Item 11 Appendix 1
Salford Local Authority
Pharmaceutical Needs Assessment
Date: 31st March 2014 v 1.0 Item 11 Appendix 1
This Pharmaceutical Needs Assessment has been produced for Salford’s Health and Wellbeing Board by Salford Council in conjunction with Greater Manchester Commissioning Support Unit.
Date: 31st March 2014 v 1.0 1 Item 11 Appendix 1 Table of Contents 1.0 Foreword and Executive Summary...... 4 2.0 Introduction and process for developing the Pharmaceutical Needs Assessment (PNA)...... 5 2.1 Background...... 5 3.0 Context of the PNA...... 6 3.1 Purpose of a PNA...... 6 3.2 Scope of assessment ...... 6 3.3 Non-commissioned added value community pharmacy services...... 12 3.5 What is excluded from scope of the assessment?...... 13 3.6 Process followed for developing the PNA...... 13 3.7 Localities for the purpose of the PNA...... 14 3.8 Services provided across the border in other Local Authority areas...... 15 3.9 PNA consultation...... 15 3.10 PNA review process...... 16 4.0 Population Demography...... 17 4.1 Overview ...... 17 4.2 Age of Population...... 17 4.3 Future Age Trends...... 18 4.4 Life Expectancy...... 19 4.5 Ethnicity...... 26 4.6 Deprivation...... 27 5.0 Locally Identified Heath Need...... 31 5.1 Salford’s Strategic Priorities ...... 31 5.2 Public Survey ...... 44 6.0 Current Pharmacy Provision and Services ...... 46 6.1 Change in number of Pharmacy contractors from 2011...... 46 6.2 Dispensing activity...... 47 6.3 Access to pharmacies by location...... 50 6.4 Access to pharmacies by opening hours...... 57 6.5 Conclusion ...... 58 7.1 Housing and development...... 60 7.2 Primary care developments...... 60 7.3 Salford’s health needs in the future...... 61 8.0 Conclusion and Recommendations...... 75 9.0 Equality Impact Assessment ...... 78 10.0 Appendices...... 78
Date: 31st March 2014 v 1.0 2 Item 11 Appendix 1
1.0 Foreword and Executive Summary
This Pharmaceutical Needs Assessment (PNA) looks at the current provision of pharmaceutical services across Salford’s Health and Wellbeing Board (HWB) footprint and whether this meets the needs of the population and identifies any potential gaps to service delivery.
The PNA will be used by NHS England in its determination as to whether to approve applications to join the pharmaceutical list under The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. i
The PNA is required to be published by each HWB by virtue of section 128A of the 2006 Act updated in 2009ii.
The conclusion of this PNA is that the population of Salford’s HWB area has sufficient service provision (including pharmacy contractors) to meet their pharmaceutical needs. This is clearly demonstrated by the following points:
areas of high population all have a pharmacy located within 1 mile of them. approximately 92% of prescriptions generated by Salford prescribers are dispensed by Salford pharmacies
The current Pharmacy services commissioned from Salford pharmacies, in addition to Pharmacy’s NHS contract, lend themselves to assisting Salford HWB in achieving the required outcomes identified as the health priorities outlined in their strategy. To ensure the locally commissioned services are meeting the health needs they were set up to tackle regular reviews of them are required.
In the new NHS there is a need to bring all health partners including pharmacies together, along with other providers to ensure that the health and pharmaceutical needs of the local population are met through the appropriate commissioning of services. There is also a need for ensuring that those additional services that are commissioned by Salford City Council and Salford CCG from Salford pharmacies are promoted to the local population so as to improve their uptake. The patient survey indicated that on average a 50% of respondents would like to use one of these services, but may not be aware of how to access them.
Commissioners need to review the currently commissioned services and assess service delivery and health outcomes achieved. Review should include whether it is preferential to allow expressions of interest from all pharmacy contractors to engage in commissioned additional services in order to target the whole population and allow maximum access or whether targeted delivery by a small number of contractors would be more appropriate e.g. where the health need is specific to a certain population or location. It is important that any review includes possible or actual service delivery by other providers where they also meet specific pharmaceutical needs.
Date: 31st March 2014 v 1.0 3 Item 11 Appendix 1 2.0 Introduction and process for developing the Pharmaceutical Needs Assessment (PNA) 2.1 Background
The Health Act 2009 128A made amendments to the National Health Service Act 2006 stating that
(1) Each Primary Care Trust must in accordance with regulations— . (a) Assess needs for pharmaceutical services in its area, and (b) Publish a statement of its first assessment and of any revised assessment.
The regulations stated that a PNA must be published by each Primary Care Trust (PCT) by the 1st February 2011. There was a duty to rewrite the PNA s within 3 years or earlier if there were any significant changes which would affect the current or future pharmaceutical needs within the PCTs locality. This meant that subsequently revised PNAs were due to be produced by February 2014.
However the Health and Social Care Act 2012 brought about the most wide-ranging reforms to the NHS since its inception in 1948. These reforms included abolition of PCTs and the introduction of clinical commissioning groups (CCGs) who now commission the majority of NHS services. Public Health functions were not transferred to CCGs and are now part of the remit of Local Authorities.
In order to ensure integrated working and plan how best to meet the needs of any local population and tackle local inequalities in health the 2012 legislation calls for Health and Wellbeing Boards (HWB) to be established and hosted by local authorities. These boards should bring together the NHS, public health, adult social care and children’s services, including elected representatives and Local Healthwatch.
The Health and Social Care Act 2012 transferred responsibility for the developing and updating of PNAs to HWBs. It also made provision for a temporary extension of PCT’s PNAs and access to them by NHS England and HWBs.
In order that these newly established HWB had enough time to gather the information and publish a new PNA the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 now gives a requirement that each HWB must publish its first pharmaceutical needs assessment by 1st April 2015, unless a need for an earlier update is identified.
Date: 31st March 2014 v 1.0 4 Item 11 Appendix 1 3.0 Context of the PNA 3.1 Purpose of a PNA
A PNA will use the Joint Strategic Needs Assessment (JSNA) and other Board approved documents to identify the local health priorities. From this it should look at current demographics and future trends and developments which may impact on the health of the local population. The PNA will look at issues that may affect it across the three years it could be valid for.
The PNA will also identify where pharmaceutical services are currently used to address these priorities and where changes may be required to fill any current identified gaps or to address possible future health issues.
The PNA should be a tool which is used to inform commissioners of the current provision of pharmaceutical services and where there are any gaps, in relation to the local health priorities, which could be addressed by improving services or access to services in that area.
The commissioners who would find it most useful are the Clinical Commissioning Groups (CCGs), Local Authority public health and NHS England.
The PNA is of particular importance to NHS England who since 1 April 2013, has been identified in the Health and Social Care Act 2012, as responsible for maintaining pharmaceutical lists. The PNA is a key document in making decisions with regard to applications made under the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013.The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013: No. 349 PART 3 Regulation 13 states that: Current needs: additional matters to which the NHSCB must have regard 13. (1) If the NHSCB1 receives a routine application and is required to determine whether granting it, or granting it in respect of some only of the services specified in it, would meet a current need— (a) for pharmaceutical services, or pharmaceutical services of a specified type, in the area of the relevant HWB; and (b) that has been included in the relevant pharmaceutical needs assessment in accordance with paragraph 2(a) of Schedule 1. Under these revised market entry arrangements, routine applications are assessed against Pharmaceutical Needs Assessments.
3.2 Scope of assessment
A pharmaceutical needs assessment is defined in the regulations as:
“The statement of the needs for pharmaceutical services which each HWB is required to publish by virtue of section 128A of the 2006 Act(1) (pharmaceutical needs assessments), whether it is the statement of its first assessment or of any revised assessment, is referred to in these Regulations as a “pharmaceutical needs assessment”.
1 NHSCB (NHS Commissioning Board) is now known as NHS England.
Date: 31st March 2014 v 1.0 5 Item 11 Appendix 1 The pharmaceutical services to which each pharmaceutical needs assessment must relate are all the pharmaceutical services that may be provided under arrangements made by the NHSCB2 for— a) The provision of pharmaceutical services (including directed services) by a person on a pharmaceutical list; b) The provision of local pharmaceutical services under an LPS scheme (but not LP services which are not local pharmaceutical services); or c) The dispensing of drugs and appliances by a person on a dispensing doctors list (but not other NHS services that may be provided under arrangements made by the NHSCB with a dispensing doctor).”
It follows, therefore, that we must understand what is meant by the term “pharmaceutical services” in order to assess the need for such services in the local authority’s area.
3.2.1 Definition of Pharmaceutical Services
Pharmaceutical services are defined by reference to the regulations and directions governing pharmaceutical services provided by community pharmacies (which may be Local Pharmaceutical Service providers [LPS]), dispensing doctors and appliance contractors.
Whether a service falls within the scope of pharmaceutical services for the purposes of PNA depends on who the provider is and what is provided. For the purposes of this PNA we have adopted the following scope:
Pharmacy Contractors For pharmacy contractors the scope of the services that need to be assessed is broad and comprehensive. It includes the essential, advanced and enhanced services elements of the pharmacy contract (full details are given at 3.2.2) whether provided under the terms of services for pharmaceutical contractors or under Local Pharmaceutical Services (LPS) contracts.
There are 61 pharmacy contractors in the Salford area. Of these eight have 100 hour contracts; two pharmacies currently have an LPS contract. There are no distance- selling pharmacy contractors.
Local Pharmaceutical Service (LPS) Contractors
LPS contracts are locally commissioned pharmacy contracts to deliver specific services, over and above the Essential and Advanced Services, to their local population or service users. LPS contracts are now commissioned by NHS England and in Salford there are currently two such pharmacies. These contracts are often used where prescription item numbers may not have been sufficient to support a standard pharmacy contract and yet a need has been identified.
Salford Royal NHS Foundation Trust (SRFT) pharmacy department currently provides a LPS pharmacy contract to support users of the out of hours doctor service and unscheduled care centre when the hospital pharmacy is closed.
2 NHSCB (NHS Commissioning Board) is now known as NHS England.
Date: 31st March 2014 v 1.0 6 Item 11 Appendix 1 A review of this service was carried out and it has now been determined that this service is no longer necessary. This is because since the LPS contract was commissioned there has been an increase in the number of pharmacies within 5 minutes travel time which are open on a 100 hour contract providing greater access to pharmaceutical services. This means that most of the hours which SRFT delivered it’s LPS service (see Table 1 below) are now covered by standard pharmacy contracts (non- LPS) nearby. Early mornings (from 6:30am Mondays to Saturdays) and open late in the evening (up to 11pm Mondays to Saturdays) and on weekends (between 6:30am to 11pm on Saturdays and a range of hours on Sundays from 10am until 8pm).
Hence following this review the Salford Royal Foundation Trust (SRFT) Local Pharmaceutical Service (LPS) contract relating to the Unscheduled Care Pharmacy (out of hours service) NHS England notified SRFT that the contract will not be renewed. The contract is due to finish at 22:00 on the 11 May 2014.
The second LPS pharmacy is based in the Irwell Riverside ward in the East Salford neighbourhood and was set up to offer intensive medicines management support to that small population, who live in an area of high deprivation. Irwell Riverside has undergone a transformation over the intervening years from the inception of this LPS contract and a growing population has returned to the area after the regeneration projects have been completed. The need for an intensive medicines management support has reduced, partly supported by the introduction of MURs and NMS Advanced Services. The additional service delivery from a LPS contract is no longer necessary and a standard contract would be a more cost effective solution for commissioners.
Table 1: Opening hours of the LPS contracts
Postc Thur Pharmacy Add 1 Add 2 Mon Tues Weds Fri Sat Sun ode s L Rowland & The 3 Co Ltd t/a M6 9am - 9am - 9am - 9am - 9am - close close Energise Douglas Rowlands 6ES 6pm 6pm 6pm 6pm 6pm d d Centre Green Pharmacy Salford Royal Salford 9am- Hospitals Royal 9am- 12pm NHSTrust Hospitals Stott M6 6pm - 6pm - 6pm - 6pm - 6pm - 12pm & SRHT Trust, Lane 8HD 10pm 10pm 10pm 10pm 10pm &4pm 2pm - Unschedule Hope -8pm 6pm d Care Hospital Pharmacy
Dispensing doctors In some areas GP practices may dispense prescriptions for their own patients and the PNA would need to take these into account but would not be concerned with assessing the need for other services dispensing doctors may provide as part of their national or local contract arrangements.
Salford’s HWB area has no dispensing doctors.
Dispensing Appliance Contractors
Date: 31st March 2014 v 1.0 7 Item 11 Appendix 1 For appliance contractors the scope of the service to be assessed in the PNA is the dispensing of appliances and the provision of the recently introduced Appliance Use Review (AUR) service and Stoma Appliance Customisation Service (SAC). This means that, for the purposes of the PNA, we are concerned with whether patients have adequate access to dispensing of appliances, AURs and SACs where these may be undertaken by an appliance contractor but not concerned with other services appliance contractors may provide.
There is one dispensing appliance contractor in Salford’s HWB area. This is located in Walkden North ward. Our population also uses dispensing appliance contractors outside the Salford area so we will need to take this into account when assessing the needs of our population.
It should be noted that all pharmacy contractors can dispense appliances and provide AURs and SAC services as part of their essential and advanced services.
Other providers may deliver services that meet a particular pharmaceutical service need, although they are not considered pharmaceutical services under the relevant regulations. It is therefore important that these are considered as part of any future service review.
3.2.2 Pharmaceutical Services Contractual arrangementsiii,iv
The Community Pharmacy Contractual Framework (CPCF) is made up of three different service types. These are defined below, for a complete description please see appendix 1.
Essential Services – which are set out in schedule 4 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (the 2013 Regulations). All pharmacy contractors must provide the full range of essential service these include:
Dispensing medicines and actions associated with dispensing (e.g. keeping records) Dispensing appliances Repeat dispensing Disposal of unwanted medicines Public health (Promotion of healthy lifestyles) Signposting Support for self-care
Advanced and Enhanced Services – Any contractor may choose to provide Advanced Services. There are requirements which need to be met in relation to premises, training or notification to the NHS England Area team, these include:
Medicines Use Review (MURs) New Medicines Service (NMS)- No decision has been made about the future of the service beyond March 2014. Appliance Use Reviews (AUR) Stoma Appliance Customisation Service (SAC)
At this time a pharmacy may undertake up to 400 MURs per annum if they have informed the NHSCB of their intention to provide the service. If a pharmacy informs
Date: 31st March 2014 v 1.0 8 Item 11 Appendix 1 the NHSCB after 1 April but before the 1st October they will be paid for up to a maximum of 200 MURs .
