PUB020 14 Pharmaceutical Needs Assessment MK A4 v3

Transcription

Milton Keynes
Draft Pharmaceutical
Needs Assessment
2014-2015
Draft Version for Public Consultation
from 15 October 2014 to 15 December 2014
Milton Keynes Draft Pharmaceutical Needs Assessment 2014-2015
1Acknowledgements
Steering Group members
Dr Zoe Aslanpour
Consultant in Public Health, Bedford Borough Council
Sean Parrett
Public Health Project Manager, Milton Keynes Council
Sarah Wetherell
Public Health Business Manager, Bedford Borough Council
Belinda Ekuban
Senior Pharmaceutical advisor, Bedfordshire CCG
Gerald Zeidman
Chief Officer, Bedfordshire Local Pharmaceutical Committee
Rosemary Plum
Chief Officer, Northamptonshire & Milton Keynes LPC
Carl Raybold
Beds& Herts Local Medical Committee.
John Hooper
Pharmacy Contracts Manager, NHS England Hertfordshire & South Midlands
Area Team
Jane Bray
Primary Care Support Manager (Pharmacy), NHS England Hertfordshire &
South Midlands Area Team
Jackie Golding
Head of Public Health (Adults and Older People), Bedford Borough Council
Martin Westerby
Head of Public Health (Adults and Older People), Central Bedfordshire Council
Edmund Tiddeman
Head of Public Health Evidence and Intelligence, Bedford Borough Council
Barbara Wonford
Senior Public Health Practitioner (Vulnerable Groups), Bedford Borough Council
Moneim Elhassan
Public Health Practitioner, Milton Keynes Council
Dzifa Agbenu
Public Health Co-Ordinator, Central Bedfordshire Council
Lead Authors
Belinda Ekuban
Senior Pharmaceutical advisor, Bedfordshire CCG
Dr Zoe Aslanpour
Consultant in Public Health, Bedford Borough Council
Sean Parrett
Public Health Project Manager, Milton Keynes Council
Other contributors
Moneim Elhassan
Public Health Practitioner, Milton Keynes Council
Edmund Tiddeman
Head of Public Health Evidence and Intelligence, BBC
Anthony Scanlon
Public Health Analyst, Bedford Borough Council
Janet Corbett
Associate Director, Transformation and Delivery, NHS Milton Keynes CCG
Sara Godward
Consultant in Public Health, Milton Keynes Council
The Milton Keynes Health and Wellbeing Board would like to acknowledge contributions of the MK
CCG, Local Pharmaceutical Committee, Local Medical Committee, Community Pharmacies, Dispensing
Practices, Healthwatch, other stakeholders and members of the public, for their input in consultation
and development of the PNA.
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2Contents
1Acknowledgements....................................................................................................................... 2
2Contents......................................................................................................................................... 3
2.1
Table of Appendices............................................................................................................. 6
3
Executive Summary...................................................................................................................... 7
3.1
Introduction.......................................................................................................................... 7
3.2
Process................................................................................................................................ 7
3.3
Key findings and recommendations..................................................................................... 8
4Introduction.................................................................................................................................. 10
4.1
What is a Pharmaceutical Needs Assessment?................................................................. 10
4.2
What is the purpose of the PNA?....................................................................................... 10
4.3
Legislative background...................................................................................................... 11
4.4
What are the NHS pharmaceutical services?.................................................................... 12
4.5
Local pharmacy services.................................................................................................... 13
4.6
Public Health services and enhanced services.................................................................. 13
4.7
What are the pharmaceutical lists?.................................................................................... 15
4.8
Information contained in this PNA...................................................................................... 15
5
Local Health Needs..................................................................................................................... 16
5.1
Joint Strategic Needs Assessment - Priorities................................................................... 16
5.2
Clinical Commissioning Group Priorities............................................................................ 16
5.3
Localities in MK.................................................................................................................. 17
5.4
The Demographics of Milton Keynes................................................................................. 18
5.4.1 Population.......................................................................................................................... 18
5.4.2 Ethnicity, Nationality and Race........................................................................................... 19
5.5
Deprivation......................................................................................................................... 22
5.6
Education........................................................................................................................... 24
5.7
Car ownership.................................................................................................................... 24
5.8
New Housing Development................................................................................................ 24
6
Current Provision of pharmaceutical services in Milton Keynes........................................... 26
6.1
6.1.1 Community Pharmacies..................................................................................................... 27
6.1.2 Comparison of pharmaceutical service provision in Milton Keynes with England.............. 29
Service providers............................................................................................................... 26
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6.2
Other providers of pharmaceutical services....................................................................... 30
6.2.1 Hospital Pharmacy............................................................................................................. 30
6.2.2 Community Health Service................................................................................................. 30
6.2.3 Milton Keynes Urgent Care Service................................................................................... 30
6.3
Opening Hours................................................................................................................... 30
6.4
Accessibility by foot/by car and public transport................................................................ 32
6.4.1 Access for people with disability........................................................................................ 33
6.4.2 Essential services.............................................................................................................. 33
6.5
6.5.1 Medicines Use Reviews and Prescription Intervention Service......................................... 36
6.5.2 New Medicines Service (NMS).......................................................................................... 37
6.5.3 Appliance Use Reviews (AUR).......................................................................................... 38
6.5.4 Stoma Appliance Customisation (SAC).............................................................................. 38
6.6
6.6.1 Pharmacy Rota Out of Hours Service................................................................................ 39
6.7
6.7.1 Minor Ailment service......................................................................................................... 39
6.7.2 Supply of Palliative Care Drugs......................................................................................... 39
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Local Health Needs..................................................................................................................... 40
7.1
Life Expectancy.................................................................................................................. 40
7.2
Mortality.............................................................................................................................. 42
7.3
Sexual Health & Contraceptive.......................................................................................... 42
7.3.1 Local Health needs............................................................................................................ 42
7.3.2 Current services................................................................................................................. 44
7.4
7.5
7.6
Community Pharmacy Advanced services......................................................................... 36
Community Pharmacy enhanced and additional services................................................. 39
Pharmaceutical services commissioned by MKCCG......................................................... 39
Smoking............................................................................................................................. 48
Drug Misuse....................................................................................................................... 50
Alcohol Misuse................................................................................................................... 53
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7.6.1 Local health needs............................................................................................................. 53
7.7
7.8
7.8.2 Diabetes............................................................................................................................. 58
7.8.3 Respiratory disease........................................................................................................... 58
7.8.4 Cardiovascular disease...................................................................................................... 60
7.8.5 Cancer................................................................................................................................ 61
7.9
7.10 Older people....................................................................................................................... 65
7.11
7.11.1 Care Home Residents........................................................................................................ 66
7.11.3 People in Domiciliary Care................................................................................................. 68
7.12 Learning Disability.............................................................................................................. 69
7.12.1 Local Health Needs............................................................................................................ 69
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Public consultation and results................................................................................................. 70
9
Summary of Gap Analysis and Recommendations.................................................................. 71
9.1
Gap analysis of local pharmaceutical services.................................................................. 71
9.2
Recommendations............................................................................................................. 76
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Process of Developing the PNA................................................................................................. 79
10.1 Summary of the process followed in developing the PNA.................................................. 79
10.2 Steering group and governance framework....................................................................... 82
Obesity............................................................................................................................... 54
Long Term Conditions........................................................................................................ 57
Mental Health..................................................................................................................... 63
Older people in Domiciliary and Residential Care.............................................................. 66
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10.3 Local Community pharmacy survey report......................................................................... 83
11Appendices.................................................................................................................................. 86
12
Glossary and abbreviations..................................................................................................... 113
12.1 Glossary of terms and phrases defined in regulation 2 of the 2013 Regulations............. 113
12.2 List of abbreviations......................................................................................................... 115
2.1 Table of Appendices
Appendix 1: List of Community Pharmacies in Milton Keynes showing services provided and
opening hours................................................................................................................................ 87
Appendix 2: Graphs showing population growth in Milton Keynes............................................... 93
Appendix 3: Demographics and IMD data..................................................................................... 95
Appendix 4: Map showing Life Expectancy in Milton Keynes....................................................... 96
Appendix 5: Supporting data for Sexual Health services.............................................................. 98
Appendix 6: Data supporting Stop Smoking Services................................................................. 100
Appendix 7: Substance Misuse service data............................................................................... 102
Appendix 8: Data on Long term Conditions in Milton Keynes..................................................... 103
Appendix 9: Mental Health Services........................................................................................... 105
Appendix 10: Distribution of Older People in Milton Keynes....................................................... 106
Appendix 11: Legislative requirements for developing PNAs...................................................... 108
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3 Executive Summary
This executive summary is preliminary and will be reviewed after completion of the consultation
(15th of October to 15th of December 2014)
3.1 Introduction
This Pharmaceutical Needs Assessment (PNA) looks at the current provision of pharmaceutical
services across Milton Keynes’ Health and Wellbeing Board (HWB) and whether this meets the needs
of the population, and identifies any potential gaps in availability of services.
The PNA will be used by NHS England in its determination as to whether to approve applications to join
the pharmaceutical list under The National Health Service (Pharmaceutical and Local Pharmaceutical
Services) Regulations 2013. The PNA is required to be published by each HWB by virtue of section
128A of the NHS Act 2006 revised in 2009.
This PNA includes information on:
• Pharmacies in Milton Keynes and the services they currently provide, including dispensing,
providing advice on health, medicines reviews and local public health services such as stop
smoking, sexual health and support for drug users.
• Maps relating to Milton Keynes and providers of pharmaceutical services in the area.
• Services in neighbouring Health and Wellbeing Board areas that might affect the need for services
in Milton Keynes.
• Potential gaps in provision that could be met by providing more pharmacy services, or through
opening more pharmacies, and likely future needs.
3.2 Process
This PNA was undertaken in accordance with the requirements set out in regulations 3-9 and Schedule
1 of the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013.
In the process of undertaking the PNA, the Milton Keynes HWB sought the views of a wide range of key
stakeholders to identify issues that affect the commissioning of pharmaceutical services and to meet
local health needs and priorities.
A public consultation will be undertaken from 15th October to 15th December 2014 to seek the views of
members of the public and other stakeholders, on whether they agree with the contents of this PNA and
whether it addresses issues that they consider relevant to the provision of pharmaceutical services. The
feedback will be reported and reflected in the final revised PNA report.
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3.3 Key findings and recommendations
Current provision
There are currently a sufficient number of community pharmacies providing essential and advanced
services in Milton Keynes. The level of provision of essential services in Milton Keynes is deemed
to be adequate for the population.
This statement is based on the following measures used in assessing the level of adequacy of
pharmaceutical service provision in comparison to national statistics:
• The number of pharmacies per 100,000 population for 2013/14 shows an increase in provision
from the last PNA (2011) from 17 to 18 pharmacies per 100,000. This mirrors the provision for the
South Central Strategic Health Authority of 18 pharmacies per 100,000 population (2012/13).
• The average number of prescription items dispensed per pharmacy per month figure for Milton
Keynes was 6,667 dispensed items, which is very similar to the national average of 6,628.
• There has been an increase in the number of community pharmacies in Milton Keynes registered
to provide pharmaceutical services under the NHS pharmacy contract from 41 (in 2011) to 47 (in
2014). One of these is a distance selling pharmacy which cannot offer services on the premises,
but delivers all essential services remotely. The number of 100 hours pharmacies has increased
from four (in 2011) to six in 2014.
• With the exception of residents living in the least dense quintile (35 to 1267 people per sq km) in
Milton Keynes, all residents can access a pharmacy within one mile of their home. All residents
can access a pharmacy within a five mile radius. This access is supplemented by providers in the
neighbouring local authority areas.
• The maps and data contained in this document show that the services which are commissioned in
addition to the NHS pharmaceutical contract, meet identified health needs.
Based on these findings, the level of provision of dispensing services in Milton Keynes is deemed to be
adequate for the population.
Potential provision
However, the existing community pharmacies could increase their contributions to improving the health
of Milton Keynes population by engaging in the following areas as highlighted by this PNA:
The population of Milton Keynes is projected to grow from 252,400 in 2012 to 302,100 in 2026. This
is an increase of 49,700 people or 19.7%, many of whom will be young people and families. The
current proportions of 0-14 year olds and people aged 25-44 in Milton Keynes are greater than England
(respectively 21.2% v 17.7% and 31.3% compared with 27.2%), while 11.7% of the population in Milton
Keynes in 2012 were aged 65+ compared with 16.9% in England.
Community pharmacy teams are best placed to proactively promote the healthy life style messages
as part of Making Every Contact Count National Campaign as well as sign-posting to local support
services. To do so effectively it is recommended that a “Directory of services in Milton Keynes” is
established and disseminated to all local pharmacies for use. Commissioners should also consider
inclusion of community pharmacies in obesity management pathways with referral by pharmacists into
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the services. A targeted commissioning of the NHS Health Checks from community pharmacies could
also increase early detection of cardiovascular diseases.
The highest proportion of clients of community pharmacies are young mothers. Local commissioners in
Milton Keynes should consider community pharmacies in the provision of smoking cessation services,
increased sexual health services such as Chlamydia screening and treatment under PGDs and
engaging in campaigns to raise awareness of and improve HIV screening. The pharmacies could also
have an important role in cancer awareness campaigns to promote early detection.
More than 25% of the population aged 16 and over are estimated to drink above the recommended
guidelines. Pharmacists can be commissioned to potentially deliver Identification and Brief advice (IBA).
Medicines Use Review and New Medicine Services are the two important aspects of pharmaceutical
services through which community pharmacists can provide support for self-care and to promote
independence and the safe administration of medicines, especially for people with long term conditions,
including people with mental health problems. Although currently 100% of the pharmacy contractors in
Milton Keynes offer these services, the level of provision varies widely. In 2013-14 the number of MUR
consultations per pharmacy ranged from one to 456 (pharmacies are contracted to provide up to 400
consultations). It is recommended that community pharmacies proactively offer these services, as well
as advisory support for carers, to enable them to administer medicines and to increase the uptake of
MUR and NMS by their local communities. This service can be maximised by ensuring that healthcare
professionals across all sectors are informed of the service to allow them to refer patients appropriately.
The service can be incorporated into treatment pathways for the management of long term conditions
e.g. diabetes, cardiovascular disease, respiratory disease.
There will be a significant rise in the population of 65+ in Milton Keynes. It is estimated that the
proportion of people aged 65+ will increase from 11.7% (2012) to 17.8% by 2026. GPs and pharmacists
should make more use of the Repeat Dispensing services to reduce the need for patients to visit
their surgery to collect repeat prescriptions. Community pharmacists can play an important role in an
increased awareness to support disability, which tends to increase with age. Older people in care
homes would benefit from an increased clinical pharmacy support and direct access of residents to
a pharmacist, as well as pharmacists’ input in staff training on medicines issues. Establishing robust
communication systems will ensure patient safety and could reduce waste.
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4Introduction
From 1st April 2013, every Health and Wellbeing Board (HWB) in England has a statutory responsibility
to publish and keep up to date a statement of the needs for pharmaceutical services of the population in
its area, referred to as a Pharmaceutical Needs Assessment (PNA).
Under the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations (“the 2013
Regulations”), a person who wishes to provide NHS pharmaceutical services must generally apply to
NHS England to be included on a relevant list by proving they are able to meet a pharmaceutical need,
as set out in the relevant PNA.
The PNA will help in the commissioning of pharmaceutical services in the context of local priorities,
and will be used by NHS England when making decisions on applications to open new pharmacies. It
is therefore important that PNAs comply with regulations and that mechanisms are established to keep
the PNA up-to-date.
This PNA describes the needs for the population of Milton Keynes Local Authority.
4.1 What is a Pharmaceutical Needs Assessment?
The PNA is a structured approach to identifying unmet pharmaceutical need. It is an effective tool to
enable HWBs to identify the current and future commissioning of services required from pharmaceutical
service providers. The Department of Health (DH) published an Information Pack to help HWBs
undertake PNAs.1
4.2 What is the purpose of the PNA?
This PNA will serve several key purposes2:
• It will be used by NHS England when making decisions on applications to open new pharmacies
and dispensing appliance contractor premises; or applications from current pharmaceutical
providers to change their existing regulatory requirements.
• It will help the HWB to work with providers to target services to the areas where they are needed
and limit duplication of services in areas where provision is adequate.
• It will inform interested parties of the pharmaceutical needs in Milton Keynes and enable work to
plan, develop and deliver pharmaceutical services for the population.
• It will inform commissioning decisions by local commissioning bodies including local authorities
(public health services from community pharmacies), NHS England and Clinical Commissioning
Groups (CCGs).
1 Department of Health. ‘Pharmaceutical needs assessments: Information Pack for local authority Health and Wellbeing Boards.’ May 2013. Available at: https://
www.gov.uk/government/uploads/system/uploads/attachment_data/file/197634/Pharmaceutical_Needs_Assessment_Information_Pack.pdf
2 Primary Care Commissioning. ‘Pharmaceutical needs assessments.’ March 2013. Available at: http://www.pcc-cic.org.uk/
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4.3 Legislative background
Section 126 of the 2006 Act places an obligation on NHS England to put arrangements in place so
that drugs, medicines and listed appliances ordered via NHS prescriptions can be supplied to persons.
This section of the 2006 Act also describes the types of healthcare professionals who are authorised to
order drugs, medicines and listed appliances on an NHS prescription. The first PNAs were published
by NHS Primary Care Trusts (PCTs) according to the requirements in the 2006 Act. Milton Keynes PCT
published their first PNA in 2011.3
The Health and Social Care Act 2012 (The 2012 Act) amended the 2006 Act. The 2012 Act established
HWBs and transferred to them the responsibility to publish and keep up to date a statement of the
needs for pharmaceutical services of the population in its area, with effect from 1 April 2013. The
requirements on how to develop and update PNAs are set out in Regulations 3-9 and Schedule 1 of the
NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013.4
The 2012 Act also amended the Local Government and Public Involvement in Health Act 2007 to
introduce duties and powers for HWBs in relation to Joint Strategic Needs Assessments (JSNAs). The
preparation and consultation on the PNA should take account of the JSNA and other relevant local
strategies in order to prevent duplication of work and multiple consultations with health groups, patients
and the public. The development of PNAs is however a separate duty to that of developing JSNAs. As
a separate statutory requirement, PNAs cannot be subsumed as part of these other documents but can
be annexed to them.
The PNA must be published by the HWB by April 2015, and will have a maximum lifetime of three
years. As part of developing their first PNA, HWBs must undertake a consultation for a minimum of 60
days. The 2013 Regulations list those persons and organisations that the HWB must consult5. This list
includes:
• Any relevant Local Pharmaceutical Committee (LPC) for the HWB area.
• Clinical Commissioning Group.
• Any Local Medical Committee (LMC) for the HWB area.
• Any persons on the pharmaceutical lists and any dispensing GP practices in the HWB area.
• Any local Healthwatch organisation for the HWB area, and any other patient, consumer
and community group which in the opinion of the HWB has an interest in the provision of
pharmaceutical services in its area.
• Any NHS trust or NHS foundation trust in the HWB area.
• NHS England.
• Any neighbouring HWB.
3 Milton Keynes PNA 2011
4 The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. Available at: http://www.legislation.gov.uk/uksi/2013/349/
made (Accessed 21 June 2014)
5 Ibid
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The 2012 ACT also transferred responsibility for using PNAs as the basis for determining market entry
as well as decision on the entry to a pharmaceutical list from PCTs to NHS England. The PNA will be
used by NHS England when making decisions on applications to open new pharmacies and dispensing
appliance contractor premises; or applications from current pharmaceutical providers to change their
existing regulatory requirements based on newly identified gaps in local pharmaceutical provision.
Such decisions are appealable to the NHS Litigation Authority’s Family Health Services Appeal Unit
(FHSAU), and decisions made on appeal can be challenged through the courts. PNAs will also inform
the commissioning of enhanced services from pharmacies by NHS England, and the commissioning of
services from pharmacies by the local authority and other local commissioners such as CCGs.
The PNA plays a significant role in the determination of applications, it is therefore important that due
process is followed in its development and that the information is kept up-to-date.
HWBs will also be required to publish a revised assessment when significant changes to the need for
pharmaceutical services are identified, unless this is considered a disproportionate response 6. HWBs
therefore need to establish systems that allow them to:
• Identify changes to the need for pharmaceutical services within their area.
• Assess whether the changes are significant.
• Decide whether producing a new PNA is a disproportionate response.
HWBs need to ensure they are aware of any changes to the commissioning of public health services
by the local authority and the commissioning of services by CCGs, as these may affect the need for
pharmaceutical services. HWBs also need to ensure that NHS England and its Area Teams have
access to their PNAs.
4.4 What are the NHS pharmaceutical services?
Pharmaceutical services are defined in the NHS (Pharmaceutical Services and Local Pharmaceutical
Services) Regulations 20137 and include:
• Essential services which every community pharmacy providing NHS pharmaceutical services must
provide (as described in Schedule 4, Part 2 of the Regulations) which includes the dispensing of
medicines, promotion of healthy lifestyles and support for self-care.
• Advanced services which community pharmacy contractors and dispensing appliance contractors
can provide, subject to accreditation. These are currently Medicines Use Reviews and the
New Medicines Service from community pharmacists; Appliance Use Reviews and the Stoma
Customisation Service which can be provided by dispensing appliance contractors and community
pharmacies.
• Enhanced services commissioned directly by NHS England. These could include anti-coagulation
monitoring, the provision of advice and support to residents and staff in care homes in connection
with drugs and appliances, on demand availability of specialist drugs, and out-of-hours services.
6Ibid
7 The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 http://www.legislation.gov.uk/uksi/2013/349/contents/
made Accessed 27/9/14
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4.5 Local pharmacy services
Local pharmacy services are services which are commissioned locally and fall outside of the NHS
(Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013. Local pharmacy
services do not impact on the commissioning of new pharmacy contracts.
