CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

Cheshire East Health and Wellbeing Board

Pharmaceutical Needs Assessment

2018

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Contents

1.0 Executive Summary ...... 4 2.0 Scope and Purpose of the Pharmaceutical Needs Assessment...... 7 3.0 Current Pharmaceutical Services...... 12 4.0 Definition of Pharmaceutical Services ...... 14 5.0 Essential Services...... 15 6.0 Advanced Services ...... 17 7.0 Locally Commissioned Services ...... 21 8.0 Dispensing Appliance Contractors (DAC) ...... 25 9.0 Distance Selling Pharmacies...... 25 10.0 Dispensing Doctors ...... 25 11.0 Community Pharmacy Provision Commissioned in Cheshire East ...... 27 12.0 Community Pharmacy Opening Hours...... 33 13.0 Prescription Collection and Delivery Services ...... 37 14.0 Factors Affecting Prescribing...... 38 15.0 Population and Housing...... 38 16.0 Ethnicity and Other Protected Characteristics ...... 42 17.0 Chronic Disease...... 46 18.0 Deprivation...... 48 19.0 The Six Statements required by Legislation ...... 49 20.0 Map of Premises at which Pharmaceutical Services are Provided...... 55 Appendix A: The Public Survey ...... 56 Appendix B GP Cluster Profiles ...... 59 Appendix C Glossary of terms and phrases defined in regulation 2 of the 2013 Regulations ...87 Appendix D Key to pharmacies in neighbouring Health and Wellbeing Boards ...... 88 Appendix E Consultation Feedback...... 89

List of Tables Table 1: Pharmacies granted Pharmacy Access Scheme Money within Cheshire East Council (September 2017)...... 12 Table 2: Eight quality criteria in the community pharmacy contract ...... 13 Table 3: Accredited Healthy Living Pharmacies within Cheshire East as at August 2017...... 16 Table 4: Pharmacies providing Public Health Services by GP Clusters ...... 21 Table 5: Community dispensing premises located in Cheshire East, May 2017...... 27 Table 6: Changes in numbers of community pharmacies since last PNA ...... 28 Table 7: Community pharmacies per 100,000 population, Cheshire East...... 30 Table 8: Average Items per month prescribed by Cheshire East CCGs during 2016/17...... 31

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Table 9: Dispensing flows for items prescribed by Cheshire East CCGs during 2016/17 ...... 31 Table 10: Prescription dispensing flows between GP Clusters in Cheshire East, 2016/17...... 32 Table 11: Prescription Collection and Delivery Services in Cheshire East ...... 37 Table 12: Predicted population change for Cheshire East, 2015 to 2025 ...... 39 Table 13: Predicted prescribing need for Cheshire East, 2015 to 2025...... 39 Table 14: Proposed housing on main Strategic Sites in Cheshire East by March 2021 ...... 40 Table 15: Accessibility aids provided by pharmacies in Cheshire East ...... 44 Table 16: Numbers on GP Disease Registers 2015/16...... 47

List of Figures Figure 1: Pharmacies per 100,000 population, May 2017...... 29 Figure 2: Pharmacy Open Hours by GP Cluster Areas - Weekday ...... 34 Figure 3: Pharmacy Open Hours by GP Cluster Areas – Saturday ...... 34 Figure 4: Pharmacy Open Hours by GP Cluster Areas – Sunday...... 35 Figure 5: Pharmacy Open Hours by Clinical Commissioning Groups – Weekday...... 35 Figure 6: Pharmacy Open Hours by Clinical Commissioning Groups – Saturday...... 36 Figure 7: Pharmacy Open Hours by Clinical Commissioning Groups – Sunday ...... 36 Figure 8: Map Index of Multiple Deprivation 2015 – Overall Deprivation by national decile ...... 48 Figure 9:Map Location of Community Pharmacies and GP Practices in Cheshire East ...... 55

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1.0 Executive Summary

A Pharmaceutical Needs Assessment (PNA) is an assessment of current and anticipated future needs for pharmaceutical services. Health and Wellbeing Boards have a statutory requirement to produce a PNA for their area at least every three years. This 2018 PNA follows the 2015 assessment. NHS England is required to use the finalised PNA to consider applications to open a new pharmacy, move an existing pharmacy or to commission additional services from a pharmacy.

The scope of the PNA is to gather information on the provision of pharmaceutical services available to the population. It covers opening times, services delivered, accessibility (disability, language, ethnicity, sexuality). This information is then used along with local public survey results and population health data, to determine whether pharmaceutical service provision is sufficient for the local population. The PNA can also be used in conjunction with the local Joint Strategic Needs Assessment (JSNA) to inform any other relevant local commissioning decisions.

PNA Conclusions Taking into account the information gathered for this PNA:

Currently pharmaceutical provision in the towns and villages of Cheshire East borough is assessed as adequate in terms of location, opening hours and pharmaceutical services offered to the population. With the available information the PNA has not identified current or anticipated future need for new NHS pharmaceutical service providers in Cheshire East.

A number of findings have been considered, including:-  Cheshire East has a similar pharmacy: population ratio to the national average. There is variation across the authority but all areas fall within the normal range; the area with the lowest number of community pharmacies per 100,000 is supplemented by pharmacies across the boundary.  Over 88% of respondents to the survey were satisfied or fairly satisfied with the pharmaceutical services of the community pharmacies. The main issues being raised were dissatisfaction with waiting times and delays in dispensing prescriptions within pharmacies.  Pharmaceutical services are available to the public between 6am–11.30pm on weekdays and Saturdays and 10-4pm on Sundays and Bank Holidays in most towns within the Borough. Eighty percent of respondents surveyed reported they were satisfied with the current opening arrangements at their local pharmacy. Councils do not have the power to stipulate pharmacy opening hours. If NHSE consider there is a need for pharmacy services in an area on a Sunday, they could direct a rota as they do for Christmas day.  Advanced pharmaceutical services such as Medicines Use Reviews, New Medicines Service and Flu Vaccination are readily available from community pharmacies. There is good coverage across the authority.

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 Cheshire East’s population projected growth is 2.0% by 2020 and by a further 2.0% by 2025, this is lower than nationally. Most of the increase in population size will occur in the age groups 60 and above.  Population growth particularly in the over 60s will increase demand for prescription dispensing by 7.7% by 2020.  The impact of proposed housing on the main Strategic Sites (SS) and potential population growth was considered. Overall resultant growth is similar to Office for National Statistics (ONS) projections. However nationally produced population projections do not include housing plans so in areas with large numbers of planned housing there are differences between modelled projections using ONS data and those using SS plans. Initial analysis suggests that the majority of the new housing appears to be purchased by families already living in Cheshire East.  A potential future gap in north Crewe was identified due to a large planned housing development , however further mapping gave assurance that this area is adequately provided for by the pharmacies in central Crewe and the local independent provider in north east Crewe.  Considerations of planned housing developments in neighbouring HWB areas gave two areas of concern - Woodford and Handforth developments. From Cheshire East’s perspective there is adequate provision for its residents, however Stockport have raised concerns regarding their provision and the Woodford site.  The closure of the dispensing branch surgery at Rode Heath may impact on accessibility in terms of location for some patients. All patients will remain registered with the GPs at the main surgery at Greenmoss Medical Centre. Patients will be able to get prescriptions dispensed by the surgery after visiting the doctor. Alternatively patients could use the three pharmacies in Alsager, all of which offer a free delivery service.  An increasing elderly population in Cheshire East will mean more people with mobility problems. In the Public Survey some respondents with an illness or disability that limits their day-to-day activities stated they were not able to get to the Pharmacy of their choice due to their preferred pharmacy not having suitable access.  Public engagement has shown that awareness of Minor Aliment Service is inconsistent.  Preventing ill health and promoting well-being are key public health priorities for both the NHS and Local Authorities. Community pharmacies are well-placed to support initiatives for early identification. The coverage of pharmacies offering Public Health Services e.g., Stop Smoking, Alcohol intervention and Sexual Health Services is good across the authority; any gaps are supplemented by other providers.  The number of Healthy Living Pharmacies in the borough has increased greatly since the last PNA.  It is likely that in the period of interest, the anticipated increase in the demand for dispensing due to the predicted population growth, increasing elderly population and increased case-finding of people with chronic diseases managed by pharmaceutical medicines, can be absorbed by increasing the capacity of the current community pharmacies rather necessitating a new entrant per se.

Recommendations Whilst no gaps in pharmaceutical service provision have been identified at present it is recommended that:

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 Any pharmacy closures within neighbouring Health and Well-being Boards will need to be considered to assess for the potential impact on areas with already lower pharmacy: population ratios.  Continued consideration should be made by NHS England, Clinical Commissioning Group (CCG) and local authority commissioners of the expertise within community pharmacies to case-find, deliver brief interventions, provide additional healthy lifestyle advice and signposting within the wider health system.  Pharmacists need to ensure accessibility of their premises and to materials such as leaflets and prescription labels.  Pharmacists need to review the dispensing process to understand the problems that are leading to general dissatisfaction of customers about long waiting times.  Clinical Commissioning Groups need to promote Minor Ailments Service more widely.

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2.0 Scope and Purpose of the Pharmaceutical Needs Assessment

2.1 Introduction and Purpose 2.1.1 The Health Act 2009 instructed NHS Primary Care Trusts (PCTs) to publish an assessment of needs for pharmaceutical services in its area. This assessment formed the basis for determining market entry onto a ‘Pharmaceutical List’ i.e. reviewing pharmacy applications to ensure adequate pharmaceutical provision to meet needs within their area.

2.1.2 With the abolition of PCTs, the Health and Social Care Act 2012 transferred the production of Pharmaceutical Needs Assessments (PNAs) to Health and Wellbeing Boards (HWBs) from the 1st April 2013. At the same time the responsibility for using these PNAs as the basis to determining market entry transferred to NHS England under the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013.

2.1.3 The main purpose of the PNA is to enable NHS England to assess applications to open new premises from a pharmacy or dispensing appliance contractor against any geographical gaps identified within the PNA. The PNA should also identify whether there is a need for an additional service or services, or whether improvements or better access to existing services are required.

2.1.4 Although a PNA is primarily a document to enable NHS England to make application decisions, a robust PNA used in conjunction with the joint strategic needs assessment (JSNA) should aid commissioners within the Local Authority and Clinical Commissioning Groups to target services from pharmacies to areas of most need.

2.1.5 It is important that the PNA reflects both current need and considers any foreseeable changes that may impact on provision during the lifetime of the PNA. If substantive changes occur, either in population need or service provision, the HWB may decide that a revised PNA is required. However, the majority of changes may not require any action or it may be decided that a supplementary statement assessing the change should be issued by the HWB.

2.2 Scope 2.2.1 The scope of the assessment of need must consider the following principles:  The safe and efficient supply of medicines, including any additional (non NHS commissioned) services provided by pharmacies such as:  support for housebound patients and older people  people with learning difficulties and  medication administration support such as monitored dosage systems (MDS) where clinically appropriate.  Pharmaceutical care that supports safe and effective use of medicines.  Pharmaceutical care that provides quality healthcare and public health information and advice to all members of the population.  High quality pharmacy premises that increase capacity and improve access to primary care services and medicines.  Enhanced services which increase access, choice and support for self-care.  Locally commissioned services (e.g. by Clinical Commissioning Groups or Local Authorities) which have the potential to reduce avoidable hospital admissions and reduce bed-days.

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 High quality pharmaceutical support to prescribers for clinical and cost effective use of resources.

2.2.2 The PNA should be utilised as a service development tool in conjunction with the JSNA and the strategic plans from local commissioners. Mapping out current services and gaining a sense of future service needs will pinpoint the areas where the development of local pharmaceutical services may be necessary.

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 - patients can see clearly where they can access a particular service.  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’ to make sure that pharmaceutical services are delivered in a targeted way.  NHS England - will be in a better position to judge new applications to join the pharmaceutical list to make sure that patients receive quality services and adequate access without plurality of supply.

2.3 Development and Governance of the PNA 2.3.1 Cheshire East Health and Wellbeing Board have a statutory responsibility to publish an up-to-date statement of pharmaceutical needs. A revised pharmaceutical needs assessment was required to be published by April 2018. Responsibility for the development and approval of the pre-consultation draft was delegated to the Director of Public Health.

2.3.2 The development of the PNA was overseen by a multi-professional steering group which included representatives from the following:

 Cheshire East Council Public Health o Member of SMT o JSNA Manager o Head of Intelligence o Senior Health Protection Manager o Specialty Registrar  Business Intelligence – Research and Consultation  NHS England  NHS Eastern Cheshire CCG  NHS South Cheshire CCG  Community Pharmacy Cheshire and Wirral (Local Pharmaceutical Committee)  Cheshire Local Medical Committee

If members were unable to attend meetings, their views and contributions were gathered via telephone and email.

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2.4 Patient and Public Involvement 2.4.1 Healthwatch Cheshire East had already undertaken engagement events with pharmacies users within the borough during 2016. Fourteen pharmacies and 137 people were consulted via group interviews, plus a number of ‘enter and view’ visits to the pharmacies themselves. The report was published in November 2016 and specific findings incorporated into the PNA.

2.4.2 To supplement the Healthwatch report, a Public Survey was carried out by Cheshire East’s Research and Consultation Team on behalf of the Steering Group. It sought views on what people thought was important in terms of location, pharmaceutical services offered and customer service as well as their experiences of pharmacies and their staff within Cheshire East. The short online questionnaire was sent to 2,004 panel members of the Influence Cheshire East Citizens’ Panel and the Council’s Digital Influence Panel during May 2017. The survey was also available on the council’s website consultation pages, advertised in the internal staff newsletter and promoted by the two CCGs. A total of 669 responses were received. Findings were collated into a report and where required supplementary analysis was undertaken to obtain more details or clarity. The results have been incorporated into the relevant sections within this PNA. An overview of additional findings plus a discussion on the representativeness of the respondents compared to Cheshire East population as a whole are included in the appendix A.

2.4.3 The views of the pharmaceutical contractors within Cheshire East were captured via an electronic Community Pharmacy Survey made available on PharmOutcomes during May 2017. The survey was developed in conjunction with the other, Health and Wellbeing Board Areas in Cheshire and Mersey and approved by the steering group in March. It included questions regarding premises, additional services offered and provision for people with protected characteristics. All 81 community pharmacies within Cheshire East returned questionnaires, a 100% response rate.

2.5 Consultation 2.5.5 A consultation exercise on the draft PNA was carried out for 60 days between 13th November 2017 and 12th January 2018 with all Stakeholders as specified by legislation. A total of 12 completed responses were received and have been incorporated into this final version, which was approved by the HWB on 27th March 2018. An outline of these responses plus the corrective action is given in Appendix E.

2.6 Localities used for considering pharmaceutical services 2.6.1 The localities used within the PNA match the standard geographies used within the Joint Strategic Needs Assessment. Data are presented by GP Clusters, Clinical Commissioning Groups (CCG) and Cheshire East Local Authority. The eight GP Clusters are based on groups of GP practices who have chosen to work together with other health and care professionals to plan and provide services locally. Physical boundaries for these localities were then developed by looking at the proportions of the registered populations of these GP groups. Standard geographies such as Middle Super Output Areas (MSOAs) were then allocated to these clusters accordingly, emcompassing both town and rural communities in each cluster. This enables us to profile standard data sets such as Census data to these new geographies. An advantage of using

Page 9 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 these localities is that they better fit general practice and community pharmacy patient flows. Another advantage was that a large amount of mapping of service provision against health need had already been undertaken with reference to these localities within the body of the JSNA. Five of the GP Clusters are within Eastern Cheshire CCG and three within South Cheshire CCG, as illustrated in the map in section 20.

2.6.2 The Cheshire East JSNA and PNA also contain some town-level analyses, constructed from Middle Level Super Output Areas (MSOAs). Town-level analyses illustrate local variations between communities, which may be hidden by the larger GP Clusters.

2.7 Strategic Direction 2.7.1 The Joint Health and Wellbeing Strategy for the Population of Cheshire East for 2014- 2017 indicated that the Cheshire East Health and Wellbeing Board would work together to make a positive difference to people’s lives through a partnership that understands and responds to the needs of the population now and in the future. The Board would do this by:

 engaging effectively with the public  enabling people to be happier, healthier, and independent for longer  supporting people to take personal responsibility and make good lifestyle choices  demonstrating improved outcomes within a broad vision of health and wellbeing

2.7.2 The Health and Wellbeing Strategy for Cheshire East for 2017-2020 is currently being developed. The Health and Wellbeing Board’s priorities for 2014-2017 were:

 Outcome one - Starting and developing well… Children and young people have the best start in life; they and their families or carers are supported to feel healthy and safe, reach their full potential and are able to feel part of where they live and involved in the services they receive  Outcome two - Working and living well… Driving out the causes of poor health and wellbeing ensuring that all have the same opportunities to work and live well and reducing the gap in life expectancy that exists between different parts of the Borough  Outcome three - Ageing well… Enabling older people to live healthier and more active lives for longer.

2.7.3 Furthermore, the NHS and local councils have come together in 44 geographical areas covering all of England to develop proposals and make improvements to health and care. These proposals, called Sustainability and Transformation Partnerships (STPs), are place-based and built around the needs of the local population1. Sustainability and Transformation Partnership development plans will support the implementation of the Five Year Forward View. This sets out the current and future direction of the NHS including an upgrade in prevention and public health; greater control of own care for patients; breaking down barriers in how care is provided including the introduction of new care models.

1 NHS England (2017). Sustainability and Transformation Partnerships. https://www.england.nhs.uk/stps/

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2.7.4 The Cheshire and Merseyside (C&M) Five Year Forward View (FYFV) outlines the Sustainability and Transformation Plans for the region. This covers 12 Clinical Commissioning Groups, 9 local authorities and many healthcare providers. Priorities identified within the C&M FYFV include to:

 Improve the health of the Cheshire & Merseyside population by: o Promoting physical and mental well being o Improving the provision of physical and mental care in the community (i.e. outside of hospital)  Improve the quality of care in hospital settings by: o Reducing the variation of care across C&M; o Delivering the right level of care in the most appropriate setting o Enhancing delivery of mental health care  Optimise direct patient care by: o Reducing the cost of administration o Creating more efficient clinical support services

These programmes are supported by eight clinical programmes looking to improve the delivery of: o Neuroscience; o Cardiovascular disease (CVD) o Learning disabilities o Urgent Care o Cancer o Mental Health o Women’s & Children’s o GPs and primary care

Furthermore, there are five additional supporting and enabling programmes: Workforce; ICT; Programme Management; Finance and Back Office

2.7.5 Nationally, the GP Five Year Forward View sets out ambitions to provide greater access to GP services during evening and weekends, including for routine appointments. Given that many primary care appointments will result in a prescription or self-care advice including purchasing over-the-counter medication being issued this development alongside a move towards greater use of online pharmacy (in keeping with a general move towards greater use of online services by consumers) is likely to change patterns of demand for community pharmacies.

2.7.6 It is essential that local pharmacists engage with the C&M FYFV and are considered within transformation plans.

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3.0 Current Pharmaceutical Services

3.1 Funding of Community Pharmacies 3.1.1 Funding of community pharmacy comes from several sources:  NHS Community Pharmacy contractors are paid for services they provide under the community pharmacy contractual framework according to a set of fees and allowances agreed between the Department of Health and Pharmaceutical Services Negotiating Committee. These are published in the Drug Tariff each month. The whole framework is being reviewed nationally.  Local Commissioners: Additional income comes from providing services commissioned locally by CCGs, Local Authorities such as smoking cessation and needle exchange services.  Sale of goods and service over the counter.

3.1.2 For most pharmacies over 80% of their funding comes from their NHS contract. The Department of Health has announced cuts to the funding of pharmacies and there is concern that this could impact on the viability of some pharmacies. At this time the full impact of how many pharmacies might close is not known. In order to mitigate the risk of pharmacy closures the Pharmacy Access Scheme (PhAS) has been introduced. Subject to fulfilling certain criteria, a pharmacy could qualify for payments to bridge the funding reduction. Currently this is only available until April 2018.

Table 1: Pharmacies granted Pharmacy Access Scheme Money within Cheshire East Council (September 2017)

GP Locality name Area Pharmacy Address Postcode Wilmslow LLOYDSPHARMACY UNIT 2, SUMMERFIELD VILLAGE CTR, DEAN ROW ROAD SK9 2TA Alderley Edge, Chelford, Prestbury THE VILLAGE PHARMACY UNICORN HOUSE, PRESTBURY, MACCLESFIELD SK10 4DG Handforth, Wilmslow Handforth INSTORE PHARMACY KILN CROFT LANE, HANDFORTH, WILMSLOW SK9 3PA Wilmslow LLOYDSPHARMACY UNIT 2, SUMMERFIELD VILLAGE CTR, DEAN ROW ROAD SK9 2TA Macclesfield Macclesfield ANDREWS PHARMACY 71 KENNEDY AVENUE, MACCLESFIELD, CHESHIRE SK10 3DE Macclesfield - Bollington ROWLANDS PHARMACY THE WATERHOUSE, WELLINGTON ROAD, BOLLINGTON SK10 5JH Bollington, Disley, Poynton Disley WELL DISLEY - FOUNTAIN SQUARE 11 FOUNTAIN SQUARE, DISLEY, STOCKPORT SK12 2AB Knutsford Mobberley WELL MOBBERLEY - TOWN LANE 93 TOWN LANE, KNUTSFORD, MOBBERLEY WA16 7HH Congleton, Holmes Chapel Goostrey GOOSTREY PHARMACY 3 CHESHIRE HOUSE, 164 MAIN ROAD,GOOSTREY, CREWE CW4 8JP Nantwich and Rural Audlem YOUR LOCAL BOOTS PHARMACY 1 CHESHIRE STREET, AUDLEM, CREWE CW3 0AH Crewe Crewe - Coppenhall RYDALE PHARMACY 18 NORTH STREET, COPPENHALL, CREWE CW1 4NL Middlewich CLEDFORD PHARMACY 70 WARMINGHAM LANE, MIDDLEWICH, CHESHIRE CW10 0DJ Sandbach - Elworth WISE PHARMACY 11 LONDON ROAD, ELWORTH, SANDBACH CW11 3BD SMASH

Crewe - Haslington ROWLANDS PHARMACY HASLINGTON SURGERY, CREWE ROAD, HASLINGTON, CREWE CW1 5QY

3.2 Quality Payment As part of the review of the pharmacy contractual framework the Department of Health wants to reward high quality and so have introduced ‘Quality Payments’. This allocates fees upon delivery of certain quality criteria.

There are four qualifying gateway criteria  Having an NHS email address  Providing Medicine Use Reviews (MURs) or, New Medicines Service (NMS) or NHS Urgent Medicines Supply Advanced Service (NUMSAS)  Keeping the pharmacy’s NHS Choices entry up to date

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 Able to demonstrate on-going usage of EPS (Electronic Prescription Service)

Once a community pharmacy contractor has achieved all of these they are able to complete eight quality criteria. A payment can be claimed for each of these providing the pharmacy meets the criteria. This is done at two points during the year (28th April 2017 and 24th November 2017).

Table 2: Eight quality criteria in the community pharmacy contract

Domain Criteria Patient Safety Written safety report at premises level available for inspection at review point, covering analysis of incidents and incident patterns (taken from an ongoing log), evidence of sharing learning locally and nationally, and actions taken in response to national patient safety alerts. Patient Safety On the day of the review 80% of registered pharmacy professionals working at the pharmacy have achieved level 2 safeguarding status for children and vulnerable adults in the last two years. Patient Experience On the day of the review, the results of the Community Pharmacy Patient Questionnaire from the last 12 months is publicly available on the pharmacy’s NHS Choices page or for distance selling pharmacies it is displayed on their website. Public Health On the day of the review, the pharmacy is a Healthy Living Pharmacy level 1 (self-assessment). Digital The pharmacy can demonstrate a total increase in access to the Summary Care Record between each review point Digital On the day of the review, the pharmacy’s NHS 111 Directory of Services entry is up to date. Clinical Effectiveness On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review. Workforce On the day of the review, 80% of all pharmacy staff working in patient facing roles are trained ‘Dementia Friends’.