Pharmacy staff may also undertake a limited number of AURs linked to the dispensing of appliances and as many SACs as required.
Enhanced Services – Only those contractors directly commissioned by NHS England can provide these services.
The National Health Service Act 2006, The Pharmaceutical Services (Advanced & Enhanced Services) (England) Directions 2013, Part 4 14.-(1) list the enhanced services as:
Anticoagulant Monitoring Service Care Home Service Disease Specific Medicines Management Service Gluten Free Food Supply Service Independent Prescribing Service Home Delivery Service Language Access Service Medication Review Service Medicines Assessment and Compliance Support Service (This is more clinical than MURs) Minor Ailments Service Needle and Syringe Exchange Service On Demand Availability of Specialist Drugs Service Out of Hours Service Patient Group Direction Service (This would include supply of any Prescription Only Medicine via PGD) Prescriber Support Service Schools Service Screening Service Stop Smoking Service Supervised Administration Service Supplementary Prescribing Service
The regulations are intended to be permissive and allow NHS England to interpret how any of the above Enhanced Services could be commissioned, its scope and method of delivery. NHS England Area Team may make arrangements for the provision of these services in its area.
Before 1 April 2013 PCTs commissioned enhanced services from pharmacy contractors in line with the needs of their population. From 1 April 2013 those public health enhanced services previously commissioned by PCTs transferred to local authorities and are now termed as locally commissioned services because NHS Pharmaceutical Services regulation only allow NHS England to commission Enhanced Services.
In Greater Manchester the NHS England Area Team has responsibility for managing Enhanced Services.
Although NHS England does not have the power to direct CCGs to manage enhanced services on its behalf there is an interim arrangement in place across Greater Manchester that CCGs will continue to manage the previous PCTs
Date: 31st March 2014 v 1.0 9 Item 11 Appendix 1 commissioned Enhanced Services which should have transferred to NHS England until April 2014. A review of these Enhanced Services will take place before this date.
3.2.3 Locally commissioned services
Community pharmacy contractors can also provide services commissioned by Local Authorities and CCGs and although they are not Enhanced Services (only NHS England can commission these), they mirror Enhanced Services that could be commissioned and therefore these need to be considered alongside Pharmaceutical Service provision in order that a full picture of current provision is identified across Salford.
However, a CCG or Local Authority can ask NHS England to commission a service listed in the Directions on their behalf, e.g. a CCG could request that a minor ailments service is commissioned as an Enhanced Service. It should be borne in mind that the cost of these services will be invoiced back to the CCG or Local Authority. Services commissioned in this way would be commissioned under pharmaceutical services and consequently the public health, NHS standard or local contracts would not be used.
Locally commissioned services within Salford may be reviewed within the planned lifespan of this document.
Public health services
Particular mention should be given to the locally commissioned services which have been designated as public health services such as population screening or prevention of disease states. These have transferred to the Local Authorities to manage. The commissioning of the following Enhanced Services which were listed in the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2012 transferred from PCTs to Local Authorities with effect from 1 April 2013:
• Needle and syringe exchange • Screening services such as Chlamydia screening • Stop smoking • Supervised administration of medicines service • Emergency hormonal contraception services through patient group directions.
Where such services are commissioned by Local Authorities they no longer fall within the definition of Enhanced Services or pharmaceutical services as set out in legislation and therefore cannot be referred to as Enhanced Services.
However, the 2013 directions do make provision for NHS England to commission the above services from pharmacy contractors were asked to do so by a local authority. Where this is the case they are treated as Enhanced Services and fall within the definition of pharmaceutical services.
For a brief summary on who can commission which services please refer to the Pharmaceutical Services Negotiating Committee’s “Community Pharmacy Local Service Commissioning Routes; July 2013” v
Date: 31st March 2014 v 1.0 10 Item 11 Appendix 1 The enhanced services carried over from the previous Primary Care Trust and transferred to Salford Council are broadly split into two categories:
Sexual Health Services of which there is one service specification Emergency Hormonal Contraception
Harm Reduction services including: Supervised Methadone/Buprenorphine Needle Exchange Smoking Cessation
Within Salford the transfer of two of these services to the Local Authority, Needle Exchange Scheme and the Supervised Methadone/ Buprenorphine, have been delayed until 31st March 2014 and are currently (August 2013) being managed on their behalf by Salford CCG.
Salford City Council recognises the important contribution that pharmacy can offer to the local population. It is the Council's intention to continue its current locally commissioned services of observed consumption, needle exchange, emergency hormonal contraception and nicotine replacement therapy. Review of these services is on-going and Salford City Council will ensure that it continues to meet the needs of Salford's population providing satisfactory access through suitable providers following this. Salford City Council will be looking at all areas that pharmacy could support the public health agenda as identified in this document along with provision by other providers, however, commissioning of new services will be dependent upon identification of adequate resources. Salford City Council will work with the Local Pharmaceutical Committee as the representative of community pharmacy.
Community Pharmacy Services now commissioned by NHS England: Minor Ailment Scheme Palliative Care Head Lice Eradication Scheme
These Enhanced Services in Salford are commissioned by NHS England; however they are currently managed on their behalf by Salford CCG. NHS England’s intention is for these to be reviewed before April 2014 and where the CCG wishes to retain this service provision they will be commissioned by the CCG using the national standard contracts as locally commissioned services.
Each service will require certain standards which should be met before they can be undertaken. These standards will be outlined in the individual service specifications and could include for example premises requirements or staff training. Staff training can be in the form of self -accreditation by the professional or staff may be required to attend specified training courses.
3.3 Non-commissioned added value community pharmacy services
Community pharmacy contractors also provide services directly to patients that are not commissioned by NHS England, Local Authorities or CCGs, for example some pharmacies provide a home delivery service as an added value service to patients.
Community Pharmacists are free to choose whether or not to charge for these services as part of their business model.
Date: 31st March 2014 v 1.0 11 Item 11 Appendix 1 3.4 Hospital pharmacy
Patients in Salford have a choice of provider for their elective hospital services. Most (92%) of our residents choose to be treated at one of the following NHS Trusts.
Table 2: Hospital Choice for Salford Residents for the year 2012/2013
Hospital Trust Patient % Numbers SALFORD ROYAL 49,087 64% CENTRAL MANCHESTER 14,165 18% BOLTON 7,372 10%
92%
The PNA makes no assessment of the need for pharmaceutical services in secondary care settings, however the HWB is concerned to ensure that patients moving in and out of hospital have an integrated pharmaceutical service which ensures the continuity of support around medicines.
LPS contract Although pharmacy services delivered to inpatients and outpatients are not considered as part of this assessment the LPS contract which is in place at Salford Royal Hospital Trust which supports the out of hours doctor, needs to be part of the assessment and this is discussed in section 3.2.1.
3.5 What is excluded from scope of the assessment?
The PNA has a regulatory purpose which sets the scope of the assessment. However pharmaceutical services and pharmacists are evident in other areas of work in which the HWB has an interest but are excluded from this assessment such as prison where patients may be obtaining a type of pharmaceutical service that is not covered by this assessment.
3.5.1. Prison pharmacy
Pharmaceutical services are provided in prisons by providers contracting directly with the NHS England or prison authorities. HM Prison Forest Bank is located on the site of the former Agecroft Power Station and is a 1064 place category B Male local prison serving the courts of the North-West, accepting remand and sentenced adults and remand young offenders. The pharmaceutical services to the prison are currently contracted to Boots Pharmacy. This arrangement is commissioned directly by the HMP Forest Bank Prison and is therefore outside of the scope of this assessment. However it is important that pharmaceutical service provision meets the needs of prisoners on their release.
Date: 31st March 2014 v 1.0 12 Item 11 Appendix 1
3.6 Process followed for developing the PNA
The PNA followed guidance set out by:
NHS Employers PNA guidancevi National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendment) Regulations 2010ii Pharmaceutical Needs Assessment, Information Pack for Local Authority Health and Wellbeing Boards (May 2013, DoH).
Stage 1: The PNA was developed using a project management approach and a steering group was established in May 2013 consisting of Local Authority representatives, GMCSU Medicines Management Team, and a Project Manager. This steering group has been responsible for the completion of the PNA and to ensure that the PNA meets at least the minimum requirements. This steering group approved the template for the PNA, along with all public facing documentation.
In order to complete the PNA in the most appropriate way, the last PNA dated September 2010 was reviewed and recommendations were made as to the content and where it was necessary to reflect.
Stage 2: The Steering group approved the pre-consultation pharmacy survey that was then issued to all Pharmacies to complete. Also during this stage a public survey was approved and distributed including advertisement on the Local Authority website and on posters in pharmacies. The survey results were then analysed.
Stage 3 The content of the PNA produced including demographics, mapping, analytics and background information which was approved by the steering group to go to consultation.
When preparing the PNA for consultation, the PNA did take into account the JSNA and other relevant strategies, in order to ensure the priorities were identified correctly. The PNA will inform commissioning decisions by the Local Authority (public health services from pharmacy contractors), by NHS England and CCGs. For this reason the PNA is a separate statutory requirement.
Stage 4 The consultation took place from 1 October 2013 to 6 December 2013 for a period of 66 days, in line with the Department of Health Regulations on the development of the PNA. This is based on Section 242 of the NHS Act 2006 which requires PCTs to involve users of services in:
The planning and provision of services; The development and consideration of proposals for changes in the way services are provided; and Decisions affecting the operation of services.
Date: 31st March 2014 v 1.0 13 Item 11 Appendix 1 The draft PNA and consultation response form were issued to all of the stakeholders listed in appendix 2. The documents were posted on the intranet and internet. The consultation responses were collated and analysed and the full consultation report can be found in Appendix 3.
Stage 5 The consultation responses have been analysed and used to pull together the final PNA document which was approved by the Health and Wellbeing Board in March 2014. The PNA was then published on the website in April 2014.
3.7 Localities for the purpose of the PNA
The PNA Task and Finish group decided on how the areas around the borough would be defined. It was agreed that we would use the current system of Salford Local Authority Council Ward boundaries. This was because the majority of available health care data is collected on a ward basis. Also wards are a well understood definition within the general population as they are used during local parliamentary elections. Within Salford JSNA the wards have been grouped into 8 Neighbourhoods and these will be referred to throughout this document also. These are:
Claremont and Weaste – includes the wards of Claremont, Weaste and Seedley East Salford - includes the wards of Kersal, Broughton and Irwell Riverside Eccles - includes the wards of Barton, Eccles and Winton Irlam and Cadishead -includes the wards of Irlam and Cadishead Little Hulton and Walkden - includes the wards of Little Hulton, Walkden North and Walkden South Ordsall and Langworthy - includes the wards of Ordsall and Langworthy Swinton - includes the wards of Swinton North, Swinton South and Pendlebury Worsley and Boothstown - includes the wards of Worsley, Boothstown and Ellenbrook
Map 1: Electoral Ward and Neighbourhood Boundaries in Salford
Date: 31st March 2014 v 1.0 14 Item 11 Appendix 1
3.8 Services provided across the border in other Local Authority areas.
In making its assessment the HWB needs to take account of any services provided to its population which may affect the need for pharmaceutical services in its area. This could include services provided across a border to the population of Salford Council by pharmacy contractors outside their area, or by GPs, or other health services providers including where these are provided by NHS Trust staff.
3.9 PNA consultation
Prior to starting the draft PNA a five week public survey was carried out to identify how the public currently use their pharmacy and whether they had any problems with areas such as access to services. We also asked them what future services they would be interested in using. Analysis for the public survey can be found in section 5.2 and the full results can be found in appendix 7.
A Pharmacy survey was also undertaken over approximately 4 weeks. This asked the pharmacy staff to identify their hours of opening, provision of current services and ease of access to services e.g. if the pharmacy had any facilities for disabled patrons or whether the staff could speak any other languages than English. We also asked them which, if any, services they would like to deliver in the future. Analysis for the pharmacy survey can be found in appendix 5.
A formal 60 day consultation process was carried out amongst the local Health Partners and other stakeholders to enable feedback from them before the PNA was published.
To facilitate this process a comprehensive communication plan was devised identifying all the local partners who had a stake in pharmaceutical service provision around the borough. This can be found in appendix 2.
Feedback was gathered to the consultation and the results were analysed. From this analysis the PNA steering group determined whether any amendments were required and updated the PNA accordingly.
3.10 PNA review process
HWBs will be required to publish a revised assessment as soon as is reasonably practical after identifying significant changes to the availability of pharmaceutical services since the publication of its PNA unless it is satisfied that making a revised assessment would be a disproportionate response to those changes.
Where changes to the availability of pharmaceutical services do not require a revision of the PNA and involve a change in pharmaceutical service provision by pharmacy contractors e.g. the opening of a distance selling pharmacy; they will be required to issue a supplementary statement as soon as practical.
The HWB will ensure there are systems in place to monitor potential changes that will affect the delivery of pharmaceutical services and have a process in place to decide whether the changes are “significant” and hence what action it needs to take.
Date: 31st March 2014 v 1.0 15 Item 11 Appendix 1 4.0 Population Demography
4.1 Overview
On 16 July 2012, the Office for National Statistics published the first release of 2011 Census data for local authority districts. The 2011 Census population total for the City of Salford is 233,900 persons. This figure is very close to the expected population total of 233,300 (the ONS 2010 based sub-national population projection for the year 2011, published March 2012). However, the 2011 Census population age profile for Salford differs markedly from the expected age profile - the Census counted significantly fewer people aged 20-29 and over 75, and counted more in all other age groups.
4.2 Age of Population
Chart 1: Mid-Year Population Estimates
The chart above shows the spread of age ranges across Salford in 5 year stages for males and females in the year 2011.
In mid-2011 Salford had a younger population with 19.0% of the total population between the ages of 20 and 30 compared to England whose 20- 30 year olds made up only 15.1% of the total populationvii.
Salford’s heavy losses in population numbers, particularly during the 1960s, 70s and early 80s, offer a possible explanation for some of the differences apparent between the local and regional / national profiles. This could certainly explain the reduced number over 75 year olds within Salford compared to England.
Date: 31st March 2014 v 1.0 16 Item 11 Appendix 1 The trend in students remaining at home and commuting in to Universities to study due to financial pressures could explain the lower than expected number of 20-29 year olds.
How can pharmacy and the local health partners make an impact?
Commissioners may need to review any services which were predominantly aimed at the 20 to 30 year olds as the investment in this group may have been overestimated due to the previous predication. However as the 20 to 30 year olds still make up the largest population commissioners may want to target health needs for this group of people, perhaps focusing on preventative services to enable these members of the public to retain their health over future years. Reducing any potential health impacts in the future should reduce the burden and cost for all health providers across the borough. Pharmacies may wish to identify the age of their customers to ensure they are providing the most effective services for their local population. For an interactive map which can plot different age bands access to NHS SHAPE tool is recommended and is free to NHS professionals and Local Authority professionals with a role in Public Health or Social Care. Access to the application is by formal registration and licence agreement at http://www.shape.dh.gov.uk/.
