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Pharmaceutical Needs Assessment

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Pharmaceutical Needs Assessment Pharmaceutical Needs Assessment APPENDICES ONLY – READ WITH PNA MAIN SECTION Version control HWB Version Date of this version Stockton-on-Tees FINAL A1 March 2018 Final publication date: March 2018 Latest date for publication of subsequent full review March 2021 (Statutory; unless superseded) Exit Logged in as: Philippa Walters from Tees LPC (Hartlepool Area) Home Services Assessments Reports Help Service Design PNA PHARMACY CONTRACTOR Questionnaire Tees Valley (Preview) • Edit Service Design Date of completion 13-Nov-2017 Provision Reports Preview Basic Premises Information Name of Contractor i.e. name of individual, partnership or company Basic Provision Record owning the pharmacy business (Sample) See explanation box to the right. 'Name of Contractor' is shown as 'Pharmacy Name' on the pdf Pharmaceutical List provided by NHS England, that you will check as part of this PNA process. You MUST USE THIS NAME when completing this box. Service Support Address of Contractor IMPORTANT: At the end of the questionnaire you will check the information held on the Pharmacy Questionnaire-PNA pharmaceutical list. A pdf of this Check pdf Pharmaceutical List for Trading Name. Where this is correct; Please complete this questionnaire information is available via a link please use the same name ONCE ONLY to report the facilities shown below. Please ensure that and services offered by your Trading Name the Basic Premises Information you usually the 'name above the door' pharmacy. input here matches that on the list Post Code OR your declaration given below If you have any questions about where different. how to fill out this questionnaire Is this a Distance Selling Yes No using PharmOutcomes, contact Pharmacy? (i.e. it cannot provide Essential Services to persons present at the pharmacy) your local LPC - Sandie Hall via [email protected] Pharmacy NHS.net email address If no email write no email Pharmacy telephone Pharmacy website address If no website write no website ODS code (also known as F code or 'PP A code') Please renew permission to hold the data you provide and use this to contact you if necessary Consent to store this Yes No data Is the pharmacy Yes No Not known authorised to access the Summary Care Record? Consultation Facilities We will assume you have an approved consultation area Confirm this is the case Yes No If Other please specify Are you willing to undertake consultations In a patients home? On another suitable site? No i.e neither of the above Accessibility; parking, public transport, adjustments for disability Parking within 50m of Yes No pharmacy? Hover over the options for more description Bus stop in walking Yes No distance? Disabled parking within Yes No 10m? On-site accessibility Does the pharmacy entrance allow for unaided wheelchair access? Wheelchair access Yes No Do you offer specific Yes No support for those with sensory loss? Advanced Services Please give details of the Advanced Services provided by your pharmacy. Please tick the box that applies for each service. Yes - Currently providing Soon - Intending to begin within the next 12 months No - Not intending to provide Medicines Use Review Yes Soon No New Medicine Service Yes Soon No Appliance Use Review Yes Soon No NUMSAS Yes Soon No Stoma Appliance Yes Soon No Customisation Influenza V accination Yes Soon No Service Hover over the options for more description Locally Commissioned Services This section is about services known as 'Locally Commissioned Services'. These are the 'Enhanced Services' that may be commissioned by NHS England (e.g., Bank Holiday opening), the 'Public Health Services' that may be commissioned by a Local Authority (e.g., supervised methadone) or 'CCG commissioned services' (e.g., Minor Ailments). There is a long list of examples of these services below. We know that many of them are not commissioned locally at the moment, but the PNA looks at possible services as well as existing ones. For each service in the list, tick to tell us if you are currently FUNDED to deliver it. IMPORTANT: You are not a 'current provider' if you only offer a service privately - there is a section for 'private' services later. If you are not a current provider of the service, we want to know if your pharmacy would (in principle) be willing to offer it, if commissioners invited you to do so. So for each service, please tick the ONE box that applies for your pharmacy . Hovering over each option will show a reminder of this list. CP - Currently providing this NHS/LA/CCG funded service WA - Not providing now but willing to provide if commissioned and trained ?? - Not providing now and unsure if would provide this service if asked X - Not willing to provide this service Healthy Start V itamins CP WA ?? X Hover over the options for more description Directed Bank Holiday CP WA ?? X opening (rota) Hover over the options for more description Out of hours call-out CP WA ?? X services Hover over the options for more description Emergency Hormonal CP WA ?? X Contraception (via PGD) Hover