DRAFT Pharmaceutical Needs Assessment 2015

Ealing PNA Draft

DRAFT

Pharmaceutical Needs Assessment 2015

Ealing Health and Wellbeing Board

This Draft Pharmaceutical Needs Assessment has been produced through the PNA Steering Group for Ealing Health and Wellbeing Board by Ealing Council with authoring support from Soar Beyond Ltd 1

Ealing PNA Draft

Contents

Contents ...... 2 Executive summary ...... 10 Section 1: Introduction ...... 14 1.1 Background ...... 14 1.2 Purpose of the PNA ...... 15 1.3 Scope of the PNA ...... 15 1.3.1 Pharmacy contractors ...... 16 1.3.2 Dispensing appliance contractors ...... 18 1.3.3 Local pharmaceutical service providers ...... 18 1.3.4 Dispensing GP practices ...... 19 1.3.5 Other providers of pharmaceutical services in neighbouring HWB areas ...... 19 1.3.6 Other services and providers in Ealing HWB area, out of scope of the PNA ...... 19 1.4 Process for developing the PNA ...... 20 1.5 Localities for the purpose of the PNA ...... 23 Section 2: Context for the PNA ...... 25 2.1 Joint Strategic Needs Assessment ...... 25 2.2 Joint Health and Wellbeing Strategy ...... 25 2.3 Population characteristics ...... 26 2.3.1 Overview ...... 26 2.3.2 Age ...... 26 2.3.3 Predicted population growth ...... 31 2.3.4 Housing development ...... 32 2.3.5 Life expectancy at birth ...... 33 2.3.6 Fertility rate ...... 35 2.3.7 Specific populations ...... 35 2.3.7.1 Ethnicity ...... 35 2.3.7.2 Language ...... 38 2.3.7.3 School children ...... 39 2.3.7.4 Children and adults in care ...... 41 2.3.7.5 Older people ...... 41

Ealing PNA Draft

2.3.7.6 Prison population ...... 43 2.3.7.7 Less-abled populations ...... 43 2.3.7.8 Homeless population ...... 45 2.3.7.9 Asylum seekers and refugees ...... 45 2.3.7.10 Traveller population ...... 45 2.3.8 Deprivation ...... 46 2.4. Other considerations ...... 47 2.4.1 Disease prevalence ...... 47 2.4.2 Hospital admissions ...... 48 2.4.3 Causes of death ...... 50 2.4.4 Palliative care ...... 52 2.4.5 Lifestyle related morbidity ...... 53 2.4.6 Health issues ...... 56 Section 3: NHS pharmaceutical services provision; currently commissioned 58 3.1 Community pharmacies ...... 58 3.1.1 Choice of community pharmacies ...... 60 3.1.2 Intensity of current community pharmacy providers ...... 60 3.1.3 Weekend and evening provision ...... 60 3.2 Dispensing appliance contractors (DACs) ...... 62 3.3 Distance-selling pharmacies ...... 62 3.4 Access to community pharmacies ...... 62 3.4.1 Routine daytime access to community pharmacies ...... 62 3.4.2 Routine weekday evening access to community pharmacies ...... 63 3.4.3 Routine Saturday daytime access to community pharmacies...... 68 3.4.4 Routine Sunday daytime access to community pharmacies ...... 75 3.4.5 Routine Bank Holiday access to community pharmacies ...... 77 3.4.6 Twenty-four hour provision ...... 77 3.5 Advanced service provision from community pharmacies ...... 77 3.6 Enhanced service provision ...... 78 3.7 Pharmaceutical service provision provided from outside Ealing HWB area 78 Section 4: Other services which may impact on pharmaceutical services provision ...... 79 4.1 Local Authority commissioned services provided by community pharmacies in Ealing ...... 79 4.2 Clinical Commissioning Group (CCG) commissioned services ...... 79 3

Ealing PNA Draft

4.3 Other services provided from community pharmacies ...... 79 4.4 Collection and delivery services ...... 80 4.5 Language services ...... 80 4.6 Services for less-abled people ...... 80 Section 5: Findings from the public survey ...... 81 Section 6: Analysis of health needs and pharmaceutical service provision .... 84 6.1 Acton Central locality ...... 84 6.1.1 Necessary services: current provision ...... 84 6.1.2 Necessary services: gaps in provision ...... 84 6.1.3 Other relevant services: current provision ...... 85 6.1.4 Improvements and better access: gaps in provision ...... 85 6.1.5 Other services ...... 85 6.2 Cleveland locality ...... 85 6.2.1 Necessary services: current provision ...... 86 6.2.2 Necessary services: gaps in provision ...... 86 6.2.3 Other relevant services: current provision ...... 86 6.2.4 Improvements and better access: gaps in provision ...... 86 6.2.5 Other services ...... 86 6.3 Dormer Wells locality ...... 87 6.3.1 Necessary services: current provision ...... 87 6.3.2 Necessary services: gaps in provision ...... 87 6.3.3 Other relevant services: current provision ...... 87 6.3.4 Improvements and better access: gaps in provision ...... 88 6.3.5 Other services ...... 88 6.4 Ealing Broadway locality ...... 88 6.4.1 Necessary services: current provision ...... 88 6.4.2 Necessary services: gaps in provision ...... 88 6.4.3 Other relevant services: current provision ...... 89 6.4.4 Improvements and better access: gaps in provision ...... 89 6.4.5 Other services ...... 89 6.5 Ealing Common locality ...... 89 6.5.1 Necessary services: current provision ...... 89 6.5.2 Necessary services: gaps in provision ...... 90 6.5.3 Other relevant services: current provision ...... 90

Ealing PNA Draft

6.5.4 Improvements and better access: gaps in provision ...... 90 6.5.5 Other services ...... 90 6.6 East Acton locality ...... 90 6.6.1 Necessary services: current provision ...... 91 6.6.2 Necessary services: gaps in provision ...... 91 6.6.3 Other relevant services: current provision ...... 91 6.6.4 Improvements and better access: gaps in provision ...... 91 6.6.5 Other services ...... 92 6.7 Elthorne locality ...... 92 6.7.1 Necessary services: current provision ...... 92 6.7.2 Necessary services: gaps in provision ...... 92 6.7.3 Other relevant services: current provision ...... 92 6.7.4 Improvements and better access: gaps in provision ...... 93 6.7.5 Other services ...... 93 6.8 Greenford Broadway locality ...... 93 6.8.1 Necessary services: current provision ...... 93 6.8.2 Necessary services: gaps in provision ...... 94 6.8.3 Other relevant services: current provision ...... 94 6.8.4 Improvements and better access: gaps in provision ...... 94 6.8.5 Other services ...... 94 6.9 Greenford Green locality ...... 94 6.9.1 Necessary services: current provision ...... 95 6.9.2 Necessary services: gaps in provision ...... 95 6.9.3 Other relevant services: current provision ...... 95 6.9.4 Improvements and better access: gaps in provision ...... 95 6.9.5 Other services ...... 95 6.10 Hangar Hill locality ...... 96 6.10.1 Necessary services: current provision ...... 96 6.10.2 Necessary services: gaps in provision ...... 96 6.10.3 Other relevant services: current provision ...... 96 6.10.4 Improvements and better access: gaps in provision ...... 96 6.10.5 Other services ...... 97 6.11 Hobbayne locality ...... 97 6.11.1 Necessary services: current provision ...... 97

Ealing PNA Draft

6.11.2 Necessary services: gaps in provision ...... 97 6.11.3 Other relevant services: current provision ...... 98 6.11.4 Improvements and better access: gaps in provision ...... 98 6.11.5 Other services ...... 98 6.12 Lady Margaret locality ...... 98 6.12.1 Necessary services: current provision ...... 98 6.12.2 Necessary services: gaps in provision ...... 99 6.12.3 Other relevant services: current provision ...... 99 6.12.4 Improvements and better access: gaps in provision ...... 99 6.12.5 Other services ...... 99 6.13 North Greenford locality ...... 99 6.13.1 Necessary services: current provision ...... 100 6.13.2 Necessary services: gaps in provision ...... 100 6.13.3 Other relevant services: current provision ...... 100 6.13.4 Improvements and better access: gaps in provision ...... 100 6.13.5 Other services ...... 100 6.14 Northfield locality ...... 101 6.14.1 Necessary services: current provision ...... 101 6.14.2 Necessary services: gaps in provision ...... 101 6.14.3 Other relevant services: current provision ...... 101 6.14.4 Improvements and better access: gaps in provision ...... 101 6.14.5 Other services ...... 102 6.15 Northolt Mandeville locality ...... 102 6.15.1 Necessary services: current provision ...... 102 6.15.2 Necessary services: gaps in provision ...... 102 6.15.3 Other relevant services: current provision ...... 103 6.15.4 Improvements and better access: gaps in provision ...... 103 6.15.5 Other services ...... 103 6.16 Northolt West End locality...... 103 6.16.1 Necessary services: current provision ...... 103 6.16.2 Necessary services: gaps in provision ...... 104 6.16.3 Other relevant services: current provision ...... 104 6.16.4 Improvements and better access: gaps in provision ...... 104 6.16.5 Other services ...... 104

Ealing PNA Draft

6.17 Norwood Green locality ...... 104 6.17.1 Necessary services: current provision ...... 105 6.17.2 Necessary services: gaps in provision ...... 105 6.17.3 Other relevant services: current provision ...... 105 6.17.4 Improvements and better access: gaps in provision ...... 105 6.17.5 Other services ...... 105 6.18 Perivale locality ...... 106 6.18.1 Necessary services: current provision ...... 106 6.18.2 Necessary services: gaps in provision ...... 106 6.18.3 Other relevant services: current provision ...... 106 6.18.4 Improvements and better access: gaps in provision ...... 107 6.18.5 Other services ...... 107 6.19 South Acton locality ...... 107 6.19.1 Necessary services: current provision ...... 107 6.19.2 Necessary services: gaps in provision ...... 107 6.19.3 Other relevant services: current provision ...... 108 6.19.4 Improvements and better access: gaps in provision ...... 108 6.19.5 Other services ...... 108 6.20 Southall Broadway locality ...... 108 6.20.1 Necessary services: current provision ...... 109 6.20.2 Necessary services: gaps in provision ...... 109 6.20.3 Other relevant services: current provision ...... 109 6.20.4 Improvements and better access: gaps in provision ...... 109 6.20.5 Other services ...... 109 6.21 Southall Green locality ...... 110 6.21.1 Necessary services: current provision ...... 110 6.21.2 Necessary services: gaps in provision ...... 110 6.21.3 Other relevant services: current provision ...... 110 6.21.4 Improvements and better access: gaps in provision ...... 110 6.21.5 Other services ...... 111 6.22 Southfield locality ...... 111 6.22.1 Necessary services: current provision ...... 111 6.22.2 Necessary services: gaps in provision ...... 111 6.22.3 Other relevant services: current provision ...... 112

Ealing PNA Draft

6.22.4 Improvements and better access: gaps in provision ...... 112 6.22.5 Other services ...... 112 6.23 Walpole locality ...... 112 6.23.1 Necessary services: current provision ...... 112 6.23.2 Necessary services: gaps in provision ...... 113 6.23.3 Other relevant services: current provision ...... 113 6.23.4 Improvements and better access: gaps in provision ...... 113 6.23.5 Other services ...... 113 Section 7: Conclusions ...... 114 7.1 Population and demography ...... 114 7.2 Services for older people ...... 114 7.3 Services for younger people ...... 115 7.4 Long-term conditions ...... 116 7.5 Harm prevention ...... 116 Appendix A: List of pharmaceutical service providers in Ealing HWB area ... 117 Appendix B: PNA Steering Group Terms of Reference ...... 133 Appendix C: Patient survey ...... 135 Appendix D: Pharmacy contractor survey ...... 142 Appendix E: Commissioner survey ...... 162 Appendix F: PNA timeline ...... 166 Appendix G: Consultation plan and list of stakeholders ...... 168 Appendix H: Summary of consultation responses and comments ...... 176 Appendix I: Results of the patient survey ...... 177 Appendix J: Results of the pharmacy contractor survey ...... 191 Appendix K: Results of the commissioner survey ...... 223 Abbreviations ...... 229 References ...... 230 Equality impact assessment ...... 232 Map A: Pharmacy locations ...... 242 Map B: Pharmacy locations and ward boundaries...... 243 Map C: Pharmacy locations and population density by output area ...... 244 Map D: Pharmacies and Index of Multiple Deprivation 2010 by output area .. 245 Map E: Average peak drive times to nearest pharmacy ...... 246

Ealing PNA Draft

Map F: Average public transport times to nearest pharmacy, Tuesday, 9am to 5pm ...... 247 Map G: Average walking times to nearest pharmacy ...... 248

Ealing PNA Draft

Executive summary Every Health and Wellbeing Board (HWB) is now required to produce a Pharmaceutical Needs Assessment (PNA). This mapping of pharmaceutical services against local health needs provides Ealing HWB with a framework for the strategic development and commissioning of services. It will enable the local pharmacy service providers and commissioners to:  Understand the pharmaceutical needs of the population  Gain a clearer picture of pharmaceutical services currently provided  Make appropriate decisions on applications for NHS pharmacy contracts  Commission appropriate and accessible services from community pharmacy  Clearly identify and address any local gaps in pharmaceutical services  Target services to reduce health inequalities within local health communities This draft PNA has been produced through the PNA Steering Group for Ealing HWB by Ealing Council with authoring support from Soar Beyond Ltd. The consultation on the draft PNA is taking place between 05/11/2014 and 04/01/2015. We wish to acknowledge the contribution of the Ealing Public Health team and in particular Dr Anthony Wakhisi for drafting Section 2: Context for the PNA. NHS Pharmaceutical Services in England NHS Pharmaceutical Services are provided by contractors on the ‘Pharmaceutical List’ held by NHS England. Types of providers are:  Community pharmacy contractors, including distance-selling pharmacies  Dispensing appliance contractors  Local pharmaceutical service providers  Dispensing doctors Community pharmacies operate under a contractual framework agreed in 2005 which sets three levels of service: Essential Services: Negotiated nationally. Provided from all pharmacies. Advanced Services: Negotiated nationally. Provided from some pharmacies, specifically accredited. Enhanced services: Negotiated locally to address local health needs. Provided from selected pharmacies, specifically commissioned.

Ealing PNA Draft

This contract enables NHS England area teams to commission services to address local needs, whilst still retaining the traditional dispensing of medicines and access to support, for self-care from pharmacies. Health in Ealing The area Ealing is a borough on the west of London. It has borders with the other London Boroughs of Hillingdon, Harrow, Brent, Hammersmith and Fulham, and Hounslow. Towns in the London Borough of Ealing include Acton, Ealing, Greenford, Hanwell, Northolt, Perivale and Southall. Covering an area of just over 21 square miles, Ealing has an array of areas of housing, industry, shopping, and many large areas of green space including ten municipal parks. The population The population has grown by 16% over the last 15 years and by 18% over the last 25 years. The current estimated population is 342,500. This number is projected to rise to:  381,500 by 2024 (9.8%)  408,200 by 2034 (17.4%) These rates are significantly higher than the England average (7.1% and 13.1% respectively). For both Ealing and England the highest increment will be amongst persons aged 65 years and over. Ealing Council plans to develop 3,042 homes during 2014-2019 which will help support the growing population and demand for housing. Ealing has a larger than average proportion of non-white ethnic population (51%) as compared to the London average of 40% and England average of 15%. The increasing population and its diversity will require significant planning for the delivery of services, in particular to meet its varied health and social care needs. Health inequalities Ealing on the whole is a relatively affluent area with pockets of deprivation. The most deprived areas within the borough are concentrated largely in the west: Southall Green, Norwood Green, Dormers Wells, Northolt North West and areas in South and Central Acton. Particular populations which may have specific health needs include asylum seekers, refugees, travellers, minority ethnic communities and disabled people. Health and illness Life expectancy in Ealing is generally on par with the national average with some localities having an improved life expectancy especially for the female population. Only South Acton locality has a lower than national average life expectancy in females.

Ealing PNA Draft

Ealing has significantly more admissions into hospital on all causes than expected and has an overall greater than expected circulatory disease related premature deaths when compared to the England average. Lifestyle Lifestyle issues are of a concern in some areas, particularly in children as Ealing overall has a significantly higher obesity rate in children in reception and year 6. Other issues are due to drug misuse, sexual health and poor dental outcomes. Pharmacies in Ealing Ealing has 75 community pharmacies (as at 08/09/2014) for a population of about 342,500. Provision of current pharmaceutical services and locally-commissioned services are well distributed serving all the main population centres. There is excellent access to a range of services commissioned, and privately provided from, pharmaceutical service providers. Table 1 shows the change in the numbers of community pharmacies compared with regional and national averages. Using current population estimates, the number of community pharmacies per 100,000 population for Ealing is currently 21.9. Ealing is well-served with community pharmacies; the rate of provision is currently greater than national average and slightly lower than the London average. Table 1 - Number of community pharmacies per 100,000 population Community pharmacies per 100,000 population England London SHA Ealing 2012/13 21.6 22.5 21.8 2011/12 21.2 22.2 21.2 2010/11 21.1 23.3 22.7

The majority of community pharmacies in Ealing are open weekday evenings (76%) and Saturdays (88%). A lower number are open on Sundays (24%), mainly in shopping areas. There is also a much higher than national ratio of independent providers to multiples providing a good choice of providers to local residents (National average is 39% independent providers versus 69% in Ealing6). Feedback on pharmaceutical services Views of pharmacy service users were gained from a questionnaire circulated for comments from the general public From the 359 responses received from the public questionnaire:  93% rated their overall satisfaction on the service received from their local pharmacy as ‘Excellent’ or ‘Good’

Ealing PNA Draft

 38% indicated that they used pharmacies up to every month for the purchase of over the counter medicines, with 87% having a regular or preferred pharmacy they use  89% rated their ease of obtaining medication as ‘Excellent’ or ‘Good’  53% rated as important that the pharmacy is close to their GP surgery; 81% that the pharmacy is close to their home; 12% that the pharmacy is close to where they work; and 53% that the pharmacy has friendly staff  64% walk to their community pharmacy; 24% use a car/taxi; 8% use public transport  83% had no difficulties travelling to their pharmacy; 11% had parking difficulties; 3% had problems with the location of the pharmacy; and 2% had problems of public transport availability  The majority of respondents had no most convenient day (63%) or time (56%) to visit their pharmacy  70% of respondents report having a journey time of no more than 10 minutes  93% rated their confidence in the pharmacists knowledge and advice as ‘Excellent’ or ‘Good’ Conclusions Provision and access to pharmaceutical services Overall, Ealing residents are satisfied with the provision of pharmaceutical services. The most important location for choosing a community pharmacy is ‘close to home’. Almost nine out of ten community pharmacies in Ealing are open on Saturdays, three out of four are open after 6pm weekdays and one in four is open on a Sunday. All residents in Ealing have an average drive time of no more than 15 minutes to their nearest community pharmacy. Average public transport time is up to 20 minutes and average walking time is up to 30 minutes for all residents. The average percentage of the population in Ealing who cannot speak English well is over 7%. In some localities it is as much as 15%. Commissioners should be assured that such populations have adequate access to language services.

No gaps have been identified in the provision of necessary pharmaceutical services within Ealing HWB area

Ealing PNA Draft

Section 1: Introduction 1.1 Background The Health Act 2009, 128A1, made amendments to the NHS Act 2006 requiring Primary Care Trusts (PCTs) to assess the needs for pharmaceutical services in its area and publish a statement of its assessment and any revised assessment. The regulations required the Pharmaceutical Needs Assessment (PNA) to be published by the 1st February 2011. There was also a requirement to re-write the PNA every three years or earlier if there were significant changes to the pharmaceutical needs of the area. Ealing PCT produced their first PNA in February 2011. The responsibility for the development, publishing and updating of PNAs became the responsibility of Health and Wellbeing Boards (HWBs) as a result of the Health and Social Care Act 20122. The Act dramatically reformed the NHS from 1st April 2013: PCTs were abolished and Health and Wellbeing Boards (HWBs), Clinical Commissioning Groups (CCGs) and NHS England were formed:  HWBs, hosted by each ‘upper tier’ local authority, have their membership drawn from local leaders (including NHS England, CCGs and local government) and are responsible for the continual improvement of the health and wellbeing of the local population  CCGs are GP led NHS bodies responsible for commissioning the majority of local health services including hospital, community, emergency and mental health care  NHS England oversees the operations of the CCGs as well as commissioning primary and specialist services (such as cancer care). Along with CCGs, it has the responsibility of improving health outcomes and reducing health inequalities The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (SI 2013/349)3, hereafter referred to as the ‘Pharmaceutical Regulations 2013’, came into force on 1 April 2013. Unless required to be produced earlier, these regulations permitted HWBs to a temporary extension of the PNAs previously produced by the PCT; HWBs are now required to publish their first PNA by 1st April 2015 latest. The 2013 Regulations were updated to The National Health Service (Pharmaceutical and Local Pharmaceutical Services) (Amendment and Transitional Provision) Regulations 2014 on 1st April 2014. This PNA has considered these amendments but the 2013 Regulations have been referenced throughout. Ealing Health and Wellbeing Board area is the same as the London Borough of Ealing.

1 Health Act 2009 - http://www.legislation.gov.uk/ukpga/2009/21/part/3/crossheading/pharmaceutical- services-in-england?view=plain 2 Health and Social Care Act 2012 - http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted 3 Pharmaceutical Regulations 2013 - http://www.legislation.gov.uk/uksi/2013/349/contents/made 14

Ealing PNA Draft

1.2 Purpose of the PNA NHS England is required to publish and maintain pharmaceutical lists for each HWB area. Any person wishing to provide NHS pharmaceutical services is required to be listed on the ‘Pharmaceutical List’. NHS England must consider any applications for entry onto the ‘Pharmaceutical List’. The Pharmaceutical Regulations 2013 requires NHS England to consider applications to fulfil unmet needs determined within the PNA of that area, or applications for benefits unforeseen within the PNA. Such applications could be for the provision of NHS pharmaceutical services from new premises or to extend the range or duration of current NHS pharmaceutical services offered from existing premises. As the PNA will become the basis for NHS England to make determinations on such applications, it is therefore prudent that the PNA is compiled in line with the regulations, and with due process, and that the PNA is accurately maintained and up-to-date. The final PNA cannot be challenged, although decisions made by NHS England regarding applications to the ‘Pharmaceutical List’ may be appealed to the NHS Family Health Services Appeals Unit. It is likely the only challenge to a published PNA will be through application for a judicial review of the process undertaken to conclude the PNA. The PNA should also be considered alongside the local authority’s Joint Strategic Needs Assessment (JSNA)4. The PNA will inform the local authority, CCG and NHS England to improve the health and wellbeing of the local population. 1.3 Scope of the PNA The Pharmaceutical Regulations 20133 details the information required to be contained within a PNA. A PNA is required to measure the adequacy of pharmaceutical services in the HWB area under five key themes:  necessary services: current provision  necessary services: gaps in provision  other relevant services: current provision  improvements and better access: gaps in provision  other services In addition, the PNA details how the assessment was carried out. This includes:  how the localities were determined  the different needs of the different localities  the different needs of people who share a particular characteristic  a report on the PNA consultation As already mentioned, the PNA is aligned with the Ealing JSNA4.

4 Ealing Joint Strategic Needs Assessment 2012 - http://www.ealing.gov.uk/downloads/download/1018/ealing_joint_strategic_needs_assessment 15

Ealing PNA Draft

To appreciate the definition of ‘Pharmaceutical Services’ as used in this PNA, it is firstly important to understand the types of NHS pharmaceutical providers comprised in the ‘Pharmaceutical List’ maintained by NHS England. They are: 1. Pharmacy contractors 2. Dispensing appliance contractors 3. Local pharmaceutical service providers 4. Dispensing doctors For the purposes of this PNA, ‘Pharmaceutical Services’ has been defined as those which are/may be commissioned under the provider’s contract with NHS England. A detailed description of each provider type, and the pharmaceutical services as defined in their contract with NHS England, is detailed below. 1.3.1 Pharmacy contractors Pharmacy contractors operate under the Community Pharmacy Contractual Framework initially agreed in 2005. This sets three levels of service under which they operate. Essential services These can be found in Schedule 4 of the Pharmaceutical Regulations 20133. These are nationally negotiated and must be provided from all pharmacies:  Dispensing of medicines  Repeat dispensing  Safe disposal of unwanted medicines  Promotion of healthy lifestyles  Signposting  Support for self-care  Clinical governance Advanced services These can be found in parts 2 and 3 of The NHS Act 2006, the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013, the ‘2013 Directions’5.

5 The 2013 Directions - https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/193012/2013-03-12_- _Advanced_and_Enhanced_Directions_2013_e-sig.pdf and amendment https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/266023/pharmaceutical _services_directions_amendment_2013.pdf

Ealing PNA Draft

They are negotiated nationally and any contractor may provide:  Medicines Use Reviews (MURs)  New Medicines Service (NMS) - this service is temporarily commissioned and is currently under review nationally  Appliance Use Reviews (AURs)  Stoma Appliance Customisation (SAC) A full list of provision of advanced services provided by pharmacies in Ealing HWB area (correct as of 08/09/2014) can be found in Appendix A. Enhanced services These can be found in part 4 of the 2013 Directions5. They are negotiated locally by NHS England Area Teams and may only be provided by contractors directly commissioned by NHS England:  Anticoagulant Monitoring Service  Care Home Service  Disease Specific Management Service  Emergency Supply Service*  Gluten Free Supply Service  Independent Prescribing Service  Home Delivery Service  Language Access Service  Medication Review Service  Minor Ailment Service  Needle and Syringe Exchange Service*  On Demand Availability of Specialist Drugs Service  Out of Hours Service  Patient Group Direction Service  Prescriber Support Service  Schools Service  Screening Service*  Stop Smoking Service*  Supervised Administration Service*  Supplementary Prescriber Service

Ealing PNA Draft

The responsibility for public health services transferred from PCTs to local authorities with effect from 1st April 2013. Where these services* are currently commissioned by local authorities, they are not considered enhanced or pharmaceutical services. The 2013 Directions, however, permit NHS England to commission them from pharmacy contractors if asked to do so by a local authority. In this case, if commissioned by NHS England they are enhanced services and fall within the definition of pharmaceutical services. In Ealing HWB area, NHS England does not currently commission any public health services from pharmacies. Pharmacy contractors comprise those located within the Ealing HWB area as listed in Appendix A, those in neighbouring HWB areas and remote suppliers, such as internet pharmacies. Although internet pharmacies may provide services from all three levels as described above, and must provide all ‘essential’ services, they may not do so ‘face- to-face’. Additionally, they must provide services to the whole population of England. There is one internet pharmacy located within Ealing HWB area:  Onsite Chemist, 8E Europa Studios, Victoria Road, London NW10 6ND It should also be noted that internet pharmacies throughout England (there were 200 in 2012-136) are capable of providing services to Ealing HWB area. 1.3.2 Dispensing appliance contractors Dispensing Appliance Contractors (DACs) operate under the Terms of Service for Appliance Contractors as set out in Schedule 5 of the 2013 Regulations3. They can supply appliances from an NHS prescription such as stoma and incontinence aids, dressings, bandages etc. DACs must provide a range of essential services such as dispensing of appliances, advice on appliances, signposting, clinical governance and home delivery of appliances. In addition, DACs may provide the advanced services of Appliance Use Reviews (AURs) and Stoma Appliance Customisation (SAC). Pharmacy contractors, dispensing doctors and Local Pharmaceutical Service (LPS) providers may supply appliances but DACs are unable to supply medicines. There are currently no DACs in the Ealing HWB area although residents can access DACs from elsewhere in the UK if required. There were 122 DACs in England 2012- 136. 1.3.3 Local pharmaceutical service providers A pharmacy provider may be contracted to perform specified services to their local population or a specific population group. This contract is locally commissioned by NHS England and provision for such contracts is made in the 2013 Regulations3 in Part 13 and Schedule 7.

6 General Pharmaceutical Services in England - 2003-04 to 2012-13: http://www.hscic.gov.uk/searchcatalogue?productid=13373andtopics=1%2fPrimary+care+services%2 fCommunity+pharmacy+servicesandsort=Relevanceandsize=10andpage=1#top

Ealing PNA Draft

Such contracts are agreed outside the national framework although may be over and above what is required from the national contract. Payment for service delivery is locally agreed and funded. There are no LPS pharmacies in the Ealing HWB area. 1.3.4 Dispensing GP practices The 2013 Regulations3, as set out in Part 8 and Schedule 6, permit GPs in certain areas to dispense NHS prescriptions for defined populations. These provisions are to allow patients in rural communities, who do not have reasonable access to a community pharmacy, to have access to dispensing services from their GP practice. Dispensing GP practices thus make a valuable contribution to dispensing services, although they do not offer the full range of pharmaceutical services offered at community pharmacies. Dispensing GP practices can provide such services to communities within areas known as ‘controlled localities’ - see section 3.3 for further details. GP premises for dispensing must be listed within the ‘Pharmaceutical List’ held by NHS England and patients retain the right of choice to have their prescription dispensed from a community pharmacy, if they wish. There are no Dispensing GP practices in Ealing HWB area. 1.3.5 Other providers of pharmaceutical services in neighbouring HWB areas There are five other HWB areas which border the Ealing HWB area:  Hillingdon HWB  Hammersmith and Fulham HWB  Harrow HWB  Brent HWB  Hounslow HWB Thus in determining the needs of, and pharmaceutical services provision to, the population of the Ealing HWB area, consideration has been made to the pharmaceutical service provision from the neighbouring HWB areas. Map A provides a detailed analysis of pharmacy contractors which lie across the Ealing HWB border but are within easy reach of the Ealing area. 1.3.6 Other services and providers in Ealing HWB area, out of scope of the PNA As mentioned on page 8, for the purpose of this PNA, ‘pharmaceutical services’ have been defined as those which are, or may be, commissioned under the provider’s contract with NHS England. The following are providers of pharmacy services in Ealing HWB area, but defined pharmaceutical services, and thus out of scope of the PNA. Prisons - in Ealing HWB area there are no prisons.

