Lincolnshire Pharmaceutical Needs Assessment Lincolnshire Health and Wellbeing Board March 2015 Final version 31 March 2015 Page 27 Foreword Our pharmacies provide people in Lincolnshire with vital supportive health services in ways which are accessible and timely. With over 19.4 million prescribed items being dispensed in Lincolnshire's pharmacies every year, the public is provided with easy access to the supply of medicines and appliances that they need as a vital part of the local healthcare system Communicating health messages to people who are sick, as well as reassurance, advice and guidance to people who are well, is another key strength of the work that pharmacies deliver, and one which we need to make the most of, and build on. We also need to ensure that pharmacies are able to play a stronger role in out-of- hospital care, the management of long-term conditions and signposting residents to useful health and wellbeing, social care and voluntary sector services, in partnership with other health professionals. I therefore welcome this Pharmaceutical Needs Assessment, which considers the need for pharmaceutical services, describes the current services available to the county, and makes recommendations for the future provision of pharmaceutical services. I trust that NHS England and others will find this assessment informative and useful in their commissioning of pharmaceutical services. Cllr Sue Woolley Chairman of the Lincolnshire Health and Wellbeing Board Acknowledgements With grateful thanks to the many people who have contributed to the production of this Pharmaceutical Needs Assessment, and special thanks to the people of Lincolnshire for their contributions to the consultation. Particular thanks to the members of the Pharmaceutical Needs Assessment Steering Group, for their significant contribution to the development and writing of the assessment. i Page 28 The Pharmaceutical Needs Assessment Steering Group Position Job title Organisation Chris Weston (Chair) Consultant in Public Health Public Health Directorate Lincolnshire County Council Avril McDermott Local Professional Network Chair NHS England David Stacey Programme Manager Public Health Directorate (Strategy and Performance) Lincolnshire County Council Stephen Gibson Head of Prescribing and Greater East Midlands Medicines Optimisation Commissioning Support Unit Mark Hall Primary Care Support NHS England Contract Manager (Leics & Lincs Area) Marta Kowalczyk Public Health Analyst Public Health Directorate Lincolnshire County Council Additional contributions For part of the assessment process, the Steering Group was assisted by Adrian Audis, Assistant Contract Manager from NHS England. ii Page 29 Table of Contents Foreword ..................................................................................................................... i Acknowledgements ..................................................................................................... i List of Tables .............................................................................................................. v List of Figures ............................................................................................................. vi List of Maps ............................................................................................................... vii Glossary ................................................................................................................... viii Executive Summary ................................................................................................... 1 1. Introduction ......................................................................................................... 3 1.1 Legal framework ............................................................................................ 3 1.1.1 Pharmaceutical needs assessment (PNA) ............................................. 4 1.1.2 Commissioning of pharmaceutical provision ........................................... 5 1.2 Production of the PNA ................................................................................... 6 1.2.1 Determination of localities ....................................................................... 7 1.2.2 Assessment of differences in need in Lincolnshire ................................. 7 1.2.3 Consultation ............................................................................................ 7 2. Lincolnshire Population and Socio-economic Context ........................................ 8 2.1 Geography of Lincolnshire ............................................................................ 8 2.2 Population ..................................................................................................... 9 2.2.1 Age structure ........................................................................................ 11 2.2.2 Births, mortality and life expectancy ..................................................... 13 2.3 Deprivation .................................................................................................. 14 2.4 Employment and skills ................................................................................ 15 2.5 Ethnicity and country of birth ....................................................................... 16 3. Health Needs in Lincolnshire ............................................................................ 17 3.1 General health ............................................................................................. 17 3.2 Health and lifestyle ...................................................................................... 17 3.2.1 Smoking ................................................................................................ 17 3.2.2 Alcohol (adults) ..................................................................................... 18 3.2.3 Drug misuse ......................................................................................... 18 3.2.4 Excess weight (adults and children) ..................................................... 20 3.3 Long-term conditions ................................................................................... 21 3.3.1 Diabetes ............................................................................................... 21 3.3.2 Coronary heart disease (CHD) ............................................................. 22 3.3.3 Chronic obstructive pulmonary disease (COPD) .................................. 24 3.3.4 Depression ........................................................................................... 25 3.4 End-of-life care ............................................................................................ 26 iii Page 30 3.5 Vulnerable groups and enclosed communities ............................................ 27 3.5.1 Adults with dementia ............................................................................ 27 3.5.2 Adults in residential homes ................................................................... 27 3.6 Sexual health and sexually-transmitted diseases........................................ 28 3.6.1 Chlamydia ............................................................................................. 28 3.6.2 Teenage pregnancy .............................................................................. 29 3.6.3 HIV / AIDS ............................................................................................ 30 3.7 Future needs ............................................................................................... 30 4. Pharmaceutical Provision .................................................................................. 31 4.1 Background ................................................................................................. 31 4.2 Access to pharmaceutical services ............................................................. 32 4.3 CCG-level provision .................................................................................... 35 4.3.1 Lincolnshire East CCG ......................................................................... 35 4.3.2 Lincolnshire West CCG ........................................................................ 37 4.3.3 South Lincolnshire CCG ....................................................................... 38 4.3.4 South West Lincolnshire CCG .............................................................. 40 5. Gaps in Pharmaceutical Provision .................................................................... 42 5.1 Provision of dispensing services ................................................................. 42 5.2 The New Medicine Service (NMS) .............................................................. 42 5.3 Medicines Use Reviews (MURs) ................................................................. 44 5.4 Opportunities ............................................................................................... 46 5.4.1 Locally-commissioned services ............................................................ 46 5.4.2 Local Health and Care (LHAC) ............................................................. 50 5.4.3 Development of electronic prescribing .................................................. 50 6. Conclusions and Recommendations ................................................................. 51 6.1 Ownership and review ................................................................................. 51 References ..............................................................................................................