Salford Pharmaceutical Needs Assessment
Published 1st April 2017 Document control
Authors: Name Title/Responsibility Sarah Cannon PH Strategic Manager Liza Scanlon Senior Intelligence Analyst Siobhan Farmer Public Health Consultant
Reviewers: This document has been reviewed by the following:
Name Date Version Primary Care Pharmacy 18/11/2016 Version 2.4 contractors Greater Manchester LPC 18/11/2016 Version 2.4 Salford Healthwatch 21/11/2016 Version 2.4
NHS England 18/11/2016 Version 2.4 Salford CCG 18/11/2016 Version 2.4 Neighbouring CCGs 21/11/2016 Version 2.4 Salford Royal Foundation 21/11/2016 Version 2.4 Trust Salford council 18/11/2016 Version 2.4
Approval: This document was approved by:
Name Date Version Salford Health and Wellbeing 28/03/2017 Version 3 Board (HWB) Table of Contents 1 Foreword and Executive Summary...... 1 1.1 Introduction...... 1 1.2 How the assessment was undertaken...... 2 1.3 Results ...... 2 1.4 Consultation ...... 3 1.5 Conclusions...... 3 2 Purpose & Background of the Pharmaceutical Needs Assessment (PNA) ...... 5 2.1 Purpose...... 5 2.2 General background...... 5 2.3 Legislative background...... 5 2.4 Wider context ...... 7 3 Pharmaceutical services...... 7 3.1 Scope of the PNA...... 7 3.2 Definition of Pharmaceutical Services...... 7 3.2.2 Pharmaceutical Services Contractual arrangements...... 9 3.2.3 Locally commissioned services ...... 11 3.3 Non-NHS commissioned added value community pharmacy services...... 12 3.4 Hospital pharmacy...... 12 3.5 What is excluded from scope of the assessment?...... 13 3.5.1. Prison pharmacy...... 13 3.5.2 Practice pharmacists ...... 13 3.6 PNA review process...... 13 3.7 Matters for consideration...... 14 3.8 Process followed for developing the PNA ...... 16 3.9 PNA consultation...... 17 3.10 Localities for the purpose of the PNA...... 19 4 Health and Wellbeing in Salford...... 20 4.1 Salford profile ...... 20 4.2 Salford demographics ...... 20 4.2.1 Age of Population ...... 20 4.2.2 Demography considerations for pharmacies ...... 22 4.3 Life Expectancy...... 23 4.3.1 Contribution to Life Expectancy Gap by Disease and gender ...... 25 4.3.2 Deaths from all causes in Salford ...... 26 4.3.3 Cancer ...... 27 4.3.4 Circulatory disease ...... 27 4.3.5 Smoking...... 28 4.4 Ethnicity...... 28 4.4.1 Ethnicity considerations for pharmacy ...... 29 4.5 Deprivation ...... 30 4.6 Disability...... 32 4.7 Conclusion on population demography...... 33 5 Locally Identified Health Need...... 35 5.1 The Salford Locality Plan ...... 35 5.2 Integrated Care in Salford ...... 40 5.3 Community pharmacy and Salford’s Strategic Priorities ...... 41 5.4 Neighbourhood Health Priorities ...... 42 5.5 Levels of service provided – overview...... 42 5.5.1 Essential Services ...... 42 5.5.2 Advanced Services ...... 43 5.5.3 Locally commissioned services ...... 43 5.5.4 Public health services ...... 43 5.5.5 Public Health campaign plans in Pharmacies for 2017 ...... 44 5.6 Community pharmacy services and their impact upon the Locality Plan ...... 46 6 Current Pharmacy Provision and Services ...... 52 6.1 100 hour pharmacies...... 52 6.2 Change in number of Pharmacy contractors from 2014...... 52 6.3 Dispensing activity...... 53 6.3.1 Dispensing of Salford prescriptions ...... 53 6.4 Access to pharmacies by location...... 56 6.4.1 Pharmacies per head of population ...... 56 6.4.2 Pharmacies per locality...... 58 6.4.3 Pharmacies per Ward ...... 58 6.4.4 Correlation with GP practices ...... 60 6.4.5 Access issues described in the Pharmacy Contractor survey ...... 60 6.4.6 Neighbouring areas ...... 60 6.4.7 Travel times to Pharmacies ...... 62 6.4.8 Population density ...... 65 6.4.9 School locations and pharmacies ...... 65 6.5 Access to pharmacies by opening hours...... 66 6.5.1 Saturday Opening...... 66 6.5.2 Sunday Opening ...... 66 6.5.3 Bank Holiday Opening ...... 67 6.6 Access to locally commissioned services...... 67 6.7 Pharmacy contractor survey – summary of results ...... 69 6.8 Public Survey ...... 70 6.8.1 Summary of the Salford Public Survey ...... 70 6.9 Conclusion...... 72 7 Future Matters...... 73 7.1 Social and economic context...... 73 7.2 Housing and development...... 74 7.2.1 Salford developments ...... 74 7.2.2 Greater Manchester Spatial Framework (GMSF) and the Local Plan ...... 75 7.3 Primary care developments...... 76 7.3.1 Planned developments ...... 76 7.3.2 Extended access services ...... 76 7.4 Future directions of Community Pharmacy Services ...... 77 7.4.1 Healthy Living Pharmacies ...... 77 7.4.2 Department of Health Community Pharmacy Savings Proposals in 2016/17...... 79 8 Conclusions (for the purpose of Schedule 1 to the 2013 Regulations)...... 81 8.1 Current provision – essential and other relevant services...... 81 8.2 Essential services – gaps in provision...... 81 8.2.1 Access to essential services...... 81 8.2.2 Access to essential services during normal working hours ...... 81 8.2.3 Access to essential services outside normal working hours...... 81 8.2.4 Access to advanced services ...... 82 8.3 Future provision of essential services ...... 82 8.4 Improvements and better access – gaps in provision ...... 82 8.4.1 Access to advanced services – present and future circumstances ...... 82 8.4.2 Current and future access to advanced services...... 82 8.4.3 Current and future access to advanced services...... 83 8.5 Other NHS Services...... 83 8.6 How the assessment was carried out...... 83 8.7 Map of provision...... 83 9 List of Appendices...... 83 1 Foreword and Executive Summary
Pharmacists are very accessible healthcare professionals, generally well placed within the different areas of Salford and have good contact with the local population who place a huge amount of trust in them regarding their health. 84% of adults visit a pharmacy each year making them the most visited healthcare setting.
Older and frail people rely on their local chemist not just as a place to get medicines, but as somewhere they can go to for informal health advice and information. Pharmacies are playing an even bigger role in providing public health services, alongside their primary role of supplying medicines. Additional investment in community pharmacies could improve the prevention of disease and help take the strain off the NHS and social care. 1.1 Introduction From 1st April 2013, Salford Health and Wellbeing Board (HWB) has a statutory responsibility to publish and keep up-to-date a statement of the needs for pharmaceutical services for the population in its area, referred to as a ‘pharmaceutical needs assessment’ (PNA). The PNA aims to identify whether current pharmaceutical service provision meets the needs of the population. The PNA considers whether there are any gaps to service delivery and may be used to inform commissioners such as NHS England, clinical commissioning groups (CCG) and local authorities (LA), of the current provision of pharmaceutical services and where there are gaps in relation to the local health priorities. The PNA 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 amended. The relevant NHS England Local Area Team will then review the application and decide if there is a need for a new pharmacy in the proposed location. When making the decision NHS England is required to refer to the local PNA.
Salford is centrally located within the Greater Manchester conurbation. The city is served by a single clinical commissioning group, a single hospital foundation trust and a single city council, all with a good history of good partnership working.
Over 25% of young people under 16 in the city (12,175 children) live in poverty, but 5% of the population live in wards amongst the least deprived in the country. Nearly 13% of the working population is claiming out of work benefits. Salford also has some of the poorest health in England and, even within Salford itself, people die younger and experience higher levels of illness in some parts of the city than others. This makes it even more important that pharmaceutical services form an integral part of the local efforts to address these health needs.
1 1.2 How the assessment was undertaken This PNA describes the needs for the population of Salford. It considers current provision of pharmaceutical services across the eight neighbourhoods in the Salford HWB area:
Claremont and Weaste, East Salford, Eccles, Irlam and Cadishead, Ordsall and Langworthy, Swinton, Walkden and Little Hulton Worsley and Boothstown
The majority of available healthcare data is collected at ward level and wards are a well understood definition within the general population as they are used during local parliamentary elections. The PNA uses this data and combines it to reflect the eight “Neighbourhoods” in Salford.
The PNA includes information on:
Pharmacies in Salford and the services they currently provide, including dispensing, providing advice on health, medicines reviews and local public health services, such as smoking cessation, sexual health and support for drug users. Other local pharmaceutical services, including dispensing appliance contractors (DAC). Relevant maps relating to Salford and providers of pharmaceutical services in the HWB area. Potential gaps in provision that could be met by providing more pharmacy services, or through opening more pharmacies, and likely future needs.
The HWB established a steering group to lead a comprehensive engagement process to inform the development of the PNA. The group undertook a public survey and sought information from pharmacies, Salford City Council, NHS Salford CCG and NHS England. 1.3 Results Salford has 59 pharmacies providing a range of essential services, advanced services, enhanced services and locally commissioned services on behalf of Salford City Council, NHS Salford CCG, and NHS England. Of those pharmacies eight are 100 hour pharmacies.
There are no dispensing doctors within Salford, however, there is one dispensing appliance contractor (DAC) who provides access to dispensing and services associated with appliances for some patients; others will access these services through pharmacy contractors or through DACs elsewhere within England.
2 The PNA concluded no gaps in essential and advanced pharmaceutical services had been established. This is clearly demonstrated by the following points:
Salford has 25 pharmacies per 100,000 population, which is the same as the Greater Manchester average but higher than England average. The majority of residents live within 1.0 miles of a pharmacy. The majority of residents can access a pharmacy within 20 minutes walking and all residents can access a pharmacy within 20 minutes of public transport or driving. The location of pharmacies within each of the eight neighbourhoods and across the whole HWB area are well distributed throughout the densely populated areas of Salford. The number and distribution of pharmacies within each of the eight neighbourhoods and across the whole HWB area are accessible to all of the population within 2 km or 20 minutes public transport. The choice of pharmacies covering each of the eight neighbourhoods and the whole HWB area. Over 80% of patients surveyed thought the location of a pharmacy was important or very important. Only 8.8% of patients surveyed were not satisfied with the opening hours of the pharmacy they used. Salford has a choice of pharmacies offering a wide range of opening times including early mornings, evenings and weekends. Salford pharmacies offer a range of pharmaceutical services to meet the requirements of the population. 1.4 Consultation As part of the PNA process there is a statutory provision that requires consultation of at least 60 days to take place to establish if the pharmaceutical providers and services supporting the population in the HWB area are accurately reflected in the final PNA document. Salford’s HWB consultation ran from 18th November 2016 until 19th January 2017. The responses received were used to inform the final conclusions which were collated and are now published as part of this PNA.
There were a total of 11 responses to the consultation collected. The majority of respondents (91%) felt the PNA reflects an adequate assessment of pharmaceutical services in Salford and that it provides a satisfactory overview of the current and future pharmaceutical needs of the Salford population. Three responses felt that the current pharmaceutical provision and services in Salford are not adequate. 1.5 Conclusions Taking into account the totality of the information available, the HWB considered the location, number, distribution and choice of pharmacies covering each of the eight neighbourhoods including the whole of Salford’s HWB area providing essential and advanced services during the standard core hours to meet the needs of the population. The HWB has not received any significant information to conclude otherwise or any future specified circumstance that would alter that conclusion within the lifetime of this PNA. The outcome of national consultation on the savings proposals for community
3 pharmacies may impact upon the numbers and distribution of pharmacies within Salford, therefore, once any proposals are confirmed, the HWB will need to assess whether a PNA revision will be required as a result.
Based on the information available at the time of developing this PNA:
No current gaps in the need for provision of essential services during normal working hours have been identified. No current gaps in the provision of essential services outside normal working hours have been identified. No current gaps in the provision of advanced services have been identified. There are potential gaps in the provision of locally commissioned services in certain wards in the city. No gaps in the need for pharmaceutical services in specified future circumstances have been identified. However, the Department of Health has imposed a two year community pharmacy funding package which includes a reduction in funding in 2016/17. It is unclear at this point if the reduction in funding will have a impact on the number of pharmacies in Salford.
4 2 Purpose & Background of the Pharmaceutical Needs Assessment (PNA)
2.1 Purpose The purpose of this Pharmaceutical Needs Assessment (PNA) is to assess the provision of pharmaceutical services across Salford and ascertain whether this is appropriate to meet the needs of our population.
The PNA will also identify where pharmaceutical services are currently used to address the priorities outlined in Salford’s Locality Plan1, and where changes may be required to fill any identified gaps or deal with possible future health issues e.g. by improving services or access to them within a specific area. The PNA will be used by NHS England to inform decisions regarding applications to join Salford’s pharmaceutical list.
2.2 General background If a person (for instance, a pharmacist, GP etc.) wishes to provide NHS pharmaceutical services, they must apply to the NHS to be added to a pharmaceutical list. These lists are compiled and held by the NHS Commissioning Board (NHS England). This is known as the NHS ‘market entry’ system.
Under the new 2013 regulations2, those wishing to provide NHS pharmaceutical services must apply to NHS England to be included on a relevant list by proving they are able to meet a pharmaceutical need as set out in the relevant PNA. Exceptions to this include emerging needs not foreseen in the PNA and services on an internet or mail-only basis.
The first PNAs were published by PCTs in 2011 and must be refreshed every three years.
2.3 Legislative background The Health and Social Care Act 2012 transfers responsibility for the developing and updating of PNAs to local Health and Wellbeing Boards. The Health and Social Care Act 20123 established Health and Wellbeing Boards and transferred the responsibility to develop and update PNAs from PCTs to local Health and Wellbeing Boards. Responsibility for using PNAs as the basis for determining market entry to a pharmaceutical list transferred from PCTs to NHS England from 1st April 2013. It also
1 Salford Locality Plan http://www.salfordccg.nhs.uk/salford-locality-plan (accessed 12/10/2016)
2 The NHS (Pharmaceutical and Pharmaceutical Services) Regulations 2013 www.legislation.gov.uk/uksi/2013/349/pdfs/uksi_20130349_en.pdf (accessed 12/10/2016) 3 Health and Social Care Act, 2012 http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted (accessed 12/10/2016)
5 sets out the requirements of local Health and Wellbeing Boards to develop and update PNAs and gives the Department of Health powers to make Regulations.
Alongside this, the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013 set out the legislative basis for developing and updating PNAs. These regulations came into force on 1st April 2013 and replace the NHS (Pharmaceutical Services) Regulations 2012 and the NHS (Local Pharmaceutical Services etc.) Regulations 2006 as the new legislative regime which governs the arrangements for the provision of these services in England.
128A Pharmaceutical Needs Assessments
(1) Each Health and Wellbeing Board must in accordance with regulations: a. Assess needs for pharmaceutical services in its area; b. Publish a statement of its first assessment and of any revised assessment.
(2) The regulations must make provision: a. As to information which must be contained in a statement; b. As to the extent to which an assessment must take account of likely future needs; c. Specifying the date by which a Health and Wellbeing Board must publish the statement of its first assessment; d. As to the circumstances in which a Health and Wellbeing Board must make a new assessment.
(3) The regulations may in particular make provision: a. As to the pharmaceutical services to which an assessment must relate; b. Requiring a Health and Wellbeing Board to consult specified persons about specified matters when making an assessment; c. As to the manner in which an assessment is to be made; d. As to the matters to which a Health and Wellbeing Board must have regard when making an assessment.
Source: Information pack for HWBs – pharmaceutical needs assessments4
4 Pharmaceutical needs assessments – Information pack for local authority and Health and Wellbeing Boards https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/197634/Pharmaceutical _Needs_Assessment_Information_Pack.pdf (accessed 12/10/2016)
6 2.4 Wider context The Health and Social Care Act 20125 also amended the Local Government and Public Involvement in Health Act 20076 to include duties and powers for Health and Wellbeing Boards in relation to Joint Strategic Needs Assessments (JSNAs). The purpose of a JSNA is to improve health and wellbeing and reduce inequalities through a continuous process of strategic assessment of the local population. Recommendations are made based on intelligence and evidence to meet the specific health and social needs of the local area and address health inequalities. Salford’s JSNA is presented via Partner in Salford website (http://www.partnersinsalford.org/)
The preparation of the PNA should take account of the JSNA and other relevant strategies. However, the production of a PNA is a separate duty to that of the JSNA itself as it specifically informs the commissioning decisions of the local authority, local Clinical Commissioning Group (CCG), and NHS England. Therefore, although the PNA can be annexed to the JSNA, as a separate statutory duty, it cannot be subsumed as part of the JSNA.