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4.0 Definition of Pharmaceutical Services

4.1 The NHS Act 2006 sets out the definition for pharmaceutical services. Pharmaceutical services are generally provided by virtue of Part 7 of the Act. Under section 126(1) – (3), NHS England is required to secure, on the basis of Regulations made by the Secretary of State, the provision of services to people in their area of medicines and listed appliances and "such other services as may be prescribed" (section 126(3)(e)). Prescribed services must be set out in Regulations. Therefore, these prescribed services, and the dispensing services referred to in section 126(3)(a) to (d), constitute the core “essential” NHS pharmaceutical services. Section 127 also provides for “additional pharmaceutical services” to be set out in Directions to NHS England. Directed services include advanced and enhanced services for pharmacy contractors and advanced services for dispensing appliance contractors.

4.2 The Community Pharmacy Contractual Framework was introduced in 2005. Under the framework, there are three types of service which can be provided by community pharmacy and/or appliance contractors. Pharmaceutical services in relation to PNAs therefore include:

 “Essential services” which every community pharmacy providing NHS pharmaceutical services must provide. These are the dispensing of medicines, promotion of healthy lifestyles, and support for self-care including appropriate signposting  “Advanced services” currently comprise five services. The first to be introduced was Medicines Use Reviews which community pharmacies can provide if they are providing all the essential services and have suitable training and accredited premises. In April 2010 a further two advanced services were introduced for both community pharmacy and appliance contractors. These are Appliance Use Reviews and Stoma Customisation Service. In October 2011 the fourth advanced service was introduced for community pharmacies, the New Medicines Service. Seasonal Influenza vaccination service was added in September 2015, this provides access to ‘flu vaccination at the community pharmacy for adults with health conditions that put them ‘at risk’. This service is re- commissioned each year and is available during the winter season ( September- March).  NHS Urgent Medicines Supply Advanced Service (NUMSAS) is being introduced as a pilot from January 2017. This service is designed to provide NHS 111 call handlers with a route to refer patients, who need an emergency supply of their medicines when they cannot get a prescription from their doctor, without being charged for their cost of the medicines.  Locally commissioned services (previously known as “enhanced services”) that are commissioned by NHS England. The Cheshire, Warrington and Wirral Area Team of NHS England commissioned a service from four pharmacies to hold stocks of medicines required in an emergency situation e.g. antivirals.

4.3 Since April 2013, the definition of pharmaceutical services in relation to the PNA do not include any services commissioned from pharmaceutical contractors by Local Authorities and Clinical Commissioning Groups.

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5.0 Essential Services

5.1 Dispensing Medicines or Appliances. Pharmacies are required to maintain a record of all medicines dispensed, and also to keep records of any interventions made which they judge to be significant. Whilst the terms of service requires a pharmacist to dispense any (non- blacklisted) medicine ‘with reasonable promptness’, for appliances the obligation to dispense arises only if the pharmacist supplies such products ‘in the normal course of his business’. The Electronic Prescription Service (EPS) has been implemented as part of the dispensing service. Prescription-linked interventions can be identified during the dispensing process and pharmacists can identify patients with specified health needs which should be addressed. The health needs that the HWB wish to be targeted could be agreed with the Cheshire, Warrington and Wirral Area Team of NHS England and the Local Pharmaceutical Committee (LPC).

5.2 Repeat Dispensing. Pharmacies will dispense repeat prescriptions and store the documentation if required by the patient. They will ensure that each repeat supply is required and seek to ascertain that there is no reason why the patient should be referred back to their General Practitioner (GP). This service is aimed at patients with long term conditions who have a stable medication routine and hence may have less opportunity to discuss any health issues with their GP or nurse. Pharmacists are required to check if a patient is using their medication. This gives them an opportunity to identify if a patient is not using their medication as intended and hence may not be getting the desired health outcomes for which they were prescribed. This process was introduced as a paper based process with low uptake by GPs. Now that EPS has been embedded, NHS Digital are supporting practices to use electronic repeat dispensing and targets have been added to the GMS contract. In the 2017-18 practices must reach a target of 25%.

5.3 Disposal of Unwanted Medicines. Pharmacies are obliged to accept back unwanted medicines from patients. The pharmacy will, if required by NHS England or the waste contractor, sort them into solids (including ampoules and vials), liquids and aerosols, and the Cheshire, Warrington and Wirral Area Team will make arrangements for a waste contractor to collect the medicines from pharmacies at regular intervals. Additional segregation is also required under the Hazardous Waste Regulations. Pharmacy staff have the opportunity to identify patients who have not taken the medicines they were prescribed. This can initiate a discussion and problems such as side effects or dosage regimes can be addressed to help improve the patients’ health outcomes. A significant amount of wasted NHS resource is attributed to medications being used incorrectly or not at all. Additionally NHS England North (Cheshire and Mersey) commissions the waste contractor to take away sharps (i.e. syringes used by diabetics, Epipens) which have been returned to the community pharmacy.

5.4 Public Health Campaigns and Promotion of Healthy Lifestyles. Each year pharmacies are required to participate in up to six public health campaigns at the request of the Cheshire, Warrington and Wirral Area Team. A number of these campaigns will be agreed nationally and a number will be local campaigns across the geography of Cheshire, Warrington and Wirral and agreed by Directors of Public Health. These campaigns involve the display and distribution of leaflets provided by NHS England. In addition, pharmacies are required to promote healthy lifestyles and undertake prescription-linked interventions on major areas of public health concern, such as encouraging smoking cessation. Since 2016 NHS England North (Cheshire and

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Mersey) has supported a project to get community pharmacies trained up as Healthy Living Pharmacies (HLPS). In Cheshire East there are 73 pharmacies which are fully accredited (December 2017).

Table 3: Accredited Healthy Living Pharmacies within Cheshire East as at December 2017

GP Locality name Area Pharmacy Address Postcode Alderley Edge CEDRICS CHEMIST LTD FESTIVAL HALL, TALBOT ROAD, ALDERLEY EDGE SK9 7HR Alderley Edge CEDRICS CHEMISTS LTD 20 LONDON ROAD, ALDERLEY EDGE, CHESHIRE SK9 7JS Handforth INSTORE PHARMACY KILN CROFT LANE, HANDFORTH, WILMSLOW SK9 3PA Alderley Edge, Chelford, Prestbury THE VILLAGE PHARMACY UNICORN HOUSE, PRESTBURY, MACCLESFIELD SK10 4DG Handforth, Wilmslow Handforth WELL HANDFORTH - 110 WILMSLOW ROAD 110 WILMSLOW ROAD, HANDFORTH, CHESHIRE SK9 3ES Handforth WELL HANDFORTH - HANDFORTH HC HANDFORTH HEALTH CENTRE, WILMSLOW ROAD, HANDFORTH SK9 3HL Wilmslow WELL WILMSLOW - KENMORE MC KENMORE MEDICAL CENTRE, 60-62 ALDERLEY ROAD, WILMSLOW SK9 1PA Wilmslow WELL WILMSLOW - WILMSLOW HC WILMSLOW HEALTH CENTRE, CHAPEL LANE, WILMSLOW SK9 5HX Macclesfield ANDREWS PHARMACY 71 KENNEDY AVENUE, MACCLESFIELD, CHESHIRE SK10 3DE Macclesfield BOOTS UK LIMITED 12 MILL STREET MALL, THE GROSVENOR CENTRE, MACCLESFIELD SK11 6AJ Macclesfield COHENS CHEMIST WATERS GREEN MEDICAL CTR, SUNDERLAND STREET, MACCLESFIELD SK11 6JL Macclesfield INSTORE PHARMACY TESCO SUPERSTORE, HIBEL ROAD, MACCLESFIELD SK10 2AB Macclesfield LLOYDSPHARMACY 61 CUMBERLAND STREET, , MACCLESFIELD SK10 1BJ Macclesfield Macclesfield LLOYDSPHARMACY 46-48 CHARLOTTE STREET, MACCLESFIELD, CHESHIRE SK11 6JB Macclesfield LONDON ROAD PHARMACY UNIT 1, 157 LONDON ROAD, MACCLESFIELD SK11 7SP Macclesfield PEAK PHARMACY 5-6 WESTON SQUARE, EARLSWAY, MACCLESFIELD SK11 8SS Macclesfield - Tytherington TYTHERINGTON PHARMACY 2-3 THE PRECINCT, TYTHERINGTON, MACCLESFIELD SK10 2HB Macclesfield WELL MACCLESFIELD - 209 PARK LANE 209 PARK LANE, MACCLESFIELD, CHESHIRE SK11 6UD Macclesfield WELL MACCLESFIELD - SUNDERLAND STREET 78-80 SUNDERLAND STREET, MACCLESFIELD, CHESHIRE SK11 6HN Poynton ROWLANDS PHARMACY 67 PARK LANE, POYNTON, CHESHIRE SK12 1RD Macclesfield - Bollington ROWLANDS PHARMACY THE WATERHOUSE, WELLINGTON ROAD, BOLLINGTON SK10 5JH Bollington, Disley, Poynton Disley WELL DISLEY - FOUNTAIN SQUARE 11 FOUNTAIN SQUARE, DISLEY, STOCKPORT SK12 2AB Poynton WELL POYNTON - PARK LANE 4 PARK LANE, POYNTON, STOCKPORT SK12 1RE Knutsford BOOTS UK LIMITED 64 KING STREET, KNUTSFORD, CHESHIRE WA16 6DT Knutsford MANNINGS 38 PRINCESS STREET, , KNUTSFORD WA16 6BN Knutsford ROWLANDS PHARMACY 4 PARKGATE LANE, , KNUTSFORD WA16 8HG Knutsford Knutsford ROWLANDS PHARMACY 6 CANUTE PLACE, , KNUTSFORD WA16 6BH Knutsford THE PRESCRIPTION SERVICE 11 TATTON STREET, KNUTSFORD, CHESHIRE WA16 6AB Mobberley WELL MOBBERLEY - TOWN LANE 93 TOWN LANE, KNUTSFORD, MOBBERLEY WA16 7HH Congleton BOOTS UNIT E RETAIL PARK, BARN ROAD, CONGLETON CW12 1LJ Congleton BOOTS UK LIMITED 14-16 BRIDGE STREET, CONGLETON, CHESHIRE CW12 1AY Congleton CONGLETON PHARMACY READESMOOR GROUP PRACTICE, 29-31 WEST STREET, CONGLETON CW12 1JP Congleton INSTORE PHARMACY BARN ROAD, CONGLETON, CHESHIRE CW12 1LR Congleton LLOYDSPHARMACY 41A WEST STREET, CONGLETON, CHESHIRE CW12 1JN Holmes Chapel LLOYDSPHARMACY 39-41 LONDON ROAD, HOLMES CHAPEL, CHESHIRE CW4 7AP Congleton, Holmes Chapel Congleton - Mossley MOSSLEY PHARMACY 18 BIDDULPH ROAD, MOSSLEY, CONGLETON CW12 3LG Congleton - Buglawton SALUS PHARMACY 62B HAVANNAH STREET, BUGLAWTON, CONGLETON CW12 2AT Congleton SUPERDRUG PHARMACY 39-41 HIGH STREET, CONGLETON, CHESHIRE CW12 1AU Congleton WELL CONGLETON - MILL STREET 2 MILL STREET, , CONGLETON CW12 1AB Congleton WELL CONGLETON - PARK LANE 1 PARK LANE, CONGLETON, CHESHIRE CW12 3DN Congleton WEST HEATH PHARMACY UNIT 3, WEST HEATH SHOPPING PCT., CONGLETON CW12 4NB Nantwich BOOTS UK LIMITED 14 SWINEMARKET, NANTWICH, CHESHIRE CW5 5LN Nantwich LLOYDSPHARMACY MIDDLEWICH ROAD, NANTWICH, CHESHIRE CW5 6PH Nantwich MORRISONS PHARMACY STATION ROAD, NANTWICH, CHESHIRE CW5 5SP Nantwich Nantwich WELL NANTWICH - BEAM STREET 57 BEAM STREET, NANTWICH, CHESHIRE CW5 5NF Nantwich WELL NANTWICH - CHURCH VIEW MC CHURCH VIEW CARE CENTRE, BEAM STREET, NANTWICH CW5 5NX Audlem YOUR LOCAL BOOTS PHARMACY 1 CHESHIRE STREET, AUDLEM, CREWE CW3 0AH Crewe ASDA PHARMACY VICTORIA CENTRE, CREWE, CHESHIRE CW1 2PT Crewe BOOTS UNIT 12, GRAND JUNCTION RETAIL PK, CREWE CW1 2RP Crewe BOOTS UK LIMITED 56-58 MARKET STREET, CREWE, CHESHIRE CW1 2EX Crewe CLEAR PHARMACY 31-32 THE MARKET CENTRE, VICTORIA STREET, CREWE CW1 2NG Crewe EAGLE BRIDGE PHARMACY EAGLE BRIDGE HEALTH CTR, DUNWOODY WAY, CREWE CW1 3AW Crewe INSTORE PHARMACY VERNON WAY, , CREWE CW1 2DD Crewe ROWLANDS PHARMACY 66 RICHARD MOON STREET, CREWE, CHESHIRE CW1 3AX Crewe Crewe - Wistaston ROWLANDS PHARMACY 7 KINGS DRIVE, WISTASTON, CREWE CW2 8HY Crewe - Coppenhall RYDALE PHARMACY 18 NORTH STREET, COPPENHALL, CREWE CW1 4NL Crewe WELL CREWE - BROOKHOUSE DRIVE 1A BROOKHOUSE DRIVE, CREWE, CW2 6NA Crewe WELL CREWE - HUNGERFORD MC HUNGERFORD MEDICAL CENTRE, SCHOOL CRESCENT, CREWE CW1 5HA Crewe WELL CREWE - NANTWICH ROAD 139-141 NANTWICH ROAD, CREWE, CW2 6DF Crewe - Shavington WELL SHAVINGTON - ROPE GREEN MC ROPE LANE MEDICAL CENTRE, ROPE LANE, SHAVINGTON, CREWE CW2 5DA Crewe - Wistaston WELL WISTASTON - THE PRECINCT 3 THE PRECINCT, READESDALE AVENUE, WISTASTON CW2 8UR Crewe WEST STREET PHARMACY 143 WEST STREET, , CREWE CW1 3HH Sandbach BOOTS UK LIMITED 5-7 HIGH STREET, SANDBACH, CHESHIRE CW11 1AH Middlewich CLEDFORD PHARMACY 70 WARMINGHAM LANE, MIDDLEWICH, CHESHIRE CW10 0DJ Alsager LLOYDSPHARMACY 25 LAWTON ROAD, ALSAGER, CHESHIRE ST7 2AA Sandbach MOSTON PHARMACY SERVICES G2 DRAGONS WHARF, DRAGONS LANE, SANDBACH CW11 3PA Middlewich ROWLANDS PHARMACY 28 WHEELOCK STREET, MIDDLEWICH, CHESHIRE CW10 9AG SMASH Crewe - Haslington ROWLANDS PHARMACY HASLINGTON SURGERY, CREWE ROAD, HASLINGTON, CREWE CW1 5QY Middlewich ROWLANDS PHARMACY ST ANNE'S WALK, , MIDDLEWICH CW10 9BE Alsager WELL ALSAGER - LAWTON ROAD LAWTON ROAD, ALSAGER, CHESHIRE ST7 2AA Sandbach WELL SANDBACH - ASHFIELDS MC ASHFIELDS P/CARE CENTRE, MIDDLEWICH ROAD, SANDBACH CW11 1DH Sandbach WELL SANDBACH - THE COMMONS UNIT 3, THE COMMONS, SANDBACH CW11 1EG Sandbach - Elworth WISE PHARMACY 11 LONDON ROAD, ELWORTH, SANDBACH CW11 3BD

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5.5 Signposting. Pharmacies will be expected to help people who ask for assistance by directing them to the most appropriate source of help, if they are unable to resolve the person’s issue. HLPs have additional training to support this function.

5.6 Support for Self Care. Pharmacies will help to manage minor ailments and common conditions, by the provision of advice and where appropriate, the sale of medicines, including dealing with referrals from NHS Direct/NHS 111. Records will be kept where the pharmacist considers it relevant to the care of the patient.

5.7 Clinical Governance. The clinical governance requirements of the community pharmacy contractual framework cover a range of quality related issues. In December 2016 the Department of Health introduced the Quality Payments scheme for community pharmacy contractors. This attached payments, for community pharmacy contractors, subject to them meeting a range of quality criteria. Although new it is it is anticipated that the quality incentives will continue but that criteria will evolve over time to encourage continuous improvements . The arrangements for some of the criteria for a distance selling pharmacy are slightly different.

6.0 Advanced Services

6.1 NUMSAS. From 1st December 2017, community pharmacies across England have been able to register on the NHS Business Services Authority (BSA) portal to provide the NHS Urgent Medicines Supply Advanced Service (NUMSAS) as part of a national pilot. The Service, which is commissioned by NHS England, will allow community pharmacies to supply a repeat medicine at NHS expense, following a referral from NHS 111 and where the pharmacist identifies that the patient has an immediate need for the medicine and that it is impractical to obtain a prescription without undue delay.

6.2 Flu Vaccination. As part of the community pharmacy funding settlement community pharmacies in England are now able to offer a seasonal influenza (Flu) vaccination service for patients in at-risk groups. This service is the fifth Advanced Service in the English Community Pharmacy Contractual Framework (CPCF). Immunisation is one of the most successful and cost- effective health protection interventions and is a cornerstone of public health. High immunisation rates are key to preventing the spread of infectious disease, complications and possible early death among individuals and protecting the population’s health. For most healthy people, influenza is an unpleasant but usually self-limiting disease. However those with underlying disease are at particular risk of severe illness if develop influenza. The aim of the seasonal influenza vaccination programme is to protect adults and children who are most at risk should they develop influenza, by offering protection against the most prevalent strains of influenza virus

The service can be provided for adults by any community pharmacy in England that fully meets the requirements for provision of the service and has notified NHS England of their intention to begin providing the service by completing a notification form on the NHS BSA website.

6.3 Medicines Use Review and Prescription Intervention Service (MUR). The Medicines Use Review and Prescription Intervention Service is an advanced service provided under the community pharmacy contractual framework. MURs can only be provided by pharmacies. The

Page 17 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 service includes MURs undertaken periodically or when there is a need to make an adherence- focused intervention due to a problem that is identified while providing the dispensing service (a prescription intervention MUR).

6.3.1 The purpose of the MUR service is to improve patient knowledge, adherence and use of their medicines by:

 establishing the patient’s actual use, understanding and experience of taking medicines  identifying, discussing and resolving poor or ineffective use of medicines  identifying side effects and drug interactions that may affect adherence  improving the clinical and cost effectiveness of prescribed medicines and reducing medicine wastage

6.3.2 The following four national target groups for MURs are:

 patients taking the following high risk medicines: non-steroidal anti-inflammatory drugs, anticoagulants including low molecular weight heparin, antiplatelets and diuretics  patients recently discharged from hospital who had changes made to their medicines while they were in hospital. Ideally patients discharged from hospital will receive an MUR within four weeks of discharge but in certain circumstances the MUR can take place within eight weeks of discharge  patients with respiratory disease taking the following medicines for asthma or COPD: adrenoreceptor agonists, antimuscarinic bronchodilators, theophylline, compound bronchodilator preparations, corticosteroids, cromoglycate and related therapy, leukotriene receptor antagonists and phosphodiesterase type-4 inhibitors  patients at risk of, or diagnosed with, cardiovascular disease and regularly being prescribed at least four medicines for any of the following conditions: coronary artery disease, diabetes, atrial fibrillation, peripheral artery disease, chronic kidney disease, hypertension, thyroid disease, heart failure, stroke/transient ischaemic attack, lipid disease

6.3.3 The service is nationally available to a national service specification, but is established locally between the Cheshire, Warrington and Wirral Area Team of NHS England and community pharmacies. A fee per MUR is payable to all pharmacy contractors that choose to provide the services and meet the requirements for this service. The maximum any contractor can be paid for under the advanced service is 400 MURs a year and at least 70% of all MURs undertaken by each pharmacy in each year should be on patients within the national target groups.

6.3.4 In 2015-16, a total of 23,996 MURs were carried out in Cheshire East, 21 out of the contracted 81 pharmacies delivered 400 or more MURs within the year. This represents an average of 296 delivered in each community pharmacy contracted, compared to an average of 304 in Cheshire and Mersey and an average of 300 in England. The volume increased in 2016-17 to 25,206, an average of 311 delivered in each community pharmacy contracted compared to a dcrease in both the Cheshire and Mersey average to 284 and nationally to an average of 292 per pharmacy.

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6.4 Appliance Use Review (AUR). Appliance Use Review (AUR) is the second advanced service and was introduced into the NHS community pharmacy contract on 1 April 2010. This service can be provided by either community pharmacy or appliance contractors and can be carried out by a pharmacist or a specialist nurse either at the contractor’s premises or at the patient's home.

6.4.1 The service has a national service specification, but was established locally between Primary Care Trusts and their pharmacy contractors. A fee is payable to all community pharmacy and appliance contractors for each AUR they have carried out. There is a different fee depending on whether the AUR was carried out in the patient’s home or on the contractor’s premises. The maximum number of AURs for which a contractor is eligible to be paid for under this service is not more 1/35th of the aggregate number of specified appliances dispensed by the contractor during the financial year.

6.4.2 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 assisting in the resolution of poor or ineffective use of the appliance by the patient  advising the patient on the safe and appropriate storage of the appliance  advising the patient on the safe and proper disposal of the appliances that are used or unwanted

6.4.3 No community pharmacies provide this service in Cheshire East. The number of Cheshire East patients who access the service in other areas is not known.

6.5 Stoma Appliance Customisation (SAC). Stoma Appliance Customisation (SAC) is the third advanced service in the NHS community pharmacy contract and was also introduced on 1 April 2010. The service involves the customisation of a quantity of more than one stoma appliance, 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 the duration of usage, thereby reducing waste. This service can be provided by either pharmacy or appliance contractors.

6.5.1 In 2016/17 there were 96 SACs carried out in Eastern Cheshire CCG and 82 in South Cheshire CCG, giving a total of 178 across the council. Although we know there is cross- boundary activity, the number of Cheshire East patients accessing this service in other areas is unknown.

6.6 New Medicines Service (NMS). The New Medicines Service (NMS) is the fourth advanced service to be introduced in the NHS community pharmacy contract and was introduced on 1 October 2011. This service can be provided by pharmacies only. The NMS was originally implemented as a time-limited service but is now an ongoing service within the Community Pharmacy Contract.

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6.6.1 The New Medicines Service aims to:

 help patients and carers manage newly prescribed medicines for a long-term condition (LTC) and make shared decisions about their LTC  recognise the important and expanding role of pharmacists in optimising the use of medicines  increase patient adherence to treatment and consequently reduce medicines wastage and contribute to the NHS Quality, Innovation, Productivity and Prevention agenda  supplement and reinforce information provided by the GP and practice staff to help patients make informed choices about their care  promote multidisciplinary working with the patient’s GP practice  link the use of newly-prescribed medicines to lifestyle changes or other non-drug interventions to promote well-being and promote health in people with LTCs  promote and support self-management of LTCs, and increase access to advice to improve medicines adherence and knowledge of potential side effects  support integration with LTC services from other healthcare providers and provide appropriate signposting and referral to these services  improve pharmacovigilance,  through increased adherence to treatment, reduce medicines-related hospital admissions and improve quality of life for patients

6.6.2 In 2015-16, the New Medicines Service was provided by 100% of the community pharmacies in Cheshire East. A total of 5,874 NMSs were carried out, representing an average of 72 in each community pharmacy compared to an average of 87 in England. The volume increased in 2016-17 to 6,243 in Cheshire East, an average of 77 compared to a decrease in the national average to 83 per pharmacy.

6.6.3 The NMS is focused on the following patient groups and conditions. For each, a list of medicines has been agreed. If a patient is newly prescribed one of these medicines for these conditions, they will be eligible to receive the service:

 asthma and chronic obstructive pulmonary disease  type 2 diabetes  antiplatelet/anticoagulant therapy (mainly but not exclusively used for atrial fibrillation)  hypertension

6.6.4 There is no routine information available about the use of NMSs for each condition, so it is not currently possible to estimate the proportion of new patients in Cheshire East who receive this service. However, the current overall volume of service is likely to be sufficient to meet need, providing the use of this service is appropriately targeted.

