Pharmaceutical Needs Assessment

Nicola RosenbergPublic Health Principal

Public Health

Pharmaceutical Needs Assessment (PNA)

What is a PNA?• A comprehensive statement of the need for pharmaceutical

services of the population in its area.• Health and Wellbeing Board were required to carry out and

publish a PNA by 1st April 2015.Purpose of the PNA• To identify the pharmaceutical needs of the local population

by mapping current pharmaceutical services, identify gaps and explore possible future needs.

• To support efforts to reduce health inequalities and improve health and wellbeing of local people.

The Community Survey421 respondents

• 96% of respondents either satisfied or very satisfied with their local pharmacy.• Most respondents visit pharmacies monthly or every 2-3 months for a health

reason• Less than a fifth of respondents use pharmacies to deliver their medicines to their

home• Most respondents are happy for their medicines record to be available to their GP

and pharmacist• Minor conditions advice was the most accessed service. Most respondents would

like pharmacies to provide minor conditions advice, urgent medicines out of hours, medicines use checks and NHS health checks in the future

• Most respondents either feel it’s important or don’t mind whether pharmacy staff know them. The most respondents have no preference whether or not they see a regular pharmacist on duty.

• Over 30% of the respondents were unsure about being able to talk to a pharmacist without being overheard

Community Pharmacy Survey36 pharmacies responded

• 100% have pharmacists accredited to deliver MURs, 97% to deliver the NMS and 71% accredited to provide smoking cessation services

• Over 91% of pharmacies have health care assistants trained to provide smoking cessation services with around 50% having health care assistants trained to support other services such as EHC (48%), chlamydia tests (45%), supervised consumption (51%) and needle exchange services (45%)

• Nearly two thirds of pharmacies have staff capable of speaking a language other than English• 77% of pharmacies have at least weekly contact with GPs in their area with 75% describing

the quality of professional contact they have with GPs either good or very good• MURs are the most common advanced NHS funded service (provided by 92% of pharmacies)

while collection and delivery of prescriptions is the most common non-NHS funded service (provided by 91% of pharmacies)

• Some of the other services pharmacies are interested in and willing to provide include: NHS Health Checks, emergency supply of medications, travel clinics and medicines advice for care homes

GP and Non-medical prescriber survey18 practices responded

• The main finding from the survey shows that the respondents either generally considered pharmacy services to be fair, good or very good or weren’t sure about the quality and range of services pharmacies provide.

• The majority (65%) of respondents had weekly contact with pharmacies and most of this contact was considered of good or very good quality.

• Overall respondents were positive about new services being delivered by pharmacies. The top four services that survey respondents would like to see pharmacies delivered in the future were: Help with weight – healthy eating and physical activity; Alcohol support – advice and information; Long term conditions advice and Immunisation and vaccinations e.g. flu

PNA RecommendationsTo improve more integrated ways of working linked with the Better Care and enhancing primary care work, joint meetings between GPs and pharmacists within local areas should take place.

• A Community Pharmacy Public Health (CPPH) Forum has been established to encourage collaborative working between Public Health, Community Pharmacy, CCG, and NHSE to consider all the recommendations discussed above and to encourage joined up working to deliver the aims and objectives of the Health and Wellbeing Board (HWB) and NHS five year plan.

• A locality meeting with practices could look specifically at closer working with pharmacies, following publication of the evaluation of the EPIC project.

• Clusters of practices to incorporate closer working with pharmacies through their action plans.

PNA RecommendationsPharmacies to train staff to communicate well with younger age groups as well as older residents.

• A new Declaration of Competence framework designed for Pharmacists offering the Emergency Contraception LCS, incorporates the importance of confidentially and how to communicate effectively with young people.

• The CPPE provide e-learning and workshops for Pharmacists to improve consultation skills.

• In the Healthy Living Pharmacies, Healthy Living Champions receive quarterly training and “Dementia friends” training has been

planned as one of the topics.• Raise awareness of BHCC courses on Dementia which are available free of charge to all pharmacy staff.

PNA RecommendationsNHS and public health commissioners to consider commissioning new services within pharmacies (in response to a given need and to learn from good practice from elsewhere)

• New EllaOne PGD to support current emergency hormonal contraception LCS

• Domiciliary Smoking Cessation service as part of the new CCG Integrated Respiratory Service.

• NHS Flu vaccination (commissioned by Public Health team within NHS England)

• National Minor Ailments Scheme (negotiation ongoing with PSNC) • Proactive Care Pharmacist commissioned by CCG to work in GP surgeries

PNA RecommendationsTo improve the GPs’ and non-medical prescribers’ knowledge and understanding of the services delivered by community pharmacies

• CCG & BHCC websites updated to include lists of pharmacies offering LCS• HLPs re-established to provide information on services within

pharmacies, GP surgeries, LA & third sector. HLPs linking in with other community service providers such as Community Navigators, Health Trainers and School Nurses.

• Focus on services accessed at the weekends such as emergency hormonal contraception and minor ailment advice.

• Communicate pharmacy services to practice managers and updates included in surgery newsletters.

PNA RecommendationsNHS England, Brighton and Hove CCG and City Council, pharmacies and patients to work together to reduce waste of medicines.

