Section II: Report and Analysis by GP Federation

7. & Area

7.1 Pharmacies and Dispensing Practices

7.1.1 The pharmacies and dispensing practices in Taunton & Area are shown in the tables below:

Table II.7.1 Pharmacies in Taunton & Area Enhanced Advanced Locally Commissioned Services Services Services

Contract

code Contract Name Trading Name Address1 Address2 Address3 Postcode Type Ailments Minor Drugs Care) (Palliative Specialist Reviews Use Medicines Service Medicines New Reviews Use Appliance Stoma Customisation of administration Supervised medicine Hormonal Emergency Contraception Bins Screening Chlamydia Service Smoking Stop exchange Needle FL864 Lydeard Care The Surgery Mount Stree t Bishops TA4 3LH 40 hr Y Y Ltd Pharmacy Lydeard

FGC75 John Ware Ltd Creech Creech Creech St TA3 5FA 40 hr Y Y Y y y y y Pharmacy Medical Michael Centre

FX748 Asda Stores Asda Pharmacy Creechbarrow Taunton TA1 2AN 40 hr Y y y y y Ltd Road

FMG12 Boots UK Ltd Boots Pharmacy 64 -65 High Taunton TA1 3PT 40 hr Y Y Y y y y y (301) Street FH013 Boots UK Ltd Boots Pharmacy Upper Holway Taunton TA1 2QA 40 hr Y Y y y y y (5416) Road

FF222 Boots UK Ltd Boots Pharmacy French Weir French Weir Taunton TA1 40 hr Y Y y y y (5428) Health Centre Avenue 1NW

FV860 Boots UK Ltd Boots Pharmacy Crown Venture Way Taunton TA2 8QY 40 hr Y Y y y y y (5429) Medical Centre

FDN85 Boots UK Ltd Boots Pharmacy St James St James Taunton TA1 1JP 40 hr Y Y y y y y (5653) Medical Street Centre

FJ206 Boots UK Ltd Boots Pharmacy 1 Cooper's Mill Norton Taunton TA2 6NX 40 hr Y Y y y y y (5654) Fitzwarren

FX068 Day Lewis Day Lewis 1 The Square Taunton TA4 2JT 40 hr Y Y Y y y y y Chemists Ltd Pharmacy

FVF04 John Ware Ltd Staplegrove Unit 1, Staplegrove Taunton TA2 6BD 40 hr L L y y y y Pharmacy Livingstone Way

FAG80 Lloyds Lloyds Blackbrook Lisieux Way Taunton TA1 2LB 40 hr Y Y S Pharmacy Ltd pharmacy Medical (6338) Centre

FWH16 National Co - Co -operative 2 The Pitts Close, Taunton TA1 4TN 40 hr Y Y Y y y y y operative Pharmacy Galmington Chemists Ltd (200290) Centre FFA77 National Co - Co -operative 5 Priorswood Priorswood Taunton TA2 7JW 40 hr Y Y y y y y operative Pharmacy Place Estate, Chemists Ltd (200278) Eastwick Road

FJ319 Sainsbury’s Sainsbury's Riverside Taunton TA1 2LR 40 hr Y Y L y y y Supermarkets Pharmacy Retail Park Ltd

FTP97 Superdrug Superdrug 1-10 Paul Taunton TA1 3PF 40 hr Y L y y y y Stores plc Pharmacy Street

FL274 Wm Morrisons Morrisons Dellers Wharf Priory Bridge Taunton TA1 1DX 40 hr Y Y L y y y Supermarkets Pharmacy Road plc Pharmacy

FJG01 Boots UK Ltd Boots Pharmacy 6 High Street Wellingto TA21 40 hr Y Y y y y y y (352) n 8RA

FFF46 Lloyds Lloyds Luson Surgery Fore Street Wellingto TA21 40 hr Y Y S y y y Pharmacy Ltd pharmacy n 8AG (0783)

FHG93 Superdrug Superdrug 5 Fore Street Wellingto TA21 40 hr Y L y y y Stores plc Pharmacy n 8AA

FQ035 Boots UK Ltd Boots Pharmacy Wellington Mantle Street Wellingto TA21 40 hr Y Y y y (862) Medical n 8BD Centre

PHARMACY ENHANCED AND ADVANCED SERVICES: KEY Minor Ailments Y Commissioned and providing the service (4 or more monthly claims in 2013/14) L Commissioned but 3 or fewer claims in 2013/14 X Commissioned but no claims in 2013/14 Blank Not commissioned Specialist Drugs Y Commissioned Blank Not commissioned Medicines Use Reviews Y Providing Medicines Use Reviews (max. 400 in a year) L Carried out less than 24 MURs in 2013/14 Blank No MURs claimed in 2013/14 New Medicines Service Y Providing New Medicines Service L Carried out less than 24 NMSs in 2013/14 Blank No NMS claimed in 2013/14 Appliance Use Reviews Note: no valid claims made by any pharmacy in 2013/14 Stoma Customisation S Has received Stoma Customisation fee in 2013/14 (paid automatically) but AreaTeam yet to verify whether actually providing this service Blank No Stoma Customisation fees paid in 2013/14

