(Public Pack)Agenda Document for Health & Wellbeing Board ...

Who are we? The Health and Wellbeing Board is the forum where representatives of the Council, NHS and Third Sector hold discussions and make decisions on the health and wellbeing of the people of Brighton & Hove. Meetings are open to the public and everyone is welcome.

Where and when is the Board meeting? This next meeting will be held in the Council Chamber, Hove Town Hall on Tuesday 6 March, starting at 4.00pm. It will last about two and a half hours. There is limited public seating available for those who wish to observe the meeting. Board meetings are also available to view on the council’s website.

What is being discussed? There are 5 items on the agenda

Moving Towards Integration

Better Care Plan

Big Health and Care Conversation

Adolescent Health Offer

Pharmaceutical Needs Assessment

Health & Wellbeing Board

Geoff Raw BHCC

Chief Executive

Daniel Yates Councillor

Chair

Elizabeth Culbert

Legal Adviser

Secretary to the Board

Public Seating For those with public items on the agenda

Press table

Public

Speaker

Public

Speaker

Adam Doyle CCG

(Voting member)

Nick Taylor Councillor

(Voting member)

Dawn Barnett Councillor

(Voting member)

Alistair Hill (Non-voting Statutory

member)

Lola BanJoko CCG

(Voting member)

Dr Manas Sikdar CCG

(Voting member)

Graham Bartlett (Safeguarding Adults

Board) (Non-voting co-optee)

Pinaki Ghoshal (Non-voting Statutory

member)

Caroline Penn Councillor

(Non-voting invitee)

Karen Barford Councillor

(Voting member)

Malcolm Dennett CCG – Lay member

(Voting member)

Dick Page Councillor

(Voting member)

Rob Persey (Non-voting Statutory

member)

Dr David Supple CCG

(Voting member)

Pennie Ford NHS England

(Non-voting co-optee)

David Liley Healthwatch

(Non-voting Statutory

member)

Chris Robson (Local Safeguarding

Children Board) (Non-voting co-optee)

Democratic Services [email protected]

Health & Wellbeing Board 6 March 2018

4.00pm Hove Town Hall, Council Chamber

Who is invited:

Contact: Tom McColgan Secretary to the Board 01273 290569 [email protected]

Voting Members: Cllrs Daniel Yates (Chair), Karen Barford, Dawn Barnett, Dick Page and Nick Taylor; Dr David Supple, Adam Doyle, Lola Banjoko, Malcolm Dennett, and Dr Manas Sikdar (Brighton & Hove Clinical Commissioning Group). Non-Voting Members: Geoff Raw, Chief Executive; Rob Persey, Statutory Director of Adult Social Care; Pinaki Ghoshal, Statutory Director of Children’s Services; Alistair Hill, Acting Director of Public Health; Cllr Caroline Penn (BHCC); Graham Bartlett (Brighton & Hove Safeguarding Adults Board); Chris Robson (Local Safeguarding Children Board) Pennie Ford (NHS England); and David Liley (Brighton & Hove Healthwatch).

This Agenda and all accompanying reports are printed on recycled paper

Date of Publication - Monday, 26 February 2018

mailto:[email protected]

AGENDA

Formal matters of procedure

This short formal part of the meeting is a statutory requirement of the Board

Page

53 DECLARATIONS OF SUBSTITUTES AND INTERESTS AND EXCLUSIONS

The Chair of the Board will formally ask if anyone is attending to represent another member, and if anyone has a personal and/or financial interest in anything being discussed at the meeting. The Board will then consider whether any of the discussions to be held need to be in private.

54 MINUTES 1 - 10

The Board will review the minutes of the last meeting held on the 30 January 2018, decide whether these are accurate and if so agree them.

55 CHAIR'S COMMUNICATIONS

The Chair of the Board will start the meeting with a short update on recent developments on health and wellbeing.

56 FORMAL PUBLIC INVOLVEMENT

This is the part of the meeting when members of the public can formally ask questions of the Board or present a petition. These need to be notified to the Board by 12 noon 28 February 2018. Contact the Secretary to the Board: [email protected]

57 FORMAL MEMBER INVOLVEMENT

THE MAIN AGENDA

58 MOVING TOWARDS INTEGRATION 11 - 32

Contact: Rob Persey Chris Clark

Ward Affected: All Wards


59 BETTER CARE PLAN 33 - 40

Contact: Chris Clark Rob Persey

Ward Affected: All Wards

60 BIG HEALTH & CARE CONVERSATION 41 - 70

Contact: Jane Lodge Ward Affected: All Wards

61 ADOLESCENT HEALTH OFFER 71 - 88

Contact: Kerry Clarke Tel: 01273 295491 Ward Affected: All Wards

62 PHARMACEUTICAL NEEDS ASSESSMENT: FINAL REPORT AND THE PROCESS FOR FUTURE SUPPLEMENTARY STATEMENTS

89 - 236

Contact: Nicola Rosenberg Tel: 01273 574809 Ward Affected: All Wards

WEBCASTING NOTICE This meeting may be filmed for live or subsequent broadcast via the Council’s website. At the start of the meeting the Chair will confirm if all or part of the meeting is being filmed. You should be aware that the Council is a Data Controller under the Data Protection Act 1998. Data collected during this web cast will be retained in accordance with the Council’s published policy (Guidance for Employees’ on the BHCC website). Agendas and minutes are published on the council’s website www.brighton-hove.gov.uk. Agendas are available to view five working days prior to the meeting date. Electronic agendas can also be accessed through our meetings app available through www.moderngov.co.uk For further details and general enquiries about this meeting contact Democratic Services, 01273 2905696 or email [email protected]

http://www.moderngov.co.uk/


Fire / Emergency Evacuation Procedure

If the fire alarm sounds continuously, or if you are instructed to do so, you must leave the building by the nearest available exit. You will be directed to the nearest exit by council staff. It is vital that you follow their instructions:

You should proceed calmly; do not run and do not use the lifts;

Do not stop to collect personal belongings;

Once you are outside, please do not wait immediately next to the building, but move some distance away and await further instructions; and

Do not re-enter the building until told that it is safe to do so.

Public Involvement The Health & Wellbeing Board actively welcomes members of the public and the press to attend its meetings and holds as many of its meetings as possible in public. If you wish to attend and have a mobility impairment or medical condition or medical condition that may require you to receive assisted escape in the event of a fire or other emergency, please contact the Democratic Services Team (Tel: 01273 291066) in advance of the meeting. Measures may then be put into place to enable your attendance and to ensure your safe evacuation from the building.

Hove Town Hall has facilities for people with mobility impairments including a lift and wheelchair accessible WCs. However in the event of an emergency use of the lift is restricted for health and safety reasons please refer to the Access Notice in the agenda below.

T

An infrared system operates to enhance sound for anyone wearing using a receiver which are available for use during the meeting. If you require any further information or assistance, please contact the receptionist on arrival.

1. Procedural Business

(a) Declaration of Substitutes: Where Members of the Board are unable to attend a meeting, a designated substitute for that Member may attend, speak and vote in their place for that meeting.

(b) Declarations of Interest:

(a) Disclosable pecuniary interests (b) Any other interests required to be registered under the local code; (c) Any other general interest as a result of which a decision on the matter

might reasonably be regarded as affecting you or a partner more than a majority of other people or businesses in the ward/s affected by the decision.

In each case, you need to declare (i) the item on the agenda the interest relates to; (ii) the nature of the interest; and (iii) whether it is a disclosable pecuniary interest or some other interest.

If unsure, Members of the Board should seek advice from the Lawyer or Secretary preferably before the meeting.

(c) Exclusion of Press and Public: The Board will consider whether, in view of the nature of the business to be transacted, or the nature of the proceedings, that the press and public should be excluded from the meeting when any of the items are under consideration.

NOTE: Any item appearing in Part Two of the Agenda states in its heading the

category under which the information disclosed in the report is exempt from disclosure and therefore not available to the public.

A list and description of the exempt categories is available from the Secretary to the Board.

BRIGHTON & HOVE CITY COUNCIL

HEALTH & WELLBEING BOARD

4.00pm 30 JANUARY 2018

COUNCIL CHAMBER, HOVE TOWN HALL

MINUTES

Present: Brighton & Hove City Council; Councillor Yates (Chair) Barford, Page (Group Spokesperson) and Barnett, Brighton & Hove Clinical Commissioning Group; Dr David Supple, Lola Banjoko, Dr Manas Sikdar and Malcolm Dennett Other Members present: Graham Bartlett, Safeguarding Adults Board; Chris Robson, Local Safeguarding Children Board; Pinaki Ghoshal, Statutory Director of Children’s Services; Rob Persey, Statutory Director for Adult Care; Alistair Hill, Acting Director of Public Health; David Liley, Healthwatch Apologies: Councillor Penn, Councillor Taylor, Pennie Ford and Wendy Carberry

PART ONE

43 DECLARATIONS OF SUBSTITUTES AND INTERESTS AND EXCLUSIONS 43.1 Councillor Janio declared that he was in attendance as a substitute for Councillor

Taylor. 44 MINUTES 44.1 Resolved: The minutes were agreed as a correct record of the previous meeting 45 CHAIR'S COMMUNICATIONS 45.1 The Chair stated:

“Update from the last meeting – Big Health & Care Conversation

“At the last Board a query regarding how Children and Young People were engaged with the Big Health & care Conversation. I am grateful to the CCG for preparing a full briefing which is available here: https://present.brighton-hove.gov.uk/Published/C00000826/M00006665/$$Supp29440dDocPackPublic.pdf

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https://present.brighton-hove.gov.uk/Published/C00000826/M00006665/$$Supp29440dDocPackPublic.pdf

https://present.brighton-hove.gov.uk/Published/C00000826/M00006665/$$Supp29440dDocPackPublic.pdf

HEALTH & WELLBEING BOARD 30 JANUARY 2018

Dance Active

Brighton & Hove Dance Active 2017 took place on December 9th at The Brighton Centre (Syndicate Wing) featuring 23 targeted community dance groups from across the city. I believe that there are slides being shown now which highlight some of the activities. This unique inclusive and intergenerational project is now in its sixth year and included:

o 10 children’s groups from the Active for Life communities

o 19% of dancers were disabled

o 45% were under 16 and 55% over 16

o 18% were over 50

o Female participants constituted 82% of those involved linking to the Sport England #THIS

GIRL CAN campaign

o Minimal cost of £1800 which largely paid for venue hire (staffing excluded)

Active for Life deliver a range of initiatives to support targeted groups to access dance opportunities. Dance Active and TAKEPART provide a framework for local dance enthusiasts to work towards key city events across the year. In addition we deliver: Active Forever Moves: Older peoples settings and supported by members of Three Score Dance Company; a group of dancers aged 60+. Young Dancers Collective: In partnership with locally/nationally acclaimed dance artist Ceyda Tanc to deliver two targeted groups for young people to access low cost contemporary dance. Inclusive Dance: The team have commissioned two inclusive groups to prepare work for events: Rounded Rhythm (young people with significant learning disabilities) and Grace Eyre Foundation (adults). Contact: [email protected]

Sussex Partnership NHS Foundation Trust I’m delighted to let you know the Care Quality Commission (CQC) has rated Sussex Partnership ‘good’ following their most recent inspection of our services last Autumn, and ‘outstanding’ in the caring domain. Sussex Community NHS Foundation has also now been rated ‘good’ as well. BCF – letter of approval has arrived As the Board is aware we have been going through the process of submitting our Better Care Plan for approval. We initially received confirmation that the Plan had been approved with conditions. Staff across the CCG and council have worked hard on resolving the outstanding issues and I can confirm that we have received confirmation that following the regional assurance process we are now fully approved.

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Weight management contract Public Health have successfully commissioned a new Tier 2 community weight management service that will commence on 1st April 2018

Following a robust tendering process which took into account a wide range of factors, including projected outcomes, costs per participant / family, and social value, the provider Beezee Bodies scored most highly at all stages of the process and has been awarded the contract to provide the service in Brighton & Hove for the next three years. BeeZee Bodies runs a wide range of programmes tailor-made both for individuals and families to help people make small changes that make a big difference. Their holistic approach emphasises an understanding of the links between diet, exercise and physical and mental health. The previous contract holders the Food Partnership and their partners Albion in the Community have done a lot of great work with Public Health on weight management in recent years. Public Health value the Partnership very highly, and look forward to continuing the excellent joint work on a broad range of issues including food poverty, food growing, community cookery, older people’s health, volunteering, food waste and the city-wide food strategy.

Public Consultation on Over the Counter drugs NHS England has launched a public consultation on proposals to rein in prescriptions for some ‘over the counter’ products such as dandruff shampoo and drops for tired eyes, in order to free-up funding to expand other treatments for major conditions such as cancer and mental health problems.

There will be a link in the minutes which will lead you to consultation should you wish to be involved.

https://www.england.nhs.uk/2017/12/nhs-england-consults-on-freeing-up-136-million-to-boost-frontline-nhs-care-by-curbing-prescription-costs/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+NHSCBoard+%28NHS+England%29 Duncan Selbie visit and response

On 8 January Duncan Selbie, the Chief Executive of Public Health England , visited Brighton & Hove and met with a range of people from the council and CCG.

The meeting was an opportunity to showcase some of the work we have undertaken including the work on Sugar Smart as well as highlight some of the challenges we face as a city

We have received a very detailed note of thanks. “

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https://www.england.nhs.uk/2017/12/nhs-england-consults-on-freeing-up-136-million-to-boost-frontline-nhs-care-by-curbing-prescription-costs/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+NHSCBoard+%28NHS+England%29





46 FORMAL PUBLIC INVOLVEMENT 46.1 The Chair noted that Mr Thomas had submitted a question to the committee. Mr Dean

asked the question on Mr Thomas’s behalf: “Brighton and Hove City Council have two current contracts with St Mungo’s:

1. “Rough Sleepers Outreach Service” that expires 31.3.18 at a value of £975,000.00

2. “St Mungo’s Housing First” that expires 3.3.19 at a value of £365,700.00 In light of their involvement in the deportation of EU nationals purely due to them being homeless, the absence of trust in St Mungo’s by rough sleepers in our city, and their reported failure to meet contractual obligations can we have an assurance that no new contract will be issued without proper due diligence.”

46.2 The Chair responded: “Thank you for your question

The council currently does have contracts with St Mungo’s. These are for the delivery of outreach services to homeless and rough sleepers in the city. The contracts went through due diligent and transparent procurement processes in accordance with the Public Contracts Regulations and the Council’s internal Contract Standing Orders. The contract has robust performance information within the contract and this is monitored. We can confirm that the contract is performing well and St Mungo’s, along with the other services in our city are meeting the increased demand for their services.”

46.3 Mr Deans asked a supplementary question:

“Will the Committee also ensure that charities, community based groups and professionals are involved in ensuring any new contract meets the needs of those it is supposed to serve and contains obligations that are meaningful and realistic?”

46.4 The Chair responded:

“All contacts have performance requirements which are focused on ensuring delivery of the commissioned service. Any contract that does not meet these expectations is open to contractual review.”

46.5 The Chair clarified that the question had been referred by the Housing & New Homes Committee to the Health and Wellbeing Board as the contracts were awarded by Adult Social Care.

45.6 Councillor Page stated that he expected most of the Board would agree that the most vulnerable individuals in the city should not be subjected to heavy handed treatment.

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47 FORMAL MEMBER INVOLVEMENT 47.1 The was none. 48 PROPOSED FEE INCREASE FOR ADULT SOCIAL CARE PROVIDERS 2018/19 48.1 Officers introduced the report which set out the recommended increase in fees paid to

adult social care providers from April 2018. 48.2 The Chair stated that he had received a representation from Mr Graham Dean on behalf

of the East Sussex, Brighton & Hove Registered Care Home Association:

“The East Sussex, Brighton & Hove Registered Care Association (RCA) feel that the proposed increase of 2.68% to the set fee is inadequate. The RCA has requested that the increase should be 3.95% to £578 per week. This takes into account CPI inflation, the National Living Wage increase to £7.83 per hour from April 2018 and the increased employer contribution from 1% to 2% from April 2018 for pension auto-enrolment.

This increase represents no more than to match inflation and whilst we do appreciate the City Council’s financial difficulties it is important that this minimum uplift be agreed. Particularly to maintain the profitability of care homes that rely mostly upon placements from Brighton & Hove City Council.

Laing and Buisson regularly update their benchmark fee rates and the lowest figure for frail elderly 2017/18 is £609 per week. This floor figure represents older converted buildings. The Laing and Buisson floor figure for dementia is £652 per week.”

48.3 The Executive Director, Health and Adult Social Care responded to the representation

from East Sussex, Brighton & Hove Registered Care Home Association:

“As you may be aware I have met with the Care Homes Association and other stakeholder on a number of occasions. This is part of our regular engagement with key stakeholders where we discuss a range of issues including: Opportunities for market development The support and training we provide to the Care Homes at no costs to support a quality offer for residents.

They will be also part of the Market Position Statement as we work in assessing the future needs for residents in this key area.

The Head of Commissioning has discussed with all stakeholders the recommendation in the fees report and whilst understandably they would like more, our rationale was explained and accepted. Whilst a significant percentage of our spend they are only one provider and suggesting a blanket increase of 3.95% would undermine our position elsewhere in the market. . In 16/17 the Council uplifted fee rates significantly and we compare very favourably with our neighbours. Please note this comparison does not include the additional support and training we provide which CQC have been very complimentary of and is not provided universally elsewhere.”

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48.4 Councillor Page stated that the care home market was fragile and that the short term gain of offering a fee increase under the 3.95% increase recommended by Laing and Buisson may be outweighed by the risk to the market. Councillor Page also stated that if there was an ambition to require the care home staff are paid the Brighton & Hove Living Wage care homes fees may have to increase.

48.5 Councillor Barford stated that the RCA were valued partners in the city and were

currently working with the council and other partners to produce a market position statement. However without additional funding the council would not be able to increase fees by 3.95%. Councillor Barford also stated that the fees did not include all the additional support offered to care homes.

48.6 Dr Sikdar stated that two of the greatest costs to the health system were non-elective

treatments and delayed transfers and asked if officers had investigated any link between investment in care homes and a reduction in these costs.

48.7 Officers responded that it was a priority to examine this as part of the Caring Together

programme. 48.8 Resolved: 1) That the Health & Wellbeing Board approved the fee increases as set out in table 1 in

section 3. 49 ANNUAL REVIEW OF ADULT SOCIAL CARE CHARGING POLICY 2018 49.1 Officers presented the report and stated that if agreed the increased charges would be

applied from 9 April 2018. 49.2 In response to Councillor Janio, Officers stated that there was no fixed price charged for

home care as it depended on the external provider. These providers generally charged the council around £17.56/ hour for the services.

49.3 Councillor Page stated that he was surprised that the annual income from in house

services was still around £1,000,000. 49.4 Officers responded that this figure was falling as services have closed. 49.5 Resolved: 1) That the council continues with the current charging policies for non-residential care

services and residential care homes which comply with the requirements of Section 17 of the Care Act 2014. The full charging policy is attached at Appendix 1.

2) To the table of charges below with effect from 9th April 2018. These charges have been

uplifted by just over 3.5% and rounded up to the nearest whole number

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Maximum Charges 2017/18 2018/19

Means Tested Charges

In-house home care/support

£23 per hour £24 per hour

In –house day care £36 per hour £38 per hour

Residential Care £115.67 per night £120 per night

Fixed Rate Charges

Fixed Rate Transport £3.70 per return £3.90 per return

Fixed Meal Charge / Day Care

£4.50 per meal £4.70 per meal

3) To an increase in Carelink fees only for those with exclusive mobile phone access but

otherwise to retain the existing fees. (see para 4.10) Standard Carelink Plus Service £18.50 per month (no change) Enhanced Carelink Service £22.17 per month (no change) Exclusive Mobile Phone Service £22.17 increase to £24.50 per month.

4) To continue with the existing policy not to charge carers for any direct provision of

support to them. 5) To increase the one-off fee charged for setting up Deferred Payment Agreements for

property owners in residential care by 3.5% from £495 to £512 6) To increase the charge for arranging and contracting non-residential care for self-

funders by just over 3.5% (only for people with savings over £23,250). From £260 to £270 for the initial one-off set-up fee From £80 to £83 per year for annual review, administration and amendments

50 LOCAL SAFEGUARDING CHILDREN BOARD 50.1 Mr Robson introduced the annual report of the Local Safeguarding Children Board

2016/17. He stated that he was grateful to have taken over such a well-established board where the partnership between the CCG, council and police worked so well. Mr Robson stated that he hoped to bring the 2017/18 annual report to the Board earlier in 2018/19.

50.2 Mr Bartlett stated that there had been informal discussion around changing the format of

the annual report to not include the individual agency reports and publish them elsewhere. Mr Bartlett stated that it may be more productive to bring a work plan looking forward to the Board rather than focus on looking backwards as the annual report does.

50.3 The Chair stated that involvement of Sussex Police in the Health & Wellbeing Board

would be welcome and there was a standing invitation to the Police and Crime Commissioner.

50.4 The Executive Director, Children, Families and Learning responded to Councillor Janio

that the council worked with the CCG and Police to cross check data points across agencies some of which is currently done through the Local Safeguarding Children Board.

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50.5 Mr Robson responded to Councillor Janio that new legislation meant that it would be for the police, local authority and local CCG to decide safeguarding governance in the future. The Government was due to issue new guidance in April 2018 on safeguarding children.

50.6 Resolved: 1) Notes the report and supports the City Council in their contribution to keep children safe

from abuse and neglect. 2) Note LSCB achievements and challenges on page 8. 51 LOCAL SAFEGUARDING ADULTS BOARD 51.1 Mr Bartlett introduced the Annual Report of the Safeguarding Adults Board 2016/17. Key

themes had emerged around the Mental Capacity Act and homelessness. The report included the finds of a safeguarding adults review of the death of a homeless man in the city. There was a clear lack of understanding of Mental Capacity Assessments and when to use them as well as around advocacy. The Safeguarding Adults Board would be working to produce a pan-Sussex procedure around the Mental Capacity Act.

51.2 Councillor Barford stated that a key challenge to the Safeguarding Adults Board was

financial pressure. The Board needed to have the budget to allow it to respond to safeguarding issues as they arise as well as to provide training and carry out reviews. Councillor Barford stated that she was pleased that new support posts had been created to increase staff capacity.

51.3 Resolved: 1) That the Health & Wellbeing Board notes the report and supports the City Council in

their contribution to keep children safe from abuse and neglect. 2) That the Health & Wellbeing Board notes LSCB achievements and challenges on page

8. 52 LOCAL ACCOUNT AND DIRECTION OF TRAVEL UPDATE 52.1 Officers introduced the Adult Social Care Local Account 2017. The report included key

developments in 2016/17 and outlined future plans in a ‘we have/ we will’ format incorporating feedback from partner organisations across the city and patients. The report would be distributing to partners, available online, in libraries and potentially in GP surgeries. An easy to read version would also be produced by the end of March 2018.

52.2 Councillor Barford stated that the purpose of the report was not for the council to

publicise it achievements but to measure how much progress has been made against targets set in 2016. The report sought to recognise where targets had not been reached and to shape priorities going forward. Future reports would include contributions from Public Health and the CCG as well as Adult Social Care.

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52.3 Councillor Page stated that he was concerned that only 43% of Adult Social Care users had received as much contact as they would like. There were a large number of frail older people who were vulnerable to isolation and loneliness.

52.4 The Acting Director of Public Health responded that Issues of loneliness and engaging

hard to reach older people fell within the Ageing Well element of the Caring Together plan and the Board was due to consider a report on this in the coming months.

52.5 Resolved: 1) That the Board note and endorse the Adult Social Care Local Account 2017 2) That the Board use the information contained within the Local Account to support future

decision making A ITEM REFERRED FROM HOUSING & NEW HOMES COMMITTEE - HOUSING

FIRST 52A.1 Officers introduced the report and stated that Housing First was a new approach to

working with entrenched homeless individuals. Instead of moving from a hostel, to support accommodation to an independent tenancy individuals move straight into independent housing with a package of support.

52A.2 Officers responded to Dr Sikdar that if an individual did not want or was not able to

move straight into an independent tenancy the existing model would still be in place to support them.

52A.3 The Acting Director of Public Health welcomed an innovative, client centred approach

particularly with the evidence based process which would reduce the risks of implementing a new approach.

52A.4 Councillor Page stated that he agreed with the Acting Director of Public Health’s

sentiments and supported a future expansion of the scheme. Councillor Page also added that Housing First would reduce the long-term cost of homelessness to public services as a whole.

52A.4 Councillor Barford asked that future reports show how Housing First could be expanded

from the pilot programme. 52A.5 The Chief Executive, Brighton & Hove City Council stated that the Housing First

programme and more generally the balance between spending on prevention verses spending on immediate issues would be something the Board would have to tackle.

52A.6 Councillor Janio asked officers how Brighton & Hove would avoid a first mover

disadvantage from offering Housing First. An improved offer could lead to an increase in homelessness in the city.

52A.7 Officers responded that Eastbourne and Hastings as well as several London Boroughs

were all in the process of implementing Housing First.

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52A.8 Dr Sikdar stated that he had found that homelessness was often a barrier to health care and suggested that Housing First could potentially reduce health spending.

52A.9 The Chair stated that the challenge for officers was to work to show the financial

benefits of the programme and invited officer to bring future reports on Housing First directly to the Health & Wellbeing Board as it oversaw the Health & Adult Social Care budget.

52A.10Resolved: 1) The Health & Wellbeing Board considered the successes achieved by Housing First in

terms of wellbeing outcomes and overall cost-effectiveness, and explored the identification of resources in collaboration with the CCG in order to be able to contribute to its expansion in 2018/19.

The meeting concluded at 5.40pm

Signed

Chair

Dated this day of

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Item 58

Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Clinical Commissioning Group (CCG), the Local Safeguarding Board for Children and Adults and Healthwatch.

Title: Moving Towards Integration Date of Meeting:

6 March 2018

Report of: Executive Director, Health and Adult Social Care Brighton & Hove CCG

Contact: Rob Persey (Executive Director Health and Adult Social Care) Chris Clark (BHCCG)

Email: [email protected]

[email protected] Wards Affected:

All

FOR GENERAL RELEASE

Executive Summary This report outlines the work being undertaken to establish a golden thread establishing the vision for health and wellbeing in the city, proposing the process to prioritise objectives and setting out how the shadow year of working arrangements between the Council and Clinical Commissioning Group will support improved integrated health and social care delivery. The paper also confirms the piloting of a policy panel with a proposal to focus this upon the refresh of the Health & Wellbeing Strategy.

Glossary of Terms BHCC - Brighton and Hove City Council CCG - Clinical Commissioning Group HWB – Health & Wellbeing Board JSNA – Joint Strategic Needs Assesment BAME – Black and Minotiy Ehtnic HWBS – Health and Wellbeing Strategy HOSC – Health Overview & Scrutiny Committee

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1. Decisions, recommendations and any options

1.1 That the Board agrees the recommendation as set out below.

Agrees the approach set out in paragraph 2.1 of the report to refresh the Health and Wellbeing Strategy using the JSNA to determine priorities

Agrees the JSNA Forward Plan from April 2018 to March 2020, as set out in paragraph 2.2 of the report

Supports the approach to developing a joint commissioning programme in the shadow year of integration including budget management and governance processes as set out in paragraph 2.3 of the report

Notes the timelines to support the integration of health and social care as outlined in Appendix 1

Agrees that the HWB establishes a pilot policy panel

Agrees that using the prioritisation and scoping document, the pilot should focus on the Joint Health and Wellbeing Strategy for the city

Agrees that the pilot panel should report the outcomes of the work to the HWB by September 2018

Agrees that the pilot panel should also report back on the resources required to support a panel to enable a decision to be making on any future panels and the forward plan for such work.

2. Relevant information 2.1 With the intention of establishing fully integrated operational and

commissioning arrangements from 2019, the Council and CCG Governing Body have approved proposals to support shadow arrangements from April 2018. These papers were previously approved at PR&G committee and the aligned CCG Governing body in July and October 2017.

2.2 This paper presents the work being planned to support this shadow year with a particular focus upon establishing the future vision for health and wellbeing in the city and how the focus upon integrated health and social care commissioning and service delivery will support this.

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Health and Wellbeing Strategy (HWBS) 2.3 We will review and refresh our Joint Health and Wellbeing Strategy for 2019-

2030 to set out a clear vision for improving health and wellbeing and reducing health inequalities in Brighton & Hove. The strategy will identify the long term outcomes we want to achieve for our residents and the high level actions that will have the greatest impact. A key objective will be to improve healthy life expectancy (including reducing inequalities between different groups) to increase the time our residents spend in good health, identify how they can maintain their independence, and reduce demand on health and care services.

2.4 The strategy will be underpinned by robust evidence of the needs of our residents, as described in our Joint Strategic Needs Assessment, as well as evidence on ‘what works’ in improving health and wellbeing.

2.5 The approach taken will follow the lives our residents, focusing on the ‘four wells’: Start Well; Live Well; Age Well; Die Well. It will recognise that action will need to support individuals, to enable them to make changes to improve their health and wellbeing, but also that a place based approach, working with communities, is needed to create sustainable improvements in outcomes.

2.6 In addition to defining the high level outcomes that will underpin an integrated local health and care system, the strategy will reflect the wide range of factors that influence health and wellbeing, for example housing, employment, the environment and culture. It will describe how the goal of improving wellbeing will be mainstreamed within our plans, services and communities across the City.

Joint Strategic Needs Assessment (JSNA) plans for 2018-2020

2.7 Following a review in 2017 the Joint Strategic Needs Assessment is being

remodelled to ensure it continues to meet the needs of local decision makers, and provides a robust evidence base to underpin the Health and Wellbeing Strategy and local health and care integration.

2.8 The following programme is being taken forward:

A comprehensive annual executive summary to be published by

October 2018

A two year programme of four in-depth needs assessments as

described below

An ongoing programme of shorter topic summaries

Some agreed specific needs analyses e.g. to support mental health

service recommissioning later in 2018

13

Relaunch a redesigned JSNA later in 2018 under the banner of:

“Brighton & Hove Insight. People, Place, Living.”

2.9 Demand for in depth needs assessments as part of the JSNA process requires prioritisation. The City Needs Assessment Steering Group conducted a prioritisation process involving City Council directorates, the CCG, Healthwatch, Community Works, Sussex Police and the Universities. A call out for topics was made to local stakeholders. The group then assessed proposals against criteria including prevalence, impact, links to equalities, commissioning timeframes, and the extent of current knowledge on the topic. A list of the short list and outcome of the process is included in Appendix 2.

2.10 Agreement is sought from the Health and Wellbeing Board for the following four in-depth needs assessments be carried out between 2018 and 2020:

Year 1 (2018-19)

o Adults with multiple long term conditions (multiple morbidity)

o Adults with multiple and complex needs (including two or more of

the following: homelessness, substance abuse, contact with the

criminal justice system and mental ill health). To include a specific

focus on women.

Year 2 (2019-20) o The oral health needs of children and adults

o BAME children and young people including educational needs

Commissioning

2.11 The HWB Strategy and JSNA, as described above, will help to inform and prioritise the development of the joint commissioning intentions. During the shadow year, joint commissioning intentions will be scoped and developed building upon the examples of joint commissioning that already exist.

2.12 Closer alignment of commissioning functions both within the Council and with the CCG will be established to support the delivery of commissioning priorities, with a new structure being developed and tested through the shadow year.

2.13 Greater oversight of contractual arrangements across Health and Adult Social Care through the creation of a single contracts’ register will support the identification of opportunities for closer alignment of commissioning and contracting.

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2.14 A refresh of the Market Position Statement will be presented to the Board in November 2018. This updated version will take into consideration the refresh of the HWBS, JSNA and the joint commissioning intentions. The Market Position Statement (MPS) provides a useful tool for informing the market of future demand. It is also useful in providing information to support provider development and to ensure that organisations position themselves and their resources to meet future demand for services.

2.15 We will further develop our joint care matching / brokerage functionality to ensure that we manage the referrals of care packages with the provider markets in an integrated way ensuring joined up market management, value for money is achieved and robust processes are in place.

Financial Management

2.16 The Joint Finance and Performance Board will further develop the draft shadow accounts, identifying areas for pooled budget arrangements to support integrated working ensuring that the necessary governance arrangements are in place to support these. This will include but is not limited to the following areas:

Continuing Health Care

Learning Disability

Community Equipment

Community Short Term Services including Home First

Areas of joint commissioning including Mental Health and Advocacy Services

Performance Management 2.17 An Integrated Performance dashboard is being created to track progress and

outcomes of integrated working. This builds on the existing integrated Better Care metrics and includes metrics from the Caring Together Outcomes framework (incorporating key NHS, public health and social care indicator sets).

2.18 As many of the Integration metrics already exist within the Better Care set a merged Integration/Better Care dashboard is being created to avoid duplication. The dashboard will come to future HWB meetings as part of the quarterly Better Care update.

15

2.19 The Integrated Performance Dashboard is work in progress and will be taken to the Performance and Information Group meeting for HWB and HOSC Members to ensure the key performance indicators reflect their needs and the cities priorities. These high level indicators are intended to give a picture of how the health and care system is performing across the city to enable early intervention if required. They do not reflect the wealth of performance information that is collected by all agencies across health and care. Within Caring Together performance indicators are being developed to monitor delivery of individual Care programmes.

2.20 Brighton and Hove CCG and BHCC are currently recruiting a jointly funded Integrating Data Project Manager. Whole systems analysis using integrated data will aid understanding of demand across health and care and inform development, and evaluation, of new ways of working.

Governance Arrangements

2.21 During the shadow year of integration, revised governance will be developed to cover the future working arrangement. Both the CCG and Council will remain as separate entities. The Council will retain all its statutory duties and political oversight both in the shadow and subsequent years. This work will be reported back to Health and Wellbeing Board in the summer of 2018 for approval with a full proposal presented to full Council in December 2018 again for approval. It is planned that any new governance arrangements will be in place for April 2019.

