Pharmaceutical Needs Assessment 2011
Published: January 2011 Review date: January 2014
Contents
1 Foreword...... 2 13 References...... 74
2 Purpose and use of this PNA...... 3 14 Acknowledgements...... 75 What is a PNA?...... 3 How to use this PNA...... 4 15 Appendices...... 76 Appendix 1 - List of community pharmacies 3 Executive summary...... 5 in Kirklees showing code for maps...... 76 Appendix 2 - List of general medical practices 4 Background to community pharmacy contract...7 in Kirklees showing code for maps...... 80 Essential services...... 7 Appendix 3 - How the PNA was developed.83 Advanced services ...... 7 Appendix 4 - Consultation list...... 85 Enhanced services...... 8 Appendix 5 - Equality impact assessment... 86
5 Who provides services to NHS Kirklees?...... 9 16 Table 1 demonstrates pharmacy opening hours, dispensed items and population per 6 Populations now and in the future...... 10 locality...... 92 Table 2 highlights the provision of directed 7 Key issues improving health and well being services by community pharmacies ...... 100 inequalities...... 13 17 Maps...... 108 8 Current pharmaceutical service provision in Map A - features the spread of primary care ...... 15 pharmacies (including the only GP Locality map and summaries...... 19 dispensing practice) within Kirklees Including: against a background showing Population and health needs deprivation index of the population...... 109 Current pharmaceutical provision Map B – demonstrates pharmacy position vs Service gaps/pressures population density...... 110 Map C – Community pharmacies with 9 Stakeholder views...... 62 weekend/100 hours opening...... 111 Patient and public...... 62 Map D – Community pharmacies providing GPs and Commissioners...... 64 sexual health services ...... 112 Local authority...... 66 Map E – Community pharmacies providing supervised consumption of methadone and Urgent Care provider...... 66 buprenorphine...... 113 Community pharmacists...... 66 Map F – Community pharmacies providing needle and syringe exchange service...... 114 10 Identified pharmaceutical needs...... 67 Current service gaps/pressures...... 67 Map G – Community pharmacies providing stop smoking services ...... 115 Looking to the future...... 71 18 Glossary...... 116 11 Summary of recommendations...... 72
12 Control of entry : Exempt applications...... 73
PHARMACEUTICAL NEEDS ASSESSMENT 1 1 Foreword The White paper, Equity and Excellence : Liberating the NHS, published in 2010 sets out the long term vision for the future of the NHS. This Pharmaceutical Needs Assessment (PNA) provides the base from which to deliver some of the aspirations of the white paper e.g. continuous service improvements through evidence based commissioning using local needs assessments and to promote integration of community pharmacy and GP led commissioning by providing the intelligence to make informed decisions on the future commissioning and provision of pharmacy services. NHS Kirklees has a statutory duty to carry out and publish a PNA. Working with representatives of community pharmacy contractors we will use this assessment to develop NHS pharmaceutical services and plan for the years ahead. There are 93 pharmacies across Kirklees of which 38 (40%) are independent contractors and the remaining are part of large chains. There are 72 general practices, 17 having branch surgeries with a total of 267 family doctors. We have 59 dental practices, and 46 opticians (plus 25 others who provide services to patients in their own homes), as well as hospitals within the Kirklees boundaries. An important part of our job is to develop and work in partnership with other key statutory stakeholders including Kirklees Council, Calderdale and Huddersfield NHS Foundation Trust, The Mid Yorkshire Hospitals NHS Trust and the South West Yorkshire Partnership NHS Foundation Trust. Other partners include the community and voluntary sector. We are all working together to make sure the health services you need are right for you. The PNA will be used as a tool in ensuring that all future commissioning decisions for the provision of pharmaceutical services meet the pharmaceutical and relevant health needs of the Kirklees population. It will inform both commissioning of pharmaceutical services and decisions on new pharmacy contract applications. The PNA and Joint Strategic Needs Assessment (JSNA) are closely aligned and future strategic responsibility for these documents is likely to sit with the Health and Well-being Board. The PNA will be regularly reviewed and updated by the appropriate authorised statutory body. The document has been fully consulted on as required by the regulations. A consultation report and equality impact assessment are published alongside this PNA. All documents are available on the NHS Kirklees website www.kirklees.nhs.uk/public-information/publications/reviews-and-assessments/. NB The contents of this publication were accurate as of 30 November 2010.
2 PHARMACEUTICAL NEEDS ASSESSMENT 2 Purpose and how to use this PNA What is a PNA? Section 128A of the NHS Act 20061 requires Primary Care Trusts (PCTs) like NHS Kirklees to assess the pharmaceutical needs for its area and to publish a statement of its assessment and of any revised assessment. Termed Pharmaceutical Needs Assessment (PNA), the National Health Service (Pharmaceutical Services) Amendment Regulations SI 2010/914 outline the minimum information to be contained in a PNA and the process to be followed for its development. This document sets out the pharmaceutical needs of our local population both now and in the immediate future in accordance with these aforementioned regulations. Community pharmacies provide people with access to medicines in a variety of ways without an appointment. In addition they offer a range of other services which promote self care and help people to use medicines safely and effectively. Patients are free to choose which community pharmacy to go to and do not need to be a registered patient of the pharmacy. In this document we will tell you how we will make sure all local people have equal access to community pharmacy services and how we will commission and develop future community pharmacy services. The aim of a PNA is to enable NHS Kirklees and our stakeholders to understand the pharmaceutical needs of our local population and to help us plan future services. This PNA will require a fundamental review every three years. However where there is a change to the availability of services following the publication of this PNA that could have an impact on the determination of an application, a supplementary statement will be issued.
The objectives of this PNA are: • To support a robust decision making process for applications for NHS community pharmacy contracts within NHS Kirklees • To have a clear picture of the current services provided by community pharmacies and identify gaps in service provision in relation to NHS pharmaceutical services • To be able to plan for future services to be delivered by community pharmacy and make sure that any gaps in services are addressed • To make sure reasonable choices of pharmaceutical services are available for the people of Kirklees • To stipulate the range of directed enhanced services expected from community pharmacies entering the pharmaceutical list under the exempt category within the ‘Control of Entry’ Regulations 2005, (e.g. 100 hour pharmacies and wholly internet pharmacies)
1 http://www.legislation.gov.uk/ukpga/2006/41/section/128
PHARMACEUTICAL NEEDS ASSESSMENT 3 • To stipulate the range of directed services expected from pharmacies with previously called ‘exempt’ type contracts (as per the 2005 regulations), in anticipation of additional regulations due for publication in 2011 which support the use of PNAs in determining pharmacy applications • To provide the basis for a robust commissioning process for enhanced services from community pharmacies which enables community pharmacy to fully participate in service re-design • To encourage the use of community pharmacies as a means of reducing health inequalities • To encourage multidisciplinary working between independent pharmacy contractors and other healthcare professionals.
Associated policies and procedures are: • Joint Strategic Needs Assessment (JSNA 2009 and 2010)2 • Five Year Strategic Plan 2008-133 How to use this PNA The PNA should be used as a tool to help deliver World Class Commissioning competences such as delivering better health and well being for people, improving health outcomes and reducing health inequalities’.4 Equally it should be utilised as a service development tool in conjunction with the Joint Strategic Needs Assessment (JSNA) and the five year strategic plan, as mapping out current services and gaining a sense of future service needs will pinpoint the localities of Kirklees that need more development of pharmaceutical services. The PNA can be used by patients, current service providers, future service providers and commissioners alike in the following ways: • Maps and tables detailing specific services will mean patients can see clearly where they can access a particular service. It will also provide another source of contact details for their local pharmacies. • Current service providers will be better able to understand the unmet needs of patients in their area and take steps to address this need. • Future service providers will be able to tailor their applications to be added to the pharmaceutical list to make sure that they provide the services most needed by the local community. • Commissioners will be able to move away from the ‘one-size fits all approach’5 to make sure that pharmaceutical services are delivered in a targeted way. • The NHS Kirklees pharmacy panel or any future appointed body will be in a better position to judge new applications to join the pharmaceutical list and make sure that patients receive quality services and adequate access without plurality of supply. If you are planning on applying to join the NHS Kirklees pharmaceutical list you should use the data contained in this document to help you decide which types of services you offer. Having assessed local needs of our population and the current provision of pharmaceutical services the following statements outline how we intend to secure improvements to, or better access to, pharmaceutical services for the benefit of the population in NHS Kirklees.
2 Health and Well-being key issues for the people of Kirklees. Joint Strategic Needs Assessment. Kirklees Partnership 2009 and 2010 (publication due shortly) http://www.kirklees.nhs.uk/public-information/publications/reviews-and-assessments/ 3 Five Year Strategic Plan 2010-2015. Revision January 2010. NHS Kirklees. www.kirklees.nhs.uk/public-information/publications/plans/ 4 Pharmaceutical Needs Assessments (PNAs) as part of world class commissioning. NHS Employers January 2009. (accessed February 2010) 5 Department of Health Single Equality Scheme 2009-2012 (accessed Sept 2009)
4 PHARMACEUTICAL NEEDS ASSESSMENT 3 Executive summary Access • As demonstrated by maps A and B (pharmacy location vs deprivation indices and population density respectively) availability of pharmacies within Kirklees is adequate and necessary to meet need, with a significant number of 100 hour pharmacies supporting the required out of hour provision. The Valleys and Mirfield, Denby Dale and Kirkburton localities are less well served by pharmacies than other localities, however the recently granted applications for new pharmacies should give better access to pharmaceutical services in these areas. More investigation of GP opening hours compared to pharmacy opening hours is needed for these localities. We will review all these issues within a year. • There are sufficient numbers and variety of pharmacies (independent and multiples) in all localities offering patients adequate choice. • We will work with our pharmacists to make sure that there is good signposting to pharmacies where other languages are spoken and share this information with other health and social care services.
Premises and infrastructure • We will work with our pharmacists to identify ways in which private consultation facilities can be further developed and fully utilised for the benefit of our population, particularly in the north of Huddersfield. • Where the infrastructure of the pharmacy does not allow for a consultation room to be available the pharmacy will be encouraged to seek alternative methods of providing this service. • We will continue to promote better access facilities for patients with a disability across Kirklees. • Robust IT support systems and effective use of such systems will improve the efficiency of community pharmacies. We will encourage all pharmacies to improve utilisation of email transmission, internet and word processing packages without disruption to the dispensing process.
Integration • We will work with our pharmacists and GPs to create better opportunities for working together. We will focus on initiatives where there is common ground such as repeat dispensing and Medicines Use Reviews (MUR). • We will emphasise in our commissioning the importance of continuity and consistency of pharmacist provision to make sure that the experience of patients reflects our aspirations.
PHARMACEUTICAL NEEDS ASSESSMENT 5 Essential services • We will work with our pharmacists to identify how to share best practice in undertaking interventions and dealing with pressures of work which present a barrier to activity. • More training, facilitation and sharing of good practice is needed amongst pharmacy staff to increase the regularity of provision and quality of the wider essential services i.e. public health, signposting and support for self care. • We need to use the planned introduction of EPS release 2 as a tool to increase the use of repeat dispensing (RD). This recommendation links with efforts to improve integration between pharmacists and GPs which is a prerequisite for successful implementation of this service. • We will raise awareness of the range of services available from community pharmacies such as public health advice, self care and disposal of waste medicines.
Advanced services • We will work to increase the number of sites which are accredited to begin providing MUR particularly in pharmacies in the north of Huddersfield and will encourage more activity across all sites. • We will work with our pharmacists to link the provision of MUR with our long term conditions strategy, particularly around patient education and improving adherence in those with long term conditions.
Enhanced services • We will make sure that commissioning of enhanced services is reflected in the activity that we see from our community pharmacies and match with areas of greatest need. • We will identify pharmacies that are successfully delivering multiple enhanced services and work with them to share best practice with other providers. • We will look at how we can use pharmacists’ willingness to provide NHS health checks, weight and pain management, disease screening and monitoring, and medicines management services for vulnerable people to support work in reducing health inequalities.
Workforce • Where new developments take place we will work with GPs, developers and community pharmacists to make sure that patients continue to have access to convenient, high quality pharmacy services. • Community pharmacies will be encouraged to raise professional standards by using opportunities to develop the skills of their staff and improve quality of services for the local population. • We will continue to make sure appropriate systems and processes are in place at community pharmacies for re-accreditation, training and clinical supervision and enhance patient safety.
6 PHARMACEUTICAL NEEDS ASSESSMENT 4 Background to community pharmacy contract The Community Pharmacy Contractual Framework 20056 is a three tiered service made up of: • Essential services (all pharmacies must provide) • Advanced services (pharmacists and the premises from which they operate need extra accreditation before delivery of these) • Enhanced services (commissioned locally, staff delivering these services might need extra accreditation and some services will also need accreditation of premises) Advanced and enhanced services are set out in Directions under section 127 of the NHS Act 2006 and the term ‘Directed services’ is sometimes used to describe both advanced and enhanced services. a. Essential services include: • Dispensing • Public health • Clinical governance • Repeat dispensing • Signposting • Waste management • Support for self care b. Advanced services: There are three advanced services7 within the NHS Community Pharmacy Contract; two of which were only introduced in April 2010. Community pharmacies can opt to provide any of these services as long as they meet the requirements set out in the Secretary of State Directions. Table two in section 16 shows extent of provision of advanced services across Kirklees.
Medicines use review (MUR) and prescription intervention service The first advanced service which was introduced on 1 April 2005 was the MUR and prescription intervention service. The service consists of accredited pharmacists doing structured reviews with patients on multiple medicines, particularly those who take medicines for long term conditions. The MUR process helps to establish a picture of the patient’s use of their medicines - both prescribed and non-prescribed. The aim of the review is to help patients understand their therapy and to identify any problems they are experiencing along with possible solutions. A report of the review will be provided to the patient and to their GP where there is an issue for them to consider.
6 Community pharmacy national contractual framework accessed via PSNC website http://www.psnc.org.uk/pages/introduction.html (June 2010) 7 Pharmaceutical Services Negotiating Committee (PSNC) accessed from http://www.psnc.org.uk/pages/advanced_services.html (June 2010)
PHARMACEUTICAL NEEDS ASSESSMENT 7 In order to address local priorities, PCTs can recommend that MURs are targeted at certain patient groups. Seventy four pharmacy contractors in Kirklees have secured accreditation for their premises so that pharmacists can deliver MURs and between April 2009 and March 2010, 70 of those premises had evidence of MUR activity. The number of pharmacists who had notified NHS Kirklees that they have personal accreditation to deliver MURs during this period was 136. The dispensing GP practice in the Valleys locality undertakes Dispensing Review of Use of Medicines (DRUMs) which are not dissimilar to MURs.
Appliance use review (AUR) service AUR is the second advanced service, introduced in April 2010. AURs can be carried out by a pharmacist or a specialist nurse in the pharmacy or at the patient’s home. AURs should improve the patient’s knowledge and use of any specified appliance by: - Establishing the way the patient uses the appliance and the patient’s experience of such use; - Identifying, discussing and helping to resolve poor or ineffective use of the appliance by the patient; - Advising the patient on the safe and appropriate storage of the appliance; and - Advising the patient on the safe and proper disposal of the appliances that are used or unwanted.
Stoma appliance customisation (SAC) service SAC was the third advanced service introduced in April 2010. This service involves the customisation of stoma appliances, based on the patient’s measurements or a template. The aim of the service is to ensure proper use and comfortable fitting of the stoma appliance and to improve how long they are used for, thereby reducing waste and unnecessary patient discomfort. c. Enhanced services: These services are commissioned locally by PCTs in response to the needs of the local population. Table two highlights current provision of commissioned enhanced services provided by community pharmacies and maps D - G identify the location of some of these services within Kirklees localities. Enhanced services currently being commissioned in NHS Kirklees include: • Sexual health services (see map D) including: - Emergency hormonal - Condom distribution contraception - Pregnancy testing - Chlamydia screening • Supervised consumption of methadone and buprenorphine (see map E) • Needle and syringe exchange (see map F) • Stop smoking services and nicotine replacement therapy (see map G) • Head lice treatment • Palliative care • Minor ailments advice (pilot scheme in parts of the Huddersfield locality) Contract monitoring NHS Kirklees monitors the quality of pharmaceutical services through our contract monitoring process, assessing pharmacies against the standards in the national contractual framework. We do contract monitoring visits on a rolling three yearly basis to each pharmacy in Kirklees. Failure to meet any requirements within the contract is managed in line with Department of Health guidance and NHS Kirklees processes. The visits are done by the community pharmacy contract manager and clinical governance facilitator; the approach being non–threatening, professional and friendly but thorough. The aim is to make the visit as beneficial as possible for both parties, using the opportunity to share good practice and promote high quality service provision. Feedback is given at the end of the visit and reports of the visit, with agreed action plans, are sent back to the pharmacy. The dispensing doctor is similarly monitored via the dispensing services quality scheme (DSQS).
8 PHARMACEUTICAL NEEDS ASSESSMENT 5 Who provides services to NHS Kirklees? NHS Kirklees is committed to commissioning services from providers who are best placed to deliver the needs of our patients and population.
Current position NHS Kirklees contracts mainly with two acute trusts, Calderdale and Huddersfield NHS Foundation Trust and The Mid Yorkshire Hospitals NHS Trust, although we also commission significant activity from Leeds Teaching Hospitals NHS Trust, Bradford Teaching Hospitals NHS Foundation Trust, Barnsley Hospital NHS Foundation Trust, and Sheffield Teaching Hospitals NHS Foundation Trust. In addition to these local services, residents of Kirklees can receive care from over 200 other acute NHS service providers across England, Scotland and Wales, either as a result of specialised care or the application of patient choice. For specialised services, it is important that patients can receive their care within reasonable travelling distances and accordingly most of our residents receive specialised care from one of the three main tertiary providers within the region: Sheffield Teaching Hospitals NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust and Hull and East Yorkshire Hospitals Trust. Some residents will also travel further afield for highly specialised services (e.g. services for children provided by Great Ormond Street Hospital). For mental health services, NHS Kirklees contracts mainly with South West Yorkshire Partnership NHS Foundation Trust, with some specialist services being provided from a range of other organisations. Emergency ambulance services are commissioned by NHS Kirklees from Yorkshire Ambulance Service NHS Trust, which is the sole provider to the majority of PCTs in the region. NHS Kirklees’ current main providers of general community services (eg district nursing, health visiting, contraception and sexual health services) are Kirklees Community Healthcare Services (KCHS) and Calderdale and Huddersfield NHS Foundation Trust. Some services are also provided by The Mid Yorkshire Hospitals NHS Trust, Kirklees Council, South West Yorkshire Partnership NHS Foundation Trust and a broad spread of other providers, including voluntary and third sector organisations, for one or more specific services. Other primary care services are provided by local independent providers of general medical, general dental, pharmaceutical and optical services. NHS Kirklees has procured a GP equitable access centre, The School House Practice, which is based within Dewsbury Health Centre in the Dewsbury locality and is open for patients who are not registered at School House Practice every day of the year; from 12pm to 8pm, Monday to Friday and from 8am to 8pm Saturdays, Sundays and bank holidays. In addition there is North Kirklees Walk-in Centre on the Dewsbury and District Hospital site which is open Monday to Friday from 9am - 6.30pm.
PHARMACEUTICAL NEEDS ASSESSMENT 9 6 Populations now and in the future Kirklees comprises a mix of urban communities and rural areas. The total population at the start of 2010 was approximately 429,106. By 2025 the population is predicted to increase by 6% to nearly 455,000. Nationally, 40% of the population is forecast to be over the age of 50 by 2026,8 therefore the ageing population needs to be considered by all health and local council services. Currently nearly one in four of the Kirklees population is aged less than 19 years. Half the population is of working age and just below one in seven (15%) are aged over 65 years. By 2025 the proportion in the working age group will have reduced and those aged over 65 will have increased to nearly one in five (20%) as people live longer than before. The increase in those aged over 65 includes a large increase (96%) in the proportion living more than 85 years - these are the people most likely to have complex health and social care needs.9 Children under 12 years old form 15% of the total population. The north of Kirklees has a larger proportion of their population of younger age than in the south of Kirklees.
Resident population by age group and ethnicity for localities and Kirklees 2010 Aged 12-64 yrs Aged over Total South Non South under 12 65 yrs Asian Asian yrs origin origin Batley, Birstall and 9,300 38,850 6,800 54,950 16,750 38,200 Birkenshaw Dewsbury 11,125 41,950 6,550 59,625 21,675 37,950 Huddersfield 19,600 97,625 19,500 136,725 27,525 109,200 Mirfield, Denby Dale 6,550 37,825 8,325 52,700 1,075 51,625 and Kirkburton Spen Valley 7,650 37,825 7,675 53,150 5,200 47,950 The Valleys 9,825 52,175 9,950 71,950 1,900 70,050 Kirklees 64,050 306,250 58,800 429,100 74,125 354,975 Source: WYCSA, January 2010
8 Audit Commission: Under Pressure Local Government report Feb 2010. 9 Projecting Older People Population Information (POPPI) System. Accessed March10
10 PHARMACEUTICAL NEEDS ASSESSMENT Graph illustrating projected demographic growth
Source: www.poppi.org.uk March 2010 Ethnicity The population of Kirklees is made up of people with different ethnic origins. Nearly one in six are of South Asian origin, Pakistani and Indian primarily. There is a small Afro-Caribbean population mainly located in Huddersfield. Over a third of young people in the north of Kirklees are of South Asian origin, which is higher than in the south of Kirklees. Languages In Kirklees there are eight main ethnic groups. The table identifies the languages spoken, written and read by these groups. Smaller ethnic groups in Kirklees include Polish, Ukrainians, Lithuanians and other East Europeans from various countries. Recently Kirklees has also had refugees, asylum seekers and people from new EU countries. Nationalities include Kurdish (mainly from Iraq), Iranians, Turkish, Polish, Czechoslovakians, Romanians, Hungarians, West Africans, East Africans, Russians, Afghanistans, Far Eastern, Middle Eastern and Chinese.
Ethnic origin Population (est from Spoken language Read/written census 2001) language White 85.6% English English Black Caribbean 1.8% English, Creole English Black African 0.2% English, French, Swahili English Indian 3.1% Gujaratis Gujarati Gujarati 0.7% Sikhs Punjabi Punjabi (Gurmukhi) 0.4% Other Hindi/Punjabi Hindi/Punjabi Pakistani 4.2% Punjabi, Urdu, Potowari Urdu Kashmiri 3.2% Pahari Urdu, Pahari Bangladeshi 0.1% Sylheti, Bengali Bengali Chinese 0.15% Cantonese Cantonese/Mandarin Others 0.45% Various Various TOTAL 100% Source : Kirklees Community Languages department, Kirklees Council (2010)
PHARMACEUTICAL NEEDS ASSESSMENT 11 Deprivation According to the Index of Deprivation (ID) 2007, Kirklees ranked as the eighty second most deprived local authority out of 354 in England. Just over 120,000 Kirklees residents (all ages), nearly one in four, lived within the top 20% worst deprived areas, identified from the national ranking of LSOAs (Lower Super Output Areas) by ID 2007 deprivation score. The pattern of deprivation across Kirklees is not evenly distributed, with some localities experiencing higher levels of deprivation than others. Dewsbury had the highest levels of deprivation with 60% of its resident population living within the 20% most deprived areas. Huddersfield and Batley, Birstall & Birkenshaw had 39% and 37% of its residents respectively living in the 20% most deprived areas. These levels of deprivation contrast significantly with the other three localities where the proportion of residents living in the 20% most deprived areas is much lower. These are Mirfield, Denby Dale & Kirkburton, Spen Valley and The Valleys which, respectively, have 14%, 13% and 5% of their residents living in the 20% most deprived areas. Life expectancy Life expectancy at birth in Kirklees is improving but remains below the national average, significantly so for women. Male life expectancy at birth in 2010 was 77.3 years and female 80.9 years. There are differences across the localities with life expectancy in Dewsbury significantly below the national rate for both men and women. Men in Dewsbury can expect to live nearly five years less than men in the Holme Valley, whilst women in Batley can expect to live four years less than women in the Holme Valley. Infant mortality remains higher than the national rate, particularly in the north of Kirklees. Health status The health of people in Kirklees is generally worse than the national average. Deaths from heart disease, stroke and cancers in those aged under 75 years remain slightly worse than the averages for England, but are improving. Long term condition management has improved locally and remains a focus given the increasing proportion of those living with these conditions. High infant mortality, particularly in the north of Kirklees has led to a focus on the personal behaviours of women of child bearing age. These women often have more influence on family behaviours, and can focus on eating a healthier diet and being physically active. Smoking levels in Kirklees remain too high and obesity is an area of increasing concern for both children and adults.
12 PHARMACEUTICAL NEEDS ASSESSMENT 7 Key issues identified for improving health and well-being inequalities The aim of a JSNA is to describe the future health and well being needs of local groups of people to inform the strategic direction of service delivery and redesign to meet those needs. It also includes identifying inequalities i.e. those most at risk or in need due to factors that can be avoided or changed. The JSNA in 2009 identified the key priorities which had the main impact on local people. These remain similar to the previous JSNA in 2008 and continue to apply in the 2010 JSNA. Priorities are broken down into issues, specific groups of people and localities most in need. Community pharmacy can play a role in helping to deliver on some of these key priorities.
Specific vulnerable groups: Conditions: • Women of child bearing age: their personal • Heart disease and • Pain behaviours stroke • Obesity • People with disabilities • Emotional • Diabetes well-being • Older people • Dementia Personal behaviours: • Smoking • Alcohol • Food and nutrition • Sexual health • Physical activity
Priorities in bold italics above are key issues identified within the JSNA for both adults and children and young people alike. Currently the only enhanced service delivered in community pharmacies across Kirklees that relates to children and young people is the community pharmacy sexual health scheme which gives access to advice and treatment to those aged 13 and over. Consideration needs to be taken as to whether a community pharmacy setting is equally appropriate for other types of services that children and young people might benefit from.