Ealing PNA Draft

Minor injury units and walk-in centres – Featherstone Road Surgery, Harlington Road, Southall, provides a GP-led walk in centre service, 8am-8pm, every day. There are no minor injury units in Ealing HWB area. The following are services provided by NHS pharmaceutical providers in Ealing HWB area, commissioned by organisations other than NHS England or provided privately, and thus out of scope of the PNA. Local authority public health services - Ealing HWB commission the following ‘locally commissioned services’ from community pharmacies in Ealing HWB area:  Sexual Health services:  Emergency hormonal contraception services  Support to stop smoking services: commissioned by the Stop Smoking Service (WLMHT)  Supervised administration of medicines commissioned by the Drug  Needle and syringe exchange service and Alcohol Service Privately provided - many NHS pharmaceutical providers offer the following services privately:  Care home service  Home delivery service  Patient group direction service  Screening service Services will vary between provider and in some cases may be provided free of charge. 1.4 Process for developing the PNA As a direct result of the Health and Social Care Act2, a paper was presented to Ealing HWB on 15 January 2014. The purpose of the paper was to inform the HWB of its statutory responsibilities under the Health and Social Care Act2 to produce and publicise a PNA for its area by 1 April 2015. The HWB accepted the content of the paper at the meeting and the recommendation to delegate responsibility of the PNA to a Steering Group. It also agreed to the funding necessary to research and produce the PNA. Public Health Ealing has a duty to complete this document on behalf of the HWB. Public Health Ealing commissioned Soar Beyond Ltd to undertake the PNA. Soar Beyond was chosen from a selection of potential candidates due to their significant experience in providing services to assist pharmaceutical commissioning, including the production and publication of PNAs. They also have a dedicated PNA project management team.

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Step 1: Steering Group On 10th June 2014, Ealing’s PNA Steering Group was established. The terms of reference and membership of the PNA Steering Group can be found in Appendix B. Step 2: Project Management At its first meeting, Soar Beyond and the Local Authority presented and agreed the project plan and ongoing maintenance of the project plan. Appendix F shows an approved time line for the project. Step 3: Review of existing PNA and JSNA Through the project manager, the PNA Steering Group reviewed the existing PNA with subsequent supplementary statements7 and JSNA4. It was agreed that the existing PNA and subsequent supplementary statements6 were accurate and up-to-date and the Deputy Director of Public Health would be responsible for the ongoing maintenance of the current PNA until this PNA is published. Step 4a: Patient Survey on Pharmacy Provision A patient survey to establish views about pharmacy services was produced by the Steering Group which was circulated to:  All pharmacy contractors in Ealing to distribute to the public  All GP practices in Ealing to distribute to the public  GP Patient Participation Groups  Ealing Advice Service  Ealing Equality Council  Ealing Grand Union Village  Southall Community Alliance  Acton Community Forum  LBE OP Forum  Ealing Carers Centre  Northolt Confederation  Ealing Centre for Independent Living  Dementia Concern  Age UK  Milap Day Centre

7 Ealing PNA and subsequent supplementary statements, accessed on 11/9/14 – http://www.ealing.gov.uk/downloads/download/3050/pharmaceutical_needs_assessment 21

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 Ealing HealthWatch  Ealing’s Online Residents Panel A total of 359 responses were received. A copy of the Public Survey can be found in Appendix C, and the detailed responses can be found in Appendix I. Step 4b: Pharmacy Survey The steering group agreed a survey to be distributed to the local community pharmacists to collate information for the PNA. The local LPC supported this survey to gain responses. A copy of the Pharmacy Survey can be found in Appendix D. Step 4c: Commissioner Survey The steering group agreed a survey to be distributed to all relevant commissioners in Ealing to inform the PNA. A copy of the Commissioner Survey can be found in Appendix E. Step 5: Preparing the draft PNA for consultation The steering group, facilitated by the Director of Public Health with support from Soar Beyond, reviewed and revised the content and detail of the existing PNA. The process took into account the JSNA4 and other relevant strategies in order to ensure the priorities were identified correctly. A draft PNA was approved for consultation by the PNA Steering Group at its meeting on 7th October 2014. Step 6: Consultation-current stage In line with the 2013 Regulations3, a consultation on the draft PNA is planned to be undertaken for 60 days between 5th November 2014 and 4th January 2015. The draft PNA and consultation response form will be issued to all identified stakeholders. These will be listed in the final PNA. The draft PNA will also be posted on Ealing Council’s website. Step 7: Collation and analysis of consultation responses - future stage The consultation responses will be collated and analysed by the Council’s Engagement Manager and Soar Beyond. A summary of the responses received and analysis will be noted in the final PNA. Step 8: Production of final PNA - future stage The collation and analysis of consultation responses will be used by the project manager to revise the draft PNA and a final PNA will be presented to the PNA Steering Group. The final PNA will then be presented to the Ealing HWB for approval and published before 1st April 2015.

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1.5 Localities for the purpose of the PNA The PNA Steering Group, at its second meeting, considered how the localities within the Ealing HWB geography would be defined. The majority of health and social care data are available at local authority council ward level and at this level provides reasonable statistical rigor. It was agreed that the council wards would be used to define the localities of the Ealing HWB geography. The localities used for the PNA for Ealing HWB area are:  Acton Central  Cleveland  Dormers Wells  Ealing Broadway  Ealing Common  East Acton  Elthorne  Greenford Broadway  Greenford Green  Hanger Hill  Hobbayne  Lady Margaret  North Greenford  Northfield  Northolt Mandeville  Northolt West End  Norwood Green  Perivale  South Acton  Southall Broadway  Southall Green  Southfield  Walpole A list of providers of pharmaceutical services in each locality is found in Appendix A.

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The information contained in Appendix A has been provided by NHS England (who is legally responsible for maintaining the pharmaceutical list of providers of pharmaceutical services in each HWB area), Ealing Council, Ealing CCG and the Middlesex Group of LPCs.

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Section 2: Context for the PNA 2.1 Joint Strategic Needs Assessment The Pharmaceutical Needs Assessment (PNA) is undertaken in the context of the health, care and wellbeing needs of the local population, as defined in the Ealing Joint Strategic Needs Assessment (JSNA)4 which is currently being refreshed. The JSNA, as well as defining the needs of the local population, also identifies a strategic direction of service delivery to meet those needs, and commissioning priorities to improve the public’s health and reduce inequalities. The PNA should therefore be read alongside the JSNA. 2.2 Joint Health and Wellbeing Strategy The current Ealing Health and Wellbeing Board Strategy (HWBS) (2012-2016)8 is guided by the JSNA and other relevant sources of information. The following are the five priority areas that have been identified as key to the improvement of the health of the local population and in reducing health inequalities:  Early years interventions (0-5 years)  Childhood obesity  Alcohol misuse  Older people and healthy ageing  Out of hospital services The HWBS highlights the need for a multiagency approach (including local pharmaceutical service providers) in addressing the above priorities in order to realise a more coherent and effective response and to accomplish set outcomes. Regulation 9 of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations5 requires that HWBS, when carrying out assessments for the purpose of publishing PNAs, have regard to:  The number of people in its area who require pharmaceutical services  The demography of its area  The risks to the health or wellbeing of people in its area Pharmaceutical service providers have the potential to play a greater role in identifying and helping address priority health needs as they are strategically placed in the community and have daily interactions with the local population.

8 Ealing Council Local Strategic Partnership, May 2013; http://www.ealing.gov.uk/info/200631/strategies_plans_and_partnerships/350/local_strategic_partners hip/7 25

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Evidence from the Healthy Living Pharmacy Initiative9 implemented since 2010 shows that community pharmacies can make a significant impact in the improvement of the health and wellbeing of local populations. In consideration of the three areas highlighted above, Section 2.3 and 2.4 further examine Ealing’s population characteristics and major causes of ill health as a pre- requisite to understanding local health needs and how pharmaceutical service providers can be involved in various interventions 2.3 Population characteristics 2.3.1 Overview The population of Ealing has grown by 16% over the last 15 years and by 18% over the last 25 years. The current estimated population is 342,500.10 The population registered with one of the 79 GP practices in Ealing is 407,541. Out of this number, 49% (200,317) were aged 15-44. Fifty two percent of all registrations were male and 48% female. Average number of registered persons per GP practice in NHS Ealing CCG was 5,159 (7,041 in England in 2013). There are 124,082 households in Ealing of which more than half (51%) own their properties while 19% occupy socially rented properties. More than half (54%) are one-two people households and about 9% have a single person aged 65 years and over. Levels of overcrowding (23%) are slightly higher than the London average (22%) and the most affected areas are Southall Green and East Acton.11 2.3.2 Age Table 2 shows Ealing’s latest population figures by sex and five-year-bands. The highest population segment in Ealing is of persons aged 30-34 years. Figure 1 shows Ealing’s population structure compared to the England average. Ealing has a higher proportion of both males and females aged 0-9 years and 25-44 years as compared to England. Ealing also has a lower proportion of persons aged 50 years and above as compared to England (Figure 1). Table 3 shows population numbers and proportions for Ealing wards, London Borough (LB) of Ealing and England. Amongst wards in Ealing, Northolt West End has the highest proportion of persons aged 0-16 years (26%) while Southall Green has the highest proportion of persons aged 16-24 years (14%). Ealing Broadway, Ealing Common and Southfield have the highest proportions of persons aged 25-64 years (63%). Walpole has the highest proportion of persons aged 65 years and over (17%).

9 Healthy Living Pharmacy: overview, National Pharmaceutical Association, 2012: http://www.npa.co.uk/Documents/HLP/HLP_overview_12.11.pdf 10 ONS Mid-Year Population Estimates (1963-2013): http://www.ons.gov.uk/ons/publications/index.html 11 ONS Census, 2011: http://www.ons.gov.uk/ons/guide-method/census/2011/census-data/index.html 26

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Table 2 - Ealing’s population estimates and proportions by sex and five-year-age- bands, 2013

Male Female Total Age band (Years) Number % Number % Number %

Under 1 2,900 1.7 2,700 1.6 5,600 1.6 1 - 4 10,700 6.2 10,100 5.9 20,700 6.1 5 - 9 11,400 6.6 10,900 6.4 22,300 6.5 10 - 14 9,800 5.7 9,300 5.4 19,100 5.6 15 - 19 9,700 5.7 9,000 5.3 18,700 5.5 20 - 24 11,100 6.5 10,300 6.0 21,500 6.3 25 - 29 15,900 9.3 15,900 9.3 31,900 9.3 30 - 34 17,200 10.0 16,600 9.7 33,800 9.9 35 - 39 14,900 8.7 13,900 8.1 28,800 8.4 40 - 44 13,300 7.7 12,600 7.4 25,900 7.6 45 - 49 11,900 6.9 11,900 6.9 23,700 6.9 50 - 54 10,000 5.8 10,200 6.0 20,200 5.9 55 - 59 8,400 4.9 8,800 5.1 17,200 5.0 60 - 64 7,100 4.1 7,500 4.4 14,600 4.3 65 - 69 5,600 3.3 6,100 3.6 11,700 3.4 70 - 74 4,300 2.5 4,700 2.8 9,000 2.6 75 - 79 3,500 2.0 4,200 2.4 7,700 2.2 80 - 84 2,200 1.3 3,000 1.8 5,200 1.5 85 and over 1,800 1.0 3,100 1.8 4,900 1.4 Total 171,600 100.0 170,900 100.0 342,500 100.0 Source: ONS Mid-Year Population Estimates, 2013

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Figure 1 - Ealing’s population pyramid

Ealing population structure 2013

85+ Ealing Females

80-84 Ealing Males England Males 75-79 England Females 70-74

65-69

60-64

55-59

50-54

45-49

40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10%

Source: ONS Mid-Year Population Estimates, 2013

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Table 3 - Ealing’s population by wards, 2012 Number of % of Number of % of Number of % of Number of % of persons persons Total persons persons persons persons persons persons Area / Ward aged 65 aged 65 Population aged 0-16 aged 0-16 aged 16- aged 16- aged 25- aged 25- years and years and years years 24 years 24 years 64 years 64 years over over Acton Central 15,690 3,069 19.6 1,840 11.7 9,254 59.0 1,527 9.7 Cleveland 14,503 3,149 21.7 1,455 10.0 8,102 55.9 1,797 12.4 Dormers Wells 13,912 3,078 22.1 1,753 12.6 7,429 53.4 1,652 11.9 Ealing Broadway 14,106 2,107 14.9 1,382 9.8 8,911 63.2 1,706 12.1 Ealing Common 13,872 2,102 15.2 1,443 10.4 8,672 62.5 1,655 11.9 East Acton 19,026 3,638 19.1 2,567 13.5 11,208 58.9 1,613 8.5 Elthorne 14,517 3,032 20.9 1,272 8.8 8,783 60.5 1,430 9.9 Greenford Broadway 17,680 4,172 23.6 2,048 11.6 9,493 53.7 1,967 11.1 Greenford Green 14,591 3,115 21.3 1,460 10.0 8,245 56.5 1,771 12.1 Hanger Hill 15,664 3,009 19.2 1,466 9.4 9,131 58.3 2,058 13.1 Hobbayne 14,368 3,287 22.9 1,559 10.9 7,851 54.6 1,671 11.6 Lady Margaret 13,854 2,817 20.3 1,786 12.9 7,715 55.7 1,536 11.1 Northfield 13,455 2,554 19.0 1,282 9.5 8,071 60.0 1,548 11.5 North Greenford 14,917 3,066 20.6 1,609 10.8 8,495 56.9 1,747 11.7 Northolt Mandeville 15,454 3,637 23.5 1,760 11.4 8,383 54.2 1,674 10.8 Northolt West End 15,351 3,980 25.9 1,830 11.9 8,044 52.4 1,497 9.8

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Number of % of Number of % of Number of % of Number of % of persons persons Total persons persons persons persons persons persons Area / Ward aged 65 aged 65 Population aged 0-16 aged 0-16 aged 16- aged 16- aged 25- aged 25- years and years and years years 24 years 24 years 64 years 64 years over over Norwood Green 14,155 2,933 20.7 1,882 13.3 7,775 54.9 1,565 11.1 Perivale 15,685 3,213 20.5 1,605 10.2 9,104 58.0 1,763 11.2 South Acton 14,834 3,088 20.8 1,550 10.4 8,531 57.5 1,665 11.2 Southall Broadway 13,687 2,970 21.7 1,760 12.9 7,525 55.0 1,432 10.5 Southall Green 14,883 3,422 23.0 2,077 14.0 8,133 54.6 1,443 10.9 Southfield 13,262 2,318 17.5 1,153 8.7 8,348 62.9 1,481 11.2 Walpole 13,205 2,525 19.1 1,115 8.4 8,084 61.2 9,056,508 16.9 Ealing LB 340,671 70,281 20.6 37,654 11.1 195,287 57.3 37,449 11.0 England 53,493,729 10,130,226 18.9 6,262,440 11.7 28,044,555 52.4 1,527 9.7 Source: ONS Mid-Year Population Estimates, 2012

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2.3.3 Predicted population growth The population of Ealing is projected to rise by 9.8% to around 381,500 by 2024 and by 17.4% to around 408,200 by 2034. These rates are significantly higher than the England average (7.1% and 13.1% respectively as in Table 4). For both Ealing and England the highest increment will be amongst persons aged 65 years and over. Table 4 - Ealing’s population projections and magnitude of change compared with England in 2014, 2024 and 2034 2014 2024 2034

Change % Change Change % Change Area Total Total Total Age Group since 2014 since 2014 since 2014 since 2014 Population Population Population (Number) (%) (Number) (%) England 0-14 9,630,300 10,451,200 820,900 8.5 10,385,400 755,100 7.8 England 15-29 10,584,100 10,286,800 -297,300 -2.8 11,173,300 589,200 5.6 England 30-44 10,782,600 11,466,300 683,700 6.3 11,303,600 521,000 4.8 England 45-64 13,700,000 14,309,000 609,000 4.4 14,145,800 445,800 3.3 England 65+ 9,530,900 11,559,400 2,028,500 21.3 14,306,900 4,776,000 50.1 England All ages 54,227,900 58,072,600 3,844,700 7.1 61,315,100 7,087,200 13.1

Ealing 0-14 68,200 73,900 5,700 8.4 72,800 4,600 6.7 Ealing 15-29 74,100 74,800 700 0.9 81,800 7,700 10.4 Ealing 30-44 89,200 94,600 5,400 6.1 92,700 3,500 3.9 Ealing 45-64 76,700 88,500 11,800 15.4 97,200 20,500 26.7 Ealing 65+ 39,300 49,500 10,200 26.0 63,700 24,400 62.1 Ealing All ages 347,600 381,500 33,900 9.8 408,200 60,600 17.4 Source: ONS 2012-based Subnational Population Projections 31

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2.3.4 Housing development Ealing Council plans to develop 3,042 homes during 2014-2019. A total of 1,102 homes will be for social rent, 238 for affordable rent, 373 for low cost ownership, 1,293 for private sale and 44 for private rent. Most of the housing developments will be in Northolt Mandeville, South Acton and Norwood Green (see Table 5 for further details). Table 5 - Planned housing completions between 2014-2019 for Ealing Council’s Estate Improvement Programme and New Build Programme Low cost Total Social Affordable home Home Private Ward Estate Homes rented rent ownership sales rented planned products Northolt Rectory Park 252 32 94 128 0 506 Mandeville South Acton South Acton 214 0 107 560 0 881 Norwood Havelock 215 0 67 226 0 508 Green Green Man Elthorne 145 0 14 203 0 362 Lane North Allen Court 45 0 0 43 0 88 Greenford Walpole Dean Gardens 112 0 22 48 0 182 East Acton Golf Links 0 51 9 0 0 60 Cleveland Copley Close 49 42 22 58 34 205 High Lane Hobbayne 70 0 5 20 0 95 Estate Other council new build 0 13 35 7 0 155 Total 1102 238 375 1293 34 3042 Source: Ealing Housing and Homelessness Strategy, 2014-19

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2.3.5 Life expectancy at birth Table 6 shows Ealing’s life expectancy rates by sex and ward compared to England. Green, amber and red rating methodology (see key at the end of Table 6) is used in comparing wards and LB Ealing rates against the England average. LB Ealing has a significantly higher female life expectancy (83.7) as compared to England average (82.8). South Acton is the only ward with a lower female life expectancy rate (80.4) as compared to the England average.

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Table 6 - Life expectancy in Ealing wards compared with England average, 2008-2012 Male Life Female Life Total male Total female Area / Ward expectancy expectancy deaths deaths (years) (years) Acton Central 207 79.1 167 86.2 Cleveland 227 78.8 215 85.2 Dormers Wells 217 78.0 199 81.8 Ealing Broadway 201 79.4 273 84.2 Ealing Common 227 78.6 237 83.1 East Acton 208 79.6 172 85.6 Elthorne 193 78.6 207 83.2 Greenford Broadway 316 77.6 361 81.9 Greenford Green 214 79.8 210 83.5 Hanger Hill 215 82.0 195 87.1 Hobbayne 221 78.4 198 83.9 Lady Margaret 221 78.1 187 83.3 North Greenford 186 81.0 162 85.4 Northfield 184 80.5 148 87.5 Northolt Mandeville 204 80.5 195 84.9 Northolt West End 260 77.6 213 82.6 Norwood Green 232 77.8 236 81.1 Perivale 190 81.6 174 84.6 South Acton 264 77.8 297 80.4 Southall Broadway 209 77.5 144 83.0 Southall Green 197 77.0 131 82.9 Southfield 174 79.4 143 85.2 Walpole 183 79.9 185 83.5 Ealing LB 4,950 79.0 4,649 83.7 England 1,115,094 78.9 1,200,567 82.8

Source: Public Health England Key Statistically significantly higher than England average The difference is not statistically significant Statistically significantly lower than England average

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2.3.6 Fertility rate Ealing’s fertility rate (71.9/1,000 females) is significantly higher than the England average (63.7/1,000 females). Most of the wards have either a higher or similar fertility rate except for Ealing Broadway, Ealing Common and Hanger Hill which have significantly lower fertility rates. Figure 2 - Fertility rate - crude rate per 1,000 females aged 15-44, Ealing wards, LB Ealing and England, 2008-2012

England 120

100

Crude rate/1,000 Crude rate/1,000 women 20

2.3.7 Specific populations

2.3.7.1 Ethnicity

Ealing has a larger proportion of non-white ethnic population (51%) compared to the London average (40%) and England average (15%). The largest proportion among non-white ethnic groups is Asians, in particular Indians (14%). Black ethnic group is the third largest in Ealing (11%) (Figure 3). Figure 3 shows numbers and proportions of Black and Minority Ethnic (BME) groups by wards in Ealing compared to England. All wards in Ealing have a higher proportion of BME groups compared to the England average. In Southall Broadway and Southall Green over 90% of the total population is made up of BME groups.

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Figure 3 - Ethnic group population proportions in Ealing, London and England, 2011

100

90 Other Ethnic Group

80 Black / African / Caribbean / Black British 70 Asian / Asian British: Other Asian

Asian / Asian British: Chinese 60

Asian / Asian British: Bangladeshi 50

Asian / Asian British: Pakistani Percentage 40 Asian / Asian British: Indian

30 Mixed / Multiple Ethnic Groups

20 Gypsy / Traveller / Irish Traveller

White 10

0 England London Ealing LB Source: ONS Census, 2011

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Table 7 - Black and Minority Ethnic (BME) population in Ealing wards, LB Ealing and England, 2011

Area / Ward Number of BME persons % BME persons

Acton Central 6,175 40.0 Cleveland 5,371 36.9 Dormers Wells 11,417 82.1 Ealing Broadway 4,280 30.5 Ealing Common 4,411 31.5 East Acton 9,367 50.1 Elthorne 5,074 34.9 Greenford Broadway 10,098 57.3 Greenford Green 7,038 49.0 Hanger Hill 6,705 43.1 Hobbayne 5,364 37.7 Lady Margaret 11,604 83.5 Northfield 3,134 23.2 North Greenford 8,298 56.4 Northolt Mandeville 7,843 51.7 Northolt West End 8,329 55.1 Norwood Green 10,951 78.0 Perivale 8,371 54.6 South Acton 6,469 43.5 Southall Broadway 12,598 93.7 Southall Green 13,322 91.4 Southfield 2,796 20.8 Walpole 3,616 27.1 Ealing LB 172,631 51.0 England 7,731,314 14.6 Source: Office for National Statistics Census, 2011

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2.3.7.2 Language The proportion of people in Ealing who cannot speak English well or at all is significantly higher than the England average in all wards. Southall Broadway and Southall Green have the highest proportions (over 15%) (Table 8). Table 8 - Proficiency in English (% of people who cannot speak English well or at all), Ealing wards, LB Ealing and England, 2011 Number of persons % persons who who cannot speak cannot speak English Area/Ward English Acton Central 1,026 7.0 Cleveland 640 4.6 Dormers Wells 1,487 11.2 Ealing Broadway 484 3.6 Ealing Common 533 3.9 East Acton 1,162 6.5 Elthorne 695 5.0 Greenford Broadway 1,210 7.3 Greenford Green 1,133 8.3 Hanger Hill 1,052 7.1 Hobbayne 801 5.9 Lady Margaret 1,297 9.7 Northfield 353 2.7 North Greenford 1,137 8.1 Northolt Mandeville 892 6.2 Northolt West End 853 6.0 Norwood Green 1,300 9.7 Perivale 1,340 9.2 South Acton 990 7.0 Southall Broadway 2,027 15.7 Southall Green 2,113 15.2 Southfield 278 2.2 Walpole 450 3.5 Ealing LB 23,253 7.2 England 843,845 1.7 Source: Office for National Statistics Census, 2011

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2.3.7.3 School children The majority of children registered in Ealing’s state funded schools and special schools are from ethnic minority groups. Amongst ethnic minority groups, Asians have the highest proportion of children in local schools (Table 9).

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Table 9 - Ethnicity of children in schools, Ealing and England, 2014

State Funded State Funded Special Schools Primary Schools Secondary Schools Ethnic Group % % % % % Ealing % Ealing England Ealing England England All White 75.8 30.5 78.1 29.7 77.7 24.3 White British 69.8 15.4 73.5 18.4 74.1 14.8 Irish 0.3 0.8 0.4 1.1 0.3 0.9 Traveller Of Irish Heritage 0.1 0.2 0.0 0.1 0.1 0.5 Gypsy/ Roma 0.3 0.1 0.2 0.1 0.3 Any Other White 5.3 13.9 4.1 10.0 2.9 7.7 Background All Mixed 5.3 8.5 4.2 7.6 4.7 9.6 White And Black 1.5 2.1 1.3 2.8 1.6 3.3 Caribbean White And Black African 0.7 1.0 0.5 1.0 0.5 1.4 White And Asian 1.2 2.2 0.9 1.6 0.8 1.9 Any Other Mixed 1.9 3.3 1.5 2.2 1.8 2.8 Background All Asian 10.5 28.6 9.5 28.6 8.7 28.7 Indian 2.7 13.1 2.7 13.4 1.6 10.4 Pakistani 4.3 6.9 3.7 7.8 4.3 9.0 Bangladeshi 1.7 1.2 1.6 1.0 1.4 1.0 Any Other Asian 1.7 7.4 1.6 6.4 1.5 7.8 Background All Black 5.6 17.4 5.1 19.9 6.2 25.2 Caribbean 1.3 3.9 1.4 5.2 1.6 4.7 African 3.7 12.2 3.1 13.6 3.6 18.8 Any Other Black 0.7 1.3 0.6 1.1 1.0 1.6 Background Chinese 0.4 0.4 0.4 0.3 0.3 0.0 Any Other Ethnic Group 1.7 14.0 1.4 13.1 1.2 12.2 Unclassified 0.7 0.5 1.2 0.9 1.2 0.7 Minority Ethnic Pupils 29.5 84.1 25.3 80.7 24.7 84.7

Source: School Census January 2014

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2.3.7.4 Children and adults in care The rate of children in care has been consistently lower than the England average for the last four years. In 2013 there were 400 children from Ealing in care (Table 10). Table 10 - Children aged under 18 in care (rate per 100,000 children), Ealing and England, 2013 2009 2010 2011 2012 2013 Number Rate Number Rate Number Rate Number Rate Number Rate Ealing 395 55 405 55 385 51 410 53 400 51 England 60,900 54 64,450 57 65,500 58 67,080 59 68,110 60 Source: Department of Education The rate of adults admitted permanently in care homes in Ealing was significantly lower than the England average during 2013/14 (see Table 11). Table 11 - Adults admitted permanently in care homes, Ealing and England, 2013-14 Ealing England Age Group Rate /100,000 Rate /100,000 Number Number people people 18-64 15 7.6 4745 14.4 65 and Over 115 304.4 60,535 668.4 Source: Health and Social Care Information Centre 2.3.7.5 Older people It is estimated that there are 37,449 older people (aged 65 years and over) living in Ealing (refer to Table 3). Ealing has a lower proportion of older people as compared to the England average population (see Figure 1). However the percentage of older people who are income deprived and those living alone is higher than the England average in most wards (Table 12).

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Table 12 - Percentage of older people (aged 65 years and over) living in income deprived homes and pensioners living alone, Ealing wards, LB Ealing and England, IMD 2010 Income Income Pensioners Pensioners deprived older Area/Ward deprived older living alone living alone people people (%) (Number) (%) (Number) Acton Central 551 29.2 558 37.9 Cleveland 438 19.2 630 36.2 Dormers Wells 689 35.4 420 26.0 Ealing Broadway 370 17.7 561 33.5 Ealing Common 441 20.3 556 35.1 East Acton 558 27.9 520 33.9 Elthorne 515 27.9 490 34.7 Greenford Broadway 722 28.1 623 32.0 Greenford Green 532 23.5 478 28.1 Hanger Hill 390 15.4 608 30.6 Hobbayne 639 28.8 569 35.5 Lady Margaret 550 28.5 283 18.6 North Greenford 418 18.8 409 24.4 Northfield 358 18.0 523 35.1 Northolt Mandeville 506 21.9 516 31.9 Northolt West End 650 30.7 603 40.9 Norwood Green 802 40.1 315 21.1 Perivale 477 21.6 425 25.3 South Acton 754 31.8 639 38.8 Southall Broadway 722 42.6 281 20.0 Southall Green 677 42.5 224 18.7 Southfield 363 18.5 542 40.3 Walpole 469 25.1 555 39.5 Ealing LB 12,593 26.2 11,328 31.3 England 2,094,588 18.1 2,725,596 31.5 Source: Department for communities and local government

NB Please see key on next page

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Key Statistically significantly lower than England average The difference is not statistically significant Statistically significantly higher than England average

2.3.7.6 Prison population In 2012 there were a total of 418 Ealing residents either in custody or probation. This was equivalent to a rate of 143/100,000 population which was lower than the England average (161/100,000 population) (Table 13). Table 13 - Population in custody or probation, Ealing and England, March 2012 Rate/100,000 Area Number population LB Ealing 486 143 England 86,048 161 Source: Offender management statistics: Ministry of Justice 2.3.7.7 Less-abled populations Table 14 shows projections of numbers and rates of disabilities amongst people aged 18-64 and 65 years and over for Ealing and England for the years 2014 and 2020. In 2014 the prevalence rates of all listed disabilities except serious visual impairment and severe learning disability were lower than the England average. Rates of all disabilities in Ealing and England are predicted to rise significantly by 2020 except for serious visual impairment

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Table 14 - Less-abled populations in Ealing and England, 2014 and 2020 projections

Ealing England 2014 2020 2014 2020 Indicator Rate Rate Number Rate /100,000 Number Rate /100,000 Number Number /100,000 /100,000

People aged 18-64 with moderate physical 16,234 7,101 17,358 7,263 2,556,634 7,710 2,659,736 7,873 disability

People aged 18-64 with serious physical 4,515 1,975 4,909 2,054 748,103 2,256 789,405 2,337 disability

People aged 18-64 with serious visual 149 65 155 65 21,553 65 21,959 65 impairment

People aged 18-64 with moderate or 7,304 3,195 8,039 3,364 1,266,436 3,819 1,347,985 3,990 serious hearing impairment

People aged 18-64 with profound hearing 60 26 67 28 11,075 33 12,003 36 impairment

People aged 18-64 with moderate or severe 1,277 559 1,339 560 184,145 555 187,714 556 learning disability

People aged 65 and over with serious 3,439 8,751 3,925 37 831,380 8,722 943,609 8,841 visual impairment

People aged 65 and over with moderate 16,474 41,919 18,821 41,639 3,997,638 41,943 4,584,392 42,950 hearing impairment

People aged 65 and over with serious 426 1,084 506 1,119 105,809 1,110 122,371 1,146 hearing impairment

People aged 65 and over with moderate or 111 282 128 283 26,887 282 29,722 278 severe learning disability

Source: PANSI12 and POPPI13

12 Projecting Adult Needs and Service Information, Institute of Public Care: http://www.pansi.org.uk/ 13 Protecting Older People Population Information, Institute of Public Care: http://www.poppi.org.uk/ 44

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2.3.7.8 Homeless population The majority (73%) of homeless people in England reside in London. Ealing’s homeless rate is significantly lower than the London average but more than three times the England average (Table 15). Table 15 - Homeless people in LB Ealing, London and England, 2012 Area Number Rate/1,000 Ealing 1106 8.6 London 40230 11.9 England 55300 2.4 Source: Public Health England 2.3.7.9 Asylum seekers and refugees About 36% of England’s asylum seekers reside in London. In 2010 there were approximately 3,400 asylum seekers in London. Ealing borough was among the top five boroughs with highest asylum seeking population alongside Newham, Haringey, Redbridge and Brent14. 2.3.7.10 Traveller population Traveller groups have frequented Ealing for many years. Department of Environment 'caravan counts' consistently record Ealing as having one of the largest Traveller populations in the Greater London area. These figures do not include the large and unrecognised 'hidden' Traveller communities who, due to a deficit in caravan site provision and rapid evictions from roadside encampments, live in other forms of accommodation15. The total Traveller population in Ealing is estimated to be in excess of 2,000 individuals at certain times of the year. Currently, the variety of Traveller groups resorting to, or residing in the borough, are largely from the following traditional communities:  Travellers of Irish heritage  East European Roma  English, European and international circus and fairground Travellers

14 Information Centre About Asylum and Refugees: http://www.icar.org.uk/9555/statistics/statistics.html 15 Ealing Council-Travellers in Ealing: http://www.ealing.gov.uk/info/100003/community/213/travellers_in_ealing 45

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2.3.8 Deprivation Figure 4 shows Ealing wards and levels of deprivation based on the Index of Multiple Deprivation (IMD) 2010 LSOA ranking16. The darker shades indicate the more deprived areas within the borough. The most deprived areas within the borough are concentrated largely in the west. Southall Green, Norwood Green, Dormers Wells, Northolt North West and areas in South and Central Acton are comparatively more deprived. Figure 4 - Ealing deprivation levels by Lower Super Output Areas (LSOA) based on IMD 2010 ranking

Source: Department for communities and local government The localities used for this PNA, community pharmacies providers in Ealing and surrounding areas and IMD per Output Area 2010 can be found on Map D.

