Agenda item

The Health and Wellbeing Board has a statutory responsibility to publish and keep up to date a Pharmaceutical Needs Assessment (PNA). In view of the recent changes to pharmaceutical provision, including 16 closures, it is proportionate to reopen the PNA (last published in 2022) to conduct a comprehensive reassessment of pharmaceutical needs. This paper outlines the proposed scope and timeline for agreement by the Board.

Witnesses:

Louis Hall, Public Health Consultant, Surrey County Council

Linda Honey, Director of Pharmacy, NHS Surrey Heartlands

Key points raised in the discussion:

1.    The Vice-Chair explained that the purpose of the Pharmaceutical Needs Assessment (PNA) is to describe gaps in current and future service provision related to access and need, and to describe how the community pharmacies can contribute to addressing the health needs of the local population. Every three years the full PNA must be refreshed, Surrey in the past eighteen months had experienced a significant number of pharmacy closures, sixteen. The cumulative impact of those closures on Surrey residents was a concern, particularly the Priority Populations and Key Neighbourhoods.

2.    The Public Health Consultant (SCC) noted that:

·         the number of closures was unprecedented, there had been four closures in the previous cycle. Measuring the impact of the closures had been challenging, thanked the Board for their patience.

·         the decision to reopen the full PNA provided a clean slate to respond to questions around pharmaceutical need.

·         the legislation stated what must be included in the PNA in terms of current and future need, and whether the provision of services was sufficient.

·         the provision of services concerned access and availability, the location of pharmacies, how long it takes for people to walk or drive to a pharmacy, the opening times and what services were provided. How those services were delivered and the quality of those was not in scope.

·         the overall purpose of the PNA was to inform those people looking to enter the pharmaceutical market, highlighting the gaps in provision to be filled.

·         regarding the measures to understand pharmaceutical needs, the report outlined the key intelligence sources, welcomed other sources being shared.

·         data and intelligence was not just about figures, but also about understanding residents’ perspective around access and availability, looking at the Priority Populations and mitigating against digital exclusion. Linking with Healthwatch Surrey, the VCSE Alliance and communications teams to work out how to capture that perspective through surveys and consultation.

·         in line with national guidance it takes a year to complete the PNA, the team was working through a series of steps and their specified timescales.

3.    The Chair noted that Europeans use their pharmacy in the first instance, which triages and provides key services. It would be useful to have comparative data about how communities in France for example are served by their pharmacy. Stressed the need to gather the right information in the PNA as pharmacies played a crucial role in channelling people to the right place and treating patients in line with the national Pharmacy First scheme. Queried how much money would need to be spent to communicate the benefit of using pharmacies in the first instance. The Director of Pharmacy (NHS Surrey Heartlands) explained that it would take time to build the public’s confidence in Pharmacy First being the right approach, noted challenges to its delivery such as the abuse suffered by pharmacists and workforce issues.

4.    A Board member noted that more people were accessing online pharmacy services, contrary to the Pharmacy First scheme. Queried what the impact of that increase in online use was on pharmacies, would their numbers decrease in the next few years as a result. The Director of Pharmacy (NHS Surrey Heartlands) recognised that patients had more choice around accessing their pharmaceutical services. The number of closures in Surrey mirrored the national trend, and that seemed to be slowing down. Community pharmacies were evolving quickly and were trying to work out their business model, many operated a hub and spoke service similar to the online pharmacy services.

5.    The Vice-Chair noted that if the Board was going to commit to open a new PNA, it must do more than follow the rigid PNA process, noted her wish of having a strategic plan for Surrey’s pharmacies that includes the national strategic direction of travel regarding their delivery of care to populations, whilst being personalised to Surrey. Noted concerns from a GP perspective that her patients cannot get their medication dosettes delivered without having to pay a delivery charge. Consideration was needed about what services - essential/additional - the pharmacies were providing. The Director of Pharmacy (NHS Surrey Heartlands) noted that the PNA’s remit concerned market entry of pharmacies, to get onto the NHS pharmaceutical list they must enter a community pharmacy contractual framework and that details what essential services that pharmacy must provide such as dispensing NHS prescriptions, that did not include the delivery of prescriptions or providing Monitored Dosage Systems (MDS).

