 40% 60% 80% 100%

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Q19. Which of the following services does the pharmacy provide, or would be willing to provide?

5% 69% Patient Group Direction Service 5% 5% 15%

44% 51% Out of Hours Services 0% 2% 4%

14% On Demand Availability of Specialist Drugs 86% 0% Service 0% 0%

4% 91% Not Dispensed Scheme 0% 2% 4%

9% 91% Obesity management - children 0% 0% 0%

7% 93% Obesity management - adults 0% 0% 0%

23% 41% Needle and Syringe Exchange Service 18% 2% 16%

0% 20% 40% 60% 80% 100%

Chlamydia treatment (6) Flu vaccinations (6) UTI – Trimethoprim; contraceptives; Influenza vaccinations Champix

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Q20. Which of the following services does the pharmacy provide, or would be willing to provide?

14% 86% Schools Service 0% 0% 0%

18% 82% Prescriber Support Service 0% 0% 0%

30% 70% Phlebotomy Service 0% 0% 0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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Q21. What Screening Services services does the pharmacy provide, or would be willing to provide?

11% 27% Seasonal influenza vaccination service 7% 5% 50%

19% 81% HIV

19% 81% Hepatitis

7% 91% HbA1C 2%

9% 91% H. pylori

16% 82% Gonorrhoea 2%

4% 91% Diabetes 2% 4%

7% 89% Cholesterol 2% 2%

9% 91% Alcohol

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

Flu service (3)

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Q22. What other vaccination services does the pharmacy provide?

18% 79% Travel vaccines

25% 74% HPV 2%

22% 76% Hepatitis (at risk workers or patients) 2%

21% 79% Childhood vaccinations

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

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Q23. Which of the following services does the pharmacy provide, or would be willing to provide?

18% 79% Supplementary Prescribing Service 0% 2% 2%

18% 75% Vascular Risk Assessment Service (NHS 2% Health Check) 0% 5%

9% 12% Supervised Administration Service 33% 9% 38%

2% 21% Stop Smoking Service 33% 9% 35%

19% 50% Sharps Disposal Service 14% 5% 12%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

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Q24. Does the pharmacy provide any of the following?

Monitored Dosage Systems - chargeable 84% 16%

Monitored Dosage Systems - free of charge 5% on request 95%

Delivery of dispensed medicines - chargeable 92% 8%

Delivery of dispensed medicines - selected 38% areas (list areas below) 63%

Delivery of dispensed medicines - selected 43% patient groups (list criteria below) 57%

Delivery of dispensed medicines - free of 13% charge on request 88%

Collection of prescriptions from GP practices 0% 100%

0% 20% 40% 60% 80% 100%

No Yes

Delivery to housebound patients (7) Local deliveries to elderly

Q25. Is there a particular need for a locally commissioned service in your area? If so, what is the service requirement and why

49% No 51% Yes

Payment for deliveries and dosettes (6) Minor ailment (9) Monitored dosage (2) Delivery service (2) Elderly patient support

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Appendix O: Equality Impact Assessment The characteristics protected by the Equality Act are: Disability Age Sex (gender) Gender reassignment Marriage/civil partnership Pregnancy/maternity Race Sexual orientation Religion/belief By law we must have due regard to the need to: (a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Act (b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it (c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it. In effect, this means that we need to ensure that our policies and services are fair, equitable and proportionate and where possible mitigate against any adverse impacts on people from the different protected characteristics. In addition to the above protected characteristics you should consider the impact of living in a rural area as part of this assessment. Where people live is not a characteristic protected by law, but for an organisation such as Suffolk County Council it is good practice to consider carefully how location may affect people’s experience of a policy or service. The Rural-Urban definition (DEFRA) introduced in 2004, defines the rurality of very small census-based geographies. Census Output Areas forming settlements with populations of over 10,000 (which are urban), while the remainder are defined as one of three rural types: town and fringe, village or hamlet and dispersed. Details Service or policy title Suffolk HWB Pharmaceutical Needs Assessment 2018 Lead officer (responsible for the policy or Natacha Bines service/function) Officers carrying out the screening (at Natacha Bines least one must have done EIA training and recommended that an officer responsible for the policy or service/function is involved in the screening) Is this new or a revision? (If revision Revision state when previous EIA undertaken) Is this the first time this policy or Second iteration – first undertaken in function has been screened? (If not, 2015 indicate which iteration this is – 2, 3, etc.) Date of completing this EIA screening 31 March 2017