The 2013 Regulations set out the enhanced services which may be commissioned from pharmacy
contractors. It is important to note that the definition of ‘Enhanced services’ has changed, and the
current commissioning arrangements can now be seen as more complex since pharmacy services
previously commissioned by one organisation (PCTs) can now be commissioned by at least
three different organisations (CCGs, local authorities and NHS England) and the responsibility for
commissioning some services is yet to be resolved.
4.6 Public Health services and enhanced services
The changes to enhanced services are summarised in the following excerpt from PCC8:
Public health services
The commissioning of the following enhanced services which were listed in the Pharmaceutical
Services (Advanced and Enhanced Services) (England) Directions 2012 transferred from PCTs to local
authorities with effect from 1 April 2013:
• Needle and syringe exchange
• Screening services such as chlamydia screening
• Stop smoking
• Supervised administration service
• Emergency hormonal contraception services through patient group directions.
Where such services are commissioned by local authorities, they no longer fall within the definition
of enhanced services or pharmaceutical services as set out in legislation and therefore should not be
referred to as enhanced services.
However, the 2013 pharmaceutical directions do make provision for NHS England to commission the
above services from pharmacy contractors where asked to do so by a local authority. Where this is the
case, they are treated as enhanced services and fall within the definition of pharmaceutical services.
8 Primary Care Commissioning. Pharmacy Enhanced Services from 1 April 2013. 25 April 2013. Accessed 5 Jun 2013 at: http://www.pcc-cic.org.uk/article/pharmacy-enhanced-services-1-april-2013
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Enhanced services
The following enhanced services may be commissioned by NHS England from 1st April 2013, in line
with Pharmaceutical Needs Assessments (PNAs) produced by PCTs up to 31st March 2013 and by
Health and Wellbeing Boards (HWBs) thereafter:
• Anticoagulation monitoring
• Care home service
• Disease specific medicines management service
• Gluten free food supply service
• Independent prescribing service
• Home delivery service
• Language access service
• Medication review service
• Medicines assessment and compliance support
• Minor ailment service
• On demand availability of specialist drugs
• Out of hours service
• Patient group direction service (not related to public health services)
• Prescriber support service
• Schools service
• Supplementary prescribing service.
Clinical Commissioning Groups (CCGs)
CCGs now have a role to commission most NHS services locally, aside from those commissioned
by NHS England, such as GP core contracts and specialised commissioned services. CCGs involve
clinicians in their area to ensure commissioned services are responsive to local needs. CCGs will be
able to commission services from pharmacies but similar to public health services these services will be
known as local services and therefore fall outside the definition of enhanced services, and so have no
bearing on pharmacy applications to provide essential pharmaceutical services.
4.7 What are the pharmaceutical lists?
Pharmaceutical lists are compiled and maintained by NHS England.
Under the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013, if a
person (a pharmacist, a dispenser of appliances or in some circumstances and, normally in rural areas,
GPs) wants to provide NHS pharmaceutical services, they are required to apply to NHS England to be
included on a relevant pharmaceutical list. This is commonly known as the NHS ‘market entry’ system.
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The person must generally prove that they are able to meet a pharmaceutical need as set out in the
relevant PNA. There are however exceptions to the applications to meet a need, such as applications
for needs not foreseen in the PNA or to provide pharmaceutical service on a distance-selling (internet or
mail order only) basis.
The following may be included in a pharmaceutical list:
• Pharmacy contractors: a person or body corporate who provides NHS Pharmaceutical Services
under the direct supervision of a pharmacist registered with the General Pharmaceutical Councils.
• Dispensing appliance contractors: appliance suppliers are a sub-set of NHS pharmaceutical
contractors who supply, on prescription, appliances such as stoma and incontinence aids,
dressings, bandages etc. They cannot supply medicines.
• Dispensing doctors: medical practitioners authorised to provide drugs and appliances in
designated rural areas known as ‘controlled localities’.
• Local pharmaceutical services (LPS) contractors also provide pharmaceutical services in some
HWB areas.
4.8 Information contained in this PNA
The information to be contained in the PNA is set out in Schedule 1 of The National Health Service
(Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013. Briefly, this PNA
includes information on:
• Pharmacies in Milton Keynes and the services they currently provide, including dispensing,
providing advice on health, medicines reviews and local public health services, such as stop
smoking, sexual health and support for drug users.
• Maps relating to Milton Keynes and providers of pharmaceutical services in the area.
• Services in neighbouring HWB areas that might affect the need for services in Milton Keynes
• Potential gaps in provision that could be met by providing more pharmacy services, or through
opening more pharmacies, and likely future needs.
The PNA is aligned with the JSNA and HWB Strategy for Milton Keynes as discussed in the next
section.
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5 Local Health Needs
The local health needs have been highlighted using various sources as below.
5.1 Joint Strategic Needs Assessment - Priorities
Cancer and circulatory diseases are the leading causes of death in Milton Keynes, each accounting for
around 28% of all deaths and nearly two thirds of all premature deaths before the age of 75. People
will substantially reduce their risk of developing a chronic disease and dying prematurely if they: do not
smoke, achieve the recommended levels of physical activity, eat a healthy balanced diet which includes
at least five portions of fruit and vegetables a day, do not exceed the recommended sensible drinking
guidelines. The followings are some of the health needs identified by the Milton Keynes Joint Strategic
Needs Assessment (MKJSNA) which could potentially be influenced or addressed by pharmacists:
• Promoting healthy lifestyle
• Contraception and Sexual Health
• Long term conditions including diabetes
• Mental health including Dementia
• Infection disease prevention (e.g. immunisation) and treatment
• Physical and learning disabilities
• End of Life care
The following work streams have been prioritised by MKJSNA to which community pharmacists can
directly contribute to:
• Focus on areas and groups with the highest need.
• Target stop smoking services, train health care workers to support smokers to quit and work with
others to enforce tobacco control measures.
• Focus on better management of medication and where shown to be effective, commission
rehabilitation at all levels of care.
• Provide opportunities for patients to increase their understanding of their health conditions to
prevent deterioration and support better self- management.
• Promote the “Health Checks” programme so early interventions are provided.
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5.2 Clinical Commissioning Group Priorities
Milton Keynes Clinical Commissioning Group (MK CCG) is responsible for planning the delivery of
health care for its population with its goals over the next three years set. MK CCG mission statement
is this: We will openly work with you to plan and buy services that are high quality and provide you with
the best health outcomes and experiences while achieving value for money for our local community.
We will listen and we will improve the health and well-being for everyone in Milton Keynes. We carry
several important principles at the heart of our decision making which include:
• We will work in a fair and inclusive way to support the most vulnerable to access health care
• We will commission safe, high quality services for all
• Clinicians will lead our commissioning decisions
NHS MK CCG aims to ensure that its commissioning will:
• continue to meet the needs of a growing population, recognising that many of the new arrivals into
Milton Keynes are young people and families;
• prepare for the ageing of the existing population by promoting good health and supporting
independence for as long as possible;
• support the regeneration work programme of the local strategic partnership by focusing efforts to
address health inequalities alongside, and integrated with, efforts to address social, economic and
other inequalities in key geographic areas, such that the gap in life expectancy between electoral
wards narrows;
• reduce premature mortality and poor outcomes from “major killers”, i.e. the three main conditions
affecting the Milton Keynes population: cardiovascular disease (which kills more people than any
other condition); cancer (which kills more people prematurely than expected); and respiratory
disease (which kills more people than expected); and
• support the care of the most vulnerable in our society, especially children, and people with physical
disabilities, learning disability or mental ill-health.
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5.3 Localities in MK
For the purpose of the PNA, localities have been defined within Medium Super Output Area (MSOA)
boundaries. These have an average population of 7,200. The localities were selected to aid local
decision making that takes into account the needs for the population in these areas.
Considerations made in defining localities
In considering how to define localities within Milton Keynes, the HWB considered using Electoral
Wards, District Council Areas, and Super Output Areas.
Electoral wards
These are key building blocks of UK administrative geography and have been used in this report. The
population size can vary from 100 to 30,000 residents.
District council areas
District council areas are well understood by many people and could enable comparison of routine data,
but were deemed too large to be sensitive to the issues involved for the PNA.
Super Output Area (SOA)
This is a way of collecting and publishing small area statistics developed by the Office of National
Statistics (ONS)9. They are of a more consistent size than electoral wards, which facilitates an
assessment of needs for the local populations. They are not subject to frequent boundary change, so
may be more suitable for comparisons over time. In addition, they will build on the existing availability
of data for census output areas. SOA data are increasingly used for health needs assessment, health
planning and assessing health inequalities.
SOAs come in two levels. Lower Layer Super Output Areas (LSOAs) have a minimum population size
of 1,000 people and the average size is 1,500 people. Additionally, LSOAs can be grouped into Middle
Layer Super Output Areas (MSOA). The MSOAs population size is minimum 5,000 people and the
average is 7,200 people. All MSOAs are contained within a local authority (LA) and do not cross LA
boundaries.
MSOAs were selected as the localities used for the PNA. MSOAs were chosen by the Public Health
Observatories for JSNAs because they are well established, durable, small enough to produce a
range of results for almost every Local Authority (LA)/Unitary Authority (UA) and sufficiently large for
many results to be reliable. MSOAs have an average population of 7,200 people, which generally
produces sufficient numbers of cases to prevent disclosure of information about identifiable individuals.
MSOAs have been used in the JSNA to determine health needs across Milton Keynes. The JSNA is a
continually updated resource and so using MSOAs for the localities means that data for these localities
is always available.
9 Office for National Statistics: Super Output Areas (SOAs).http://www.ons.gov.uk/ons/guide-method/geography/beginner-s-guide/census/super-output-areas-soas-/index.html (accessed 17.7.14)
18
5.4 The Demographics of Milton Keynes
5.4.1
Population
The population of Milton Keynes was 252,400 in 2012 (MK population Bulletin 2013/14). It is projected
to grow from 252,400 in 2012 to 302,100 in 2026. This is an increase of 49,700 people or 19.7%. See
Appendix 2 for graphs showing projected growth in population.
The pyramid below shows the age structure of the population of Milton Keynes in 2012 compared with
England. In 2012 Milton Keynes had a larger proportion of 0-14 year olds than England. 21.2% of the
Milton Keynes population were aged 0-14 in 2012 compared with 17.7% in England. Milton Keynes
also has a larger proportion of people aged 25-44 (31.3% compared with 27.2%). However, just 11.7%
of the population in Milton Keynes in 2012 were aged 65+ compared with 16.9% in England.
Figure 1: Age Structure for Milton Keynes and England 2012
Source: MK Population Bulletin 2013/14
By 2026 the population of Milton Keynes is forecast to have aged. The median age will have grown
to 39.5. The proportion of people aged 65+ in Milton Keynes will have risen to 17.8%, this is closer
to the England figure of 20.5%. The proportion of 0-4 year olds will then be similar to that of England,
however, the proportion of 5-19 year olds will be significantly higher than England (20.9% in Milton
Keynes compared with 17.8% in England).
19
5.4.2
Ethnicity, Nationality and Race
• 26.1% of the Milton Keynes population in 2011 were from a black and minority ethnic group. This
compares to 13.2% in 2001 and 20.2% for England as a whole.
• The largest single ethnic group after White British was Black African. In 2011 13,060 people
classified themselves as Black African, this is 5.2% of the total population. White Other was the
third largest group, accounting for 5.1% of the total population.
• The Black African group had the highest growth between 2001 and 2011. The group increased
from 1.3% of the population in 2001 to 5.2% in 2011.
• Linguistic Diversity – as important as ethnicity is linguistic diversity. In Milton Keynes, 10.6% of
households have at least one person whose main language is not English and 109 languages are
reported to be spoken as first languages. Language can be a barrier to communication and provide
an additional need. In 1,255 households (1.3%) no person aged 16 and over in the households
has English as a main language, but at least one person aged three to 15 in the same households
has English as a main language.
The 2011 Census, conducted by the Office for National Statistics, provides information on the size of
the population by ethnic group. The data includes borough level information and the latest data is for
2011.
Table 1 shows a comparison of population by ethnic group for England and Milton Keynes and Figure 2
is a map of the ethnic population distribution at MSOA level.
Table 1: Population by Ethnic Group: MK & England 2011
Ethnic Group
Milton Keynes
England
Persons
%
%
White: British
183,934
73.9
79.8
White: Irish
2,498
1.0
1.0
White: Gypsy or Irish Traveller
72
0.0
0.1
White: Other White
12,590
5.1
4.6
Mixed/multiple ethnic groups
8,235
3.3
2.2
Asian/Asian British: Indian
8,106
3.3
2.6
Asian/Asian British: Pakistani
3,851
1.5
2.1
Asian/Asian British: Bangladeshi
1,989
0.8
0.8
Asian/Asian British: Chinese
2,722
1.1
0.7
Asian/Asian British: Other Asian
6,114
2.5
1.5
Black/Black British: African
13,058
5.2
1.8
Black/Black British: Caribbean
2,524
1.0
1.1
Black/Black British: Other Black
1,549
0.6
0.5
Other Ethnic Group: Arab
565
0.2
0.4
Other ethnic group
1,014
0.4
0.6
All usual residents
248,821
100.0
100.0
Total Non-White British
64,887
26.1
20.2
20
Figure 2: Population of ethnic groups by MSOA
21
5.5 Deprivation
The Indices of Multiple Deprivation (IMD 2010) are measures of deprivation for every Super Output
Area and Local Authority area in England. IMD combines a number of indicators across seven domains
(income, employment, heath deprivation and disability, education, skills and training deprivation,
barriers to housing and services, living environment deprivation and crime) into a single deprivation
score and rank for each area (MKi Observatory). It provides links to key deprivation data.
The National Index of Multiple Deprivation calculating methodology was broadly unchanged from the
previous iteration, to allow comparability with the index of deprivation 2007. The index was released at
the lower super output area (LSOA) geography.
Key Results for Milton Keynes:
• Milton Keynes has a local authority rank of 211, compared to 212 last time – where 1 is the most
deprived.
• Authorities ranked closely to Milton Keynes include Cheltenham (214); Chichester (213); Solihull
(212); Braintree (210); East Devon (209).
• Seven LSOAs are in the 10% most deprived in England, compared to six in the 2007 index.
• 18 LSOAs are in the 20% most deprived in England, compared to 15 in the 2007 index and 13 in
2004.
• 17 LSOAs are in the 10% least deprived in England, compared to 14 in the 2007 index.
• 51 LSOAs are in the 20% least deprived in England, compared to 49 in the 2007 index and 40 in
2004.
• This continues the trend, seen between the 2004 and 2007 indices, of increasing numbers in the
most and in the least deprived quintiles of the national population.
The seven LSOAs in the 10% most deprived covers large parts of Woughton ward, parts of Eaton
Manor and Fuller Slade (MK Social Atlas 2013)
22
Figure 3: Index of Multiple Deprivation 2010 Milton Keynes
23
5.6 Education
Levels of qualifications in Milton Keynes are slightly higher than the England average. 18% have no
qualifications compared with 22.5% in England. 28.2% have a degree or higher qualification compared
with 27.4% in England. Levels of qualifications in Milton Keynes have increased considerably since
2001. In 2001 just 18.9% of residents aged 16+ had a degree or higher qualification. In 2011 this had
increased to 28.2%.
5.7 Car ownership
There were 22,900 more cars or vans in Milton Keynes households in 2011 compared with 2001. This is
a 21.8% increase compared to the population growth of 17%. In total there are 128,000 cars or vans in
Milton Keynes, however 18.9% of households have no car or van.
A smaller proportion (5.5%) of people in Milton Keynes travel to work via bus compared with England
as a whole (7.2%) and by foot (7.1% compared with 9.7% in England). A larger proportion (61.8%) of
people in Milton Keynes drive a car or van to work compared with England (54.2%)
5.8 New Housing Development
Milton Keynes is experiencing another period of rapid growth. It is anticipated that up to 21,000 new
homes will be built between 2014 and 2025.
Whilst there will be some smaller in-fill developments, the majority of new homes will be built in eight
new development areas. These are: Western Flank, Central Milton Keynes and Campbell Park,
Northern Expansion Area, Newton Leys, Eastern Expansion Area, Strategic Land Allocation, Western
Expansion Area.
Whilst information currently available provides forecasts for the anticipated rates of development on
planned developments, there is a degree of uncertainty as to the exact time frames involved and
therefore the potential impact on pharmaceutical needs for the next three years is subject to change.
This PNA takes into consideration the areas of proposed residential development as understood now
and the current capacity for pharmaceutical provision. Should the population increase significantly
before the PNA is revised in three years’ time, the pharmaceutical needs for the growth areas will be
reviewed. It is anticipated that residents in the small areas of in-fill will receive pharmaceutical services
within the current provision.
The table below provides a snap shot view of current pharmaceutical provision in the proposed areas of
growth:
24
Table 2: Pharmaceutical provision in Milton Keynes based on development strategy
Areas of Housing
Development
Proposed development (up
to 2025
Current Pharmaceutical
provision
Comments
Western Flank (Oxley Park,
Kingsmead South, Tattenhoe
Park)
3000 new homes
There are two pharmacies in
Westcroft situated between
Oxley Park and Kingsmead
South / Tattenhoe Park
One of these pharmacies
has recently opened
providing additional capacity
in the area. Additional
pharmaceutical needs will
have to be assessed with
actual increase in population.
Central Milton Keynes and
Campbell Park
6625 new homes
This area is close to three
pharmacies in the town
centre and one at Bradwell
Common and Fishermead.
The Campbell Park end of
this development is further
away from current pharmacy
provision. There are two 100
hours pharmacies in or close
to this development area.
Additional pharmaceutical
needs will have to be
assessed with actual
increase in population.
Northern Expansion Area
(Oakgrove, Oakridge Park,
Redhouse Park
2275 new homes
There are existing
pharmacies close to
Oakgrove (in Milton Keynes
Village), Oakridge Park
and New Bradwell and
Stantonbury (for Redhouse
Park)
These three areas are
geographically distinct.
Pharmaceutical provision
will have to be determined
for each taking into account
capacity in the nearby area.
Newton Leys
1610 new homes
Current pharmaceutical
provision is available in
Water Eaton
The five central Bletchley
pharmacies could also serve
this population. There is 100
hours provision in Bletchley.
Eastern Expansion Area
(Brooklands, Broughton
Gate, Magna Park)
4027 new homes
Current pharmacy provision
at Broughton Gate and
Kingston.
increase in population. There
is 100 hours provision at
Kingston.
Strategic Land Allocation
(Eagle Farm North, Eagle
Farm South, Golf Course /
Haynes Land, Glebe Farm,
Church Farm, West of
Stockwell Lane
2900 new homes
at Broughton Gate, Kingston
and Woburn Sands in
Bedfordshire.
There is 100 hours provision
at Kingston. Additional
pharmaceutical needs will
have to be assessed with
actual increase in population.
Western Expansion Area
(Area 10, Area 11
4286 new homes (up to 6550
in total post 2026)
at Two Mile Ash and Stony
Stratford
25
6 Current Provision of pharmaceutical services in Milton Keynes
6.1 Service providers
Pharmaceutical services are those provided from community pharmacies, dispensing doctors and
appliance contractors. This document also considers services from other service providers such as
GPs, hospitals and Sexual Health Clinics, as it is recognised that “need” may be met in ways other than
via pharmaceutical service provision.
This PNA identifies and maps the current provision of pharmaceutical services in order to assess the
adequacy of provision of such services. Information was collected up until 31st July 2014 and any
changes in pharmacies delivering Enhanced and Advanced services beyond this date may not be
reflected. The details and opening hours of pharmaceutical service providers are found in Appendix 1.
Figure 4 below is a map of the geographical locations of all the pharmaceutical service providers in
Milton Keynes and indicates the locations of providers outside the borders of the Borough, but which
can readily be accessed by residents.
6.1.1 Community Pharmacies
In Milton Keynes there are 47 community pharmacies (as of 31st July 2014) registered to provide
pharmaceutical services under the NHS pharmacy contract, providing a range of dispensing and other
services, with business models varying from multiple store organisations to independent contractors.
The registered pharmacies can be broken down by the type of services provided:
• 38 Community pharmacies
• Six Community pharmacies with 100 hour opening contract
• One Distance selling pharmacy (which cannot offer services on the premises, but delivers all
essential services remotely)
• Two Essential Small Pharmacy Local Pharmaceutical Service (ESPLPS)*
There are no Dispensing Doctors or Dispensing Appliance Contractors in Milton Keynes.
*Essential Small Pharmacies are contracted under the Local Pharmaceutical Services provisions.
These contracts were originally scheduled to end in 2011, however have been extended by the
Department of Health to terminate in March 2015, following negotiations with the Pharmaceutical
Services Negotiations Committee (PSNC). Further discussions will be held between NHS England and
PSNC about any support available for Essential Small Pharmacies from that date.10
10 http://psnc.org.uk/contract-it/pharmacy-regulation/essential-small-pharmacies/ Website access 11/8/2014.
26
Figure 4: Map of Pharmaceutical service providers in Milton Keynes
27
6.1.2 Comparison of pharmaceutical service provision in Milton Keynes with England.
The table below provides information on dispensing activity in England and at Strategic Health Authority
(SHA) level in 2012-13.
Table 3: Community pharmacies on a PCT pharmaceutical list at 31st March 2013, prescription
items dispensed per month and population by SHA in England 2012-1311
Number of
Prescription
Population
Pharmacies
Average items
community
items dispensed
(000)s Mid
per 100,000
dispensed per
pharmacies
per month (000)s
2011
population
pharmacy per
month
ENGLAND
11,495
76,191
53,107
22
6,628
South Central
756
4,898
4,177
18
6,479
North East
606
5,095
2,596
23
8,408
North West
1,812
12,334
7,056
26
6,807
Yorkshire and the Humber
1,206
8,557
5,288
23
7,096
East Midlands
919
6,476
4,537
20
7,047
West Midlands
1,297
8,247
5,609
23
6,359
East Of England
1,148
7,625
5,862
20
6,642
London
1,846
9,644
8,204
23
5,225
South East Coast
857
5,767
4,476
19
6,729
South West
1,048
7,546
5,301
20
7,201
Milton Keynes PCT
43
287
255
17
6667
The number of pharmacies per 100,000 population ranges at SHA level ranges between 18 and 26
with an average of 22. It must be noted that this will vary widely across the country, as some areas
have dispensing doctors accounting for some of the dispensing activity. In 2012-13 Milton Keynes had
17 pharmacies per 100,000 population which is lower than the England average, but very close to the
South Central SHA average.