6.    The Public Health Consultant (SCC) added that some elements of the above comments could be captured in the survey to community pharmacies. The challenge was that because such services were not part of the contract, they could be offered one day and ended the next day. Having a separate document alongside the PNA could be feasible detailing locally commissioned services. The Chair suggested that the Vice-Chair and report authors discuss the matter.

7.    A Board member supported the Director of Pharmacy (NHS Surrey Heartlands) regarding the communications plan. Noted that last month the combined meeting of the local committees did a deep dive on the Pharmacy First scheme, about how to communicate and build public confidence, and how to create the connections between GPs and their local community pharmacists; Surrey Heartlands was committed to develop that. It was challenging as pharmacy numbers declined in the context of the contract and the 8% reduction against the inflationary cost. The Chair noted that pharmacies have real estate which they could leverage in other ways to make money, and wondered whether they could be supported on the matter.

8.    A Board member noted that there was an opportunity for a conversation across Surrey about what pharmacies mean in communities. It was important to create the atmosphere where pharmacies want to open, with communities caring about pharmacy provision; the communications strategy must reflect that. Noted that there were many organisations and charities that work with populations that are heavy pharmacy users, noted the importance of listening to them. 

9.    A Board member noted the importance of listening to the voice of those using pharmacies, for example noted frustrations with a busy pharmacy in Woking.

10.   A Board member referred to the strategic aspect, regarding the drivers that mean that either more or less pharmacies were needed. As the Surrey Heartlands Joint Forward Plan sought to move healthcare from hospitals into community services, wondered therefore whether an explicit statement was needed on driving up the need for community pharmacies and driving down the need for the alternatives. Highlighted the need to look at that strategic planning about redevising healthcare regarding what pharmacy service was needed in three years and noted the need to analyse the interrelationships of the various measures and link to the communities work around vulnerabilities.

11.   A Board member provided reassurance that Healthwatch Surrey had a huge increase in feedback for people using pharmacies, there were several surveys in areas with pharmacy closures. Noted that it might be possible to use some of those insights to inform the PNA surveys being developed, feedback included: definitions of access with people with disabilities noting that it was not the quickest route to the pharmacy that matters but the most accessible; welcomed the additional measures around access that go beyond the stipulated measures.

12.   A Board member highlighted the 2021 guidance to boards about what should be included in PNAs, it was not solely about going to a pharmacy, but about the range of pharmaceutical needs including appliances and a consideration of Priority Populations. Assumed that the team would use that guidance which would help address the points raised and for it to be shared with Board members.

13.   The Public Health Consultant (SCC) welcomed the comments noting that was why he flagged the scope in terms of setting expectations that the PNA is a statutory duty with strict legislation about its purpose. However, there was an opportunity with the Pharmacy First scheme to look at the strategic direction and use the broad range of intelligence from quantitative and qualitative data. It was important to understand some of that unmet need for pharmacies, who was going to A&E, their GP or calling NHS 111, before their pharmacy in the first instance. Welcomed being involved in conversations about what is happening with pharmacies to help influence the PNA being developed and sharing intelligence to support partners’ work.

14.   A Board member stressed the need to ensure that the PNA is not out of date when published.

RESOLVED:

1.    Acknowledged the reopening of the Pharmaceutical Needs Assessment (PNA) and noted that this work will supersede the publication of an interim annual statement.

2.    Agreed the proposed measures (and provided a steer on additional measures) that will be used to assess pharmaceutical need in the Surrey PNA 2025 (see section 5, table 1).

3.    Agreed the timeline (see section 7, table 2) for publication for the Surrey PNA 2025.

Actions/further information to be provided:

1.    The Public Health Consultant (SCC) and Director of Pharmacy (NHS Surrey Heartlands) will liaise with the Vice-Chair around the consideration needed about what services - essential/additional - the pharmacies were providing; will consider having a separate document alongside the PNA personalised to Surrey detailing locally commissioned services.

2.    The Committee Manager (SCC) will circulate the 2021 national guidance regarding PNAs to Board members.

3.    The Public Health Consultant (SCC) and Director of Pharmacy (NHS Surrey Heartlands) will reflect on the comments made by Board members, feeding those into the work on the PNA being developed; and sharing intelligence to support partners’ work.