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Nhs Havering NHS HAVERING Pharmaceutical Needs Assessment 1 Document Control Title: NHS Havering – Pharmaceutical Needs Assessment Authors: Mohamed Kanji – Senior Pharmaceutical Advisor Matthew Henry – Medicines Management Data Analyst Belinda Krishek – Chief Pharmacist Sanjay Patel – Head of Community Pharmacy Denise Baker – Community Pharmacy Administrator Approved By: NHS Havering Board Version: 2011 Final Version 1.0 2 CONTENTS PAGE Page Number 1. Executive Summary 5 2. 10 Key Points for Decision Makers 8 3. Pharmaceutical Needs Assessment 9 3.1 What is a PNA? 9 3.2 What will the PNA achieve? 10 3.3 NHS Havering Vision and Context 10 3.4 National Policy Context 10 3.5 Assessment of Needs 10 3.6 Pharmaceutical Services Covered 11 3.7 What is a Joint Strategic Needs Assessment? 11 3.8 Commissioning Arrangements 12 3.9 Characteristics of Localities 12 3.10 Applications 12 3.11 Assessment of Pharmaceutical Services and Pharmaceutical Needs 13 3.12 Process followed in developing the PNA 15 3.13 Mapping 16 3.14 Consultation 16 4. Demographics & Future Growth 17 4.1 Current Population 17 4.2 Future Growth 17 4.3 Life Expectancy 20 5. Pharmacies Key Information 21 5.1 Location of Pharmacies 23 6. GPs, Hospitals & Polysystems 25 6.1 JSNA Recommendations 25 6.2 GP Practices 25 6.3 Hospitals 27 6.4 Polysystems 27 7. Opening Hours 28 7.1 100 hour Pharmacies 30 7.2 Sunday Rota Service 30 7.3 Bank Holiday Rota Service 30 7.4 Out of Hours Access to Medicines 30 7.5 GP Opening hours 31 7.6 How Pharmacy Can Contribute? 31 8. Essential Services 32 8.1 Equality Act 2010 ( Formerly Disability and Discrimination Act) 32 8.2 Monitoring of the Community Pharmacy Contractual Framework 32 8.3 Local Support Groups 33 8.4 Language Line 33 9. Advanced services 34 9.1 Stoma Customisation & Appliance Use Review 34 9.2 Medicines Usage Reviews (MURs) 34 9.3 Advanced Service Tables 35 10. Enhanced Services 38 10.1 Summary table 38 10.2 Enhanced Services for Substance Misuse 41 10.3 Diabetes 46 10.4 Anti-coagulation Monitoring (Warfarin) 49 10.5 Smoking Cessation Service 51 10.6 Chlamydia Screening & Treatment 53 10.7 Medicines Administration Record (MAR) Service 55 3 Page Number 11. Better Management of Medicines 56 11.1 Background 56 11.2 Enhanced Medication Usage Reviews 58 11.3 Repeat Dispensing 58 11.4 Integrated Case Management 60 11.5 Improved Medicines Management in Nursing Homes 60 11.6 Other Areas 60 12. Patient Feedback 62 13. Pharmacists Survey 63 14. GP Survey 66 15. Identified Health Needs 67 15.1 Background. 67 15.2 Emergency Hospital Admissions 68 15.3 Under 18 Conception 70 15.4 Chronic Obstructive Pulmonary Disorder (COPD) 72 15.5 Obesity & Physical Activity 75 15.6 Cancer 78 15.7 Stroke 79 15.8 Hypertension 81 15.9 Healthy Eating 84 15.10 Alcohol 85 15.11 Dementia 88 15.12 Transforming Community Equipment Service (TCES) 88 16. Appendices 90 16.1 (Appendix 1) Glossary 90 16.2 (Appendix 2) Consultation Report 92 16.3 (Appendix 3) List of pharmacies 107 16.4 (Appendix 4) Patient Survey Responses 109 16.5 (Appendix 5) Opening Hours of Pharmacies 116 4 1. EXECUTIVE SUMMARY Legislation requires that each Primary Care Trust has a Pharmaceutical Needs Assessment (PNA). The regulations set out the scope of the PNA and require a PNA to be in place by the 1st of February 2011. NHS Havering’s PNA is a tool to help in the commissioning of pharmaceutical services. It is focused on the priorities identified locally, in particular within the Joint Strategic Needs Assessment (JSNA). DH guidance states that the PNA must be a key component of the JSNA, whilst being a separate document. The PNA is in line with the vision in the DH White Paper Equity and Excellence: Liberating The NHS which states ‘The community pharmacy contract, through payment for performance, will incentivise and support high quality and efficient services, including better value in the use of medicines through better informed and more involved patients. Pharmacists, working with doctors and other health professionals, have an important and expanding role in optimising the use of medicines and in supporting better health. GP consortia and the NHS commissioning board will use the JSNA to inform their healthcare commissioning decisions’. The PNA is also in line with the QIPP (Quality Improvement Productivity Prevention) agenda. Below are the key points arising from the PNA grouped into different categories. General Pharmacy Provision • Havering has good coverage of pharmaceutical service providers and the PNA has not identified a need for any new pharmaceutical service providers • Over 600 members of the public completed the PNA patient survey in a variety of settings. Patients are very happy with the pharmacy services and access to pharmacies • NHS Havering will work with all