Policy Panels 2.22 In order to support the development of the JHWB Strategy, it is proposed that

a policy panel is formed. This will enable Health & Wellbeing members (with others) to review and make recommendations to help shape and inform policy. Set out below are details on policy panels and how they can be used.

2.23 The Council constitution allows each committee to establish policy panels. As a committee of the Council, the Health & Wellbeing Board can established policy panels. Policy Panels are short term task and finish groups which look at an area in more detail and report back to the committee or board concerned.

2.24 The membership of the panel can vary but as a panel of the HWB it would be

open for the HWB to decide on the membership which can include external stakeholders but should avoid HOSC members to allow for decision making and scrutiny to continue to be separate processes.

16

How do they operate? 2.25 Firstly an area of work needs to be identified. A scoping and prioritisation

document is attached as Appendix 3 which provides some guidance on selection and also the work that needs to be done to enable potential panel members undertake the task. These are not scrutiny panels which have an evidence and inquisitorial nature. These are information gathering and recommending panels. Panels can meet in private or public but the focus should be on what setting will enable the panel to best operate and report back. It is proposed that one pilot panel is established. This will not only provide an example for review and critic but also clarification of the resources to support such a panel (or panels) in future.

3. Important considerations and implications

Legal: 3.1 The Health and Wellbeing Board continues to be the body with responsibility

for approving and publishing the Joint Health and Wellbeing Strategy and Joint Strategic Needs Assessment for the City. In addition, the Board has delegated authority to promote integration and joint working in health and social care services across the City in order to improve the health and wellbeing of the people of Brighton & Hove.

3.2 At this stage there are no specific legal implications arising from the proposals for joint working set out in the recommendations. However, the legal implications of any future governance arrangements that come back to the Board will need to be addressed at that stage. Lawyer consulted: Elizabeth Culbert Date: 06 February 2018

Finance:

3.3 There will be significant financial implications for all partners resulting for the proposals outlined in this paper. Where appropriate, budgets will be aligned during the shadow year commencing 1st April 2018 and there will be ongoing work to identify potential areas for pooling resources where this is deemed beneficial and desirable. Robust financial governance arrangements will have to be agreed within the partnership that will give flexibility to ensure optimum us of resources while allowing each organisation to maintain its statutory and constitutional financial obligations. There is a possibility that these proposals could expose the Council to financial risks. Further analysis of the budget areas to be aligned would need to be undertaken to ascertain the likelihood and level of these risks.

Finance Officer consulted: David Ellis Date: 05 February 2018

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Equalities:

3.3 This report provides an update to the integration of health and care services in Brighton & Hove. This is a significant piece of work which has been reported to the Board through regular updates under the standing agenda item of Brighton & Hove Caring Together. This report does not specify any service changes. Equality Impact Assessments will be developed in relation to individual commissioning processes or service change carried out as part of integration.

3.4 The Health and Wellbeing Strategy has the high level objective of reducing health inequalities between groups in the city. The outcomes and actions will developed from the JSNA data that includes assessment of the needs and assets of people who share a protected characteristic. The four planned in-depth needs assessments all have a specific or likely focus on people sharing a characteristic and findings will inform the commissioning defined in the report, as well as informing the Market Position Statement. The proposed policy panel also provides an opportunity for ongoing monitoring of the outcomes of planned actions on particular groups and to refine and refocus as needed. Equalities Officer consulted: Sarah Tighe-Ford Date: 23 February 2018

Supporting documents and information

Appendix1: Timetable Appendix 2: Outcome of prioritisation process conducted by City Needs Assessment Steering Group

Appendix 3: Criteria for prioritising policy panels and scoping document

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Appendix 1

Draft Health and Social Care Moving Towards Integration Programme Plan (High Level)

Target Date

Jan-18

Feb-18

Mar-18

Apr-18

May-18

Jun-18

Jul-18

Aug-18

Sep-18

Oct-18

Nov-18

Dec-18

Jan-19

Feb-19

Mar-19

Activity

Strategy and Needs Assessment Development

Health and Wellbeing Strategy Refresh 01/06/18

JSNA Executive Summary Produced 01/10/18

Develop four detailed needs assessments 01/03/20

Develop Governance

Governance Proposal 'Live year' Developed 31/05/18

Paper To scope governance timetable 28/02/18

Draft Governance paper to HSCIB pre consultation 22/03/18

Members consultation 31/05/18

Partner Consultation 31/05/18

Paper to HSCIB 21/06/18

Ongoing

19

Develop Governance (Cont.)

Proposal to - HWB 10/07/18

Proposal to - PR&G (July or October) 12/07/18

Proposal to - CCG Governing body TBC

Proposals to Council 13/12/18

Target For Any S75 Based Changes 31/09/18

Business Intelligence & Planning

Create a single shared picture of local need to inform discussion on the prioritisation of delivery (utilising the JSNA).

Link to other relevant strategies / initiatives (Accommodation strategy)

Investigate the potential to create a single Health and social Care Intelligence unit for B&H.

20

Commissioning

Develop joint Commissioning Intentions Nov'18

Prioritise and timetable what is to be delivered and create a delivery plan.(linked to CaTo). Nov'18

Develop an integrated contacts register. Mar'18

Develop Joint Market Position statement Nov'18

Develop Joint brokerage facility for sourcing beds, care etc Dec'18

Introduce common fees, charges and set rates for goods and services where applicable Jan'19

Identify opportunities for increased integrated commissioning and funding arrangements Apr'19

21

Performance

Agree Performance targets KPI’s to cover all areas of delivery.

Highlight the top ten indications that reflect progress with the integration agenda.

22

Appendix 2: Outcome of prioritisation process conducted by City Needs Assessment Steering

Group to agree in depth needs assessments for 2018/19 -2019/20

Proposal Proposer Score Outcome

A Women with

multiple complex

needs (and their

children)

Survivors

Network/RISE/Women’s Centre

120 Undertake needs

assessment Year 1

to fit Caring

Together timescales

B Adults with multiple

complex needs

Brighton Housing Trust 115

C Oral health (adults

and children)

BHCC (Public Health) 110 Undertake needs

assessment Year 2

in time for service

re-commission 2020

D BAME children and

young people

BME Young People’s Project 110 Undertake needs

assessment Year 2

E Adults with multiple

long- term

conditions

CCG/BHCC (Public Health) 110 Undertake needs

assessment Year 1

F Adult mental health BHCC (Public Health) 110 Undertake analysis

to inform

commissioning

G Mental health of

vulnerable/minority

groups

BHCC (Public Health) 110 Undertake analysis

to inform

commissioning

H Dual diagnosis BHCC (Public Health) 105

I SEN and disability in

the Early Years

BHCC (Family, Children,

Learning)

105

J Stress, anxiety,

depression

BHCC (Public Health) 100

K Nutrition and food

poverty

Brighton & Hove Food

Partnership

95

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L Fuel and food

poverty

CAB and Brighton & Hove Food

Partnership

95

M Pre-diabetes CCG 90

N Sensory disabilities

+ and mental health

(adults)

Action on Hearing Loss 90

O Adults with serious

mental illness

CCG 90

P Physical activity (all

ages)

BHCC (Public Health ) 85

Q LGBTQ LGBT Switchboard 85

R Prisoners’ families Sussex Prisoners’ Families 70

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Appendix 3: Draft Terms of Reference for Policy Panels

Introduction

These are skeleton Terms of Reference to help support the pilot Policy Panel.

The Health & Wellbeing Board will need to review these Terms of Reference for each proposed

Policy Panel and:

add the membership for that specific Panel - see scooping document attached

include the scoping document as a draft to be agreed at the first meeting

confirm the task and finish key dates and outline timetable.

It needs to be noted that Policy Panels are NOT scrutiny panels as they are part of the decision

making committee and not part of scrutiny. Policy Panels are meant to explore areas of Health &

Wellbeing Board interest and support the policy making as well as enable a wider membership to be

engaged in the process.

As Policy Panels are meant to be supporting decision making exclusions to the Policy Panels should

include those members that are part of scrutiny.

It has been suggested that the first Policy Panel should focus on the refreshed Joint Health &

Wellbeing Strategy. A scoping document has been included as part of the Board papers.

The operation of this Policy Panel will be revised and evaluated to help inform future activity.

Outline Terms of Reference for the Pilot Policy Panel

General Terms of Reference for all Panels These Policy Panels will be sub committees of the Health & Wellbeing Board and will form and operate with the agreement of the Health & Wellbeing Board. The Panel will operate following the councils overall constitution and within its code of conduct. Changes to the Terms of Reference for Panels are subject to agreement and amendment by the Health & Wellbeing Board. The Pilot Panel will be serviced by the Health & Wellbeing Board Manager, with minutes taken by Democratic Services. Other officers will attend as required. Policy Panels will meet as a task and finish group. Each Panel will set out and agree the outline of its meetings and reporting back to the Health & Wellbeing Board at its first meeting. Panels will normally run as the Panel wishes. Between meetings, the Chair of the Health & Wellbeing Board and Chair of the Panel will discuss the agendas for meetings in line with any recommendations or requests made by the Board and / Panel and with the needs of the Panel Lead Officer (Executive Director Rob Persey , Executive Director Pinaki Ghoshal , or CCG Managing Director Wendy Carberry dependent on topic) to put items forward for consideration. The Panel Chair will also be asked to check minutes before they are sent, but accuracy will be decided by the Panel.

25

. Membership The scoping document will outline skill areas required and the Panel membership is open to:

• Councillors unless they are members of Health Overview and Scrutiny • Health & Wellbeing Board members • Lay members and CCG members • HealthWatch • Chairs of Safeguarding Boards • Representatives from the wider health & wellbeing system within the city including VCS

partners Members may not represent the Panel outside of meetings unless they are specifically delegated to do so. The quorum will be set by each panel. The Pilot Panel will be held in private to allow learning. Subsequent meetings may be held as meetings in public if the Health & Wellbeing Board so agree. Voting Policy Panels should aim to agree any papers and / or recommendations through consensus. Should voting need to occur each Panel member shall have one vote. The Chairing of meetings The Panel will be chaired as decided by the Panel. The Chair ensures that the Panel functions properly, that there is full participation at meetings, all relevant matters are discussed and that effective decisions are made and carried out. The Chairing of the Panel will be agreed at the first meeting of the Panel. A Vice Chair will also be nominated. If the Chair is absent from a meeting, the Vice Chair will act as chair for all purposes. In the absence of both Chair and Vice Chair, the meeting shall decide who will act as Chair. Conflict of Interest A conflict of interest is any situation in which an individual’s personal and / or professional interests, or interests which they owe to another body, and those of the panel arise simultaneously or appear to clash. Conflicts of interest may come in a number of different forms: a) direct financial gain or benefit such as: • payment for services provided to the organisation; • the award of a contract to another organisation in which the member has an interest and from which they will receive a financial benefit; or • the employment the member within the organisation. b) indirect financial gain, such as employment by the organisation of a spouse or partner of a member, where their finances are interdependent.

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Disclosure of interest A Panel member, including the chair, with a vested interest in the matter to be discussed at a panel will declare it at the beginning of the topic, or when that interest becomes apparent. The Panel will decide how to proceed which will usually be that the individual takes no part in the discussion or decision on that matter. The Panel may instead: a) Ask the person to leave the meeting during the item b) Allow the person to stay and take part in the discussion but not to vote c) To allow the person to fully participate in the item, but only if the Panel can see no prospect of gain for the person d) Any other suitable decision as agreed by the Panel. Reporting The Policy Panel will report to the Health & Wellbeing Board through the normal processes. Interim reports may be requested by the Board. As Policy Panels are not decision making bodies in their own right their report will focus on recommendations which the Health & Wellbeing Board will consider in its decision making. Draft ToR BDH 22.02.2018

27

28

1


Policy Panels – DRAFT Scoping Paper

The following scoping panel has been developed to assist with the pre

agreement of establishing a policy panel for an area of work.

The intention is to work with potential policy panel members on

clarifying the issues, assessing value, type of policy panel and resources as

well as information required.

Title

Joint Health and Wellbeing Strategy

Wellbeing Framework

Summary of Issue

The Health & Wellbeing Strategy was agreed by the Health

& Wellbeing Board in December 2015. The strategy needs

to be refreshed.

Request originator


Lead officers

Executive Director Health & Adult Social Care, Rob

Persey, Executive Director Families, Children and Learning

Pinaki Ghoshal, Deputy Managing Director B& H CCG,

Chris Clark, Acting Director of Public Health, Alistair Hill.

Chair notified Health & Wellbeing Chair 6 March 2018

Relevant legislation/

summary of most

recent legislative

changes

The Health & Wellbeing Board has to have a Joint Health &

Wellbeing Strategy for the city. This is laid out in the

Health & Social Care Act 2012.

The City will be refreshing it current strategy and a

foundation block will be the development of the Wellbeing

Framework.

Policy context/

summary of most

recent policy

changes

It is proposed that the strategy will be structured around a

Wellbeing Framework that:

Is based around the life course: Start Well; Live

Well; Age Well; Die Well.

Can be used to identify actions for

o individuals - to support people to live long

and healthy and independent lives and

maintain their independence,

o community – working with groups and

neighbourhoods to strengthen health and

wellbeing

o place - ensuring our city enables residents

to be active and healthy

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2

Report back to

HWB

(date & link)

We have a draft timetable which will go to the Panel.

Ideally we would like to get a draft strategy to the July

HWB for final agreement in November 2018

Key issues

Identify key gaps in current strategy

provide a report on the progress made and acheivements

Focus

To ensure that we have a high level strategy that reflects

the City and its needs

Performance data

& information

sources

The strategy will be underpinned by robust evidence of the needs of our residents, as described in our Joint Strategic Needs Assessment, as well as evidence on ‘what works’ in improving health and wellbeing.

In addition to defining the high level outcomes that will underpin an integrated local health and care system, the strategy will reflect the wide range of factors that influence health and wellbeing, for example housing, employment and culture. It will describe how the goal of improving wellbeing will be mainstreamed within our plans, services and communities across the City.

Key partners

Community Works

HealthWatch

Chamber of Commerce

Possible outcomes

A refreshed high level Vision and Strategy

Timetable

it is proposed that there are 3 meetings: one in April, May

and June with the possibility of a further meeting after

feedback

30

3

Style of panel for

this topic:

desk top review/

Panel/workshop/

Panel and workshop approach is planned

Suggested

membership (HWB

and others)

Members of the HWB to be agreed

Ideally we would like to engage:

Community Works

HealthWatch

Chamber of Commerce

supporting officers from Public Health, Heads of

Community Safety & Community, Equalities and Third

Sector, CFL and ASC

31

32

Item 59


Title:

Better Care Plan Quarterly Report and Briefing

Date of Meeting:

6 March 2018

Report of:

Brighton & Hove CCG Executive Director, Health & Adult Social Care

Contact:

Chris Clark (BHCCG) Rob Persey (BHCC)

Email:

[email protected] [email protected]

Wards Affected:

All

FOR GENERAL RELEASE

Executive Summary This report provides the Health and Wellbeing Board with an update on the Better Care Plan for Brighton and Hove including a performance dashboard currently being developed to provide quarterly measures to demonstrate progress. The Better Care Plan is a national programme of integration aimed at investing a joint funded budget in integrated health and social care services. Brighton and Hove City Council and Brighton and Hove Clinical Commissioning Group have committed a £25m investment into the Better Care Plan, approved at a previous Health and Wellbeing Board (November 2017). The HWB Board authorised the Executive Director Health and Adult Social Care and the CCG Chief Operating Officer (or equivalent) to finalise and enter into a new Section 75 Partnership Agreement for the commissioning of health and social care services from the Brighton & Hove Better Care Fund for the period 2017-2019.

33



The Board requested an update on:

how the performance would be monitored

key timelines for reporting to the Board

the governance structure that would support the Better Care Plan. The BCF dashboard enclosed contains the metrics agreed by the BCF steering group, with the most recently validated data added. Amongst a number of measures, delayed transfers of care are shown to have reduced significantly in the last 12 months, which was one of the key objectives of the Better Care Plan.

Glossary of Terms BCP – Better Care Plan BCF – Better Care Fund NHSE – National Health Service England


1.1 That the Board note the progress and updates reported from the Better Care

Fund Steering Group

1.2 That the Board review the draft BCF Dashboard metrics for discussion and assurance of the Better Care Plan.

2. Relevant information

2.1 The Better Care Plan is over seen by a BCF Steering Group, joint chaired by

the CCG Director of Commissioning and the Councils Executive Director of Health & Adult Social Care. The membership includes social care commissioners, health commissioners and members of the local public health team. The BCF Steering Group is accountable to the HWB via the Integration Board.

2.2 The BCP requires regular report to NHSE. We have not been given the final

reporting dates for the 2018 – 2019 financial year. However the submission dates for the Q3 and Q4 period for 2017 – 2018 are:

Q3 - 19 January 2018 Q4 - 20 April 2018.

2.3 To prevent duplication of effort the HWB will receive the submitted

performance reports at the next Board. 2.4 The Brighton and Hove Better Care Plan incorporates a range of projects and

services which provide health and social care aimed at preventing unplanned admission to hospital, supporting frail people within the community, reducing delays in discharging people from hospital and preventing readmission.

34

2.5 In order to assess the efficacy and value for money it was agreed with the HWB that a dashboard of metrics should be developed and presented to the board on a quarterly basis. This report provides the first of these dashboards. A statutory quarterly assurance report is also submitted to NHS England, and it is intended that the two reporting processes will align moving forward.

2.6 The BCF Steering Group meets monthly. In addition to monitoring the agreed

metrics, new projects are also discussed for future investment through the Better Care Fund. Specific projects currently being developed for proposal are:

Increasing investment in social care prescribing to support patients with navigating to:

o community and voluntary sector services o seeking support and advice in accessing health and

social care .

Developing a new integrated team to case manage patients being discharged into care homes and community wards from hospital, in order to ensure every patient has a care plan to bring them home where appropriate.

2.7 The BCF Steering Group reports into the Joint Finance and Performance

Working Group, which also meets monthly, and reports into the Integration Board.

2.8 The Integration Board will provide reports to the Health & Wellbeing Board as

required. 2.9 The Board are reminded that the BCF programme has a specific remit around

preventing admission to hospital and reducing delays to discharge by effectively deploying initiatives in an integrated way between NHS and Local Authority agencies.

3 Important considerations and implications

3.1 Under the Health and Wellbeing Board there is a statutory duty to have an NHS England approved better care plan and an agreed section 75 agreement for a joint funding commitment between the CCG and Local Authority.

Legal: 3.2 The Governance arrangements in relation to the BCF S75 Partnership

Agreement include oversight by the Health and Wellbeing Board through quarterly performance reporting, and this report forms part of that process.

Lawyer consulted: Date: Elizabeth Culbert Date 26th February 2018

35

Finance: 3.3 The Better Care fund is a section 75 pooled budget which totals £25.350m for

2017/18, including £5.093m Improved Better Care funding (iBCF). The CCG contributes £18.276m to the pooled budget and the Council contributes £7.074m including the iBCF. Any spend variance at outturn is subject to a 50:50 risk share as per the section 75 agreement. We are in the process of setting the 2018/19 budget however there are timing issues due to the differing budget timetables between the Council and the CCG. The financial performance of the Better Care fund is regularly reported to the joint Health & Adult Social Care Finance and Performance Board.

Finance Officer consulted: Sophie Warburton Date: 14/02/2018

Equalities:

3.4 This report provides an update to the Better Care Plan report which came to the Board in November. As stated then Equality Impact Assessments will be developed in relation to individual commissioning processes carried out under the projects as they arise. An equalities impact assessment has not been completed on the running BCF programme within the last 12 months. This has been added to the 2018/19 BCF Steering Group work plan.

Equalities Officer consulted: Sarah Tighe-Ford Date: 23 February 2018 Sustainability:

3.5 All BCF funds come from recurrent funding resources and some projects

within the Better Care Plan are expected to deliver sustainable savings.

3.6 The City’s Public Health team are included in the membership of the BCF Steering Group and are therefore an instrumental part of developing BCF strategy and planning.


Appendix 1: Better Care Plan Dashboard Appendix 2: Governance Arrangements Items of note: Of the 10 core metrics agreed for the BCF dashboard, 8 are showing an improving trend, 1 is static and 1 has shown a deterioration. Members of the Health and Wellbeing Board are invited to review the BCF data and progress report for assurance.

36

DRAFT Better Care Performance Dashboard 2017_18 Q3 Delayed Transfer of Care Total Delayed Bed Days

Chart 1 - Source: NHS Statistics Data Total Delayed Days Brighton UA area

Delayed Transfer of Care Reasons for Delay

Chart 2 - Source: NHS Statistics Data Delay Reasons December 2017 Brighton UA

0

200

400

600

800

1000

1200

1400

1600

1800

2017/18

2016/17

37

38

Appendix 2 – Better Care Fund Governance Arrangements

Heal

Health and Wellbeing

Board

Health and Wellbeing

Pre meeting – forward

agenda agreement

Health and Social Care

Integration Board

(Joint Officer Board)

Joint Commissioning

Steering Group

Joint Finance and

Performance Board

Better Care Fund

Steering Group

39

40

Item 60


Title:

Big Health and Care Conversation

Date of Meeting:

6 March 2018

Report of:

Brighton & Hove CCG Executive Director, Health & Adult Social Care

Contact:

Jane Lodge, Head of Engagement, Central Sussex Commissioning Alliance

Email: [email protected] Wards Affected:

All

FOR GENERAL RELEASE

Executive Summary The “Big Health and Care Conversation” was a joint CCG and Adult Social Care engagement exercise, held from July to December 2017. The “Big Conversation” focussed largely on local plans, but there were also opportunities to discuss health and care issues across the wider STP footprint, and the development of the STP itself. During the period of the Big Conversation, over 2,700 conversations were held about health and care issues that are important to the residents of the city. This report summarises the feedback provided, actions that have been taken or will be taken, and where issues cannot be addressed.

Glossary of Terms CCG: NHS Brighton and Hove Clinical Commissioning Group STP: Sustainability and Transformation Partnership (relating to the Sussex and East Surrey STP) CVS – Community and Voluntary Sector

41


1. Decisions, recommendations and any options That the Health and Wellbeing Board:

1.1 Notes the feedback and associated actions outlined in the report

1.2 Endorse the proposed approach for the Council and the CCG to refer to and reflect the findings in this report when they plan, commission and re tender services


2.1 The CCG and Local Authority have legal duties to engage with service users, carers and local residents in the planning and commissioning of services.

2.2 There are also related duties under the Equality Act 2010 (Public Sector

Equality Duty), which require engagement with protected characteristic groups and communities.

2.3 The Big Health and Care Conversation was initiated as a concentrated period

of engagement with “the public”, specifically aligned with key areas in the Caring Together Programme, and incorporating opportunities for discussion on the development of the STP.

2.4 The Big Conversation included targeted engagement with key equalities

groups and communities in the city, in addition to wider conversations with service users, carers and the public.

2.5 Over the period of the Big Conversation, over 2,700 conversations took place

with over 2,300 people; it should be noted that many of the conversations took place with people who represented wider groups, therefore the reach was wider in reality than these figures suggest.

2.6 Engagement was largely carried out by CCG and Adult Social Care staff;

however, local Community Researchers reached 83 people from BAME communities and young people. In addition, a discrete workshop and survey on “The Future of the NHS” was led by the CVS group Right Here, where the views of over 200 young people were gathered.

2.7 The feedback from these conversations was collated by themed “Talking

Points” and commissioners were asked to respond to indicate:

“We have” – where work is already progressing

“We will” - where work will be carried out

“We cannot” – where it is not feasible to progress (for example, where the issue related to a national level lead)

All feedback is aligned with Caring Together Care Programmes, and will be incorporated into plans as appropriate.

42

2.8 A further analysis of progress will be carried out in September 2018 to review progress against the “we have” and “we will” areas, which will be reported on.


Legal: 3.1 There are no legal implications arising from the recommendations in the

report.

Lawyer consulted: Elizabeth Culbert Date:08.02.17 Finance: 3.2 There are no financial implications as a direct result of the recommendations

of this report. However future commissioning decisions will have an impact on Council funding and may expose the council to financial risks.

Finance Officer consulted: David Ellis Date:12.02.2018

Equalities: 3.3 The intention to engage with and reflect the views of a wide range of residents

has been built into the ‘Conversation’ process from the start. The use and analysis of data and engagement will help ensure that funding is spent on healthcare that best meets the needs of the local population. Community researchers were recruited and trained specifically to increase opportunities for people from specific groups to engage. Barriers and concerns for people who share a protected characteristic are identified throughout this report and actions responding to them have been noted. These include targeted provision, accessible information, work with focused CVS groups and diversifying the workforce. If either the CCG or Council were going to make any significant / substantive changes the relevant party would have to decide if this required formal consultation. The Big Health & Care Conversation is not formal consultation in but engagement.

Equalities Officer consulted: Sarah Tighe-Ford Date: 7.02.2018

Health, social care, children’s services and public health:

3.4 The Big Health and Care Conversation sought feedback on areas related to

health and care.


Appendix 1: Big Health and Care Conversation Final Report

43

44

The Big Health and Care ConversationImproving health and care for our city

45

Introductions from leaders across the health and social care system

As a local GP, I know about the value of hearing from people who use local health services; as the CCG’s Clinical Chair I was delighted at this period of targeted engagement, and the opportunities it would bring to build on our existing excellent engagement work with local people.

We have gathered a huge amount of high quality feedback and ideas for change and improvement, and these will now be incorporated into our work, whether in the short term or long term.

I am encouraged to see how we are already responding to some of the points raised and I feel that the Big Health and Care Conversation will help shape our work and services in the future. We will of course continue to seek the views of people using our services, and their carers, and ensure that all of our plans for transformation across health and care have the views of those who use them at the centre.

I look forward to taking these plans forward, and hope that we will get to wear our “Big Health and Care Conversation” t-shirt again.

Dr David Supple Clinical Chair

NHS Brighton and Hove Clinical Commissioning Group

Lifestyle choices, an ageing population, increasing demand and continual developments in treatment are some of the significant changes we need to address and take account of, no less so in Brighton and Hove than anywhere else. The Big Health and Care Conversation has enabled the City Council, Clinical Commissioning Group, Healthwatch and key Voluntary and Community Sector organisations to engage with a broad range of organisations and individuals to inform the future priorities and design of health and care services in the city.

We have listened to peoples feedback across really important areas such as public health promotion, access to services in the community and what you want from your local hospital and you will see these coming through more and more in a range of actions under the Caring Together programme and related initiatives.

As we implement our plans to more closely integrate health and social care to improve your access to information and services we will look to build upon the positive experience of the Big Health and Care Conversation. By maintaining an ongoing dialogue we can ensure the voice of the patient, service user, carer or family/friend will continue to help shape our actions.

Rob PerseyExecutive Director Health and Adult Social Care

Brighton & Hove City Council

2 Caring Together Improving health and care for our city

Introductions from leaders across the health and social care system 3

Welcome to the Brighton and Hove Big Health & Care Conversation 4

Big talking point 1: How can we help you to stay healthy? 8

Big talking point 2: How can we make better use of medicines? 12

Big talking point 3: How can we prevent people ending up in A&E? 15

Big talking point 4: How can we improve care when you are referred by your GP? 19

Big talking point 5: How can we make sure mental health is treated equally? 23

Big talking point 6: How can we support people to stay out of hospital? 29

Big talking point 7: How can we make it easier to see you GP when you need to? 33

Big talking point 8: How can we give children and families a better start in life? 38

Big talking point 9: The Sustainability and Transformation Partnership (STP) 42

Media Coverage of the Big Health and Care Conversation 46

Our Engagement 47

Contents

2 3Caring Together Improving health and care for our city

Introduction

46

Welcome to the Brighton and Hove Big Health & Care Conversation

Over six months in 2017, Brighton and Hove residents helped to shape health and social care for the city by sharing their feedback, and experiences on local services in the Big Health and Care Conversation. We had nearly 2,800 conversations with people from across the city, and collected a rich and diverse range of comments, views, experiences and suggestions for change.

NHS Brighton and Hove Clinical Commissioning Group (CCG) and Brighton and Hove City Council initiated the Big Health and Care Conversation to obtain the views and experiences of as many local people as possible about what matters most to them in health and care, in order to shape and transform services in the future and contribute to the development of our ‘Caring Together’ programme.

The CCG, council colleagues from Public Health and Adult Social Care teams, partners from the Voluntary and Community Sector, and Brighton and Hove Healthwatch carried out engagement between June and December 2017.

Different audiences were identified and targeted with the aim of reaching not only a large number of local people, but also a wide ranging demographic.

A number of different communication and engagement approaches and channels were used, including events, small groups, one to one conversations, and online surveying. The key themes emphasised in all approaches were openness and transparency, and a willingness to hear and learn from what people told us. The Big Conversation encouraged the public to be active participants, rather than spectators or recipients.

The feedback has been being captured and collated from each engagement activity that took place and this is being used to shape the projects within our wider Caring Together programme which details our local plans for health and care.

We had more than 2,750 different conversations with over 2,300 local people about their health and care services; it should be noted that the number of people reached for each engagement activity detailed in this report describes the actual number of people who attended or gave their views. Many of these people represent others in the community and, therefore, the reach will in reality be significantly larger than the numbers indicated.

What is Caring Together?

Caring Together is a programme that builds on work that is already underway in Brighton and Hove to improve local health and social care for people living in our city.

It involves looking at the health and care needs of everyone in the city and sets out how we can improve and transform services for adults and children, physical and mental health, social care, public health, GP services, pharmacies, voluntary and community sector and hospital services. It is led by NHS Brighton and Hove Clinical Commissioning Group (CCG) and Brighton & Hove City Council, alongside local hospital, and community and mental health services. We are working in partnership with Brighton and Hove Healthwatch and representatives from the local Voluntary and Community sector. Caring Together supports the wider aims to transform health and care services across Sussex and will help us respond to the rising demand on services with the resources we have available to deliver the best possible care and outcomes.

Why do we need Caring Together?

The local NHS and City Council have worked together for many years to provide services that matter to people in a number of areas, including mental health and children and young people’s services. You may have heard of some of this work under different names, such as the ‘Better Care Plan’ and ‘Brighton Rock’. However, there has never been one single programme of joint-work between the organisations that covers all health and care services in the city.

Caring Together builds on the many examples of joint working and planning already underway in Brighton and Hove and sets out a clear way of working that is easily identifiable to people in our city.

By working in this way we can transform how we provide health and social care for residents to better meet their needs and address some of the challenges that we are currently facing.

What did we hear from local people?

This report gives an overview of the engagement that has taken place, summarises the key themes from the feedback collected and highlights any actions that have already been taken from that feedback. It covers the period from June to December 2017.

We have shared this information with commissioners, clinicians and service providers in The CCG and in Adult Social Care and Public Health, and have included their responses to the feedback. We can implement some of the suggestions and feedback fairly quickly, other suggestions may take longer to implement and will help to shape services in the long term. If there are any suggestions that we cannot take forward, we have included this in the report.

Wider Engagement Work

In addition to our direct engagement, we have been working with local Voluntary and Community sector (VCS) organisations to take the Big Conversation further into communities, in order to reach people that we might not usually get to speak to.

The Community Researchers Project worked with trained community researchers from communities who may not otherwise be heard. Five organisations worked in partnership to reach a total of 83 people from different communities, including older people, Black, Asian and Minority Ethnic communities, and young people. You can find a summary of findings from the Community Researchers Project on The CCG’s website.

You and Your NHS: A Case Study is a report produced by Right Here (a YMCA Downslink project). Right Here worked with the CCG to engage with local young people around our local plans to integrate health and social care. They also worked with the CCG to address some of the anxieties that young people felt about the wider health economy. You can find the report on The CCG’s website.


Welcome

47

https://www.brightonandhoveccg.nhs.uk/publications/plans-priorities-and-progress/plans/big-health-and-care-conversation

https://www.brightonandhoveccg.nhs.uk/publications/plans-priorities-and-progress/plans/big-health-and-care-conversation

How did we speak to people? What did we talk about?Of the 2761 conversations we had, these were the main talking points?

Thank you

We would like to thank all the residents of the city who shared their views and experiences with us. We are also grateful to our partners in the Voluntary and Community Sector and Brighton and Hove Healthwatch who supported the Big Health and Care Conversation and who continue to work with us collaboratively to ensure health and care services are responsive to local need.

Thank you also to the staff within the CCG and Brighton and Hove City Council who carried out much of this engagement work, and whose enthusiasm and focus ensured we heard from this wide range of local people.

Who did we speak to?Of the 2326 people we spoke to…

714 How can we make better use of medicines?

502 Sustainability and Transformation Partnership

418 How can we make it easier to see your GP when you need to?

310 How can we prevent people ending up in A&E?

249 How can we help you to stay healthy?

233 How can we support people to stay out of hospital?

148 How can we make sure mental health is treated equally?

127 How can we improve care when you are referred by your GP?

60 How can we give children and families a better start in life?

750

676

528

103

95

82

60

32

people reached through 9 Public outreach sessions

people reached through 10 Community-led Consultations

people reached through 11 Hosted Events

people reached through 5 Meetings

people reached through 9 Community Groups

people reached through Community Researchers

people reached through 2 Surveys

people reached through 3 Focus Groups

656

474

376

227

275

267

160

64

15

were under the age of 26

were over the age of 50

were Disabled People

told us they were Lesbian, Gay or Bisexual

were from Black and Minority Ethnic backgrounds

told us they had a Faith

were Carers

were Trans or Non-Binary

were Homeless or insecurely housed


Welcome

48

Big talking point 1:How can we help you to stay healthy?

Information and Communication

What did you tell us?

• You would like more trustworthy information on prevention, self-management and support. This includes online resources such as the My Life directory and It’s Local Actually, as well as local campaigns.

• You would like more to be done around educating children at a young age about active living and healthy lifestyles.

What are we doing?

We have expanded the information available on My Life on prevention and services and community groups that can provide support. We will continue to review this information and add to it if needed.

We will continue to work with Public Health’s ’Active for Life’ team who run a range of programmes that support activity for children and young people, including ‘Active Travel’.

We have commissioned a new weight management service in the city, which includes support for families and young people.

