Agenda item

This paper provides an update on the progress made to update the Medway PNA to conform to statutory requirements. The Council has conducted a 60-day consultation on its revised draft PNA. There was a good response to the consultation and several issues were identified. The PNA has been updated to reflect feedback received and the PNA is now ready for final sign-off by the HWB.

Discussion

The Pharmaceutical Needs Assessment (PNA) had previously been considered by the Board in November 2017, before the start of the 60 day public consultation on the draft PNA. It had also been considered by the Health and Adult Social Care Overview and Scrutiny Committee in March 2018.

The PNA had been circulated to the Board for comment ahead of it being published on the Council website on 28 March 2018. This fulfilled the statutory requirement to publish the PNA by the end of March 2018.

Recent changes to legislation allowed the consolidation of existing pharmacies to be proposed. NHS England would notify the Health and Wellbeing Board of any proposed consolidations and there was then a statutory requirement for the Board to make a representation to NHS England within 45 days, stating whether or not it considered that the consolidation would create a gap in pharmaceutical services provision. The PNA Steering group had agreed they would provide the technical support to the Board to help in the response to such requests.

There had been a good response to the PNA consultation. Around half of the responses were from regular service users and it was therefore considered that the responses were representative of this group.

Three key concerns had been identified from the consultation feedback. Concerns had been raised about a GP practice on the Hoo Peninsula, which had stopped dispensing, with regards to the provision of services in the Cuxton and Halling area, in view of new development; and in relation to whether the planned London Resort theme park could lead to increased demand for pharmaceutical services.

In relation to the London Resort, it was not anticipated that this would lead to increased demand for pharmaceutical services during the next three years (the life of the PNA). Cuxton and Halling had been determined by NHS England to have the characteristics of a rural area and was a controlled locality which meant that there were limitations on pharmacies moving into the area. If this status were to change, it would be possible for a new pharmacy to be established. In relation to the Hoo Penisula, one dispensing practice, which had 3,000 patients, had stopped dispensing. A delivery service was being provided by three pharmacies in Hoo St Werburgh to mitigate the closure. Consequently, it would be recommended to the Health and Wellbeing Board that provision on the Hoo Peninsula and in Cuxton and Halling be kept under close scrutiny over the next three years and recommendations made to NHS England to change the PNA if there were significant changes in those areas during the next three years.

A number of concerns had been raised by the Health and Adult Social Care Overview and Scrutiny Committee (HASC). The first of these was whether Cuxton and Halling should continue to be classed as a rural area in view of local developments. It was confirmed that NHS England was responsible for determining whether an area was rural for the purposes of the provision of pharmaceutical services. Once an area had been assessed as being rural, it would not be reassessed for five years unless there was evidence of change during that period.

The second concern raised was that there was currently no 24-hour dispensing pharmacy in Medway or in Kent. The Board  was advised that there were eight, 100 hour services operating. These provided pharmaceutical services for 16 hours each day, Monday to Saturday. Outside these hours, services were commissioned from the local out-of-hours provider, Medway on Call Care (MedOCC).

A third concern raised by HASC had been in relation to a patient, who was registered with a dispensing GP practice in Cuxton, not being allowed to obtain a prescription from their GP. This was due to nationally determined pharmaceutical regulations specifying that patients could not use the pharmacy provision of a dispensing GP if they lived within 1.6 kilometres of a pharmacy and they also lived in a rural area. There was an exemption to this where a GP practice had less than 2,750 patients. Members of HASC had also raised concerns in relation to pharmaceutical provision on the Hoo Peninsula, as detailed in the consultation feedback above.

A Board Member asked how a patient would know that they needed to contact MedOCC for out of hours pharmacy provision and what they could do to get an out of hours GP prescription fulfilled. The Member also considered it to be unacceptable that there was no 24/7 pharmacy operating in Medway or Kent. He also asked how emergency deliveries were arranged for people who were housebound.

The Board was informed that GP answering phones should be advising who to contact for out of hours care  as should NHS 111. Out of hours GPs were able to issue a small supply of a prescription drug to a patient out-of-hours, for urgent conditions. In relation to a case where a Medway resident had travelled to London to access an out- -of-hours pharmacy service, it was acknowledged that this should not have been necessary  as MedOCC or 111 should have been able to direct the patient to a local service.. Although there was no 24 hour pharmacy, there were pharmacists on call who would be able to fulfil an out-of-hours prescription. In relation to deliveries, there was no requirement for pharmacies to provide a delivery service. This was at the discretion of the individual pharmacy.

The Director of Public Health advised that the paper being considered by the Board was specifically in relation to the Pharmaceutical Needs Assessment and the provision of pharmaceutical services rather than being about pharmaceutical services more generally, including how they were advertised.

The Board Member felt that the issues were linked and should therefore be considered together. After further discussion, during which other Members felt that there was an issue in relation to how details of available services were communicated, the Board Member said that he would raise the issue for further consideration during the work programme agenda item.

Another Board Member asked about the impact of internet pharmacies and whether there was a risk that their existence could make some smaller pharmacies unviable. The Board was advised that many pharmacies already offered a collection and delivery service whereby they would collect prescriptions from GP practices then fulfil and deliver them.

A Member noted the issues raised in relation to pharmaceutical provision in Halling and on the Hoo Peninsular. He agreed that the proposed London Resort would have no impact during the three year period covered by the PNA. The Member was concerned that locating out-of-hours pharmacy services at hospitals made work to persuade people to use our community health services, rather than attending A&E unnecessarily, more challenging.

Decision

The Health and Wellbeing Board:

i)     Noted that the PNA has been updated and had been published before the end of March 2018.

ii)    Agreed to monitor the situation in Cuxton and Halling to determine if the need in the area changes significantly over the next three years (the life of the PNA).

iii)  Agreed to monitor the situation on the Hoo Peninsula to explore whether wHoo Cares or other voluntary organisations could help to support access to pharmacies where public transport links are weak.

iv)  Noted that NHS England is expected to liaise with the local providers and voluntary organisations, such as wHoo Cares, to achieve an innovative, financially viable solution to the current situation in the Hoo Peninsula.

v)    Noted that there were concerns in relation to how details of out-of-hours pharmacy provision in Medway were shared with patients.