The number of pharmacies per 100,000 population revised for 2013/14 shows an increase in
provision to 18 pharmacies per 100,000. This mirrors the provision for the South Central SHA
area, matching the trends in this region.
Another measure to consider in assessing the level of adequacy of pharmaceutical service provision
in comparison to national statistics is the number of prescription items dispensed per pharmacy per
month. The average figure for Milton Keynes was 6667 dispensed items, which is very similar to the
national average of 6,628 items.
Based on these findings the level of provision of dispensing services in Milton Keynes is
deemed to be adequate for the population.
11 Sources: NHS Prescription Services part of the NHS Business Services Authority, Population data - Office for National Statistics
28
6.2 Other providers of pharmaceutical services
6.2.1
Hospital Pharmacy
Patients under the care of Milton Keynes General Hospital and those attending other neighbouring
acute trusts will receive pharmaceutical services from the hospital pharmacy. In-patients are supplied
with medication whilst on admission and will receive at least 14 days’ supply of medication on
discharge. Out-patient services will also supply medication (or issue a prescription to be dispensed in
the community) for their out-patient care. The hospital pharmacy will also dispense some medicines that
are more difficult to obtain in the community pharmacy or where there are particular risks associated
with medications e.g. cytotoxics for treatment of cancer.
6.2.2
Community Health Service
Central and North West London NHS Trust provides some pharmaceutical services as part of their
community health services in Milton Keynes. This includes dispensing and medicines optimisation for
in-patients in the wards and at HMP Woodhill Prison.
6.2.3 Milton Keynes Urgent Care Service
The urgent care service provides FP10s for patients attending the out of hours and walk in centre.
Some patients may also be provided with medicines issued under Patient Group Direction.
6.3 Opening Hours
Core hours: Each pharmacy is required to be open for a minimum of 40 hours (or 100 hours for
100 hour pharmacies) a week as part of the requirement for providing ‘essential’ pharmacy service.
Contractors cannot change their core hours without approval from NHS England.
Supplementary hours: These are provided as an addition to the pharmacy’s contracted core hours
and pharmacies must state at the time of application to NHS England what the supplementary opening
hours will be. Contractors can alter their supplementary hours by giving 90 days’ notice of the change to
NHS England.
Out of Hours Service: This service is commissioned as a Local Enhanced Service by NHS England in
Milton Keynes and ensures that there is a pharmacy open on special public holidays.
A list of community pharmacy contractors providing pharmaceutical services and their opening hours
can be found in Appendix 1.
There is good provision of community pharmacy services from Sunday through to Saturday.
Weekday provision
From Monday to Friday pharmacies opening hours range from 6am through to midnight, with 100 hour
pharmacies providing these extended hours. 26 out of the 47 pharmacies close for lunch.
Saturday provision
44 pharmacies are open on Saturdays – opening hours range from 6am through to midnight; 23 of
these are open all day, and 21 are open till lunch time.
Sunday provision
12 pharmacies are open on Sundays with opening hours ranging from 10am to 5pm.
29
6.4 Accessibility by foot/by car and public transport
Figure 5: Map showing access to pharmacy services by MK residents
30
The map above indicates the accessibility of community pharmacies within one, two and a half, and 5
mile radii of residents in Milton Keynes.
With the exception of residents living in the least dense quintile (35 – 1267 people per sq km) in Milton
Keynes, all residents can access a pharmacy within one mile of their home. All residents can access a
pharmacy within a five miles radius. This access is supplemented by providers in the neighbouring local
authority areas.
6.4.1Access for people with disability
The Equality Act 2010 includes anti-discrimination laws that are applicable to all businesses and service
providers in the UK. Under the law, service providers are legally required to make changes to improve
services for disabled customers wherever disabled customers would be at a “substantial disadvantage”
compared with non-disabled people. They must:
• Make reasonable changes to the built environment – for example, making changes to a building to
improve access.
• Provide auxiliary aids and services – for example, provide an induction loop for people with hearing
aids.
• Make reasonable changes to the way things are done – for example, change a policy.
Community pharmacy contractors also have a duty to make reasonable adjustment to dispensed
medicines to allow for disability.
90% of pharmacy contractors who responded to the survey indicated that they have a disabled parking
space within close proximity of the pharmacy.
6.4.2Essential services
The following services form the core service provision required of all 47 pharmacies as specified by the
NHS Community Pharmacy Contract 2005:
•Dispensing,
• Repeat dispensing,
• Disposal of unwanted medicines,
• Public health promotion,
•Signposting,
• Self-care promotion
• Clinical Governance.
Dispensing
This is the supply of medicines and devices ordered through NHS prescriptions together with
information and advice to enable safe and effective use by patients. There are sometimes challenges
with maintaining stock that are outside the control of the pharmacy.
31
Pharmacists advise patients on how to take prescribed medication effectively and warn them of
potential side effects. They can adjust their services to suit the individual needs of the patient e.g.
large print on prescription labels, easy-open tops and devices to facilitate the firing of inhalers and
administration of eye drops.
Repeat dispensing
This is the management of repeatable NHS prescriptions for medicines and appliances in partnership
with the patient and prescriber. This service is available through all pharmacies in Milton Keynes,
although it is not utilised consistently by GP practices. Repeat dispensing allows patients to collect their
repeat prescriptions directly from the pharmacy, reducing unnecessary visits to the surgery. In rural
areas this can improve access for patients who do not have their own transport, as pharmacies will
then often deliver the medicines to the patients at home. The introduction of Release 2 of the Electronic
Prescription Service may increase the number of patients using this service. Many pharmacies also
offer a repeat prescription ordering and collection service for patients. This is popular but is not provided
under the NHS contractual arrangements.
Disposal of unwanted medicines
Pharmacies are required to accept, from patients, unwanted medicines which require safe disposal.
NHS England (who holds the responsibility for community pharmacy contracts) is obliged to put
collection services in place for such waste medicines. This service is available through all pharmacies
in Milton Keynes.
Public health promotion
Pharmacies can provide opportunistic advice on lifestyle and public health issues to patients receiving
prescriptions and pro-active participation in national or local public health campaigns.
32
All pharmacies in Milton Keynes display public health leaflets and posters. Milton Keynes Public Health
team, in conjunction with the local Area Team, have encouraged pharmacies to target particular patients
groups for each campaign and has offered support to staff on how to approach customers pro-actively.
Pharmacies are asked to report back on general activity for each campaign at year end.
Signposting
The pharmacies have a duty to provide information to people visiting the pharmacy who require further
support, advice or treatment which cannot be provided by the pharmacy, about other health and
social care providers or support organisations who may be able to assist the person. Signposting by
community pharmacies will be optimised through access to a well maintained Directory of Services.
This directory should contain up-to-date details of all the services including social, community and
health, and mental health services for pharmacists’ signposting to be effective in helping people to
access the right services.
Support for Self care
Pharmacists have welcomed the ambitions expressed for GPs by NHS England, their own profession’s
call to action, and they suggest that the network of England’s community pharmacies is more than
ready to step up to the plate.
The pharmacy call to action, which closed in mid-March, 2014 asked pharmacists and other
professional stakeholders to comment on four areas that have the potential to see community pharmacy
become an effective alternative to over-subscribed primary care services – particularly GP practices –
and act as an important triage to emergency services. The areas are:
• creating a “pharmacy first” culture
• ensuring patients get the best from their medicines
• integrating community pharmacy into the patient pathway
• increasing safety of dispensing.
Done well, self-care can have a leading role in the expected direction of NHS care over the next five
years: by focusing on healthy living, minimising preventable ill health, enabling the self-management of
long term conditions, encouraging early diagnosis and making every contact with the NHS count.
As a result, the need for acute secondary care will be reduced.
Understanding self-care and the fact that it is not a fixed, single act is key to understanding how it can
be adopted more effectively in the NHS. Self-care is a continuum of activity that at one end supports
people as they take individual responsibility for their daily lifestyle choices, for example, eating healthily
or choosing to do exercise. Moving along the continuum, self-care can be applied to the care of minor
ailments or long term conditions where people often self-manage without intervention from a health
professional.
Pharmacy staff can provide advice and support to enable people to derive maximum benefit from
caring for themselves and their families. In Milton Keynes there is a Minor Ailment service provided by
community pharmacies in more deprived areas. This is to support and empower people to become selfreliant in self-care.
33
Clinical Governance
Pharmacies are required to have an identifiable clinical governance lead and achieve a number of
clinical governance standards, including participating in clinical audit, undertaking a patient survey,
having Standard Operating Procedures, training staff, having confidentiality policies in place and
dealing with complaints.
6.5 Community Pharmacy Advanced services
6.5.1
Medicines Use Reviews and Prescription Intervention Service
Medicines Use Reviews (MURs) are a face to face conversation between patients and pharmacists and
are designed to improve compliance, adherence and safe use of medicines. The underlying purpose of
MUR service is, with the patient’s agreement, to improve his or her knowledge and use of drugs by, in
particular:
a) Establishing the patient’s actual use, understanding and experience of taking drugs;
b) Identifying, discussing and assisting in the resolution of poor or ineffective use of drugs by the
patient;
c) Identifying side effects and drug interactions that may affect the patient’s compliance with
instructions given to him or her by a health care professional for the taking of drugs; and
d) Improving the clinical and cost effectiveness of drugs prescribed to patients thereby reducing the
wastage of such drugs.
The service provides an opportunity to improve patient’s use of their medicines, reduce wastage,
improve their health and reduce unnecessary hospital admissions. Prescription Intervention service is
similar to an MUR and will be triggered by the pharmacist identifying a potential clinical issue from a
prescription handed in at the pharmacy, which is then investigated further by in an MUR consultation.
The service consists of accredited pharmacists undertaking structured adherence-centred reviews with
patients on multiple medicines, particularly those receiving medicines for long term conditions. In the
course of this consultation the pharmacist has the opportunity to also discuss medicines purchased by
the patient over the counter, as these have a potential to interact with prescribed medication or have an
impact on underlying conditions.
Where a pharmacist has concerns about a patient’s medication in the course of an MUR, a referral is
made to the GP with the patient’s consent. Pharmacists must have the necessary accreditation in order
to provide this service and the pharmacy must also have a consultation area on their premises which
meets the national standards, to ensure the MURs take place in a confidential environment.
Patients are expected to have no more than one MUR within 12 months unless an exceptional need
necessitates this. In 2013-14 a total of 12,324 MUR consultations were conducted in Milton
Keynes. The average number of MURs per accredited pharmacy was 273. The service was
provided by 100% of pharmacies in Milton Keynes. The number of consultations ranged from one to
456. 13 pharmacies achieved their annual maximum of 400 consultations, with six of these exceeding
this maximum. 22 pharmacies provided more than 300 consultations in the year.
34
Medicines Use Review service is very useful for patients, particularly for older people and for people
with long term conditions. This service can be maximised by ensuring that healthcare professionals
across all sectors are informed of the service, to allow them to refer patients appropriately. The service
can be incorporated into treatment pathways for the management of long term conditions e.g. diabetes,
cardiovascular disease, respiratory disease.
6.5.2
New Medicines Service (NMS)
Following the prescribing of a new medicine for the management of a Long Term Condition (within the
specified criteria), patients will be recruited to the service by prescriber referral (which could include
referral for medicines prescribed to the patient as a hospital inpatient or outpatient) or opportunistically
by the community pharmacy. These patients will then be advised on the appropriate use of the newly
prescribed medication and also followed up either by a face to face consultation or telephone within 14
to 21 days.
The service is designed to provide support and empower patients in the management of their LTC
by helping improve their adherence to their newly prescribed medicine(s). This, coupled with advice
on lifestyle changes and other non-drug interventions, can promote patient well-being and healthy
living. Participation in this service will not only offer benefits to patients, but also local primary care
services and the NHS by savings through a reduction in medicines wastage and drug-related hospital
admissions.
In 2013-14 a total of 3,912 New Medicines Services were conducted in Milton Keynes. The
average number of NMS per accredited pharmacy was 87. The number of consultations ranged
from one to 372. 80% of pharmacies provided NMS consultations in the year.
The figure below shows the level of activity across pharmacies in Milton Keynes for MUR and NMS
services. Whilst most pharmacies are performing well for the MUR service, availability of NMS is widely
varied and can be improved on.
Figure 6: Number of MUR and NMS consultations per pharmacy (2013-14)
35
6.5.3 Appliance Use Reviews (AUR)
Appliance Use Reviews can be carried out by a pharmacist or a specialist nurse in the pharmacy, or at
the patient’s home. AURs should improve the patient’s knowledge and use of any ‘specified appliance’
by:
• Establishing the way the patient uses the appliance and the patient’s experience of such use;
• Identifying, discussing and assisting in the resolution of poor or ineffective use of the appliance by
the patient;
• Advising the patient on the safe and appropriate storage of the appliance; and
• Advising the patient on the safe and proper disposal of the appliances that are used or unwanted.
The service can be provided by pharmacies that normally provide the specified appliances in the
normal course of their business. There are currently no pharmacies providing AUR in Milton Keynes.
6.5.4 Stoma Appliance Customisation (SAC)
Stoma Appliance Customisation involves the customisation of a quantity of more than one stoma
appliance, based on the patient’s measurements or a template. The aim of the service is to ensure
proper use and comfortable fitting of the stoma appliance and to improve the duration of usage, thereby
reducing waste. The stoma appliances that can be customised are listed in Part IXC of the Drug Tariff
(July 2014). Pharmacies that are unable to provide this service are required, with the patient’s consent,
to refer the prescription to another pharmacy or an appliance provider.
Six pharmacies provided Stoma Appliance Customistation in the financial year from 1st April 2013 to
31st March 2014 in Milton Keynes.12
6.6 Community Pharmacy enhanced and additional services
The services listed below are currently commissioned from community pharmacies in Milton Keynes
and details of service provision for the first five can be found under ‘Current Provision’ for Local Health
Needs.
1 Stop smoking service
2 Emergency Hormonal Contraception
3 Chlamydia testing
4 Supervised administration
5 Needle exchange
6 Out of Hours service (pharmacy rota for Christmas and Easter holidays)
12 Source: NHS England Hertfordshire & South Midlands Area Team
36
6.6.1 Pharmacy Rota Out of Hours Service
A Rota service is commissioned by NHS England Area Team in Milton Keynes to ensure that there
is access to pharmaceutical serviced on special public holidays such as Christmas day and Easter
Sunday when there would normally be no pharmacy open. Community pharmacies are able to
participate in this service by expression of interest in targeted areas.
6.7 Pharmaceutical services commissioned by MKCCG
6.7.1 Minor Ailment service
Milton Keynes CCG commissions a Minor Ailments Service. The service is open to all pharmacies
within Milton Keynes. This allows them to provide advice and treatment for a range of conditions
including thrush, cough, sore throat, constipation, hay fever, nappy rash etc. Patients who do not pay a
prescription charge do not have to pay for this service so it is a good way of reducing GP appointments
for minor, self-limiting conditions.
6.7.2 Supply of Palliative Care Drugs
This service is aimed at the supply of specialist medicines, the demand for which may be urgent and/
or unpredictable. The pharmacy contractor will stock a locally agreed range of specialist medicines for
palliative care and will make a commitment to ensure that users of this service have prompt access to
these medicines at all times, agreed with the CCG.
The service is currently not funded by the CCG, although the pharmacy is reimbursed for any unused
medicines when they become date-expired. 12 pharmacies currently provide this service in Milton
Keynes as well as MK Urgent Care Services. The service is publicised to GP practices and Palliative
Care nursing teams.
Access to this service across Milton Keynes meets the needs of the population.
37
7 Local Health Needs
7.1 Life Expectancy
Life expectancy for men and women in England and for those living in Milton Keynes continues to
rise. National statistics show that it has risen from 78.5 years for females in 1991-1993 to 82.5 years
in 2010-2012. For males, life expectancy has increased from 73.8 years to 78.7 years during the same
period. These figures are below the England average (Females 83.0 years Males 79.2 years) being
statistically significantly lower for females and boarder line for males. The chart below shows the trends
from 1992 to 2012.
Figure 7: Trends showing Life Expectancy in Milton Keynes
Source: Compendium of Population Health Indicators (indicator.ic.nhs.uk or nww.indicators.ic.nhs.uk)
This overall increase in life expectancy in both genders masks the inequalities that exist between areas
within Milton Keynes. Statistics clearly illustrate the association between life expectancy and where
people live. Locally we calculate life expectancy at ward level to better understand differences within
the Borough. Although there are some minor year to year changes in the order of ward rankings on
life expectancy, these changes are often mere statistical variations and the broad perspective remains
similar. The chart below shows life expectancy by ward.
38
Figure 8: Person’s Life Expectancy at birth by ward in Milton Keynes, 2007-2011 average
Middleton
Hanslope Park
Furzton
Bradwell
Newport Pagnell South
Stantonbury
Stony Stratford
Campbell Park
Danesborough
Wolverton
Olney
Sherington
Loughton Park
Denbigh
Emerson Valley
Whaddon
Newport Pagnell North
Bletchley & Fenny Stratford
Walton Park
Linford South
Eaton Manor
Linford North
Woughton
0
10
20
30
40
50
60
70
80
90
100
Life Expectancy
Source: Milton Keynes Council
Date Published by Source: December 2012
7.2 Mortality
The total number of deaths in Milton Keynes in 2012 was 1654 (787 males and 867 females) of which
614 (37%) were in people aged under 75 years (369 males and 245 females). Deaths in people less
than 75 years of age are considered to be premature deaths. Men are at more risk than women of dying
prematurely. A broad range of interventions is required to reduce the number of deaths due to cancer,
lung and heart diseases and stroke. Many deaths are preventable by lifestyle changes.
In 2010-2012, the primary causes of premature death in men were cancers (31.8% of premature
deaths) particularly lung cancer (6.2%), and circulatory diseases (22.7%), especially coronary heart
disease (8.6%) and acute myocardial infarction (4.8%). Suicide and undetermined injury accounted for
9.9% of male premature deaths. In women, the top causes of premature death were cancers (49.2%
of premature deaths), with breast cancer (12.2%) and lung cancer (6.1%) predominating. Circulatory
diseases accounted for 15.0% of female premature deaths (coronary heart disease 5.0%).
39
In the over 75 age group circulatory diseases account for 28.2% of deaths, with coronary heart disease
accounting for 59.0% of these deaths. The next greatest concern in this age group are the numbers of
people dying from pneumonia (11.3%). This is of particular concern as national figures show that the
mortality rate from pneumonia in Milton Keynes is 63% higher than that of England. Reducing these
deaths is an area of particular concern in 2014/15.
7.3 Sexual Health & Contraceptive
Nationally, the greatest burden of poor sexual health is borne by young adults, men who have sex with
men, some black and minority ethnic groups and those living in areas of greatest deprivation. These
inequalities are reflected in Milton Keynes where under 25 year olds have the highest diagnosed rates
of chlamydia and the highest proportion of terminations of pregnancy. There are also higher rates of
some sexually transmitted infections amongst particular ethnic groups.
It is for this reason the local sexual health strategy recommends resources are directed towards
communities where the burden of sexual ill health is greatest. (Milton Keynes Sexual Health Strategy
2010-13)
7.3.1 Local Health needs
Between the years 2011 and 2012, Milton Keynes has seen an increase in the rate of diagnosis across
Chlamydia (over 25 year olds), gonorrhoea, herpes and genital warts. Overall, with the exception
of Chlamydia amongst 15-24 year olds, diagnosed rates of infection remained lower than England.
Rates of herpes, genital warts and Chlamydia diagnosis amongst 15-24 year olds were higher than the
regional average.
Table 4: Rate of diagnosed Sexually Transmitted Infection per 100,000 population
Source: Sexual and Reproductive Health Profiles (Milton Keynes Area Profile), Public health England13
13 Sexual and Reproductive Health Profiles (Milton Keynes Area Profile), Public health England, Accessed on September 2014 http://fingertips.phe.org.
uk/profile/SEXUALHEALTH/data#gid/8000057/pat/43/ati/102/page/1/par/X25002AA/are/E06000042
40
Chlamydia is the most common sexually transmitted infection (STI) in the United Kingdom. Most
people have no symptoms and are left untreated. Chlamydia can lead to long term health problems,
including infertility (NCSP 2012). In recognition that young people have the highest incidence of
Chlamydia, a National Chlamydia Screening Programme is operational. In 2013, 9,110 15-24 year old
Milton Keynes residents were tested for Chlamydia, 8.5% of them had a positive diagnosis and links
were made to treatment, contact tracing and prevention programmes.14
Human Immunodeficiency Virus (HIV)
Milton Keynes continues to be an area of ‘high HIV prevalence’ as defined, which is defined as an area
where the diagnosed prevalence of HIV is greater than two per 1,000 15-59 year olds. There has been
a year-on-year increase in the numbers of residents in Milton Keynes diagnosed with HIV. By the end
of 2012, 2.7 per 1,000 15-59 year old adults resident in Milton Keynes had received a diagnosis of HIV
(Public Health England).
A local HIV Needs Assessment (Milton Keynes HIV HNA, 2012) was carried out. The greatest burden
of infection is amongst the Black African population. In Milton Keynes there is a very high proportion of
individuals diagnosed late (Public Health England) and this is of continuing public health concern due
to the higher chance of onward transmission before diagnosis, and the poorer outcomes for people who
are diagnosed late.