We support wellbeing programmes and campaigns in schools, and we will continue to review these programmes to ensure they respond to identified need.

Community


• Public spaces like parks are very important for keeping active and healthy. Healthwalks and other community services play a large role in supporting people to stay healthy and giving people confidence and motivation to live active lifestyles.

• You said more action needs to be taken to combat social isolation. Befriending schemes and care plans involving neighbours and carers were suggested.

• You said pharmacists can support health in the community

• You said we need to make sure that all people can access free community classes and services. Some people with language needs (including Deaf/ hard of hearing and people for whom English is not their first language) felt they had not been referred to support due to communication barriers.

• You said that local workplaces could do more to encourage exercise including walking groups, cycle storage and showers. You would like employers to have more support and guidance on healthy workplaces, including mental health and wellbeing.

What are we doing?

We have continued funding for befriending schemes across the city, recognising their importance in combating social isolation. We will continue to work with the Voluntary and Community Sector to support other initiatives that may help reduce isolation, such as older people’s activities, low cost shopping transport service and coffee mornings for parent carers.

We will continue to support the use of outside spaces for activities, such as challenge programmes and Park Run. We will continue to run Healthwalks, building on the success of initiatives such as the Soup and Stomp walk for families and the new relationship between Healthwalks and the Living Coast (Biosphere) initiative

We will continue to work with local organisations to conduct health and wellbeing surveys of their workforce, resulting in action plans for staff.

We are creating a Single Point of Contact for individuals and organisations to contact the Public Health Healthy Lifestyles Team. This will help support NHS Healthchecks carried out in the workplace.

We have secured funding for an Active Travel project, which involves working with businesses and encouraging them to up-date and/or develop action plans that support active and sustainable.

Diet / Exercise


• A key theme highlighted was the benefits of cycling – a lot of people said this was the main way they keep healthy.

• Local cyclists and would-be cyclists would like to see Brighton and Hove become a bike-friendly city, including more cycling paths and more places to lock bicycles.

• You said that targeted groups, like the “Cycling without Age” scheme is a really good one,

especially for residents of care/nursing homes and for people with dementia.

• You would like more affordable exercise classes in local parks as well as affordable access to and local leisure centres and pools.

• You would like more healthy food classes and ‘cooking for one’ classes, as well as better access to affordable nutritional food.

• You highlighted nutrition as a key part of keeping healthy and are concerned that it is difficult for insecurely housed people to access healthy food. You would also like more advice and support around healthy eating and nutrition for older people.

• You want us to use different approaches to meet the needs of diverse communities to ensure that all people can access support and advice around healthy living. This includes making sure community services are LGBTQ-friendly, dementia friendly, accessible in different languages and accessible for disabled people.

• You would also like to make sure there is support for vulnerable people to access community services.


How can we help you to stay healthy?

49

What are we doing?

We have schemes in place to support cycling, including match funding for organisations to support a move towards active travel (cycling/walking) and a partnership with Love to Ride.

The City Council’s transport department has secured funding for more active travel projects; this will include Employment focused Personalised Travel Planning, Access to Work, Access to Education, Encouraging Cycling and Road Safety, a bike share scheme and increased cycle parking. The projects are aimed at residents, visitors, employees and students.

We will use the feedback from the Big Health and Care Conversation in further considering the opportunities and resource implications of developing a wider plan that encompasses walking and cycling to support our approach and investment in active travel.

We provide a range of opportunities to help people be more physically active, including the Freedom Leisure card for those on low incomes, and our Active for Life community park events. We will review this provision and explore if there are any groups and communities in particular that cannot or do not access these activities.

We have worked with Age UK and the Food Partnership to produce a leaflet on healthy eating for older people, as a direct result of feedback from work with older people.

Our Public Health team commission various projects, such as a healthy weight service, plus advice through Healthy Living Pharmacies and Health Trainers. We will continue to work with these services, ensuring that information and advice on healthy eating is available as widely as possible. We will use mechanisms such as Patient Participation Groups to help promote these services.

We will work together to find out more about the needs of diverse communities and vulnerable people in relation to healthy living information, and will respond to these needs.

Self-Help and Social Prescribing


• You said that GPs are ‘too busy’ for prevention – but a lot of you would still like to access support around healthy living from your local surgery.

• You said that you would like GPs to have more education on self-management, in order to support patients.

• You said that you value the Health Trainer service and would like them to be more integrated with GP practices.

• You would like Community Navigation to be extended in the city. You would like patients to be able to self-refer and to have navigators in communities, like a “go to” person.

• You would like GPs, Community Navigators and Health Trainers to have more awareness of mental health and wellbeing.

What are we doing?

We will extend the existing Community Navigation (social prescribing) service to cover all GP surgeries in the city in early 2018. We will explore self-referral to Community Navigation later in 2018. We will explore the development of social prescribing in communities, through our Health Champion work.

We have trialled some different ways of working between Health Trainers and GP practices and we will evaluate these and roll out across the city if appropriate. We will continue to promote the Health Trainer service through Patient Participation Groups, to help support good links with GP practices, and will increase the links between the service and named staff in practices.

We will ensure that Community Navigators and Health Trainers have appropriate and up to date information on mental health services. We will build on the training received by Health Trainers in their induction to ensure their knowledge is current.

We will continue to ensure that GPs and other clinicians receive support and awareness on mental health services

and mental wellbeing. We are developing a Mental Health training programme for all Primary Care staff as part of the Serious Mental Illness locally commissioned service. Training has been delivered in all GP Cluster groups to Clinicians and reception staff during 2017 and, building on feedback from this, a new syllabus is being produced to start in April 2018.

Health Checks and Screening


• You would like more communication and information about NHS Health Checks available in places like GP Practices in order to improve uptake.

• You would like more work to be done to support patients to access sensitive health care, sexual health care and cervical screening, including transgender patients, sexual assault survivors and others who have experienced trauma.

What are we doing?

We publicise NHS Health Checks widely – for example through libraries and pharmacies. We will talk to GP practice managers about making information on Health Checks more visible within practices. We will arrange further NHS Health Check training for primary care practice staff.

We provide a fully integrated sexual health and contraception (SHAC) service with walk-in and booked appointments available 6 days each week from three sites across the City. SHAC also provides specialist sexual health clinics for transgender clients (Clinic T), men who have sex with men (Clinic M) and women (Clinic M) as well as a dedicated care pathway for sex workers.

We will continue to promote sexual health services through targeted communication channels. We will raise awareness of the availability of services among voluntary and community sector groups which support transgender clients, survivors of sexual violence and others who have experienced trauma. We will work with Brighton Oasis Project and other agencies and stakeholders who work with and support sex workers (including trans sex workers) to develop innovative and effective services (for example piloting the offer of on-line HIV home testing service).

We will publicise and promote the sexual health service Twitter and Facebook profiles in order to increase targeted health promotion for those at risk of sexual ill-health.

We will work to ensure that patients have relevant information on cervical screening and will explore what additional support may be needed.

Proportion of Themes

Information and Communication34%

Community11%

Diet / Exercise32%

LocalSuggestions

18%

Self-help and Social Prescribing

5%


How can we help you to stay healthy?

50

Big talking point 2:How can we make better use of medicines?

Access


• You said that pharmacies play a key role in support and advice for a variety of conditions and concerns. One way you would like to see this improved is improving access to pharmacies in the evenings.

• You have concerns that some over the counter medications may be taken off prescription, which might be a barrier for people on lower incomes.

• You would like us to make sure that all communications are accessible and easy to understand. We should make sure important information is available in community languages, easy-read and different formats.

What are we doing?

The CCG’s medication review pharmacists, who work in care and nursing homes and also do home visits to housebound people, use a variety of different resources and materials to improve patient’s access and understanding of their medicines.

We will develop an information leaflet about services available in community pharmacies. This will be finished in Spring 2018, and will then be translated into community languages and Easy Read. We will work with the Deaf/deafened communities to cascade information about the services available in community pharmacies. We will also look into doing a short BSL signed video, if feedback indicates this would be useful.

The city-wide “Pharmaceutical Needs Assessment” (PNA) is currently being finalised and includes analysis on the distribution and availability of pharmacies at evenings and weekends. We will ensure feedback from the Big Conversation is included in the PNA as appropriate, and look at provision of pharmacy opening times in the evening.

There is currently a national consultation on the supply of over the counter medication on prescription. We will continue to share this national consultation, so that local residents can share their concerns and feedback into the national guidelines. We will ensure that we engage with local communities when the outcome of this consultation is known.

Medicines and Prescriptions


• You felt that one way to reduce medicines being wasted would be to have a campaign to raise awareness about the cost of prescription versus over the counter medicines. In order to make this accessible it could be produced in video, easy-read and community languages.

• You want medicines reviews in pharmacies to improve in terms of consistency of quality and consistency of timing. You also thought that medicines reviews could be improved by offering to conduct reviews over the telephone or in community-based settings.

• You felt one way to improve uptake of medication reviews, would be to highlight the positive effects of reviews, and follow up if people miss their review.

• You think we should assess whether patients can read and understand instructions on medicines; and provide support if not. You also want us to be aware that packaging can be an issue, especially for elderly patients with arthritis.

• You would like more research to be undertaken to understand self-medicating and the barriers to prescription medicines.

• You would like advocates, community navigators and health coaches to have a greater role in supporting people to understand their health conditions and medicine prescribing.

What are we doing?

In January 2017, we launched a public awareness campaign called #HelpMyNHS, part of which explains the costs associated with GP prescriptions for medicines that are also available to buy over the counter.

We have 28 Healthy Living Pharmacies in the city. These pharmacies have a role in signposting people to other services that may provide support for example, health trainers, Voluntary and Community sector support and mental health services.

We will work with the relevant partners, such as care agencies, the voluntary sector and patient groups to promote the use of medication reviews and highlight to patients the benefits.

We will continue to offer medicine reviews via telephone consultation, home visits and at GP surgeries where appropriate.



• You said that not enough people know about the wide range of services pharmacies can offer, and would like us to promote the role of pharmacies using social media, on TV screens in GP Surgeries and through Patient Participation Groups (PPGs).

• You would like more people to know about services which can make pharmacies more accessible including interpreting services, private consulting rooms, audio medications information, braille and home visits etc.

• You would like a list of trustworthy websites/ sources of information about medications and information about pharmacy services to be given out with prescriptions.

• You said there is not enough information and support for carers/families on medicines; and that we should include carers in conversations about medicines.

• You said that advice leaflets in medicines often contradict GP instructions, and that you want more consistent information.

What are we doing?

The CCG medication review pharmacists have been working with voluntary sector organisations to promote the role of pharmacists and medication reviews. We have worked with the Carers Centre to provide information on pharmacy services, including how carers can get advice on medicines and be involved in medicine reviews.


How can we make better use of medicines?

51

Big talking point 3:How can we prevent people ending up in A&E?

Alternatives to A&E


• You said that you would use alternatives to A&E, including Walk-in Centres, Minor Injuries Unit or Urgent Care Treatment Centres if they can offer you medical treatment when it is not an emergency.

• Some of you said that your experience of accessing the Walk-in Centre was positive, others said that there are still long waiting times.

• You said that people need to take more responsibility to save A&E for emergency situations.

• You said that when people can’t make appointments with their GP, some people will go to A&E even if it is not an emergency.

• Some of you said that pharmacists can play a greater role in urgent care, but that some people are not aware of this.

• You said that NHS Choices (www.nhs.uk) is helpful in terms of finding out about symptoms and deciding whether you should wait to see you GP, access other urgent care or go to A&E.

What are we doing?

We have developed and launched a #HelpyMyNHS campaign which includes messaging about the range of options available for urgent care. We will continue to promote this through a multitude of channels, including to local community and patient groups.

We have promoted the use of pharmacies in our #HelpyMyNHS campaign, and, as a result of wider feedback, we have developed a short information leaflet explaining about services available in local pharmacies. When finished, this will be translated into community languages and Easy Read, and will be sent out widely through local community and patient groups.

We will promote the My Life online directory (www.mylifebh.org.uk) as a trusted source of information on health conditions, also local health and care services and other sources of support.

Concerns


• You are concerned about experiencing long waits at A&E and some of you fed back that you are concerned about the numbers of people needing A&E due to drugs or alcohol on the weekend.

• Some of you had concerns that you were not treated equally at A&E, including young people and homeless people.

• You were concerned about the workforce and staffing levels – especially with regard to leaving the EU, public sector pay freezes and low morale.

• You were concerned about funding for urgent care services and pressure on the NHS over winter.

• You said limited access to GP’s made it more likely for people to the hospital for care.

What are we doing?

We are working closely with the local hospital Trust to try to minimise waits in A&E; however, we know that in particularly busy periods, people will have to wait to be seen as they are seen and treated based on their clinical priority/need. We have developed the #LoveMyNHS campaign which helps to inform and support people to use alternatives to A&E where appropriate, which will help with waiting times.

We will feed back concerns about inequity to treatment to the hospital and ask them to respond.

We do provide free interpreting services to all pharmacies; we will ensure that information about interpreting services is resent to pharmacies and that they are aware of how to access and use these services.

We will work with pharmacies to ensure they are aware of their responsibilities to provide information in a range of formats.

We will work with community pharmacies to highlight to people the range of services which make pharmacies more accessible e.g. interpreting service.

We will work with community pharmacies to encourage them to signpost housebound patients to the CCG medication review team to arrange home visits.

We will increase awareness about pharmacy services available in Brighton and Hove with a new leaflet, use different methods of communication to reach patients and carers e.g. website, social media, posters and GP surgeries’ TV screens.

We will continue to advise people to use the NHS Choices, My Life online directory (www.mylifebh.org.uk) and patient.co.uk websites as reliable sources of information for patients about their conditions and medications.


Accessibility17%


Prescriptions and Medicines

63%


52

We have secured additional funding from NHS England for the winter period, which pays for more beds in the community, more therapy and home care. This helps to ensure that people, who need care over winter, whether due to an accident or illness, get prompt and appropriate care through timely discharge from hospital.

We are working closely with primary care colleagues to enhance access to GPs, including extending opening hours and the number and type of clinicians available.

We cannot influence government policy over Brexit and the public sector pay freeze. We suggest that people liaise with their local MP to raise their concerns.


What did you say?

• You said that some people only know to go to A&E for urgent care – there is a lack of awareness about other places people can go.

• You said that more needs to be done to promote the alternative to A&E and opening times. You said that we could have a campaign, visit community groups and tell people face-to-face.

• You said that information about alternatives to A&E should be in accessible formats including community languages, easy-read and British Sign Language (BSL).

• You said that increased use of online health information would reduce pressures on urgent care services.

• You said there should be more information about alternatives to A&E out in the community- so that people who need urgent care can find out where they should go without needing internet access.

• You suggested that day centres for homeless people should have better signposting of where to go for urgent care needs.

• You said that there needs to be better record sharing between health services, so that all urgent care services can access your medical records.

• You said that you did not know that there is an NHS Dental Helpline and that more should be done to advertise this.

What are we doing?

We have developed and launched a #HelpMyNHS campaign, which includes messaging about the range of options available for urgent care. We will continue to promote this through a multitude of channels, including to local community and patient groups. We will ensure that our bi lingual Health Promotion volunteers have this information and that they cascade in the communities they work with.

We will ensure that services that support homeless people and those who are insecurely housed are provided with information about the range of urgent care services and #HelpMyNHS materials.

We will liaise with Deaf/Deafened and hearing impaired people to find out more about their knowledge and experience of urgent care services, and establish what information they need and the format that will be most helpful.

We are working hard to resolve the key challenge for the urgent care workforce to ensure patient information is available at the point of treatment. We will continue to promote the utilisation of Summary Care Records and will focus on increasing the take up by patients to provide explicit consent enabling the sharing of more detailed information especially across the more vulnerable groups of patients.

We have included information on the dental helpline on our #HelpMyNHS materials; we will ensure that this information is cascaded widely in the city and that it is also on the My Life directory. We will also ask our Patient Participation Groups in GP practices to help publicise this service.

Local Suggestions

What did you say?

• You said you would like an urgent care centre, based near A&E. You said it will need to have all the skills and knowledge there and be open all hours. The centre should be very clear about what it can and can’t do and it should have access to mental health specialists.

• You said that health needs should be triaged so that only the people who need to be in A&E are there.

• You would like us to pilot an A&E social prescribing project.

• You said you would like another walk-in centre, perhaps in the Hove area and another polyclinic.

• You suggested that we develop initiatives such as a ‘health passport’ to ensure that people from diverse communities can access appropriate urgent care quickly. This could include health conditions and communication needs – and might be helpful for young people, some disabled people and non-English speakers.

• You said you would like to find out the current waiting times for urgent care services like A&E and the walk-in clinic so that people realise they will be seen quicker at alternative services to A&E.

• You would like First Aid Centres to treat minor injuries like cuts, minor burns or sprains.

What are we doing?

We are currently working to develop a model of an Urgent Care Centre, which is likely to be based very near the A&E department. This centre will help treat minor injuries and ailments, however we will continue to promote self-care and ways to find appropriate information, such as at a pharmacy.

We are developing a service which will which will ensure that A&E treat those who need to be there and non-emergency presentations are signposted to attend alternative services.

We will ask the groups in the Voluntary and Community sector whom we work with to reach some of our most marginalised communities about the usefulness of a “health passport”. There has already been work to develop a health summary for people with learning disabilities and a “Carers Passport”; we will look into whether these initiatives can be built across other communities within the city.

We do have the information on waiting times at A&E; however as these do vary during the day, we cannot provide up to date information on these waits at all times at this time, although an app may be developed which could provide details of services, opening times and waiting times. We will inform you as this progress develops but suggest that in the meantime, when people attend they ask how long the wait is likely to be.

We cannot at the moment pilot a social prescribing service within A&E; however we will look into the need for this and whether it is feasible to develop a pilot later in 2018.

“Care needs to be 24 hours a day because our lives are 24 hours a day.”


How can we prevent people ending up in A&E?

53


Alternatives to A&E12%


NHS 11137%

Local Suggestions

10%

Concerns18%

NHS 111

What did you say?

• You said that NHS 111 relies on people being articulate and communicating their symptoms clearly, this can be more difficult for people who do not speak English as a first language, people with learning disabilities, young people and older people as well as others.

• You raised concerns that some of the questions are not relevant or do not make sense when calling an ambulance or using NHS 111, and this can delay care.

• You had mixed experiences of using NHS 111. Some of you had found it useful in terms of getting advice, information or emergency prescriptions. Some of you had found it difficult in terms of being asked irrelevant questions, being signposted to A&E unnecessarily, and experiencing long delays for call backs.

• You have concerns about call-handlers giving advice or signposting without being a medical professional. You would like to speak to a medically trained person when you call NHS 111.

What are we doing?

We will feed the concerns above about accessibility of NHS 111, questions used by NHS 111 and the professional approach of call handlers into the current recommission of this service. The new recommissioning of the service in 2019 will resolve some if not all of the concerns raised.

Big talking point 4:How can we improve care when you are referred by your GP?

Appointments and Referral Management


• You said that the process of making a hospital appointment needs streamlining. Some of you said the process seemed to have many stages and take up a lot of time at your GP and hospital. You would like the appointment process to have fewer stages.

• You said that some patients have been referred for appointments at health services which are located out of area. You said you would like more support with transport if you are referred to a service outside of Brighton and Hove.

• You said that there can be particular difficulty for older people, people with long-term health conditions and disabled people. This should be taken into account when making the referral.

• Some of you said that once in the system it works well, but the process of making an appointment is uncoordinated.

• You said that when you are referred to an out of area service, it can be unclear who to contact regarding your care or your appointment.

• You said the referral management service does not feel patient centred.

What are we doing?

We are working with our referral management service to ensure that their communication, and access to appointments, is appropriate for all patients, including those with sensory impairments or disabilities. We will carry out an Equality Impact Assessment which will highlight any areas of improvement required.

“I had a bad experience of A&E, I think because I was homeless, they assumed I just wanted drugs and I had to wait a really long time.”

“Referral systems do not seem to work – patients have to do the work to connect the dots” HKP Multicultural Women’s Group.


54

We will do a patient/carer-led review of all the information our referral management service sends to patients.

We will continue to work with our referral management service to continue to gather feedback from patients and their families/carers and use this to continually improve their service.

We will work with our GP practices to ensure the referral management service receives all the information they need to make a booking that is suitable for the needs of the patient.

We will continue to ask our referral management service to support patients to choose care that provides access to timely care and treatment, which may be outside of Brighton and Hove. We cannot withdraw choice as this is a patient’s right under the NHS Constitution.

We will promote the Healthcare Travel Costs Scheme more widely, in order that some groups of patients, and their carers, can access help with travel costs.

We are implementing E-Referral for all hospital services – this means that appointments can be directly booked onto an electronic system which is more effective and will streamline the process for patients and GPs after appointment.

Concerns and Delays


• You said that you have concerns around private companies being contracted to deliver specific health services – such as high street opticians delivering audiology services.

• You are concerned about funding for the NHS and how this is impacting on services that you need to be referred to.

• A lot of you said that you had waited a long time for an appointment after being referred by your GP. You said that delays in referrals can affect patients’ mental health and cause deterioration in physical health – it can also leave people feeling confused or worried.

• You said that a lot of responsibility is placed on patients to make sure that referrals are successful – and this is more difficult for patients with complex needs.

What are we doing?

We work in partnership with our local hospitals to make the changes necessary to the way care and treatment is delivered to make sure that patients don’t have to wait longer than 18 weeks to be seen and treated. We know that sometimes patients have to wait longer than 18 weeks but this is a NHS Constitutional standard that we take very seriously.

We are working with our GP practices to support them with alternative ways to get advice from hospital based specialists. This helps to reduce the numbers of patients who need to go to hospital to be seen.

We are working with neighbouring CCGs to ensure that health care we provide is based on clinical evidence that shows maximum benefit for patients’ health. Any private providers that we buy health care from receive the same payments, or less, than the local hospital. By buying audiology services from local private providers we can make sure patients are seen quickly (in less than 6 weeks) and at a place nearest to their home. It also helps the CCG to manage costs as providing these services away from the hospital helps us to keep costs

down. We will continue to monitor all of our private providers rigorously to ensure standards of quality, safety and timeliness are maintained.

We will continue to work with a number of different departments at our local hospital to look at how they can provide services differently.

We will work with our referral management service to ensure that the diverse range of patient needs are recognised and responded to.

We will continue to work with neighbouring CCGs to ensure the health care offered is consistent across different areas and based on clinical evidence of success, in order to ensure the best outcomes for patients. We cannot influence the funding we receive from central Government, but we can ensure it is spent on the healthcare that best meets the needs of our population.



• You said that patients can feel they are not kept informed about their referrals. You said that you would like to be kept informed throughout the referral process. You said that a range of methods are required to meet communication needs; some people may prefer online services or text messages, whilst others may prefer letters. More work needs to be done to communicate with homeless/ insecurely housed people who may not have a fixed address or mobile phone.

What are we doing?

We will continue to work with our referral management service and local hospitals to support them to recognise and meet the range of communication needs amongst our patients.

“I had an appointment at Hove Polyclinic – the appointment has been changing since January – the doctor did not explain what the appointment is for so I don’t even know if I need it.” GP Waiting Room Outreach

“Letters and more letters – can’t they use text messages or email for contact?”


How can we improve care when you are referred to your GP?

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Big talking point 5:How can we make sure mental health is treated equally?

Accessibility


• You told us that mental health needs to be treated equally with physical health.

• You told us that it can be hard to manage mental health conditions if you have complex needs such as homelessness, or addiction.

• You said that isolation is a key factor in poor mental health.

• You said that you wanted more investment in ways to reach the most vulnerable patients and those who are harder to reach.

What are we doing?

Our Specialist Children and Adolescent Mental Health Service (CAMHS) has reduced waiting times for routine treatment to be no more than 8 weeks from referral and for priority to be a maximum of 2 weeks for treatment (excluding neuro-developmental referrals); this is a marked improvement to the 18 weeks that children and young people previously had to wait.

We have arranged for support in a variety of community settings, such as the Young People’s Centre.

We have a specialist service for people with serious mental illness to ensure they can be seen by their GP and a mental health professional, looking at both physical and mental health at the same time.

We have commissioned a specialist Homeless Primary Care Plus service to provide more responsive and proactive services for, and to improve the health and wellbeing of, those with complex needs across the city.

We have developed staff skills to support people with substance misuse and mental health issues, to help

improve access to and engagement with treatment.

We have introduced Community Resources Advice Service which is open access and can be contacted by anyone with a concern about their own or someone else’s mental health. This can be accessed by GPs and offers advice on relevant services and support for people with mental health.

We have developed our social prescribing service across GP practices, which can support people to access information and support on mental wellbeing.

In recognition of the effect of loneliness on mental health, we have continued to fund a city wide befriending service, plus groups and activities across the city for older people in particular. Our social prescribing service also supports people to access befriending and community based activities.

We are currently working with our Specialist CAMHS to develop and provide mental health support to vulnerable groups of children and young people, including those who are in care, with substance misuse or known to the Youth Justice system

We are engaging with service users and their carers to gather feedback and ideas for improvements that will feed into our redesign of Mental Health Support services, to be in place by April 2019.

Patient Experience and Patient Choice


• The GP should spend more time explaining the options around referral to secondary care.

• There needs to be better communication on patient choice.

• You would like us to encourage patients to become more involved in understanding where to access information on waiting times and the referral process.

• You would like to speak to the same person about your care and the referral process.

• You would like more alternatives for local appointments.

• Some of you described a positive experience of going through the referral process and receiving care quickly and efficiently.

What are we doing?

We will do a patient-led review of all information sent to patients from our referral management service.

We will continue to work on E-Referral, including making sure patients know how to access this system if they wish to, to make changes to booked appointments, or even make the appointments themselves.

We will work with GPs on having informed conversations with patients around choice of provider, and make sure the information on providers on the CCG website is kept up to date.

We will continue to look at ways care and treatment can be delivered away from hospital.

We cannot promise that local appointments can always be an option given the current pressures on health care.

We cannot guarantee you will always speak to the same person about your care and the referral process.


“I have worked in Mental Health Care Homes and felt very disappointed by how overstretched and unavailable out of hours mental health support is until the need is critical and even then it is often inadequate.” Internet Survey

Appointments and Referral Management22%

Concerns / Delays27%


37%

Patient Experience and choice

14%

“I am disabled, and it is difficult for me and my wife to travel to a hospital that is miles away.”


56

Community Support


• You told us that there is not enough supported accommodation in the city.

• You said that availability of talking therapies need to be expanded, including improved access to talking therapies for victims of crime including survivors of sexual violence.

• You said that the Voluntary and Community Sector could work in a more joined up way to provide mental health support.

• You said that there should be increased peer support for people with mental health needs. You also said that true peer support comes from the ground up from people with lived experience.

• You said that more support and encouragement needed for people to access mental health services.

• You said that we could utilise libraries as a place to give talks and drop in support, as well as continuing to develop the ‘Shelf-Help’ books recommended by professionals.

• You said that community groups and services can have a hugely positive impact on mental health and social isolation, and that information about

these groups and services should be offered to anyone who does not meet the threshold for mental health services.

• You asked if we could offer mindfulness courses as an alternative to Cognitive Behavioural Therapy.

• You suggested that we could have Community Care Centres attached to GP Clusters (a group of local GP practices) where all kinds of community support could be offered, including mental health support.

• You said that people with mental health needs should have access to longer GP appointments and the possibility of home visits.

What are we doing?

We have commissioned therapeutic support for children under 14 years old who are victims of sexual assault.

We have created an online website www.findgetgive.com where children, young people, parents/ carers and professionals can access information, advice, guidance, self-help support, blogs, vlogs, apps etc. to support their emotional wellbeing. They can also find information on which services to access via self-referral and give feedback on those services. There is also a range of information about mental wellbeing on the Brighton and Hove City Council Website and the My Life online directory www.mylifebh.org.uk.

We will promote these resources, and we will ensure that the difficulty in finding the right mental health support is addressed through our recommission of support services during 2018/19.

We have developed and commissioned an all ages Wellbeing Service where services for children and young people are provided by a range of statutory and voluntary sector providers working in partnership.

We have commissioned Mental Health accommodation with support services and are strengthening links with clinical services and community rehabilitation pathways.

We have peer support integrated within a number of services and pathways e.g. Day services, peer trainers with Recovery College, and in Eating Disorder services. We recognise the value of peer support and we will continue to explore ways to develop and support this within and outside of our services,

We have ensured that Mindfulness is available through our existing mental health services.

We will develop a role for a specialist to support GPs to ensure children and young people get the support they need for mental health issues as soon as possible, and to support the increase of knowledge and expertise within primary care. This will be implemented in Spring 2018.

We will ensure that the views of service users and carers are central to the design of our new model for Mental Health Support services and recovery support. We are

aware of the pressures on some services and this will be taken into account when we redesign the model.

We will work with GPs and the Wellbeing Service to ensure that information on ways to look after mental wellbeing is provided whilst people are waiting for a clinical appointment, which will include accessing information through libraries, online information and community based support.

We will review the need for supported accommodation as part of our redesign of Mental Health Support services.

We will promote the fact that patients can ask for longer appointments with GPs, although we do recognise that this can be a challenge to provide due to the pressure on primary care appointments.

We are not currently looking at a model of Community Care Centres aligned to GP clusters, but may do so in the future.

Crisis Support


• You would like a 24-hour crisis services available with peer volunteers and staff.

• Some would like a crisis support cafe open at night in the early hours, where it’s most needed.

• You would like a mental health nurse to be based within police teams.

• You suggested piloting a mental health bus, which is based in community locations and offers crisis support.

• You fed back that the Assertive Outreach Team are important and offer a tailored, flexible service to people with complex needs.

What we are doing?

We have implemented a mental health liaison team at The Royal Alexandra Children’s Hospital which runs 7 days a week (until 8pm on weekdays and 6pm on

“Going to a community group saved my life. I saw the brochure in the library when I was feeling very low after a lot of life changes, I didn’t really know what I was living for. I intend to go to the group regularly, even though it is difficult.” Community Group


How can we make sure mental health is treated equally?

57

weekends), and we are trialling a telephone system running Monday – Friday until 10pm for professionals to use in accessing specialist mental health advice for young people under 18 years old.

We have successfully bid for funding from NHS England to develop a team to support the mental health needs of hospital inpatients, specifically on older people’s wards.

The CCG and Public Health have been working together to improve our service that supports people with addiction and mental health issues. These changes will be in place in spring/summer 2018.

We are looking at ways to provide better support across the geography and diverse communities of the city; this does not currently include a bus, but we will be reviewing all options in the redesign of our Mental Health Crisis Pathway in spring/summer 2018.

We will examine the effectiveness of ‘crisis cafes’ as ‘drop-in’ centres (particularly out-of-hours) where the homeless and people at risk of mental health crises can receive support and advice. We will also review the use of other public buildings (libraries included) as centres offering support and advice; we are working on this with East Sussex Fire and Rescue, who may be able to contribute volunteers.

We will look at the appropriateness of developing a crisis house or recovery house as an alternative to inpatient treatment, giving support in less intensive and more accessible settings, and avoiding lengthy inpatient admissions (which may not be the best support for some people suffering poor mental health).

We are developing a ‘crisis hub’ which will bring together our Crisis Response and Home Treatment teams with the Mental Health Rapid Response service, into an integrated holistic service which will improve patient outcomes and patient experience in community settings. We are looking at ways to improve Home Treatment Teams, which will include increased time to work with primary care, carry out medicine reviews and provide support to avoid a crisis.

We are hoping to bid for money to work with the organisation Grassroots, to upgrade their “Stay Alive” suicide prevention app.

Concerns


• You are concerned around inconsistency of reviews for people on antidepressant medication.

• You are concerned about long waiting lists for people to access mental health support, and how this might result increase suicide and self-harm.

• You told us that physical health of mental health service users can sometimes be overlooked by professionals.

• You told us that attitudes to people with mental health issues are still inconsistent amongst health professionals.

• You said that you are concerned about funding issues within the NHS and the impact this is having on mental health services.

• You said that more should be done to tackle stigma around mental health.

What we are doing?

In Oct 2016 we launched #IAMWHOLE – a social media campaign aimed at young people to reduce stigma, encourage them to recognise they needed help and see that help. In Oct 2017 we took the message from #IAMWHOLE to create a story aimed at 8/9 year olds and integrated this as part of the PHSE in schools.

We know that waiting times for the Wellbeing Service have been too long, and we have worked with the provider of this service to take measures to ensure waiting times return to normal levels.

We have a specialist service for people with serious mental illness to ensure they can be seen by their GP and a mental health professional, looking at both physical and mental health at the same time.

We will implement the action plan recommendations from the recent self-harm needs assessment that is due to be published by end March 2018.

We will ensure that we look at the issue of inconsistencies between mental health support services in terms of knowledge and treatment as part of our redesign of these services. We will ensure that GPs are supported to increase their knowledge and skills to deal with mental health issues through the ongoing support of specialist colleagues as previously mentioned.

We will ensure that our redesign of mental health support services across both the CCG and The City Council will provide the best possible model to support mental wellbeing within the available finances.

Dementia

What did you say?

• You said that you would like us to learn from the ‘Dementia Villages’ and make Brighton and Hove a dementia-friendly city.

• You said that patients are having to wait too long to have memory tests after they have been referred by their GP. You also said that

communication between the Memory Assessment Service and GPs needs to improve.

• You said that there should be a single point of contact for patients and carers, and more information on how to access dementia services in the city.

What are we doing?

Brighton & Hove has officially been recognised as “working towards becoming a dementia friendly community”. The local Dementia Action Alliance have signed up more than 100 local organisations in the last year. We will work with partners to increase information on, and awareness of, current services and support, including initiatives such as Dementia Cafes.

We have provided more funding to the local Memory Assessment Service to increase staff levels in order to decrease the waiting list that has built up recently.

We know that current services are fragmented, time limited and variable in terms of support offered. We will be working with partners – including services, the voluntary and community sector, and people living with dementia and their carers, to understand the problems with existing services and to co design a model of what would represent better care support.


What did you say?