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7.0 Locally Commissioned Services

7.1 Services Commissioned by Cheshire East Council 7.1.1 Under the Health and Social Care Act 2012, responsibility for commissioning certain public health services sits in Local Authorities. It is now mandatory for Cheshire East Council to commission community based sexual health services, NHS Health Checks and the National Child Measurement Programme. Local authorities can also commission other public health services according to local needs. Other public health services are commissioned by NHS England for example, screening and immunisation programmes.

7.1.2 Several public health services may be provided by and within community pharmacies. This is evident in current local arrangements. In 2016, many local authority services were re- commissioned through a formal recommissioning process. In commissioning these services, efforts have been taken to ensure that the provision reflects local needs. The table below illustrates the number and proportion of community pharmacies that provide public health services currently commissioned by Cheshire East Council. Pharmacy level tables can be found in the Appendix B.

Table 4: Pharmacies providing Public Health Services by GP Clusters

Chlamydia Screening Emergency Option 2 – Stop Hormonal Quick Start Testing and Smoking and No. Contraception Contraceptio Option 1 – treatment Alcohol Supervised Needle GP Locality Pharmacies (EHC) n Postal kit service Services Consumption Exchange Alderley Edge, Chelford, ECCCG01 Handforth, Wilmslow 11 4 4 1 1 5 3 2 ECCCG02 Macclesfield 12 7 6 3 2 3 8 7 ECCCG03 Bollington, Disley, Poynton 4 2 2 2 2 4 2 0 ECCCG04 Knutsford 6 5 4 3 3 2 3 1 ECCCG05 Congleton, Holmes Chapel 14 8 7 4 2 2 10 3 SCCCG01 Nantwich and Rural 6 5 5 2 2 2 5 1 SCCCG02 Crewe 15 14 14 7 5 6 12 4 SCCCG03 SMASH 13 7 7 5 3 7 6 4

NHS Eastern Cheshire CCG area 47 26 (55%) 23 (49%) 13 (28%) 10 (21%) 16 (34%) 26 (55%) 13 (28%) NHS South Cheshire CCG area 34 26 (76%) 26 (76%) 14 (41%) 10 (29%) 15 (44%) 23 (68%) 9 (26%)

Cheshire East 81 52 (64%) 49 (60%) 27 (33%) 20 (25%) 31 (38%) 49 (60%) 22 (27%)

Data Source: Public Health Commissioners

7.1.3 Emergency Hormonal Contraception (EHC). This service facilitates the provision of Levonorgestrel and Ulipristal Acetate for Emergency Hormonal Contraception (EHC) by pharmacists in Cheshire East. This is provided when appropriate to clients in line with the requirements of a Patient Group Direction (PGD). As part of the assessment for eligibility, under 16s must be competent to consent to the treatment (Fraser competencies). The service constitutes a particularly important component of the total contraceptive and sexual health service provision and is essential in order to support the service already provided by sexual health clinics provided by East Cheshire Trust. The service helps to support the reduction of teenage pregnancy.

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7.1.4 EHC is available from 64% of community pharmacies in Cheshire East, although this proportion is higher in the Crewe, Knutsford and Nantwich and Rural GP Clusters. The lowest level of provision is in the Alderley Edge, Chelford, Handforth, Wilmslow GP Cluster at 36%, however the Bollington, Disley, Poynton GP Cluster has only has two pharmacies that are contracted to provide this service, however neither pharmacy provided EHC under the scheme in 2016/17.

7.1.5 Quick Start Contraception. This concerns the provision of free starter packs for women to start on oral contraception under a Patient Group Direction, specifically a progestogen only pill (POP). Quick Start Contraception is used as a bridging method for women accessing EHC with a view to service users obtaining further supplies via (in most cases) their local GP or local sexual health clinic. It is anticipated that this service will be available from November 2017.

7.1.6 Chlamydia screening service for people aged 15-24. Established in 2003 the National Chlamydia Screening Programme (NCSP) aims to prevent and control chlamydia through early detection, treatment of infection and reduction in onward transmissions in young people between the ages of 15 to 24. Chlamydia is the most commonly diagnosed sexually transmitted infection (STI) in England. If left untreated it can have serious long-term consequences including infertility and pelvic inflammatory disease in women and epididymitis in men. It often has no symptoms but is very easy to diagnose and treat. The aims of this service include increasing access to the programme by providing additional locations where people can access testing and treatment for chlamydia under a PGD. Commissioned pharmacies can distribute postal chlamydia testing kits and/or can provide a chlamydia treatment service for patients referred by East Cheshire NHS Trust who will carry out partner notification and contact tracing. It is anticipated that this service will be available at the end of 2017.

7.1.7 C-card. A small number of pharmacies have signed up to be a registration and distribution site for the c-card scheme which provides free condoms to people aged under 30. The c-card scheme is co-ordinated by Body Positive who is a sub-contractor to the Sexual Health contract with East Cheshire NHS Trust.

7.1.8 Stop smoking and alcohol services. This service forms part of the One You Cheshire East services and aims to improve access to stop smoking services by establishing a one to one stop smoking service in community pharmacies, with Nicotine Replacement Therapy (NRT) dispensing and stop smoking consultation. More recently, Varenicline (Champix) may also be offered under a Patient Group Direction. The service aims to improve the health of the local population by supporting as many quitters as possible to the four week quit target, especially through the targeting of smokers living in deprived areas. In addition, as part of this service, pharmacies are also delivering identification and brief advice of increased risk drinking to enable individuals to change their drinking behaviour and thus reduce alcohol related harm.

More detailed needs analysis for drugs and alcohol was undertaken recently and can be found within the Cheshire East Drugs and Alcohol JSNA (February 2017), which is being used to inform commissioning decisions. The JSNA contains an asset map identifying Pharmacy Treatment Services within Cheshire East; pharmacies were identified as potential deliverers for the Wider delivery of Identification and Brief Advice (IBA).

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The Tobacco JSNA (June 2017) highlighted pharmacies as key providers in identification and brief intervention with new commissioned services:-  Between the two community pharmacies (Well and Rowlands) identifying smokers within their own patient population including via medication reviews  Community Stop Smoking Services also commissioned to provide alcohol brief intervention  All Cheshire East pharmacists dispensing Nicotine Replacement Therapy via the local voucher scheme to support smokers to quit

7.1.9 Supervised consumption and needle exchange. This includes supervised consumption of prescribed opiate maintenance treatment (Methadone or Buprenorphine) at the point of dispensing in the pharmacy, ensuring that the dose has been consumed by the patient. In addition, needle exchange schemes aim to reduce the rate of blood-borne infections and drug related deaths among service users and support the safe disposal of used injecting equipment.

7.1.10 In total, 51 pharmacies provide supervised consumption and/or needle exchange services to drug users, 31 pharmacies providing one of these services and 20 providing both services. The Alderley Edge, Chelford, Handforth, Wilmslow GP Cluster has the lowest proportion of pharmacies providing drug services, although three pharmacies do provide supervised consumption and two needle exchange. There is a good provision of pharmacy-based drug services across the Cheshire East area.

7.1.11 The Future of Public Health Commissioning in Pharmacies in Cheshire East. Contracts for many public health services will be due for review during the life cycle of the current pharmaceutical needs assessment. Community pharmacies in Cheshire East could potentially offer several public health services. Within the Community Pharmacy Survey, pharmacies were asked about additional Public Health services they would consider providing. A total of 76 (94%) pharmacies would be willing to provide Obesity Mangement for adults and children and 71 (88%) would be interested in delivering NHS Health Checks. Apart from the Drug services, only small numbers of pharmacies indicated that they would not be willing to provide the existing Public Health Services but the willingness expressed within the survey responses is not reflected in the numbers of pharmacies currently contracted to provide these services. Numbers of pharmacies unwilling to provide Public Health services was as follows:-

Emergency hormonal contraception (EHC) 2 (2.5%) Quick Start Contraception 4 (4.9%) Chlamydia Testing 7 (8.6%) Chlamydia Treatment Services 7 (9.9%) Stop Smoking and alcohol services: Smoke cessation counselling 5 (6.2%), NRT Voucher dispensing (7.4%) and Varenicline PGD 4 (4.9%) Supervised consumption and needle exchange: Needle and Syring Exchange service 15 (18.5%) and Supervised Administration 8 (9.9%)

Interestingly, the results of the survey of residents in Cheshire East indicate that there is low uptake of or interest in using the four current Public Health services provided, percentages responding ‘haven’t used and don’t intend to use in the future’ were 85% for sexual health

Page 23 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 service, 89% emergency hormonal contraception, 90% stop smoking service and 93% substance misuse service. However, these results need to be considered with caution as the age distribution of the respondents to the public survey is not representative of the Cheshire East population as a whole, it is heavily skewed towards the 55 to 64 and 65 to 74 age groups with overrepresentation in both these age groups (see Appendix A for more details of the characteristics of respondents). Certain sexual health and emergency hormal contraception services offered by pharmaceutical providers may not be consideration for many within these age groups. Also, substance misuse services are only needed by a small proportion of the population, the JSNA stated that there were 786 opiate and crack users in treatment in Cheshire East during 2015/16.

7.2 Services Commissioned by South Cheshire CCG and Eastern Cheshire CCG

7.2.1 Think Pharmacy Urgent Palliative Care Medicines Service. This service is commissioned from 29 pharmacies (15 in NHS Eastern Cheshire CCG and 14 in NHS South Cheshire CCG) to ensure that residents in Cheshire East have access to a defined list of medicines that should be provided to patients nearing the end of their life. Each pharmacy providing the service receives a retainer payment to hold the palliative care formulary list of medicines in stock in anticipation of receiving prescriptions to dispense at short notice. The medicines can then be provided to the patient to have at their home so that they can be administered if needed for palliative care. Not all of the medicines may be needed by each patient, but all are prescribed to ensure that they are available if the need arises. The service was reviewed in early 2017 to ensure provision was up to date. The service is currently available from 7 of the pharmacies that provide services for 100 hours per week.

7.2.2 Think Pharmacy Minor Ailments Service. The Think Pharmacy Minor Ailments Service aims to support patients to recover quickly and successfully from episodes of ill health that are suitable for management in a community pharmacy setting. The service is currently provided by 42 (52%) community pharmacies in Cheshire East (20 in NHS Eastern Cheshire CCG and 22 in NHS South Cheshire CCG). It aims to divert patients with specified minor ailments from general practice and urgent care settings into community pharmacies, where the patient can be seen and treated in a single episode of care. Both South Cheshire CCG and Eastern Cheshire CCG are keen to see patients supported to self-care for minor limiting conditions. This service was reviewed in early 2017.

7.2.3 In the public survey, use of the minor ailments service had remained almost static in terms of those respondents who had used the service, 30% in 2015 and 28% in 2017. However, it was promising to find that over half of respondents, 54% in 2017, selected that they hadn’t used the service but might in the future, in comparison to 39% in 2015. In line with this finding, the proportion of those selecting that they hadn’t used a service and don’t intend to in the future had decreased from 27% in 2015 to 15% in 2017. The Healthwatch enquiry around the Minor Aliments Service found that awareness was variable but roughly 50% of respondents were aware of the alternative services available. Healthwatch Cheshire East felt that it was an important option for people to seek help and support for their healthcare needs via pharmacies and concluded that they would continue to inform the public about pharmacy services. It has been nearly 12 months since the Healthwatch report and the results from the more recent public survey may reflect the awareness work undertaken since November 2016.

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8.0 Dispensing Appliance Contractors (DAC)

8.1 DAC are unable to supply medicines. Most specialise in dispensing stoma appliances, such as colostomy, urostomy and ileostomy bags and associated products, providing a specialist service to a niche market. DACs cover a wider geographical area than a community pharmacy, often spanning more than one health locality or providing services nationwide. Every DAC has to provide mandatory essential services relating to these products and can choose to provide two advanced services: Appliance Use Reviews (AURs) and Stoma Appliance Customisation (SAC).

8.2 Cheshire East has no DACs within its boundaries. Cheshire East patients requiring appliances may be served by appliance contractors from other areas of the country operating within a network of local distribution centres on a national basis. There have been no reported issues from patients or prescribers to indicate that patients in Cheshire East have difficulty in obtaining the products that they require.

8.3 Pharmacy contractors can choose to accept prescriptions for appliances and dispense them under their pharmaceutical contract to obtain the service from a DAC or wholesaler located at a national distribution site. It is often a joint decision between the specialist from secondary care and the patient as to where the prescription for an appliance is sent and thus how the dispensing appliance service is provided.

9.0 Distance Selling Pharmacies

9.1 In Cheshire East, there are currently three distance selling/ internet pharmacies, two are located within the SMASH GP Cluster and the third falls within the Congleton, Holmes Chapel GP Cluster boundary. The three distance selling pharmacies are currently responsible for dispensing 0.6% of prescriptions issued to patients registered with Cheshire East practices.

9.2 In the public survey, 28 respondents regularly use an online pharmacy, with an additional 56 who sometimes use an online pharmacy. 38% (254) had not used an online pharmacy, but may in the future.

10.0 Dispensing Doctors

10.1 Pharmacies may not always be viable in more rural areas. This is where the services of dispensing doctors can play an important role in ensuring that patients receive their medicines promptly, efficiently, conveniently and to high standards. Certain conditions have to be met to determine whether or not a patient is eligible to receive NHS dispensing services from a general practitioner. They need to live in a designated controlled locality (which is an area that has been determined by NHS England or a predecessor organisation to be 'rural in character’) and also live more than 1.6km (as the crow flies) from a pharmacy. Patients who live within 1.6km of a

Page 25 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 pharmacy cannot be dispensed to, unless they live in a reserved location that was defined in connection with a pharmacy, or the pharmacy is a distance selling pharmacy.

10.2 In the Cheshire East Health and Wellbeing Board area as at the 4th October 2017 there are currently eight practice premises at which dispensing doctor services are available to eligible patients. These are:

 Annandale Medical Centre, Knutsford  Mobberley Surgery, Mobberley (a branch surgery of Annandale MC)  Bunbury Medical Practice, Bunbury (a practice in NHS West Cheshire CCG)  Chelford Surgery, Chelford  Greenmoss Medical Centre, Scholar Green  Rode Heath Surgery, Rode Heath (a branch surgery of Greenmoss MC) – closing 28th October 2017  Holmes Chapel Health Centre, Holmes Chapel  Wrenbury Medical Practice, Wrenbury

10.3 The four dispensing practices that are commissioned by the Eastern Cheshire CCG and Wrenbury Medical Practice commissioned by South Cheshire CCG dispensed 362,152 items during 2016/17, almost 5% of all items prescribed and dispensed within the borough. This is the equivalent of an average of 6036 items per month per dispensary.

10.4 The Rode Heath Surgery closed on 28th October 2017. 79% of the items prescribed by Greenmoss Medical Centre are dispensed by the practice, we are unable to determine the proportion relating to the branch surgery at Rode Heath and thus effected by the closure. Patients can remain registered with the GPs at the main surgery, Greenmoss Medical Centre, Portland Drive, Scholar Green, Stoke on Trent and have any presriptions dispensed there. Alternatively patients could use the three pharmacies in Alsager (approximately 2 miles by car from Rode Heath), all of which offer a free delivery service.

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11.0 Community Pharmacy Provision Commissioned in Cheshire East 11.1 At the beginning of October 2017 there were 81 community pharmacies, including 3 that operate as a distance selling pharmacy, and 8 dispensing general practices on the pharmaceutical list in Cheshire East. There were no dispensing appliance contractors.

Table 5: Community dispensing premises located in Cheshire East, May 2017

GP Distance Dispensing Practices Of which, Community Selling Appliance (Main & Branch Dispensing GP Clusters Pharmacies Pharmacies Contractors Surgeries) GP Practices Alderley Edge, Chelford, Handforth, Wilmslow 11 0 0 7 1 Macclesfield 12 0 0 6 Bollington, Disley, Poynton 4 0 0 4 Knutsford 6 0 0 4 2 Congleton, Holmes Chapel 14 1 0 4 1 Nantwich and Rural 6 0 0 6 2 Crewe 15 0 0 6 SMASH 13 2 0 8 2

NHS Eastern Cheshire CCG area 47 1 0 25 4 NHS South Cheshire CCG area 34 2 0 20 4

Cheshire East 81 3 0 45 8

GP Practices allocated to Localities according to their physical position GP Practices include Bunbury Medical Practice and Hulme Hall Medical Group as they lie within Cheshire East Data Source: National GP Practice and Pharmacy tables as at May 2017

11.2 Cheshire East’s Pharmaceutical Needs Assessment published in March 2015 identified 79 community pharmacies which fell within the Cheshire East Local Authority boundary. The number of pharmacies is now 81, an overall increase of 2 (2.5%). The number of 100 hour pharmacies has remained the same. The table below shows the change across the various localities.

11.3 There is a very strong correlation between population size and the number of local community pharmacies. The highest population density areas of the towns of Crewe, Macclesfield, Congleton and Wilmslow have between eight and fifteen pharmacies. Most of the main towns in Cheshire East are served by at least two pharmacies. Several towns and villages have a single community pharmacy, including Audlem, Bollington, Disley, Goostrey, Haslington, Holmes Chapel, Mobberley, Prestbury and Shavington.

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Table 6: Changes in numbers of community pharmacies since last PNA

Data Source: National Pharmacy tables as at May 2017, Pharmacy Survey 2017

11.4 Figure 1 illustrates the national distribution of the number of community pharmacies per 100,000 population. In 2016/17 there were 21 pharmacies per 100,000 in England. According to the list released in May 2017, City of London Borough had the most pharmacies with 180 per 100,000 and Uttlesford CD (Essex) the least pharmacies with 9 per 100,000. Cheshire East’s rate of 21.5 per 100,000 is similar to the England average. The chart illustrates the fact that there are fewer community pharmacies in the NHS South Cheshire CCG area (19 per 100,000) than in the NHS Eastern Cheshire CCG area (24 per 100,000).

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Figure 1: Pharmacies per 100,000 population, May 2017

Data Source: National Pharmacy tables as at May 2017, ONS Population estimates: Persons by single year of age and sex for local authorities in the UK, mid-2016 General Pharmaceutical Services England 2007/08 to 2016/17 Appendix 1 Table 3 Publication date: 07/11/2017

11.5 Table 7 shows the number of community pharmacies per 100,000 population for the eight GP Cluster areas in Cheshire East. The Congleton, Holmes Chapel GP Cluster, Alderley Edge, Chelford, Handforth, Wilmslow GP Cluster and Knutsford GP Cluster all have a higher rate i.e. have more pharmacies per 100,000 than the Cheshire East average, while Macclesfield, Nantwich, Crewe, SMASH and Bollington, Disley, Poynton GP Clusters have fewer. The area with the lowest number of community pharmacies per 100,000 is Bollington, Disley, Poynton GP Cluster, however the rate is still within the normal range and is not significantly different statistically to either Cheshire East or England. The area is also served by several pharmacies in Cheadle Hulme and Hazel Grove which lie just outside the area. The number of pharmacies required within an area can not be based purely on the size of the local population, the population served by a particularly pharmacy can be hard to determine as people chose to use a specific pharmacy for various reasons. The results from the patient survey showed 41% used a pharmacy near to their GP Practice and 33% used one near shops. Easy of parking (26%), range of services offered (71%) or products available (77%) were also important, as well as knowledgeable (95%) and friendly staff (86%). Economical viablilty and transport links will also determine where pharmacies are located.

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Table 7: Community pharmacies per 100,000 population, Cheshire East

Community pharmacies per 100,000 population Community Population Pharmacies per GP Clusters Pharmacies Mid 2015 100,000 population Alderley Edge, Chelford, Handforth, Wilmslow 11 44657 25 Macclesfield 12 61788 19 Bollington, Disley, Poynton 4 26403 15 Knutsford 6 25090 24 Congleton, Holmes Chapel 14 38587 36 Nantwich and Rural 6 37030 16 Crewe 15 77755 19 SMASH 13 64082 20 CCGs NHS Eastern Cheshire CCG area 47 196525 24 NHS South Cheshire CCG area 34 178867 19

Cheshire East 81 375392 22 England 21 Data Source: National Pharmacy tables as at May 2017, ONS Population estimates: Persons by single year of age and sex for LSOA, mid-2015 General Pharmaceutical Services England 2007/08 to 2016/17 Appendix 1 Table 3 Publication date: 07/11/2017

11.6 The average number of prescriptions dispensed per pharmacy in Cheshire East was 7,166* per month during 2016/17, slightly lower than the England average of 7,218 per month. If we assume that cross boundary dispensing is similar across all areas and recalculate the average number of prescriptions using all items prescribed in Cheshire East regardless of whether dispensed within Cheshire East or not, the average items per month increases to 8,079. The Cheshire East figure is not significantly different to the England average regardless of which method is used i.e. both the Cheshire East values calculated are lower than the highest 25% of values calculated nationally.

In 2016/17, community pharmacies in the South Cheshire CCG area dispensed over 1,000 items more per month (7,771) than those in the Eastern Cheshire CCG area (6,729), which is consistent with having fewer pharmacies per 100,000 population. An above average number of prescriptions dispensed per pharmacy is not a reason to assume underprovision. Within the patient survey the GP Cluster of Bollington, Disley, Poynton with the highest dispensing rate had minimal negative feedback with only one out of the 39 respondants suggesting that the volume of prescriptions was affecting the service.

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Table 8: Average Items per month prescribed by Cheshire East CCGs during 2016/17

Average items Prescribed in Average items per month per Location of Dispenser Cheshire East No. Pharmacies per month pharmacy Alderley Edge, Chelford, Handforth, Wilmslow 710540 11 59212 5383 Macclesfield 1379776 12 114981 9582 Bollington, Disley, Poynton 459444 4 38287 9572 Knutsford 404267 6 33689 5615 Congleton, Holmes Chapel 840857 14 70071 5005 Nantwich and Rural 541049 6 45087 7515 Crewe 1558984 15 129915 8661 SMASH 1070428 13 89202 6862 NHS Eastern Cheshire CCG 3794884 47 316240 6729 NHS South Cheshire CCG 3170461 34 264205 7771 Cheshire East 6965345 81 580445 7166 England 11,699 84447 7218 Data Source: ePACT, General Pharmaceutical Services England 2007/08 to 2016/17 Appendix 1 Publication date: 07/11/2017 * ePACT is a prescribing system so we are only able to analyse items that are prescribed by providers commissioned by ECCCG & SCCCG. Any items prescribed by providers in other CCGs but dispensed by Cheshire East pharmacies will not be included. The average items may be underestimated.

11.7 In 2016/17, 95.3% of prescriptions issued in Cheshire East practices i.e. GP Practices commissioned by Eastern Cheshire CCG or South Cheshire CCG, were dispensed by community pharmacies located inside Cheshire East.

Table 9: Dispensing flows for items prescribed by Cheshire East CCGs during 2016/17

Dispensed in Dispensed in Dispensed Out Location of Prescriber Cheshire East Neighbouring LA of Area Total Items Alsager 93.0% 3.3% 3.7% 365353 Congleton 97.9% 0.3% 1.7% 688254 Crewe 97.5% 0.8% 1.7% 1552585 Eastern Cheshire CCG Rural 91.9% 5.9% 2.1% 609596 Knutsford 95.2% 3.6% 1.2% 477565 Macclesfield 97.9% 0.9% 1.1% 1535279 Middlewich 94.9% 3.8% 1.4% 296902 Nantwich 97.4% 0.6% 2.1% 510407 Poynton 81.3% 16.9% 1.8% 386173 Sandbach 96.6% 1.2% 2.2% 382874 South Cheshire CCG Rural 93.7% 1.0% 5.3% 428502 Wilmslow 92.3% 6.2% 1.4% 619033 Grand Total 95.3% 2.8% 1.9% 7852523 Neighbouring LA= Cheshire West and Chester, Manchester, Shropshire, Stockport, Stoke on Trent, Trafford, Warrington Data Source: ePACT

Another 2.8% were dispensed by community pharmacies within the surrounding HWB areas, reflecting close geographical proximity and/or commuter or shopper flows (this proportion was highest for Bollington, Disley, Poynton GP Cluster at 16.9%, Alderley Edge, Chelford, Handforth, Wilmslow GP Cluster 5.9%, Knutsford GP Cluster 3.6%, SMASH GP Cluster 2.3% and was under 1% for Macclesfield, Crewe, Nantwich and Congleton, Holmes Chapel Clusters). This includes Altrincham in the Trafford HWB area; Cheadle, Hazel Grove and Stockport in the Stockport

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HWB; Winsford and Northwich in the Cheshire West and Chester HWB; Kidsgrove in Staffordshire HWB; and Hanley in the Stoke-on-Trent HWB area. A further 1.9% of prescriptions were dispensed by community pharmacies elsewhere in the country or by distance selling pharmacies.