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Description What exactly is proposed? (Describe the service/policy and the changes that are being planned) An assessment of pharmaceutical service provision in the Suffolk HWB area Why? (Give reasons why these changes are being introduced) Required by Pharmaceutical Regulations 2013 What will the effect of the changes be? (Describe which people, communities, localities etc. will be affected by the changes) All residents of Suffolk HWB area How will it be implemented? (Describe the decision-making process, timescales, process for implementation) Used by NHS England to determine access to pharmaceutical services provision. Used by Suffolk HWB in conjunction with the JSNA to plan services to improve health and wellbeing When is it due to start? (Planned start of new/revised policy/service) 1 April 2018 Any other relevant details A Pharmaceutical Needs Assessment was published in 2015 by Suffolk CC on behalf of Suffolk HWB. An EIA was undertaken as part of this process.

Data about the user population What is the demographic profile of the community you are serving? (A brief overview of quantitative data used and qualitative research undertaken, including customer surveys and focus groups, plus links to reports, local or national data that you have used) Health and Wellbeing data for Suffolk population, access to pharmaceutical services provision in Suffolk, public views on pharmaceutical services provision for a public questionnaire. What is the profile of your service users by protected characteristics? (Where this data is available. If it is not currently available state any plans to collect this in future) Pharmacy user survey, pharmacy contractor survey, GP dispensing practice survey, pharmacy complaints received by NHS England (February 2017-April 2017). Consultation on the Draft 2018 Pharmaceutical Needs Assessment.

Implications for communities and workforce Disability What is the impact on people with a disability (including children with additional needs) and what Positive impact evidence do you have? (If you do not believe there is any impact describe why not)

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Implications for communities and workforce Disability The 2018 PNA takes account of health needs and how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and How does it have a positive availability to pharmaceutical services in Suffolk will or negative impact? be assessed and options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board. Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision, mitigate any adverse impact affecting people with a disability. 2018 PNA reviewed or further promote positive by Steering Group (with Healthwatch representation), impact? and signed off by HWB Board. Age What is the impact on people of different ages and what evidence do you have? Positive impact (If you do not believe there is any impact describe why not) The 2018 PNA takes account of health needs and how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and availability to pharmaceutical services in Suffolk will How does it have a positive be assessed and options considered to improve or negative impact? access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board. With regard to age, the 2018 PNA is considering in particular the health of pre-school age children and over 65s. Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision for mitigate any adverse impact all ages. 2018 PNA reviewed by Steering Group (with or further promote positive Healthwatch representation), and signed off by HWB impact? Board.

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Implications for communities and workforce Sex (gender) What is the impact on people of different genders and what evidence do you Positive impact have? (If you do not believe there is any impact describe why not) The 2018 PNA takes account of health needs and how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and How does it have a positive availability to pharmaceutical services in Suffolk will or negative impact? be assessed and options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board. Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision for mitigate any adverse impact all sexes. 2018 PNA reviewed by Steering Group or further promote positive (with Healthwatch representation), and signed off by impact? HWB Board. Gender reassignment What is the impact on people who have undergone gender reassignment (i.e. transgender people) and Positive impact what evidence do you have? (If you do not believe there is any impact describe why not) The 2018 PNA takes account of health needs and how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and How does it have a positive availability to pharmaceutical services in Suffolk will or negative impact? be assessed and options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board

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Implications for communities and workforce Gender reassignment Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision for mitigate any adverse impact people with gender reassignment. 2018 PNA or further promote positive reviewed by Steering Group (with Healthwatch impact? representation), and signed off by HWB Board. Marriage/civil partnership What is the impact on people who are married or in a civil partnership and what evidence do you have? (If Positive impact you do not believe there is any impact describe why not) The 2018 PNA takes account of health needs and how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and How does it have a positive availability to pharmaceutical services in Suffolk will or negative impact? be assessed and options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision to mitigate any adverse impact married or civil partnership populations. 2018 PNA or further promote positive reviewed by Steering Group (with Healthwatch impact? representation), and signed off by HWB Board. Pregnancy/maternity What is the impact on people who are pregnant women or those with a young child and what Positive impact evidence do you have? (If you do not believe there is any impact describe why not)

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Implications for communities and workforce Pregnancy/maternity The 2018 PNA takes account of health needs and how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and How does it have a positive availability to pharmaceutical services in Suffolk will or negative impact? be assessed and options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board. Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision for mitigate any adverse impact pregnant people. 2018 PNA reviewed by Steering or further promote positive Group (with Healthwatch representation), and signed impact? off by HWB Board. Race What is the impact on people from different races or ethnic groups and what evidence do you have? (If Positive impact you do not believe there is any impact describe why not) The 2018 PNA takes account of health needs and how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and How does it have a positive availability to pharmaceutical services in Suffolk and or negative impact? options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision for mitigate any adverse impact race. 2018 PNA reviewed by Steering Group (with or further promote positive Healthwatch representation), and signed off by HWB impact? Board.