3 Pharmaceutical services 3.1 Scope of the PNA The Regulations pertaining to PNAs limit the scope of this assessment. As such this document considers community pharmaceutical provision only.
This document does not cover pharmaceutical services for hospital patients, but will deal with community services that patients may utilise following discharge from Salford Royal Foundation Trust (SRFT) and other Trusts used by Salford residents. It also does not deal with the GP practice pharmacist scheme currently commissioned by Salford CCG.
HM Forest Bank prison is located within the Salford boundary. The pharmaceutical needs of prisoners from Salford are managed by providers contracting with the prison authorities and are commissioned by the Prison Service and so not considered herein. 3.2 Definition of Pharmaceutical Services
Section 1267 of the 2006 Act places an obligation on NHS England to put arrangements in place so that drugs, medicines and listed appliances ordered via NHS prescriptions can be supplied to people. This section also makes provision for the types of healthcare professional who are authorised to order drugs, medicines and listed appliances on an NHS prescription.
5 Health and Social Care Act 2012 http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted (accessed 15/11/2016) 6 Local Government and Public Involvement in Health Act 2007 http://www.legislation.gov.uk/ukpga/2007/28/contents (accessed 15/11/2016) 7 National Health Service Act 2006 http://www.legislation.gov.uk/ukpga/2006/41/contents (accessed 12/10/2016)
7 The following are included in a pharmaceutical list: 1. Pharmacy contractors: Healthcare professionals working for themselves or as employees who practice in pharmacy, the field of health sciences focusing on safe and effective medicines use; 2. Dispensing appliance contractors: Appliance suppliers are a specific sub-set of NHS pharmaceutical contractors who supply, on prescription, appliances such as stoma and incontinence aids, dressings, bandages, etc. They cannot supply medicines.
In addition to the above, there are two other types of pharmaceutical contractor: 1. Dispensing doctors: Medical practitioners authorised to provide drugs and appliances in designated rural areas known as ‘controlled localities’; 2. Local Pharmaceutical Services (LPS) contractors: Provide a level of pharmaceutical services in some Health and Wellbeing Board areas. A Local Pharmaceutical Service (LPS) contract allows NHS England to commission community pharmaceutical services tailored to specific local requirements. The contract provides flexibility to include within a single locally negotiated contract, a broader or narrower range of services (including services not traditionally associated with pharmacy) than is possible under national pharmacy arrangements. However, all LPS contracts must include an element of dispensing.
The definition of pharmaceutical services in relation to PNAs is given below:
Regulation Explanation Regulation 3(2): The pharmaceutical There are three types of services to which each pharmaceutical pharmaceutical service provided by needs assessment must relate are all pharmacy and dispensing appliance the pharmaceutical services that may contractors as outlined above. Directed be provided under arrangements made services are those services set out in by the NHS CB for: Secretary of State Directions to NHS (a) The provision of pharmaceutical England (medicines use reviews and services (including directed services) by NHS England commissioned enhanced a person on a pharmaceutical list. pharmaceutical services, such as services to care homes, language access and patient group directions).
(b) The provision of local An LPS contract allows NHS England pharmaceutical services under an LPS to commission community scheme (but not LP services which are pharmaceutical services tailored to not local pharmaceutical services). specific local requirements. “LP services” is a legal term. NHS England has powers to include in LPS contracts other NHS services or other wider services, such as services relating to the provision of education and training. However, including those other
8 services in an LPS contract turns those services into “LP services” but it does not turn them into “local pharmaceutical services”.
(c) The dispensing of drugs and For dispensing doctors, only the appliances by a person on a dispensing provision of those services set out in doctors list (but not other NHS services their pharmaceutical services terms of that may be provided under service (set out in the Schedules to the arrangements made by the NHS CB 2013 Regulations) is included within with a dispensing doctor). the definition of pharmaceutical services. Services such as GP enhanced services – either directed, such as childhood immunisation programmes or local, such as phlebotomy are not “pharmaceutical services”.
Source: Information pack for HWBs – pharmaceutical needs assessments8
3.2.2 Pharmaceutical Services Contractual arrangements The Community Pharmacy Contractual Framework (CPCF) is made up of three different service types. These are defined below. For a complete description please see Appendix 1.
Essential Services – which are set out in schedule 4 of the NHS Pharmaceutical and Local Pharmaceutical Services Regulations 2013 (the 2013 Regulations). All pharmacy contractors must provide the full range of essential services. These include:
Dispensing medicines and actions associated with dispensing (e.g. keeping records) Dispensing appliances Repeat dispensing Disposal of unwanted medicines Public health (Promotion of healthy lifestyles) Signposting Support for self-care
Advanced – Any contractor may choose to provide Advanced Services. There are pre-requisite conditions which need to be met in relation to compliance with their terms
8 Pharmaceutical needs assessments – Information pack for local authority and Health and Wellbeing Boards https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/197634/Pharmaceutical _Needs_Assessment_Information_Pack.pdf (accessed 12/10/2016)
9 of service, premises, training and submit a notification to the NHSCB; the services to which these applies includes:
Medicines Use Review (MURs) New Medicines Service (NMS)- Appliance Use Reviews (AUR) Stoma Appliance Customisation Service (SAC) Flu vaccination Urgent Medicine Supply Service – National Pilot commissioned from December 2016 to March 2018. Referrals from NHS 111 for urgent repeat medicines will be directed to community pharmacies who sign up to deliver the service.
At this time, a pharmacy may undertake up to 400 MURs per annum if they have informed the NHSCB of their intention to provide the service. If a pharmacy informs the NHSCB after 1 April but before the 1st October they may undertake up to a maximum of 200 MURs in that financial year.
Pharmacist(s) or a pharmacy employed nurse may also undertake a limited number of AURs linked to the dispensing of appliances and as many SACs as required.
Enhanced Services – Only those contractors directly commissioned by NHS England can provide these services.
The National Health Service Act 2006, the Pharmaceutical Services (Advanced & Enhanced Services) (England) Directions 2013, Part 4 14.-(1) list the enhanced services as:
Anticoagulant Monitoring Service Care Home Service Disease Specific Medicines Management Service Gluten Free Food Supply Service Independent Prescribing Service Home Delivery Service Language Access Service Medication Review Service Medicines Assessment and Compliance Support Service (this is more clinical than MURs) Minor Ailments Service Needle and Syringe Exchange Service On Demand Availability of Specialist Drugs Service Out of Hours Service Patient Group Direction Service (This would include supply of any Prescription Only Medicine via PGD) Prescriber Support Service Schools Service Screening Service
10 Stop Smoking Service Supervised Administration Service Supplementary Prescribing Service
The regulations are intended to be permissive and allow NHS England to interpret how any of the above Enhanced Services could be commissioned, its scope and method of delivery. NHS England local team may make arrangements for the provision of these services in its area.
Before 1 April 2013 PCTs commissioned enhanced services from pharmacy contractors in line with the needs of their population. From 1 April 2013 those enhanced services previously commissioned by PCTs transferred to CCGs and local authorities and are now termed as “locally commissioned services” because NHS Pharmaceutical Services Regulation only allow NHS England to commission Enhanced Services.
3.2.3 Locally commissioned services Community pharmacy contractors can also provide services commissioned by Local Authorities and CCGs and although they are not Enhanced Services (only NHS England can commission these), they mirror Enhanced Services that could be commissioned and therefore these need to be considered alongside Pharmaceutical Service provision in order that a full picture of current provision is identified across Salford.
However, a CCG or Local Authority can ask NHS England to commission a service listed in the Directions on their behalf, e.g. a CCG could request that a minor ailments service is commissioned as an Enhanced Service. It should be borne in mind that the cost of these services will be invoiced back to the CCG or Local Authority. Services commissioned in this way would be commissioned under pharmaceutical services and consequently the public health, NHS standard or local contracts would not be used.
Locally commissioned services within Salford may be reviewed within the planned lifespan of this document.
Community Pharmacy Services now commissioned by Salford CCG: Minor Ailment Scheme Palliative Care on demand drugs
These locally commissioned services are commissioned by Salford CCG; however the minor ailment service is currently managed by NHS England local team on behalf of Salford CCG. NHS England’s intention is for these to be reviewed before April 2017 and where the CCG wishes to retain this service provision they will be commissioned by the CCG using the national standard contracts as locally commissioned services. Due to the consultation times required for this document, it will not be possible to include the results of this review in this PNA.
11 Each service will require certain standards which should be met before they can be undertaken. These standards will be outlined in the individual service specifications and could include for example premises requirements or staff training. Staff training can be in the form of self -accreditation by the professional or staff may be required to attend specified training courses.
3.3 Non-NHS commissioned added value community pharmacy services Community pharmacy contractors also provide services directly to patients that are not commissioned by NHS England, Local Authorities or CCGs. For example some pharmacies provide a home delivery service, or blood pressure, cholesterol and/or blood glucose checks as an added value service to patients.
Community Pharmacists are free to choose whether or not to charge for these services as part of their business model.
3.4 Hospital pharmacy Patients in Salford have a choice of provider for their elective hospital services. 63% of patients registered with a Salford GP are treated at SRFT – the Trust situated within the Salford boundary.
Table 1: Hospital Choice for Salford registered patients for the year 2015/16 Table 1: Provider share Salford registered patients 2015/16 COUNT PERCENTAGE INPATIENT Elective Emergency Elective Emergency SRFT 28629 23241 63.0% 76.4% CMFT 6161 2315 13.6% 7.6% RBFT 2792 2625 6.1% 8.6% Oaklands 2652 0 5.8% 0.0% PAHT 907 1167 2.0% 3.8% UHSM 1065 383 2.3% 1.3% Spamedica 1327 0 2.9% 0.0% Christie 576 104 1.3% 0.3% WHH 244 174 0.5% 0.6% WWL 456 58 1.0% 0.2% Other Providers 647 335 1.4% 1.1% Total 45456 30402 100.0% 100.0% (For a full list of hospital providers see Appendix 9)
The PNA makes no assessment of the need for pharmaceutical services in secondary care settings, however the Health and Wellbeing Board (HWB) is concerned to ensure that patients moving in and out of hospital have an integrated pharmaceutical service which ensures the continuity of support around medicines.
Salford CCG is funding the pilot of an electronic system whereby community pharmacies are notified if a patient they dispense for is admitted to Salford Royal
12 Foundation Trust (SRFT) and the discharge summary is sent to community pharmacies; to improve medicines reconciliation and reduce medicines waste.
3.5 What is excluded from scope of the assessment? The PNA has a regulatory purpose which sets the scope of the assessment. However pharmaceutical services and pharmacists are evident in other areas of work in which the HWB has an interest but are excluded from this assessment. One example is prisons, where patients may be obtaining a type of pharmaceutical service that is not covered by this assessment. In addition, Salford CCG has commissioned a GP practice based pharmacist team which is beyond the scope of this PNA.
3.5.1. Prison pharmacy Pharmaceutical services are provided in prisons by providers contracting directly with the NHS England or prison authorities. HM Prison Forest Bank is located on the site of the former Agecroft Power Station and is a 1364 place category B Male local prison serving the courts of the North-West, accepting remand and sentenced adults and remand young offenders. This is a privately run prison operated by Sodexo services. The pharmaceutical services to the prison are currently contracted to Boots Pharmacy. This arrangement is commissioned directly by the HMP Forest Bank Prison and is therefore outside of the scope of this assessment. However it is important that pharmaceutical service provision meets the needs of prisoners on their release.
3.5.2 Practice pharmacists Salford CCG has also invested in GP practice based pharmacist resources with 23 pharmacists to work across the 46 GP practices in Salford to ensure every CCG member practice has clinical pharmacist input on a regular basis. This team, will have close working relationships with all community pharmacies in Salford. These pharmacists do not provide pharmaceutical services themselves, but support the safe and effective administration of medicines across Salford. 3.6 PNA review process The NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013 came into force on 1st April 2013. Regulations 5 and 6 cover the date by which Health and Wellbeing Boards first PNA must be published and the arrangements for revising the PNA: Health and Wellbeing Boards are required to produce the first assessment by 1st April 2015; Health and Wellbeing Boards are required to publish a revised assessment within three years of publication of the first assessment; Health and Wellbeing Boards are required to publish a revised assessment as soon as is reasonably practical after identifying significant changes to the availability of pharmaceutical services since the publication of its PNA unless it is satisfied that making a revised assessment would be a disproportionate response to those changes.
13 Salford prepared its first PNA in 2011 with a second PNA published in April 2014. There have been supplementary statements at regular intervals to provide assurance that no significant revisions are required. This document marks the second mandated revision and will be within the three year period.
3.7 Matters for consideration Regulation 9 sets out the matters Health and Wellbeing Boards must have regard to when developing their PNAs as far as is practicable to do so.
The following are the matters for consideration by Health and Wellbeing Boards: The demography of its area; Whether there is sufficient choice with regard to obtaining pharmaceutical services; o What is the current level of access within the locality to NHS pharmaceutical services? o What is the extent to which services in the locality already offer people a choice, which may be improved by the provision of additional facilities? o What is the extent to which there is sufficient choice of providers in the locality, which may be improved, by additional providers? o What is the extent to which current service provision in the locality is adequately responding to the changing needs of the community it serves? o Is there a need for specialist or other services, which would improve the provision of, or access to, services such as for specific populations or vulnerable groups? o What is the Boards assessment of the overall impact on the locality in the longer-term? o improvements, or better access, to pharmaceutical services, or pharmaceutical services of a specified type, in its area; Any different needs of different localities in its area; The pharmaceutical services provided in the area of any neighbouring Health and Wellbeing Board which affect the need for pharmaceutical services in its area, or whether further provision of pharmaceutical services in its area would secure improvements, or better access, to pharmaceutical services, or pharmaceutical services of a specified type, in its area Any other NHS services provided in or outside the area which affect the need for pharmaceutical services in its area, or whether further provision of pharmaceutical services in its area would secure improvements, or better access, to pharmaceutical services, or pharmaceutical services of a specified type, in its area; Likely future needs. o Known firm plans for the development/expansion of new centres of population i.e. housing estates, or for changes in the pattern of population i.e. urban regeneration, local employers closing or relocating? o Known firm plans in and arising from local JSNA or JHWS?
14 o Known firm plans for changes in the number and/or sources of prescriptions i.e. changes in providers of primary medical services, or the appointment of additional providers of primary medical services in the area? o Known firm plans for developments which would change the pattern of local social traffic and therefore access to services i.e. shopping centres or significant shopping developments whether these are in town, on the edge of town or out of town developments? o Plans for the development of NHS services? o Plans for changing the commissioning of Public Health services by community pharmacists, for example, weight management clinics, life checks? o Introduction of special services commissioned by clinical commissioning groups? o New strategy by social care/occupational health to provide aids/equipment through pharmacies or dispensing appliance contractors?
15 3.8 Process followed for developing the PNA The PNA followed guidance set out by:
NHS Employers PNA guidance9 National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendment) Regulations 201310 Pharmaceutical Needs Assessment, Information Pack for Local Authority Health and Wellbeing Boards11.
Stage 1: The PNA was developed using a project management approach and a steering group was established in May 2016 consisting of Local Authority representatives, CCG Medicines Management Team, Local Pharmaceutical Committee, NHS England and a Project Manager. This steering group was responsible for overseeing the completion of the PNA and ensured that the PNA meets at least the minimum legislative requirements. This steering group approved the template for the PNA, along with all public facing documentation. As a starting point, the last PNA (dated 31st March 2014) was reviewed and recommendations were made as to the content.
Stage 2: The steering group approved the pre-consultation pharmacy survey that was then issued to all Pharmacies to complete. Also during this stage a public survey was approved and distributed including advertisement on the Local Authority website, the Local Authority household magazine, on posters in pharmacies and social media. The survey and posters were also translated into Arabic, Urdu and Polish which are the three main languages (other than English) that are spoken in Salford. Other languages were available on request, but no requests were received for this service. A total of 578 responses were received from the customer survey and 53 out of 59 pharmacies completed the contractor survey.
Stage 3 The content of the PNA produced, including demographics, mapping, analytics and background information, was approved by the steering group to go to consultation.