11.8 The majority of prescriptions issued by the general practitioners in each cluster are dispensed by community pharmacists in that cluster. The major flows between towns occur as inflows to Crewe, Macclesfield and Eastern Cheshire CCG Rural. There is a significant inflow to Crewe from prescriptions issued in Nantwich (59,383) but also a significant flow the other way of 38,410 items prescribed in Crewe but dispensed in Nantwich.

Table 10: Prescription dispensing flows between GP Clusters in Cheshire East, 2016/17

Dispensing Cluster

, d r o w f

l l o

s l e , a s e r y h u e C m m l l l R ,

i s i o e d g D H d W n

l , , d , a a e E n n h i e d h t f r o o r y r c n s t t a i o l e o g o e H e f l f f e l t l e w r s S n c o t d i g t n p e w l c A

t Number of n n l y n a u d e a a u l a o o o h r n M

Prescribing Cluster A H B P C C C K M N S O items Alderley Edge, Chelford, Handforth, Wilmslow 77.3 0.0 0.4 0.0 0.5 2.9 0.0 0.0 18.8 855,955 Bollington, Disley, Poynton 2.9 66.7 0.1 0.0 0.0 13.1 0.0 0.0 17.2 683,794 Congleton, Holmes Chapel 0.0 0.0 82.8 0.7 0.0 0.5 0.0 0.1 15.8 970,791 Crewe 0.0 0.0 0.1 92.5 0.0 0.0 2.5 0.6 4.2 1 ,552,585 Knutsford 0.2 0.0 0.4 0.0 83.3 4.4 0.0 0.0 11.6 477,565 Macclesfield 2.1 0.2 0.7 0.0 0.1 93.3 0.0 0.0 3.6 1 ,327,795 Nantwich and Rural 0.0 0.0 0.0 10.5 0.0 0.0 73.8 0.9 14.8 677,235 SMASH 0.0 0.0 1.6 3.4 0.0 0.0 0.2 80.6 14.2 1 ,306,803 Unknown 9.0 5.9 10.7 19.9 5.1 17.6 6.9 13.6 11.3 7 ,852,523 Data Source: ePACT 2016/17

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12.0 Community Pharmacy Opening Hours

12.1 Community pharmacies are contracted to provide a minimum of 40 hours of essential services per week, the ‘core’ hours. Many choose to provide more than 40 hours, these extra hours are known as ‘supplementary hours’.

12.2 The graphs over the next three pages illustrate the distribution of hours combined across the GP Cluster Areas or Clinical Commissioning Groups (CCG). Reviewing the current provision, there is good coverage during weekdays with extended opening hours from 6.30 in the morning and throughout the day up to midnight. There is some geographical difference in access on Sundays, with no community pharmacies open after 5.00pm in the South Cheshire CCG area.

12.3 Opening hours were one of the main themes which resulted from the engagement work with residents. Within the public survey respondents ranked opening hours as the 2nd most important aspect of pharmacy service (88%). Eighty percent reported they were satisfied with the current opening arrangements at their local pharmacy, however seven individual comments regarding a desire for extended opening hours, particularly at weekends were received from residents living in 5 of the GP Clusters: Alderley Edge, Chelford, Handforth, Wilmslow; Bollington, Disley, Poynton; Congleton, Holmes Chapel; Macclesfield and Nantwich and Rural.

12.4 There are no 100 hour pharmacies in either the Alderley Edge, Chelford, Handforth, Wilmslow GP Cluster Area, Bollington, Disley, Poynton GP Cluster Area or the SMASH GP Cluster Area. Bollington, Disley, Poynton GP Cluster Area and the SMASH GP Cluster Area do not have early morning and late night provision on weekdays and Saturday, or provision on Sundays. Nevertheless, people living in these areas can use the nearby 100 hour pharmacies in Macclesfield, Crewe, Congleton, and Nantwich within Cheshire East plus Winsford (in Chester and Cheshire West HWB area), Cheadle (in Stoke on Trent HWB area) and Heald Green (in the Stockport HWB area). A council cannot stipulate pharmacy opening hours, they form part of the contract with NHS England (NHSE). If NHSE consider there is a need for pharmacy services in an area on a Sunday, they could direct a rota as they do for Christmas day.

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Figure 2: Pharmacy Open Hours by GP Cluster Areas - Weekday

Data Source: Pharmacy Survey 2017 Updated hours provided by Well, Portfolio Support Co-ordinator on 15/01/18

Figure 3: Pharmacy Open Hours by GP Cluster Areas – Saturday

Data Source: Pharmacy Survey 2017

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Figure 4: Pharmacy Open Hours by GP Cluster Areas – Sunday

Data Source: Pharmacy Survey 2017

Figure 5: Pharmacy Open Hours by Clinical Commissioning Groups – Weekday

Data Source: Pharmacy Survey 2017 Updated hours provided by Well, Portfolio Support Co-ordinator on 15/01/18

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Figure 6: Pharmacy Open Hours by Clinical Commissioning Groups – Saturday

Data Source: Pharmacy Survey 2017

Figure 7: Pharmacy Open Hours by Clinical Commissioning Groups – Sunday

Data Source: Pharmacy Survey 2017

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13.0 Prescription Collection and Delivery Services 13.1 All 81 pharmacies offer a prescription collection service from patients’ GP surgeries. Seventy-six (94%) answered the questions regarding delivery of dispensed medicines on the Community Pharmacy Survey, 86% stated that they offer this service free of charge. In the public survey, only 3% of respondents stated that they use the prescription delivery service.

Table 11: Prescription Collection and Delivery Services in Cheshire East Current provision

Number of Non-NHS funded services pharmacies Percentage Electronic Prescription Service (EPS) 81 100.0% Collection of presriptions from surgeries 81 100.0% Free delivery of dispensed medicinces 70 86.4% Chargeable delivery of dispensed medicinces 6 7.4% Data Source: Pharmacy Survey 2017

13.2 The Electronic Prescription Service (EPS), allows a patient to choose or “nominate” a pharmacy to get their medicines or appliances from. The patient’s GP sends the prescription electronically to the nominated pharmacy, giving more choice and saving time.

13.3 Within the public survey, there was considerable dissatisfaction expressed around repeat prescriptions, waiting times for prescriptions and availability of prescription items. There were fourteen complaints related to issues with repeat prescriptions, citing that the changes to the “system” had been a “step backwards”, causing inconvenience as the pharmacies were no longer able to order items, adding another step to the process. Twenty-two comments specifically mention unacceptable waiting times, half of theses related to pre-ordered prescriptions not being ready for collection.

Concerns around waiting times were raised from respondents from all GP Clusters. However, it was more frequently raised by those living within the SMASH area (11 of 42 comments). This area also received the largest proportion of negative comments regarding issues with the pharmacy having the things respondents needed (7 of 17 comments).

Waiting times were also highlighted as a key finding within the Healthwatch report from November 2016. “Speed of service was identified as a notable limitation of the pharmacy with many respondents citing an unacceptable waiting time between presenting and receiving their prescription”.

Difficulties seem to arise at several different points along the ordering and collection process, causing delays and high levels of dissatisfaction. For some residents expectations are now low, with long waiting times and poor service the ‘norm’, this is evident from the language used in the comments by respondents to the public survey.

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“Service is appalling. Long waits for prescriptions even when ordered in advance. Staff don’t manage expectations by saying 'we are busy now, you can wait or come back etc.’ No information given on estimated wait times. Staff are brusque with customers yet laughing and chatting with each other.“

There is an opportunity for staff to increase satisfaction levels by better managing waiting times.

14.0 Factors Affecting Prescribing

14.1 Factors which may influence the growth in prescribing, and so the need for pharmaceutical services, include:  the size of the population  the age structure of the population, notably the proportion of the elderly, who generally receive more prescriptions than the young  improvements in diagnosis, leading to earlier recognition of conditions and earlier treatment with medicines  development of new medicines for conditions with limited treatment options  development of more medicines to treat common conditions  increased prevalence of some long term conditions, for example, diabetes  shifts in prescribing practice in response to national policy, and new guidance and evidence, for example, in cardiovascular disease

15.0 Population and Housing

15.1 Population Structure and Growth

15.1.1 The size of the Cheshire East population was estimated to be 375,400 people in 2015. According to the Office for National Statistics (ONS) this is projected to grow by 7,500 (2.0%) to 382,900 people in 2020 and by a further 7,600 (2.0%) over the following five years (almost 390,500 people in 2025).

15.1.2 In simple terms when modelling population projections ONS consider the following factors: the number of births minus the numbers of deaths; the numbers of people moving into Cheshire East from other areas of the country minus Cheshire East resident’s moving out to other parts of the country (internal migration) and people moving into Cheshire East from abroad minus Cheshire East resident’s moving to other parts of the world (international migration).

15.1.3 The majority of the growth between the base year 2015 and 2025 will take place in the Knutsford GP Cluster (5.7%) and the Bollington, Disley, Poynton GP Cluster (5.6%). Modelled projections, using ONS data, forecasts relatively little population growth in the Crewe area (2.0%), this doesn’t include the housing developments planned in the area within this timeframe. 1700 dwellings are predicted to be built within the Crewe area on Strategic sites

Page 38 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 alone, this suggests that the modelled figure is potentially under estimated if occupancy on the planned housing is greater than I person per household. When populations are forecast using occupancy of 2.2 per household, the resultant population estimate for 2025 is 3% higher for Crewe GP Cluster than predicted using ONS data.

Table 12: Predicted population change for Cheshire East, 2015 to 2025

Data Source: ONS Population estimates 2015 MSOA SYOA, ONS Population projections for 2020 and 2025 Cheshire East Local Authority, Eastern Cheshire CCG and South Cheshire CCG.

15.1.4 Most of the increase in population size will occur in the age groups 60 and above. The number of people aged between 60 and 84 will increase by 17%, and the number of very elderly people aged 85 and over will increase by nearly 48%. There will only small changes in the size of other age groups in the population.

Table 13: Predicted prescribing need for Cheshire East, 2015 to 2025

Year Percentage Percentage Percentage change 2015 change 2020 change 2015 Eligibility for Free Age Band 2015 2020 2025 to 2020 to 2025 to 2025 prescriptions 0-4 20405 19990 20187 -2.0% 1.0% -1.1% Under 16 5-15 45776 47980 48114 4.8% 0.3% 5.1% 16-18 13178 12045 13439 -8.6% 11.6% 2.0% Aged 16-18 and in 19-59 190834 187422 179888 -1.8% -4.0% -5.7% full-time education 60-64 22959 24697 28889 7.6% 17.0% 25.8% 65-84 71026 77350 83419 8.9% 7.8% 17.4% Aged 60 and over 85+ 11214 13389 16555 19.4% 23.6% 47.6% Total 375392 382873 390491 2.0% 2.0% 4.0% Data Source: ONS Population estimates 2015 MSOA SYOA, ONS Population projections for 2020 and 2025 Cheshire East Local Authority, ASTRO-PU 2013

15.1.5 People’s need for prescribed medicines increases with age. Although Cheshire East is only growing moderately in terms of the overall number of people in the population, the population is living longer and there will be a proportionately higher growth in the number of people in age groups over 60. Prescribing need can be assessed using a measure called the item

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ASTRO-PU 2013, which is a national weighting formula that weights different age groups based on their current usage of medicines. Using Item ASTRO-PU 2013 weighted populations; there will be a 7.7% growth in medicines use by 2020 and a further 7.7% increase by 2025, a total increase in medicines use of 16% over the ten year period.

15.2 Proposed Housing Developments

15.2.1 Proposed housing developments in Cheshire East are contained in Cheshire East’s Local Plan Strategy 2010-2030 which was adopted on 27 July 2017. The overall growth proposition in Cheshire East is to deliver at least 36,000 new homes by 2030, an average of 1,800 net additional dwellings per year across the borough. The plan identifies 50 strategic sites and 3 strategic locations that will accommodate most of the new development needed and forms the basis for determining planning applications. Strategic Sites are those with a final total capacity of over 150 dwellings.

15.2.2 This current Local Plan Strategy Document covers development until 31st March 2030, beyond the time scales for this PNA, which considers pharmaceutical need within the population over the next 3 years (2018-2021). However, Strategic Sites are divided into 5 year phases; this has enabled us to give a rough estimate of potential housing numbers within these larger developments by 2021. The table below gives an estimate of the additional housing due to be built across Strategic Sites by the end of March 2021 based on information provided by Cheshire East Spatial Planning Department. Unfortunately the estimates do not consider the housing developers’ phasing, which may change due to economic pressures, nor do they included the numerous smaller developments that are under construction or planned within the next 5 years.

Table 14: Estimates of proposed housing on main Strategic Sites in Cheshire East by March 2021

Estimated new homes Number of Location of Strategic Current Average Total by current GP Cluster areas Sites population each year March 2021 pharmacies Nantwich and Rural Nantwich 37,030 103 315 6 Crewe Crewe 77,755 385 1700 15

SMASH (Sandbach, Middlewich, Sandbach 138 230 7 64,082 Alsager, Scholar Green, Haslington) Middlewich 98 295 3 Alsager 100 435 3

Congleton and Holmes Chapel Congleton 38,587 208 1135 14 Macclesfield Macclesfield 61,788 213 805 12

Bollingtin, Poynton, Disley Poynton 26,403 33 235 4

Wilmslow 45 300 5 Chelford, Alderley Edge, Wilmslow, Handforth 44,657 110 420 3 Handforth Alderley Park, Monks Heath 90 3 Knutsford Knutsford 25,090 48 400 6 Data Source: Cheshire East Housing Supply and Delivery Topic Paper (August 2016)

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15.2.3 To understand the impact of new housing on internal migration locally, the location from where new home owners had moved was analysed for two new housing developments within South Cheshire. This showed that majority (approximately 70%) of families had moved less than 3 miles to the new developments, which suggests that the majority of movement is internal to Cheshire East rather than from outside Cheshire East. This analysis used school census data so may only be applicable to families and may not be representative of movements into other new housing developments. Further analysis of who bought their previous houses would be needed to identify the impact on the overall population of Cheshire East. The findings are supported by net migration figures, published by the Office of National Statistics, which gave the net increase in population, including international migration, between 2014 and 2015 as 1,283 or 0.34% i.e. 1,283 more people moved into Cheshire East than moved out of the borough. Previous year on year increases have been even smaller. In terms of the impact on health infrastructure it suggests that the ageing of the population is a bigger consideration than actual increasing numbers.

15.2.4 We have taken consideration of the main Strategic Sites in relation to current pharmaceutical provision, and Cheshire East is generally well provided for. One area of concern is to the north east of Crewe, where an additional 380 houses are planned (22% of 1,700 houses planned on Strategic Sites in the whole of the Crewe area). This area has been highlighted in previous PNAs as having limited access to community pharmacies. Having undertaken a mapping exercise we are assured that this area is adequately provided for by the pharmacies in central Crewe and the local independent provider in north east Crewe.

15.2.5 Other areas considered in detail include:-

 Alderley Park Opportunity Site near Monks Heath/ Nether Alderley. Initially 90, out of a potential 275 dwellings, could be built by the end of March 2021. This site is approximately 2.5 miles from the closest community pharmacy in Alderley Edge, however like many other rural parts of Cheshire East residents will also have to travel to other facilities, including shops.  North Cheshire Growth Village, situated to the east of Handforth, just off the A34 bypass. This has been identified as a Strategic Site that will provide up to 1500 houses once fully completed. It is expected that up to 325 of these (less than 22%) could be built by March 2021. The site is close to the Handforth Dean Retail Park which includes a pharmacy within a superstore with extended opening hours.  At the northern boundary of Cheshire East, between Handforth and Poynton, is the Woodford opportunity area which lies within Stockport Metropolitan Borough. The site has planning permission for over 900 homes, phase 1 is already built and phase 2 started, with phases 3 to 5 having outline planning permission. The previous Stockport PNA in 2015 identified that this development once fully occupied may lead to a gap in essential service provision as the nearest pharmacy is more than 2km away. A review at 50% occupancy is planned, with consideration of their strategic ambition for 90% of Stockport resident’s homes to be within 1km of a community pharmacy. Woodford itself is around 1.5 miles south of Bramhall, a suburb of Stockport, where there are already a number of community pharmacies and a GP surgery. There are also good links to local facilities in Cheshire East including a

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number of community pharmacies, with Handforth to the west and Poynton to the north east, both within a 3 mile radius.

15.2.6 Potential business, retail and leisure developments across Cheshire East have also been considered in terms of potential impact on where people may wish to access community pharmacy services. The largest developments are taking place within the more urban areas of the Borough that are already well provided for in terms of pharmacy provision, such as the redevelopment of Royal Arcade in Crewe and the Barracks Mill site close to Macclesfield, plus the expansion of the Handforth Dean Retail Park.

15.2.7 In the engagement undertaken by Healthwatch, Cheshire East residents cited "the location, proximity to the home and physical accessibility of the community pharmacy as the primary consideration when choosing which pharmacy to use". All participants stated that they accessed the pharmacy that was most convenient to them geographically. The respondents that had visited their GP found that the pharmacy near to that location more convenient and for others they preferred to access the in-store pharmacy at their local supermarket whilst they shopped.

15.2.8 The pharmacy users’ survey asked “In terms of location, why do you use this pharmacy regularly?” 47% of respondents gave ‘near to home’, followed by being ‘near to their doctors surgery’ at 41%, and ‘near to other shops I use’ 33%. Respondents within Crewe raised no concerns regarding access to pharmacies other than the need for weekend opening hours (1 comment) and expressing a preference for pharmacies to be in a convenient location for access, such as a supermarket (1 comment).

16.0 Ethnicity and Other Protected Characteristics

16.1 The Equality Act (2010) defines nine characteristics which are protected in law. Ethnicity, age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, religion and belief and sexual orientation are classed as protected characteristics. In April 2013, the Health and Social Care Act imposed new duties on all the component organisations with respect to reducing inequalities in access and outcomes. In addition to these two Acts, all bodies have a duty to comply with the Human Rights Act. The rights of all these groups and any specific issues regarding their access to services and outcomes from such services must be considered as part of the PNA.

16.2 All community pharmacies must assess both physical access to the premises and also amendments to basic delivery of essential services for patients with regard to their culture, ethnicity or disability. For example:

 provision of an automatic door or bell to alert staff to the needs of wheelchair users  provision of a hearing loop  provision of plain lids for those who have difficulty opening child resistant containers  provision of large print medication labels

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 MARS (medicines administration record sheets) or monitored dosage systems to support medicines adherence  ability to source and supply non gelatine based products

16.3 A review of current provision was undertaken via the Community Pharmacy Questionnaire (CPQ) undertaken during May 2017. The questionnaire distributed to all pharmacies asked various questions regarding accessibility and provision of aids for people with poor hearing or eye-sight. Questions regarding the provision, accessibility and facilities available within a consultation room or area were also included. All 81 pharmacies within Cheshire East returned completed questionnaires; the following sections give the findings from those who responded.

16.4 Disability

16.4.1 It is known that 4.9% (18,161) people in Cheshire East reported having poor health over the year preceding the 2011 Census and nearly 18% of residents indicated that they have an illness or disability that limits their day-to-day activities. It is difficult to get a comprehensive picture; various estimates are available via Projecting Older People Population Information System (POPPI) and Projecting Adult Needs and Service Information (PANSI) or from the latest Census Estimates but some people will have multiple disabilities and therefore may be counted in more than one estimate.

16.4.2 It is estimated that 15,817 residents over the age of 65 will have mobility problems that affect them with day to day activities such as going out of doors and walking down the road; getting up and down stairs; getting around the house on the level; getting to the toilet; getting in and out of bed. An estimated 28,698 residents over 65 require assistance with self-care activities including help to bathe, shower or wash all over, dress and undress, wash their face and hands, feed, cut their toenails, take medicines. National prevalence rates applied to local populations suggest that 18,303 of residents of working age may have a moderate physical disability and a further 5,599 may have a serious physical disability.

16.4.3 The majority of pharmacies 86% (78 out of 81) have an entrance that enables wheelchair users to access the pharmacy independently, 97% of these pharmacies stated that all floor areas of the pharmacy were accessible by wheelchair users. 58% indicated that they had either an automatic door and/or a bell at the front door and 51% have designated disabled parking. In the public survey, for those respondents who selected that their day to day activities are ‘limited due to a health problem or disability’, 4 reported not being able to get to the Pharmacy of their choice due to their preferred pharmacy not having suitable access.

16.4.4 All 81 Pharmacies provide a private consultation room or area, of these 85% stated that it is accessible by wheelchair users.

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Table 15: Accessibility aids provided by pharmacies in Cheshire East

Data Source: Pharmacy Survey 2017

16.4.5 National estimates of prevalence for learning disability suggest that there are likely to be 1,439 adults residents with a moderate or severe learning disability. However, a further 5,604 adults are likely to have a mild learning difficult that may impair their ability to understand instructions and they may need longer consultations or support when visiting a pharmacist.

16.4.6 The results indicate a high level of accessibility for customers in wheelchairs or with mobility problems. However, pharmacies do not always consider all the needs of people with other physical disabilities such as hearing or visual impairments. Although 73% have a hearing loop to support customers wearing hearing aids and 83% provide large print labels for prescriptions, only 23% provide large print leaflets to support people with poor eye sight. Only 18 provided both large print labels and leaflets, 13 provided neither.

16.4.7 The latest data available stated that nearly 2,300 people in Cheshire East were registered as blind or partially sighted, of whom 68% are aged 75 year or over. 49% have additional disabilities and 80% of these are aged 65 years or over. The Royal National Institute of Blind People (RNIB) estimate that 14,130 people in Cheshire East are living with some degree of sight loss, 3.7% of the total population. Of this total, 9,090 are living with mild sight loss, 3,130 are living with moderate sight loss and 1,910 are living with severe sight loss. Indicating that there is a large difference in the number of people living with sight loss and those actually registered as blind or sight impaired. By 2025, it is expected there will be 17,770 people in Cheshire East living with sight loss, the number of people living with severe sight loss is estimated to be 2,480. Around 15% (46,002) of the adult population have some form of hearing loss, and around 2% of these are profoundly deaf communicate by lip-reading and BSL may be their first or preferred language.

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16.5 Ethnicity, religion and belief

16.5.1 Cheshire East is less ethnically diverse than England, with 96.7% of the population giving their ethnicity as white in the 2011 Census, compared to a national average of 86%. However, ethnic diversity has increased since the 2001 Census, when 98.2% of the population declared their ethnicity to be white. Over a ten year period, the Black Minority Ethnic (BME) population has nearly doubled from 6,200 to 12,200 and all BME groups have increased in number. Also of note is the increase in those giving their ethnicity as ‘other white’, which rose from 4,600 to 9,400 between 2001 and 2011. The majority of this increase represents the Eastern European – predominantly Polish – population in Crewe. Wilmslow LAP has the most ethnically diverse population, with 11% ‘Non-White British’ – 3.9% are Asian and 3.4% ‘Other White’.

16.5.2 According to the 2011 Census, 68.9% of Cheshire East residents were Christian (97.5% of those who stated they had a religion. This represents a reduction of 27,500 (10%) since 2001. There was a concomitant increase in the proportion with no religion or who did not state their religion, which rose from 18.6% in 2001 to 29.3% in 2011. Despite the increase in the number of people describing their religion as Buddhist, Hindu, Jewish, Muslim, Sikh and Other, the proportions for each of these religions are still less than 1%. However small these minorities, pharmacy staff still need to be mindful of customers’ religious and cultural background to ensure that they are sensitive to any specific requirements.