Preventing Unplanned Pregnancy
Access to effective contraception and emergency contraception is key in preventing unplanned
pregnancy and reducing termination of pregnancy rates. In Milton Keynes, the oral contraceptive
pill is the most commonly used contraceptive. However, although it is effective when used as the
manufacturer intended, it does have a significant failure rate due to user error. In comparison, Long
Acting Reversible Contraceptives (LARC) are the most effective forms of contraception and should
be offered to all women as part of their contraceptive choice (NICE 2005). In 2013 in Milton Keynes,
the GP prescribed rate of LARC was 61.9% per 1,000, which was higher than the England rate of
52.7/1,000.
Each year, around 40,000 young women under 18 become pregnant in England. Where young women
choose to go ahead with the pregnancy, they are at greater risk of experiencing a range of poor health
and social outcomes. The number of conceptions and terminations amongst under 18 year olds
resident in Milton Keynes has fallen from 51.2 per 1,000 in 1998 to 25.5 per 1,000 in 2012. The %
leading to termination was 49.6% (ONS data 2012).
Table 5: Rate of Conceptions under 18 years old: Top 4 highest wards
Ward
Rate/1000
Woughton
63
Campbell Park
60
Eaton Manor
55
Denbigh
49
14Source
http://fingertips.phe.org.uk/profile/sexualhealth/data#gid/8000035/pat/43/ati/102/page/1/par/X25002AA/are/E06000042
41
7.3.2 Current services
Within Milton Keynes, contraceptive and sexual health services are delivered by a network of
providers and since 2013 have been commissioned by a variety of organisations. Providers include
GPs, pharmacists, Brook East of England (specialist young people’s service) Virgin Care Sexual
Health Milton Keynes (integrated contraceptive and sexual health service). Current commissioning
arrangements are described within the National Framework for Sexual Health Improvement in England
(2013). Providers of sexual health and contraceptive services in Milton Keynes include:
a)
General Practitioners (GPs)
All Milton Keynes GP practices provide level 1 sexual health services. Contracts are in place
between Milton Keynes Council and some General Practices to deliver level 2 services, including
Chlamydia screening and Long Acting Reversible Contraceptives (LARC). Of the 27 GP practices
in Milton Keynes 24 are currently offering contraceptive implants, with 1028 implants fitted during
the financial year 2013/14. 24 practices also provide Intra Uterine Contraceptive Devices (IUCD),
with 882 fits carried out during the financial year 2013/14. Only one GP practice does not provide
a form of LARC.
All GP practices delivered some Chlamydia screening as part of the national Chlamydia screening
programme, with 456 screens carried out in 2013/14.
A contract to deliver HIV testing for new registrants in General Practices in Milton Keynes started
in February 2014. To date,15 five practices have received training to enable them to deliver this
testing and in the first two months of 2014, 11 tests were undertaken.
b)Pharmacies
Contracts are in place with individual pharmacies throughout Milton Keynes for the provision of
Chlamydia screening and free emergency contraception for under 25 year olds.
Of the 47 community pharmacies in Milton Keynes, 11 have been accredited to provide free
Emergency Hormonal Contraception (EHC) to under 25 year olds and nine pharmacies offer
Chlamydia screening. 38 EHC consultations and 22 Chlamydia screens were undertaken through
pharmacies in 2012/13. Activity for 2013/2014 financial year showed 50 EHC consultations
and 24 Chlamydia screens. Work is underway to strengthen the scheme, ensuring accredited
pharmacies are able to offer EHC during the majority of their opening hours and that there is good
access to EHC in all areas in Milton Keynes.
c)
Young Peoples Specialist Contraceptive and Sexual Health Service
(Level 1 and 2 services)
In Milton Keynes, Brook East of England is commissioned to provide a comprehensive specialist
contraceptive and sexual health service for under 25 year olds. As part of their work, Brook
also co-ordinates the free emergency contraception (in pharmacy scheme) and a free condom
distribution scheme for under 25 year olds in Milton Keynes. Brook also provides support for
Relationship and Sex Education (RSE) in some schools and other relevant settings. Brook’s main
clinic is located in Milton Keynes city centre, and targeted outreach services are undertaken by its
peripatetic nursing service. 15 Based on information available up to 31 July 2014
42
d)
Integrated Contraceptive and Sexual Health Service
Levels 1, 2 and 3)
Virgin Care (VC) is commissioned to provide specialist level 3 sexual health services, also known
as Genitourinary Medicine (GUM) to all age groups, outreach HIV prevention and testing and
specialist contraceptive services. In addition, the service is commissioned to provide level 2
sexual health services predominantly to over 25 year olds and training for professionals, and is
the lead provider for the provision of Chlamydia screening. Services are delivered as a hub and
spoke model, with the main hub in Milton Keynes situated in Boots, Central Milton Keynes, with
spokes operating in five other areas of Milton Keynes.
e)
ShikaTamaa Support Services (STaSS)
ShikaTamaa, from the Swahili language, means “living in hope”. The service is commissioned to
provide advocacy and support, drop-in sessions and peer support services, signposting to other
services, drug adherence, and information and outreach services to individuals and families both
infected and affected by HIV. STaSS promotes and raises awareness of HIV to potentially high
prevalence groups by providing outreach events for people from Sub Saharan Africa, MSM (men
who have sex with men) and Sex Workers, along with events focused on the wider population
and faith groups. The service encourages people to get tested and delivers safe sex information,
whilst offering free HIV quick tests at events. In the last two quarters of 2013/14, the service
distributed 5360 packs of condoms and 400 packs of condoms and lubrication via 19 venues and
seven events in communities. In the same period the service supported 127 people living with or
affected by HIV.
f)
Condom Distribution Schemes
Currently a number of condom distributions schemes operate, aiming to provide free and easily
accessible condoms to groups most at risk of sexually transmitted infections, including HIV. Brook
East of England is formally commissioned to operate a scheme to provide free condoms to under
25 year olds. Appendix 5 shows C card update for Milton Keynes.
g)
Post Exposure Prophylaxis
In Milton Keynes, Post Exposure Prophylaxis (PEP) for HIV is available within Milton Keynes
Hospital’s ‘Management of Occupational and Non Occupational Exposures to Blood Borne
Viruses Policy’. For the general population PEP is available from the Accident and Emergency
Department and Sexual Health Milton Keynes. Table 5 shows the number of Post Exposure
Prophylaxis packs issued from A & E and GUM clinics. It is important to ensure continued and
speedy access to this provision.
Table 6: Number of post exposure prophylaxis Packs issued from A & E and GUM clinics.
Financial year
A&E
GUM
2013/14
10 packs
0 packs
2012/13
11 packs
6 packs
2011/12
13 Packs
19 Packs
2010/11
13 Packs
7 Packs
Source: Performance intelligence and pharmacy procurement services Milton Keynes Hospital
43
h)
HIV Testing and Diagnosis
National Health Service HIV testing in Milton Keynes is offered at:
• Sexual Health Milton Keynes, including all spokes, Brook’s specialist contraceptive and
sexual health service for under 25 year olds
• Antenatal clinics – all pregnant women are offered HIV testing as a routine part of their
antenatal care
• Hospital departments will undertake HIV tests when HIV is considered to be part of the
differential diagnosis
• GPs will undertake HIV tests where HIV is indicated and HIV quick testing of new GP
registrants is a newly commissioned service.
In Milton Keynes uptake of antenatal HIV testing is high and in line with recommended levels.
There is evidence that GP practices and hospital departments are offering HIV tests to their
patients, with approximately 1700 of these tests being carried out annually (Milton Keynes HIV
Needs Assessment, 2012). There is no formal arrangement in place with GP practices or Milton
Keynes Hospital to determine the exact level of testing for specific at risk groups.
How can Pharmacies help?
Pharmacy staff offer advice on safe sexual health opportunistically as well as more
pro-actively during monthly campaigns. Pharmacists also provide access to the
sale of condoms which help prevent both pregnancy and STI.
There is currently no provision for treatment of Chlamydia by PGD in pharmacies –
this service should be considered.
The location of pharmacies means that they are easily accessible to teenagers
requiring EHC, which is ideal for this age group who are often unwilling to use other
services. Most pharmacies (39/47) are currently accredited to provide EHC and
chlamydia testing.
Through public health campaign programmes, pharmacies can also run outreach
programmes for example, in secondary school, educating the youth about the risks
of sexually transmitted infections and promoting healthy lifestyles.
44
7.4 Smoking
Smoking-related disease is still the leading cause of preventable death in the UK. Even though rates of
smoking have been steadily declining from 45% in 1974 to 20% in 2012.
It is estimated that illness and diseases associated with smoking costs the NHS £1.7 billion annually,
including 462,900 hospital admissions related to diseases attributable to smoking. However, the
cost to society is estimated at £13.74 billion a year, with social care payments, sickness and costs to
employers (DoH, Healthy Lives, Healthy People: A Tobacco control plan for England, 9 March 2011)
Smoking prevalence in Milton Keynes amongst the adult population is estimated at 18.1%. For 2013,
the population of Milton Keynes was 255,700, 22.6% aged under 16, with a smoking population
amongst adults of 35,624. This prevalence is not significantly different from the overall rate for England
(20.0%).
Tobacco use is also the leading cause for health inequalities. In 2012 nationally 14% of adults
in managerial and professional occupations smoked, compared with 33% in routine and manual
occupations, this figure is estimated at 28.6 % in Milton Keynes (PHE, Local Tobacco Control Profiles
online). Smokers in Milton Keynes are not evenly distributed, figures show that smoking is more
prevalent amongst the younger age groups of 18-34 years.
Addressing Smoking in Pregnancy
Smoking is a significant risk factor for pregnant women, as it can lead to a range of serious health
problems and is estimated to increase the risk of infant mortality by 40%.
Babies from deprived backgrounds are more likely to be born to mothers who smoke and to have much
greater exposure to second-hand smoke in childhood. This passive smoking can also increase the risk
of respiratory infections in children.
Smoking in pregnancy prevalence in Milton Keynes is 11.9%, lower than England average of 12.7%
(2012/13). The rates of smoking in pregnancy have been falling since 2008 however, it remains a key
priority.
Primary Prevention: Smoking in Young People
Half of the young people who take up smoking will die prematurely from a smoking-related disease if
they continue to smoke. Although smoking rates among young people are declining, still 23% of pupils
had tried smoking at least once.
In England, almost two-thirds of current and ex-smokers say that they started smoking regularly before
they were 18 years old. Research also suggests that very few individuals will start smoking after the
age of 25 (www.ash.org.uk, Smoking Statistics).
45
7.4.2Current services
a)
Stop Smoking Service Milton Keynes
Currently referrals come to the Stop Smoking Service from Milton Keynes General Hospital,
Children Centres, Dentists and Pharmacies. However, there is a gap and the service finds it
difficult to capture those with chronic conditions, until they present at Milton Keynes General
Hospital, patients with limited mobility or those who do not visit their GP, and patients with mental
health conditions.
Once referred, the service offers support at a variety of settings including GP surgeries,
pharmacies, two children centres, at HMP Woodhill, the Youth Offending Team and some
schools as part of a structured intervention programme. Where a patient prefers not to see an
advisor at their local GP they do have a wide choice of alternative locations, some of which offer
appointments out of work hours, and a number of pharmacies are happy to see patients without
an appointment. The service also has recently recruited two specialist level 3 advisors offering
clinics across Milton Keynes, telephone support and home visits specifically for those from hard
to reach groups, and patients who may have seen their local advisor a number of times and
feel a new face may help to re-motivate them. Advisers can issue a voucher and patients only
have to go into their local pharmacy to collect the product. Prescription only medication, such as
varenicline or bupropion, still have to be requested from a GP.
b)
Community Pharmacies
Pharmacies are able to offer stop smoking support under a Local Enhanced Service specification
and to provide services at two levels:
• Level 1 staff offer brief advice and refer to the specialist stop smoking service and accept NRT
vouchers. (36 out of 47 pharmacies accept NRT vouchers)
• Level 2 staff offer five weeks of 1-2-1 support from an advisor to discuss behavioural changes
required to support their quit attempt, and up to 12 weeks of nicotine replacement therapy or
access to medication on prescription.
Currently 27 pharmacies offer the Level 2 service. The list of providers can be found in Appendix
6.
c)
GP surgeries
Level 2 provision is available in all GP surgeries and is generally undertaken by trained HCAS
or Practice Nurses, or independent stop smoking advisors, all of whom have been trained by the
Milton Keynes Stop Smoking Service.
46
There is a strong evidence base for the effectiveness of pharmacy-led stop
smoking programmes. Abstinence rates from 1-2-1 services provided by pharmacy
staff are similar to those of other primary care services. More pharmacies should
sign up to provide commissioned stop smoking services.
There is an identified need in particular to target these services at patients with
chronic diseases and pregnant women. These patient groups frequently visit
pharmacies, making them an ideal outlet for accessing stop smoking services.
7.5 Drug Misuse
Drug addiction is a key cause of societal harm, including crime, family breakdown and poverty. Public
Health England report that 2.7 million adults used an illegal drug in the past year and that 1.2 million
people are affected by drug addiction in their families, mostly in poor communities (MKC, JSNA Drug
Misuse 2013/14).
Whilst drug dependence can affect anyone, we know that those in our society with a background of
childhood abuse, neglect, trauma or poverty are disproportionately likely to be affected. In turn, the
children of those dependent on drugs have to cope with the impact on their own lives and some may
end up in state care. Parental drug use is a risk factor in 29% of all serious case reviews.
Young people’s substance use is a distinct problem. The majority of young people do not use drugs
and of those that do, most are not dependent. However, substance misuse can have a major impact
on young people’s education, their health, their families and their long-term life chances. Cannabis and
alcohol are the most common substances used by young people. Over the last few years evidence has
emerged that young people are taking new psychoactive substances (NPS), also known as ‘legal highs’
instead of or as well as other drugs. These are often sold as ‘research chemicals’ and are particularly
worrying because of the limited research regarding their immediate, short and long term effects.
Heroin, other opiates and crack cocaine are the drugs associated with the highest levels of harm.
Recent prevalence estimates provided by the Centre for Drug Misuse Research at the University of
Glasgow suggest that the number of opiate and/or crack users (OCUs) in Milton Keynes is around 932.
Of these, it is estimated that 24% are injecting drug users. In 2012/13, 517 adults accessed specialist
drug treatment in Milton Keynes of which 425 (83%) were OCU’s. Generally, drug misuse is more
prevalent among men, making up approximately 70% of the treatment population. Over three quarters
of clients in treatment are aged between 25 and 45.
In 2012/13, 124 adults accessing drug treatment had at least one child living with them, equating to
23% of the drug treatment population.
There are no equivalent prevalence estimates for young people under 18, however, OCU prevalence
estimates for 15 to 24 year olds in Milton Keynes are lower than the England average. In 2012/13, 124
47
young people under 18 accessed specialist treatment in Milton Keynes, the majority for cannabis and/or
alcohol. None of these were OCU’s.
a)
Crime Reduction Initiatives
Milton Keynes Council commissions Crime Reduction Initiatives (CRI) to provide brief
interventions and structured treatment for adults who are misusing drugs or alcohol. Compass is
commissioned to provide targeted interventions and structured treatment for young people under
18 who are misusing, or at risk of misusing drugs or alcohol.
CRI and Compass work closely with other agencies including Milton Keynes Council, Health
Services, HMP Woodhill, Thames Valley Police, Thames Valley Probation, Safer Milton Keynes
(Community Safety Partnership) and Public Health England to reduce substance misuse and the
related harms in Milton Keynes.
b)
Community Pharmacy
Community pharmacies offer two main services in this area, supervised methadone consumption
and needle exchange. There are 16 pharmacies (34%) that currently provide both needle
exchange and supervised methadone consumption. (See Appendix 7).
•Supervised methadone consumption
This service requires the pharmacist to supervise the consumption of methadone (used for the
management of opiate dependence) at the point of dispensing in the pharmacy, ensuring that the
dose has been administered to the patient. Contracted pharmacies aim to offer a user-friendly,
non-judgmental, client-centred and confidential service. They provide support and advice to the
patient, including referral to primary care or specialist centres where appropriate.
•Needle exchange service
Participating pharmacies provide access to sterile needles and syringes, and sharps containers
for return of used equipment. The pharmacy provides support and advice to the user, including
referral to other health and social care professionals, specialist drug and alcohol treatment
services where appropriate. They also promote safe practice, including advice on sexual health,
STIs, HIV and Hepatitis C transmission and Hepatitis B immunisation. The contracted pharmacies
provide a sufficient level of privacy and safety and have a duty to ensure that pharmacists and
staff involved in the provision of the service have relevant knowledge and are appropriately
trained in the operation of the service, including allocation of a safe place to store equipment and
returns for safe onward disposal. Storage containers provided by the Specialist Drug Treatment
commissioned clinical waste disposal service are used to store returned used equipment.
Some of the community pharmacies provide access to sterile needles and syringes, and sharps
containers for return of used equipment. Where agreed locally, associated materials will be
provided (for example condoms, citric acid and swabs) to promote safe injecting practice and
reduce transmission of infections by substance misusers.
c)
Other work streams
The following are some of the actions being taken to reduce drug related harm in Milton Keynes:
48
• Drug treatment services are regularly monitored to ensure that expected outcomes are being
achieved.
• CRI are opening a second ‘hub’ site in Central Milton Keynes and will be expanding their
‘spoke’ sites to improve access to services.
• Working with HMP Woodhill, Oakhill STC, Thames Valley Police and Probation to ensure
people have easy access to drug treatment at every stage of the criminal justice system.
• Compass are developing their prevention and targeted interventions work to ensure young
people identified as being at risk of substance misuse problems are offered support.
People who use illicit drugs are often not in contact with health care services and
their only contact with the NHS may be through a needle exchange service within
a community pharmacy. At a minimum, the pharmacy can provide advice on safer
injecting and harm reduction measures including advice on sexual health and STIs,
HIV and Hepatitis.
In addition, community pharmacies can provide information and signposting to
treatment services, together with information and support on health issues other
than those that are specifically related to the client’s addiction.
Other considerations for pharmacies include hepatitis screening and vaccination
service, HIV and syphilis testing. Similar services have been successfully trialled
in the Isle of Wight.
7.6 Alcohol Misuse
Alcohol is a complex public health problem. There is a general perception that individuals with alcohol
problems are either alcohol dependent or regular binge drinkers. The biggest challenge for public health
continues to be effective communication about the serious health impacts of regularly drinking above
the recommended guidelines, a level of drinking which is usually socially acceptable. Estimates suggest
that in Milton Keynes 37,000 people drink at a level of increased risk and 9,000 at a level of high risk
(MKC, JSNA Alcohol Misuse 2013/14).
Drinking alcohol above the recommended guidelines directly impacts on health, people are at increased
risk of liver disease, cancer, stroke and heart disease. In addition, alcohol is involved in a range of
other social and health issues, risky behaviours such as domestic violence; suicide and self-harm; child
abuse and neglect; mental health problems; unsafe sex; unwanted pregnancies and homelessness.
7.6.1 Local health needs
Alcohol continues to be detrimental to the health of people in Milton Keynes due to the significant
health and social harms caused by drinking alcohol excessively. It is estimated that more than 25%
of the population aged 16 and over drink above the recommended guidelines. Recent modelling work
49
based on the Adult Psychiatric Morbidity Survey estimates that there are 3,298 dependent drinkers in
Milton Keynes who would benefit from alcohol treatment, including Extended Alcohol Brief Interventions
(MKC, JSNA Alcohol Misuse 2013/14). Nearly one in five adults in drug treatment also cites additional
problematic alcohol use.
Milton Keynes has one of the highest rates of alcohol-related hospital admissions in the South East
region and although the rate of alcohol related crimes has been falling over recent years, it is still
greater than the regional average, influenced by the large night time economy in Milton Keynes (MKC,
JSNA Alcohol Misuse 2013/14).
Milton Keynes Council commissions Crime Reduction Initiatives (CRI) to provide brief interventions
and structured treatment for adults who are misusing alcohol or drugs. Compass is commissioned to
provide targeted interventions and structured treatment for young people under 18 who are misusing or
at risk of misusing alcohol or drugs.
A range of agencies are involved in reducing alcohol related harm including Milton Keynes Council,
Health Services, HMP Woodhill, Oakhill STC, Thames Valley Probation, Thames Valley Police, the Fire
and Rescue Service, Public Health England and Safer Milton Keynes (Community Safety Partnership).
The following actions are being taken to reduce alcohol related harm in Milton Keynes:
• Alcohol treatment services are regularly monitored to ensure that expected outcomes are being
achieved. During 2012/13, 268 adults received structured treatment for alcohol and this is
expected to increase in 2013/14 (MKC, JSNA Alcohol Misuse 2013/14).
• Alcohol Identification and Brief Advice (IBA) helps professionals identify individuals whose
drinking might be impacting on their health and deliver simple, structured advice. IBA is being
developed further across primary and secondary care settings including the hospital, GP practices,
pharmacies and sexual health services.
• In addition to offering general medical services, GP practices can provide enhanced services.
Three quarters of Milton Keynes GP practices offer IBA to patients who are drinking above the
recommended guidelines. Patients requiring further support can be supported through their GP
practice or be referred to the specialist alcohol services.
• An alcohol liaison service is being piloted in Milton Keynes Hospital with the aim of improving
access to services and ensuring those admitted to hospital with alcohol related conditions receive
appropriate treatment.
50
Pharmacies can be commissioned to provide Identification and Brief Advice (IBA)
as this has been proven to be a cost-effective intervention. The demographic
of people visiting pharmacies differs from those visiting GP practices, allowing
pharmacy staff to reach a wider target group. The service can be targeted to those
who may be at high risk such as those who come in for hangover remedies, with
gastric problems or falls.
7.7 Obesity
‘Obese’ is a term used to define a child or adult who is carrying too much body fat for their height
and sex. Being obese increases the risk of developing serious diseases such as Type 2 diabetes,
cardiovascular disease and cancer. It can also impact on an individual’s prospects in life, affecting their
self-esteem and mental health and their ability to get and hold down work.
In Milton Keynes, 10.4% of Reception class children, 19.1% of Year 6 pupils and 25.3% of adults are
defined as clinically obese. It is clear that, both nationally and locally, levels of obesity have been
increasing over many years and this is a major public health concern.
