Hertfordshire Pharmaceutical Needs Assessment 2018 Hertfordshire Health and Wellbeing Board This Pharmaceutical Needs Assessment has been produced by Hertfordshire County Council through a steering group on behalf of Hertfordshire Health and Wellbeing Board, with authoring support from Soar Beyond Ltd. Hertfordshire PNA 2018 Contents Executive summary ................................................................................................... 6 Section 1: Introduction............................................................................................ 16 1.1 Background ...................................................................................................... 16 1.1.1 Essential Small Pharmacy Scheme (ESPS) .............................................. 17 1.1.2 Influenza vaccination advanced service ..................................................... 17 1.1.3 NHS Urgent Medicine Supply Advanced Service (NUMSAS) .................... 17 1.1.4 Pharmacy Access Scheme (PhAS) ............................................................ 18 1.1.5. Quality payment scheme ........................................................................... 18 1.1.6. Pharmacy consolidations .......................................................................... 18 1.2 Purpose of the Pharmaceutical Needs Assessment (PNA) .............................. 19 1.3 Scope of the PNA ............................................................................................. 20 1.3.1 Pharmacy contractors ................................................................................ 20 1.3.2 Dispensing Appliance Contractors (DACs) ................................................ 22 1.3.3 Local Pharmaceutical Service (LPS) providers .......................................... 23 1.3.4 Dispensing GP practices ............................................................................ 23 1.3.5 Other providers of pharmaceutical services in neighbouring Health and Wellbeing Board (HWB) areas .................................................................... 23 1.3.6 Other services and providers in Hertfordshire ............................................ 24 1.4 Process for developing the PNA ....................................................................... 27 1.5 Localities for the purpose of the PNA ............................................................... 30 Section 2: Population health .................................................................................. 31 Summary of Hertfordshire key statistics ................................................................ 31 2.1 Context for the PNA ......................................................................................... 36 2.2 Demographics .................................................................................................. 37 2.2.1 Size of the population ................................................................................. 37 2.2.2 Age structure .............................................................................................. 37 2.2.3 Ethnicity ..................................................................................................... 39 2.2.5 Predicted population growth ....................................................................... 42 2.2.6 Workplace population ................................................................................. 43 2.3 Vulnerable populations ..................................................................................... 44 2.3.1 Children and adults in care and adult safeguarding ................................... 44 2.3.2 Prison populations, including young offenders, detention centres ............. 46 1 Hertfordshire PNA 2018 2.3.3 People with disabilities ............................................................................... 46 2.3.4 Homeless populations ................................................................................ 47 2.3.4 Gypsy and Traveller population ................................................................. 48 2.3.5 Housebound populations ........................................................................... 49 2.3.6 Residential and nursing home populations ................................................ 49 2.4 Wider determinants of health............................................................................ 50 2.4.1 Indices of Multiple Deprivation (IMD) 2015 ................................................ 50 2.4.3 Housing ...................................................................................................... 52 2.4.4 Crime ......................................................................................................... 53 2.4.5 Domestic violence ...................................................................................... 53 2.5 High-level health and wellbeing indicators ....................................................... 54 2.5.1 Life expectancy .......................................................................................... 54 2.5.2 Healthy life expectancy and disability-free life years .................................. 56 2.5.3 Wellbeing indicators ................................................................................... 57 2.6 Lifestyle ............................................................................................................ 58 2.6.1 Physical activity and diet ............................................................................ 58 2.6.2 Healthy eating ............................................................................................ 58 2.6.3 Obesity ....................................................................................................... 59 2.6.4 Smoking ..................................................................................................... 61 2.6.5 Drug and alcohol misuse ............................................................................ 62 2.6.6 Sexual health and teenage pregnancy ....................................................... 63 2.6.7 Oral health ................................................................................................. 63 2.7 Burden of disease ............................................................................................ 64 2.7.1 Years of Life Lost (YLL) and Years Lived with a Disability (YLD): preventable and avoidable burden .............................................................. 64 2.7.2 Cardiovascular diseases – coronary heart disease, stroke, hypertension .. 65 2.7.3 Diabetes and hyperglycaemia .................................................................... 66 2.7.4 Musculoskeletal conditions ........................................................................ 67 2.7.5 Cancers ...................................................................................................... 67 2.7.6 Respiratory diseases – asthma and Chronic Obstructive Pulmonary Disease (COPD) ......................................................................................... 68 2.7.7 Mental health ............................................................................................. 69 2.7.8 Dementia .................................................................................................... 70 2.7.9 Accidental and unintentional injuries .......................................................... 70 2 Hertfordshire PNA 2018 2.7.10 Palliative care ........................................................................................... 71 2.7.11 Infectious diseases – national immunisation, Sexually Transmitted Infection (STIs), etc. .................................................................................... 72 2.8 Key messages .................................................................................................. 74 Section 3: NHS pharmaceutical services provision; currently commissioned .. 76 3.1 Community pharmacies .................................................................................... 76 3.1.1 Choice of community pharmacies .............................................................. 78 3.1.2 Weekend and evening provision ................................................................ 78 3.2 Dispensing appliance contractors ..................................................................... 79 3.3 Distance-selling pharmacies ............................................................................ 79 3.4 Access to community pharmacies .................................................................... 79 3.4.1 Routine daytime access to community pharmacies ................................... 80 3.4.2 Routine weekday evening access to community pharmacies .................... 80 3.4.3 Routine Saturday daytime access to community pharmacies .................... 89 3.4.4 Routine Sunday daytime access to community pharmacies .................... 102 3.4.5 Routine bank holiday access to community pharmacies .......................... 105 3.5 Advanced service provision from community pharmacies .............................. 105 3.6 Enhanced service provision ........................................................................... 107 3.7 Pharmaceutical service provision provided from outside Hertfordshire .......... 107 Section 4: Other services which may impact on pharmaceutical services provision ...................................................................................................... 108 4.1 Local authority-commissioned services provided