• You said that you would like local communities’ events such as Pride, the Fringe Festival and the Great Escape to be used as platforms to raise awareness about mental health.

• You said there should be more information about children and young people’s mental health, building on the I Am Whole campaign.

What are we doing?

In October 2016, we launched #IAMWHOLE – a social media campaign aimed at young people to reduce stigma, encourage them to recognise they needed


How can we make sure mental health is treated equally?

58

help and see that help. In Oct 2017 we took the message from #IAMWHOLE to create a story aimed at 8/9 year olds and integrated this as part of the PHSE in schools.

We will develop information on mental health services that are available via a range of media that ensures optimal accessibility (both online and printed copy). We will ensure these are distributed widely across the city, including at key events.

Positive Experiences

What did you say?

• Some of you said that you had a very positive experience of psychiatrists and mental health services

• You highlighted the Lighthouse personality disorder service as working well and developing good peer support networks.

What are we doing?

We are pleased to hear that people like the Lighthouse personality disorder service; we are working with people who access the Lighthouse service to find out what works well for them and how we incorporate this into future services.

Big talking point 6:How can we support people to stay out of hospital?



• Some of you fed back that you had positive experiences of care following hospital discharge, with a diverse range of practitioners supporting you in the community.

• You fed back positive experiences of liaising with a care coordinator, rather than trying to coordinate your care with several different practitioners.

What are we doing?

We are working closely with our community providers to develop the ‘responsive services’ model, which is a multi-disciplinary team of clinicians, social workers and therapists, working together to support people to stay out of hospital.

We have developed a new team to support people to go home from A&E and short stay units, rather than being admitted. The team can access therapy and home care quickly so people can go home with the right support.

We have increased funding for the “Link Back“ service, which provides support to people after discharge from hospital and helps refer and support them to access community based information, support and activities.

We will look at developing more short term home care services to respond quickly to people who may be at risk of admission and not to delay discharges.

Community Care


• You said that you would prefer to receive some services in the community, rather than everything centred at the hospital. You said you would like to see more community beds and community nurses so that people can stay out of hospital.

• You want services and equipment to be delivered at the right time to patients in the community.

• You said that you would like to see phone calls and home visits included in care plans so that people are not left alone; you suggested that this includes neighbours, friends and befriending schemes.

• You suggested discounted repairs for older people to prevent falls or trips and make sure that people can stay in their homes.

• You said that community groups are a good way to offer support for local people, and volunteering opportunities, but sometimes there are barriers to this community support.

• You said that you want continuity of care from nurses and carers in the community, instead of different people each day.

• You said that people should have support with making healthy and nutritious meals at home.

• More support for people on hospital discharge in terms of adding rails/ bars at home to prevent falls.


“The issue is the time it takes to get referred. I ended up borrowing money to pay privately as I could not wait that long.” Internet Survey

Accessibility5%

CommunitySupport20%

Crisis Support5%

Concerns37%

Dementia12%


12%

PositiveExperience

9%


59

What are we doing?

We are looking for areas of opportunity where services can be delivered in a community setting, and strengthening partnerships between community and hospital services. For example community services now have increased access to advice and support from senior clinicians to manage a person’s condition in a community clinic.

We are also working in partnership with our neighbouring health and care organisations to share good practice on how out of hospital services are delivered, for example cardiovascular and heart failure services and fall prevention services.

We have commissioned 40 new community short terms beds recently as a short term initiative to support people to have appropriate care outside of a hospital setting. These beds are in a range of places which means that specialist help for people with a range of needs can be provided.

We have recommissioned our Community Equipment service and people are being discharged from hospital quickly due to the efficiency of the equipment service but we now need to concentrate on ensuring that we collect more equipment that is no longer needed.

We commission the community equipment service to deliver equipment with same day (if ordered before 2pm), next day, 3 day and 7 day deliveries, with equipment prescribed and ordered based on an individual’s need. Minor adaptations such as grab rails are also provided and fitted within these timeframes as clinically prescribed and at no cost.

We will continue to commission a support and advice service that helps people access repairs and adaptations to their homes and to help them make their homes more energy efficient.

We have supported Age UK and Brighton and Hove Food Partnership to produce a leaflet about healthy eating for older people; this was a direct result of feedback indicating a need for this information. We have also consulted with the Food Partnership as part of our ongoing work on prevention, recognising the role of good food which should be recognised in keeping people both physically and mentally healthy. We have promoted initiatives such as the Casserole Club to our staff and clinicians.

We will work with the Voluntary and Community sector and to identify barriers to people accessing community groups, and address these where we can. We know that one of the barriers is physically accessing community groups and activities; we will continue to explore ways to promote schemes to support people to get to these initiatives, including buddying and local transport projects.

We will be developing the communities of practice model in partnership with our local provider of community services, to ensure services are developed to divert people from having to attend hospital and where possible deliver care within a community clinic.

We will continue to fund the city wide befriending service, plus other initiatives to help prevent isolation and loneliness. We will continue to support our Voluntary and Community sector partners to develop a shared resource of recommended support at home services, such as repairs, shopping and gardening.

We cannot guarantee that people will receive consistent care from home care support workers, although we do recognise this is important, and ask our home care providers to take this into account. We monitor continuity of care on a monthly basis for all care delivered.



• There needs to be more communication about care in place before patients are discharged.

• You said that care homes are not always called before hospital discharge, which means that they cannot prepare to care for people returning there from hospital.

What are we doing?

We are working closely with our community providers to develop the ‘responsive services’ model, which is a team of clinicians, social workers and therapists, working together to support people to be safely discharged out of hospital. On some wards at the Royal Sussex County Hospital, the ‘Home First’ pathway is in place, where a follow up check can be undertaken of someone’s care and support arrangements within two hours of the person arriving

back home.

Joined-up Services


• You said that you would like more funding for social care and higher wages for home care assistants in order to improve quality and staff retention.

• You said there needs to be a combined workforce with recognised skills to bridge the gaps between services.

• You suggested a ‘halfway-house’ for people who need to be discharged from hospital but cannot yet go back into the community.

• You said that accelerated discharge needs to be done carefully to prevent readmission.

• You said that there needs to be a single budget for services to ensure they work together.

What are we doing?

Brighton and Hove City Council introduced the new UK Living Wage for their lowest paid staff in April 2013 and are now accredited as a Living Wage employer.

We have developed combined workforces, which have been in place for some time. Many of these combined teams work across a number of organisations including social care, community providers and the voluntary sector. However, we recognise there is more work to be done to deliver the best possible services and reduce the need for multiple workers undertaking duplicate tasks, and we will continue to review the service and make improvements.

We have commissioned a number of community rehabilitation beds, for people who are discharged from hospital but not ready to return home.

We will look at developing the workforce further across community short term services, to enable social care staff to deliver tasks previously delivered by clinicians.


How can we support people to stay out of hospital?

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We will develop a well-trained, non-medical workforce to provide a more holistic model of care, including volunteers and paid carers.

We will build on our existing social prescribing service and ensure the “Making Every Contact Count” approach is embedded in our health and care workforce.

Concerns


• You said you have concerns that patients are discharged from hospital too soon after operations.

• You have concerns about how assessments and home-checks are conducted to see if it is safe for a patient to be discharged – it needs to be done in a timely and robust way.

• You said that there is a burden placed on patients to be assertive and be able to do administrative work in order to ensure their health and care works as it should.

What are we doing?

We recognised that an ‘accelerated discharge’ can often lead to a readmission to hospital and have evidence to support this. We will ensure that people will not be discharged from hospital until they have been deemed medically ready, and continue to roll out our “Home First” service to support people straight after discharge, and provide other support such as the Link Back social prescribing service to support people to re-engage with wider support and activities.

We have identified that a key component of delivering integrated services will be the need to continue to pool existing resources across organisations including the consideration of shared budgets to support people focused services delivering the ‘right care, right place, right time’ policy to enable services to flex resources to provide what is needed when. We will continue to build on the existing shared budget arrangements, moving towards integrated health and care services.

Big talking point 7:How can we make it easier to see you GP when you need to?

Accessibility & Patient Experience


• You told us that more work needs to be done to support people who are Deaf/ Deafened to see their GP. Examples include using qualified BSL interpreters instead of families or friends and offering longer appointments.

• You said you would like GPs to have more awareness and understanding of mental health conditions, LGBTQ and BAME identities.

• You said that telephone appointments can be difficult for people who do not speak English as a first language, people who are Deaf/ Hard of Hearing and other people who find it hard to talk on the phone.

• You said that telephone appointments could be preferable for people who have anxiety or some disabled people.

• You suggested that patients need to take responsibility themselves for whether they need to be seen urgently or not.

• Some of you said that it is easy to make an urgent appointment if you have serious symptoms.

What are we doing?

We will continue to work closely with local communities and Voluntary and Community sector organisations to increase awareness and understanding about diverse communities including LGBTQ people, BAME communities as well as mental health conditions and learning disabilities. We will continue to work with specialist organisations to deliver awareness sessions and training for primary care teams.

We will roll out the LGBT Inclusion Award that has been developed by LGBT Switchboard and the Trans Alliance across primary care; this will help increase awareness about LGBT communities, and support services to be more aware and more responsive.

We are working to develop a culture of prevention, self-care and self-management of long-term conditions among patients, supporting people to take more responsibility for their own health and care. We will continue to provide information about the range of services available, to support people to make the right choices about their care.

We are already providing telephone appointments with a GP or nurse for appropriate conditions (e.g. those that don’t require a physical examination) through our Practice Assist pilot. This service is available through a number of local GP practices in the city and is currently being evaluated. However, we know that telephone consultations are not always the best way to communicate. We will continue to raise awareness of best ways to communicate with people for whom telephone calls and consultations are not appropriate; for example, we will use the excellent films from Carousel to highlight the difficulties faced by people with learning disabilities, and we will work with Deaf / Deafened communities to establish best modes of communication with GP practices in particular.

We are already providing trained British Sign Language interpreters across GP practices, pharmacies, opticians and NHS Dentists. This is free of charge to both the service user and the service. No Deaf / Deafened person should have to rely on family or friends to interpret, so we will re publicise the interpreting provision to the service, and also within the local communities as people can also self-refer to interpreting.


Community Care55%

Concerns15%


10%

Joined-up Services

17%

Positive Experience

3%


61

Concerns


• You said you have concerns about long waiting times and difficulties in making appointments – specifically being able to reach the surgery by phone to make an appointment in the morning. Often the phone is engaged and when you do get through, there are no appointments left.

• You said that you have concerns about GP closures creating a burden on the remaining practices.

• You have concerns about impact of increasing demand, cuts in funding, practice closures and shortage of GPs.

• You have concerns about GPs not picking up serious conditions early enough and patients feeling “fobbed off”.

• You sometimes find it difficult to get a routine appointment in good time.

• You have concerns about how GP services will cope with offering extended access (Appointments from 8am – 8pm and at weekends).

What are we doing?

We are developing an ambitious Primary Care Strategy for the city to address the workforce challenges our local primary care system faces; which are also felt at a national level. This strategy includes a workforce strand that describes how we will recruit new clinical staff, retain staff we already have who may be thinking of leaving and support those who have left to clinical practice to return. Building meaningful partnerships with local Medical Schools is just one way of nurturing talent and creating career pathways in our primary care system.

We are building capacity across the range of clinical staff to make sure that they are working appropriately, and not getting bogged down by process and administration.

We will be offering extended hours through a third party provider, so it’s not the case that the existing

primary care workforce will be asked to work longer hours. In fact, the extra provision at evenings and weekends will help to ease the demand for weekday daytime appointments which may make it easier to get appointments during these core hours without long waits.

We know that when smaller practices close this cause a lot of anxiety. However there is a move towards fewer, larger practices providing primary care services because bigger primary care teams can provide greater resilience, for example when clinicians are long-term sick or retire, and better opportunities for sharing and learning across the team. Primary care for every resident of the city will always be provided, though there may be changes in GP practices over time. Where there are changes, we will work hard to ensure that patients are transferred to other practices seamlessly and that there is no break in their care.

Our local clinical staff apply evidence-based approaches to healthcare which maximise the chances of identifying serious health conditions

early. Patients should not feel that their concerns are disregarded and their needs are not taken seriously. Where a patient feels that they have not been treated with appropriate care or courtesy, we suggest they speak to the practice manager initially, or they can make a complaint to the practice or to NHS England.



• You said the information in GP practices such as the TV screens, needs to be more effective, and up to date.

• You said that you would like to know if appointments are running behind when you arrive at the surgery. This could be communicated face-to-face or on the screen.

• You said that GP practices could make more use of social media, being mindful that this cannot be the only way as some people are not online.

• You said that Patient Participation Groups can be key in helping to cascade information.

• You said that notes from your GP appointment should be made available to you following you appointment via online services.

What are we doing?

We promote best practice among GP practices with regard to communicating with patients. Where patients see information that is incorrect, out of date or unhelpful they should raise this with the practice. Similarly, suggestions can be made to the practice about updating patients e.g. around current waiting times in clinic or with regard to social media presence.

We will continue to support Patient Participation Groups to take a role in cascading information to the wider patient list, and to be a way of bringing the views of patients and carers to the GP practiced. We will continue to work according to national guidelines and projects on improving access to patient records; in the meantime, patients can request to see their records at their own practice.

Local Suggestions


• You said that you would like a more diverse workforce to improve accessibility. For example recruiting Deaf/ Hard of Hearing GPs and other health professionals who use BSL.

• You suggested a local scheme to offer GPs and nurses affordable accommodation in order to attract new health practitioners to the city.

• You suggested that we reduce the amount paid to locums – if the incentive is removed they might be more likely to work in a practice.

• You said that not enough people know that nurse practitioners can often diagnose and prescribe treatment.

• You said that GPs should utilise social prescribing (assistance from the Voluntary and Community organisations) more.

• You said that having two sessions to book appointments can work well – so that you can phone in the morning or afternoon to make an appointment.

“I waited a long time to for a GP call-back. English is not my first language and it is difficult to talk to the doctor over the phone. I don’t have the words and we need to point and see each other.”


How can we make it easier for you to see your GP when you need to?

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Triaging


• You said you have concerns about non-clinical staff (such as receptionists) triaging health conditions and concerns about confidentiality and sensitivity in this process.

• You said that you would like more recognition, support and training for receptionists, particularly around customer relations.

• You said that you would like receptionists to have more awareness about learning disabilities and dementia.

What are we doing?

We will provide training for reception teams, recognising that receptionists are no longer just responsible for their traditional role of booking appointments. With the right training, they are can now assist in providing a more interactive role in ensuring patients see the right professional in the right place at the right time. For example, where appropriate, the receptionist could refer to a nurse or specialist worker which would ensure the GP’s time is used effectively.

• You said you would like us to help people prepare for their appointment – to think about and record their questions.

What are we doing?

We will, like all NHS organisations, continue to promote diversity in the workforce and this includes physical disabilities.

We will look at what might attract healthcare staff to the city as part of our workforce strand in the developing Primary Care Strategy, including looking at factors such as accommodation, and also examining how we might address the culture of locum working by making salaried GP status or GP partnership attractive and rewarding to doctors. The strategy also includes supporting staff, for example nurses and health care assistants to offer skilled care for many issues. We will look at increasing awareness amongst patients of clinicians other than GPs working in general practice – for example, nurse and paramedic practitioners in order that people do not always expect to see a GP.

As part of the prevention, self-care and self-management approach that the CCG wants to promote among patients, we will be looking at how we can embed ‘shared decision making’ in primary care consultations.

We will extend our social prescribing scheme – Community Navigation – across all GP practices in the city. Clinicians and practice staff are able to refer people with a non-medical need to the Community Navigation service, which will explore the needs and refer on to community services as appropriate.

New Ways of Working


• You said that we need to continue to improve access to online booking, but recognise that this is not suitable for all.

• You have concerns around telephone appointments – one of the reasons for this is that a GP or nurse could spot signs or symptoms in face-to-face

situations, but cannot do this over the phone.

• Some of you fed back that online service makes it is easier for you to make appointments.

• You said that we should explore different ways for patients to get support, such as Skype, mobile units and remote monitoring.

• You said that surgery staff could have a key role in encouraging patients to sign up for online services.

• Use of text reminders for appointments is a good idea.

• There needs to be less emphasis on telephone access and more on face-to-face care. Telephone access and consultation is not appropriate for all patients.

What are we doing?

Appointment booking systems are a matter for individual practices but we will always promote best practice in this area in the interests of patients.

We know that telephone consultations are only suitable for some patients, and these consultations are governed by a list of criteria to ensure they are offered appropriately. We will be exploring different ways of accessing care through some regional work and learning from good practice elsewhere; though there are versatile and exciting opportunities provided by technology, face-to-face consultations are likely to remain the main way in which patient receive their care in future.


“I resent telling the receptionist details about my health.”

Accessibility and Patient Experience16%

Concerns35%


11%

LocalSuggestions

10%

New ways of working

16%

Triaging12%


How can we make it easier for you to see your GP when you need to?

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Big talking point 8:How can we give children and families a better start in life?

Community Support


• You said that more should be done to support young carers, who should be encouraged to disclose their caring role and seek help.

• You said that there should be more clubs and groups in children’s centres.

• You said that parents with depression or mental health conditions should be offered support to access community services.

• Some of you fed back that you had to change community groups if you move house due to catchment areas – although you would have liked to continue going to the same groups.

• You said that you would like services to have more consideration for LGBTQ families.

• You would like more information about children’s services available in other languages.

What are we doing?

We have commissioned an all ages Wellbeing Service that provides an opportunity for a family approach to emotional and mental health support.

We have developed a Family FindGetGive webpage as part of www.findgetgive.com that provides advice, information and guidance to parents/ carers including how to seek further help.

We have commissioned a Carers’ Hub which includes support for young carers. The Carers’ Centre carries out specific work around young carers, including going into schools to raise awareness. We will feed this into the Carers’ Strategy group to ensure it informs ongoing work with young carers.

We will liaise with the providers of community services to ensure that they take steps to provide appropriate awareness for staff around LGBTQ issues. We will put services in touch with LGBTQ community groups for more information. The Wellbeing Service has a particular focus on reaching out and supporting LGBTQ communities.

NHS services should provide accessible information about their service, including translated information where needed. We will work with those providing services to help ensure this is implemented.

“[I would like to see] more information about the services available in other languages. Many people, especially those who come from other countries where these services don’t exist, don’t know about them. They would really benefit as they’re often isolated.”

Concerns


• You said that difficulties in making GP appointments mean parents sometimes take their children to A&E.

• You said that poverty and inadequate nutrition is an increasing problem in giving children the best start in life.

• You said that you would like practitioners to have more support and training about special education needs.

• You said that you have concerns about maternity services and would like to see this service better-funded and better-staffed.

• You wanted to ensure communities/families are included in decision making.

• You said you would like to see more consistency in communications for all families.

• You said you would like better training for Special Educational Needs Coordinators (SENCOs).

• You said you would like parents of learning disabled children to have regular respite care to allow them to work.

• You told us that Deaf/ Deafened parents can find it difficult to make appointments for their child and are concerned about the availability of BSL interpreters.

“My husband and I are deaf and we have a baby who can hear. I have concerns about getting care for my baby, as there can be a long wait for a translator. No staff at the surgery know any BSL, so I feel very cut off and alone.”


How can we give children and families a better start in life?

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What are we doing?

Our GPs and surgery staff have received training in supporting children and young people with special educational needs and disabilities. We will explore further awareness raising sessions, with a focus on support around Special Educational Needs.

We know that many people have problems making appointments; we have, in our new Primary Care Strategy, outlined ways to improve access to GP care, including providing appointments at evenings and weekends, and increasing access to other clinicians in the GP surgery, for example, nurse and paramedic practitioners. We will be working with GP surgeries to help them manage demand more effectively. We have set up a Primary Care Reference Group, which includes Parent Carer representation, to help ensure the changes we make are responsive and meet the needs of identified groups.

We will continue to fund and support the very active “Maternity Voices Partnership” which is chaired by local parents and made up of parent representatives and NHS staff, who work together to help improve maternity services in the city. We will pass concerns about maternity services on to them.

We are working together with the City Council to ensure that children and families are at the heart of all of our decision and planning processes. We are committed to a model of ‘co-production’ with families who use our services. We will continue to work in partnership with organisations representing families on commissioning of services and new developments. There is a joint commitment to support and strengthen families facing challenges and to meet the education, health and care needs of all children as locally as possible.

We provide British Sign Language interpreters free of charge to anyone accessing GP surgeries, and other health services in the city. We will ensure information about BSL interpreting is recirculated to GP surgeries, and we will work with the Deaf/deafened community to cascade information about this service.

Learning Disabilities


• You said that workers have a huge role in terms of implementing treatment, explaining medical conditions and accessing health care.

• You said that you would like a “support for” card which people can carry with them detailing their name, address, communication needs and health needs in case of emergency.

• You said that we should raise awareness about health passports.

• You said that most people would talk to their keyworker if they had mental health concerns.

“My son has Downs Syndrome, the staff who have supported us have a high level of knowledge and support which has made our experiences of services very positive” Jubilee Library Infopoint What are we doing?

We are currently developing a business case to improve access and waiting times for neuro-developmental issues as well as support for parents/ carers through a key worker/ coordinator role, this will include learning disabilities. This will be progressed during 2018.

Mental Health


• You would like us to continue to tackle stigma around mental health by building on the #IAMWHOLE campaign.

• You would like more clarification around access to Children and Adolescent Mental Health Services (CAMHS) and the current thresholds.


What are we doing?

In Oct 2016 we launched #IAMWHOLE – a social media campaign aimed at young people to reduce stigma, encourage them to recognise they needed help and see that help.

In Oct 2017 we took the message from #IAMWHOLE to create a story aimed at 8/9 year olds and integrated this as part of the PHSE in schools.

The www.findgetgive.com website provides information on all CYP MH services, how to access them and also provides an opportunity to feed aback about your experiences.

SPFT who provide Specialist CAMHS are currently developing information that can be shared with parents/ carers and CYP about how to access their services including links to their newly developed website.



• Some people fed back positive experiences of maternity services.

• You said that your experiences of the local children’s hospital were very good.

What are we doing?

We will continue collect feedback and learn from positive experiences of healthcare.

Prevention


• You said that behaviour change needs to start with children; it can take a whole generation to see the impact.

• You said that we need to build in resilience at primary school age; one way of doing this would be to provide mindfulness courses.

• You said you would like us to provide more health screening at pre-school.

What are we doing?

The CCG and City Council have worked together to develop a commissioning strategy for children and young people with the LA that includes an aim to give children the best start in life.

We have developed a story “Flo and the Funny Feelings” to be used with 8/9 year olds in primary schools as part of PHSE to support developing their emotional resilience and seeking help.

This is supported by the www.FindGetGive.com website which includes Family FindGetGive providing help and support for emotional wellbeing and mental health from primary age upwards.

We will use this feedback in our health teams, who work with schools to support young people from an early age.

Community Support7%

Concerns22%

Learning Disabilities28%

Mental Health6%

PositiveExperience

30%

Prevention7%


How can we give children and families a better start in life?

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Key Talking Points

Many of the conversations comprised questions, which were answered by senior NHS and Care staff. The following is a summary of key points pulled from the conversations.

Finance

• We heard that local people have concerns over the national funding position of the NHS and the gap in funding for the STP area.

• There are questions on how the STP will be funded.

• There are concerns that any plans would be a cost cutting exercise.

• There are concerns that the STP is adding costs to a system under pressure.

• There are concerns that private contractors are being used too often – where their only aim is to make a profit.

Big talking point 9:The Sustainability and Transformation Partnership (STP)

In response to an increasing volume of questions and comments about the emerging STP, we held a number of STP specific opportunities for questions and comments. These events generally took the format of some scene setting with background information on STP development, national drivers and key challenges, followed by questions and answers and discussion on pertinent areas.

We also worked with YMCA Downslink Group’s Right Here project to gather the views of young people on “You and Your NHS” – focussing on STP wide issues. This took the form of a flash consultation and an evening event.

What is the Sustainability and Transformation Partnership?

The Sustainability & Transformation Partnership is a way of working together across health and social care. The Sussex and East Surrey STP is made up of 24 organisations including CCGs, Providers (hospitals etc.) and local authorities.

The STP is not a single plan, it is a partnership, within which we have local plans built around places and populations. The STP provides a way of aligning the plans of all the partners.

Our local plans for Brighton and Hove are called Caring Together, and these plans sit within the STP.

EventNumbers of conversations

Big Conversation launch event Approx. 60

Daytime event September 2017 Approx. 50

Evening event September 2017 Approx. 50

November 2017 Approx. 40

Young people’s event December 2017

Approx. 40

Young people’s flash consultation survey

170 responses

• We heard suggestions that while investment in prevention will save the NHS more money in the future people who are in greater financial need, are less likely to listen to prevention messages.

• We need to learn the most effective way to purchase equipment and medication and we can learn this from other countries models.

• There are concerns about NHS workers if the system is unsustainable financially.

• We heard that people have concerns about losing doctors and nurses from the NHS, and this may be made worse by Brexit.

• We heard that people have concerns about how the current system doesn’t support consistency of care. Locum doctors earn more than salaried staff – this incentivises locums rather than those who want to stay in place and provide consistency of care.

“I am worried that we do not currently have adequate resources to provide good quality care at home and things would get worse with further cuts.”

Our Response

Like all parts of the health and care system, demand for our services is growing much faster than the resources we have available. If we simply carry on providing services in the way we have in the past and do nothing to change the way we work, then by 2020/21 the gap between the resources available and the money we will have spent across the STP will be close to £900m. The partnership gives us the opportunity to work together to make the best use of the available resources.

We believe that integrated and community-based health and social care, a focus on supporting people to stay well, more joined-up specialist services and a more effective use of our hospitals will enable us to offer people better health and better services within the available resources.

In addition, we are working together to ensure that every penny of the health and care budget is well spent. For example, reducing the reliance on expensive bank and agency staff, back-office costs, and the cost of ineffective treatments and wasted medicines.

Governance

• We heard through local engagement that there needs to be transparency in how the STP is developed and how decisions are made.

• We heard that there is a lack of clarity about accountability and who will be in charge.

• We heard that local people need to know how the STP relates to local decision making and spending.

Our response

The STP is a partnership and a way of working. It has no powers to make decisions on behalf of the individual partner organisations. These powers continue to sit with each partner organisations’ board or on the case of CCG’s, Governing Bodies. Partner organisations also remain responsible for involving their local communities, patients, the public, staff and clinicians in their local plans and decision-making.

Bob Alexander has been appointed as the STP Executive Chair, and robust governance measures are being put in place to ensure that the STP is working consistently and systematically.

“Underlying the STP is integrated health and social care which can be delivered, and delivered better.”

“Our deficits can’t just be balanced through efficiencies.”


The Sustainability and Transformation Partnership (STP)

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Processes

• You said that we do need consistency across the area, no postcode lottery.

• We heard that moving services from hospital to community won’t save much money but much more efficient for patients.

• We heard the local people have concerns that the move towards “Accountable Care Systems” may not be the right way forward.

“Doesn’t every hospital/trust need to work from the same hymn sheet?

Our Response

We are working across the CCG to review our policies on treatments and to develop jointly agreed policies that are based on clinical evidence and the best possible outcomes for patients. This will ensure that there will be consistency for patients from different areas within the STP.

We are working to develop systems that are responsive to the needs of our local populations, and that ensures that patients receive support from a range of services in a coordinated way. We also want to make sure that people only go to hospital when it is appropriate to do so, so we are developing ways to ensure the right support is available in the community, closer to home.

Local Plans

• There are questions about how the STP fits in with, and affects, our local plans.

• We heard that you need us to concentrate on what is right for our population.

• We heard questions about what will actually change in Brighton & Hove due to the STP.

• You said that loneliness is a big problem – older people can become lonely and need more than health and care services.

• We heard that there is a time delay between NHS and Social Care, which means delays in people being discharged from hospital care.

“Are budgets being merged which will mean money is drawn away from Brighton?”

Our Response

Each area within the STP retains its own local plans, which respond to the needs of the local population. The STP provides oversight and co-ordination, and brings the benefits of partnership working to work that can be delivered across this wider area, without losing the focus on local plans.

One key area of focus for Brighton and Hove is to ensure people are discharged promptly, with the appropriate care – including social care – and support in place. We have also developed a range of services that can help prevent people becoming isolated, such as befriending and community based activities.

Engagement on the STP

• We heard that people want to know when will there be clear plans to engage on.

• You said that we still need to engage on local plans and services, not just the bigger picture.

• You said that there needs to be transparency in engagement, not a censored process. The public need to know the full facts.

• You said that the NHS needs to give more time for community involvement.

• We heard that we must work with marginalised groups (BME, Travellers, younger people, older people, disabled people, carers, and people with learning disabilities) in order to understand the impact of changes.

• You said that we need to plan new ways to engage with people.

Flash Consultation – key topics:

Our Response

We will continue to engage with local people on the plans for health and care services in Brighton and Hove. We recognise the value of community engagement, and we will continue to support and fund this within the city to ensure we hear from individuals and groups that may be marginalised and from whom we often do not hear.

We will engage on cross STP issues, including the development of any area wide plans, as appropriate. We are committed to openness and transparency and ensuring the views of residents are sought and acted upon.

We have established an Engagement and Equalities Reference group across the STP, whose remit will include ensuring that there is appropriate engagement with patients, carers and the public, and that equalities issues – including hearing from marginalised groups – are identified and addressed.

What young people said on “You and Your NHS”

Right Here worked with us to engage with local young people around our local plans to integrate health and social care. They also worked with us to address some of the anxieties that young people felt about the wider health economy and the Sustainability and Transformation Plan. We have integrated the key discussion themes in the section above. Below are the key issues identified in the flash consultation as concerns felt by young people in relation to the NHS. You can find the full report on the CCGs website.

The biggest issues identified by local young people were:

1. GP’s and primary care (getting an appointment, service capacity, friendliness).

2. Mental Health (services structures, waiting lists, stigma).

3. Privatisation, funding and stability (NHS funding, staff shortages, free healthcare, longevity of the NHS, private contracts).

4. Health Inequalities.

Funding

Staffing

Privatisation

Health Inequality

NHS Collapsing

Waiting Lists

Brexit

Stress on Staff

No Longer Free

Aging Population

Mental Health

Border Control

Travelling Long Distances

10%

8%

19%

15%2%6%

8%

8%

8%

4%

6%4% 2%


The Sustainability and Transformation Partnership (STP)

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Our Engagement Public Outreach

Pop-up stall at Pavilions GP Surgery Waiting Room

Stall at Whitehawk Community Event Stall

Stall at Sussex University Fresher’s Fair

Stall at Older People’s Festival in Hangleton

Pop-up outreach at Asda at the Marina

Pop-up outreach Co-op on Portland Road

Stall at Cancer Health and Wellbeing Event

Stall at Jubilee Library Infopoint

Mail out to Residents Association

Targeted Outreach to Community Groups

Knit and Natter at Jubilee Library

Age UK Coffee Morning

Brighton Housing Trust (BHT) First Base Day Centre for people who are sleeping rough or insecurely housed

Speak Out Advocacy Group for adults with learning disabilities

Hove Park Healthwalk

Hangleton & Knoll Project’s Multicultural Women’s Group

Baby Boogie at Jubilee Library

Hove Town Hall Customer Services outreach

Filipino Community Meeting

Community Led Consultations

10 Equalities Groups Consultations into Medicines and Pharmacies

Community Researchers ‘Big Conversation’ Consultation

Focus Groups

Mental Health focus group (Urgent Care)

Right Here Young Peoples Focus Group

GP Enhanced Access Focus Group

Hosted Events & Public Meetings

Big Conversation Launch Event

Patient Participation Group Workshop- Online NHS Services

Keeping People Healthier Longer public discussion

Sustainability & Transformation Partnership Events (3 events)

Primary Care Discussion Event

Patient Participation Group Network’s Hosted Event on Dementia Services

Commissioning Intentions Public Discussion

Youth Sustainability & Transformation Partnership event

Digital Health Living Lab

Surveys

Big Conversation Talking Points Survey

Extended Hours Survey

Meetings

Craven Vale Community Centre AGM

Big Conversation Sessions with the Governing Body (2 sessions)

Community Researchers Meeting

Community and Voluntary Sector Health and Social Care Network

Media Coverage of the Big Health and Care Conversation

Print/web media

The Argus

A proactive press release was issued ahead of the engagement event around the STP held in September, which was published on the Argus website.

Brighton Independent

A proactive press release was issued ahead of the three engagement events in September, which was published on the Brighton Independent website.

The Guardian

Information and quotes from Clinical Chair Dr David Supple were provided for a feature on GP recruitment in the society section of the Guardian. Brighton and Hove was used as the case study to highlight innovative ways of recruiting and retaining GPs.

Broadcast media

BBC Inside Out

Dr David Supple took part in an eight-minute feature on the local Sustainability and Transformation Partnership (STP) for the regional version of BBC Inside Out. This involved visiting different parts of the health ‘system’ and speaking to frontline staff. The feature aimed to inform people on what the STP is trying to achieve and received significant exposure, with viewing figures of 450,000.

Social media

There has been extensive use of social media channels to promote events and an online survey intended to gather data.

Twitter June July Aug Sept Oct Nov Dec

Total Followers 1,743 1,757 1,757 1,799 1818 1844 1861

Number of Tweets in Month 29 47 47 40 37 16 61

Tweet Impressions: (Number of times users saw tweet)

8.7k 25.1k 25.1 16 k 14.2k 13.6k 30.7k

Top Tweet (Impressions) 1036 1901 908 1586 1327 2333 4547

Facebook June July Aug Sept Oct Nov Dec

Followers 583 585 585 602 609 612 645

Posts 18 37 37 28 20 8 53

Reach 3000 4256 4256 10.9k 15k 1415 26k

Top Posts 313 468 232 3150 3,455 252 4.8k


Media Coverage / Our Engagement

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48 Caring Together Improving health and care for our city

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70

Item 61


Title:

Adolescent Health Offer: a new integrated approach to reduce the harm to young people caused by substance misuse (drugs, alcohol and tobacco) and early sexual relationships (teenage pregnancy and sexually transmitted infections).