16.5.3 Within the public survey no specific issues were raised concerning ethnicity or religion. However, even though in terms of proportion the sample is representative of Cheshire East’s religious mix, the small numbers of respondents who were not Christian (97% of those who stated their religion selected Christian) make it difficult to truly know if there are any issues. The non-white ethnic mix within the survey was under-representative of the underlying population; again numbers are very small which make any conclusions very difficult.

16.5.4 97.4% of residents in the 2011 census stated that English was their main language, 77.4% of the remainder stated that although English wasn’t their main language they spoke it well or very well. This means that less than 1% (2,109) of the population cannot speak English or feel they do not speak it well. We are unable to determine which languages are spoken by these non-English speakers as these census tables are only available at a regional level which may be distorted by more ethnically rich areas. However, the results from the main language question on the census gives polish as the area’s second language at 1%.

16.5.5 Within Cheshire East 28 of the pharmacies (35%) advised that they have either a pharmacist or other member of staff who could speak at least one additional language to English. There was a wide variety of different languages spoken; Urdu, Punjabi, French, Arabic, Polish, Armenian, Mandarin, Hindi, Cantonese, Gujarati and Spanish were all spoken at more than one pharmacy.

16.6 Gender, sexual orientation

16.6.1 The latest population estimates give the gender breakdown in Cheshire East as 51% female and 49% male. The proportion of respondents from the public survey who answered the gender question (Base:648) was 49% female and 50% male.

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16.6.2 Of the 643 respondents who answered the sexual orientation question in the public survey, 2% identified themselves as Gay/Lesbian or Bisexual, slightly higher than the national proportion of 1.6%.

16.6.3 Within Cheshire East 27 of the pharmacies stated they were able to offer advice and support to customers wishing to speak with a person of the same sex within the normal opening times; a further 37 were able to make arrangements for a same sex consultation. However, this does leave 21% (17 pharmacies) unable to offer this.

16.6.4 No issues concerning same sex consultations were voiced in the Public Survey.

16.6.5 Eight negative comments were received in regards to privacy when speaking to the Pharmacist; three respondents stated that conversations were held on shop floor, four stated that there was no area to speak privately and one respondent who did speak privately raised the concern that the room was not soundproofed and could still be overheard. Respondents from the Congleton/ Holmes Chapel area more frequently brought this up as an issue (3 of 9 comments). This may be a general point about the importance of privacy when speaking to the pharmacist rather than a point specific to protected characteristics. .

16.7 Sensitivity to changes in the population Although the Cheshire East population is predominantly white it has become more diverse and this is likely to continue in the future. This may to lead to a higher population where English is not their main language, a wider range of languages spoken and increased numbers speaking these languages. This will increase demand for interpreter and Language Line services within community health settings including pharmacies. This diversity will need greater awareness and sensitivity to different cultural requirements from pharmacy staff. Whilst it is difficult to predict the level of international migration into the area at this time, one certainty is the increasing elderly population, potentially increasing numbers of customers with mobility problems, visual and hearing impairments. Pharmacists need to ensure accessibility of their premises and to materials such as leaflets and prescription labels.

17.0 Chronic Disease

17.1 An important common factor for patients on a chronic disease register is that it supports the provision of structured care including the provision of drug treatments. The table illustrates the top four most common reasons for people being on a general practice chronic disease register. Chronic conditions are common in all GP clusters, but it is not currently possible to make direct comparisons of prevalence between areas as areas with higher numbers of older people will tend to have higher numbers of people with chronic conditions.

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Table 16: Numbers on GP Disease Registers 2015/16

Hypertension Asthma Diabetes CHD

GP Clusters Numbers Prevalence Numbers Prevalence Numbers Prevalence Numbers Prevalence Alderley Edge, Chelford, Handforth, Wilmslow 6490 14.2% 2642 5.8% 1838 5.0% 1455 3.2% Macclesfield 9198 15.0% 3710 6.1% 3263 6.5% 2028 3.3% Bollington, Disley, Poynton 5428 16.4% 1961 5.9% 1553 5.6% 1226 3.7% Knutsford 3307 14.5% 1481 6.5% 1183 6.4% 857 3.8% Congleton, Holmes Chapel 6561 15.2% 2599 6.0% 2400 6.8% 1598 3.7% Nantwich and Rural 5479 16.9% 1931 6.0% 1637 6.1% 1221 3.8% Crewe 11794 14.1% 4783 5.7% 4400 6.6% 2839 3.4% SMASH 11040 17.0% 4026 6.2% 3559 6.6% 2494 3.8% NHS Eastern Cheshire CCG 30984 15.0% 12393 6.0% 10237 6.1% 7164 3.5% NHS South Cheshire CCG 28313 15.7% 10740 5.9% 9596 6.5% 6554 3.6% Cheshire East 59297 15.3% 23133 6.0% 19833 6.3% 13718 3.5% Data Source: QOF Table 1, 2 and 4: Recorded disease prevalence, 2015-16, GP practice level

17.2 There are other chronic conditions in addition to the above. In Cheshire East general practices have recorded 27,191 people with depression, 14,647 with chronic kidney disease, 11,042 with cancer, 8,759 with atrial fibrillation, 6,587 with chronic obstructive pulmonary disease, 3,391 with heart failure, 2,776 with peripheral arterial disease, and 2,550 with epilepsy.

17.3 The prevalence rates shown in this table are calculated from numbers on the GP Disease registers (QOF) and are therefore diagnosed cases only. Low prevalence may not indicate low underlying prevalence in the general population but may result from poor case finding. Although there have been significant improvements in the detection and recording of risk factors in primary care, more could be done to identify people with conditions that contribute to our major killers such as cardiovascular disease.

For example, current prevalence estimates produced by Public Health England indicate that there are believed to be 38,300 residents in Cheshire East aged 16 and over with undiagnosed high blood pressure. Once diagnosed it may need to be controlled by daily medication. If case- finding improves this could potentially increase the number of prescriptions requiring dispensing.

17.4 The prevalence of hypertension increases progressively with age; ethnic background is another consideration with people of African or Caribbean origin being at greater risk. As the population structure of Cheshire East changes we will need to consider its impact on the incidence e.g. the number of new cases of certain diseases which are managed by prescription drugs and whether this has workload implications for the community pharmacies.

17.5 Hypertension has been identified as a priority within the Cheshire and Merseyside sub- region and a five year cross-sector strategy to tackle high blood pressure “Saving lives: Reducing the pressure” has been developed. This sits within the prevention stream of the STP Five Year Forward View (C&M FYFV). It identifies pharmacies as an ideal setting to reach the community, expanding their role from not just providing medication support (MURs etc.) to include carrying out early identification of hypertension through blood pressure testing, providing additional healthy lifestyle advice and signposting within the wider health system.

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18.0 Deprivation

18.1 The map shows the level of deprivation in Cheshire East by the national Index of Multiple Deprivation (IMD) 2015 deciles. The LSOAs shaded in red are among the 10% most deprived in England, with dark orange representing the second most deprived 10%. The areas shaded dark blue are among the least deprived 10% nationally. Cheshire East is generally very affluent, but small areas of deprivation can be found across the authority, mainly clustering in central Crewe. There are also isolated pockets of deprivation in Macclesfield, Congleton, Wilmslow and Alsager.

Figure 8: Map Index of Multiple Deprivation 2015 – Overall Deprivation by national decile

18.2 About 3% of the population of Cheshire East live in Lower Level Super Output Areas (LSOAs) that are among the 10% most deprived areas in England. All six of these LSOAs are in Crewe. Socioeconomic deprivation is strongly associated with early death rates; within Cheshire East analysis has shown that these areas experience higher rates of premature mortality from cancer, heart disease, stroke, lung disease and liver disease. People living in these areas will have higher levels of pharmaceutical need than in other areas.

18.3 Based on the proportion of respondents to the Public Survey who provided a postcode and could therefore be allocated to a national deprivation quintile, respondents living within the fourth or lowest national quintiles are more likely to visit ‘about once a month’ than those in the middle quintile. However the numbers of respondents within the most deprived and second most deprived quintiles were small so it is difficult to draw any conclusions. It was also noted that there were more respondents to the public survey from the the least deprived quintile than

Page 48 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 other quintile, with representation decreasing with increasing deprivation. This means that any results and conclusions may not be applicable to the general population.

19.0 The Six Statements required by Legislation

19.1 Necessary services: current provision. A statement of the pharmaceutical services that the HWB has identified as services that are provided: (a) in the area of the HWB and which are necessary to meet the need for pharmaceutical services in its area; and (b) outside the area of the HWB but which nevertheless contribute towards meeting the need for pharmaceutical services in its area (if the HWB has identified such services).

19.1.1 There is currently an adequate level of community pharmacy provision in every major town in the Borough, although the level of provision is lower in the NHS South Cheshire CCG area than in the NHS Eastern Cheshire CCG area, both are within the normal national range. The maps show that this provision is mostly located either in the town centres or close to GP surgeries.

19.1.2 There is evidence that residents living in peripheral areas of the Borough use pharmacies in adjacent Health and Wellbeing Board areas to have prescriptions dispensed. This is particularly evident in the north of the Borough, where over 75,000 items are dispensed each year by five community pharmacies in Cheadle, Heald Green, Hazel Grove and High Lane.

19.1.3 The public survey shows that 58% of residents are “very satisfied” with community pharmacy services, and a further 30% are “fairly satisfied”. Satisfaction with their regular pharmacy is slightly higher for those respondents residing in the GP Clusters within Eastern Cheshire CCG, when compared to the GP Cluster of South Cheshire CCG. The average proportion of people who were “very satisfied” or “fairly satisfied” across the five clusters within the ECCCG is 91%, in comparison to 83% for the within the SCCCG. Five percent of respondents were “fairly” or “very” dissatisfied with community pharmacy services. There was also a very high level of satisfaction with pharmacy opening hours (80% satisfied).

19.2 Necessary services: gaps in provision. A statement of the pharmaceutical services that the HWB has identified (if it has) as services that are not provided in the area of the HWB but which the HWB is satisfied- (a) need to be provided (whether or not they are located in the area of the HWB) in order to meet a current need for pharmaceutical services, or pharmaceutical services of a specified type, in its area; (b) will, in specified future circumstances, need to be provided (whether or not they are located in the area of the HWB) in order to meet a future need for pharmaceutical services, or pharmaceutical services of a specified type, in its area.

19.2.1 The current dispensing workload as demonstrated by the number of items dispensed per pharmacy is not significantly different to the England average i.e. within the normal range. The prescribing of medicines is predicted to grow by 7.7% by 2020 and then a further 7.7% increase

Page 49 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 by 2025, a total increase in medicines use of 16.0% over the next ten years. Increases of this magnitude are likely in all areas of the country. Existing pharmacies may have to increase their capacity and review their working practices to meet this need.

19.2.2 Most of the increase in prescribing need will occur among older people. This PNA has highlighted several issues relevant to older people, including poor physical access to some community pharmacies, and insufficient accessibility aids in some pharmacies.

19.2.3 When using the Office of National Statistics population projections pharmaceutical need is predicted to increase to a greater extent in Eastern Cheshire than in South Cheshire. However the current dispensing workload is higher in the South with over 1,000 more items per month per pharmacy (7,771) than those in the Eastern Cheshire CCG area (6,729), which is consistent with having fewer pharmacies per 100,000 population. This might involve a change in the skill mix and capacity within each pharmacy to cope with the predicted additional demand.

19.2.4 The town of Crewe has the greatest level of deprivation in the Borough, and it also has the highest levels of premature mortality. There is a lower level of community pharmacy provision in the Crewe cluster area and particularly in the north of the town, although the number of pharmacies per 100,000 population is still reasonable in terms of the national range. Consideration has been given within this and the previous PNA in relations to the planned housing developments in the area. However, we are assured that this area is adequately provided for by the pharmacies in central Crewe and the local independent provider in north east Crewe. The public survey respondents who reside in Crewe raised no concerns regarding access to pharmacies in terms of location. The population of Crewe may benefit from having a greater level of outreach provision of community pharmacy services by the current pharmacy services.

19.2.5 The Pharmaceutical Needs Assessment has highlighted the existence of cross-border dispensing flows across the Cheshire East / Stockport border. It has also considered housing developments within both the Health and Wellbeing Board Areas which may impact on these flows in the future. There is a proposed development to the east of Handforth, the North Cheshire Growth Village; this is a Strategic Site that will provide up to 1500 houses once fully completed. However, it is expected that this will be less than 22% complete by March 2021 and there is already a hour pharmacy within a superstore at the nearby Handforth Dean Retail Park which has extended opening hours. Also, at the northern boundary of Cheshire East, between Handforth and Poynton within Stockport Metropolitan Borough, is the Woodford opportunity area. The site has planning permission for over 900 homes, phase 1 is already built. Although there is already provision within nearby Bramhall, Stockport’s strategic ambition for 90% of their resident’s homes to be within 1km of a community pharmacy, means that they have identified a potential gap when the development is fully occupied. However, there is currently no planned development on the ex-aerodrome site within Cheshire East borders and we consider there is adequate provision to cope with the cross-boundary dispensing, with a number of community pharmacies within a 3 mile radius, with Handforth to the west and Poynton to the north east.

19.2.6 Extended opening hours are a beneficial feature of pharmacy provision locally, and in many areas there is weekday access to community pharmacies from 6.30 in the morning and

Page 50 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 throughout the day up to midnight. There are no community pharmacies open after 5.00pm on Sunday in any part of the South Cheshire CCG area. A council cannot stipulate pharmacy opening hours, they form part of the contract with NHS England (NHSE).

19.2.7 There are seven practice premises in Cheshire East at which dispensing doctor services are available to eligible patients. Some of these practices cover very rural areas. Patients who receive dispensing doctor services are able to be supplied with medicines, but they may not be able to benefit from the wider range of essential and advanced services that community pharmacies are able to provide, or the CCG and public health commissioned services.

19.3 Other relevant services: current provision. A statement of the pharmaceutical services that the HWB has identified (if it has) as services that are provided- (a) in the area of the HWB and which, although they are not necessary to meet the need for pharmaceutical services in its area, nevertheless have secured improvements, or better access to pharmaceutical services in its area; (b) outside the area of the HWB and which, although they do not contribute towards meeting the need for pharmaceutical services in its area, nevertheless have secured improvements, or better access, to pharmaceutical services in its area; (c) in or outside the area of the HWB and, whilst not being services of the types described in sub-paragraph (a) or (b), or paragraph 1, they nevertheless affect the assessment by the HWB of the need for pharmaceutical services in its area.

19.3.1 Both CCG’s commission a Think Pharmacy urgent palliative care medicines service and an emergency supply service which have led to improvements in access to medicines that may be needed either in an emergency or for palliative care. Cheshire East Council also commissions a range of services.

19.3.2 The Think Pharmacy Minor Ailments Service was reviewed in 2017. 28% of respondents in the public survey stated that they had already used the minor ailments service, however a further 54% of respondents say that they might use it in the future.

19.3.3 Responses from the Community Pharmacy Survey indicate that, only small numbers of pharmacies within Cheshire East are unwilling to provide the existing Public Health Services:  Emergency Hormonal Contraception (EHC)  Quick Start Contraception  Chlamydia screening service for people aged 15-24  Nicotine Replacement Therapy (NRT)  Intermediate Smoking Cessation Services  Varenicline Initiation  Supervised Consumption of Methadone  Needle Exchange

However, the willingness expressed within the survey responses is not reflected in the numbers of pharmacies currently contracted to provide these services. During the recommissioning through invitations to tender (ITT) process in 2016, the local authority made efforts to ensure that the provision reflected local need. In areas where need has been demonstrated but

Page 51 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 community pharmacies offering the service is low, other providers fill the provision gap e.g. EHC and Chlamydia screening in young people is provided within community settings under the current Sexual Health Services Contract, also GP Practices are prescribing EHC in the Bollington, Disley, Poynton GP Cluster.

19.4 Improvements and better access: gaps in provision. A statement of the pharmaceutical services that the HWB has identified (if it has) as services that are not provided in the area of the HWB but which the HWB is satisfied- (a) would, if they were provided (whether or not they were located in the area of the HWB), secure improvements, or better access to pharmaceutical services, or pharmaceutical services of a specific type, in its area, (b) would, if in specified future circumstances they were provided (whether or not they were located in the area of the HWB), secure future improvements, or better access, to pharmaceutical services, or pharmaceutical services or a specified type, in its area.

19.4.1 Previous Annual Reports of the Director of Public Health have highlighted the high numbers of people in the Borough who have undiagnosed risk factors for cardiovascular disease. Current prevalence estimates produced by Public Health England indicate that there are believed to be 38,300 residents aged 16 and over with undiagnosed high blood pressure. There is a need to identify people with hypertension using a wide range of community settings, which will include community pharmacies. If case-finding improves this could potentially increase the number of prescriptions requiring dispensing. As the Cheshire and Merseyside sub- region five year cross-sector strategy to tackle high blood pressure indicates pharmacies can play an important role in helping patients to manage long-term conditions such as cardiovascular disease and its associated risk factors e.g. high blood-pressure. Pharmacies are able to offer checks for blood pressure, blood sugar and if necessary signpost affected individuals into primary care for definitive management.

19.4.2 Within the Community Pharmacy Survey, pharmacies were asked about additional Public Health services they would consider providing. A total of 76 (94%) pharmacies would be willing to provide Obesity Mangement for adults and children and 71 (88%) would be interested in delivering NHS Health Checks.

19.5 Other NHS services. A statement of any NHS services provided or arranged by the HWB, NHS CB, a CCG, an NHS trust or an NHS foundation trust to which the HWB has had regard in its assessment, which affect- (a) the need for pharmaceutical services, or pharmaceutical services of a specified type, in its area; or (b) whether further provision of pharmaceutical services in its area would secure improvements, or better access to pharmaceutical services, or pharmaceutical services of a specific type in its area.

19.5.1 NHS Eastern Cheshire CCG has commissioned a neighbourhood integrated medicines optimisation service from East Cheshire NHS Trust which involves clinical pharmacists providing pharmaceutical services such as medication use reviews, inhaler technique assessments to patients deemed as being “high risk", increasing access for patients to specialist advice and attempting to reduce the need for patients to access urgent care services.

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19.6 An explanation of how the assessment has been carried out, in particular – (a) how it has determined what are the localities in its area; (b) how it has taken into account (where applicable)- (i) the different needs of different localities in its area, and (ii) the different needs of people in its area who share a protected characteristic; and (c) a report on the consultation that it has undertaken.

19.6.1 Most of the analyses of the different needs of different localities in the area have been based on the geography of Cheshire East’s eight GP Clusters, five of which are within Eastern Cheshire CCG and three within South Cheshire CCG, as illustrated in the map in section 20. A GP Cluster is a group of GP practices who have chosen to work together with other health and care professionals to plan and provide services locally. By looking at the registered populations of these GP groups, we have been able to allocate standard geographies such as Middle Super Output Areas (MSOAs) to these clusters, emcompassing both town and rural communities in each cluster. This enables us to profile standard data sets such as Census data for them. An advantage of using this geography is that it better fits general practice and community pharmacy patient flows. Another advantage is that GP clusters are already used as standard geographies within Cheshire East’s JSNA.

19.6.2 The Cheshire East JSNA and PNA also contain some town-level analyses, constructed from Middle Level Super Output Areas (MSOAs). Town-level analyses illustrate local variations between communities, which may be hidden by the larger GP Clusters.

19.6.3 NHS Eastern Cheshire CCG covers 52.4% of the population of Cheshire East and NHS South Cheshire CCG covers 47.6% (as per mid-2015 estimates). There are two general practices within the Borough that are aligned to CCGs in neighbouring HWB areas. Bunbury Medical Practice links to NHS Western Cheshire CCG but geographically lies within NHS South Cheshire CCG. In Handforth there is a branch surgery of Cheadle Hulme Health Centre which links to Stockport CCG but geographically lies within NHS Eastern Cheshire CCG.

19.6.4 This Pharmaceutical Needs Assessment has taken into account the different needs of people in its area who share a protected characteristic. A description of these groups and the response of community pharmacies to these needs are described in section 16.

19.6.5 Healthwatch Cheshire East engaged with members of the public who they perceived to be ‘primary users’ of pharmacies. In addition to undertaking group interviews, they completed a number of ‘enter and view’ visits to the pharmacies themselves. The activity took place from May – July 2016, involving 137 people and 14 pharmacies.

19.6.6 To supplement the Healthwatch report, a Public Survey was carried out to seek the views of the local population about community pharmacy services. The survey was conducted in May 2017 with members of the Influence Cheshire East Citizens’ Panel and the Council’s Digital Influence Panel. A short online questionnaire was sent to 2,004 panel members and the survey was available on the council’s website consultation pages and advertised in the internal staff newsletter. It was also promoted by the two CCGs. A total of 669 responses were received. Specific findings on different aspects of pharmacy services from the 2016 Healthwatch report

Page 53 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018 and the 2017 public survey are included in the relevant section of the PNA. An overview of additional findings is also included in the appendix A.

19.6.7 A Community Pharmacy Survey was developed in conjunction with the other, Health and Wellbeing Board Areas in Cheshire and Mersey. The questionnaire was based on previous questionnaires used for PNAs across Cheshire and Mersey. It was available electronically via PharmOutcomes. All 81 community pharmacies returned questionnaires, a 100% response rate.

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20.0 Map of Premises at which Pharmaceutical Services are Provided

Paragraph 7 of Schedule 1 of the 2013 Regulations specifies that HWBs are required to include a map in their PNA identifying the premises at which pharmaceutical services are provided in the area of the HWB.

Figure 9:Map Location of Community Pharmacies and GP Practices in Cheshire East

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10 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

Appendix A: The Public Survey

The survey was conducted in May 2017 with members of the Influence Cheshire East Citizens’ Panel and the Council’s Digital Influence Panel. An online questionnaire was sent to 2,004 panel members. The survey was also available on the council’s website consultation pages and advertised in the internal staff newsletter. It was also promoted by the two CCGs. A total of 669 responses were received.

Demographics of Respondents Age Table i below shows the age profile of those who completed the public survey compared to the current estimated population of Cheshire East. This shows that the the younger age bands, 16-24, 25-34 and 35-44 are underrepresented within the survey. For the age band 45-54 the proportion is representative. The 55-64 and 65-75 age bands are overrepresentative, whereas the oldest age band (75 and over) is again underrepresentative. This is clearly shown by the weight factor, the value used to calculate the weighted data of questions in a survey. Real values of response levels are increased (or decreased) by this factor.

Table i: Age Profile of survey respondents and Cheshire East Estimated Population 2016 Cheshire East % of Survey % of Population population Weight Age Respondents respondents 16 and over 16 and over Factor 0-15 16-24 6 1% 34,511 11% 12.04 25-34 27 4% 38,318 12% 2.97 35-44 59 9% 45,365 15% 1.61 45-54 115 18% 58,955 19% 1.07 55-64 168 26% 48,912 16% 0.61 65-74 226 35% 45,924 15% 0.43 75 and over 42 6% 38,001 12% 1.89 Prefer not to say 6 1% Total 649 309,986

Gender The public survey is generally representative of Cheshire East population in terms of gender, the table below shows that males are slightly underrepresented.

Table ii: Gender Profile of survey respondents and Cheshire East residents in 2016

% of % of population Weight Age respondents Factor Males 50% 51% 1.02 Females 49% 49% 1.00 Prefer not to say 1% Total

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Limited Long Term Illness Within the public survey respondents were asked to report on whether they had a long term health problem or disability which limited their day to day activities, 18% responded ‘yes, limited a little’ and an additional 6% selected ‘yes, a lot’, equating to 24% with a limiting long term illness. This question was designed to replicate the Census 2011 question, 17.5% of residents in Cheshire East answered in the positive. This means that this group of individuals are overrepresented in the survey. This is not surprising as they are more likely to require pharmaceutical services.

Response rate by localities Table iii shows response rates by GP Cluster. Only the proportion of responses from SMASH GP Cluster are representative.