When preparing the PNA for consultation, the PNA did take into account the JSNA and other relevant strategies (specifically the Salford Locality Plan), in order to ensure the
9 Pharmaceutical Needs Assessments – a practical guide http://www.nhsemployers.org/case-studies- and-resources/2009/07/pharmaceutical-needs-assessments--a-practical-guide (accessed 12/10/2016)
10 The National Health Service (pharmaceutical and Local Pharmaceutical Services) Regulations 2013 http://www.legislation.gov.uk/uksi/2013/349/contents/made (accessed 12/10/2016)
11 Pharmaceutical needs assessments – Information pack for local authority and Health and Wellbeing Boards https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/197634/Pharmaceutical _Needs_Assessment_Information_Pack.pdf (accessed 12/10/2016)
16 priorities were identified correctly. The PNA will inform commissioning decisions by the Local Authority (public health services from pharmacy contractors), by NHS England and CCGs. For this reason the PNA is a separate statutory requirement.
Stage 4 The consultation took place from 18th November 2016 to 19th January 2017 for a period of 63 days, in line with the Department of Health Regulations on the development of the PNA (see Section 3.9).
The draft PNA and consultation response survey link were issued to all of the stakeholders listed in Appendix 2. The documents were posted on the Council intranet and internet. The consultation responses were collated and analysed and the full consultation report can be found in Appendix 3.
Stage 5 The consultation responses were analysed and used to pull together the final PNA document which was approved by the Health and Wellbeing Board in March 2017. The PNA was then published on the Salford Council website in April 2017.
3.9 PNA consultation Regulation 8 sets out the requirements for consultation on PNAs. The local authority duty to involve was first introduced in the Local Government and Public Involvement in Health Act 2007 and was updated and extended in the Local Democracy, Economic Development and Construction Act 200812.
Health and Wellbeing Boards must consult the bodies set out in Regulation 8 at least once during the process in developing the PNA. These bodies are:
Any Local Pharmaceutical Committee (LPC) for its area (including any LPC for part of its area or for its area and that of all or part of the area of one or more other Health and Wellbeing Boards); Any Local Medical Committee (LMC) for its area (including any LMC for part of its area or for its area and that of all or part of the area of one or more other Health and Wellbeing Boards); Any persons on the pharmaceutical lists and any dispensing doctors list for its area; Any LPS chemist in its area with whom the NHS Commissioning Board has made arrangements for the provision of any local pharmaceutical services; Any Local Healthwatch organisation for its area, and any other patient, consumer or community group in its area which in the opinion of the Board has an interest in the provision of pharmaceutical services in its area; Any NHS Trust or NHS Foundation Trust in its area; The NHS Commissioning Board; Any neighbouring Health and Wellbeing Board.
12 Local Democracy, Economic Development and Construction Act 2008 http://www.legislation.gov.uk/ukpga/2009/20/contents (accessed 15/11/2016)
17 Those being consulted can be directed to a website address containing the draft PNA but can, if they request, be sent an electronic or hard copy version. There is a minimum period of 60 days for consultation responses. A consultation plan accompanies this PNA, available in Appendix 2.
Prior to starting the draft PNA, a public survey was carried out to identify how the public currently use pharmacies and whether they had any problems with areas such as access to services. We also asked the public what future services they would be interested in using. A summary for this survey can be found in section 5.7 and the full results can be found in Appendix 7.
A Pharmacy Contractors survey was also undertaken over approximately 6 weeks. This asked the pharmacy staff to identify their hours of opening, provision of current services and ease of access to services e.g. if the pharmacy had any facilities for disabled patrons or whether the staff could speak any other languages than English. We also asked them which, if any, services they would like to deliver in the future. Analysis for the pharmacy survey can be found in Appendix 5.
A formal 60 day consultation process was carried out among the local health partners and other stakeholders to enable feedback from them before the PNA was published.
To facilitate the consultation period, a comprehensive communication plan was devised identifying all the local partners who had a stake in pharmaceutical service provision around the borough. This can be found in Appendix 2. All of the stakeholders listed in Regulation 8 (as described above) were made aware of the start of the consultation and the Health and Wellbeing Board retained oversight of this process through the steering group.
Feedback was gathered through the consultation and the results were analysed. From this analysis the PNA steering group determined whether any amendments were required and updated the PNA accordingly.
18 3.10 Localities for the purpose of the PNA Schedule 1 of the 2013 Regulations specifies that Health and Wellbeing Boards are required to include a map in their PNA identifying the premises at which pharmaceutical services are provided in their area. Furthermore, Regulation 4(2) requires Health and Wellbeing Boards to keep the above map up to date, in so far as is practicable (without the need to republish the whole of the assessment or publish a supplementary statement).
The PNA completed in 2014 used ward boundaries to define the areas within the Borough. Following the review of this document it was decided the boundaries should remain at ward level, because the ward boundaries are well understood within the general population and are used during local parliamentary elections. Most health data is also available at Middle Super Output Area (MSOA) level, which show indicators to a lower geographical level. The advantage of this is that MSOA level data avoids the issue observed when using ward data which is that some areas and indicators are averaged out and can mask trends that can instead be seen at MSOA level. Therefore, where appropriate, health indicators have also been supplied at MSOA level.
Map 1: Electoral Ward and Neighbourhood Boundaries in Salford
19 4 Health and Wellbeing in Salford The following section is based on evidence from the Salford Joint Strategic Needs Assessment (JSNA), see http://www.salford.gov.uk/jsna 4.1 Salford profile Salford is centrally located within the Greater Manchester conurbation. It is bounded on the south east by the River Irwell, which forms its boundary with the city of Manchester and by the Manchester Ship Canal to the south, which forms its boundary with Trafford. The metropolitan boroughs of Wigan, Bolton and Bury lie to the west, northwest and north respectively. Some parts of the city are highly industrialised and densely populated, but around one third of the city consists of rural open space. This is because the western half of the city stretches across an ancient peat bog known as Chat Moss.
The city is served by a single clinical commissioning group, a single hospital foundation trust and a single city council, all with a good history of good partnership working.
Key messages identified from the JSNA: 70% of the population live in areas classified as highly deprived Over 25% of young people under 16 in the city (12,175 children) live in poverty, but 5% of the population live in wards amongst least deprived in the country Salford has the second highest proportion of primary school children eligible for free school meals in GM, at 21.4%, one and a half times the England average Early years & primary schools perform well – but success rates at GCSE are amongst the lowest in England Nearly 13% of the working population is claiming out of work benefits Salford’s residents health and wellbeing that is worse than the national average Life expectancy is increasing, but for women is 2.5 years less than the England average, for men 2.8 years less. The life expectancy gap within the City is increasing. Death rates are reducing but not fast enough to narrow the gap with the England average The major causes of ill health include CHD/CVD/Cancers & respiratory conditions
4.2 Salford demographics The 2011 Census population total for the City of Salford is 233,900 persons. In June 2016 the Office for National Statistics published the 2015 mid-year population estimates for local authority districts and higher geographies. The 2015 population figure for Salford was 245,614, the highest figure since 1983. This consisted of 123,672 Males and 121,942 Females.
4.2.1 Age of Population
In mid-2015, Salford had a younger population compared to England: 17.4% of the total population in Salford were between the ages of 25 and 35, but in England the same age group made up only 13.7% of the total population. There is also a lower
20 proportion of over 75 year olds within Salford compared to England (6.6% of total population compared to 8.1%).
Chart 1 below shows the spread of age ranges across Salford in 5 year bands for males and females in 2005, 2015 and projected to 2025.
Chart 1: Mid-Year Population Estimates in 2005, 2015 and projected to 2035
Population Trends - Salford
Males 2015 Males 2005 Females 2015 Females 2005 Males 2035 Females 2035
85+ 1602 3071
80 - 84 1919 2745
75 - 79 3144 3686
70 - 74 3939 4412
65 - 69 5611 5638
60 - 64 5623 5326
55 - 59 6766 6493
50 - 54 8091 7669 d
n 8144 a 45 - 49 7954 b
e 40 - 44 7705 7548 g A 35 - 39 8621 7792
30 - 34 10778 10168
25 - 29 11293 10608
20 - 24 9848 9455
15 - 19 7069 6938
10 - 14 6464 6319
5 - 9 8152 7493
0 - 4 8903 8627
5 4 3 2 1 0 1 2 3 4 5 Proportion of total population in each age band Source: Office for National Statistics13
Table 2: Population Projections 2015 to 2035 by age group14
2014 BASED POPULATION PROJECTIONS FOR SALFORD 2015 TO 2035 0-14 15-44 45-64 65-74 75+ Total 2015 45,958 107,823 56,066 19,600 16,167 245,614 2020 49,807 111,852 59,143 20,315 17,098 258,215 2025 51,487 116,442 60,701 20,957 19,878 269,465 2030 51,862 119,039 62,910 24,228 21,569 279,608 2035 52,244 120,724 65,446 26,354 24,210 288,978
13 Mid year population estimates ad population projections, Office for National Statistics https://www.ons.gov.uk/ (accessed 13/10/2016) 14 Mid year population estimates ad population projections, Office for National Statistics https://www.ons.gov.uk/ (accessed 13/10/2016)
21 ONS 2014 based population projections show Salford’s total population is forecast to increase to 269,465 in 2025 and then further increase to 288,978 in 2035. This is an increase of 17.7% over the period 2015 to 2035. Within these figures, all the age groups are expected to increase but the one which is predicted to increase the fastest is the 75 and over age group which is forecast to increase by 49.7% from 2015 to 2035. The age group which will have the second fastest rate of increase from 2015 to 2035 is the 65 to 74 age group which is forecast to increase by 34.5%.
4.2.2 Demography considerations for pharmacies The Salford population is increasing and with it, the need for pharmacy services will increase. Older people are the most frequent users of pharmacy services and health services in general.
Commissioners should ensure that sufficient pharmacy resources are in place to manage the expected increase in elderly population outlined in section 4.2.1. An increase in items will in turn lead to a greater impact on pharmacy services as more items will be dispensed and there will be a greater need for patients to understand their medication. Pharmacies can benefit from this by implementing services targeted to an older population. There could therefore be a need to review the current community pharmacy skill mix. The increased population may lead to a greater need for deliveries to less mobile patients as identified in the Prescriptions Dispensed in the Community Statistics for 2003 – 201315.
As 25 to 35 year olds still make up the largest proportion of population (as in the 2014 PNA), commissioners should consider preventative and overall health needs for this group of people. Given the prevalence of long-term conditions in Salford, it is recommended to ensure there is a focus on services within pharmacies to enable this group to lower their risk and so lead to better chances improved future health. Reducing any potential health impacts in the future should reduce the burden and cost for all health providers across the city. This fits with the strategic priorities of Salford and the Locality Plan, which identify the need to increase services to improve the ability of the population to self-care whenever possible, rather than utilise GP and hospital services if not necessary (see Section 5).
The local health partners (CCG, LA and NHSE) may also want to think about which pharmacy services are going to be beneficial to their population in order that a greater proportion of money can be invested in prevention of disease or disease progression rather than recovery e.g. targeted medication, or using reviews to reduce hospital admissions and medication wastage. Commissioners may need to consider additional services that could be required to support the delivery of health care to specific patient groups, and where pharmaceutical service provision sits within this; public health within Salford city council plans to lead on this work in 2017/18.
Pharmacies may wish to identify the age of their customers to ensure they are providing the most effective services for their local population. The NHS SHAPE tool is a free to use interactive map which can plot different age bands: NHS professionals and Local Authority professionals with a role in Public Health or Social Care can access the application by formal registration and licence agreement at http://www.shape.dh.gov.uk/. More detail can also be obtained from the latest Salford
15 Prescriptions Dispensed in the Community, statistics for England – 2003-2013, NHS Digital http://content.digital.nhs.uk/catalogue/PUB14414 (accessed 13/10/2016)
22 Ward Profiles (available at https://www.salford.gov.uk/people-communities-and-local- information/my-local-community/ward-profiles/).
4.3 Life Expectancy Currently Salford men are, on average, likely to live 2.8 fewer years than their counterparts in England. The gap for women is 2.5 fewer years. The trend is improving for men and women as life expectancy gradually increases.
Infographic 1: Life Expectancy Gap at birth in Salford
To close the gap, action should be taken to address the cause of ill health especially in areas of Salford where the gaps are wider. The wards where the life expectancy
23 for residents is highest are Boothstown and Ellenbrook, Worsley and Walkden South, while Langworthy, Little Hulton and Broughton have the lowest life expectancy among Salford residents.
This internal life expectancy gap can be seen in maps 2 and 3 below. The data is presented at MSOA level with a ward boundary overlay. This is because some ward boundaries span areas of differing deprivation, so the data for health outcomes are averaged out if using the ward level data. Thus, by mapping data at the lower geographical area, these inequalities even within wards are seen. For example, using MSOA level data, parts of Barton, Ordsall, Broughton and Little Hulton show differences in Life Expectancy in both males and females which would be missed if we used only the ward level figures.
Map 2: Salford Life expectancy at Birth, Males 2010/141617
16 2010/14 is a five year average and includes the years 2010, 2011, 2012, 2013, 2014. 17 Life Expectancy at birth Males, Local Health, Public Health England http://www.localhealth.org.uk/#l=en;v=map11 (accessed 13/10/2016)
24 Map 3: Salford Life expectancy at Birth, Females 2010/1418
4.3.1 Contribution to Life Expectancy Gap by Disease and gender To improve Life Expectancy and health outcomes, the disease areas which have the greatest impact on life expectancy should be a focus. Chart 2 below show the contribution to the gap in life expectancy from England by disease area for men and women for 2012 to 2014.
For males the disease areas where currently there is the greatest variation in the contribution to the life expectancy gap from England are circulatory disease (28.4%) and cancer (24%) whereas for women it is cancer (31.5%) and respiratory disease (24.4%).
18 Life Expectancy at birth females, Local Health, Public Health England http://www.localhealth.org.uk/#l=en;v=map11 (accessed 13/10/201)
25 Chart 2: Life Expectancy Gap by Cause of Death19
Breakdown of Life Expectancy gap between Salford and England, by broad cause of death, 2012-2014 100% Other, 1.1% Other, 9.5% Mental and Behavioural, 11.5% 90% Mental and Behavioural, 3.9% External causes, 6.0% External causes, 5.2% 80% Digestive, 9.5% Digestive, 10.9% d n
a 70% l g n E
h
t Respiratory, 17.3% Respiratory, 24.4% i 60% w
y c n a
t 50% c e p x E Cancer, 24.0% e 40% f i L
n i
Cancer, 31.5% p
a 30% G
20%
Circulatory, 28.4% 10% Circulatory, 16.8%
0% Male Female
4.3.2 Deaths from all causes in Salford The pattern of differing health outcomes across Salford is also reflected in the deaths from all causes to residents aged under 75 by Ward (Chart 3). Boothstown & Ellenbrook and Worsley, are the wards where residents’ mortality rates are better (lower) than the England average, although only Worsley is statistically significant; 12 out of 20 wards are significantly worse (higher) than the England average.
19 Breakdown of Life Expectancy Gap by broad cause of death 2012-2014, Public Health England https://fingertips.phe.org.uk/profile/segment (accessed 15/11/2016)
26 Chart 3: Salford Deaths from All Causes, All Ages by Ward20
Deaths from all causes aged under 75, Salford wards, 2010-2014
Similar to England Significantly lower than England Significantly higher than England England
250
200 ) R M S (
e t a R
150 y t i l a t r o M
d
e 100 s i d r a d n a t S 50 2 9 4 0 4 8 9 9 1 7 3 3 4 ...... 2 3 7 5 4 8 1 8 8 7 1 7 8 4 3 4 3 7 9 3 ...... 8 7 5 6 5 4 3 3 2 2 1 0 0 8 6 4 1 5 9 6 1 1 1 1 1 1 1 1 1 1 1 1 1 9 9 9 9 8 6 6 0
4.3.3 Cancer Lung cancer is the main contributor to the cancer incidence and death rates. Deaths rates from lung cancer are declining however Salford remains among the worst local authorities in the country and has the second highest (worst) death rates to under 75s in Greater Manchester. Incidence rates for lung cancer are significantly higher (worse) than the England average for both men and women. For more information, see the Cancer Needs Assessment within the Salford JSNA. https://www.salford.gov.uk/media/388055/cancer_needs_assessment_oct_2015.pdf
4.3.4 Circulatory disease Cardiovascular disease (CVD) is one of the major causes of death in under 75s, particularly amongst men, in Salford and in England overall. There have been huge gains over the past decades in terms of better treatment for CVD and improvements in lifestyle. The variation between Salford and England has been significantly reduced since 1997 which shows how circulatory disease around the city has improved, however the variation against England is still significant and this should still be an area for improvement in health.