PHARMACEUTICAL NEEDS ASSESSMENT 13 Services for adults within NHS Kirklees that are currently provided by community pharmacies and fit in with the JSNA priorities include: • A requirement to comply with the Disability Discriminations Act (DDA) 1995 ‘to make reasonable adjustments to their services and provide auxiliary aids where appropriate for people with disabilities.’10 • Stop smoking services and free access to nicotine replacement therapy (NRT) for those who do not pay for prescriptions. • Sexual health services that include: - Access to free emergency hormonal contraception (EHC) - Chlamydia testing - Pregnancy testing - Access to free condoms • A requirement to take part in up to six public health campaigns per annum that cover a range of topics including: - Stop smoking - Obesity - Heart disease - Physical activity - Breast feeding awareness - Healthy eating - Diabetes In the Huddersfield locality there is also a minor ailments pilot scheme which is being reviewed in Dec 2010-Jan 2011, results of which will determine the future of the scheme and its potential roll out. Other health and well-being inequalities for adults in Kirklees There are currently other services that community pharmacies provide, for conditions and specific vulnerable groups that have not been highlighted as key priorities in the JSNA but are identified key PCT priorities. These include the following: • Access to free head lice treatment • Supervised consumption schemes for methadone and buprenorphine • Needle and syringe exchange schemes for substance misusers • Disposal of waste medicines – helping to reduce the number of accidental poisonings in the home. • Access to palliative care medicines – (scheme guarantees stocks of certain palliative care drugs always being available in participating pharmacies)
10 Disability Discrimination Act (DDA) 1995. Pharmacy & the Disability Discrimination Act. PSNC 2009 (accessed 31 December 2009)
14 PHARMACEUTICAL NEEDS ASSESSMENT 8 Current pharmaceutical service provision in primary care
Map A shows the spread of pharmacies (including the only GP dispensing practice) within Kirklees against a background showing deprivation index of the population. Map B highlights the position of pharmacies vs population density in Kirklees. There are 93 pharmacies in Kirklees, all commissioned via the national contractual framework. These pharmacies dispense prescriptions which have mainly been generated from the 72 general practices and 59 dental practices in the area. A range of other essential services are provided and they also have the option of providing advanced and enhanced services under their contractual framework. See section 4 Background to community pharmacy contract. A key part of their role is the provision of advice to members of the public. In England 84% of adults, (78% for health-related reasons) visit a pharmacy at least once a year, with the average number of visits per adult user being 16 per year. Women, those aged over 35 and those with a long term health condition or disability are the most frequent users.11 Of the 93 pharmacies, 14 are exempt category pharmacies - one being a wholly internet pharmacy, another is an out of town shopping development pharmacy and 12 are 100 hour pharmacies. The rest are standard 40 hour contract pharmacies. NHS Kirklees also has one dispensing GP practice within its boundary – situated in The Valleys locality. Some Kirklees people will go to pharmacies just outside the Kirklees border, provided by neighbouring PCTs (Calderdale, Bradford and Airedale, Leeds, Wakefield district, Barnsley, Oldham and Derbyshire county). Analysis of prescription data for period September 09 to March 10 shows that 82,961 (2%) of Kirklees prescriptions are dispensed by dispensers outside Kirklees borders. The majority are dispensed by appliance contractors. Other providers of primary care pharmaceutical services include:
• Dispensing Appliance Contractors (DACs) NHS Kirklees patients can access supplies of appliances from a range of appliance contractors who are based outside our boundaries and also from our local community pharmacies. A total of 34,201 appliance items were dispensed by 37 appliance companies based outside of Kirklees in 2009/10. Over 90% of these items were supplied by just 14 of the 37 companies.
11 Medicines Adherence, NICE 2009. Pharmacy in England, DH 2008. Safety in Doses, NPSA 2007.
PHARMACEUTICAL NEEDS ASSESSMENT 15 Community pharmacies within Kirklees also supply some appliances. Since April 2010 community pharmacists are able to provide AUR and SAC services. By July 2010 three Kirklees community pharmacy contractors had declared an intention to provide both the AUR and SAC services, with an additional pharmacy providing just the SAC service. There is nothing to suggest that provision of appliances to patients of NHS Kirklees is inadequate.
• Wholly internet/mail order pharmacies Patients are at liberty to use any available registered internet pharmacy to dispense their prescriptions and do so regardless of where the pharmacy is based. The northern part of Huddersfield locality contains the only wholly internet pharmacy we have in Kirklees, however there are other wholly internet pharmacies outside the boundaries of Kirklees which are used by some NHS Kirklees registered patients. In addition some local Kirklees pharmacies offer a mail order service.
Miscellaneous • KCHS manage some services that are able to supply medicines to patients. These include the North Kirklees Walk-in Centre based at Dewsbury and District Hospital. They can supply some take home medicines to patients using the patient group direction (PGD) or non medical prescribing supply route. Likewise medicines are supplied to patients treated at the Moorfield Primary Care Centre, Princess Royal Community Health Centre and Holme Valley Memorial Hospital, Batley Health Centre, Dewsbury Health Centre, Cleckheaton Health Centre, Thornton Lodge and Chestnut Centre. • Supplies of some medicines are made from substance misuse service providers such as Huddersfield Lifeline and Dewsbury Lifeline. In addition our Out of Hours provider Local Care Direct can also make supplies of medicines to patients where necessary. Pharmacy facilities Opening hours Each locality has access to pharmacy services from Monday to Saturday. Apart from The Valleys and Mirfield, Denby Dale and Kirkburton localities all have some provision on Sundays. See table below. Details of opening hours for individual pharmacies can be found on the NHS choices website at www.nhs.uk/serviceDirectories Map C shows those community pharmacies with weekend and extended/100 hours opening in Kirklees and the table below shows the range of opening hours in each locality.
Range of opening hours in Kirklees pharmacies Weekday Saturday Sunday Open Close Open Close Open Close Batley, Birstall and 8.00am 10.30pm 8.00am 10.30pm 8am 10.30pm Birkenshaw Mirfield, Denby Dale 8.00am 6.15pm 9.00am 5.00pm - - and Kirkburton Dewsbury 6.30am 12midnight 7.00am 10.30pm 8.00am 10.00pm Huddersfield North 8.00am 10.00pm 8.00am 10.00pm 10.00am 4.00pm Locality South 7.00am 12midnight 7.00am 12midnight 10.00am 8.30pm Spen Valley 8.00am 10.30pm 8.00am 10.30pm 8.00am 9.00pm The Valleys 9.00am 6.30pm 9.00am 4.30pm - -
12 High Quality Care For All, Primary Care and Community Services: Improving pharmaceutical services. World Class Commissioning.
16 PHARMACEUTICAL NEEDS ASSESSMENT Travel to pharmacies Nationally, community pharmacies are easily accessible. 99% of the 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.12 The position in Kirklees is demonstrated in the table below. 86% of the population can walk to their nearest pharmacy in less than 20 minutes; the average walking time being just under 12 minutes. Analysis showed that the furthest distance from a pharmacy was 4.7 miles, and that was in a remote part of the Holme Valley (top of Holme Moss). Some populations in Mirfield, Denby Dale and Kirkburton had the longest walking time at 22 minutes. However the opening of a new pharmacy in Denby Dale in July 2010 has shortened the walking time for many of those affected considerably. 100% of our population can reach a pharmacy within 20 minutes by car.
Average walking time to pharmacies, for localities in Kirklees, November 2010 Locality Average time Average road Number of (walking) distance (miles) addresses Batley, Birstall and Birkenshaw 10.5 0.53 24388 Dewsbury 9.5 0.47 24761 Huddersfield 8.8 0.44 66527 Mirfield, Denby Dale and Kirkburton 18.2 0.91 25697 Spen Valley 13.0 0.65 25616 The Valleys 14.9 0.74 35434 Kirklees 11.9 0.59 202425
Notes ITN road network used to calculate time with a walking speed of three miles per hour. Postcodes used to model origins, these postcodes include non-domestic addresses. Pharmacies bordering Kirklees were included as destinations so that the possible nearest pharmacy could be used. Source: Kirklees Council (accessed Nov 2010)
The following information was obtained from a questionnaire sent out to all community pharmacies and GP dispensing practice in May 2010. Responses were received from 83 out of 92 Kirklees pharmacies and the GP dispensing practice.
Access Seventy community pharmacies and the dispensing practice report that customers can legally park within 50 metres of the store and the bus stop is less than five minutes walking distance from the shop. Forty five community pharmacies plus the dispensing practice reported the entrance to their premises was suitable for unaided wheelchair access with an additional 20 reporting alternative facilities e.g. availability of a door buzzer. Fifty seven community pharmacies and the dispensing practice report their consultation area is accessible to wheelchair users. Consultation areas Sixty seven community pharmacies report that they have accredited consultation areas suitable for MUR services with 44 being suitable for diagnostic services (as they include washing facilities) and have a table for writing or examining medicines/products. A further 10 are planning on installing a consultation room by April 2012. This puts pharmacies in a good position to undertake current or any new enhanced services that might be commissioned in the future.
PHARMACEUTICAL NEEDS ASSESSMENT 17 Information technology (IT) Sixty four community pharmacies report they can regularly access internet, e-mail and use word processing packages without disrupting the dispensary process and 70 have a printer which can print A4 size paper. Sixty six pharmacies access emails at least once a day but only 11 have systems which automatically make them aware that mail is waiting. There is a lot of work to be done to make sure pharmacies use IT systems more effectively, as this will significantly ease communication difficulties currently experienced between PCT staff and pharmacy contractors during times of emergency/crisis, e.g. flu pandemic. All pharmacies need to have IT systems in place to be ready for electronic transmission of prescription (ETP). Ninety two of our pharmacies have an EPS Release 1 compliant system and N3 connectivity. The remaining pharmacy is expected to be compliant by spring 2011. NHS Kirklees has applied to be part of the third wave roll-out of EPS 2 which means that from summer 2011 prescribers may be able to prescribe electronically and transmit prescriptions directly to the pharmacy nominated by the patient, with no need to produce paper prescriptions. The PCT plans to roll out implementation of EPS release 2 in a phased manner ensuring adequate training of staff and appropriate communication and education of patients. The new system is not mandatory and will be another option open to patients which could help with management of their repeat prescriptions. Human resources Eighteen pharmacies report that they normally have two pharmacists on duty at some time during the week. Duties of the second pharmacist are mainly to give additional support to the dispensary or relieve a pharmacist for administration work. Some check monitored dosage systems and a few provide additional services such as medication reviews. From the 68 pharmacy questionnaire responses the following mean averages of staffing per pharmacy across Kirklees was calculated as follows: Pharmacist hours per week 59.36hrs Pharmacist wte* 1.58 Registered technician hours per week 15.23hrs Registered technician wte* 0.41 Other dispensary support staff hours 102.61hrs per week Other dispensary support staff wte* 2.74 * Whole time equivalent (wte) based on 37.5 hr week
There are a range of full-time and part-time dispensing assistants/technicians and medicines counter assistants working in pharmacies across Kirklees. Annual contract monitoring of pharmacies indicates that all have qualified dispensary staff and medicine counter assistant support staff that have a recognised qualification or are training. Pharmaceutical support, when it is needed, is by the use of locum pharmacists who are used regularly and usually known by the managing pharmacist. The skill mix employed by some pharmacy contractors shows that there is a strong commitment to the development of the pharmacy workforce that will be better able to support the services being delivered under the new contract. Multi-cultural Post the formal consultation out of 93 responses received there are 60 pharmacies plus the dispensing practice that have staff members who speak a second language. Of these, the most common languages spoken are Urdu (54 pharmacies) and Punjabi (50 pharmacies) with Gujarati spoken in 19 pharmacies. It is encouraging to note that the areas with high South Asian populations do have pharmacies with staff that speak relevant languages. Other languages spoken by staff include French (4), Swahili (3), Pahari-Potowari (9), Hindi (2) and two have British Sign Language skills.
18 PHARMACEUTICAL NEEDS ASSESSMENT Locality summaries Localities are operational areas used by public organisations within Kirklees. Kirklees has recently aligned its area committees to become six town and valley committees as listed below. These will also form the basis for locality working in future and so pharmacy activity should embrace this change. By aligning NHS Kirklees, local council and other key partners we can operate together more effectively, driving service development in all localities.
The three goals of locality working are 13 • Better common understanding of place and priorities within each locality • Better and more co-ordinated engagement of residents and NHS Kirklees in developing responsive, locally sensitive services and investment to shape those places • Services and partners working better together to improve life for residents.
The six town and valley committees Batley, Birstall and Birkenshaw Dewsbury Huddersfield Mirfield, Denby Dale and Kirkburton Spen Valley The Valleys
On the following pages is a summary of the population and health statistics from our most recent JSNA together with pharmaceutical service provision for each locality in Kirklees. Areas of potential pharmaceutical need are mentioned and gaps are identified for each locality. Details of opening hours, items dispensed, and directed (advanced and enhanced) service provision from each pharmacy, grouped into localities, are available in table one and two at Section 16.
13 Kirklees Council website http://www.kirklees.gov.uk/you-kmc/kmc-howcouncilworks/area- committee/areacommittees.asp accessed Oct 2010
PHARMACEUTICAL NEEDS ASSESSMENT 19 Batley, Birstall and Birkenshaw locality
20 PHARMACEUTICAL NEEDS ASSESSMENT Nearly 55,000 people lived in Batley, Birstall and Birkenshaw in 2009. One in four was of South Asian origin, and tended to be younger people. Batley had a high proportion of young people (aged under 19), and a significantly higher proportion of South Asian origin than across Kirklees. Conversely Birstall and Birkenshaw had fewer young people and significantly less of South Asian origin. The birth rate in Batley was the highest in Kirklees and half of them were to women of South Asian origin – the highest proportion in Kirklees. Batley also had a higher proportion of its population aged under 45 than other parts of Kirklees, and the highest proportion of adults of South Asian origin. Birstall and Birkenshaw had a higher proportion of its population aged over 45 than other parts of Kirklees, few of them of South Asian origin. Batley Issues relating to children/young adults Potential need for services Batley had a higher rate of teenage pregnancies Currently there is one pharmacy delivering sexual than the local or national average. Fourteen year health services in Batley. This is not enough to meet olds having sex also had a poor use of the needs identified in the JSNA. contraception. In this locality there were high levels of alcohol Alcohol treatment services could be introduced into consumption in 14 year olds. Just under a quarter community pharmacies in this locality to help tackle drank alcohol weekly. Drinking alone and being out the problem. of control from drinking alcohol was worst in Batley. The incidence of asthma in this locality was worse Whilst there are significant numbers of pharmacies than elsewhere in Kirklees. providing stop smoking services in this locality In Batley one in five young people had asthma. The refocusing some of these services to specialise in locality also had one of the highest rates of adult stop smoking services for young people should be smokers and a higher number of young people considered. who were happy to continue smoking. More young people in Batley live with a smoker than the Kirklees average. Children had high levels of decayed teeth, more Focus on dental health, e.g. providing advice on than double the national rate, possibly as a result of oral hygiene and use of sugar free medicines. poor diet and/or poor dental care. The level of recommended physical activity in Batley Weight management services delivered by was lower than other areas and levels of inactivity pharmacies, aimed at young people should be had increased. considered in the future.
Issues relating to adults Potential need for services Adults in Batley, particularly those aged under 65 Introduction of services that will either help to years, experienced more episodes of high blood reduce the incidences of these diseases in this pressure, heart disease and stroke than other areas locality by increasing early identification of affected of Kirklees. patients or better management of existing patient’s treatment would be useful. NHS health checks from pharmacies might be particularly helpful. Smoking levels remain high particularly in women A re-focusing of some of the existing stop smoking of child bearing age. services towards specialist treatment for pregnant women would be appropriate. Alcohol consumption amongst men and women in Given that there are similar concerns for children Batley remains a concern. and young people in this locality it might be appropriate to increase range of alcohol treatment services to these patients. Half the adult population are overweight or obese. Greater need for healthy lifestyle interventions and weight management services.
PHARMACEUTICAL NEEDS ASSESSMENT 21 Birstall and Birkenshaw Issues relating to adults Potential need for services There are high rates of stroke and high blood Introduction of services that will either help to pressure in this area, particularly in those aged over reduce the incidences of these diseases in this 65. locality and/or treat existing patients should be considered. There are high rates of death from cancer in under Potential to introduce relevant screening services in 75s. community pharmacies. Residents experienced the highest rate of back pain. Greater need for healthy lifestyle interventions and also potential for pain management services in community pharmacy, Levels of alcohol consumption both in terms of Given that there are similar concerns for children being over sensible limits and binge drinking are and young people in this locality it might be amongst the worst in Kirklees especially amongst appropriate to introduce alcohol treatment services women of child bearing age. to these patients, The proportion of overweight adults in this locality Greater need for healthy lifestyle interventions and is the highest in Kirklees and half the adult weight management services from pharmacies population are overweight or obese. should be considered.
Community pharmacy services provided in this locality There are 12 pharmacies in the Batley, Birstall and Birkenshaw locality. Ten pharmacies provide MURs (Apr 09 - Mar 2010, 2266 MURs undertaken). Twenty nine pharmacists are accredited to provide MURs (although not all are). See tables on page 24 and 25 for pharmaceutical services provided in this locality. Other provision Nurse led contraception and sexual health clinics provided in this locality • Batley Health Centre
Stop smoking specialist advisors provided in this locality • Batley Health Centre
Weight management clinics • Batley Health Centre • Batley Salvation Army GPs also provide stop smoking, alcohol treatment and chlamydia treatment services. Service gaps/pressures Access This locality is served well with pharmacies having 22 pharmacies per 100,000 population and availability of early and late closing including weekend opening on both Saturday and Sunday. The two 100 hour pharmacies adequately meet the pharmaceutical needs for out of hours services although more enhanced service provision might be necessary at some future time.
Directed services All but one pharmacy has an accredited consultation room with all but one pharmacy undertaking MURs. All currently commissioned enhanced services are available from at least one pharmacy in this locality. Stop smoking services and palliative care services offered by pharmacies adequately meet the identified needs in this locality.
22 PHARMACEUTICAL NEEDS ASSESSMENT There is only one pharmacy participating in the sexual health local enhanced service (LES) and as this locality has higher prevalence of teenage pregnancy, expansion of this service into some more pharmacies when resources permit would be useful. Provision for head lice service and supervised consumption services is adequate in this locality. There is higher need for provision of needle and syringe exchange service in this locality and as there are only two pharmacies providing this service currently. More pharmacies will be required to provide this service in future when funds permit. It would be reasonable to try and place the needle and syringe services in those pharmacies currently offering the supervised consumption service. Pending the outcome of the minor ailments pilot service in the Huddersfield locality this locality could benefit from this service given its high level of deprivation. As services delivering reduction in health inequalities and responding to the health needs of the population in this locality, are expanded or newly developed, relevant enhanced services within community pharmacies will be considered to form part of the overall service provision in the locality.
NHS Kirklees concludes that it is not necessary to increase the number of pharmacies in this locality. Current provision of pharmacies including the out of hours provision from the two 100 hours pharmacies is adequate and necessary to meet the populations needs. There is reasonable choice of pharmaceutical services available in this locality. Any future granting of new developments would only serve to secure improvements to or better access to pharmaceutical services. Any required expansion or future development of enhanced services is only necessary in current pharmacies within this locality.
PHARMACEUTICAL NEEDS ASSESSMENT 23 22 per 100,000's Number of Population Pharmacies per 54,953 Locality Population 5,361 Average Average Monthly Items per pharmacy per locality Locality 771,964 Items per Dispensed 2009/2010 Y Y N N N N N N N N N N (Y/N) 100hour Pharmacy Y Y Y N N N N N N N N N Open Hours (Y/N/) Extended Y Y Y N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Number of pharmacies per 100,000 and population in Yorkshire Humber = 21 Number of pharmacies per 100,000 population in England = 21 Y N N N N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y Y Y N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address 157 Upper Commercial Street, WF17 5DH Batley, Unit 3, Birstall Retail Park, Birstall, WF17 9DT Off Soothill 3-5 Oxford Terrace, WF17 5ST Lane, Batley, 8 Market Place, Birstall, Batley, WF17 9EL Street Medical Centre, Town Street, Birkenshaw, Town Bradford, BD11 2HX 133 Upper Commercial Street, WF17 5DH Batley, The Old Salvation Hall, 74 Blackburn Road, Birstall, Batley, WF17 9PL In-Store Pharmacy, Tesco WF17 Bradford 5TJ Road, Batley, 4 Market Place, Batley, 4 WF17 Market Place, Batley, 5DA 104 Upper Commercial Street, WF17 5DP Batley, 67B Purlwell Lane, Mount WF17 7PF Pleasant, Batley, 1 Bond Street, Birstall, Batley, WF17 9EX Pharmacy Name Batley Pharmacy Boots UK Limited Hughes Chemists (Northern) Limited Lloyds Pharmacy Lloyds Pharmacy Mileusnic G Oakwood Pharmacy In-Store Tesco Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy Winer (Chemists) Ltd Batley, Birstall and Birkenshaw locality- pharmacy out of hours opening/items dispensed per locality per dispensed opening/items hours of out pharmacy locality- Birkenshaw and Birstall Batley, Source of dispensed items and population data: NHS Business Services Authority website (NHSBSA) accessed Nov 2010 England Average = 6340 items/pharmacy and Humber average Yorkshire = 6880 items/pharmacy NHS Kirklees average = 6104 items per pharmacy
24 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking Data correct as at 30 Nov 2010
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 51 12 61 2009/10 397 287 110 393 258 331 366 Advanced services Accredited consultation room www.report.ppa.org.uk/ActProd1/getfolderitems.do Pharmacy address 157 Upper Commercial Street, WF17 5DH Batley, Unit 3, Birstall Retail Park, Birstall, WF17 9DT Off Soothill 3-5 Oxford Terrace, WF17 5ST Lane, Batley, 8 Market Place, Birstall, Batley, WF17 9EL Street Medical Centre, Town Street, Birkenshaw, Town Bradford, BD11 2HX 133 Upper Commercial Street, WF17 5DH Batley, The Old Salvation Hall, 74 Blackburn Road, Birstall, Batley, WF17 9PL In-Store Pharmacy, Tesco WF17 Bradford 5TJ Road, Batley, 4 WF17 Market Place, Batley, 5DA 104 Upper Commercial Street, WF17 5DP Batley, 67B Purlwell Lane, Mount WF17 7PF Pleasant, Batley, 1 Bond Street, Birstall, Batley, WF17 9EX Pharmacy name Batley Pharmacy Boots UK Limited Hughes Chemists (Northern) Limited Lloyds Pharmacy Lloyds Pharmacy Mileusnic G Oakwood Pharmacy In-Store Tesco Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy Winer (Chemists) Ltd Batley, Birstall and Birkenshaw locality - Directed pharmaceutical services pharmaceutical Directed - locality Birkenshaw and Birstall Batley, Source of MUR data:
PHARMACEUTICAL NEEDS ASSESSMENT 25 Dewsbury locality
26 PHARMACEUTICAL NEEDS ASSESSMENT Nearly 60,000 people lived in Dewsbury in July 2009. Nearly one in three are of South Asian origin and tend to be younger people. Life expectancy at birth for men in Dewsbury was the lowest in Kirklees and two years below the national level. Life expectancy at birth for women in Dewsbury was the second lowest in Kirklees and just under two years less than nationally. Overall, Dewsbury had many health inequalities across a range of conditions, personal behaviours, living and working conditions. Dewsbury had significant levels of deprivation and health inequalities. Some of those health issues were the worst across all of Kirklees. Dewsbury had 29% of its population aged under 19, the highest in Kirklees, with half of them of South Asian origin. Issues relating to children and young people Potential need for services Teenage pregnancies were higher than the average Sexual health services could be further expanded in Kirklees. Use of contraception in young people into more community pharmacies. had markedly increased but one in five still did not use contraception. Nearly half of all 14 year olds drinking alcohol did Alcohol treatment services could be introduced into so weekly or more. More were getting out of community pharmacies in this locality to help tackle control weekly and monthly than in Kirklees overall. the problem. One in eight 14 year olds smoke, a decrease, but Whilst there are significant numbers of pharmacies still the highest in Kirklees. Of these one in five providing stop smoking services in this locality started smoking before the age of 10 and over a refocusing some of these services to specialise in quarter were happy to continue smoking. stop smoking services for young people is necessary.
Issues relating to adults Potential need for services Being overweight or obese was the norm as it Greater need for healthy lifestyle interventions and affected the majority of adults. The locality is also introduction of weight management services should one of the least physically active. be considered. In Dewsbury there were high levels of depression There might be need for extra mental health coupled with feelings of being lonely. services some of which could be provided by community pharmacy. High levels of heart disease, high blood pressure, Pharmacy led health checks in this locality would stroke and diabetes particularly in those under 65 assist. exist. Half of men aged over 65 suffered pain. Higher need for healthy lifestyle services in this locality and pain management services in community pharmacy. Highest rates of death in Kirklees for those aged Greater need for healthy lifestyle interventions and under 75 in cancers and coronary heart disease. screening of relevant cancers. Smoking was the highest in Kirklees, one in four Whilst there are significant numbers of pharmacies and deaths in under 75s with bronchitis and from providing stop smoking services in this locality lung cancer were also highest in Kirklees. Dewsbury refocusing some of these services towards specialist also has the highest percentage of women smoking treatment for pregnant women is necessary. during pregnancy.
PHARMACEUTICAL NEEDS ASSESSMENT 27 Community pharmacy services provided in this locality There are 19 pharmacies altogether in this locality. Seventeen pharmacies are providing MURs (Apr 09 - Mar 2010, 2077 MURs undertaken). Thirty three pharmacists are accredited to provide MURs. See tables on pages 30-32 for pharmaceutical services provided in this locality. Other provision Nurse led contraception and sexual health clinics provided in this locality • Dewsbury Health Centre • Lifeline Dewsbury
Stop smoking specialist advisors provided in this locality • Dewsbury Health Centre • Dewsbury and District Hospital (antenatal only) • Ravensthorpe Health Centre
Alcohol treatment services provided in this locality • On TRAK Dewsbury
Weight management services • Multidisciplinary team at Dewsbury District Hospital • Dietetics led programme at - Dewsbury District Hospital - Dewsbury Primary Care Centre GPs also provide stop smoking, alcohol treatment and chlamydia treatment services. Service gaps/pressures Access This locality is oversubscribed with pharmacies, having 32 pharmacies per 100,000 population compared to the average number for Kirklees being 23 and for Yorkshire and Humber region is 21. Availability of early and late closing including weekend opening on both Saturday and Sunday is very good. There are six 100 hour pharmacies in this locality which excessively meets the pharmaceutical needs for out of hours services and oversupply of pharmacy services during office hours. This locality contains the GP equitable access centre and the North Kirklees Walk in Centre therefore there is greater need for out of hours pharmaceutical services and analysis of dispensed prescriptions originating from these two establishments indicates that over 50% are dispensed by the 100 hour pharmacies.
Directed services All but one pharmacy has an accredited consultation room with only two of these not providing an MUR service. There is adequate provision of stop smoking, head lice, supervised consumption of methadone and buprenorphine, and palliative care services. There are only two pharmacies participating in the sexual health LES and as this locality has higher prevalence of teenage pregnancy, expansion of this service into some current pharmacies when resources permit would be useful. There is higher need for provision of needle and syringe exchange service in this locality and more pharmacies will be required to provide this service in future when funds permit. It would be reasonable to try and place the needle and syringe services in some of those pharmacies currently offering the supervised consumption of methadone and buprenorphine service. Pending the outcome of the minor ailments pilot service in the Huddersfield locality this locality could benefit from such a service given its high levels of deprivation.
28 PHARMACEUTICAL NEEDS ASSESSMENT As services to deliver reduction in health inequalities and respond to the health needs of the population in this locality, are expanded or newly developed, relevant enhanced services within community pharmacies will be considered to form part of the overall service provision.