16 Office For National Statistics, Atlas of Deprivation, 2010: http://www.ons.gov.uk/ons/rel/regional- trends/atlas-of-deprivation--england/2010/atlas-of-deprivation-2010.html 46

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2.4. Other considerations 2.4.1 Disease prevalence Table 16 shows GP recorded and estimated prevalence rates for leading causes of long-term ill health in Ealing. The difference between recorded and estimated prevalence rates is indicative of the magnitude of undiagnosed cases. Table 16 - GP recorded and estimated disease prevalence, Ealing, 2012-2013 and 2011

QOF Estimated Recorded Disease Prevalence (%) Prevalence (2011) (%) (2012/13)

Stroke or Transient Ischaemic Attacks (TIA) (All Ages) 0.9 1.42 Coronary Heart Disease (All Ages) 2.5 3.4 Hypertension (All Ages) 11.5 20.6 Chronic Obstructive Pulmonary Disease (All Ages) N/A 2.75 Diabetes Mellitus (Diabetes) 6.8 (ages 17+) 8.8 (ages 16+) Mental Health 1.0 N/A Dementia 0.4 N/A Depression (18+) 3.3 N/A Source: Public Health England – National GP Profiles

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2.4.2 Hospital admissions Table 17 shows all causes, Coronary Heart Disease (CHD), stroke and COPD standardised admissions ratios (SAR) for LB Ealing and wards. Overall Ealing had significantly more admissions than expected for all causes, CHD and stroke. Six wards also had higher than expected numbers of COPD admissions. Table 17 - All causes, CHD, stroke and COPD emergency standardised admission ratios, Ealing wards, LB Ealing and England, 2008-2013 All causes CHD Stroke COPD Area Name observed SAR all observed observed SAR observed admissions causes admissions SAR CHD admissions Stroke admissions SAR COPD Acton Central 7,039 107.0 196 142.3 68 97.5 131 130.6 Cleveland 6,448 98.7 129 80.3 84 104.5 101 84.6 Dormers Wells 8,364 141.9 326 242.1 78 119.3 81 79.3 Ealing Broadway 5,448 88.2 132 91.5 72 93.7 60 55.7 Ealing Common 5,933 95.9 154 106.3 70 95.3 94 86.3 East Acton 8,178 106.8 188 125.5 63 84.6 161 145.5 Elthorne 6,893 112.0 198 150.9 72 113.1 100 104.0 Greenford Broadway 9,905 128.2 255 148.3 115 128.5 169 130.2 Greenford Green 6,536 104.8 180 126.7 76 108.5 124 113.9 Hanger Hill 5,994 87.0 166 102.3 76 90.5 73 58.9 Hobbayne 7,357 117.5 159 108.5 95 130.3 157 141.2 Lady Margaret 8,020 136.5 277 200.0 93 139.6 88 85.3 North Greenford 5,295 88.8 203 135.8 73 99.9 69 60.7 Northfield 5,703 87.3 145 105.6 68 98.2 62 60.2

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All causes CHD Stroke COPD Area Name observed SAR all observed observed SAR observed admissions causes admissions SAR CHD admissions Stroke admissions SAR COPD Northolt Mandeville 6,972 105.5 185 126.6 78 106.5 145 131.3 Northolt West End 8,417 127.5 234 166.8 67 95.7 141 135.6 Norwood Green 8,885 150.4 319 241.6 78 118.0 116 118.3 Perivale 6,137 92.5 247 163.5 95 131.4 81 70.7 South Acton 6,953 107.4 162 114.8 63 88.6 112 105.7 Southall Broadway 8,931 158.1 334 267.1 93 155.1 109 113.8 Southall Green 8,999 159.2 294 249.5 82 149.1 78 89.6 Southfield 4,904 85.2 81 63.5 44 73.9 85 91.4 Walpole 5,415 95.4 142 114.2 65 104.5 76 82.5 Ealing LB 162,727 111.7 4,708 144.5 1,767 109.2 2,411 98.9 England 25,623,623 100.0 706,513 100.0 368,284 100.0 552,386 100.0 Source: Public Health England Key Statistically significantly less admissions than expected The difference is not statistically significant Statistically significantly more admissions than expected

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2.4.3 Causes of death Table 18 shows Ealing wards which had significantly more deaths than expected for all causes, all cancers, circulatory and respiratory diseases. The table also includes deaths for all ages and for persons aged under 75 years (premature deaths). Overall LB Ealing had significantly more than expected circulatory disease related premature deaths. Table 18 - All causes, all cancers, circulatory and respiratory diseases standardised mortality ratios (SMR), Ealing wards, LB Ealing and England, 2008-2012

All All All Circulatory Circulatory Respiratory SMR

All causes Cancers cancers SMR diseases SMR all diseases SMR diseases deaths all

causes SMR all Under 75 SMR all ages SMR all Under 75 Under 75 all ages ages under 75 under 75 all ages age all

Observed ages all observed Under 75 observed ages all observed all observed Circulatory observed Circulatory observed respiratory

Area Name deaths causes deaths all causes deaths Cancers deaths Cancers deaths diseases deaths diseases deaths diseases

Acton Central 374 84.8 173 107.1 115 95.6 60 98.0 106 83.5 43 121.8 45 74.1

Cleveland 442 88.4 155 88.1 125 90.1 49 70.7 123 84.4 35 88.4 73 105.6

Dormers Wells 416 105.5 195 119.2 101 85.0 62 96.7 123 110.0 58 159.4 63 121.7

Ealing Broadway 474 92.0 134 85.3 107 80.3 51 83.4 134 87.3 29 83.5 85 115.0

Ealing Common 464 102.1 166 102.0 115 91.2 57 90.0 136 103.2 40 109.9 85 136.0

East Acton 380 86.2 179 101.1 122 97.7 76 114.9 115 92.2 41 108.5 44 75.3

Elthorne 400 99.4 158 101.6 102 90.0 54 91.4 125 108.4 43 126.9 46 84.6

Greenford Broadway 677 118.1 185 96.4 144 93.4 65 88.1 190 112.8 51 119.6 125 154.9

Greenford Green 424 96.4 169 96.9 128 98.6 72 105.8 124 98.1 40 101.7 59 100.5

Hanger Hill 410 73.7 133 71.0 128 83.3 64 86.8 132 80.8 33 79.1 43 54.8

Hobbayne 419 96.1 183 108.6 132 103.9 72 109.5 116 93.0 35 93.8 57 97.5

Lady Margaret 408 100.7 181 109.7 110 92.5 63 97.2 117 101.7 43 115.1 64 117.9

North Greenford 334 76.9 134 74.3 110 85.1 55 77.5 101 82.1 32 80.0 58 100.7

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All All All Circulatory Circulatory Respiratory SMR

All causes Cancers cancers SMR diseases SMR all diseases SMR diseases deaths all

causes SMR all Under 75 SMR all ages SMR all Under 75 Under 75 all ages ages under 75 under 75 all ages age all

Observed ages all observed Under 75 observed ages all observed all observed Circulatory observed Circulatory observed respiratory

Area Name deaths causes deaths all causes deaths Cancers deaths Cancers deaths diseases deaths diseases deaths diseases

Northfield 346 83.4 126 79.3 113 96.5 58 94.8 90 75.5 26 74.8 47 83.3

Northolt Mandeville 399 86.3 180 106.7 123 94.8 67 103.0 129 96.6 50 133.8 59 93.0

Northolt West End 473 107.9 205 125.5 132 107.1 73 117.1 141 111.8 55 153.4 73 123.6

Norwood Green 468 106.3 192 124.9 87 71.4 51 85.2 132 103.2 50 146.4 75 123.6

Perivale 364 83.7 152 81.3 108 82.7 52 71.0 111 90.5 38 91.1 60 105.5

South Acton 561 115.5 195 118.5 150 113.5 76 120.4 162 114.3 35 96.4 70 103.7

Southall Broadway 353 103.9 184 120.9 63 60.0 34 57.8 140 148.1 61 181.6 46 107.0

Southall Green 328 108.5 183 125.2 73 78.7 40 71.8 104 126.2 52 164.8 30 80.6

Southfield 317 87.6 135 83.9 103 96.4 55 88.3 91 89.8 31 88.6 33 69.6

Walpole 368 92.9 126 83.1 92 83.0 40 68.5 108 95.2 39 116.4 60 111.8

Ealing LB 9,599 95.3 3,823 99.9 2,583 90.4 1,346 90.8 2,852 98.5 960 113.4 1,400 102.7

England 2,315,661 100.0 762,945 100.0 651,010 100.0 310,211 100.0 686,806 100.0 176,217 100.0 327,787 100.0 Source: Public Health England Key Statistically significantly less deaths than expected The difference is not statistically significant Statistically significantly more deaths than expected

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2.4.4 Palliative care Ealing had a significantly higher percentage of deaths in hospital (59.1%) as compared to England average (50.7%) during the period 2010-2012. Table 19 - Place of death, LB Ealing and England, 2010-2012 Number of Ealing Place of death % deaths % deaths deaths in compared to (%) Ealing England Ealing England Significantly Hospital 1123 59.1 50.7 Higher Significantly Own home 374 19.7 21.5 Lower Significantly Hospice 87 4.6 5.6 Lower Significantly Care home 256 13.5 19.6 Lower

Source: Public Health England: End of life care intelligence network

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2.4.5 Lifestyle related morbidity Table 20 shows prevalence rates of childhood obesity, adult obesity and injuries amongst children and young people in Ealing wards. Overall LB Ealing had a significantly higher obesity prevalence rate than the England average amongst children in reception and year 6. Table 20 - Prevalence of lifestyle related morbidities, Ealing wards, LB Ealing and England

Number of Emergency Obese children % of adult Number of Obese admissions children in and young for injury in population Number of children in children in Number of reception people children and with Area Name children in year 6 year 6 (%) adults (%) aged 0-17 young obesity reception 2010/11- 2010/11- years (2013) 2010/11- people 2006-2008 2012/13 2012/13 2012/13 2008/09 – (Crude model 2012/13 rate/100,000) Acton Central 453 12.4 379 19.0 16,249 810.2 9,840 15.5 Cleveland 551 10.2 478 18.8 17,339 939.6 11,690 16.0 Dormers Wells 606 13.5 537 24.4 17,291 918.0 10,310 19.6 Ealing Broadway 223 6.7 169 14.8 11,173 845.1 10,887 11.6 Ealing Common 270 9.3 203 19.7 11,486 836.4 10,911 12.9 East Acton 559 11.4 469 23.7 19,207 948.9 12,299 19.0 Elthorne 618 10.0 404 22.0 15,298 1,098.1 10,640 15.5 Greenford Broadway 801 14.6 627 23.8 22,061 964.4 11,835 22.6 Greenford Green 589 9.3 437 22.9 16,370 858.8 10,649 21.5 Hanger Hill 393 8.7 272 17.3 15,230 722.0 12,206 12.7

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Number of Emergency Obese children % of adult Number of Obese admissions children in and young for injury in population Number of children in children in Number of reception people children and with Area Name children in year 6 year 6 (%) adults (%) aged 0-17 young obesity reception 2010/11- 2010/11- years (2013) 2010/11- people 2006-2008 2012/13 2012/13 2012/13 2008/09 – (Crude model 2012/13 rate/100,000) Hobbayne 558 9.9 483 20.9 17,771 1,003.4 10,232 18.0 Lady Margaret 536 11.9 486 21.2 15,954 882.3 10,399 20.4 North Greenford 576 9.2 496 24.0 16,693 825.4 10,917 21.4 Northfield 592 5.7 340 13.5 13,512 730.1 9,924 13.1 Northolt Mandeville 704 12.2 558 23.8 19,484 1,021.8 10,885 24.6 Northolt West End 761 15.1 590 20.0 21,331 1,013.5 10,992 26.4 Norwood Green 484 13.2 502 22.5 16,496 861.8 10,491 21.3 Perivale 570 9.8 479 23.8 16,997 847.0 11,201 18.7 South Acton 441 12.2 392 27.3 16,001 953.6 10,826 16.6 Southall Broadway 597 15.9 500 23.6 16,197 1,113.2 9,414 19.5 Southall Green 694 14.7 545 24.4 17,787 1,060.5 10,903 21.2 Southfield 266 7.1 167 16.2 12,631 760.0 9,554 13.4 Walpole 421 7.8 295 15.6 13,018 923.3 10,339 14.0 Ealing LB 12,263 11.4 9,808 21.7 375,576 919.1 247,344 18.1 England 1,694,595 9.4 1,475,617 19.1 56,477,460 1,180.9 41,422,025 24.2

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Source: Public Health England

Key Statistically significantly lower than England average The difference is not statistically significant Statistically significantly higher than England average

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2.4.6 Health issues Ealing has significantly higher rates for drug misuse and injuries due to falls amongst people aged 65 and over than the England average. Flu vaccine uptake rate among persons aged 65 years and below is significantly lower than the England average. Sexual health and dental outcomes are significantly worse than the England average (see Table 21). Table 21 - Health issues, LB Ealing, London and England

Indicator Ealing London England Year

Breastfeeding initiation (%) 88.3 86.8 73.9 2013

Breastfeeding at 6-8 weeks (%) 71 68.5 47.2 2013

Smoking prevalence (18+ years) (%) 19.6 19.9 19.5 2012

Smoking at time of delivery (%) 3.8 5.7 12.7 2012/13

Drug Misuse (15-64 year olds) (crude 10.2 Not available 8.6 2010/11 rate / 1,000) Admissions due to substance misuse 42.7 Not available 75.2 2012/13 (15-24 year olds, DSR* / 100,000) Alcohol related admissions 550 554 637 2012/13 (DSR/100,000)

Injuries due to falls in people aged 65 2,923 2,242 2,011 2012/13 and over (DSR / 100,0000) 2012/13 Flu vaccine uptake (%) 67.7 71.2 73.4

2012 Under 18 conceptions (%) 22.4 25.9 27.7

Chlamydia diagnoses (15-24 year 1,392 2,179 2,016 2013 olds)17 HIV diagnosis at late stage of infection 50.3 44.9 48.3 2010-12 (15+ year olds newly diagnosed) (%)18 Acute sexually transmitted infections 996 1,336 804 2012 (per 100,000)

17 Higher diagnoses are indicative of good performance. The national target was least 2,000 diagnoses. 18 50% and above rate is an issue of concern. . 56

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Indicator Ealing London England Year Children aged 5 with one or more 42.1 Not available 27.9 2011/12 decayed, missing or filled teeth (%) Children and adolescents aged 0-19 years admitted to hospital for tooth 0.8 0.7 0.5 2012/13 extraction (%)

Source: Public Health England, NHS Dental Statistics (*DSR: Directly Standardised Ratio) Key Statistically significantly better than England average The difference is not statistically significant Statistically significantly worse than England average

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Section 3: NHS pharmaceutical services provision; currently commissioned 3.1 Community pharmacies There are 75 community pharmacies in Ealing HWB area (as at 17th October 2014) for a population of 342,500. This equates to an average of 21.9 pharmacies per 100,000 population. Latest data shows the England average is 21.6 community pharmacies per 100,000 population and the London average is 22.5 community pharmacies per 100,000 population. London has a transient population, with generally good transport links. Populations may therefore find community pharmacies in neighbouring HWB areas more accessible and/or more convenient. There is a high rate of community pharmacies per 100,000 population in neighbouring HWB areas to Ealing: Brent (24.0), Hammersmith (22.0), Harrow (25.4), Hillingdon (24) and Hounslow (22.0). 359 responses were received to the pharmacy user questionnaire undertaken in the summer of 2014. Over 87% of respondents used the same pharmacy. When asked what factors they considered when choosing their pharmacy, over 80% indicated ‘Close to home’ and over 52% ‘Close to GP surgery’ as important reasons. Almost two out of three respondents walk to their community pharmacy, whilst one in four use a car or taxi. The full results of the pharmacy user survey is detailed in Section 5. Table 22 provides a breakdown, by locality, of the average number of community pharmacies per 100,000 population. All localities have at least one community pharmacy. The number and rate of community pharmacies vary widely by locality and may be indicative of the relatively small size (population and geography) of the localities chosen for this PNA. Populations in all localities have access to extensive public transport links and road networks and for some populations the nearest community pharmacy provision from their home may be in a neighbouring locality or HWB area. Maps E to G show the travel times to nearest community pharmacy for residents of Ealing HWB area.

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Table 22 - A breakdown of average community pharmacies per 100,000 population6

Number of Total Average number of community population community pharmacies

pharmacies (as (ONS 2012 per 100,000 population Area of 10/09/14) estimates) (as of 19/07/14)

Acton Central 5 15,690 31.9 Cleveland 2 14,503 13.8 Dormers Wells 3 13,912 21.6 Ealing Broadway 5 14,106 35.4 Ealing Common 1 13,872 7.2 East Acton 2 19,026 10.5 Elthorne 4 14,517 27.6 Greenford Broadway 6 17,680 33.9 Greenford Green 3 14,591 20.6 Hanger Hill 2 15,664 13.9 Hobbayne 3 14,368 20.9 Lady Margaret 4 13,854 28.9 North Greenford 1 14,917 6.7 Northfield 5 13,455 37.2 Northolt Mandeville 2 15,454 12.9 Northolt West End 2 15,351 13.3 Norwood Green 3 14,155 21.2 Perivale 3 15,685 19.1 South Acton 4 14,834 27.0 Southall Broadway 5 13,687 36.5 Southall Green 5 14,883 33.6 Southfield 1 13,262 7.5 Walpole 4 13,205 30.3 Ealing Health and Wellbeing Board area 75* 342,500 21.9* (2013/14 data) London region (2012/13 1,846* 8,204,000 22.5* data)

England (2012/13 data) 11,495* - 21.6*

*Data includes distance-selling (internet) pharmacies, which do not provide face-to-face services 59

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Section 1.3 lists the Essential Services of the pharmacy contract. It is assumed that provision of all of these services is available from all contractors. Map C shows population densities and community pharmacies. Further analysis of the pharmaceutical service provision and health needs for each locality is explored in Section 6. 3.1.1 Choice of community pharmacies Table 23 shows the breakdown of community pharmacy ownership in Ealing. The data shows that pharmacy ownership is at levels similar to those seen regionally and higher than those seen nationally, with no one provider having a monopoly in any locality. People in Ealing therefore have a good choice of pharmacy providers. Table 23 - Community pharmacy ownership, 2012/136 Area Multiples (%) Independent (%) England 61.4 38.6 London 38.5 61.5 Ealing (2014 data) 31.1 68.9

3.1.2 Intensity of current community pharmacy providers For most community pharmacy providers, dispensing provides the majority of their activity. Table 24 shows the average monthly dispensing activity from community pharmacies. The data shows that average activity in Ealing is higher than the London region, but lower than the England average. This data suggests that, as a whole, community pharmacies in Ealing are well-placed for the anticipated population growth in the HWB area. Table 24 - Average dispensed items per community pharmacy, 2012/136 Average number of monthly Area dispensed item per community pharmacy England 6628 London region 5225 Ealing 5554

3.1.3 Weekend and evening provision It is estimated that collectively, community pharmacies in England are open approximately 150,000 hour4se per week more than 10 years ago19.

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This has been primarily driven through the opening of ‘100 hour’ pharmacies. There are now over 700 community pharmacies in England open for 100 hours or more per week. Table 25 shows that Ealing has a high percentage of its pharmacies open for 100 hours or more compared with regionally and nationally. Most 100 hour pharmacies are open late and at the weekends and one is open throughout the night on Monday and Tuesday nights. Table 25 - Numbers of 100 hour pharmacies (and percentage of total) Area Number (%) of 100 hr pharmacies England (2012/13 data) 6 773 (6.7%) London region 71 (3.8%) Ealing 7 (9.3%) Acton Central 1 (20%) Cleveland 0 Dormers Wells 1 (33.3%) Ealing Broadway 0 Ealing Common 0 East Acton 0 Elthorne 0 Greenford Broadway 1 (16.7%) Greenford Green 0 Hanger Hill 0 Hobbayne 0 Lady Margaret 1 (25%) North Greenford 0 Northfield 1 (20%) Northolt Mandeville 0 Northolt West End 0 Norwood Green 0 Perivale 0 South Acton 0 Southall Broadway 0 Southall Green 1 (20%) Southfield 0 Walpole 1 (25%)

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3.2 Dispensing appliance contractors (DACs)

There are no DACs in Ealing HWB area but DAC services are available to the population from elsewhere in the UK. Appliances may also be dispensed from community pharmacies. 52 responses were received from the community pharmacy contractor questionnaire. Three out of four respondents reported that they provide stoma and/or incontinence appliances, with a further 12% indicating that they intend to begin providing in the next 12 months. As part of the essential services of appliance contractors a free delivery service is available to all patients. It is therefore likely that patients will obtain appliances delivered from DACs outside the HWB area. There were 118 DACs in England in 2012/13, 14 in London6. 3.3 Distance-selling pharmacies A distance-selling pharmacy provides services as per the Pharmaceutical Regulations, 20133. It may not provide essential services face-to-face and therefore provision is by mail order and/or wholly internet. As part of the terms of service for distance-selling pharmacies, provision of all services offered must be offered throughout England. It is therefore likely that patients within Ealing HWB area will be receiving pharmaceutical services from a distance-selling pharmacy outside Ealing HWB area. There are no distance-selling pharmacies in Ealing HWB area. Figures in 2012/136 show that in England there were 200 distance-selling pharmacies, accounting for 1.7% of the total number of pharmacies (London: 7 (0.4%)). 3.4 Access to community pharmacies The majority of community pharmacy providers in Ealing HWB area are sited in areas co-located with shops, GP practices, or other routine destinations; many also provide extended opening hours. As such they attract a high level of convenience. The white paper, ‘Pharmacy in England: Building on strengths – delivering the future’19 noted that 99% of the population – even those living in the most deprived areas – can get to a community pharmacy within 20 minutes by car and 96% by walking or using public transport. Maps E to G provide a travel analysis of the population of Ealing to their nearest community pharmacy. A list of community pharmacies in Ealing HWB area and their opening hours can be found in Appendix A. 3.4.1 Routine daytime access to community pharmacies Percentages of the Ealing HWB area and average daytime drive time, walking and public transport travel times to their nearest community pharmacy can be found in Table 26.

19 ‘Pharmacy in England: Building on strengths – delivering the future’, Department of Health (2008) - http://www.official-documents.gov.uk/document/cm73/7341/7341.pdf . 62

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Average drive time to community pharmacies in Ealing is shown in Map E. Average public transport time to community pharmacies is shown in Map F. Average walking time to community pharmacies is shown in Map G. A recently published article20 suggests that over 89% of the population of England has a maximum 20 minute walk to a community pharmacy, although this figure falls to as low as 14% in rural areas. The same study found that access is greater in areas of high deprivation. Higher levels of deprivation are linked with increased premature mortality rates. 100% of Ealing HWB area population has an average drive time not exceeding 15 minutes to their nearest community pharmacy, 100% has an average public transport time not exceeding 20 minutes, and over 97% has an average walking time not exceeding 20 minutes. There are also many localities in Ealing with populations amongst the most deprived in England. Table 26 - Percentage of population of Ealing HWB and average daytime travel times to nearest community pharmacy Average peak Average public Average walking drive transport 0-5 mins 96% 33.9% 21.7% 0-10 mins 99.5% 90.2% 70.4% 0-15 mins 100% 97.9% 92.3% 0-20 mins 100% 100% 97.3% 0-25 mins 100% 100% 99.4% 0-30 mins 100% 100% 100%

3.4.2 Routine weekday evening access to community pharmacies The number, location and opening hours of community pharmacy providers open in the evenings (which has been taken as beyond 6pm), Monday to Friday (excluding bank holidays) varies within each locality; they are listed in the table below. ‘Average’ access is difficult given the variety of opening hours and locations. Access is therefore considered at locality level and, as can be found from Table 27, the population of Ealing has reasonable access to community pharmacies in the evening as the majority of providers in Ealing HWB area are open after 6pm. A further analysis of provision in each locality is detailed in Section 6.