In 2011, the Department of Health released an obesity call to action (MKC, JSNA Health weight
2013/14) which outlined a new approach to tackling obesity, including a national ambition to achieve
a downward trend in the levels of excess weight in adults and children. This new approach is
underpinned by the latest evidence about the causes of obesity, good practice and engagement with
a wide range of partners and experts. It outlines the role for Government and partners at national and
local level to transform the environment, so that it promotes healthy lifestyles, provides information and
supports people to make healthier choices, and secures appropriate services to tackle excess weight.
51
Figure 9: Percentage of adult population with BMI of 30+
52
1. More than 60 staff have completed the core HENRY (Health, Exercise, Nutrition for the Really
Young) training, with more than 20 of the staff progressing into the group facilitation course
2. The Motiv8 programme continues to support children and their families to lead healthier lifestyles
and control their weight. An evaluation of the programme has been completed
3. HALO (Health & Lifestyle Opportunities) is delivered by the Health Promotion Dietetics service,
supporting individuals to lose weight and eat more healthily
4. There are a number of activities taking place in Milton Keynes to support Change4Life
5. Reactivate Milton Keynes offers a variety of different activities and courses running across the
area, offering individuals the opportunity to become more active and try new activities during the
‘Give it a Go’ weeks over the year
Pharmacies are well placed to provide a weight management service effectively. This has
been evidenced by pharmacy programs (e.g. Coventry, Portsmouth, Lancashire) resulting
in significant reduction in BMI for patients with at least one diagnosed or established risk
factor such as hypertension and diabetes.
Pharmacies can also signpost to the various services available in the community as well
as participate in public health promotions.
7.8 Long Term Conditions
Around 15 million people of all ages in England have a medical condition that cannot be cured, but can
be controlled by medication, other treatments or therapy. Examples include diabetes, asthma, heart
disease, stroke, and dementia. Such people are intensive users of health and social care services.
Long term conditions (LTCs) can impact significantly on a persons’ ability to work and live a full life.
People with at least one LTC are about 10% less likely to be in employment. People with physical LTCs
are up to four times more likely to experience depression and anxiety.
The key factors for developing a LTC are lifestyle and ageing. Smoking is the most important major
avoidable risk factor for circulatory and respiratory diseases, coronary heart disease, stroke, Chronic
Obstructive Pulmonary Disease (COPD) and various cancers. Genes also play a role, as does ethnicity
and deprivation level.
As people live longer, the likelihood of developing more than one LTC rises. Often, people have three
or more conditions occurring simultaneously. Physical health difficulties can both contribute to and be
compounded by depression, anxiety, and acute and chronic confusion.
GP practices hold condition-specific registers which help to understand the local need, though they are
not comprehensive. Estimates suggest that around 18% of the Milton Keynes population are living with
53
one or more LTC (MKC, JSNA Long term conditions 2013/14).
The main users of health services are people aged 65+. Over 80% of people aged 70+ suffer from
a significant physical illness. At any one time in the UK older people occupy around two-thirds of
hospital beds (DoH, 2001). Whilst the majority of people with LTCs have mild to moderate disease,
these often lead to complications and more severe disease. Because of their complex health and
social care needs, approximately 1,600 people in Milton Keynes would benefit from some form of case
management to improve their quality of life (MKC, JSNA Long Term Conditions 2013/14).
7.8.2
Diabetes
Diabetes affects 2.9m people in the UK (a third of whom are undiagnosed). An estimated 24,000
avoidable deaths are caused annually by diabetes-related complications, resulting in 325,000 lost
working years (MKC, JSNA Diabetes 2013/14). Diabetes represents a huge financial burden, costing
£25 million a day. The York Health Economics Consortium estimates that diabetes spending could
reach £16.9bn by 2025, representing 17% of the entire NHS budget.
Diabetes develops when the body cannot make enough insulin, or when the produced insulin does not
work properly. There are some rare forms of diabetes, but there are two main types: Type 1 and Type
2. Type 1 (15%), in which the body is unable to produce insulin, usually develops early in life and is
the more common type in children. It is treated either with insulin injections or an insulin pump. Type
2 diabetes is the more widespread (85%) and usually develops during adulthood, and may be treated
with diet and physical activity alone.
Lifestyle plays a major part in the conditions prevalence, with around one-third of the risk of Type 2
diabetes (90% of the increasing burden of the disease) being attributed to obesity. In Type 1 diabetes,
the contribution of genetics is comparatively greater. The latest data for Milton Keynes record that in
March 2013 there were 10,731 adults living with diabetes i.e. 5.2% of the adult population (MKC, JSNA
Diabetes 2013/14).
7.8.3 Respiratory disease
There are two main conditions affecting the respiratory tract: Chronic Obstructive Pulmonary Disease
(COPD) and Asthma. COPD is used to describe a syndrome of chronic progressive airflow obstruction
which is not completely reversible, and now includes conditions such as bronchitis or emphysema.
Smoking is the predominant cause.
Milton Keynes rank 96th out of 150 local authorities for mortality from lung diseases. It is worse than the
national average, 40.0 per 100,000 for 2010-2012: 16
Chronic Obstructive Pulmonary Disease (COPD)
COPD is also a smoking related disease. It is incurable and its prevalence is higher in more deprived
areas. Historically deaths from COPD have been significantly high in Milton Keynes, but a fall in the
death rate in 2007 has been sustained and mortality rates are now comparable to the England Average.
This progress is welcome and interventions to maintain this improvement need to be sustained.
16
Lung disease interventions: http://longerlives.phe.org.uk/health-intervention/cancer#are/E06000042/par/E92000001
54
Asthma
Asthma is a chronic inflammatory disorder of the airways with reversible airway obstruction. There
is an increase in airway resistance to certain triggers, for example animal hairs, exercise or cold air.
Obstruction is usually reversible spontaneously or with treatment. In England, 5.9% of people had
asthma in 2012.
In April 2013 in Milton Keynes there were 14,800 patients registered with their GPs with asthma as long
term condition.
Pneumonia
Pneumonia can be a preventable disease, but it remains a leading recorded cause of respiratory death
in Milton Keynes. The standardised mortality ratio for pneumonia in Milton Keynes is approximately
50% higher than that of England and Wales. Because of the high mortality and morbidity of this
disease, it has been made a priority for public health focus since 2012.
Steps required to be taken to reduce respiratory diseases include:
1. Promoting smoking cessation
Ø Provision of smoking cessation services within primary care and the workplace, and possible
provision of pharmacotherapy
Ø Regular, targeted campaigns designed to prevent smoking uptake among under-18s and
promote smoke-free homes and cars
Ø Greater enforcement of under-age sales and counterfeit tobacco penalties
2. Reducing air pollution
Ø Reinforce the importance of monitoring the local environment to determine levels of air
pollution
Ø Consider reducing pollution from vehicle exhausts through measures such as congestion
reduction and pedestrianisation.
7.8.4 Cardiovascular disease
Cardiovascular disease (CVD) is the collective term for a group of related conditions affecting the heart,
arteries or blood vessels. It includes coronary heart disease and stroke, which account for about 50%
and 25% of these conditions respectively. The combined cost of CVD to the NHS and the UK economy
was £30.6 billion. Smoking is one major cause of CVD and the biggest single avoidable cause of
death, accounting for 82,000 deaths a year (see smoking chapter). Obesity is another of the major
causes of CVD.
Milton Keynes rank 71st out of 150 local authorities for mortality from heart diseases and stroke, 84
deaths per 100,000 in 2010-2012 17. In 2013, 6,393 of persons residing in Milton Keynes Borough
were diagnosed with coronary heart disease (CHD) and are on the disease register. The NHS Health
Checks programme not only identifies those aged 40-74 at greatest risk of cardiovascular disease, but
17
Heart disease interventionshttp://longerlives.phe.org.uk/health-intervention/cancer#are/E06000042/par/E92000001
55
also identifies diabetes, kidney disease, excessive alcohol use, and raises awareness of dementia - all
crucial aspects of delivering healthier longer lives.
Steps required to be taken to reduce cardiovascular disease include:
Ø Greater enforcement of underage sales and counterfeit tobacco penalties
2. Address poor diet and physical inactivity
Ø Healthy eating learning programmes for children, to establish healthy patterns earlier
Ø Community support for physically active modes of travel, like walking and cycling
Ø Delivery of planned care pathways like ‘Let’s Get Moving’, involving screening, counselling and
self-monitoring
3. Reduce high blood pressure
Ø Advice to reduce intake of salt and processed food, which is high in salt and is linked with high
blood pressure
Ø Campaigns to promote physical activity
7.8.5Cancer
Cancer is the largest cause of premature death in England and the second largest cause (after
cardiovascular disease) of mortality for all ages. Overall, more than one in four people die from cancer
and about 40% of those are under the age of 65. A major factor increasing an individual’s risk of
cancer is increasing age, but much cancer is preventable and its main risk factors are use of tobacco,
overweight, having an unhealthy diet, and drinking excessive alcohol.
Milton Keynes ranks 90th out of 150 local authorities for mortality from cancer. It is worse than national
average, 153 deaths per 100, 000 for 2010-2012:18
In 2010, the primary causes of premature death in men were cancers (32.8% of premature deaths)
particularly lung cancer (8.3%). In women, the top causes of premature death were all cancers (46.3%
of premature deaths), with breast cancer (10.0%) and lung cancer (7.7%) predominating.
Lung cancer remains the most common cause of cancer death In Milton Keynes. In 2010 it accounted
for 22% of all cancer deaths and 21% of all cancer deaths in the under 75s. Although this is a minor
decrease from the previous year, lung cancer remains a problem in the population. Smoking is the
biggest avoidable cause of these deaths.
18
Cancer interventionshttp://longerlives.phe.org.uk/health- intervention/cancer#are/E06000042/par/E92000001
56
Steps required to reduce the prevalence of cancer include:
Ø Greater enforcement of under-age sales and counterfeit tobacco penalties
2. Improving diet
Ø Campaigns promoting healthy eating and exercise, such as Change4Life
Ø Healthy eating learning programmes for children, to establish healthy patterns earlier
Ø Delivery of planned care pathways like ‘Let’s Get Moving’, involving screening, counselling and
self-monitoring
3. Reducing alcohol intake
Ø Campaigns to raise awareness of the dangers of alcohol and the silent nature of liver disease
Ø Consider the restriction of alcohol consumption in public places and enforcement of under-age
sales penalties.
The routine clinical care of the majority of people with mild to moderate disease is provided by GPs,
primary health care teams, and community health and social care teams. Depending on the condition,
this may be supplemented by hospital out-patient clinical care. Severe conditions involve more
secondary care, sometimes requiring out-of-area specialist services. There are a number of other
community-based services locally that support people with a long term condition (MKC, JSNA Long
Term conditions 2013/14).
Community pharmacy services
Pharmacy services are ideally developed to support patients with Long Term Conditions (LTCs). People
with LTCs are likely to be taking medication regularly and as such, have a particular need to understand
the role of the medicines in managing the condition, in order to gain maximum benefit. They would also
need support to reduce potential adverse reactions and interactions with other medicines. including
those available over the counter.
Several pharmacies offer repeat ordering and collection services (a non-NHS service) to people with
LTCs, which is invaluable to patients. Within the NHS Pharmaceutical Contract, pharmacies are also
able to offer a Repeat Dispensing service, informally referred to as Batch Prescribing, which improves
convenience for regular supply of prescription medicines and ensures continued monitoring of the safe
and appropriate use of medicines.
57
Under NHS contractual arrangements community pharmacists already have the opportunity to carry
out Medicines Use Reviews (MURs). MURs are designed to improve the patient’s understanding of the
importance of the medicine in controlling their disease and the reason for taking medicine appropriately.
These can improve patient concordance and support, and reinforce the advice given by the prescriber.
There are opportunities to increase the uptake of MURs and in the future to target pharmaceutical care
towards complex cases.
The New Medicines Service (NMS) provides support for people with long-term conditions newly
prescribed a medicine to help improve medicines adherence, it is initially focused on particular patient
groups and conditions.
Currently 42 pharmacies provide MURs and 43 pharmacies provide NMS in Milton Keynes.
NHS health checks are not commissioned from pharmacies in Milton Keynes, however, some
pharmacies provide a private service for health checks and healthy living programs. These programmes
help to prevent the onset or assist with early diagnosis of LTCs.
Strategies for individual LTCs such as Diabetes, Asthma & COPD, and Cardiovascular
disease should include the role of the pharmacy team in the management pathway.
Building on current NHS contractual services – both Essential and Advanced services,
pharmacies can play a substantial role in management of LTCs such as: improving
inhaler technique, providing INR monitoring.
Other health care services should refer suitable patients to their pharmacy for MUR
and NMS.
With the high percentage of BME groups in Milton Keynes, future service considerations
could include language access services in pharmacies.
7.9 Mental Health
Mental health problems are linked to a wide range of issues including poor educational achievement,
poor physical health, sickness absence and early death. Half of all mental illness starts by the age of
14, but by ensuring a positive start in life, up to a half of these are preventable (MKC, JSNA Mental
health 2013/14).
Tackling mental illness and promoting mental wellbeing is essential not only for individuals and their
families, but also to society as a whole. At least one in four people will experience a mental health
problem at some point in their life and one in six adults has a mental health problem at any one time.
Almost half of all adults will experience at least one episode of depression during their lifetime. One
in ten new mothers experiences postnatal depression. Mental ill health represents up to 23% of ill
health in the UK and is the largest single cause of disability. People with severe mental illnesses die on
average 20 years earlier than the general population. In Milton Keynes suicide rates, whilst remaining
low, are no longer statistically significantly low.
58
In 2007, the Office for National Statistics (ONS), psychiatric morbidity survey found that one in four
people at any one time experience mental illness. According to the ONS survey, the most common
form of mental illness is mixed anxiety and depression (9%), followed by general anxiety (4.4%) and
depression without the symptoms of anxiety (2.3%).
People with possible mental health problems are slightly more likely to be obese than the general
population (32% vs 26% in 2010). This has been the pattern over the last seven years and the latest
figures show the gap widening. Alcohol misuse is more prominent in people with possible mental health
problems, compared to the general population.
The percentage of the practice populations with dementia in Milton Keynes in 2011/12 was only 0.32%
compared to the England average of 0.53%. This can be explained by the fact that the proportion of the
Milton Keynes population older than 65 years is much lower than the England average and therefore
one would expect fewer patients with dementia. See Appendix 9
At present there is a pooled budget between NHS Milton Keynes and Milton Keynes Council
to jointly commission and provide health and social care services for people with mental health
problems. Services are commissioned through Milton Keynes Council and the Milton Keynes Clinical
Commissioning Group and provided by Milton Keynes Community Health Services provision of joint
mental health services.
The gateway to secondary mental health services for individuals aged 18 and over, who have a
presentation of severe and/or enduring mental illness, is provided by Central and North West London
(CNWL) NHS Foundation Trust. The Assessment and Short Term Intervention Team (ASTI) has merged
with the Acute Home Treatment Team (AHTT) during 2012/13 to create a Mental Health Assessment
Service which provides a single point access available 24/7. It accepts referral for those registered with
a Milton Keynes GP. The Assertive Outreach Team works with clients who are difficult to engage, nonconcordant with prescribed medication and who need help with social inclusion, activities of daily living
and need motivation to attend activities. You can be referred by any Recovery and Rehabilitation Team.
A new Complex Needs Service (Personality Disorder) is under development. The expected outcomes
across all agencies will be that staff are better able to support people with personality disorder within
the community, with less out of area placements, a reduction in crisis management and an improvement
in the quality of life for people treated Improving Access to Psychological Therapies (IAPT) service is
also provided by CNWL NHS Trust. This provides evidence-based psychological therapy services for
people experiencing depression and anxiety disorders.
59
Strategies for individual LTCs such as Diabetes, Asthma & COPD, and Cardiovascular
disease should include the role of the pharmacy team in the management pathway.
Building on current NHS contractual services – both Essential and Advanced services,
pharmacies can play a substantial role in management of LTCs such as: improving
inhaler technique, providing INR monitoring.
Other health care services should refer suitable patients to their pharmacy for MUR
and NMS.
With the high percentage of BME groups in Milton Keynes, future service considerations
could include language access services in pharmacies.
7.10Older people
The population of the UK is ageing. The proportion of people aged over 65 rose from 15% to 17% from
1985-2010, an increase of 1.7m people, and is projected to reach 23% by 2035, according to the Office
of National Statistics. Older people account for the majority of adult social care service users and of
public spending on adult care (MKC, JSNA Older People 2013/14). NHS Information Centre figures for
2012-13 in England show the following data relating to personal social services:
• 77% of the 225,600 council-funded people in residential or nursing homes were aged over 65
• 65% of the 1.54m council-funded users of community-based social care were aged over 65
• 56% of the £16.8bn spent by councils on adult social care was for people aged over 65
There will be a significant rise in the population over-65 in Milton Keynes. By 2025, there will be an
increase of 63% for the over-65 population (from 31,190 to 50,700). However, the population of people
aged over 85 will grow at a faster rate - 66% for the 85-89 population (up from 2,500 to 4,150) and
81% for the over-90s (up from 1,440 to 2,600). Living status is also a predictor of use of services, as
older people with an informal carer are more likely to remain in their own home. The number of people
predicted to be living alone will increase by 55% in the 65-74 population, and by 85% in the over-75
population to 2025. (See Appendix 10 for the distribution maps).
Pharmacy services are very supportive of the older population as this group also have
a high prevalence Long Term Conditions. Pharmacies often offer prescription ordering,
collection and delivery services (these are non-NHS services) which is useful for patients
who are less mobile.
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7.11 Older people in Domiciliary and Residential Care
There are two main groups of older people that are identified to potentially have need for enhanced
pharmaceutical services. These are:
1. People living in Care Homes (both residential and nursing homes)
2. People living in their own homes with a domiciliary care package (this includes extra care housing)
7.11.1 Care Home Residents
Care home residents do not have any direct interaction with community pharmacy staff as all their
medication needs are managed by the Care Home staff. Some patients are able to self-administer
their medication, but the majority of residents will have their medication administered by the staff. The
staff are responsible for ordering prescriptions from the resident’s GP and for arranging for a single
pharmacy contractor to provide a dispensing service for all of the residents. Residents do not usually
have a choice of pharmacy provider.
The absence of any direct interaction between the pharmacy staff and care home residents means
that residents do not have access to the majority of services, the most significant being Medicines Use
Reviews and New Medicines Service. NICE Social Care guideline SC1, Managing Medicines in Care
Homes19; identified the need for residents to have medication reviews, as set out in their care plan, and
for this review to include the resident and/or a representative as well as a multidisciplinary team, which
may include a pharmacist.
Identified needs
There is an increasing number of frailer older people living with long term conditions, with complex
requirements such as palliative care needs that are being provided by care homes, who would
historically have been cared for in hospital. It is important that people in care homes receive the same
standards of health care as those living in their own home and that evidence based clinical guidelines
and practice are applied to their care.20
Some of pharmaceutical services required in care homes include:
• Improving safety through sharing hospital discharge information and clinical information
between the pharmacy provider, GP and care provider.
• Efficient management of repeat medicines and supply and administration
• Having their medicines available to them at the times they need them, and in a safe way.21
• Wherever possible will have information about the medicine being prescribed made available
to them or others acting on their behalf.
• Health and social care practitioners (care home staff, social workers, case managers, GPs,
pharmacists and community nurses) should ensure that care home residents have the same
opportunities to be involved in decisions about their treatment and care as people who do not
live in care homes, and that residents get the support they need to help them to take a full
19
20
21
NICE SC1; Managing medicines in care homes; March 2014 http://www.nice.org.uk/guidance/SC1 Accessed 20.7.2014
Royal Pharmaceutical Society, Scotland: Improving Pharmaceutical Care in Care Homes, March 2012 http://www.rpharms.com/promoting-pharmacy-
pdfs/rpscarehomereportfinalmarch2012.pdf Accessed 20.7.2014
Care Quality Commission: Guidance about compliance Essential standards of quality and safety March 2010 Outcome 9
61
part in making decisions. This includes supporting self-administration of medication wherever
possible22 .
• Regular medication reviews particularly in poly pharmacy, including a review of residents’
ability to use their prescribed medication as intended, as well as any required devices such as
inhalers.
• Robust contract system and service level agreement between pharmacy service provider and
care home providers.
Pharmacy services
All care homes receive a service from a pharmaceutical provider, either a community pharmacy or a
distance selling pharmacy. However, the level of additional professional services and quality of support
provided varies from one contractor to the next. There is no national or local service level agreement for
pharmacy services to care homes. Private contracts may be agreed between provider and care home
where there may be no quality assurance processes imbedded.
Pharmaceutical service providers can improve on the medicines optimisation by supporting
medication reviews, medicines reconciliation and providing support to care home staff to
administer medication safely and appropriate to the needs of the individual. This service
can be made more equitable through the introduction of robust service level agreements
between the pharmaceutical provider and care provider, which is able to be monitored and
audited to demonstrate improved quality in medicines management. Relevant information
about residents’ medicines should be shared with all healthcare providers involved in their
care, especially in the transfer of residents from one care setting to another, to ensure safe
and optimum use of medicines as specified in NICE guidance.
7.11.3 People in Domiciliary Care
People in domiciliary care are likely to be housebound and not have direct interaction with their
community pharmacy. Care packages may include support for managing their medicines at various
levels, determined by the needs of the person. People living in Extra Care housing generally have more
timely access to support as care services are on site.
Again, some of these people will have complex health care needs being managed at home with the
support of a multidisciplinary team, and these needs must be provided as they would in a hospital or
care home setting. Community pharmacists do not routinely visit patients at home, which means that
housebound patients will not have face to face contact with a pharmacist, however, they can have
telephone contact. Interaction with pharmacy staff is often via a representative such as family members,
friends or social care providers.
