Pharmaceutical Needs Assessment (PNA) 2022
Health and Wellbeing Board: 14th September 2022
Presented by: Louise Wallace
Introduction
· The Pharmaceutical Needs Assessment (PNA) considers current and future need for pharmaceutical services in a geographical area, and describes to what extent current pharmaceutical services meet that need.
· PNAs are used by NHS England to assess whether there is a need to make changes to or open/close pharmacies - the current PNA full update is due to be published on 1st October 2022.
· Section 128A of the National Health Service Act 2006 (NHS Act 2006) requires each Health and Wellbeing Board to assess, consult on, and produce an updated PNA document at least every 3 years.
· Owing to the pandemic, the PNA refresh (originally due to be published in March 2021) was granted an extension until October 2022 to enable stakeholders and the public the opportunity to fully engage in the process
· In the North Yorkshire HWB area there are currently 104 dispensing contractors providing NHS pharmaceutical services made up of 92 standard contract (40 hour) pharmacies, 7 pharmacies operating under 100 hour contracts, 4 distance selling pharmacies and 1 dispensing appliance contractor. Furthermore, there are 48 dispensing doctor practices in the more rural locations within North Yorkshire provide additional access to dispensed medicines.
· An initial Climate Change Impact Assessment form has been completed. This indicates that a full assessment is not required
Report purpose
The purpose of this is report is to provide an overview of the process and key findings of the 2022 PNA, and for the board to formally approve the document for publication. It is appended.
As this meeting is currently held remotely, it is recommended that the decision as to whether or not to approve the PNA be delegated to the Chair and Vice-Chair, having regard to any views expressed by Members at the meeting.
Whilst the substance will be unchanged, there may be minor changes in relation to formatting and clarification of terminology required following this meeting and before publication.
To gain an understanding of the impact of the PNA on the environment, an Initial Climate Change Impact Assessment was completed. The PNA has a neutral impact on the environment; therefore, a full Climate Impact assessment is not required.
Document production
The Public Health Team oversaw the development of the PNA on behalf of the Health and Wellbeing Board. In the process of undertaking the PNA, a joint multi-agency steering group was established in December 2021.
The drafting of the 2022 PNA included extensive consultation with pharmacies, stakeholders and the public, mapping of services and analysis of data. Work has taken approximately twelve months to complete.
As with the 2018 PNA, North Yorkshire County Council carried out the coordination of work jointly with the City of York Council (CYC), while still producing a separate PNA for each footprint. Collaboration included the coordinating of the PNA Steering group and the commissioning of specialist work to the North of England Commissioning Support (NECS).
Stakeholder engagement
Views obtained during the engagement were a key part of the early work to develop this PNA. The engagement (conducted over a six-week period during February and March 2022) involved the completion of an online survey, aimed at the following key groups:
· Public/residents
· Pharmacies
· Strategic commissioning partners & health and social care service providers
Surveys were promoted via the NYCC website, press, social media platforms, radio, with ‘have your say’ posters displayed in pharmacies, GP surgeries, community centres and libraries.
Groups and services were also contacted directly to encourage them to engage with the survey. These included older people, carers & disability groups, town and parish councils, commissioned services (drugs, alcohol, tobacco and mental health), dentists, GPs, pharmacies and opticians.
Public/residents survey:
A total of 447 members of the public responded to the survey; significantly higher than the last PNA when 374 responses were received. The full results of the survey can be found in appendix 3 of the PNA.
Key headlines from the survey responses show that the majority of North Yorkshire residents were positive about the availability of pharmacies and services provided which suggests that overall, they were happy with the services their usual pharmacy provided. Areas for improvement were more staffing, medication availability, and better waiting times.
The previous PNA indicated that around 98% of the population of North Yorkshire lives within five miles (as the crow flies of a pharmacy); with around 63% of the population living within a 20 minute walk of a pharmacy (within 1 mile as the crow flies from a pharmacy). Although this suggests generally very good access to community pharmacies across the County there is a small minority of residents, who do not have access to a pharmacy within five miles of their home. This has remained relatively unchanged since the last PNA.
Since the last PNA, there has been a significant increase of use of electronic prescriptions which enable patients to have their prescriptions (especially repeat prescriptions) sent electronically to a pharmacy of their choice.
In response to the resident’s survey, when asked how people usually travel to the pharmacy, the majority of people indicated that they travelled by car (55%) or on foot (39%), with 12% of people having their medicines delivered by the pharmacy.