NHS Kirklees concludes that provision of pharmacies in this locality exceeds need both for during office hours and out of hours period. Current high provision of pharmacies is not necessary but serves to secure improvements to or better access to pharmaceutical services. There is extremely good choice of pharmaceutical services available in this locality. Any required expansion or future development of enhanced services is only necessary in current pharmacies within this locality.
PHARMACEUTICAL NEEDS ASSESSMENT 29 32 per 100,000's Number of Population Pharmacies per 59,614 Locality Population 5,324 Average Average Monthly Items per pharmacy per locality Locality Items per 1,213,869 Dispensed 2009/2010 Y Y Y Y Y N N N N N N N N N (Y/N) 100hour Pharmacy Y Y Y Y Y N N N N N N N N N Open Hours (Y/N/) Extended Y Y Y Y Y Y N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y N N N N N N N N N N N N N Open all day Saturday Saturday only (Y/N) N N N N N N N N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address Mill Street West, Dewsbury, WF12 9AE 27 The Princess Of Wales Precinct, Long Causeway, WF13 1NH Dewsbury, 49 Brewery Lane, Thornhill Lees, WF12 9DU Dewsbury, 51 Walnut Lane, Chickenley, 51 Lane, Walnut Chickenley, WF12 8NJ Dewsbury, 78 High Street, Westtown, WF13 2QQ Dewsbury, 11B South Street, Savile Town, WF12 9NB Dewsbury, 119 Heckmondwike Road, Dewsbury, Dewsbury Moor, WF13 3NT 20A West Park Street, Dewsbury, WF13 4LA 6D Ravensthorpe Retail Park, Huddersfield Road, Dewsbury, WF13 3HN 13 Halifax Road, Dewsbury, WF13 2JH Unit 1, South Street, Dewsbury, WF13 1JS 92 Savile Road, Savile Town, WF12 9LP Dewsbury, Dewsbury Health Centre, Wellington Road, Dewsbury, WF13 1HN 71 Halifax Road, Dewsbury, WF13 4HD Pharmacy Name Asda Pharmacy Boots UK Limited Brewery Brewery Lane Pharmacy Chickenley Pharmacy Cohens Chemist Cohens Chemist Dewsbury Moor Pharmacy Pharmacy Dewsbury Eye Pharmacy G Pharmacy Pharmacy D Noble’s Chemist Noble’s Pharmacy-D R Drummond Chemist Dewsbury locality - pharmacy out of hours opening/items dispensed per locality per dispensed opening/items hours of out pharmacy - locality Dewsbury
30 PHARMACEUTICAL NEEDS ASSESSMENT per 100,000's Number of Population Pharmacies per Locality Population Average Average Monthly Items per pharmacy per locality Locality Items per Dispensed 2009/2010 Y N N N N (Y/N) 100hour Pharmacy Y N N N N Open Hours (Y/N/) Extended Y N N N N and (Y/N) Open Sunday Saturday Saturday N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y N N Open morning Saturday Saturday only (Y/N) Pharmacy Address Earlsheaton Medical Centre, 252 Road, Wakefield Earlsheaton, WF12 8AH Dewsbury, Thornhill, 30 The Town, WF12 0RB Dewsbury, Goods Lane, Railway Street, WF12 8EB Dewsbury, 140A Slaithwaite Road, Thornhill WF12 9DW Lees, Dewsbury, 620 Huddersfield Road, WF13 Ravensthorpe, Dewsbury, 3HL Pharmacy Name Rowlands Pharmacy Rowlands Pharmacy Sainsburys Pharmacy Sykes Chemist The Co-Operative Pharmacy Source Source of dispensed items and population data: NHS Business Services Authority website (NHSBSA) accessed Nov 2010 England Average = 6340 items/pharmacy and Humber average Yorkshire = 6880 items/pharmacy NHS Kirklees average = 6104 items per pharmacy Number of pharmacies per 100,000 and population Humber in = Yorkshire 21 Number of pharmacies per 100,000 population in England = 21
PHARMACEUTICAL NEEDS ASSESSMENT 31 Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 5 25 10 34 62
2009/10 142 414 139 125 331 113 Advanced services Accredited consultation room Pharmacy address Mill Street West, Dewsbury, Mill Street West, Dewsbury, WF12 9AE 27 The Princess Of Wales Precinct, Long Causeway, WF13 1NH Dewsbury, 49 Brewery Lane, Thornhill Lees, WF12 9DU Dewsbury, 51 Lane, Walnut Chickenley, WF12 8NJ Dewsbury, 78 High Street, Westtown, WF13 2QQ Dewsbury, 11B South Street, Savile Town, WF12 9NB Dewsbury, 119 Heckmondwike Road, Dewsbury, Dewsbury Moor, WF13 3NT 20A West Park Street, Dewsbury, WF13 4LA 6D Ravensthorpe Retail Park, Huddersfield Road, Dewsbury, WF13 3HN 13 Halifax Road, Dewsbury, WF13 2JH Unit 1, South Street, Dewsbury, WF13 1JS 92 Savile Road, Savile Town, WF12 9LP Dewsbury, Pharmacy name Asda Pharmacy Boots UK Limited Brewery Lane Pharmacy Chickenley Pharmacy Cohens Chemist Cohens Chemist Dewsbury Moor Pharmacy Dewsbury Pharmacy Eye Pharmacy G Pharmacy Pharmacy D Chemist Noble’s Dewsbury locality - Directed pharmaceutical services pharmaceutical Directed - locality Dewsbury
32 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking Data correct as at 30 Nov 2010
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 11 27 39 15
2009/10 189 307 Advanced services Accredited consultation room www.report.ppa.org.uk/ActProd1/getfolderitems.do Pharmacy address Dewsbury Health Centre, Wellington Road, Dewsbury, WF13 1HN 71 Halifax Road, Dewsbury, WF13 4HD Earlsheaton Medical Centre, 252 Road, Wakefield Earlsheaton, WF12 8AH Dewsbury, Thornhill, 30 The Town, WF12 0RB Dewsbury, Goods Lane, Railway Street, WF12 8EB Dewsbury, 140A Slaithwaite Road, Thornhill WF12 9DW Lees, Dewsbury, 620 Huddersfield Road, WF13 Ravensthorpe, Dewsbury, 3HL Pharmacy name Pharmacy-D R Drummond Chemist Rowlands Pharmacy Rowlands Pharmacy Sainsburys Pharmacy Sykes Chemist The Co-Operative Pharmacy Source Source of MUR data:
PHARMACEUTICAL NEEDS ASSESSMENT 33 Huddersfield locality
34 PHARMACEUTICAL NEEDS ASSESSMENT Huddersfield had a population of nearly 137,000 in 2009. Of these just under a fifth were of South Asian origin. The locality experienced similar health to that of Kirklees as a whole. However, it still had a number of significant health inequalities. Huddersfield had a similar proportion of young people aged under 19 compared to Kirklees as a whole, 23%. Nearly a third of them were of South Asian origin. The birth rate was also similar to Kirklees overall, with one in three of South Asian origin.
Issues relating to children and young people Potential need for services This locality has the highest rate of teenage Whilst pharmacies are delivering sexual health pregnancy across Kirklees and well above the services there is a need to focus more on the needs national rate. of young people in this locality. Areas with highest rates of teenage pregnancy are lacking services and expansion should be prioritised into such areas, when resources allow. Regular drinking amongst 14 year olds is a Pending adequate funding, alcohol treatment challenge for this locality with one in six drinking services delivered by community pharmacies are to weekly or more. be prioritised in this locality to help tackle the problem. Smoking amongst young people had not decreased A re-focusing of some of the existing stop smoking and a quarter were happy to continue smoking. services towards specialist treatment for young people is appropriate.
Issues relating to adults Potential need for services This locality experiences higher levels of diabetes Pharmacy led health checks in this locality could than others across Kirklees particularly in those prove useful. aged under 65. Rates of new cases of breast cancer and prostate Greater need for healthy lifestyle interventions and cancer are higher than the Kirklees rate in this screening of relevant cancers in relation to this locality. patient population. This locality had one of the highest rates of stroke Pharmacy led health checks could prove useful in across Kirklees. this locality. Rates of asthma in adults was the highest in Development of community pharmacy led asthma Kirklees, particularly in those aged over 65 years. clinics and re–focus of MURs to this therapeutic area would be ideal. More residents aged over 18, a third of adults, Pharmacy led pain management services could be suffered pain than elsewhere in Kirklees, useful. There are high rates of depression, anxiety and Pharmacy led mental health services could be nervous illness in this locality. appropriate. This locality has the highest rate of being either Healthier lifestyle interventions aimed at this patient overweight or obese in women of child bearing group and great potential for pharmacy led weight age. management services as resources permit. Over one in five adults in this locality smoke. Need to at least double stop smoking pharmacy services in this area. The rates of adults doing physical exercise were More healthy lifestyle interventions aimed at this below the Kirklees rate. patient group required from Pharmacies in this locality.
PHARMACEUTICAL NEEDS ASSESSMENT 35 Community pharmacy services provided in this locality There are 34 pharmacies in this locality, one of which is a wholly internet pharmacy. Sixteen pharmacies are within the boundaries of the most deprived parts of Huddersfield. Twenty pharmacies (majority located in the south of the town, are providing MURs (Apr 09 - Mar 2010, 3288 MURs undertaken). Fifty eight pharmacists are accredited to provide MURs (but only 46 are). There is scope to improve the take up of MUR carried out in the north particularly. Twenty one pharmacies have an accredited consultation room, the majority of which are located in the south of the locality but two pharmacies in the north have a consultation room but no accreditation. See tables on pages 38-43 for pharmaceutical services provided in this locality. Other provision Nurse led contraception and sexual health clinic provided in this locality: • New College Huddersfield • Chestnut Centre • Princess Royal Community Health Centre • Thornton Lodge Clinic • Lifeline Huddersfield
Alcohol treatment services provided in this locality • On TRAK Huddersfield
Stop smoking specialist advisors provided in this locality • Chestnut Centre • Fartown Health Centre • Huddersfield Royal Infirmary • Gateway to Care • Mill Hill Health Centre
Weight management services • Three different levels of services at Chestnut Centre • Dietetics led programme at Mill Hill Health Centre GPs also provide stop smoking, alcohol treatment and chlamydia treatment services. Service gaps/pressures Access This locality has 25 pharmacies per 100,000 population so there is adequate provision of pharmacies in this locality. The three 100hour pharmacies and an extended hour pharmacy in the northern part of the locality give good weekend and evening/early morning openings.
Directed services Accredited consultation rooms are numerous in the southern part of Huddersfield but sparse in the north of the locality. Consequently a lot less MURs are provided in the northern part of Huddersfield. More pharmacies need to get accredited consultation rooms and provide the MUR service in the north of Huddersfield. A review of the minor ailments pilot scheme taking place within this locality will determine whether this scheme will continue. Current provision adequately serves the populations need. The same is true of the palliative care service and supervised consumption scheme, but expansion of the needle and syringe exchange scheme is needed when resources permit preferably into some of those pharmacies offering the supervised consumption scheme.
36 PHARMACEUTICAL NEEDS ASSESSMENT Smoking rates and teenage pregnancy rates are very high in this locality and more pharmacies will be encouraged to participate in stop smoking services and the sexual health scheme so as to promote even geographical coverage. As services to deliver reduction in health inequalities and respond to the health needs of the population in this locality, are expanded or newly developed, relevant enhanced services within community pharmacies will be considered to form part of the overall service provision.
NHS Kirklees concludes that it is not necessary to increase the number of pharmacies in this locality. There is reasonable choice of pharmaceutical services available in this locality. Current provision of pharmacies is adequate and necessary. Any future granting of new developments would only serve to secure improvements to or better access to pharmaceutical services. Any required expansion or future development of enhanced services is only necessary in pharmacies approved within this locality.
PHARMACEUTICAL NEEDS ASSESSMENT 37 23 per 100,000's Number of Population Pharmacies per 59,907 Locality Population 5,315 Average Average Monthly Items per pharmacy per locality Locality 892,964 Items per Dispensed 2009/2010 N N N N N N N N N N N N N N N (Y/N) 100hour Pharmacy Y N N N N N N N N N N N N N N Open Hours (Y/N/) Extended Y N N N N N N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y Y N N N N N N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y Y Y Y Y Y N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address Longhill Road, Off Bradford Road, Brackenhall, Huddersfield, HD2 2LQ 6 Church Street, Paddock, Huddersfield, HD1 4TR 107 Bradford Road, Fartown, Huddersfield, HD1 6DZ 56 Sheepridge Road, Huddersfield, HD2 1HG 62 Westbourne Road, Marsh, Huddersfield, HD1 4LE 80 New Hey Road, Lindley, Huddersfield, HD3 4AJ 2 Grimscar Avenue, Birkby, Huddersfield, HD2 2TW 140 Westbourne Road, Marsh, Huddersfield, HD1 4LF 5 Copthorne Square, Bradley, Huddersfield, HD2 1SZ Unit 2,Salendine Nook Shopping Centre, Moorhill Road, Salendine Nook, Huddersfield, HD3 3XA 203 Luck Lane, Paddock, Huddersfield, HD1 4RB Fartown Grange, Spaines Road, Fartown, Huddersfield, HD2 2QA 14 Spaines Road, Fartown, Huddersfield, HD2 2QA 59 Lidget Street, Lindley, Huddersfield, HD3 3JP Wellfield House, 33 New Hey Road, Huddersfield, HD3 4AL Pharmacy Name Asda Pharmacy B Singh Bradford Bradford Road Pharmacy Cohens Chemist Cw Peach (Chemists) Chemist Dickinson’s K Pharmacy Medicare Chemists Medicare Chemists Medicare Chemists Paddock Head Pharmacy S T Shaw Ltd Siddique Pharmacy LTD S T Shaw Ltd Pharmacy Wellcare Huddersfield locality - northern area - pharmacy out of hours opening/items dispensed per locality per dispensed opening/items hours of out pharmacy - area northern - locality Huddersfield
38 PHARMACEUTICAL NEEDS ASSESSMENT 25 per 100,000's Number of Population Pharmacies per 76,457 Locality Population 6,249 Average Average Monthly Items per pharmacy per locality Locality Items per 1,424,799 Dispensed 2009/2010 Y Y N N N N N N N N N N N N (Y/N) 100hour Pharmacy Y Y N N N N N N N N N N N N Open Hours (Y/N/) Extended Y Y Y N N N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y N N N N N N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y Y N N N N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address 2 Thorne Road, Thornton Lodge, Huddersfield, HD1 3JJ 63-65 Highgate Lane, Lepton, Huddersfield, HD8 0DS Unit 2B, Great Northern Retail Park, Leeds Road, Huddersfield, HD1 6ND 22 king street, huddersfield, HD1 2QE 2 Greenhead Road, Huddersfield, HD1 4EL 325 Meltham Road, Netherton, Huddersfield, HD4 7EX 332-334 Road, Wakefield Moldgreen, Huddersfield, HD5 8DQ 1 Bankfield Lane, Kirkheaton, Huddersfield, HD5 0JE 45-47 Market Street, Huddersfield, HD1 2HL 9 Meltham Road Surgery, Meltham Road, Lockwood, Huddersfield, HD1 3UP 1A Church Lane, Newsome, Huddersfield, HD4 6JE 125 Fitzwilliam Street, Huddersfield, HD1 5PS 5 Broad Lane, Dalton, Huddersfield, HD5 9BU 65A Northgate, Almondbury, Huddersfield, HD5 8RX Pharmacy Name Akram Za Ltd Rowlands Pharmacy Boots UK Limited Boots UK Limited Greenhead Greenhead Pharmacy K & M Pharmacy Ltd Rowlands Pharmacy Kirkheaton Pharmacy Lloyds Pharmacy Medicare Chemists Newsome Health Centre Pharmacy Rowlands Pharmacy Rowlands Pharmacy Rowlands Pharmacy Huddersfield locality - southern area - pharmacy out of hours opening/items dispensed per locality per dispensed opening/items hours of out pharmacy - area southern - locality Huddersfield
PHARMACEUTICAL NEEDS ASSESSMENT 39 per 100,000's Number of Population Pharmacies per Locality Population Average Average Monthly Items per pharmacy per locality Locality Items per Dispensed 2009/2010 Y N N N N (Y/N) 100hour Pharmacy Y Y N N N Open Hours (Y/N/) Extended Y Y N N N and (Y/N) Open Sunday Saturday Saturday Y N N N N Open all day Saturday Saturday only (Y/N) Y Y N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address Southgate, Huddersfield, HD1 6QR 20 Princess Alexandra Walk, Huddersfield, HD1 2TT Viaduct Street, Off Fitzwilliam Street, Huddersfield, HD1 1RW 617 Wakefield 617 Road, Wakefield Waterloo, Huddersfield, HD5 9XP Moorfield Shopping Centre, 3 Park Road West, Crosland Moor, Huddersfield, HD4 5RX Pharmacy Name Sainsburys Pharmacy Superdrug Tesco In-Store Tesco Pharmacy Rowlands Pharmacy Your Local Boots Your Pharmacy Source Source of dispensed items and population data: NHS Business Services Authority website (NHSBSA) accessed Nov 2010 England Average = 6340 items/pharmacy and Humber average Yorkshire = 6880 items/pharmacy NHS Kirklees average = 6104 items per pharmacy Number of pharmacies per 100,000 and population Humber in = Yorkshire 21 Number of pharmacies per 100,000 population in England = 21 Huddersfield locality has 25 pharmacies per 100,000 population
40 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 0 0 0 0 0 0 37 40 33 2009/10 161 Advanced services Accredited consultation room Pharmacy address Longhill Road, Off Bradford Road, Brackenhall, Huddersfield, HD2 2LQ 6 Church Street, Paddock, Huddersfield, HD1 4TR 107 Bradford Road, Fartown, Huddersfield, HD1 6DZ 56 Sheepridge Road, Huddersfield, HD2 1HG 62 Westbourne Road, Marsh, Huddersfield, HD1 4LE 80 New Hey Road, Lindley, Huddersfield, HD3 4AJ 2 Grimscar Avenue, Birkby, Huddersfield, HD2 2TW 140 Westbourne Road, Marsh, Huddersfield, HD1 4LF 5 Copthorne Square, Bradley, Huddersfield, HD2 1SZ Unit 2,Salendine Nook Shopping Centre, Moorhill Road, Salendine Nook, Huddersfield, HD3 3XA 203 Luck Lane, Paddock, Huddersfield, HD1 4RB Fartown Grange, Spaines Road, Fartown, Huddersfield, HD2 2QA Pharmacy name Huddersfield locality - northern area Asda Pharmacy B Singh Bradford Road Pharmacy Cohens Chemist Cw Peach (Chemists) Dickinson’s Chemist K Pharmacy Medicare Chemists Medicare Chemists Medicare Chemists Paddock Head Pharmacy S T Shaw Ltd Huddersfield locality - Directed pharmaceutical services pharmaceutical Directed - locality Huddersfield
PHARMACEUTICAL NEEDS ASSESSMENT 41 Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 0 0 0 0
2009/10 401 293 400 147 149 193 Advanced services Accredited consultation room Pharmacy address 14 Spaines Road, Fartown, Huddersfield, HD2 2QA 59 Lidget Street, Lindley, Huddersfield, HD3 3JP Wellfield House, 33 New Hey Road, Huddersfield, HD3 4AL 2 Thorne Road, Thornton Lodge, Huddersfield, HD1 3JJ 63-65 Highgate Lane, Lepton, Huddersfield, HD8 0DS Unit 2B, Great Northern Retail Park, Leeds Road, Huddersfield, HD1 6ND 22 King Street, Huddersfield, HD1 2QE 2 Greenhead Road, Huddersfield, HD1 4EL 325 Meltham Road, Netherton, Huddersfield, HD4 7EX 332-334 Road, Wakefield Moldgreen, Huddersfield, HD5 8DQ 1 Bankfield Lane, Kirkheaton, Huddersfield, HD5 0JE 45-47 Market Street, Huddersfield, HD1 2HL Pharmacy name Siddique Pharmacy LTD S T Shaw Ltd Pharmacy Wellcare Huddersfield locality - southern area Akram Za Ltd Rowlands Pharmacy Boots UK Limited Boots UK Limited Greenhead Pharmacy K & M Pharmacy Ltd Rowlands Pharmacy Kirkheaton Pharmacy Lloyds Pharmacy
42 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking Data correct as at 30 Nov 2010
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 30 33 83 2009/10 180 111 172 176 102 163 378 Advanced services Accredited consultation room www.report.ppa.org.uk/ActProd1/getfolderitems.do Pharmacy address Meltham Road Surgery, 9 Meltham Road Surgery, Meltham Road, Lockwood, Huddersfield, HD1 3UP 1A Church Lane, Newsome, Huddersfield, HD4 6JE 125 Fitzwilliam Street, Huddersfield, HD1 5PS 5 Broad Lane, Dalton, Huddersfield, HD5 9BU 65A Northgate, Almondbury, Huddersfield, HD5 8RX Southgate, Huddersfield, HD1 6QR 20 Princess Alexandra Walk, Huddersfield, HD1 2TT Viaduct Street, Off Fitzwilliam Street, Huddersfield, HD1 1RW 617 Road, Wakefield Waterloo, Huddersfield, HD5 9XP Moorfield Shopping Centre, 3 Park Road West, Crosland Moor, Huddersfield, HD4 5RX Pharmacy name Medicare Medicare Chemists Newsome Health Centre Pharmacy Rowlands Pharmacy Rowlands Pharmacy Rowlands Pharmacy Sainsburys Pharmacy Superdrug In-Store Tesco Pharmacy Rowlands Pharmacy Local Boots Your Pharmacy Source Source of MUR data:
PHARMACEUTICAL NEEDS ASSESSMENT 43 Mirfield, Denby Dale and Kirkburton
44 PHARMACEUTICAL NEEDS ASSESSMENT Just over 52,000 people lived in Mirfield, Denby Dale and Kirkburton locality in 2009. They experienced better health than all the other localities in Kirklees, and better health than all other areas apart from Holme Valley. Many health measures were improving. Just over a fifth of its population was aged under 19, lower than Kirklees and the second lowest of all localities. It had the lowest proportion of people of South Asian origin in Kirklees. The birth rate was the lowest in Kirklees and very few births were to people of South Asian origin. The locality also had the lowest proportion of babies born with a low birth weight in Kirklees. Life expectancy at birth was one of the highest in Kirklees, for both men and women.
Issues relating to children and young people Potential need for services Teenage conceptions were the lowest in Kirklees More emphasis on services for sexually transmitted but the locality had the highest number of young diseases might be necessary in those pharmacies people reporting having had sex by 14 years and delivering the sexual health LES. not using contraception. Nearly four out of five 14 year olds had tried Alcohol treatment services introduced into alcohol in this locality, but only one in 20 does so community pharmacies in this locality could help weekly. tackle the problem. Fewer young people now smoke in this locality and There might be no further need for stop smoking the majority of these would like to stop. services in this locality. This locality had the highest number of young If this trend continues there might be need in the people who felt miserable, one in four. A third felt future for extra mental health services in the area angry, one in five felt lonely and a quarter had some of which could be interventions provided by sudden mood swings which is worse than for all community pharmacy. other localities. Only two in three young people are doing the Potential greater need for healthy lifestyle recommended level of physical activity. interventions aimed at children and young people.
Issues relating to adults Potential need for services New cases of cervical, prostate and melanoma Potential greater need for healthy lifestyle cancers were higher than the Kirklees rate, interventions aimed at these diseases. although rates were generally reducing. Obesity rates were lower than the Kirklees rate but Community pharmacy based weight management half of all adults were either overweight or obese. services could support this health need. This locality had the lowest level of smoking across A re-focusing of some of the existing stop smoking Kirklees but one in eight still smoked and more services towards specialist treatment for pregnant than one in seven woman of child bearing age women might be appropriate. smoked. The rates of men drinking over sensible limits had It might be appropriate for alcohol treatment increased since 2005 (now drinking 23 units per services to be introduced into community week). Rates of binge drinking amongst men and pharmacies in this locality to help tackle the women were higher than Kirklees average but had problem. A proportion of these services should be improved since 2005. aimed at women of child bearing age. Women of child bearing age had the highest mean consumption of alcohol per week over all of Kirklees.
PHARMACEUTICAL NEEDS ASSESSMENT 45 Community pharmacy services provided in this locality There are currently eight community pharmacies in this locality. Seven pharmacies are providing MURs (Apr 09 - Mar 2010, 1419 MURs undertaken) and the remaining pharmacy will be providing this service shortly. Sixteen pharmacists in this locality are accredited to provide MURs. See tables on pages 47-48 for pharmaceutical services provided in this locality. Other providers GPs also provide stop smoking, alcohol treatment and chlamydia treatment services. Service gaps/pressures Access This locality has a smaller number of community pharmacies per 100,000 population than most other localities (15 pharmacies). Availability of early and late closing including weekend opening on both Saturday and Sunday is poor. There are no 100 hour or extended hour pharmacies in this locality.
Directed services All pharmacies have an accredited consultation room and all will provide an MUR service. There is little need for supervised consumption services, particularly in the southern half of the locality which has no service at all. In the northern area - Mirfield need is still relatively low but greater than in the south of the locality. There is one pharmacy providing this service in the northern part of the locality but there are another two pharmacies situated in Dewsbury at close proximity to the border, which could also serve this population. Provision needs to increase to have at least two extra pharmacies offering this service in the Mirfield, Denby Dale and Kirkburton locality when resources allow for expansion. Requirement for needle and syringe exchange services mirror the supervised consumption services i.e. minimal need and it would be ideal for the same pharmacies to offer both services. There is full coverage of head lice service provision by all pharmacies. Availability of stop smoking and palliative care service by pharmacies is adequate due to minimal identified need. Any further expansion of these services would serve to secure improvement /access to these services but is not necessary. Rate of teenage pregnancy is very low for the northern and southern most parts of this locality however Kirkburton has a slightly higher rate (see map D). There is only one pharmacy offering the sexual health service and expansion into a few other pharmacies to give better geographical cover is necessary. This locality has lower levels of deprivation compared to most of Kirklees and therefore apart from a small pocket of need in the most northern part of the locality, the minor ailments scheme is not a priority for this locality. As services to deliver reduction in health inequalities and respond to the health needs of the population in this locality, are expanded or newly developed, relevant enhanced services within community pharmacies will be considered to form part of the overall service provision.
NHS Kirklees concludes that there is a gap in service provision in this locality. Opening hours need to extend into the evening on weekdays and improvements to weekend openings are required. Current provision of pharmacies is necessary to meet need; any increase in pharmacies must satisfy the extended hour and weekend opening requirement. It is hoped that current pharmacies will review their opening hours in response to this identified need. Any future granting of new developments would only serve to secure improvements to or better access to pharmaceutical services. There is reasonable choice of pharmaceutical services available in this locality. Any required expansion or future development of enhanced services is only necessary in pharmacies approved within this locality.