4.3 Future Age Trends
Chart 2: Population Projections to year 2016
The Salford population as a whole is likely to increase from approximately 234,000 to 249,300 by the year 2016. An increase of 6.54%
Within these figures all the age groups are expected to increase but the one which is predicted to increase fastest is the 65 to 74 years age group by 9.53%. The age group which will have the second fastest rate of increase is the 0 to 14 years old, increasing by 8.69%.
Date: 31st March 2014 v 1.0 17 Item 11 Appendix 1
This may put further strain on the health services as these age ranges (especially over 65 year olds) are the most frequent users of pharmacy services and health services in general as discussed in the Prescriptions Dispensed in the Community Statistics for 2002 – 2012.vi viii
“A new collection of data on prescriptions dispensed free of charge shows that over 90.6 per cent of all prescriptions were dispensed free of charge. Sixty per cent of items were dispensed free to patients exempt from the prescription charge because of old age (aged 60 and over) and five per cent went to the young (aged under 16 or 16-18 and in full-time education) who are also exempt from the charge.”
Commissioners should be aware when looking to commission future services that sufficient resources are in place to manage this expected increase in elderly population.
How can pharmacy and the local health partners make an Impact?
An increase in age of a population will lead to an increase in prescription items.
This increase in items will in turn lead to a greater impact on pharmacy services as more items will be dispensed and there will be a greater need for patients to understand their medication. Pharmacies can benefit from this by implementing services targeted to an older population. There could therefore be a need to review the current community pharmacy skill mix.
The local health partners, CCG, LA and GM AT may also want to think about which pharmacy services are going to be beneficial to their population in order that NHS money can be invested in prevention of disease or disease progression rather than recovery e.g. targeted medication use reviews to reduce hospital admissions and medication wastage. Commissioners may need to consider additional services that could be required to help support delivery of health care to these patient groups and where pharmaceutical service provision sits.
4.4 Life Expectancy
Table 3: Life Expectancy Gap at birth in Salford
Currently Salford men are, on average, likely to live 3.21 fewer years than their counterparts in England and Wales. The gap for women is 2.41 fewer life expectancy years. However the gain for Women over the two years to 2011 is 0.5 years compared to the England and Wales gain of 0.38 years and Salford have almost doubled the gain for men (+0.8 versus +0.41).
Date: 31st March 2014 v 1.0 18 Item 11 Appendix 1
This shows how actions on health improvement have added years to life in Salford. There is still room for improvement however and commissioners should focus on the areas within Salford where the gaps are higher and also focus on the disease areas which have the greatest impact on life expectancy. These are discussed below.
The internal life expectancy gap between Salford wards can be seen in map 2 below. This data is also reflected in the Deaths from All Causes, All Ages by Ward bar chart 3.
Map 2: Salford Life expectancy at Birth by Electoral Ward
Date: 31st March 2014 v 1.0 19 Item 11 Appendix 1 Chart 3: Salford Deaths from All Causes, All Ages by Ward
The wards where, on average, Salford residents die before their counterparts are in Broughton (East Salford neighbourhood) and Barton (Eccles neighbourhood). This is also reflected in the deaths from all causes data chart 3.
The four wards where the average life expectancy for residents is highest (Expected average age band 80 to 83 years old) are Boothstown and Ellenbrook, Worsley (both in Worsley and Boothstown neighbourhood) and Walkden South (Little Hulton & Walkden neighbourhood) and Cadishead (Irlam and Cadishead neighbourhood)
Disease Specific Population Statistics.
The two charts below show the difference in life expectancy from England by disease area for men (A) and women (B). The yellow bars show where Salford was in 2009 (the most recent data) compared to previous years, the zero line is where England average lies.
Date: 31st March 2014 v 1.0 20 Item 11 Appendix 1 Chart 4A Contributing Factors to the life expectancy gap for men
For the men of Salford the disease area where currently there is the greatest variation from the England average is digestive disease including cirrhosis. Cirrhosis can affect anyoneix – men and women, young and old. People most at risk of cirrhosis are those who:
drink too much alcohol have a long-term liver infection, such as hepatitis B or hepatitis C have an inherited liver disease, such as haemochromatosis have an immune system problem that leads to liver disease are clinically overweight or obese and have a fatty liver
Unlike some of the other disease areas the variation from the England average for digestive disease has become significantly worse for the years 2007 – 2009 (the latest available data). Improvement in local residents’ alcohol awareness, public health initiatives to reduce the spread of hepatitis infections and reduction in population obesity could all impact on this disease prevalence and reduce the increasing numbers of deaths attributed to digestive diseases.
Date: 31st March 2014 v 1.0 21 Item 11 Appendix 1 Commissioners may want to target this health need by improving access and awareness of the current services available. Commissioners should evaluate the current service outcomes to ensure the service is still targeting the correct people and improving Salford’s health as was intended. Salford commissioners have already made tackling obesity and alcohol related admissions to hospital a priority for the borough as discussed in Section 5.1 Salford’s Strategic priorities.
The second area of disease variation for men against the England average is coronary disease. The variation between Salford and England has been significantly reduced since 1997 which shows how coronary disease around the borough has improved, however the variation against England is still significant and this should still be an area for improvement in health.
The other main disease variation areas are generally related to respiratory conditions and cancers. These include lung cancer, Bronchitis and COPD and oral or throat cancers.
Smoking is the main contributor to these diseases and also plays a significant role in coronary disease. Considerable steps to reduce the smoking prevalence across the borough have been made since the introduction of NHS stop smoking services in 2000. Salford services were developed first in primary care in GP practices and community pharmacies in order to make them available to as many smokers as possible. Community pharmacies were also involved at the outset in order for nicotine replacement therapy to be offered on a voucher scheme.
Stop smoking support and wider tobacco control activities to de-normalise smoking have been extensively developed with particular focus on the neighbourhoods where smoking prevalence is greatest. Section 5.1 Table 5: Salford’s Priority Neighbourhood Health Indicators show where rates are higher than the England average and indicate where the related services continue to be most appropriate.
Date: 31st March 2014 v 1.0 22 Item 11 Appendix 1 Chart 4B Contributing Factors to the life expectancy gap for women
The 3 main contributors to a variation from the England average life expectancy is lung cancer, digestive disease, and bronchitis and COPD for women in Salford borough.
Lung cancer is the main contributor to the variation and there has been little change since 1997 in this health area. The HWB partners have already identified reducing smoking prevalence in all adults and specifically in women during pregnancy as a priority for the borough. Although smoking prevalence in Salford has reduced from an estimated 34% in 2004 to 25.4% in 2013 (www.healthprofiles.info) there is a time lag for the effect to show on a disease like lung cancer which can take 20-30 years to manifest. Smoking in pregnancy (measured by smoking at time of delivery in all local hospitals) is more immediate in terms of change, but this has also reduced from 19.5% in 2011 to 16.2% in 2013.
Evaluation of the smoking cessation services should be made to ensure the desired outcomes are being delivered. Future commissioning of this service should include specific key performance indicators which relate to long term smoking cessation targets and wider tobacco control measures such as reducing the supply of cheap cigarettes in deprived areas.
Date: 31st March 2014 v 1.0 23 Item 11 Appendix 1 4.5 Ethnicity
According to the 2011 census Salford has a population made up of 84.4% White British compared with both the England and Greater Manchester averages of 79.8%. The main other ethnic minorities within Salford are 2.3% Black African (versus 1.7% GM and 1.8% England), 1.4% Polish (vs. 0.8% and 0.9%), 1.2% Irish (vs. 1.3% and 1.0%), 1.1 % Chinese (vs. 1.0% and 0.7%), 1.1% Indian (vs. 2.0% and 2.6%), 0.8% Pakistani (vs. 4.8% and 2.1%), 0.6% Arab (vs. 0.6% and 0.4%), 0.3% Bangladeshi (vs. 1.3% and 0.8%)
CHART 4: Ethnic Group by Ward
The wards show a variation in ethnic minority groups ranging from around 4 % Black and Minority Ethnic Groups (BME) in Irlam and Walkden South to 20% BME population in Broughton and Ordsall. The way the BME communities are made up within each ward are also different and can be seen from this stacked bar chart above. As an example Broughton have approximately a 7% Black African population but relatively low Bangladeshi population. Unlike Eccles which has a relatively high Bangladeshi community with a smaller Black African population.
Some ethnic populations have increased health problems in certain disease areasx, e.g. Black African and Black Caribbean populations have a higher stroke incidence rate than in the White ethnic population. South Asians, which includes those from Pakistan and Bangladesh, have an increased risk of myocardial infarction whereas the white populations are more likely to binge drink.
Date: 31st March 2014 v 1.0 24 Item 11 Appendix 1 Smoking prevalence also varies between the ethnic groups. The prevalence of smoking in England is approximately 25%, but for Indian men this drops to 20 %. Yet the average increases to 40% in Bangladeshi males, although only 2% in Bangladeshi females.
How can pharmacy and the local health partners make an impact?
Pharmacy contractors located within areas where there is a high population of a certain ethnic group should provide services that are targeted to achieve improved health outcomes in those populations. They should also look at how best to communicate with their clients. Cultural differences account for a wide variation in patients’ view of medications and the healthcare system. Pharmacy contractors should ensure that they are able to deliver the Essential and Advanced Services to different ethnic groups in a way that meets their needs.
The commissioners could identify areas where there are high density of ethnic communities and target health promotion and services through pharmacy contractors in those areas.
As described in the pharmacy contractor survey (Appendix 5), which all pharmacy contractors were sent, many of the pharmacies already have staff who can communicate in languages, other than English, which are spoken within their community. Of the 40 respondents (out of a possible 61) 60.0% said they had a regular pharmacist that could speak a foreign language and 19.51% of regular staff could also speak a foreign language. Pharmacy contractors should continue to consider the diversity of cultures and languages spoken in their locality when employing staff.
4.6 Deprivation
The Index of Multiple Deprivation (IMD) is a composite measure of deprivation for small geographical areas that attempts to combine a number of different aspects of deprivation (income, employment, health and disability, education, skills and training, housing, crime and living environment) into a single measure that reflects the overall experiences of individuals living in an area.
The term used to describe these small geographical areas is of Super Output Areas. These are then ranked nationally, the term Lower Super Output Areas are then used to identify the most deprived.
The combined scores for the Lower Super Output Areas for a Local Authority area can then be compared to other Local Authority areas nationally.
Date: 31st March 2014 v 1.0 25 Item 11 Appendix 1 MAP 3: Deprivation by LSOA
The map above shows that the areas with the highest deprivation are in the East of Salford closest to Manchester city centre, also in the North, in the ward of Little Hulton. Of the 144 LSOAs in Salford 10 are ranked in the worst 1% of deprived LSOAs across England, while 4 LSOAs are in the top 10% across England. These 4 are located in Boothstown and Ellenbrook and Worsley.
Date: 31st March 2014 v 1.0 26 Item 11 Appendix 1 MAP 4: Health Deprivation and Disability Index2007
The health deprivation and disability markers shown on the map above are also worse where the general deprivation scores are lowest. This shows that there is a need to improve health outcomes where people experience lower levels of deprivation. Health outcomes can be influenced by a number of factors not just direct healthcare initiatives. Township regeneration, through improved education outcomes and employment prospect can all impact on health deprivation scores The community pharmacies, identified on map 3 by green dots, can be seen to be located in areas where the deprivation scores are high or within a distance of one mile. This shows that pharmacy settings can be an ideal location from which to deliver targeted health improvement schemes.
Date: 31st March 2014 v 1.0 27 Item 11 Appendix 1
4.7 Conclusion on population demography
Currently there is a young population in Salford with almost one in five people between the ages of 20 and 30 years old. Over the next four years however the age ranges of 0- 14 years and 65- 74 year olds will have the biggest increase in numbers. This means that commissioners should review service provision on a regular basis to ensure it is still relevant to the population of Salford and delivering the desired health outcomes that the HWB are targeting. Digestive disorders, coronary disease and respiratory conditions are recognised health priorities and pharmacy services need to be developed in line with priorities. Ethnic diversity of the wards should be considered when commissioning services to ensure they are accessible to the ethnic groups who may contribute significantly to the variation from average health in that locality.
Date: 31st March 2014 v 1.0 28 Item 11 Appendix 1 5.0 Locally Identified Heath Need
To identify how pharmaceutical service provision can help tackle the need of Salford’s local population we have used Salford's Joint Health and Wellbeing Strategyxi. This document is continually updated and revised in line with other strategic documents produced across the borough of Salford. It pulls together aspects of health and social care which are provided and looks at population requirements to help improve the health and wellbeing of the population is details.
5.1 Salford’s Strategic Priorities
Salford's Joint Health and Wellbeing Strategy has a clear vision statement and identifies some pressing health needs. The health needs are addressed by three priority areas each of which are subdivided to three desired outcomes, as set out here in Table 4.
Table 4: Salford HWB Strategic Priorities
Priority 1 Ensure all children have the best start in life and continue to develop well during their early years Outcome 1a Promoting healthy weight at primary school age, in targeted schools Outcome 1b Increasing breastfeeding initiation, with additional focus in wards currently less likely to breastfeed. Outcome 1c Reducing teenage conceptions with a particular focus on hotspot wards Priority 2 Local residents achieve and maintain a sense of wellbeing by leading a healthy lifestyle supported by resilient communities Outcome 2a Provide more effective joined up systems and services to support the wellbeing of people who are vulnerable Outcome 2b Positively influence individual and neighbourhood health and wellbeing Outcome 2c Communities have the resilience to respond to and manage local community issues for wellbeing Priority 3 All local residents can access quality health and social care and use it appropriately Outcome 3a Timeliness of access to services
Outcome 3b Ensuring people feel supported to manage their condition
Outcome 3c Enhanced quality of life for carers
Date: 31st March 2014 v 1.0 29 Item 11 Appendix 1 Our vision for a Healthier Salford by 2016
The Vision
. We want to improve the lives of the citizens of Salford - improving health, wellbeing and removing health inequalities. We will create an integrated system of support services that responds to local needs and gains public trust. . We believe that prevention is better than cure and that by helping people to help themselves we can improve their lives and the long-term health of the population.