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Implications for communities and workforce Sexual orientation What is the impact on people according to their sexual orientation and what evidence do you have? (If Positive impact you do not believe there is any impact describe why not) How does it have a positive The 2018 PNA takes account of health needs and or negative impact? how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and availability to pharmaceutical services in Suffolk will be assessed and options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board. Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision for mitigate any adverse impact sexual orientation. 2018 PNA reviewed by Steering or further promote positive Group (with Healthwatch representation), and signed impact? off by HWB Board. Religion/belief What is the impact on people according to their religion or belief and what evidence do you have? (If Positive impact you do not believe there is any impact describe why not) How does it have a positive The 2018 PNA takes account of health needs and or negative impact? how differing population groups' needs may vary. It will then consider any actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and availability to pharmaceutical services in Suffolk will be assessed and options considered to improve access and availability. Persons with this characteristic will be specifically targeted within the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board

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Implications for communities and workforce Sexual orientation Do you expect the extent of the impact to be low, Low medium or high? What could be done to 2018 PNA to note any gaps in access or provision for mitigate any adverse impact people of any particular religion or belief. 2018 PNA or further promote positive reviewed by Steering Group (with Healthwatch impact? representation), and signed off by HWB Board. Rurality Where people live is not a characteristic protected by law: but for an organisation such as Suffolk County Council it is good practice to consider carefully how location may affect people’s experience of a policy or service. What is the impact on people according to whether they live in an urban or rural environment and what Positive impact evidence do you have? (If you do not believe there is any impact describe why not) Effect of rurality specifically reviewed through the needs assessment and travel access maps. Any How does it have a positive gaps or improvements in access will be stated in the or negative impact? 2018 PNA, to open up applications from providers to fill. Do you expect the extent of the impact to be low, Low medium or high? 2018 PNA to note any gaps in access or provision for What could be done to mitigate any adverse impact people living in rural areas. 2018 PNA reviewed by or further promote positive Steering Group (with Healthwatch representation), impact? and signed off by HWB Board

Recommendation to Policy Clearing House In your opinion, should a full Equality Impact Assessment be carried out for this policy or function? Why? A full EIA involves consultation with all stakeholders: actual and potential service users, staff and management likely to be delivering the policy, partner agencies and Trade Unions. For guidance contact the Equalities Lead Adviser.

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Abbreviations AF – Atrial Fibrillation AIMp – Association of Independent Multiple pharmacies AURs – Appliance Use Reviews BME – Black and Minority Ethnic Groups BSA – Business Services Authority CCA – Company Chemists Association CCGs – Clinical Commissioning Groups CHD – Coronary Heart Disease CMO – Chief Medical Officer COPD – Chronic Obstructive Pulmonary Disease CPCF – Community Pharmacy Contractual Framework CVD – Cardiovascular Disease DACs – Dispensing Appliance Contractors DH – Department of Health DRUM – Dispensing Review of Use of Medicines DSQS – Dispensing Services Quality Scheme EHC – Emergency Hormonal Contraception EPS – Electronic Prescription Services ESA – Employment Support Allowance ESPS – Essential Small Pharmacy Scheme GP – General Practitioner HIV – Human Immunodeficiency Virus HLP – Healthy Living Pharmacy HMP – Her Majesty’s Prison HSCIC – Health and Social Care Information Centre HWB – Health and Wellbeing Board IMD – Index of Multiple Deprivation JSNA – Joint Strategic Needs Assessment KSI – Killed or Seriously Injured LA – Local Authority

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LMC – Local Medical Committee LPC – Local Pharmaceutical Committee LPN – Local Professional Network LPS – Local Pharmaceutical Service LSOAs – Lower-layer Super Output Areas MIU – Minor Injuries Unit MUR – Medicines Use Review NHS – National Health Service NMS – New Medicine Service NUMSAS – NHS Urgent Medicines Supply Advanced Service ONS – Office for National Statistics OTC – Over the Counter PCT – Primary Care Trust PhAS – Pharmacy Access Scheme PHE - Public Health England PhIF – Pharmacy Integration Fund PNA – Pharmaceutical Needs Assessment PSNC – Pharmaceutical Services Negotiating Committee QOF – Quality and Outcomes Framework RAF – Royal Air Force SAC – Stoma Appliance Customisation SHA – Strategic Health Authority STI – Sexually Transmitted Infection TIA – Transient Ischaemic Attack USAF – United States of America Air Force YLL – Years of Life Lost YOI – Young Offenders Institute