20 Deaths from all causes, under 75 years (SMR), Local Health, Public Health England http://www.localhealth.org.uk/#l=en;v=map11 (accessed 13/10/2016)
27 4.3.5 Smoking Smoking is the main cause of death due to respiratory diseases and also plays a significant role in coronary heart disease and cardiovascular diseases. Although smoking prevalence in Salford has reduced from an estimated 34% in 2004 to 22.4% in 201521 there is a time lag for the effect to show on a disease like lung cancer or COPD which can take 20-30 years to manifest.
4.4 Ethnicity Salford is less ethnically diverse than the national population as, according to the 2011 census, Salford has a population made up of 84.4% White British compared with both the England and Greater Manchester averages of 79.8%. Table 3 shows how the diversity of the population is changing and the number of people identifying themselves as from a Black or Minority Ethnic Group (BME)22 has almost trebled from 2001 to 2011, at 33,606.
Table 3: Ethnic Group in Salford 2001 - 201123 Persons Percentage Ethnic Group 2001 2011 2001 2011 British 200,343 197,445 92.7 84.4 Irish 3,870 2,882 1.8 1.2 White Other White 3,533 10,535 1.6 4.5 Total White 207,746 210,862 96.1 90.1 White & Black Carribean 839 1,647 0.4 0.7 White & Black African 318 1,058 0.1 0.5 Mixed White & Asian 495 929 0.2 0.4 Other Mixed 494 982 0.2 0.4 Total Mixed 2,146 4,616 0.9 2.0 Indian 1,196 2,553 0.6 1.1 Pakistani 963 1,843 0.4 0.8 Bangladeshi 402 605 0.2 0.3 Asian or Asian British Chinese 1,191 2,547 0.6 1.1 Other Asian 428 1,881 0.2 0.8 Total Asian 4,180 9,429 2.0 4.1 Black Carribean 417 666 0.2 0.3 Black African 709 5,354 0.3 2.3 Black or Black British Other Black 134 521 0.1 0.2 Total Black 1,260 6,541 0.6 2.8 Other Ethnic Groups 771 2,485 0.4 1.1 Total 216,103 233,933 100 100
21 Smoking prevalence in adults – current smokers, Public Health England http://www.tobaccoprofiles.info/ (accessed 16/11/2016) 22 BME includes people identifying themselves as all categories other than ‘White - British’ or ‘White – Irish’ 23 Table KS201EW, Census 2011, NOMIS https://www.nomisweb.co.uk/census/2011 (accessed 13/11/2016)
28 The distribution of the BME population across Salford is not equal and the variation in ethnic minority groups ranges from around 4% BME in Irlam and Walkden South, to 20% BME population in Broughton and Ordsall. The way in which the BME communities are made up within each ward is also different. As an example, Broughton have approximately a 7% Black African population but relatively low Bangladeshi population, unlike Eccles which has a relatively high Bangladeshi community with a smaller Black African population.
Some ethnic populations have increased risk of health problems in certain disease areas, e.g. Black African and Black Caribbean populations have a higher stroke incidence rate than the White ethnic population. South Asians, which includes those from Pakistan and Bangladesh, have an increased risk of heart attacks, whereas the White populations are more likely to binge drink.
Smoking prevalence also varies between the ethnic groups. The prevalence of smoking in England is approximately 25%, but for Indian men this drops to 20%. Yet the average increases to 40% in Bangladeshi males, although it is only 2% in Bangladeshi females.
A BME Needs Assessment has been completed within Salford and will be published on the JSNA website of Salford Council when finalized. https://www.salford.gov.uk/people-communities-and-local-information/joint-strategic- needs-assessment/jsna-topic-areas/
4.4.1 Ethnicity considerations for pharmacy Pharmacy contractors located within areas where there is a high population of a certain ethnic group should provide services that are targeted to achieve improved health outcomes in those populations. They should also look at how best to communicate with their clients. Cultural differences account for a wide variation in patients’ view of medications and the healthcare system. Pharmacy contractors should ensure that they are able to deliver the Essential and Advanced Services to different ethnic groups in a way that meets their needs.
Commissioners should continue to identify areas where there are high density of ethnic communities and target health promotion and services through pharmacy contractors in those areas.
As described in the pharmacy contractor survey (Appendix 5) many of the pharmacies already have staff who can communicate in languages (other than English) which are spoken within their community. Of the 53 respondents (out of a possible 59) just over half (50.9%) said they had a qualified pharmacist that could speak a foreign language and 34% of regular staff could also speak a foreign language. Polish, Arabic and Urdu are the most common foreign languages within Salford, there is representation of pharmacists who speak these languages across the city at 5.7%, 11.3% and 26.4% respectively (of the 53 contractors who replied to the survey). Pharmacy contractors should continue to consider the diversity of cultures and languages spoken in their locality when employing staff.
29 4.5 Deprivation The Indices of Deprivation 2015 (IMD 2015)24 was released by the Department for Communities and Local Government (DCLG) and updates the previously published Indices of Deprivation 2010. The IMD is a composite measure of deprivation for small geographical areas that attempts to combine a number of different aspects of deprivation (income, employment, health & disability, education, skills & training, housing, crime, and living environment) into a single measure that reflects the overall experiences of individuals living in an area.
The term used to describe these small geographical areas is Lower Super Output Areas (LSOAs). These are ranked, allowing identification of the most deprived areas across England (and separately in other parts of the UK). The combined scores for the Lower Super Output Areas for a Local Authority area can then be compared to other Local Authority areas.
Separately a DCLG approved methodology has been used to rank wards in Salford based on LSOA deprivation scores.
The following map compares the pattern of overall deprivation within Salford in 2015. Relative levels of deprivation in Ordsall, Irwell Riverside, and Broughton have reduced markedly between 2010 and 2015. Smaller but relatively significant improvements have also occurred in, Cadishead, Winton, and Swinton North.
In contrast relative levels of deprivation in other parts of the city have worsened substantially between 2010 and 2015 including in Charlestown, East Irlam, and the Eccles New Road/ Howard Street area.
High relative levels of deprivation persist in parts of the city, most notably the Lower Kersal, Charlestown, Pendleton and Lower/ Higher Broughton areas. High levels also persist in the Amblecote, Peel and Madamswood areas within Little Hulton, in the New Lane area of Winton, and the Merlin Road area in Irlam.
24 English indices of deprivation 2015, Department of Communities and Local Government, Gov.uk https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015 (accessed 13/10/2016)
30 Map 4: Deprivation by LSOA
The map above shows that the areas with the highest deprivation are in East Salford close to Manchester city centre, with a smaller, less severely deprived cluster in West Salford, in the ward of Little Hulton. Of the 150 LSOAs in Salford, 7 are ranked in the worst 1% of deprived LSOAs across England, while 43 LSOAs are in the worst 10% across England.
31 Map 5: Deprivation – Health domain by LSOA
In terms of health and disability deprivation, almost all wards of the city experience very high health deprivation, with the biggest cluster in Pendleton, followed by Broughton, Ordsall, Weaste & Seedley, and parts of Eccles. North Little Hulton also has a sizable but slightly less severe area of health deprivation.
The health deprivation and disability markers shown on the map above are generally worse where the overall deprivation scores are highest. This shows that there is a need to improve health outcomes where people experience higher levels of deprivation. Health outcomes can be influenced by a number of factors, including direct healthcare initiatives, regeneration, improved education outcomes and employment prospects, which can all impact on health deprivation scores. 4.6 Disability Comprehensive estimates of the population of Salford who have a disability are not available; however it is known that 7.6% people in Salford reported having poor health25 over the year preceding the 2011 Census, a rate that is higher than the national average. 11% of Salford’s population stated that they have an illness or condition which “limits their day-to-day activities a lot” which is higher than the national average of 8.3%.
25 Table QS302EW – General health, Official labour market statistics, NOMIS https://www.nomisweb.co.uk/ (13/10/2016)
32 Overall in Salford the uptake of disability related benefits is higher than the national average, with 14,25026 working age people claiming Incapacity Benefit/Severe Disablement Allowance/Employment and Support Allowance and 15,81027 claiming Disability Living Allowance. Mental ill-health is the most common condition leading to benefit uptake.
National estimates28 of prevalence for learning disability suggest that there are likely to be around 4,566 adults with a learning disability in Salford, of which 1,071 will be moderate or severe. Further to this are around 1,000 people with Autistic Spectrum Disorder (ASD). All estimates are likely to be conservative in Salford as deprivation and learning disability are closely linked and deprivation does not factor into national estimates.
2,00529 people in Salford are registered as blind or partially sighted, of whom 65% are aged 75 years or over. Around 1 in 6 of the population have some form of hearing loss, and around 2% are regular users of hearing aids30.
People with varying types of disabilities including mobility, sensory and learning have varying and differing needs from pharmacy services. These should be considered when commissioning services to ensure that they are accessible (in terms of mobility) and understood by those with learning or sensory disabilities for example, large print and/or Braille, use of hearing loops and clear explanations as to the purpose of medicines.
4.7 Conclusion on population demography Whilst young people aged 25 to 35 years represent the largest proportion of people in Salford, over the next 20 years those aged 65 to 74 years and the over 75s will increase the most. This means that commissioners should review service provision on a regular basis to ensure it is still relevant to the population of Salford and delivering the desired health outcomes that the HWB are targeting.
Digestive disorders, coronary disease and respiratory conditions are recognised health priorities and pharmacy services need to be developed in line with priorities.
26 Benefit claimants – incapacity benefit/severe disablement, employment and support allowance (February 2016) DWP benefits, NOMIS https://www.nomisweb.co.uk/query/select/getdatasetbytheme.asp?theme=35 (accessed 13/10/2016) 27 Benefit claimants – disability lioving allowance(February 2016) Bo-p-serv01- w.salford.gov.uk:8080/BOE/OpenDocument/1607260528/OpenDocument/opendoc/openDocument.fa ces (accessed 13/10/2013) 28 Learning disability baseline estimates, Projecting Adult Needs and Service Information (PANSI), http://www.pansi.org.uk/ (accessed 08/09/2016) 29 Table B1 People registered blind and partially sighted (March 2014), http://content.digital.nhs.uk/catalogue/.../peop-regi-blin-part-sigh-eng-14-coun-tab.xlsx (accessed 13/10/2016) 30 Action Plan on hearing loss, NHS England https://www.england.nhs.uk/wp- content/uploads/2015/.../act-plan-hearing-loss-upd.pdf (accessed 13/10/2016)
33 Ethnic diversity of the wards should be considered when commissioning services to ensure they are accessible to the ethnic groups who may contribute significantly to the variation from average health in that locality.
Pharmacy services should be accessible to all patients and the public, and pharmacy owners should make sure the pharmacy has appropriate arrangements or adaptations in place to help all people access the pharmacy services they need and to meet any specific needs of patients.
34 5 Locally Identified Health Need The Locality Plan details the strategic approach to improving the health outcomes of residents of the city, whilst also moving towards financial and clinical sustainability of health and care services.
This section outlines the Locality Plan in more detail, including the Integrated Care System, whilst considering the neighbourhood priorities and how these are impacted by the Community Pharmacy Forward View. The profiles and the Locality Plan will help organisations across Salford to know which services are needed and where across the city and to make decisions about how to commission services which respond to the needs of the people who live within Salford.
5.1 The Salford Locality Plan Salford’s Locality Plan ‘Our Vision for a Healthier Salford’ describes the strategic priorities for improving health outcomes for the people of Salford and the move towards a future sustainable system. Developed by the Health and Wellbeing Board, the Locality Plan explains why radical reform is required and how it will be delivered. The Locality Plan approach reflects the aims of the Greater Manchester Sustainability and Transformation Plan (STP).
“Start, live and age well in Salford – Citizens will get the best start in life, will go on to have a fulfilling and productive adulthood, will be able to manage their health well into their older age and die in a dignified manner in a setting of their choosing. People across Salford will experience health on a parallel with the current “best” in Greater Manchester, and the gaps between communities will be narrower than they have ever been before.”
Salford’s Locality Plan and the Joint Strategic Needs Assessment, explain clearly the need to improve health and well-being outcomes for people in Salford. To address this need alongside growing demand and constrained resources the Locality Plan uses the life stage model ‘starting well, living well, ageing well’ to determine person-centred outcomes for people, linked to specific measures and interventions. Diagram 1 shows some of the main outcomes expected from the Locality Plan.
35 Diagram 1: Main outcomes expected from the Locality Plan
36 The impact of delivering and investing in the priority areas identified in the Locality Plan and the Greater Manchester Sustainability and Transformation Plan (STP) has been assessed to contribute to closing the financial gap within Salford as shown in Diagram 2 below. The health needs are addressed by three priority areas each of which are subdivided into outcome measures for monitoring, as set out in Table 4.
Diagram 2: Impact of delivering and investing in priority areas
Salford Locality Plan – our vision for a healthier Salford
Rationale, context, shared vision The Life Course: Governance, leadership and Starting, living and ageing well management
• Integrated commissioning • • Co-production and social value Quality of care • • IM&T Transforming primary care • Integrated care • Estates Delivering • Workforce • Hospital care • • Innovation Long term conditions • Mental health Improved outcomes and • Public Engagement experience, with specific set of measures Enabling Better Care Financial sustainability, Transformation tackling 2021 ‘do nothing’ gap of £157m workstreams Prevention • Fair share and protection: £48.7m • Social movement for change • Prevention: £15.9m • Place-based working • Locality Plans, Better • Best start in life Care: £18.2m (including • Promoting healthy lifestyles integrated care) • Screening and early detection • Provider efficiency • Wider determinants of health and wellbeing £69.7m
37 Table 4: Outcome measures – Salford Locality Plan Vision Overarching measures used at end of 5 years to see the Start, live and age well in Salford - Citizens will get the best start in life, will go on to have difference made: a fulfilling and productive adulthood, will be able to manage their health well into their Deprivation score (Index of Multiple Deprivation) older age and die in a dignified manner in a setting of their choosing. People across Potential years of life lost Salford will experience health on a parallel with the current “best” in Greater Manchester Life expectancy / Healthy Life expectancy (GM), and the gaps between communities will be narrower than they have ever been Disability free life years before. Percentage of children living in poverty Outcomes for people Outcome measures Dashboard indicators used for quarterly / annual monitoring Starting Well I am a young person who will achieve Increased proportion of 1.02i - School Readiness: The percentage of children their potential in life, with great young people who achieving a good level of development at the end of Children will learning, and employment achieve their potential in reception have the best opportunities learning and employment 1.05 - 16-18 year olds not in education, employment or start in life and training continue to GCSE achieved (5 A*-C including English & Maths) or develop well replacement during their early years I am a child who is physically and Improved physical and 2.08 - Emotional wellbeing of looked after children emotionally healthy, feel safe and able emotional health in young 4.02 - Tooth decay in children aged 5 to live life in a positive way people 2.06ii - Excess weight in 4-5 and 10-11 year olds Low birth weight babies (less than 2500g)
I am as good a parent as I can be Improved support 2.07i - Hospital admissions caused by unintentional and provided for young people deliberate injuries in children (aged 0-14 years) by families and carers Child Wellbeing Index: Average Score (replaced by national child mental wellbeing survey using WEMWEBS) Criminal justice indicator?
Living Well I am able to take care of my own Healthier lifestyles and Long term unemployment health, wellbeing and am economically situation for Salford 2.12 Excess weight in adults or Citizens will active people 2.13ii - Percentage of physically active and inactive adults achieve and (inactive adults) maintain a sense 7.01 Alcohol-related hospital admission (Broad)
38 of wellbeing by 1.17 - Fuel poverty? leading a healthy lifestyle My lifestyle helps me to stop any Long Improved lifestyle, which Smoking attributable hospital admissions supported by Term Condition or disability getting lead to longer, more Mortality rates (various long term conditions) resilient worse, and keeps the impact of this contented lives for those Long-term health problems or disability: % of people whose communities condition or disability from affecting my with long term health day-to-day activities are limited by their health or disability life conditions
I lead a happy, fulfilling and purposeful Increased happiness and 2.23iii - Self-reported wellbeing - people with a low life, and am able to manage the life satisfaction, with happiness score OR 2.23v - average Warwick-Edinburgh challenges that life gives me improved personal Mental Wellbeing Scale (WEMWBS) score resilience 1.11 - Domestic abuse rates A&E attendances? Health Watch Salford locally collected Wellbeing Star survey (range of wellbeing measures)
Ageing Well I am an older person who is looking Improved health and Increased flu vaccine uptake after my health and delaying the need situation for older people Number of falls in the over 65s or over 80s Older people will for care Proportion of people that feel supported to manage own maintain condition wellbeing and Number of avoidable emergency admissions and re- can access high admissions quality health ASCOF 2B(1) proportion of older people (65+) who were still at home 91 days after discharge from hospital into re- and care, using it ablement / rehabilitation services appropriately ASCOF 2A(2) Permanent admissions of older people (aged 65 and over) to residential and nursing care homes per 1000 population If I need it, I will be able to access high Increased quality and Estimated diagnosis rate for people with dementia (place quality care and support personalisation of care for holder) older people Quality of Life of service users and carers Patient / service user experience or satisfaction measure I know that when I die, this will happen Improved end of life care Proportion of people that die at home/in usual residence (or in the best possible circumstances preferred place of dying) 4.15i - Excess Winter Deaths Index (single year, all ages)
39 5.2 Integrated Care in Salford Integration of health and social care services is one part of the Salford Locality Plan. Salford is creating an Integrated Care System (ICS) for adults which aims to improve outcomes and shift towards more preventative, anticipatory care, helping people live well and independently for longer. The Integration Programme for adults is led by Salford Together which is a partnership of NHS Salford CCG, Salford City Council, Greater Manchester West Mental Health NHS Foundation Trust, Salford Royal NHS Foundation Trust and Salford Primary Care Together.