over the options for more description LARC Contraception CP WA ?? X (not an EHC service) Hover over the options for more description C-Card (registration or CP WA ?? X supply) Hover over the options for more description On demand availability of CP WA ?? X specialist drugs Hover over the options for more description Supervised Self- CP WA ?? X Administration Hover over the options for more description Needle and Syringe CP WA ?? X Exchange Hover over the options for more description Obesity management CP WA ?? X Hover over the options for more description Pharmacy First / Minor CP WA ?? X Ailment Hover over the options for more description Care Home Service CP WA ?? X Hover over the options for more description Anti-viral Distribution CP WA ?? X Hover over the options for more description Gluten Free Food Supply CP WA ?? X i.e not supply on FP10 prescription Hover over the options for more description Adherence support for CP WA ?? X Long T erm Conditions Hover over the options for more description e.g., hypertension, diabetes etc Anticoagulant CP WA ?? X monitoring Hover over the options for more description Cardiovascular Risk CP WA ?? X Assessment Hover over the options for more description (sometimes known as NHS Healthchecks Sharps Disposal eg CP WA ?? X diabetic not needle ex Hover over the options for more description Phlebotomy CP WA ?? X Hover over the options for more description Independent Prescribing CP WA ?? X Hover over the options for more description Schools Service CP WA ?? X Hover over the options for more description Prescriber Support CP WA ?? X Hover over the options for more description Directly Observed CP WA ?? X Therapy eg., drugs for Hover over the options for more description TB or HIV Smoking Cessation Services: NRT (Dispensing only) CP WA ?? X Voucher Hover over the options for more description Level 2 Smoking CP WA ?? X Cessation (full 'One Hover over the options for more description Stop') Varenicline via PGD CP WA ?? X Hover over the options for more description Screening Services Alcohol Brief CP WA ?? X Interventions Hover over the options for more description Chlamydia (test only) CP WA ?? X Hover over the options for more description Chlamydia (test and CP WA ?? X treat) Hover over the options for more description HIV CP WA ?? X Hover over the options for more description Gonorrhoea CP WA ?? X Hover over the options for more description Hepatitis B or C CP WA ?? X Hover over the options for more description Cholesterol CP WA ?? X Hover over the options for more description diabetes CP WA ?? X Hover over the options for more description H Pylori CP WA ?? X Hover over the options for more description COPD screening CP WA ?? X Hover over the options for more description Other Screening (please state) Other vaccinations i.e not Seasonal Flu V ac None are currently commissioned so this option is removed. Please indicate of you are WA - willing to provide if commissioned ?? - not certain if would provide if asked X - not willing to provide Childhood vaccinations WA ?? X Hover over the options for more description HPV WA ?? X Hover over the options for more description Hepatitis B WA ?? X Hover over the options for more description Travel vaccines WA ?? X Hover over the options for more description Other (please state) Providing Private Services Indicate with a tick each and ALL the services your pharmacy offers as a private service. First, screening services or tests: Private services the pharmacy offers Cholesterol Diabetes COPD HIV Hepatitis B Gonorrhoea Chlamydia (test only) Chlamydia (test & treat) Full sexual health screen H. pylori Alcohol Other Next, vaccination services Private services provided - vaccination HPV Hepatitis B Travel vaccine(s) Childhood vaccine(s) Varicella Pneumococcal pneumonia Other Other services Private services provided, continued Medicines sales for self care Cardiovascular risk EHC LARC Weight management Care home service Phlebotomy Needles/syringes supply Sharps disposal Gluten free food supply Smoking cessation behavioural support Varenicline private PGD Prescriber support Independent prescribing Schools service Adherence support (long term conditions) Blood pressure Medicines delivery (see later) Other Healthy Living Pharmacy Is this a Healthy Living Pharmacy Is this a Healthy Living Pharmacy Yes working towards HLP status No, not planned If Yes, how many Healthy Full Time Equivalents Living Champions do you currently have? Collection and Delivery services Does the pharmacy provide any of the following? Collection of prescriptions Yes No from surgeries Delivery of dispensed Yes No medicines - Free of charge on request Delivery of dispensed medicines - free for selected patient groups List criteria or groups eligible Delivery of dispensed medicines - free to selected areas List geographical areas eligible Delivery of dispensed Yes No medicines - chargeable Have you introduced or substantially increased your charges for delivery within the last 3 years? delivery charges in last 3 years Yes No Not applicable Languages One potential barrier to accessing services at a pharmacy can be language.
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