• Adherence campaigns and promotion of MURs/NMS• Better management of repeat medications• Develop incentives for pharmacist to target prescribing interventions

similar to the incentives used for GP surgeries.• This will be included as a topic for the next community pharmacy and

public health forum

Pharmaceutical Needs Assessment

Nicola RosenbergPublic Health Principal

Public Health

Healthy Living Pharmacy

Janet RittmanPharmaceutical Advisor

Public Health

Victorian Pharmacy

How can Pharmacies help address Health Inequalities?

• People from disadvantaged areas are twice as likely to visit a pharmacy than people from more affluent areas.– linked to GPs visits & long term conditions

• Centre of communities, on bus route, near shops and GP surgeries. • In B&H the majority of residents are within 1 mile of a pharmacy most of

the time.(PNA 2015)• Open at weekends, long opening hours, appointments not necessary,

don’t need to register. Some patients prefer a more informal approach• Engagement with Communities. • Through locally commissioned services such as Substance Misuse,

Smoking Cessation and Sexual Health Services.• Trained healthcare team who are able to take amore opportunistic

approach to healthcare for example Flu Vaccination and Smoking Cessation.

Healthy Living Pharmacy

• Health promotion and self-care at the core of the Pharmacy.• Engaging with Local Communities.• Focused on health inequalities.• Dedicated health promotion area.• Signposting to services in Community Pharmacy, NHS, Local

Authority& Third Sector.• To maintain a core set of six leaflets (year round) that support

Health and Wellbeing Board (HWB) priorities for Brighton and Hove.(Alcohol, Well-being, Smoking Cessation, Diabetes, Cancer, Dementia)

• The whole pharmacy team are engaged-Every contact counts!

National Data for HLPs

• Improvements and delivery &uptake of LCS• 99.9% Happy to receive services in pharmacy• 98.3% Recommend service to others• Mirrored by PNA 96% of respondents were

very/fairly satisfied with their pharmacy.

National Data for HLPs

• 60.2% would visit GP - approx. 622 appointments• 21.1% “wouldn’t have done anything”

Location of HLPs

Benefits to Pharmacies

• Enhances role of pharmacy in NHS 5 Year Plan and Public Health Outcomes Framework.

• Increased staff satisfaction and retention• Increased footfall and sales• Increased uptake of LCS• Increased uptake of private service• Support NHSE essential contract criteria

Role Clarification

• HLP project leader• HLP steering group • HLP leader within the pharmacy • Healthy Living Champions engage with

patients and staff to promote healthy lifestyles/ Signposting/manage displays/provide advice/ referrals to pharmacist/understand &promote LCS

HLP TrainingHealthy Living Champion Training • Quarterly training is provided for all Healthy Living Champions.• It is a requirement to attend the training to qualify for the £50 quarterly training

payment.• If the HLC is unable to attend then another member of staff trained to healthcare

assistant level can attend in their place.• Brighton and Hove City Council (BHCC) provide training courses for healthcare related

employees, including pharmacies.

HLP Leaders Training• The CPPE www.cppe.ac.uk provide numerous HLP courses. The two courses listed

below are recommended to support the HLP leadership training.Healthy Living Pharmacies: making a difference, e-learning (2hrs)Leadership for Healthy Living Pharmacy, e-learning, study time (8hrs)

• CPPE Leadership workshop on Sunday 27th September.

Measuring Outcomes

• Record baseline LCS data & capture data quarterly e.g. EHC provision, 4 week quits.

• C-Test returned from pharmacies & C-card condom supply.

• Advanced services such as New Medicine Service• No. leaflets at start and end of campaign• Referrals into another Community/NHS service• Monitor activity in private services(optional)

Evaluation

• National “What good looks like” criteria• Process HLP handbook and SOPs (HLCs will

manage)• Six monthly audits• Quarterly Training• HLP Evaluation Form

Payments• A quarterly fee of £100 paid to all HLPs and an additional £50 when HLCs

attend the quarterly training, and evaluation data is returned.

• The maximum annual claim is £600.

• The HLP payment option will be added to the quarterly Locally Commissioned Service claim form.

• Payments are subject to HLP meeting the agreed quality criteria and achieving sign off.

The Vision

• Information gateway to services in LA ,NHS and voluntary sectors

• Platform for health promotion• HLCs work across pharmacies signposting each

others services• HLCs strong community presence and links in the

local community• HLP format rolled out to other pharmacies in B&H

with a focus on disadvantaged areas.

HLP Campaigns• NHS England campaigns-Dementia, Change for life, Mens’ health, No smoking.• April- Diabetes• May- dementia/older people• June-Cancer• July- Change for Life• August- (rollover)• Sept- Flu/Antibiotic guardianship/Winter Programme • Oct- Mental Health& Wellbeing (All pharmacies)• Nov- Mens’ health• Dec-(rollover)• Jan- Alcohol and Drug Awareness• Feb- Healthy Heart• March- No Smoking

Healthy Living Champions

Lane and Steadman

Kamsons St James Street

Boots North Street

1950’s Health Promotion

Healthy Living Pharmacy

Janet RittmanPharmaceutical Advisor

Public Health