Table II.7.2 Dispensing Doctors’ Practices and Branches in Taunton & Area

Contract Code Contract Name Address1 Address2 Address3 Postcode Opening Hours Type dispensing GP L85037 Health Centre Greenway North Curry Taunton TA3 6NQ Monday-Friday, 9.00-18.00 practice Lister House dispensing GP L85038 Surgery Bollams Mead Wiveliscombe TA4 2PH Monday-Friday, 8.30-18.00 practice Quantock Vale Bishops Monday -Friday, 9.00 -13.00, 14.00 - dispensing GP L85036 Surgery Mount Street Lydeard Taunton TA4 3LH 18.00 practice Milverton Creedwell Monday, Thursday, Friday, 8.30 -17.00; dispensing GP L85038 Surgery Orchard Milverton Taunton TA4 1JZ Tuesday, Wednesday 8.30-18.00 practice branch Monday 8.30am - 12.30pm; 3.00pm - 6.00pm; Tuesday 8.30am - 12.30pm, 3.00pm - 6.00pm; Wednesday 8.30am - 12.30pm; Thursday 8.30am Churchinford - 12.30pm, 3.00pm - 6.00pm; Friday dispensing GP L83044 Surgery Fairfield Green Churchinford Taunton TA3 7RR 8.30am - 12.30pm, 3.00pm - 6.00pm practice branch

7.1.2 There are no 100 hour pharmacies. However, there are twenty-one 40 hour pharmacies in the Taunton & Area federation region and Sainsbury’s pharmacy at Hankridge Farm next to Junction 25 of the M5 is open for 86 hours per week (this was opened under the regulations based on the size of the retail park not opening hours). Fifteen of the 40 hour pharmacies are in Taunton and four are based in Wellington. There are also two dispensing GP practices and two dispensing GP practice branch in Taunton and a further dispensing practice in Wiveliscombe. There is a dispensing practice in Wiveliscombe which serves the surrounding rural area (but not the town itself, where there is a pharmacy), along with a further dispensing practice and two dispensing branch serving other rural parts. In Bishops Lydeard the community pharmacy (Lydeard Care Ltd) acts as the dispensary for the dispensing practice, thereby serving both the village and the wider rural area.

Table II.7.3 Number of Pharmacies and Dispensing Practices – Taunton & Area

GP Pharmacies Dispensing GP Pharmacies Providers Total registered /100,000 /100,000 100 hr 40 hr practice branch population Taunton & 21 3 2 26 117,200 17.9 22.2 Area 12 91 22 5 130 554,100 18.6 23.5 South West 1048 181 1229 5,301,000 19.8 23.2 Federation and Somerset Pharmacies, Dispensing GP and population figures as at July 2014, rounded to nearest 100

South West Pharmacies and Dispensing GP figures as at March 2013; population mid-2011 ONS estimate rounded to nearest 1000

7.1.3 The number of pharmacies per 100,000 and pharmaceutical providers per 100,000 in Taunton & Area is slightly below that for Somerset and the South West region as a whole, but the concentration of population and services in the county town probably compensates by greater accessibility of pharmaceutical service providers than in the more rural areas. This figure is only indicative and does not indicate a required or standard ratio for pharmacies per head.

Table II.7.4: Location of Pharmacies in relation to local distribution (Addresses)

Total Addresses within Addresses more Percentage of Addresses 1.6km of than 1.6km of addresses within (2013) pharmaceutical pharmaceutical 1.6km service provider service provider

Taunton and 52,200 44,100 8,100 84% Area Somerset 257,200 193,900 63,300 75%

7.1.4 The number of addresses within effective walking distance of a pharmaceutical service provider is above the county average, with over four fifths of addresses within 1.6 km. This shows that the pattern of providers very broadly reflects the distribution of dwellings and workplaces. Access by car (see Map 5.2 in county analysis) suggests that almost all of the Federation’s population is within 15 minutes’ drive of a pharmacy.

7.1.5 There are no 100 hours pharmacies in Taunton and Area Federation. The map (5.3 in county analysis) suggests that the majority of the population is within 25 minutes’ drive of such a pharmacy; relatively sparsely populated areas to the north west of Taunton town in the Brendon and are 35 minutes’ drive from such a pharmacy. However, these are relatively sparsely populated areas. As the administrative centre and largest town of the county it might be expected that the opening hours of pharmaceutical services providers would be as long, or longer than elsewhere; this is not the case, as Taunton does not have a 100 hour pharmacy, although Sainsbury’s pharmacy at Hankridge Farm by Junction 25 of the M5 does currently open for 86 hours per week. An intention to open a 100 hour pharmacy in Taunton was made by Boots before 2010, but was not taken up. A lack of demand for such extended hours is also suggested by the fact that no respondent in the Federation has suggested that this constitutes a gap in provision for the town. Should such a need emerge during the period of the PNA then NHS should work with existing providers to consider this possible improvement.