Date of Meeting:

6th March 2018.

Report of:

Executive Director, Health & Adult Social Care

Contact:

Kerry Clarke, Children, Young People and Public Health Schools Programme Commissioner,

Anna Gianfrancesco, Head of Service BHCC (Adolescents), Children Families and Learning.

Tel: 01273 295491 Tel: 01273 296169

Email:

[email protected] [email protected]

Wards Affected:

All

FOR GENERAL RELEASE

Executive Summary The paper provides the Board with an update and seeks the endorsement on the new Adolescent Health Offer being developed to reduce the harm to young people caused by substance misuse (drugs, alcohol and tobacco) and early sexual relationships (teenage pregnancy and sexually transmitted infections). Members of the Health and Wellbeing Board noted this as an area where improvements could be made in July 2017.

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2

Whilst most young people are not using substance or involved in early sexual practices, there are a significant percentage for which this is causing a concern for. The impact of this set of risky behaviours has a significant effect on young people’s lives, so it remains that reducing the harms caused by substance misuse (drugs, alcohol and tobacco) and early sexual relationships (teenage pregnancy and sexually transmitted infections) is a high priority area for improvement. The paper outlines the background and delivery position in July 2017, the process completed to inform the changes and the stages required to complete the process so that a better response is applied. Young people and families, plus residents from all wards will be affected.

Glossary of Terms BHCC – Brighton & Hove City Council PSHE – Personal Social Health Education NHS – National Health Service CVS – Community & Voluntary Sector SCFT – Sussex Community Foundation Trust FC&L – Families, Children & Learning GCSE – General Certificate of Secondary Education

1. Decisions, recommendations and any options 1.1 That the Health and Wellbeing Board endorse the city wide approach

addressed in this paper to reducing the harm caused to young people by substance misuse (drugs, alcohol and tobacco) and early sexual relationships (teenage pregnancy and sexually transmitted infections).

2. Relevant information 2.1. Members of the Board welcomed the Public Health Annual Report 2016/17

in July 2017 and also noted that there could be improvements made to reduce the level of young people misusing cannabis and alcohol in the city. This paper provides the Board with an update and seeks its endorsement to the new approach.

2.2. Prevalence: National and local data trends have shown that young people’s use of drugs and alcohol tobacco had been declining since 2000. But the rate of decline slowed around 2013/4 (appendix one).

2.3. However the ‘What about youth’ survey data from 2014/15 revealed that Brighton and Hove had a significantly high rate compared with the rest of the country (appendix one) for drugs, alcohol and tobacco.

2.4. This is not the case for teenage pregnancy rates. Reducing teenage

conceptions has been a corporate priority and seen as ‘everyone’s business’ since the national teenage pregnancy strategy was launched in 1998. Locally

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3

there has been a 63% reduction in the under 18 conception rate which is currently ahead of reductions seen in the South East and England which have both reduced by 59% over the same time period.

2.5. The adverse impacts on the health of young people from substance misuse,

early conception/ sexual transmitted infection and smoking tobacco makes a strong case for these to remain high priority areas for improvement (See Appendix 2) There are added complexities to be addressed when creating an effective response such as the mixed messages attached to the legal position of smoking, using drugs or having underage sex, the pleasurable and acceptability for some young people of this risky behaviour and the clear links with exploitation, violence and criminal activity, such as drug dealing and the growing concern attached to County Lines.

2.6. The central focus of the new approach to address these behaviors will take into account the challenge practitioners will have in engaging young people:

Who do not see their behaviours as a problem and who, by changing their behaviors may find themselves having to break away from their friendship groups or

Live in families where parents are uncertain how to respond, don’t see there is a problem or in some cases know illegal activities are happening and don’t challenge this.

2.7. The commissioning and delivery background:

2.8. Historically, young people’s services had been set up around specific health

areas such as under 18’s substance misuse or teenage pregnancy, resulting in quite separated services. These services included PSHE support, early intervention and prevention for teenage pregnancy, substance misuse prevention, termination of pregnancy support and substance misuse treatment all in different parts of Children Services. There were further agreements with third sector partners and with the NHS for teenage pregnancy prevention support.

2.9. The structure was for different services to be delivered separately, but often with the same young people. There were six different access processes, management structures and quality assurance process. The ability to develop effective working relationships between settings such as schools and the network of providers was complex and not the most efficient use of the resource.

2.10. In August 2017, a review and redesign process found:

Existing service arrangements, were not responding effectively to the clustering of behaviours demonstrated by young people most at risk.

Some young people were falling between services and not having their needs met in a timely way.

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It did not address the apparent culture of acceptance regarding the use of substances across the city which has been confirmed by partners, parent / carers and young people.

2.11. The findings from an evidence review, feedback from key stakeholders and

trends within existing performance identified the need to move towards an integrated and streamlined Adolescent Health Offer. The new service would need to be able to respond across the cluster of health behaviours (substances misuse and sexual health) and provide a joined up response.

2.12. The target audiences for the Adolescent Health Offer are to be:

Young people who are involved in risky behaviour – but do not see it as a concern through diversionary activities delivered by an experienced partner agency.

Young people who will engage with support and treatment through talking therapies

All young people will have the opportunity to receive high quality teaching and learning by being provided with PSHE support to school staff

Parent / carers will have access to health promotion information and signposting via social media communication, workshops plus consultation support or direct work where a young person is in treatment.

2.13. Summary of the process being completed to achieve the future position.

(From August 2017 to March 2018)

2.14. The new Integrated Adolescent Health Offer will cluster health behaviours together (working across substances misuse and sexual health) and provide a single, branded service placed under the leadership of Families, Children and Learning, in partnership with an external partner to deliver diversionary activities and social media driven health promotion. Central to the model will be that young people and their families have single joined up plans.

2.15. To develop the new Adolescent Health Offer, there are three components to be completed to achieve a single service offer from April 2018 which will build on:

o The recognition that young people are ‘vulnerable’ rather than problematic when experimenting or involved in risky life choices.

o The adolescent research that shows the brain is still developing and young people are learning how to assess risks, make moral and political judgements and control impulses. It will recognise the balance of influence shifts during this stage from parents to peers or other significant adults.

o Improving protective factors around young people in families or with

key adults such as teachers, youth workers and health team workers.

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2.16. Component One: Strategic Leadership and operational delivery of the talking therapies / education support.

2.17. The leadership role will be held with Families Children & Learning Directorate and redesign period is under way. This will mean that the Adolescent Health offer will be an integral part of the citywide adolescent response which fits strategically under the Adolescent Management Board. This strategic leadership will also ensure the Adolescent Health offer meets all the requirements attached to any Safeguarding Learning Review / Serious Case Review, as appropriate

2.18. The Adolescent Management Board, chaired by the Executive Director, Families, Children & Learning, brings together the statutory partner agencies as identified in the Crime and Disorder Act 1998 and wider non-statutory partner agencies in Brighton and Hove. The Board will incorporate the statutory duties and functions of a youth offending board which cover young people up to 18 and address the wider issues of risk and safety (exploitation), health (substance misuse and early sexual relationship) housing and transition issues as young people move to adulthood and adult services.

2.19. The new Adolecent Health offer will continue to have an emphasis on

prevention through supporting quality teaching and delivering health promotion activity to ensure young people are educated and informed to make healthy and safe choices. Talking therapies will enagage with young people who want to change or can be encouraged to change their behaviour. Different packages of support will provide wrap around behaviour change support for young people through trusted adults, such as parents / carers and key professionals.

2.20. In addition, this partnership approach between Public Health and FC&L will ensure connectivity with the future strategic planning for Vulnerability, Violence and Exploitation. This new strategy will incorporate prevention, intervention and enforcement within its remit and was borne out of initial intelligence linked to gangs, knives and County Lines.

2.21. Component Two: Purchasing of Diversionery Activities and social media health promotion to engage with targeted young people.

2.22. A commissioning process has begun to purchase a menu of diversionary activities that will engage young people who do not see their risky health behaviour as a problem or cannot see a way from their situation, into an intervention that will support the reduction of such risky behaviour and improve their resilience. In year one the priority group identified by data will be young men.

2.23. Such activities will need to be engaging and attractive enough to move young people away from what they consider to be attractive and risky activities, and who themselves may have already been involved in diversionary activities earlier in their lives. This may include a process of dynamically engaging

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young people into activities such as drill / rap music, filming, drama, adrenalin sports.

2.24. The provider will also use social media to take forward the campaign started in component three and innovatively implement a social media strategy over the life course of the contract.

2.25. The first commissioning process has been completed and no contract was awarded. This is due to the bids not meeting the quality threshold and Public Health are in the process of feeding this back. An exit plan is being agreed with the existing provider which will include an appropriate timeline.

2.26. In partnership with FCL, an interim arrangement is being finalised and an update will be provided to the board in the chairs communication at the June board.

2.27. Component Three: Social media campaign

2.28. To ensure we have a comprehensive response available, a campaign and

accompanying social media strategy is being developed to go live with the new health offer. The consultation process clearly identified that parents and carers were in need of additional support and there has been a growing local debate attached to the acceptance of young people’s use of cannabis.

2.29. The social media campaign being developed will inform the parent / carers of the health promotion key facts and create a dialogue between young people and parents / carers on the health and wellbeing impacts of substance, alcohol and tobacco use.

2.30. The Adolescent Health Offer’s overarching outcomes include:

• More young people who smoke, drink or use drugs are supported to

stop/reduce their use.

• More young people choose not to smoke, drink or use drugs.

• More young people choose not to have early sexual relationships.

• Increased reporting of young people who are sexually active using

contraception effectively.

• Reduction in the number of young people who have sexually transmitted

infections. (Chlamydia)

• There are fewer school exclusions/ managed moves: • All young people found in possession of cannabis have a joint family

plan with the school; this will include input from the Adolescent Health Offer from point of fixed / internal exclusion.

• All young people found dealing drugs, have a joint family plan that is flexible and can move with the young person which includes input from the Adolescent Health Offer.

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Increased confidence of parents / carers in supporting their young people to

make healthy choices attached to drugs, alcohol, tobacco and sexual

relationships.

2.31. Joint city-wide ownership:

2.32. Key to success for this model is a joint understanding and approach, whereby

Council and NHS partners, Police, schools and colleges, and the breadth of services working with young people such as the CVS, SCFT, mental health services, youth workers and the Adolescent Health Team work together to create an integrated city wide response.

2.33. Reducing the harm to young people caused by substance misuse (drugs, alcohol and tobacco) and delaying early sexual relationships (teenage pregnancy and sexually transmitted infection) needs to be every body’s business, not a single provider or a single school. Hence the recommendation, the Health and Wellbeing Board takes a city wide leadership role and endorses the Adolescent Health offer described. This will ensure our city leaders champion the approach, as well as key stakeholders.

2.34. Next steps:

To work with two schools to co-produce a whole school approach to reduce the harms caused by such risky behaviours and to ensure the two systems work seamlessly together. (Cardinal Newman and Patcham High School) from January to May 2018.

To complete FC&L redesign by March 2018

To purchase Diversionery Activities and social media health promotion by May 2018.

To launch the rebranded service in May 2018

To launch the social media campaign in June 2018, prior to the school summer holidays and festival periods.

3. Important considerations and implications Legal: 3.1 New service contracts will need to be procured in accordance with the

Council’s Contract Standing Orders and the Public Procurement Regulations 2015 as applicable. Legal advice as to adherence to the necessary processes and content of any contractual arrangement should be sought as appropriate.

Lawyer consulted: Judith Fisher Date: 8.02.2018

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Finance:

3.2 The budgets currently held under the function of Children’s 5-19 Public Health Programmes and Substance Misuse Ru- ok? contracts in 17-18 will be funding the new Adolescent Health offer.

The total of the in house provision from Pubic Health totals £0.276m per annum or £0.828 over 3 years. In addition there is a contribution from FC&L of £0.060 per annum from the YOT (Youth Offending Team) budget or £0.180m over 3 years.

The external Commissioning contracts affected total £0.125m per annum, £0.375m over 3 years. These are currently with Impact Initiatives (Youth Collective), YMCA (Teenage Pregnancy Prevention post) and YMCA Downslink (peer led group work). There will be a minimum savings of £0.025m per year from the Integrated Offer in 2017/18 to 2018/19 onwards, reducing the annual amount from £0.461 to £0.436 pa or £1.308 over 3 years. These figures are all based upon pre-savings 17-18 budget figures and are subject to final negotiation. Any re-provision of this service will need to be managed within this existing budget.

Finance Officer consulted: David Ellis Date: 22/02/18

Equalities: This report is focused on a particular cohort of young people, those who are affected by the harm caused by substance misuse (drugs, alcohol and tobacco) and early sexual relationships. There are a wide range of services in place which provide services for all young people. The findings from an evidence review, a review of data and feedback from key stakeholders (young people, parents / carers and professionals working with young people) highlighted that there were a small group of young people with multiple needs who required a specific intervention. The Adolescent Health Offer has been set up to respond to the specific equalities implications identified in the joint strategic needs assessments in Improving Health: Developing Well (Children and Young People). http://www.bhconnected.org.uk/content/needs-assessments In year one, the focus for the diversionary activities includes young men who do not see their risk taking behaviour as a problem or do not know how to move away from their risky lifestyle.

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http://www.bhconnected.org.uk/content/needs-assessments

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There will be on going monitoring of the service and its outcomes to ensure it does reach its key group and also to build any learning into other existing services. With a full Equalities Impact Assessment being required in year one to inform this process further.

Equalities Officer: Sarah Tighe-ford Date 23/02/2018

3.1

Sustainability:

4 There are no significant sustainability implications. Any initiatives implemented will build local social value through networking, volunteering, mentoring and workforce development. Diversionary activities will be encouraged to use local assets both indoor and outdoor, such as venues and parks. Any service base will be in line with the Council Policy to use sustainable materials and wider issues such as using water fountains to avoid plastic and promote healthy drinks.

Health, social care, children’s services and public health: The implications for health, social care, children’s services and public health have already been covered in this paper.

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Appendix 1: Adolescent Health Offer: Prevalence 1.1. National and local data trends have shown that young people’s use of drugs

and alcohol had been declining since 2000. But the rate of decline slowed around 2013/4 (figure 1).

1.2. Key national findings from the smoking, drinking and drug use among young people in England’ survey completed in the Autumn term 2016 show:

1.3. 19 per cent of 11-15 year old pupils had ever smoked a cigarette, which was similar to 2014.

1.4. 44 per cent of pupils had ever drunk alcohol. This question was not asked in earlier surveys.

1.5. 24 per cent of pupils reported they had ever taken drugs (including cannabis). This compares to 15 per cent in 2014. Part of the increase since 2014 may be explained by the addition of questions on nitrous oxide and new psychoactive substances. After allowing for this however, it still represents a large increase.

1.6. 3 per cent of pupils were weekly (regular) smokers, 10 per cent had drunk alcohol in the last week and 10 per cent had taken drugs in the last month

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Figure 1: Shows trends data from smoking, drinking and drug use among young people in England’ for 11-15 year olds.

1.7. So whilst most young people are not using substances (drugs, alcohol or

tobacco), there are a significant number who are and who are causing concern to themselves, or their families or professionals working with them. Local intelligence suggested that whilst the trends were improving, the percentage involved in risky behaviour was still high. In 2016 Public Health England released the ‘What about you’ Data which showed how high Brighton and Hove’s figures were compared with the rest of the country.

1.8. Brighton and Hove:

Indicator aged 15 Period BH Region England Highest % in England

BH Rank in England

% who have taken drugs excluding cannabis in the last month

2014/15 4% 1% 1% 4% Highest

% who have ever tried cannabis

2014/15 24% 12% 11% 24% Highest

% who have taken cannabis in the last month.

2014/15 14% 6% 5% 14% Highest

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Indicator aged 15 Period BH Region England Highest in England %

BH Rank in England

% who have ever had an alcoholic drink

2014/15 76% 67% 62% 78%

% of regular drinkers 2014/15 11% 6% 6% 12% Third Highest

Indicator aged 15 Period BH Region England Highest in England %

BH Rank in England

% of current smokers 2014/15 15% 9% 8% 15% Highest

% of regular smokers 2014/15 10% 6% 6% 11%

2. Teenage Pregnancy:

2.1. Teenage pregnancy has been a national and local priority since 1998 as a

response to England having one of the highest rates in the western world. Reducing teenage conceptions has been a corporate priority since the national strategy was launched and locally there has been a 63% reduction in the under 18 conception rate since 1998. This is currently ahead of reductions seen in the South East and England which are both 59% over the same time period. Figure 2: Quarterly under-18 conception rates, 2007- Q3 2016 (rolling average over 4 quarters) ONS 2016

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Appendix 2: Adolescent Health Offer: the health impact of misusing substances and early sexual relationships. 1.1. Teenagers are particularly vulnerable to the effects of substance misuse

(including cannabis and drinking alcohol) because their brains are still developing1. Those who use cannabis particularly at a younger age have a higher than average risk of developing a psychotic illness. Regular, early substance misuse is linked to addiction in adult life and cannabis use at an early stage is associated with mental health issues even after abstaining for at least a year.2

1.2. NHS England provide the key facts on cannabis3: The effects of cannabis vary from person to person:

you may feel chilled out, relaxed and happy

some people get the giggles or become more talkative

hunger pangs ("the munchies") are common

colours may look more intense and music may sound better

time may feel like it's slowing down

1.3. Cannabis can have other effects too:

if you're not used to it, you may feel faint or sick

it can make you sleepy and lethargic

it can affect your memory

it makes some people feel confused, anxious or paranoid, and some

experience panic attacks and hallucinations – this is more common with

stronger forms of cannabis like skunk or spice

it interferes with your ability to drive safely

1 Konrad K, Firk C, Uhlhaas PJ: Brain development during adolescence: neuroscientific insights into

this developmental period. Dtsch Arztebl Int 2013; 110(25): 425–31. Available from URL: https://www.aerzteblatt.de/pdf/DI/110/25/m425.pdf 2 Public Health England (PHE). Specialist substance misuse services for young people A rapid mixed

methods evidence review of current provision and main principles for commissioning. 2017 Jan. Available from URL: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/583218/Specialist_substa nce_misuse_services_for_young_people.pdf 3 Key Facts on Cannabis: NHS Choices: 2017 https://www.nhs.uk/Livewell/drugs/Pages/cannabis-

facts.aspx

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https://www.nhs.uk/conditions/stress-anxiety-depression/pages/coping-with-panic-attacks.aspx

https://www.aerzteblatt.de/pdf/DI/110/25/m425.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/583218/Specialist_substa%20nce_misuse_services_for_young_people.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/583218/Specialist_substa%20nce_misuse_services_for_young_people.pdf

https://www.nhs.uk/Livewell/drugs/Pages/cannabis-facts.aspx

https://www.nhs.uk/Livewell/drugs/Pages/cannabis-facts.aspx

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1.4. If you use cannabis regularly, it can make you demotivated and uninterested in other things going on in your life, such as education or work. Long-term use can affect your ability to learn and concentrate.

1.5. Researchers from the University of Bristol have found regular and occasional

cannabis use as a teen is associated with a greater risk of other illicit drug taking in early adulthood. The study by Bristol’s Population Health Science Institute, published online in the Journal of Epidemiology & Community Health, also found cannabis use was associated with harmful drinking and smoking4

1.6 One in five adolescents follow a pattern of occasional or regular cannabis use and that those individuals are more likely to be tobacco dependant, have harmful levels of alcohol consumption or use other illicit drugs in early adulthood.

1.7 The long term effects of alcohol are well evidenced and include5:

o Young people who drink are also much more susceptible to long-term

damage to their health and more likely to be involved in an accident and in hospital.

o 15-year olds who drink once or twice a week are likely to score significantly lower at GCSE – the difference between A* and E.

o For each year during adolescence a young person doesn’t drink alcohol, they are 10% less likely to misuse alcohol as an adult. Delaying the age when teenagers start to drink means their prospects are happier, wealthier and healthier.

1.8 In 2016, the Chief Medical Officer of England published the first official guidance on alcohol aimed specifically at children and young people.6 It recommended that the healthiest and safest option was for children to remain alcohol free up to age 18. If they did drink alcohol it should not be at least until the age of 15. For young people aged 15 to 17, it is suggested they should only drink in a supervised environment, and no more than once a week. The 2012 Alcohol Strategy7 had a particular focus on excessive drinking by adults,

4 http://www.bristol.ac.uk/news/2017/june/cannabisuse.html

5 Mentor-Adepis.org Alcohol and Drug Education and Prevention Information. http://mentor-

adepis.org/prevention/ 6 Official Guidance on Alcohol and Young People: Drink Aware: 2016

https://www.drinkaware.co.uk/advice/underage-drinking/the-law/ 7 The Governments Alcohol Strategy; MH Government: 2012

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224075/alcohol-strategy.pdf

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http://www.bristol.ac.uk/news/2017/june/cannabisuse.html

http://mentor-adepis.org/prevention/

http://mentor-adepis.org/prevention/

https://www.drinkaware.co.uk/advice/underage-drinking/the-law/



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but also included the ambition to achieve ‘a sustained reduction in both the numbers of 11 to 15 year olds drinking alcohol and the amounts consumed’

1.9 Smoking remains a significant public health challenge and is the leading

cause of death and illness in the UK. Approximately 207,000 children start smoking each year and two thirds of adult smokers report starting smoking under 18. Smoking is linked with coronary heart disease, strokes, lung cancer, asthma and chronic obstructive pulmonary disease. The earlier children become regular smokers, the greater the risk of ill health. People who smoke between one and 14 cigarettes a day are eight times more likely to die from lung cancer than non-smokers8. One of the national ambitions in the government’s new Tobacco Control Plan published in 20179, is to reduce the number of 15 year olds who regularly smoke to 3% or less.

1.10 Teenage pregnancy is strongly associated with deprivation and social exclusion. Having children at a young age can damage young women’s health and well-being and limit their education and career prospects. While some young people can be competent parents, studies show that children born to teenagers are more likely to experience a range of negative outcomes in later life, and are up to three times more likely to become a teenage parent themselves. Young fathers are twice as likely to be unemployed aged 30, even after taking account of the effects of deprivation10.

8 Action on Smoking and Health. 2015 Jun. Smoking Still Kills: Protecting Children, Reducing

Inequalities. 15 National Institute for Health and Care Excellence (NICE). 9 “Towards a Smokefree Generation”, Tobacco Control Plan: Department of Health July

2017.http://ash.org.uk/about-ash/all-party-parliamentary-group-on-smoking-health/new-tobacco-

control-plan-for-england-published/ 10 Teenage Pregnancy National Support Team. Effective Public Health Practice. 2011 Apr. Available

from URL: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21633

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http://ash.org.uk/about-ash/all-party-parliamentary-group-on-smoking-health/new-tobacco-control-plan-for-england-published/

http://ash.org.uk/about-ash/all-party-parliamentary-group-on-smoking-health/new-tobacco-control-plan-for-england-published/

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21633

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Item 62


Title:

Pharmaceutical Needs Assessment

Date of Meeting:

06/03/2018

Report of:

Brighton & Hove Pharmaceutical Needs Assessment Steering Group

Contact:

Nicola Rosenberg 01273 296558

Email:

[email protected]

Wards Affected:

All

FOR GENERAL RELEASE

Executive Summary The Health and Wellbeing Board (HWB) has a statutory responsibility to publish a revised Pharmaceutical Needs Assessment (PNA) every three years. The PNA maps current pharmaceutical services, identifying gaps and highlighting future needs. It’s used by NHS England to decide upon applications to open new pharmacies and informs the commissioning of pharmaceutical services by NHS England, Brighton and Hove Clinical Commissioning Group (CCG) and Brighton and Hove City Council (BHCC). This paper presents the 2018 PNA to the Health and Wellbeing Board. It describes the changes that have taken place in the provision of pharmaceutical services to the city since the last report was published in 2015. As part of the process, the PNA Steering Group carried out four surveys with the public, GPs, pharmacists and care homes. In addition to in-depth engagement through surveys as part of the PNA process, there was a formal consultation period of two months which included completion of a questionnaire by the neighbouring Health and Wellbeing Boards. The report includes recommendations for the CCG, NHS England and BHCC based upon assessment of health assets and needs, analysis of demographic and service level data and the findings from the surveys.

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The next PNA will need to be completed and approved by the HWB in April 2021. If there are significant changes before this time, the HWB are asked to approve the process for supplementary statements and to delegate authority to the Director of Public Health working with the PNA Steering Group to identify and implement any future amendments to the report.

Glossary of Terms Chapter 11 is a Table of abbreviations used in the report.


1.1 That the Board approves publication of the 2018 Pharmaceutical Needs Assessment Report.

1.2 The HWB are asked to approve the process for supplementary statements delegating authority to the Director of Public Health working with the PNA Steering Group to identify and implement any future amendments to the PNA and to bring back a full revised PNA to the HWB in April 2021. Before this any pharmacy closures will be reported to the HWB.


2.1 There are 56 community pharmacies in the city (including one distance selling online pharmacy), four less than at the time of the 2015 PNA. This translates to 19 pharmacies per 100,000 residents compared to a range of 18 to 26 per 100,000 for our comparable local authority neighbours (where 2018 PNA data has been published) with a median of 19 per 100,000. This is the same as 19 per 100,000 for Kent, Surrey and Sussex and lower than 22 for England. The PNA Steering Group concludes that the current number of pharmacies and pharmacists is sufficient to meet needs of residents. This is due the proximity of pharmacies in the city to where residents live and travel times to reach a community pharmacy (see appendix 1: PNA report Map 2 page 49 and Maps 7, 8 page 59) as well as and the increasing numbers of pharmacist roles (such as through the Better Care work) and the numbers of non-medical prescribers which supports increased access to pharmaceutical advice and support overall. Mapping was done showing the travel distances between closed pharmacies and the next nearest pharmacy (see appendix 1: PNA report Map 9 page 60).

2.2 The PNA steering group has noted that if the number of pharmacies continues to

reduce, this may have an impact on the capacity of the remaining pharmacies to pick up the additional workload. This could potentially lead to longer waits for prescriptions to be dispensed for patients and may reduce the ability of pharmacies to decrease the GP practice workload by offering services such as minor conditions advice. One strategy being implemented to ease the burden on GPs is to move pharmacists into GP Practices, as with the Better Care Pharmacists, who conduct medicine reviews with patients. However they do not dispense and therefore will not offset any further loss of community pharmacies. The PNA Steering Group on behalf of the Director of Public and Health and Wellbeing Board will review capacity

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should another pharmacy close. The Steering group is not aware of other pharmacies planning on closing.

2.3 A patient and public survey was conducted with a high response rate. 727

respondents submitted questionnaires. This was analysed alongside data from an annual city wide survey, the City Tracker and 9 reports on the use of pharmacies submitted by voluntary sector groups. Findings from the City Tracker survey showed that 94% of respondents were very or fairly satisfied with their local pharmacy. More than 4 out of 5 residents (86%) had used their local pharmacy in the previous 12 months, and in this group, satisfaction with their local pharmacy rises slightly to 96%. User satisfaction with community pharmacy has been at 95% or above in 4 out of the last 5 years falling to 90% in 2014. Results from the 2017/8 PNA patient and public survey found that 87% of respondents are satisfied with pharmacy. 76% of respondents to the PNA community survey agreed that they can find and use an open pharmacy when they need with only 5% disagreeing, in comparison to 78% agreeing they could find and use an open pharmacy and 9% disagreeing in 2014.

2.4 There is good geographical coverage across the city of community pharmacies

including advanced and public health commissioned locally commissioned services such as Healthy Living Pharmacies (HLPs) and smoking cessation. There are 28 HLPs a significantly improved number from 12 in 2014/15. HLPs carry out additional health improvement activities. The findings from the previous PNA drove HLP developments and coverage across the city, particularly within deprived areas (see appendix 1: PNA report page Map 19, page 79).

2.5 The PNA report includes 27 recommendations summarised below (see appendix 1

PNA report page 124 onwards):

2.8.1 Access to pharmaceutical services: The population demographics, housing projections and distribution of community pharmacies in Brighton & Hove suggest that the current level of pharmacy services will be sufficient to meet current need until the next PNA is published in 2021. However, where housing developments are planned and/or pharmacies have a change in contract which may result in their closure within the lifetime of this PNA, further consideration may be required.

2.8.2 Service Quality Improvements: The CCG and BHCC should develop a campaign to improve GPs’ and non-medical prescribers’ knowledge and understanding of the services offered by community pharmacies. Pharmacists should provide information and advice on medication aids and medications, including side effects and drug interactions. In particular this advice or training should be given to people with complex needs, including older people, and those with mental ill health, long term conditions and carers.

2.8.3 Improving outcomes: Develop the HLP service to include more mental health elements and joint campaigns with neighbouring GP Practices. In view of the projected increase in the proportion of older people living in the city all community pharmacies should be trained in communicating with older people. Public Health to promote the uptake of Make Every Contact Count training amongst community pharmacies.

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The role of pharmacies in offering stop smoking services should be strengthened through the development of action plans and training and review of payments. When commissioning, the CCG, NHS England and BHCC should consider the role of community pharmacies to support patients with long term conditions.

2.8.4 Medicines optimisation: The CCG to increase the proportion of electronic prescriptions converted to electronic repeat dispensing (eRD). Communication systems to be improved between community pharmacies and GPs, non-medial prescribers, Better Care pharmacists, care and nursing homes, Nursing Home Medication Review Team and hospital pharmacies. CCG to promote the understanding of the role of Better Care pharmacists amongst community pharmacists in each GP Practice cluster.

2.8.5 Information Management Tools (IMT): Data sharing of patients’ records by GPs with pharmacies to be improved, where appropriate. Improve joint working through greater use of digital communications between community pharmacies and GP Practices.

2.6 In conclusion, the PNA considers there to be sufficient coverage of community pharmacies and related services. The report supports commissioners to design services to address local health and wellbeing needs and reduce health inequalities.


Legal 3.1 The National Health Service (Pharmaceutical and Local Pharmaceutical Services)

Regulations 2013 (“the Regulations”) set out the legislative basis and requirements of the Health and Wellbeing Board for developing and updating the PNA. The proposals set out in this paper are consistent with ensuring that the HWB is in a position to discharge its duties.

Lawyer consulted: Elizabeth Culbert Date: 29/01/2018

Finance

3.2 There are no financial implications as a direct result of the recommendations of this report. Finance Officer consulted: David Ellis Date: 29/01/2018 Equalities

3.3 We have incorporated Equality Act 2010 requirements throughout the PNA. During the PNA process we have taken into consideration protected characteristics and vulnerable groups at each stage of the process and details relating to how services affect different groups are detailed in the main report. In the PNA report’s appendix 3 there is a “Statement of Due Regard” relating to the Equality Act 2010. As advised by the Equalities Team, this states that the needs assessment has paid due regard to the council’s duties. Equalities officer consulted: Sarah Tighe-Ford Date 30/01/2018

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Sustainability 3.4 Brighton & Hove CCG and Community Pharmacies have been working to reduce

pharmaceutical waste through the “Breathe Better Waste Less” scheme for inhalers and the “Green Bag” scheme for carrying current medication when admitted to hospital or a care home.

Health, social care, children’s services and public health: 3.5 Implications for health, social care, children’s services and public health are

included throughout the PNA report.


Appendix1: PNA Report 2018

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Pharmaceutical needs assessment

Brighton & Hove City Council

Public Health Intelligence Team

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Executive Summary

This report sets out the draft Pharmaceutical Needs Assessment (PNA) for Brighton

and Hove. The PNA is a comprehensive statement of the need for pharmaceutical

services of the population in its area. The PNA aims to identify the pharmaceutical

needs of the local population by mapping current pharmaceutical services,

identifying gaps and highlighting future needs. It aims to support efforts to reduce

health inequalities and improve health and wellbeing of local people. The PNA will be

used by NHS England to decide upon applications to open new pharmacies and it

will inform all commissioners regarding the commissioning of pharmaceutical

services.

Since April 1st 2015, every Health and Wellbeing Board (HWB) has had the

responsibility to carry out and publish a PNA at least very three years. The

development of this PNA includes the analysis of health needs, local information,

intelligence, plans and strategies; surveys with the public, pharmacies, GPs, care

and nursing homes. Formal public consultation lasting 60 days took place between

October and December 2017.

Local population

There are a number of demographic factors that affect the need for pharmacy

services within the city. It is estimated that there are 289,200 people living in

Brighton and Hove, an increase of 4,000 people (1.4%) since 2015 when the last

PNA was published. This number is expected to increase by 6.7% to 305,900

people, by 2026. The city has a relatively younger adult population than the rest of

England with higher proportions of people aged 16-64 years and lower proportions of

children and older people aged 65-74. The proportion of the population aged 85

years or over is similar to the rest of the country.

Pharmacy services

There are currently 56 community pharmacies within the city (including one distance

selling pharmacy), four less than at the time of the 2015 PNA. This translates to 19

pharmacies per 100,000 residents compared to a range of 18 to 26 per 100,000 for

CIPFA neighboursa (where 2018 PNA data has been published) with a median of 19

per 100,000, this is the same as 19 per 100,000 for Kent, Surrey and Sussex and

lower than 22 for England. The PNA Steering Group concludes that the current

number of pharmacies and pharmacists is sufficient to meet pharmaceutical needs of

residents. This is due the proximity of pharmacies in the city to where residents live

a The Chartered Institute of Public Finance Accountants has developed a model to measure similarity

between local authorities. The nearest neighbours with PNA data available for 2018 included: Southampton and Reading 18 per 100,000, Portsmouth, and Swindon 19 per 100,000, Southend 21.8 per 100,000, Medway, and Newcastle 22 per 100,000, and North Tyneside 25.7 per 100,000.

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and travel times to reach a community pharmacy as well as and the increasing

numbers of pharmacist roles (such as through the Better Care work) and the

numbers of non-medical prescribers which supports increased access to

pharmaceutical advice and support overall. The number of pharmacist roles in the

city has increased through the recruitment of specialist pharmacists e.g. Better Care

Pharmacists, Rapid Response Pharmacists, NHS England Pharmacists, Practice

Pharmacists, and Care Home Pharmacists. Many of these posts are being trained

as non-medical prescribers.