The scale of our ambition
. To improve life expectancy in Salford so that the gap between Salford and the UK average is reduced . To improve health and wellbeing at every stage of life, How we will achieve our ambition - we will: . Work with and involve the people of Salford . Support local communities to promote their own health and wellbeing . Address inequality . Ensure that health and wellbeing is everyone's responsibility . Promote partnership and ‘joining up' of services . Focus on prevention and early intervention throughout life . Encourage Quality, Innovation and Evidence-based work
Neighbourhood Health Priorities
A more detailed analysis of the health needs of each neighbourhood has been made and compared to the England average.
These can be found at the Partners in Salford website under JSNA neighbourhood profilesxii .
The Health Needs within each neighbourhood profiles focuses on: Infant Mortality , Teenage Conceptions, Oral Health, Breastfeeding, Child Obesity, Adult Obesity, Mental Health, Long Term Conditions, Life Expectancy, Alcohol Use, Drug Use, Smoking
Below is a summary of this information in Table 5.
There are many ways in which pharmacy services can impact on these health needs and we will look at each priority health indicator and discuss these separately by focusing on the three sections of the community pharmacy contract, as set out in section 3.2.2. Examples of how the current pharmacy services meet Salford’s HWB strategic priorities are laid out in the section 5.1.4 Table 6.
Date: 31st March 2014 v 1.0 30 Item 11 Appendix 1
Table 5: Salford’s Priority Neighbourhood Health Indicators
Health indicators where Salford should be the same or below the England average. Ref Neighbourhood Claremont & East Salford Eccles Irlam & Little Hulton Ordsall & Swinton Worsley & . Health Indicator Weaste Cadishead & Walkden Langworthy Boothstown A Infant mortality This rate Has Rate in Appears to Rate has Rates Has been has been increased under 1’s is be reducing remained are reducing over stable for 8 since 2005/7 showing from 2005/7 static over fluctuating time. years. signs of a the past few rising trend years. B Teenage Little 2nd highest Highest of conceptions change in rate of Salford rates for Salford neighbourho Winton & neighbourhoo ods Barton wards ds. but Eccles ward is reducing C Oral health (Decayed, Claremont South missing or filled Weaste Walkden teeth) &Seedley North Walkden & Little Hulton D Child obesity Lower Reception rates for class children Reception reception are at the class class same level as children children. England have a lower rate than the England average. E Adult obesity
Date: 31st March 2014 v 1.0 31 Item 11 Appendix 1
Health indicators where Salford should be the same or below the England average. Ref Neighbourhood Claremont & East Salford Eccles Irlam & Little Hulton Ordsall & Swinton Worsley & . Health Indicator Weaste Cadishead & Walkden Langworthy Boothstown F Mental health -- 2nd highest -- Increasing -- Highest use -- Use -- Use has -- In the last -- Among -- Lowest use (Use of mental use of use of of outpatient increased increased in 3 years use the lowest of outpatient health outpatient outpatient outpatient services for sharply in the last 3 of outpatient use of services. services) services but services over past 3 years, 2010/11. years but still services has outpatient reduced in last 3 years, and trend is Irlam has the lower than increased services. 2010/11. High now one of rising. One of highest Salford and is the suicide rates. the highest in highest suicide rates average. highest of Salford suicide and in Salford and the self-harm Cadishead neighbourho rates in has among ods Salford. the lowest. G Long term Significant Significant Significant Significant conditions gap in death gap in death gap in death gap in death rates still rates still rates still rates still exists. exists. exists. exists. H Adult carers (Percentage of adults that are carers)
I Alcohol Weaste & Higher Lower High in Binge Lower than (Related hospital Seedley Admissions than the levels of Little Hulton drinking is the Salford admissions) wards higher highest in Salford alcohol and Walkden also high. average. rates Broughton & average in consumption North Irwell Barton & compared to Riverside. Winton wards other areas of High levels of and around Salford. binge the Salford drinking. average for Eccles ward.
Date: 31st March 2014 v 1.0 32 Item 11 Appendix 1
J Drugs Claremont Broughton Barton & Lower than -- Little Hulton Lower Lower than (Users in below city ranks highest Winton rank the Salford ranks highest Langworthy than the the Salford treatment) average for in the 3 in the top average. of Salford is the highest Salford average. users in wards. Kersal quarter for wards for ward for average for treatment and and Irwell Salford, while young people adult drug adults and adults testing Riverside are Eccles is in treatment users in under-25s +ve for drugs closer to the lower. and 3rd treatment. in on arrest. city average. highest for Ordsall is treatment. Weaste adults. lower and &Seedley Walkden below above the city South is Salford average. below city average. and England averages. K Smoking High Claremont levels of Weaste smoking. &Seedley
Health indicators where Salford should be the same or above the England average. Ref. Neighbourhood Claremont & East Salford Eccles Irlam & Little Hulton Ordsall & Swinton Worsley & Health Indicator Weaste Cadishead & Walkden Langworthy Boothstown L Breastfeeding Highest in Salford at initiation M Life expectancy 2 years 2 years 5 years less less less 2.9 years 10 years less 2 years 2.3 years less for men. for men. less. longer for 1.8 years 5 years less men. less for for women. 1 year longer women. for women.
- higher than England average - lower than the England average - similar to England average -- - not available If the position against England is good the arrow is green; If the position against England is poor, but improving, the arrow is amber.
Date: 31st March 2014 v 1.0 33 Item 11 Appendix 1
5.1.1 Essential Services
These are mandatory within the pharmacy contract and are managed and monitored by NHS England’s Greater Manchester Area Team (GM AT). As all pharmacy contractors must provide these services it would be sensible to use these across all wards to reduce health inequalities.
Essential services should be used by all pharmacy contractors to help deliver the local authority public health messages, improving outcomes by targeting people using a proactive approach.
Should any of the local health partners feel that a more directed service is required e.g. targeted to specific age groups or in specific wards then discussions with the LPC or the GM AT about how this could be managed within the desired budget could raise a number of solutions. This could include locally commissioned services or enhanced services.
5.1.2 Advanced Services
Any contractor may choose to provide Advanced Services. There are requirements which need to be met in relation to premises, training or notification to the NHS England Area Team.
Advanced services offer an opportunity for pharmacy contractors to engage patients and empower them to take greater responsibility for their health through their prescribed medication or appliance. Similarly dispensing appliance contractors should do the same for patients to whom they supply appliances.
Providing patients with a better understanding of their medication or appliance can help to prevent unnecessary exacerbations of conditions and reduce the possible risk of patients accessing urgent care services; hopefully leading to better health outcomes.
Date: 31st March 2014 v 1.0 34 Item 11 Appendix 1
5.1.3 Locally commissioned services
For a list of which locally commissioned services each community pharmacy is delivering currently (August 2013) refer to appendix 6.
GM AT Enhanced Services At present (Aug 2013) GM AT commission enhanced services, which are currently being managed by Salford CCG.
After April 1st 2014 some of these services should transfer permanently to the CCG as locally commissioned services on a standard NHS contract. The CCG will then determine, based on the local population needs and the service delivery outcomes, whether to re- commission or decommission these services.
CCG commissioned services including those managed on behalf of the GM AT. Salford CCG has the current responsibilities for managing the commissioned services, with arrangements underway to transfer these to CCG NHS Standard Contracts in order to comply with the regulations which state CCGs cannot commission enhanced services.
The CCGs commissioning intentions are that the services would remain with Salford-wide specifications unless there was clearly identified local need to commission independently for a local population.
Date: 31st March 2014 v 1.0 35 Item 11 Appendix 1 5.1.4 Community pharmacy services impact on the HWB strategic priorities.
Table 6: Current Community Pharmacy Services and their Impact on Local Health Priorities
Community Which of the Comments/Examples Pharmacy Salford’s Strategic Service Priorities or Refer to table in Neighbourhood Appendix 1 for a Health Indicators service description will this impact?* *Refer to Section 5.0 for detailed list of priorities
Essential Services Dispensing 2 – 2b Explanation of medicines prescribed at the time of dispensing can increase the understanding Medicines or 3 – 3a, 3b, 3c of why and how medicines should be taken. This should lead to a more informed medicine user Appliances and reduce adverse effects which may require interventions such as A&E admission. G, J, K, M EXAMPLE: Pharmacies could be asked to target patients who come into the pharmacy with a prescription relating to respiratory disease and ask about their smoking habits. This could bring about a referral into the stop smoking service if a patient was a smoker who was contemplating stopping.
This could impact on Strategic Priority 2b to reduce smoking prevalence in adults and Neighbourhood Health indicators G, K and M Repeat Dispensing 1 – 1c Patients who use a repeat dispensing service use less GP staff time and appointments whilst 2 – 2a, 2b ordering their medication. This leaves GPs and their staff extra time to help the people who 3 - 3a, 3b, 3c have more severe health needs and therefore more health services could be identified to remain in the community. B, F, K, M Checking how patients use their prescribed medication can avert incidences arising from inappropriate use. Patients with long-term conditions are better managed and supported.
EXAMPLE: Patients with an increased use of their opioid analgesics could be identified by patients returning for repeats early than anticipated. Increase use could be a sign of a reduction in the patient’s quality of life (Strategic Priority 3c) or could lead to excessive drowsiness and falls. (Strategic Priority 3b)
Date: 31st March 2014 v 1.0 36 Item 11 Appendix 1 Disposal of 2 – 2a, Again this is another area where pharmacy staff have the opportunity to identify patients unwanted who have not taken the medicines they were prescribed. This can initiate a discussion and medicines G, M problems such as side effects or dosage regimes can be addressed to help improve the patients’ health outcomes. When controlled systems of disposal are used, it can also help the pharmacist to identify other issues such as non-compliance or excessive prescribing. CCGs would be interested in knowing whether issued medicines are not being used correctly. A significant amount of wasted NHS resource is attributed to medications being used incorrectly or not at all.
Public health ANY highlighted priority In 2013/ 2014 the Health promotion campaigns have been linked to national priorities and (Promotion of area. local public health messages across Greater Manchester. healthy lifestyles) In 2013 /2014 Please see the list below of the health promotional campaign ‘topics' and relevant dates for specifically: promoting these:
1 – 1a, 1c 1. Healthy Lifestyles (including Smoking, Alcohol, Healthy eating and Physical activity) – 2 - 2a, 2b, July/August 2013 3 -3a, 2. Oral Health - September 2013 3. Sexual Health OR Dementia – October 2013 – please choose the relevant health topic A, B, C, D, E, F, most suited for your patient population need within your area 4. Cancer (including Breast and/or Mouth cancer) – November 2013. Winter Planning - December 2013/January 2014 5. To be confirmed at a later date
Promotion of these messages will reinforce wider campaigns to improve health in the locality and are a useful tool to engage the public in meaningful discussions about preventing illness and staying well.
EXAMPLE: An oral health campaign can be used to target awareness of tooth decay in children aged 5 (Neighbourhood Health Indicator C )
Signposting 1 -1a, 1b, 1c Pharmacists are a community hub and as such are in an ideal and convenient position to 2 – 2a, 2b, 2c signpost patients to specific services they require. Pharmacists can deliver an invaluable signposting service that can be used to direct patients and help achieve Our vision for a Healthier Salford by 2016 EXAMPLE: Pharmacists could direct nursing mothers to their local breastfeeding nurse if they are having difficulties. (Strategic priority 1b)
Date: 31st March 2014 v 1.0 37 Item 11 Appendix 1 Support for Self 2 -2a, 2b, 2c EXAMPLE: If patients used pharmacies for advice on a more frequent basis this would free Care 3 -3a, 3b, 3c other health care settings which they might have otherwise accessed, such as A&E or GP practices. This would free resources including money to be redirected into patient care B, D, E, G, K, L thereby further enhancing the population’s health outcomes. (Strategic Priority 3a, 3b)
Advanced Services Medicines Use 2 – 2a, 2b, 2c EXAMPLE: Review (MURs) 3 – 3a, 3b, 3c . patients taking high risk medicines; (Neighbourhood Health Indicator F) . patients recently discharged from hospital that had changes made to their medicines F, G, M while they were in hospital. Ideally patients discharged from hospital will receive an MUR within four weeks of discharge but in certain circumstances the MUR can take place within eight weeks of discharge; (Strategic Priority 3b), and . patients with respiratory disease. (Neighbourhood Health Indicator G)
New Medicine 2 – 2a, 2b, 2c The service provides support for people with long-term conditions newly prescribed a service (NMS) 3 – 3a, 3b, 3c medicine to help improve medicines adherence; it is initially focused on particular patient groups and conditions. G, M EXAMPLE: when a person is discharged from hospital they may have had their medication regime altered and a new medicine added. Patients who have been ill sometimes do not realise they should stop a certain medicine. This could lead to the person taking two medicines which interact and they could return to hospital for treatment.
A NMS aims to stop these problems before they occur by helping the patient to understand why certain medicines have been stopped or started. (Strategic priority 3b)
Appliance Use 2- 2a, AURs should improve the patient’s knowledge and use of any ‘specified appliance’ Review (AUR) 3- 3b (Strategic priority 3b)
G Stoma Appliance 2- 2a, The aim of the service is to ensure proper use and comfortable fitting of the stoma appliance Customisation 3- 3b and to improve the duration of usage, thereby reducing waste. Service (SAC) EXAMPLE: if a patient is able to manage their stoma products themselves they are less G likely to need costly, intensive nursing and also less likely to be admitted to a residential or nursing home. (Strategic priority 2a)
Date: 31st March 2014 v 1.0 38 Item 11 Appendix 1
LA – Locally Commissioned Services Emergency 1 – 1c EXAMPLE: if a patient has unprotected sexual intercourse and requires EHC or advice Hormonal 2- 2a, 2b, 2c over a weekend when their GP surgery and many of the health clinics are closed then Contraception 3- 3a pharmacy locations are the ideal place to receive treatment especially during out of hours. (EHC) If patients were unable to get EHC promptly they may decide to go to A&E which would be A, B, an inappropriate use of NHS funding. (Strategic priority 1c, Neighbourhood Health Indicator B )
Supervised 2 – 2a, 2b, 2c EXAMPLE: Supervision of medicine use for some individuals leads to a more stable Methadone/ 3 -3b routine and reduction in street drug misuse. (Strategic Priority 2c, Neighbourhood Health Buprenorphine Indicator J) J Needle Exchange 2 – 2a, 2b, 2c Needle exchange is a harm reduction programme designed to stop the spread of disease 3 -3b via needle sharing between drug users (strategic priority 2a, Neighbourhood Health Indicator G). The pharmacies are also asked to take the opportunity to talk to their clients G, J about reduction of self-harm and health benefits resulting from this, and promoting other services which would be beneficial to the drug users. This would meet strategic priority 3b)
Smoking 1 Pharmacist promotion of stop smoking service gives clients access to this service at a time Cessation 2- 2b, convenient for them and reduces their need to access GP appointments for repeat 3- 3a, 3b prescriptions. (Neighbourhood Health Indicator K)
A, C, G, K, M
CCG – Locally Commissioned Services Minor Ailment 2 – 2b, 2c Minor ailment scheme allows easy access to advice and medication from pharmacies Scheme 3 – 3a, 3b thereby reducing the number of GP appointments booked for minor conditions. These freed appointments can then be used to target patients with long term complicated conditions hopefully improving the health outcomes of a local population. (Strategic priority 3a) Head Lice 1 Patients can get access to head lice eradication treatments directly from their pharmacy. Eradication 2- 2c This reduces the number of patients accessing GP practices and using appointments when 3 -3a not necessary. (Strategic priority 3a) Palliative Care 3 -3a, 3b, 3c Palliative care patients’ health can deteriorate rapidly. If there is no facility to ensure there is prompt access and availability to medicines then this may result in the patient being G taken into hospital, this not only affects the patient but their carers who find it difficult to be away from their loved ones during a difficult period in their illness, (Strategic priority 3c). Date: 31st March 2014 v 1.0 39 5.2 Public Survey
Further to the health needs identified through the local statistics by the HWB, Salford public also have opinions about how they would like their pharmacies to provide services. These were explored in a survey which the PNA steering group developed. A summary of the findings is set out below, for the full results please refer to appendix 7.