Table iii: Response rates by GP Cluster compared to Cheshire East Estimated Population 2015

Cheshire East % of Survey % of Population population Weight Locality Respondents respondents 16 and over Factor Alderley Edge, Chelford, ECCCG01 Handforth, Wilmslow 51 8% 36,602 12% 1.55 ECCCG02 Macclesfield 96 14% 51,078 17% 1.15 ECCCG03 Bollington, Disley, Poynton 39 6% 22,046 7% 1.22 ECCCG04 Knutsford 20 3% 20,724 7% 2.24 ECCCG05 Congleton, Holmes Chapel 81 12% 31,978 10% 0.85 SCCCG01 Nantwich and Rural 42 6% 30,761 10% 1.58 SCCCG02 Crewe 73 11% 62,639 20% 1.86 SCCCG03 SMASH 117 17% 53,383 17% 0.99 Eastern Cheshire CCG 287 43% 162,428 53% 1.22 South Cheshire CCG 232 35% 146,783 47% 1.37 Unknown 150 22% Total Cheshire East 669 309,211

When specific groups are over or under represented this causes selection bias and any inferences of the results in terms of the general population need to be done with caution. However, the qualitative insights the survey provides are still important.

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Specific findings on different aspects of pharmacy services from this survey are included in the relevant sections of this PNA. Below are some additional findings.

Key Additional Findings from Public Survey

* In the public survey, 86% of residents cited collecting prescription medications as the main reason that they access a pharmacy. In contrast, only 28% access the pharmacy for the minor ailment service and 16% do so for flu vaccinations. * Although ‘Having the things I need’ and ‘Knowledgeable staff’ are factors that have both been selected by almost all respondents’ as important aspects of pharmacies`, (96% and 95% respectively), analysis of the free text comments indicates respondents tend to be either ‘Trust focused’ or ‘Product/medicine focused’:

i) ‘Trust focused’ were those that were driven by the connection to a pharmacy; they often used the same one, and valued the relationship between themselves and the pharmacist. They valued the knowledge and trust they had between themselves and the pharmacist and those in this group tended to favour the independent pharmacies. These respondents were more likely to be dissatisfied by poor customer service, or a lack of staff knowledge, as this was something that was essential to them. ii) In contrast ‘Product focused’ users were those that were driven by obtaining the item or product from the pharmacy, as quickly and conveniently as possible. These respondents valued there being a choice of pharmacies, in locations that were convenient to them. These users tended to prefer the supermarket pharmacies due to their location and longer opening hours, allowing maximum time and minimum effort for acquiring products. These respondents were more likely to be dissatisfied by the lack of availability, or longer waiting time for products.

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Appendix B GP Cluster Profiles

GP CLUSTER PROFILE: ECCCG01 Alderley Edge, Chelford, Handforth and Wilmslow

Opening Hours as at September 2017

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 7 BOOTS UK LIMITED 24-26 GROVE STREET WILMSLOW 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 11:00 - 16:00 No CHESHIRE SK9 1DY 13 CEDRICS CHEMIST LTD FESTIVAL HALL TALBOT ROAD 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 14:00 Closed No ALDERLEY EDGE SK9 7HR 35 INSTORE PHARMACY KILN CROFT LANE 09:00 - 14:30 , HANDFORTH 09:00 - 21:00 09:00 - 21:00 09:00 - 21:00 09:00 - 21:00 09:00 - 21:00 10:00 - 16:00 No 15:00 - 21:00 WILMSLOW SK9 3PA 36 THE VILLAGE PHARMACY UNICORN HOUSE PRESTBURY 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 13:00 Closed No MACCLESFIELD SK10 4DG 45 WELL KENMORE MEDICAL CENTRE 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 Closed Closed No 60-62 ALDERLEY ROAD WILMSLOW SK9 1PA 48 WELL HANDFORTH HEALTH CENTRE 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 Closed Closed No WILMSLOW ROAD HANDFORTH SK9 3HL 49 WELL 110 WILMSLOW ROAD HANDFORTH 09:00 - 18:30 09:00 - 18:30 09:00 - 18:30 09:00 - 18:30 09:00 - 18:30 09:00 - 13:00 Closed No CHESHIRE SK9 3ES 53 WELL WILMSLOW HEALTH CENTRE 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 09:00 - 12:00 Closed No CHAPEL LANE WILMSLOW SK9 5HX 54 WELL 1 LINDOW PARADE 09:00 - 13:00 , 09:00 - 13:00 , 09:00 - 13:00 , 09:00 - 13:00 , 09:00 - 13:00 , CHAPEL LANE Closed Closed No 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 WILMSLOW SK9 5JL 56 CEDRICS CHEMISTS LTD 20 LONDON ROAD 09:00 - 13:00 , ALDERLEY EDGE 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 Closed No 14:00 - 17:00 CHESHIRE SK9 7JS 68 LLOYDSPHARMACY UNIT 2 SUMMERFIELD VILLAGE 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 17:00 Closed No CTR DEAN ROW ROAD SK9 2TA

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017

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GP CLUSTER PROFILE: ECCCG01 Alderley Edge, Chelford, Handforth and Wilmslow

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS_Alc EHC QS Chl-1 Chl-2 Code BOOTS UK LIMITED, 24-26 GROVE 7 Yes Yes Yes Yes Yes Yes STREET, WILMSLOW, CHESHIRE CEDRICS CHEMIST LTD, FESTIVAL 13 HALL, TALBOT ROAD, ALDERLEY EDGE INSTORE PHARMACY, KILN CROFT 35 LANE, HANDFORTH, WILMSLOW THE VILLAGE PHARMACY, UNICORN 36 HOUSE, PRESTBURY, Yes Yes MACCLESFIELD WELL, KENMORE MEDICAL CENTRE, 45 Yes Yes Yes 60-62 ALDERLEY ROAD, WILMSLOW WELL, HANDFORTH HEALTH 48 CENTRE, WILMSLOW ROAD, Yes HANDFORTH WELL, 110 WILMSLOW ROAD, 49 Yes Yes Yes Yes Yes HANDFORTH, CHESHIRE WELL, WILMSLOW HEALTH CENTRE, 53 Yes Yes Yes Yes CHAPEL LANE, WILMSLOW WELL, 1 LINDOW PARADE, CHAPEL 54 Yes LANE, WILMSLOW CEDRICS CHEMISTS LTD, 20 56 LONDON ROAD, ALDERLEY EDGE, CHESHIRE LLOYDSPHARMACY, UNIT 2, 68 SUMMERFIELD VILLAGE CTR, DEAN Yes Yes ROW ROAD PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS_Alc= Stop Smoking and alcohol services; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

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GP CLUSTER PROFILE: ECCCG01 Alderley Edge, Chelford, Handforth and Wilmslow

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map Dispense Pharmacy MUR New Med AUR SAC Code Appliances 7 BOOTS UK LIMITED, 24-26 GROVE STREET, WILMSLOW All Types Yes Yes CEDRICS CHEMIST LTD, FESTIVAL HALL, TALBOT ROAD, 13 Dressings Yes Yes ALDERLEY EDGE INSTORE PHARMACY, KILN CROFT LANE, HANDFORTH, 35 All Types Yes Yes Yes WILMSLOW THE VILLAGE PHARMACY, UNICORN HOUSE, PRESTBURY, 36 All Types Yes Yes Soon Soon MACCLESFIELD WELL, KENMORE MEDICAL CENTRE, 60-62 ALDERLEY ROAD, 45 All Types Yes Yes WILMSLOW WELL, HANDFORTH HEALTH CENTRE, WILMSLOW ROAD, 48 All Types Yes Yes HANDFORTH 49 WELL, 110 WILMSLOW ROAD, HANDFORTH All Types Yes Yes WELL, WILMSLOW HEALTH CENTRE, CHAPEL LANE, 53 All Types Yes Yes WILMSLOW 54 WELL, 1 LINDOW PARADE, CHAPEL LANE, WILMSLOW All Types Yes Yes 56 CEDRICS CHEMISTS LTD, 20 LONDON ROAD, ALDERLEY EDGE Dressings Yes Yes LLOYDSPHARMACY, UNIT 2, SUMMERFIELD VILLAGE CTR, 68 All Types Yes Yes Yes DEAN ROW ROAD MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

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GP CLUSTER PROFILE: ECCCG01 Alderley Edge, Chelford, Handforth and Wilmslow

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All BOOTS UK LIMITED, 24-26 GROVE STREET, 7 Yes Yes Yes Yes Yes Yes Yes WILMSLOW CEDRICS CHEMIST LTD, FESTIVAL HALL, 13 Yes Yes Yes Yes Yes Yes TALBOT ROAD, ALDERLEY EDGE INSTORE PHARMACY, KILN CROFT LANE, 35 Yes Yes Yes Yes Yes Yes Yes Yes Yes HANDFORTH, WILMSLOW THE VILLAGE PHARMACY, UNICORN 36 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes HOUSE, PRESTBURY, MACCLESFIELD WELL, KENMORE MEDICAL CENTRE, 60-62 45 Yes Yes Yes Yes Yes Yes Yes ALDERLEY ROAD, WILMSLOW WELL, HANDFORTH HEALTH CENTRE, 48 Yes Yes Yes Yes Yes Yes Yes Yes WILMSLOW ROAD, HANDFORTH WELL, 110 WILMSLOW ROAD, 49 Yes Yes Yes Yes HANDFORTH WELL, WILMSLOW HEALTH CENTRE, 53 Yes Yes Yes Yes Yes Yes Yes CHAPEL LANE, WILMSLOW WELL, 1 LINDOW PARADE, CHAPEL LANE, 54 Yes Yes Yes Yes WILMSLOW CEDRICS CHEMISTS LTD, 20 LONDON 56 Yes Yes ROAD, ALDERLEY EDGE LLOYDSPHARMACY, UNIT 2, 68 SUMMERFIELD VILLAGE CTR, DEAN ROW Yes Yes Yes Yes Yes Yes ROAD DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: ECCCG01 Alderley Edge, Chelford, Handforth and Wilmslow

General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice Kenmore Medical Centre, 60-62 Alderley Road, Wilmslow, Cheshire, NHS Eastern N81002 Main No SK9 1PA Cheshire CCG NHS Eastern N81033 George Street Surgery, Alderley Edge, Cheshire, SK9 7EP Main No Cheshire CCG Prestbury Surgery, Hope Cottage, Macclesfield Road, Prestbury, NHS Eastern N81033 Branch No Macclesfield, SK10 4BW Cheshire CCG NHS Eastern N81069 Chelford Surgery, Elmstead Road, Chelford, Cheshire, SK11 9BS Main Yes Cheshire CCG Handforth Health Centre, Wilmslow Road, Handforth, Cheshire, SK9 NHS Eastern N81070 Main No 3HL Cheshire CCG NHS Eastern N81086 Wilmslow Health Centre, Chapel Lane, Wilmslow, Cheshire, SK9 5HX Main No Cheshire CCG Hulme Hall Medical Group - Handforth, Handforth, Wilmslow, P88025 Branch No NHS Stockport CCG Cheshire, SK9 3LF

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GP CLUSTER PROFILE: ECCCG02 Macclesfield

Opening Hours as at September 2017

100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Map hours Code 4 BOOTS UK LIMITED 12 MILL STREET MALL THE GROSVENOR 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 11:00 - 16:00 No CENTRE MACCLESFIELD SK11 6AJ 21 PEAK PHARMACY 5-6 WESTON SQUARE EARLSWAY 09:00 - 18:00 09:00 - 18:00 09:00 - 17:30 09:00 - 18:00 09:00 - 18:00 09:00 - 17:30 Closed No MACCLESFIELD SK11 8SS 22 ANDREWS PHARMACY 71 KENNEDY AVENUE MACCLESFIELD 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 12:30 Closed No CHESHIRE SK10 3DE 23 TYTHERINGTON PHARMACY 2-3 THE PRECINCT 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No TYTHERINGTON MACCLESFIELD SK10 2HB 26 INSTORE PHARMACY TESCO SUPERSTORE HIBEL ROAD 08:00 - 20:00 08:00 - 20:00 08:00 - 20:00 08:00 - 20:00 08:00 - 20:00 08:00 - 20:00 10:00 - 16:00 No MACCLESFIELD SK10 2AB 33 WELL 209 PARK LANE MACCLESFIELD 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No CHESHIRE SK11 6UD 55 WELL BOLLIN HOUSE SUNDERLAND STREET 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 Closed Closed No MACCLESFIELD SK11 6JL 63 COHENS CHEMIST WATERS GREEN MEDICAL CTR 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 10:00 - 20:00 Yes SUNDERLAND STREET MACCLESFIELD SK11 6JL 66 LLOYDSPHARMACY 46-48 CHARLOTTE STREET 08:00 - 22:30 08:00 - 22:30 08:00 - 22:30 08:00 - 22:30 08:00 - 22:30 08:00 - 22:30 09:30 - 22:30 Yes MACCLESFIELD CHESHIRE SK11 6JB 92 WELL 78-80 SUNDERLAND STREET 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No MACCLESFIELD CHESHIRE SK11 6HN 96 LONDON ROAD PHARMACY UNIT 1 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 12:30 Closed No 157 LONDON ROAD MACCLESFIELD SK11 7SP 101 LLOYDSPHARMACY 61 CUMBERLAND STREET 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 22:00 10:00 - 16:00 Yes MACCLESFIELD SK10 1BJ

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017

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GP CLUSTER PROFILE: ECCCG02 Macclesfield

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS_Alc EHC QS Chl-1 Chl-2 Code BOOTS UK LIMITED, 12 MILL STREET 4 MALL, THE GROSVENOR CENTRE, Yes Yes Yes Yes MACCLESFIELD PEAK PHARMACY , 5-6 WESTON 21 SQUARE, EARLSWAY, Yes Yes Yes Yes Yes Yes Yes Yes MACCLESFIELD ANDREWS PHARMACY , 71 22 KENNEDY AVENUE, MACCLESFIELD, Yes Yes Yes Yes CHESHIRE TYTHERINGTON PHARMACY, 2-3 23 THE PRECINCT, TYTHERINGTON, Yes Yes MACCLESFIELD INSTORE PHARMACY, TESCO 26 SUPERSTORE, HIBEL ROAD, Yes Yes Yes Yes Yes Yes MACCLESFIELD WELL, 209 PARK LANE, 33 Yes Yes Yes Yes Yes MACCLESFIELD, CHESHIRE WELL , BOLLIN HOUSE, 55 SUNDERLAND STREET, Yes Yes Yes MACCLESFIELD COHENS CHEMIST, WATERS GREEN 63 MEDICAL CTR, SUNDERLAND Yes Yes Yes Yes Yes STREET, MACCLESFIELD LLOYDSPHARMACY, 46-48 66 CHARLOTTE STREET, Yes Yes MACCLESFIELD, CHESHIRE WELL, 78-80 SUNDERLAND STREET, 92 Yes Yes Yes Yes Yes Yes MACCLESFIELD, CHESHIRE LONDON ROAD PHARMACY, UNIT 96 1, 157 LONDON ROAD, Yes Yes Yes Yes MACCLESFIELD LLOYDSPHARMACY, 61 101 CUMBERLAND STREET, Yes Yes MACCLESFIELD PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS_Alc= Stop Smoking and Alcohol Services; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

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GP CLUSTER PROFILE: ECCCG02 Macclesfield

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map Dispense Pharmacy MUR New Med AUR SAC Code Appliances BOOTS UK LIMITED, 12 MILL STREET MALL, THE GROSVENOR 4 All Types Yes Yes CENTRE, MACCLESFIELD PEAK PHARMACY, 5-6 WESTON SQUARE, EARLSWAY, 21 All Types Yes Yes Yes MACCLESFIELD 22 ANDREWS PHARMACY, 71 KENNEDY AVENUE, MACCLESFIELD All Types Yes Yes TYTHERINGTON PHARMACY, 2-3 THE PRECINCT, 23 All Types Yes Yes TYTHERINGTON, MACCLESFIELD INSTORE PHARMACY, TESCO SUPERSTORE, HIBEL ROAD, 26 All Types Yes Yes MACCLESFIELD 33 WELL, 209 PARK LANE, MACCLESFIELD All Types Yes Yes 55 WELL, BOLLIN HOUSE, SUNDERLAND STREET, MACCLESFIELD All Types Yes Yes COHENS CHEMIST, WATERS GREEN MEDICAL CTR, 63 All Types Yes Yes SUNDERLAND STREET, MACCLESFIELD 66 LLOYDSPHARMACY, 46-48 CHARLOTTE STREET, MACCLESFIELD All Types Yes Yes Yes Yes 92 WELL, 78-80 SUNDERLAND STREET, MACCLESFIELD All Types Yes Yes LONDON ROAD PHARMACY, UNIT 1, 157 LONDON ROAD, 96 All Types Yes Yes MACCLESFIELD 101 LLOYDSPHARMACY, 61 CUMBERLAND STREET, MACCLESFIELD Yes Yes MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

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GP CLUSTER PROFILE: ECCCG02 Macclesfield

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All BOOTS UK LIMITED, 12 MILL STREET MALL, THE 4 Yes Yes Yes Yes Yes Yes GROSVENOR CENTRE, MACCLESFIELD PEAK PHARMACY, 5-6 WESTON SQUARE, EARLSWAY, 21 Yes Yes MACCLESFIELD ANDREWS PHARMACY, 71 KENNEDY AVENUE, 22 Yes Yes Yes Yes Yes Yes MACCLESFIELD TYTHERINGTON PHARMACY, 2-3 THE PRECINCT, 23 Yes Yes Yes Yes Yes Yes TYTHERINGTON, MACCLESFIELD INSTORE PHARMACY, TESCO SUPERSTORE, HIBEL 26 Yes Yes Yes Yes Yes Yes Yes Yes Yes ROAD, MACCLESFIELD 33 WELL, 209 PARK LANE, MACCLESFIELD Yes Yes Yes Yes Yes Yes WELL, BOLLIN HOUSE, SUNDERLAND STREET, 55 Yes Yes Yes Yes Yes Yes Yes MACCLESFIELD COHENS CHEMIST, WATERS GREEN MEDICAL CTR, 63 Yes Yes Yes Yes Yes Yes Yes Yes Yes SUNDERLAND STREET, MACCLESFIELD LLOYDSPHARMACY, 46-48 CHARLOTTE STREET, 66 Yes Yes Yes Yes Yes MACCLESFIELD 92 WELL, 78-80 SUNDERLAND STREET, MACCLESFIELD Yes Yes Yes Yes Yes Yes LONDON ROAD PHARMACY, UNIT 1, 157 LONDON 96 Yes Yes Yes Yes Yes ROAD, MACCLESFIELD LLOYDSPHARMACY, 61 CUMBERLAND STREET, 101 Yes Yes Yes Yes Yes Yes Yes Yes MACCLESFIELD DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: ECCCG02 Macclesfield

General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice High Street Surgery, Waters Green Medical Ctr, Sunderland Street, NHS Eastern N81013 Main No Macclesfield, Cheshire, SK11 6JL Cheshire CCG South Park Surgery, Waters Green Medical Ctr, Sunderland Street, NHS Eastern N81029 Main No Macclesfield, Cheshire, SK11 6JL Cheshire CCG Cumberland House Surgery, Waters Green Medical Ctr, Sunderland NHS Eastern N81062 Main No Street, Macclesfield, Cheshire, SK11 6JL Cheshire CCG Park Lane House Medical Centre, Waters Green Medical Ctr, NHS Eastern N81085 Main No Sunderland Street, Macclesfield, Cheshire, SK11 6JL Cheshire CCG Park Green Surgery, Waters Green Medical Ctr, Sunderland Street, NHS Eastern N81088 Main No Macclesfield, Cheshire, SK11 6JL Cheshire CCG Broken Cross Surgery, Waters Green Medical Ctr, Sunderland Street, NHS Eastern N81632 Main No Macclesfield, Cheshire, SK11 6JL Cheshire CCG

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GP CLUSTER PROFILE: ECCCG03 Bollington, Disley and Poynton

Opening Hours as at September 2017

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 44 WELL 11 FOUNTAIN SQUARE DISLEY 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No STOCKPORT SK12 2AB 46 ROWLANDS PHARMACY 67 PARK LANE 09:00 - 18:30 09:00 - 18:30 09:00 - 18:30 09:00 - 18:30 09:00 - 18:30 09:00 - 17:30 Closed No POYNTON CHESHIRE SK12 1RD 52 WELL 4 PARK LANE POYNTON 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 09:00 - 17:30 Closed No STOCKPORT SK12 1RE 57 ROWLANDS PHARMACY THE WATERHOUSE 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 09:00 - 13:00 Closed No WELLINGTON ROAD BOLLINGTON SK10 5JH

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017

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GP CLUSTER PROFILE: ECCCG03 Bollington, Disley and Poynton

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS_Alc EHC QS Chl-1 Chl-2 Code WELL, 11 FOUNTAIN SQUARE, 44 Yes DISLEY, STOCKPORT ROWLANDS PHARMACY, 67 PARK 46 Yes Yes Yes Yes Yes Yes Yes LANE, POYNTON, CHESHIRE WELL, 4 PARK LANE, POYNTON, 52 Yes STOCKPORT ROWLANDS PHARMACY, THE 57 WATERHOUSE, WELLINGTON Yes Yes Yes Yes Yes Yes Yes ROAD, BOLLINGTON PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS_Alc= Stop Smoking and Alcohol Services; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

GP CLUSTER PROFILE: ECCCG03 Bollington, Disley and Poynton

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map Dispense New Pharmacy MUR AUR SAC Code Appliances Med 44 WELL , 11 FOUNTAIN SQUARE, DISLEY, STOCKPORT All Types Yes Yes 46 ROWLANDS PHARMACY, 67 PARK LANE, POYNTON All Types Yes Yes Yes Yes 52 WELL, 4 PARK LANE, POYNTON, STOCKPORT All Types Yes Yes ROWLANDS PHARMACY, THE WATERHOUSE, WELLINGTON 57 All Types Yes Yes ROAD, BOLLINGTON MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: ECCCG03 Bollington, Disley and Poynton

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All 44 WELL, 11 FOUNTAIN SQUARE, DISLEY, STOCKPORT Yes Yes Yes Yes 46 ROWLANDS PHARMACY, 67 PARK LANE, POYNTON Yes Yes Yes Yes Yes Yes 52 WELL, 4 PARK LANE, POYNTON, STOCKPORT Yes Yes Yes Yes Yes Yes Yes ROWLANDS PHARMACY, THE WATERHOUSE, 57 Yes Yes Yes Yes Yes Yes Yes Yes WELLINGTON ROAD, BOLLINGTON DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

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GP CLUSTER PROFILE: ECCCG03 Bollington, Disley and Poynton

General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice Mcilviride Medical Practice, The Chestnuts, 5 Chester Road, Poynton, NHS Eastern N81021 Main No Macclesfield, Cheshire, SK12 1EU Cheshire CCG Bollington Medical Centre, Wellington Road, Bollington, Cheshire, NHS Eastern N81022 Main No SK10 5JH Cheshire CCG Priorslegh Medical Centre, Civic Centre, Off Park Lane, Poynton, NHS Eastern N81073 Main No Cheshire, SK12 1GP Cheshire CCG The Schoolhouse Surgery, Buxton Old Road, Disley, Cheshire, SK12 NHS Eastern N81112 Main No 2BB Cheshire CCG

Page 69 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: ECCCG04 Knutsford

Opening Hours as at September 2017

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 3 BOOTS UK LIMITED 64 KING STREET KNUTSFORD 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 08:30 - 17:30 10:30 - 16:30 No CHESHIRE WA16 6DT 12 MANNINGS 38 PRINCESS STREET 08:30 - 19:30 08:30 - 19:30 08:30 - 19:30 08:30 - 19:30 08:30 - 19:30 09:00 - 17:30 Closed No KNUTSFORD WA16 6BN 61 ROWLANDS PHARMACY 4 PARKGATE LANE 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 12:00 Closed No KNUTSFORD WA16 8HG 62 ROWLANDS PHARMACY 6 CANUTE PLACE 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No KNUTSFORD WA16 6BH 85 WELL 93 TOWN LANE KNUTSFORD 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 Closed Closed No MOBBERLEY WA16 7HH 95 THE PRESCRIPTION SERVICE 11 TATTON STREET 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 07:00 - 22:00 09:00 - 19:00 Yes KNUTSFORD CHESHIRE WA16 6AB