However, if the number of pharmacies continues to reduce, this may have an impact

on the capacity of the remaining pharmacies to pick up the additional workload. This

could potentially lead to longer waits for prescriptions to be dispensed for patients

and may reduce the ability of pharmacies to decrease the GP workload by offering

services such as minor conditions advice. One strategy being implemented to ease

the burden on GPs is to move pharmacists into GP Practices, as with the Better

Care Pharmacists in the city. These are not dispensing pharmacists though, so they

will not offset any further loss of community pharmacies.

However, the PNA Steering Group will review capacity should another pharmacy

close.

Residents on the whole (87%) are satisfied with pharmacy services however

opportunities remain to maximise the role of pharmacies in reducing health

inequalities and improving health and wellbeing.

76% of respondents to the PNA community survey agreed that they can find and use

an open pharmacy when they need one. Only 10% said the opening times of the

pharmacy they used didn’t meet their needs. This report recommends that

information about pharmacies opening times and the services provided, should be

made more readily available to residents in different ways to ensure local people are

aware of where and when services are available.

The survey with residents, GPs and non-medical prescribers showed that there is a

lack of knowledge and understanding about the services delivered by community

pharmacies. This report recommends that information on all pharmacy services

should be made more readily available locally to different audiences, including GPs

and residents. The survey with community pharmacies showed that only a third

(32%) was aware of Better Care pharmacists. This report recommends that steps

should be taken to increase their awareness of these.

There is good geographical coverage across the city of community pharmacies

including advanced and public health commissioned locally commissioned services

such as Healthy Living Pharmacies (HLPs) and smoking cessation. There are 28

HLPs a significantly improved number from 12 in 2014/15. HLPs carry out additional

health improvement activities. The findings from the previous PNA drove HLP

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developments and coverage across the city, particularly within deprived areas. The

PNA has not identified any significant gaps in the current pharmaceutical provision.

Summary of recommendations

Access to pharmaceutical services

The population demographics, housing projections and distribution of community pharmacies in Brighton & Hove suggest that the current level of pharmacy services will be sufficient to meet current need until the next PNA is published in 2021. However, where housing developments are planned and/or pharmacies have a change in contract which may result in their closure within the lifetime of this PNA, further consideration may be required. (Recommendation: Page 46)

Service Quality Improvements

The Clinical Commissioning Group (CCG) and Brighton & Hove City Council (BHCC) should develop a campaign to improve GPs’ and non-medical prescribers’ knowledge and understanding of the services offered by community pharmacies. This should help to alleviate the pressure on GPs by directing suitable patients to access pharmacy services instead (Recommendation: Page 119)

Pharmacists should provide information and advice on medication aids and medications, including side effects and drug interactions. In particular this advice (or training where appropriate) should be given to people with complex needs, including older people, and those with mental ill health, long term conditions and carers. (Recommendation: Page 87)

Improving outcomes: Public Health Services provided by community

Pharmacies

Develop the Healthy Living Pharmacy service to include more mental health

elements and joint campaigns with neighbouring GP Practices.

(Recommendation: Page 120)

In view of the projected increase in the proportion of older people living in the

city all community pharmacies should be trained in communicating with older

people. (Recommendation: Page 32)

Public Health to promote the uptake of Make Every Contact Count (MECC)

training amongst community pharmacies. (Recommendation: Page 113)

The role of pharmacies in offering stop smoking services should be

strengthened through the development of action plans and training, where

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appropriate. BHCC should also review its payment schedules.


When making commissioning decisions the CCG, NHS England and BHCC

should take into consideration the role of community pharmacies in

addressing the needs of patients with long term conditions.


Medicines optimisation service: the safe and effective use of medicines to

enable the best possible outcomes

The CCG to increase the proportion of electronic prescriptions converted to electronic repeat dispensing (eRD). (Recommendation: Page 103)

Communication systems to be improved between community pharmacies and GPs, non-medial prescribers, Better Care pharmacists, care and nursing homes, Nursing Home Medication Review Team and hospital pharmacies. (Recommendation: Page 80 and 119)

CCG to promote the understanding of the role of Better Care pharmacists

amongst community pharmacists in each GP Practice cluster.


Information Management Tools (IMT)

Data sharing of patients’ records by GPs with pharmacies to be improved,

where appropriate.(Recommendation: Page 103)

Improve joint working through greater use of digital communications

between community pharmacies and GP Practices. (Recommendation:

Page 80)

In conclusion

The PNA report considers there to be sufficient coverage of community pharmacies and related services in the city. The report supports commissioners to design services to address local health and wellbeing needs and reduce health inequalities.

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CONTENTS

1. Introduction 7

2. Demographic profile 17

3. Local health needs 33

4. Current pharmaceutical provision 47

5. Patient /public survey and feedback 81

6. Community pharmacy survey 104

7. GP and non-medical prescribers survey 113

8. Care home survey 120

9. Formal consultation feedback 123

10. Recommendations and conclusions 124

11. Table of abbreviations 129

12. Appendix 1 Brighton & Hove Health Profile 2017 132

13. Appendix 2 List of pharmacies in Brighton & Hove 138

14. Appendix 3 Equality Act, “Statement of Due Regard” 140

15. References 141

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1. Introduction

1.1. What is a PNA?

The Pharmaceutical Needs Assessment (PNA) is a comprehensive statement of the

need for pharmaceutical services of the population in its area. The National Health

Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (“the

Regulations”) set out the legislative basis and requirements of the Health and

Wellbeing Board for developing and updating the PNA as well as the responsibility of

NHS England in relation to “market entry”.

The provision of NHS Pharmaceutical Services is a controlled market. If an applicant

wants to provide NHS pharmaceutical services, they are required to apply to NHS

England to be included on a pharmaceutical list. Since April 2013 pharmaceutical

lists are compiled and held by NHS England. This is commonly known as the NHS

“market entry” mechanism. Other types of contractor include dispensing doctors,

authorised to dispense drugs and appliances in designated rural areas.

Under the Regulations, applications for inclusion in the pharmaceutical list must

prove that they are able to meet a pharmaceutical need as set out in the relevant

PNA. There are two exceptions, one for services provided by distance selling (e.g.

internet pharmacies), and the second is an application for needs not foreseen in the

PNA (known as “unforeseen benefits”).

NHS England will use the PNA when making decisions on applications. Such

decisions are appealable and decisions made on appeal can be challenged through

the courts.

PNAs can also be used by the Local Authority and the NHS locally in making

decisions on which Local Authority and NHS funded services could be provided by

local community pharmacies e.g. Chlamydia Screening, Emergency Hormonal

Contraception Service etc.

Health and Wellbeing Boards (HWBs) have the responsibility to carry out and publish

a PNA for its population at least every three years and publish supplementary

statements stating any changes to local pharmaceutical services. These should be

published as soon as is reasonably practical after identifying significant changes to

the availability of pharmaceutical services since the publication of its PNA; unless it

is satisfied that making a revised assessment would be a disproportionate response

to those changes.

Changes have also been made to the market entry regulations to facilitate the

consolidation of pharmacies. These require the HWB to comment on whether or not

a gap in pharmaceutical service provision would be created by the proposal for

consolidation. If the application is granted and pharmacy premises are removed from

the relevant pharmaceutical list, and the HWB does not consider that a gap in

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service provision is created as a consequence, it must publish a supplementary

statement alongside its PNA recording its view.

The HWB is also required to maintain an up to date map of provision of NHS

Pharmaceutical Services.

HWBs need to ensure that the NHS England Area Teams have access to their

PNAs.

Under the Regulations each HWB was initially required to publish its own revised

PNA for its area by 1st April 2015 and update this every three years. In order to

obtain HWB sign-off a two month period of public consultation beforehand is required

(Part 2 NHS regulation, 2013)1

1.2. Purpose of the PNA

The PNA aims to identify the pharmaceutical needs of the local population by

mapping current pharmaceutical services, identifying gaps and exploring possible

future needs. It aims to support the efforts to reduce health inequalities and improve

health and wellbeing of local people.

The PNA is used for commissioning services, to align pharmaceutical services

provision with local needs.

It will be used by different organisations to inform their commissioning of

pharmaceutical services as follows:

NHS England – to make decisions on applications to open new pharmacies,

dispensing appliance contractor premises and dispensing doctors, as well as

changes to existing NHS pharmaceutical services. It will also be used to

inform the provision of locally commissioned services from pharmacies

Clinical Commissioning Groups (CCG) and Local Authorities – to inform their

commissioning of local services.

1.3. Context

This PNA is being written against a background of funding cuts in the wider health

and social care economy and at a time of increasing demand as patients are living

longer with more co-morbid conditions. To address these demands changes in the

models of care are being implemented, all of which will have an impact on the work

of community pharmacies by the time this PNA is refreshed in three years.

Until recently government funding for community pharmacy was £2.8 billion a year,

but in 2016 this was reduced to £2.687 million for 2016/17 and £2.592 million for

2017/18. This represents a 4% reduction in 2016/17 and 3.4% in 2017/18.

Changes have also been made to the way funding is distributed.

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Establishment payments will be phased out, and a range of dispensing-

related fees will be amalgamated into a single activity fee: the

professional/dispensing fee, practice payment, repeat dispensing payment

and monthly electronic prescription service (EPS) payment.

A Pharmacy Access Scheme (PhAS) has been introduced to support

services in isolated areas. Pharmacies will be eligible if (i) the pharmacy is

more than a mile away from the nearest other pharmacy by road and (ii) the

pharmacy is on the pharmaceutical list as at 1 September 2016 and (iii) the

pharmacy is not in the top 25% largest pharmacies by dispensing volume.

There are six pharmacies eligible for the Pharmacy Access scheme in

Brighton & Hove.b

A £75 million Quality Payment Scheme (which includes a Quality Premium for

level 1 Healthy Living Pharmacies) will reward pharmacies with funding based

on how well they perform against criteria set out by the government. To be

eligible pharmacies must meet the four “Gateway” criteria which are: provide

at least one specified advanced service; have an up to date NHS Choices

entry; have NHS mail; use the Electronic Prescription Service. Pharmacies

will then receive payment if they achieve additional quality criteria.

A Pharmacy Integration Fund will support the integration of pharmacists

across the NHS/primary care work force. The fund will provide an additional

£42 million to the funding set out for 2016-18.

1.4. Medication Supply

Nationally, medication supply issues are exerting pressure on community

pharmacies. Supply and demand issues have arisen as a result of: quotas, branded

generic supplies and wholesale availability and supply from manufacturers.

Other contributory issues are:

Manufacturing problems

Raw material problems

Regulatory problems.

The priority for community pharmacies is to get medicines to patients when they

need them. NHS regulations require all prescriptions to a pharmacy to be

dispensed but the law does not oblige manufacturers and wholesalers to meet

the orders in a similar way. This can cause problems for pharmacists and

patients.

b Asda in Crowhurst Road, Coldean, Leybourne, Matlock pharmacies and Well pharmacies in Chalky Road and

Warren Way.

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1.5. Pharmacy – A way forward for Public Health. 2017.

Public Health England published Pharmacy – A way forward for Public Health in September 2017. This document outlines the opportunities commissioners and local providers can use to enable community pharmacies to play a key role in delivering public health interventions. These include pharmacists in GP Practices; optimising the role of community pharmacies; commissioning pharmacies to deliver public health interventions; playing a role in Sustainability and Transformation Partnerships and through Healthy Living Pharmacies. It also highlights the key priorities community pharmacies can focus on: NHS Health Checks; Sexual health/contraception; Healthy Child Programme; Alcohol; Drugs; Falls & MSK; Smoking; Diet & obesity; Blood Pressure & Atrial Fibrillation; Mental Health; Healthy Ageing ( including dementia and frailty); Maternity & Early Years; Antimicrobial Resistance; Diabetes; Health & work and Physical Activity.

1.6. Caring Together

Caring Together is a joint programme led by Brighton & Hove CCG Clinical Leadership Group and Brighton & Hove City Council (BHCC), which sets out how the city can improve and transform adult and children’s health and care services, physical and mental health, social care, public health, GPs, pharmacies, community, voluntary sector and hospital services. The Caring Together plan is aligned to the Sustainability and Transformation Partnership (STP), which covers the wider area of Sussex and East Surrey. Caring Together is Brighton and Hove's local footprint of the STP.

Caring Together has six clinical programmes: Prevention and Community Care; Planned Care and Cancer; Access to Primary Care and Urgent Care; Mental Health, Learning Disability, Children and Families; Medicines Optimisation and Future Models for Acute Care

The Medicines Optimisation strand has six principal deliverable outcomes.

Project 5A. Better Care Pharmacists (BCP)

Project 5B: Pharmacy Support to Discharge.

Project 5C: Non-Medical Prescribers.

Project 5D: Support to Practice Support Staff.

Project 5E: Paediatric Formulary.

(Projects 5A to 5C are linked under the heading of “Establishing unified medicines optimisation support to General Practice”)

The purpose of this programme is to optimise the use of medicines across the Brighton and Hove health economy to ensure that the right patient receives the right choice of medicine at the right time to improve patient outcomes.

This care programme delivers the following overall benefits to the local Health and

Social Care environment:

Establishing unified medicines management support to General Practice.

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Increasing skills in the workforce to release time from GPs and extending the role of pharmacists in primary care to include non-medical prescribing cluster clinics in Long Term Conditions (LTCs).

Supporting and educating practice staff to manage repeat prescribing more effectively and efficiently.

Reducing medicines wastage from inefficient processes and also from medication reviews, therefore releasing savings that can be invested elsewhere in healthcare.

Educating and empowering patients to understand their medications better and to signpost where to go when they need medicines for minor ailments.

Promoting better interface communication between Brighton and Sussex University Hospital NHS Trust (BSUH) and GPs with regards to paediatric medicines, enabling the use of more cost effective medicines whilst improving the patient/carer experience and reducing transfer of care issues.

It is planned to deliver the outcomes of the Medicines Optimisation strand by the end of 2018/19.

Engagement with community pharmacies is an important element of the Medicines Optimisation strand. To facilitate closer working the CCG is arranging engagement workshops between GPs and pharmacies within each local GP Practice cluster in 2018.

1.7. The Big Health and Care Conversation

Between July and December 2017 the CCG Engagement Team carried out an extensive outreach process with community groups, public meetings and street outreach, to find out what help patients and the public want with their healthcare. One theme that emerged from this process was, “How can we make better use of medicines?” Some of the comments relating to this are relevant to the PNA e.g. service information, including evening access and have been considered as part of the PNA.

Recommendation

The Caring Together Partnership Board should strengthen its links with community pharmacies.

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1.8. Brighton & Hove PNA background

This is the fourth PNA published for Brighton & Hove since 2005. The last full PNA was published in March 2015. It found our population had better access to pharmacies per head of population compared to neighbouring areas. There were 60 community pharmacies in the city, with 22 pharmacies per 100,000 residents compared to 19 per 100,000 for Kent, Surrey and Sussex. No significant gaps in service were found. Residents were on the whole satisfied or very satisfied with pharmacy services but opportunities were identified for maximising the role of pharmacies within primary care and public health.

The 2015 PNA made 18 recommendations. These are set out below, together with an update on action that has taken place since publication.

a) Should the status of the current pharmacy at the University of Sussex change, BHCC, CCG and NHS England with the local professional representative/s to work together to look at primary care provision at the University of Sussex, both the GP practice and the pharmacy, to ensure sufficient primary care provision is available

The University of Sussex contract was due to come to an end in March 2018, but it has now been agreed by NHS England to extend the contract for a further two years. Should the University of Sussex pharmacy be recommissioned in 2020, students’ views on pharmacy services will need to be considered as part of the commissioning process.

b) To improve the public's knowledge and understanding of the services delivered by community pharmacies. This could be achieved through a national campaign led by NHS England to improve understanding of pharmacy services across the country. Brighton and Hove City Council and CCG should ensure information is available locally in a number of different ways to different audiences to ensure residents are aware of and have easy access to up to date information about what, when and where services are provided by pharmacies. Pharmacies should also actively promote the services they provide.

Brighton & Hove CCG launched a public awareness campaign in January 2017 called #HelpMyNHS, part of which included helping the public understand better the services pharmacies provide. This includes the costs associated with GP prescribed medicines that are also available to buy over the counter at pharmacies without prescriptions.

https://www.brightonandhoveccg.nhs.uk/helpmynhs-campaign-launches-across-city

c) For there to be no significant reduction to existing opening hours for pharmacies across the city. Where there are pharmacies open in the evenings, late at night and throughout the weekend, more information should be made available to patients / residents using different avenues

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(web and non-web based). When a pharmacy is closed a clear notice should be put on the door to state where the closest pharmacy is open.

Information on opening hours is available on NHS Choices, and is displayed by pharmacies in a place that is visible to the public even when the pharmacy is shut. NHS England distributes a poster on opening hours for pharmacies to display at Christmas and Easter.

d) To develop and deliver new initiatives including a local campaign regarding safe disposal of medications tailored to target groups as identified by the survey findings.

The findings of the Community Survey undertaken for this PNA indicate that the public has increased its knowledge of the safe disposal of medications since the 2015 PNA report was published.

e) For NHS England to note that patients would like to know more about the home delivery of medications service that some pharmacies provide.

NHS England has noted that patients would like more information about home delivery of medications. However, this is a service that is provided privately outside the NHS contract. Pharmacies advertise this service if they provide it on websites, in practice leaflets and in the pharmacy itself.

f) Pharmacies to train staff to communicate well with younger age groups as well as older residents

The Sexual Health and Contraceptive Locally Commissioned Service specification requires pharmacies to provide a young people friendly service incorporating the principles of the “You’re Welcome” criteria.

All staff have under taken Dementia Friends Training as part of the criteria for claiming quality payments. It is recommended that Healthy Living Pharmacy Training includes communication skills for working with older people.

g) NHS England, Brighton and Hove City Council and CCG and pharmacies to work together to communicate clearly with patients regarding pharmacy services that are already available such as minor conditions advice.

This is being addressed as part of the Brighton & Hove CCG #HelpMyNHS campaign.

h) NHS and public health commissioners to consider commissioning new services within pharmacies in response to a given need and to learn from

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good practice from elsewhere e.g. NHS Health Checks and advice regarding managing long term conditions

The NHS NUMSAS (NHS Urgent Medicine Supply Advanced Service) Service enables NHS 111 to refer patients to pharmacies for urgent medicine supplies out of hours. The public health Healthy Living Pharmacy Locally Commissioned Service is running in 28 pharmacies and includes the requirement to run 12 annual health promotion campaigns; train staff as health champions to provide signposting to health promotion services and maintain a health promotion area and materials; as well as targeting inequalities and supporting vulnerable groups.

i) Brighton and Hove CCG to share information regarding Sussex Interpreting Service and for this to be shared widely with both pharmacies and residents to ensure arrangements are made for patients to communicate with pharmacies in their chosen language.

Information about interpretation services was sent twice in 2016 to pharmacies and has been cascaded widely through Black and Minority Ethnic (BME) services. However, despite these actions uptake of the interpretation services remains low.

j) To improve the GPs’ and non-medical prescribers’ knowledge and understanding of the services delivered by community pharmacies. Brighton and Hove City Council and CCG should also develop training and a local information campaign to ensure GPs and non-medical prescribers are aware of, understand and have easy access to up to date information about what, when and where services are provided by pharmacies.

This is being addressed by ongoing work, including through the work of Better Care Pharmacists to improve joint working between GPs and Community Pharmacists.

k) To review and evaluate the impact of the roles pharmacies played within the EPIC project alongside the findings from this PNA to inform future commissioning of services

The pharmacy element of the EPIC project has now stopped as it was not increasing GP capacity as had been originally envisaged.

l) All pharmacies should have an understanding of the 2010 Equality Act requirements for their premises

NHS England has taken action in relation to the Equality Act and community pharmacies and sent information to all pharmacies about this.

m) BHCC Public Health Directorate to further develop the Healthy Living Pharmacy scheme working with pharmacies to focus on efforts on reducing

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inequalities and addressing needs of vulnerable groups. This will include pharmacies actively promoting public health campaigns and information on access to local authority, voluntary sector and other primary care services including GPs and dentists and appropriate use of NHS services.

Since March 2015, 28 Level 2 Healthy Living Pharmacies have been established. In December 2017 there were 28 pharmacies out of 56 community pharmacies (55 plus 1 distance selling pharmacy) participating in the Brighton & Hove Public Health, Healthy Living Pharmacy, Locally Commissioned Service. They all participate in two days annual training to undertake this role. In 2016 a national Public Health England Level 1 Healthy Living Pharmacy Programme was introduced. This is based on self-assessment process of clear quality criteria. Level 1 focuses on pharmacies creating a proactive health promoting culture and environment. Implementation and accreditation of levels 2 and 3 remains with local authorities. Further information on this is detailed within this report.

n) For pharmacies to have more of a lead role regarding repeat dispensing. Pharmacists would inform GPs which patients could go onto repeat dispensing and receive prescriptions and medications directly from the pharmacy without having to go to the GP practice

NHS England is working on this issue with NHS Digital and Brighton & Hove CCG. Part of the pharmacy contract includes recommending to patients to talk to their GPs about repeat dispensing.

o) NHS England, Brighton and Hove CCG and City Council, pharmacies and patients to work together to reduce waste of medicines.

Between 2015 and 2016, Brighton & Hove CCG and Glaxo Smith Klein ran the “Breathe Better Waste Less” campaign, to reduce the wastage caused by inhalers. Nationally 63% of inhalers end up in landfill and many are discarded when they are only partially used. The aim of the campaign was to train community pharmacists in the correct inhaler technique; the checking of patient inhaler technique at Medicine Use Reviews and the provision of inhaler recycling facilities in pharmacies. Analysis of the returned inhalers found 82%were partially full or full.

Brighton & Hove has also been running a “Green Bag” scheme via its community pharmacies, since 2015. This encourages patients to carry all their current medication in a special green bag when they are admitted to hospital or a care home, to reduce medication errors and waste

p) To share practice and pharmacy email addresses between practices and

pharmacies. Pharmacists should use an nhs.net email account for communication.

All Brighton & Hove pharmacies now have an nhs.net email address

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q) To improve more integrated ways of working linked with Better Care pharmacists and enhancing primary care work, joint meetings between GPs and pharmacists within local areas should take place. Exchanges and joint meetings should also happen between practice and pharmacy staff to help share understanding of different roles and issues pharmacies and practices both face.

Each cluster of GP Practices in the city has a Better Care pharmacist. Further information on this is detailed in this report.

r) Pharmacies use the new online portal being developed by the Council as

part its Care Act (2014) duties to provide up to date information to patients and carers in the city. Pharmacies to also use the council website for signposting information, for a wide range of services, such as addressing social isolation and weight management. The links for these key websites to be provided by Brighton and Hove City Council (BHCC) Public Health Directorate. BHCC Public Health Directorate to share web links for information on signposting, emailed to pharmacies with all GP practices

As part of their training all Level 2 Healthy Living Pharmacists receive a signposting directory with links to key websites. These are then used as part of their Making Every Contact Count role to signpost people to appropriate services within the city. They also direct people to the “Mylife” website. https://www.mylifebh.org.uk/

1.9. PNA Methodology The Brighton & Hove PNA 2017 used the following methodology. 1.9.1. PNA Steering Group A PNA Steering Group was formed to oversee the PNA process and ensure that the PNA meets the statutory requirements on behalf of the HWB. Membership of the group included a range of stakeholders:

Brighton & Hove City Council Nicola Rosenberg (Chair) Public Health Consultant

Brighton & Hove City Council Barbara Hardcastle (Project lead) Public Health Specialist

Brighton & Hove City Council David Golding Public Health Intelligence Research Officer

Brighton & Hove Clinical Commissioning Group

Katy Jackson Chief Pharmacist

Brighton & Hove Clinical Commissioning Dr Katie Stead

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https://www.mylifebh.org.uk/

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Group Clinical Lead for Primary Care and Public Health

East Sussex Local Pharmaceutical Committee

Vanessa Taylor Executive Officer

NHS England Amanda Marshall Contracts Manager For Pharmacy and Eye Care

Healthwatch Sylvia New

1.9.2. Surveys Public views about the current and potential future of pharmaceutical services in Brighton & Hove were collected using surveys. The questionnaires were approved by the Steering Group; it was available online and as hard copy. Details of the survey were distributed to pharmacies, GP Practices, libraries, main public council venues, the Third Sector, Patient and Public Participation Groups and Universities. Surveys were also undertaken with Pharmacists, GPs, non-medical prescribers and care and nursing homes, to ascertain their views of current and potential future pharmacy services. The voluntary sector also carried out a number of engagement exercise on medicines and pharmacies for the CCG, and their survey findings have been included in this report. Healthwatch were also conducting a survey of GP Practices and included some questions about pharmacies to be used in the PNA. All the survey results were analysed and the findings are included as part of this report. 1.9.3. Other data Other sources of data used in the PNA include the Joint Strategic Needs Assessment 2017, the Public Health Outcomes Framework May 2017, Public Health England Health Profiles 2017, Quality and Outcomes Framework 2016/17, Annual Report of the Director of Public Health 2016/17, Brighton & Hove City Plan Part 1 2016, NHS Business Services Authority, NHS England, NHS Digital and Brighton and Hove CCG. 1.10. Consultation All the data collected was used to inform the draft PNA. After approval by the Steering Group, the draft report was posted on the BHCC Consultation Portal for a statutory minimum 60 day consultation period between October and December 2017. 1.11. Sign Off and publication The final PNA will be presented to the March 2018 HWB for sign off and will be published by April 1st 2018.

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2. Demographic profile This section describes the demography of the Brighton and Hove City Council and

CCG including its GP Practice Clusters, it includes population estimates and

projections and resident profiles. The majority of the data in this chapter was sourced

from various documents available from the Reports and Needs Assessments pages

of the Local Intelligence webpage hosted by Brighton & Hove Connected at

http://www.bhconnected.org.uk/content/local-intelligence

2.1. GP Practice Clusters

For the purposes of the PNA the localities used have been defined as the Brighton

and Hove CCG GP Practice Clusters.

The Brighton and Hove CCG consists of six GP Practice Clusters as shown below.

The population data used in this section are taken from the Office for National

Statistics (ONS) Mid-Year Estimates publication therefore the population figures will

not match up with the local GP Practice Cluster population figures derived from the

GP registrations.

Map 1. Brighton and Hove CCG GP practice cluster maps

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2.2. Population

Population size, structure and composition are crucial elements in any attempt to

identify measure and understand health and wellbeing. It is important to know how

many people live in an area and their demographic characteristics such as age and

gender.

2.2.1. Age

According to the Office for National Statistics (ONS) the latest mid-year population

estimate (2016) show there are 289,200 residents in Brighton & Hove. This is an

increase of 4,000 people (1.4%) compared to 2015 and 33,700 people (13.2%)

compared to 2006. Between 2006 and 2016 the city has seen a bigger increase in its

population than the South East (9.8%) and England (8.9%).

In Brighton & Hove (2016) 16% of the population are aged 0-15 years, 71% aged 16-

64 years and 13% aged 65 years or over. This compares to the South East (19%,

62% and 19%) and England (19%, 63%, and 18%). So whilst there are a lower

proportion of children in the city, there are also a lower proportion of older people,

giving the city a different age-structure than England and the South East (Figure 1).

There are a much higher proportion of people aged 19–44 years, with lower

proportions of children aged 0 to 15 and older people aged 65 to 84. However, there

are a similar proportion of people aged 85 years or older in Brighton & Hove as in

South East and England.

Figure. 1: Single year of age as a proportion of the total population, Brighton &

Hove, South East and England, 2016

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Source: 2016 ONS mid-year population estimates

2.2.2. Projected population change

According to the latest available ONS population projections, the resident population

of the city is predicted to increase to 305,900 by 2026, a 6.7% increase compared to

2016 (an increase of 19,100 people). This is lower than the predicted increases for

the South East (7.9%) and England (7.1%).

The city’s population is predicted to get older (Figure 2) with the greatest projected

increase (37%, 9,300 extra people) will be seen in the 55-64 year age group. The

proportion of people aged over 70 is also predicted to increase by 21% (5,500

people) including those aged 90 or older (500 people, 21%). People aged 45 to 54

are predicted to fall by 6% (2,600 people) and people aged 20 to 29 are predicted to

fall by 3% (1,600 people).

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

Brighton and Hove South East England

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Figure. 2. Projected population change for Brighton and Hove, 2016 to 2026.

Source: ONS 2014-based Subnational Population Projections for England (rounded to the nearest

hundred)

2.2.3. Gender

Brighton & Hove has an even population split by gender with 50% (145,500 people)

of the population being male and 50% (143,800 people) female (Figure 3). There is

a younger age structure for men in the city, which is also seen nationally, mainly due

to lower life expectancy for men. The proportion of male to female residents remains

at around plus or minus 5% until around the age of 80 and thereafter the gap widens

until for residents aged 90 and older there are 1,700 females (70%), more than two

times the number of males (700 people, 30%).

Figure. 3: Gender as a proportion of total population, Brighton & Hove 2016.

-20% -10% 0% 10% 20% 30% 40% 50%

90+ (n=2,900)

85-89 (n=4,000)

80-84 (n=6.400)

75-79 (n=9,200)

70-74 (n=9,800)

65-69 (n=12,400)

60-64 (n=17,000)

55-59 (n=18,800)

50-54 (n=18,900)

45-49 (n=19,500)

40-44 (n=20,400)

35-39 (n=22,800)

30-34 (n=24,300)

25-29 (n=25,100)

20-24 (n=30,700)

15-19 (n=18,500)

10-14 (n=14,700)

5-9 (n=14,700)

0-4 (n=15,600)

All (n=305,900)

< % decrease - % increase >

Ag

e /

Pre

dic

ted

po

pu

lati

on

in

2026

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Source: 2016 ONS mid-year population estimates (rounded to the nearest hundred)

2.2.4. Population and gender by GP Practice Cluster

There are no 2016 ONS population estimates currently available at geographies

below the local authority level so the figures used here are from the 2015 ONS Mid-

Year Population Estimates.

At 56,500 people (20%) Cluster 6 has the largest population and Cluster 2 with

35,300 people (12%) the smallest (Table 1). All Clusters have a relatively even

gender split with Cluster 4 having the widest (48% male, 52% female).

Table 1: Population of Brighton and Hove by GP Cluster, 2015

Persons Males Female

Number % of

Population Number Cluster % Number Cluster %

Cluster 1 52,000 18% 26,700 51% 25,300 49%

Cluster 2 35,300 12% 17,400 49% 17,900 51%

Cluster 3 43,400 15% 21,600 50% 21,800 50%

Cluster 4 39,300 15% 18,900 48% 20,300 52%

Cluster 5 38,900 14% 20,000 51% 18,900 49%

Cluster 6 56,500 20% 28,600 51% 27,900 49%

Brighton & Hove 285,300 142,100 50% 143,200 50%

50%

51%

50%

51%

53%

51%

50%

50%

48%

41%

30%

50%

49%

50%

49%

47%

49%

50%

50%

52%

59%

70%

All (n=289,200)

0 to 9 (n=29,400)

10 to 19 (n=31,300)

20 to 29 (n=59,500)

30 to 39 (n=42,800)

40 to 49 (n=41,400)

50 to 59 (n=34,600)

60 to 69 (n=23,400)

70 to 79 (n=15,400)

80 to 89 (n=8,900)

90 and older (n=2,400)

Male

Female

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Looking at GP Clusters by broad age groups there are big difference in the

proportion of people in different age groups (Table 2). Cluster 5 has the highest

proportion of working age people (78%) and also the smallest proportion of children

12% and older people 9%. Cluster 4 has the smallest proportion of working age

residents at just 63% and the highest proportion of children (20%). Cluster 2 has the

highest proportion of older people (18%) twice the proportion of Cluster 5 (9%).

Table 2: Population of Brighton & Hove by broad age groups and GP Clusters

Aged 0 to 15 Aged 16 to 64 Aged 65 and older

n Cluster % n Cluster % n Cluster %

Cluster 1 7,500 14% 39,100 75% 5,400 10%

Cluster 2 5,600 16% 23,200 66% 6,400 18%

Cluster 3 7,900 18% 29,700 68% 4,800 13%

Cluster 4 7,900 20% 24,800 63% 6,500 17%

Cluster 5 4,800 12% 30,500 78% 3,600 9%

Cluster 6 8,500 15% 40,400 71% 7,600 14%

Brighton & Hove 45,700 16% 201,500 71% 38,100 13%


2.2.5. Transient population

The city population is highly transient with one in five resident (20%, 54,885 people)

having moved address within the last 12 months (Table 3). However, this rises to

30% (10,710 people) in Cluster 5 and 26% (12,920 people) in Cluster 1. Only 10% of

people in Cluster 4 have moved in addresses in the last 12 months.

Table 3: People who have moved addresses in the last 12 months

Number Cluster %

Cluster 1 12,920 26%

Cluster 2 5,520 16%

Cluster 3 7,410 18%

Cluster 4 3,885 10%

Cluster 5 10,710 30%

Cluster 6 10,780 20%

Brighton & Hove 54,885 20%

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Source: ONS 2011 UK Population Census

2.2.6. Trans

It is estimated that at least 2,760 trans adults live in Brighton & Hove. The true figure is probably greater than this because a significant proportion of trans people do not disclose their gender identity in surveys. In addition, as Brighton & Hove is seen as inclusive, many trans people who live elsewhere visit Brighton & Hove to socialise study and/or work. Datac suggest that trans people in Brighton & Hove;

have a younger population distribution than the overall population, although trans people are represented in all age groups

have diverse gender identities, including non-binary identities

are more likely to have a limiting long-term illness or disability than the overall population

come from a diverse range of ethnic backgrounds

have diverse sexual orientations

live throughout the city, with no concentration in any particular area

are more likely to live in private sector rented housing than the overall population

2.2.7. Lesbian, Gay and Bisexual (LGB)

The city is known for its LGB community. Our best estimate of the number of LGB residents is 11% to 15% of the population aged 16 years or more.d This estimate draws on information collected via large scale surveys and audits conducted over the last ten years (including Count Me In Too2). This is similar to two recent representative surveys conducted across Brighton & Hove (Health Counts3 and City Tracker4), where 11% of respondents identified themselves as lesbian, gay, bi-sexual, unsure or other sexual orientation.