5.2.1 Summary of the Salford Public Survey
A survey about local pharmacy provision was created and ran from the 5th July 2013 until the 2nd August 2013 to gather people’s views on what works well, and what could be improved.
The survey was completed by 744 people. The small majority of respondents were female aged between 55-64 years old and were of a White British ethnicity.
The results to the survey of pharmacy services and experiences tell a positive story about the pharmacy services in Salford. Shortage of provision is not an issue; most residents (90%) use a regular or preferred pharmacy. The most commonly selected location related reason for using a pharmacy was the proximity to the respondent’s home or doctors. Whereas the service related motivations for the use of pharmacy are friendly and knowledgeable staff. Those that don’t use a regular pharmacy choose their pharmacy based on convenience of location and late opening as there are sufficient alternative pharmacies to choose from.
Pharmacies are easily accessible with the majority of respondents travelling less than two miles to the pharmacy on foot (43%) or by driving (46%). 3% of respondents are unable to get to a pharmacy of their choice due to mobility issues.
When asked about their knowledge, awareness and use of pharmacy services such as blood pressure checks only 7% of respondents use this service although 37% of respondents would use this service if available; therefore pharmacies who provide this as part of their business model may wish to advertise this service more. Also if commissioners identified a need for particular services then it would be worthwhile investing in the promotion or communication of the service to ensure the public took full advantage of it.
The majority of respondents were satisfied with all aspects of service at their regular pharmacy including being open when they need it. There were however, a small number of respondents who were unsatisfied with waiting times and private consultation areas. Overall, 96% of respondents were either satisfied or very satisfied with the service they receive from their pharmacy.
A key recommendation arising from these results would be that the council, CCG and pharmacies need to communicate better the benefits of accessing additional services from the pharmacies as on average 50% of respondents would like to use one of these services but a smaller % had actually used one of the services.
Details of the survey methodology and findings together with a copy of the questions asked can be found in appendix 7.
Date: 31st March 2014 v 1.0 40 Item 11 Appendix 1
5.3 Conclusion
The current pharmacy services lend themselves to achieving the required outcomes identified as the health priorities outlined in the Salford Health and Wellbeing Strategy and the identified Neighbourhood health needs defined in the JSNA.
However commissioners need to review the currently commissioned services and assess service delivery and health outcomes achieved to ensure maximum benefit is gained for the resources available.
Many health issues will require a service to be provided from a wide number of contractors across the borough to achieve a whole population change, but it may be prudent to focus resources to a smaller number of contractors where a health issue is identified that significantly affects a particular locality or certain demographic of the population more than other areas of the borough.
Hence the service reviews should include whether it is preferential to allow expressions of interest from all pharmacy contractors to engage in commissioned additional services in order to target the whole population and allow maximum access or whether targeted delivery by a small number of contractors would be more appropriate such as where the health need is specific to a certain population or location, this could focus resources to deliver improved health outcomes for certain health issues. It is important that any review includes possible or actual service delivery by other providers where they also meet specific pharmaceutical needs.
If a smaller selection of providers is desired then commissioners may want to write into the service level agreement some key performance indicators such as a guaranteed number or range of hours per week that the service will be available, or a certain number of patients through the service, or a payment threshold for specific service outcomes.
The review should at the same time consider, alongside pharmacy service providers, other providers of services which target that particular health need. Consideration should be made that service delivery may be more accessible from pharmacy contractors as the public have direct access to their services and also because some provide extended hours.
Date: 31st March 2014 v 1.0 41 Item 11 Appendix 1
6.0 Current Pharmacy Provision and Services
Across the Salford area there is one Dispensing Appliance Contractor and 61 Community Pharmacies of which There are currently no distance selling pharmacies which provides wholly mail-order or internet based pharmacy services. Eight pharmacies open for more than 100 hours per week Two pharmacies have an LPS contract.
New pharmacy application regulations (2012) no longer allow prospective owners to gain exemption from the statutory test for market entry by agreeing to provide services for at least 100 hours a week. However existing 100 hour pharmacies must continue trading for at least 100 hours a week.
Pharmacies previously granted a contract under the 100 hours exemption category (under the 2005 regulations) make an important contribution to access to pharmacy services across the borough. Under the current regulations there is no provision for a 100 hour pharmacy to reduce their hours of service over the week. If these regulations were to alter and the eight pharmacies which currently hold a 100 hour contract applied to decrease their opening hours the HWB would be concerned as they are relied upon to provide extended and out of hours cover of pharmacy contractual services for patients across the borough.
6.1 Change in number of Pharmacy contractors from 2011
The Salford PNA published in 2011 identified 55 community pharmacies. The number of pharmacies in August 2013 is now 61, an increase of six (10.9%) community pharmacy outlets.
Included in these figures the number of 100 hour pharmacies has also increased by from three to eight since 2011. This is an increase of 166.67%.
The number of dispensing appliance contractors has remained the same since 2011 with one provider.
39 (5.4%) of the public survey respondents indicated they used an appliance contractor, with 29 (4%) saying the use a distance selling pharmacy. Both of these services can be accessed from any national contractor and hence the number of suppliers solely within Salford borough does not impede the Salford residents from accessing pharmaceutical services from this type of contractor.
As discussed in section 4.1 the Salford population in 2011 was 233,900, an increase of 5.7% since 2008 (221,253) as detailed in the 2011 Salford PNA
Date: 31st March 2014 v 1.0 42 Item 11 Appendix 1
6.2 Dispensing activity
This section examines in more detail the level of dispensing activity for the pharmacies in Salford. Based on community pharmacy dispensing data from the Information Centrexiii covering 2011 to 2012 comparisons are made with the national average and regional averages.
Of the 24 former PCTs (See table 7 below) in the North West SHA Salford PCT had the 2nd highest average items per month per pharmacy at 7680, with only Knowsley higher, dispensing 8050 items per month on average. Blackburn with Darwen Teaching Trust had the lowest with 5410 per month on average.
The range across England was from 2880 in Westminster PCT to 10200 in Redcar and Cleveland PCT with the England Average being 6550 items per month per pharmacy.
The Salford PCT 7680 items dispensed per month per pharmacy are higher than both the England average and the North West Average (6790). This is because there are a higher number of items per head of population prescribed per month (1.93) even though current population is relatively young as described in section 4.2.
There could be a number of reasons for this such as the high number of deprived LSOAs which result in increased demand for prescriptions for minor illnesses as these populations tends to access healthcare services rather than self-care. It is also possible that Salford’s PCT had a policy to encourage 28 day prescribing which would increase items per month.
Pharmacies could be used to move prescribing of minor ailment away from GP practices so that GPs can concentrate on the long term condition patients. This may also reduce the number of items per month prescribed.
Date: 31st March 2014 v 1.0 43 Table 7: Community pharmacies in contract with PCTs at 31 March, prescription items dispensed per month and population by PCT, England 2011-12 Prescriptio Prescription Average items Number of n items Pharmacies items Population (000)s per community dispensed per 100,000 dispensed per (000)s Mid month per pharmacies per 100,000 population month (000)s 2011 (1) community 2011-12 population 2011-12 2011-12 pharmacy 2011-12 5LC Westminster 92 265 220 1.21 42 2.88 TAP Blackburn with Darwen Teaching 50 271 148 1.83 34 5.41 5NT Manchester 133 789 503 1.57 26 5.93 5NN Western Cheshire 58 347 236 1.47 25 5.99 5NK Wirral 90 554 320 1.73 28 6.15 5NH East Lancashire 101 629 383 1.64 26 6.23 5NL Liverpool 133 841 466 1.81 29 6.33 5NR Trafford 61 390 227 1.72 27 6.40 ENGLAND 11,236 73,568 53,107 1.39 21 6.55 5NG Central Lancashire 109 717 467 1.53 23 6.58 Q31 NORTH WEST 1,764 11,978 7,056 1.70 25 6.79 5NJ Sefton 76 523 274 1.91 28 6.88 5J2 Warrington 45 312 203 1.54 22 6.93 5NE Cumbria 107 745 500 1.49 21 6.96 5J5 Oldham 55 384 225 1.71 24 6.99 5NP Central & Eastern Cheshire 101 709 464 1.53 22 7.02 5HQ Bolton 68 479 277 1.73 25 7.04 5NM Halton and St Helens 77 552 301 1.83 26 7.16 5NQ Heywood, Middleton & Rochdale 50 363 212 1.71 24 7.26 5JX Bury 39 285 185 1.53 21 7.29 5HG Ashton, Leigh and Wigan 70 511 318 1.61 22 7.30 5NF North Lancashire 77 568 322 1.76 24 7.37 5F7 Stockport 66 491 283 1.73 23 7.44 5LH Tameside and Glossop 59 442 253 1.75 23 7.50 5HP Blackpool 44 335 142 2.36 31 7.60 5F5 Salford Teaching 59 453 234 1.93 25 7.68
Date: 31st March 2014 v 1.0 44 Item 11 Appendix 1 5J4 Knowsley 36 290 146 1.99 25 8.05 5QR Redcar and Cleveland 28 286 135 2.11 21 10.20 Sources: NHS Prescription Services of the NHS Business Services Authority Population data - Office of National Statistics (2011 mid-year Estimates based on 2011 census)
Date: 31st March 2014 v 1.0 45 6.2.1 Where are Salford Prescriptions dispensed?
Using Data taken from electronic Prescribing Analysis and CosT (ePACT) for the year from April 2012 to March 2013 it can be seen that for all the items issued by Salford GPs that 91.582% are dispensed within Salford pharmacies (Bar Chart 5).
Chart 5: Percentage of items issued by Salford prescribers which are dispensed within Salford pharmacies.
Of the 7.2% which were dispensed by non-Salford pharmacies the majority (85%) were dispensed within Greater Manchester. The borough that most of these went to was Manchester, followed by Bolton then Bury.
Also whilst most of Salford pharmacies dispensed approximately 4000 to 6000 items per month, the other Greater Manchester pharmacies dispensed less than 1000 items per month from Salford prescribers.
This information leads us to the conclusion that for the prescriptions generated by Salford prescribers (i.e. predominately for Salford residents) the current number of dispensing pharmacy contractors within Salford is sufficient.
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Chart 6: Average monthly items dispensed outside of Salford
6.3 Access to pharmacies by location
6.3.1 Pharmacies per head of population vs. national/ NW level and neighbouring PCTsxiv
Salford had 25 pharmacies per 100,000 population up to March 2012, this is higher than the England average (21) and the same as the North West Average (25). In fact overall the former North West SHA locality had the highest average number of pharmacies per 100,000 head of population across England and Salford PCT was 26th highest out of the 151 former PCTs.
As data is from 2011 to 2012 the table 7 in section 6.2 shows a breakdown by former PCTs within the former North West SHA region.
Pharmaceutical provision has increased from 24.4 pharmacies per 100,000 population in 2011 to 25 pharmacies per 100,000 population in 2013/14. This is due to six new pharmacies (an 11% increase) opening since the 2011 PNA was written. As five of these six pharmacies are 100 hour contracts, the number of hours available for accessing pharmaceutical services via pharmacy contractors has also significantly increased From this information we can draw a conclusion that there are sufficient pharmacy locations to meet the needs of Salford’s population.
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6.3.2 Pharmacies per locality
The number of pharmacies per locality is:
Table 8: Pharmacy Contractors and GP practices by Salford Neighbourhood
Dispensing LPS 100hour GP Salford All Appliance pharmacies pharmacies Practices Neighbourhood pharmacies Contractors
Claremont & Weaste 5 1 4 East Salford 11 1 2 8 Eccles 11 1 8 Irlam & Cadishead 5 1 5 Little Hulton & 7 8 Walkden Ordsall & 12 3 9 Langworthy Swinton 7 1 4 Worsley & 3 1 3 Boothstown Salford 61 2 8 1 49
6.3.3 Pharmacies per Ward
Table 9: Pharmacies per Ward 2013 vs. 2011
Ward Pharmacy Pharmacy Pharmacies GP population Neighbour per ward Ward Name per ward per 1000 Surgery in 2011 hood (new Aug (old 2011) population* per ward 2013)
Barton 12,321 Eccles 1 1 0.08 1
Boothstown & Worsley & 9,599 2 2 0.21 2 Ellenbrook Boothstown
Broughton 13,869 East Salford 5 7 0.50 7
Irlam & Cadishead 10,264 4 4 0.39 3 Cadishead Claremont & Claremont 9,891 2 2 0.20 1 Weaste
Eccles 11,217 Eccles 6 6 0.53 6
Irlam & Irlam 9,803 1 1 0.10 2 Cadishead
Irwell Riverside 12,901 East Salford 2 2 0.16 0
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Ward Pharmacy Pharmacy Pharmacies GP population Neighbour per ward Ward Name per ward per 1000 Surgery in 2011 hood (new Aug (old 2011) population* per ward 2013)
Kersal 12,694 East Salford 2 2 0.16 1
Ordsall & Langworthy 12,935 7 9 0.70 6 Langworthy Little Hulton Little Hulton 12,851 1 2 0.16 1 & Walkden Ordsall & Ordsall 14,194 3 3 0.21 3 Langworthy
Pendlebury 13,069 Swinton 1 1 0.08 2
Swinton North 11,108 Swinton 3 3 0.27 1
Swinton South 11,325 Swinton 2 3 0.26 1
Little Hulton Walkden North 11,647 3 3 0.26 5 & Walkden Little Hulton Walkden South 10,237 2 2 0.20 2 & Walkden Claremont & Weaste &Seedley 11,906 2 2 0.17 3 Weaste
Winton 12,067 Eccles 4 4 0.33 1
Worsley & Worsley 10,035 1 1 0.10 1 Boothstown
TOTALS 233,933 54 60 0.26 49 *Using the latest data of 2011 data per ward and 2013 number of pharmacies
The average number of pharmacies across Salford is 3.05 per ward.