46 PHARMACEUTICAL NEEDS ASSESSMENT 15 per 100,000's Number of Population Pharmacies per 52,698 Locality Population 6,727 Average Average Monthly Items per pharmacy per locality 645,795 Locality Items per Dispensed 2009/2010 N N N N N N N N (Y/N) 100hour Pharmacy N N N N N N N N Open Hours (Y/N/) Extended N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y Y N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address 315 Road, Wakefield Denby Dale, Huddersfield, HD8 8RX Kirkburton Health Centre, Shelley Lane, Kirkburton, Huddersfield, HD8 OSJ Shepley Health Centre, 25 Jos Lane, Huddersfield, HD8 8DJ Shepley, The Health Centre, Road, Wakefield Scissett, Huddersfield, HD8 9JL 38 Commercial Road, Skelmanthorpe, Huddersfield, HD8 9DA 142 Huddersfield Road, Mirfield, WF14 8AN 54 Old Bank Road, Mirfield, WF14 0JA Mirfield Health Centre, Doctor Lane, Mirfield, WF14 8DU Pharmacy Name Denby Pharmacy Rowlands Pharmacy Shepley Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy Local Boots Your Pharmacy Boots UK Ltd Local Boots Your Pharmacy Mirfield, Denby Dale and Kirkburton - pharmacy out of hours opening/items dispensed per locality per dispensed opening/items hours of out pharmacy - Kirkburton and Dale Denby Mirfield, Source of dispensed items and population data: NHS Business Services Authority website (NHSBSA) accessed Nov 2010 England Average = 6340 items/pharmacy and Humber average Yorkshire = 6880 items/pharmacy NHS Kirklees average = 6104 items per pharmacy Number of pharmacies per 100,000 and population Humber in = Yorkshire 21 Number of pharmacies per 100,000 population in England = 21
PHARMACEUTICAL NEEDS ASSESSMENT 47 Minor ailments
Palliative care ü
Condom distribution ü
Pregnancy testing ü
Chlamydia screening ü
Emergency contraception ü
Supervised
methadone/ ü buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking ü ü ü Data correct as at 30 Nov 2010
Headlice ü ü ü ü ü ü ü ü
Stoma Appliance Customisation
Appliance Use
Review N/A
Number of MURs 33 N/A 2009/10 115 101 243 120 380 427 Advanced services Accredited consultation room ü ü ü ü ü ü ü ü www.report.ppa.org.uk/ActProd1/getfolderitems.do Pharmacy address 315 Wakefield 315 Road, Wakefield Denby Dale, Huddersfield, HD8 8RX Kirkburton Health Centre, Shelley Lane, Kirkburton, Huddersfield, HD8 OSJ Shepley Health Centre, 25 Jos Lane, Huddersfield, HD8 8DJ Shepley, The Health Centre, Road, Wakefield Scissett, Huddersfield, HD8 9JL 38 Commercial Road, Skelmanthorpe, Huddersfield, HD8 9DA 142 Huddersfield Road, Mirfield, WF14 8AN 54 Old Bank Road, Mirfield, WF14 0JA Mirfield Health Centre, Doctor Lane, Mirfield, WF14 8DU Pharmacy name Denby Pharmacy Rowlands Pharmacy Shepley Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy Local Boots Your Pharmacy Boots Uk Ltd Local Boots Your Pharmacy Mirfield, Denby Dale and Kirkburton - Directed pharmaceutical services pharmaceutical Directed - Kirkburton and Dale Denby Mirfield, Source of MUR data:
48 PHARMACEUTICAL NEEDS ASSESSMENT PHARMACEUTICAL NEEDS ASSESSMENT 49 Spen Valley locality
50 PHARMACEUTICAL NEEDS ASSESSMENT Approximately 53,000 people lived in Spen Valley in 2009. There is a small proportion of the population of South Asian origin. Spen Valley had an average proportion of young people (aged under 19), but significantly fewer young people of South Asian origin compared with Kirklees. Even so, nearly one in six were of South Asian origin. The picture of health and inequalities in Spen Valley reflected Kirklees and has changed little in the last few years, unlike many other localities which had often worsened. The exception was obesity which was the highest across Kirklees.
Issues relating to children and young people Potential need for services Although teenage pregnancy rates have improved, Expansion of pharmacy led sexual health services is the area still has a worse rate than Kirklees overall. required. These services might need to be better One in 10 fourteen year olds had sexual intercourse tailored to suit the needs of young people. with one in five not using contraception. Children in year six and in reception class were Future pharmacy led weight management services more likely to be obese than elsewhere in Kirklees are a priority for this area. and more likely to be overweight. Fourteen year olds drinking weekly or more was Potential for pharmacy led alcohol treatment above the Kirklees average, but those ‘out of services. control’ was less than in Kirklees overall The rate of young people smoking was better than Refocusing of stop smoking services to concentrate in Kirklees overall, but a third were happy to on young people is necessary. continue smoking. Emotional well being of young people in this Potential need for pharmacy led mental health locality particularly feeling miserable was worse services and greater emphasis on public health than in Kirklees overall. campaigns.
Issues relating to adults Potential need for services Whilst improving, lung cancer rates were still higher Greater use of healthy lifestyle interventions might than Kirklees overall, particularly for women. be appropriate. Expansion of stop smoking services Asthma rates were also higher than in Kirklees are required in this locality overall. This locality had the second worst rate of heart Pharmacy based health checks would be an ideal disease across Kirklees. Nearly half of all people development in this locality. aged 65 and over had high blood pressure. This locality had the highest rate of adult obesity Pharmacy led weight management services should and has risen since 2005. Women of child bearing be prioritised for delivery in this locality when age in this locality also had the highest levels of resources allow. obesity in Kirklees. 57% of adults are either obese or overweight. The rate of smoking remained too high with one in More targeted stop smoking services might be five continuing to smoke. necessary, particularly towards women of child Nearly one in four women of child bearing age bearing age. smoke and one in four non South Asian women were still smoking at the birth of their child. This locality had one of the highest rates for binge Pharmacy led alcohol treatment services should be a drinking in Kirklees. priority for this area.
PHARMACEUTICAL NEEDS ASSESSMENT 51 Community pharmacy services provided in this locality There are 10 community pharmacies in this locality. A small pocket of high deprivation exists on the western border of the locality neighboring Calderdale which has three pharmacies in that geographical area. Pharmacies are appropriately placed to adequately serve the deprived areas of the population. Nine pharmacies are providing MURs (Apr 09 - Mar 2010, 1550 MURs undertaken). One pharmacy has a consultation room with no accreditation. Seventeen pharmacists are accredited to provide MURs (but only 16 are). See tables on pages 53-54 for pharmaceutical services provided in this locality. Other provision Nurse led contraception and sexual health clinics provided in this locality: • Cleckheaton Health Centre
Stop smoking specialist advisors provided in this locality • Cleckheaton Health Centre
Weight management clinics • Dietetics led programme at Cleckheaton Health Centre GPs also provide stop smoking, alcohol treatment and chlamydia treatment services. Service gaps/pressures Access This locality has 19 pharmacies per 100,000 population therefore has adequate provision of pharmacies. Availability of early and late closing including weekend opening on both Saturday and Sunday is very good. There is one 100 hour pharmacy in this locality.
Directed services All except one pharmacy has an accredited consultation room, with all of those providing a MUR service. There are five pharmacies providing a stop smoking service in the southern half of the locality which has high smoking rates but no provision in the northern part. Although smoking rates are less in the northern area, a minimum of one pharmacy would be required to provide this service when resources allow. Provision of supervised consumption of methadone and buprenorphine is sufficient to meet the needs of this population but more providers are required for the needle and syringe exchange scheme. Ideally both these services would run from the same pharmacies. Rates of teenage pregnancy are relatively high in this locality and expansion of the sexual health service into most pharmacies would seem appropriate when resources allow. There is full coverage of head lice service provision by all pharmacies and provision of palliative care service satisfies need. Should the minor ailment scheme be rolled out the service will need to be prioritised to providers in the few areas containing small pockets of deprivation as demonstrated on map A. As services to deliver reduction in health inequalities and respond to the health needs of the population in this locality, are expanded or newly developed, relevant enhanced services within community pharmacies will be considered to form part of the overall service provision.
NHS Kirklees concludes that it is not necessary to increase the number of pharmacies in this locality. Current provision of pharmacies is adequate and necessary, with opening times sufficiently satisfying need. There is reasonable choice of pharmaceutical services available in this locality. Any future granting of new developments would only serve to secure improvements to or better access to pharmaceutical services. Any required expansion or future development of enhanced services is only necessary in current pharmacies within this locality.
52 PHARMACEUTICAL NEEDS ASSESSMENT 19 per 100,000's Number of Population Pharmacies per 53,152 Locality Population 6,332 Average Average Monthly Items per pharmacy per locality Locality 759,880 Items per Dispensed 2009/2010 Y N N N N N N N N N (Y/N) 100hour Pharmacy Y N N N N N N N N N Open Hours (Y/N/) Extended Y N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y Y N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address 4 Batley Road, Heckmondwike, WF16 9NE 260 Oxford Road, Gomersal, Bradford, BD19 4PY St Johns House, Cross Church Street, Cleckheaton, BD19 3RQ 5 Greenside, Cleckheaton, BD19 5AN 673 Bradford Road, Oakenshaw, Bradford, BD12 7DT Heckmondwike Primary Care Centre, Algenon, Firth Park, Heckmondwike, WF16 0HH 26 Market Street, Cleckheaton, BD19 5AJ 69 Road, Valley Liversedge, WF15 6DL Unit 8, Northgate Retail Centre, Heckmondwike, WF16 9RL Morrisons Superstore, Union Street, Heckmondwike, WF16 0HL Pharmacy Name Cohens Chemist Gomersal Pharmacy Kirklees Pharmacy Lloyds Pharmacy Oakenshaw Pharmacy Rowlands Pharmacy Rowlands Pharmacy Pharmacy Shah’s The Co-Operative Pharmacy The Co-Operative Pharmacy Spen Valley - pharmacy out of hours opening/items dispensed per locality per dispensed opening/items hours of out pharmacy - Valley Spen Source of dispensed items and population data: NHS Business Services Authority website (NHSBSA) accessed Nov 2010 England Average = 6340 items/pharmacy and Humber average Yorkshire = 6880 items/pharmacy NHS Kirklees average = 6104 items per pharmacy Number of pharmacies per 100,000 and population Humber in = Yorkshire 21 Number of pharmacies per 100,000 population in England = 21
PHARMACEUTICAL NEEDS ASSESSMENT 53 Minor ailments
Palliative care ü
Condom distribution ü ü ü
Pregnancy testing ü ü ü
Chlamydia screening ü ü ü
Emergency contraception ü ü ü
Supervised
methadone/ ü ü ü ü ü buprenorphine Enhanced services (commissioned) Needle and syringe exchange ü
Stop smoking ü ü ü ü ü Data correct as at 30 Nov 2010
Headlice ü ü ü ü ü ü ü ü ü ü
Stoma Appliance Customisation ü ü
Appliance Use Review ü
Number of MURs 6 0 37 16 2009/10 367 135 240 158 275 316 Advanced services Accredited consultation room ü ü ü ü ü ü ü ü ü www.report.ppa.org.uk/ActProd1/getfolderitems.do Pharmacy address 4 Batley Road, Heckmondwike, WF16 9NE 260 Oxford Road, Gomersal, Bradford, BD19 4PY St Johns House, Cross Church Street, Cleckheaton, BD19 3RQ 5 Greenside, Cleckheaton, BD19 5AN 673 Bradford Road, Oakenshaw, Bradford, BD12 7DT Heckmondwike Primary Care Centre, Algenon, Firth Park, Heckmondwike, WF16 0HH 26 Market Street, Cleckheaton, BD19 5AJ 69 Road, Valley Liversedge, WF15 6DL Unit 8, Northgate Retail Centre, Heckmondwike, WF16 9RL Morrisons Superstore, Union Street, Heckmondwike, WF16 0HL Pharmacy name Cohens Chemist Gomersal Pharmacy Kirklees Pharmacy Lloyds Pharmacy Oakenshaw Pharmacy Rowlands Pharmacy Rowlands Pharmacy Pharmacy Shah’s The Co-Operative Pharmacy The Co-Operative Pharmacy Spen Valley locality - Directed pharmaceutical services pharmaceutical Directed - locality Valley Spen Source of MUR data:
54 PHARMACEUTICAL NEEDS ASSESSMENT PHARMACEUTICAL NEEDS ASSESSMENT 55 The Valleys locality
56 PHARMACEUTICAL NEEDS ASSESSMENT The population of The Valleys was nearly 72,000 in 2009. Low levels of the population are of South Asian origin. The Valleys had an average proportion of young people (aged under 19), but significantly fewer of South Asian origin compared with Kirklees. The Colne Valley has one of the highest proportions of people of working age. Generally adults living in The Valleys had better health than adults in Kirklees overall – however it was worse than the national average in the Colne Valley. Older people were those most likely to experience poor health, which had worsened since 2005. The Holme Valley had some of the best levels of health in Kirklees, including the best life expectancy at birth for both men and women. Children and young people living in the Colne Valley experienced broadly better health than Kirklees overall. But within the locality young people had a significantly different set of issues compared with those in the Holme Valley. Generally, people living in the Holme Valley experienced broadly similar health to Kirklees overall. Colne Valley Issues relating to children and young people Potential need for services Although nearly nine out of 10, 14 year olds had Pharmacy led alcohol treatment services, less of a tried alcohol, the area had one of the lowest rates priority in this locality. of regular drinking in 14 year olds. Fourteen year olds smoking weekly or more was Stop smoking services need to adapt towards higher than in Kirklees overall. supporting teenagers in this locality. Greater provision of smoking cessation enhanced service required from pharmacies. Use of illegal drugs was highest in this area with Public health messages on substance misuse aimed nearly one in five having tried illegal drugs. at schools should be stronger in this area. Dedicated services specifically for young people should be developed in this area Emotional health and well being is worse than in Potential need for pharmacy led mental health most other areas, particularly anxiety, feeling services and greater emphasis on public health miserable or lonely. campaigns. Holme Valley Issues relating to children and young people Potential need for services Smoking levels were higher than other parts of Dedicated services for children and young people Kirklees, except Batley and Dewsbury. required in this area. Greater provision of stop smoking enhanced service required from pharmacies. Regular drinking amongst young people was higher Pharmacy led alcohol treatment services should be than elsewhere but being out of control less than prioritised in this area. elsewhere. More young people than Kirklees overall felt Greater use of healthy lifestyle interventions and miserable, angry and lonely. potential for pharmacy led mental health Bullying reports are higher than elsewhere. interventions.
PHARMACEUTICAL NEEDS ASSESSMENT 57 The Valleys Issues relating to adults Potential need for services Rates of colon and prostate cancer in men were Public health campaigns relating to these subjects higher than in Kirklees overall, and melanomas required in this locality. were higher for both men and women. Reported levels of back pain were higher in Colne Greater need for healthy lifestyle services aimed at Valley than elsewhere. this population and also a priority area for pharmacy led pain management services if developed. Rates of high blood pressure, asthma and diabetes Pharmacy led health checks would support this in the Colne Valley had all increased since 2005. issue. Half of all adults were obese or overweight. Pharmacy led weight management services are a priority for this area if commissioned. In Holme Valley the emotional well being of older Greater use of healthy lifestyle interventions and people had deteriorated. potential for pharmacy led mental health services. One in five adults smoke at least one cigarette a Increase of stop smoking services in pharmacies in day. There is particular concern in the Colne Valley. Colne Valley required. More men in Holme Valley than in Kirklees drank Pharmacy led alcohol treatment services are a over the sensible limit. One in three men and priority for this area if commissioned. women binge drink over a week particularly in the Colne Valley.
Community pharmacy services provided in this locality This locality contains 10 community pharmacies and the only dispensing doctor practice in NHS Kirklees. Seven pharmacies are providing MURs (Apr 09 - Mar 2010, 833 MURs undertaken). Fourteen pharmacists are accredited to provide MURs (but only 10 are). See tables on pages 60-61 for pharmaceutical services provided in this locality. Other provision Weight management clinic • Golcar Health centre GPs also provide stop smoking, alcohol treatment and chlamydia treatment services. Service gaps/pressures Access This locality has the least number of pharmacies per 100,000 population (14 pharmacies) in Kirklees however pharmacies are situated in the more populated parts of the locality – see map B. There are a significant number of potential new pharmacy applications (including 100 hour contracts) approved or pending approval by the pharmacy panel which would increase the coverage to nearer average levels for this locality. (See section 10 – future developments.) Currently there are no 100 hour or extended hour pharmacies in this locality. Nine pharmacies open on a Saturday but only one opens all day. No pharmacies open on a Sunday (however a new pharmacy has been granted permission to open in Holmfirth by April 2011 with opening hours on Monday - Friday evenings and Saturday and Sunday. Development of any of the previously mentioned 100hr applications would also improve the situation in this locality).
58 PHARMACEUTICAL NEEDS ASSESSMENT Directed services All but two pharmacies have an accredited consultation room, the vast majority of which provide an MUR service. Provision of supervised consumption services adequately serves need although there is a gap in service for needle and syringe exchange services. Ideally both services would be provided from the same pharmacies. Provision of stop smoking services is poor in this locality and majority of pharmacies would be encouraged to offer this service so as to satisfy need. Wider participation is required on the palliative care scheme from another one or two pharmacies geographically spread across the locality. Similarly more provision is required for the sexual health enhanced service to cover those areas with higher teenage pregnancy rates that are currently lacking a service. This suggested expansion can only occur when funds are in place. Should the minor ailment scheme be rolled out the service will need to be prioritised to providers in the few areas containing small pockets of deprivation as demonstrated on map A. As services to deliver reduction in health inequalities and respond to the health needs of the population in this locality, are expanded or newly developed, relevant enhanced services within community pharmacies will be considered to form part of the overall service provision.
NHS Kirklees concludes that there is a potential gap in service provision in this locality as opening hours need to extend into the evening on weekdays with improvements on weekend openings. Current provision of pharmacies is necessary to meet need; there is reasonable choice of pharmaceutical services available in this locality. Any increase in pharmacies must satisfy the extended hour and weekend opening requirement. It is anticipated that the latest run of applications for 100hour pharmacies in this locality will satisfy this gap in the very near future. Opening of at least one 100 hour pharmacy would adequately satisfy the identified need in this locality. Any future granting of new developments would only serve to secure improvements to or better access to pharmaceutical services. Any required expansion or future development of enhanced services is only necessary in community pharmacies approved within this locality.
Areas that have been reviewed in relation to rurality In the last five years, NHS Kirklees has done one review of rural locations in relation to NHS Pharmaceutical Services. This review incorporated areas within the Holme Valley where the only Kirklees GP dispensing practice is sited. This review was completed in April 2008, therefore the rurality of this area cannot be re-assessed until April 2013 as per the NHS (Pharmaceutical Services) Regulations 2005. Controlled localities Currently only the area in and around Holmfirth has been clearly identified by NHS Kirklees as a controlled locality. The rural areas and urbanised areas are clearly marked on a map of the area, and includes the location of all pharmacies within the area. This map can be viewed on the NHS Kirklees website at www.kirklees.nhs.uk
PHARMACEUTICAL NEEDS ASSESSMENT 59 14 per 100,000's Number of Population Pharmacies per 71,949 Locality Population 6,634 Average Average Monthly Items per pharmacy per locality Locality 796,046 Items per Dispensed 2009/2010 N N N N N N N N N N N/A (Y/N) 100hour Pharmacy N N N N N N N N N N N/A Open Hours (Y/N/) Extended N N N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y N N N N N N N N N N Open all day Saturday Saturday only (Y/N) Number of pharmacies per 100,000 and population Humber in = Yorkshire 21 Number of pharmacies per 100,000 population in England = 21 Y Y Y Y Y Y Y Y N N N Open morning Saturday Saturday only (Y/N) Elmwood Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TR 1 The Cobbles, Meltham, Huddersfield, HD9 5QQ End, Golcar, 38 Town Huddersfield, HD7 4QD 63 Market Street, Milnsbridge, Huddersfield, HD3 4HZ 32 Peel Street, Marsden, Huddersfield, HD7 6BW Drs Shamsee & Oaklands Ward, Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TP Pharmacy Address 9-10 Carr Lane, Slaithwaite, Huddersfield, HD7 5AN 903 Manchester Road, Cowlersley, Huddersfield, HD4 5SX 14 Huddersfield Road, Meltham, Huddersfield, HD9 4AE 8-10 Westgate, Honley, Huddersfield, HD9 6AA Unit 5, Riverside Shopping Centre, 90 Huddersfield Road, Holmfirth, Huddersfield, HD9 3AZ Medicare Medicare Chemists Rowlands Pharmacy S T Shaw Ltd The Co-Operative Pharmacy Local Boots Your Pharmacy Oaklands Health Centre (Dispensing Practice) Pharmacy Name Cohens Chemist K & M Pharmacy Ltd Lloyds Pharmacy Medicare Chemists Medicare Chemists The Valleys - pharmacy out of hours opening/items dispensed per locality per dispensed opening/items hours of out pharmacy - Valleys The Source of dispensed items and population data: NHS Business Services Authority website (NHSBSA) accessed Nov 2010 England Average = 6340 items/pharmacy and Humber average Yorkshire = 6880 items/pharmacy NHS Kirklees average = 6104 items per pharmacy
60 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care ü
Condom distribution ü ü ü
Pregnancy testing ü ü ü
Chlamydia screening ü ü ü
Emergency contraception ü ü ü
Supervised
methadone/ ü ü ü ü ü ü buprenorphine Enhanced services (commissioned) Needle and syringe exchange ü ü
Stop smoking ü ü Data correct as at 30 Nov 2010
Headlice ü ü ü ü ü ü ü ü
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 2 0 1 53 2009/10 153 301 145 178 358** Advanced services Accredited consultation room ü ü ü ü ü ü ü ü www.report.ppa.org.uk/ActProd1/getfolderitems.do Pharmacy address 9-10 Carr Lane, Slaithwaite, Huddersfield, HD7 5AN 903 Manchester Road, Cowlersley, Huddersfield, HD4 5SX 14 Huddersfield Road, Meltham, Huddersfield, HD9 4AE 8-10 Westgate, Honley, Huddersfield, HD9 6AA Unit 5, Riverside Shopping Centre, 90 Huddersfield Road, Holmfirth, Huddersfield, HD9 3AZ Elmwood Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TR 1 The Cobbles, Meltham, Huddersfield, HD9 5QQ End, Golcar, 38 Town Huddersfield, HD7 4QD 63 Market Street, Milnsbridge, Huddersfield, HD3 4HZ 32 Peel Street, Marsden, Huddersfield, HD7 6BW Drs Shamsee & Oaklands Ward, Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TP Pharmacy name Cohens Chemist K & M Pharmacy Ltd Lloyds Pharmacy Medicare Chemists Medicare Chemists Medicare Chemists Rowlands Pharmacy S T Shaw Ltd The Co-Operative Pharmacy Local Boots Your Pharmacy Oaklands Health Centre (Dispensing Practice) The Valleys - Directed pharmaceutical services pharmaceutical Directed - Valleys The Source of MUR data:
PHARMACEUTICAL NEEDS ASSESSMENT 61 9 Stakeholder views In order to make sure the PNA reflects up to date views, opinions from a range of stakeholders were sought during the development of the PNA including: patients, GPs - via the Local Medical Committee (LMC) and Practice Based Commissioning Groups/stand alones, out of hours providers, the local authority, PCT commissioners, community pharmacists as well as the LPC and the dispensing GP. Opinions were obtained using a range of methods e.g. questionnaires, letters, meetings and workshops. Please note at the time of seeking views the localities in Kirklees were slightly different to the current situation. Mirfield was coterminous with Dewsbury and Huddersfield locality was split into two separate localities; Huddersfield North and Huddersfield South. Patient and public views Information already held by NHS Kirklees about patients experience of community pharmacy provision was reviewed. This was supplemented by a short patient questionnaire which was distributed through our patient and public involvement team and all community pharmacies. Groups receiving the questionnaire included Voluntary Action Kirklees (VAK), LINK, EPP Support Group, Readers Panel, Diabetes Reference Group, working in partnership distribution list and database of people expressing an interest to be involved in our work.
Patient Advice and Liaison Service The records of patient contact with NHS Kirklees Patient Advice and Liaison Service (PALS) were trawled for 2008 and 2009, to establish whether there were any common themes relating to pharmacy that would need to be considered as part of the pharmaceutical needs assessment. Forty one records were identified and the key issues were: • Lack of access to pharmacies for those people living in rural areas • Being prescribed medication that was out of date • Being dispensed the wrong medication • Patient choice on where prescriptions are dispensed • Not being dispensed the full prescription and having to go back a second time to collect the remainder of the prescription
Complaints Complaints made to NHS Kirklees during 2008 and 2009 were reviewed to find out whether there were any issues of relevance to the PNA that had been the subject of a formal complaint. During the past two years 2008 and 2009 a combined total of 11 complaints were received. Issues included: • Marketing strategies used by new pharmacists to recruit new patients to their service • Being dispensed the wrong medication • Being prescribed medication that was out of date • Not being dispensed the full prescription and having to go back a second time to collect the remainder of the prescription
62 PHARMACEUTICAL NEEDS ASSESSMENT Annual patient satisfaction survey Pharmacies must undertake a patient satisfaction survey annually. The aim of the survey is to understand the main areas where the pharmacy is performing well and the main areas in need of improvement. Analyses of patient surveys for 2008/09 highlight that the top areas where pharmacies are performing well are: politeness and accessibility of staff, service from the pharmacist and overall rating of the staff. The areas most in need of improvement are: promotion of healthy lifestyle advice, including increasing physical exercise, healthy eating and stopping smoking. The results of the survey should positively inform pharmacies on how to improve their service. • Strong points indicate that patients are particularly pleased with the service received from staff and the fact that they are available and accessible for consultation. • Some pharmacists are obviously having difficulty being pro-active with the public health aspect of their role. This is an area where sharing of successes and good practice would be beneficial. • More pharmacies (now 75) have a consultation area and pharmacies should be well signposted so the public are able to make full use of this facility. Pharmacies without a consultation room should consider how they can offer customers privacy during a conversation. • Problems with disposal of medicines are a cause for concern in case this leads to medicines being discarded in a non-approved manner. This is an essential service which is offered by every pharmacy. The public need more education around correct disposal of medicines, and the service offered by community pharmacists need to be better publicised.