20 ‘The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England’, BMJ Open 2014, Vol. 4, Issue 8 - http://bmjopen.bmj.com/content/4/8/e005764.full.pdf%20html

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Table 27 - Community pharmacy providers open Mon-Fri (excl. BHs) beyond 6pm Opening hrs Locality Pharmacy name and address (Mon - Fri, excl BHs) Zahra Pharmacy, 06:30-22:30 72 High Street, Acton, W3 6RE

Horn Lane Pharmacy, Mon, Tue, Wed, Fri 148 Horn Lane, Acton, W3 6PG 09:00-18:30 Acton Central Jallas Chemist, 313 Horn Lane, Acton, W3 0BU 09:00-18:30

Conway Chemists, Mon, Tue, Thurs, Fri 8 Station Parade, West Acton, W3 0DS 09:00-18:30

Temple Pharmacy, Mon, Tue, Thu, Fri: Cleveland 110 Pitshanger Lane, Ealing, W5 1RU 09:00-18:30

Anmol Pharmacy, Mon - Thu 07:00-23:30 97 North Road, Southall, UB1 2JW Fri 06:00-23:30

Dormers Kings Pharmacy, 09:30-19:00 Wells 50 Greenford Road, Greenford, UB6 9AT Chana Chemist, 09:00-19:00 Unit 3, 33 High Street, Southall, UB1 3HA Boots, 08:45-20:00 Unit 36 Ealing B'way Centre, Ealing, W5 5JY Ealing Superdrug, Broadway 18-19 Broadway Shopping Centre, Ealing, 09:00-19:00 W5 5JY Ealing Walker Chemist, 6 The Broadway, Acton, W3 08:00-18:30 Common 8HR Banks Chemist, East Acton 59 Old Oak Common Lane East, Acton, W3 09:00-18:30 7DD Church Pharmacy, 09:00-19:30 83 Uxbridge Rd, H’well, W7 3ST Elthorne Touchwood Pharmacy, 09:00-19:00 20 Church Rd, Hanwell, W7 1DR

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Opening hrs Locality Pharmacy name and address (Mon - Fri, excl BHs) Northolt Pharmacy, Grand Union Health Centre, Taywood, 09:00-18:30 Northolt, UB5 6WL Ariana Pharmacy, Mon - Tue 00:00-23:59 Greenford Broadway 472 Greenford Road, Greenford, Wed 00:00-20:00 UB6 8SQ Thu - Fri 08:00-20:00 Chief Cornerstone Ltd., 08:30-19:00 4 Eastmead Avenue, Greenford, UB6 9RA Boots, 08:30-19:30 47A-47B Oldfields Circus, Northolt, UB5 4RR Boots, Greenford 09:00-19:00 Green Unit 11, Westway Cross Retail Pk, 100 Greenford Road, Greenford, UB6 0UW Parade Pharmacy, 09:00-19:00 386 Oldfield Lane, North Greenford, UB6 8PU Cross Chemist, 09:00-19:00 5 Royal Parade, Hanger Lane, W5 1ET Hanger Hill Megson’s Pharmacy, Thu - Fri 09:00-18:30 15 Queens Parade, Hanger Lane, W5 3HU

Remedy Pharmacy, Mon, Tue, Thu, Fri Hobbayne 83 Greenford Avenue, Hanwell, W7 1LJ 09:00-18:30 Shah Pharmacy, 13 North Parade, North Road, Southall, UB1 09:00-19:00 2LF H J Dixon Chemist 09:00-18:30 Lady 185 Lady Margaret Road, Southall, UB1 2PT Margaret Allenby Chemist 09:00-19:00 251 Allenby Road, Southall, UB1 2HB Lady Margaret Road Pharmacy, 223 Lady Margaret Road Southall Middlesex, 07:00-23:00 UB1 2NH

North Westlake Pharmacy, 09:00-18:30 Greenford 1318 Greenford Road, Greenford, UB6 0HL 65

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Opening hrs Locality Pharmacy name and address (Mon - Fri, excl BHs) Daru Pharmacy, 08:30-18:30 186 South Ealing Road, W5 4RJ

Midhurst Chemist, Mon, Tue, Wed, Fri 92 Elthorne Pk Road, Ealing, W7 2JD 09:00-18:30 Northfield Harbs Pharmacy, 193 South Ealing Road, South Ealing, W5 08:00-23:00 4RH Bramley Pharmacy, 09:00-18:30 261 Northfield Avenue, Ealing, W5 4UA

M. Gokani Chemist, Mon, Tue, Thu, Fri 09:00-19:00 Northolt 32 Church Road, Northolt, UB5 5AB Mandeville Boots, 09:00-18:30 5 Haydock Green, Northolt, UB5 4AP

Northolt West Touchwood Pharmacy, 09:00-19:00 End 493-495 Yeading Lane, Northolt, UB5 6LN Gill Chemists, 09:00-20:30 Norwood 31-33 King Street, Southall, UB2 4DG Green K L Pharmacy 09:00-13:00 1 Tyler Road, Southall, UB2 4XQ 14:00-18:30 Watmans Pharmacy, 09:00-19:00 192 Bilton Road, Perivale, UB6 7HQ Perivale Tesco Pharmacy, 08:00-20:00 Hoover Building, Bideford Ave, UB6 8DW LloydsPharmacy, 08:30-18:45 Crown Street, Acton, W3 8SA LloydsPharmacy, South Acton 08:45-18:45 377 Uxbridge Road, Ealing, W3 9RH Dillons Chemist 09:00-18:30 17 Church Road, Acton, W3 0DS

Southall Woodland Pharmacy, Mon-Fri 09:00-19:00 Broadway 227 The Broadway, Southall, UB1 1ND (Wed 09:00-17:00)

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Opening hrs Locality Pharmacy name and address (Mon - Fri, excl BHs) Sherry’s Pharmacy 09:30-19:00 48 South Road, Southall, UB1 1RR Chana Chemist 09:00-21:00 52 South Road, Southall, UB1 1RQ Alchem Pharmacy 09:15-19:30 123 The Broadway, Southall, UB1 1LW Boots, 09:00-14:00 61 The Broadway, Southall, UB1 1JY 14:30-20:00 Puri Chemists, 09:15-19:00 39 Western Road, Southall, UB2 5HE Cheema Pharmacy 09:00-20:00 49-51 King Street, Southall, UB2 4DQ Gill Chemists Southall 09:00-19:00 79 Norwood Road, Southall, UB2 4EA Green Fountain Pharmacy 08:00-23:00 43 Featherstone Road, Southall, UB2 5AB Tesco Pharmacy Hayes Road, Bulls Bridge Industrial Estate, 09:00-21:00 UB2 5NB Crossbells Pharmacy, Southfield 09:00-18:30 131 The Vale, Acton, W3 7RQ Northfield Pharmacy, 30 Northfield Avenue, W13 9RL 08:30-18:30 Mattock Lane Chemist,

8 St. Johns Parade, Mattock Lane, 08:45-19:00 Walpole W13 9LL Grosvenor House Pharmacy, 07:00-23:00 147 The Broadway, Ealing, W13 9BE

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3.4.3 Routine Saturday daytime access to community pharmacies The number, location and opening hours of community pharmacy providers open on a Saturday varies within each locality. Over 90% of pharmacies in Ealing HWB area are open on Saturdays, the majority of which are open into the late afternoon. ‘Average’ access is difficult given the variety of opening hours and locations. Access is therefore considered at locality level. Table 28 shows that over two-thirds of all pharmacies in Ealing HWB area open on a Saturday. A further analysis of provision is detailed in Section 6. Table 28 - Community pharmacy providers open Saturdays Locality Pharmacy name and address Saturday opening hrs Acton Central Horn Lane Pharmacy, 10:00-13:00 148 Horn Lane, Acton, W3 6PG Zahra Pharmacy, 08:00-20:00 72 High Street, Acton, W3 6RE Boots, Unit 17 The Oakes Shopping Centre, 09:00- 18:00 Acton High Street, W3 6RE Conway Chemists, 09:00-17:00 8 Station Parade, West Acton. W3 0DS Jallas Chemists, 09:00-18:00 313 Horn Lane, Acton, W3 0BU Cleveland Ealing Pharmacy, 09:00-17:00 157 Pitshanger Lane, Ealing, W5 1QX Temple Pharmacy, 09:00-18:00 110 Pitshanger Lane, Ealing, W5 1RU Dormers Wells Anmol Pharmacy, 06:00-23:30 97 North Road, UB1 2JW Chana Chemist, 09:00-19:00 Unit 3, 33 High St, Southall, UB1 3HA Ealing Boots, Broadway 24 Ealing Broadway, Ealing, 08:30-17:30

W5 2NH Boots, Unit 36 Ealing Broadway Centre, Ealing, 08:45-19:00 W5 5JY

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Locality Pharmacy name and address Saturday opening hrs Terry’s Pharmacy, 4 Castle Hill Pde, The Avenue, 09:00-13:30 W13 8JP Lewis Pharmacy, 10:00-15:00 36 Haven Green, Ealing, W5 2NX Superdrug Pharmacy, 08:30-17:30 96 The Broadway, West Ealing, W13 0SY Ealing Walker Chemist, 6 The Broadway, Acton, 10:00-17:00 Common W3 8HR East Acton Banks Chemist, 59 Old Oak Common Lane East, Acton, 09:00-14:00 W3 7DD Marcus Jones Pharmacy 96 Old Oak Common Lane, East Acton, 09:00-13:00 W3 7DA Elthorne Boots, 09:00-18:00 68 The Broadway, West Ealing, W13 0SR Church Pharmacy, 83 Uxbridge Road, Hanwell, 09:00-18:30 W7 3ST Superdrug Pharmacy, 18-19 Broadway Shop Centre, Ealing W5 09:00-17:30 5JY Greenford Boots, Broadway 42 The Broadway, Ruislip Road, 09:00-18:00 Greenford. UB6 9PT Ariana Pharmacy, 09:00-19:00 472 Greenford Road, Greenford, UB6 8SQ Ravenor Chemist, 70 The Broadway, Greenford, 09:00-16:00 UB6 9QA Roxanne’s Dispensing Chemist, 51 The Broadway, Greenford, 09:00-17:30 UB6 9PN

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Locality Pharmacy name and address Saturday opening hrs Chief Cornerstone Ltd., 08:30-13:00 4 Eastmead Avenue, Greenford, UB6 9RA Greenford Boots, Green 47A-47B Oldfields Circus, Northolt, UB5 08:30-19:00 4RR Boots, Unit 11, Westway Cross Retail Pk., 100 09:00-19:00 Greenford Road, Greenford UB6 0UW Parade Pharmacy, 386 Oldfield Lane, North Greenford, UB6 09:00-13:00 8PU Hanger Hill Cross Chemist, 09:00-17:00 5 Royal Parade, Hanger Lane, W5 1ET Megson’s Pharmacy, 15 Queens Parade, Hanger Lane, 09:00-13:30 W5 3HU Hobbayne Co-Op Pharmacy, 333 Greenford Avenue, 09:00-14:00 W7 7RQ Greenford Chemist, 348 Greenford Avenue, Hanwell, 09:00-13:00 W7 3DA Lady Margaret Chana Chemist, 251 Allenby Road, Southall, 09:00-18:00 UB1 2HB H.J. Dixon Chemist, 185 Lady Margaret Rd., Southall, 09:00-13:00 UB1 2PT Lady Margaret Road Pharmacy, 223 Lady Margaret Road, Southall, 07:00-20:00 UB1 2NH North No pharmacies open Greenford

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Locality Pharmacy name and address Saturday opening hrs Northfield Richards Chemists, 112 South Ealing Road, 09:00-16:00 W5 4QJ Midhurst Chemist, 92 Elthorne Park Road, Ealing, 09:00-13:00 W7 2JD Harbs Pharmacy, 193 South Ealing Road, 07:00-22:00 South Ealing, W5 4RH Bramley Pharmacy, 261 Northfield Avenue, Ealing, 09:00-13:00 W5 4UA Northolt Boots, Mandeville 5 Haydock Green, Northolt, 09:00-17:00 UB5 4AP M. Gokani Chemist, 09:00-14:00 32 Church Road, Northolt, UB5 5AB Northolt West Alpha Chemist, End 480 Church Road, Northolt, 09:00-17:30 UB5 5AU Touchwood Pharmacy, 493-495 Yeading Lane, Northolt, 09:00-17:00 UB5 6LN Norwood K.L. Pharmacy, Green 09:00-13:00 1 Tyler Road, Southall, UB2 4XQ Gill Chemists, 09:00-20:30 31-33 King Street, Southall. UB2 4DG Jade Pharmacy 3 Crosslands Parade, Crossland Avenue, 09:00-13:00 Norwood Green, UB2 5RB Perivale Medway Pharmacy, 18 Medway Parade, Perivale, Greenford, 09:00-13:00 UB6 8HT

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Locality Pharmacy name and address Saturday opening hrs Northfield Richards Chemists, 112 South Ealing Road, 09:00-16:00 W5 4QJ Midhurst Chemist, 92 Elthorne Park Road, Ealing, 09:00-13:00 W7 2JD Harbs Pharmacy, 193 South Ealing Road, 07:00-22:00 South Ealing, W5 4RH Bramley Pharmacy, 261 Northfield Avenue, Ealing, 09:00-13:00 W5 4UA Watmans Pharmacy, 09:00-13:30 192 Bilton Road, Perivale, UB6 7HQ Tesco Pharmacy, Hoover Building, Bideford Ave, Perivale, 0800-20:00 UB6 8DW South Acton Dillons Chemist, 09:00-13:00 17 Church Road, Acton, W3 8PU Lloydspharmacy, 08:30-17:00 Crown Street, Acton, W3 8SA Lloydspharmacy, 09:00-17:00 77 Uxbridge Road, Ealing, W3 9RH SR Pharmacy, 09:00-18:00 155 High Street, Acton, W3 6LP Southall Alchem Pharmacy, Broadway 10:00-18:00 123 The Broadway, Southall, UB1 1LW Boots, 09:00-19:00 61 The Broadway, Southall, UB1 1JY Chana Chemist, 09:00-20:00 52 South Road, Southall, UB1 1RQ Sherry’s Pharmacy, 10:00-14:00 48 South Road, Southall, UB1 1RR

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Locality Pharmacy name and address Saturday opening hrs Northfield Richards Chemists, 112 South Ealing Road, 09:00-16:00 W5 4QJ Midhurst Chemist, 92 Elthorne Park Road, Ealing, 09:00-13:00 W7 2JD Harbs Pharmacy, 193 South Ealing Road, 07:00-22:00 South Ealing, W5 4RH Bramley Pharmacy, 261 Northfield Avenue, Ealing, 09:00-13:00 W5 4UA Southall Green Cheema Pharmacy, 49-51 King Street, Southall, 09:00-19:00 UB2 4DQ Gill Chemists, 09:00-14:00 79 Norwood Road, Southall, UB2 4EA Fountain Pharmacy, 08:00-23:00 43 Featherstone Road, Southall, UB2 5AB Tesco Pharmacy Hayes Road, Bulls Bridge Ind Est. 09:00-21:00 UB2 5NB Southfield Crossbells Pharmacy, 09:00-13:00 131 The Vale, Acton, W3 7RQ Walpole Michael Pharmacy, 09:30-14:30 75 New Broadway, Ealing, W5 5AL Northfield Pharmacy, 30 Northfield Avenue, 09:00-17:30 W13 9RL Mattock Lane Chemists, 8 St. Johns Parade, Mattock Lane, 09:00-17:00 W13 9LL

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3.4.4 Routine Sunday daytime access to community pharmacies The number, location and opening hours of community pharmacy providers which open on a Sunday vary within each locality. Fewer pharmacies are open on Sundays than any other day in Ealing HWB area, although each of the main shopping areas has a pharmacy open on Sundays. Table 29 - Community pharmacy providers open Sundays Openings hours Locality Pharmacy name and address (Sundays) Acton Central Zahra Pharmacy, 09:00-18:00 72 High Street, Acton, W3 6RE Boots, Unit 17 The Oakes Shopping Centre, 10:00-16:00 Acton High Street, W3 6RE Cleveland No pharmacies open Dormers Wells No pharmacies open Ealing Boots, Broadway 11:00-17:00 24 Ealing Broadway, Ealing, W5 2NH Boots, Unit 36 Ealing B'way Centre, Ealing, W5 11:00-17:00 5JY Ealing No pharmacies open Common East Acton No pharmacies open Elthorne Boots, 12:00-18:00 68 The Broadway, Ealing, W13 0SR Greenford Boots, Broadway 42 The Broadway, Ruislip Road, 09:00-16:00 Greenford. UB6 9PT Ariana Pharmacy, 10:00-16:00 72 Greenford Road, Greenford. UB6 8SQ Greenford Boots, Green Unit 11, Westway Cross Retail Pk., 11:00-17:00 100 Greenford Road, Greenford. UB6 0UW Hanger Hill No pharmacies open

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Openings hours Locality Pharmacy name and address (Sundays) Hobbayne No pharmacies open Lady Margaret Lady Margaret Road Pharmacy, 223 Lady Margaret Road, Southall. 10:00-17:00 UB1 2NH North No pharmacies open Greenford Northfield Harbs Pharmacy, 193 South Ealing Road, South Ealing. 11:00-17:00 W5 4RH Northolt No pharmacies open Mandeville Northolt West No pharmacies open End Norwood Gill Chemists, Green 12:00-19:30 31-33 King Street. Southall, UB2 4DG Perivale Tesco Pharmacy, Hoover Building, Bideford Ave, Perivale. 10:00-16:00 UB6 8DW South Acton Lloydspharmacy, 10:00-14:00 377 Uxbridge Road, Ealing, W3 9RH

Southall Boots, 10:30-14:00 Broadway 61 The Broadway, Southall, UB1 1JY 14:30-19:00 Chana Chemist, 10:00-19:00 52 South Road, Southall, UB1 1RQ Southall Green Fountain Pharmacy, 08:00-18:00 43 Featherstone Road, Southall, UB2 5AB Tesco Pharmacy Hayes Road, Bulls Bridge Ind Est. UB2 11:00-17:00 5NB Southfield No pharmacies open Walpole Grosvenor House Pharmacy, 147 The Broadway, 10:00-17:00 West Ealing, W13 9BE

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3.4.5 Routine Bank Holiday access to community pharmacies Community pharmacies are not obliged to open on nominated bank holidays. Whilst many opt to close, a number of pharmacies (often those in regional shopping centres, retail parks, supermarkets, and major high streets) opt to open - often for limited hours. The number, location and opening hours of community pharmacy providers open on a bank holiday vary within each locality and on different bank holidays. Annually, NHS England requests feedback from community pharmacies on their bank holiday intentions. For most bank holidays, a number of providers have planned to open and NHS England has deemed provision as satisfactory and not commissioned any further provision. NHS England may often need to commission a bank holiday rota service from a small number of pharmacies, particularly in some areas for Easter Sunday and Christmas Day. 3.4.6 Twenty-four hour provision Ealing CCG has a strategy to develop ‘out-of-hospital’ services over the next few years. There may therefore become an increasing need for a 24 hour pharmaceutical service. There is currently one provider in Ealing HWB area providing continuous 24 hour provision from midnight Sunday/Monday to 8pm on Wednesday:  Ariana Pharmacy, 472 Greenford Road, Greenford. 3.5 Advanced service provision from community pharmacies Section 1.3 lists all Advanced Services which may be provided under the pharmacy contract. As these services are discretionary, not all providers will provide them all of the time. Data supplied from NHS England has been used to demonstrate in Appendix A which pharmacies have previously claimed (and therefore provided) MURs and NMSs until 31/3/2014. Table 30 lists a summary of the latest available data (2012/13) on provision of advanced services. Table 30 - Advanced Service provision Percentage of providers currently providing (Average Advanced Service number per provider, 2012/13) England London Ealing Medicines Use Reviews (MURs) 92% (267) 89.9% (263) 91.9% (292) New Medicines Service (NMS) 82.3% (68) 78.7% (74) 83.8% (94) Appliance Use Review (AUR)* 1.2% (197) 0.5% (242) 0 Stoma Customisation (SC)* 15.2% (635) 4.1% (921) 4.1% (14) *AUR and SC data includes provision from Dispensing Appliance Contractors The number of providers and rate of provision of both the MUR and NMS services in Ealing HWB area exceeds the regional and national levels. Appendix A lists those community pharmacies that have provided these services (up until 31st March 2014). 77

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Seven community pharmacies in Ealing HWB area (10% of providers) had not provided the NMS service and three community pharmacies in Ealing HWB area (4% of providers) had not provided the MUR service. Two respondents to the community pharmacy contractor questionnaire indicated that they do not have a consultation room which complies with the requirements to perform NMS/MUR services. Provision of the SC service is low compared with nationally but equal to rates seen regionally. There has been no recorded provision of the AUR service from community pharmacy providers in Ealing HWB area up until 31st March 2014. The number of providers of the AUR is very low regionally and nationally: there were only 143 community pharmacy or DAC providers nationally (1.2%) and 9 community pharmacy or DAC providers (0.5%) in the whole of London in 2012/13. 3.6 Enhanced service provision

Under the pharmacy contract, enhanced services are those directly commissioned by NHS England. Therefore any ‘locally commissioned services’ commissioned by CCGs or the Local Authority are not considered here. They are outside the scope of the PNA but are considered in Chapter 4. There are currently no enhanced services commissioned by NHS England from pharmacies in Ealing HWB area. 3.7 Pharmaceutical service provision provided from outside Ealing HWB area

Ealing HWB area is bordered by five other HWB areas: Brent, Hammersmith and Fulham, Harrow, Hillingdon and Hounslow. As previously mentioned, like most London boroughs, Ealing has a comprehensive transport system. As a result, it is anticipated that many residents in Ealing HWB area will have reasonable access to pharmaceutical service providers in neighbouring HWB areas and beyond. It is not practical to list here all those pharmacies outside the HWB area by which Ealing residents will access pharmaceutical service. A number of providers lie within close proximity to the borders of Ealing HWB area boundaries and are demonstrated on maps A to G. Further analysis of cross-border provision is undertaken in Section 6. Over 80% of respondents to the pharmacy user questionnaire noted that they choose a pharmacy provider close to their home, whilst over half chose a provider close to their GP. Over 80% had no difficulties in accessing their community pharmacy, whilst over 10% had difficulties with parking. Almost 90% rated ease of obtaining medication as excellent or good.

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Section 4: Other services which may impact on pharmaceutical services provision Community pharmacies and GP practices provide a range of other services. These are not considered ‘pharmaceutical services’ under the 2013 Pharmaceutical Regulations3 and may be either free of charge, privately funded or commissioned by NHS England, the local authority or the CCG. Examples of such services include delivery services, allergy testing, care homes services and sexual health services; this is not an exhaustive list. 4.1 Local Authority commissioned services provided by community pharmacies in Ealing

Ealing Council commission the following services from community pharmacies:  Sexual Health services:  Emergency hormonal contraception services  Support to stop smoking services: commissioned by the Stop Smoking Service (WLMHT)  Supervised administration of medicines commissioned by the Drug  Needle and syringe exchange service and Alcohol Service The first two services are also offered by other providers, for example GP practices. A full list of services and community pharmacy providers can be found in Appendix A. 4.2 Clinical Commissioning Group (CCG) commissioned services Ealing CCG currently commissions a minor ailments scheme from 59 community pharmacies in Ealing HWB area. A full list of community pharmacy providers is listed in Appendix A. Local Authority and CCG commissioners were asked for their views on which services they would consider commissioning from community pharmacy providers. Many services are already commissioned by the CCG or local authority from other providers. For the majority of services, the CCG or local authority would be willing to commission from community pharmacies. A copy of the survey can be found in Appendix E and the full results of the survey in Appendix K. 4.3 Other services provided from community pharmacies As part of the community pharmacy contractor survey, found in Appendix D, community pharmacies were asked to indicate against a range of other services which they currently provide, would be willing to provide or would not be willing to provide. A number of these services are privately provided and funded. Some are also commissioned by the local authority. 52 pharmacies (69%) completed the survey. A summary of the survey responses is detailed in Appendix J. 79

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4.4 Collection and delivery services From the Pharmacy Contractor Survey, 85% of pharmacies offer a free delivery service of dispensed medicines upon request; 8% offer a chargeable delivery service. Two out of three offer this service only to selected patient groups. Almost all pharmacies who responded offer a repeat prescription service to order repeat prescription on the patient’s behalf, collect the prescription from their surgery and dispense it ready for the patient to collect/be delivered. 4.5 Language services All pharmacies who responded to the community pharmacy contractor questionnaire reported that they offer at least one additional language to English. Most common spoken additional languages were: Gujarati (29% of respondents); Hindi (27%) of respondents; Punjabi (22% of respondents); Arabic (7%); and Polish (6%). 4.6 Services for less-abled people As a requirement of the Equalities Act 2012, community pharmacies are required to make ‘reasonable adjustments’ to their services to ensure they are accessible by all equalities groups, including less-abled persons. From the community pharmacy contractor survey, over 80% of respondents have disabled car parking facilities available close to the premises and almost 90% have a consultation room which is accessible to wheelchair users. Over 90% of respondents were satisfied that access to the pharmacy complies with the Equalities Act. Only 18% of pharmacies were unable to provide printed information in easy-read, and/or large print, and/or braille formats. 4.7 Electronic Prescription Service Many GP practices are now able to transmit prescriptions electronically to a pharmaceutical service provider (community pharmacy or dispensing appliance contractor). This system is known as EPS Release 2 and means that the patient no longer needs to obtain a paper prescription and present it to their pharmacy for dispensing. Electronic prescriptions are sent directly to the pharmacy nominated by the patient. GP practices which are enabled to provide this service are only able to transmit electronic prescriptions to a pharmacy who has a dispensing system enabled to receive electronic (‘Release 2’) prescriptions. 96% of respondents to the community pharmacy contractor questionnaire report that they have a system which is compliant to receive electronic prescriptions, with a further 2% intending to have such a system in the next 12 months. Data available on which pharmacies in England are enabled to offer the Electronic Prescription Service is available from NHS Choices21. Appendix A contains information (correct as 12/9/14) from the NHS choices website showing that 94% of pharmacies in Ealing HWB area are enabled to provide the Electronic Prescription Service.

21 NHS Choices website: http://www.nhs.uk/Service-Search/Pharmacy/LocationSearch/10 80

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Section 5: Findings from the public survey A public survey about pharmacy provision was developed (Appendix C) and compiled by Ealing PNA Steering Group. This was circulated by the Local Authority to a range of stakeholders:  All pharmacy contractors in Ealing to distribute to the public  All GP practices in Ealing to distribute to the public  GP Patient Participation Groups  Ealing Advice Service  Ealing Equality Council  Ealing Grand Union Village  Southall Community Alliance  Acton Community Forum  LBE OP Forum  Ealing Carers Centre  Northolt Confederation  Ealing Centre for Independent Living  Dementia Concern  Age UK  Milap Day Centre  Ealing HealthWatch  Ealing’s Online Residents Panel A total of 359 surveys were received. The full results can be found in Appendix I. Below is a summary of the results:  93% rated their overall satisfaction on the service received from their local pharmacy as ‘Excellent’ or ‘Good’  38% indicated that they used pharmacies up to every month for the purchase of over the counter medicines, with 87% having a regular or preferred pharmacy they use  89% rated these ease of obtaining medication as ‘Excellent’ or ‘Good’  53% rated as important that the pharmacy is close to their GP surgery; 81% that the pharmacy is close to their home; 12% that the pharmacy is close to where they work; and 53% that the pharmacy has friendly staff  64% walk to their community pharmacy; 24% use a car/taxi; and 8% use public transport

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 83% had no difficulties travelling to their pharmacy; 11% had parking difficulties; 3% had problems with the location of the pharmacy; and 2% had problems of public transport availability  The majority of respondents had no most convenient day (63%) or time (56%) to visit their pharmacy  70% of respondents report having a journey time of no more than 10 minutes  93% rated their confidence in the pharmacists knowledge and advice as ‘Excellent’ or ‘Good’ Table 31 provides the demographic analysis of respondents. No views were obtained from residents under 18 years of age or from the following ethnic origins: Bangladeshi, Chinese, other Black/African/Caribbean/Black British, Gypsy or Traveller of Irish Heritage or Other Ethnic groups. Table 31 - Demographic analysis of the community pharmacy user questionnaire respondents Sex (%) Male Female 55% 45% Age (%) U18 18-24 25-34 35-44 45-54 55-64 65-74 75+ 0 2.7% 8.4% 11.4% 18.6% 22.4% 27% 9.5% Illness or disability (%)? Yes No 15.6% 84.4% 2011 Ethnic origin (%) Survey census Arab 1.9% 2.9% Asian/Asian British- Bangladeshi 0 0.5% Asian/Asian British – Indian 17.6% 14.3% Asian/Asian British – Pakistani 0.8% 4.3% Asian/Asian British – Chinese 0 1.2% Asian/Asian British – Other (please state) 1.1% 9.3% Black/African/Caribbean/Black British – African 3.4% 5.1% Black/African/Caribbean/Black British – Caribbean 3% 3.9% Black/African/Caribbean/Black British – Other (please state) 0 1.9%

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2011 Ethnic origin (%) Survey census Gypsy or Traveller of Irish Heritage 0 0.1% Mixed/Multiple Ethnic Groups – White and Asian 1.1% 1.4% Mixed/Multiple Ethnic Groups – White and Black African 0.8% 0.6% Mixed/Multiple Ethnic Groups – White and Black Caribbean 0.4% 1.2% Mixed/Multiple Ethnic Groups – Other (please state) 0.4% 1.3% White – English/Welsh/Scottish/Northern Irish/British 57.3% 30.4% White – Irish 3.8% 3.1% White - Other 8.4% 15.4% Other ethnic group (please state) 0 3.1%

Ealing PNA Draft

Section 6: Analysis of health needs and pharmaceutical service provision As described within Section 1.5, the PNA Steering Group decided that the Ealing HWB PNA should be divided into 23 localities - Acton Central; Cleveland; Dormers Wells; Ealing Broadway; Ealing Common; East Acton; Elthorne; Greenford Broadway; Greenford Green; Hanger Hill; Hobbayne; Lady Margaret; North Greenford; Northfield; Northolt Mandeville; Northolt West End; Norwood Green; Perivale; South Acton; Southall Broadway; Southall Green; Southfield; and Walpole. Substantial health data are available at this level, and populations and their health needs vary widely between wards. Each locality has pockets of marked health inequalities. This chapter analyses the health needs of each of the localities of Ealing and considers the pharmaceutical service provision. Where referred to, necessary services are regarded as the essential and advanced services of the community pharmacy contract, listed in section 1.3.1. 6.1 Acton Central locality

The 2012 resident population10 of Acton Central locality was 15,690. The percentage of people in the age range 25-64 is slightly greater than seen nationally. Whilst male life expectancy is on-par with national average, female life expectancy is statistically significantly higher. The BME populations represents 40% of the population of the locality total. As is seen in Ealing as a whole, around 7% of the population cannot speak English well. Acton Central has pockets of marked deprivation, amongst the 20% most deprived population in England. The percentages of income deprived older people and pensioners living alone are significantly higher than seen in Ealing as a whole and nationally. Hospital admissions from CHD and COPD are statistically significantly higher than nationally, although respiratory disease account for less deaths compared to Ealing and England. Obesity rates in children are higher than national, but lower than national in adults. 6.1.1 Necessary services: current provision There are five community pharmacies in this locality, all of which are open on Saturdays. Four are open after 6pm weekdays, and two are open on Sunday. The majority of pharmacies provide the MUR and NMS advanced services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory. 6.1.2 Necessary services: gaps in provision A significant percentage of the population does not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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Ealing PNA Draft

No gaps have been identified in Acton Central locality for the provision of necessary services

6.1.3 Other relevant services: current provision The majority of community pharmacies in this locality are commissioned through the WLMHT to provide the Smoking Cessation service. There is one provider of the needle exchange service in this locality, two providers of the supervised consumption service, four providers of the smoking cessation service and four providers of the Minor Ailments Service. Although there are no providers of the EHC service, there is one community pharmacy provider in the neighbouring South Acton locality, which is reasonably accessible from Acton Central locality. Opportunities may exist to reduce the CHD hospitalisations rate through the improved screening of ‘at risk’ patients and better management of patients currently under treatment. 6.1.4 Improvements and better access: gaps in provision As already mentioned, there are pockets of high deprivation in the north and south of the locality. No pharmacies in this, or neighbouring localities, are commissioned to provide the Minor Ailments Scheme. 6.1.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Acton Central locality

6.2 Cleveland locality

This locality is sited centrally to the Ealing HWB area and has a resident population10 of 14,503. There are relatively higher rates of children and older persons living in the locality compared with Ealing and national rates. A small housing estate is planned for the next five years, but the new population will not significantly impact the provision of health services. Whilst male life expectancy is on-par with national average, female life expectancy is statistically significantly higher. The BME population represents just over one-third of the population of the locality total. Deprivation rates in this locality area varies compared with national, with some pockets of areas being more affluent than the England average and other pockets being amongst the most deprived 20% in England. The percentage of income deprived older people is less than seen on average in Ealing, though slightly higher than national.