With ranges from one in Worsley, Pendlebury, Irlam and Barton wards to a high of nine in Langworthy ward. It should be born in mind that each ward will have different size of population with differing health needs. Also the area of the ward will affect the travel time to pharmacies within it’s boundaries, so the number of pharmacies per ward cannot be used to directly compare one ward to another unless these other statistics are taken into account.
Every ward has at least one community pharmacy, and since 2011 PNA four of the wards have had additional pharmacies open in them. There has been no reduction in pharmacy outlets since 2011 in any of the Salford wards so we can conclude that, as there was no requirement for extra pharmacies following the 2011 PNA, there has not been any further need for extra pharmacy outlets.
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6.3.4 Correlation with GP practices
In relation to GP practices eight of the 20 wards in Salford have more pharmacies than GP practices, while five of the wards have fewer pharmacies than GP practices.
However if we look at the neighbourhoods rather than at ward level only one neighbourhood has more GP practices than pharmacies – this is Little Hulton and Walkden where there are seven pharmacies and eight GP practices.
Each of the wards mentioned have extended hour pharmacies within their locality so patients have access to pharmacy services outside standard hours.
6.3.5 Access issues described in the Public survey
During the public survey we asked questions relating to ease of access for the respondents to their local community pharmacies. Of the 733 respondents 89.5% said they used a community pharmacy with 41.33% of respondents using a community pharmacy at least once every month.
90.12% of respondents said they used a regular pharmacy, however 62.9% said they would find an alternative pharmacy if their usual one was not open. Further to this over 95% of respondents said they can access the pharmacy of their choice.
The survey shows that over 90% of the population is happy with one pharmacy and virtually all the respondents (95.57%) had no difficulty accessing a pharmacy.
6.3.6 Neighbouring areas
Salford has borders with 5 other local authorities within Greater Manchester. To the north we have Wigan, Bolton and Bury. To the south we have Trafford, with Manchester to the southeast. The southwest of Salford also shares borders with Warrington County.
Date: 31st March 2014 v 1.0 50 Item 11 Appendix 1
Postcodes map Copyright © 2005 John Moss.
Map 5: Postcode boundary across Greater Manchester.
A map of Greater Manchester postcodes can be seen above.
Most of these local authority areas have a co-terminus CCG apart from Manchester City Council who have three CCGs (North Manchester, Central Manchester and South Manchester) within its boundaries.
The services provided by both the local authorities and the CCGs within these neighbouring area may also be accessed by Salford residents particularly if they are provided from healthcare providers located close to the border with Salford.
Commissioners should consider, when making a proposal to amend or start a service close to a neighbouring area whether there is already a service provided by another healthcare provider with accessibility to the Salford residents they are trying to target. Conversely consideration should be made when altering a service if this may affect the population of a neighbouring local authority.
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6.3.7 Travel times to Pharmacies
Another important consideration to make when determining whether or not to increase the number of pharmacy outlets within a community is how long it takes to travel to a pharmacy.
One Mile Boundary
The latest information shows that 99% of the English population - even those living in the most deprived areas - can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. Therefore it is considered reasonable that a person could walk or drive or catch public transport one mile to their nearest pharmacy.
This is also corroborated by the results of our Patient and Public survey (Appendix 7) where 49.73% of patients said they would be willing to travel less than one mile to a pharmacy. A further 34.2% of patients would be willing to travel up to two miles to their pharmacy.
Approximately 43% said they usually walk to their pharmacy whilst over 50% usually access pharmacy by car. Also the public survey indicates that over 95% of respondents are able to access a pharmacy of their choice.
Of the 36 pharmacists who responded to the pharmacy services survey 100% reported that it was less than five minutes to walk to the nearest bus stop.
With this in mind map 6 below shows a green one mile boundary line around our pharmacy locations.
Date: 31st March 2014 v 1.0 52 Item 11 Appendix 1
MAP 6: One Mile Boundary
It can be seen from the map that the areas of high population all have a pharmacy located within one mile of them. Therefore it is concluded that Salford has no requirement for additional pharmacy premises at this time.
Date: 31st March 2014 v 1.0 53 Item 11 Appendix 1
6.3.8 Unpopulated areas
Areas such as local parks would reduce the land available for pharmacy development and also indicate a lower population. It can be seen from Google Mapsxv that the area to the West lying between the M62 and the A580 East Lancashire Road is mainly fields and an area of woodland called Botany Bay Wood. Hence there are very few residential properties in this location and therefore no requirement for a pharmacy contract to be established to cover this gap.
6.4 Access to pharmacies by opening hours
For a table of opening times see appendix 8.
For a map showing location of opening hours see the one mile boundary map 6 above in section 6.3.7. The dots are colour coded to represent the hours the pharmacy in that location is open, the same coding is used in the table of opening hours.
Colour codes for Opening Hours of Dispensing Contractors Yellow – Opens later on weekdays and open Saturdays and Sundays Blue – Pharmacy opens weekdays and on Saturdays Orange – Open standard core hours Monday – Friday (over 40 hours per week) Green – Internet pharmacies Purple – Appliance suppliers
It appears from Table 8 that most of Salford neighbourhoods have 100 hour contractor within their boundaries. The exceptions are Claremont and Weaste, Little Hulton and Walkden, and Worsley and Boothstown.
Table 10: Saturday and Sunday opening.
Open on a Open on a Sunday 100hour Saturday Salford Number of (earliest open – contract (earliest open – Neighbourhood pharmacies latest closing) latest closing) Claremont & Weaste 4 - 2 (9am -5pm) - 9am- 12noon, 9am- 12noon, LPS – Salford Royal 4pm- 8pm 2pm- 8pm East Salford 11 2 4 (7am – 10pm) 3 (7am – 9pm) 5 (8.30am- Eccles 11 1 1 (10am – 3.30pm) 6pm) Irlam & Cadishead 5 1 4 (6am – 10pm) 1 (10am - 4pm) Little Hulton & 7 - 4 (8am – 9pm) 1 (10am – 4pm) Walkden Ordsall & 12 3 8 (7am -11pm) 4 (11am – 8pm) Langworthy 3 (8.30am- Swinton 7 1 1 (10am – 3.30pm) 6pm) Worsley & 3 - 2 (9am-1pm) - Boothstown Salford 61 8 33 12
Date: 31st March 2014 v 1.0 54 Item 11 Appendix 1
6.4.1 Saturday Opening
Over half of the pharmacy contractors are open on a Saturday with at least one open in every neighbourhood. Access to pharmaceutical services provided from a pharmacy can be found between the hours of 6am to 11pm within Salford. This gives good cover for Salford on Saturdays both in terms of opening hours and number of locations.
6.4.2 Sunday Opening
Two neighbourhoods, Claremont and Weaste and Worsley and Boothstown, have no standard pharmacy contractors open on a Sunday. Although within Claremont and Weaste there is the LPS contract within Salford Royal Hospital Trust. This service has been reviewed and the contract is due to end on 11th May 2014 at 22:00 as discussed in section 3.2.1
Although there is little standard pharmacy contractual cover in this Claremont and Weaste neighbourhood over Sundays there are pharmacies close by within the Eccles neighbourhood which are easily accessible to the population. There are 4 pharmacies located within 2 miles of Salford Royal Foundation Trust which are open on a Sunday.
Worsley and Boothstown neighbourhood are the least well served at a weekend with access up to 1pm on a Saturday and no cover of pharmacy services on a Sunday.
This is particularly noticeable in the Boothstown and Ellenbrook ward where there are no pharmacies open on a weekend. However this is the most affluent ward within Salford and as such the population generally will have access to their own transport allowing them to travel within the borough to another location quite readily,
The conclusion drawn in term of the opening hours for pharmacies around Salford is that all neighbourhoods have sufficient cover except for Boothstown and Ellenbrook ward, but that the need for additional Sunday hours has not been identified by the public in this area. This, in conjunction with the access to transport for the residents of Boothstown and Ellenbrook, leads the HWB to conclude that additional Sunday opening is not necessary in any of the Salford neighbourhoods.
6.4.3 Bank Holiday Opening
Where the HWB identify a requirement for additional provision on a Bank Holiday or a named day under regulations, then there would be a requirement to consider either requesting NHS England to commission an enhanced service or the LA could commission a local service.
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6.5 Conclusion
The number of pharmacies is sufficient for the population of Salford. This is borne out by
areas of high population all have a pharmacy located within 1 mile of them. approximately 92% of prescriptions generated by Salford prescribers are dispensed by Salford pharmacies.
Pharmacy opening hours are currently sufficient during the week and on Saturdays. This is also true for Sundays even though in some neighbourhoods there is no pharmacy open. This is because the public have not requested extended hours in these areas as many have access to their own transport and are willing to travel to a pharmacy elsewhere to obtain pharmacy services.
Date: 31st March 2014 v 1.0 56 Item 11 Appendix 1
7.0 Future Matters
7.1 Housing and development
Between the dates 1 April 2014 to 31 March 2017 it is estimated that across Salford there will be a net additional increase of around 4,300 dwellings, with an estimated 800 of these being of an affordable tenure. Half of the total additions are likely to be within the wards of Ordsall and Broughton. The latest government forecasts estimate that over the same period there will a population increase of 5,700 across the city. The actual population increase may be higher than this, particularly having regard to the level of estimated housing completions.
The wards of Ordsall and Broughton are currently well served by pharmacy contractors with 3 and 7 pharmacies respectively, and the neighbourhoods they are in having access to extended opening hours with two and three 100 hour contract pharmacies in the neighbourhood. Therefore it is not deemed necessary to increase the number of pharmacies in these areas solely because of the planned housing developments.
In relation to retail developments in the city, work is ongoing in relation to the remodeling of the Ellesmere Centre and Ellesmere Retail Park in Walkden Town Centre (8,302 sq.m of space), whilst construction is underway on a new Asda supermarket in Swinton Town Centre (6,671sqm of floorspace). These developments may significantly increase the number of trips to the centres once these units are occupied. Planning permission for new retail space, but where development has not yet started, has also been granted for Pendleton Town Centre (8,225sqm), Mocha Parade Local Centre (1,426sqm), City of Salford Stadium (21,367sqm) and in the Salford Central area (10,810sqm). The major employment developments in the period between 2014 and 2017 city will be Port Salford at Barton, various large office schemes around the regional centre, and the commencement of works for a major logistics area at Cutacre (primarily in Bolton but spreading into the city to the west of Little Hulton).
Little Hulton and Walkden neighbourhood currently has 7 pharmacies. Between these 7 pharmacies they have opening hours during the week, on a Saturday from 8am until 9pm and on a Sunday between 10am and 4pm. These times would coincide with standard shopping hours and therefore it is not necessary to open any further pharmacies due to the development of the shopping centres in Walkden.
Likewise Swinton has 7 pharmacies open during standard retail hours, including 8.30am till 6pm on a Saturday and between 10am and 3:30pm on a Sunday. Again these should be sufficient to cope with any influx of shoppers at the new Asda site.
Date: 31st March 2014 v 1.0 57 Item 11 Appendix 1
7.2 Primary care developments
As the new NHS structure is in its first year there will inevitably some movement of commissioned services between the new NHS organisations. This may lead to services being de-commissioned and different ones commissioned in their place.
Any potential change to the services should be based on the population need of the local areas of which the PNA, along with the JSNA and HWB strategy, is an important document to inform such decisions.
7.3 Salford’s health needs in the future
In the table below we discuss, according to the identified health priorities which are the target populations or localities which current pharmacy services and other health care service providers are currently supporting this health need. We then discuss where gaps lie and how pharmacy provision may provide a solution to address those gaps.
Date: 31st March 2014 v 1.0 58 7.3.1 Identification of the gaps between heath need and current services.
Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service)
Salford Priority 1: Ensure all children have the best start in life and continue to develop well during their early years HWB Strategic Priorities Priority 2: Local residents achieve and maintain a sense of wellbeing by leading a healthy lifestyle supported by resilient communities
Salford JSNA Health Priority 3: All local residents can access quality health and social care and use it appropriately Indicators
Date: 31st March 2014 v 1.0 59 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Infant Deaths in children under the All neighbourhoods in Essential Local Authority Salford must find Pharmacies could target pregnant Mortality age of one are a good Salford except Worsley service: Commissioned ways to work women and promote healthy marker of the health of an and Boothstown are Health services: with communities pregnancy guidance. They could area. The recommendations above England average. promotion and and individual(s) also advise on issues such as how to reduce infant deaths are advisory service From GP: and to help them to minimize the risk of Sudden to: In Irlam and Cadishead Public Health Ad hoc imms for to focus the Infant Death Syndrome (SIDS). neighbourhood, the death promotion, at risk Patients existing services. -Increase breastfeeding rate in the under 1s is Signposting, Ensure patients are able to contact -Reduce child poverty showing evidence of Dispensing Smoking There appears to relevant health professionals such -Reduce the prevalence of increasing. Medicines or Cessation (35) be gaps in as Midwives and Health Visitors by obesity Appliances, current services signposting when appropriate. -Reduce overcrowded Figures in Eccles, Winton Repeat in certain housing (which relates to and Barton suggest death Dispensing neighbourhoods Supporting parents through sudden -unexpected death rate is also rising. In one supporting infant pregnancy, early years and through in infancy) part of Barton the death Advanced mortality and to school, to give children the best -Reduce smoking in rate in less than 1 year service: MUR, service providers start in life pregnancy olds is more than twice NMS need to think -Reduce teenage pregnancy the Salford rate of 6.0 per very differently -Support pre- and post-natal 1000 live births. Local Authority about the roles care Commissioned and the way services: services are Smoking currently cessation (53) delivered.