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: ECCCG04 Knutsford

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS_Alc EHC QS Chl-1 Chl-2 Code BOOTS UK LIMITED, 64 KING 3 Yes Yes Yes Yes Yes Yes STREET, KNUTSFORD, CHESHIRE MANNINGS, 38 PRINCESS STREET, , 12 Yes Yes Yes Yes KNUTSFORD ROWLANDS PHARMACY, 4 61 Yes Yes Yes Yes Yes Yes PARKGATE LANE, , KNUTSFORD ROWLANDS PHARMACY, 6 CANUTE 62 Yes Yes Yes Yes PLACE, , KNUTSFORD WELL, 93 TOWN LANE, 85 Yes Yes Yes Yes KNUTSFORD, MOBBERLEY THE PRESCRIPTION SERVICE, 11 95 TATTON STREET, KNUTSFORD, Yes Yes Yes Yes CHESHIRE PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS_Alc= Stop Smoking and Alcohol Services; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

Page 70 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: ECCCG04 Knutsford

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map Dispense New Pharmacy MUR AUR SAC Code Appliances Med 3 BOOTS UK LIMITED, 64 KING STREET, KNUTSFORD All Types Yes Yes Yes 12 MANNINGS, 38 PRINCESS STREET, KNUTSFORD All Types Yes Yes 61 ROWLANDS PHARMACY, 4 PARKGATE LANE, KNUTSFORD All Types Yes Yes 62 ROWLANDS PHARMACY, 6 CANUTE PLACE, KNUTSFORD All Types Yes Yes 85 WELL, 93 TOWN LANE, KNUTSFORD, MOBBERLEY All Types Yes Yes 95 THE PRESCRIPTION SERVICE, 11 TATTON STREET, KNUTSFORD All Types Yes Yes Yes MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: ECCCG04 Knutsford

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All 3 BOOTS UK LIMITED, 64 KING STREET, KNUTSFORD Yes Yes Yes Yes Yes Yes Yes 12 MANNINGS, 38 PRINCESS STREET, KNUTSFORD Yes Yes Yes Yes ROWLANDS PHARMACY, 4 PARKGATE LANE, 61 Yes Yes Yes Yes Yes Yes KNUTSFORD ROWLANDS PHARMACY, 6 CANUTE PLACE, 62 Yes Yes Yes Yes KNUTSFORD 85 WELL , 93 TOWN LANE, KNUTSFORD, MOBBERLEY Yes Yes Yes Yes Yes Yes Yes Yes THE PRESCRIPTION SERVICE, 11 TATTON STREET, 95 Yes Yes Yes Yes Yes Yes KNUTSFORD DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: ECCCG04 Knutsford

General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice Toft Road Surgery, Toft Road, Knutsford, Cheshire, NHS Eastern N81026 Main No WA16 9DY Cheshire CCG Manchester Road Medical Centre, 27-29 Manchester Road, Knutsford, NHS Eastern N81042 Main No Cheshire, WA16 0LY Cheshire CCG Annandale Medical Centre, Mobberley Road, Knutsford, Cheshire, NHS Eastern N81049 Main Yes WA16 8HR Cheshire CCG NHS South N81049 Mobberley Surgery, 99 Town Lane, Mobberley, Cheshire, WA16 7HH Branch Yes Cheshire CCG

Page 71 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: ECCCG05 Congleton and Holmes Chapel

Opening Hours as at September 2017

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 1 BOOTS UK LIMITED 14-16 BRIDGE STREET CONGLETON 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 00:00 - 00:00 No CHESHIRE CW12 1AY 25 LLOYDSPHARMACY 41A WEST STREET CONGLETON 08:30 - 18:15 08:30 - 18:15 08:30 - 18:15 08:30 - 18:15 08:30 - 18:15 09:00 - 13:00 Closed No CHESHIRE CW12 1JN 29 LLOYDSPHARMACY 39-41 LONDON ROAD HOLMES CHAPEL 08:30 - 19:00 08:30 - 19:00 08:30 - 19:00 08:30 - 19:00 08:30 - 19:00 08:30 - 17:00 Closed No CHESHIRE CW4 7AP 42 WELL 1 PARK LANE CONGLETON 08:45 - 18:30 08:45 - 18:30 08:45 - 18:30 08:45 - 18:30 08:45 - 18:30 09:00 - 13:00 Closed No CHESHIRE CW12 3DN 51 SUPERDRUG PHARMACY 39-41 HIGH STREET 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 Closed No CONGLETON CHESHIRE CW12 1AU 67 MOSSLEY PHARMACY 18 BIDDULPH ROAD 09:00 - 13:00 , 09:00 - 13:00 , 09:00 - 13:00 , 09:00 - 13:00 , MOSSLEY 09:00 - 18:00 09:00 - 13:00 Closed No 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 CONGLETON CW12 3LG 89 WELL 2 MILL STREET 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 13:00 Closed No CONGLETON CW12 1AB 93 INSTORE PHARMACY BARN ROAD CONGLETON 06:30 - 22:30 06:30 - 22:30 06:30 - 22:30 06:30 - 22:30 06:30 - 22:30 08:00 - 22:00 10:00 - 16:00 Yes CHESHIRE CW12 1LR 97 BOOTS UNIT E RETAIL PARK BARN ROAD 08:00 - 00:00 08:00 - 00:00 08:00 - 00:00 08:00 - 00:00 08:00 - 00:00 08:00 - 22:00 10:00 - 16:00 Yes CONGLETON CW12 1LJ 98 SALUS PHARMACY 62B HAVANNAH STREET 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No BUGLAWTON CONGLETON CW12 2AT 105 KEEN PHARMACY UNIT2, JUBILEE TRADING EST NEWCASTLE 09:00 - 17:00 09:00 - 17:00 09:00 - 17:00 09:00 - 17:00 09:00 - 17:00 Closed Closed No ROAD,MORETON NR CONGLETON CW12 4SB 108 WEST HEATH PHARMACY UNIT 3, WEST HEATH 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 13:00 Closed No SHOPPING PCT. CONGLETON CW12 4NB 110 CONGLETON PHARMACY READESMOOR GROUP PRACTICE 07:00 - 22:30 07:00 - 22:30 07:00 - 22:30 07:00 - 22:30 07:00 - 22:30 07:00 - 22:30 12:00 - 19:00 Yes 29-31 WEST STREET CONGLETON CW12 1JP 114 GOOSTREY PHARMACY 3 CHESHIRE HOUSE 164 MAIN 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 Closed Closed No ROAD,GOOSTREY CREWE CW4 8JP

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017

Page 72 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: ECCCG05 Congleton and Holmes Chapel

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS_Alc EHC QS Chl-1 Chl-2 Code BOOTS UK LIMITED, 14-16 BRIDGE 1 Yes Yes Yes Yes Yes STREET, CONGLETON, CHESHIRE LLOYDSPHARMACY, 41A WEST 25 Yes Yes Yes STREET, CONGLETON, CHESHIRE LLOYDSPHARMACY, 39-41 LONDON 29 Yes ROAD, HOLMES CHAPEL, CHESHIRE WELL, 1 PARK LANE, CONGLETON, 42 Yes Yes Yes Yes Yes Yes CHESHIRE SUPERDRUG PHARMACY, 39-41 51 HIGH STREET, CONGLETON, Yes CHESHIRE MOSSLEY PHARMACY, 18 BIDDULPH 67 Yes Yes ROAD, MOSSLEY, CONGLETON WELL, 2 MILL STREET, , 89 Yes Yes Yes Yes CONGLETON INSTORE PHARMACY, BARN ROAD, 93 Yes Yes Yes Yes Yes Yes CONGLETON, CHESHIRE BOOTS, UNIT E RETAIL PARK, BARN 97 Yes Yes Yes Yes Yes Yes ROAD, CONGLETON SALUS PHARMACY, 62B HAVANNAH 98 STREET, BUGLAWTON, Yes Yes CONGLETON KEEN PHARMACY, UNIT2,JUBILEE 105 TRADING EST, NEWCASTLE ROAD,MORETON, NR CONGLETON WEST HEATH PHARMACY, UNIT 3, 108 WEST HEATH SHOPPING PCT., Yes Yes CONGLETON CONGLETON PHARMACY, 110 READESMOOR GROUP PRACTICE, Yes Yes 29-31 WEST STREET, CONGLETON GOOSTREY PHARMACY, 3 CHESHIRE 114 HOUSE, 164 MAIN Yes Yes Yes ROAD,GOOSTREY, CREWE PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS_Alc= Stop Smoking and Alcohol Services; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

Page 73 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: ECCCG05 Congleton and Holmes Chapel

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map New Pharmacy Dispense Appliances MUR AUR SAC Code Med 1 BOOTS UK LIMITED, 14-16 BRIDGE STREET, CONGLETON All Types Yes Yes 25 LLOYDSPHARMACY, 41A WEST STREET, CONGLETON Dressings Yes Yes 29 LLOYDSPHARMACY, 39-41 LONDON ROAD, HOLMES CHAPEL Yes Yes Soon Soon 42 WELL, 1 PARK LANE, CONGLETON All Types Yes Yes 51 SUPERDRUG PHARMACY, 39-41 HIGH STREET, CONGLETON Yes Yes MOSSLEY PHARMACY, 18 BIDDULPH ROAD, MOSSLEY, 67 All Types Yes Yes Yes CONGLETON 89 WELL, 2 MILL STREET, CONGLETON All Types Yes Yes 93 INSTORE PHARMACY, BARN ROAD, CONGLETON All Types Yes Yes Stoma 97 BOOTS, UNIT E RETAIL PARK, BARN ROAD, CONGLETON Yes Yes Yes appliances;Dressings SALUS PHARMACY, 62B HAVANNAH STREET, BUGLAWTON, 98 All Types Yes Yes Yes Yes CONGLETON KEEN PHARMACY, UNIT2,JUBILEE TRADING EST, NEWCASTLE 105 All Types Yes Yes ROAD,MORETON, NR CONGLETON WEST HEATH PHARMACY, UNIT 3, WEST HEATH SHOPPING 108 All Types Yes Yes PCT., CONGLETON CONGLETON PHARMACY, READESMOOR GROUP PRACTICE, 110 All Types Yes Yes 29-31 WEST STREET, CONGLETON GOOSTREY PHARMACY, 3 CHESHIRE HOUSE, 164 MAIN Incontinence 114 Yes Yes ROAD,GOOSTREY, CREWE appliances;Dressings MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: ECCCG05 Congleton and Holmes Chapel

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All BOOTS UK LIMITED, 14-16 BRIDGE STREET, 1 Yes Yes Yes Yes Yes Yes Yes CONGLETON 25 LLOYDSPHARMACY, 41A WEST STREET, CONGLETON Yes Yes Yes Yes LLOYDSPHARMACY, 39-41 LONDON ROAD, HOLMES 29 Yes Yes Yes Yes Yes Yes CHAPEL 42 WELL, 1 PARK LANE, CONGLETON Yes Yes Yes Yes Yes Yes SUPERDRUG PHARMACY, 39-41 HIGH STREET, 51 Yes Yes Yes Yes Yes Yes CONGLETON MOSSLEY PHARMACY, 18 BIDDULPH ROAD, 67 Yes Yes Yes Yes Yes MOSSLEY, CONGLETON 89 WELL, 2 MILL STREET, CONGLETON Yes Yes Yes Yes Yes Yes 93 INSTORE PHARMACY, BARN ROAD, CONGLETON Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes BOOTS, UNIT E RETAIL PARK, BARN ROAD, 97 Yes Yes Yes Yes Yes Yes Yes Yes CONGLETON SALUS PHARMACY, 62B HAVANNAH STREET, 98 Yes Yes Yes Yes BUGLAWTON, CONGLETON KEEN PHARMACY, UNIT2, JUBILEE TRADING EST, 105 Yes Yes Yes Yes Yes Yes Yes Yes Yes NEWCASTLE ROAD,MORETON, NR CONGLETON WEST HEATH PHARMACY, UNIT 3, WEST HEATH 108 Yes Yes Yes Yes Yes Yes SHOPPING PCT., CONGLETON CONGLETON PHARMACY, READESMOOR GROUP 110 Yes Yes Yes Yes Yes Yes Yes Yes PRACTICE, 29-31 WEST STREET, CONGLETON GOOSTREY PHARMACY, 3 CHESHIRE HOUSE, 164 114 Yes Yes Yes MAIN ROAD,GOOSTREY, CREWE DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

Page 74 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: ECCCG05 Congleton and Holmes Chapel

General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice Readesmoor Medical Group Practice, 29-31 West Street, Congleton, NHS Eastern N81027 Main No Cheshire, CW12 1JP Cheshire CCG Lawton House Surgery, Bromley Road, Congleton, Cheshire, CW12 NHS Eastern N81052 Main No 1QG Cheshire CCG The Health Centre (Holmes Chapel), London Road, Holmes Chapel, NHS Eastern N81077 Main Yes Cheshire, CW4 7BB Cheshire CCG Meadowside Medical Centre, Meadowside, Mountbatten Way, NHS Eastern N81118 Main No Congleton,Cheshire, CW12 1DY Cheshire CCG

Page 75 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: SCCCG01 Nantwich and Rural

Opening Hours as at September 2017

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 5 BOOTS UK LIMITED 14 SWINEMARKET NANTWICH 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 Closed No CHESHIRE CW5 5LN 60 MORRISONS PHARMACY STATION ROAD 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13.00 , 10:00 - 13.00 , No NANTWICH 14.00 - 19:00 14.00 - 19:00 14.00 - 19:00 14.00 - 19:00 14.00 - 20:00 14.00 - 20:00 14.00 - 16:00 CHESHIRE CW5 5SP 65 LLOYDSPHARMACY MIDDLEWICH ROAD NANTWICH 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 22:00 10:00 - 16:00 Yes CHESHIRE CW5 6PH 78 WELL CHURCH VIEW CARE CENTRE 08:00 - 18:30 08:00 - 18:30 08:00 - 18:30 08:00 - 18:30 08:00 - 18:30 08:30 - 13:00 Closed No BEAM STREET NANTWICH CW5 5NX 79 WELL 57 BEAM STREET NANTWICH 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 Closed Closed No CHESHIRE CW5 5NF 106 YOUR LOCAL BOOTS PHARMACY 1 CHESHIRE STREET 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13.00 , 09:00 - 13:00 Closed No AUDLEM 14.00 - 18:00 14.00 - 18:00 14.00 - 18:00 14.00 - 18:00 14.00 - 18:00 CREWE CW3 0AH

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017 Well, 57 Beam St., Nantwich updated hours provided by Portfolio Support Co-ordinator on 15/01/18.

Page 76 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: SCCCG01 Nantwich and Rural

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS EHC QS Chl-1 Chl-2 Code BOOTS UK LIMITED, 14 5 SWINEMARKET, NANTWICH, Yes Yes Yes Yes Yes Yes Yes CHESHIRE MORRISONS PHARMACY, STATION 60 Yes Yes Yes ROAD, NANTWICH, CHESHIRE LLOYDSPHARMACY, MIDDLEWICH 65 Yes Yes Yes ROAD, NANTWICH, CHESHIRE WELL, CHURCH VIEW CARE CENTRE, 78 Yes Yes Yes Yes Yes Yes BEAM STREET, NANTWICH WELL, 57 BEAM STREET, 79 Yes Yes Yes Yes Yes NANTWICH, CHESHIRE YOUR LOCAL BOOTS PHARMACY 1 106 CHESHIRE STREET, AUDLEM, Yes Yes Yes Yes Yes CREWE PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS= Stop Smoking; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

GP CLUSTER PROFILE: SCCCG01 Nantwich and Rural

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map Dispense Pharmacy MUR New Med AUR SAC Code Appliances 5 BOOTS UK LIMITED, 14 SWINEMARKET, NANTWICH All Types Yes Yes 60 MORRISONS PHARMACY, STATION ROAD, NANTWICH All Types Yes Yes 65 LLOYDSPHARMACY, MIDDLEWICH ROAD, NANTWICH Dressings Yes Yes WELL, CHURCH VIEW CARE CENTRE, BEAM STREET, 78 All Types Yes Yes NANTWICH 79 WELL, 57 BEAM STREET, NANTWICH All Types Yes Yes YOUR LOCAL BOOTS PHARMACY, 1 CHESHIRE STREET, 106 All Types Yes Yes AUDLEM, CREWE MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

Page 77 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: SCCCG01 Nantwich and Rural

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All 5 BOOTS UK LIMITED, 14 SWINEMARKET, NANTWICH Yes Yes Yes Yes Yes Yes Yes Yes MORRISONS PHARMACY, STATION ROAD, 60 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes NANTWICH 65 LLOYDSPHARMACY, MIDDLEWICH ROAD, NANTWICH Yes Yes Yes Yes Yes Yes Yes Yes Yes WELL, CHURCH VIEW CARE CENTRE, BEAM STREET, 78 Yes Yes Yes Yes Yes Yes Yes Yes NANTWICH 79 WELL, 57 BEAM STREET, NANTWICH Yes Yes Yes Yes Yes Yes YOUR LOCAL BOOTS PHARMACY, 1 CHESHIRE STREET, 106 Yes Yes Yes Yes AUDLEM, CREWE DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: SCCCG01 Nantwich and Rural

General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice Audlem Medical Practice, 16 Cheshire St, Audlem, Crewe, Cheshire, NHS South N81001 Main No CW3 0AH Cheshire CCG NHS West Cheshire N81006 Bunbury Medical Practice, Bunbury, Tarporley, Cheshire, CW6 9PE Main Yes CCG Nantwich Health Centre, Church View Pcc, Beam St., Nantwich, NHS South N81010 Main No Cheshire, CW5 5NX Cheshire CCG The Kiltearn Medical Ctr., Church View Pcc, Nantwich, Cheshire, CW5 NHS South N81047 Main No 5NX Cheshire CCG Tudor Surgery, Church View Pcc, Beam St, Nantwich, Cheshire, CW5 NHS South N81090 Main No 5NX Cheshire CCG The Surgery, Nantwich Road, Wrenbury, Cheshire, NHS South N81614 Main Yes CW5 8EW Cheshire CCG

Page 78 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

GP CLUSTER PROFILE: SCCCG02 Crewe

Opening Hours as at September 2017

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 2 BOOTS UK LIMITED 56-58 MARKET STREET CREWE 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 Closed No CHESHIRE CW1 2EX 18 ROWLANDS PHARMACY 66 RICHARD MOON STREET 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 09:00 - 13:00 Closed No CREWE CHESHIRE CW1 3AX 20 ROWLANDS PHARMACY 7 KINGS DRIVE 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No WISTASTON CREWE CW2 8HY 24 RYDALE PHARMACY 18 NORTH STREET 09:00 - 13:00 , 09:00 - 13:00 , 09:00 - 13:00 , 09:00 - 13:00 , - 13:00 , 14:00 COPPENHALL 09:30 - 12:30 Closed No 14:00 - 17:30 14:00 - 17:30 14:00 - 17:00 14:00 - 17:30 - CREWE CW1 4NL 34 WELL 3 THE PRECINCT READESDALE AVENUE 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 Closed Closed No WISTASTON CW2 8UR 64 ASDA PHARMACY VICTORIA CENTRE CREWE 08:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 23:00 07:00 - 22:00 10:00 - 16:00 Yes CHESHIRE CW1 2PT 75 WELL HUNGERFORD MEDICAL CENTRE 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 Closed Closed No SCHOOL CRESCENT CREWE CW1 5HA 76 WELL 139-141 NANTWICH ROAD 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No CREWE CW2 6DF 80 WELL 1A BROOKHOUSE 08:45 - 13:00 , 08:45 - 13:00 , 08:45 - 13:00 , 08:45 - 13:00 , 08:45 - 13:00 , DRIVE Closed Closed No 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 14:00 - 18:00 CREWE CW2 6NA 87 WELL ROPE LANE MEDICAL CENTRE ROPE LANE, 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 09:00 - 13:00 Closed No SHAVINGTON CREWE CW2 5DA 90 WEST STREET PHARMACY 143 WEST STREET 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No CREWE CW1 3HH 91 EAGLE BRIDGE PHARMACY EAGLE BRIDGE HEALTH CTR 08:30 - 20:00 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 09:00 - 13:00 Closed No DUNWOODY WAY CREWE CW1 3AW 100 BOOTS UNIT 12 GRAND JUNCTION 08:00 - 00:00 08:00 - 00:00 08:00 - 00:00 08:00 - 00:00 08:00 - 00:00 08:00 - 22:00 11:00 - 17:00 Yes RETAIL PK CREWE CW1 2RP 104 INSTORE PHARMACY VERNON WAY 06:30 - 22:30 06:30 - 22:30 06:30 - 22:30 06:30 - 22:30 06:30 - 22:30 08:00 - 22:00 10:00 - 16:00 Yes CREWE CW1 2DD

Page 79 of 90 DRAFT 30th January 2018 CHESHIRE EAST PHARMACEUTICAL NEEDS ASSESSMENT 2018

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 109 CLEAR PHARMACY 31-32 THE MARKET CENTRE 08:45 - 17:30 08:45 - 17:30 08:45 - 17:30 08:45 - 17:30 08:45 - 17:30 08:45 - 17:30 Closed No VICTORIA STREET CREWE CW1 2NG

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: SCCCG02 Crewe

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS_Alc EHC QS Chl-1 Chl-2 Code BOOTS UK LIMITED, 56-58 MARKET 2 Yes Yes Yes Yes Yes STREET, CREWE, CHESHIRE ROWLANDS PHARMACY, 66 18 RICHARD MOON STREET, CREWE, Yes Yes Yes Yes Yes Yes Yes Yes CHESHIRE ROWLANDS PHARMACY, 7 KINGS 20 Yes Yes Yes Yes Yes DRIVE, WISTASTON, CREWE RYDALE PHARMACY, 18 NORTH 24 Yes Yes Yes Yes Yes STREET, COPPENHALL, CREWE WELL, 3 THE PRECINCT, 34 Yes Yes Yes Yes READESDALE AVENUE, WISTASTON ASDA PHARMACY, VICTORIA 64 Yes Yes Yes Yes Yes Yes Yes CENTRE, CREWE, CHESHIRE WELL, HUNGERFORD MEDICAL 75 CENTRE, SCHOOL CRESCENT, Yes Yes Yes Yes CREWE WELL, 139-141 NANTWICH ROAD, 76 Yes Yes Yes Yes Yes CREWE, WELL, 1A BROOKHOUSE DRIVE, 80 Yes Yes Yes Yes CREWE, WELL, ROPE LANE MEDICAL CENTRE, 87 Yes Yes Yes Yes Yes ROPE LANE, SHAVINGTON, CREWE WEST STREET PHARMACY, 143 90 Yes Yes Yes Yes Yes WEST STREET, , CREWE EAGLE BRIDGE PHARMACY, EAGLE 91 BRIDGE HEALTH CTR, DUNWOODY Yes Yes Yes Yes Yes Yes WAY, CREWE BOOTS, UNIT 12, GRAND JUNCTION 100 Yes Yes Yes Yes Yes Yes Yes Yes RETAIL PK, CREWE INSTORE PHARMACY, VERNON 104 Yes Yes Yes Yes Yes WAY, CREWE CLEAR PHARMACY, 31-32 THE 109 MARKET CENTRE, VICTORIA STREET, Yes Yes Yes Yes CREWE PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS_Alc= Stop Smoking and Alcohol Services; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

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GP CLUSTER PROFILE: SCCCG02 Crewe

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map Dispense Pharmacy MUR New Med AUR SAC Code Appliances 2 BOOTS UK LIMITED, 56-58 MARKET STREET, CREWE All Types Yes Yes 18 ROWLANDS PHARMACY, 66 RICHARD MOON STREET, CREWE All Types Yes Yes 20 ROWLANDS PHARMACY, 7 KINGS DRIVE, WISTASTON, CREWE All Types Yes Yes 24 RYDALE PHARMACY, 18 NORTH STREET, COPPENHALL, CREWE All Types Yes Yes 34 WELL , 3 THE PRECINCT, READESDALE AVENUE, WISTASTON All Types Yes Yes 64 ASDA PHARMACY, VICTORIA CENTRE, CREWE All Types Yes Yes Yes WELL, HUNGERFORD MEDICAL CENTRE, SCHOOL CRESCENT, 75 All Types Yes Yes CREWE 76 WELL, 139-141 NANTWICH ROAD, CREWE, All Types Yes Yes 80 WELL, 1A BROOKHOUSE DRIVE, CREWE, All Types Yes Yes WELL, ROPE LANE MEDICAL CENTRE, ROPE LANE, 87 All Types Yes Yes SHAVINGTON, CREWE 90 WEST STREET PHARMACY, 143 WEST STREET, CREWE All Types Yes Yes EAGLE BRIDGE PHARMACY, EAGLE BRIDGE HEALTH CTR, 91 All Types Yes Yes DUNWOODY WAY, CREWE 100 BOOTS, UNIT 12, GRAND JUNCTION RETAIL PK, CREWE All Types Yes Yes 104 INSTORE PHARMACY, VERNON WAY, CREWE Dressings Yes Yes CLEAR PHARMACY, 31-32 THE MARKET CENTRE, VICTORIA 109 Yes Yes STREET, CREWE MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: SCCCG02 Crewe