Pharmacies Survey:
28 of the pharmacies responded to the survey (50 in the last PNA), out of a total of 104 dispensing pharmacies providing NHS pharmaceutical services.
In terms of provision of, or willingness to provide additional locally commissioned services, it was clear that responding pharmacy providers would be willing to support and deliver additional services, if these were commissioned. Note, the commissioning of services is outside the scope of the Health and Wellbeing Board. This responsibility lies within commissioning of health services.
Strategic Commissioning Partners & Health and Social Care Service Providers Survey:
Three responses were received to the survey (37 responses in the last PNA), one from the voluntary sector and two from GP practices. Both GP practices felt that the local extended GP services opening hours match the rota times/extended opening hours of local pharmacies, which indicates the current pharmacy hours provision is adequate.
Areas identified for improvement included funding, training, and communication. Various services that were offered by community pharmacies were identified as not meeting the needs of people with which the respondents work with.
Statutory consultation
In line with the regulations, North Yorkshire Health and Wellbeing Board consulted for a minimum of 60 days with the following statutory consultees about the contents of this PNA. In total 11 responses to the consultation were received from 5 individuals, 1 GP practice, 2 neighbouring local authorities and 3 pharmacy contractors.
Additionally, Community Pharmacy North Yorkshire (Local Pharmaceutical Committee) provided responses to the consultation via email rather than through the online questionnaire.
A further separate response during the consultation period was received from Public Health North Yorkshire regarding community pharmacy access to medicines prescribed in the management of substance misuse.
Feedback includes two comments expressing the view that there is a shortage of pharmacists in the region and that the workforce was under pressure. The PNA acknowledges this national issue and it also acknowledges that it can be further exacerbated in coastal communities.
Ten responses were received with suggestions for communication and publicising services. These included using social media/online, radio, television, local newspapers, healthcare settings (e.g. electronic noticeboards) and signposting by community groups. One respondent also suggested that close working and collaboration with the Integrated Care System ICS Boards, Partnerships and Primary Care Networks (PCNs) with a seamless approach to integration was an important factor. These have been acknowledged and noted.
One comment expressed the view that pharmacies don't always have the required medicines in stock and on occasions do not have a pharmacist available, which impacts on the services they are able to provide
Key findings
· In general, there is a good distribution and sufficient provision of community pharmacies in or near to areas with the highest levels of deprivation and areas with a high proportion of the population aged 65 years.
· Most parts of more densely populated areas in North Yorkshire are accessible by public transport and therefore access to pharmacies by foot or by public transport. The majority of residents can also access a pharmacy within a 20-minute walking distance and there is adequate choice of pharmacy.
· In terms of pharmacy opening hours, there is good provision in urban areas during week days, week day evenings and at weekends.
· Access to community pharmacy services is reduced in the rural areas, in particular the North Yorkshire Moors and the Yorkshire Dales, although there is provision of dispensing doctors' services to enable access to dispensed medicines from Monday to Friday.
· Most of the patients who live in the rural areas can access a community pharmacy within a 20-minute car drive if necessary. Whilst evening opening during this time within the rural areas would improve access and choice, no specific need for additional pharmacies to open has been identified.
· There is good uptake of both advanced services and locally commissioned services in North Yorkshire, however, there could be better awareness and improved multi-agency working to significantly improve uptake of services in North Yorkshire,
· It is important to continue to be vigilant in monitoring the impact of changes of hours and services of community pharmacy providers (including supporting infrastructure e.g. public transport) and to review any changes in need, for example in relation to new housing developments.
· There could be improved promotion of community pharmacy services to the local community as feedback from the resident’s survey identified lack of awareness. It is important for the pharmaceutical needs assessment to consider ‘knowledge gaps’ as well as ‘service gaps’. Pharmacists may offer support the opportunistic delivery of consistent and concise healthy lifestyle information to individuals by using the Make Every Contact Count (MECC) approach.
What happens next?
Once published, the PNA will be valid for three years from 1st October 2022 to 30th September 2025. During this time the HWB has specific duties which in summary are to:
· Publish revised PNAs on a three-yearly basis
· Publish a subsequent PNA sooner when it identifies changes to the need for pharmaceutical services which are of a significant extent, unless to do so would be a disproportionate response to those changes and
· Produce supplementary statements which explain changes to the availability of pharmaceutical services in certain circumstances
A process for reviewing and revising the 2022 PNA is currently being developed by Public Health, on behalf of, and subject to H&WBB approval.