22
NICE SC1; Managing medicines in care homes; March 2014 1.2.1
62
Instructions for medicines administration, in most cases, are written by the care provider who has no
clinical training and this may involve them making decisions for the time of day each medicine should
be given, as it is unspecified by the prescriber.
There is no requirement in the pharmaceutical contract for supporting people in domiciliary care making
the provision and quality of service delivery inequitable. Community pharmacies provide a range of
support usually by private arrangement, often at no fee to the patient, including a prescription ordering
and collection service from the GP and a delivery service to the patient.
There is a provision for pharmacists to deliver Medicines Use Reviews off site (at the patient’s home) or
by telephone. Pharmacists need approval from NHS England Area Team to provide this service on an
individual patient basis. New Medicines Service is accessible to this group of patients, as the service
specification allows for telephone consultations.
Identified need
It is a well-accepted fact that people in domiciliary care do not have access to the full range of
pharmaceutical services, however, they tend to have a greater need for support around their use of
medicines due to the increased prevalence of co-morbidities in this group. There is evidence of poor
management of ordering of medication, often resulting in stock piling.
The current production of MAR sheets by individual care agencies has the potential for error, as
decisions are being made which are outside of the competencies of the carer. A MAR sheet should only
be generated at the time of a prescription being dispensed.
Community pharmacists could be commissioned to support carers who provide medicines
administration support to their clients. In particular, they should be involved in producing
medicines administration records for carers where this is need.
7.12Learning Disability
Adults with Learning Disabilities can experience significant disadvantages in terms of their health and
physical and emotional wellbeing. National reports and media coverage have demonstrated that there
is a need for constant assurance of the safety of health and social care services, along with action to
minimise inequalities in service delivery.
7.12.1 Local Health Needs
National prevalence data suggests 883 (0.47%) of people will be known to learning disability services
in Milton Keynes. However, the actual number known to the Joint Learning Disability Service (including
those who are funded by a different local authority but who are known to Milton Keynes Health services)
during the year to 31st March 2012 was 729 (0.39%). It is estimated that there are 4,396 people aged
18+ in Milton Keynes with a Learning Disability (MKC, JSNA Learning Disability 2013/14)
63
The Joint Learning Disability Service, comprised of staff from Milton Keynes Council and Milton Keynes
Community Health Services, provides a range of services including day activities, supported living and
short breaks. All of these services are also provided on a smaller scale by the private and voluntary
sector, which also provides residential care in and out of the area.
In 2011-12, 223 health checks were carried out. By October 2012, 24 out of 28 GP Practices had
signed up to the Local Enhanced Service. Over 200 Health Passports have been issued to people with
learning disabilities. A steady increase in the number of checks is required in 2012-13 and subsequent
years.
Transition from children’s to adult services is particularly important in health services, where young
people and their parents move from involvement with a paediatrician to a range of different adult
clinicians.
64
8 Public consultation and results
To be included following the consultation.
65
Pharmacy Public Health
campaigns include sexual
health awareness.
Chlamydia prevalence
for England and the East
region.
is higher than the average
HIV – Milton Keynes is an
area of high HIV prevalence.
11 community pharmacies
provide EHC and nine offer
chlamydia screening.
Sale of NRT over the
counter – available from all
pharmacies.
Level 2 smoking advice
service is accessible from
27 (57%) of community
pharmacies and NRT
vouchers can be redeemed
from 36 pharmacies.
Current service provision
by Community Pharmacy
Sexual Health
Teenage Pregnancy – four
wards in Milton Keynes are
‘Hotspot’ wards.
Smoking Cessation
Smoking prevalence in
Milton Keynes is now 18%
with higher prevalence in
groups such as Routine and
Manual workers, people
aged 18 to 34 years. It is
also a significant issue in
pregnancy.
Identified Need
66
HIV services at MK Hospital.
GUM clinic.
Community Contraceptive
and Sexual Health services
provided by Brook.
GPs.
Level 3 services at clinics,
youth centres and at HMP
Woodhill.
GP practices offer a Level 2
advisory service.Specialist
advisors provide
Several Health Care
professionals offer a referral
service to ‘Stop smoking
advisers’.
by other providers
9.1 Gap analysis of local pharmaceutical services
9 Summary of Gap Analysis and Recommendations
Low uptake of EHC and
chlamydia screening
services.
No access to chlamydia
treatment from
pharmacy.
Young people and
pregnant women are
also target groups that
can be reached by
pharmacies.
Targeted activity
required in more
deprived wards
including: Wolverton,
Bradwell, Woughton
& Fishermead and
Bletchley.
Gaps in provision
Potential to commission
chlamydia treatment by
Patient Group Direction from
pharmacies.
Campaigns to raise awareness
of and improve HIV screening.
Improved uptake of chlamydia
screening and EHC especially
in teenage hot spot wards.
Sign-posting.
Self-care support.
Community based outreach
Promoting healthy lifestylesopportunistic and brief advice/
interventions.
Sign-posting to services
Increased delivery in Level 2
services
How Community Pharmacy
can meet identified Gaps
In Milton Keynes, 10.4% of
Reception class children,
19.1% of Year 6 pupils and
25.3% of adults are defined
as clinically obese.
Obesity
Drug Misuse
Pharmaceutical services
support programmes
designed to help reduce
addiction and improve
safety.
Alcohol Misuse
Estimates show that more
than 25% of the population
aged 16 and over drink
above the recommended
guidelines.
Identified Need
Healthy lifestyle advice
through public health
campaigns, MUR and NMS
services available from all
pharmacies.
67
Reaching a wider target
population to raise
awareness of the health
risks associated with
obesity and to drive a
sustainable change in
lifestyle.
Identification and Brief
Advice (IBA) is currently
not available from
community pharmacies.
Brief interventions and
structured treatment for
people who are misusing
alcohol is provided by CRI
and Compass.
There is no specially
commissioned service
from pharmacies, however,
healthy lifestyle advice
would be given through
other services such as
MUR, NMS and public
health campaigns.
There are a number of
Over the counter sale of
weight loss aids and support community based services
to support healthy lifestyle,
for self-care.
diet programmes and weight
Some private (non NHS)
reduction.
initiatives to support weight
management including diet
programmes.
Opportunity to improve
safety for this patient
group through screening
for infectious diseases.
Gaps in provision
Crime Reduction Initiatives
(CRI) provides a number of
services in the community
to support drug and alcohol
misuse.
by other providers
Supervised consumption
service and needle
exchange is available from
16 pharmacies
NHS Health Checks from
pharmacies.
Potential development of an
obesity management service
from pharmacy.
Sign-posting to local support
services.
Public Health campaigns to
promote healthy lifestyles.
Potential to deliver IBA
intervention.
Sign-posting.
Potential for pharmacies to offer
screening services for sexually
transmitted infections to this
target group.
Cancer
In 2010, the primary
causes of premature death
in men and women were
cancers (32.8% and 46.3%
respectively.
Dispensing and medicines
management.
Smoking cessation services
Public health campaigns to
prevent certain cancers
Long Term Conditions
Estimates suggest that
Dispensing.
around 18% of Milton
Keynes population are living Sign-posting.
with one or more LTC.
Self-care support.
There is a growing need
Disposal of medicines.
for promoting preventative
lifestyles, screening for early Medicines Use Reviews.
detection, and management New Medicines Service .
of the LTC.
Seasonal influenza
vaccination.
Identified Need
Gaps in provision
68
Community outreach teams.
Community health services.
GPs.
Need for an increase
in the level of activity
and participation in
campaigns.
Low uptake of Repeat
Dispensing by GPs.
NHS health checks provided Preventative care.
by GPs and Community
Currently low uptake for
Outreach service.
NMS and MUR following
Hospital pharmacies.
hospital discharge. A
good referral system
from secondary
care and GPs to the
pharmacy services will
improve optimisation of
medicines and better
disease management.
by other providers
Capacity to increase level
of provision of stop smoking
support.
Potential to introduce screening
in pharmacies.
Access to healthy lifestyle
services e.g. smoking cessation,
weight management
Seasonal vaccination – improve
access and choice.
Monitoring and screening
services for early detection of
LTCs.
Repeat Dispensing to improve
medicines optimisation and
monitor compliance.
Targeted MURs with referrals
from other HCP.
Require extra support with
managing their medication.
A lot of them depend on
carers to who are restricted
in the level of support
they can provide in the
administering of medicines.
This sometimes leads to
unsafe and demanding
requests for pharmacists
to re-pack medication into
compliance aids.
Patients in Domiciliary care
Older People
There will be a significant
rise in the population of 65+
in Milton Keynes. By 2025,
there will be an increase of
63% for this population.
Mental Health
People with mental health
conditions are also more
likely to have other risks
such as obesity, smoking
and alcohol misuse.
Identified Need
Prescription collection and
delivery (non-NHS funded).
Re-packaging of medicines
into compliance aids.
Medicines Use Reviews.
Dispensing.
Support for self-care – use
of compliance aids where
appropriate.
Dispensing (often with
private arrangements for
collection and delivery
services)
Essential pharmaceutical
services.
69
Social services.
GP medication reviews may
cover some of these issues.
Community specialist
services.
GPs.
by other providers
Ability to access GP
/ Pharmacies with
a risk of medicines
management issues
being overlooked.
Use of a variety of
medicines management
compliance aids to
support disabilities.
Targeted approach for
medicines optimisation,
life style advice and
services relevant to
smoking, obesity and
alcohol misuse for
people with mental
health problems.
Gaps in provision
Referral system through
community nurses, social
services and carers
Advisory support for Carers
to enable them to administer
medicines.
Repeat dispensing.
Targeted MURs (may have to
be done in the patient’s home).
Self-care support – promoting
independence and the safe
administration of medicines.
There should be an increased
awareness to support disability,
which tends to increase with
age, for example poor eyesight,
impaired hearing, reduced
dexterity.
Repeat Dispensing.
Sign-posting to local support
programs.
Pro-active support to patients
for medicines optimisation with
an aim to improve compliance
of medicines use.
Residents have their
medicines managed usually
by Care Home staff and
the level of pharmaceutical
support in Homes is
variable.
Older People
Residents of Care Homes
Identified Need
Disposal of unwanted
medicines (only for Care
Homes without Nursing).
Prescription collection and
delivery.
Dispensing.
70
Dispensing doctors
by other providers
Staff training.
This need is currently addressed
by the Care Home Pharmacist
funded by MKCCG which should
continue.
Regular support from dispensing
contractor with regards to staff
training on medicines issues.
Development of good ordering
systems to reduce waste.
There is an urgent need Increased clinical pharmacy
to improve prescription support and direct access of
ordering systems in
residents to a pharmacist.
order to reduce waste.
Access to all available
Pharmaceutical support pharmaceutical services by
for the use of medicines. residents including advanced
services and local enhanced
Supporting residents to services.
be independent.
Robust communication systems
Improving medicines
to be implemented to ensure
reviews.
patient safety.
Gaps in provision
9.2 Recommendations
Current provision
There is currently a sufficient number of community pharmacies providing essential and advanced
services in Milton Keynes. The level of provision of essential services in Milton Keynes is deemed to be
This statement is based on the following measures used in assessing the level of adequacy of
pharmaceutical service provision in comparison to national statistics:
• The number of pharmacies per 100,000 population for 2013/14 shows an increase in provision from
the last PNA (2011) from 17 to 18 pharmacies per 100,000. This mirrors the provision for the South
Central Strategic Health Authority of 18 pharmacies per 100,000 population (2012/13).
• The average number of prescription items dispensed per pharmacy per month, figure for Milton
Keynes was 6,667 dispensed items, which is very similar to the National average of 6,628.
• There has been an increase in the number of community pharmacies in Milton Keynes registered
to provide pharmaceutical services under the NHS pharmacy contract from 41 (in 2011) to 47 (in
2014). One of these is a distance selling pharmacy which cannot offer services on the premises, but
delivers all essential services remotely. The number of 100 hours pharmacies has increased from
four (in 2011) to six in 2014.
• With the exception of residents living in the least dense quintile (35 to 1267 people per sq km) in
Milton Keynes, all residents can access a pharmacy within one mile of their home. All residents
can access a pharmacy within a five mile radius. This access is supplemented by providers in the
neighbouring local authority areas.
• The maps and data contained in this document show that the services which are commissioned in
addition to the NHS pharmaceutical contract, meet identified health needs.
Based on these findings the level of provision of dispensing services in Milton Keynes is deemed to be
Potential provision
However, the existing community pharmacies could increase their contributions to improving the health
of Milton Keynes population by engaging in the following areas as highlighted by this PNA:
The population of Milton Keynes is projected to grow from 252,400 in 2012 to 302,100 in 2026. This
is an increase of 49,700 people or 19.7%, many of whom will be young people and families. The
current proportions of 0-14 year olds and people aged 25-44 in Milton Keynes are greater than England
(respectively 21.2% v 17.7% and 31.3% compared with 27.2%), while 11.7% of the population in Milton
Keynes in 2012 were aged 65+ compared with 16.9% in England.
Community pharmacy teams are best placed to proactively promote the healthy life style messages
as part of Making Every Contact Count National Campaign, as well as sign-posting to local support
services. To do so effectively it is recommended that a “Directory of services in Milton Keynes” is
established and disseminated to all local pharmacies for use.
71
Commissioners should also consider inclusion of community pharmacies in obesity management
pathways with potential referral by pharmacists into the services. A targeted commissioning of
the NHS Health Checks from community pharmacies could also increase early detection of
cardiovascular diseases.
The highest proportion of clients of community pharmacies are young mothers. Local commissioners in
Milton Keynes should consider community pharmacies in the provision of smoking cessation services,
increased sexual health services such as Chlamydia screening and treatment under PGDs, and
engaging in campaigns to raise awareness of and improve HIV screening. The pharmacies could also
have an important role in cancer awareness campaigns to promote early detection.
More than 25% of the population aged 16 and over are estimated to drink above the recommended
guidelines. Pharmacists can be commissioned to potentially deliver Identification and Brief advice (IBA).
Medicines Use Review and New Medicine Services are the two important aspects of pharmaceutical
services through which community pharmacists can provide support for self-care, and to promote
independence and the safe administration of medicines, especially for people with long term conditions
including people with mental health problems. Although currently 100% of the pharmacy contractors in
Milton Keynes offer these services, the level of provision varies widely. In 2013-14 the number of MUR
consultations per pharmacy ranged from one to 456 (pharmacies are contracted to provide up to 400
consultations). It is recommended that community pharmacies proactively offer these services, as well
as advisory support for carers to enable them to administer medicines and to increase the uptake of
MUR and NMS by their local communities. This service can be maximised by ensuring that healthcare
professionals across all sectors are informed of the service to allow them to refer patients appropriately.
The service can be incorporated into treatment pathways for the management of long term conditions
e.g. diabetes, cardiovascular disease, respiratory disease.
There will be a significant rise in the population of 65+ in Milton Keynes. It is estimated that the
proportion of people aged 65+ will increase from 11.7% (2012) to 17.8% by 2026. GPs and pharmacists
should make more use of the Repeat Dispensing services, to reduce the need for patients to visit
their surgery to collect repeat prescriptions. Community pharmacists can play an important role in an
increased awareness to support disability, which tends to increase with age. Older people in care
homes would benefit from an increased clinical pharmacy support and direct access of residents to
a pharmacist, as well as pharmacists’ input in staff training on medicines issues. Establishing robust
communication systems will ensure patient safety and could reduce waste.
72
10 Process of Developing the PNA
10.1Summary of the process followed in developing the PNA
In developing the PNA for Milton Keynes, information from the JSNA and Public Health sources were
used to explore the characteristics of the population in the borough and local health needs that may be
addressed through pharmaceutical services. The current provision of such services is described.
The process of developing the PNA has taken into account the requirement to involve and consult
people about changes to health services. The specific legislative requirements in relation to
development of PNAs were duly considered. An extract of part of these regulations can be found in the
Appendix 11.
Stakeholders involved in the development of the PNA
Stakeholders were consulted throughout the process of developing the PNA. A pre-consultation
exercise was carried out to seek the views and initial feedback of key partners on the proposals to be
set out in the draft PNA.
The list of stakeholders consulted included the following groups:
•
•
•
•
•
•
•
•
•
Milton Keynes LPC
Berks, Bucks & Oxon LMC
MK Clinical Commissioning Group
Community Pharmacy Contractors in Milton Keynes
Milton Keynes Healthwatch
Milton Keynes Hospital NHS Foundation Trust
NHS Central Eastern Commissioning Support Unit
NHS England Hertfordshire & South Midlands Area Team
Neighbouring Health and Wellbeing Boards
How stakeholders were involved
Key stakeholders were invited to join a Steering Group, which met regularly to support the Executive
Project Group during the development of the PNA (see Acknowledgements for list of steering group
members).
A Stakeholder Workshop was held in March 2014 to introduce the PNA to all stakeholders and present
the planned project milestones. The workshop was attended by, amongst others, representatives from
the LMC, LPC, MK General Hospital Foundation Trust, MK CCG Medicines Management Team, NHS
England LAT, NHS Central Eastern CSU, the chair of the Local Professional Network, Healthwatch and
the Community and Voluntary Sector representative on the MK HWB. Stakeholder views were gathered
through feedback in meetings, via telephone, or feedback online via email.
Once each draft of the PNA was completed the document was sent out to key stakeholders to
comment upon should they so wish.
Questionnaires relating to service provision were sent out to all pharmacies and dispensing
GP practices in Milton Keynes, to serve as an internal audit of the information held by the Public
Health team.
73
As part of the PNA process, the HWB in Milton Keynes has written to neighbouring HWBs to inform
them that the PNA was in development, and underscore the importance of HWBs working together to
ensure that commissioned enhanced services are available to residents in the border areas, regardless
of which side of the border they live.
The wider public in Milton Keynes and other interested parties are being informed of the PNA, and their
views on the PNA will be sought through a formal 60 day consultation running from 15th October 2014
to 15th December 2014. A consultation questionnaire has been produced and publicised, which seeks
the views of the public and their experiences of using pharmaceutical services.
Posters to inform members of the public of the PNA consultation, and direct them to the online
questionnaire, are being distributed to GPs, community pharmacies and libraries to display in public
areas. The Parish Council Network has been notified and asked to include a notification of the
upcoming consultation in their parish newsletters. The public will also be signposted to the consultation
by Milton Keynes Council’s major media publications, the homepage of the Council website and the
official twitter page.
Alongside this, the Council’s Corporate Communications team will release a press release to coincide
with the launch of the consultation period.
After the consultation period is completed, feedback gathered from members of the public and
stakeholders will be reflected in a Consultation Report which will be an Appendix to the final PNA.
Localities used for considering pharmaceutical services
The localities used for considering pharmaceutical services are based on MSOA boundaries and have
an average population of 7,200. The localities were selected to aid local decision making that takes into
account the needs for the population in these areas.
Assessment of need for pharmaceutical services
Assessing need for pharmaceutical services is a complex process. In addition to taking account of
all views submitted from the stakeholders outlined above, this PNA considered a number of factors,
including:
74
• The size and demography of the population across Milton Keynes.
• Whether there is adequate access to pharmaceutical services across Milton Keynes and available
choices.
• Where practicable, whether there is sufficient choice with regard to obtaining pharmaceutical
services.
• Different needs of different localities within Milton Keynes.
• Pharmaceutical services provided in the area of neighbouring HWBs which affect the need for
pharmaceutical services in Milton Keynes (as per figure 5: map showing access to pharmacy
service).
• Other NHS services provided in or outside its area which affect the need for pharmaceutical
services in Milton Keynes.
• Whether further provision of pharmaceutical services in Milton Keynes would secure
improvements, or better access, to pharmaceutical services, or pharmaceutical services of a
specified type, in the area.
• Likely changes to needs in the future occurring due to changes to the size of the population, the
demography of the population, and risks to the health or wellbeing of people in its area which could
influence an analysis to identify gaps in the provision of pharmaceutical services.
Future PNAs and supplementary statements
The PNA will be updated every three years and supplementary statements may be published before
this, if deemed necessary by the HWB.
On behalf of the HWB, the Public Health Consultant with a lead responsibility for PNAs will consider the
need for producing a supplementary statement every six months, in consultation with steering group
members.
10.2Steering group and governance framework
The Project Lead, with the assistance of the Executive Project Group, held responsibility for the delivery
of the project by the statutory deadline. In this the guidance of the wider Steering Group, made up of
representatives from the aforementioned stakeholder groups, was sought.
Representatives received a standing invite to the monthly Steering Group meetings, chaired by the
Project Lead. Key decisions were either taken, by the Executive Project Group, to these meeting or
electronically circulated for suggestion and approval.
All action points were agreed by the group and subsequently forwarded to the Director of Public Health
and the Public Health officer responsible for liaising with portfolio holders, in order that Members be
kept informed of progress with the PNA.
The draft PNA was also brought to a meeting of the HWB and sent to the LAT, LPC, LMC, CCG
Medicines Management team, and Chief Pharmacist at Milton Keynes NHS Hospital Foundation Trust
for endorsement prior to the formal consultation period.
75
To produce a fully informed PNA, the Executive Project Group sought the input of other departments
within the Local Authority. This assured the appropriate level of expertise for this process and included
support and contributions from the Planning, Communications and Legal directorates. The Executive
Project Group met with these departments to introduce the PNA and receive for advice and guidance.
Once each draft of a chapter had been completed, it was sent to the relevant department to review and
agree.
10.3Local Community pharmacy survey report
A survey was sent to all Community Pharmacies in Milton Keynes as a means to validate the data
to be included within the PNA. This comprised information supplied by the LPC, LAT and PH team.
The exercise was also used as a means to obtain any required data not held by the aforementioned
sources.
The survey was designed and piloted in partnership with the Milton Keynes LPC and supported by
the medicines management team at MKCCG. Out of 47 pharmacies in Milton Keynes there were 31
returned surveys (66%). A summary of the responses is given below and the full report is available on
request.
Summary of the responses received
Staffing
A high proportion of pharmacies are open with a pharmacist on site for longer than the contractual 40
core hours or 100 hours (for 100 hour contracts).