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Map A: Suffolk pharmacies and population density by output area

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Map B: Suffolk pharmacy and dispensing GP practice locations

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Map C: GP practice locations in Suffolk (April 2017)

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Map D: Ipswich GP practices (April 2017)

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Map E: Suffolk GP practices by locations and codes (April 2017)

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GP Practice Name GP Practice Name D83001 Constable Country Rural Medical Practice D83044 Stow Health D83002 Alexandra Rd Surgery D83045 Lakenheath Surgery D83003 Wickhambrook Surgery D83046 Two Rivers Medical Centre D83004 Felixstowe Road Medical Practice D83047 Rosedale Surgery D83005 Angel Hill Surgery D83048 Grove Medical Centre D83006 Bildeston Health Centre D83049 Little St John Street Surgery D83007 Ixworth Surgery D83050 Deben Road Surgery D83008 Burlington Road Surgery D83051 The Derby Road Practice D83009 Beccles Medical Centre D83053 Saxmundham Health Centre D83010 Longshore Surgeries D83054 The Peninsula Practice D83011 Bridge Road Surgery D83055 Woolpit Health Centre D83012 Clements and Christmas Maltings Surgery D83056 Hawthorn Drive Surgery D83013 The Guildhall and Barrow Surgery D83057 Framfield House Surgery D83014 The Long Melford Practice D83058 The Norwich Road Surgery D83015 Howard House Surgery D83059 Barrack Lane Medical Centre D83016 Victoria Road Surgery D83060 Hardwicke House Group Practice D83017 Country Practice D83061 Wickham Market Medical Centre D83018 Market Cross Surgery D83062 Forest Surgery D83019 Mendlesham Health Centre D83064 Glemsford Surgery D83020 The Holbrook and Shotley Practice D83067 Oakfield Surgery

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

GP Practice Name GP Practice Name D83021 Haverhill Medical Practice D83069 Fressingfield Medical Centre D83022 Sole Bay H/C D83070 Stanton Surgery D83023 High Street Surgery D83073 Orchard Street Medical Practice - Blue D83024 Ivry Street Medical Practice D83074 Orchard Medical Practice D83026 Framlingham Surgery D83075 Siam Surgery D83027 Orchard House Surgery D83076 Clare Guildhall Surgery D83028 Leiston Surgery D83078 White House Surgery D83029 The Rookery Medical Centre D83079 Combs Ford Surgery D83030 Kirkley Mill Health Centre D83080 Martlesham Surgery D83033 Botesdale Health Centre D83081 Haven Health D83034 Bungay Medical Centre D83082 Walton Surgery D83035 Cutlers Hill Surgery D83084 The Birches Medical Centre D83036 Church Farm Surgery D83608 Andaman Surgery D83037 Hadleigh Health Centre D83610 Swan Surgery D83038 Mount Farm Surgery D83615 The Barham & Claydon Surgery D83039 The Chesterfield Drive Practice D83619 Westwood Surgery D83040 Victoria Surgery Y00774 Brandon Medical Practice D83041 Debenham Surgery Y01794 Ravenswood Medical Practice D83043 Eye Health Centre

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Map F: Suffolk 1.6 km buffers around pharmacies

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map G: Suffolk pharmacy opening hours

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map H: Suffolk pharmacies and deprivation by LSOA

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map I: Suffolk pharmacies and Black and Minority Ethnic levels by LSOA

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Map J: Suffolk off-peak drive time to nearest pharmacy

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map K: Suffolk peak drive time to nearest pharmacy

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map L: Suffolk public transport time to nearest pharmacy, Tuesday, 9am to 1pm

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map M: Suffolk public transport times to nearest pharmacy, Tuesday, 1pm to 5pm

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map N: Suffolk walking times to nearest pharmacy

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

Map O: Suffolk pharmacies, dispensing practices and Standard Mortality Ratio (SMR) for all- cause mortality under 75 (2010-2014 inclusive), July 2017

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Draft Pharmaceutical Needs Assessment for Suffolk Health and Wellbeing Board

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