According to the 2011 UK Census, 6,425 people aged 16 and over (and living in a household) were living as part of a same sex couple (in a civil partnership or cohabiting).e This represents 2.9% of all residents age 16 and over, three times higher than the rate for both the South East (0.9%) and England (0.9%).

2.2.8. Households

According to the 2011 UK Census there are 121,540 households in Brighton & Hove.

c Equalities in Brighton & Hove: Data snapshot for equalities groups across the city, April 2017. Available at

http://www.bhconnected.org.uk/content/reports d Brighton & Hove Joint Strategic Needs Assessment: Sexual orientation:

http://www.bhconnected.org.uk/sites/bhconnected/files/jsna/jsna-3.2.3-Sexual-orientation.pdf e Office for National Statistics. Census 2011, table QS108EW – Living arrangements

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A quarter of households in Brighton & Hove are single person households

aged under 65 (25%, 29,835 households) compared to only 16% in the South

East and 18% in England. Single person households aged under 65 is

highest in Cluster 6 (30%, 8,120 households) and Cluster 5 (30%, 4,590

people) almost twice the proportion found in Cluster 4 (16%, 2,535 people).

More than a quarter of households (29%) with dependent children in Brighton

& Hove are lone parent families compared to 25% in England. However in

Cluster 1 this rises to over a third (37%, 1,750 households) and 32% (1,225

households) in Cluster 2.

Less than a fifth of households (17%) in Brighton & Hove are pensioner

households, however a high proportion of these are single pensioner

households (70%). In England the comparable figures are 21% and 60%

respectively. In Cluster 5 only 13% of households are pensioner households

compared to 23% in Cluster 2.

Table 4: Household types by GP Cluster

Lone parent

families as a

proportion of all

families with

children

One person

households

aged under 65

Pensioner

households

One pensioner

households

n Cluster

% n

Cluster

% N

Cluster

% n

%

pensioner

h’holds

Cluster 1 1,750 37% 6,440 29% 3,210 14% 2,502 78%

Cluster 2 1,225 32% 2,465 17% 3,310 23% 2,101 64%

Cluster 3 1,255 25% 3,245 19% 2,960 17% 1,931 65%

Cluster 4 1,420 27% 2,535 16% 3,345 21% 2,187 65%

Cluster 5 885 29% 4,590 30% 1,960 13% 1,415 72%

Cluster 6 1,520 27% 8,120 30% 4,310 16% 3,188 74%

Brighton & Hove 8,635 29% 29,835 25% 20,670 17% 14,468 70%


2.2.9. Deprivation

The Index of Multiple Deprivation 2015 (IMD 2015) ranks all local authorities in England in terms of their relative deprivation. Out of 326 authorities, Brighton & Hove is ranked the 102 most deprived authority in England (using the most commonly used summary measure, average score). This means we are among the third (31 per cent) most deprived authorities in England. IMD 2015 is made up of seven domains of deprivation one of which is Health Deprivation & Disability. For the Heath Deprivation & Disability domain Brighton & Hove is ranked 91 most deprived,

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meaning we are ranked in the second quintile (28 per cent) of most deprived authorities in England. Table 5: Number of people living in the 20% most deprived areas in England

IMD 2015 Health deprivation &

Disability domain

Number Cluster % Number Cluster %

Cluster 1 20,626 41% 20,410 41%

Cluster 2 11,581 34% 11,002 32%

Cluster 3 3,266 7% 2,946 7%

Cluster 4 6,650 17% 6,682 17%

Cluster 5 4,597 13% 5,021 14%

Cluster 6 4,818 9% 6,572 12%

Source: English Indices of Deprivation 2015, available via individual area reports at

http://brighton-hove.communityinsight.org/

Clusters one and two are by some considerable distance the most deprived of the

six clusters (Table 5). Two out of five people (41%) living in Cluster 1 are living in

the 20% most deprived areas in England for both the overall IMD index and the

Health Deprivation & Disability domain. This is twice the Brighton & Hove average

and nearly 6 times the higher than found in Cluster 3.

2.2.10. Long term health problem or disability by GP Practice Cluster

For more than one in twenty Brighton & Hove residents (20,445 people, 7.5%) their

day to day activities are ‘limited a lot’ due to a long term health problem or disability.

For a further 24,124 residents (8.8%) their day to day activity is ‘limited a little’. This

is similar to the proportions found in the South East and England.

Nearly one in twenty five of Brighton & Hove residents (3.7%, 10,680 people) claim

Disability Living Allowance (DLA) similar to that seen in England (3.7%).

Table 6: Health and disability GP Practice Cluster

A long-term illness, health problem or disability which limits someone's daily activities or the

work they can do.

Disability Living Allowance claimants

Number Cluster % Number Cluster %

Cluster 1 8,550 17% 2,490 4.8%

Cluster 2 6,655 19% 1,660 4.7%

Cluster 3 6,020 15% 1,230 2.8%

Cluster 4 6,990 18% 1,785 4.5%

Cluster 5 4,695 13% 1,025 2.6%

Cluster 6 8,480 16% 1,765 3.1%

Brighton & Hove 44,570 16% 10,680 3.7%

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http://brighton-hove.communityinsight.org/

27

Source: ONS 2011 UK Population Census and DWP February 2017

For all 6 GP Practice clusters the proportion of people with a long term health

problem or disability that affects their activity is within plus or minus 3% of the

Brighton & Hove average (Table 6). Cluster 2 (19%) has the highest proportion while

Cluster 5 (13%) has the lowest proportion. Cluster 5 (2.6%) also has the lowest

proportion of people claiming DLA almost half the proportion of people living in

Cluster 1 (4.8%).

2.2.11. Provision of unpaid care

Nearly one in ten of the city’s residents (23,987 people, 8.8%) provide unpaid care to

a family member, friend or neighbour who has either a long term illness or disability

or problems related to old age. Two thirds of those providing unpaid care (16,401

people, 68.4%) do so for 1 to 19 hours a week. However, 4,716 people, nearly 2% of

the total population, provide more than 50 hours a week of unpaid care. The

proportion of residents providing unpaid care (8.8%) is slightly lower compared to the

South East (9.8%) and England (10.2%). For all six GP Practice clusters the

proportion of people providing unpaid care is within plus or minus 2% of the Brighton

& Hove average (Table 7). Cluster 2 (11%) has the highest proportion with Cluster 5

(7%) the lowest proportion.

Table 7: Provision of unpaid care by GP Practice clusters

Number Cluster %

Cluster 1 3,903 8%

Cluster 2 3,702 11%

Cluster 3 3,821 9%

Cluster 4 3,934 10%

Cluster 5 2,588 7%

Cluster 6 4,360 10%



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2.2.12. Ethnicity

Table 8: Ethnicity in Brighton and Hove, South East, England, 2011

Brighton & Hove South East England

Number % % %

All usual residents 273,369

White 243,512 89.1% 90.7% 85.4%

English/Welsh/Scottish/Northern Irish/British

220,018 80.5% 85.2% 79.8%

Irish 3,772 1.4% 0.9% 1.0%

Gypsy or Irish Traveller 198 0.1% 0.2% 0.1%

Other White 19,524 7.1% 4.4% 4.6%

Mixed / multiple ethnic group 10,408 3.8% 1.9% 2.3%

White and Black Caribbean 2,182 0.8% 0.5% 0.8%

White and Black African 2,019 0.7% 0.3% 0.3%

White and Asian 3,351 1.2% 0.7% 0.6%

Other Mixed 2,856 1.0% 0.5% 0.5%

Asian / Asian British 11,278 4.1% 5.2% 7.8%

Indian 2,996 1.1% 1.8% 2.6%

Pakistani 649 0.2% 1.1% 2.1%

Bangladeshi 1,367 0.5% 0.3% 0.8%

Chinese 2,999 1.1% 0.6% 0.7%

Other Asian 3,267 1.2% 1.4% 1.5%

Black/African/Caribbean/Black British 4,188 1.5% 1.6% 3.5%

African 2,893 1.1% 1.0% 1.8%

Caribbean 879 0.3% 0.4% 1.1%

Other Black 416 0.2% 0.2% 0.5%

Arab 2,184 0.8% 0.2% 0.4%

Any other ethnic group 1,799 0.7% 0.4% 0.6%

Black & Minority Ethnic (BME) 53,351 19.5% 14.8% 20.2%

Note: Black & Minority Ethnic (BME) is defined as all ethnic groups other than White English / Welsh / Scottish / Northern Irish / British.

Source: ONS, 2011 Census, table KS201EW

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One out of five Brighton & Hove residents (53,351, 19.5%) are from a BME

background, higher than is found in the South East (14.8%) but similar to England

(20.2%).

The largest BME community is Other White with 19,524 people. This is 7.1% of the

total population and more than a third (36.6%) of the BME population. It is also

higher than found in the South East (4.4%) and England (4.6%).

Brighton & Hove has a higher proportion of people of mixed ethnicity (3.8%) than the England average (2.3%), with the proportion of people of mixed white and Asian (1.2%) and other mixed ethnicity (1.0%) double the value found in England. Other ethnicities that are more prevalent in Brighton & Hove than across England include white Irish (1.4%), Chinese (1.1%) and Arab (0.8%). By contrast, the proportion of Asian people (4.1%) is below that for the South East (5.2%) and England (7.8%), with particularly low numbers of people from Pakistani ethnicity (0.2%) compared with England as a whole (2.1%). The proportion of Black people in Brighton & Hove (1.5%) is also less than half that for England (3.5%) but similar to the South East (1.6%)

The overall age structure of the Black and Minority Ethnic (BME) population is comparably younger than the White British population (Table 9). 2011 Census data shows that, whilst across the city 22% of the population are aged 19 or younger, for residents of a mixed ethnic background the proportion is 50%. For Asian, Black and Arab residents the proportion is also higher than the 22% average. People aged 65 or older make up 13% of the city’s population, with 15% white UK/British and 21% White Irish. For all other high level ethnic group 6% or less are aged 65 or older.

Table 9: Age profile by high level ethnic group

Ethnic group

Age group (%)

0 to 19 years

20 to 44 years

45 to 64 years

65 years and older

All persons (n=273,369) 22% 43% 22% 13%

White UK/British (n=220,018) 21% 40% 24% 15%

White Irish (n=3,772) 7% 45% 28% 21%

Other White (n=19,524) 13% 66% 15% 5%

Mixed / multiple ethnic group (n=10,408) 50% 38% 9% 2%

Asian/Asian British (n=11,278) 26% 55% 15% 5%

Black/Black British (n=4,188) 24% 57% 17% 3%

Arab (n=2,184) 30% 49% 16% 5%

Other ethnic group (n=1,799) 20% 53% 22% 6%

All BME (n=53,351) 24% 55% 15% 5%

Source: ONS 2011 census, table DC210EW

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Ethnicity data for GP Practice clusters is only available by high level ethnic groups

(Table 10)

Table 10: Brighton & Hove ethnicity by GP Practice clusters

White British / UK BME (Non White

British/UK) White non British

Non White ethnicity

n Cluster

% n

Cluster %

n Cluster

% n

Cluster %

Cluster 1 38,560 78% 11,050 22% 4,945 10% 6,125 12%

Cluster 2 28,980 85% 5,295 16% 2,000 6% 3,300 10%

Cluster 3 34,830 84% 6,675 16% 2,820 7% 3,850 9%

Cluster 4 32,780 85% 5,815 15% 2,015 5% 3,800 10%

Cluster 5 27,450 77% 8,395 23% 3,815 11% 4,570 12%

Cluster 6 41,840 77% 12,550 23% 6,165 11% 6,365 11%

Brighton & Hove 220,020 81% 53,350 20% 23,495 7% 29,865 12%


More than a third (39%, 20,549 people) of our total BME population live in the six

central wards of Central Hove, Brunswick & Adelaide, Goldsmid, Regency, Queens

Park and St. Peter’s & North Laine. On the other hand North Portslade, Patcham &

Woodingdean wards have BME populations of ten per cent or less. This is reflected

in the GP Practice cluster profile where clusters that include these central areas

have higher proportion of BME residents; Cluster 1 (22%), Cluster 5 (23%) and

Cluster 6 (23%) compared with Cluster 2 (16%), Cluster 3 (16%) and Cluster 4

(15%).

2.2.13. Language

For one in twelve residents (8.3%, 21,833 people) aged three or over, English is not

their first or preferred language. Other than English, Arabic is the most widely

spoken language in the city (2,226 people, 0.8%), followed by Polish (2,043 people,

0.8%) Chinese (1,940 people, 0.7%), Spanish (1,624 people, 0.6%), and French

(1,335 people, 0.5%). One in twenty residents (11,985 people, 4.5%) has a

European language other than English (and others in the UK) as their main

language, proportionally higher than is found in the South East (2.7%) and England

(3.2%).

For one in twenty households in Brighton & Hove (5,925, 5%) no adults have English

as their main language. The proportion of households increases to 7% in GP

Clusters 5 and 6, twice the proportion found in GP Clusters 2, 3 and 4 (Table 11).

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Table 11: No household members have English as their main language

Number Cluster %

Cluster 1 1,230 5%

Cluster 2 435 3%

Cluster 3 440 3%

Cluster 4 445 3%

Cluster 5 1,015 7%

Cluster 6 1,890 7%



2.2.14. Students

Brighton & Hove has a substantial student population with two universities.

According to the 2011 Census students represent 16% of the city’s total population

aged 16-74 years or 12% of the total population of the city (this will include students

in sixth form, further education and higher education).

There had been a sustained increase in the numbers of students at the two

universities in the city from around 26,000 in 1995/96 to 35,205 in 2011/12.

However, 2012/13 onwards saw a decrease in total student numbers at the two

universities to 34,220 in 2014/15 (a fall of 985 students between 2011/12 and

2014/15, or 3%). It should be noted that not all students at one of our two

universities will live within the city boundaries.

2.2.15. Religion

More than two out of five residents (117,276 people, 42.9%) are Christian,

significantly lower than can be found in England (59.4%) and the South East

(59.8%). More than two out of five city residents (115,954 people, 42.4%) have no

religion, significantly higher than in the South East (27.7%) and England (24.7%).

The Muslim community is the largest non-Christian faith group in the city with 6,095

people, (2.2%), this is similar to the South East (2.3%) but half the proportion found

in England (5.0%).

2.2.16. Armed forces personnel

Brighton and Hove is not home to any military installations and therefore does not

house a substantial community of armed forces personnel. At the time of the 2011

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Census there were 147 residents employed by the armed forces in the city, less than

0.1% of the total population. As at March 2015, 610 veterans were receiving a

pension or compensation under the Armed Forces Pension Scheme in Brighton &

Hove. This is a rate of 26.6 per 10,000 people aged 16+, much lower than the South

East (93.0) or England (71.8).

2.2.17. Car ownership

More than a third of households (38.2%, 46,415) in Brighton & Hove do not own or

have access to a car or van. This is significantly higher than for the South East

(18.6%) and England (28.8%). There are significant differences in the household

with access to a car or van by GP clusters. A half of households (50%) in Cluster 1

do not have access to a car or van falling to just over a quarter (27%) in Cluster 4

(Table 12).

Table 12: Households without access to a car or van by cluster

n Cluster %

Cluster 1 11,310 50%

Cluster 2 4,565 32%

Cluster 3 4,790 28%

Cluster 4 4,320 27%

Cluster 5 7,140 46%

Cluster 6 10,905 41%



2.2.18. Visitors

As a popular tourist destination, Brighton and Hove sees large numbers of visitors

each year. In 2015, 9 million people made day trips and there were nearly 5 million

overnight stays.f

Recommendation

In view of the projected increase in the proportion of older people living in the

city, it is recommended that all community pharmacies are trained in

communicating with older people. This should include Dementia Friends

training which all community pharmacy staff have so far received training in.

f The Economic Impact of Tourism Brighton & Hove 2015, Tourism South East

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Brighton & Hove Pharmaceutical Needs Assessment 2018

33

3. Local health needs

This section focuses on local health needs by examining the variation in morbidity, mortality and health service utilisation across the population in Brighton & Hove. It also discusses their implications for pharmacy provision. The main data sources used were the Brighton and Hove JSNA and Public Health Outcomes Framework.g

3.1. General health

3.1.1. Life expectancy

In 2013-15, the life expectancy at birth for Brighton & Hove among females was 83.5 years and 79.3 among males.5 Females in the city can expect to live on average around four months longer than the average female in England (83.1 years), life expectancy for males is approximately two months lower than in England (79.5 years). Life expectancies for both genders were lower than the South East, by five months for females ( 84.0 years) and 12 months for men ( 80.5 years).8

Life expectancy at age 65 among females in Brighton & Hove was 21.5 years for females and 18.8 years for males. This compares to 21.1 years and 18.7 years respectively, at a national level and 21.7 years and 19.2 years in the South East.8

The slope index of inequality in life expectancy gives a measure of the hypothetical difference in life expectancy between the most deprived and least deprived individuals. It is a more sensitive measure than the difference in mortality between the most deprived and least deprived quintiles of population as it looks at differences in life expectancy across the whole population. In 2013-15 the slope index was 10.4 years for males and 6.0 years for females in Brighton & Hove. For males this gap is 12 months wider than nationally and for females it is 11 months narrower than nationally.8 Mortality rates are improving for all groups across the city but it is improving faster for more affluent groups which will widen inequalities.6

3.1.2. Teenage conceptions

The 2015 under-18 conception rate for Brighton & Hove was 25.2 per 1,000 females aged 15-17 years, compared with the national rate of 20.8 per 1,000 and 17.1 in the South East. Between 1998 and 2015 the under-18 conception rate in the city fell from 48 to 25.2 per 1,000.8 This is a 48% reduction which is the same as the reduction seen nationally over this period, and slightly higher than the reduction seen in the South East (46%).7 There has been a rapid decline in the under-18 termination rate since the 2005 peak of 27.2 per 1,000 15-17 year old women, to an all-time low of 16.7 in 2013. Second termination rates have also dropped from 19% in 2006 to 12% in 2014.10

g Public Health England. Public Health Outcomes Framework. May 3

rd 2017.

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3.1.3. HIV

In 2014 Brighton & Hove had the eleventh highest HIV prevalence in England at 8.6 per 1,000 population (aged 15-59 years), compared with 2.2 in England, & the highest prevalence outside of London. In 2014 1,734 residents of the City accessed NHS HIV treatment services. The total figure for both sexes has been increasing rapidly: in 2005 it was 942 people; in 2002 it was 717 people.8

3.1.4. Mental Health

The percentage of people aged 18 or over on a GP register for depression was 9.3% in 2015/16 in Brighton & Hove, significantly higher than England (8.3%).9 The percentage of people of all ages on a GP register for Severe Mental Illness is 1.19% in Brighton & Hove, again significantly higher than the average for England, at 0.9% (2015-16). Severe mental illness includes schizophrenia, bipolar affective disorder and other psychoses.12

Similarly, GP surveys (2015-16) show significantly higher proportions of patients reporting depression and anxiety (15.6% Brighton & Hove, 12.7% England) and reporting a long-term mental health problem (8.8% Brighton & Hove, 5.2% England).12 In 2016, 9,546 secondary school students from 10 schools took part in the Safe and Well at School Survey (SAWSS) in Brighton and Hove. 92% of young people in Year 7 had often felt happy in the last few weeks and 80% of those in Year 11. Students aged 14-16 years worried more often than younger students. 85% of 14-16 year olds were worried about exams; 77% the future in work and education, while 64% worried about being healthy. 15% of 14-16 year olds said they often or sometimes had suicidal thoughts and 11% that they often or sometimes harm themselves.10 3.1.5. Visitors It is likely that visitors to the city utilize healthcare services in different ways to local residents. Over the period of April 2017 to August 2017, out of hours primary care services, run by Integrated Care 24 (IC24)h, were used by 10,536 patients. Of these 1,631 patients were not registered with a local GP. This corresponds to 15% of the users of this service over this period. This is an increase on the 2015 PNA when 7% of patients were non-registered users. This increase should be considered by commissioners of pharmacy services, as a proportion of those accessing services will be from outside of the city.11

h IC24 is a Social Enterprise company providing a range of primary care services

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3.2. Health profiles 2017

Health profiles are produced for each Local Authority by Public Health England (PHE).12 The profile consists of 31 indicators grouped under five main domains:

Our communities

Children and young people’s health

Adults’ health and lifestyles

Disease and poor health

Life expectancy and causes of death

The purpose of health profiles is to help local authorities, health services and commissioners identify problems in their areas and develop strategies to address them. Performance for local authorities in England is benchmarked against the England average for the 31 specified indicators. Table13 shows indicators for Brighton & Hove where performance is significantly worse than the England average (See Appendix 1: Brighton & Hove Health Profile 2017 for a full profile). These areas are then considered further in this section.

Table 13. 2017 Health Profile indicators where Brighton & Hove’s performance is significantly worse than the England average

Domain Indicator

Our communities Violent crime

Children and young people’s health Admission episodes for alcohol-specific conditions

(under 18s)

Adults’ health and lifestyle Smoking prevalence in adults

Disease and poor health Hospital stays for self-harm

New sexually transmitted infections

Life expectancy and causes of death Suicide rate

Killed and seriously injured on roads

Source: Public Health England, 2017 Health Profiles

3.2.1. Violent crime

There were 6,285 crimes of violence against the person recorded by police in

2014/15.13 The city has a relatively high rate of violent crime per head of resident

population 22.7 per 1,000 population compared to 17.2 per 1,000 for England.14 The

recorded crime rates do not take account of the high number of non-residents visiting

the city.16

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3.2.2. Admission episodes for alcoholic-specific conditions (under 18s)

In 2013/14 - 2015/16 the crude rate of hospital admissions for people under 18 due to alcohol was 58.2 per100, 000 compared to 37.4 per 100,000 for England.15

The 2016 Safe and Well at School Survey (SAWSS) reported an increase in the proportion of 11-14 year olds who had never tried alcohol from 59% in 2011 to 74% in 2016. There was also an increase for 14-16 year olds from 18% in 2011 to 30% in 2016. Brighton & Hove has the third joint highest rate of 15 year olds who drink regularly at least once a week, at 11% in 2016. The average rate for England and the South East is 6%.15

3.2.3. Smoking prevalence in adults

The prevalence of smoking amongst adults in the city was estimated to be 20% in the

2016 Annual Population Survey. This is a decrease from 21% in 2015 but it is still

significantly higher than for England (15%).15

3.2.4. Hospital stays for self-harm

In 2015/16, the directly age and sex standardised rate for hospital admissions among all

city residents was 306.2 per 100,000, this is higher than for England (196.5 per

100,000)11 but is lower the Brighton and Hove rate in 2012/13, of 366 per 100,000.6 248

children and young people were admitted to hospital for self-harm in 2015/16 a rate of

448 per 100,000 10-24 year olds compared to 431 per 100,000 for England.8

3.2.5. New sexually transmitted infections (STI)

In 2016, the crude rate of new STIs was 1,387 per 100,000 (excluding Chlamydia under

age 25) in Brighton and Hove, this is higher than England which is 795 per 100,000.11

3.2.6. Killed and seriously injured on the roads

From 2013-15, there were 54.0 people per 100,000 killed or seriously injured on the

roads in Brighton and Hove, which is higher than 38.5 per 100,000 for England.11

3.2.7. Suicide rate

From 2013-15, the directly age standardised mortality rate from suicide and injury of

undetermined intent was 15.2 per 100,000 (aged 10 and over) compared to 10.1 per

100,000 for England.11

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Recommendations

In view of the higher rates of self-harm, suicide, depression and anxiety in

Brighton & Hove compared to England, it is recommended mental health first aid

is included initially as part of the Healthy Living Pharmacies training. HLPs

should also be provided with the information to be able to signpost patients to

community based mental health and wellbeing services. If this is successful

extend the training to all pharmacies. Currently HLPs have the opportunity to run

mental health campaigns in May and December.

The Community Pharmacy Postgraduate Education (CPPE) to be approached by

Brighton & Hove City Council to provide mental health consultation skills e-

learning to registered pharmacists and technicians

In view of the higher rates of smoking amongst adults and young people in

Brighton & Hove compared to England, the 48 pharmacies offering stop smoking

services to increase Making Every Contact Count, to engage more clients with

the service and ultimately increasing support for people to quit through stop

smoking services.

3.3. Disease prevalence from Annual Report of the Director of Public Health 2016/17 and QOF data 2016/17

The Annual Report of the Director of Public Health 2016/17 “Living well in a healthy city”16 includes data on disease prevalence and multi-morbidity. The majority of residents have no long term conditions up to the age of 49. By 50-54 years, 53% have one or more condition, with the average being one condition. By the age of 65-69 the average increases to two conditions and three by 80-84years. By 95 years and over people have fewer conditions than 80-94 year olds. Patients with diabetes, Chronic Obstructive Pulmonary Disease (COPD), and Coronary Heart Disease (CHD) all have on average three or more other long term conditions. Resource use is related to age for long term conditions, by 70-74 years 20% of patients are high to very high users of services, increasing to 40% for 90-94 year olds. Thus an increasingly ageing population will have increasing multiple long term conditions placing greater demands on community pharmacy services.

Table 14 gives England, Brighton and Hove and CCG GP Practice cluster prevalence of various health conditions, along with modelled prevalence for some of these conditions. This section explores Quality and Outcomes Framework (QOF) disease registers prevalence data for the city, compares this with modelled prevalence data and explores the potential impact of these on pharmaceutical services. QOF registers are records from GP practices which give an indication of the overall achievement of a practice through a points system. They contain information on the prevalence of a range of indicators among the registered population of that practice. Comparisons between QOF prevalence and modelled prevalence estimates for England allow us to assess how much of the population may have a given condition but may be undiagnosed or unidentified.

The paragraphs below outline key health conditions and issues relevant to pharmacy

services.

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3.3.1. Asthma

Asthma patients require support to understand self-management of their disease and

maintain competency with inhaler devices.

3.3.2. Atrial Fibrillation

Patients with Atrial Fibrillation are prescribed anticoagulant and antiplatelet medication

which needs to be carefully managed. There is evidence that community pharmacist led

anticoagulation clinics achieve good therapeutic control and are welcomed by

patients.17

3.3.3. Cancer

The directly age-standardised mortality rate for all cancers for persons under 75 years

in Brighton and Hove in 2013-15 was 146.4 per 100,000. Higher than the England

average for the same period which was 138.8 per 100,000.11 In 2015, there were 608

deaths attributable to cancers among residents of the city, constituting 31% of deaths in

that year.18

Screening coverage for breast and cervical cancer is lower for Brighton & Hove than

England, with 72.1% of women screened for breast cancer in 2016, compared to 75.5%

for England. 69.5% women were screened for cervical cancer in 2016, compared to

72.2% for England. In 2016 the city ranked 17/19 for breast screening and cervical

screening uptake in the South East Region and 17/19 and 16/19 for Abdominal Aortic

Aneurysm Screening and Bowel Cancer Screening respectively.19

Part of the service specification for level 2 Healthy Living Pharmacies includes running

an annual campaign to promote cancer screening in April and supply eligible patients

who have completed Medication Use Reviews with a public health approved booklet on

cancer screening.

3.3.4. Cardiovascular disease

The role of pharmacists in the management of chronic diseases has been shown to be

important.20 As with other chronic conditions, Cardiovascular Disease (CVD) patients

may require support to manage their medication regimes. Comparison between

recorded QOF prevalence in 2015/16 and modelled prevalence in 2011 shows a 8%

lower recorded prevalence than would be expected, suggesting that CVD may be

underreported or under identified in Brighton and Hove (and England). More specific

types of CVD are also covered in this section.

3.3.5. Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) patients with moderate or severe

disease may require support to manage their medication regimes. If they have not yet

given up smoking community pharmacists can offer opportunities to access smoking

cessation services. Brighton and Hove (and England) has lower prevalence of COPD

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recorded through QOF than modelled estimates suggest, which may mean there is

underreporting or under identification of the condition.

3.3.6. Coronary Heart Disease

Patients with Coronary Heart Disease (CHD) are prescribed multiple medications and

require support to ensure compliance and adherence to regimens. Similarly with CVD

and COPD Brighton and Hove (and England) has lower prevalence of CHD recorded

through QOF than modelled estimates suggest, which may mean there is under

reporting or under identification of the condition. In 2015/16, 2.2% of GP registered

patients in Brighton & Hove had a recorded prevalence of CHD, compared to 3.2% for

England.21

3.3.7. Chronic Kidney Disease

Chronic kidney disease is a long term condition that can be associated with a range of

other conditions, as well as with getting older and ethnicity. Medication can help to

control associated problems such as high blood pressure and high cholesterol. Brighton

and Hove (and England) has lower prevalence of CKD recorded through QOF than

modelled estimates suggest, which may mean there is under reporting or under

identification of the condition. There is also a suggestion that the modelled estimate

may be an over estimate because CKD was determined by one blood test, rather than

two 3 months apart as recommended by NICE.22 In 2015/16, the recorded prevalence

of CKD in GP patients in Brighton & Hove was 3.3%, compared to 4.1% in England.23

3.3.8. Dementia

Patients with dementia frequently have other co-morbid conditions for which they have

medication prescribed. As the disease progresses significant support is required to

maintain independence. Supply of compliance aids by community pharmacies directly to

patients or to their carers can provide assistance in maintaining control of other medical

conditions and preventing hospital admissions. In 2017, 64% of Brighton & Hove GP

registered patients over 65 were diagnosed with dementia, compared to 68% in

England.17

3.3.9. Depression

Treatment for depression may involve a combination of self-help, talking therapies and

medication. People with moderate to severe depression are more likely to be prescribed

anti-depressants. In 2015/16, 9.3% of Brighton & Hove GP registered patients (18+)

had a recorded prevalence of depression, compared to 8.3% for England.17

3.3.10. Diabetes

Early detection of diabetes contributes to improved clinical outcomes. In 2015/16,

Brighton and Hove had lower GP recorded prevalence of diabetes among those aged

over 17 years (4.1%) than England (6.5%).24 As part of the National Diabetes

Prevention Programme being implemented locally Lloyd’s pharmacies deliver the blood

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testing element. Diabetes is also one of the campaign topics run by level 2 Health Living

Pharmacies.

3.3.11. Heart Failure

Patients with heart failure may be prescribed multiple medications and require support

to ensure compliance and adherence to regimens, as with other long term conditions. In

2015/16, recorded prevalence of Brighton & Hove GP registered patients (all ages) with

heart failure was 0.5%, compared to 0.8% for England.25

3.3.12. Hypertension

Community pharmacies can provide screening services to direct patients to GP

surgeries for further diagnosis. Early detection of hypertension contributes to improved

clinical outcomes. There is a lower recorded prevalence of hypertension recorded

through QOF in Brighton and Hove (and England) which may mean there is

underreporting or under identification of the condition. In 2015/16, recorded prevalence

of Brighton & Hove GP registered patients (all ages) with hypertension was 9.8%,

compared to 13.8% for England.

3.3.13. Hypothyroidism

Patients with hypothyroidism may be prescribed multiple medications and require

support to ensure compliance and adherence to regimens. There are currently no

modelled estimates of hypothyroidism prevalence available.

3.3.14. Mental Health

Brighton and Hove has a high prevalence of mental illness and depression. Both QOF

and GP Survey data (2015/16) for the prevalence of depression and anxiety are higher

than the prevalence for England. In 2015/16, the prevalence of depression and anxiety

in GP patient survey responders (18+) was 15.6% in Brighton & Hove, compared to

12.7% for England.26 All patients including those with mental illness can benefit from

receiving information about the Five Ways to Wellbeing and other mental health and

wellbeing services. Mental health patients on medication would also benefit from

support with medication regimes to ensure compliance.

3.3.15. Obesity

Obesity is an important health issue for the UK as it can lead to diseases such as type 2

diabetes, CVD and joint pain. Future impact on health services if obesity levels are not

controlled will be substantial – the prevalence of obesity nationally is growing

consistently. In Brighton & Hove in March 2017 26% of 10-11 year olds were overweight

or obese.15This is lower than the England average of 34%. Obesity prevalence from

QOF for Brighton and Hove (5%) aged 18 years or over is lower than national QOF

estimates for England (2015/16) at 9.5% of adults aged 18 years or over. The Active

People Survey 2013-2016 reported that 52.6% of adults in Brighton & Hove were

overweight or obese compared to 64.8% for England.17

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3.3.16. Osteoporosis

Losing bone is a normal part of the ageing process, but some people lose bone density

much faster than normal. The use of medication in the treatment of osteoporosis is to

help strengthen bones and reduce the risk of fractures. There are currently no modelled

estimates of osteoporosis prevalence.

3.3.17. Palliative care

Patients in palliative care may be prescribed multiple medications and require support to

ensure compliance and adherence to regimens. Additionally, the community pharmacist

may be a source of psychological and social support.

3.3.18. Peripheral Arterial Disease

Patients with peripheral arterial disease may be prescribed multiple medications and

require support to ensure compliance and adherence to regimens. There are currently

no modelled estimates of peripheral arterial disease prevalence available.

3.3.19. Rheumatoid Arthritis

Rheumatoid arthritis is a long term condition causing pain, swelling and stiffness in the

joints. Treatment includes the long term use of medication to relieve the symptoms and

slow the progress of the condition.

3.3.20. Stroke/Transient Ischaemic Attack

Brighton and Hove (and England) has lower prevalence of stroke/transient ischaemic

attack (TIA) recorded through QOF than modelled estimates.

Recommendation

In view of the increasingly ageing population living with multiple morbidities - when

making commissioning decisions the CCG, NHS England and BHCC should take into

consideration the role of community pharmacies in addressing the needs of patients

with long term conditions.

