Agenda item

The Acting Director of Public Health to submit a report seeking approval of the Pharmaceutical Needs Assessment (PNA).

The Board is asked to:-

1)   Approve the final PNA report for publication;

2)   Note the need to update the PNA by  March 2018, as set out in the Pharmaceutical Regulations;

3)   Note and approve the ongoing responsibilities with respect to the publication of an up-to-date map of all pharmacy provision and the arrangements that have been proposed to ensure that this takes place.

The Acting Director of Public Health submitted a report seeking approval of the Pharmaceutical Needs Assessment (PNA).

The Acting Director commented that it is a statutory responsibility of the Board, to produce the PNA.  The responsibility had transferred from the Primary Care Trust to the Health and Wellbeing Board in April 2013.  One of the key functions of the PNA is to provide a basis upon which NHS England can responds to applications for new pharmacies in the area.

It was noted that there are three main components in the national contractual framework.  These are Essential Services, which must be provided by all contractors, Advance Services, which community pharmacies can choose to provide following appropriate training or accreditation by NHS England, and Community Based Services, which pharmacies can offer to provide if commissioned by local health commissioners, the CCG and local authorities, to meet local health needs.

The PNA also provides information on how services in the national framework are delivered locally and on the wider voluntary role of pharmacies.  It also considers the future projected needs and predicted population growths.  The list of statutory consultees is outlined in section 7 of the assessment and, whilst there was no obligation to consult with the public, the public were consulted and made responses either through paper questionnaires or on-line through the website.  A summary of responses from both the statutory consultees and the public were listed in the PNA.  The PNA presented a number of conclusions and recommendations for commissioners to consider. 

There was a duty to keep the PNA up to date and for it to be reviewed in 3 years’ time.  There was a requirement to publish a map of the pharmaceutical services in the City on the Council’s website and it was proposed that this would become part of the Joint Integrated Commissioning Board’s responsibilities to facilitate the plan being kept up to date.  This would also be dependent upon NHS England to provide the information required, which was an implicit requirement within the PNA process.

Professor Farooqi referred to recent media reports which described how pharmacists were being used by some GP practices elsewhere in the country to treat patients for minor ailments as part of the process to address the shortage of GPs.  He asked if there was any evidence that pharmacies were being underutilised and, if so, what plans were there to utilise these services.

In response, the Acting Director of Public Health stated that this responsibility lay with the commissioners in the first instance.  There were only 3 pharmacies undertaking the maximum of 400 Medicines Use Reviews (MURs) per year in the City. This was a free NHS service offered by pharmacies to have a private consultation with a patient to discuss their knowledge and use of the medicines.   Professor Farooqi felt that this was an under-utilised resource because if people used their medications properly it did have an impact upon future health care and pressures on GP services.  He felt that further work should be undertaken to understand why this was under-utilised, as it could provide an additional and much needed resource and capacity within the NHS at a time when NHS resources were under pressure.  Sue Lock commented that the new co-commissioning arrangements did not bring pharmacies within the CCG’s responsibilities, so further work would need to be undertaken with NHS England to understand why that capacity was underused and to take steps to maximise its potential and make best use of this resource.

It was noted that the number of New Medicines Services (NMS) reviews carried out by pharmacies also varied from 2 to 443, with most pharmacies doing approximately up to 200 reviews.  NMS reviews were intended to help provide support and advice to people who were newly prescribed a medicine to help them manage a long term condition to make sure they understood how the medication should be taken to improve the self-management of their condition.

The Acting Director of Public Health stated that the pharmacy professional bodies were keen to do more and one of the recommendations in the PNA referred to the opportunity to include pharmacies and develop their roles in commissioning strategies and through the wider Better Care Together Programme plans; particularly in relation to deflecting work out of primary care general practices for treating minor ailments and emergency supplies schemes etc.

The Chair commented that it was important to regard the PNA as a live resource to inform commissioning and service provision.  Although the PNA had a great deal of useful information within it, one of the limitations was that much of the information was based upon ward boundaries which often don’t reflect natural neighbourhood and communities or how people exercise their lifestyle patterns.  For example, people may use city centre pharmacies in preference to ones in their own neighbourhood as these might be more convenient in relation to their place of work or people may wish to preserve a degree of anonymity.

The Chair felt that it was important, in view of the comments and observations made at the meeting, that the recommendations in relation to pharmacies should be strengthened and pursued.  He welcomed the accompanying Equality Impact Assessment which picked up important issues such as economic equity, ethnicity, language and sexual orientation.  In particular, there was no data available to indicate whether patients within the gender reassignment group, experienced difficulties in seeking health advice or medications from their local pharmacy.

Mr Richard Clark concurred and referred to section 2.7 of the PNA which gives an overview on Sexual Ill Health and referred to the lack of demographic mapping and analysis in relation to men having sex with men.  This created some blind spots between the identification of health inequality issues identified in the report and the subsequent recommendations.  There needed to be a more integrated approach to using the available information to try and identify what the priority health needs were for seldom heard and hard to reach groups.

The Acting Director of Public Health stated that the direct link to progress these issues would be through the Joint Integrated Commissioning Board, which could discuss the issues further with the pharmacies and professional associations to put firm mechanisms in place to achieve the desired outcomes.   Sue Lock also commented that the CCG had direct links into the Local Pharmaceutical Committee and could feed these issues into them.   GPs also have links with their local pharmacies and, additionally, these issues could also be addressed through the proposed emerging health needs neighbourhoods.

The Chair referred to the Stoneycroft pharmacy that was mentioned in the Needs Assessment under the Essential Small Pharmacies Local Pharmaceutical Services Contract and which had faced possible closure in January.  He stated that he had made representations to NHS England that the pharmacy, which served Knighton, Evington and Stoneygate, was essential to the needs of local area. Local ward councillors had also made representations and it had also been discussed at the Health and Wellbeing Scrutiny Commission

RESOLVED:

1)         That the final PNA report be approved for publication.

2)         That the need to update the PNA by March 2018, as set out in the Pharmaceutical Regulations be noted.

3)         That the ongoing responsibilities with respect to the publication of an up-to-date map of all pharmacy provision and the arrangements that have been proposed to ensure that this takes place be noted and approved.

4)         That a further report be submitted to the Board in 12 months to report the progress made with delivering the recommendations in the report and the observations made by the Board on the PNA.