The strategic aims are:
deliver better health and care outcomes via innovation and exploration, coupled with the testing of different models of care and funding mechanisms; improve the experiences of users and carers; and reduce system costs.
The ICS is funded via a health and social care pooled budget. In addition Salford has received transformational monies from Greater Manchester Health and Social Care Partnership to transform services over the next three years (2016/17 - 18/19). This follows national Vanguard funding in 2015/16 for the Salford Primary and Acute Care Vanguard site. One enabler to the Salford Integrated Care System is the Salford Integrated Care Organisation (ICO). The ICO was formed in July 2016, when social care provision was transferred to Salford Royal Foundation Trust (SRFT), from the City Council. Adult mental health services are also sub-contracted by the SRFT from July 2016.
The Salford Integrated Care Programme for adults will build on the model of integration that was used for older people in Salford over the previous three years. The model is summarised in diagram 3. It will include stratifying the population according to need, neighbourhood - based out of hospital services and community services that support people to avoid hospital admission.
40 5.3 Community pharmacy and Salford’s Strategic Priorities The Community Pharmacy Forward View31 describes the vision and ambitions for the future of community pharmacy focusing on the following key roles:
i. facilitation of personalised care for people with long-term conditions: ii. as the trusted, convenient first port of call for episodic healthcare advice and treatment iii. as a neighbourhood health and wellbeing hub.
These ambitions resonate with both national and Salford Strategic aims and align with support being available in communities which would:
Empower patients and support people to manage their own health Improve access, choice and integration Engage communities, helping people stay well and independent and improving health and wellbeing for the whole population.
Opportunities for pharmacy to engage and collaborate in the development of health and care in Salford are recommended. This has already commenced as the Greater Manchester Health and Social Care Partnership have agreed a Greater Manchester pilot transformation project for community pharmacy in 2017. This pilot will support people with long-term
31 Community Pharmacy Forward View, August 2016 http://psnc.org.uk/wp-content/uploads/2016/08/CPFV- Aug-2016.pdf
41 conditions through developing and managing care plans within community pharmacy. One area of Salford (Eccles) will participate in this pilot.
5.4 Neighbourhood Health Priorities Neighbourhood profiles allow access to a wide range of information about health and wellbeing issues in each local area and have been produced as part of the Joint Strategic Needs Assessment (JSNA). The profiles have been put together using the most recent, reliable and robust data available at the time. The profiles and the Locality Plan will help organisations across Salford to know which services are needed and where across the city and to make decisions about how to commission services which respond to the needs of the people who live here. The profiles are available at the Partners in Salford website - JSNA neighbourhood32.
5.5 Levels of service provided – overview There are several levels of services provided by pharmacies commissioned by NHS England, the CCG and Local Authority.
5.5.1 Essential Services These are mandatory within the pharmacy contract and are managed and monitored by NHS England’s local team. As all pharmacy contractors must provide these services it would be sensible to use these across all wards to reduce health inequalities.
Essential services should be used by all pharmacy contractors to help deliver the local authority public health messages, improving outcomes by targeting people using a proactive approach.
Should any of the local health partners feel that a more directed service is required e.g. targeted to specific age groups or in specific wards then discussions with the LPC or NHS England about how this could be managed within the desired budget could raise a number of solutions. This could include locally commissioned services or enhanced services.
The Electronic Prescription Service (EPS) enables prescriptions to be sent electronically from the GP practice to the pharmacy and then on to the Pricing Authority for payment. The CCG actively works with GP patient participations groups, GP practices and Salford pharmacies to promote and trouble shoot the delivery of EPS in Salford.
32 Neighbourhood profiles, Partners in Salford http://www.salford.gov.uk/people-communities-and-local- information/my-local-community/neighbourhood-areas/ (accessed 16/11/2016)
42 5.5.2 Advanced Services Any contractor may choose to provide Advanced Services. There are requirements which need to be met in relation to compliance with their essential services, premises, training or notification to the NHS England Area Team.
Advanced services offer an opportunity for pharmacy contractors to engage patients and empower them to take greater responsibility for their health through their prescribed medication or appliance. Similarly, dispensing appliance contractors should do the same for patients to whom they supply appliances.
Providing patients with a better understanding of their medication or appliance can help to prevent unnecessary exacerbations of conditions and reduce the possible risk of patients accessing urgent care services; hopefully leading to better health outcomes.
5.5.3 Locally commissioned services Locally commissioned services are identified in detail by each community pharmacy in Appendix 6.
NHS England Enhanced Services NHS England currently does not commission any enhanced services from Salford pharmacies.
CCG commissioned services including those managed on behalf of NHS England. Salford CCG has the current responsibilities for managing the commissioned services, with arrangements underway to transfer these to CCG NHS Standard Contracts in order to comply with the regulations which state CCGs cannot commission enhanced services.
The CCGs commissioning intentions are that the services would remain with Salford-wide specifications unless there was clearly identified local need to commission independently for a local population.
5.5.4 Public health services Some locally commissioned services have been designated as public health services such as population screening or prevention of disease interventions. Since the Health and Social Care Act 2012, these have transferred to the Local Authorities to manage. The commissioning of the following Enhanced Services which were listed in the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2012 transferred from PCTs to Local Authorities with effect from 1 April 2013:
• Needle and syringe exchange • Screening services such as Chlamydia screening • Stop smoking • Supervised administration of medicines service • Emergency hormonal contraception services through patient group directions.
43 Where such services are commissioned by local authorities they no longer fall within the definition of Enhanced Services or pharmaceutical services as set out in legislation and therefore cannot be referred to as Enhanced Services.
However, the 2013 directions do make provision for NHS England to commission the above services from pharmacy contractors were asked to do so by a local authority. Where this is the case they are treated as enhanced services and fall within the definition of pharmaceutical services.
For a brief summary on who can commission which services please refer to the Pharmaceutical Services Negotiating Committee’s “Community Pharmacy Local Service Commissioning Routes; July 2013”
The enhanced services carried over from the previous Primary Care Trust and transferred to Salford Council are broadly split into two categories:
Sexual Health Services of which there are two service specifications: Emergency Hormonal Contraception National Chlamydia Screening Programme for 15- 25 year olds
Harm Reduction services including: Supervised Methadone/Buprenorphine Needle Exchange Smoking Cessation and Nicotine Replacement Therapy
Within Salford the transfer of two of these services were split between two commissioners with the harm reduction services being commissioned by GMW, and the sexual health services continue to be directly commissioned by the local authority. In 2015, The Needle Exchange Scheme and the Supervised Methadone/ Buprenorphine service provision within Primary Care have been re-tendered as part of the larger Drugs and Alcohol Services re- procurement exercise. These services are still delivered in Salford pharmacies but are now commissioned and managed by the drug and alcohol service lead provider, Greater Manchester West Mental Health NHS Foundation Trust.
5.5.5 Public Health campaign plans in Pharmacies for 2017 Pharmacies will start 2017 promoting the ‘One You New Year campaign’33. Public Health England began to promote this campaign from 28th December 2016 and will continue into early January 2017. This is the first Pharmacy Health Promotion campaign of 2017 which Salford Public Health is promoting for our Pharmacies. The use of this campaign is supported by NHS England, Public Health England, Salford City Council and Salford CCG. Themes will run throughout 2017 as follows:
New year, New You January – March 2017 Long-Term Conditions February – March 2017
33 One You New Year campaign, Public Health England https://www.nhs.uk/oneyou#kfHk423zvVZd3b9d.97 [Accessed 31/01/2017]
44 Living well/Healthier lifestyle April - May 2017 Physical activity/Nutrition June – August 2017 Self-Care September – October 2017 Keep well/Lifestyle Practice November – December 2017
45 5.6 Community pharmacy services and their impact upon the Locality Plan Table 5: Community pharmacy services and their impact up on the Locality Plan Community Pharmacy How do these Comments/Examples Service * impact on the Locality Plan? ** Dispensing Medicines Starting Well Explanation of medicines prescribed at the time of dispensing can increase the understanding of why and how or Appliances Living Well medicines should be taken. This should lead to a more informed medicine use and reduce adverse effects which Ageing Well may require interventions such as A&E admission.
EXAMPLE: Pharmacies could be asked to target patients who come into the pharmacy with a prescription relating to respiratory disease and ask about their smoking habits. This could bring about a referral into the stop smoking service if a patient was a smoker who was contemplating stopping. In particular this could impact on the hospital admissions attributable to smoking and Smoking at time of delivery. Repeat Dispensing Starting Well Patients who use a repeat dispensing service use less GP staff time and appointments whilst ordering their Living Well medication. This leaves GPs and their staff extra time to help the people who have more severe health needs and Ageing Well therefore more health services could be identified to remain in the community. Services Checking how patients use their prescribed medication can avert incidences arising from inappropriate use. Patients with long-term conditions are better managed and supported.
Essential EXAMPLE: Patients with an increased use of their opioid analgesics earlier than anticipated might indicate a pattern of increased usage which could be a sign of a reduction in the patient’s quality of life or could lead to excessive drowsiness and falls. Disposal of unwanted Living Well Pharmacy staff have the opportunity to identify patients who have not taken the medicines they were prescribed. medicines Ageing Well This can initiate a discussion so that problems such as side effects or dosage regimes can be addressed to help improve the patient’s health outcomes. When controlled systems of disposal are used, it can also help the pharmacist to identify other issues such as non-compliance or excessive prescribing. CCGs would be interested in knowing whether issued medicines are not being used correctly. A significant amount of wasted NHS resource is attributed to medications being used incorrectly or not at all.
46 Community How do these Comments/Examples Pharmacy impact on the Service * Locality plan? ** Public health Starting Well NHS England has linked health promotion campaigns to national priorities and local public health messages from Health and (promotion of Living Well Wellbeing Board areas across Greater Manchester. Below is the list of the six health promotional campaign themes and healthy Ageing Well relevant dates for promoting these: 1. New Year, New You January – March 2017 lifestyles) 2. Long-Term Conditions (LTCs) February – March 2017 3. Living well/Healthier lifestyle March – May 2017 4. Physical activity/Nutrition June – August 2017 5. Self-Care September – October 2017 6. Keep well/Lifestyle Practice November – December 2017 Promotion of these messages will reinforce wider campaigns to improve health in the locality and are a useful tool to engage the public in meaningful discussions about preventing illness and staying well.
EXAMPLE: 1.An oral health campaign connected to nutrition messages could be used to target awareness of tooth decay in children aged 5 2. Pharmacies becoming Dementia Friendly sites in order to offer additional help and support to dementia patients and their family. Signposting Starting Well Pharmacists are a community hub and as such are in an ideal and convenient position to signpost patients to specific services Living Well they require. Pharmacists can deliver an invaluable signposting service that can be used to direct patients and help achieve Ageing Well Salford’s vision for a healthier population.
EXAMPLE: patients with depression and anxiety condition could be directed to a local mental health support group or voluntary services (Samaritans). Support for Self Living Well Pharmacists are ideally placed to be the first point of call for health concerns in the community. If patients used pharmacies for Care Ageing Well advice on a more frequent basis this would free up resource in other health care settings which they might have otherwise accessed, such as A&E or GP practices. This would allow money to be redirected into patient care thereby further enhancing the population’s health outcomes. EXAMPLE: A new pilot scheme34 has been launched in some pharmacies whereby patients with sore throats can attend for a simple, quick swab test to determine if their infection is viral or bacterial. If it is the latter, the pharmacist can issue antibiotics. This not only frees up GP time, but also minimizes the risk of inappropriate antibiotic prescribing for sore throats.
34 Sort throat test and treat, NHS England https://www.england.nhs.uk/ourwork/innovation/nia/case-studies/malcolm-harrison/ (accessed 16/11/2016) 47 Community Pharmacy How do these Comments/Examples Service * impact on the Locality plan? ** Medicines Use Review (MURs) Starting Well Medicine Use Reviews are an opportunity for patients to discuss their medicines with a qualified Living Well pharmacist, it is a structured review to help patients to manage their medicines more effectively. Ageing Well EXAMPLE: patients taking high risk medicines; patients recently discharged from hospital that had changes made to their medicines while they were in hospital. Ideally patients discharged from hospital will receive an MUR within four weeks of discharge but in certain circumstances the MUR can take place within eight weeks of discharge; and patients with respiratory disease. patients at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines.
New Medicine service (NMS) Starting Well The service provides support for people with long-term conditions who have been newly prescribed a Living Well medicine, to help improve medicines adherence; it is initially focused on particular patient groups and Ageing Well conditions. The conditions/therapies included in the initial rollout of the service are: Services asthma and COPD diabetes (Type 2) antiplatelet / anticoagulant therapy
Advanced hypertension EXAMPLE: when a person is discharged from hospital they may have had their medication regime altered and a new medicine added. Patients who have been ill sometimes do not realise they should stop a certain medicine. This could lead to the person taking two medicines which interact and they could return to hospital for treatment.
A New Medicine Service (NMS) aims to stop these problems before they occur by helping the patient to understand why certain medicines have been stopped or started. Appliance Use Review (AUR) Living Well AURs should improve the patient’s knowledge and use of any ‘specified appliance’. If a pharmacy cannot provide this specialist service themselves they will be able to signpost patient to a Dispensing Appliance Contractor (DAC) of their choice. Stoma Appliance Ageing Well The aim of the service is to ensure proper use and comfortable fitting of the stoma appliance and to Customisation Service (SAC) improve the duration of usage, thereby reducing waste. 48 EXAMPLE: if a patient is able to manage their stoma products themselves they are less likely to need costly, intensive nursing and also less likely to be admitted to a residential or nursing home. If a pharmacy cannot provide this specialist service themselves they will be able to signpost patient to a Dispensing Appliance Contractor (DAC)
NHS Flu Vaccination Service Living Well The service covers those patients most at risk from influenza aged 18 years and older and is in one of the eligible group below:
all people aged 65 years and over (including those becoming age 65 years by 31 March 2017); people aged from 18 to less than 65 years of age with one or more of the following medical conditions: chronic (long-term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis; chronic heart disease, such as heart failure; chronic kidney disease at stage three, four or five; chronic liver disease; chronic neurological disease, such as Parkinson’s disease or motor neurone disease, or learning disability; diabetes; a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment); or splenic dysfunction pregnant women aged 18 or over (including those women who become pregnant during the flu season); people aged 18 or over living in long-stay residential care homes or other long-stay care facilities*; carers aged 18 or over; or household contacts of immunocompromised individuals who are aged 18 or over.
Since 2015/16 NHS England has commissioned pharmacists to provide the flu vaccine for those eligible groups over the age of 18. Pharmacies are responsible for informing GPs of those patients vaccinated within the Pharmacy setting.