PNA patient questionnaire A short patient questionnaire was distributed through our Patient and Public Involvement Team and all community pharmacies in April 2010. A total of 305 completed questionnaires were received. The questionnaire looked at two main areas, the services people currently use and the services that they would like to see available at their pharmacy. A summary of responses is provided below. Pharmacies are well used across Kirklees in all localities with most responders (90-100% per locality) claiming to use the same pharmacy all or most of the time and on average over three quarters of responders visit their pharmacy more than six times a year. In the main, the most used services on a regular or occasional basis were: • Dispensing of acute and repeat prescriptions • Purchasing over the counter medicines • Seeking advice on medicines • Disposal of old or unwanted medicines. Most enhanced services were used to a smaller degree in all localities. There were differences reported in the use of the MUR service across localities, the highest use reported was in Batley, Birstall and Birkenshaw where 45% of responders reported occasionally sitting down with their pharmacist to discuss how to use their medicines. On the other hand no responders in Huddersfield North reported using this service. In the remaining localities approximately one third of responders reported occasionally using this service. Home delivery services are not part of the NHS pharmaceutical terms of service and are provided by pharmacies as a business enhancement and added value service to patients. Responders from all localities reported using this service, with 100% of Huddersfield North responders using this service (possibly an explanation for the absence of responders using MUR service in this locality?). On average the home delivery service was used by about 40% to 50% of responders in the remaining localities. When asked about what future services patients might like to see provided in their pharmacies; of the options suggested the most favoured services for all localities without exception were: • NHS health checks • Services for pain management • Weight management services • Vaccination services
PHARMACEUTICAL NEEDS ASSESSMENT 63 Anticoagulation monitoring was the next most favoured meaning that alcohol brief interventions and chlamydia treatment were the publics’ least favoured services for future development. Overall, NHS health checks (including blood pressure monitoring, diabetes testing, cholesterol monitoring and spirometry testing) was the most popular service identified by patients and the public for future development. Patients were asked to give additional views on pharmaceutical services in their area. The main themes included:
• Customer service Customer service was important to patients as was the availability of a confidential area for consultations. In all localities patients were very satisfied with the service they received from pharmacies, emphasising the professional, helpful and caring nature of staff. A small minority of patients expressed dissatisfaction with the level of service from their local pharmacy in terms of poor staff attitude and out of stock medicines (Holmfirth area) and closing times (Mirfield area).
• Access Patients felt pharmacies were conveniently located and more accessible than GP surgeries. There was suggestion that longer opening hours were needed in The Valleys. Apart from Denby Dale village, no-one living in Kirklees expressed a need for more pharmacies in any of the localities however longer opening hours were sought in Mirfield and Saturday opening of existing pharmacies in some rural villages.
• Provision of additional services Patients in all localities were keen to have additional services provided in their local pharmacies because of their accessibility but there was a concern about their capacity to deliver such services because of manpower and time constraints and lack of confidence in counter staffs ability to carry out such duties. There was also fear of duplicating services between GPs and pharmacists and wasting resources.
• Miscellaneous There seemed to be a general lack of knowledge amongst the public about what services community pharmacists could offer outside of the standard dispensing and over the counter medicines sales. More publicity was felt to be needed on the range of services offered by community pharmacies. Interest in extending the Minor Ailments Scheme currently running as a pilot in parts of Huddersfield was mentioned more than once by patients from several localities. GP and commissioner views The LMC and PBCs were sent a letter asking for their views on local pharmaceutical services. In addition a workshop was held with PBC representatives and a meeting with LMC to explain the background to the PNA and get views on current services and future pharmaceutical provision in Kirklees. PCT commissioners were also asked to forward their opinions. Feedback was as follows:
PBC consortia and GP practices in north of Kirklees Covering localities of - Batley, Birstall and Birkenshaw - Dewsbury and Mirfield - Spen Valley
Services which could be usefully provided by community pharmacists included: • Clinical medication review • Care homes management service (but not duplicating GP role) • Introduction of electronic prescription service was seen as having great potential to stream line the repeat dispensing process for GPs.
64 PHARMACEUTICAL NEEDS ASSESSMENT When considering the health needs of their population it was felt that: • Chlamydia screening was a useful enhanced service as community pharmacists were more likely to capture teenagers who would find a drop in arrangement for accessing health care more attractive • Weight management services particularly for diabetics and those with chronic heart disease were also felt to be a worthwhile service development in community pharmacies. Availability/access of community pharmacies was also considered. It was felt that in Mirfield, community pharmacies did not stay open for long enough and although provision of pharmacies was ample there was lack of competitive choice in that area. Provision in the remaining localities of North Kirklees was felt to be good.
PBC consortia and GP practices in South of Kirklees Covering localities of - The Valleys - Denby Dale and Kirkburton - Huddersfield South - Huddersfield North
Key messages and overall views • Use contract payments to avoid pharmacy services providers using default “Go see your GP” when they commence the provision and are not able to complete all aspects of a service • Use social marketing (sic) to publicise any services being provided by pharmacists in order to make sure they are fully utilised (possibly with pharmacists paying for this advertising to increase their market share). • Make sure national level evidence (when available) is integral to all accreditation criteria for practitioners delivering pharmacy services. • Concern that expanding pharmaceutical services might lead to duplication of services already covered by GPs and that a holistic view must be taken when redesigning new services and pathways. • Consideration should be given to pharmacies hosting services provided by a PCT employed practitioner who delivers the services, so they can access NHS infrastructure to deal with follow up interventions. Overall the PNA was welcomed as a means of identifying potential over-provision or under-utilisation perhaps giving NHS Kirklees scope to re-assess provision of enhanced services from all professional groups and re-commission as appropriate or necessary for a particular geographical area. It would provide an opportunity to direct resources to areas of most need, improving access and increasing use of pharmacist’s skills. Services identified that could be provided by pharmacies included: • Minor ailment (some provision by practices now, but a pharmacist could do it all) • Mental health services for young people (i.e. peer support) but this needs integrating with the children’s services’ initiative • Explaining / training patients on the use of medication to improve concordance • Low level mental health problems (with clear strategies to identify and refer on those beyond their ability) • Out of hours access for basic health advice and minor ailment treatments • Stop smoking advice • Heart failure and hypertension monitoring (with strict criteria agreed by GPs / Medical Specialists) • Chlamydia screening (as per the current national protocol) • More emphasis is needed on counselling patients about inhaler use and reviewing technique as this should improve compliance and effectiveness of treatments given to asthmatic patients • Opportunistic lung function testing to find undiagnosed patients
PHARMACEUTICAL NEEDS ASSESSMENT 65 Local authority views A particular issue raised by the local authority was the need for an improved medicine management system to be in place for frail, vulnerable people supported in their own homes and especially for those with dementia. The number of people with some form of dementia will increase as the population over 65 increases, resulting in a growing number of people who will need support to manage their medication. Therefore commissioning arrangements would need to be in place for local pharmacists to do assessments and provide individualised medicine support as required for this at risk group. As a key part of the local authority and NHS Kirklees shared approach to avoiding hospital admission / speeding up discharge, consideration of commissioning such services in the future would be important. Urgent care provider view Out of hours (OOH) services are currently provided by NHS Direct, and Local Care Direct (LCD) under a new contract agreement from April 2009. LCD felt that pharmaceutical service provision during out of hours was sufficient to meet current need. All locations where LCD saw patients (HRI, Bradley and Dewsbury District Hospital) are near to extended hours pharmacies and the OOH staff have good relationships with several of these pharmacies. Some areas of Kirklees specifically Denby Dale and Kirkburton and The Valleys localities, are not so well served with extended hours pharmacies however this did not cause LCD any problems as they currently did not operate any OOH services from these areas other than home visits. LCD maintains a stock of medicines (including palliative care drugs) which reflects the national OOH formulary and in instances when a medicine is needed urgently or access via a prescription will cause problems for the patient then this stock is used rather than giving a prescription. Lists of the pharmacies which are part of the community pharmacy palliative care scheme are available for the doctors/drivers who do home visits. Provision of palliative care drugs to patients is also supplemented by the community pharmacy palliative care service. Other initiatives such as anticipatory prescribing of palliative care drugs for relevant patients might also be reducing access problems. A review of the palliative care scheme is underway to assess options for the future and determine the future approach which will give the most benefit. Community pharmacists views Community pharmacists were asked for their views of current gaps in pharmaceutical services particularly considering the needs of the more vulnerable and hard to reach groups within their communities. Key themes mentioned across all localities were: • Development of a minor ailments scheme; this would help low income families access medicines without having the need to visit their GP. This would also benefit GPs by reducing consultation rates for self limiting illnesses. • Health checks such as blood pressure and cholesterol monitoring, diabetes testing and weight checks, advice on diet and exercise was a very common consistent message. • Another strong theme was around developing pharmaceutical services specifically aimed at the elderly, disabled and housebound. Suggestions included expanding the MUR services to allow domiciliary visits for review of medicines use and compliance. Enhanced services to facilitate provision of aids such as dosette boxes, MAR sheets etc were also mentioned.
Suggested needs in specific localities were: • Services to support patients with language barriers so they could better understand their medicines in the Batley, Birstall and Birkenshaw, Dewsbury and Mirfield and Huddersfield North localities. • Vaccination services and hepatitis C screening was also mentioned for these localities.
Formal consultation A formal consultation of the draft PNA took place between 9 August and 15 October 2010. A report on the consultation and the PCTs response is available on the PCT website www.kirklees.nhs.uk/public-information/publications/reviews-and-assessments/
66 PHARMACEUTICAL NEEDS ASSESSMENT 10 Identified pharmaceutical needs Having assessed local needs and the current provision of pharmaceutical services, gaps have been identified. Some gaps will need collaborative working with current community pharmacy providers to encourage transition towards the PCT’s ultimate goals. Others will need to be prioritised and might not be immediately commissioned even if a new applicant or existing pharmacy offers to provide the service. NHS Kirklees would need to identify overall provision of a service in each locality, ensure appropriateness, value for money, quality and patient satisfaction of any related services currently provided before progressing expansion or commissioning of new services. Any new enhanced service commissioned is likely to be offered to existing providers of pharmaceutical services first before considering new applications. Current service gaps/pressures Availability of pharmacies In 2009/2010, NHS Kirklees had the third highest number of pharmacies per 100,000 population in the Yorkshire and Humber region with 23 pharmacies. The average for both the Yorkshire and Humber region and England was 21. At that time Kirklees had 92 pharmacies. NHS Kirklees currently has 93 pharmacies. The exemption clause in NHS (Pharmaceutical Services) Regulations 2005, allowing pharmacies to open without consideration of control of entry test; necessary, desirable and expedient, has seen a significant rise in Kirklees pharmacies; from 85 in 2006/07 to 93 in 2010/11. Five out of the additional eight pharmacies were 100 hour contracts. Over the past year, the pharmacy panel has granted approval for seven new pharmacies to be opened by June 2011 (pending extension rights). Four are for 100 hour pharmacies; two based in the southern part of the Huddersfield locality in Lockwood, and the rest are based in The Valleys locality in and around the village of Slaithwaite. In addition two 40 hour applications were also approved for The Valleys locality (one having extended opening hours which would enhance access in the Holmfirth and surrounding areas, the second application for the New Mill area has now missed its deadline to open or gain extension for ongoing approval). The remaining one opened in Denby Dale village in July 2010. Furthermore four new applications are awaiting consideration by the Kirklees pharmacy panel or the appeals authority in the near future, one of these being for a wholly internet/mail order pharmacy in the Huddersfield locality, the second for a 40 hour contract in the village of Golcar, part of The Valleys locality, and the rest are 100 hour applications in the Paddock area (Huddersfield locality) and Slaithwaite (The Valleys locality). See section 10 for the list of applications. NHS Kirklees currently has the highest number of 100 hour pharmacies (12) in the Yorkshire and Humber region, almost twice as many compared to the neighbouring West Yorkshire PCTs. One hundred hour pharmacies in Kirklees have improved access during evenings and weekends for patients and the PCT would not want to see a reduction in provision of pharmaceutical services during these extended hours or out of hours period from any contracted 100 hour pharmacy apart from in the Dewsbury locality. These
PHARMACEUTICAL NEEDS ASSESSMENT 67 100 hour pharmacies fulfil an identified need for essential and directed services particularly at times when other pharmacies are closed. Any additional 100 hour pharmacies which open in the interim are likely to only fulfil a need for service provision in the out of hours periods and provision of directed services (advanced and enhanced) at these times would be necessary as current pharmacies provide adequate cover for the remainder times. These statistics would suggest Kirklees is more than adequately supplied with community pharmacies and any further granting of new applications would not be meeting an identified need for pharmaceutical services during the normal working day but only serve to secure improvements or better access during evenings or weekends.
Access As depicted in section eight under pharmacy facilities and locality summaries, all except two localities have good access to pharmaceutical service provision into late evenings on weekdays and Saturday. Similarly in those localities there are pharmacies open throughout Sunday. Localities with poorest opening times are Mirfield, Denby Dale and Kirkburton and The Valleys. The number of pharmacies in these two localities is markedly less than in other localities. Mirfield, Denby Dale and Kirkburton locality has the second least number of pharmacies per 100,000 population with The Valleys locality having the least number in Kirklees at 14. There are no 100 hour or extended hour pharmacies in either of these localities. However with the potential opening of 100 hour pharmacies in The Valleys, provision will be adequately met and there will be no further need in this locality for more pharmacies. Provision in Mirfield, Denby Dale and Kirkburton locality has improved since the recent opening of a pharmacy in Denby Dale however longer weekday opening including Saturday and Sunday opening would be welcome in this locality. This issue has been identified by both patients and health providers (see section 9). Longer weekday opening and Saturday and Sunday opening is therefore identified as a gap in service provision for this locality. The need for extended hour weekday provision and better weekend opening in these specified areas would ideally come from current providers. It is felt current provision of pharmacies in this locality is necessary and that any further developments are only necessary to secure improvements or better access. Disabled access could be improved upon across Kirklees, as could availability of staff with bilingual skills relevant to the local ethnic population in which the pharmacy is sited. These gaps should be addressed by existing providers.
Applications relating to change of hours When considering applications from contractors to change hours, the pharmacy panel must always review availability of core hours amongst pharmacies in the vicinity of the locality so as to maintain adequate opening times throughout the seven day week for each locality in Kirklees.
Services There appears to be a lack of knowledge from both patients and health care staff about the range of services available from pharmacies. In particular more publicity for the public is needed about the disposal of waste medication service provided by all pharmacies and the availability of directed services. Similarly community pharmacists at times appear unaware of services currently commissioned by NHS Kirklees. As the range of services provided through community pharmacies increases the training and skills of pharmacists and their support team will also need to be developed. NHS Kirklees will make sure that adequate training opportunities are provided to members of the pharmacy team to enable them to deliver services to meet the needs of NHS Kirklees.
68 PHARMACEUTICAL NEEDS ASSESSMENT Directed service provision Contractual arrangements allow pharmacies to conduct a maximum of 400 MURs annually and dispensing GPs must perform DRUMs on a minimum of 10% of their registered dispensing patients to get the specified payment. Table two shows the level of reviews undertaken in 2009/10 per pharmacy and GP dispensing practice. 78.3% of Kirklees pharmacies provide an MUR service compared to 85.4 % in Yorkshire and Humber and 85.7% in England. NHS Kirklees has the second lowest percentage for all PCTs in Yorkshire and Humber region. Whilst a small number of pharmacies achieved the maximum allowed number of reviews there is scope to deliver more reviews from this service. In particular the northern part of the Huddersfield locality delivers the least number of reviews of all localities with significant numbers of pharmacies not delivering any at all. This MUR advanced service has great potential for delivering much better value for money and improving patients use and understanding of their medicines. NHS Kirklees can encourage tailoring of reviews to support particular, specific patient groups e.g. elderly, disabled, and housebound. Also, targeting reviews towards patients with long term conditions of particular significance to our population e.g. diabetes, coronary heart disease and asthma will further help effective use of medicines within Kirklees. Health needs of the population in the seven Kirklees localities which could be supported by commissioning of enhanced pharmaceutical services have been addressed in section 8 of the PNA under each locality summary. Currently commissioned enhanced services such as stop smoking, sexual health, supervised consumption of methadone and buprenorphine and needle and syringe exchange are important resources satisfying our populations health needs. Section eight identifies gaps and pressures in each of the localities. A refocus of the target audience might be required for stop smoking services e.g. in Batley, Dewsbury and north of Huddersfield towards young people. Also in Batley, Dewsbury, and Spen stop smoking services should be targeted at pregnant women. The current service is under review and is likely to be transformed into a voucher scheme operating as an access scheme only, where the pharmacy dispenses Nicotine Replacement Therapy (NRT) from a voucher issued to the patient by a specialist advisor. This scheme will be offered widely across Kirklees. Some pharmacies, particularly those whose staff trained as Level 2 advisors will also have the opportunity to continue offering specialist smoking cessation advice clinics. The sexual health scheme is a fairly new service and the intention is to contract more pharmacies in areas of greatest need as depicted on Map D. We would like to engage with more pharmacists and increase the points of access across Kirklees. Sharing training for the sexual health pharmacy LES across West Yorkshire should increase the opportunity for pharmacists to join this scheme. Furthermore, in 2011 the PCT sexual health team are working to develop tiered sexual health services based on areas of need, which will include access to sexual health services in pharmacies as well as through other access points e.g. GPs. The head lice scheme is well received by the public and health care professionals alike and at present adequately serves the populations needs. Assessment of the potential benefits of the minor ailment pilot scheme, currently running in parts of Huddersfield will determine its future roll out across Kirklees. Continuation of the scheme and extent of expansion will depend on evaluation of the pilot scheme. Consideration of the current health needs of the Kirklees population and the views from stakeholders suggests there are potentially many new enhanced services which could be commissioned. Of significance and resonating from all quarters surveyed is the possible need for: • NHS health checks/screening services • Weight management clinics including healthy lifestyle interventions • Pain management services • Alcohol treatment services • Medicines management services specifically aimed at the elderly, disabled and housebound. However when judging levels and type of service provision needed from community pharmacies a holistic review of all services from all providers in the locality contributing to reducing that specific health need has to be undertaken. This will make sure resources are used effectively and efficiently. Section eight identifies potential need for such services in each locality. New services or expansion of current services will be commissioned as and when the PCT or PBC consortia are in a position to fund such services.
PHARMACEUTICAL NEEDS ASSESSMENT 69 Future developments The following paragraphs outline the known or potential developments of primary care medical services within NHS Kirklees, applications for new community pharmacies or minor relocations and any planned developments forwarded by the local council.
Primary care medical services • Drs Taylor and Martin, Crosland Moor Practice in the Huddersfield South locality is likely to move to a site at Moorfield Primary Care Centre, Park Road West, Crosland Moor by December 2010. This move should not cause any loss of access to pharmaceutical services in this locality. • Drs Butt and Ahmed, Bradford Road Medical Centre in Huddersfield North locality is approved to move to a site on Cobcroft Road. This move is not anticipated to take place for another 12-18 months. • New surgeries are planned for Dr Ghafoor and Partners, West Park Surgery and Dr Asmal and Partners of Warren Street but new sites and dates for these moves are yet to be confirmed. It is highly unlikely that these practices will move more than half a mile a way from their current sites therefore access to pharmaceutical services is unlikely to be disrupted.
Community pharmacy panel applications At the time of writing this document the following applications had been granted by the pharmacy panel. • Mr A M Khan preliminary consent (40 hour) at New Mill Road, Holmfirth, Huddersfield expired 01/12/2010 • Nasim Akhtar preliminary consent (100 Hours) in the vicinity of 8-14 Meltham Road, Lockwood, HD1 3TJ expires 07/12/2010. However full consent has since been applied for and granted till 7/6/2011 for premises at 6, 8 and 12 Meltham Road, Lockwood, HD1 3TJ • NACAD Ltd full consent at Oaklands Health Centre, Huddersfield Road, Holmfirth, HD9 3TP expires 1/3/2011 • Gorgemead Ltd preliminary consent (100 Hours) at Croft House Surgery, Manchester Road, Slaithwaite, HD7 5JY grant expires 6/4/2011 • Huddersfield Health Focus Ltd full consent (100 Hour) at 1137 Manchester Road, Slaithwaite, HD7 5LU - grant expires 6/4/2011 • Mr M Ghaffar (Lockwood Pharmacy) preliminary consent (100 Hour) in the vicinity of 227 – 231 Lockwood Road, Lockwood, Huddersfield HD1 3TG - grant expires 6/4/2011 • Thimmegowda Associates Limited (full consent minor relocation under 500m) from 13 Halifax Road, WF13 2JH to 47 Albion Street, WF13 2AJ - grant due to lapse 21/05/2011 The application listed below was rejected by the pharmacy panel and is currently under appeal with a decision expected from the appeals authority during winter 2010: • M S Health Ltd preliminary consent (40 hour) in the vicinity of Sycamore Avenue, Golcar, Huddersfield Applications currently under consultation or being processed by the pharmacy panel include: • Synergy P ltd T/A HD Pharmacy, Cobcroft Road, Huddersfield, HD2 (wholly internet /mail order pharmacy) • Pathvalley Limited (minor relocation under 500m) from 9-10 Carr Lane, HD7 5AN to Croft House Surgery, Manchester Road, Slaithwaite, HD7 5JY • PathValley Ltd preliminary consent (100 hours) at 9-10 Carr Lane, HD7 5AN, Slaithwaite. • Mr I Younis for full consent (100 hours) at 5 Brow Road, Paddock, Huddersfield, HD1 4TP • Application by Mr A Hafiz for preliminary consent for minor relocation (over 500 metres) within the same neighbourhood from 107 Bradford Road, Huddersfield, HD1 6DZ to land at 5, Cobcroft Road, Fartown. HD2 2RJ
70 PHARMACEUTICAL NEEDS ASSESSMENT Local authority developments In respect of developments with Kirklees Council a number of proposed developments targeted at older people are planned. However, apart from the ones being organised by the council directly none of these are yet at a stage where we can be definite about them going ahead – so the impact on pharmacy is unquantifiable at this stage. Looking to the future There is scope to design and commission a range of new services to be delivered in a community pharmacy setting such as: • NHS health checks • Weight management • Medicines management services for the elderly and vulnerable • Alcohol brief interventions • Vaccination services • Pain management • Anticoagulation clinics • Chlamydia treating Over the past 18 months, NHS Kirklees has been working with service providers to develop a Kirklees wide chronic pain care pathway and to commission new services in line with evidence based practice, and to respond more effectively to patient outcomes. Pharmacists will play a key role in supporting individuals with low impact chronic pain. Pain management clinics delivered by community pharmacies should be an incorporated part of the pathway, making sure that customers have access to medicines management advice and support for self care techniques to help them manage their chronic pain condition. Managing abuse of alcohol is a PCT priority for both adults and children and young people although there are selected areas where we have specific concerns as outlined in section eight. In the future we might be able to start an alcohol identification and brief advice (IBA) pilot local enhanced service in a limited number of pharmacies provided there is sufficient resource and capacity. These services could either give greater access, where these types of services are already being delivered by other healthcare professionals, (i.e. increase productivity) or result in service re-designs to maximise efficiency savings and improve the quality of patient care. These actions will link in with statements made in ‘NHS 2010–2015: from good to great. Preventative, People-centred, Productive’ helping to make sure that NHS Kirklees complies with relevant guidance and key documents. The benefits of using the repeat dispensing (RD) system will possibly be better received following the implementation and roll out of phase two of electronic prescription services (EPS) anticipated to start in Kirklees in summer 2011.
PHARMACEUTICAL NEEDS ASSESSMENT 71 11 Summary/conclusions This needs assessment suggests that there are sufficient pharmacies in Kirklees; however there might be a need for longer opening hours both at weekends and weekdays in The Valleys and Mirfield, Denby Dale and Kirkburton localities. All remaining localities particularly those containing the most deprived populations are well served with pharmacies having a good range of opening hours throughout the week. The extended hours GP service and Walk In Centre also have sufficient pharmacies open after 6pm to meet their current need. Community pharmacy is a well-used service which is highly valued by those who use it; however there is room for improvement in delivery of some of the essential and advanced service indicators. It is apparent that patients, carers and health professionals are not aware of the full range of enhanced services currently commissioned by the PCT. Greater emphasis will have to be put into both advertising these services and recruiting pharmacies in areas most wanting of those services. Community pharmacy is well placed as a service provider because it is more accessible to local people than either hospital or GP services and because of its longer opening hours especially weekend opening. Community pharmacists will need to continue to acquire many new clinical and consultation skills so that they can better meet the challenges the community pharmacy contract brings. Pharmacies currently not participating in advanced services will be encouraged to acquire accredited consultation rooms and offer the MUR service to appropriate patient groups as identified by the PCT or PBC groups. These developments will need investment in training for pharmacists and pharmacy support staff to capitalise on these possible future roles. In order for these to be effective the contract must be underpinned by a robust IT support system being in place, so that progress of ETP and access to care records is facilitated. IT facilities within community pharmacies must be improved upon and used more effectively as email transmission becomes the more accepted route of communication in the workplace compared to more traditional routes. Regular access to the internet and word processing packages without disrupting the dispensary process will have to become routine practice. It will help enormously with rapid communication in times of emergency/major incidents. All pharmacy applicants granted a contract under an exempt category (other than mail order) will be expected to fulfil the criteria listed in section 12 Control of Entry: Exempt Applications. The PNA will be used as a tool in commissioning decisions for new pharmacy services, where the clinical resource within community pharmacy can be used to maximum effect in meeting the health needs of the Kirklees population and after a holistic review of service provision from all providers. New services or expansion of current services will be dependent on availability of sufficient financial resource.
72 PHARMACEUTICAL NEEDS ASSESSMENT 12 Control of Entry: Exempt Applications Applicants using one of the four exemptions to the control of entry test (pertaining to current and amended NHS Regulations 2005) are required to provide within three months of opening, the following enhanced services subject to PCT-determined need for the service at the time of application and availability of resources: • Stop smoking service • Head lice scheme • Sexual health services including: - Emergency hormonal contraception (extends to females from 13 years old) - Chlamydia screening - Pregnancy testing - Condom distribution • Supervised consumption of methadone and buprenorphine • Needle and syringe exchange • Palliative care service Other enhanced services (e.g. stop smoking voucher scheme, NHS health checks, weight management clinics, pain management clinics, minor ailments scheme, vaccination clinics etc) might be commissioned at a future date and contractors will be expected to provide such services as deemed necessary by the PCT or PBCs to fulfil a need in the local community. Applicants must be willing to make sure that there will be a pharmacist present at all times when pharmaceutical services are to be provided, who has undergone the PCT’s required training for all of the above mentioned services making sure that the services specified above are provided for the entire opening hours of the pharmacy. Applicants are also required to provide the advanced services. The pharmacy will have a consulting room and will carry out MURs. Provision of essential, advanced services particularly MURs and enhanced services during extended hours and out of hours opening times are deemed necessary from this group of contractors as they will be fulfilling a need when other pharmacies are closed. Applicants should be willing to fully comply with all the requirements of the NHS Kirklees monitoring procedure for pharmacies that are obligated to open for 100 hours, including informing NHS Kirklees of the planned and actual pharmacist cover. Applications relating to change of hours When considering applications from contractors to change hours, the pharmacy panel must always review availability of core hours amongst pharmacies in the vicinity of the locality so as to maintain adequate opening times throughout the seven day week for each locality.
