Health and Wellbeing Board	14 September 2022
Report of Phil Truby, Public Health Specialist Practitioner Advanced, City of York Council

Pharmaceutical Needs Assessment 2022 - 2025

Summary

1. This report will provide an overview of the updated Pharmaceutical Needs Assessment [PNA] 2022 – 2025, outlining the process undertaken to produce the assessment and the main outcomes. The board is asked to approve the report for publication on the City of York Council website and Joint Strategic Needs Assessment [JSNA] website.

Background

2. Section 128A of the National Health Service Act 2006 (NHS Act 2006) requires each health and wellbeing board to assess the need for pharmaceutical services in its area and to publish a statement of its assessment. Termed a ‘pharmaceutical needs assessment’, the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013, set out the minimum information that must be contained within a pharmaceutical needs assessment and outline the process that must be followed in its development.

3. The last PNA produced covered the years 2018 – 2021, however due to the covid pandemic, an extension was granted allowing expired PNAs to stay valid for an additional 18 months. Therefore, PNA’s were not required to be updated until October 2022.

4. Previously, the local authorities of City of York and North Yorkshire worked in collaboration to produce the assessment. Separate PNAs were produced for each authority area. The process worked well, as there is much overlap in terms of providers of pharmaceutical services, primary and secondary care services and residents crossing boundaries to access services. As such, a joint approach was taken in producing the current assessment.

5. Operational pressures in both York and North Yorkshire local authorities, led to a tender process to commission an external provider to undertake the assessment on behalf of the local authorities. A request for quotes process was undertaken, through YorTender, running for 3 weeks from 2 February 2022 to 23 February 2022. Following assessment, North East Commissioning Support Unit [NECS] were awarded the contract to write the assessment.   

6. The regulations outline 6 main steps in producing a PNA which are detailed below and were followed accordingly:

a. Step 1 - Governance: A joint York and North Yorkshire steering group was established to provide oversight and governance of the process. The steering group included representatives from both local authorities’ public health departments, the Local Pharmaceutical Committee, the Local Medical Committee, Healthwatch, NHS England and NHS Improvement, the Clinical Commissioning Group and the Integrated Care System.   

b. Step 2 – Establish health needs and priorities: NECS undertook research to ascertain current needs across the city, liaising with local authority planning/development staff to understand upcoming housing developments and the requirement for future pharmacy provision.

c. Step 3 - Patient/public questionnaire: A questionnaire was developed to capture the views of pharmacy service users across the city. The survey was promoted through the local authority’s social media channels, through commissioned services and directly in community pharmacies. It ran from 28 February 2022 to 28 March 2022.

d. Step 4: Current pharmaceutical services provision: Alongside the public/patient questionnaire, a pharmacy contractor questionnaire was developed to capture the views of pharmacy providers in the City. The survey was sent directly to every pharmacy through the Local Pharmaceutical Committee (Community Pharmacy North Yorkshire) and in-person visits by the public health team to each community pharmacy in York. 

e. Step 5 - Synthesis and drafting: NECS used the information gathered at steps 2, 3 and 4 to draft the PNA. This was presented to the steering group for comment and revision.

f. Step 6 - Consultation: Within the legislation, there is a requirement for the final draft PNA to go out to consultation for 60 days to a specific list of organisations. All specified organisations were served with a copy of the draft and invited to provide comments through a short survey. In addition, the consultation was opened to citizens of York (this not required by legislation, however it is good practice). The consultation ran from 1 July 2022 to 29 August 2022. The results of the consultation were analysed, revisions to the PNA were made as appropriate and all responses are summarised in the PNA at section 10.

Summary of the PNA

7. 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.

8. Community pharmacy opening hours in York are sufficient to meet need, and there is adequate provision in the evening and weekends. This is reflected in the survey results which identified that most people could find a pharmacy open in the evening or at weekends. The survey identified that people in York value extended opening hours, and value the better access that this provides. Therefore, any applications to reduce pharmacy opening hours in York should be considered carefully, with appreciation of the importance to the public in this matter.

9. Overall, the quantity of community pharmacies in York is good and appears sufficient to broadly meet the health needs of residents in York. The data suggests that a large proportion of the adult population of York use a pharmacy at least once a month and public satisfaction in community pharmacy services in York appears good.

