Agenda item

Health and Wellbeing Boards are under a statutory duty to develop and update their Pharmaceutical Needs Assessment (PNA) every three years. The PNA tells us what pharmaceutical services are currently available and where we are likely to need changes in the future because of demographic or other changes.

This report presents the refreshed PNA for Medway for 2025–2028 for comment.

Discussion:

The Director of Public Health (DPH) introduced the report which presented the refreshed Pharmaceutical Needs Assessment (PNA) for Medway for 2025-2028. He added that a representative from the Local Pharmaceutical Council (LPC) was also in attendance to answer questions.

Members then raised a number of questions and comments, which included:

• Outsourcing PNA development – in response to a question the DPH confirmed that outsourcing development of the PNA was normal practice across local authorities, particularly due to the strict guidelines, and specialist advice and knowledge that was needed to undertake a PNA.
• Balancing financial viability and community need – in response to a question about how the balance was struck between meeting local population needs and ensuring financial viability of a pharmacy, officers recognised this was a real challenge and added that having high numbers of pharmacies in close proximity as much more difficult due to resultant market instability. The costs in operating pharmaceutical provision was much higher in many cases than the profits made to keep a pharmacy financially viable and although some clinical services were being moved into pharmaceutical settings, there had not been an increase in funding for dispensing items.
• Provision of services – the LPC representative explained that the PNA referred to core pharmaceutical services only.  Advanced services, such as blood pressure checks or smoking cessation support was something pharmacies could sign up to. There had been good uptake of such services in Medway but it was not mandated for pharmacies to provide these additional, valuable services.
• Managing stock issues – the LPC representative explained that work was ongoing with the ICB to require GPs to prescribe generically to make sourcing medication for patients easier for pharmacies.
• Addressing poor performance – comment was made that the PNA did not highlight where there was poor performance within a pharmacy, which in turn was creating a gap in provision. Nor did it address provision levels outside of core hours. The Director of Public Health advised the Committee that the PNA’s remit did not cover the quality of pharmaceutical services. The LPC representative explained that the PNA was based on core hours provision. He added that where poor performance was an issue, regular meetings took place with the Integrated Care Board (ICB), as the commissioner, with power to remove a pharmacy from the list where necessary. Equally, providing out of hours service was often unviable for pharmacies due to low demand balanced again staffing costs. 
• Inconsistency in provision – reference was made to the inconsistency in pharmaceutical services, highlighting the difficulties in provision levels on the peninsula and the lack of needle exchange services in Medway, despite it being an area with high numbers of drug related deaths. Equally reference was made to the inconsistency in the provision of services across pharmacies of services such as sexual health contraception and smoking cessation support. In response, officers reiterated the issues around financial stability and the lack of interest currently in setting up a pharmacy on the peninsula but as the population in that area increases, so will the viability for additional pharmaceutical services.
• Fragility of the market – concern was raised that the PNA recognised no gaps in service provision, yet many were struggling to remain open.  The Committee were advised that pharmacy service provision across Medway was monitored on a monthly basis and if any changes exposed a gap in provision, then the Health and Wellbeing Board would be asked to publish a supplementary statement to identify the gap in provision. In addition, the Public Health Team were developing an interactive map to keep updated on provision across Medway.
• Inaccurate reflection – The Committee were concerned that, due to the limitations of the PNA and how it is developed, it did not reflect the true picture of pharmaceutical provision in Medway and gave the impression that service levels and coverage was far stronger than the reality, and that it did not draw attention to the real risks of some pharmacies being close to closure.
• Dashboard of key findings – it was suggested that in future, to help the general public understand the document and the key headlines, a one page dashboard should be produced so the highlights could be seen at a quick glance.

Decision:

The Committee noted the report and recommended it to the Health and Wellbeing Board for approval