Ealing PNA Draft

More pensioners live alone than in Ealing as a whole or nationally. Health outcome rates are not significantly different than seen nationally. As seen with Ealing as a whole, childhood obesity rates are slightly higher than seen nationally, whilst adult obesity rates are lower than national. 6.2.1 Necessary services: current provision There are two community pharmacies in this locality, both of which are open on Saturdays. One is open until 6.30pm on some weekdays. Neither are open on Sundays. Both pharmacies provide advanced services of MURs and NMS. The neighbouring locality of Ealing Broadway borders Cleveland and has numerous providers open after 6pm and on Sunday. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory. 6.2.2 Necessary services: gaps in provision A significant percentage of the population does not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No other gaps have been identified in Cleveland locality for the provision of necessary services

6.2.3 Other relevant services: current provision Both providers in this locality are commissioned to provide smoking cessation services and minor ailments services. There is one provider of the needle exchange service in the neighbouring locality of Perivale and three providers of supervised consumption in the neighbouring localities of Ealing Broadway, Perivale and Elthorne which are easily accessed from this locality. 6.2.4 Improvements and better access: gaps in provision As already mentioned there are providers of the needle exchange and supervised consumption services in neighbouring localities and access to these providers is reasonable. An opportunity exists to improve access to these services should commissioners deem the need in the Cleveland locality to be a priority and/or existing access be deemed not reasonable. 6.2.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

Ealing PNA Draft

No further gaps have been identified for Cleveland locality

6.3 Dormer Wells locality

The population10 of Dormers Wells is 13,912, with significantly greater percentages of people aged 0-16, 16-24, and over 65 than nationally. Female and male life expectancy is slightly below the national average. Fertility rates are slightly higher than Ealing and England averages. The majority of the population is made up of BME persons, accounting for 82% of the population, with over 11% of the community not speaking English well. Over 1 in 3 older persons are income deprived and whilst there are pockets of affluent areas, the majority of this locality is amongst the most deprived 20% in England. CHD related deaths are over twice the national rate and deaths in under 75s are significantly higher than nationally, in particular deaths due to circulatory diseases. Childhood obesity rates are significantly higher than nationally. 6.3.1 Necessary services: current provision The three community pharmacies in this locality are all open weekday evenings after 6pm, whilst two are open on Saturdays. Nearest Sunday provision is in neighbouring localities where there are a choice of six pharmacies open, all within accessible locations. All three community pharmacies in this locality provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory. 6.3.2 Necessary services: gaps in provision Over 11% of the population do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Dormers Wells locality for the provision of necessary services

6.3.3 Other relevant services: current provision Smoking cessation services are commissioned from two providers and supervised consumption and needle exchange from one provider in this locality. All three community pharmacies in this locality are commissioned by the Minor Ailments service. Although there are no providers of the EHC service in this locality, there are four community pharmacies in the neighbouring localities of Greenford Broadway and Lady Margaret, all within reasonable access.

Ealing PNA Draft

6.3.4 Improvements and better access: gaps in provision There are no providers of the local authority commissioned EHC service in this locality. Pockets of marked deprivation exist in the majority of this locality. As described above (Section 6.2.4), should commissioners deem it a priority, consideration could be given to commissioning the EHC service from providers within Dormers Wells to improve access to this service. 6.3.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Dormer Wells locality

6.4 Ealing Broadway locality

Ealing Broadway population10 is 14,106, and has higher percentages of people in the 25-64 age band. Male life expectancy for residents of this locality is slightly lower than national average and female life expectancy slightly higher. Fertility rates are significantly lower than Ealing and England average. BME populations account for 30% of the overall population. Fewer people (3.6%) than the average for Ealing can speak English well, though this is still higher than nationally. Deprivation is less marked in this locality, though some neighbourhoods have residents in the most deprived 20- 40% of the country. Hospital admission rates are generally lower than national and Ealing rates, and causes of death rates are generally lower than national. Obesity rates are lower than both national and Ealing rates. 6.4.1 Necessary services: current provision This locality has a significant shopping district. All five community pharmacies in this locality are open on Saturdays, two also on Sundays and two are open after 6pm on weekday evenings. All contractors provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory. 6.4.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher than national percentage population who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

Ealing PNA Draft

No gaps have been identified in Ealing Broadway locality for the provision of necessary services

6.4.3 Other relevant services: current provision Smoking cessation services are provided by all contractors in this locality; two are also commissioned to provide EHC services and one is commissioned to provide supervised consumption services. Three providers in the neighbouring Walpole locality provide needle exchange services and are satisfactorily accessible. There are three providers of the CCG commissioned Minor Ailments Scheme. The population of this locality is less markedly deprived than other localities in Ealing. 6.4.4 Improvements and better access: gaps in provision No identified improvements and better access comments have been identified. 6.4.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Ealing Broadway locality

6.5 Ealing Common locality Ealing Common’s population10 is 13,872 with almost two-thirds is made up by persons in the 25-64 year group, which is a much higher percentage than seen nationally. Life expectancy for males and females is not significantly different than the average for England. Fertility rate is much lower than the Ealing and England averages. The percentage of the population from BME communities is consistent with neighbouring Ealing Broadway and although less than the Ealing average is much higher than England. The same is true for the percentage of the population who cannot speak English well. Deprivation is amongst the middle 20% to the least deprived 20-40% in England. Hospital admission rates are not significantly different than those seen in England. Rates of death from respiratory diseases are significantly higher than seen in Ealing as a whole or England. Childhood obesity rates are comparable with the average for England and adult obesity rates are significantly lower than the average for England. 6.5.1 Necessary services: current provision There is one community pharmacy within the locality of Ealing Common. This pharmacy provides the MUR and NMS services and is open weekdays after 6pm and on Saturdays. There are ten community pharmacies on or near the borders of neighbouring localities, three which are open on Sundays.

Ealing PNA Draft

Maps E to G show the travel time to access the nearby provision. Average drive times do not exceed 15 minutes, average public transport times do not exceed 20 minutes and average walking times do not exceed 30 minutes. For the majority of the population, the average travel times are much less. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory. 6.5.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from neighbouring providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Ealing Common locality for the provision of necessary services

6.5.3 Other relevant services: current provision The one provider in this locality is commissioned to provide the smoking cessation and Minor Ailments Services. Provision of the EHC, supervised consumption and needle exchange commissioned services are available from one or more of the community pharmacies in neighbouring localities on or just over the border with Ealing Common locality. Opportunities may exist to reduce the respiratory disease death rate through the improved screening of ‘at risk’ patients and better management of patients currently under treatment. 6.5.4 Improvements and better access: gaps in provision No identified improvements and better access comments have been identified. 6.5.5 Other services A number of community pharmacies nearby provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Ealing Common locality

6.6 East Acton locality

The population10 of East Acton is 19,026, and has relatively more people in the 25-64 age category than the national average.

Ealing PNA Draft

A small, new housing development is planned for this locality in the next five years and current provision is anticipated to be adequate to meet its needs. Life expectancy for males and females is higher than national average. Over half of the population of East Acton is from BME ethnic communities. Around 6.5% do not speak English well. A significantly higher than average percentage of the older persons’ population is income deprived and/or lives alone. Almost the entire locality is amongst the most deprived 20% in England. Hospital admissions for CHD and COPD are significantly higher than the Ealing and England averages. 6.6.1 Necessary services: current provision There are two community pharmacy providers in East Acton locality. Both community pharmacies in this locality are open after 6pm weekdays and on a Saturday and one is open on Sunday. Both community pharmacies provides the MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory in the East Acton locality. 6.6.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in East Acton locality for the provision of necessary services

6.6.3 Other relevant services: current provision Minor ailments and smoking cessation services are provided by one community pharmacy contractor in this locality. A community pharmacy in the neighbouring Acton Central locality provides needle exchange and is satisfactorily accessible. 6.6.4 Improvements and better access: gaps in provision One community pharmacy provider in the neighbouring Hammersmith and Fulham HWB area is commissioned by Ealing Council to provide EHC. Fertility rates in the locality are similar to the national rate and slightly less than Ealing as a whole. Pockets of marked deprivation exist in the majority of this locality. As described above (Section 6.2.4), should commissioners deem it a priority, consideration could be given to commissioning this service from providers within East Acton to improve access to the service.

Ealing PNA Draft

6.6.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for East Acton locality

6.7 Elthorne locality

The locality of Elthorne has a population10 of 14,517. There are significantly higher than average populations of people in the 0-16 years old and 25-64 years age old groups. Housing developments comprising over 350 new homes are planned for the next five years. It is not anticipated that these will require any further pharmaceutical service provision beyond the providers already commissioned. Life expectancy for Elthorne residents is not significantly different than local and national expectations. One third of the resident population is from BME communities. 5% do not speak English well. Higher percentages of older people live alone and/or are deprived. Northern parts of Elthorne are amongst the most deprived 20% in England. Hospital admissions from CHD are 50% higher than nationally. 6.7.1 Necessary services: current provision There are four community pharmacies in Elthorne ward. Three are open weekdays after 6pm, three are open on Saturdays and one is open on Sundays. All provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in the Elthorne locality. 6.7.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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

6.7.3 Other relevant services: current provision Smoking cessation services are provided by all community pharmacies in the Elthorne locality. One pharmacy provides EHC services and one pharmacy provides supervised consumption services.

Ealing PNA Draft

Three pharmacies are commissioned to provide the Minor Ailments Service. Opportunities may exist to reduce the CHD hospitalisations rate through the improved screening of ‘at risk’ patients, and better management of patients currently under treatment. 6.7.4 Improvements and better access: gaps in provision There are four providers commissioned to provide needle exchange services in the neighbouring Walpole and Northfield localities. All are within reasonable access to Elthorne locality. Pockets of marked deprivation exist in the majority of this locality. As described above (Section 6.2.4), should commissioners deem it a priority, consideration could be given to commissioning this service from providers within the Elthorne locality to improve access. 6.7.5 Other services A number of community pharmacies provide free prescription delivery services, which it is anticipated many residents may rely upon.

No further gaps have been identified for Elthorne locality

6.8 Greenford Broadway locality

Greenford Broadway has a population10 of 17,680. It has a significantly higher percentage of 0-16 years old and 25-64 years old and 65+ years old populations compared with nationally. Life expectancy is similar to national expectations. Fertility rates are significantly higher than national average and Ealing as a whole. Over 57% of the population is from BME origin. Over 7% of the population do not speak English well. There is a higher than average population of income deprived older people, and the majority of people in the locality are amongst the 20% or 20-40% most deprived in England. Hospital admission rates are significantly higher than national average for CHD, Stroke and COPD. All-cause mortality, particularly from respiratory diseases, is significantly higher than England average. Childhood obesity rates are around 50% higher than national. 6.8.1 Necessary services: current provision Five community pharmacies provide services in the area. Two are open weekdays after 6pm, all are open on Saturdays and two are open on Sundays. One pharmacy is open non-stop from 8am Mondays to 8pm Wednesdays. All pharmacies provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality.

Ealing PNA Draft

6.8.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Greenford Broadway locality for the provision of necessary services

6.8.3 Other relevant services: current provision All community pharmacies in Greenford Broadway are commissioned to provide the Minor Ailments and smoking cessation services. Three provide EHC services and one provides supervised consumption services. Opportunities may exist to reduce the CHD, stroke and COPD hospitalisations through better management of patients currently under treatment. 6.8.4 Improvements and better access: gaps in provision There are no pharmacies commissioned to provide needle exchange services, although four providers are commissioned to provide this service in the Northolt West End, Greenford Green, and Perivale localities. All are accessible from this locality. As described above (Section 6.2.4), should commissioners deem it a priority, consideration could be given to commissioning this service from providers within Greenford Broadway locality to improve access. 6.8.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified in Greenford Broadway locality

6.9 Greenford Green locality

The population10 for Greenford Green is 14,591. Life expectancy is slightly above national average for males and females. 49% of the population is from BME origins and over 8% do not speak English well. A number of areas in Greenford Green are amongst the 20-40% most deprived in England. CHD admission rates are higher than English average for this locality.

Ealing PNA Draft

6.9.1 Necessary services: current provision There are three community pharmacy providers in Greenford Green locality, all of which are open weekday evenings after 6pm and Saturdays; one is open on Sundays. All provide the MUR and NMS advanced services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.9.2 Necessary services: gaps in provision This locality has a higher percentage population than both Ealing and nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No further gaps have been identified in Greenford Green locality for the provision of necessary services

6.9.3 Other relevant services: current provision All community pharmacies in Greenford Green are commissioned to provide smoking cessation service. One provider is commissioned to provide supervised consumption services, two are commissioned to provide the needle exchange service and two are commissioned to provide the Minor Ailments Service. Opportunities may exist to reduce the CHD hospitalisations rate through the better management of patients currently under treatment. 6.9.4 Improvements and better access: gaps in provision There are no providers of the locally-commissioned EHC service. Nearest providers are in the neighbouring localities of Northolt Mandeville and Greenford Broadway and for some residents will be a significant distance to travel. Pockets of marked deprivation exist in this locality. As described above (Section 6.2.4), should commissioners deem it a priority, consideration could be given to commissioning the EHC service from providers in Greenford Green locality to improve access to this service. 6.9.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Greenford Green locality

Ealing PNA Draft

6.10 Hangar Hill locality

The population10 of Hanger Hill locality is 15,664. The percentage of populations from the 25-64 year old and 65+ year old age groups is significantly higher than national average. Life expectancy for both males and females in this locality is significantly higher than would be expected. The fertility rate is lower than national average. 43% of the population is from BME origins and over 7% do not speak English well. Apart from a pocket in the southern part of the locality, the population is relatively affluent. Overall hospital admission rates are below the national average, as are adult and childhood obesity rates. 6.10.1 Necessary services: current provision There are two community pharmacy providers in Hanger Hill locality. Both are open weekday evenings after 6pm and on Saturdays. Neither are open on Sunday, although nearby provision on a Sunday is available in the neighbouring localities. Both pharmacies provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.10.2 Necessary services: gaps in provision Although similar to the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Hanger Hill locality for the provision of necessary services

6.10.3 Other relevant services: current provision All community pharmacies in Hanger Hill are commissioned to provide a smoking cessation service and two are commissioned to provide the Minor Ailments Service. 6.10.4 Improvements and better access: gaps in provision There are no providers of the locally-commissioned EHC service. Nearest providers are in the neighbouring localities of Ealing Broadway, South Acton and Cleveland; for some residents (particularly those in the north of the locality) these will be a significant distance to travel. There are no providers of the locally-commissioned needle exchange services in this locality. Of the neighbouring localities only Acton Central and South Acton each have a pharmacy commissioned to provide these services. There are no providers of the supervised consumption services, although providers exist in each of the Acton central, Ealing Broadway and South Acton localities.

Ealing PNA Draft

As described above (Section 6.2.4), should commissioners deem it a priority, consideration could be given to commissioning these service for the populations of Hanger Hill from providers within the locality. 6.10.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Hanger Hill locality

6.11 Hobbayne locality

Hobbayne locality has a population10 of 14,368. There is a significantly higher percentage of the population in the 0-16 year old and 65+ year old bands compared with nationally. Future housing programmes are planned for this locality in the next five years, but unlikely to require any additional provision. Over a third of the population is from BME origin. Over 5% of the population do not speak English well. Significantly higher populations of income deprived older people and pensioners living alone reside in Hobbayne compared to nationally and Ealing. There are pockets of deprivation in Hobbayne amongst the most deprived wards in England. Hospital admission rates for stroke and COPD are significantly higher than the England average. 6.11.1 Necessary services: current provision There are three community pharmacy providers in Hobbayne. One is open most weekday evenings after 6pm and all three are open on Saturdays. None are open on Sundays, but there are four community pharmacies open in the neighbouring localities of Elthorne, Greenford Broadway and Perivale. All three of the community pharmacies in Hobbayne provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.11.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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

Ealing PNA Draft

6.11.3 Other relevant services: current provision Minor ailments is provided by one operator and smoking cessation services are provided by all community pharmacies in Hobbayne locality. Opportunities may exist to reduce the stroke and COPD hospitalisations rate through the better management of patients currently under treatment. 6.11.4 Improvements and better access: gaps in provision No pharmacy is commissioned to provide EHC services although there are five providers in the bordering localities of Greenford Broadway, Elthorne and Cleveland, two of which are within reasonable access from Hobbayne. There are five reasonably accessible providers of supervised consumption services in the neighbouring localities of Greenford Broadway, Dormers Wells, Elthorne and Perivale. There are two reasonably accessible providers of needle exchange services in the neighbouring localities of Dormers Wells and Perivale. As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning these services for the population of Hobbayne to improve access. 6.11.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Hobbayne locality

6.12 Lady Margaret locality

This locality has a population10 of 13,854. There is a significantly higher percentage of the population in the 0-16 year old and 65+ year old bands compared with nationally. Over 83% of the population is from BME origin. Almost 1 in 10 of the population do not speak English well. Significantly higher populations of income deprived older people reside in Lady Margaret compared with nationally and Ealing. Almost all areas of Lady Margaret are amongst the 20-40% most deprived in England. CHD hospital admissions are twice the national average and stroke admissions 40% higher. Childhood obesity rates are higher than nationally. 6.12.1 Necessary services: current provision There are four community pharmacy providers in Lady Margaret locality. All are open weekday evenings, three are open on Saturdays and three are open on Sundays. Three out of four of the community pharmacies in Lady Margaret provide NMS services, whilst they all provide MUR services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 98

Ealing PNA Draft

6.12.2 Necessary services: gaps in provision The Lady Margaret locality has a significantly higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Lady Margaret locality for the provision of necessary services

6.12.3 Other relevant services: current provision All community pharmacies are commissioned to provide the Minor Ailments Service. Smoking cessation services are provided by two out of four of the community pharmacies in Lady Margaret locality. One pharmacy is commissioned to provide EHC services and one provider is commissioned to provide supervised consumption services. Opportunities may exist to reduce the CHD and stroke hospitalisations rate through better management of patients currently under treatment. 6.12.4 Improvements and better access: gaps in provision There are two reasonably accessible providers of needle exchange services in the neighbouring localities of Dormers Wells and Southall Broadway. As described above (Section 6.2.4), should commissioners deem it a priority, consideration could be given to commissioning this service for the population of Lady Margaret locality to improve access. 6.12.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Lady Margaret locality

6.13 North Greenford locality

The population of this locality10 is 14,917. The percentage of persons aged 25-64 years old and 65+ years old is significantly higher than nationally. A housing estate is planned, but is unlikely to require additional pharmaceutical services commissioned for the new population. Male and female life expectancy is higher in North Greenford than nationally. Over half of the population is from BME origins and over 8% do not speak English well. The population is comparably affluent, with lower deprivation rates than nationally. CHD hospital admission rates are significantly higher than the England average.

Ealing PNA Draft

6.13.1 Necessary services: current provision There is one community pharmacy provider in North Greenford which is open weekday evenings after 6pm and Saturdays. It is not open Sundays, although one pharmacy is open in each of the neighbouring localities of Perivale and Greenford Green. The community pharmacy in North Greenford provides both MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.13.2 Necessary services: gaps in provision The North Greenford locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in North Greenford locality for the provision of necessary services

6.13.3 Other relevant services: current provision The community pharmacy in North Greenford is commissioned to provide the Minor Ailments and smoking cessation services. Opportunities may exist to reduce the CHD hospitalisations rate through the improved screening of ‘at risk’ patients and better management of patients currently under treatment. 6.13.4 Improvements and better access: gaps in provision There is no community pharmacy provider of needle exchange or supervised consumption services in North Greenford locality. One pharmacy is commissioned in each of the neighbouring localities of Greenford Green and Perivale to provide these services, although from some parts of North Greenford these are a significant distance. There is no provider of the EHC service in North Greenford or in the neighbouring localities. Nearest providers may be a significant distance to travel to. As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning these services for the population of North Greenford locality to improve access. 6.13.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

100

Ealing PNA Draft

No further gaps have been identified for North Greenford locality

6.14 Northfield locality

The Northfield locality has a population10 of 13,455. The percentage of persons aged 25-64 years old and 65+ years old is significantly higher than nationally. Male and female life expectancies are higher than national. Almost one quarter of the population is from BME origin and 2.7% do not speak English well. There is a higher percentage of pensioners living alone compared with nationally. The population in this locality is predominantly amongst the least deprived in England, although a pocket of deprived residents reside in the east of the locality. Hospital admission rates and obesity rates are significantly less than national. 6.14.1 Necessary services: current provision There are five community pharmacy providers in the Northfield locality. Three are open after 6pm weekdays, four are open on Saturdays and one is open on Sundays. All provide MUR services and four provide the NMS service. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.14.2 Necessary services: gaps in provision Although lower than the Ealing average and only just higher than the England average, there is a small population in this locality who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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

6.14.3 Other relevant services: current provision There are three community pharmacies commissioned to provide the Minor Ailments Service. Smoking cessation services are provided by four out of five of the community pharmacies in this locality. There is one provider in this locality commissioned to provide the needle exchange and supervised consumption services. 6.14.4 Improvements and better access: gaps in provision Four pharmacies are commissioned to provide EHC services in the neighbouring localities of Walpole and Elthorne, at least one provider of which is within reasonable access from the Northfield locality. 101

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Nearest providers may be a significant distance to travel to. As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning these services for the population of Northfield locality to improve access. 6.14.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Northfield locality

6.15 Northolt Mandeville locality

The population10 of North Mandeville locality is 15,454. There is a significantly higher population of people aged 0-16 years old compared with England. Housing developments are planned to provide in excess of 500 new homes over the next five years. The new populations will have a significant impact on the current healthcare provision but are not anticipated to require the commissioning of any further pharmaceutical service providers beyond those currently commissioned. Fertility rates in this locality are higher than seen in Ealing and England. Over half of the Northolt Mandeville population is from BME origin. Over 6% of the population do not speak English well. Many parts of Northolt Mandeville have deprivation rates amongst the most deprived 20% in England. Rates of hospital admissions from CHD are about 25% higher than national. Childhood obesity rates are higher than nationally. 6.15.1 Necessary services: current provision There are two community pharmacy providers in the Northolt Mandeville locality. Both are open most weekday evenings after 6pm and one is open on Saturdays. Whilst neither are open on Sundays, there are three open in the neighbouring localities of Greenford Green and Greenford Broadway and one in the neighbouring Harrow HWB area. All community pharmacy providers in Northolt Mandeville provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.15.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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No gaps have been identified in Northolt Mandeville locality for the provision of necessary services

6.15.3 Other relevant services: current provision Both pharmacies in Northolt Mandeville are commissioned to provide the Minor Ailments and smoking cessation services and one is commissioned to provide EHC services and supervised consumption services. Opportunities may exist to reduce the CHD hospitalisations rate through better management of patients currently under treatment. 6.15.4 Improvements and better access: gaps in provision Three community pharmacies in Northolt West End and Greenford Green have been commissioned to provide needle exchange services and are reasonably accessible from Northolt Mandeville locality. As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning this service for the populations of Northolt Mandeville to improve access. 6.15.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Northolt Mandeville locality

6.16 Northolt West End locality

This locality has a population10 of 13,351. Male life expectancy is slightly less than England average and female life expectancy is average. Fertility rate is higher than Ealing and national average. Over 55% of the population is from BME origin. 6% do not speak English well. There is a significantly higher percentage of income deprived older people and pensioners living alone than the Ealing and national average. The population in this locality is amongst the most deprived in England. CHD and COPD hospital admission rates are significantly higher than the national average, as are premature mortality rates in under 75s particularly due to respiratory disease. Obesity rates are significantly higher than Ealing and England averages. 6.16.1 Necessary services: current provision There are two community pharmacy providers in the Northolt West End locality. One is open weekdays after 6pm and both are open on Saturdays.

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Although neither are open on Sundays, provision is available from three pharmacies in the neighbouring localities of Greenford Broadway and Lady Margaret. There are also a number of pharmacies open on Sundays in the neighbouring Hillingdon HWB area to the west of the locality. Both pharmacies in the Northolt West End locality provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.16.2 Necessary services: gaps in provision Although lower than the Ealing average, this locality has a higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Northolt West End locality for the provision of necessary services

6.16.3 Other relevant services: current provision Both community pharmacies in the Northolt West End locality are commissioned to provide the Minor Ailments, smoking cessation, EHC, needle exchange and supervised consumption services. Opportunities may exist to reduce the CHD and COPD hospitalisation rates through the better management of patients currently under treatment. 6.16.4 Improvements and better access: gaps in provision No identified improvements and better access comments have been identified. 6.16.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Northolt West End locality

6.17 Norwood Green locality

This locality’s population10 is 14,155. Populations in the 0-16 years old, 16-24 years old and 25-64 years old bands are significantly higher than national average. Housing developments of over 500 houses are planned to be built in the next five years, although it is anticipated that pharmaceutical provision will be provided from existing providers. Life expectancy in this locality is slightly below the national average. 78% 104

Ealing PNA Draft of the population is from BME origin. Almost 10% of the Norwood Green population do not speak English well. Norwood Green is a very deprived area, with much of the population amongst the most deprived 20% in England and over twice the national rate of income deprived older people living there. Hospital admissions are 50% higher than the national average, with CHD admissions almost two and a half times the national average. All-cause mortality rates in under 75s, in particular due to circulatory disease, are significantly higher than the national average. 6.17.1 Necessary services: current provision There are three community pharmacy providers in the Norwood Green locality. Two are open most weekdays after 6pm and all are open on Saturdays. One is open on Sunday. All pharmacies in the Norwood Green locality provide MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.17.2 Necessary services: gaps in provision The Norwood Green locality has a significantly higher percentage population than nationally who do not speak English well. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Norwood Green locality for the provision of necessary services

6.17.3 Other relevant services: current provision All community pharmacies in the Norwood Green locality are commissioned to provide the smoking cessation service. One pharmacy is commissioned to provide the Minor Ailments, needle exchange, supervised consumption and EHC services. Opportunities may exist to reduce the CHD and COPD hospitalisations rate through the better management of patients currently under treatment. 6.17.4 Improvements and better access: gaps in provision No identified improvements and better access comments have been identified. 6.17.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

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No further gaps have been identified for Norwood Green locality

6.18 Perivale locality

Perivale’s population10 is 15,685. There are significantly greater percentages of 0-16 year old and 35-64 year old people than England average living in Perivale. Average life expectancy for both males and females in Perivale locality is greater than England average. Over 50% of the population is from BME origins and over 9% do not speak English well. The population is amongst the middle 20% affluent in England, although there is a significantly higher rate of income deprived older people. Hospital admissions for CHD and stroke are significantly higher than England average. 6.18.1 Necessary services: current provision There are three community pharmacy providers in Perivale locality. Two are open weekday evenings after 6pm, all are open on Saturdays and one is open on Sundays. All three provide both the MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.18.2 Necessary services: gaps in provision There is a significantly higher percentage population than nationally who do not speak English well in the Perivale locality. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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

6.18.3 Other relevant services: current provision All community pharmacies in Perivale are commissioned to provide the Minor Ailments Service. Two community pharmacies are commissioned to provide the smoking cessation service and one is commissioned to provide the supervised consumption and needle exchange services. There are no providers of the CCG commissioned Minor Ailments Scheme. Opportunities may exist to reduce the CHD and stroke hospitalisations rate through the improved screening of ‘at risk’ patients and better management of patients currently under treatment.

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6.18.4 Improvements and better access: gaps in provision There are three providers of the EHC service in the neighbouring locality of Greenford Broadway and one in Cleveland locality, all within reasonably accessible from the Perivale locality. There is also a number of providers in the neighbouring Brent HWB area, easily accessible from eastern parts of the locality. As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning this service for the populations of Perivale to improve access. 6.18.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

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

6.19 South Acton locality

The population of South Acton10 is 14,834. There are a number of housing developments planned over the next five years, providing almost 900 new homes. Consideration will need to be given to the exact location and phasing of these new developments and current pharmaceutical service provision. It is not currently anticipated that there will be any need for additional pharmaceutical service providers above those currently commissioned. Life expectancy for females is significantly less than national and for males it is slightly less. Over 43% of the population of South Acton is from BME origin. 7% do not speak English well. Deprivation rates are within the most deprived bands for many parts of South Acton and there are significantly higher rates of income deprived older people and pensioners living alone compared with nationally. Hospital admission rates are significantly higher than national average. Mortality rates, in particular in the under 75 year old age group, are significantly greater than national average. Childhood obesity in Perivale is significantly greater than nationally. 6.19.1 Necessary services: current provision There are four community pharmacy providers in the South Acton locality. Three are open most weekday evenings after 6pm, all are open on Saturdays and one is open on Sundays. Three provide the MUR and NMS advanced services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.19.2 Necessary services: gaps in provision There is a significantly higher percentage population than nationally who do not speak English well in the South Acton locality. 107

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Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in South Acton locality for the provision of necessary services

6.19.3 Other relevant services: current provision Three community pharmacies in South Acton are commissioned to provide the Minor Ailments Service, two are commissioned to provide the smoking cessation service and one is commissioned to provide the EHC, needle exchange and supervised consumption services. Opportunities may exist to reduce the higher than average hospitalisation rate through the improved screening of ‘at risk’ patients and better management of patients currently under treatment. 6.19.4 Improvements and better access: gaps in provision No identified improvements and better access comments have been identified. 6.19.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for South Acton locality

6.20 Southall Broadway locality

This locality has a population10 of 36,687. There are significantly greater percentages of populations in the 0-16 years old, 16- 24 years old and 25-64 years old age groups. Life expectancy is not statistically significantly different than national. The rate of fertility is significantly greater than the Ealing and national rates. Over 93% of the population is from BME origin and over 15% do not speak English well. The population of Southall Broadway is among the most deprived 20% in England and there is a significantly greater proportion of income deprived older people compared with national rates. Hospital admission rates are significantly higher than national, in particular from CHD and stroke. Under 75 mortality rates, particularly from circulatory diseases, are significantly greater than national. Childhood obesity rates are significantly greater than national.