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All 2 BOOTS UK LIMITED, 56-58 MARKET STREET, CREWE Yes Yes Yes Yes Yes Yes Yes ROWLANDS PHARMACY, 66 RICHARD MOON STREET, 18 Yes Yes Yes Yes Yes Yes Yes CREWE ROWLANDS PHARMACY, 7 KINGS DRIVE, 20 Yes Yes Yes Yes Yes Yes Yes WISTASTON, CREWE RYDALE PHARMACY, 18 NORTH STREET, 24 Yes Yes Yes Yes Yes COPPENHALL, CREWE WELL , 3 THE PRECINCT, READESDALE AVENUE, 34 Yes Yes Yes Yes Yes Yes WISTASTON 64 ASDA PHARMACY, VICTORIA CENTRE, CREWE Yes Yes Yes Yes Yes Yes Yes Yes Yes WELL, HUNGERFORD MEDICAL CENTRE, SCHOOL 75 Yes Yes Yes Yes Yes Yes Yes Yes CRESCENT, CREWE 76 WELL, 139-141 NANTWICH ROAD, CREWE, Yes Yes Yes Yes Yes Yes 80 WELL, 1A BROOKHOUSE DRIVE, CREWE, Yes Yes Yes Yes Yes Yes Yes WELL, ROPE LANE MEDICAL CENTRE, ROPE LANE, 87 Yes Yes Yes Yes Yes Yes Yes Yes SHAVINGTON, CREWE 90 WEST STREET PHARMACY, 143 WEST STREET, CREWE Yes Yes Yes Yes Yes Yes EAGLE BRIDGE PHARMACY, EAGLE BRIDGE HEALTH 91 Yes Yes Yes Yes Yes Yes Yes CTR, DUNWOODY WAY, CREWE BOOTS, UNIT 12, GRAND JUNCTION RETAIL PK, 100 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes CREWE 104 INSTORE PHARMACY, VERNON WAY, CREWE Yes Yes Yes Yes Yes Yes Yes CLEAR PHARMACY, 31-32 THE MARKET CENTRE, 109 Yes Yes Yes Yes Yes VICTORIA STREET, CREWE DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

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GP CLUSTER PROFILE: SCCCG01 Nantwich and Rural

General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice NHS South N81016 Millcroft Medical Centre, Dunwoody Way, Crewe, Cheshire, CW1 3AW Main No Cheshire CCG Hungerford Medical Centre, School Crescent, Crewe, Cheshire, CW1 NHS South N81044 Main No 5HA Cheshire CCG Earnswood Medical Centre, Dunwoody Way, Crewe, Cheshire, CW1 NHS South N81053 Main No 3AW Cheshire CCG NHS South N81068 Gresty Brook Medical Centre, Brookhouse Drive, Crewe, CW2 6NA Branch No Cheshire CCG Grosvenor Medical Centre, Grosvenor Street, Crewe, Cheshire, CW1 NHS South N81068 Main No 3HB Cheshire CCG Rope Green Medical Centre, Rope Lane, Shavington, Crewe, Cheshire, NHS South N81084 Main No CW2 5DA Cheshire CCG

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GP CLUSTER PROFILE: SCCCG03 SMASH

Opening Hours as at September 2017

Map 100 Pharmacy Address Monday Tuesday Wednesday Thursday Friday Saturday Sunday Code hours 10 BOOTS UK LIMITED 5-7 HIGH STREET SANDBACH 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 Closed No CHESHIRE CW11 1AH 19 ROWLANDS PHARMACY HASLINGTON SURGERY 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 08:30 - 18:00 09:00 - 13:00 Closed No CREWE ROAD, HASLINGTON CREWE CW1 5QY 27 LLOYDSPHARMACY 25 LAWTON ROAD ALSAGER 08:15 - 18:30 08:15 - 18:30 08:15 - 18:30 08:15 - 18:30 08:15 - 18:30 09:00 - 17:00 Closed No CHESHIRE ST7 2AA 32 WELL ASHFIELDS P/CARE CENTRE 07:00 - 20:00 08:00 - 19:00 08:00 - 19:00 08:00 - 19:00 08:00 - 19:00 Closed Closed No MIDDLEWICH ROAD SANDBACH CW11 1DH 39 ROWLANDS PHARMACY ST ANNE'S WALK 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 08:30 - 18:30 09:00 - 13:00 Closed No MIDDLEWICH CW10 9BE 41 WELL LAWTON ROAD ALSAGER 08:45 - 18:45 08:45 - 18:45 08:45 - 18:00 08:45 - 18:45 08:45 - 18:45 08:45 - 13:00 Closed No CHESHIRE ST7 2AA 47 ROWLANDS PHARMACY 28 WHEELOCK STREET 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:00 Closed No MIDDLEWICH CHESHIRE CW10 9AG 86 WELL CEDARS MEDICAL CENTRE 12 SANDBACH ROAD 08:30 - 18:30 08:30 - 18:30 08:30 - 17:00 08:30 - 18:30 08:30 - 18:30 Closed Closed No SOUTH ALSAGER ST7 2AD 88 WELL UNIT 3 THE COMMONS 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 17:30 Closed No SANDBACH CW11 1EG 103 MOSTON PHARMACY SERVICES G2 DRAGONS WHARF 09:00 - 17:00 09:00 - 17:00 09:00 - 17:00 09:00 - 17:00 09:00 - 17:00 Closed Closed No DRAGONS LANE SANDBACH CW11 3PA 107 WISE PHARMACY 11 LONDON ROAD ELWORTH 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 12:30 Closed No SANDBACH CW11 3BD 111 CHEMIST COUNTER DIRECT LIMITED 42 GOLDSMITH DRIVE 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 17:30 09:00 - 13:00 Closed No ETTILEY HEATH SANDBACH CW11 3GR 113 CLEDFORD PHARMACY 70 WARMINGHAM LANE 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 18:00 09:00 - 13:00 Closed No MIDDLEWICH CHESHIRE CW10 0DJ

Note : Pharmacies have a requirement to keep their NHS Choices profile including opening hours up-to-date at least every 6 months within the Quality Payments Scheme.

Data Source: Pharmacy Survey 2017. Well, Lawton Rd, Alsager updated hours provided by Portfolio Support Co-ordinator on 15/01/18.

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GP CLUSTER PROFILE: SCCCG03 SMASH

CCG and Public Health Commissioned Services as at October 2017

CCG Commissioned Public Health Commissioned Services Services Map Pharmacy PCS MAS SC NE SS_Alc EHC QS Chl-1 Chl-2 Code BOOTS UK LIMITED, 5-7 HIGH 10 Yes Yes Yes Yes Yes STREET, SANDBACH, CHESHIRE ROWLANDS PHARMACY, 19 HASLINGTON SURGERY, CREWE Yes Yes Yes Yes Yes Yes ROAD, HASLINGTON, CREWE LLOYDSPHARMACY, 25 LAWTON 27 Yes Yes Yes Yes Yes ROAD, ALSAGER, CHESHIRE WELL, ASHFIELDS P/CARE CENTRE, 32 Yes Yes Yes Yes Yes Yes MIDDLEWICH ROAD, SANDBACH ROWLANDS PHARMACY, ST ANNE'S 39 Yes Yes Yes Yes Yes WALK, , MIDDLEWICH WELL, LAWTON ROAD, ALSAGER, 41 Yes CHESHIRE ROWLANDS PHARMACY, 28 47 WHEELOCK STREET, MIDDLEWICH, Yes Yes Yes Yes Yes Yes CHESHIRE WELL, CEDARS MEDICAL CENTRE, 86 12 SANDBACH ROAD SOUTH, Yes Yes Yes Yes Yes Yes ALSAGER WELL, UNIT 3, THE COMMONS, 88 Yes Yes Yes Yes Yes Yes SANDBACH MOSTON PHARMACY SERVICES, G2 103 DRAGONS WHARF, DRAGONS LANE, SANDBACH WISE PHARMACY, 11 LONDON 107 Yes ROAD, ELWORTH, SANDBACH CHEMIST COUNTER DIRECT LIMITED, 111 42 GOLDSMITH DRIVE, ETTILEY HEATH, SANDBACH CLEDFORD PHARMACY, 70 113 WARMINGHAM LANE, Yes Yes Yes MIDDLEWICH, CHESHIRE PCS =Palliative Care Scheme; MAS= Minor Ailments Scheme; SC= Supervised Consumption; NE= Needle Exchange; SS= Stop Smoking and Alcohol Services; EHC= Emergency Hormonal Contraception; QS= Quick Start Contraception; Chl-1= Chlamydia Option 1; Chl-2= Chlamydia Option 2

Data Source: Public Health Commissioners, PharmOutcomes, Medicines Management Team

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GP CLUSTER PROFILE: SCCCG03 SMASH

Advanced Services from pharmacy survey with addresses as of 03/10/2017

Map Dispense New Pharmacy MUR AUR SAC Code Appliances Med 10 BOOTS UK LIMITED, 5-7 HIGH STREET, SANDBACH All Types Yes Yes ROWLANDS PHARMACY, HASLINGTON SURGERY, CREWE ROAD, 19 All Types Yes Yes HASLINGTON, CREWE 27 LLOYDSPHARMACY, 25 LAWTON ROAD, ALSAGER All Types Yes Yes WELL, ASHFIELDS P/CARE CENTRE, MIDDLEWICH ROAD, 32 All Types Yes Yes SANDBACH 39 ROWLANDS PHARMACY, ST ANNE'S WALK, MIDDLEWICH All Types Yes Yes 41 WELL, LAWTON ROAD, ALSAGER All Types Yes Yes Yes 47 ROWLANDS PHARMACY, 28 WHEELOCK STREET, MIDDLEWICH All Types Yes Yes WELL, CEDARS MEDICAL CENTRE, 12 SANDBACH ROAD SOUTH, 86 All Types Yes Yes ALSAGER 88 WELL, UNIT 3, THE COMMONS, SANDBACH All Types Yes Yes MOSTON PHARMACY SERVICES, G2 DRAGONS WHARF, DRAGONS 103 All Types Yes Yes Soon LANE, SANDBACH 107 WISE PHARMACY, 11 LONDON ROAD, ELWORTH, SANDBACH All Types Yes Yes CHEMIST COUNTER DIRECT LIMITED, 42 GOLDSMITH DRIVE, 111 All Types Yes Yes Yes Soon ETTILEY HEATH, SANDBACH 113 CLEDFORD PHARMACY, 70 WARMINGHAM LANE, MIDDLEWICH All Types Yes Yes MUR = Medicines Use Review; New Med = New Medicines Service; AUR = Appliance Use Review; SAC = Stoma Appliance Customisation

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: SCCCG03 SMASH

Accessibility from pharmacy survey with addresses as of 03/10/2017

Map WA Pharmacy DP WA AD/B HL LPL CA CAWA T TWA Code All 10 BOOTS UK LIMITED, 5-7 HIGH STREET, SANDBACH Yes Yes Yes Yes Yes Yes Yes ROWLANDS PHARMACY, HASLINGTON SURGERY, 19 Yes Yes Yes Yes Yes Yes Yes Yes Yes CREWE ROAD, HASLINGTON, CREWE 27 LLOYDSPHARMACY, 25 LAWTON ROAD, ALSAGER Yes Yes Yes WELL, ASHFIELDS P/CARE CENTRE, MIDDLEWICH 32 Yes Yes Yes Yes Yes Yes Yes ROAD, SANDBACH ROWLANDS PHARMACY, ST ANNE'S WALK, 39 Yes Yes Yes Yes Yes Yes Yes Yes MIDDLEWICH 41 WELL, LAWTON ROAD, ALSAGER Yes Yes Yes Yes Yes Yes Yes ROWLANDS PHARMACY, 28 WHEELOCK STREET, 47 Yes Yes Yes Yes MIDDLEWICH WELL, CEDARS MEDICAL CENTRE, 12 SANDBACH 86 Yes Yes Yes Yes Yes Yes Yes ROAD SOUTH, ALSAGER 88 WELL, UNIT 3, THE COMMONS, SANDBACH Yes Yes Yes Yes Yes Yes Yes MOSTON PHARMACY SERVICES, G2 DRAGONS 103 Yes Yes Yes Yes Yes Yes Yes Yes WHARF, DRAGONS LANE, SANDBACH WISE PHARMACY, 11 LONDON ROAD, ELWORTH, 107 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes SANDBACH CHEMIST COUNTER DIRECT LIMITED, 42 GOLDSMITH 111 Yes Yes Yes Yes DRIVE, ETTILEY HEATH, SANDBACH CLEDFORD PHARMACY, 70 WARMINGHAM LANE, 113 Yes Yes Yes Yes Yes MIDDLEWICH DP= Designated Disabled Parking within 50m; WA= Entrance suitable for unaided wheelchair; WA all= all areas accessible by wheelchair; AD/B= Automatic door or bell at front door; HL= Hearing Loop; LPL= Large Print Labels or Leaflets; CA= Consultation area; CAWA= Consultation area accessible by wheelchair; T= access to toilet during consultation; TWA= toilet facilities accessible by wheelchair users

Data Source: Pharmacy Survey 2017

GP CLUSTER PROFILE: SCCCG03 SMASH

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General Practices as of 03/10/2017

GP Practice Surgery Dispensing GP Practice Address Responsible CCG Code Type Practice The Cedars Medical Centre, Sandbach Rd South,Alsager, Stoke On NHS South N81008 Main No Trent, ST7 2LU Cheshire CCG Ashfields P/Care Centre, Middlewich Road, Sandbach, Cheshire, CW11 NHS South N81032 Main No 1EQ Cheshire CCG Oaklands, Middlewich Medical Centre, St.Ann's Walk, Middlewich, NHS South N81039 Main No Cheshire, CW10 9BE Cheshire CCG Haslington Surgery, Crewe Road, Haslington, Crewe, Cheshire, CW1 NHS South N81043 Main No 5QY Cheshire CCG Greenmoss Medical Centre, Scholar Green, Cheshire, NHS South N81071 Main Yes ST7 3BT Cheshire CCG Rode Heath Surgery, 130 Heath Avenue, Rode Heath, Stoke On Trent, NHS South N81071 Branch Yes ST7 3TH Cheshire CCG Merepark Medical Centre, 12 Sandbach Road South, Alsager, NHS South N81111 Main No Cheshire, ST7 2LU Cheshire CCG Water's Edge Medical Centre, 10-12 Leadsmithy Street, Middlewich, NHS South N81642 Main No Cheshire, CW10 9BH Cheshire CCG

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Appendix C Glossary of terms and phrases defined in regulation 2 of the 2013 Regulations

Term or phrase Explanation Advanced services These are one class of directed services which can be provided by every community pharmacy providing NHS pharmaceutical services. The pharmacy must have a consultation room which complies with specifications in the regulations where these services are conducted with the patient.

These services are medication use reviews (MURs), New medicines service (NMS), seasonal flu vaccination service and currently NHS Urgent Medicines Supply Advanced Service (NUMSAS) pilot. Distance- selling pharmacy contractors can provide these services at their premises, face to face with patients. Controlled A controlled locality is an area which has been determined, either by localities/controlled NHS England, a primary care trust a predecessor organisation or on locality appeal by the NHS Litigation Authority (whose appeal unit handles appeals for pharmaceutical market entry and performance sanctions matters), to be “rural in character”. It should be noted that areas that have not been formally determined as rural in character and therefore controlled localities, are not controlled localities unless and until NHS England determines them to be. Such areas may be considered as rural because they consist of open fields with few houses but they are not a controlled locality until they have been subject to a formal determination. Directed services Means additional pharmaceutical services provided in accordance with directions under section 127 of the 2006 Act. These are essential, advanced and enhanced services as set out in Directions. Dispensing doctor(s) These are providers of primary medical services who provide pharmaceutical services from medical practice premises in the area of NHS England; and general practitioners who are not providers of primary medical services but who provide pharmaceutical services from medical practice premises in the area of the HWB. Distance selling These premises could have been approved under the 2005 Regulations premises in which case they could be pharmacies or DACs. Under the 2012 and 2013 Regulations only pharmacy contractors may apply to provide services from distance selling premises. Distance-selling contractors are in the main internet and some mail-order, but they all cannot provide “essential services” to persons face to face at their premises and must provide a service across England to anyone who requests it. Electronic Prescription This service allows prescriptions to be sent electronically to community Service (EPS) pharmacy directly from the prescriber e.g. the GP. It removes the need for the doctor to supply a written paper prescription. Essential services These are services which every community pharmacy providing NHS pharmaceutical services must provide and is set out in their terms of service – these include the dispensing of medicines, promotion of healthy lifestyles and support for self-care. Distance-selling pharmacy contractors cannot provide essential services face to face at their premises. Locally commissioned These are pharmaceutical services commissioned by NHS England, such services as services to Care Homes, language access and patient group directions. Medicines Use Review One of the advanced services. It enables the pharmacist to sit down (MUR) with the patient and their representative and discuss the medicines they are prescribed and address any issues.

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Term or phrase Explanation Neighbouring HWB Used when, for example, an HWB is consulting on their draft PNA and needs to inform the HWBs which border their HWB area. New Medicines One the advanced services. The service provides support for people Service(NMS) with long-term conditions newly prescribed a medicine to help improve medicines adherence; it is initially focused on particular patient groups and conditions. NHS Urgent Medicines One the advanced services. The objectives of the service are to manage Supply advanced appropriately NHS 111 requests for urgent medicine supply, reduce service demand on the rest of the urgent care system, resolve problems leading to patients running out of their medicines and increase patients’ awareness of electronic repeat dispensing. It allows community pharmacists to provide patients with an emergency supply of their medicines. NHS chemist Means an NHS appliance contractor or an NHS pharmacist. Seasonal Flu One of the advanced services. The service allows community Vaccination pharmacists to vaccinate patients, in various at risk groups, against influenza.

Appendix D Key to pharmacies in neighbouring Health and Wellbeing Boards (shown in map on page 52)

Pharmacy Address Postcode Code

200 BOOTS UK LIMITED 5-7 DINGLE WALK Cheshire West and Chester CW7 1BA 201 SZ ENTERPRISE LIMITED 31 LONDON ROAD Cheshire West and Chester CW9 5HQ 202 UNG LIMITED UNIT 3, 469 MANCHESTER RD Cheshire West and Chester CW9 7QB 205 MOORLAND SURGICAL SUPPLIES LIMITED 68 HYDE ROAD Tameside M34 3AG 206 MALPAPHARM LTD 28 FLIXTON ROAD Trafford M41 5AA 209 LLOYDS PHARMACY LTD 236 WELLINGTON ROAD SOUTH Stockport SK2 6NW 210 CATTEE P & AJ (CHEMISTS) LTD THE VILLAGE GREEN Stockport SK6 8DR 211 L ROWLAND & CO (RETAIL) LTD 61 ARUNDEL AVENUE Stockport SK7 5LD 212 RB HEALTHCARE LIMITED 87 MACCLESFIELD ROAD Stockport SK7 6BG 213 BOOTS UK LIMITED 32 HIGH STREET Stockport SK8 1AL 214 SAS HEALTHCARE LIMITED 208 FINNEY LANE Stockport SK8 3QA 215 VKM HEALTHCARE LIMITED 262 FINNEY LANE Stockport SK8 3QD 217 BOOTS UK LIMITED 3-5 UPPER MARKET SQUARE Stoke on Trent ST1 1PZ 218 DONALD WARDLE & SON LIMITED HEALTHCARE SERVICE CENTRE Stoke on Trent ST3 7UN 219 U MIR PHARMA LTD UNIT 10 Staffordshire ST5 0TW 221 TESCO STORES LIMITED LIVERPOOL ROAD Staffordshire ST7 1DX 222 BUTT LANE HEALTHCARE LIMITED 147 CONGLETON ROAD Staffordshire ST7 1LL

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Appendix E Consultation Feedback

As required by legislation, a consultation exercise with Stakeholders was carried out for 60 days between 13th November 2017 and 12th January 2018. A total of 12 completed responses were received. The draft PNA concluded that pharmaceutical provision within Cheshire East is currently satisfactory, 9 out of 12 respondants (75%) agreed with this statement, 3 of whom strongly agreed. Six of the responses provided additional information, which we have duly considered. An outline of these are given in the table below plus any action taken. A copy of the new Healthwatch report ‘Public Experience of Community Pharmacies in Cheshire’ was received outside of the formal consultation but its findings have also been considered.

Consultation response Action taken Notification of the publication of a new Though there were no new insights, this Healthwatch report ‘Public Experience of reinforced the conclusions from the previous Community Pharmacies in Cheshire’ Healthwatch report published in November December 2017 2016 which has been taken into account in the PNA. Due to the different emphasis and geographies, it was difficult to conclude whether there had been any deterioration or improvement in services provided by Community Pharmacies across Cheshire East between the two reports. 5 responses agreeing that PNA shows that No action required pharmaceutical provision within Cheshire East is currently satisfactory. 1 response stating concerns that geographies Additional wording included in paragraph 2.3 used within the PNA are based on towns and to clarifiy that the GP Cluster geographies do not consider the rural areas. used within the PNA included both town and rural areas. 3 responses received raising concerns that Additional wording included to clarify:- Pharmacy provision may not be adequate to a) the methods used to estimate dwelling meet the population needs of Poynton once numbers in Section 15.2. all proposed housing developments, both b) the fact that councils are unable to within Poynton and within Stockport stipulate opening hours (Section 12.1). Borough at the Woodford Garden Village site c) purpose of PNA is to inform NHS England and High Lane are built (NHSE) commissioning decisions d) production of supplementary statements during life of PNA (Section 2) Steering group considerations:- All housing development numbers presented in the PNA are taken from the Local Plan and constrained to the lifetime of the PNA i.e. up to March 2021. This estimates 235 new houses to be built within the Poynton area. The steering group considered the impact if building schedules were brought forward and

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Consultation response Action taken more housing was completed within the PNA lifetime. If half of the potential 650 homes planned were built in Poynton were completed by 2021, this would generate about 7 or 8 more pharmacy visits per day per pharmacy (based on the assumptions of local occupancy of 2.29 people per dwelling, national pharmacy use estimated at 2% of population per day and all new residents will only use the 2 pharmacies in Poynton and not use pharmacies outside the area) The steering group consider this would be within the capacity of existing provision.

1 response suggesting context around the Additional wording included in paragraphs number of pharmacies per 100,000 15.4 & 15.5 to add context that the number population for Bollington, Disley and of pharmacies per 100,000 for CEC areas are Poynton and Nantwich and rural GP clusters within normal range. England rate added to which appear low at 15 and 16 pharmacies Table 17: Community pharmacies per respectively. 100,000 population, Cheshire East.

It was noted that analysis of free text from the patient survey found their was minimal negative comments from residents who responded from the Bollington, Disley and Poynton GP cluster. 1 response from a Pharmaceutical Services Opening hours and data source in Appendix B provider regarding their opening hours and updated for this provider. Commissioners contracted services provided at some of their notified of discrepancies on commissioned sites services between provider and contract information. 1 response requesting more detail and clarity Updated Section 2 ‘Scope and purpose of on the methods used when undertaking the PNA’ to include more details regarding the PNA governance process and development of the PNA. 1 response regarding use of standard Advised commissioner of home care to medicines packs and the provision of include training requirements for carers in medicines for patients with formal carers medicine taking.

The Steering Group have examined all of the consulation responses received, any additional information collated as part of the response exercise and the reworked sections of the revised PNA. They have concluded that the original statement remains valid, that there is adequate provision in regards to location, number and distribution of pharmacies providing essential and advance services during standard core hours to meet the needs of the Cheshire East population.

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