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Health, Housing, and Adult Social Care Scrutiny Committee.
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11 September 2024 |
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Report of the Director of Public Health
Community Pharmacy Provision in York |
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Summary
1. Community pharmacy in our city is a huge asset to local communities and to public health. It has ‘fantastic potential to improve access to healthcare and alleviate pressures on the wider health service’[1]. However, it as a sector it faces a number of challenges.
2. This report provides an overview of recent changes to pharmacy provision in York, and the potential impact on resident access to pharmacies. This report also provides an overview of the broader challenges facing community pharmacies in the UK.
3. Evidence for this Scrutiny session has been gathered from Public Health through the pharmaceutical needs assessment (PNA), with updates on changes since the PNA was published.[2] This is presented together with a summary of national and local challenges facing the sector, which has had input from both the local pharmaceutical committee (Community Pharmacy North Yorkshire, “CPNY”) and the commissioner of community pharmacy (NHS Integrated Care Board, “the ICB”)
Background
4. A paper on this topic was requested following a meeting of HHASC Scrutiny Committee in January 2024.
National context
5. There is much ambition for community pharmacy to continue as the linchpin of local same-day, minor ailment, and routine care in communities, as well as dispensing the majority of medications to the population. The NHS Long-term Plan in 2019 acknowledged the essential role pharmacists play within a health and care system with a commitment to community pharmacy ‘to make greater use of community pharmacists’ skills and opportunities to engage patients, while also exploring further efficiencies through reform of reimbursement and wider supply arrangements.’
6. Recent examples of this include the ambition to expand the scope of pharmacy services include Pharmacy First, a service includes enabling patients to get certain prescription medications directly from a pharmacy, without a GP appointment, for seven common conditions (Acute otitis media, Impetigo, Infected insect bites, Shingles, Sinusitis, Sore throat, Uncomplicated urinary tract infections), and the introduction of independent prescriber roles within the pharmacy workforce.
7. The recent Health and Social Care Select Committee report into Pharmacy highlights a number of challenges to these ambitions.
8. In terms of funding, it identifies that Community pharmacy funding has fallen by over 30% in real terms since 2015. For individual pharmacy owners this has often meant an annual shortfall for their business.
9. Viability of community pharmacy, which is delivered by independent contractors not salaried NHS staff, has therefore been poor, leading to the number of community pharmacies reducing by over 1,100 since 2015, of which 35% were in the most deprived communities. In addition, opening hours have also been affected.
10. The report notes ongoing challenges relating to medicine shortages and the major impacts on patients and pharmacies. People living with type 2 diabetes ADHD, epilepsy, and cystic fibrosis and those experiencing the menopause have faced challenges accessing the vital medication they need.
11. Staffing problems reflect broader health and care workforce challenges, and the Select Committee report notes that most pharmacies are now facing staffing shortages, and 86% of the pharmacy workforce is at risk of burnout. They state that ‘the government is right to want to grow the pharmacy workforce, but the necessary training places, and support for those in training, are not available to meet that ambition.”
Community pharmacy provision and issues in York
12. The pharmaceutical needs assessment (PNA) process is a statutory duty of the Health and Wellbeing Board (HWBB) and is carried out by public health. The PNA provides a descriptive overview of all pharmacy services in York, including opening hours, location, and services offered. It also makes a judgement on whether pharmacy services are sufficient to meet the needs of the population, or whether there is a local ‘gap’ in provision.
13. The PNA offer 29 conclusions on pharmacy services, access, provision, type of service, opening hours and the future demographics affecting pharmacy in the city, utilising data and responses to a public consultation. The PNA process is repeated on a three-year cycle; the current PNA covers 2022-2024, and a new PNA will be published in 2025.
14. There is no national standard for ‘Good’ access to pharmaceutical services, no threshold based on population size or distance travelled. A gap in provision is identified based on professional judgment and knowledge of the local area. On this basis, the conclusions of the current PNA did not identify any gaps in pharmaceutical provision:
“There is adequate choice of pharmacies and a good geographic spread of pharmacies in York. The majority of people are within reasonable walking or travel distance of a pharmacy. Overall, there is good pharmaceutical service provision in most of York from Monday to Friday. In urban areas there is good provision of pharmaceutical services on Saturday and Sundays.”
15. Pharmacies have both core contractual and additional supplementary opening hours. Core hours cannot be changed without approval from the Pharmacy Services Regulations Committee (PSRC) and supplementary hours can be removed if the contractor provides 5 weeks' notice. If the contractor wishes to remove these opening hours with less than 5 weeks' notice, this needs approval from the PSRC.
16. If a pharmacy wishes to close, as long as they provide the notice period required by regulations, this is treated as a notification with no further consultation. As with the supplementary hours, if the contractor wishes to close with less than the notice period required by regulations, this will need support from PSRC.
17. Some of the applications to change pharmacy provision require comments from the HWBB lead. Others are notifications and, in these instances, the ICB notify the local public health team. Since publishing the PNA, the following changes to provision have been notified. It was decided that none of the changes resulted in a ‘gap’ in provision:
· Four 100hr pharmacies have reduced their hours to between 72 and 82 hours during 2023. All four pharmacies still provide a seven-day service, and still provide a service until 9pm on weekday nights[3].
· Lloyds pharmacy at Monks Cross closed on 23 April 2023. The nearest pharmacy is 0.2 miles away.