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6.20.1 Necessary services: current provision There are three community pharmacy providers in Southall Broadway. All are open weekday evenings after 6pm, two are open on Saturdays and one is open on Sundays. All three provide MURs and two provide NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.20.2 Necessary services: gaps in provision There is a significantly higher percentage population than nationally who do not speak English well in the Southall Broadway locality. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Southall Broadway locality for the provision of necessary services

6.20.3 Other relevant services: current provision Three community pharmacies in Southall Broadway are commissioned to provide the Minor Ailments and smoking cessation services. One is commissioned to provide the supervised consumption and needle exchange. Opportunities may exist to reduce the CHD and stroke hospitalisation rates through the improved screening of ‘at risk’ patients and better management of patients currently under treatment. 6.20.4 Improvements and better access: gaps in provision There is one pharmacy commissioned to provide EHC services in each of the neighbouring Lady Margaret and Norwood Green localities, both of which are within reasonable access from residential parts of Southall Broadway. As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning these services for the population of Southall Broadway locality to improve access. 6.20.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Southall Broadway locality

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6.21 Southall Green locality

The population of Southall Green10 is 14,883 and has higher than England average percentages of people aged 25-64 years old and over 65 years old. Life expectancy for males is below the national average and female life expectancy is comparable with national average. Southall Green has the highest fertility rate in all of Ealing and is significantly higher than national average. Over 91% of the population is from BME origin and over 15% do not speak English well. The population is within the 20-40% most deprived within England and the rate of income deprived older people is over twice that seen nationally. Hospital admissions are significantly higher than national, in particular from CHD and stroke. Under 75 mortality rates, particularly from circulatory diseases, are significantly greater than national. Childhood obesity rates are significantly greater than national. 6.21.1 Necessary services: current provision There are five community pharmacy providers in the Southall Green locality, all of which are open on weekday evenings after 6pm, with four open on Saturdays. Two providers are open on Sundays. All provide the MUR and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.21.2 Necessary services: gaps in provision There is a significantly higher percentage population than nationally who do not speak English well in the Southall Green locality. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

No gaps have been identified in Southall Green locality for the provision of necessary services

6.21.3 Other relevant services: current provision Four of the community pharmacies in Southall Green are commissioned to provide the Minor Ailments and the smoking cessation services; one is commissioned to provide the supervised consumption and needle exchange services. Opportunities may exist to reduce the CHD and stroke hospitalisation rates through the improved screening of ‘at risk’ patients and better management of patients currently under treatment. 6.21.4 Improvements and better access: gaps in provision There is one provider commissioned to provide EHC services just over the border in the neighbouring locality of Norwood Green which is within reasonable accessibility of Southall Green.

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As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning this service for the population of Southall Green to improve access. 6.21.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Southall Green locality

6.22 Southfield locality

Southfield’s population10 is 13,262. The population has greater percentages of people in the 25-64 years old and 65+ year old bands compared with national. Life expectancy for males is slightly higher than national average and for females is significantly higher than national average. Over 20% of the population are from BME origin and just over 2% do not speak English well. A significantly higher percentage of pensioners live alone compared with nationally. Northern parts of the locality are generally more deprived than nationally, whereas the remainder of the locality has deprivation rates lower than or amongst the average for England. Hospital admission rates for residents from this locality are lower than the English average. 6.22.1 Necessary services: current provision One community pharmacy provides services from the Southfield locality. They are both open weekdays after 6pm and on Saturdays. Although there is no provider in this locality open on Sundays, there are reasonably accessible providers in the neighbouring Kensington and Fulham HWB areas, two each within Chiswick and Shepherds Bush. The community pharmacy in Southfield provides MUR services and NMS services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality. 6.22.2 Necessary services: gaps in provision The percentage of the population of Southfield locality who do not speak English well is lower than that for Ealing and only slightly higher than the average for England. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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

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6.22.3 Other relevant services: current provision The community pharmacy in Southfield is commissioned to provide the Minor Ailments Service and the smoking cessation service. Opportunities may exist to reduce the CHD and stroke hospitalisation rates through the better management of patients currently under treatment. 6.22.4 Improvements and better access: gaps in provision The neighbouring locality of South Acton has one pharmacy commissioned to provide EHC, supervised consumption and needle exchange services and is within reasonable access to Southfield locality. There are also a number of providers commissioned to provide similar services just over the locality border in the neighbouring HWB area of Hammersmith and Fulham. As described above (Section 6.2.4), should commissioners deem it a priority, consideration should be given to commissioning this service for the population of Southfield to help improve access. 6.22.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Southfield locality.

6.23 Walpole locality

The population10 of Walpole is 13,205. The 25-64 year old and 65+ year old populations are significantly higher than the average for England. New houses are due to be built in Walpole in the next five years, although the additional population will not require further pharmaceutical service providers in addition to those currently commissioned. Life expectancy in Walpole is not significantly different to the average for England. The population is 27% BME origin and 3.5% do not speak English well. There are populations within the ward among the most deprived in England with a higher percentage of older people who are income deprived and live alone. Hospital admission rates, mortality and childhood obesity are not statistically significantly different to the average for England. Adult obesity rates are significantly lower than the England average. 6.23.1 Necessary services: current provision There are four community pharmacy providers in the Walpole locality. Three are open weekdays after 6pm and all are open on Saturdays. One is open on a Sunday. All provide both the MUR and NMS advanced services. Although specific data are not available, it is anticipated that some residents may rely upon the delivery services provided by distance-selling pharmacies and DACs. Access to necessary services is satisfactory to residents in this locality.

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6.23.2 Necessary services: gaps in provision The percentage of the population of Walpole locality who do not speak English well is lower than that for Ealing but double the average for England. Assurance should be sought from current providers that the provision of translation services for these populations is available to ensure equity of access to pharmaceutical service provision.

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

6.23.3 Other relevant services: current provision All community pharmacies in the Walpole locality are commissioned to provide the smoking cessation service. Three pharmacies are commissioned to provide the Minor Ailments, supervised consumption, needle exchange and EHC services. 6.23.4 Improvements and better access: gaps in provision No identified improvements and better access comments have been identified. 6.23.5 Other services A number of community pharmacies provide free prescription delivery services which many residents may rely upon.

No further gaps have been identified for Walpole locality.

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Section 7: Conclusions 7.1 Population and demography

The London Borough of Ealing has a current population of 342,500. This is expected to grow significantly faster than the England average over the next 10-20 years. The rate of community pharmacies per population in Ealing is slightly below the average for England, although providers in Ealing currently dispense fewer prescriptions compared with the average community pharmacy in England. Three out of four community pharmacies in Ealing are open after 6pm on weekdays. Almost 90% are open on Saturdays and one in four are also open on Sundays. One pharmacy is open throughout the night on Mondays and Tuesdays. Overall, the total number and availability of community pharmacies in Ealing is satisfactory for the current population. The non-white ethnic population of Ealing is 51% compared with 40% in London and 15% in England. In the Southall Broadway and Southall Green localities over 90% of the population is made up from BME groups. These localities also have the highest percentage of the population who cannot speak English well, at over 15%. The figure for Ealing overall is significantly higher than the England average (7.2% versus 1.7%). Commissioners should seek assurance from providers that they are able to ensure their services are accessible to non-English speaking populations. If deemed necessary and a priority, NHS England may commission an enhanced Language Access Service from community pharmacies. Ealing has a number of communities amongst the most deprived in England. Continued provision of the Minor Ailments Service will permit access to medicines for self-care at NHS expense without the need for a GP appointment. Access to this service is satisfactory for all populations within the Ealing HWB area. 7.2 Services for older people

Many localities have higher percentages of deprived older people and pensioners living alone compared with the England average. The current Ealing Health and Wellbeing Board Strategy (HWBS) (2012-2016)8 has identified a number of priority areas for the local population to reduce health inequalities. ‘Out of hospital services’ and ‘older people and healthy ageing’ are two of these priorities. Provision of delivery services and compliance aids from community pharmacies help support patient compliance. Commissioners may wish to consider how community pharmacies may otherwise contribute to keeping older people well and out of hospital. The ‘flu vaccination uptake rate in Ealing is significantly lower than the London and national rates. An opportunity exists to secure improvements to increase uptake rates and provide better access for the ‘flu vaccination service. Consideration could be given as to how to incentivise current providers and ‘at risk’ patients, along with a review of current provision. From the community pharmacy survey, there is a mix of pharmacies providing either or both NHS and private ‘flu vaccination services and a number would be willing to provide the service if it was locally-commissioned.

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A significantly higher percentage of the population of Ealing die in hospital compared to the England average. An opportunity exists to review palliative care services available in the community to give more choice to patients about where they wish to die, enabling them to choose between their home, in a care home or a hospice. Community pharmacies holds stocks of medicines for a range of conditions including palliative care, hence the on- demand availability of specialist drugs is a service which may be commissioned through community pharmacies by NHS England. This should be considered as an improvement and better access: gap in provision. Injuries due to falls in people aged 65 years and over are significantly higher in the Ealing population than the London and England average. 7.3 Services for younger people

The rate of conception in the under 18s in Ealing is lower than the London and national averages. The percentage of young people aged 16-25 years is comparable with Ealing and England rates. There are a number of localities where there are no providers of the locally commissioned EHC service. Although this is not a pharmaceutical service and therefore its commissioning is outside the scope of the PNA, improvements and better access to EHC services could be secured through commissioning the service via community pharmacy providers in the deprived parts of the HWB area. Those providers open late in the evenings and at weekends may be considered a priority if commissioners wish to extend the commissioning of this service. There are a number of community pharmacy providers in these localities and therefore the potential gap in provision is not deemed to influence the commissioning of additional pharmaceutical services providers. The rate of acute sexually transmitted infections is significantly higher in the population of Ealing compared with the England average. Chlamydia diagnosis rates in 15-24 year olds in Ealing as a whole is significantly lower than London and national rates. This population is expected to fall in the next 10 years and then rise again. An opportunity exists to increase diagnosis rates of Chlamydia and improve access to such services through the review of current service provision. National dental health measures in children and young people (the percentage of missing, decayed or filled teeth in children under 5 years old and the percentage of 0- 19 year olds admitted to hospital for tooth extraction) are significantly lower than the London and Ealing averages. The promotion of healthy dental hygiene and signposting to dental services are opportunities for community pharmacies to improve these measures for Ealing populations through their health promotion work. Ealing has higher obesity prevalence rates than the England average amongst children in reception and Year 6. The Essential Services of the Community Pharmacy Contract requires all pharmacies to participate in up to six directed health promotion campaigns per year.

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An opportunity exists for Ealing Council Public Health teams to work with NHS England London Area Team to develop health promotion campaigns aimed at promoting healthy eating and exercise the children. 7.4 Long-term conditions

Overall, Ealing has significantly more admissions then expected for all causes, but in particular as a result of coronary heart disease and stroke. Some localities have rates one and a half times the national average. If considered a priority, services may be commissioned by NHS England to decrease avoidable hospital admissions from CHD and stroke. More deaths than expected occur in Ealing particularly due to circulatory and respiratory deaths. Additionally, Ealing has significantly more than expected premature deaths due to circulatory disease. Community pharmacists can support patients in their medications compliance and adherence through the MUR and NMS services. Uptake and delivery of these services from community pharmacies in Ealing exceeds the national average. Commissioners may wish to consider other services provided through community pharmacies to help reduce circulatory and respiratory deaths, such as management and monitoring services. 7.5 Harm prevention

Overall, Ealing has higher rates of drug misuse than the England average. Needle exchange and supervised consumption services are provided in areas of need. Commissioners may wish to review current needs and provision and identify if it is a priority to commission further provision from existing providers. As this service is not currently commissioned by NHS England, it is not considered as a pharmaceutical service here and therefore outside the scope of the PNA. However, it is a service which NHS England could commission and therefore the potential gap could be considered as an improvements and better access: gap in provision. As there are community pharmacies in the localities where there is no current provision, any potential gap in provision is not deemed to require the commissioning of additional pharmaceutical services. Injuries due to falls in people aged 65 years old and over are significantly higher in Ealing compared to the London and England averages. It has already been mentioned that a greater percentage of pensioners in Ealing live alone compared with the national average. If this is deemed a priority for commissioners, a falls prevention service through community pharmacies could support a reduction in avoidable fall injuries in the elderly. No further gaps in the provision of pharmaceutical services have been identified.

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

NHS England CCG Advanced commissi services- oned previously service provided providers Local Authority before in commissioned 31/3/14 2014/15 service providers in Opening hours (Y/N) (Y/N) 2014/15 (Y/N)

Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

Map name of company Mon-Fri opening opening MURs

Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Michael A. A. Michael 75 New Broadway, Mon - Fri Sat: 09:30- 1 Closed Pharmacy Pharma Ltd. Ealing, W5 5AL Walpole Ward 09:00-18:00 14:30 Y Y Y N Y Y N Y Horn Lane Aash Pharm 148 Horn Lane, Acton, Acton Central Mon - Fri: Sat: 10:00- 2 Closed Pharmacy Ltd. London, W3 6PG Ward 09:00-18:30 14:00 Y N Y Y Y Y N Y 123 The Broadway, Southall 3 Alchem Akhtar Ali Southall, Middlesex, Broadway Mon - Fri Sat: 10:00- Closed Pharmacy UB1 1LW Ward 09:15-19:30 18:00 Y N Y Y N N N N 251 Allenby Road, 4 Chana Allenby Southall, Middlesex, Lady Margaret Mon - Fri: Sat: 09:00- Closed Chemist Chemist Ltd. UB1 2HB Ward 09:00-19:00 18:00 Y N Y Y N Y N N 49-51 King Street, 5 Cheema Almeric Southall, Middlesex, Southall Green Mon- Fri: Sat: 09:00- Closed Pharmacy Pharmacy Ltd UB2 4DQ Ward 09:00-20:00 19:00 Y Y Y Y Y Y N Y

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Mon-Fri: 480 Church Road Alpha Alpha Chemist Northolt West 09:00-18:00 Sat: 09:00- 6 Northolt Middlesex UB5 Closed Y Y Y Y Y Y Y Y Chemist Ltd End Ward Wed: 09:00- 17:30 5AU 17:30 Mon - Thu: Anmol Anmol 97 North Road UB1 Dormers Wells 07:00-23:30 Sat: 06:00- 7 Closed Y Y Y Y N N N N Pharmacy Harsukh Ltd 2JW Ward Fri: 06:00- 23:30 23:30 Grand Union Health Greenford Northolt Centre Taywood Road Mon - Fri: 8 Ashlex Ltd Broadway Closed Closed Y Y Y Y N N Y Y Pharmacy Northolt Middlesex UB5 09:00-18:30 Ward 6WL 185 Lady Margaret Rd H.J. Dixon Lady Margaret Mon - Fri: Sat: 09:00- 9 Ashlex Ltd. Southall Middlesex UB1 Closed Y Y Y Y N N N Y Chemist Ward 09:00-18:30 17:00 2PT

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Marcus 96 Old Oak Common East Acton Mon - Fri: Sat: 09:00- 10 Jones Avni Ltd Closed Y Y Y Y N N Y Y East Acton W3 7DA Ward 09:00-18:00 13:00 Pharmacy Sun: Zahra B & R Vision 72 High Street Acton Acton Central Mon - Fri: Sat: 08:00- 11 09:00- Pharmacy Ltd. London W3 6RE Ward 06:30-22:30 20:00 18:00 Y Y Y Y N N N Y Mon - Wed, K.L 1 Tyler Road Southall Norwood Fri: 09:00- Sat: 09:00- 12 B.K.R. Ltd. Closed Pharmacy Middlesex UB2 4XQ Green Ward 18:30 Thu: 13:00 09:00-13:00 N Y Y N N N N Y 47A-47B Oldfields Greenford Mon - Fri: Sat: 08:30- 13 Boots Boots UK Ltd. Circus Northolt Closed Green Ward 08:30-19:30 19:00 Middlesex UB5 4RR Y Y Y Y N N N Y Ealing Sun: 24 Ealing Broadway Mon - Fri: Sat: 08:30- 14 Boots Boots UK Ltd. Broadway 11:00- Ealing London W5 2NH 08:30-17:30 17:30 Ward 17:00 Y Y Y N N N N Y

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Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Unit 36 Ealing B'way Ealing Sun: Mon - Fri: Sat: 09:00- 15 Boots Boots UK Ltd. Centre Ealing London Broadway 11:00- Y Y Y Y N Y N Y 09:00-20:00 19:00 W5 5JY Ward 17:00 61 The Broadway Southall Sun: Mon - Fri: Sat: 09:00- 16 Boots Boots UK Ltd. Southall Middlesex UB1 Broadway 10:30- Y Y Y Y Y Y N Y 09:00-20:00 19:00 1JY Ward 19:00 Unit 17 The Oakes Sun: Shopping Centre Acton Acton Central Mon - Fri: Sat: 09:00- 17 Boots Boots UK Ltd. 10:00- Y Y Y N N N N N High Street London W3 Ward 09:00-18:00 18:00 16:00 6RE 5 Haydock Green Northolt Mon - Fri: 18 Boots Boots UK Ltd. Northolt Middlesex UB5 Mandeville Closed Closed Y Y Y Y N N N Y 09:00-18:30 4AP Ward Sun: 68 The Broadway West Mon - Fri: Sat: 09:00- 19 Boots Boots UK Ltd. Elthorne Ward 10:00- Y Y Y N N N N Y Ealing London W13 0SR 09:00-18:00 18:00 16:00

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Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per 42 The Broadway Greenford Sun: Mon - Fri: Sat: 09:00- 20 Boots Boots UK Ltd. Ruislip Road Greenford Broadway 11:00- Y Y Y Y N N N Y 09:00-18:00 18:00 UB6 9PT Ward 17:00 Unit 11, Westway Cross Sun: Retail Pk 100 Greenford Greenford Mon - Fri: Sat: 09:00- 21 Boots Boots UK Ltd. 11:00- Y Y Y N N N N Y Road, Greenford Green Ward 09:00-19:00 19:00 17:00 Middlesex UB6 0UW Mon - Fri: Dillons 17 Church Road Acton South Acton 09:00-18:30 Sat: 09:00- 22 Carecamp Ltd Closed Y Y Y Y N N N Y Chemist London W3 8PU Ward Wed: 09:00- 13:00 15:00 Mon-Fri: Conway 8 Station Parade West Acton Central 09:00-18:30 Sat: 09:00- 23 Conway, T. Closed N N N Y N N N Y Chemists Acton London W3 0DS Ward Wed: 09:00- 17:00 18:00

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Co-Operative Co-Op Group 333 Greenford Avenue Hobbayne Mon - Fri: Sat: 09:00- 24 Closed Y Y Y Y N N N Y Pharmacy Healthcare London W7 1JH Ward 09:00-18:00 14:00 Limited Crossbells 131 The Vale Acton Southfield Mon - Fri: Sat: 09:00- 25 Crossbell Ltd. Closed Y N Y Y N N N Y Pharmacy London W3 7RQ Ward 09:00-18:30 13:00 Daru Daru Pharma 186 South Ealing Road Northfield Mon - Fri: 26 Closed Closed Y Y Y Y N N N Y Pharmacy Ltd. London W5 4RJ Ward 08:30-18:30 Richards Dudzinska, 112 South Ealing Road Northfield Mon - Fri: Sat: 09:00- 27 Closed Y Y N N N N N N Chemists Mrs B. K. London W5 4QJ Ward 09:00-18:00 16:00 59 Old Oak Common Banks East Acton Mon - Fri: Sat: 09:00- 28 Enimed Ltd. Lane East Acton London Closed Y Y Y Y N N N Y Chemist Ward 09:00-18:30 14:00 W3 7DD Midhurst Free Access 92 Elthorne Park Road Northfield Mon- Fri: Sat: 09:00- 29 Closed Y Y Y Y N N N Y Chemist Ltd Ealing London W7 2JD Ward 09:00-18:30 13:00

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per 31-33 King Street Sun: Gill Gill, M.S. & Norwood Mon - Fri: Sat: 09:00- 30 Southall Middlesex UB2 12:00- Y Y Y Y N Y Y Y Chemists Sons Ltd Green Ward 09:00-20:30 20:30 4DG 19:30 79 Norwood Road Gill Gill, M.S. & Southall Green Mon - Fri: Sat: 09:00- 31 Southall Middlesex UB2 Closed Y Y Y Y N N N Y Chemists Sons Ltd. Ward 09:00-19:00 14:00 4EA Northfield 30 Northfield Avenue Mon - Fri: Sat: 09:00- 32 Gillygrade Ltd Walpole Ward Closed Y Y Y Y N N Y Y Pharmacy London W13 9RL 08:30-18:30 17:30 50 Greenford Road Kings Dormers Wells Mon - Fri: 33 Hanns Ltd. Greenford Middlesex Closed Closed Y Y Y Y Y Y N Y Pharmacy Ward 09:30-19:00 UB6 9AT 193 South Ealing Road Sun: Harbs Harbs Med Northfield Mon - Fri: Sat: 07:00- 34 South Ealing London 11:00- Y Y Y Y N N N Y Pharmacy Limited Ward 08:00-23:00 22:00 W5 4RH 17:00

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Ealing Walkers 6 The Broadway Acton Mon - Fri: Sat: 10:00- 35 Hemeena Ltd Common Closed Y Y Y Y N N N Y Chemist London W3 8HR 08:30-18:30 17:00 Ward Mon- Tue: 00:00-23:59 472 Greenford Road Greenford Sun: Ariana Isaac, Wed: 00:00- Sat: 09:00- 36 Greenford Middlesex Broadway 10:00- Y Y Y Y N N N Y Pharmacy Abdullah 20:00 Thu - 19:00 UB6 8SQ Ward 16:00 Fri: 08:00- 20:00 Southall Sun: Chana 52 South Road Southall Mon - Fri: Sat: 09:00- 37 K.S.C.1T Ltd Broadway 10:00- Y Y Y Y N N N Y Chemist Middlesex UB1 1RQ 09:00-21:00 20:00 Ward 19:00 Southall Sheery's 48, South Road Southall Mon - Fri: Sat: 10:00- 38 K.S.C.1T Ltd Broadway Closed Y Y Y Y N N N Y Pharmacy Middlesex UB1 1RR 09:30-19:00 14:00 Ward

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Unit 3, 33 High Street Chana Dormers Wells Mon - Fri: Sat: 09:00- 39 K.S.C.1T Ltd. Southall Middlesex UB1 Closed Y Y Y Y N N N Y Chemist Ward 09:00-19:00 19:00 3HA 386 Oldfield Lane North Parade Greenford Mon - Fri: Sat: 09:00- 40 Leegrade Ltd Greenford Middlesex Closed Y Y Y Y Y Y N Y Pharmacy Green Ward 09:00-19:00 13:00 UB6 8PU Lloydsphar Lloyds Crown Street Acton South Acton Mon - Fri: Sat: 08:30- 41 Closed Y Y Y Y Y Y Y Y macy Pharmacy Ltd. London W3 8SA Ward 08:30-18:45 17:00 Sun: Lloydsphar Lloyds 377 Uxbridge Road South Acton Mon - Fri: Sat: 09:00- 42 10:00- Y Y Y Y N N N Y macy Pharmacy Ltd. Ealing London W3 9RH Ward 08:45-18:45 17:00 14:00 Mon-Fri: 32 Church Road Northolt M.Gokani M. Gokani 09:00-19:00 Sat: 09:00- 43 Northolt Middlesex UB5 Mandeville Closed Y Y Y Y N Y Y Y Chemist Ltd. (Wed: 09:00- 14:00 5AB Ward 18:00)

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Mattock 8 St. Johns Parade Mansell, Mon - Fri: Sat: 09:00- 44 Lane Mattock Lane London Walpole Ward Closed Y Y Y Y Y Y Y Y A.J.M. 08:45-19:00 17:00 Chemist W13 9LL Lady 223 Lady Margaret Sun: Margaret Medi Lady Margaret Mon - Fri: Sat: 07:00- 45 Road Southall 10:00- Y Y Y Y N N N Y Road Pharmacy Ltd. Ward 07:00-23:00 20:00 Middlesex UB1 2NH 17:00 Pharmacy Grosvenor Sun: Medipharmacy 147 The Broadway West Mon - Fri: Sat: 07:00- 46 House Walpole Ward 10:00- Y Y Y Y Y Y Y Y Ltd. Ealing London W13 9BE 07:00-23:00 20:00 Pharmacy 17:00 43 Featherstone Road Sun: Fountain Mohamed A. Southall Green Mon - Fri: Sat: 08:00- 47 Southall Middlesex UB2 08:00- N Y Y N N N N N Pharmacy Yusuf Ward 08:00-23:00 23:00 5AB 18:00 Cross Mr Pradip 5 Royal Parade Hanger Hanger Hill Mon - Fri: Sat: 09:00- 48 Closed Y Y Y Y N N N Y Chemist Patel Lane London W5 1ET Ward 09:00-19:00 18:00

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Bramley Mrs Aruna 261 Northfield Avenue Northfield Mon - Fri: Sat: 09:00- 49 Closed Y Y Y N Y Y N Y Pharmacy Patel Ealing London W5 4UA Ward 09:00-18:30 13:00 70 The Broadway Greenford Ravenor Nathwani, C. Mon - Fri: Sat: 09:00- 50 Greenford Middlesex Broadway Closed Y Y Y Y N N Y Y Chemist K. 09:00-18:00 16:00 UB6 9QA Ward 83 Uxbridge Road Church Nilesh & Bimal Mon - Fri: Sat: 09:00- 51 Hanwell London W7 Elthorne Ward Closed Y Y Y Y N N Y Y Pharmacy Morjaria 09:00-19:30 18:30 3ST Jallas Patel, Mr V. 313 Horn Lane Acton Acton Central Mon - Fri: Sat: 09:00- 52 Closed N Y Y Y N Y N Y Chemist N. London W3 0BU Ward 09:00- 18:30 18:00 192 Bilton Road Watmans Pharmacy Mon - Fri: Sat: 09:00- 53 Perivale Middlesex UB6 Perivale Ward Closed Y Y Y Y N N N N Pharmacy Initiative 2 Plc 09:00-19:00 13:30 7HQ Greenford Pharmapost 348 Greenford Avenue Hobbayne Mon - Fri: Sat: 09:00- 54 Closed Y Y Y Y N N N Y Chemist Ltd Hanwell W7 3DA Ward 09:00-18:00 13:00

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Ealing Pi-Gen 157 Pitshanger Lane Cleveland Mon - Fri: Sat: 09:00- 55 Closed Y Y Y Y N N N Y Pharmacy Pharma Ltd. Ealing London W5 1QX Ward 09:00-18:00 17:00 4 Castle Hill Parade The Ealing Terry's Princemount Mon - Fri: Sat: 09:00- 56 Avenue London W13 Broadway Closed Y Y Y N N N N Y Pharmacy Ltd. 09:00-18:00 13:00 8JP Ward 1318 Greenford Road North Westlake Pro Med Mon - Fri: Sat : 09:00 57 Greenford Middlesex Greenford Closed Y Y Y Y N N N Y Pharmacy Pharma Ltd 09:00-19:00 - 13:00 UB6 0HL Ward Roxanne’s 51 The Broadway Greenford Mon - Fri: Sat: 09:00- 58 Dispensing PRSS Ltd. Greenford Middlesex Broadway Closed Y Y Y Y N N Y Y 09:00-18:00 17:30 Chemists UB6 9PN Ward Puri Puri Chemists 39 Western Rd Southall Southall Green Mon - Fri: Sat : 09:00 60 Closed Y Y Y Y Y Y N Y Chemists Ltd Middx UB2 5HE Ward 09:00-19:00 - 13:00 SR Raja, Mr 155 High Street Acton South Acton Mon - Fri: Sat: 09:00- 61 Closed Y N N N N N N N Pharmacy Shyam London W3 6LP Ward 09:00-18:00 18:00

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Mon-Fri: Remedy Remedy 83 Greenford Avenue Hobbayne 09:00-18:30 Sat : 10:00- 62 Closed Y Y Y Y N N N Y Pharmacy Pharm Ltd. Hanwell London W7 1LJ Ward Wed: 09:00- 13:00 18:00 Mon - Wed: 15 Queens Parade Megson's Rosemead Hanger Hill 09:00-18:00 Sat: 10:00- 63 Hanger Lane London Closed Y Y Y Y N N N Y Pharmacy Ltd. Ward Thu - Fri: 13:30 W5 3HU 09:00-18:30 13 North Parade, North Shah Shah Lady Margaret Mon - Fri: 64 Road Southall Closed Closed Y Y Y Y N N Y N Pharmacy Pharmacy Ltd. Ward 09:00-19:00 Middlesex UB1 2LF Ealing Lewis 36 Haven Green Ealing Mon - Fri: Sat: 09:30- 65 Shilun's Ltd Broadway Closed Y Y Y Y N N Y Y Pharmacy London W5 2NX 09:30-18:00 17:00 Ward Superdrug Superdrug 96 The Broadway West Mon - Fri: Sat: 08:30- 66 Elthorne Ward Closed Y Y Y Y N Y N Y Pharmacy Stores Plc. Ealing London W13 0SY 08:30-18:00 17:30

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per 18-19 Broadway Shop Ealing Superdrug Superdrug Mon - Fri: Sat: 09:00- 67 Centre Ealing London Broadway Closed Y Y Y Y N N Y Y Pharmacy Stores Plc. 09:00-19:00 17:30 W5 5JY Ward 3 Crosslands Parade Jade Surreal Crosslands Avenue Norwood Mon - Fri: Sat: 09:00- 68 Closed Y Y Y N N N N Y Pharmacy Medicare Ltd Norwood Green UB2 Green Ward 09:00-17:00 13:00 5RB Mon-Fri: Temple Temple 110 Pitshanger Lane Cleveland 09:00-18:30 Sat: 09:00- 69 Closed Y Y Y Y N N Y Y Pharmacy Pharmacy Ltd. Ealing London W5 1RU Ward Wed: 09:00- 18:00 18:00 Hoover Building Sun: Tesco Tesco Stores Mon- Fri: Sat: 08:00- 70 Bideford Ave Perivale Perivale Ward 10:00- Y Y Y Y N N N Y Pharmacy Ltd. 08:00-20:00 20:00 UB6 8DW 16:00 Sun: Tesco Tesco Stores Hayes Road Bulls Southall Green Mon - Fri: Sat: 09:00- 71 11:00- Y Y Y Y N N N Y Pharmacy Ltd. Bridge Ind Est UB2 5NB Ward 09:00-21:00 21:00 17:00 130

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Chief The Chief 4 Eastmead Avenue Greenford Mon - Fri: Sat: 08:30- 72 Cornerstone Cornerstone Greenford Middlesex Broadway Closed Y Y Y Y N Y N Y 08:30-19:00 13:30 Ltd. Ltd. UB6 9RA Ward Mon, Tue, 18 Medway Parade Thu, Fri: Medway Venture Sat: 09:00- 73 Perivale Greenford UB6 Perivale Ward 09:00-18:00 Closed Y Y Y Y Y Y N Y Pharmacy Medica Ltd. 13:00 8HT Wed: 09:00- 17:00 Mon-Fri: 227 The Broadway Southall Woodland Woodland 09:00-19:00 74 Southall Middlesex UB1 Broadway Closed Closed Y N Y N N N N N Pharmacy Pharmacy Ltd. (Wed: 09:00- 1ND Ward 17:00) 493-495 Yeading Lane Touchwood Northolt West Mon- Fri: Sat: 09:00- 75 X-Pharm Ltd. Northolt Middlesex UB5 Closed Y Y Y Y Y Y Y Y Pharmacy End Ward 09:00-19:00 17:00 6LN

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Choices (Y/N)

Trading Pharmacy Sat Sun

NMS

MURs

Map name of company Mon-Fri opening opening Needle

Scheme

Smoking

Exchange Cessation index pharmacy name Address Locality Opening hrs Hrs hrs Supervised

Consumption

EHC EHC Scheme

Minor Ailments

Electronic Prescription Service,as NHS per Hanwell Health Centre Touchwood Mon - Fri: 76 X-Pharm Ltd. 20 Church Rd London Elthorne Ward Closed Closed Y Y Y Y N N N Y Pharmacy 09:00-19:00 W7 1DR Note: there is no Map index (pharmacy) number 59 as this pharmacy has since closed.