7.2 Population & context for health (from the Somerset Public Health Federation profile)

7.2.1 The Federation has a similar population age profile to the Somerset average. Federation has similar levels of deprivation to the Somerset average. The Index of Multiple Deprivation score for the Federation is 16.7. This is similar to the average for Somerset of 16.9

7.2.2 Mortality, causes and places of death

7.2.3 Life expectancy is the shortest in the county at birth and age 65. Premature mortality is similar to the county average, with 12% of deaths occurring before age 65 compared to 13% Somerset average. The area has the highest all-cause mortality and mortality rate for circulatory diseases across all age groups. Mortality rates for cancers are similar to average. A lower than average proportion of people die in their own home and the area has the highest proportion who die in hospital.

7.2.4 Disease prevalence

7.2.5 Disease prevalence is generally lower than expected compared to modelled rates. However the Federation has the highest rates compared to expected levels for dementia and epilepsy. Disease levels compared to the rest of Somerset are generally much lower and often the lowest in the county. This may indicate low need or missed diagnoses. The proportions of people with diabetes, COPD and dementia who have been diagnosed is about average for diabetes, highest for dementia and slightly below average for COPD compared to other areas of the county.

7.2.6 Smoking

7.2.7 Smoking rates are similar to the rest of the county with 16% of adults 16+ recorded as smokers compared to 16% Somerset average. Low numbers of smokers go through smoking cessation services. Smoking in pregnancy remains a challenge for the whole county with high rates compared to the rest of England, although a Federation breakdown is not available.

7.2.8 Excess weight

7.2.9 Rates of adult obesity and childhood excess weight are similar to the Somerset average.

7.2.10 Drugs and Alcohol

7.2.11 Hospital admissions for drug and alcohol related reasons are higher than the Somerset average.

7.2.12 Sexual health

7.2.13 Cervical screening rates (25-49y) are better than the county average. Rates of teenage deliveries are similar to the county average. 7.2.14 Immunisations

7.2.15 Childhood vaccination rates are generally very good with absolute levels generally increased from last year. DH targets are for 95% uptake for all so there is still room for improvement. The Federation has the highest rates of flu vaccination in the county for those aged 65 and over and <65 at risk. Rates for pregnant women and carers are also above average.

7.2.16 Screening

7.2.17 Bowel and in general breast cancer screening rates are about average in the county whilst cervical screening rates are some of the best. The Federation has one of the lowest rates of invitation and checking of those eligible for NHS Health Checks programme.

7.2.18 Hospital admission rates

7.2.20 Emergency admission rates for falls in over 65s are 24 per 1000 compared to 26 per 1000 county average. Rates for under 18 admissions are the highest in the county. As a proxy for mental health, admissions for self-harm hospital and mental and behavioural disorders are the highest / worst in the county.

7.2.21 Suggested public health areas to prioritise

i. Increase numbers of smokers referred to smoking cessation services ii. Increase use of interventions to address drug and risky alcohol use iii. Improve mental health iv. Increase delivery of health checks as a measure to combat high local mortality rates from cardiovascular disease

7.3 Population Growth

7.3.1 Taunton & Area lies entirely within Taunton Deane District, which is projected by the ONS to grow by 4.7% between 2012 and 2018. The population structure is expected to age roughly in line with the county average, with an increase in the population aged 65 to 84 of 22.0%, and of population of 85 and over of 22.2% in the same period.

7.3.2 Housing allocations suggest that approximately 5,400 new dwellings are expected in Taunton & Area which is more than any other federation or district, implying a higher level of growth. Declining household size and limited house building may mean a falling population in some rural parts.

Map II.7.1 Housing Developments and Pharmacy Services in Taunton & Area.

7.3.3 The map indicates the relatively high scale of housing development expected in Taunton & Area, especially to the east of the county town, and that the sites of such development are relatively close to existing pharmacies.

Map II.7.2 Deprivation and Pharmacy Services in Taunton & Area

7.3.4 The map, showing Somerset quintiles of deprivation in the 2010 Index of Multiple Deprivation, indicates that deprivation levels are high in the areas around Taunton and Wellington: both of these areas are well supported by pharmaceutical services. The rest of the federation has lower levels of deprivation but has good cover for a rural area. 7.4 Conclusion

7.4.1 Taunton and Area appears to have adequate provision of pharmaceutical services. It is perhaps surprising that, as the county town, the level is not higher, but that is not to suggest a gap in the existing services. The latest pharmacies open on a Saturday close at 9PM, and on a Sunday all are closed by 6 PM (please see section on opening times). Whilst there is no indication that this is creating a gap in provision, it might ‘normally’ be expected that the county town would have the most services. The town of Taunton is expected to grow during the PNA, particularly to the east. There is no indication that existing providers could not cope with this continued growth. However, if a gap is to emerge it is most likely to be in such peripheral housing estates where access to existing providers is, for whatever reason, difficult. As this depends on details of the design of housing estates and development that are not yet certain, it cannot be said that a definite gap has been identified here.