West Kent Pharmaceutical Needs Assessment

Pharmaceutical HEALTH NEEDS ASSESSMENT FOR WEST KENT December 2010 Pharmaceutical Health Needs Assessment December 2010 The ‘Patient Offer’ for the People in West Kent: You can expect your pharmacy to provide you with a wide range of over the counter and NHS services. These include accurate and timely dispensing of prescriptions including repeatable NHS prescriptions, disposal of unwanted medicines, support and advice for self care and healthy lifestyles, and signposting where appropriate to other health and social care providers. Most pharmacies also have a dedicated consultation room to provide you with a confidential consultation to help you get the best out of the medicines you are taking. “You can expect your pharmacy to meet the following standards: • To be open at least 40 hours a week (most pharmacies in NHS West Kent are open longer) • To clearly show their opening hours and, when closed to clearly show the location and times of the nearest open pharmacies • To have information available in an easily accessible form on the services provided in the form of a practice leaflet and • At least once a year, to ask you what you think about their services through a patient questionnaire.” Fig. 1 Community Pharmacies (+) and Dispensing GP Practices (●) in West Kent A list of Pharmacies is attached at Appendix 1: and a list of Dispensing GPs at Appendix 4. Page 2 Pharmaceutical Health Needs Assessment December 2010 Contents Page 1 Executive Summary 4 2 Introduction and Context 8 3 Methodology 12 4 Overview of Health Needs in NHS West Kent 14 5 Local Health Needs in West Kent 28 6 Current Service Provision in West Kent 43 7 Outcomes of the PNA Consultation Process 52 8 Conclusion and Recommendations 53 9 Glossary 56 10 Appendices (in separate documents) 1) List of pharmacies in West Kent and services provided 2) Opening hours in pharmacies 3) Summary narrative of advanced, enhanced services and other pharmaceutical services provided by pharmacies 4) List of dispensing practices 5) Maps showing pharmaceutical provision by location 6) Summary of local data for deprivation (LLSOAs and IDACI) 7) Local data for chronic disease in West Kent 8) Local data and priorities for public health in West Kent 9) Patient Involvement summary feedback 10) PNA Consultation Summary Report Authors: Linda Prickett, Public Health Specialist, West Kent PCT Claire Johnson, Head of Medicines Management SW Locality, West Kent PCT Dr Grace Howarth, Specialist Registrar in Public Health, West Kent PCT Jessica Mookherjee, Consultant in Public Health, West Kent PCT With thanks to: Natasha Roberts, Head of Health Intelligence, Kent & Medway Public Health Observatory Balraj Minhas, Prescribing Adviser / Lead for Community Pharmacy, West Kent PCT Michelle Jee, Community Pharmacy Contracts Manager Emma Cain, Community Involvement Manager & Vicky Dyer, Head of User Research, WKPCT Michael Keen, Chief Executive Officer, Kent Local Pharmaceutical Committee Susan Sparrow, Personal Assistant, Public Health, West Kent PCT All data within this document and associated appendices was as up to date as possible at the time of writing (December 2010), and may be subject to change thereafter. To access updated figures, contact the Customer Services Team on 0800 0 850 850 Page 3 Pharmaceutical Health Needs Assessment December 2010 1 Executive Summary All Primary Care Trusts (PCTs) in England must publish a Pharmaceutical Needs Assessment (PNA) by 1 February 2011. This PNA covers NHS Pharmaceutical services provided by Community Pharmacy contractors, Appliance contractors and Dispensing Doctors. It will be used to determine gaps in service and whether applications to provide access to new pharmaceutical and dispensing services will be approved; for example, by opening a new pharmacy or moving to new premises. In considering ease of access to pharmacies, opening times, travelling distances and physical access to premises must be addressed, while holding in mind the profile of the community served. This PNA includes links to the pharmacy white paper, market entry and Joint Strategic Needs Assessments (JSNAs). The geographical area of the PCT has been divided into the six localities of the second tier councils (Boroughs and Districts of Dartford, Gravesham, Sevenoaks, Maidstone, Tonbridge & Malling and Tunbridge Wells in order to review service provision, to tie in with data presented in the Joint Strategic Needs Assessment. In future iterations of the PNA data will be made more compatible with new commissioning boundaries, which at this time are still in a state of flux. The West Kent PNA has been developed in partnership with the Local Pharmaceutical Committee, Local Medical Committee, individual GPs, individual pharmacies, local patient and public stakeholders (through