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Appendix B: PNA Steering Group Terms of Reference Purpose The Steering Group will oversee the development of the Pharmaceutical Needs Assessment (PNA) for Ealing Health and Wellbeing Board. Objectives 1. To oversee the development of the pharmaceutical needs assessment in accordance with and ensure the Ealing PNA complies with the NHS Pharmaceutical Services and Local Pharmaceutical Services Regulations 2013. 2. Ensure the PNA takes into account the local demography within Ealing Borough and ascertain whether there is sufficient choice with regard to obtaining pharmaceutical services. 3. Ensure the PNA takes into account Ealing’s JSNA and all relevant strategies and plans both in the Ealing CCG and the Council. These include for example the Children and Young People’s Plan, Ealing Clinical Commissioning Group Commissioning Intentions 2014/15, the Ealing CCG Out of Hospital Strategy 2012 /15 and the Health and Wellbeing Strategy. 4. Ensure the consultation on the PNA meets the requirements of Regulation 8 of the 2013 Regulations. In particular, ensure that both patients and the public are involved in the development of the PNA. 5. Ensure all appropriate stakeholders in Ealing are aware, engaged and involved in the development of the PNA. 6. Present the PNA first and final draft to the Health and Wellbeing Board. 7. Publish the PNA on the Council’s website by April 2015. Governance 1. The Health and Social Care Act 2012 transferred the statutory responsibility for PNAs from NHS Primary Care Trusts (PCTs) to Health and Wellbeing Boards (HWB) from 1 April 2013. 2. This Steering Group has been established to oversee the production of the PNA for the London Borough of Ealing, reporting progress and presenting the final report to the HWB on or before the March 2015 meeting. 3. The Health and Wellbeing Board will be informed of progress towards the production of the PNA and relevant milestones through the HWB Programme Manager’s quarterly updates. 4. If a statement or decision from the Health and Wellbeing Board is needed in relation to the production of the draft PNA, the Chair of the Steering Group is welcome to draft a formal report for consideration.

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Dates for Health and Wellbeing Board meetings, 2014/2015:

29 July 2014 9 Sept 2014 18 Nov 2014

13 Jan 2015 10 March 2015 (final draft PNA due)

Membership

Member Role

Dr Maha Saeed Consultant Public Health Medicine, LBE (Chair)

Anjna Sharma Operations Manager, Soar Beyond Ltd

Christiana Torricelli Health and Wellbeing Programme Manager, LBE

Hiten Patel Representing Ealing LPC

Dr Sukhpal Shergill Ealing LMC

Anthony Wakhisi Senior Public Health Analyst, LBE

Andy Mahady Communication Lead, LBE

Bal Hampal Medicines Management, NHS Ealing CCG

Rajiv Ahlawat Research and Consultation Manager, LBE

Alan Cook HealthWatch Ealing

Perry King HealthWatch Ealing

Jill Downey Patient and Public Engagement Lead, Ealing CCG

Peter Vittles Ealing CVS

Mike Nelson NHS England (NW London)

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Appendix C: Patient survey

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Appendix D: Pharmacy contractor survey

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Appendix E: Commissioner survey

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Appendix F: PNA timeline Stage Dates Key Actions Outcomes Set up June 2014 HWB paper to outline PNA Delegated authority to PNA Steering Group for PNA production. Isolation responsibilities of necessary funding and resource for PNA production. Produce project plan and Formation of PNA Steering Group and PNA Project Group. Roles and secure resources. responsibilities defined. Terms of Reference and meeting dates agreed. Agree work stream plans and timelines. Information June-August First Steering Group Workstreams and timeline agreed. finding 2014 meetings Public and Pharmacy questionnaires agreed. Consultation plan drafted. Localities agreed. GIS maps agreed. Second Steering Group Public Health and Pharmaceutical provision information presented. meeting Results from Public and Pharmacy questionnaires presented. Pharmaceutical provision and access maps presented. Analysis September Third Steering Group Analysis of information finding. Collation of findings to inform Draft PNA. 2014 meeting Consideration of need for further public qualitative feedback. Identification and agreement to any potential gaps in provision of services.

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Stage Dates Key Actions Outcomes Further, focussed public Agreement to consultation plan. Results and analysis from further public engagement (if required engagement. following initial public survey results) Draft PNA September Electronic circulation of Agreement of final Draft PNA for consultation. production 2014 various draft PNA Presentation to HWB on progress and draft PNA. documents to Steering Group members HWB Board paper Consultation 5th November Various stakeholder events Distribution and (60 day) consultation on draft PNA. th 2014 to 4 Feedback obtained on Draft PNA. January 2015 Collation of responses to consultation. Final January – Fourth Steering Group Analysis of consultation responses. considerations February 2015 meeting Agreement on Final PNA. HWB approval February 2015 Health and Wellbeing Board Approval and sign-off by HWB Board of Final PNA. report Obtain HWB approval and resource allocation for ongoing review/update PNA. Publish final March 2015 Circulate Final PNA and HWB PNA now ‘live’ and used by NHS England to consider ‘Control of PNA host on HWB/Council Entry’ applications. website

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Appendix G: Consultation plan and list of stakeholders Stakeholder Engagement during PNA production Draft PNA consultation Role/Organisation PNA Steering Questionnaire (Pharmacy PNA Draft PNA Meeting/ Other Briefing group contractor/ Service User/ Briefing link sent workshop letter representation Commissioner) paper and (Y/N) attendance sent (Y/N) consultation (Y/N) questions sent (Y/N) HWB Programme Y Y None sent Y N Manager To be determined and completed after

HWB Area LPC Y Y None sent Y N consultation HWB Area LMC Y Y None sent Y N

Pharmacy contractor Y Y Pharmacy contractor Y N

Local HealthWatch Y Y Service user Y N

Ealing CVS Y Y Link to pharmacy user Y N questionnaire sent to all patient participation groups

Regulations, 2103, Part 2 (8)Part Regulations,2103, GP Patient Groups Y Y Link to pharmacy user Y N questionnaire sent to all

Consultee as required by Pharmaceutical Consultee as required patient participation groups

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Stakeholder Engagement during PNA production Draft PNA consultation Role/Organisation PNA Steering Questionnaire (Pharmacy PNA Draft PNA Meeting/ Other Briefing group contractor/ Service User/ Briefing link sent workshop letter representation Commissioner) paper and (Y/N) attendance sent (Y/N) consultation (Y/N) questions sent (Y/N) Ealing Advice Service N N Link to pharmacy user Y N questionnaire sent to all To be determined patient participation groups and completed after Ealing Equality N N Link to pharmacy user Y N consultation Council questionnaire sent to all patient participation groups

Grand Union Village N N Link to pharmacy user Y N questionnaire sent to all patient participation groups Southall Community N Link to pharmacy user Y N Alliance questionnaire sent to all

patient participation groups

Acton Community N Link to pharmacy user Y N Forum questionnaire sent to all patient participation groups

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Stakeholder Engagement during PNA production Draft PNA consultation Role/Organisation PNA Steering Questionnaire (Pharmacy PNA Draft PNA Meeting/ Other Briefing group contractor/ Service User/ Briefing link sent workshop letter representation Commissioner) paper and (Y/N) attendance sent (Y/N) consultation (Y/N) questions sent (Y/N) LBE OP Forum N Link to pharmacy user Y N questionnaire sent to all patient participation groups To be determined Carers Centre N Link to pharmacy user Y N and completed after questionnaire sent to all consultation patient participation groups

Northolt N Link to pharmacy user Y N Confederation questionnaire sent to all patient participation groups Ealing Centre for N N Link to pharmacy user Y N Independent Living questionnaire sent to all To be determined patient participation groups and completed after Dementia Concern N N Link to pharmacy user Y N consultation questionnaire sent to all patient participation groups

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Milap Day Centre N N Link to pharmacy user Y N Asian OP Day Centre questionnaire sent to all patient participation groups

Chief Pharmacist, N N None sent Y N To be determined Ealing Hospital NHS and completed after Foundation Trust consultation NHS England Area Y Y Commissioner Y N Team NHS England NWL N N None sent Y N Hillingdon HWB N N None sent Y N

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Hounslow LPC N N None sent N Y To be determined

and completed after Middlesex Group of N N None sent N Y consultation LPCs

London-wide LMC N N None sent N Y Parish and town N N None sent N Y

Other consultees councils

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Stakeholder Engagement during PNA production Draft PNA consultation Role/Organisation PNA Steering Questionnaire (Pharmacy PNA Draft PNA Meeting/ Other Briefing group contractor/ Service User/ Briefing link sent workshop letter representation Commissioner) paper and (Y/N) attendance sent (Y/N) consultation (Y/N) questions sent (Y/N) Medicines Y Y Commissioner N Y Management Ealing CCG Patient and Public Y Y None sent N Y Engagement Lead Ealing CCG Committee Liaison Y N None sent N Y Executive PH Senior Public Y Y None sent Y Health Analyst Communication Lead Y Y None sent N Y To be determined and completed after Research and Y Y None sent N Y consultation Consultation Manager Public Health Officer N N Commissioner N Y

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Stakeholder Engagement during PNA production Draft PNA consultation Role/Organisation PNA Steering Questionnaire (Pharmacy PNA Draft PNA Meeting/ Other Briefing group contractor/ Service User/ Briefing link sent workshop letter representation Commissioner) paper and (Y/N) attendance sent (Y/N) consultation (Y/N) questions sent (Y/N) Public Health N N Commissioner N Y Specialist, Health Inequalities Public Health N N Commissioner N Y Registrar Public Health N N Commissioner N Y Registrar Public Health Team N N Commissioner N Y Admin Director of Public N N Commissioner N Y Health PH Drugs and N N Commissioner N Y To be determined Alcohol Services and completed after consultation PH Sexual Health N N Commissioner N Y Services

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Stakeholder Engagement during PNA production Draft PNA consultation Role/Organisation PNA Steering Questionnaire (Pharmacy PNA Draft PNA Meeting/ Other Briefing group contractor/ Service User/ Briefing link sent workshop letter representation Commissioner) paper and (Y/N) attendance sent (Y/N) consultation (Y/N) questions sent (Y/N) PH Physical Activity, N N Commissioner N Y oral health, LTC PH Tobacco control, N N Commissioner N Y LTC, cancer PH Mental Health, N N Commissioner N Y older people PH Adult Services N N Commissioner N Y PH Children’s N N Commissioner N Y Services

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Appendix H: Summary of consultation responses and comments To be completed after the consultation on the Draft PNA

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Appendix I: Results of the patient survey

Q1 How often have you visited the pharmacy in the last 6 months

27% 26% 17% For Someone else? 17% 5% Once in 6 months 8% Once every few months Once a month Once every couple of weeks 10% Once a week 24% More than once a weel 28% For yourself? 21% 9% 8%

0% 5% 10% 15% 20% 25% 30%

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

13%

Yes No

87%

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

Other 10%

Prefer not to say 0%

Friendly staff 53%

They offer a specific service 15%

Close to work 12%

Close to GP surgery 53%

Close to home 81%

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

Q4 Who would you normally visit the pharmacy for?

Other 0.3%

Someone you are a carer for 5.4%

Neighbour/friend 5.1%

A family member 51.0%

Yourself 89.6%

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

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

Other 16%

Most Convenient 60%

Access(for example 20% disability/transport)

Opening hours of the pharmacy not 22% suitable for patient

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

Reasons for visiting your pharmacy for someone else Ill and can’t pick up a prescription Children Disability They are my children's and husbands Have pharmacist who checks my Relative unable to come due to disability mother’s vast amount of medication It's more convenient for me to collect the script from the GP and then collect For my baby straight away. To drop in or collect medication if they Child / children haven't had time to do it themselves. On behalf of my sons - too young to go Delivery to retirement block of flats themselves My husband’s medicine- changes quite a Patient is often away from home lot To collect the prescription also for myself Medicine is for my child Minor patient My husband My friend is house-bound and elderly Sometimes I pick up a prescription for my over 90 yrs husband as he is busy during the day

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Reasons for visiting your pharmacy for someone else As I work full time - inconvenient opening On behalf of my daughter times and out of location To collect parents' medication They’re my children!! My wife is semi disabled 2-year olds can't buy medicine Children who are 3 and 4, not able to go Teenager themselves

Q6 How would you usually travel to a pharmacy?

70% 64% 60%

50%

40%

30% 24% 20% 8% 10% 3% 1% 0% Car/taxi Public Walk Bicycle Other transport

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

Don't know/ not sure/ varies 1%

Over 30 minutes 1%

20 - 30 minutes 5%

10 - 20 minutes 24%

0 - 10 minutes 70%

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

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Q8Do you have any difficulties when travelling to your pharmacy due to the following reasons? 90% 83% 80%

70%

60%

50%

40%

30%

20% 11% 10% 3% 3% 0% Location of Parking difficulties Public Transport No Difficulties pharmacy availability

Q9 What is the most convenient day for you to visit your pharmacy? 70% 63% 60%

50%

40%

30% 26%

20%

10% 7% 3% 0% Monday to Friday Saturday Sunday Don't mind/ varies

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Q10 What is the most convenient time for you to visit your pharmacy?

Don't mind/varies 56%

Late Evening 9%

Early Evening 9%

Afternoon 9%

Lunchtime 4%

Morning 13%

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

Q11 How regularly do you buy an over the counter medicine from a pharmacy?

Prefer not to say 5%

Never 4%

Less than once a year 11%

Yearly 4%

More than once a year but less than 38% omonthly

Monthly 17%

More than once a month 15%

Weekly 3%

More than once a week 4%

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

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Q12 Do you buy over the counter medicines anywhere else?

5% Nowhere else 10% 28% Supermarket 1% 6% The internet Garage / petrol station 7% Local / community shop Other shop Prefer not to say

58%

Q13: How do you rate the ease of obtaining medication (for example - waiting time or stock availability)?

10%

Excellent Good Fair

53% Poor 36%

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Q14 Are you provided with sufficient information about your medication (such as dosage and side effects)? 100% 91% 90% 80% 70% 60% 50% 40% 30% 20% 9% 10% 0% Yes No Yes No

Q15: Would you ask your pharmacist for advice about medication prescribed by your GP?

80% 75% 70%

60%

50%

40%

30% 25% 20%

10%

0% Yes No Yes No

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Q16 Which of the following pharmacy services are you aware that your pharmacy provides?

Needle exchange 7%

Supervised consumption of methadone and buprenorphine 11%

Getting medicines for free without a prescription for minor ailments 15%

Palliative care 6%

Sexual health services (pregnancy testing, Chlamydia testing/ treating, condom distribution, emergency… 26%

Stop smoking/ nicotine replacement therapy 48%

Sitting down with your pharmacist and talking about how you use your medicines 49%

Disposing of unwanted medicines 66%

Advice from your pharmacist (eg. healthy lifestyle, medicines advice, signposting) 76%

Buying over the counter medicines 87%

Home delivery services and prescription collection services 62%

Repeat Dispensing 88%

Dispensing of prescriptions 92%

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Q17 How often have you used any of the following services at your pharmacy? At least Every once a 1-3 Occasionally Never month months Dispensing of prescriptions 32.6% 40.1% 23.2% 4.1% Repeat dispensing 28.4% 36.0% 10.4% 25.2% Home delivery services and prescription collection services 9.7% 11.5% 14.9% 63.9% Buying over the counter medicines 14.9% 23.3% 54.0% 7.8% Advice from your pharmacist (eg healthy lifestyle, medicines advice, signposting) 10.3% 10.3% 47.6% 31.7% Disposing of unwanted medicines 7.6% 6.4% 43.6% 42.4% Sitting down with your pharmacist and talking about how you use your medicines 7.0% 7.7% 30.8% 54.5% Stop smoking/nicotine replacement therapy 4.6% 2.3% 6.5% 86.6% Sexual health services (pregnancy testing, Chlamydia testing/treating, condom distribution, emergency contraception) 0.7% 1.4% 5.4% 92.5% Palliative care 1.1% 0.4% 3.8% 94.7% Getting medicines for free without a prescription for minor ailments 2.1% 1.1% 11.0% 85.8% Supervised consumption of methadone 4.2% 0.0% 0.0% 83.0% and buprenorphine Needle exchange 6.3% 6.3% 0.0% 75.0%

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Q18: How do you rate the ease of obtaining medication (for example - waiting time or stock availability)?

33%

60%

Excellent Good Fair Poor

Q19 Did you know the pharmacists can give private consultations?

No 40%

Yes 60%

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

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Q20 Is there a private consultation room available in the pharmacy you normally visit?

Don't know 35%

No 3%

Yes 62%

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

Q21 Would you like to see any other services provided by pharmacists?

52% Smoking cessation 48%

30% Prescription home delivery service 70%

47% Pregnancy testing 53%

53% Head lice management 47%

Cholesterol/lipid measurement and 27% advice 73%

37% Annual review of medication 63%

0% 20% 40% 60% 80%

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Q22 Please could we have the name and address of your pharmacy you use the most

Medi Pharmacy 8

Remedy 7

Jallas Pharmacy 9

Shah Pharmacy 16

Northfield pharmacy 16

Fountain 17

Zahra 17

Co-operative pharmacy 12

Midhurst Pharmacy 9

Gill 5

Parade 15

Boots pharmacy 58

Temple pharmacy 24

0 10 20 30 40 50 60 70

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Q23 How would you rate your overall satisfaction with this pharmacy?

1% 6%

29%

64%

Excellent Good Fair Poor

Q24 Any other comments you would like to make about your pharmacy Main Comments Friendly and helpful Staff 64 Good prescription service 17 Good open hours 7 Could be better opening hours 2

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Appendix J: Results of the pharmacy contractor survey

Q1 Is your pharmacy independent or part of a national group?

Group with more than 10 pharmacy 47% premises

Group with 6-10 pharmacy premises 0%

Group with 1-5 pharmacy premises 8%

Independent 45%

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

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Q2 Select the times your pharmacy is open from

Open on or before Closed on or after 6pm 9am Monday 96% 98% Tuesday 94% 98% Wednesday 94% 94% Thursday 96% 98% Friday 96% 98%

Yes No Open after 1pm

Saturday 90% 10% 81%

Yes No

Sunday 29% 71%

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Q3 With regard to the above opening times, what are your core contracted hours at the pharmacy?

Before 9am Close After 6pm

Monday 91% 54%

Tuesday 89% 54%

Wednesday 89% 48%

Thursday 89% 52%

Friday 91% 54%

Yes No Open after 1pm Saturday 67% 33% 74%

Yes No

Sunday 5% 95%

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Q4 Does your pharmacy provide printed information in the following formats?

80%

70% 67%

60% 51% 50%

40%

30%

20% 18%

10% 4% 0% Easy to read Large prints Braille None of these

Q5 There are free car parking facilities available close to the premises during opening hours

Don't know

No, but planned for the future

No 18%

Yes 82%

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

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Q6 Car parking facilities that require payment are available close to the premises during opening hours

8% 4%

Yes

29% No, but planned for the future 59% Don't know

Q7 Disabled car parking facilities are available close to the premises during opening hours

2% 2%

14% Yes

No, but planned for the 82% future Don't know

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Q8 The consultation area/room is clearly signposted as a private consultation area within the pharmacy

2% 2% 2% Yes

No, but planned for the future Don't know

94%

Q9: Conversations in the consultation area/room cannot be overheard when talking at normal speaking volumes by other patients and staff

2% 2% 4% Yes

No, but planned for the future Don't know

92%

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Q10 Hand washing facilities are available close to the consultation area/room

4% 4% Yes

No, but planned for the future Don't know 92%

Q11 Patients have access to toilet facilities 60% 56%

50% 40% 40%

30%

20%

10% 4% 0% 0% Yes No No, but planned Don't know for the future

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Q12 There is a consultation area/room which complies with MUR/NMS requirements

Don't know 0%

No, but planned for the future 4%

No 4%

Yes 92%

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

Q13 The consultation area/room is accessible to wheelchair users 100% 90% 88% 80% 70% 60% 50% 40% 30% 20% 8% 10% 4% 0% Yes No No, but planned Don't know for the future

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Q14 There is access to an offsite consultation area/room

9% 7%

Yes

No, but planned for the future Don't know

85%

Q15 We can undertake consultations in patients’ homes (or other suitable sites)

4% 12% Yes 38% No

No, but planned for the future Don't know 45%

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Q16* The access to the pharmacy premises complies with the Equalities Act 2% 4%

Yes

No, but planned for the future Don't know

94%

Q17*: Is your IT system ‘Release 2’ enabled?

Don't know 0%

No intention 0%

Intending within next 12 months 4%

Yes 96%

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

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Q18*: Do you have access to an IT system within the consultation area/room?

Don't know 4%

No, and no intention to gain access 8%

Intending to within next 12 months 12%

Yes 76%

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

Q19* Do you have access to a Microsoft Office package (e.g. Word/Excel)

92%

Yes No

*Q16-19: Feedback received from pharmacy contractors. When they came to input data into the electronic pharmacy questionnaire, it became apparent that with questions 16-19, they were unable to answer accurately as the program did not allow more than one response to be ticked. Thus, contractors were unable to state that in addition to providing a service privately, they would also be willing to provide it at public expense were they to be commissioned to do so.

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Q20 Do you have access to a NHS.net email?

No 8%

Yes 92%

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

Q21 You have said that you do not have access to NHS.net email. Please explain why not. We have our own Boots email system The regular pharmacist has moved to a new position and a replacement has not yet been allocated. We are currently working with relief/locum pharmacists Has not been set up yet by proscript We have a premises specific e-mail address. Neither branch nor head office has seen any information about obtaining an NHS address We have tried to gain one but they have said to us they are not supplying pharmacies with this email format at present. We are trying so hard to get hold of this email in order to communicate with doctors I don’t know but I would like to set up with your help Using Lloyds pharmacy emailing system Company doesn’t allow us to have one I have tried to get in touch with the IT system within the commissioning but they couldn’t set an email account for me

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Q22 Do you dispense the appliances below? Intending to No and not Yes within next 12 intending to months Stoma appliances 72.9% 14.6% 12.5% Incontinence 72.4% 12.8% 14.9% appliances Just dressings 87.0% 4.4% 8.7% Other 25.0% 25.0% 50.0%

Other specified appliances dispensed  Mobility products via TCES scheme  Any appliance on a FP10 will be dispensed/ no other contract in place  Any prescribed appliances as listen in Part IX of the Drug Tariff

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Q23 Are you following ADVANCED services offered? Yes Intending to No and not Don’t know begin within the intending to next 12 months provide Stoma 72.9% 14.6% 12.5% appliances Incontinence 72.4% 12.8% 14.9% appliances Just dressings 87.0% 4.4% 8.7% Other 25.0% 25.0% 50.0% Q24 Other than dispensing services, does your pharmacy offer any of the following disease specific services? Currently Currently Currently Would be Not provided provide provide via willing to willing via NHS privately LA provide if or able commissioned to provide Allergies 2.2% 2.2% 0.0% 87.0% 8.7% Alzheimer’s 2.1% 0.0% 0.0% 87.2% 10.6% dementia Asthma 6.4% 4.3% 0.0% 83.0% 6.4% CHD 4.3% 2.1% 0.0% 80.9% 12.8% COPD 6.5% 4.4% 0.0% 78.3% 10.9% Depression 4.3% 0.0% 0.0% 83.0% 12.8% Diabetes Type I 6.4% 4.3% 0.0% 78.7% 10.6% Diabetes Type 6.4% 6.4% 0.0% 78.7% 8.5% II Epilepsy 4.4% 0.0% 0.0% 84.8% 10.9% Heart Failure 4.2% 0.0% 0.0% 83.0% 12.8% Hypertension 6.4% 6.38% 2.1% 78.7% 6.4% Parkinson’s 4.2% 0.0% 0.0% 83.0% 12.8% Disease Other 6.3% 6.3% 0.0% 75.0% 12.5%

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Q25 Are the following screening and monitoring services offered?* Currently Currently Currently Would be Not provided provide provide via willing to willing via NHS privately LA provide if or able commissioned to provide Alcohol 6.4% 0.0% 0.0% 80.9% 12.8% Anticoagulant 0.0% 0.0% 0.0% 78.7% 21.2% monitoring service Asthma 0.0% 0.0% 0.0% 91.5% 8.5% management Chlamydia 4.3% 0.0% 0.0% 83.0% 12.8% screening service Cholesterol 0.0% 19.2% 2.1% 61.7% 17.0% Diabetes 0.0% 14.9% 2.1% 72.3% 10.6% Management Gonorrhoea 0.0% 0.0% 0.0% 81.8% 18.2% H Pylori 2.2% 0.0% 0.0% 82.2% 15.6% HbA1C 0.0% 2.2% 0.0% 77.8% 20.0% Hepatitis 0.0% 0.0% 0.0% 73.9% 26.1% Spot HIV 0.0% 0.0% 0.0% 77.8% 22.2% testing Other 0.0% 8.3% 0.0% 75.0% 16.7%

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Q26 Are the following vaccination services offered?* Currently Currently Currently Would be Not provided provide provide willing to willing via NHS privately via LA provide if or able commissioned to provide Pneumococcal 2.1 0.0 0.0 83.0 14.9 or pneumo jab (PCV) Rotavirus 0.0 0.0 0.0 83.0 17.0 vaccine Meningitis C 0.0 2.2 0.0 78.3 19.6 (Men C) 5-in-1 vaccine 0.0 0.0 0.0 80.4 19.6 Hib/Men C 0.0 0.0 0.0 82.6 17.4 (booster) MMR 0.0 0.0 0.0 80.4 19.6 Flu vaccine 44.7 14.89 0.0 34.0 6.4 Intranasal flu 12.8 0.0 0.0 70.2 17.0 vaccine for children 4-in-1 pre- 0.0 0.0 0.0 80.4 19.6 school booster HPV vaccine 0.0 0.0 0.0 83.0 17.0 (girls only) 3-in-1 teenage 0.0 0.0 0.0 83.0 17.0 booster Chickenpox 0.0 0.0 0.0 82.6 17.4 vaccination (varicella) Shingles 4.26 0.0 0.0 78.7 17.0 BCG 0.0 0.0 0.0 80.4 19.6 (tuberculosis) vaccination Hepatitis A 0.0 4.4 0.0 75.6 20.0 immunisation

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Currently Currently Currently Would be Not provided provide provide willing to willing via NHS privately via LA provide if or able commissioned to provide Hepatitis B 0.0 8.7 0.0 71.7 19.6 immunisation Meningococcal 0.0 13.0 0.0 71.7 15.2 meningitis Rabies 0.0 2.2 0.0 78.2 19.6 Japanese 0.0 4.3 0.0 74.5 21.3 encephalitis Tick-borne 0.0 2.1 0.0 76.6 21.3 encephalitis Tuberculosis 0.0 0.0 0.0 80.9 19.2 (TB) Yellow fever 0.0 0.0 0.0 82.6 17.4 Diphtheria, 0.0 4.4 0.0 76.1 19.6 polio and tetanus (combined booster) Typhoid 0.0 4.3 0.0 76.6 19.2 Cholera 0.0 2.1 0.0 78.7 19.2 Whooping 0.0 0.0 0.0 80.4 19.6 cough (Pertussis for children) Whooping 2.17 0.0 0.0 78.3 19.6 cough (Pertussis for pregnant women) Immunisations 0.0 10.6 0.0 74.5 14.9 and travel vaccines Other 0.0 0.0 0.0 76.5 23.5

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Q27 Are the following other services offered?* Would be Currently Currently Currently Not willing willing to Answer Options provide provide provide or able to provide if via NHS privately via LA provide commissioned Advice to care homes 0.00% 13.04% 0.00% 63.04% 15.22% service Chlamydia treatment 4.44% 2.22% 0.00% 82.22% 11.11% service Emergency Hormonal Contraception service – 36.96% 21.74% 4.35% 26.09% 10.87% 72 hours Emergency Hormonal Contraception service – 8.51% 10.64% 0.00% 72.34% 8.51% 120 hours Gluten Free Food Supply Service (i.e. not 4.35% 4.35% 0.00% 78.26% 13.04% via FP10) Home Delivery Service 29.17% 39.58% 2.08% 20.83% 8.33% Independent / Supplementary 2.13% 2.13% 0.00% 76.60% 19.15% Prescribing service Language access service (e.g. language 6.67% 4.44% 0.00% 73.33% 15.56% line) Medication review 70.21% 2.13% 0.00% 25.53% 2.13% service Diet and nutrition advice 21.74% 19.57% 0.00% 54.35% 4.35% Diet and nutrition 23.40% 17.02% 0.00% 51.06% 8.51% supplements Monitored Dosage Service (MDS) / 58.33% 16.67% 2.08% 18.75% 4.17% Medicine Reminder Services (MRS) Minor ailment scheme 34.78% 2.17% 6.52% 47.83% 8.70% MUR plus service 8.89% 2.22% 0.00% 82.22% 6.67%

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Would be Currently Currently Currently Not willing willing to Answer Options provide provide provide or able to provide if via NHS privately via LA provide commissioned Obesity management 0.00% 10.64% 0.00% 78.72% 10.64% (adults and children) PGD: Erectile 4.26% 34.04% 2.13% 53.19% 6.38% Dysfunction PGD: Weight Loss 2.17% 13.04% 2.17% 73.91% 8.70% PGD: Quit Smoking 44.68% 4.26% 2.13% 40.43% 8.51% PGD: Hair Loss 2.13% 17.02% 2.13% 70.21% 8.51% PGD: Malaria 8.51% 38.30% 4.26% 44.68% 4.26% PGD: Oral 8.51% 12.77% 2.13% 70.21% 6.38% Contraception Adrenaline Injection 4.26% 2.13% 0.00% 76.60% 17.02% Phlebotomy Service 0.00% 2.22% 0.00% 80.00% 17.78% Prescriber support service to General 2.17% 6.52% 0.00% 73.91% 17.39% Practice Stop smoking service 70.21% 2.13% 4.26% 14.89% 8.51% Substance misuse service - Supervised 42.55% 6.38% 2.13% 36.17% 12.77% consumption Needle and syringe 25.53% 4.26% 2.13% 53.19% 14.89% exchange service Sharps disposal service 15.22% 2.17% 2.17% 63.04% 17.39% NHS Health Checks (Vascular risk 0.00% 4.26% 0.00% 80.85% 14.89% assessment) service In hours palliative care 8.70% 0.00% 2.17% 71.74% 17.39% services Out of hours palliative 15.22% 0.00% 4.35% 52.17% 28.26% care services Other (please specify 0.00% 9.09% 0.00% 63.64% 27.27% below)

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Q28 Does your pharmacy provide any of the following non-commissioning services?