EXAMPLE: Access to the flu vaccine for eligible patients at a location and time which is convenient to them means they are more likely to have the vaccine and it frees up GP Service appointment time. Community Pharmacy How do these Comments/Examples Service * impact on the 49 Locality plan? ** Emergency Hormonal Living Well If a patient (female)has unprotected sexual intercourse and requires EHC or advice either out of normal Contraception (EHC) working hours when their GP surgery and many of the health clinics are closed then pharmacy locations are the ideal place to receive treatment especially as EHC service is usually available throughout the pharmacy’s contracted opening hours . If patients were unable to get EHC promptly they may decide to go to A&E which would be a less cost effective use of NHS funding, or they may not be able to access services in time resulting in an unwanted pregnancy. The National Chlamydia Living Well Pharmacies can offer an alternative screening site for 15-24 year olds for Chlamydia screening and may Screening Programme for 15- also offer treatment. This will complement the core sexual health services screening and treatment work 24 year olds along with the screening done in GPs to increase the detection rate and therefore decrease the likelihood on onward transmission and lower the future prevalence of Chlamydia. Again, the weekend availability of
– some Pharmacies will help young people access screening and treatment when other clinical services are unavailable. Health Checks Living Well The NHS Health Check is a national initiative lead by Public Health England to detect early signs of heart service disease amongst people aged 40-74 (who are not already on a risk register at their GP practice). The NHS Health Check involves simple measurements such as height, weight, blood pressure and a blood test for cholesterol to prevent diabetes, heart disease, kidney disease, stroke and vascular dementia. Authority In Salford it is estimated that approximately 62,000 people are eligible for a Health Check and those eligible should be identified and invited to their GP practice to have their Health Check once every 5 Local commissioned years. However, in practice many people are of working age and find it difficult to take time off to go to their GP practice, so a pilot was set up to offer NHS Health Checks in a small number of community pharmacies to make them more accessible to those eligible. Locally Eight community pharmacies were involved in the pilot for 18 months, but they could only offer opportunistic Health Checks, (due to the Data Protection Act) which meant that they were only able to deliver relatively small numbers per year. This service should be reviewed under the new Healthy Living Pharmacy scheme that will be explored locally.
Smoking Cessation Living Well Pharmacist promotion of the stop smoking service gives clients access to this service at a time convenient for them and reduces their need to access GP appointments for repeat prescriptions. It also reduces their need to go to access GP appointments for nicotine replacement therapy (such nicotine gum and patches etc.). This medication can be provided by most pharmacies through a voucher scheme for up to 12 weeks as part of their support to help smokers to quit (prescription charges apply to the vouchers). Around 30%
50 of pharmacies offer this level 2 stop smoking support.
Supervised Methadone/ Living Well Supervision of medicine use for some individuals leads to a more stable routine and reduction in street Buprenorphine drug misuse. service Needle Exchange Living Well Needle exchange is a harm reduction programme designed to stop the spread of disease via needle commissioned West sharing between drug users. The pharmacies are also asked to take the opportunity to talk to their clients Locally GM about reduction of self-harm and health benefits resulting from this, and promoting other services which – would be beneficial to the drug users.
Minor Ailment Scheme Living Well The minor ailment scheme allows easy access to advice and medication (if appropriate) from pharmacies which may be free at the point of delivery, thereby reducing the number of GP appointments booked for minor conditions. These freed appointments can then be used to target patients with long term complicated conditions hopefully improving the health outcomes of a local population. Head Lice Eradication (this Starting Well Patients can get access to head lice eradication treatments directly from their pharmacy. This reduces the
service service is now included in the number of patients accessing GP practices and using appointments when not necessary. Minor Ailment Service) commissioned Palliative Care (medicines Ageing Well Palliative care patients’ health can deteriorate rapidly. If there is no facility to ensure there is prompt CCG
- supply scheme) access and availability to medicines then this may result in the patient being taken into hospital, this not
Locally only affects the patient but their carers who find it difficult to be away from their loved ones during a difficult period in their illness, * Refer to table in Appendix 1 for a service description ** Refer to Section 5.1 for detailed list of priorities
51 6 Current Pharmacy Provision and Services Across Salford there is one Dispensing Appliance Contractor and 59 community pharmacies of which
Eight pharmacies open for more than 100 hours per week 51 pharmacies open for a standard 40 hours with varying amount of additional hours provision offered Two pharmacies offering extended opening hours of 70 and 84 hours per week 29 open on Saturdays 11 open on Sundays
6.1 100 hour pharmacies New pharmacy application regulations (2012) no longer allow prospective owners to gain exemption from the statutory test for market entry by agreeing to provide services for at least 100 hours per week. However, existing 100 hour pharmacies must continue trading for at least 100 hours per week.
Pharmacies previously granted a contract under the 100 hours exemption category (under the 2005 regulations) make an important contribution to access to pharmacy services across the borough. Under the current regulations there is no provision for a 100 hour pharmacy to reduce their hours of service over the week. If these regulations were to alter and the eight pharmacies which currently hold a 100 hour contract applied to decrease their opening hours, this would potentially be a concern in the context of this needs assessment as they are relied upon to provide extended and out of hours cover of pharmacy contractual services for patients across the borough.
6.2 Change in number of Pharmacy contractors from 2014 At the time of scoping this PNA, it was brought to the attention of the steering group that Lloyd’s pharmacy, 13 Hankinson Way, M6 5JA may close. The notification of permanent closure was accepted by NHS England and it closed on 31st October 2016. As a result the pharmacy has not been included in the provider survey has been removed from all current service provision maps and numbers of pharmacies by ward. However, this pharmacy was still operating at the time of the public survey and so was included in the survey results; there would be no way to identify which respondents counted this as their local pharmacy. It is worth noting though that there are 9 pharmacies within a 1 km radius of this establishment and so its closure should not adversely affect patients.
The Salford PNA published in 2011 identified 55 community pharmacies. The number of pharmacies in April 2014 was 60 and as at November 2016 is 59. This is a decrease of one pharmacy from 2014.
The number of 100 hour pharmacies has remained the same at a total of 8 pharmacies. These are included in the total of 59 pharmacies above.
The number of dispensing appliance contractors has remained the same since 2011 with one provider.
52 Appliance contractors and distance selling (internet) pharmacies can be accessed from any national contractor and hence the number of suppliers solely within Salford borough does not impede the Salford residents from accessing pharmaceutical services from this type of contractor.
6.3 Dispensing activity This section examines in more detail the level of dispensing activity for the pharmacies in Salford.
6.3.1 Dispensing of Salford prescriptions Data taken from electronic Prescribing Analysis and CosT (ePACT) for the year from April 2015 to March 2016 can be used to inform commissioners of the level of prescribing. Chart 4 shows that 92.5% of the prescriptions generated by Salford GP’s are dispensed within Salford boundaries. Of the remaining 7.5%, the majority were dispensed within Greater Manchester, with the most commonly accessed areas being Manchester, Bolton then Bury.
Chart 4: Percentage of items issued by Salford prescribers which are dispensed within Salford pharmacies.
Pharmaceutical items dispensed from Salford prescriptions, 2015/16
% of items Dispensed by Pharmacies within Salford 1.1%
7.5% % of items Dispensed by Salford GP Practices
91.4% % of items Dispensed by Pharmacies outside Salford
Infographic 2 – number of items prescribed per year by postcode The spread across England of items dispensed by postcode is shown below. The maps show that the majority of items are dispensed within Salford but with a small amount of prescriptions (<2%) dispensed outside of Greater Manchester and across the country. Near neighbour is defined as a local authority with similar characteristics, this is in terms of deprivation, population demography or economic structure.
53 54 55 Chart 5: Average monthly items dispensed outside of Salford
Average monthly items prescribed in Salford but dispensed elsewehere, 2014/2015
Outside GM 6,251
Manchester 10,677
Bolton 6,708
Bury 5,197
Trafford 4,630 a e r A Wigan 2,945
Oldham 784
Tameside 406
Stockport 192
Rochdale 161
0 2000 4000 6000 8000 10000 12000 Number of items dispensed
This information leads us to the conclusion people may have their GP in Salford but will cash their prescription where convenient to them, the majority of which is within the Salford boundary. However, some people may choose to cash their prescription near a work place or relative’s house.
6.4 Access to pharmacies by location
6.4.1 Pharmacies per head of population Based on community pharmacy dispensing data from the Information Centre covering 2014 to 2015, comparisons are made with the national average and regional averages. Previously, the data to PCT level was available publicly, however, in 2014/15 the lowest level published was to Area Team. The data for Salford has been calculated internally to give an understanding of the situation in the local area.
The items dispensed per month per pharmacy in Salford (items dispensed within Salford only) is 7,640 which is higher than both the England and Greater Manchester Area Team averages of 6,983 and 7,167 respectively. This means Salford has one of the highest figures nationally for average monthly items dispensed.
There is a higher number of items per head of population prescribed per month (1.92) even though current population is relatively young as described in section 4.
56 There could be a number of reasons for this. One example is that the high number of deprived LSOAs may result in increased demand for prescriptions for minor illnesses, as these populations tend to access healthcare services rather than self-care.
The number of community pharmacies per 100,000 population in Salford compares favorably with the national average and is the same as the Greater Manchester average at 25 pharmacies per 100,000 population in 2014/15.
This information includes the pharmacy that closed on 31st October 2016 (Lloyd’s pharmacy, Hankinson Way, M6 5JA) as it was open at the time of the published data collection around average prescription items per month. The population data used is for 2013 as this covers the same time period as published data so comparisons can be made against other areas using the same source of data.
Table 6: Community pharmacies and average prescription items per month per pharmacy 2014/15 Number of Prescription Average Population Pharmacies Prescription community items monthly (000)s per 100,000 items pharmacies dispensed items per Mid 2013 population dispensed in 2014/15 per month pharmacy per 100,000 (000)s population 2014/15 (average per month)
ENGLAND 11,674 81,525 6,983 53,866 22 1.51 North of England 3,704 28,028 7,567 15,198 24 1.84 Greater Manchester Area Team 695 4,981 7,167 2,748 25 1.81 Salford (items dispensed within Salford only) 60 458 7640 239 25 1.92 Sources: NHS Prescription Services of the NHS Business Services Authority35
Population data - Office of National Statistics (2013 mid-year Estimates)36
35 Table 2b: Community pharmacies on the pharmaceutical list, prescription items dispensed per month, General Pharmaceutical Services, Health and Social Care Information Centre http://www.hscic.gov.uk/catalogue/PUB19026/gen- pharm-eng-201415-appendix1VER2.xlsx (accessed 18/10/2016)
36 Population mid year estimates (2013), Office for National Statistics https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates (accessed 18/10/2016)
57 Pharmacies could be used to move the prescribing of minor ailment away from GP practices so that GPs can concentrate on the long term condition patients. This may also reduce the number of items per month prescribed as if people self manage their care some items may not be needed to be provided on prescription.
Despite the high number of prescriptions and high levels of deprivation across the city there are still higher numbers of pharmacies per 100,000 population available to Salford residents than compared to England and the same number as across Greater Manchester generally.
6.4.2 Pharmacies per locality There is pharmacy provision across all neighbourhoods ranging from three in Worsley and Boothstown to 11 in Ordsall and Langworthy.
Table 7: Pharmacy contractors and GP practices by neighborhood 2016 Dispensing GP 100 hour Salford All Appliance Practices pharmacies Neighbourhood pharmacies Contractors 2016
Claremont & Weaste 4 3 East Salford 11 2 8 Eccles 11 1 6 Irlam & Cadishead 5 1 5 Little Hulton & Walkden 7 1 8 Ordsall & Langworthy 11 3 10 Swinton 7 1 3 Worsley & Boothstown 3 3 Salford 59 8 1 46
6.4.3 Pharmacies per Ward The average number of pharmacies across Salford is three per ward (Table 8). This ranges from one in Worsley, Little Hulton, Irlam and Walkden South wards to a high of nine in the Langworthy ward. It should be borne in mind that each ward will have different size of population with differing health needs and different urban structures (e.g. more or less built up). Also the area of the ward will affect the travel time to pharmacies within it’s boundaries, so the number of pharmacies per ward cannot be used to directly compare one ward to another unless these other statistics are taken into account.
Every ward has at least one community pharmacy, and since 2013 there has been a reduction of just one pharmacy in Salford. Two Salford pharmacies have relocated to other sites within Salford since 2013. These applications were reviewed by the Health and Wellbeing Board as part of the statutory consultation process in context of the 2014 PNA.
58 Table 8: Pharmacies by ward 2013 and 2016 Ward Pharmacy Pharmac Pharmacies per GP Neighbour Ward Name population in per ward y 1000 Surgery hood 2014 ( 2013) per ward population* per ward Barton 12,462 Eccles 1 ( 2016)2 0.16 20161 Boothstown & Worsley & 9,532 2 2 0.21 2 Ellenbrook Boothstown Broughton 14,916 East Salford 7 7 0.47 6 Irlam & Cadishead 10,739 4 4 0.37 3 Cadishead Claremont & Claremont 10,166 2 2 0.20 1 Weaste Eccles 11,499 Eccles 6 5 0.43 4 Irlam & Irlam 9,857 1 1 0.10 2 Cadishead Irwell 12,939 East Salford 2 2 0.15 0 Riverside Kersal 12,929 East Salford 2 2 0.15 2 Ordsall & Langworthy 12,980 9 8 0.62 7 Langworthy Little Hulton & Little Hulton 13,469 2 1 0.07 2 Walkden Ordsall & Ordsall 16,725 3 3 0.18 3 Langworthy Pendlebury 13,434 Swinton 1 2 0.15 1
Swinton North 11,473 Swinton 3 2 0.17 1
Swinton South 11,458 Swinton 3 3 0.26 1
Walkden Little Hulton & 12,232 3 5 0.41 4 North Walkden
Walkden Little Hulton & 10,185 2 1 0.10 2 South Walkden Weaste Claremont & 12,616 2 2 0.16 2 &Seedley Weaste Winton 12,339 Eccles 4 4 0.32 1 Worsley & Worsley 10,090 1 1 0.10 1 Boothstown
TOTAL 242,040 60 59 0.24 46
* Number of pharmacies in 2016 divided by 2014 ward population data37
37 Population mid year estimates 2014, Office for National Statistics https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates (accessed 18/10/2016)
59 6.4.4 Correlation with GP practices Twelve of the 20 wards in Salford have more pharmacies than GP practices, while three of the wards have fewer pharmacies than GP practices. Five wards have equal numbers of pharmacies and GP practices.
However, if we look at the neighbourhoods rather than at ward level only one neighbourhood has more GP practices than pharmacies – this is Little Hulton and Walkden where there are seven pharmacies and eight GP practices.
6.4.5 Access issues described in the Pharmacy Contractor survey Out of 53 pharmacists who responded to the survey, one skipped the question around access issues. Of those who responded, 13.5% (seven pharmacies) reported that not all areas of the pharmacy floor are accessible by wheelchair. The most common facilities in the pharmacy aimed at helping disabled people access the pharmacy were ‘Large print labels/leaflets’ (at 57.1% of respondents), ‘Wheelchair ramp access’ (55.1%), ‘Hearing loop’ (46.9%), and ‘Disabled parking spaces’ (44.9%).
6.4.6 Neighbouring areas Salford has borders with 5 other local authorities within Greater Manchester. To the north are Wigan, Bolton and Bury and to the south are Trafford with Manchester to the southeast. The southwest of Salford also shares borders with Warrington.
60 Map 6: Greater Manchester local authorities and neighbouring areas
Most of these local authority areas have a co-terminus CCG apart from Manchester City Council who have three CCGs (North Manchester, Central Manchester and South Manchester) within its boundaries.
The services provided by both the local authorities and the CCGs within these neighbouring area may also be accessed by Salford residents particularly if they are provided from healthcare providers located close to the border with Salford.
Commissioners should consider, when making a proposal to amend or start a service close to a neighbouring area whether there is already a service provided by another healthcare provider with accessibility to the Salford residents they are trying to target. Conversely consideration should be made when altering a service if this may affect the population of a neighbouring local authority. This is currently addressed by consulting neighbouring Health and Wellbeing Boards when an application for new provision is received by NHS England.
61 6.4.7 Travel times to Pharmacies Another important consideration to make when determining whether or not to increase the number of pharmacies within a community is how long it takes to travel to a pharmacy.
All areas of high population have a pharmacy located within 2km and almost all areas have access within one mile, only small parts of Worsley and northern/northeastern Pendlebury cannot access a pharmacy within one mile of their home (Maps 7 and 8 ).
Map 7: Location of pharmacies within a 2KM boundary
62 Map 8: Location of pharmacies within a 1 mile boundary
All areas within Salford can access a Pharmacy within 20 minutes of public transport (Map 9) whilst the same areas of Worsley and Pendlebury identified above would have to walk more than 20 minutes to a pharmacy (Map 10). These areas, however, have a higher likelihood of access to a car/van in the household and would be able to access pharmacies further afield if required.
63 Map 9: Pharmacies within a 20 minute Public Transport catchment area
Map 10: Pharmacies within a 20 minute walk catchment area
64 6.4.8 Population density The more densely populated areas are indicated by blue areas in map 11. The densely populated areas of Langworthy and Broughton are well served by pharmacies. Areas such as local parks would reduce the land available for pharmacy development and also indicate a lower population. The area to the west of Salford lying between the M62 and the A580 East Lancashire Road is mainly fields and an area of woodland called Botany Bay Wood. Hence there are very few residential properties in this location and therefore there is no requirement for a pharmacy contract to be established to cover this geographical gap
Map 11: Location of pharmacies and urban population density
.