completion of a questionnaire) and Kent County Council. Consultation with these parties has informed the final version of this document. The population of West Kent is ageing. There are significant health inequalities both between and within localities in West Kent. There is a mix of urban and rural communities. Some areas in West Kent have not yet been determined as urban or rural, it is a priority to complete these determinations as soon as possible. The proportion of ethnic minority population varies widely between localities, and there have been changes in the representation of different ethnic groups within the BME population. Increases in population and changes in age and demographics will be kept under review in order to ensure that pharmaceutical services are accessible for all residents. Some issues were raised in consultation regarding equity, equality, confidentiality and disability. Consultation also showed that people want more detailed information about what pharmaceutical services are available to them, where and when, to inform their choice. Dispensing services are provided by 113 pharmacies and 32 dispensing practices in West Kent. Physical access to pharmacy premises is good, with all households within 20 minutes’ drive of a pharmacy, and most pharmacies located in the most deprived areas within 20 minutes’ walking distance. There are six ‘100 hours’ pharmacies in West Kent, situated relatively evenly across the six localities. These provide essential additional access to pharmaceutical services on evenings and weekends for people who find it difficult to access pharmacies in core hours. Consultation showed that this level of access to extended hours is the minimum needed; any reduction in the opening hours of those pharmacies would create a gap in service provision. West Kent pharmacies are efficient, with high rates of prescriptions dispensed. Although the population is increasing there is no evidence that more ‘standard hours’ pharmacies are required at present. The projected growth and development in housing for Dartford may require a review of the situation in future years. Page 4 Pharmaceutical Health Needs Assessment December 2010 In West Kent the number of community pharmacies is less than the national average of 20 per 100,000 population. However, the GP dispensing practices complement this with good dispensing provision, especially in countryside communities. Many pharmacies provide a prescription collection and delivery service for the housebound, but details of equity of coverage across West Kent is not known. Further explanation and analysis of equity of provision of timely access to this service for vulnerable patients is required. There is a gap in provision of some non-dispensing pharmaceutical services (for example, domiciliary MURs) in some areas outside the towns. While provision of services on pharmacy premises is good, there is room to improve access to the increasing range of services pharmacies will be expected to provide (especially those where pharmacies are the sole providers) for people who are housebound. Medicines Use Review (MUR) is available in most pharmacies; current commissioners would like to see provision in all pharmacies. There is a gap in providing domiciliary MUR to care homes and housebound patients as an integral part of the patient care pathway for long term conditions (e.g. at annual reviews). West Kent pharmacies offer a good range of locally commissioned advanced, enhanced and other services, to improve public health and management of long-term conditions. Some services are most appropriately provided by Pharmacies, rather than by any other community providers. These include Medicines Use Review, Emergency Hormonal Contraception, the Minor Ailments Service, Needle and Syringe Exchange and Supervised Consumption. Most of this provision is spread evenly across: but can be better focussed within localities, according to need as detailed in the profiles detailed on pages 25-37. In areas where there is a lack of provision appropriate to specific needs, commissioners will require pharmacies (either existing or when being proposed) to provide these services, for example Emergency Hormonal Contraception for teenagers and Chlamydia screening in wards of high teenage pregnancy, and needle exchange in wards where data shows that drug use is prevalent. Minor ailments service provision from Community Pharmacies is not evenly distributed across localities, and this provision should be reviewed to ensure the service is provided in a targeted manner to those areas that need it most. Provision of End of Life and palliative care drugs in West Kent has been reviewed during the preparation of this needs assessment and an enhanced service has been approved by the

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