Collection of prescriptions from surgeries

No 2%

Yes 98%

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

Delivery of dispensed medicines - free of charge on request

No 15%

Yes 85%

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

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Delivery of dispensed medicines - free of charge to selected patient groups only

No 36%

Yes 64%

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

Delivery of dispensed medicines – selected areas (list areas)

No 39%

Yes 61%

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

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Delivery of dispensed medicines - chargeable

No 91%

Yes 9%

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

Repeat prescription services

No 2%

Yes 98%

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

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Q29 Would you be interested in becoming accredited Healthy Living Pharmacy?

No 13%

Yes 87%

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

Q30: Please confirm the number of pharmacist hours a week within your pharmacy

Average 66

0 20 40 60 80 100

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Q31 Do you have any pharmacists with a specilaist interest (PHWSI)?

Don't Know 25%

No 58%

Yes 17%

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

Q32 How many other support staff do you have in your pharmacy (in WTE)? Please include any dispensing practice staff and dispensing appliance contractors.

Average 9

0 20 40 60 80 100

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Q33 In addition to English, please list any languages spoken by members of staff at the pharmacy

Somalian 3 Swahili 5 Farsi 5 Bengali 4 Polish 8 Arabic 11 Urdu 13 Gujarati 24 Hindi 38 Italian 1 Punjabi 20

0 10 20 30 40 50

Q34 Do you have health champions working with your pharmacy?

10% 8%

81%

Yes No Don't Know

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Q35 Do you have any health trainers working with your pharmacy? 100% 96% 90% 80% 70% 60% 50% 40% 30% 20%

10% 4% 0% 0% Yes No Don't Know Yes No Don't Know

Q36 Do you have dementia friends working with your pharmacy? 100% 90% 79% 80% 70% 60% 50% 40% 30%

20% 13% 8% 10% 0% Yes No Don't Know Yes No Don't Know

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Q37 In your opinion does the current local provision of pharmaceutical services provide adequate access to the following?

You have a good relationship 17% with your NHS England local 35% area team 48%

You have a good relationship 11% with you local authority (Public 36% Health / Adult Services) 53%

You have a good relationship 4% Not at all with your local Clinical 40% Yes, partly Commissioning Group (CCG) 56% Yes, totally

0% You have a good relationship 10% with local General Practices 90%

0% The clinical skills in your 26% pharmacy are well utilised 74%

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

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Q38 What could be done or changed to improve pharmaceutical services for your local population? Increase commissioning of pharmaceutical services in order to facilitate local ethnical groups Increasing number of local services commissioned Minor Ailment Service Need to commission more services e.g. emergency contraceptive etc. Communication with pharmacy as opposed to expectation Better Minor Ailment Service, better discharge process from secondary care, seamless care for patients with all healthcare professionals working together. Pharmacy training to be able to provide some services which would be beneficial to specific groups of people who are seen very often in the pharmacy. Raise the service and the pharmacy profile i.e. advertise Provide satisfactory remuneration for service Allow pharmacies to provide services and NOT to favour certain pharmacies over other, Do not segment the services and make pharmacies confused, unaware of what's going on. Services provided by pharmacy should be promoted well locally especially by the GP surgeries. More services should be commissioned to the pharmacy as population can get easy walk in access without appointments. Use this PNA exercise to find out health needs of local population and then commission services to pharmacy where appropriate, as community pharmacy is easily accessible More opportunities for managing long term conditions within the community More commissioned services, especially supervised methadone where we have lots of patients but they haven't given us the supervised consumption service (commissioned) To commission targeted services required in Ealing such as: Diagnostic screening for CHD and diabetes, Healthy Living pharmacies. To commission targeted services required in Ealing such as: Diagnostic screening for CHD and Diabetes, Healthy Living pharmacies By providing pharmacy more services to help the local people More funding should be provided to pharmacies for specific health promotions and better relationship with GP's working as a team rather than separately.

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To include a wider range of services such as INR monitoring service, NHS Health Checks. More commissioned services available to pharmacy Having direct access to patients’ records and funding to allow all Pharmacists access to patients home to carry out MUR. This will allow ensure that patients are not hoarding medicines at home. NIL GP surgeries to open weekends More advertisement for the shop Commission New local services Provide protected Pharmacist and Staff training Local GP has requested in-pharmacy INR monitoring for warfarin patients due to ease of accessibility NHS Health checks to be done via community pharmacies Provide more services More services commissioned by CCG's More commissioned services Increased amount of funding and training to provide an increased amount of services More integration with other medical fraternity Provision for more NHS services - screening, counselling and vaccination To encourage more NHS commissioned services Better communication and little barriers There is a need for a pharmacy that opens long hours like us to provide needle exchange service as there is a lot or request from patients coming through

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Q39 What do you see as the major opportunities and challenges for pharmaceutical services locally in the next three years? Cost is always a challenge however I see pharmacy as a cost effective way of providing services in an efficient way Opportunities- Growth in population, if more services commissioned to us Challenges- Cut in NHS funding, deterioration of public health eg diabetes, obesity and increased competitor activity Tackling smoking, obesity, cancer awareness More pharmacy involvement in the ICP and WSIC programme. Pharmacists stepping up to provide more clinical services and fulfilling the roles that they take on. Many opportunities lie ahead provided pharmacist time is taken away from dispensing process, which can only happen with excellent support staff. Different pharmacies in this region should undertake training for different services so that there is always a pharmacy in the area that can help them without intruding on doctors' time. Opportunities - provide newer services Challenges - reduction in revenue from prescriptions, competing with supermarkets, groceries etc. who also sell GSL medicines, managing to provide services and dispensing medicines at the same time i.e. bureaucracy. Need funding for more staff and training. NHS health checks and other pharmaceutical services like the Flu vaccination programme Between CCGs and Public Health, if they can understand how community pharmacy can help achieve local health targets then there is an opportunity for more services, but if they don't then we face an uphill task Challenges = NHS Funding and stability of NHS commissioning organisations. Opportunities = to commission new services through Pharmacy and strengthening existing service provision Growing immigrant population with unmet healthcare needs. greater emphasis needed on disease prevalence of diabetes care in local population Diabetes Health screening Clinical opportunities are all well documented. Our challenge is recognition and funding Clinical opportunities are all well documented. Our challenge is recognition and funding

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Ways to reduce the burden on the main hospital by providing more commissioned services in pharmacy Challenges as no funding to commission certain services that will be beneficial to the health of local population. Most services will be privately run in which as a pharmacy will this be beneficial to our business plan. The major opportunities will be the provision of new services in community pharmacies such as a phlebotomy service, Diabetes screening service and other services that will become commissioned in our area. This will expand the role of pharmacists and increase ease of access for customers. The challenges will be the funding of these serviced also existing services such as the MUR and NMS service, the challenge will be to provide more with reduced funding. More commissioned services- opportunity Availability of adequate funding- challenge In addition to MUR and NMS, managing repeat prescriptions for patients with chronic conditions Advanced services When EPS2 goes live all over the UK Lack of money driving patients to seek help from Pharmacies and OTC. Ageing population needing support to manage long term conditions and medicines Require Public health to understand local needs and procure them to pharmacy - patients find pharmacy easily accessible and pharmacists skills under-utilised Pharmacy being involved with patients with long term conditions Additional services such as diabetes management, weight loss etc. allow pharmacists to make a massive difference to quality of life, the challenges include funding and time pressures Increase in pharmacy services assigned as a major opportunity. Reduction in payments and increase in drug cost due to short supply Weight management, health checks and vaccinations It will be more NHS services based Commissioned services and better patient access Independent prescribing helps a lot of patients who can't access GPs after opening hours

Do you have any other comments?

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A pharmacist on the CCG Board and on the HWB board would help enormously with communications and integration of pharmacy services with the other NHS services. This would also help to improve patient care! Haven't worked for long which is why I don’t have much of a relationship with our local authority/CCG. I'm not sure who is my port of call for any assistance as I do not know names and responsibilities We need to be aware of what is going on in terms of services, what’s available, who commissions it? How can we provide these services etc? We need pharmacies to work together to save profits being diminished from prescriptions. We need help to raise our profile in the community. Clinical skills of pharmacists are under-utilised. CCGs need to analyse QOF and see where pharmacy can help GPs, and Public Health need to identify the local health needs and then procure services to pharmacy to enable these needs to be met We would love to become a healthy living pharmacy as we are open for 100 hours and we have gained a good relationship with the community and would like to put our clinical skills to the test more than we do already. Please note in answer above to all questions where it is noted we provide a particular private service, we wish to make it clear that we would be also be willing to provide an NHS commissioned service too, if it were made available to us. Please note also our opening hours are 8.45 am, to 7 pm. Some of the questions being asked are rather ambiguous! We deliver to Ealing and Hanwell area. We need extra services available for us to provide most urgently Lots of unused full packs of medicines are being returned to Pharmacies especially when the patient expires or are taken into care homes. Lot of extra work i.e. paperwork etc. and long hours in pharmacy for less and less money!! Too much work in the pharmacy i.e. paperwork etc. and not enough money in pharmacy! Pharmacy under utilised We all need to work together in best interest of patients

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Appendix K: Results of the commissioner survey

Q1 Which of the following services do you commission or may be considering commissioning from local community pharmacies?

67% Contraceptive service 33% (not EHC) 0

50% Chlamydia Treatment 50% Service 0% Not able or willing to commission

50% 50% Chlamydia Testing May consider Service 0% commissioning

50% Currently 0% commissioned under Care Home Service contract with LA 50% Currently 33% commissioned under contract with CCG Anti-viral Distribution 67% Service 0% Currently commissioned under contract with Area 50% Team Anticoagulant Monitoring 50% Service 0%

0% 50% 100%

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

Currently Currently Currently commissio Not able or commissioned commissioned May consider ned under willing to under contract under contract commissioning contract commission with Area Team with CCG with LA Allergy management 0% 0% 0% 0% 100% service Alzheimer’s/ dementia 0% 0% 0% 33% 67% management service Asthma management 0% 0% 0% 50% 50% service CHD management 0% 0% 0% 50% 50% service COPD management 0% 0% 0% 50% 50% service Depression management 0% 0% 0% 50% 50% service Diabetes type I management 0% 0% 0% 50% 50% service Diabetes type II management 0% 0% 0% 50% 50% service Epilepsy management 0% 0% 0% 50% 50% service Heart Failure management 0% 0% 0% 50% 50% service Hypertension management 0% 0% 0% 50% 50% service Parkinson’s 0% 0% 0% 50% 50% disease Emergency Hormonal 0% 0% 75% 0% 25% Contraception Service 224

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Currently Currently Currently commissio Not able or commissioned commissioned May consider ned under willing to under contract under contract commissioning contract commission with Area Team with CCG with LA Gluten Free Food Supply Service (i.e. 0% 0% 0% 50% 50% not via FP10) Home Delivery Service (not 0% 0% 0% 0% 100% appliances) Independent 0% 0% 0% 50% 50% Prescribing Service If currently providing an Independent Prescribing 0% 0% 0% 0% 100% Service, what therapeutic areas are covered? Language Access 0% 0% 0% 0% 100% Service Medication Review 0% 0% 0% 50% 50% Service Medicines Assessment and 0% 0% 0% 50% 50% Compliance Support Service Minor Ailment 0% 50% 0% 0% 50% Scheme MUR Plus/Medicines 0% 0% 0% 0% 100% Optimisation Service If currently providing an MUR Plus/ Medicines Optimisation 0% 0% 0% 0% 100% Service, what therapeutic areas are covered? Needle and Syringe 25% 0% 50% 0% 25% Exchange Service

Obesity 0% 0% 0% 0% 100% management

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Currently Currently Currently commissio Not able or commissioned commissioned May consider ned under willing to under contract under contract commissioning contract commission with Area Team with CCG with LA (adults and children) On Demand Availability of 0% 0% 0% 0% 100% Specialist Drugs Service Out of Hours 0% 0% 0% 0% 100% Services Patient Group Direction Service (name the 0% 0% 67% 0% 33% medicines covered by the Patient Group Direction) Phlebotomy 0% 0% 0% 0% 100% Service Prescriber Support 33% 0% 0% 0% 67% Service Schools Service 0% 0% 0% 0% 100% Other (please state) 0% 0% 0% 50% 50%

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

100% 0% Other (please state below) 0%

50% Seasonal Influenza 0% Vaccination Service(2) 50%

67% 33% HIV screening service 0%

33% Not able or willing to 67% commission Hepatitis screening service 0% May consider 0% 67% commissioning HbA1C screening service 33% Currently commissioned 50% under contract with LA 50% H. pylori screening service 0% Currently commissioned 25% under contract with CCG 75% Gonorrhoea screening service 0% Currently commissioned under contract with Area 0% 67% Team Diabetes screening service 33%

33% 33% Cholesterol screening service 33%

0% 67% Alcohol screening service 33%

0% 50% 100%

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

Currently Currently Currently commissione Not able or commissioned commissioned May consider d under willing to under contract under contract commissioning contract with commission with Area Team with CCG LA Childhood 0% 0% 0% 0% 100% vaccinations Hepatitis (at risk workers 0% 0% 0% 0% 100% or patients) HPV 0% 0% 0% 50% 50% Travel 0% 0% 0% 50% 50% vaccines

Q5 Which of the following services do you commission or may be considering commissioning from local community pharmacies?

Currently Currently Currently Not able or commissioned commissioned commissioned May consider willing to under contract under contract under contract commissioning commission with Area Team with CCG with LA Sharps Disposal Service 25% 0% 0% 50% 25% Stop Smoking Service 0% 0% 100% 0% 0% Supervised Administration Service 33% 0% 33% 0% 33% Supplementary Prescribing Service (what therapeutic areas are covered?) 33% 0% 0% 33% 33% Vascular Risk Assessment Service (NHS Health Check) 0% 0% 67% 0% 33%

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Abbreviations AURs- Appliance Use Reviews BME- Black and Minor Ethnicity Groups CCGs- Clinical Commissioning Groups COPD- Chronic obstructive pulmonary disease CVD- Cardiovascular disease DACs- Dispensing Appliance Contractors DSR- Directly Standardised Ratio EHC- Emergency Hormonal Contraception HLP- Healthy Living Pharmacy HWB- Health and Wellbeing Board IMD- Index of Multiple Deprivation JSNA- Joint Strategic Needs Assessment LA- Local Authority LB- London Borough LPS- Local Pharmaceutical Service LSOAs- Lower Super Output Areas MIU- Minor Injuries Unit MURs- Medicines Use Reviews NMS- New Medicines Service ONS- Office for National Statistics PCTs- Primary Care Trusts PNA- Pharmaceutical Needs Assessment PSNC- Pharmaceutical Services Negotiating Committee SAC- Stoma Appliance Customisation SAR- Standardised Admission Rates SC- Supervised Consumption SHA- Strategic Health Authority SMR- Standardised Mortality Rates TIA- Transient Ischaemic Attack WLMHT- West London Mental Health Trust 229

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References 1. Health Act 2009 - http://www.legislation.gov.uk/ukpga/2009/21/part/3/crossheading/pharmaceut ical-services-in-england?view=plain 2. Health and Social Care Act 2012 - http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted 3. Pharmaceutical Regulations 2013 - http://www.legislation.gov.uk/uksi/2013/349/contents/made 4. Ealing Joint Strategic Needs Assessment 2012 - http://www.ealing.gov.uk/downloads/download/1018/ealing_joint_strategic_n eeds_assessment 5. The 2013 Directions - https://www.gov.uk/government/uploads/system/uploads/attachment_data/file /193012/2013-03-12_-_Advanced_and_Enhanced_Directions_2013_e- sig.pdf and amendment https://www.gov.uk/government/uploads/system/uploads/attachment_data/file /266023/pharmaceutical_services_directions_amendment_2013.pdf 6. General Pharmaceutical Services in England - 2003-04 to 2012-13: http://www.hscic.gov.uk/searchcatalogue?productid=13373andtopics=1%2fPr imary+care+services%2fCommunity+pharmacy+servicesandsort=Relevance andsize=10andpage=1#top 7. Ealing PNA and subsequent supplementary statements, accessed on 11/9/14 – http://www.ealing.gov.uk/downloads/download/3050/pharmaceutical_needs_ assessment 8. Ealing Council Local Strategic Partnership, May 2013; http://www.ealing.gov.uk/info/200631/strategies_plans_and_partnerships/350 /local_strategic_partnership/7 9. Healthy Living Pharmacy: overview, National Pharmaceutical Association, 2012: http://www.npa.co.uk/Documents/HLP/HLP_overview_12.11.pdf 10. ONS Mid-Year Population Estimates (1963-2013): http://www.ons.gov.uk/ons/publications/index.html 11. ONS Census, 2011: http://www.ons.gov.uk/ons/guide- method/census/2011/census-data/index.html 12. Projecting Adult Needs and Service Information, Institute of Public Care: http://www.pansi.org.uk/

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13. Protecting Older People Population Information, Institute of Public Care: http://www.poppi.org.uk/ 14. Information Centre About Asylum and Refugees: http://www.icar.org.uk/9555/statistics/statistics.html 15. Ealing Council-Travellers in Ealing: http://www.ealing.gov.uk/info/100003/community/213/travellers_in_ealing 16. Office For National Statistics, Atlas of Deprivation, 2010: http://www.ons.gov.uk/ons/rel/regional-trends/atlas-of-deprivation-- england/2010/atlas-of-deprivation-2010.html 17. Higher diagnoses are indicative of good performance. The national target was least 2,000 diagnoses. 18. 50% and above rate is an issue of concern. 19. ‘Who do you think we are? Community Pharmacy: dispensers of health’, Pharmacy Voice: http://www.dispensinghealth.org/wp- content/uploads/2014/01/DH-Launch-FINA1.pdf 20. ‘Pharmacy in England: Building on strengths – delivering the future’, Department of Health (2008) http://www.official-documents.gov.uk/document/cm73/7341/7341.pdf 21. ‘The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England’, BMJ Open 2014, Vol. 4, Issue 8 - http://bmjopen.bmj.com/content/4/8/e005764.full.pdf%20html 22. NHS Choices website: http://www.nhs.uk/Service-Search/Pharmacy/LocationSearch/10

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Equality impact assessment

Overview

Legal obligations under Section 149 of the Equality Act 2010: The Public Sector Equality duty

 As a public authority we must have due regard to the need to: a) Eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; b) Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; c) Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.  The protected characteristics are: AGE, DISABILITY, GENDER REASSIGNMENT, RACE, RELIGION & BELIEF, SEX, SEXUAL ORIENTATION, PREGNANCY & MATERNITY, MARRIAGE & CIVIL PARTNERSHIP  Having due regard to advancing equality of opportunity between those who share a protected characteristic and those who do not, involves considering the need to: a) Remove or minimising disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic b) Take steps to meet the needs of persons who share a relevant characteristic that are different from the needs of the persons who do not share it. c) Encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low.  Having due regard to fostering good relations between persons who share a relevant protected characteristic and persons who do not, involves showing that you are tackling prejudice and promoting understanding.  Complying with the duties may involve treating some people more favourably than others; but this should not be taken as permitting conduct that would be otherwise prohibited under the Act.

Proposal Summary Information

Choose Initiative/Function/Policy/Project/ Title: Pharmaceutical Needs Assessment Is it HR Related? From: Scheme (pick one) 2015 Yes No

Author Dr J Chin Service Public Health Directorate

Corporate Cabinet Report Decision/ EA (New) or (Adapted) or (Review) If other please Purpose Not Required for Cabinet/ relates Policy/Strategy/Service/Function/Project/ specify: Full Council (pick one) to Evaluation (pick one)

1. What is the Initiative/Function/Policy/Project/Scheme (pick one) looking to achieve? Provision of pharmaceutical services in the Ealing Borough

2. Which protected groups who will be affected22: All

22 AGE, DISABILITY, GENDER REASSIGNMENT, RACE, RELIGION & BELIEF, SEX, SEXUAL ORIENTATION, PREGNANCY & MATERNITY, MARRIAGE & CIVIL PARTNERSHIP 232

Assessment of the Potential Effect on People with the Protected Characteristics

Characteristic: AGE Does Your Proposal: Description: A Eliminate discrimination, harassment, victimisation and Advance equality of opportunity between persons who Foster good relations between persons who person of a any other conduct that is prohibited by or under this Act; share a relevant protected characteristic and persons share a relevant protected characteristic and particular age or who do not share it; persons who do not share it. being within an age group For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce combination of both, or neutral: negative effect: Describe the effect: Describe the action: Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide their age actions necessary within the provision of pharmaceutical service range, to ensure a wide age-range of respondents participate. provision to reduce these health inequalities. Access and availability to Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board. With regards to age, the PNA is considering in particular, the health of pre-school age childrena nd over 65's

Characteristic: DISABILITY Does Your Proposal: Description: A Eliminate discrimination, harassment, victimisation Advance equality of opportunity between persons Foster good relations between persons who share a person has a and any other conduct that is prohibited by or under who share a relevant protected characteristic and relevant protected characteristic and persons who do disability if s/he has this Act; persons who do not share it; not share it. a physical or mental impairment For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce which has a combination of both, or neutral: negative effect: substantial and long term adverse effect on their ability to carry out normal day to day activities23 Describe the effect: Describe the action:

23 Due regard to meeting the needs of people with disabilities involves taking steps to take account of their disabilities and may involve making reasonable adjustments and prioritizing certain groups of disabled people on the basis that they are particularly affected by the proposal. 233 Assessment of the Potential Effect on People with the Protected Characteristics

Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide information actions necessary within the provision of pharmaceutical service on any diabilities they may consider themselves to have, to ensure a wide provision to reduce these health inequalities. Access and availability to range of respondents participate. A pharmacy contractor survey wil be Pharmaceutical Services in the Borough of Ealing will be assessed and undertaken to establish what necessary adjustments pharmacy providers options considered to improve access and avilabaility. Persons with this are making to ensure disabled people may still fully access characteristic will be specifically targetted wthin the consultation. A pharmaceutical services Steering Group will consider any responses, and the final report will be signed off by the HWB Board

Characteristic: GENDER REASSIGNMENT Does Your Proposal: Description: This is Eliminate discrimination, harassment, victimisation Advance equality of opportunity between persons Foster good relations between persons who share a the process of and any other conduct that is prohibited by or under who share a relevant protected characteristic and relevant protected characteristic and persons who do transitioning from this Act; persons who do not share it; not share it. one sex to another. This includes For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce persons who combination of both, or neutral: negative effect: consider themselves to be trans, transgender and transsexual Describe the effect: Describe the action: Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide information actions necessary within the provision of pharmaceutical service on any gender reassignment they may have had or are undergoing, to provision to reduce these health inequalities. Access and availability to ensure a wide range of respondents participate. Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board.

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Characteristic: RACE Does Your Proposal: Description: A Eliminate discrimination, harassment, victimisation Advance equality of opportunity between persons Foster good relations between persons who share a group of people and any other conduct that is prohibited by or under who share a relevant protected characteristic and relevant protected characteristic and persons who do defined by their this Act; persons who do not share it; not share it. colour, nationality (including For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce citizenship), ethnic combination of both, or neutral: negative effect: or national origins or race Describe the effect: Describe the action: Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide information actions necessary within the provision of pharmaceutical service on their race, to ensure a wide range of respondents participate provision to reduce these health inequalities. Access and availability to Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board

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Characteristic: RELIGION & Does Your Proposal: BELIEF Description: Eliminate discrimination, harassment, victimisation Advance equality of opportunity between persons Foster good relations between persons who share a Religion means and any other conduct that is prohibited by or under who share a relevant protected characteristic and relevant protected characteristic and persons who do any religion. this Act; persons who do not share it; not share it. Belief includes religious and For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce philosophical combination of both, or neutral: negative effect: beliefs including lack of belief (for example, Atheism). Generally, a belief should affect a person’s life choices or the way you live for it to be included. Description: Description: Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide information actions necessary within the provision of pharmaceutical service on their gender, to ensure a wide range of respondents participate provision to reduce these health inequalities. Access and availability to Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board.

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Characteristic: SEX Does Your Proposal: Description: Eliminate discrimination, harassment, victimisation Advance equality of opportunity between persons Foster good relations between persons who share a Someone being a and any other conduct that is prohibited by or under who share a relevant protected characteristic and relevant protected characteristic and persons who do man or a woman this Act; persons who do not share it; not share it.

For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce combination of both, or neutral: negative effect: Describe the effect: Describe the action: Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide information actions necessary within the provision of pharmaceutical service on their gender, to ensure a wide range of respondents participate provision to reduce these health inequalities. Access and availability to Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board.

Characteristic: SEXUAL ORIENTATION Does Your Proposal: Description: A Eliminate discrimination, harassment, victimisation Advance equality of opportunity between persons Foster good relations between persons who share a person’s sexual and any other conduct that is prohibited by or under who share a relevant protected characteristic and relevant protected characteristic and persons who do attraction towards this Act; persons who do not share it; not share it. his or her own sex, the opposite sex or For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce to both sexes. combination of both, or neutral: negative effect: Description: Description: Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide information actions necessary within the provision of pharmaceutical service on their sexual orientation, to ensure a wide range of respondents provision to reduce these health inequalities. Access and availability to participate Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board

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Characteristic: PREGNANCY & MATERNITY Does Your Proposal: Description: Eliminate discrimination, harassment, victimisation Advance equality of opportunity between persons Foster good relations between persons who share a Pregnancy: Being and any other conduct that is prohibited by or under who share a relevant protected characteristic and relevant protected characteristic and persons who do pregnant. this Act; persons who do not share it; not share it. Maternity: The period after giving For the three duties above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce birth - linked to combination of both, or neutral: negative effect: maternity leave in the employment context. In the non-work context, protection against maternity discrimination is for 26 weeks after giving birth, including as a result of breastfeeding Describe the effect: Describe the action: Positive impact- The PNA takes account of health needs and how Pregnancy and breastfeeding groups have not been specifically differing population groups' needs may vary. It will then consider any monitored actions necessary within the provision of pharmaceutical service provision to reduce these health inequalities. Access and availability to Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board

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Characteristic: MARRIAGE & CIVIL PARTNERSHIP Does Your Proposal: Description: Eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; Marriage: A union Yes No between a man and For the duty above, consider whether the impact is positive, negative, a Alternatives and mitigating actions which have been considered in order to reduce a woman. Civil combination of both, or neutral: negative effect: partnership: Civil partners must be treated the same as married couples on a range of legal matters. Describe the effect: Describe the action: Positive impact- The PNA takes account of health needs and how A public survey is to be undertaken to establish views on pharmaceutical differing population groups' needs may vary. It will then consider any survey provision. Survey respondents will be asked to provide information actions necessary within the provision of pharmaceutical service on their married status, to ensure a wide range of respondents participate provision to reduce these health inequalities. Access and availability to Pharmaceutical Services in the Borough of Ealing will be assessed and options considered to improve access and avilabaility. Persons with this characteristic will be specifically targetted wthin the consultation. A Steering Group will consider any responses, and the final report will be signed off by the HWB Board

4. Human Rights 4a. Does your proposal impact on Human Rights as defined by the Human Rights Act 1998? Yes No

4b. Does your proposal impact on the rights of children as defined by the UN Convention on the Rights of the Child? Yes No

4c. Does your proposal impact on the rights of persons with disabilities as defined by the UN Convention on the Rights of persons with disabilities?

Yes No

For further guidance please refer to the Human Rights & URNC Guidance on the Council Equalities web page.

Describe the effect and any mitigating action you have considered.

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5. Information 5a. What evidence, data sources and intelligence did you use to assess the potential impact/effect of your proposal? Please note the systems/processes you used to collect the data that has helped inform your proposal. Please list the file paths and/or relevant web links to the information you have described. Public survey and consultation responses. Previous complaints raised by NHS England and the Clinical Commissioning Groups. Pharmacy provider survey. Commissioner survey Lb. What has your analysis of the information shown? Is there evidence of lawful/unlawful discrimination? None

6. Action Actions (Include any actions you plan to take to Outcomes Success Timescales/ Lead Officer (Include contact Planning reduce any negative effect on your proposal in Measures Milestones email and telephone number) addition to other key project milestones)

7. Have the above actions If no, how will you measure the effect of your decision/policy/project/service on an ongoing basis? What ongoing outcomes are Date for post been incorporated into your you intending to monitor? implementation service/business plan or review dedicated project plan? Yes No 1/4/2015

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Completing Officer Sign Off: Service Director Sign Off: For HR related activities/projects/reviews only:

Signed Signed Signed

Name (Please print) Name (Please print) Name (Please print)

Date: Date: Date:

For EA’s relating to Cabinet decisions: received by Committee Section for publication by (date):

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Map A: Pharmacy locations

. 242

Ealing PNA Draft Map B: Pharmacy locations and ward boundaries

243 Ealing PNA Draft Map C: Pharmacy locations and population density by output area

244 Ealing PNA Draft Map D: Pharmacies and Index of Multiple Deprivation 2010 by output area

245 Ealing PNA Draft Map E: Average peak drive times to nearest pharmacy

246 Ealing PNA Draft Map F: Average public transport times to nearest pharmacy, Tuesday, 9am to 5pm

247 Ealing PNA Draft Map G: Average walking times to nearest pharmacy

248