CCG Commissioned Services: Minor ailment scheme(28),
LPS OOH Medical and Pharmacy provision
Date: 31st March 2014 v 1.0 60 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Teenage Reducing the conception The rate of teenage Essential Local Authority The gap As well as the usual Essential Conceptions rate in those under 18 conceptions is directly service: Commissioned regarding services the EHC and Chlamydia reduces the impact of related to the levels of Public Health services: teenage screening programmes could be teenage pregnancy on social deprivation for each promotion, conception is promoted and extended in the exclusion, educational neighbourhood, the Signposting, From GP: around education Neighbourhoods where the teenage attainment, social aspiration higher the deprivation, Dispensing Sexual Health of young people conception rates are highest. and the health and wellbeing the greater the rate of Medicines and and conception. of the mothers and children. teenage pregnancy. Repeat Contraception Salford must find Pharmacist EHC and Chlamydia Dispensing ways to work service provides opportunities in For neighbourhoods with All neighbourhoods have Greater with communities educating young people around high and stable teenage a higher than England Advanced Manchester and individual(s). teenage conceptions conception or termination average rate except service: Sexual Health levels, co-ordinated activity Worsley and Boothstown. MUR, Network services Young people Pharmacists could be considered to should be commissioned to: – RUClear? (13 need to be aware carry out education programmes on Ordsall and Langworthy Local Authority clinic sites in of existing the use of contraception services -Educating young people to has the highest rate of all Commissioned Salford with services and the within school. risk taking behaviour and a Salford neighbourhoods. services: varying and support in the focus on supporting positive Little Hulton and Walkden Emergency restricted opening community and Ensure patients are able to contact health behaviours. have the second highest Hormonal times) ensure this relevant health professionals in rate. Contraception information is their neighbourhood and are aware -Ensure high schools (42), continuously of the nearest contraception and serving the neighbourhood's Chlamydia available. sexual health services. young people, provide pupils Testing (0) with age appropriate [Note: Salford Relationships and Sex has a selection Education (and risk taking of participating behaviour prevention pharmacies education) as part of a providing Personal, Social and Health Chlamydia Education curriculum. testing and treatment privately over the counter]
CCG Commissioned Services: Date: 31st March 2014 v 1.0 61 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Oral Health Poor dental health is All Salford areas have a Essential GM AT Salford must find Pharmacist can promote good oral closely linked to socio- higher than England service: Commissioned ways to work hygiene and healthy eating economic deprivation. average except Health Services: with communities regimes. Decay levels for five year Claremont, Worsley, promotion and NHS Dental and individual(s) olds in Salford are higher Boothstown and South advisory service, services and to help them Pharmacies can ensure patients than for the North West of Walkden. Public Health to focus new and are able to contact relevant health England which in turn is promotion, Emergency/ existing oral professionals such as Dentists by higher than for England as Signposting, Out Of Hours health signposting when appropriate. a whole. Dental, promotions. Advanced Medical and Pharmacists can support carers to A survey of adult dental service: Pharmacy There appears to recognise oral health problems in health in 2009 showed provision be gaps in older people, to help them care for that adults in the North Local Authority current services their mouths to prevent problems and West are less likely to Commissioned Smoking in certain to ensure accessible dental care have excellent dental services: Cessation (35) neighbourhoods products is available to meet the health and more likely to Smoking and service needs of this group. suffer decay and gum cessation (53) providers need to problems than in other think differently Ensuring that healthy, sugar-free regions of the country. about roles and snacks and drinks are available in all CCG the way services settings including the Pharmacy The Salford Oral Health Commissioned are currently premises Strategy 2007-12 Services: delivered. identified the following Minor ailment Integrating oral health into healthy priorities: scheme(28), Educating young weight and healthy eating initiatives. people appears -Improving the oral health to be an Pharmacist can support patients who of young children through essential are breast-feeding or signpost when work with health visitors, recommendation appropriate early years, children's to support centres and school. Salford’s Pharmacist can sell cost-price management toothpaste and toothbrushes so that -Improving access to around oral fluoride toothpaste protection and dental care in Salford- health. good oral hygiene is accessible to all. including preventive dental treatment and advice.
-Improving access to Date: community-based31st March 2014 v 1.0 62 specialist dental services. Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Breastfeeding Salford JSNA have made All neighbourhoods have Essential Local Authority Salford must find Ensure patients are able to contact several aims to support a lower than England service: Commissioned ways to work with relevant health professionals such breastfeeding: average rate. Public Health services: communities and as Midwives and Health Visitors by promotion, individual(s) and to signposting when appropriate. -Encourage services to work Little Hulton and Walkden Signposting, From GP: Health help them to toward UNICEF Baby have the lowest visitor and increase Pharmacies could target pregnant Friendly Initiative percentage and Irlam and Advanced Midwife support breastfeeding women and promote healthy pre- accreditation. Cadishead are the service: numbers. and post-pregnancy guidance. second lowest. -Breastfeeding support The gaps in current Pharmacists will play a crucial part from experienced mothers Broughton is an area with Local Authority in neighbourhoods in sustaining breastfeeding, as one can be important families from a wide range Commissioned and ethnic groups of the barriers women face is alongside professional of cultures and ethnicities. services: need to be around over the counter and support. Salford has a There are currently few addressed. prescribed medicines. The typical paid team of Infant volunteer Breast mates in patient information leaflet will say Feeding Workers, who this area to share their CCG The general culture not to take medication during offer one-to-one support, experiences of Commissioned assumes that bottle lactation; often because there are and their role should breastfeeding with other Services: feeding is normal no trials conducted by the continue to evolve in mothers. and many people manufacturer hence some mothers response to needs that feel uncomfortable if are reluctant to continue are identified. In Charlestown and Lower they see a breastfeeding. Kersal, families tend to be breastfeeding -Encourage the use of White British, where mother, this may They could also provide facilities for Infant Feeding Workers or breastfeeding rates tend present challenges. breastfeeding mothers to breast Breast mate volunteers. to be low as family feed in their consultation facilities expectation is that babies There are currently -A programme which sets will be bottle-fed. no known local simple steps for cafes and cafes or shops that businesses to follow to are clearly ensure they are welcoming to welcoming to breastfeeding breastfeeding mothers mothers and this and babies. should be addressed.
. Date: 31st March 2014 v 1.0 63 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Child Obesity The level of obesity in Eccles ward had a lower Essential Local Authority Commissioners Pharmacist are readily accessible Salford is not significantly prevalence of overweight service: Commissioned need to ensure health care locations within the different to the England and obesity in Reception Public Health services: that any austerity communities that can promote average, but is more than year children compared promotion, measures do not healthy eating messages and double the level recorded in to the Salford average. Signposting, further encourage exercise programmes the mid 1990's. However over this same disadvantage e.g. National Change4life time period, and in the Advanced such children programme Salford is not alone in facing same age group, the service: and young the challenge of such high Barton ward had a people by Commissioners should consider levels of obesity and the significantly higher identifying the introducing healthy weight impact on health and prevalence of overweight Local Authority groups of management clinics from wellbeing it causes. A similar and obesity in Reception Commissioned children who are pharmacies or any willing provider picture can also be seen year children compared services: most likely to be where appropriate across England. to the Salford average. affected and intervene at the Pharmacist can provide support Figures suggest the rate of In Claremont and Weaste CCG earliest around pre-conception, ante natal and obesity is higher in children neighbourhood, one in Commissioned opportunity. early year's programmes, working living in the most deprived ten 4-5 year olds and one Services: towards UNICEF Baby Friendly status areas than children living in in five 10-11 year olds The current gaps and offering the best start for children. the least deprived areas. are classified as obese. and variation in services, In summary, all facilities and It is recommended neighbourhoods except education in commissioners of services Swinton, Worsley and certain must ensure at-risk groups Boothstown are above neighbourhoods are targeted within England average is affecting child mainstream health service obesity. provision. Children who have a limiting illness or disability Service providers are more likely to be need to think overweight or obese, very differently particularly if they also and offer earlier have a learning disability. intervention when services are currently delivered. Date: 31st March 2014 v 1.0 64 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Adult Obesity One in four adults are obese, All neighbourhoods have Essential Local Authority Commissioners Pharmacies are readily accessible and when combined with the similar rates to the service: Commissioned need to ensure health care locations within the number of adults who are England average of 1 in 4 Public Health services: that any austerity communities that can promote overweight, it means that obese adults. promotion, measures do not healthy eating messages and there are more overweight Signposting, From GP: further encourage exercise programmes and obese adults living in the disadvantage at e.g. National Change4life Salford area than there are Advanced risk-groups who programme adults who are of a healthy service: are most likely to weight. be affected and Commissioners could consider intervene at the introducing healthy weight The most recent information Local Authority earliest management clinics from available shows that the Commissioned opportunity. pharmacies or any willing provider. number of adults who are services: obese in Salford is not There are no significantly different to the commissioned national averages; but this CCG services from still means that nearly one in Commissioned pharmacies four adults are obese and Services: which target are likely to suffer ill health obesity. Gaps because of their weight. and variation in other services The population of Salford and education in would gain major health certain benefits by eating more neighbourhoods healthily, taking more regular are affecting physical activity and moving adult obesity. towards a more healthy weight. It is recommended commissioners of services must ensure all obese patients are targeted within the mainstream health service provision.
Date: 31st March 2014 v 1.0 65 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Mental Health Salford has some of the The neighbourhood Essential Local Authority Pharmacists are readily accessible highest levels of mental ill Ordsall& Langworthy are service: Commissioned Ensuring access to health care locations within the health in the country. the highest use of mental Public Health services: mental health communities. They are a good Figures from the health health outpatient services promotion, services is essential opportunity to promote recovery needs assessment in 2010 Claremont and Weaste is Signposting, and must be and self-care as an outcome for found that approximately the second highest user Dispensing addressed. people with mental ill health issues. 36,000 adults (20% of and have among the Medicines or This will increase the access to people aged 16+) and 6,000 highest suicide rates in Appliances, Having assessed advice and signposting for patients children (12% of people Salford Repeat local needs there around the city aged 0-18) living in Salford Dispensing appear to be gaps in have a mental health need. Irlam – highest suicide the potential Pharmacies already provide services These levels are higher than rate Advanced available mental to substance misusers but the English averages. service: health services. commissioners could consider Broughton has some of MUR, NMS Salford would extending it to include mental health Self-harm (e.g. cutting, the highest reported rates benefit with various screening. taking an overdose) is a of anxiety and depression Local Authority service re-design to sign that someone is Commissioned achieve this priority. suffering from poor mental services: Early intervention, maintenance and health. In 2010/11 there Needle management of a stable mental were 665 people across the exchange health are vital and medication can city admitted to hospital for programme play a huge role in achieving that. self-harm. This is an increase of 14% (81 cases) Supervised Education around reasons for taking compared to 2009/10. More consumption medicines and how they work can aid women than men self- harm the patient’s understanding of their and the main age group that CCG condition and therefore improve their we are concerned about is Commissioned outcome. 14-19 year old girls. Services:
The population of Salford would gain mental health benefits by supporting and promoting the ‘Five ways to wellbeing’:
-Connect with family and friends Date: -Take31st Marchnotice 2014 v 1.0 66 -Learn a new skill -Be Active -Give Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Long Term Life expectancy in Salford Swinton Neighbourhood Essential service: Local Authority Use pharmacists as part of a Conditions is improving but the gap has a significant number Health promotion and Commissioned Need to expand and multidisciplinary team to help between Salford and of people with a LTC. advisory service, services: improve GP patients understand and manage Especially England and between Public Health From GP: registers for LTC more effectively e.g. via promotion -Cancer different areas of the city Although improvements targeted MURs, supplementary Signposting, The NHS Salford managing patients -Circulatory continues. About 35% of have been made in all Dispensing Medicines Health Checks with LTC at high prescribing pharmacist clinics or Disease the life expectancy gap in other neighbourhoods or Appliances, Repeat (47) offers risks i.e. developing other innovative mechanisms. -Respiratory Salford is because of they are still above Dispensing screening to men CVD and those with Disease cardiovascular disease England average except aged 40-74 and raised BP and Atrial Disease screening to identify which includes diabetes, Worsley and Boothstown Advanced service: women aged 45- Fibrillation. patients with particular LTC could coronary heart disease MUR, NMS 74 for coronary be carried out form pharmacy and stroke. Cancer makes heart disease, Salford must find locations. up around 25% of the gap Local Authority stroke, diabetes ways to work Commissioned with respiratory diseases services: and kidney with communities Pharmacies themselves, as well as contributing around 15%. Smoking Cessation disease. and individual(s) national pharmacy bodies and local and to help them commissioners, need to do more to Salford can reduce risks of to focus the promote the pharmacy as centres of long term conditions (LTC) CCG Commissioned Smoking existing services. excellence for supporting self-care. by: Services: Cessation (35) Minor ailment Pharmacies could reach those -Stopping smoking scheme(28), Near Patient patients who would not usually Heal lice scheme(54) testing (44) attend the GP surgery. – It is anticipated such -Drinking sensibly schemes will relieve GP consultation time There are a number Early intervention, maintenance and -Maintaining a healthy and enable greater of strategies to management of a long term condition weight (through healthy support around LTC improve LTC in are vital and medication can play a eating and taking plenty of Palliative care Salford: huge role in achieving that. exercise) -Working Together Education around reasons for taking in Salford: An Alcohol Harm for a Change 4 Life; medicines and how they work can aid Reduction Strategy For the patient’s understanding of their 2010-2020 -Salford's Healthy condition and therefore improve their Weight Strategy outcome. 2009-12
-Tobacco Control Strategy Date: 31st March 2014 v 1.0 67 -A Good Life with Alcohol Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Life All neighbourhoods Essential service: Local Authority Salford must find Innovative health promotion campaigns Expectancy Salford can improve the life except Worsley, Health Commissioned ways to work can increase population awareness e.g. expectancy by: Boothstown, Irlam and promotion and services: with communities Cancer awareness campaigns, Drug Cadishead are below advisory service, and individual(s) and alcohol and weight management programmes. -Supporting prevention of ill the England average, Public Health From GP: where the gaps health and reduce smoking Looking at ways of increasing the promotion, are greatest. in the population (particularly The NHS Salford number of smokers who quit. pregnant women), excessive In Ordsall and Signposting, Health Checks alcohol drinking and obesity Langworthy, men have Dispensing (47) offers Use pharmacists as part of a which will reduce the high 10yr lower life Medicines or screening to men multidisciplinary team to help patients death rate from heart expectancy and 5yr Appliances, aged 40-74 and understand and manage long term disease, cancer and lower for women. Repeat women aged 45- conditions more effectively e.g. via respiratory disease. targeted MURs, supplementary Dispensing 74 for coronary prescribing pharmacist clinics or other Men and women in heart disease, innovative mechanisms. -Raise awareness in people of Eccles have a 5yr lower Advanced stroke, and the signs and symptoms of life expectancy. service: diabetes and Disease screening to identify patients disease so that they seek help MUR, NMS kidney disease. with particular long term conditions earlier from the doctor, get could be carried out from pharmacy treated earlier and reduce their Local Authority locations. chance of dying. Ad hoc imms for Commissioned at risk Patients services: Pharmacies themselves, as well as -Ensure screening programmes Smoking national pharmacy bodies and local are fit for purpose to detect Smoking commissioners, need to do more to disease before symptoms are Cessation Cessation promote the pharmacy as centres of noticeable (vascular health excellence for supporting self-care. checks and cancer screening CCG programmes). Commissioned Pharmacies could reach those patients Services: who would not usually attend the GP -Ensure health services are Palliative Care surgery. designed to detect and treat disease as early as possible Ensure professionals are trained across partnerships to signpost local people to and refer onto hospital if services to help them stop smoking, drink needed. sensibly, eat healthily and improve their life chances.