10. The population in York is growing and is getting older. Within the next three years the population of York will include a greater number of people with long-term health conditions, this will rise faster than the total number of people. Overall, this means that the population need for community pharmacies in York may be expected to increase.

11. There is good pharmacy coverage in the more deprived wards in York. This is partly because the more deprived wards of York tend to be the more urban wards nearer the city centre, where the majority of pharmacies are situated.

12. Some population groups have more limited access to pharmacies. This includes residents living in the rural areas on the edge of the city boundaries. If community pharmacy services were not maintained, then travel time to the next available pharmacy would be significantly increased for some residents.

13. Opening times are important to people and are an important element of the overall accessibility of that pharmacy, at present there appear to be a sufficient number of pharmacies open during evenings and weekends, most people report they can find a pharmacy when they need one. York has a high rate of employment and an overrepresentation of employment sectors that use shift work rotas. This means reduced flexibility to access pharmacy services during the working day. Therefore, any applications to reduce pharmacy opening hours in York should be considered carefully, with appreciation of the importance to the public in this matter.

Consultation

14. As outlined above, a 60-day consultation was undertaken. Full details of the consultation questions and summary of responses can be found in the PNA document at section 10.2. In total 66 responses were received, 6 from statutory consultees, 3 from other organisations, 10 declined to say and 47 from citizens. Of all responses only 17 were fully completed (i.e. provided a response to each question).

15. From the consultation, there were four main points raised; access to pharmacy services in Wheldrake, roles of other pharmacy sectors, weekend opening and finally 100-hour pharmacies. Notably, access in Wheldrake received the most comments and is discussed further below.  

16. The Wheldrake branch of Elvington Medical Practice closed during the initial COVID period when sites were prioritised and rationalised for infection control purposes. Since then, a number of concerns have become apparent around the material condition of the building and it is currently unsuitable for delivery of GP services. As part of the formal process for GP estate, a three-facet building survey has been undertaken which recommended significant capital investment in order to bring the building back up to an acceptable standard for the delivery of safe services, and the discussions are currently ongoing around the funding of repairs or alternative premises.

17. Elvington Medical Practice dispensary remains open for collection of medication. A service to collect prescriptions at Wheldrake Surgery continues, but on a reduced basis between 2-4pm on Fridays.

18. There has been no change since the previous PNA in access to the nearest community pharmacy for residents of Wheldrake. According to the Public Health England SHAPE tool, access by car to the nearest pharmacy on the outskirts of York city centre is approximately 10 minutes (Citywide Health, Fulford Pharmacy). Access by public transport is approximately 30 minutes, although there are a limited number of bus services per day.

19. 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, such as one close to their workplace or near their home. Some pharmacies in the area offer a collection and delivery service to ensure that patients can access medicines. In addition, patients can choose to access medicines via a distance selling pharmacy, again utilising the electronic prescription service, thereby broadening possible choice of pharmacy service for the customer.

20. While acknowledging the current issues in Wheldrake with regards to access to GP services, these are outside of the scope of this PNA. It is acknowledged that the dispensing service from the practice has been reduced and continued local dialogue to improve access from either the existing site, or from alternative premises is encouraged. Access to the nearest pharmacy has remained unchanged and is not dissimilar to other rural villages.

Risk Management

21. Legislation (The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013) states that the Health and Wellbeing Board is to have an up-to-date PNA in place by 1 October 2022. Not meeting the deadline, set by legislation, would lead the board open to scrutiny. 

        Recommendations

22. The Health and Wellbeing Board are asked to:

i. Approve the Pharmaceutical Needs Assessment for publication.

Reason: To meet the board’s statutory duty to update and publish an up to date PNA by 1 October 2022.

Contact Details

Author:	Chief Officer Responsible for the report:
Phil Truby Public Health Specialist Practitioner Advanced City of York Council 07767 318091	Peter Roderick Consultant in Public Health City of York Council 07549 123357
	Report Approved	ü	Date	01.09.2022
Wards Affected:					All	ü
For further information please contact the author of the report

Annexes

Annex A - Pharmaceutical Needs Assessment 2022 - 2025