6.4.9 School locations and pharmacies Health priorities and needs of children and young people can be partly covered by pharmacies. The locations of schools and colleges has been plotted on a map (Map 12) against pharmacies and are located within close proximity to primary and secondary school locations.
65 Map 12: Locations of schools and pharmacies
6.5 Access to pharmacies by opening hours Full opening hours of all pharmacies and locations can be found in Appendix 8. The availability of pharmaceutical services out of hours cover is readily accessible on Salford CCG’s website and via contact with 111
More than half of Salford’s neighbourhoods have 100 hour contractors within their boundaries or nearby. The neighbourhoods without a pharmacy operating for 100 hours are Worsley and Boothstown; Claremont and Weaste; Little Hulton and Walkden.
6.5.1 Saturday Opening Half of the pharmacies are open on a Saturday with at least one open in every neighbourhood. Access to pharmacy services can be found between the hours of 6.30am to 11pm on a Saturday at certain locations within Salford.
6.5.2 Sunday Opening Two neighbourhoods, Claremont and Weaste and Worsley and Boothstown, have no standard pharmacy contractors open on a Sunday.
Although there is no standard pharmacy contractual cover in Claremont and Weaste neighbourhood on Sundays, there are pharmacies close by within the Eccles neighbourhood which are easily accessible by either walking or car travel to the population. There are four
66 pharmacies located within 2 miles of Salford Royal Foundation Trust which are open on a Sunday.
Worsley and Boothstown neighbourhood are the least well served at a weekend with access up to 1pm on a Saturday and no open pharmacy services on a Sunday.
6.5.3 Bank Holiday Opening NHS England has a responsibility to ensure the population of HWB areas can access pharmaceutical services on normal days as well as days specified as Bank Holidays when pharmacies would not be expected to open (public or bank holidays and Easter Sunday). Where there is a need for additional provision on a Bank Holiday or on a named day under the regulations which has been identified, NHS England may consider directing pharmacies to open.
Alternatively the HWB could commission a local service to meet the need of its resident. 6.6 Access to locally commissioned services Locally Commissioned Services are commissioned via the local authority, CCG or GMW and are described in further detail in Appendix 1 with a full list of pharmacies offering each service available in Appendix 6.
Whilst the coverage through sign up to these locally commissioned services is very good, analysis of the claims made for activity under these contracts suggests that fewer pharmacies may actually be delivering. It is important to note that just because pharmacies have not claimed does not mean they are not providing the services.
Needle exchange is available in at least one pharmacy across all neighbourhoods other than Claremont & Weaste and Worsley & Boothstown. However, Claremont & Weaste are also served by pharmacies close by in Eccles neighbourhood which are easily accessible by either walking or car travel to the population. There is a low level of need for this service in Worsley and Boothstown, however, the majority of this population are more likely to have access to private transport which enables them to travel further for services required.
There are no pharmacies offering palliative care within East Salford. The service requires a pharmacist to stock and supply an agreed list of specialist medicines for use in palliative care and in addition to ensure there is prompt access and availability to these medicines at all times the pharmacy is open.
The locally commissioned services form the local authority are shown in map 13.
The Nicotine Replacement Therapy (NRT) voucher scheme was set up to support the community stop smoking services in order to make medicinal nicotine such as patches, easily accessible. The alternative for smokers wanting help to quit would be to send them to their GP for a prescription.
The majority of community pharmacies will exchange nicotine replacement therapy vouchers that have been given out by advisers in the Health Improvement Service or the Stop Smoking in Pregnancy Service scheme. Clients may have up to 12 weeks of NRT supplied
67 every 2 weeks and prescription charges apply. A small number of pharmacies will not exchange NRT vouchers, so clients need to ask first.
Pharmacies which offer smoking cessation support can provide NRT vouchers directly to their clients who want help to quit smoking (for up to 12 weeks and prescription charges apply).
The Emergency Hormonal Contraception (EHC) service involves the supply of Levonorgestrel when appropriate to clients in line with the requirements of the Patient Group Direction (PGD). Pharmacy based provision of EHC is an essential alternative point of access compared to traditional sexual and reproductive health services, particularly for attendances outside of normal working hours. Under 16 year olds must be competent to consent to the treatment (using the Fraser Guidelines).
The Chlamydia screening services in Pharmacies are part of the National Chlamydia Screening Programme aimed at 15-24 year olds which seeks to mass screen at least 2.3% of this population annually in order to diagnose, treat and ultimately reduce the prevalence of Chlamydia in the this age group. Several Pharmacies are signed up to provide Chlamydia screening and some also provide treatment services in line with the requirements of Patient Group Directions (PGD). Under 16 year olds must be competent to consent to the treatment (using the Fraser Guidelines). These services are also available in GPs and sexual and reproductive health services in Salford as well as from the Greater Manchester Chlamydia screening service (RUClear) which provides training and support to all participating Pharmacies.
68 Map 13: Pharmacy sign up to locally commissioned services (local authority)
There are potentially some gaps identified in some of the locally commissioned services from the local authority, CCG and GMW. Further analysis is required to ascertain which of those pharmacies commissioned actually deliver; whether further provision is required currently or in the future. The needs of the local population for these services should be further assessed also.
To gain a better understanding of the pharmacies commissioning services and the delivery of such services, it is recommended that a full review of the locally commissioned services is undertaken as part of Healthy Living Pharmacy (HLP) framework and should be completed by November 2017.
6.7 Pharmacy contractor survey – summary of results The purpose of the survey was to understand from pharmacists a range of issues about to questions relating to pharmacy provision, accessibility, languages, and services. Salford has 59 chemists, with many now based in a major retail stores or supermarkets but operating independently within that store - 53 pharmacies responded to the survey representing a 90% response rate.
69 Extended opening is available in 20 pharmacies (37.7% of respondents) who provide early opening hours (before 9am), with a further 46 (86.8%) being open throughout lunchtimes, and eight (15.1%) providing late opening hours (after 7pm).
Access to pharmacies for those in a wheelchair is not suitable at 12 pharmacies (22.6%), with a further seven pharmacies reporting that all areas of the pharmacy floor are not accessible by a wheelchair and 19% do not have disabled parking within 10 metres of the pharmacy.
Looking at specific facilities aimed at helping people with disabilities, no pharmacies have ‘Talking labels’,98% do not provide an ‘Assistance required intercom button’, 98% do not have an LCD display for queue ticket numbers, and 98% do not have ‘Subtitles/ closed captions on visual monitors’. Also 80% do not have a ‘Disabled toilet facility’, 55% do not have ‘Disabled parking spaces’, and 53% do not have a ‘Hearing loop’.
Just over half (50.9%) of all pharmacies surveyed suggested that their qualified pharmacists could speak a language other than English with a further 34% of non-qualified staff.
Other than English the most common languages spoken by qualified staff are Urdu (51.9% of pharmacies answering the question), Gujarati (37.0%), Hindi (33.3%), Punjabi (29.6%), Arabic (22.2%), and French (22.2%).
The number of such pharmacies that speak foreign languages are highest in M30 (Eccles) = 9, M7 (Broughton) = 4, and M6 (Pendleton) = 4.
There are no qualified pharmacists (that responded) able to communicate with British Sign Language/ BSL, Cantonese, Georgian, Japanese, Kurdish, or Romanian. 6.8 Public Survey Further to the health needs identified through the local statistics by the HWB, the residents of Salford also have opinions about how they would like their pharmacies to provide services. These were explored in a survey which the PNA steering group developed. A summary of the findings is set out below, for the full results please refer to Appendix 7.
6.8.1 Summary of the Salford Public Survey The purpose of the survey was to consult with the public in relation to their use and opinions of pharmacies (also known as chemists), and asked questions relating to pharmacy provision, accessibility, and services.
The total number of respondents was 578. The response rate was lower in Central Salford, as well as among the youngest/ oldest age bands, some ethnic groups, students, and unemployed people.
Customer service criteria were found to be a priority for the majority of respondents. When asked about why people use their pharmacy regularly ‘staff are friendly’ and ‘staff are knowledgeable’ came up respectively as 1st and 2nd highest (out of 8 criteria). When asked about importance, ‘Knowledgeable staff’ and ‘Friendly staff’ were rated 1st and 3rd highest (out of 9 criteria).
70 Opening times are generally considered to be less important than customer service with 81% finding ‘knowledgeable staff’ more important than early opening (52%) or Sunday opening (45%). Response rates include those who skipped the question.
In terms of accessibility 45% of respondents (of the 497 who answered the question) are not willing to travel more than a mile to access a pharmacy (Q11), although 63% (of the 531 who answered the question) said that if their regular pharmacy was not open or out of stock they would ‘find another pharmacy’. Of the 496 who answered the question about accessibility to the pharmacy, 96.4% were able to get to the pharmacy of their choice.
71 6.9 Conclusion The number of pharmacies appears sufficient for the population of Salford. Almost all areas of high population have a pharmacy located within 1 mile of them and more than 92% of prescriptions generated by Salford prescribers are dispensed by Salford pharmacies.
Pharmacy opening hours are currently sufficient during the week and on Saturdays. This is also true for Sundays, even though in some neighbourhoods there is no pharmacy open. This is because the public have not requested extended hours in these areas as many have access to their own transport and are willing to travel to a pharmacy elsewhere to obtain pharmacy services. Out of hours cover for pharmacies is readily available on Salford CCG’s website and via 111, further communication about this to the public will be launched throughout 2017/18 in line with the extended GP access service. NHS Choices is available to show availability of services, but is currently under utilized for this purpose, further work will be completed by NHS England to improve this throughout 2017/18 and beyond.
The conclusion drawn in terms of the opening hours for pharmacies around Salford is that all neighbourhoods have sufficient cover except for Boothstown and Ellenbrook ward, but that the need for additional Sunday hours has not been identified by the public in this area. This, in conjunction with the access to transport for the residents of Boothstown and Ellenbrook, leads the HWB to conclude that additional Sunday opening is not necessary in any of the Salford neighbourhoods.
There are weaknesses in relation to accessibility for people with disabilities particularly if they are in a wheelchair as access into and around the pharmacy floor is an issue in approximately one fifth of pharmacies. Plus there are no pharmacies with ‘Talking labels’ and almost all do not provide ‘Assistance Required’ intercom button; LCD display for queue ticket numbers; Subtitles/closed captions on visual monitors. There is also limited availability of disabled toilets or parking spaces. This will be highlighted to the LPC as a possible area for further inquiry.
There are potentially some gaps identified in some of the locally commissioned services from the local authority, CCG and GMW. Further analysis is required to ascertain which of those pharmacies commissioned actually deliver; whether further provision is required currently or in the future. The needs of the local population for these services should be further assessed also. To gain a better understanding of the pharmacies commissioned services and the delivery of such services. It is recommended that a full review of the locally commissioned services is undertaken as part of Healthy Living Pharmacy (HLP) framework and should be completed by November 2017.
72 7 Future Matters 7.1 Social and economic context The 2015 Index of Multiple Deprivation (IMD) indicates that Salford is the 22nd most deprived local authority in England out of a total of 326 local authority areas. The average household income in Salford is £28,894 in 2015 which is below the UK average of £37,542, furthermore the unemployment rate in Salford in June 2016 is 1.7% of the working age population which is higher than the UK average of 1.4%. Although this figure has fallen in recent years there are still areas of the inner city where unemployment is a significant problem. In addition the worklessness rate for Salford is 12.9% in November 2015 which is higher than the GB average of 9%, (the out of work benefits figures are used to measure worklessness). Child poverty is a further measure of deprivation and in 2013 Salford had 25.3% of Children living in families in poverty which compares with 18% for England as a whole. (These figures have used the official Government definition). These indicators of poverty and deprivation mentioned in this paragraph all have an impact on Salford’s population in terms of health and well being.
Significant changes are being made to the benefits and tax credit system due to the introduction of the Welfare Reform Act 2012. The biggest impact upon vulnerable households will be introduction of Universal Credit and the benefit cap. Universal Credit will combine key benefits such as jobseekers allowance, housing benefit, and tax credits. The benefit cap will limit the amount of any benefit paid to households of working age to £350 per week for a single adult with no children and £500 per week for a couple or lone parent, regardless of the number of children they have. The changes will impact on those households reliant upon benefit payments, which are likely to be the most vulnerable and low income households in the City.
Welfare reform will impact on disabled people and carers through the reassessment for Disability Living Allowance and the move to Personal Independence Payments and through the shift to Universal Credit and the tie in of Carers Allowance. The impact of the Work Capability Assessment is likely to be the highest on people with mental health problems who may not comply with the reassessment process or whose conditions are difficult to assess by generalists.
The single prescription charge in England increased by 35p to £8.40 in April 2016 from £8.05 in 2014. This is a 4.3% increase over a two year period. Prescriptions are free of charge to patients with certain eligible criteria ranging from claiming certain benefits; being aged over 60 years or under 16 years (or 19 years and in full time education); an NHS hospital in- patient; receiving treatment for certain conditions and diseases or being pregnant (or gave birth in previous 12 months). Prepayment certificates are also available at a cost of £29.10 for three months or £104 for 12 months38.
The increased use of community pharmacies could take the pressure off A&E departments, where many people go for minor ailments, and off General Practitioners, where the average
38 Prescription charges/Health benefits, Disability Rights UK http://www.disabilityrightsuk.org/prescription- chargeshealth-benefits (accessed 17/11/2016)
73 waiting time for a non-urgent appointment is around two weeks. This is particularly important for the poorest areas where more people die from conditions such as smoking, alcohol abuse and obesity compared to people from more affluent areas.
The less formal approach and sheer convenience provided by a high street pharmacy means they can provide advice and wellbeing to many who would simply never engage with other healthcare settings. Community pharmacies are a socially inclusive healthcare service providing a convenient and less formal environment for those who cannot easily access or do not choose to access other kinds of health service. The causes of health inequalities are complex and pharmacists are well-placed to understand and deliver tailored solutions which will work well in the communities they serve.
7.2 Housing and development
7.2.1 Salford developments Between 1 April 2015 and 31 March 2020 it is estimated that across Salford there will be a net additional increase of around 10,500 dwellings39, with an estimated 1,000 of these being of an affordable tenure. Over 70% of the total additions are likely to be within the wards of Ordsall and Irwell Riverside. The latest government projections based on past trends estimate that over the same period there will a population increase of 13,100 across the city. The actual population increase is though likely to be significantly higher than this, particularly having regard to the level of estimated housing completions.
The wards of Ordsall and Broughton (and the neighbourhoods they are in) are currently well served by pharmacy contractors with 3 and 7 pharmacies respectively, with access to extended opening hours with two and three 100 hour contract pharmacies in each neighbourhood respectively. Therefore it is not deemed necessary to increase the number of pharmacies in these areas solely because of the planned housing developments. As a statutory consultee, the Salford Health and Wellbeing board will consider any pharmacy merger applications in light of how they will fit with the future growing population needs of Salford. The Board would review each application and where it concludes mergers may leave gaps in provision, it would respond to NHS England highlighting this accordingly, and ask for this to be factored in to any decision made.
In relation to retail developments in the city, work is ongoing in relation to the remodeling of the Ellesmere Centre and Ellesmere Retail Park in Walkden Town Centre (4,253 sq.m of space), whilst construction was completed on a new Asda supermarket in Swinton Town Centre in 2013/14 (6,671sqm of floorspace). These developments have potential to significantly increase the number of trips to the centres. Planning permission for new retail space, but where development has not yet started, has also been granted for Mocha Parade Local Centre (1,426sqm), the AJ Bell Stadium (21,367sqm) and in the Salford Central area (10,810sqm). The major employment developments in the period between 2015 and 2020 in the city will be Port Salford at Barton, MediaCityUK, various large office schemes around the
39 Housing and Economic Land Availability Assessment (2010 to 2035) https://www.salford.gov.uk/helaa-2015-to-2035 (accessed 20/10/2016)
74 regional centre, and a major logistics area at Cutacre (primarily in Bolton but spreading into the city to the west of Little Hulton).
Developments of new and redevelopments will increase the number of potential customers for pharmacies ranging from those with complex and long term conditions to a population with diverse needs or faiths/religions.
Little Hulton and Walkden neighbourhood currently has 7 pharmacies. Between these 7 pharmacies they have opening hours during the week, on a Saturday from 8am until 9pm and on a Sunday between 10am and 4pm. These times would coincide with standard shopping hours and therefore it is not necessary to open any further pharmacies due to the development of the shopping centres in Walkden.