PHARMACEUTICAL NEEDS ASSESSMENT 73 13 References 1 http://www.legislation.gov.uk/ukpga/2006/41/section/128 2 Health and Well-being key issues for the people of Kirklees. Joint Strategic Needs Assessment. Kirklees Partnership 2009 and 2010 (publication due shortly) http://www.kirklees.nhs.uk/public-information/publications/reviews-and-assessments/ 3 Five Year Strategic Plan 2010-2015. Revision January 2010. NHS Kirklees. www.kirklees.nhs.uk/public-information/publications/plans/ 4 Pharmaceutical Needs Assessments (PNAs) as part of world class commissioning. NHS Employers January 2009. (accessed February 2010) 5 Department of Health Single Equality Scheme 2009-2012 (accessed Sept 2009) 6 Community pharmacy national contractual framework accessed via PSNC website http://www.psnc.org.uk/pages/introduction.html 7 Pharmaceutical Services Negotiating Committee (PSNC) accessed from http://www.psnc.org.uk/pages/advanced_services.html (June 2010) 8 Audit Commission: Under Pressure Local Government report Feb 2010. 9 Projecting Older People Population Information (POPPI) System. Accessed March 10 10 Disability Discrimination Act (DDA) 1995. Pharmacy & the Disability Discrimination Act. PSNC 2009 (accessed 31 December 2009) 11 Medicines Adherence, NICE 2009. Pharmacy in England, DH 2008. Safety in Doses, NPSA 2007 12 High Quality Care For All, Primary Care and Community Services: Improving pharmaceutical services. World Class Commissioning 13 Kirklees Council website http://www.kirklees.gov.uk/you-kmc/kmc-howcouncilworks/locality/ locality.shtml accessed July 2010 14 NHS 2010–2015: from good to great. Preventative, People-centred, Productive. The Stationary Office.
74 PHARMACEUTICAL NEEDS ASSESSMENT 14 Acknowledgements Thanks are extended to members of the PNA project board, PCT staff, and Local Authority staff for their participation and contributions during the development of this PNA. Also all stakeholders who provided data, answered questionnaires and gave views during the engagement exercises are thanked. Further acknowledgment is due to Emma Jones, Acting Information Manager, Information Team, NHS Wakefield District, who provided invaluable mapping expertise and to Su Kent, PA/Admin Team Leader, Medicines Management & Prescribing, NHS Kirklees for vital administrative support.
PHARMACEUTICAL NEEDS ASSESSMENT 75 15 Appendices
Appendix 1 - List of community pharmacies in Kirklees showing code for maps
Map Pharmacy Name Address Postcode Code 1 Batley Pharmacy 157 Upper Commercial Street Batley WF17 5DH 2 Boots UK Limited Unit 3, Birstall Retail Park, Birstall Leeds WF17 9DT 3 Hughes Chemists 3-5 Oxford Terrace, Off Soothill Lane Batley WF17 5ST (Northern) Limited 4 Lloyds Pharmacy 8 Market Place, Birstall Batley WF17 9EL 5 Lloyds Pharmacy Town Street Medical Centre, Town Street, Bradford BD11 2HX Birkenshaw 6 Mileusnic G 133 Upper Commercial Street Batley WF17 5DH 7 Oakwood Pharmacy The Old Salvation Army Hall, 74 Blackburn Batley WF17 9PL Road, Birstall 8 Tesco In-Store Pharmacy Tesco In-Store Pharmacy, Bradford Road Batley WF17 5TJ 9 The Co-Operative 4 Market Place Batley WF17 5DA Pharmacy 10 The Co-Operative 104 Upper Commercial Street Batley WF17 5DP Pharmacy 11 The Co-Operative 67B Purlwell Lane, Mount Pleasant Batley WF17 7PF Pharmacy 12 Winer (Chemists) Ltd 1 Bond Street, Birstall Batley WF17 9EX 13 Denby Pharmacy 315 Wakefield Road, Denby Dale Huddersfield HD8 8RX 14 Rowlands Pharmacy Kirkburton Health Centre, Shelley Lane, Huddersfield HD8 0SJ Kirkburton 15 Shepley Pharmacy Shepley Health Centre, 25 Jos Lane, Huddersfield HD8 8DJ Shepley 16 The Co-Operative The Health Centre, Wakefield Road, Scissett Huddersfield HD8 9JL Pharmacy 17 The Co-Operative 38 Commercial Road, Skelmanthorpe Huddersfield HD8 9DA Pharmacy 18 Your Local Boots 142 Huddersfield Road Mirfield WF14 8AN Pharmacy 19 Boots UK Ltd 54 Old Bank Road Mirfield WF14 0JA 20 Your Local Boots Mirfield Health Centre, Doctor Lane Mirfield WF14 8DU Pharmacy
76 PHARMACEUTICAL NEEDS ASSESSMENT Map Pharmacy Name Address Postcode Code 21 Asda Pharmacy Mill Street West Dewsbury WF12 9AE 22 Boots UK Limited 27 The Prince Of Wales Precinct, Long Dewsbury WF13 1NH Causeway 23 Brewery Lane Pharmacy 49 Brewery Lane, Thornhill Lees Dewsbury WF12 9DU 24 Chickenley Pharmacy 51 Walnut Lane, Chickenley Dewsbury WF12 8NJ 25 Cohens Chemist 78 High Street, Westtown Dewsbury WF13 2QQ 26 Cohens Chemist 11B South Street, Savile Town Dewsbury WF12 9NB 27 Dewsbury Moor 119 Heckmondwike Road, Dewsbury Moor Dewsbury WF13 3NT Pharmacy 28 Dewsbury Pharmacy 20A West Park Street Dewsbury WF13 4LA 29 Eye Pharmacy 6D Ravensthorpe Retail Park, Huddersfield Dewsbury WF13 3HN Road 30 G Pharmacy 13 Halifax Road Dewsbury WF13 2JH 31 Lloyds Pharmacy Unit 1, South Street Dewsbury WF13 1JS 32 Noble’s Chemist 92 Savile Road, Savile Town Dewsbury WF12 9LP 33 Pharmacy-D Dewsbury Health Centre, Wellington Road Dewsbury WF13 1HN 34 R Drummond Chemist 71 Halifax Road Dewsbury WF13 4HD 35 Rowlands Pharmacy Earlsheaton Medical Centre, 252 Wakefield Dewsbury WF12 8AH Road, Earlsheaton 36 Rowlands Pharmacy 30 The Town, Thornhill Dewsbury WF12 0RB 37 Sainsburys Pharmacy Goods Lane, Railway Street Dewsbury WF12 8EB 38 Sykes Chemist 140A Slaithwaite Road, Thornhill Lees Dewsbury WF12 9DW 39 The Co-Operative 620 Huddersfield Road, Ravensthorpe Dewsbury WF13 3HL Pharmacy 40 Asda Pharmacy Longhill Road, Off Bradford Road, Huddersfield HD2 2LQ Brackenhall 41 B Singh 6 Church Street, Paddock Huddersfield HD1 4TR 42 Bradford Road Pharmacy 107 Bradford Road, Fartown Huddersfield HD1 6DZ 43 Cohens Chemist 56 Sheepridge Road Huddersfield HD2 1HG 44 CW Peach (Chemists) 62 Westbourne Road, Marsh Huddersfield HD1 4LE 45 Dickinson’s Chemist 80 New Hey Road, Lindley Huddersfield HD3 4AJ 46 K Pharmacy 2 Grimscar Avenue, Birkby Huddersfield HD2 2TW 47 Medicare Chemists 140 Westbourne Road, Marsh Huddersfield HD1 4LF 48 Medicare Chemists 5 Copthorne Square, Bradley Huddersfield HD2 1SZ 49 Medicare Chemists Unit 2,Salendine Nook Shopping Centre, Huddersfield HD3 3XA Moorhill Road, Salendine Nook 50 Paddock Head Pharmacy 203 Luck Lane, Paddock Huddersfield HD1 4RB 51 S T Shaw Ltd Fartown Grangek, Spaines Road, Fartown Huddersfield HD2 2QA 52 Siddique Pharmacy Ltd 14 Spaines Road, Fartown Huddersfield HD2 2QA 53 S T Shaw Ltd 59 Lidget Street, Lindley Huddersfield HD3 3JP 54 Akram Za Ltd 2 Thorne Road, Thornton Lodge Huddersfield HD1 3JJ 55 Rowlands Pharmacy 63-65 Highgate Lane, Lepton Huddersfield HD8 0DS 56 Boots UK Limited Unit 2B, Great Norther Retail Park, Leeds Huddersfield HD1 6ND Road
PHARMACEUTICAL NEEDS ASSESSMENT 77 Map Pharmacy Name Address Postcode Code 57 Boots UK Limited 22 King Street Huddersfield HD1 2QE 58 Greenhead Pharmacy 2 Greenhead Road Huddersfield HD1 4EL 59 K & M Pharmacy Ltd 325 Meltham Road, Netherton Huddersfield HD4 7EX 60 Rowlands Pharmacy 332-334 Wakefield Road, Moldgreen Huddersfield HD5 8DQ 61 Kirkheaton Pharmacy 1 Bankfield Lane, Kirkheaton Huddersfield HD5 0JE 62 Lloyds Pharmacy 45-47 Market Street Huddersfield HD1 2HL 63 Medicare Chemists Meltham Road Surgery, 9 Meltham Road, Huddersfield HD1 3UP Lockwood 64 Newsome Health Centre 1A Church Lane, Newsome Huddersfield HD4 6JE Pharmacy 65 Rowlands Pharmacy 125 Fitzwilliam Street Huddersfield HD1 5PS 66 Rowlands Pharmacy 5 Broad Lane, Dalton Huddersfield HD5 9BU 67 Rowlands Pharmacy 65A Northgate, Almondbury Huddersfield HD5 8RX 68 Sainsburys Pharmacy Southgate Huddersfield HD1 6QR 69 Superdrug 20 Princess Alexandra Walk Huddersfield HD1 2TT 70 Tesco In-Store Pharmacy Viaduct Street, Off Fitzwilliam Street Huddersfield HD1 1RW 71 Rowlands Pharmacy 617 Wakefield Road, Waterloo Huddersfield HD5 9XP 72 Your Local Boots Moorfield Shopping Centre, 3 Park Road Huddersfield HD4 5RX Pharmacy West, Crosland Moor 73 Cohens Chemist 4 Batley Road Heckmondwike WF16 9NE 74 Gomersal Pharmacy 260 Oxford Road, Gomersal Bradford BD19 4PY 75 Kirklees Pharmacy St Johns House, Cross Church Street Cleckheaton BD19 3RQ 76 Lloyds Pharmacy 5 Greenside Cleckheaton BD19 5AN 77 Oakenshaw Pharmacy 673 Bradford Road, Oakenshaw Bradford BD12 7DT 78 Rowlands Pharmacy Heckmondwike Pcc, Algenon, Firth Park Heckmondwike WF16 0HH 79 Rowlands Pharmacy 26 Market Street Cleckheaton BD19 5AJ 80 Shah’s Pharmacy 69 Valley Road Liversedge WF15 6DL 81 The Co-Operative Unit 8, Northgate Retail Centre Heckmondwike WF16 9RL Pharmacy 82 The Co-Operative Morrisons Superstore, Union Street Heckmondwike WF16 0HL Pharmacy 83 Cohens Chemist 9-10 Carr Lane, Slaithwaite Huddersfield HD7 5AN 84 K & M Pharmacy Ltd 903 Manchester Road, Cowlersley Huddersfield HD4 5SX 85 Lloyds Pharmacy 14 Huddersfield Road, Meltham Huddersfield HD9 4AE 86 Medicare Chemists 8-10 Westgate, Honley Huddersfield HD9 6AA 87 Medicare Chemists Unit 5, Riverside Shopping Centre, 90 Huddersfield HD9 3AZ Huddersfield Road, Holmfirth 88 Medicare Chemists Elmwood Health Centre, Huddersfield Huddersfield HD9 3TR Road, Holmfirth 89 Rowlands Pharmacy 1 The Cobbles, Meltham Huddersfield HD9 5QQ 90 S T Shaw Ltd 38 Town End, Golcar Huddersfield HD7 4QD 91 The Co-Operative 63 Market Street, Milnsbridge Huddersfield HD3 4HZ Pharmacy
78 PHARMACEUTICAL NEEDS ASSESSMENT Map Pharmacy Name Address Postcode Code 92 Your Local Boots 32 Peel Street, Marsden Huddersfield HD7 6BW Pharmacy 93 Wellcare Pharmacy Wellfield House, New Hey Road Huddersfield HD3 4AL 94 Oaklands Health Centre Drs Shamsee & Ward, Oaklands Health Huddersfield HD9 3TP (Dispensing Practice) Centre, Huddersfield Road, Holmfirth NON KIRKLEES PHARMACIES PHARMACIES WITHIN 1 MILE RADIUS OUTSIDE OF THE KIRKLEES BORDER 95 Ryburn Pharmacy 79 Elizabeth Street Elland HX5 0JH 96 Bierley Pharmacy The Old School Building, Bierley Lane, Bradford BD4 6AA Bierley 97 Felkris Ltd 516 Huddersfield Road, Wyke Bradford BD12 8AD 98 Middlestown Pharmacy 97 New Road Middleton WF4 4NS 99 Asda Pharmacy Rooley Lane Bradford BD4 7SR 100 Lloyds Pharmacy Rooley Lane Medical Centre, Rooley Lane Bradford BD4 7SS 101 As Carlton Ltd 10 Station Road, Ossett Wakefield WF5 8AD 102 Wellcare Pharmacy 2 Castle Avenue, Rastrick Brighouse HD6 3HT 103 Currie’s Chemists (Wyke) Unit 2, Netto Foodstore, Townsgate Wyke BD12 9JQ Ltd 104 Giles & Ward Pharmacy 21 Church Street, Ossett Wakefield WF5 9DG 105 Medicx Pharmacy Ossett Health Village, Kingsway, Ossett Wakefield WF5 8DF 106 Hirst A 52 Southgate Elland HX5 0DQ 107 C E Naylor Rastrick Health Centre, Chapel Croft, Brighouse HD6 3NA Rastrick 108 Asda Pharmacy Morley Howley Park Road, Morley Leeds LS27 0BP 109 Lloydspharmacy 95 Holme Wood Road Bradford BD4 9EJ 110 The Co-Operative Yorkshire Co-Op Foodstore, Dale Street, Wakefield WF5 9HQ Pharmacy Ossett 111 Stephen Baskind 176 Whitehall Road, Drighlington Bradford BD11 1AU Pharmacy Ltd 112 Bailiff Bridge Pharmacy 615 Bradford Road, Bailiff Bridge Brighouse HD6 4DN 113 Kr Rutter 25 Finkle Lane, Gildersome, Morley Leeds LS27 7DX 114 K Pharmacy 68 Stainland Road, Greetland Halifax HX4 8BD 115 Scholes (Chemist) Ltd Highfield Medical Centre, 2 Proctor Street Bradford BD4 9QA 116 Edward Marks Chemist The Stannary, 350 Stainland Road, Halifax HX4 9EH Stainland 117 Drighlington Pharmacy 151 King Street, Drighlington Bradford BD11 1EJ
PHARMACEUTICAL NEEDS ASSESSMENT 79 Appendix 2 - List of general medical practices in Kirklees showing code for maps
Map GP Surgery Address Postcode code G1 Dr Clayden, Shamsee & Oaklands Health Centre, Huddersfield Road, Huddersfield HD9 3TP Associates Holmfirth G2 Skelmanthorpe Family Commercial Road, Skelmanthorpe Huddersfield HD8 9DA Doctors GB2 The Surgery 313 Wakefield Road, Denby Dale Huddersfield HD8 8RX G3 Shepley Health Centre 25 Jos Lane, Shepley Huddersfield HD8 8DJ G4 Greenside Surgery 4 Greenside Cleckheaton BD19 5AN G5 Cherry Tree Surgery 132 Upper Commercial Street Batley WF17 5DH GB5 Dr Sood York House, 284a Oxford Road Gomersal BD19 4PY G6 Drs Patel & Sharma 140 Slaithwaite Road, Thornhill Lees Dewsbury WF12 9DW GB6 Drs Patel & Sharma 90 Savile Road, Savile Town Dewsbury WF12 9LP G7 The Albion Mount Medical 47 Albion Street Dewsbury WF13 2AJ Practice GB7 Mountain Road Surgery 111 Mountain Road, Thornhill Dewsbury WF12 0BS G8 Dr Hariharan & Partner Clifton House, 1 Church Street, Golcar Huddersfield HD7 4AQ GB8 Dr Hariharan & Partner The Nook Surgery, 144 Moor Hill Road, Huddersfield HD3 3XA Salendine Nook G9 Dr Boulton And Partners The New Street Surgery, 21 New Street, Huddersfield HD3 4LB Milnsbridge GB9 Dr Boulton And Partners Netherton Surgery, 327 Meltham Road, Huddersfield HD4 7EX Netherton G10 Dr Gowa Trinity Street Surgery, 124 Trinity Street Huddersfield HD1 4DT G11 Dr Das & Partner 71a Woodhouse Hill, Fartown Huddersfield HD2 1DH G12 Dr Glencross 140 Fitzwilliam Street Huddersfield HD1 5PU G13 Marsh Surgery 42 Westbourne Road, Marsh Huddersfield HD1 4LE G14 Dr Singh Birkby Health Centre, 37 Norwood Road, Huddersfield HD2 2YD Birkby G15 Lockwood Surgery 3 Meltham Road, Lockwood Huddersfield HD1 3XH G16 Dr Barnwell And Partners Lepton Surgery, Highgate Lane, Lepton Huddersfield HD8 0HH GB16 Dr Barn1 Kirkheaton Surgery, 2 Heaton Moor Road, Huddersfield HD5 0ET Kirkheaton G17 Lindley Village Surgery Thomas Street, Lindley Huddersfield HD3 3JD G18 Dr Taylor & Partners Crosland Moor Surgery, St Luke’s Hospital, Huddersfield HD4 5RQ Blackmoorfoot Road, Crosland Moor G19 Paddock And Longwood Speedwell Surgery, 1 Speedwell Street, Huddersfield HD1 4TS Family Practice Paddock GB19 Paddock And Longwood 101 Thornhill Road, Longwood Huddersfield HD3 4UL Family Practice G20 Thornton Lodge Surgery 60 Thornton Lodge Road, Thornton Lodge Huddersfield HD1 3SB G21 Fieldhead Surgery Golcar Huddersfield HD7 4QQ G22 Dr Wybrew & Partner 15 Wentworth Street Huddersfield HD1 5PX G23 Dalton Surgery 364a Wakefield Road, Dalton Huddersfield HD5 8DY G24 Dr Handa & Partner Dr Handa’s Surgery, 34 Fartown Green Road, Huddersfield HD2 1AE Fartown
80 PHARMACEUTICAL NEEDS ASSESSMENT Map GP Surgery Address Postcode code G25 Dr Butt & Partner Bradford Road Medical Centre, 93 Bradford Huddersfield HD1 6DZ Road, Fartown GB25 Dr Butt & Partner 8-10 Brook Street, Thornton Lodge Huddersfield HD1 3JW G26 Dr Reddy & Partner 19 Greenhead Road Huddersfield HD1 4EN GB26 Dr Reddy & Partner 584 Wakefield Road, Greenside Huddersfield HD5 8PY G27 Westbourne Surgery 11a St James Road, Marsh Huddersfield HD1 4QR G28 Almondbury Surgery Longcroft, Almondbury Huddersfield HD5 8XW G29 The Waterloo Practice Waterloo Health Centre, Wakefield Road, Huddersfield HD5 9XP Waterloo G30 Whitehouse Centre 23a New North Parade Huddersfield HD1 5JU G31 Lindley Group Practice 62 Acre Street, Lindley Huddersfield HD3 3DY G32 The Grange Group Practice Fartown Grange, Spaines Road, Fartown Huddersfield HD2 2QA GB32 Keldregate Surgery 268 Keldregate, Deighton Huddersfield HD2 1LE G33 Savile Town Medical Scarborough Street, Savile Town Dewsbury WF12 9BA Centre G34 Victoria Medical Practice Dewsbury Health Centre, Wellington Road Dewsbury WF13 1HN G35 Albion Street Surgery 10 Albion Street Heckmondwike WF16 9LQ G36 Ravensthorpe Health Netherfield Road Dewsbury WF13 3JY Centre G37 Dr Medley & Partners Dewsbury Health Centre, Wellington Road Dewsbury WF13 1HN G38 Mount Pleasant Medical 69 Purwell Lane Batley WF17 7PF Centre GB38 Earlsheaton Medical 252 Wakefield Road, Earlsheaton Dewsbury WF12 8AH Centre G39 The Health Centre 130 Upper Commercial Street Batley WF17 5ED GB39 York House 284a Oxford Road Gomersale BD19 4PY G40 West Park Surgery 20 West Park Street Dewsbury WF13 4LA G41 Dr Chandra & Partners Ravensthorpe Health Centre, Netherfield Dewsbury WF13 3JY Road G42 Undercliffe Surgery Heckmondwike Health Centre, 16 Union Heckmondwike WF16 0HH Street G43 Brookroyd House Heckmondwike Health Centre, 16 Union Heckmondwike WF16 0HH Street G44 Windsor Medical Centre 2 William Street, Leeds Road Dewsbury WF12 7BD G45 Wellington House Henrietta Street Batley WF17 5DN GB45 Drs Barker et al 4 Bond Street, Market Place, Birstall Batley WF17 9EX G46 Broughton House Surgery 20 New Way Batley WF17 5QT G47 Grove House Surgery Soothill Lane Batley WF17 5SS GB47 Chickenley Medical Centre Walnut Lane, Chickenley Dewsbury WF12 8NJ G48 Dr T Unnikrishnan’s Ravensthorpe Health Centre, Netherfield Dewsbury WF13 3JY Practice Road G49 The Health Centre Doctor Lane Mirfield WF14 8DU G50 Eightlands Surgery Dewsbury Health Centre, Wellington Road Dewsbury WF13 1HN G51 Kirkgate Surgery 3 Kirkgate, Birstall Batley WF17 9HE G52 St John’s House Cross Church Street Cleckheaton BD19 3RQ G53 Blackburn Road Medical Blackburn Road, Birstall Batley WF17 9PL Centre
PHARMACEUTICAL NEEDS ASSESSMENT 81 Map GP Surgery Address Postcode code GB53 Birkenshaw Health Centre Town Street Birkenshaw BD11 2HX G54 School House Practice Dewsbury Health Centre, Wellington Road Dewsbury WF13 1HN G55 Dr Scrivings & Partners Cleckheaton Health Centre, Greenside Cleckheaton BD19 5AP G56 Liversedge Medical Centre Valley Road Liversedge WF15 6DF G57 The Paddock Surgery Chapel Hill, Thornhill Dewsbury WF12 0DH G58 Drs Watts & Selbie The Junction Surgery, Birkhouse Lane, Huddersfield HD5 8BE Moldgreen G59 Drs Fox & Stringer Cleckheaton Health Centre, Greenside Cleckheaton BD19 5AP G60 Dr Hamid And Partners Newsome Surgery, 1 Church Lane, Newsome Huddersfield HD4 6JE G61 Dr Jennison & Partners Elmwood Health Centre, Huddersfield Road, Huddersfield HD9 3TR Holmfirth G62 Slaithwaite Health Centre New Street, Slaithwaite Huddersfield HD7 5AB G63 University Health Centre The Health Centre, 12 Sand Street Huddersfield HD1 3AL G64 The New Brewery Lane Brewery Lane, Thornhill Lees Dewsbury WF12 9DU Surgery GB64 Warren Street Surgery 37 Warren Street, Savile Town Dewsbury WF12 9LX G65 The Health Centre Victoria Street, Marsden Huddersfield HD7 6DF G66 Meltham Group Practice 1 The Cobbles, Meltham Huddersfield HD9 5QQ G67 Dearne Valley Health Wakefield Road, Scissett Huddersfield HD8 9JL Centre G68 Croft House Surgery Colne Valley Family Doctors, Croft House, Huddersfield HD7 5JY Manchester Road, Slaithwaite G69 Meltham Road Surgery 9 Meltham Road, Lockwood Huddersfield HD1 3UP G70 Meltham Village Surgery 11 Parkin Lane, Meltham Huddersfield HD9 4EN G71 Honley Surgery Marsh Gardens, Honley Huddersfield HD9 6AG G72 Kirkburton Health Centre 5a Shelley Lane, Kirkburton Huddersfield HD8 0SJ
G - General practice GB - General practice branch surgery
82 PHARMACEUTICAL NEEDS ASSESSMENT Appendix 3 - How the PNA was developed The following steps were taken to develop this PNA: • A PNA project board was developed in December 2009 with the following purpose: • To develop a draft pharmaceutical needs assessment (PNA) for the population of NHS Kirklees by July 2010. • To undertake required consultation with stakeholders and publish a finalised PNA by December 2010.
Core membership included • Senior Medicines Management Advisor – Strategy and Operational development (Chair) • Director of Patient Care and Professions • Assistant Director of Public Health (PH Intelligence) • Calderdale & Kirklees Local Pharmaceutical Committee representative • Communications lead • Community Pharmacy Contract Manager • Patient and Public Involvement (PPI) lead • Practice Based Commissioning representative • Primary Care Contracts representative • Senior Public Health Manager • Administrative support
And co-opted members included • Assistant Director of Medicines Management and Prescribing • Assistant Director of Quality and Clinical Governance (or nominated deputy) • Assistant Director Risk, Safety and Security • Deputy Director of Commissioning and Strategic Development • Public Health Programme managers
Regular meetings have been held and formal minutes recorded decisions of this group. Minutes were routinely shared with various PCT and stakeholder groups. Terms of reference were signed off by the PCT governance committee.
January – March 2010 • A timeline for development of the PNA was agreed and shared with stakeholders. • Development of the PNA identified for adding to the risk register. • An assessment of local health needs and inequalities which could be influenced or supported by local pharmaceutical service provision was undertaken by reviewing the JSNA 2009 and the five year strategic plan 2010. • The locality structure used in the JSNA was determined as the most suitable method of dividing the geographic area of Kirklees. • All PCT held data recording activity of community pharmacies (e.g prescription dispensing, MUR reviews performed) and participation in commissioned enhanced services was identified. • Provision of services from other providers that supported the identified health needs or inequalities were agreed to be incorporated into the PNA.
