Agenda item

Members are asked to consider an update on the provision of community pharmacy services in York, including recent changes and the potential impact on resident access to pharmacies.

Members considered an update on the provision of community pharmacy services in York, including recent changes and the potential impact on resident access to pharmacies.

Officers were joined by the Programme Lead for Primary Care from NHS Humber and North Yorkshire ICB in providing an overview and responding to questions from the committee. The Chair also invited Mr Harrison, the public participant, to join the discussion. It was noted that:

·       Community pharmacy was an important asset to the city, although there were challenges around funding and workforce. The council had no direct responsibility for pharmacy services, which were commissioned by the ICB, but there was a statutory duty to produce a Pharmaceutical Needs Assessment (PNA) and to comment on applications to open pharmacies in relation to the PNA.

·       The PNA considered access to and quality of services and was informed by public consultation. At the time of publication of the current 2022-25 PNA, it was felt there while there were differences between weekdays and weekends, there was adequate choice of pharmacies with good geographic spread. With no national benchmark available, the locally determined benchmark used was a 15-minute walk.

·       Through the Health and Wellbeing Board a supplementary statement noting a gap in provision had been issued following the Clifton pharmacy closure in February 2024, and support had since been given to three applications to open a new pharmacy in the Clifton area; all three applications had been rejected by the ICB.

·       The ICB’s pharmacy committee had followed official guidance in using the current 2022 PNA in determining the applications rather than supplementary statements; although there had been unprecedented pharmacy changes including closures over the last few years, supplementary statements were considered statements of fact rather than a vehicle for assessing the impact of proposed changes. In the case of the Clifton applications the pharmacy committee had not been assured that relevant criteria under NHS pharmacy regulations around improved access, reasonable choice and innovative approaches had been met.

·       The regulations were complex and could offer greater clarity. Given that national systems did not appear to be working for residents in this case, it was suggested that the Minister of State for Care, Stephen Kinnock MP, be invited to visit York to look at the situation around ‘pharmacy deserts’. It was also suggested that given the complexities of the application process, support could be offered to those submitting applications to open pharmacies where there was a gap in provision.

·       Community pharmacy operated on a contractor model, and there was no cost to the council or the NHS from the opening of a new pharmacy as this was borne by the contractor. There was no longer any margin in dispensing as funding was based on delivering Pharmacy First appointments. Given the increased numbers attending pharmacies for prescriptions, staff were often kept busy on work pharmacies were not reimbursed for, which in turn affected their capacity for Pharmacy First appointments.

·       National NHS efforts to put more pharmacists into GP practices had contributed to staffing challenges; while this offered more attractive hours for pharmacists, it had led a shortfall of trained staff and greater reliance on locums in community pharmacies.

·       When the Public Health team were notified of issues such as a lack of step-free access at pharmacies, they would seek to influence contractors to improve accessibility. With reference to travel to pharmacies, it was also noted that there was a lack of taxi provision for those with accessibility needs.

·       Several members drew attention to access issues for those living in rural wards who lived further than a 15-minute walk from a pharmacy and often not on a direct public transport route, including those in Skelton who had to travel to Tower Court. The climate change implications of a lack of rural provision were noted, and it was suggested that a strategy for the entire council area, including support for primary care centres incorporating pharmacy services in the villages, be considered. The maps in the report referred to recent closures; full maps of the whole council area were published in the PNA.

·       While the council worked with the ICB to identify needs, its role in this area was as a supportive partner as it did not commission or provide pharmacy services. However good pharmacy provision could relieve demand on other council services, as well as on primary care and urgent care.

·       With reference to increased pressures on services from new housing developments, it was important to ensure that services beyond primary care had the resources they needed, although it was uncertain if Section 106 agreements had ever been used to fund pharmacy provision.

·       Community pharmacies played an important role in the provision of winter flu and Covid vaccinations, and a report on health protection issues for the coming winter was scheduled for the committee’s November meeting.

·       The Executive Member for Health, Wellbeing and Adult Social Care re-iterated the benefits of good community pharmacy provision and the need for a pharmacy in Clifton.

Resolved:

i.                    To note the report.

Reason:     To keep the committee updated.

ii.                  That the chair write to the Minister of State for Care, Stephen Kinnock MP, inviting him to visit York to look at the situation around ‘pharmacy deserts’.

Reason:     To ensure the Minister is informed about the issue of ‘pharmacy deserts’ in York.

iii.                 With reference to the rejection of the applications to open a pharmacy in Clifton:

a.         That the committee is not satisfied that there would not be any improvements or better access by granting these applications;

b.         That the committee is not satisfied that there is a reasonable choice relating to obtaining pharmaceutical services in the Clifton area;

c.          That the committee is not satisfied that there is no evidence to support innovative approaches to the delivery of pharmaceutical services;

d.         That points a.-c. above be forwarded as a resolution to the ICB, and to the Council’s Executive requesting it to urgently review the situation.

Reason:      To ensure the ICB and the Council Executive are informed of the committee’s views on this issue.

iv.                That the Director of Public Health request clarity from the Minister over the status of supplementary statements to the PNA, and to request that these be taken into account when applications were considered.

Reason:     To provide clarity to the ICB, Public Health, members and residents around the process for updating the PNA.

v.                  That the impact of a lack of taxi provision for those with accessibility needs on access to healthcare also be raised with the ICB.

Reason:      To ensure the ICB is informed about this issue.

vi.                    That with reference to applications to open pharmacies, advice be sought around the possibility of offering communication in terms of interpreting and offering clarity on the PNA, and including appropriate contact details in the PNA or the website it appears on,

Reason:     To ensure that any opportunity for clarity around the interpretation of the PNA was open to all.

vii.              That a strategy for provision in rural areas be considered, including shared primary care facilities in villages, including consideration of travel and climate implications.

Reason:      To ensure accessibility to services for all residents.

[The meeting adjourned from 7:09-7:20 pm for a comfort break].