· Citywide 100hr pharmacy in Huntington closed on 27 May 2023. There are 6 other pharmacies within a mile.
· Boots pharmacy on Kings Square closed on 28 October 2023. There are 10 other pharmacies within a mile.
· There was also a change of ownership of a pharmacy in Huntington in April 2023.
18. So far, in 2024 there have been two pharmacy closures who closed on 17 February and 9 March 2024 respectively:
· Boots on 86 Clifton (see map below). Yellow shading indicates locations within 15 minute walk of a pharmacy. The red dot indicates where the pharmacy was, and the non-shaded residential area to the north of that red dot is the area which is now more than a 15 minute walk from a pharmacy.
· Boots on 10 East Parade Heworth (see map on next page). The red dot marks where the pharmacy was. This closure does not put any additional residents more than 15 minute walk from a pharmacy.
19. There are no legal powers to require a community pharmacy to open or remain open in a location. However, PNAs identify within them whether there is a gap, a current or future need. Where there are changes in pharmacy provision, a supplementary statement may be published which will state what the changes are. These must be taken into by the ICB commissioners of pharmacy services in assessment of applications for a pharmacy licence.
20. In response to the Clifton pharmacy closure in February 2024, public health drafted a supplementary statement which was issued by the chair of the Health and Wellbeing Board, stating a gap in provision in the Clifton area.[4] This document does not automatically mean new applications for pharmacies will be successful, but it is one of the factors considered when applications are made.
21. There have been three applications to open a new pharmacy in the Clifton area.
· Application by Marra Healthcare, submitted March 2024.
· Application by Haxby Group, submitted April 2024.
· Application by Pharmacy Group Corp, submitted June 2024.
22. Public Health/Health and Wellbeing Board responded to these applications. Support was given to each application in line with the identified a gap in pharmacy provision in the Clifton Area. In some cases, additional comments were made about the benefit of more comprehensive opening hours.
23. In August 2024, the ICB issued responses and has rejected all three of the applications for a new pharmacy in the Clifton area.
24. In July there was an application for a distance selling pharmacy. This type of pharmacy operates exclusively online and has no in-person customers. Public Health/Health and Wellbeing Board responded to the application with no objection to the application. The ICB will publish their decision in October 2024.
25. In 2024 so far, two pharmacies have notified a permanent decrease to their supplementary dispensing hours. This means that they will now only operate for the core hours.
· Fittleworth Medical at Kettlestring Court, Clifton Moor: new dispensing hours are Monday-Friday 9:00-15:00.
· Monkton Road Pharmacy: new dispensing hours are Monday-Friday 9:00-17:00.
Consultation
26. The production of a PNA involves a 60-day statutory consultation process with the public and key professional bodies.
27. Scrutiny is asked to note that there was a resident led petition in January 2024 to keep the pharmacy in Clifton open.
Options
28. The Committee is asked to note and comment on pharmacy access and provision in York, as set out in this report and in the verbal evidence presented at the committee.
Analysis
29. Pharmacies are a crucial part of the health and care system, are key local community assets, and have a significant role to play in improving the health of our city, which is statutory duty of the council.
Council Plan
30. Health is one of the four key commitments of the council plan. Within this, the council commits to ‘strengthen York’s integrated prevention and early intervention model’. Although not specifically mentioned, high street pharmacy services are one part of primary and secondary care.
Implications
· Financial There are no financial implications.
· Human Resources (HR) There are no HR implications.
· Equalities There are no equalities implications.
· Legal There are no legal implications.
· Crime and Disorder There are no crime and disorder implications.
· Information Technology (IT) There are no IT implications.
· Property There are no property implications.
· Other There are no implications to other departments.
Risk Management
31. There are no direct risks to the council, with pharmacy services being commissioned and provided as part of the NHS. However as local community assets and health facilities, the provision of and access to, pharmacy services is of importance to local residents and members.
Recommendations
Contact Details
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Author: |
Chief Officer Responsible for the report: |
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Jennifer IrvingPublic Health Specialist Practitioner
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Peter RoderickDirector of Public Health
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Report Approved √ |
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Date |
03/09/2024 |
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Wards Affected: List wards or tick box to indicate all |
All |
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For further information please contact the author of the report |
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Background Papers:
Current York Pharmaceutical Needs Assessment 2022-2025, https://www.healthyork.org/jsna/downloads/file/35/2022-york-pharmaceutical-needs-assessment-2022-to-2025
Supplementary Statement to the York Pharmaceutical Needs Assessment 2022-2025, April 2024, https://www.healthyork.org/jsna/downloads/file/39/2022-pharmaceutical-needs-assessments-supplementary-statement
House of Commons Health and Social Care Committee Pharmacy Report, May 2024, https://committees.parliament.uk/publications/45156/documents/223614/default/
National Health Service (Pharmaceutical and Local Pharmaceutical Services) (Amendment) Regulations 2023, https://www.legislation.gov.uk/uksi/2023/479/made
Annexes
There are no annexes.
Abbreviations
CPNY Community Pharmacy North Yorkshire
ICB Integrated Care Board
HWBB Health and Wellbeing Board
HHASC Health, Housing, and Adult Social Care Scrutiny Committee
PNA Pharmaceutical Needs Assessment
PSRC Pharmacy Services Regulations Committee