Accessibility
100% of respondents have a consultation room, 30 % of which also have hand washing facilities for
patients.
97% responded as having internet access however only 60% have an N3 connection. Pharmacies
should seriously consider good internet access and N3 connectivity to allow improved transfer of
confidential information between healthcare professionals.
There appears to be good access by public transport with 87% of the pharmacies having a bus stop
within 100m. 90% have a disabled parking space.
Electronic Prescription Services
84% of pharmacies are enabled for Release 2 of Electronic Prescribing Services. The remaining 16%
responded as intending to have this service.
Service Provision
94% offered a repeat prescription service and 100% collected prescriptions from GP surgeries on
behalf of their patients free of charge.
The table below summarises current enhanced and advanced service provision with an indication of
the willingness for future provision. With regards to Medicines Use Reviews, 79% of contractors were
willing to undertake consultations in a patient’s home or other suitable site.
76
77
Dispensing of appliances
The following responses were given for the dispensing of appliances:
Which appliances does the pharmacy dispense?
Answer choices
Responses
Stoma appliances**
71% (22)
Incontinence appliances
84% (26)
Dressings
97% (30)
Other (Specified as “All legal prescriptions”)
3% (1)
** One respondent also offered stoma appliance customisation.
Potential Future Services:
Most contractors repsonded as being willing to provide the following potential services:
• Anti-coagulant monitoring
• Disease specific medicines reviews
• Gluten-free food supply service
• Weight Management
• Benzodiazepine withdrawal service
• Instalment dispensing for substance misuse*
* This service is currently commissioned from pharmacy contractors in Milton Keynes.
Additional specific health needs identified included:
1. Addiction advice within the ethnic communities in Bletchley
2. Support for patients in own homes/retirement villages - a commissioned service to provide Monitored
Dosette Boxes/MAR charts
3. Emergency Hormonal Contraception (EHC), Minor Ailments, and Smoking Cessation. (N=8) [Note:
these services are currently being commissioned in Milton Keynes.
Health needs which pharmacists felt able to help to address included:
1. Smoking cessation
2. Drug and alcohol problems
3. Sexual health
4. Health checks
5. Medicines compliance and optimisation
6. Weight management
90% of respondents rated the current provision of pharmaceutical services as Excellent, Very Good or
Good.
78
Address
Asda Super
Store, 1
Bletcham
Way
44
Wordsworth
Ave, Newport
Pagnell
14 St Mary’s
Avenue,
Bletchley
43 High
Street, Stony
Stratford
86 High
Street,
Newport
Pagnell
1 The
Concourse,
Brunel
Centre,
Bletchley
19 Barnsdale
Drive,
Westcroft
Pharmacy
Name
Asda
Pharmacy
Astons
Pharmacy
[ESPLPS
Bliep Chemist
[ESPLPS]
Boots
Pharmacy
Boots
Pharmacy
Boots
Pharmacy
Boots
Pharmacy
100 Hour Pharmacies
KEY
MK4
4DD
MK2
2ES
Y
Y
Y
Y
MK11
1AA
MK16
8PY
Y
Y
Y
Electronic
Prescribing
MK3
5DT
MK16
8SB
MK1
1QB
Post
code
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
MUR NMS
ESPLPS Pharmacies
N
N
N
N
N
N
Y
EHC
N
Y
N
N
N
N
N
Chlamydia
Screening
79
Y
Y
Y
Y
Y
N
N
Stop Smoking
Service
N
N
N
N
N
N
N
Supervised
Admin
N
N
N
N
N
N
N
Needle
Exchange
Y
Y
Y
Y
Y
Y
Y
Minor Ailment
Service
M-F
Lunch
Sat
Lunch
Sun
M-F
Sat
M-F
Lunch
Sat
M-F
Sat
M-F
Lunch
Sat
M- F
lunch
M-F
lunch
Sat
lunch
Sun
lunch
1730
1730
2000
1500
1800
1400
1600
0900
1400
0900
1300
1000
1900
1500
1730
0800
1400
0830
0900
0900
1730
1730
1730
1400
1245
0915
1300
0900
0900
0900
1830
1400
2100
1430
2100
1430
1600
1430
0900
1300
0900
1230
0900
1230
1000
1230
Opening Hours
Appendix 1: List of Community Pharmacies in Milton Keynes showing services provided and opening hours
11 Appendices
Y
Y
Y
Y
MK10
0BA
MK13
8RN
MK13
7PN
MK11
1BE
Unit 2A,
Beacon
Retail Park
Winchester
Circle,
Kingston
MK Medical
Centre, 68
Bradwell,
Common
Boulevard
3 Swinden
Court,
Glovers
Lane,
Heelands
1 Market
Square,
Stony
Stratford
239
Queensway,
Bletchley
13 Melrose
Avenue,
Bletchley
14 Market
Place, Olney
95
Fishermead
Boulevard,
Fishermead
Boots
Pharmacy
(100 Hours)
Boots
Pharmacy
(100 Hours)
Chapharm Ltd
Dispensing
Chemists
Cox and
Robinson
Pharmacy
Cox and
Robinson
Pharmacy
Cox and
Robinson
Pharmacy
Cox and
Robinson
Pharmacy
Cox and
Robinson
Pharmacy
Y
Y
MK6
2AG
Y
Y
Y
MK46
4BA
MK3
6PB
MK2
2EH
MK1
1BN
Y
Boots
Pharmacy
(100 Hours)
MK9
3AH
18 Crown
Walk,
Secklow
Gate West
Electronic
Prescribing
Boots
Pharmacy
Post
code
Address
Pharmacy
Name
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
MUR NMS
Y
Y
Y
Y
Y
N
N
N
Y
Y
EHC
Y
Y
Y
Y
Y
N
N
N
N
N
Chlamydia
Screening
80
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Stop Smoking
Service
Y
Y
Y
Y
Y
N
N
N
Y
Y
Supervised
Admin
Y
Y
Y
Y
Y
N
N
N
Y
Y
Needle
Exchange
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Minor Ailment
Service
M-F
lunch
Sat
M- F
lunch
Sat
lunch
M-F
lunch
Sat
M-F
lunch
Sat
M-F
lunch
Sat
lunch
M –Tu
W - Fri
Sat
M-F
Sat
Sun
M-F
Lunch
Sat
M-F
Sat
Sun
M-F
lunch
Sat
1900
1400
1500
1400
0830
1330
0900
1330
1830
1400
1300
1830
1400
1700
1400
0900
1300
0900
1300
0900
1300
0900
1830
1400
1300
0900
1300
0900
1830
1400
1200
1830
1800
1400
0830
0830
0900
0830
1300
0900
2300
2200
1700
2400
2400
1600
2200
2000
1700
1830
1400
1200
0700
0800
1100
0800
0800
1000
0600
0600
1100
0845
1300
0900
Opening Hours
MK7
7AN
2 Perrydown,
Beanhill
12 Fyfield
Barrow,
Walnut Tree
Hilltops
Medical
Centre
Highland
Drive,
Broughton
MK Village
Practice,
Griffith Gate,
Middleton
Texel Close
3 Tower
Crescent,
Neath Hill
Centre
65 High
Street,
Newport
Pagnell
69 Dulverton
Drive,
Furzton
32 Benbow
Court,
Shenley
Church End
Cox and
Robinson
Pharmacy
Cox and
Robinson
Pharmacy
Hilltops
Pharmacy
Jardines
Pharmacy
Jardines
Pharmacy
Jardines
Pharmacy
Jardines
Pharmacy
Jardines
Pharmacy
Jardines
Pharmacy
Jardines
Pharmacy
Y
MK5
6JG
Y
MK16
8AQ
Y
Y
MK14
6JY
MK4
1EW
Y
Y
MK14
6GL
MK10
9BQ
Y
MK10
7EF
Y
Y
Y
Y
Y
Y
Y
Y
Y
MK8
9HN
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
MUR NMS
Y
Y
Y
Electronic
Prescribing
Y
MK1
4NE
MK6
4JH
9 Farthing
Grove,
Netherfield
Local Centre
Cox and
Robinson
Pharmacy
Post
code
Address
Pharmacy
Name
N
N
N
N
N
N
N
N
Y
Y
Y
EHC
N
N
N
N
N
N
N
N
Y
Y
Y
Chlamydia
Screening
81
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Stop Smoking
Service
Y
N
N
Y
N
N
N
N
Y
N
Y
Supervised
Admin
Y
N
N
Y
N
N
N
N
Y
N
Y
Needle
Exchange
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Minor Ailment
Service
M-F
lunch
Sat
M-F
lunch
Sat
M- F
lunch
Sat
lunch
M-F
lunch
Sat
M-F
lunch
M-F
Sat
Sun
M-F
lunch
Sat
Lunch
Sun
M-F
Sat
Sun
M-F
Lunch
Sat
M-F
Sat
Sun
M-F
lunch
Sat
0900
1300
0900
1900
1400
1400
1800
1400
1200
1800
1400
1800
1400
0900
1300
0900
1300
0830
1300
0900
1830
1400
1400
1830
1400
0900
1300
0900
0830
1300
2000
1900
1700
1900
1400
1900
1400
1900
0900
1300
0900
1300
1600
0830
0830
1030
1830
1400
1300
1800
1400
1500
1830
1400
1200
1830
1400
1500
0900
1300
0900
0900
1300
0900
0845
1300
0900
0845
1330
1100
Opening Hours
Y
Y
15 The
Square,
Wolverton
Stantonbury
MK14
Centre, 22-24 6BL
Purbeck,
Stantonbury
MK16
2 Kingfisher
0JR
Centre,
Elthorne
Way, Newport
Pagnell
127-129
Queensway,
Bletchley
106
Serpentine
Court, Lakes
Estate,
Bletchley
32 St James
St, New
Bradwell
143
Queensway
12 White
Horse Drive,
Emerson
Valley
Unit 1, Willen
Healthcare
Plus,
Beaufort
Drive
Lloyds
Pharmacy
Lloyds
Pharmacy
Lloyds
Pharmacy
Lloyds
Pharmacy
McLaren
Pharmacy
Queensway
Pharmacy
(100 Hours)
Rainbow
Pharmacy
Rowlands
Pharmacy
N
Y
Y
MK4
2AS
MK15
9ET
N
MK13
0BH
MK2
2DY
Y
Y
Y
MK2
3QL
MK2
2DH
MK12
5DG
Y
Lloyds
Pharmacy
MK19
6JA
1c Puxley
Road,
Deanshanger
Electronic
Prescribing
Jardines
Pharmacy
Post
code
Address
Pharmacy
Name
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
MUR NMS
N
N
N
N
N
N
N
N
N
N
EHC
N
N
N
N
N
N
N
N
N
N
Chlamydia
Screening
82
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Stop Smoking
Service
N
N
Y
N
N
N
Y
Y
Y
N
Supervised
Admin
N
N
Y
N
N
N
Y
Y
Y
N
Needle
Exchange
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Minor Ailment
Service
M-F
lunch
Sat
M-F
lunch
Sat
M- F
Sat
Sun
M-F
lunch
Sat
M-F
Sat
M-F
Sat
M-F
Sat
M-F
Sat
M-F
Sat
M, Tu, F
Wed
Thu, Sat
0900
1300
0900
0900
1300
0900
1830
1320
1300
1830
1400
1200
2200
2200
2000
1830
1400
1400
0900
1300
0900
0700
0700
1000
1800
1300
1830
1730
1900
1400
1830
1300
1900
1700
1730
1800
1300
0900
0900
0900
0900
0830
0900
0830
0900
0900
0900
0900
0900
0900
Opening Hours
799 Witan
Gate
206 Whaddon
Way, Bletchley
Unit 4
Woolworths
Development,
Midsummer
Arcade
Watling Street,
Bletchley
Tesco Super
Store,
Kingston
Central
Shopping
Centre
6 Ardwell
Lane,
Greenleys
1 Savill Lane,
Westcroft
Sainsbury’s
Pharmacy
(100 Hours)
Smiths
Pharmacy
Superdrug
Pharmacy
Tesco
Pharmacy
Tesco
Pharmacy
The Cooperative
Pharmacy
Westcroft
Pharmacy
(100 Hours)
MK4
4EN
Y
N
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
MUR NMS
N
N
N
N
N
N
N
N
EHC
N
N
N
N
N
N
N
N
Chlamydia
Screening
Address 1
Lakeside
Pharmacy Name
Jardines Wholly Internet/Mail
Order Pharmacy
83
Shirewell Crescent
Address 2
Table 7: Distance Selling Pharmacy service providers
N
N
Y
Y
MK10
0AH
MK12
6AX
Y
Y
Y
Y
Electronic
Prescribing
MK1
1DD
MK9
3BB
MK3
7DG
MK9
2FW
Post
code
Woburn Sands 31 High Street, MK17
Pharmacy
Woburn Sands 8RB
Address
Pharmacy
Name
N
N
Y
Y
Y
Y
N
N
Stop Smoking
Service
Furzton
Address 3
N
N
N
N
N
Y
Y
N
Supervised
Admin
N
N
N
N
N
Y
Y
N
Needle
Exchange
Y
Y
Y
Y
Y
Y
Y
Y
M-F
lunch
Sat
Mon
Tues
W-F
Sat
Sun
M-F
Sat
M-F
lunch
Sat
lunch
Sun
M-F
Sat
Sun
M-F
Sat
Sun
M-F
Lunch
Sat
Mon
Tu-Fri
Sat
Sun
MK4 1GA
0900
1300
0900
1800
1330
1300
Midnight
2030
2030
2100
2000
0730
0001
0730
0800
0900
2000
1400
2000
1400
1600
0800
1300
0800
1300
1000
1830
1230
2000
2000
1600
0900
0800
1000
0900
0900
2000
1900
1700
1800
1400
1300
2300
2300
2200
1600
0900
0830
1100
0900
1300
0900
0800
0700
0700
1000
Opening Hours
Post Code
Minor Ailment
Service
Appendix 2: Graphs showing population growth in Milton Keynes
Milton Keynes -‐ Persons -‐ Popula8on growth to 2017 & 2024 80.00 70.00 Growth (%) 60.00 50.00 40.00 30.00 20.00 10.00 4 0-‐
-‐10.00 5-‐
9
10 -‐1
4
15 -‐1
9
20 -‐2
4
25 -‐2
9
30 -‐3
4
35 -‐3
9
40 -‐4
4
45 -‐4
9
50 -‐5
4
55 -‐5
9
60 -‐6
4
65 -‐6
9
70 -‐7
4
75 -‐7
9
80 -‐8
4 85
+ 0.00 -‐20.00 Growth to 2017 Growth to 2024 5-‐
9
10 -‐1
4
15 -‐1
9
20 -‐2
4
25 -‐2
9
30 -‐3
4
35 -‐3
9
40 -‐4
4
45 -‐4
9
50 -‐5
4
55 -‐5
9
60 -‐6
4
65 -‐6
9
70 -‐7
4
75 -‐7
9
80 -‐8
4 85
+ 4 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 -‐10.00 0-‐
Growth (%) Milton Keynes -‐ Males -‐ Popula8on growth to 2017 & 2024 Growth to 2017 Growth to 2024 84
Milton Keynes -‐ Persons -‐ Popula8on growth to 2017 & 2024 80.00 70.00 50.00 40.00 30.00 20.00 10.00 9
10 -‐1
4
15 -‐1
9
20 -‐2
4
25 -‐2
9
30 -‐3
4
35 -‐3
9
40 -‐4
4
45 -‐4
9
50 -‐5
4
55 -‐5
9
60 -‐6
4
65 -‐6
9
70 -‐7
4
75 -‐7
9
80 -‐8
4 85
+ -‐20.00 5-‐
-‐10.00 4 0.00 0-‐
Growth (%) 60.00 Growth to 2017 Growth to 2024 85
Appendix 3: Demographics and IMD data
WARDS(S)
IMD 2010 adjusted
Rank in England*
Rank in Milton Keynes**
Eaton Manor
55.0
1409
1
Eaton Manor
51.9
1859
2
Woughton
49.7
2231
3
Woughton
49.1
2361
4
Woughton
49.0
2371
5
Woughton
47.8
2605
6
Stony Stratford
45.8
3046
7
Eaton Manor
43.8
3511
8
Bradwell
42.1
3971
9
Stantonbury
39.2
4852
10
Woughton
38.5
5068
11
Campbell Park
38.3
5134
12
Woughton
37.4
5435
13
Campbell Park
36.4
5786
14
Stony Stratford/Wolverton
35.8
6001
15
Campbell Park
35.5
6080
16
Campbell Park
35.5
6081
17
Wolverton
34.8
6348
18
Campbell Park
34.6
6418
19
Wolverton
33.9
6649
20
Wolverton
33.3
6858
21
Bletchley and Fenny Stratford
28.6
8937
22
*Of 32,844 LSOAs where 1 = most deprived
**Of 154 LSOAs where 1 = most deprived
Source:Index of Multiple Deprivation 2010 - adjustments to align scores with 2011 boundaries for Lower
Layer Super Output Areas (LSOAs)
86
Appendix 4: Map showing Life Expectancy in Milton Keynes
Figure 10: Life Expectancy for Males 2008 - 2012
87
Figure 11: Life Expectancy for Males 2008 – 2012
88
Appendix 5: Supporting data for Sexual Health services
Table I: C card update
2013/2014
2012/2013
Total Number of Condoms Distributed
20118
18576
New Registrations
351
236
Most Accessed Postcode
MK6
MK6
Least Accessed Postcode
MK1
MK1
Total Condoms to Females (%)
7176 (36%)
5824 (31%)
Total Condoms to Males (%)
12942 (64%)
12752 (69%)
Number of Card Outlets
51
40
Source: Milton Keynes C card Annual Report 2013-2014
Table II: 2009 to 2011 CONCEPTIONS FOR WARDS - 2001 CENSUS WARD BOUNDARIES. LAD1,
LAD2 and former districts.
Ward
Conception rates per 1,000 under 18 year olds
Danesborough
Values 5 or fewer
Olney
Values 5 or fewer
Sherington
Values 5 or fewer
Furzton
More than 11 below MK UA average
Loughton Park
Linford North
Linford South
Emerson Valley
Walton Park
Middleton
Newport Pagnell North
Bradwell
Between 11 above and 11 below average
Hanslope Park
Whaddon
Bletchley and Fenny Stratford
Stony Stratford
Wolverton
Stantonbury
Denbigh
More than 11 above MK UA average
Eaton Manor
Campbell Park
Woughton
89
Table 8: Pharmacies offering Sexual health services in Milton Keynes
Pharmacy Name
Ward
Postcode
Emergency
Hormonal
Contraception
Chlamydia Testing
Asda Pharmacy
Bletchley & Fenny
Stratford
MK1 1QB
Y
N
Boots Pharmacy
Bletchley & Fenny
Stratford
MK1 1BN
Y
N
Boots Pharmacy
Bletchley & Fenny
Stratford
MK2 2ES
N
Y
Boots Pharmacy
Campbell Park
MK9 3AH
Y
N
Cox and Robinson
Pharmacy
Stony Stratford
MK11 1BE
Y
Y
Cox and Robinson
Bletchley & Fenny
MK2 2EH
Y
Y
Pharmacy
Stratford
Cox and Robinson
Pharmacy
Bletchley & Fenny
Stratford
MK3 6PB
Y
Y
Cox and Robinson
Pharmacy
Olney
MK46 4BA
Y
Y
Cox and Robinson
Pharmacy
Campbell Park
MK6 2AG
Y
Y
Cox and Robinson
Pharmacy
Woughton
MK6 4JH
Y
Y
Cox and Robinson
Pharmacy
Woughton
MK6 4NE
Y
Y
Cox and Robinson
Pharmacy
Walton Park
MK7 7AN
Y
Y
90
Appendix 6: Data supporting Stop Smoking Services
Table 9: List of Pharmacies offering Level 2 smoking support &/ NRT Voucher scheme
Pharmacy Name
Ward
Postcode
Stop Smoking Accept
Bliep Chemist
Bletchley East
MK3 5DT
Y
Voucher
Y
Boots Pharmacy
MK1 1BN
Y
Y
Boots Pharmacy
Stony Stratford
MK11 1AA
Y
Y
Boots Pharmacy
Monkston
MK10 0BA
Y
Y
Boots Pharmacy
Bradwell
MK13 8RN
Y
N
Boots Pharmacy
MK16 8PY
Y
N
Boots Pharmacy
MK2 2ES
Y
N
Boots Pharmacy
Emerson Valley
MK4 4DD
Y
N
Boots Pharmacy
Campbell Park
MK9 3AH
Y
N
MK13 7PN
Y
Y
Chapharm Ltd Dispensing Chemists Bradwell
Cox and Robinson Pharmacy
Stony Stratford
MK11 1BE
Y
Y
MK2 2EH
Y
Y
Bletchley Park
MK3 6PB
Y
Y
Olney
MK46 4BA
Y
Y
Woughton & Fishermead
MK6 2AG
Y
Y
MK6 4JH
Y
Y
Monkston
MK7 7AN
Y
Y
MK6 4NE
Y
Y
Jardines Pharmacy
Broughton
MK10 7EF
N
Y
Jardines Pharmacy
Shenley Brook End
MK4 1EW
Y
Y
Jardines Pharmacy
Loughton & Shenley
MK5 6JG
Y
Y
Jardines Pharmacy
Broughton
MK10 7EF
Y
Y
Jardines Pharmacy
Newport Pagnell North & Hanslope
MK10 8AB
Y
Y
Jardines Pharmacy
Stantonbury
MK14 6JY
N
Y
Jardines Pharmacy
Stantonbury
MK14 6GL
N
Y
Jardines Pharmacy (Astons)
Newport Pagnell North & Hanslope
MK16 8SB
N
Y
Lloyds Pharmacy
Bletchley East
MK2 3QL
N
Y
Lloyds Pharmacy
Bletchley Park
MK2 2DH
N
Y
Lloyds Pharmacy
Stantonbury
MK14 6BL
N
Y
Lloyds Pharmacy
MK16 0JR
N
Y
Lloyds Pharmacy
Wolverton
MK12 5DG
N
Y
McLaren Pharmacy
Wolverton
MK13 0BH
N
Y
P & I Smiths Chemist
Bletchley West
MK4 7DG
Y
Y
Queensway Pharmacy
Central Bletchley
MK2 2DY
Y
Y
Hilltops Pharmacy
Stony Stratford
MK8 9HN
Y
Y
Rainbow Pharmacy
Shenley Brook End
MK4 2AS
Y
Y
Rowlands Pharmacy
Broughton
MK15 9ET
N
Y
Superdrug Pharmacy
Central Milton Keynes
MK9 3BB
N
Y
Tescos Pharmacy
Monkston
MK10 0AH
Y
Y
Tescos Pharmacy
MK1 1DD
N
Y
The Co-operative Pharmacy
Wolverton
MK12 6AX
N
Y
91
Appendix 7: Substance Misuse service data
Table 10: List of pharmacies providing needle exchange and supervised consumption services
(Substance Misuse)
Pharmacy Name
Ward
Postcode
Supervised
Administration
Needle Syringe
Exchange
Boots Pharmacy
Bletchley & Fenny
Stratford
MK1 1BN
Y
Y
Boots Pharmacy
Campbell Park
MK9 3AH
Y
Y
Cox and Robinson
Pharmacy
Stony Stratford
MK11 1BE
Y
Y
Cox and Robinson
Pharmacy
Bletchley & Fenny
Stratford
MK2 2EH
Y
Y
Cox and Robinson
Pharmacy
Bletchley & Fenny
Stratford
MK3 6PB
Y
Y
Cox and Robinson
Pharmacy
Olney
MK46 4BA
Y
Y
Cox and Robinson
Pharmacy
Campbell Park
MK6 2AG
Y
Y
Cox and Robinson
Pharmacy
Woughton
MK6 4JH
Y
Y
Cox and Robinson
Pharmacy
Walton Park
MK7 7AN
Y
Y
Jardines Pharmacy
Linford South
MK14 6JY
Y
Y
Jardines Pharmacy
Loughton Park
MK5 6JG
Y
Y
Lloyds Pharmacy
Wolverton
MK12 5DG
Y
Y
Lloyds Pharmacy
Stantonbury
MK14 6BL
Y
Y
MK2 2DY
Y
Y
Queensway
Pharmacy
Smiths Pharmacy
Whaddon
MK3 7DG
Y
Y
Superdrug
Pharmacy
Central Milton
Keynes
MK9 3BB
Y
Y
92
Appendix 8: Data on Long term Conditions in Milton Keynes
Table 11: Number of people on Milton Keynes GP practice registers at April 2013 with specified long
term conditions
Practice registers for long term conditions 28 Practices:
Number of people MK CCG
Practice population size at Jan 2013-269,950
on register in MK - Prevalence
March 2013
Coronary Heart Disease (CHD)
6,393
2.4%
Heart Failure
1,249
0.5%
Stroke or Transient Ischaemic Attacks (TIA)
2,827
1.0%
Hypertension
31,964
11.8%
Diabetes (age 17 and over)
10,783
5.2%
Chronic Obstructive Pulmonary Disease (COPD)
3,840
1.4%
Epilepsy (age 18 and over)
1,304
0.6%
Hypothyroidism
6,027
2.2%
Cancer
3,727
1.4%
Palliative Care
464
0.2%
Mental Health
1,632
0.6%
Asthma
14,800
5.5%
Dementia
936
0.3%
Chronic Kidney Disease (CKD) (age18 and over)
5,263
2.6%
Atrial Fibrillation
2,742
1.0%
Obesity (age 16 and over)
19,975
9.4%
Learning Disability (age 18 and over)
766
0.4%
Peripheral Arterial Disease
1,235
0.5%
Source: QMAS database - 2012/13 data for Milton Keynes PCT - extracted locally from database See:
http://www.hscic.gov.uk/qof
93
Table 12: Estimated and projected number of people aged 65 and over with a limiting long-term
illness, in Milton Keynes by age group.