Likewise, Swinton has 7 pharmacies open during standard retail hours, including 8.30am till 6pm on a Saturday and between 10am and 3:30pm on a Sunday. Again these should be sufficient to cope with any influx of shoppers at the new Asda site.
7.2.2 Greater Manchester Spatial Framework (GMSF) and the Local Plan
A joint plan to manage the supply of land for jobs and new homes across Greater Manchester is being undertaken by the Greater Manchester Combined Authority. The Greater Manchester Spatial Framework (GMSF) will ensure that the right land is in the right places to deliver the homes and jobs needed up to 2035, along with identifying the new infrastructure (such as roads, rail, Metrolink and utility networks) required to achieve this.
It will be the overarching development plan within which Greater Manchester’s ten local planning authorities can identify more detailed sites for jobs and homes in their own area. As such, the GMSF will not cover everything that a local plan would cover and individual districts will continue to produce their own local plans.
Importantly, the GMSF will address the environmental capacity of Greater Manchester, setting out how we enhance and protect the quality of the natural environment, conserve wildlife and tackle low carbon and flood risk issues, so that we can accommodate growth sustainably. Alongside the GMSF, we are also developing an integrated appraisal framework (including a strategic environmental assessment, sustainability appraisal, health impact assessment and equality impact assessment) to ensure we understand the impacts of decisions and agree the best policies for Greater Manchester.
At the time of the consultation for this PNA, both the GMSF and Local Plan were out for public consultation. As such, future PNAs will need to consider the GMSF and Local Plan and the indications they give to population growth and regeneration, as well as the potential sites for new GP surgeries or changes to existing ones, so that the population of Salford can still be served effectively.
7.3 Primary care developments
75 7.3.1 Planned developments In 2016 there are three planned developments of new primary care facilities as follows:
Little Hulton, where a project brief outline plans and funding are agreed in principle. Construction is planned to start in 2017. Lower Broughton where draft plans are in place with a developer for regeneration land Construction is intended to be completed by end of 2017, pending agreement with practices. Irlam and Cadishead is a joint development with the council and the Hamilton Davies Trust. Currently new premises adjacent to the existing leisure centre are being considered but no plans are agreed yet. Construction is likely to start in 2018/19 at the earliest.
7.3.2 Extended access services Primary care provides the first point of contact in the health care system. In the NHS, this includes community pharmacies, dentists and optometrists; however, the main source of primary health care for most people is general practice. There are 46 GP practices in Salford, serving a registered population of approximately 240,000 people.
Extended GP Access enables patients see a GP outside of normal surgery hours. The service is particularly valuable for workers who may find it difficult to make an appointment during weekdays, for family members supporting an elderly relative, children returning unwell from school and need to be seen. Extended GP access enables patients, parents and family members/carers to make and attend appointments which are mutually convenient or for when the patient’s own surgery appointments are fully booked.
The proposed hubs for the extended access services are:
Swinton Gateway Walkden Gateway Pendleton Gateway The Willow Tree Eccles Gateway
Pharmacies, as part of the first line primary care team, support GPs to manage routine and non-urgent cases. By redirecting a proportion of routine cases to pharmacists there will be increased capacity within General Practice to see more complex and frail patients. The extended access programme will intensify demand on Pharmacists to support GPs further in the management of minor ailments and non-urgent patients.
How this will impact on the need for pharmaceutical services is difficult to quantify and it will be important that commissioners are mindful of the requirement for people to have access to pharmaceutical services as part of this transformation. As a statutory consultee, the Salford Health and Wellbeing board will consider any pharmacy merger applications in light of how they will fit with the future growing population needs of Salford. The Board would review each application and where it concludes mergers may leave gaps in provision, it would respond to NHS England highlighting this accordingly, and ask for this to be factored in to any decision made.
76 7.4 Future directions of Community Pharmacy Services
7.4.1 Healthy Living Pharmacies This PNA assesses the current and future pharmaceutical needs for Salford. The health and care system is constantly evolving and the development of Healthy Living Pharmacies may influence the need for pharmaceutical services in the future.
The Healthy Living Pharmacy (HLP) framework is a tiered commissioning framework aimed at achieving consistent delivery of a broad range of high quality services through community pharmacies to meet local need, improving the health and wellbeing of the local population and helping to reduce health inequalities.
There are three levels of increasing complexity and required expertise with pharmacies aspiring to go from one level to the next within the HLP framework. It is also an organisational development framework underpinned by three enablers of:
workforce development – a skilled team to pro-actively support and promote behaviour change, improving health and wellbeing; premises that are fit for purpose; and engagement with the local community, other health professionals (especially GPs), social care and public health professionals and local authorities.
A pharmacy must consistently exhibit a healthy living ethos and proactive approach to health before being awarded the HLP quality mark. The pharmacy must have at least one qualified Health Champion and demonstrated that they meet a set of quality criteria covering workforce development, premises and engagement with their community and other providers. The pharmacy also has to demonstrate consistent delivery of contracted services to a high level, e.g. medicines support services and health improvement services.
77 The Impact of Healthy Living Pharmacies
Governments in the UK and across the world are universally facing financial challenges plus increased and ageing populations and health inequalities. The need for cost effective treatment of those who are ill and keeping them out of hospital is a common theme and, with medicines being the most frequent clinical intervention, optimising the value of the effective use of those medicines as part of the system cost is increasingly a focus of attention rather than just reducing their cost.
Pharmacies, being an integral part of the community, are well placed to offer services that improve the public's health and there is increasing evidence of the value of these interventions. 70% of people who visit pharmacies do not regularly access other health care services so HLPs can provide health and wellbeing support to people in their community. Improved choice and access to early interventions on issues such as optimal medicines use, obesity, alcohol and smoking should improve outcomes in the short and long term and therefore impact cost of care in the future.
Evaluations of Healthy Living Pharmacies (HLP) to date demonstrate an increase in successful smoking quits, extensive delivery of alcohol brief interventions and advice, emergency contraception, targeted seasonal flu vaccinations, common ailments, NHS Health Checks, healthy diet, physical activity, healthy weight and pharmaceutical care services. The reports also indicate that the HLP model is working in areas with different demography and geography. As awareness of what services people can access in a community pharmacy increases and they experience the pro-active support and healthy living ethos of an HLP, the benefits will spread in both breadth and depth to a wider population helping them live well for longer.
Salford City Council is responsible for the commissioning of several Public Health Services that are delivered in Pharmacies across Salford which are:
1. Smoking Cessation and Nicotine Replacement Therapy (NRT) 2. The National Chlamydia Screening Programme for 15-24 year olds 3. Emergency Hormonal Contraception 4. NHS Health Checks (currently being piloted in 8 Pharmacies)
78 These have been commissioned by the local authority since the adoption of these public Health responsibilities as part of the Health and Social Care Act 2012. As part of a wider review of Primary Care deliver models of our Public Health services, Salford City Council is considering using the Healthy Living Pharmacies model as a new ‘wrap around’ framework for these services which will also include the training of Pharmacy staff to increase their knowledge and delivery of other brief interventions such as:
Long Term Conditions Alcohol Food & Diet Mental WB Physical Activity Sexual Health Smoking
There are some Pharmacies in Salford that have already begun the accreditation procedure for Healthy Living Pharmacies and we will look to support other local Pharmacies in gaining this accreditation this year and beyond as we look to introduce this model more widely across Salford Pharmacies.
A review of Healthy Living Pharmacies will be undertaken that will include improving access to and public awareness of commissioned services, particularly for vulnerable and hard to reach groups within the population. Discreet pieces of work around these groups and locally commissioned services will be added to the intelligence calendar.
7.4.2 Department of Health Community Pharmacy Savings Proposals in 2016/17 In the Spending Review, the Government re-affirmed the need for greater efficiency and productivity, and the need for the NHS to deliver £22 billion efficiency savings by 2020/21, as set out in the NHS’s own plan, the Five Year Forward View. Community pharmacy will need to play its part in delivering those efficiencies.
Community pharmacies already play a vital role in dispensing medicines, advising on medicine use, promoting good health and supporting the prevention agenda and supporting people to look after themselves. However it could play an even greater role as part of more integrated local care models in optimising medicine usage, supporting people with long term conditions, treating minor illness and injuries, taking referrals from other care providers, preventing ill health and supporting good health.
Pharmacy at the heart of the NHS To integrate Pharmacies with the wider health and social care system to help relieve pressure on GPs and Accident and Emergency Departments, ensure optimal use of medicines, and will mean better value and patient outcomes.
NHS funding for community pharmacy In 2016/17, the total funding commitment for pharmacies under the community pharmacy contractual framework (essential and advanced services) will be no higher than £2.63bn, compared to £2.8bn in 2015/16. The average pharmacy receives £220,000 a year in NHS fees and allowances and in the context of the NHS needing to deliver £22 billion in efficiency
79 savings by 2020/21; the government has said it wants to examine community pharmacy and the contribution it can make to this challenge.
Efficiency in community pharmacy It is suggested that there are approximately 3000 too many pharmacies in England and many of them are grouped together, with 40% located in clusters of three or more within a 10- minute walk of each other and thus between 1,000 and 3,000, out of 11,674 should or could close overall.
Salford City Council has a strong working relationship with Salford and Trafford Local Pharmaceutical Committee (LPC), which is now part of Greater Manchester Local Pharmaceutical Committee (LPC). Salford council and partners (e.g. GMW) work with pharmacies to deliver a needle exchange service, observed consumption treatment, emergency contraception, Chlamydia treatment and stop smoking interventions.
The Council’s Public Health team works in partnership with local pharmacies to deliver a national pharmacy contract requirement to hold six annual public health campaigns and contributes funding and is aiming to develop the Healthy Living Pharmacy (HLP) framework in Salford. The HLP scheme will ensure that all those pharmacies that sign up to the scheme are trained and prepared to offer advice and practical interventions to help people manage minor illness, to prevent illness through self-care and give healthy lifestyle advice to maximise good health and wellbeing, improve quality of life. It is hoped that training of an initial small cohort of Pharmacies will begin in 2017/18, that will then be able to provide brief health and wellbeing interventions to the Salford population that visit their Pharmacies. This new model will support them to work towards the suggested proposal of community pharmacy playing a greater role as part of more integrated care models. The proposals may encourage more pharmacies to become members of the scheme providing an extended service to prevent ill health and support good health.
The change in funding is likely to reduce the number of pharmacies therefore reducing access to the public. These changes are likely to have greater impact on the smaller pharmacies dispensing less than 5,000 prescriptions per month and many of these pharmacies are in the areas of highest deprivation and greatest need.
Once any proposals are confirmed, the HWB will need to assess whether a PNA revision will be required as a result.
80 8 Conclusions (for the purpose of Schedule 1 to the 2013 Regulations)
8.1 Current provision – essential and other relevant services As described in particular in section 6 and required by paragraphs one and three of schedule 1 to the Regulations, Salford’s HWB has had regard to the pharmaceutical services referred to in this PNA in seeking to identify those that are essential, have secured improvements or better access, or have contributed towards meeting the need for pharmaceutical services in the area of the HWB. Salford’s HWB has determined that while not all provision was essential to meet the need for pharmaceutical services, the majority of the current provision was likely to be essential as described in section 6. 8.2 Essential services – gaps in provision As described in particular in section 6 and required by paragraph two of schedule 1 to the Regulations, Salford’s Health and Wellbeing Board (HWB) has had regard to the following in seeking to identify whether there are any gaps in necessary services in the area of the HWB.
8.2.1 Access to essential services In order to assess the provision of essential services against the needs of our population we consider access (distance to travel and opening hours) as the most important factor in determining the extent to which the current provision of essential services meets the needs of the population.
8.2.2 Access to essential services during normal working hours Salford’s HWB has determined that the travel times as identified in section 6 to access essential services are reasonable in all the circumstances. Based on the information available at the time of developing this PNA, no current gaps in the need for provision of essential services during normal working hours have been identified.
8.2.3 Access to essential services outside normal working hours In Salford there is satisfactory access to essential services outside normal working hours in all eight Neighbourhoods and across the HWB area. This is due to the supplementary opening hours offered by certain pharmacies. It is not expected that any of the current pharmacies will reduce the number of core opening hours and NHS England foresees no reason to agree a reduction of core opening hours for any service provider except on an ad hoc basis to cover extenuating circumstances. Based on the information available at the time of developing this PNA, no current gaps in the provision of essential services outside normal working hours have been identified. The outcome of national consultation on the savings proposals for community pharmacies (see section 7) may impact upon the numbers and distribution of pharmacies within Salford, therefore, once any proposals are confirmed, the HWB will need to assess whether a PNA revision will be required as a result.
81 8.2.4 Access to advanced services Insofar as only NHS England may commission these services, section 6 of this PNA identify access to enhanced services. Based on the information available at the time of developing this PNA, no current gaps in the provision of advanced services have been identified. 8.3 Future provision of essential services Salford’s HWB has not identified any pharmaceutical services that are not currently provided but that will, in specified future circumstances, need to be provided in order to meet a need for pharmaceutical services. Based on the information available at the time of developing this PNA, no gaps in the need for pharmaceutical services in specified future circumstances have been identified. 8.4 Improvements and better access – gaps in provision As required by paragraph 4 of schedule 1 to the 2013 Regulations, Salford’s HWB has had regard to the following in seeking to identify whether there are any gaps in other relevant services within the eight Neighbourhoods and the area of the HWB.
8.4.1 Access to advanced services – present and future circumstances
Salford’s HWB considered the conclusion in respect of current provision as set out at 8.1 above and the information in respect of essential services as it had done at 8.2. While it was not possible to determine which current provision of advanced services by location or standard hours provided improvement or better access, the HWB was satisfied that some current provision did so. Salford’s HWB has not identified services that would, if provided either now or in future specified circumstances, secure improvements to or better access to advanced services. Based on the information available at the time of developing this PNA, no gaps have been identified in advanced services that if provided either now or in the future would secure improvements, or better access, to advanced services.
8.4.2 Current and future access to advanced services All pharmacies are currently offering MURs or NMS. These services are not commissioned by NHS England but provided by the pharmacy should it choose to do so. NHS England continues to encourage these pharmacies and pharmacists to become eligible to deliver MURs and to encourage all pharmacies to complete the maximum number of MURs allowed to ensure more eligible patients are able to access and benefit from this service. NHS England continues to encourage pharmacies and pharmacists to become eligible to deliver the service so that more eligible patients are able to access and benefit from this service. 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 these services. Pharmacies and DACs may choose which appliances they provide and may also choose whether or not to provide the two related advanced services. NHS England continues to encourage those contractors in the area that do provide appliances to become eligible to deliver these advanced services where appropriate. Based on the information available at the time of developing this PNA, no gaps have been identified in the need for advanced services that if provided either now or in the future would secure improvements, or better access, to advanced services.
82 8.4.3 Current and future access to advanced services NHS England commissioned just two enhanced services (minor ailment scheme and inhaler technique) from pharmacies. This service is also provided from other non-pharmacy providers, principally GP practices. Many of the enhanced services listed in the 2013 directions are now commissioned by Salford City Council (public health services) Salford CCG, Based on the information available at the time of developing this PNA, no gaps in respect of securing improvements, or better access, to enhanced services either now or in specified future circumstances have been identified. 8.5 Other NHS Services As required by paragraph five of schedule 1 to the 2013 Regulations, Salford’s HWB has had regard in particular to section 6 considering any other NHS services that may affect the determination in respect of pharmaceutical services in the area of the HWB. Based on the information available at the time of developing this PNA, no gaps in respect of securing improvements, or better access, to other NHS services either now or in specified future circumstances have been identified. 8.6 How the assessment was carried out As required by paragraph 6 of schedule 1 to the 2013 Regulations: In respect of how the HWB considered whether to determine localities in its area for the purpose of this PNA, see section 3. In respect of how the HWB took into account the different needs in its area, including those who share a protected characteristic, see sections 4. In respect of the consultation undertaken by the HWB, see Appendix 2. 8.7 Map of provision As required by paragraph seven of schedule 1 to the 2013 Regulations, the HWB has published a map of premises providing pharmaceutical services in maps 7-11 (Section 6). Additional maps are also provided throughout this document.
9 List of Appendices
Appendix 1 - Pharmacy Service descriptions Appendix 2 - PNA 60 day consultation plan Appendix 3 - 60 day consultation analysis Appendix 4 - Pharmacies by neighbourhood and ward Appendix 5 - Pharmacy Survey 2013 and analysis (Salford) Appendix 6 - Locally Commissioned Services at Salford pharmacies Appendix 7 - Public Survey 2013 and analysis (Salford) Appendix 8 - Opening hours of contractors Appendix 9 - Glossary of terms Appendix 10 - Community Impact Assessment
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