Raise awareness around winter deaths and support policies to cut this death rate e.g. improving the uptake of the flu vaccine.
Date: 31st March 2014 v 1.0 68 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Alcohol Use Salford is significantly All Wards except Worsley Essential Local Authority Particular patient Pharmacies could provide worse than the England and Boothstown are service: Commissioned demographics can community-level leadership to and north west averages above England average. Health services: point to a potential promote sensible alcohol use and for the following indicators promotion and abuse of alcohol. community champions to lead on of alcohol related harm: Levels of alcohol specific advisory service From GP: These populations excess alcohol alcohol -attributable hospital admissions are Public Health General Practice should be targeted deaths, deaths from highest in Winton. The promotion, NHS service as first line to reduce Pharmacies are readily accessible chronic liver disease, wider range of alcohol Signposting, the Salford alcohol- health care locations within the alcohol-related hospital related conditions are Dispensing The NHS Salford related hospital communities that can provide early admissions, alcohol also higher than average Medicines or Health Checks admissions. intervention and prevention of related crimes and violent in Barton as well as in Appliances, offers screening alcohol-related harm. crimes, alcohol-related Winton. Repeat to men aged 40- claims of incapacity Dispensing 74 and women Pharmacies can support the: A Good benefit, and estimates of aged 45-74 for Life with Alcohol in Salford: An binge drinking. Advanced coronary heart Alcohol Harm Reduction Strategy For service: MUR, disease, stroke, 2010-2020. The latest published annual NMS diabetes and data (2011) ranks Salford kidney disease Pharmacies could reach those as worst among English Local Authority patients who would not usually local authority areas for Commissioned Ad hoc imms for attend the GP surgery. alcohol related hospital services: at risk Patients admissions. Screening for increased Smoking alcohol risk can be offered CCG Cessation (35) opportunistically in a number of front Commissioned line settings. Services: Minor ailment For example collection of scheme(28), medications would offer Out Of Hours opportunity to identify, advise and Medical and intervene where appropriate. Pharmacy provision
Date: 31st March 2014 v 1.0 69 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Drug Use Salford has more than twice All Wards except Worsley Essential service: Local Authority Salford must find Commissioners should look at the the number of drug-related and Boothstown are Health promotion Commissioned ways to work neighbourhoods’ health needs and offenders (2.56 per 1,000 above England average and advisory services: with communities determine which services can be population) than England service and individual(s) targeted where e.g. Drug and and Wales (1.26 per 1,000). Public Health From GP: and to help them alcohol programmes. promotion, The NHS Salford disseminate the However, Salford does well Signposting, Health Checks message that Pharmacies already provide services at finding and engaging local Dispensing offers screening drugs can have to substance misusers are readily drug users in treatment. Of Medicines or to men aged 40- potentially accessible health care locations the estimated 1,700 heroin Appliances, Repeat 74 and women devastating within the communities. Pharmacist and crack cocaine users in Dispensing aged 45-74 for effect on lives. can take this opportunity to provide the city, 65% (1098) have coronary heart early intervention and prevention of engaged in treatment. Of the Advanced service: disease, stroke, Screening for drug-related harm remainder very few can be MUR, NMS diabetes and increased identified through the kidney disease Drug abuse can be Pharmacies could provide criminal justice system. Local Authority offered community-level leadership to Commissioned Ad hoc imms for opportunistically in a promote expertise in drug use and services: at risk Patients number of front line become community champions to Supervised settings. support health indicator. Methadone/Bupreno rphine (17), Needle For example Pharmacies could reach those Exchange scheme collection of patients who would not usually attend (10). medications would the GP surgery. Smoking Cessation offer opportunity to (35) assess risk, advise and CCG intervene where Commissioned appropriate. Services:
Date: 31st March 2014 v 1.0 70 Item 11 Appendix 1 Identified Health Partners Target Areas Relevant Services Service Gap between How could community pharmacy Health target/aims: (Neighbourhoods) currently delivered provided by need and meet the Indicators: from community other current needs in the future? pharmacy (number providers provision service) Smoking Tobacco smoking is still All Wards except Essential Local Authority Salford must find Screening for smokers can be offered the leading cause of ill Claremont, Worsley and service: Commissioned ways to work opportunistically in a number of front health and premature Boothstown are above Health services: with communities line settings. Such settings must be death in Salford. England average for promotion and and individual(s) used effectively offering treatment, Approximately 18% of smokers. advisory service, From GP: to reduce advice, monitoring and any other women in Salford Public Health The NHS Salford smoking support to stop smoking. continue to smoke during In the Ordsall and promotion, Health Checks prevalence and pregnancy which is higher Langworthy Signposting, offers screening reengage failed Pharmacist can raise awareness than the England average neighbourhood, they are Dispensing to men aged 40- quitters. amongst the population of the signs of 14%. the highest. Medicines or 74 and women and symptoms of smoking-related Appliances, aged 45-74 for disease (particularly respiratory The NHS Specialist Stop Repeat coronary heart disease such as a smokers cough) so Smoking Service Dispensing disease, stroke, that they seek treatment earlier and ‘Legends' generally see diabetes and have support to quit. smokers with more Advanced kidney disease complex needs or those service: This will include Pharmacist can promote the range of who have made repeated smoking status. local stop smoking services amongst quit attempts and require the population. more intensive CCG behavioural support. Commissioned Services: Pharmacies can support campaigns Focus on smokers in which aim to improve people's workplaces (particularly knowledge and awareness of local routine and manual Local Authority stop smoking services. workers who have higher Commissioned than average smoking services: Pharmacies can support both parents rates), hospital patients Smoking Cessation to quit through pregnancy and during with smoking-related (35) their child's early years through to illnesses and also school to give them the best start in pregnant smokers and life and to help ‘de-normalise' their family members. smoking.
Date: 31st March 2014 v 1.0 71 8.0 Conclusion and Recommendations
8.1 Conclusion
Salford Local Authority has a resident population of 233,900 people. Compared to the England average Salford has relatively high levels of deprivation contrasting with pockets of affluence. It currently has a relatively young population but in the longer term there will be an increase in the older population in line with national trends.
The life expectancy for Salford’s residents is below the England average but the gap is narrowing. There are still some significant variations for particular disease areas which need to be addressed in order to continue to improve the health of Salford’s residents.
Pharmacies’ wider role in improving health
Pharmaceutical services play an important role in helping the HWB and their partners deliver the desired health outcome for the population of Salford. The PNA shows that those pharmaceutical services delivered by the community pharmacies across the borough are well placed to improve access for patients. Community pharmacists should be considered when commissioning services as they are in an ideal situation to serve local populations and to contribute to the wider self-care and prevention agenda.
In order that the public can benefit more widely from the current pharmaceutical services on offer it is suggested that public promotion of pharmacies is necessary. This is not necessarily a focus just for the local commissioners and contractors themselves, but should also be addressed by the national and local pharmacy bodies.
Current pharmaceutical services across Salford
Pharmaceutical provision has increased from 24.4 pharmacies per 100,000 population in 2011 to 25 pharmacies per 100,000 population in 2013/14. This is due to six new pharmacies (an 11% increase) opening since the 2011 PNA was written. As five of these six pharmacies are 100 hour contracts, the number of hours available for accessing pharmaceutical services via pharmacy contractors has also significantly increased.
In 2013 there are 61 pharmacy contractors in the Salford area. Of these:
eight have contracts which say they should open for 100 hours each week two pharmacies have a Local Pharmacy Services contract where additional services are bought by the NHS England Local Area Team
Date: 31st March 2014 v 1.0 72 Item 11 Appendix 1
one pharmacy also dispenses appliances, in addition to medicines. For example catheter accessories that have been prescribed by a doctor.
A distance selling pharmacy must manage patients’ medicines and provide all their pharmaceutical services without the need for a face-to-face consultation. This could be managed by receiving prescriptions via post and sending dispensed items via courier or by post. There are no distance-selling pharmacy contractors in Salford.
On average, 92% of items that are prescribed in Salford are dispensed in Salford. There is good access to pharmacies which open early, late and at the weekends across Salford. This allows good access to pharmaceutical services for the public. This PNA has concluded that access to pharmaceutical services, in terms of opening hours, are sufficient.
Public use and perception of community pharmacies
The public survey showed that
90% of respondents use a regular pharmacy 96% were satisfied or very satisfied with their pharmacy Almost 96% of respondents to the public consultation said they had no problems accessing a pharmacy.
This suggests the number of pharmacies is sufficient to manage the need of the population for dispensing of prescriptions.
Conclusion on pharmaceutical provision
The conclusion of this PNA is that the population of the Salford local authority area has sufficient service provision (including pharmacy contractors) to meet its pharmaceutical needs. This is clearly demonstrated by the following points:
areas of high population all have a pharmacy located within 1 mile of them. The number of community pharmacies has increased from 55 to 61 between 2011 and 2013 and the number of 100 hour pharmacies has increased from 3 to 8 in that time. approximately 92% of prescriptions generated by Salford prescribers are dispensed by Salford pharmacies
Date: 31st March 2014 v 1.0 73 Item 11 Appendix 1
Recommendations
1. That currently there are sufficient pharmaceutical services to meet the needs of the population.
For Commissioners
2. To challenge local commissioners to consider community pharmacies as a setting for delivery of a range of services that are not traditionally provided by them, including for specific groups in the population for example residents of different ethnic backgrounds.
3. For commissioners of statutory and locally defined services to work with pharmacies to increase awareness of pharmacy services. This would help services to be used more effectively and contribute to the improvement of the health of the local population.
4. To review the LPS contract in Irwell Riverside and consider if a standard contract would be a more cost effective solution for commissioners (see Section 3.2.1).
5. To plan pharmaceutical services for projected demographic changes, for example the expected increase in elderly population (see Section 4.3).
6. To evaluate levels and effectiveness of medication use reviews to contribute to reducing hospital admissions and medication wastage (see Section 4.3).
For the Health and Wellbeing Board:
7. ensure there are systems in place to monitor potential changes that will affect the delivery of pharmaceutical services and have a process in place to decide whether the changes are “significant” and hence what action it needs to take.
8. monitor changes in national and local policy and strategy e.g. the national primary care contract and the local Alliance Agreement for Integrated Care for the Elderly, to determine if this PNA needs to be refreshed sooner than in three years’ time.
For community pharmacies:
9. For pharmacies to carry out their own customer satisfaction surveys to identify future improvements to customer service.
Date: 31st March 2014 v 1.0 74 Item 11 Appendix 1
9.0 Equality Impact Assessment
An equality assessment has been carried out on the PNA and can be found in appendix 10.
10.0 Appendices
APPENDIX 1 - Pharmacy Service Descriptions APPENDIX 2 - PNA 60 day Consultation plan APPENDIX 3 - 60 day Consultation Analysis –to be inserted when complete APPENDIX 4 - Pharmacies listed by locality and ward APPENDIX 5 - Pharmacy Survey 2013 (Salford) APPENDIX 6 - Locally Commissioned Services – Salford APPENDIX 7 - Public Survey 2013 (Salford) APPENDIX 8 - Pharmacy Contractor Opening Hours APPENDIX 9 - List of Acronyms APPENDIX 10 - Equality Analysis
i The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. Accessed 6.8.13 http://www.legislation.gov.uk/uksi/2013/349/contents/made ii http://www.legislation.gov.uk/ukpga/2009/21/section/25 iii Primary Care Commissioning http://www.pcc-cic.org.uk/article/pharmacy-enhanced-services-1-april- 2013 accessed 6.8.13 iv Pharmaceutical Services Negotiating Committee ahttp://psnc.org.uk/contract-it/the-pharmacy-contract/ accessed at 6.8.13 v Pharmaceutical Services Negotiating Committee accessed 6.8.13 http://psnc.org.uk/services- commissioning/locally-commissioned-services/ vi NHS Employers PNA guidance Accessed 25.6.2013 http://www.nhsemployers.org/Aboutus/Publications/Documents/Pharmaceutical_Needs_Assessments %E2%80%93a_practical_guide.pdf vii Office National Statistics accessed 10 9 2013; viii Prescriptions dispensed in the community, Stats for England 2002 – 2012 accessed: 10.9.2013 http://www.hscic.gov.uk/catalogue/PUB11291 ix British Liver Trust accessed 10.9.2013 http://79.170.44.126/britishlivertrust.org.uk/home-2/liver- information/liver-conditions/cirrhosis/ x British Heart Foundation Publications. Ethnic Differences in Cardiovascular Disease 2010 edition accessed 11. 9. 2013 http://www.bhf.org.uk/plugins/PublicationsSearchResults/DownloadFile.aspx?docid=a60f60ea-3c48-
Date: 31st March 2014 v 1.0 75 Item 11 Appendix 1
4632-868f-1fcfd00e088f&version=- 1&title=Ethnic+Differences+in+Cardiovascular+Disease&resource=HS2010ED xi Salford's Joint Health and Wellbeing Strategy: Our vision for a Healthier Salford by 2016 accessed20.8.2013 xii Partners in Salford, JSNA Neighbourhood profiles accessed 7.8.13; http://www.partnersinsalford.org/jsnaprofilesalford.htm xiii General Pharmaceutical Services in England: 2002-03 to 2011-12 Published 22 November 2012 accessed 27.8.2013https://catalogue.ic.nhs.uk/publications/primary-care/pharmacy/gen-pharm-eng-2002-03-2011-12/gen- pharm-eng-2002-03-2011-12-rep.pdf xiv General Pharmaceutical Services in England: 2002-03 to 2011-12 Published 22 November 2012 accessed 27.8.2013https://catalogue.ic.nhs.uk/publications/primary-care/pharmacy/gen-pharm-eng-2002-03- 2011-12/gen-pharm-eng-2002-03-2011-12-rep.pdf xv Google Maps 2013 search criteria Cadishead, Salford. accessed 11 9 2013 https://maps.google.co.uk/maps?q=cadishead+&hl=en&ll=53.461993,- 2.44257&spn=0.0604,0.169086&sll=53.488465,- 2.298297&sspn=0.060362,0.169086&t=h&hnear=Cadishead,+United+Kingdom&z=13
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