PHARMACEUTICAL NEEDS ASSESSMENT 83 March – May 2010 • An initial draft of this collated information was circulated to various stakeholders i.e. PBC groups and stand-alones, LMC, PCT commissioners, LPC, urgent care provider and local authority using a variety of engagement exercises. The background to the PNA was explained and stakeholders were asked to comment on the draft document and shape of future pharmaceutical services. • A patient questionnaire was developed and distributed to the public via local network groups and through community pharmacies to gain their views on current pharmaceutical provision and future developments/services they would like to see from their local pharmacies. • Community pharmacist views on services offered and their future aspirations were also sought using a questionnaire agreed with the LPC.
June – August 2010 • A series of maps were agreed to be incorporated into the PNA. These included a map which identified the premises at which pharmaceutical and dispensing services are provided and assorted maps showing particular services provided at each set of premises. • A trawl of complaints/issues received by NHS Kirklees over the past two year period was investigated together with any other information highlighting patients viewpoint on current pharmaceutical provision within Kirklees in order to gain a more complete picture for the PNA. • Further information obtained included; opening hours of community pharmacies and average walking time for each locality population to reach their nearest community pharmacy • Recent decisions taken by the pharmacy panel on applications to join the NHS pharmaceutical list and current applications being processed by the panel were identified as these could have a significant impact on any gaps identified. • Having assessed local needs and current provision of services gaps in provision were identified. • Communication plan and consultation process agreed. • Draft finalised for consultation, published on the NHS Kirklees website, distributed to stakeholders and presented to PCT Primary care commissioning group, PCT Governance committee, and PCT Board.
August – October 2010 • Consultation period ran from Monday 9 August to 15 October 2010. • A range of consultation activities were undertaken during the 10 week consultation period.
Nov 2010 – Jan 2011 • Comments received from consultation were reviewed by PNA project board and Consultation report produced as formal PCT response to Consultation exercise. See report at www.kirklees.nhs.uk • PNA updated in light of consultation and ratified by PCT Board on 26 January 2011 along with Equality impact assessment and Consultation report. • PNA, Equality impact assessment and Consultation report formally published on 1 February 2011 and available on NHS Kirklees website. www.kirklees.nhs.uk
NB The PNA 2011 document contains information available and known to the PCT as at 30 November 2010.
84 PHARMACEUTICAL NEEDS ASSESSMENT Appendix 4 - Consultation list The following is a list of organisations that have been sent the draft version of the NHS Kirklees Pharmaceutical Needs Assessment. • Calderdale and Kirklees Local Pharmaceutical Committee • Kirklees Local Medical Committee • Local pharmaceutical committees of NHS Barnsley, NHS Bradford and Airedale, NHS Derbyshire County, NHS Leeds, NHS Oldham, NHS Wakefield District • Local medical committees of NHS Barnsley, NHS Bradford and Airedale, NHS Calderdale, NHS Derbyshire County, NHS Leeds, NHS Oldham, NHS Wakefield District • 93 local community pharmacies (including known company head office contacts forwarded to NHS Kirklees in respect of PNA communications) • 1 local dispensing general practice • 74 local general practices • 4 practice based commissioning groups + 9 standalones within Kirklees • Commissioning managers of NHS Kirklees • Public health commissioning managers of NHS Kirklees • NHS Kirklees board • NHS Kirklees governance committee • NHS Kirklees pharmacy panel • NHS Kirklees primary care commissioning group • Kirklees Community Health Service • Local Care Direct • Voluntary Action Kirklees (VAK) and to the 1,200 voluntary and community organisations it represents • Kirklees Council distribution list of key stakeholders. • Local Involvement Network (LINk) • Overview and Scrutiny Committee • Local Area Committees • Calderdale and Huddersfield NHS Foundation Trust • The Mid Yorkshire Hospitals NHS Trust • South West Yorkshire Partnership NHS Foundation Trust • Yorkshire Ambulance Service NHS Trust • NHS Barnsley • NHS Bradford and Airedale • NHS Calderdale • NHS Derbyshire County • NHS Leeds • NHS Oldham • NHS Wakefield District
PHARMACEUTICAL NEEDS ASSESSMENT 85 Appendix 5 - Equality impact assessment 1 What is being equality impact assessed? Pharmaceutical Needs Assessment (PNA)
2 Description of the function being equality impact assessed: The aim of a PNA is to enable NHS Kirklees and relevant stakeholders to understand the pharmaceutical needs of the local population.
The objectives of this PNA are: • To have a clear picture of the current services provided by community pharmacies • To have a robust decision making process in respect of applications for NHS community pharmacy contracts within NHS Kirklees • To make sure that there is a robust commissioning process to commission enhanced services from community pharmacies and enable community pharmacies to take part in service re-design • To be able to plan for future services to be delivered by community pharmacy • To stipulate the range of directed enhanced services that community pharmacies entering the pharmaceutical list under the ‘exempt’ category within the ‘Control of Entry’ Regulations (e.g. 100 hour pharmacies and wholly internet pharmacies) • To make sure that any gaps in service provision are adequately addressed • To encourage the use of community pharmacies as a means of reducing health inequalities • To encourage multidisciplinary working between independent pharmacy contractors and other healthcare professionals
The PNA should be used by patients, current service providers, future service providers and commissioners alike in the following way: • Maps and tables detailing specific services will enable patients to see clearly where they can access a particular service. It will also provide another source of contact details of their local pharmacies. • Current service providers will be better able to understand the unmet needs of patients in their vicinity and take steps to address this need. • Future service providers will be able to tailor their application to be added to the pharmaceutical list in a manner that makes sure that they will provide the services most needed by the local community. • Commissioners will be able to move away from the ‘one-size fits all approach’ 4 to make sure that pharmaceutical services are delivered via a targeted approach • Members of the NHS Kirklees pharmacy panel will be in a better position to judge the validity of new applications to join the pharmaceutical list and make sure that patients receive the services they need rather than duplicating effort.
3 Lead contact person for the Equality Impact Assessment: Lucianne Ricketts – Senior Medicines Management Adviser, NHS Kirklees. Email: [email protected].
4 Who else is involved in this equality impact assessment: Members of the PNA project group - see appendix 3.
5 Sources of information used to identify barriers etc Information used in this assessment has been derived from a range of sources including Kirklees JSNA 2009, NHS Kirklees five year strategic plan, PPI complaints, local PNA patient questionnaire, local PNA Community pharmacist questionnaire. DH equality impact assessment on the development of PNA regulations, DH publications on world class commissioning and pharmaceutical service provision, NHS health informatics data, pharmaceutical standards of conduct, ethics and performance.
86 PHARMACEUTICAL NEEDS ASSESSMENT What does your research tell you about the impact your proposal will have on the following equality groups? Kirklees comprises a mix of urban communities and rural areas. The total population in 2009 was approximately 427,700. By 2025 the population is predicted to increase by 7.4% to nearly 455,000. Pharmaceutical services are available to any patients regardless of age, religious belief and sexual orientation. The eligibility to provide pharmaceutical services covers any applicant regardless of age, religious belief and sexual orientation. The impact of the PNA on health is expected to be positive, as pharmaceutical service provision will better reflect the needs of the local communities to be served and thereby have a positive impact on health inequalities. This would give the NHS Kirklees greater control over the services commissioned against those needs and raise standards for NHS patients.
BME groups: The population of Kirklees has a mix of people with different ethnic origins. More than one in five are of South Asian origin, Pakistani and Indian primarily. Batley, Birstall and Birkenshaw locality, together with Dewsbury and Mirfield locality have the highest concentration of South Asians around 30% compared to The Valleys and Denby Dale and Kirkburton with 2.6% and 1.7% respectively (lowest %). There is a small Afro-Caribbean population mainly located in Huddersfield. Information from our patient questionnaire suggests good usage of community pharmacists by BME groups with the majority using pharmacies more than six times a year. Services used regularly include dispensing of prescriptions and buying over the counter medicines. Home delivery and prescription collection services together with enhanced services are not well used by BME population compared to the white British population. This could be due to language or literacy barriers causing lack of awareness of the services available? In contrast however there was overwhelming support from this group to have NHS health checks, weight/ pain management clinics and vaccination services to be developed in community pharmacies. Results from the community pharmacy questionnaire revealed that there was availability of South Asian speaking staff within some pharmacies located in areas with high South Asian populations. However support with language barriers was reported as an additional need in localities containing higher ethnic populations.
Disability groups: It is a requirement that community pharmacy contractors, in fulfilling their responsibility to provide a range of essential services under the current contractual framework, comply with the requirements of the Disability Discrimination Act 1995. This also applies to pharmacies who would be commissioned to provide services based on PNAs. Pharmacy contractors as service providers have a duty to make reasonable adjustments to enable someone with a disability to use the service. Reasonable adjustment might include the provision of an auxiliary or compliance aid to enable a person who is disabled to take their medicines. Our patient survey indicated that those with limited activity used the same pharmacy. Their use regularly compared to the non disabled group and not surprisingly their use of home delivery services was much higher. Sixty five out of 92 pharmacies reported having a means of access for disabled people with 57 having a consultation area with wheelchair access.
Age and gender: Currently nearly one in four of the population is aged less than 19 years. Half the population is of working age and just less than one in seven are aged over 65 years. By 2025 the proportion in the working age group will have reduced and those aged over 65 will have increased to nearly one in five as people live longer than before. The increase in those aged over 65 includes a large increase in the proportion living over 85 years. Frequent users of pharmacies include females, those aged over 35 and those with a long term health condition or disability (LTC). Those working full time visit pharmacies less frequently than other groups.
PHARMACEUTICAL NEEDS ASSESSMENT 87 If gender and age are considered together, the highest frequency pharmacy users are female aged 35 -74 and males aged over 55. Males aged 16-24 use pharmacies the least. Older people are more likely to be regular users of pharmaceutical services. A study conducted for the Office of Fair Trading in 2002 found that 22% of the sample of 1434 households who used pharmacies to make their prescriptions up were between 60 and 70 and 17% were over the age of 70, compared with 10% and 11% of the UK population generally. The PNA has identified older people as potentially needing extra services in the future and young peoples needs (i.e. expansion of sexual health services and potential for alcohol interventions) have also been identified.
Sexual orientation: Part of the sexual health range of enhanced services commissioned by NHS Kirklees from community pharmacy contractors includes the distribution of condoms. The aim being to reduce the rates of teenage pregnancy and STIs. The training and service specification might need stronger emphasis on raising awareness of safer sex amongst sexually active young people, regardless of sexuality or sexual orientation.
Religion and belief: Standards of conduct, ethics and performance set out the behaviours, attitudes and values expected of pharmacy professionals. Standard 3.4 of the pharmacists code of ethics enables a pharmacy professional to refer a patient to an alternative provider where the professionals religious or moral beliefs prevent them from providing a service. This can have implications for some services particularly in relation to provision of emergency hormonal contraception (EHC) treatment. The future pharmacy regulator – the General Pharmaceutical Council – has agreed to review the inclusion of the “conscience clause” in its first year of operation.
6 Consultation: new or previous: During the development of the draft PNA several engagement exercises were carried out during the months of March, April and May 2010. These included a patient questionnaire seeking views on services provided currently by local pharmacies and services which people might like to see provided in the future. The questionnaire was available as hard copy or on line at www.kirklees.nhs.uk. Community pharmacies were asked to distribute them to their customers. The following groups also received the questionnaire including Voluntary Action Group (VAK), LINk, EPP support group, readers panel, diabetes reference group, working in partnership distribution list and database of people expressing an interest to be involved in NHS Kirklees work. Presentations were provided to LMC, PBC and LTC team with the opportunity to give feedback on current and future pharmaceutical service provision which would support their populations health needs. An assessment of complaints received at NHS Kirklees about community pharmacies was done by the patient and public Involvement team. A questionnaire aimed at the professionals (community pharmacists and dispensing doctors) was circulated to identify the current pharmaceutical service available across Kirklees and also gain an understanding of gaps in service provision and potential unmet need. A formal consultation of the draft PNA is being conducted from August to October 2010. The draft PNA is available on the NHS Kirklees website and the web link has been forwarded to all stakeholders and neighbouring PCTs. In addition hard copies of the document have been sent to local community pharmacist contractors. Several drop-in consultation sessions are arranged in key locality sites to collect views from various public groups, healthcare professionals and managers and local authority staff.
88 PHARMACEUTICAL NEEDS ASSESSMENT 7 Assessment and actions needed Location of Assumption of normality / Action needed Responsibility Deadline organisational description of barrier barriers Geographical Normal None location Built Normal None environment PCTs would have to assess local pharmaceutical services provision in rural areas and make sure provision is adequate and proportionate to meet the needs of the local population. Information Spoken and written language Pharmacies based in areas Community Ongoing and difficulties might pose a problem with of high BME populations pharmacy communication non – English speaking people will be encouraged to contracting and accessing the full range of services employ staff with relevant clinical governance available to them. language skills that can team support them.
The PNA is written in English and Care has been taken in the Communications July 2010 contains a number of coloured maps choice of colours used for and graphics team which might be difficult for people the development of maps with colour blindness to decipher. and the PNA document. Timing No - In order to meet the strict The consultation period PNA project group October timelines for completion of the PNA was extended for longer 2010 the formal consultation had to take than the prerequisite 60 place over late summer which is a key days giving opportunity for holiday time. participation during early October Involvement in Normal Following the deadline for PNA project group Dec 2010 planning Extensive engagement and the end of the formal consultation has been carried out with consultation a briefing will the public, health and social care be produced including a professionals throughout the summary of responses development of the PNA. received and actions taken to address these. Costs of the Ongoing human and financial A briefing outlining the Lead director and August service resources will be needed to do implications of the PNA strategic and 2010 statutory annual and three yearly will be taken to the NHS operational lead updates and reviews of the PNA. Kirklees board. for PNA
The PNA identifies gaps in service Service leads will have to Relevant service provision and some of these will have provide business cases to leads financial implications for NHS Kirklees. support a case of need Customer care Commissioners should refer to this The PNA will be available PNA project group Feb 2011 and staff document when scoping new service on the NHS Kirklees training developments, redesigning care website for easy access. pathways or judging applications for admission to the PCT pharmaceutical list. The PNA is a new commissioning tool Following publication of PNA project group Feb 2011 for pharmaceutical service the PNA in February 2011 development and awareness raising there will be amongst commissioners and applicants comprehensive circulation alike. of the document to all stakeholders.
PHARMACEUTICAL NEEDS ASSESSMENT 89 Specific issues/ Provision of emergency hormonal Commissioners must be Service lead/ Ongoing barriers contraception could be hampered by aware and mitigate service commissioner of any pharmacist who wants to apply disruption by appropriate sexual health the conscious clause exemption. commissioning of sexual services health services. Contract monitoring to Contract Ongoing highlight to relevant monitoring team. pharmacists their responsibilities to refer affected patients appropriately.
8 Methods of monitoring progress on actions The PNA should be reviewed on an annual basis to make sure service provision has not altered and if necessary a supplementary statement will be added to the PNA highlighting such changes. At this review progress on any actions needed for the equality impact assessment will be monitored.
9 Publishing the equality impact assessment The equality impact assessment is published as an appendix to the completed PNA document. Copies are available either online by visiting www.kirklees.nhs.uk/public-information/publications/reviews-and-assessments or as a hard copy by contacting: NHS Kirklees Broad Lea House Bradley Business Park Dyson Wood Way Bradley Huddersfield HD2 1GZ Tel: 01484 464000
10 Signing off equality impact assessment The NHS Kirklees Board signed off the full and complete PNA containing all supporting documents on 26 January 2011.
90 PHARMACEUTICAL NEEDS ASSESSMENT 16 Tables
Table 1 - pharmacy opening hours, dispensed items and population per locality Table 2 - the provision of directed services by community pharmacies
PHARMACEUTICAL NEEDS ASSESSMENT 91 22 per 100,000's Number of Population Pharmacies per 54,953 Locality Population 5,361 Average Average Monthly Items per pharmacy per locality Locality 771,964 Items per Dispensed 2009/2010 Y Y N N N N N N N N N N (Y/N) 100hour Pharmacy Y Y Y N N N N N N N N N Open Hours (Y/N/) Extended Y Y Y N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y N N N N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y Y Y N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address 157 Upper Commercial Street, WF17 5DH Batley, Unit 3, Birstall Retail Park, Birstall, WF17 9DT Off Soothill 3-5 Oxford Terrace, WF17 5ST Lane, Batley, 8 Market Place, Birstall, Batley, WF17 9EL Street Medical Centre, Town Street, Birkenshaw, Town Bradford, BD11 2HX 133 Upper Commercial Street, WF17 5DH Batley, The Old Salvation Hall, 74 Blackburn Road, Birstall, Batley, WF17 9PL In-Store Pharmacy, Tesco WF17 Bradford 5TJ Road, Batley, 4 Market Place, Batley, 4 WF17 Market Place, Batley, 5DA 104 Upper Commercial Street, WF17 5DP Batley, 67B Purlwell Lane, Mount WF17 7PF Pleasant, Batley, 1 Bond Street, Birstall, Batley, WF17 9EX Pharmacy Name Locality Birkenshaw and Birstall Batley, Batley Pharmacy Boots UK Limited Hughes Chemists (Northern) Limited Lloyds Pharmacy Lloyds Pharmacy Mileusnic G Oakwood Pharmacy In-Store Tesco Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy Winer (Chemists) Ltd Table 1 - pharmacy opening hours, dispensed items and population per locality per population and items dispensed hours, opening pharmacy - 1 Table
92 PHARMACEUTICAL NEEDS ASSESSMENT 32 per 100,000's Number of Population Pharmacies per 59,614 Locality Population 5,324 Average Average Monthly Items per pharmacy per locality Locality Items per 1,213,869 Dispensed 2009/2010 Y Y Y Y Y N N N N N N N N N (Y/N) 100hour Pharmacy Y Y Y Y Y N N N N N N N N N Open Hours (Y/N/) Extended Y Y Y Y Y Y N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y N N N N N N N N N N N N N Open all day Saturday Saturday only (Y/N) N N N N N N N N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address Mill Street West, Dewsbury, WF12 9AE 27 The Princess Of Wales Precinct, Long Causeway, WF13 1NH Dewsbury, 49 Brewery Lane, Thornhill Lees, WF12 9DU Dewsbury, 51 Walnut Lane, Chickenley, 51 Lane, Walnut Chickenley, WF12 8NJ Dewsbury, 78 High Street, Westtown, WF13 2QQ Dewsbury, 11B South Street, Savile Town, WF12 9NB Dewsbury, 119 Heckmondwike Road, Dewsbury, Dewsbury Moor, WF13 3NT 20A West Park Street, Dewsbury, WF13 4LA 6D Ravensthorpe Retail Park, Huddersfield Road, Dewsbury, WF13 3HN 13 Halifax Road, Dewsbury, WF13 2JH Unit 1, South Street, Dewsbury, WF13 1JS 92 Savile Road, Savile Town, WF12 9LP Dewsbury, Dewsbury Health Centre, Wellington Road, Dewsbury, WF13 1HN 71 Halifax Road, Dewsbury, WF13 4HD Pharmacy Name Locality Dewsbury Asda Pharmacy Boots UK Limited Brewery Brewery Lane Pharmacy Chickenley Pharmacy Cohens Chemist Cohens Chemist Dewsbury Moor Pharmacy Pharmacy Dewsbury Eye Pharmacy G Pharmacy Pharmacy D Noble’s Chemist Noble’s Pharmacy-D R Drummond Chemist
PHARMACEUTICAL NEEDS ASSESSMENT 93 23 per 100,000's Number of Population Pharmacies per 59,907 Locality Population 5,315 Average Average Monthly Items per pharmacy per locality Locality 892,964 Items per Dispensed 2009/2010 Y N N N N N N N N N N N N N (Y/N) 100hour Pharmacy Y Y N N N N N N N N N N N N Open Hours (Y/N/) Extended Y Y N N N N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y Y N N N N N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y Y Y Y Y
N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address Earlsheaton Medical Centre, 252 Road, Wakefield Earlsheaton, WF12 8AH Dewsbury, Thornhill, 30 The Town, WF12 0RB Dewsbury, Goods Lane, Railway Street, WF12 8EB Dewsbury, 140A Slaithwaite Road, Thornhill WF12 9DW Lees, Dewsbury, 620 Huddersfield Road, WF13 Ravensthorpe, Dewsbury, 3HL Longhill Road, Off Bradford Road, Brackenhall, Huddersfield, HD2 2LQ 6 Church Street, Paddock, Huddersfield, HD1 4TR 107 Bradford Road, Fartown, Huddersfield, HD1 6DZ 56 Sheepridge Road, Huddersfield, HD2 1HG 62 Westbourne Road, Marsh, Huddersfield, HD1 4LE 80 New Hey Road, Lindley, Huddersfield, HD3 4AJ 2 Grimscar Avenue, Birkby, Huddersfield, HD2 2TW 140 Westbourne Road, Marsh, Huddersfield, HD1 4LF 5 Copthorne Square, Bradley, Huddersfield, HD2 1SZ Pharmacy Name Rowlands Pharmacy Rowlands Pharmacy Sainsburys Pharmacy Sykes Chemist The Co-Operative Pharmacy Huddersfield Locality - northern area northern - Locality Huddersfield Asda Pharmacy B Singh Bradford Bradford Road Pharmacy Cohens Chemist Cw Peach (Chemists) Chemist Dickinson’s K Pharmacy Medicare Chemists Medicare Chemists
94 PHARMACEUTICAL NEEDS ASSESSMENT 25 per 100,000's Number of Population Pharmacies per 76,457 Locality Population 6,249 Average Average Monthly Items per pharmacy per locality Locality Items per 1,424,799 Dispensed 2009/2010 Y Y N N N N N N N N N N N N (Y/N) 100hour Pharmacy Y Y N N N N N N N N N N N N Open Hours (Y/N/) Extended Y Y Y N N N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday N N N N N N N N N N N N N N Open all day Saturday Saturday only (Y/N)
Y Y Y Y Y Y N N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address Unit 2,Salendine Nook Shopping Centre, Moorhill Road, Salendine Nook, Huddersfield, HD3 3XA 203 Luck Lane, Paddock, Huddersfield, HD1 4RB Fartown Grange, Spaines Road, Fartown, Huddersfield, HD2 2QA 14 Spaines Road, Fartown, Huddersfield, HD2 2QA 59 Lidget Street, Lindley, Huddersfield, HD3 3JP Wellfield House, 33 New Hey Road, Huddersfield, HD3 4AL 2 Thorne Road, Thornton Lodge, Huddersfield, HD1 3JJ 63-65 Highgate Lane, Lepton, Huddersfield, HD8 0DS Unit 2B, Great Northern Retail Park, Leeds Road, Huddersfield, HD1 6ND 22 king street, huddersfield, HD1 2QE 2 Greenhead Road, Huddersfield, HD1 4EL 325 Meltham Road, Netherton, Huddersfield, HD4 7EX 332-334 Road, Wakefield Moldgreen, Huddersfield, HD5 8DQ 1 Bankfield Lane, Kirkheaton, Huddersfield, HD5 0JE Pharmacy Name Medicare Chemists Paddock Head Pharmacy S T Shaw Ltd Siddique Pharmacy LTD S T Shaw Ltd Pharmacy Wellcare area southern - Locality Huddersfield Akram Za Ltd Rowlands Pharmacy Boots UK Limited Boots UK Limited Greenhead Greenhead Pharmacy K & M Pharmacy Ltd Rowlands Pharmacy Kirkheaton Pharmacy
PHARMACEUTICAL NEEDS ASSESSMENT 95 15 per 100,000's Number of Population Pharmacies per 52,698 Locality Population 6,727 Average Average Monthly Items per pharmacy per locality 645,795 Locality Items per Dispensed 2009/2010 N N N Y N N N N N N N N N N (Y/N) 100hour Pharmacy N N N Y Y N N N N N N N N N Open Hours (Y/N/) Extended N N N Y Y N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday N N N Y Y N N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y N Y Y Y Y N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address 45-47 Market Street, Huddersfield, HD1 2HL 9 Meltham Road Surgery, Meltham Road, Lockwood, Huddersfield, HD1 3UP 1A Church Lane, Newsome, Huddersfield, HD4 6JE 125 Fitzwilliam Street, Huddersfield, HD1 5PS 5 Broad Lane, Dalton, Huddersfield, HD5 9BU 65A Northgate, Almondbury, Huddersfield, HD5 8RX Southgate, Huddersfield, HD1 6QR 20 Princess Alexandra Walk, Huddersfield, HD1 2TT Viaduct Street, Off Fitzwilliam Street, Huddersfield, HD1 1RW 617 Wakefield 617 Road, Wakefield Waterloo, Huddersfield, HD5 9XP Moorfield Shopping Centre, 3 Park Road West, Crosland Moor, Huddersfield, HD4 5RX 315 Road, Wakefield Denby Dale, Huddersfield, HD8 8RX Kirkburton Health Centre, Shelley Lane, Kirkburton, Huddersfield, HD8 OSJ Shepley Health Centre, 25 Jos Lane, Huddersfield, HD8 8DJ Shepley, Pharmacy Name Lloyds Pharmacy Medicare Chemists Newsome Health Centre Pharmacy Rowlands Pharmacy Rowlands Pharmacy Rowlands Pharmacy Sainsburys Pharmacy Superdrug Tesco In-Store Tesco Pharmacy Rowlands Pharmacy Your Local Boots Your Pharmacy Locality Kirkburton and Dale Denby Mirfield, Denby Pharmacy Rowlands Pharmacy Shepley Pharmacy