pharmacies to ensure that they deliver services to the quality expected from their service contracts • A pharmacy minor ailments scheme could address the patients’ feedback for extended GP opening hours by capitalising on the extended pharmacy opening hours. It would also bring Havering in line with all the other PCTs in North East London and the majority of PCTs nationally who commission such a service. Such schemes are a cost effective way of reducing the 18% of GP appointments that are solely for minor ailments, and are supported by patients and GPs • PCTs are required to consider changes that take place after the publication of the PNA and decide if a supplementary statement or the publication of a new assessment is required. The Community Pharmacy Steering Group will consider changes in the health needs and in the provision of pharmaceutical services on an on-going basis and decide the appropriate revisions that need to take place Substance Misuse Services • Substance misuse services through pharmacy offer an excellent opportunity to target hard to reach groups. NHS Havering will work with the Drug Alcohol Action Team (DAAT) and community pharmacists to maximise the number of problematic drug users in treatment through enhancement of existing services • The majority of the Havering population can access the pharmacy needle exchange and supervised consumption services easily. However consideration needs to be given to commissioning these services in specific identified wards highlighted in the PNA 5 Other Enhanced Services • Pharmacies are making a valuable contribution to meeting the health needs of the population through enhanced services commissioned by NHS Havering and the Local Authority, in particular smoking cessation and anti-coagulation monitoring • Anticoagulation (Warfarin) service - Over 1400 patients have been transferred from secondary care to monitoring by community pharmacies. There is a high level of satisfaction with the service offered and projected savings are at least £84k in 2010/11 • Pharmacies are making a valuable contribution to helping smokers quit in Havering accounting for 53% of all the recorded, successful 4 week smoking quitters in Havering during 2009/10 • Overall there is a good distribution of pharmacies providing Chlamydia screening and treatment across Havering. However additional distribution points should be considered in Rainham & Wennington. NHS Havering will work with pharmacy providers to increase Chlamydia screening Better Management of Medicines • National Institute Clinical Excellence (NICE) guidance indicates that between a third and half of all the medication taken for long term conditions may not be taken as directed. Over 5% of hospital admissions may be medicines related of which half are preventable • The primary care prescribing budget in Havering is in excess of £34 million and better management of medication could help with the optimal use of this significant resource. Improving medicines taking could potentially have a greater impact on clinical outcomes than changing treatments and it could reduce hospital admissions • Community Pharmacists have contact with patients and their carers every time they are issued with medication. Patient groups in Havering strongly support greater information and education for patients around medication. Community Pharmacists can have a greater role in the management of medicines through enhanced Medication Use Review schemes in diabetes, hypertension and stroke. Also through Repeat Dispensing, the Electronic Prescription Service (EPS) and the Medicines Administration Record (MAR) scheme • Consideration needs to be given to improved medication management in the integrated case management work and also within nursing homes Health Needs • The success of the pharmacy smoking cessation and anti-coagulation services demonstrate that community pharmacy can provide cost effective and highly rated services that can meet the health needs of the population • Havering has an increasing under 18 conception rate, which is now higher than the national average. Some wards have amongst the highest rates in the country and termination rates are also above the national average. A pharmacy emergency contraception service should be commissioned, in line with the majority of PCTs in London and in line with the JSNA recommendations • A contraceptive service through pharmacy can be piloted in the specific wards. This will help the uptake of contraceptive services as recommended in the JSNA • A service should be commissioned in pharmacies to identify the 2.7% of the population who may have undiagnosed Chronic Obstructive Pulmonary Disease (COPD). A pilot in Havering 6 identified 7 severe COPD cases out of 126 smokers screened and potentially saved £12K
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