2011 Census
Estimates
Total
%
2015
2020
People aged 65-74 with a limiting long-term illness
5,876
38.3%
7,674
9,083
People aged 75-84 with a limiting long-term illness
5,201
63.6%
6,288
7,736
People aged 85 and over with a limiting long-term illness
2,399
84.1%
3,549
4,434
Total population aged 65 and over with a limiting long13,476
51.1%
17,511
21,253
term illness
Source: Synthetic Estimate based on 2011 census percentages applied to ONS 2011 Population
Projections
94
Table 13: Major Causes of Death - Standardised Mortality Ratio (SMR - Standardised so that 100 is
England average)
2008 - 2010, All Ages
Observed SMR
95%
Confidence
Lower Upper
Pneumonia
374
156
141
173
Statistically Significantly
High
Suicide
44
131
95
176
Acute MI
311
121
108
135
High
Accidents
150
120
101
140
High
Coronary Heart Disease
787
117
109
125
High
Colorectal Cancer
155
112
95
131
Bladder Cancer
45
110
81
148
Breast Cancer
118
109
90
131
COPD, Bronchitis Emphysema 226
104
91
119
All Cancers
1378
102
97
108
Lung Cancer
296
101
90
113
All Circulatory Diseases
1488
101
96
106
Prostate Cancer
83
100
79
123
Stomach Cancer
38
91
64
125
Malignant Melanoma
18
90
53
142
Diabetes
44
89
65
120
Chronic Renal Failure
11
86
43
153
Stroke
335
85
76
94
Low
Asthma
8
78
34
154
Chronic Liver Disease
58
74
57
96
Low
Cervical Cancer
6
66
24
143
95
Appendix 9: Mental Health Services
Table 14: People aged 18-64 predicted to have a mental health problem in Milton Keynes.
2012
2014
2016
2018
2020
People aged 18-64 predicted to have a common mental
disorder
25,962
26,292
26,671
27,050
27,397
People aged 18-64 predicted to have a borderline
personality disorder
726
735
746
756
766
People aged 18-64 predicted to have an antisocial
personality disorder
562
569
578
586
595
People aged 18-64 predicted to have psychotic disorder 645
653
663
672
681
People aged 18-64 predicted to have two or more
psychiatric disorders
11,746
11,918
12,090
12,248
11,601
Table produced on 15/11/13 from http://www.pansi.org.uk/index.php?pageNo=402&areaID=8329&l
oc=8329
The prevalence rates have been applied to ONS population projections for the 18-64 population to give
estimated numbers predicted to have a mental health problem, projected to 2020.
Prevalence Rates Summary:
%
Males
12.5
0.3
0.6
0.3
6.9
Common mental disorder
Borderline personality disorder
Antisocial personality disorder
Psychotic disorder
Two or more psychiatric disorders
Source: Projecting Adult Needs and Service Information (PANSI)
96
Females
19.7
0.6
0.1
0.5
7.5
Appendix 10: Distribution of Older People in Milton Keynes
a)
97
b)
98
Appendix 11: Legislative requirements for developing PNAs
This section contains an extract from The National Health Service (Pharmaceutical and Local
Pharmaceutical Services) Regulations 2013. Please note that the HWB takes no responsibility for the
accuracy of the extract. The full text of the Regulations is available at: http://www.legislation.gov.uk/
uksi/2013/349/contents/made
1. These regulations may be cited as the National Health Service (Pharmaceutical and Local
Pharmaceutical Services) Regulations 2013 and come into force on 1st April 2013.
2. Interpretation (see website)
3. The pharmaceutical services the PNA must cover are all the pharmaceutical services that may
be provided under arrangements made by the NHSCB for:
a) the provision of pharmaceutical services (including directed services) by a person on a
pharmaceutical list;
b) the provision of local pharmaceutical services under an LPS scheme (but not LP services which
are not local pharmaceutical services); or
c) the dispensing of drugs and appliances by a person on a dispensing doctors list (but not other
NSH services that may be provided under arrangements made by the NHSCB with a dispensing
doctor)
4. Information to be contained in PNA
(1) Each PNA must contain the information set out in Schedule 1.
(2) Each HWB must, in so far as is practicable, keep up to date the map which it includes in its PNA
pursuant to paragraph 7 of Schedule 1 (without needing to republish the whole of the assessment or
publish a supplementary statement)
5. Date by which the first HWB PNAs are to be published
Each HWB must publish its first PNA by 1st April 2015.
6. Subsequent assessments
(1) After it has published its first PNA, each HWB must publish a statement of its revised assessment
within 3 years of its previous publication.
(2) A HWB must make a revised assessment as soon as is reasonably practicable after identifying
changes since the previous assessment, which are of a significant extent, to the need for
pharmaceutical services in its area, having regard in particular changes to –
a) the number of people in its area who require pharmaceutical services;
b) the demography of its area; and
c) the risks to the health or wellbeing of people in its area, unless it is satisfied that making a revised
assessment would be a disproportionate response.
99
(3) Pending the publication of a statement or a revised assessment, a HWB may publish a
supplementary statement explaining changes to the availability of pharmaceutical services (..) where –
a) the changes are relevant to the granting of applications referred to in section 129(2)(c)(i) or(ii) of
the 2006 Act; and
b) the HWB –
(i) is satisfied that making its first or revised assessment would be a disproportionate response, or
(ii) is in the course of making its first or revised assessment and is satisfied that immediate
notification of its PNA is essential in order to prevent significant detriment to the provision of
pharmaceutical services in its area.
7. Temporary extension of PCT PNAs and access by the NHSCB and HWBs to PNAs
Before the publication by an HWB of the first PNA that it prepares for its area, the PNA that relates
to any locality within that area is the PNA that relates to that locality of the PCT for that locality
immediately before the appointed day, read with
a) any supplementary statement published by the PCT (..)
b) any supplementary statement published by the HWB (..)
Each HWB must ensure that the NHSCB has access to –
a) the HWB’s PNA (including any supplementary statements) (..)
b) any supplementary statement that the HWB publishes (..)
c) any PNA of a PCT that it holds, which is sufficient to enable the NHSCB to carry out its functions
under these Regulations
Each HWB must ensure that, as necessary, other HWBs have access to any PNAs of any PCT that it
holds, which is sufficient to enable the other HWBs to carry out their functions under these Regulations.
8. Consultation on PNAs
(1) When making an assessment for the purposes of publishing a pharmaceutical needs assessment,
each HWB (HWB1) must consult the following about the contents of the assessment it is making—
(a) any Local Pharmaceutical Committee for its area (including any Local Pharmaceutical Committee
for part of its area or for its area and that of all or part of the area of one or more other HWBs);
(b) any Local Medical Committee for its area (including any Local Medical Committee for part of its
area or for its area and that of all or part of the area of one or more other HWBs);
(c) any persons on the pharmaceutical lists and any dispensing doctors list for its area;
(d) any LPS chemist in its area with whom the NHSCB has made arrangements for the provision of
any local pharmaceutical services;
(e) any Local Healthwatch organisation for its area, and any other patient, consumer or community
group in its area which in the opinion of HWB1 has an interest in the provision of pharmaceutical
services in its area; and
100
(f) any NHS trust or NHS foundation trust in its area;
(g) the NHSCB; and
(h) any neighbouring HWB.
(2) The persons mentioned in paragraph (1) must together be consulted at least once during the
process of making the assessment on a draft of the proposed pharmaceutical needs assessment.
(3) Where a HWB is consulted on a draft under paragraph (2), if there is a Local Pharmaceutical
Committee or Local Medical Committee for its area or part of its area that is different to a Local
Pharmaceutical Committee or Local Medical Committee consulted under paragraph (1)(a) or (b), that
HWB—
(a) must consult that Committee before making its response to the consultation; and
(b) must have regard to any representations received from the Committee when making its response
to the consultation.
(4) The persons consulted on the draft under paragraph (2) must be given a minimum period of 60 days
for making their response to the consultation, beginning with the day by which all those persons have
been served with the draft.
(5) For the purposes of paragraph (4), a person is to be treated as served with a draft if that person is
notified by HWB1 of the address of a website on which the draft is available and is to remain available
(except due to accident or unforeseen circumstances) throughout the period for making responses to
the consultation.
(6) If a person consulted on a draft under paragraph (2)—
(a) is treated as served with the draft by virtue of paragraph (5); or
(b) has been served with copy of the draft in an electronic form, but requests a copy of the draft in
hard copy form, HWB1 must as soon as is practicable and in any event within 14 days supply a
hard copy of the draft to that person (free of charge).
9. Matters for consideration when making assessments
each HWB must have regard, in so far as it is practicable to do so, to the following matters—
(a) the demography of its area;
(b) whether in its area there is sufficient choice with regard to obtaining pharmaceutical services;
(c) any different needs of different localities within its area;
(d) the pharmaceutical services provided in the area of any neighbouring HWB which affect—
(i) the need for pharmaceutical services in its area, or
(ii) whether further provision of pharmaceutical services in its area would secure improvements, or
better access, to pharmaceutical services, or pharmaceutical services of a specified type, in its
area; and
101
(e) any other NHS services provided in or outside its area (which are not covered by subparagraph
(d)) which affect—
(i) the need for pharmaceutical services in its area, or
(ii) whether further provision of pharmaceutical services in its area would secure improvements, or
area.
each HWB must take account of likely future needs—
(a) to the extent necessary to make a proper assessment of the matters mentioned in paragraphs 2
and 4 of Schedule 1; and
(b) having regard to likely changes to—
(i) the number of people in its area who require pharmaceutical services,
(ii) the demography of its area, and
(iii) the risks to the health or wellbeing of people in its area.
102
SCHEDULE 1 Regulation 4(1)
Information to be contained in pharmaceutical needs assessments
Necessary services: current provision
1. A statement of the pharmaceutical services that the HWB has identified as services that are
provided—
(a) in the area of the HWB and which are necessary to meet the need for pharmaceutical services in
its area; and
(b) outside the area of the HWB but which nevertheless contribute towards meeting the need for
pharmaceutical services in its area (if the HWB has identified such services).
Necessary services: gaps in provision
2. A statement of the pharmaceutical services that the HWB has identified (if it has) as services that are
not provided in the area of the HWB but which the HWB is satisfied—
(a) need to be provided (whether or not they are located in the area of the HWB) in order to meet a
current need for pharmaceutical services, or pharmaceutical services of a specified type, in its
area;
(b) will, in specified future circumstances, need to be provided (whether or not they are located in the
area of the HWB) in order to meet a future need for pharmaceutical services, or pharmaceutical
services of a specified type, in its area.
Other relevant services: current provision
provided—
(a) in the area of the HWB and which, although they are not necessary to meet the need for
pharmaceutical services in its area, nevertheless have secured improvements, or better access,
to pharmaceutical services in its area;
(b) outside the area of the HWB and which, although they do not contribute towards meeting the
need for pharmaceutical services in its area, nevertheless have secured improvements, or better
access, to pharmaceutical services in its area;
(c) in or outside the area of the HWB and, whilst not being services of the types described in subparagraph (a) or (b), or paragraph 1, they nevertheless affect the assessment by the HWB of the
need for pharmaceutical services in its area.
Improvements and better access: gaps in provision
not provided in the area of the HWB but which the HWB is satisfied—
(a) would, if they were provided (whether or not they were located in the area of the HWB), secure
improvements, or better access, to pharmaceutical services, or pharmaceutical services of a
103
specified type, in its area,
(b) would, if in specified future circumstances they were provided (whether or not they were located
in the area of the HWB), secure future improvements, or better access, to pharmaceutical
services, or pharmaceutical services of a specified type, in its area.
Other NHS services
5. A statement of any NHS services provided or arranged by a local authority, the NHSCB, a CCG,
an NHS trust or an NHS foundation trust to which the HWB has had regard in its assessment, which
affect—
(a) the need for pharmaceutical services, or pharmaceutical services of a specified type, in its area;
or
(b) whether further provision of pharmaceutical services in its area would secure improvements, or
area.
How the assessment was carried out
6. An explanation of how the assessment has been carried out, and in particular—
(a) how it has determined what are the localities in its area;
(b) how it has taken into account (where applicable)—
(i) the different needs of different localities in its area, and
(ii) the different needs of people in its area who share a protected characteristic; and
(c) a report on the consultation that it has undertaken.
Map of provision
7. A map that identifies the premises at which pharmaceutical services are provided in the area of the
HWB.
104
12 Glossary and abbreviations
12.1Glossary of terms and phrases defined in regulation 2 of the 2013
Regulations
Term or phrase
Controlled localities/controlled
locality
Core opening hours
Definition as per regulation 2
of the 2012 Regulations
Means an area that is a
controlled locality by virtue of
regulation 36(1) or is determined
to be so in accordance with
regulation 36(2).
Is to be construed, as the
context requires, in accordance
with paragraph 23(2) of
Schedule 4 or paragraph 13(2)
of Schedule 5, or both.
105
Explanation
A controlled locality is an area
which has been determined,
either by NHS England, a
primary care trust a predecessor
organisation or on appeal by the
NHS Litigation Authority (whose
appeal unit handles appeals for
pharmaceutical market entry and
performance sanctions matters),
to be “rural in character”. It
should be noted that areas
that have not been formally
determined as rural in character
and therefore controlled
localities, are not controlled
localities unless and until NHS
England determines them to be.
Such areas may be considered
as rural because they consist
open fields with few houses but
they are not a controlled locality
until they have been subject to a
formal determination.
Pharmacies are required to be
open for 40 hours per week,
unless they were approved
under Regulation 13(1)(b) of the
2005 Regulations in which case
they are required to open for
100 hours per week. Dispensing
appliance contractors (DACs)
are required to be open for not
less than 30 hours per week.
Directed services
Dispensing doctor(s)
Distance selling premises
Enhanced services
Means additional pharmaceutical
services provided in accordance
with directions under section 127
of the 2006 Act.
Is to be construed in accordance
with regulation 46(1).
These are advanced and
enhanced services as set out in
Directions.
These are providers of primary
medical services who provide
pharmaceutical services from
medical practice premises in
the area of NHS England; and
general practitioners who are
not providers of primary medical
services but who provide
pharmaceutical services from
medical practice premises in the
area of the HWB.
Listed chemist premises, or
These premises could have
potential pharmacy premises,
been approved under the 2005
at which essential services
Regulations in which case they
are or are to be provided but
could be pharmacies or DACs.
the means of providing those
Under the 2012 and 2013
services are such that all
Regulations only pharmacy
persons receiving those services contractors may apply to provide
do so otherwise than at those
services from distance selling
premises.
premises. Distance-selling
contractors are in the main
internet and some mail-order,
but they all cannot provide
“essential services” to persons
face to face at their premises
and must provide a service
across England to anyone who
requests it.
Means the additional
These are pharmaceutical
pharmaceutical services that
services commissioned by NHS
are referred to in direction 4 of
England, such as services to
the Pharmaceutical Services
Care Homes, language access
(Advanced and Enhanced
and patient group directions.
Services) (England) Directions
2013.
106
Essential services
Except in the context of the
definition of “distance selling
premises”, is to be construed in
accordance with paragraph 3 of
Schedule 4.
Neighbouring HWB
In relation to a HWB (HWB1),
means the HWB of an area that
borders any part of HWB1.
NHS chemist
Means an NHS appliance
contractor or an NHS
pharmacist.
107
These are services which every
community pharmacy providing
NHS pharmaceutical services
must provide and is set out in
their terms of service – these
include the dispensing of
medicines, promotion of healthy
styles and support for self-care.
Distance-selling pharmacy
contractors cannot provide
essential services face to face at
their premises.
Used when, for example, an
HWB is consulting on their draft
PNA and needs to inform the
HWBs which border their HWB
area.
12.2List of abbreviations
A&E
AUR
BME
CASH
CCG
CHD
CKD
COPD
CRI
CSU
CVD
EHC
EPS
ESPLPS
GP
GUM
HF
HIV
HWB
IBA
IMD
JSNA
LA
LES
LMC
LPC
LPS
LSOA
LTC
MAR
MDS
MECC
MKC
MKCCG
MSOA
MUR
NE
NHS
Accident and Emergency
Appliance Use Review
Black and Minority Ethnic
Contraceptive and Sexual Health Services
Clinical Commissioning Group (groups of GPs responsible for designing
local health services in England)
Coronary Heart Disease
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease
Crime reduction initiatives
Commissioning Support Unit
Cardio Vascular Disease
Emergency Hormonal Contraception
Electronic Prescription Service
Essential Small Pharmacy Local Pharmaceutical Service
General Practitioner
Genitourinary medicine
Heart Failure
Human immunodeficiency virus
Health and Wellbeing Board
Identification and Brief Advice (alcohol intervention tool)
Indices Of Multiple Deprivation
Joint strategic needs assessment
Local Authority
Local Enhanced Service
Local Medical Committee
Local Pharmaceutical Committee
Local Pharmaceutical Services
Lower Super Output Areas
Long Term Condition
Medicines Administration Record
Monitored Dosage System
Making Every Contact Count
Milton Keynes Council
Milton Keynes Clinical Commissioning Group
Middle layer Super Output Area
Medicines Use Review
Needle Exchange
National Health Service
108
NHSIC
NICE
NMS
NRT
ONS
OOH
PCT
PMR
PNA
QOF
SHA
SOA
STI
THT
UA
NHS Information Centre
National Institute of Healthcare and Clinical Excellence
New Medicines Service
Nicotine Replacement Therapy
Office of National Statistics
Out of Hours
Primary Care Trust
Patient Medication Record
Pharmaceutical Needs Assessment
Quality and Outcomes Framework
Strategic Health Authority
Super Output Area
Sexually Transmitted Infection
Terence Higgins Trust
Unitary Authority
109
Finding out more
If you would like further copies, a large-print copy
or information about us and our services, please
telephone or write to us at our address below.
01234 XXXXXX
Name Surname
Department
Borough Hall
Cauldwell Street
Bedford MK40 9AP
@ name@bedford.gov.uk
www.bedford.gov.uk
PBH020_14 design@bedford.gov.uk
www.bedford.gov.uk

PUB020 14 Pharmaceutical Needs Assessment MK A4 v3

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