96 PHARMACEUTICAL NEEDS ASSESSMENT 19 per 100,000's Number of Population Pharmacies per 53,152 Locality Population 6,332 Average Average Monthly Items per pharmacy per locality Locality 759,880 Items per Dispensed 2009/2010 N N N N N Y N N N N N N N N N (Y/N) 100hour Pharmacy N N N N N Y N N N N N N N N N Open Hours (Y/N/) Extended N N N N N Y N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y Y N N N Y Y N N N N N N N N Open all day Saturday Saturday only (Y/N) Y N N N N Y Y Y N N N N N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address The Health Centre, Road, Wakefield Scissett, Huddersfield, HD8 9JL 38 Commercial Road, Skelmanthorpe, Huddersfield, HD8 9DA 142 Huddersfield Road, Mirfield, WF14 8AN 54 Old Bank Road, Mirfield, WF14 0JA Mirfield Health Centre, Doctor Lane, Mirfield, WF14 8DU 4 Batley Road, Heckmondwike, WF16 9NE 260 Oxford Road, Gomersal, Bradford, BD19 4PY St Johns House, Cross Church Street, Cleckheaton, BD19 3RQ 5 Greenside, Cleckheaton, BD19 5AN 673 Bradford Road, Oakenshaw, Bradford, BD12 7DT Heckmondwike Primary Care Centre, Algenon, Firth Park, Heckmondwike, WF16 0HH 26 Market Street, Cleckheaton, BD19 5AJ 69 Road, Valley Liversedge, WF15 6DL Unit 8, Northgate Retail Centre, Heckmondwike, WF16 9RL Morrisons Superstore, Union Street, Heckmondwike, WF16 0HL Pharmacy Name The Co-Operative Pharmacy The Co-Operative Pharmacy Local Boots Your Pharmacy Boots UK Ltd Local Boots Your Pharmacy Locality Valley Spen Cohens Chemist Gomersal Pharmacy Kirklees Pharmacy Lloyds Pharmacy Oakenshaw Pharmacy Rowlands Pharmacy Rowlands Pharmacy Pharmacy Shah’s The Co-Operative Pharmacy The Co-Operative Pharmacy
PHARMACEUTICAL NEEDS ASSESSMENT 97 14 per 100,000's Number of Population Pharmacies per 71,949 Locality Population 6,634 Average Average Monthly Items per pharmacy per locality Locality 796,046 Items per Dispensed 2009/2010 N N N N N N N N N N N/A (Y/N) 100hour Pharmacy N N N N N N N N N N N/A Open Hours (Y/N/) Extended N N N N N N N N N N N and (Y/N) Open Sunday Saturday Saturday Y N N N N N N N N N N Open all day Saturday Saturday only (Y/N) Y Y Y Y Y Y Y Y N N N Open morning Saturday Saturday only (Y/N) Pharmacy Address 9-10 Carr Lane, Slaithwaite, Huddersfield, HD7 5AN 903 Manchester Road, Huddersfield, HD4 Cowlersley, 5SX 14 Huddersfield Road, Meltham, Huddersfield, HD9 4AE 8-10 Westgate, Honley, Huddersfield, HD9 6AA Unit 5, Riverside Shopping Centre, 90 Huddersfield Road, Holmfirth, Huddersfield, HD9 3AZ Elmwood Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TR 1 The Cobbles, Meltham, Huddersfield, HD9 5QQ End, Golcar, 38 Town Huddersfield, HD7 4QD 63 Market Street, Milnsbridge, Huddersfield, HD3 4HZ 32 Peel Street, Marsden, Huddersfield, HD7 6BW Drs Shamsee & Oaklands Ward, Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TP Pharmacy Name Locality Valleys The Cohens Chemist K & M Pharmacy Ltd Lloyds Pharmacy Medicare Chemists Medicare Chemists Medicare Chemists Rowlands Pharmacy S T Shaw Ltd The Co-Operative Pharmacy Local Boots Your Pharmacy Oaklands Health Centre (Dispensing Practice)
98 PHARMACEUTICAL NEEDS ASSESSMENT
www.nhs.uk/serviceDirectories NHS Business Services Authority website (NHSBSA) accessed Nov 2010 England Average = 6340 items/pharmacy Yorkshire and Humber average Yorkshire = 6880 items/pharmacy NHS Kirklees average = 6104 items per pharmacy Number of pharmacies per 100,000 and population Humber in = Yorkshire 21 Number of pharmacies per 100,000 population in England = 21
Source Source of dispensed items and population data: 2009/10 Huddersfield locality has 25 pharmacies per 100,000 population Opening hours for individual Pharmacies available at
PHARMACEUTICAL NEEDS ASSESSMENT 99 Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 51 12 61 2009/10 397 287 110 393 258 331 366 Advanced services Accredited consultation room Pharmacy address 157 Upper Commercial Street, WF17 5DH Batley, Unit 3, Birstall Retail Park, Birstall, WF17 9DT Off Soothill 3-5 Oxford Terrace, WF17 5ST Lane, Batley, 8 Market Place, Birstall, Batley, WF17 9EL Street Medical Centre, Town Street, Birkenshaw, Town Bradford, BD11 2HX 133 Upper Commercial Street, WF17 5DH Batley, The Old Salvation Hall, 74 Blackburn Road, Birstall, Batley, WF17 9PL In-Store Pharmacy, Tesco WF17 Bradford 5TJ Road, Batley, 4 WF17 Market Place, Batley, 5DA 104 Upper Commercial Street, WF17 5DP Batley, 67B Purlwell Lane, Mount WF17 7PF Pleasant, Batley, 1 Bond Street, Birstall, Batley, WF17 9EX Pharmacy name Batley, Birstall and Birkenshaw Locality Birkenshaw and Birstall Batley, Batley Pharmacy Boots UK Limited Hughes Chemists (Northern) Limited Lloyds Pharmacy Lloyds Pharmacy Mileusnic G Oakwood Pharmacy In-Store Tesco Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy Winer (Chemists) Ltd Table 2 - the provision of directed services by community pharmacies pharmacies community by services directed of provision the - 2 Table
100 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 5 25 10 34 62
2009/10 142 414 139 125 331 113 Advanced services Accredited consultation room Pharmacy address Mill Street West, Dewsbury, Mill Street West, Dewsbury, WF12 9AE 27 The Princess Of Wales Precinct, Long Causeway, WF13 1NH Dewsbury, 49 Brewery Lane, Thornhill Lees, WF12 9DU Dewsbury, 51 Lane, Walnut Chickenley, WF12 8NJ Dewsbury, 78 High Street, Westtown, WF13 2QQ Dewsbury, 11B South Street, Savile Town, WF12 9NB Dewsbury, 119 Heckmondwike Road, Dewsbury, Dewsbury Moor, WF13 3NT 20A West Park Street, Dewsbury, WF13 4LA 6D Ravensthorpe Retail Park, Huddersfield Road, Dewsbury, WF13 3HN 13 Halifax Road, Dewsbury, WF13 2JH Unit 1, South Street, Dewsbury, WF13 1JS 92 Savile Road, Savile Town, WF12 9LP Dewsbury, Pharmacy name Dewsbury Locality Dewsbury Asda Pharmacy Boots UK Limited Brewery Lane Pharmacy Chickenley Pharmacy Cohens Chemist Cohens Chemist Dewsbury Moor Pharmacy Dewsbury Pharmacy Eye Pharmacy G Pharmacy Pharmacy D Chemist Noble’s
PHARMACEUTICAL NEEDS ASSESSMENT 101 Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 0 0 37 11 27 39 15 161 2009/10 189 307 Advanced services Accredited consultation room Pharmacy address Dewsbury Health Centre, Wellington Road, Dewsbury, WF13 1HN 71 Halifax Road, Dewsbury, WF13 4HD Earlsheaton Medical Centre, 252 Road, Wakefield Earlsheaton, WF12 8AH Dewsbury, Thornhill, 30 The Town, WF12 0RB Dewsbury, Goods Lane, Railway Street, WF12 8EB Dewsbury, 140A Slaithwaite Road, Thornhill WF12 9DW Lees, Dewsbury, 620 Huddersfield Road, WF13 Ravensthorpe, Dewsbury, 3HL Longhill Road, Off Bradford Road, Brackenhall, Huddersfield, HD2 2LQ 6 Church Street, Paddock, Huddersfield, HD1 4TR 107 Bradford Road, Fartown, Huddersfield, HD1 6DZ 56 Sheepridge Road, Huddersfield, HD2 1HG 62 Westbourne Road, Marsh, Huddersfield, HD1 4LE Pharmacy name Pharmacy-D R Drummond Chemist Rowlands Pharmacy Rowlands Pharmacy Sainsburys Pharmacy Sykes Chemist The Co-Operative Pharmacy area northern - Locality Huddersfield Asda Pharmacy B Singh Bradford Road Pharmacy Cohens Chemist Cw Peach (Chemists)
102 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 0 0 0 0 0 0 40 33 2009/10 401 293 400 Advanced services Accredited consultation room Pharmacy address 80 New Hey Road, Lindley, Huddersfield, HD3 4AJ 2 Grimscar Avenue, Birkby, Huddersfield, HD2 2TW 140 Westbourne Road, Marsh, Huddersfield, HD1 4LF 5 Copthorne Square, Bradley, Huddersfield, HD2 1SZ Unit 2,Salendine Nook Shopping Centre, Moorhill Road, Salendine Nook, Huddersfield, HD3 3XA 203 Luck Lane, Paddock, Huddersfield, HD1 4RB Fartown Grange, Spaines Road, Fartown, Huddersfield, HD2 2QA 14 Spaines Road, Fartown, Huddersfield, HD2 2QA 59 Lidget Street, Lindley, Huddersfield, HD3 3JP Wellfield House, 33 New Hey Road, Huddersfield, HD3 4AL 2 Thorne Road, Thornton Lodge, Huddersfield, HD1 3JJ 63-65 Highgate Lane, Lepton, Huddersfield, HD8 0DS Unit 2B, Great Northern Retail Park, Leeds Road, Huddersfield, HD1 6ND Pharmacy name Dickinson’s Dickinson’s Chemist K Pharmacy Medicare Chemists Medicare Chemists Medicare Chemists Paddock Head Pharmacy S T Shaw Ltd Siddique Pharmacy LTD S T Shaw Ltd Pharmacy Wellcare area southern - Locality Huddersfield Akram Za Ltd Rowlands Pharmacy Boots UK Limited
PHARMACEUTICAL NEEDS ASSESSMENT 103 Minor ailments
Palliative care
Condom distribution
Pregnancy testing
Chlamydia screening
Emergency contraception
Supervised
methadone/ buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking
Headlice
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 0 0 0 30 33 83 2009/10 147 149 193 180 111 172 176 102 Advanced services Accredited consultation room Pharmacy address 22 King Street, Huddersfield, HD1 2QE 2 Greenhead Road, Huddersfield, HD1 4EL 325 Meltham Road, Netherton, Huddersfield, HD4 7EX 332-334 Road, Wakefield Moldgreen, Huddersfield, HD5 8DQ 1 Bankfield Lane, Kirkheaton, Huddersfield, HD5 0JE 45-47 Market Street, Huddersfield, HD1 2HL 9 Meltham Road Surgery, Meltham Road, Lockwood, Huddersfield, HD1 3UP 1A Church Lane, Newsome, Huddersfield, HD4 6JE 125 Fitzwilliam Street, Huddersfield, HD1 5PS 5 Broad Lane, Dalton, Huddersfield, HD5 9BU 65A Northgate, Almondbury, Huddersfield, HD5 8RX Southgate, Huddersfield, HD1 6QR 20 Princess Alexandra Walk, Huddersfield, HD1 2TT Viaduct Street, Off Fitzwilliam Street, Huddersfield, HD1 1RW Pharmacy name Boots UK Limited Greenhead Pharmacy K & M Pharmacy Ltd Rowlands Pharmacy Kirkheaton Pharmacy Lloyds Pharmacy Medicare Chemists Newsome Health Centre Pharmacy Rowlands Pharmacy Rowlands Pharmacy Rowlands Pharmacy Sainsburys Pharmacy Superdrug In-Store Tesco Pharmacy
104 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care ü
Condom distribution ü ü
Pregnancy testing ü ü
Chlamydia screening ü ü
Emergency contraception ü ü
Supervised
methadone/ ü buprenorphine Enhanced services (commissioned) Needle and syringe exchange
Stop smoking ü ü ü ü
Headlice ü ü ü ü ü ü ü ü ü ü
Stoma Appliance Customisation
Appliance Use
Review N/A
Number of MURs 37 33 163 378 367 N/A 2009/10 115 101 243 120 380 427 Advanced services Accredited consultation room ü ü ü ü ü ü ü ü ü ü Pharmacy address 617 Wakefield 617 Road, Wakefield Waterloo, Huddersfield, HD5 9XP Moorfield Shopping Centre, 3 Park Road West, Crosland Moor, Huddersfield, HD4 5RX 315 Road, Wakefield Denby Dale, Huddersfield, HD8 8RX Kirkburton Health Centre, Shelley Lane, Kirkburton, Huddersfield, HD8 OSJ Shepley Health Centre, 25 Jos Lane, Huddersfield, HD8 8DJ Shepley, The Health Centre, Road, Wakefield Scissett, Huddersfield, HD8 9JL 38 Commercial Road, Skelmanthorpe, Huddersfield, HD8 9DA 142 Huddersfield Road, Mirfield, WF14 8AN 54 Old Bank Road, Mirfield, WF14 0JA Mirfield Health Centre, Doctor Lane, Mirfield, WF14 8DU 4 Batley Road, Heckmondwike, WF16 9NE 260 Oxford Road, Gomersal, Bradford, BD19 4PY Pharmacy name Rowlands Pharmacy Local Boots Your Pharmacy Locality Kirkburton and Dale Denby Mirfield, Denby Pharmacy Rowlands Pharmacy Shepley Pharmacy The Co-Operative Pharmacy The Co-Operative Pharmacy Local Boots Your Pharmacy Boots Uk Ltd Local Boots Your Pharmacy Locality Valley Spen Cohens Chemist Gomersal Pharmacy
PHARMACEUTICAL NEEDS ASSESSMENT 105 Minor ailments
Palliative care ü ü
Condom distribution ü ü ü
Pregnancy testing ü ü ü
Chlamydia screening ü ü ü
Emergency contraception ü ü ü
Supervised
methadone/ ü ü ü ü ü ü ü buprenorphine Enhanced services (commissioned) Needle and syringe exchange ü
Stop smoking ü ü ü ü ü
Headlice ü ü ü ü ü ü ü ü ü ü ü
Stoma Appliance Customisation ü ü
Appliance Use Review ü
Number of MURs 6 0 0 0 16 2009/10 135 240 158 275 316 153 301 Advanced services Accredited consultation room ü ü ü ü ü ü ü ü ü ü Pharmacy address St Johns House, Cross Church Street, Cleckheaton, BD19 3RQ 5 Greenside, Cleckheaton, BD19 5AN 673 Bradford Road, Oakenshaw, Bradford, BD12 7DT Heckmondwike Primary Care Centre, Algenon, Firth Park, Heckmondwike, WF16 0HH 26 Market Street, Cleckheaton, BD19 5AJ 69 Road, Valley Liversedge, WF15 6DL Unit 8, Northgate Retail Centre, Heckmondwike, WF16 9RL Morrisons Superstore, Union Street, Heckmondwike, WF16 0HL 9-10 Carr Lane, Slaithwaite, Huddersfield, HD7 5AN 903 Manchester Road, Huddersfield, HD4 Cowlersley, 5SX 14 Huddersfield Road, Meltham, Huddersfield, HD9 4AE 8-10 Westgate, Honley, Huddersfield, HD9 6AA Pharmacy name Kirklees Pharmacy Lloyds Pharmacy Oakenshaw Pharmacy Rowlands Pharmacy Rowlands Pharmacy Pharmacy Shah’s The Co-Operative Pharmacy The Co-Operative Pharmacy Locality Valleys The Cohens Chemist K & M Pharmacy Ltd Lloyds Pharmacy Medicare Chemists
106 PHARMACEUTICAL NEEDS ASSESSMENT Minor ailments
Palliative care
Condom distribution ü ü
Pregnancy testing ü ü
Chlamydia screening ü ü
Emergency contraception ü ü
Supervised
methadone/ ü ü ü ü buprenorphine Enhanced services (commissioned) Needle and syringe exchange ü ü
Stop smoking ü
Headlice ü ü ü ü ü
Stoma Appliance Customisation
Appliance Use Review
Number of MURs 2 0 1 53 2009/10 145 178 358** Advanced services Accredited consultation room ü ü ü ü ü https://www.report.ppa.org.uk/ActProd1/getfolderitems.do
Pharmacy address Unit 5, Riverside Shopping Centre, 90 Huddersfield Road, Holmfirth, Huddersfield, HD9 3AZ Elmwood Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TR 1 The Cobbles, Meltham, Huddersfield, HD9 5QQ End, Golcar, 38 Town Huddersfield, HD7 4QD 63 Market Street, Milnsbridge, Huddersfield, HD3 4HZ 32 Peel Street, Marsden, Huddersfield, HD7 6BW Drs Shamsee & Oaklands Ward, Health Centre, Huddersfield Road, Holmfirth, Huddersfield, HD9 3TP Pharmacy name Medicare Medicare Chemists Medicare Chemists Rowlands Pharmacy S T Shaw Ltd The Co-Operative Pharmacy Local Boots Your Pharmacy Oaklands Health Centre (Dispensing Practice) Source Source of MUR data: Data correct as at 30 Nov 2010 N/A - Not appliacble as pharmacy only opened in July 2010 ** The dispensing practice undertakes DRUMs (similar to MURs) only for those patients as registered ‘dispensing patients’
PHARMACEUTICAL NEEDS ASSESSMENT 107 17 Maps
Map A – features the spread of pharmacies (including the only GP dispensing practice) within Kirklees against a background showing deprivation index of the population. Map B – demonstrates pharmacy position vs population density. Map C – Community pharmacies with weekend/100hours opening. Map D – Community pharmacies providing sexual health services Map E – Community pharmacies providing supervised consumption of methadone and buprenorphine Map F – Community pharmacies providing needle and syringe exchange service Map G – Community pharmacies providing stop smoking services
108 PHARMACEUTICAL NEEDS ASSESSMENT Map A - features the spread of pharmacies (including the only GP dispensing practice) within Kirklees against a background showing deprivation index of the population.
PHARMACEUTICAL NEEDS ASSESSMENT 109 Map B – demonstrates pharmacy position vs population density
110 PHARMACEUTICAL NEEDS ASSESSMENT Map C – Community pharmacies with weekend/100hours opening
PHARMACEUTICAL NEEDS ASSESSMENT 111 Map D – Community pharmacies providing sexual health services
112 PHARMACEUTICAL NEEDS ASSESSMENT Map E – Community pharmacies providing supervised consumption of methadone and buprenorphine
PHARMACEUTICAL NEEDS ASSESSMENT 113 Map F – Community pharmacies providing needle and syringe exchange service
114 PHARMACEUTICAL NEEDS ASSESSMENT Map G – Community pharmacies providing stop smoking services
PHARMACEUTICAL NEEDS ASSESSMENT 115 18 Glossary AUR - Appliance Use Review Dispensing assistant - A member of staff that has BP - Blood Pressure an NVQ 2 or is working towards NVQ 2 in dispensing. CaSH – Contraception and Sexual Health Service Dispensing GP – General practitioner that is able to Clinical governance – An essential service of the dispense medicines for some patients in rural areas community pharmacy contract. Requirements when a pharmacy is not readily accessible. include use of standard operating procedures, patient safety incident reporting to National Patient Dispensing technician - A member of staff that Safety Agency, demonstrating evidence of has an NVQ 3 or is working towards NVQ 3 in pharmacist continuing professional development, dispensing. conducting clinical audits and patient satisfaction Disposal of unwanted medicines - Collection of surveys. unwanted medicines from households and Community pharmacy contract - The community individuals via pharmacies. Special arrangements will pharmacy contract is made up of three service apply to controlled drugs (post Shipman inquiry). levels: essential services, advanced services and This is an essential service of the community enhanced services. (See page 7). pharmacy contract. Consultation facilities /area - Most community DRUMs – Dispensing Review of Use of Medicines – pharmacies now have an area in the pharmacy this is an integral requirement of the Dispensing where the patient and pharmacist can have a private Services Quality Scheme (DSQS). The requirement is consultation. The design and specification of these for 10% of the practice’s dispensing patients, or facilities varies from pharmacy to pharmacy. their carers, to receive a face-to-face review at least once every year. Control of entry - Regulatory framework for assessment and approval or rejection of pharmacy DSQS – Dispensing Service Quality Scheme –The applications. scheme rewards GP dispensing practices for providing high quality services to their dispensing CPPQ - Community Pharmacy Patient Questionnaire patients. Practices which sign up to the scheme and DAC - Dispensing Appliance Contractor – Dispenser achieve all the standards will receive a payment for of appliances such as stoma appliances; each dispensing patient. incontinence appliances; catheters, trusses and EHC - Emergency Hormonal Contraception – the dressings. “morning after pill” DES - Directed Enhanced Services - The enhanced EPP - Expert Patients Programme – a self- services that a PCT can require applicants who apply management programme which was introduced into through the exemption route to provide as part of the NHS in England in 2002. A support group is their terms of service used to support people with long-term health Dispensing - Supply of medicines or appliances, conditions, to better manage their health and well- advice given to the patient about the medicines being, by developing confidence, self-efficacy and being dispensed and advice about possible enhanced self-management skills. NHS Kirklees interactions with other medicines. Also recording all established a support group for those people that medicines dispensed and significant advice provided, had successfully completed the programme in order referrals and interventions made. to provide them with ongoing support.
116 PHARMACEUTICAL NEEDS ASSESSMENT EPS - The Electronic Prescription Service will enable a safe, controlled and convenient alternative to the prescribers such as GPs and practice nurses to send traditional way of supplying care and medicines for prescriptions electronically to a dispenser (such as a self-limiting conditions. pharmacy) of the patient’s choice. This will make the MUR - Medicines Use Reviews - The aim of an MUR prescribing and dispensing process safer and more is to help people to use their medicines more convenient for patients and staff. effectively. Specifically, the aims are to improve EPS release 2 - The latest development of the patient knowledge, concordance and use of electronic prescription service which removes the medicines. need for the patient to obtain or present a paper Needle and syringe exchange schemes – an prescription. enhanced service to reduce the risk of blood borne ETP – Electronic Transmission of Prescriptions – the disease and facilitate the safe disposal of used process by which prescriptions will be sent ‘sharps’ from substance misusers. electronically from the GP surgery to the pharmacy NHSIC - NHS Information Centre and then on to NHS Prescription Services for payment. NHS Regulations 2005 – These regulations incorporate the Control of Entry provisions Exemption application - One of the four (including the four exemptions from Control of categories of application under the control of entry Entry), rural dispensing regulations, the terms of system that does not have to satisfy the necessary or service under the new pharmacy contractual expedient test framework and fitness to practice provisions for Extended hours – opening times of the community pharmacy contractors. pharmacy extend beyond the normal working day NRT - Nicotine Replacement Therapy i.e. open later than 6pm or 7pm and usually open on both Saturdays and Sundays. ONS - Office of National Statistics GP - General Practitioner OoH - Out of hours – includes Headlice scheme - a pharmacist led enhanced (a) the period beginning at 6:30pm on any day scheme that provides convenient access to advice from Monday to Thursday and ending at and free lotions for treatment of head lice, a 8am on the following day, condition which predominantly affects school age (b) the period between 6:30pm on Friday and children, where head to head contact is common. 8am on the following Monday, and JSNA - Joint Strategic Needs Assessment. Since 1 (c) Good Friday, Christmas Day and bank April 2008, local authorities and PCTs have been holidays; ‘out of hours services’ means under a statutory duty to produce a Joint Strategic services required to be provided in all or Needs Assessment. The JSNA establishes the current part of the out of hours period which and future health and well-being needs of a would be essential, advanced and enhanced population, leading to improved outcomes and services if provided by a provider of reductions in health inequalities. pharmaceutical services in core hours. LINks - Local Involvement Network– LINks are local Palliative care scheme - Some pharmacies organisations in each local authority area set up to guarantee to stock an agreed range of palliative represent views of local people on health and social care drugs to help with the support of patients who care services. choose to die at home. This enhanced service is LMC – Local Medical Committee – representative important to patients, carers and professional staff. committee of the local General Practitioner (GP) PBC - Practice Based Commissioning - A providers government proposal set out in April 2005 where all LPC - Local Pharmaceutical Committee – practices or groups of practices will have the right to representative committee of the local community receive a budget from the primary care trust to pharmacy providers purchase health care for their registered patients. They will be able to change how and where care is LTC - Long Term Condition provided in order to benefit patients. Minor ailment scheme – an enhanced service PCT - Primary Care Trust - a public body responsible whereby patients can present to a community for commissioning the best possible health care for pharmacy instead of a GP practice in order to everyone resident within its boundaries. receive advice and a medicine for a limited range of minor ailments e.g. coughs, colds. The service offers
PHARMACEUTICAL NEEDS ASSESSMENT 117 PGD – Patient Group Direction – This is a written Signposting patients to other health care direction relating to supply and/or administration of providers - An essential service of the community a prescription-only medicine to persons generally pharmacy contract. Pharmacist and staff will refer (subject to specified exclusions), and is signed by a patients to other health care professionals or care doctor or a dentist, and by a pharmacist. providers when appropriate. The service also Pharmacist - A registered pharmacist has typically includes referral on to other sources of help such as completed five years of training which includes a local or national patient groups. degree and post graduate training. Stakeholder - a person, group, organisation, or Pharmacy - A registered pharmacy premises that is system who affects or can be affected by an regulated by the Royal Pharmaceutical Society and organisation’s plans. appears on the PCT’s pharmaceutical list. Supervised consumption scheme -This enhanced Pharmacy assistant - A member of staff that has a service will require the pharmacist to supervise the medicines counter assistant qualification. consumption of prescribed methadone or buprenorphine (subutex®) at the point of dispensing Pharmacy panel - under the National Health in the pharmacy, making sure that the dose has Service (Pharmaceutical Services) Regulations 2005 been administered to the patient. the PCT has an obligation to consider and approve a wide range of issues in relation to the provision of Support for self-care – An essential service of the community pharmacy services, including the location community pharmacy contract. Includes the of community pharmacies, opening hours and new provision of advice and support by pharmacy staff to contract requests. The pharmacy panel holds this enable people to derive maximum benefit from responsibility on behalf of the PCT. caring for themselves or their families. The service will initially focus on self-limiting illness, but support PNA - Pharmaceutical Needs Assessment for people with long-term conditions is also a Practice based commissioning Consortia - a feature of the service. commissioning collaborative VAK - Voluntary Action Kirklees - is a charity that Prescription item(s) - Each medicine on a supports the development of an effective and prescription is counted as one item. A prescription influential voluntary and community sector locally. can have many items. VAK provides a wide range of services, including Promotion of healthy lifestyles (public health) - specialist support, advice and training to voluntary An essential service of the community pharmacy and community organisations in Kirklees and they contract. Provision of opportunistic one to one promote and support volunteering. VAK also advice given on healthy lifestyle topics such as supports networks and partnership working within smoking cessation to certain patient groups who the voluntary and community sector and with other present prescriptions for dispensing. Also sectors, so that voluntary and community involvement in six local campaigns a year, organised organisations can contribute to Kirklees’ by PCTs. Campaign examples can include promotion development, work and services. of flu vaccination uptake or educating the public WCC - World Class Commissioning - a statement of about the appropriate use of antibiotics. intent, aimed at delivering outstanding performance RD - Repeat dispensing – Management of repeat in the way health and care services are medication for up to one year, in partnership with commissioned in the NHS. the patient and prescriber. The patient will return to the pharmacy for repeat supplies, without first having to visit the GP surgery. Before each supply the pharmacy will ascertain the patient’s need for a repeat supply of a particular medicine. The pharmacist will communicate all significant issues to the prescriber with suggestions on medication changes as appropriate. This is an essential service of the community pharmacy contract.
118 PHARMACEUTICAL NEEDS ASSESSMENT PHARMACEUTICAL NEEDS ASSESSMENT 119 NHS Kirklees Broad Lea House Bradley Business Park Dyson Wood Way Bradley Huddersfield HD2 1GZ Tel: 01484 464000 www.kirklees.nhs.uk
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Reference: LR3870 • Date of publication: Jan 11 © Kirklees Primary Care Trust • www.kirklees.nhs.uk