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Table 14. Disease prevalence from QOF by GP Practice Cluster Brighton and Hove and England (2015-16) and modelled

prevalence for Brighton and Hove and England

Condition

QOF disease registers (prevalence %) 2015/16

CCG GP Practice Clusters

Modelled

estimates (%) –

2011

Ag

e f

or

mo

dell

ed

esti

mate

s if

dif

fer

fro

m

QO

F

Model 1 2 3

4

5

6 Bri

gh

ton

&

Ho

ve

En

gla

nd

Bri

gh

ton

&

Ho

ve

En

gla

nd

Asthma 6.2% 6.0% 5.3% 6.4% 4.0% 5.2% 5.5% 5.9% - -

Atrial fibrillation 1.2% 1.6% 1.4% 1.7% 0.6% 1.3% 1.3% 1.7% - -

Cancer 1.7% 2.5% 2.1% 2.4% 1.2% 1.9% 1.9% 2.4% - -

Cardiovascular

disease (30-74

years) 0.8% 0.9% 0.9%

0.9%

0.6%

0.7% 0.8% 1.1% 9% 9.5% 16+

ERPHO,

December 2011

Chronic

obstructive

pulmonary

disease 1.7% 1.8% 1.0%

1.7%

0.6%

1.2% 1.3% 1.9% 3.7% 2.9% 16+

ERPHO,

December 2011

Coronary heart

disease 0.8% 0.9% 0.9%

0.9%

0.6%

0.7% 2.2% 3.2% 4.5% 4.7% 16+

ERPHO,

December 2011

Chronic Kidney

Disease

(2014/15) 3.1% 4.4% 4.2%

4.3%

1.2%

3.0% 3.3% 4.1% 4.9% 6.1% 16+

University of

Southampton

2011

Dementia 0.4% 0.8% 0.5% 0.7% 0.3% 0.7% 0.6% 0.8% - -

Depression(18+) 10.1% 9.7% 9.7%

8.4%

7.5%

10.3% 9.3% 8.3% - -

Diabetes (17+) 4.4% 5.7% 3.8%

5.8%

1.8%

3.8% 4.1% 6.5% 6.2% 7.3% 16+

APHO,

December 2012

Epilepsy (17+) 0.8% 0.8% 0.6% 0.8% 0.4% 0.7% 0.7% 0.8% - -

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Condition

QOF disease registers (prevalence %) 2015/16

CCG GP Practice Clusters

Modelled

estimates (%) –

2011

Ag

e f

or

mo

dell

ed

esti

mate

s if

dif

fer

fro

m

QO

F

Model 1 2 3

4

5

6 Bri

gh

ton

&

Ho

ve

En

gla

nd

Bri

gh

ton

&

Ho

ve

En

gla

nd

Heart failure 0.6% 0.7% 0.5% 0.6% 0.2% 0.5% 0.5% 0.8% - -

Hypertension 9.4% 12.4 % 10.0%

12.9%

5.0%

9.4% 9.8% 13.8% 27.5% 30.6% 16+

ERPHO,

December 2011

Hypothyroidism - - - - - - - - - -

Learning

Disability 0.5% 0.5% 0.4%

0.4%

0.2%

0.5% 0.4% 0.5% - -

Mental health 1.7% 1.1% 0.8% 1.0% 0.9% 1.4% 1.2% 0.9% - -

Obesity (18+) 5.5% 5.3% 5.2% 6.5% 3.0% 5.0% 5.0% 9.5% - -

Osteoporosis(50

+) 0.2% 0.1% 0.2%

0.2%

0.2%

0.2% 0.2% 0.3% - -

Palliative care 0.2% 0.4% 0.2% 0.3% 0.1% 0.2%

0.2% 0.3% - -

Peripheral

arterial disease 0.5% 0.6% 0.4%

0.6%

0.2%

0.4% 0.4% 0.6% - -

Rheumatoid

arthritis (16+) 0.5% 0.7% 0.5%

0.8%

0.2%

0.4% 0.5% 0.7% - -

Stroke/TIA 1.2% 1.7%

1.2%

1.6%

0.6% 1.3% 1.3% 1.7% 1.93% 2.07% 16+

ERPHO

December 2011

Source: Brighton & Hove CCG June 2017.

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3.4. Future Health Needs

Future health needs will continue to change as the population lives longer. The population of people aged over 70 is predicted to increase by 21% (5,500 people) by 2026.27 A consequence of more people living longer includes an increased risk of dementia. In March 2016 there were 1,739 registered patients with dementia in the city (0.6%).28 It is estimated that by 2035, 4,368 people aged 65 and over in the city will have a dementia diagnosis.29 A higher proportion of older people in Brighton & Hove live alone 41% compared to 31% nationally, which will increase the risk of loneliness and depression.25 Both dementia and depression have implications for placing increased demands on community pharmacies as more people will require prescribed medications. As providers of services to older people, pharmacies also have their part to play within the Age Friendly City and Dementia Action Alliance initiatives in Brighton & Hove.

As people live longer the proportion living with multiple long term conditions requiring medication will also increase. People aged 65-69 years have on average two long term conditions, increasing to three by age 80-84 years. Patients with diabetes, Chronic Obstructive Pulmonary Disease (COPD) and Coronary Heart Disease (CHD) all have on average 3 or more other long term conditions.26

The increase in obesity nationally has also led to an increase in the number of people diagnosed with type 2 diabetes. Brighton & Hove has low recorded diabetes prevalence at 4.1% compared to 6.5% for England (2015/16).22 There are an estimated 16,600 people in the city with undiagnosed diabetes. As diabetes prevalence increases pharmacies will have an important role to play in increasing awareness of the potential risk factors. This could be through participating in the Healthy Living Pharmacy Scheme and signposting people to healthy weight and physical activity services, to help prevent the development of diabetes. As well as opportunistic use of the NICE supported Diabetes UK risk assessment tool and running pharmacy-based diabetes prevention health promotion campaigns.

Other future health needs include cancer, alcohol and substance misuse and sexual health. Cancer is one of the commonest causes of death in the city, particularly lung cancer. Community pharmacies will continue to play an important role in reducing this by offering stop smoking and domiciliary stop smoking services via the public health locally commissioned services.

Alcohol and drug misuse continue to be significant issues for the city. 41% of adults are drinking more than the recommended weekly levels. Households in more deprived areas are less likely to drink at the greater at risk levels but they are more likely to die of alcohol related conditions. Alcohol related hospital attendances in the city are 50% higher in city residents in the most deprived quintile compared to the least deprived quintile.25 The city has a higher drug related deaths rate than England, as well as higher than average use of opiates and crack amongst adults. Community pharmacies have an important role in harm minimisation through the provision of needle exchanges and the supervised consumption of methadone.

In 2015, Brighton & Hove had the 17th highest rate of new Sexually Transmitted Infections (STIs) of all 326 English local authorities. The city also has a higher rate of teenage conceptions than England; at 25 per 1,000 compared to 21 per 1,000.26 Community pharmacies play an important role preventing STIs and unplanned

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pregnancies through the c-card scheme of free condom distribution and provision of Emergency Hormonal Contraception through the public health locally commissioned services.

3.4.1. Housing

Planned developments to increase the provision of new housing in the city by 13,200 homes by 2030 are likely to increase demand for community pharmacy services in the next 12 years. Going forward this impact will need to be considered by future PNAs.

The Brighton & Hove City Plan Part 1 plans new housing across the city as a whole and higher density development in 8 broad development areas.30

Table 15. New homes planned by development areas by 2030

Development Areas Number of new homes planned by

2030

Brighton Centre and Churchill Square 20

Brighton Marina, Gas Works and Black

Rock

1940

Lewes Road 875

New England Quarter and London Road

area

1130

Eastern Road and Edward Street area 515

Hove Station Area 525

Toad’s Hole valley 700

Shoreham Harbour 300

Rest of the city & small site developments

within built up area and urban fringe

7205

Total 13,210

Source: Brighton & Hove City Plan Part 1 (adopted March 2016)

Development plans for Preston Barracks were approved in October 2017. The Preston Barracks site is owned by the council. It was acquired from the Ministry of Defence because of its strategic significance and potential to contribute towards many of the city's priorities. It will be used to create sustainable, employment-led, mixed-use development to help regenerate the area. The site, on the main Lewes Road, is an 'urban gateway' to the city from the 'Academic Corridor' (close to Brighton and Sussex Universities). The number of student units of accommodation across the Barracks Road site and on University of Brighton land will be approximately 1300 student beds.

The plans for Brighton Marina have identified a need for a health facility, which may have implications for the provision of community pharmacy in this area. It is estimated

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that the delivery of new housing between 2014 -19 is likely to be 660 units a year and increasing thereafter to 2024.

Figure 4: Housing Trajectory 2010 – 2030 (Based on 2014 SHLAA update)

Source: Brighton & Hove City Plan. Part One. March 2016.

Recommendation

The population demographics, housing projections and distribution of community pharmacies in Brighton & Hove suggest that the current level of pharmacy services will be sufficient to meet current need until the next PNA is published in 2021. However, where housing developments are completed within the lifetime of this PNA, further consideration may be required.

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4. Current pharmaceutical provision

This section describes in detail the different roles of pharmacists in the city and the current pharmaceutical service provision in Brighton & Hove which includes services provided by community pharmacies, other NHS and non-NHS institutions. There are currently no dispensing GP practices in the city. Information on level of access to pharmaceutical services including opening hours, distance and travel times is presented, along with maps to show service coverage. Pharmaceutical service performance levels are compared with regional and national averages where applicable.

4.1 Pharmacist roles

There are currently a range of roles being undertaken by pharmacists across the city.

Better Care pharmacists – There are six whole time equivalent pharmacists in the Better Care Pharmacists’ team with one pharmacist working within each GP Practice Cluster in Brighton and Hove (more details in section 4.11.2).

CCG pharmaceutical advisor pharmacists and CCG prescribing support technicians – These assist primary care prescribers in achieving rational prescribing that maximises clinical and cost-effectiveness, minimises risk, and reflects national and local targets. The pharmaceutical advisors lead on a number of prescribing projects, support the development of prescribing guidelines and provide advice on medication related queries from prescribers. The CCG prescribing support technicians work in GP practices to assist the Medicines Management Team in implementing CCG prescribing initiatives in line with practice & CCG prescribing policies. In addition to supporting prescribing projects and audits in individual practices, implementing changes and liaising with GPs, practice staff and patients

Rapid response pharmacists and pharmacy technicians (more details in section 4.5.2)

Community health services pharmacists and pharmacy technicians (more details in section 4.5.2)

NHS England pharmacists, Practice pharmacists and pharmacy technicians (directly employed by practices) – There are 3 wte NHS England Pharmacists and 0.67 technicians in Cluster 1; 2 wte NHS England Pharmacists in Cluster 3; 1 wte NHS England Pharmacist in Cluster 4 and a 2.75 wte NHS England Pharmacists and 0.8 technicians in Cluster 6. These pharmacists are directly employed by GP Practices as part of an NHS England pilot project to resolve medicine issues as they arise, by directly consulting and treating patients. There are plans to recruit further practice pharmacists.

Consultant cardiac pharmacist – This post is divided between primary and secondary care and leads on medicines optimisation for patients with cardiovascular conditions. Work is taking place with GPs and non-medical prescribers to improve the prescribing of anticoagulation to patients with atrial fibrillation, to reduce stroke risk and to improve management of hypertension.

Care Home pharmacists and pharmacy technicians - Undertake comprehensive medication reviews for Nursing Home residents with a focus on those who would benefit most - new admissions, recent hospital discharges, Polypharmacy and those who would benefit from a face to face discussion about their medicines to enable shared decision making, reduced pill burden and better

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outcomes. Appropriate prescribing is an essential part of this service, working closely with residents, GPs, Care home nurses and community pharmacy with full read/ write access to patient records with patient and GP consent.

Specialist pharmacists and pharmacy technicians, mental health community teams (including dementia)

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4.2 Community pharmacies

There are currently 56 community pharmacies in Brighton & Hove, four less than at the time of the 2015 PNA; since when five pharmacies have closed and one distance selling pharmacy has opened. A full list of pharmacies can be found in Appendix 2: List of Pharmacies in Brighton & Hove. This translates to 19 pharmacies per 100,000 residents (excludes distance selling pharmacy) based on ONS 2016-mid-year population estimates, compared to a range of 18 to 26 per 100,000 for CIPFA neighboursi (where 2018 PNA data has been published) with a median of 19 per 100,000, this is the same as 19 per 100,000 for Kent, Surrey and Sussex and lower than 22 for England. This is a decrease from 22 pharmacies per 100,000 in Brighton & Hove in 2013, the number of England and KSS pharmacies have remained the same.

Map 2. Distribution of community pharmacies in Brighton and Hove, April 2018

4.2.1. Distance selling pharmacies.

Online pharmacies, internet pharmacies, or mail order pharmacies are pharmacies that

operate over the internet and send orders to customers through the mail or shipping

companies. The National Health Service (Pharmaceutical and Local Pharmaceutical

Services) Regulations 2013 detail a number of conditions for distance selling

pharmacies: 1

i The Chartered Institute of Public Finance Accountants has developed a model to measure similarity between local authorities. The nearest neighbours with PNA data available for 2018 included: Southampton and Reading 18 per 100,000, Portsmouth, Swindon 19 per 100,000, Southend 21.8 per 100,000, Medway, Newcastle 22 per 100,000, and North Tyneside 25.7 per 100,000.

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must provide the full range of essential services during opening hours to all

persons in England presenting prescriptions;

cannot provide essential services face to face;

must have a responsible pharmacist in charge of the business at the premises

throughout core and supplementary opening hours; and

must be registered with the General Pharmaceutical Council.31

Patients have the right to access pharmaceutical services from any community

pharmacy including mail order/wholly internet pharmacy of their choice and therefore

can access any of the many internet pharmacies available nationwide. Their very nature

means they are not constrained by geographical boundaries. The number of online

pharmacies is growing in the UK.

Currently there is one distance selling pharmacy based in Brighton and Hove that

opened in March 2017. During 2017, the national distance selling pharmacy

“Pharmacy2u” has been running a marketing campaign in the city.

4.3. Dispensing Appliance Contractors

Dispensing Appliance Contractors (DACs) hold an NHS contract to dispense dressings

and appliances as defined in the Drug Tariff at the request of a patient (or their

representative).

There are currently no DACs within Brighton and Hove. Patients residing within Brighton

and Hove may wish to exercise their right to have an appropriate prescription dispensed

by a DAC from outside this area under patient choice.

4.4. Dispensing GP practices

Provision for doctors to dispense pharmaceutical servicesj in certain circumstances

has been made in various NHS Acts and Regulations since at least the 1920s.1 These

circumstances are in summary:

• A patient satisfies the CCG or a predecessor organisation that they would

have serious difficulty in obtaining any necessary drugs or appliances from a

chemist by reason of distance or inadequacy of means of

communication(colloquially known as the serious difficulty test which can apply

anywhere in the country), or

• A patient is resident in an area which is rural in character, known as a

controlled locality, at a distance of more than one mile (1.6km) from a

pharmacy’s premises (but excluding any distance selling chemist premises).

The pharmacy’s premises do not have to be in a controlled locality.

There are currently no GP practices that have permission to dispense medicines in

Brighton and Hove.

jThe term pharmaceutical services, used in the context of the provision of services by a medical practitioner, means the dispensing of drugs and appliances, but not the other pharmaceutical services that contractors on a pharmaceutical list could provide.

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4.5 Other Pharmaceutical Services

4.5.1. Brighton and Sussex University Hospitals NHS Trust

The local acute hospital trust is Brighton and Sussex University Hospitals NHS Trust.

The pharmacy department at Brighton and Sussex University Hospital (BSUH) provides

the following services: -

a dispensing service for inpatients and outpatients

aseptic dispensing service for chemotherapy

clinical pharmacy service to all wards

medicines management service to the all wards

procurement for all drugs and related products

procurement of drugs through homecare

medicines information service to the Trust

management of the joint drug formulary

clinical prescribing services for inpatient and outpatient work

Training of undergraduates, pre-registration pharmacists and pre-registration technicians

The pharmacy service is split over three sites the largest of which is at Royal Sussex

County Hospital Brighton which has a wholly owned subsidiary pharmacy

(Pharm@Sea) for dispensing of prescriptions to outpatients and provision of homecare

medicines for patients requiring specialist services. Pharm@Sea was opened to

improve work flow for outpatients; but also reduces turnaround times at the main

pharmacy which concentrates on inpatient work. In addition Pharm@Sea offers

commissioned ancillary services such as flu vaccines and smoking cessation. This

service may be extended to the Princess Royal Hospital site, Haywards Heath.

Most outpatient appointments result in a recommendation being sent to the patient’s GP

for prescribing, that are subsequently dispensed in a community pharmacy. The

exceptions to this are immediate need for treatment and unusual or hospital only

medicines.

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4.5.2. Sussex Community NHS Foundation Trust

Sussex Community NHS Foundation Trust (SCFT) is the main provider of community health services in the city. SCFT provides the following pharmaceutical services in Brighton & Hove with the aim of working with patients and their carers to optimise their use of medicines:

A clinical pharmacy service consisting of pharmacists and pharmacy technicians to Community Short Term Services (CSTS) beds

A full time pharmacist post and part-time pharmacy technician who are integrated within the responsive services multidisciplinary team with the aim of optimising patients medicines, preventing hospital admission and facilitating hospital discharge

A clinical pharmacist running a weekly postural hypotension clinic alongside a falls specialist nurse

SCFT pharmacy staff liaise with patients/carers and additionally community pharmacists, acute hospital pharmacists and consultants, Better Care pharmacists, GP pharmacists and the patients’ GP when required.

4.5.3. Sussex Partnership NHS Foundation Trust

Sussex Partnership NHS Foundation Trust (SPFT) provides care, support and treatment in Brighton and Hove for people with a learning disability and/or a mental health issue. The services provided include; child and adolescent mental health, older people’s mental health, learning disability services, adult mental health and secure and forensic services. Outpatients are usually given FP10 prescriptions when they need to start a new medicine to take to their community pharmacy of choice. Some specialist medications, such as clozapine, are prescribed on hospital prescriptions and dispensed through a hospital pharmacy. SPFT has a number of shared care agreements with GPs, so the GP can prescribe, while the patient is still under the care of a SPFT community team. Two SPFT pharmacists support the general community mental health teams and the early intervention team in Brighton and Hove to help optimise medicines use across multi-disciplinary teams.

4.5.4. Brighton & Hove CCG

A key role of the CCG is medicines management and optimisation, to ensure safe and effective use of medicines by patients. This is achieved through providing Practice Prescribing Support; Better Care Pharmacists; Nursing Home Medication Review Team; Consultant Cardiac Pharmacist Reviews; Dietetic work and Stoma Nurse work.

4.6. Cross border NHS Services

Brighton and Hove is bounded to the north and west by West Sussex and to the north and east by East Sussex. Patients who live toward the borders of the city may choose to access pharmaceutical services from pharmacies located in the towns close to these boarders, namely Shoreham-by-Sea, Southwick, Lancing, Steyning, Henfield, Hassocks, Hurstpierpoint, Burgess Hill, Peacehaven and Newhaven, all of which are

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found within five miles of the Brighton and Hove border. There are 39 pharmacies within 5 miles of the Brighton & Hove boarder (Map 3).

Map 3. Distribution of Community pharmacies in Brighton & Hove and within 5

miles of the city border, April 2018.

Source: NHS England SHAPE Atlas (www.shapeatlas.net/PNA)

Note: The white circle containing numbers represents the number of pharmacies within a confined area – these

pharmacies are too close together to show individually using this tool.

4.7. Non-NHS Services

4.7.1. Private hospitals

There are three private hospitals within the city: The Montefiore (Spire Health care), Nuffield Health and Brighton and Hove Clinic (provided by Elysium Healthcare, formerly provided by The Priory). The Montefiore and Nuffield Health provide a number of specialities including surgery, whilst the Brighton and Hove Clinic provides mental health and substance misuse services. All have in-house pharmacy services.

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4.7.2. Residential and nursing care homes and hospices

Brighton & Hove City Council places residents in 58 residential nursing and care homes in the city. These provide approximately 1,900 combined beds.32

Table 16. Type and number of places in BHCC registered nursing and care homes. 2017.

Type of residential nursing or care

home

Number of

homes

Older person’s residential placement 16

Older person’s residential EMI placement 13

Older person’s nursing placement 15

Older person’s EMI placement 14

Source: Brighton & Hove City Council. Adult Social Care. 2017.

Brighton & Hove City Council has created a post within the CCG Medicines Management Team specifically to train residential nursing and care home staff in issues related to medication reviews.

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Core hours: The hours for which a pharmacy is formally contracted to provide NHS pharmaceutical services.

Supplementary hours: Additional hours a pharmacy opens beyond their core hours. These can be modified with 90 days’ notice.

4.8. Community pharmacy opening hours

Opening hours of pharmacies include a pharmacy’s core hours, 40 hours per week, and supplementary hours.

Supplementary hours may be varied by giving three months’ notice, core hours are not variable.

One hundred hour pharmacies are obliged to fulfil this minimum requirement each week unless prevented from doing so by legislation.

Public holiday opening hours are serviced by voluntary opening arrangements covered by supplementary hours.

Following the closure of the 100 hour pharmacy in Sainsbury’s at Benfield Valley in December 2017, none of the remaining 56 pharmacies in Brighton & Hove, has a core hours contract of 100 hours per week. They all (excluding 1 internet pharmacy) have standard 40 hour contracts (Map 4). This does not preclude pharmacies with 40 hour contracts opening for longer under supplementary hours. Two pharmacies in the city do have late night opening until 10pm as part of their supplementary hours - Westons pharmacy in Lewes Road and Ashtons Late Night pharmacy in Dyke Road. It is for this reason historically, that the city has not needed a late night opening rota and currently remains the case, despite the closure of the 100 hour pharmacy. There also continues to be a good spread of pharmacies open weekday evenings and at weekends.

Table 17 provides the numbers and percentage of pharmacies with 40 and 100 hour contracts locally.

It is noted that there is one pharmacy in the city based at the University of Sussex which

has a local pharmaceutical contract (LPS), with a clause that allows the contractor to

return to the general pharmaceutical list at any stage. This pharmacy receives a

monthly allowance based on the number of prescriptions they dispense; the volume

of prescriptions is considerably lower than the norm. Therefore, if the allowance is no

longer available some LPSs may be non-viable and close. NHS England has agreed to

financially support the pharmacy in 2017/18 and over that time will seek views from

service users and interested parties to assess the need for ongoing support. In January

2018 NHS England agreed to extend the pharmacy’s contract for a further two years.

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Table 17. Brighton & Hove Community Pharmacies opening hours, September 2017

Core hours

contract Number

Weekday

Evening

(after 18:00)

Saturday

am

opening

Saturday

pm opening

Any

Sunday

opening

40 hours 55 28 48 22 10

100 hours 0 0 0 0 0

All pharmacies (%) 100% 51% 87% 40% 18%

Denominator excludes internet pharmacies

Source: NHS England Supplementary Statement April-June 2017

4.8.1. Out of hours services

These are generally perceived as those not routinely covered by GP practices (i.e.

those between 1830 and 0800 hours Monday to Friday, and all day on Saturdays,

Sundays and Public Holidays). During these times general medical services are largely

channelled through the Out of Hours provider, IC24, which provides general medical

services to all patients in need of immediate medical treatment. When no pharmacy is

open, the Out of Hours providers have access to medicines under the National Out of

Hours Formulary. Only if they do not have appropriate stock is there a need to issue a

patient with a prescription.

Much of general practice out of hours is covered by community pharmacy with 28

pharmacies (51%) open on weekday evenings, 48 pharmacies (87%) open on Saturday

mornings, 22 pharmacies (40%) open on Saturday afternoons, and 10 pharmacies

(18%) open on Sundays (Table 18). Compared to 2015 there is the same number of

pharmacies open weekday evenings and open on Sunday. However, there are four

fewer pharmacies open on a Saturday morning and six fewer on a Saturday afternoon.

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Map 4. Pharmacies open on weekday evenings (after 1800), Brighton and Hove,

April 2018

Map 5. Pharmacies open on Saturdays, Brighton and Hove, April 2018

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Map 6. Pharmacies open on Sunday, Brighton and Hove, April 2018

4.9. Distance and travel times

The 2008 White

Paper Pharmacy in

England: Building on

strengths – delivering

the future states that

it is a strength of the

current system that

community

pharmacies are

easily accessible,

and that 99% of the

population – even

those living in the most deprived areas – can get to a pharmacy within 20 minutes by

car and 96% by walking or using public transport.33In a NHS Litigation Authority ruling

(Box), access and choice of pharmaceutical services within a travel distance of six miles

by car or public transport was considered reasonable in rural areas.

Using NHS England’s SHAPE Atlas travel time and distance mapping tool shows that

98.9% of the population is within 15 minute walk of a pharmacy (Map 7) and the whole

population is within a 10 minute drive of a pharmacy (Map 8).

The Committee noted the applicant's assertion that there is no choice of pharmacy … and the Committee agreed with this. However, the Committee noted that it should have regard to there being a reasonable choice with regard to obtaining pharmaceutical services in the area ... the nearest … approximately six miles away. The Committee noted that there is an hourly bus service to surrounding areas, and taking into account the rural nature … relatively high car ownership the Committee considered that there is a reasonable choice with regard to obtaining pharmaceutical services.

NHS Litigation Authority 17182 http://www.nhsla.com/Pages/Publications.aspx?library=fhsau%7cdecisions%7cpharmaceutical2012%7c2013/2014

152

http://www.nhsla.com/Pages/Publications.aspx?library=fhsau%7cdecisions%7cpharmaceutical2012%7c2013/2014

http://www.nhsla.com/Pages/Publications.aspx?library=fhsau%7cdecisions%7cpharmaceutical2012%7c2013/2014


59

Map 7. Area within 15 minutes walking time of a pharmacy, Brighton & Hove,

April 2018

Walk by time minutes



pharmacies are too close together to show individually using this tool

Map 8. Area within 10 minute drive of a pharmacy, Brighton & Hove, April 2018

Drive time by car minutes



pharmacies are too close together to show individually using this tool.

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Map 9 shows the location of community pharmacies that have closed since the last Pharmaceutical Needs Assessment was published in 2015. The locations of the next nearest pharmacies are all within six miles.

Map 9. Distance between closed pharmacies and the next nearest pharmacy, April 2018

4.10. NHS Pharmaceutical Services Provision

This section provides further details on the provision of NHS Pharmaceutical Services

as defined in the Community Pharmacy Contractual Framework. Whilst it is recognised

that dispensing doctors’ practices provide valuable services to their registered

dispensing patients, these are limited by statute to the dispensing of prescriptions. A

number of related services are provided as part of their General Medical Services on

Personal Medical Services contract and will not be described in any further detail.

Community Pharmacies provide three tiers of Pharmaceutical Services, defined in the

Regulations.29

Essential Services and clinical governance – services provided by all

pharmacies and commissioned by NHS England.

Advanced Services – additional services all pharmacies can provide once they

have reached accreditation requirements and commissioned by NHS England.

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Locally commissioned services – commissioned by local authorities, CCGs and local NHS England area teams (i.e. “Enhanced Services” outlined in the Drug Tariff) in response to the needs of the local population.

4.10.1. Essential service provision

Essential services are specified by a national contractual framework and all community

pharmacies are required to provide all the essential services. NHSE is responsible for

ensuring that all pharmacies deliver essential services as specified. Essential services

include:

Dispensing medicines

Pharmacies are required to keep a record of all medicines dispensed, and also keep a

record of any interventions made which they judge to be significant. In 2016-17

pharmacies in Brighton & Hove dispensed an average of 4,760,305 items an increase

from 4,750,744 in 2015-16. The average number of items dispensed per month by

pharmacy was 6,723 in 2016-17 compared to 6,598 in 2015-16. This was lower than

Kent, Surrey and Sussex where the average per pharmacy per month was 7,222 (2016-

17) and 7,135 in 2015-16.

Table 18. Prescription items dispensed by pharmacies in Brighton & Hove in 2015-2017.

Number of

community

pharmacies

Number of items

dispensed

Prescription items

dispensed per

month

Average per

pharmacy

per month

2015-16 2016-17 2015-16 2016-17 2015-16 2016-17 2015-16 2016-17

Brighton &

Hove

60 59 4,750,774 4,760,305 395,000 396,000 6,598 6,723

Kent,

Surrey,

Sussex

882 887 75,526,573 76,877,394 6,293 6,406 7,135 7,222

England 11,688 - 995,300,000 - 82,940,000 - 7,096 -

Source: NHS Business Services Authority August 2017

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Electronic prescribing data

The Electronic Prescription Service (EPS) is being implemented as part of the dispensing service.

In 2014-15 there were 334,123 electronic prescriptions dispensed in Brighton & Hove community pharmacies. This increased to 1,197 930 electronic prescriptions dispensed in 2015-16 and 2,764,600 in 2016/17.k This rise can be accounted for by an increase in the number GP practices having the software to make EPS referrals during 2014/15 and 2015/16, as the system was rolled out.

In May 2017, 41% of Brighton & Hove patients on GP lists in the CGG had been nominated for the EPS. Business Services Authority data for April 2017 indicates that 67% of GP practices in the CCG were offering an EPS in co-ordination with community pharmacies and 15% of repeat dispensing was by the electronic Repeat Dispensing (eRD) with community pharmacies.34

Dispensing of appliances

Pharmacies are required to dispense appliances ordered on NHS prescriptions only if they supply such products in the “normal course of their business”.35

Repeat dispensing

Pharmacies dispense repeat dispensing prescriptions issued by GPs. They ensure each repeat supply is required and ascertain that there is no reason the patient should be referred back to their GP. The majority of repeat prescribing is now carried out by the Electronic Prescription Service and is termed electronic repeat dispensing (eRD).

Clinical governance

Schedule 4 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 set out the ‘Terms of Service’ of NHS pharmacists in four parts. Part 4 set out the other terms of service, which includes Clinical Governance. Adherence with clinical governance requirements is therefore a part of the terms of service.1

k 2015-16 data, NHS BSA, August 2017. 2016-17 data, Brighton & Hove CCG August 2017. Information

on EPS data is derived from electronic messages submitted by prescribers to dispensing contractors in

the community. The data is based on what was electronically prescribed in England and will only include

items dispensed in England. Please note this means that if a prescription message was sent but the

patient did not collect the dispensed item(s) then it is not included in the data provided. Data included

will relate to Practices registered under CCGs, no other organisations will be included within the EPS

data.

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Public Health campaigns (promotion of healthy lifestyles)

Each year pharmacies are required to participate in up to six campaigns at the request of NHS England. This involves the display and distribution of leaflets provided by NHS England.

In addition, pharmacies are required to undertake prescription-linked interventions on major areas of public health concern, such as encouraging smoking cessation.

Disposal of unwanted medicines

Pharmacies are obliged to accept back unwanted medicines from patients.

Signposting

NHS England will provide pharmacies with lists of sources of care and support in the area. Pharmacies will be expected to help people who ask for assistance by directing them to the most appropriate source of help.

Support for Self-care

Pharmacies help manage minor ailments and common conditions, by the provision of

advice and where appropriate the sale of medicines, including dealing with referrals

from out of hours providers and NHS 111.

Pharmacies are monitored by NHSE to ensure proper provision of these services

(either in person or by submission of a self-assessment questionnaire). This includes

the requirement to submit summaries of patient surveys, details of complaints

received and a clinical audit. In addition, they are all obliged to participate in a multi-

disciplinary audit.

4.10.2. Advanced service provision

There are six Advanced Services within the NHS Community Pharmacy Contractual Framework (CPCF).

Flu Vaccination

Medicine Use Reviews (MURs)

New Medicines Service (NMS)

Appliance Use Reviews (AUR)

Stoma Appliance Customisation (SAC)

NHS Urgent Medicine Supply Advanced Service (NUMSAS)

Community pharmacies can opt to provide any of the above services as long as they

meet the requirements set out in the Secretary of State Directions.

Pharmacies are required to seek approval from NHSE before providing the services, are

required to have an appropriate consultation area and have a pharmacist who has

undertaken an accredited training course to provide the service.

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Flu Vaccination

NHS England commissions pharmacies to deliver the seasonal flu programme to those over 65 years, at risk patients and carers. The proportion of pharmacies providing this service in Brighton & Hove has increased from 77% in 2015-16 to 86% in 2016-17. This is higher than the proportion of pharmacies offering this service in East Sussex. In the 2016/17 the proportion of over 65s having a flub jab in the city was 64.3%, compared to the national target of 70%.

Table 19. Number of flu vaccinations in Brighton & Hove pharmacies 2015-17

Number of

community

pharmacies

Number of flu

vaccinations

Number of

pharmacies

providing service

Average per

pharmacy per

annum

2015-16 2016-17 2015-16 2016-17 2015-16 2016-17 2015-16 2016-17

Brighton &

Hove

60 59 2,983 4,900 46(77%) 51(86%) 64 96

Kent, Surrey

and Sussex

882 887 45,652 73,727 552(63%) 660(74%) 82 111

England 11,688 - 595,467 - 7,195 - - -

Source: NHS Business Services Authority 2017

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Map 10. Distribution of pharmacies providing flu vaccinations, April 2018

Medicine Use Reviews (MURs)

The MUR and Prescription Intervention Service consists of accredited pharmacists

undertaking structured adherence-centred reviews with patients on multiple medicines,

particularly those receiving medicines for long term conditions.

National target groups have been agreed in order to guide the selection of patients to

whom the service will be offered. Since January 2015 these target groups have

included:

Patients taking high risk medicines

Patients recently discharged from hospital that had changes made to their

medicines while in hospital. Ideally they should receive an MUR within 4 weeks

of discharge but in certain circumstances the MUR can take place within 8 weeks

of discharge

Patients with respiratory disease

Patients at risk of or diagnosed with cardiovascular disease and regularly being

prescribed with four medicines

The MUR process attempts to establish a picture of the patient’s use of their medicines

– both prescribed and non-prescribed. The review helps patients understand their

therapy and identifies any problems and possible solutions.36 Each pharmacy is subject

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to a cap of 400 MURs per year as the maximum that they can provide and must give

MURs to at least 70% of patients in the target groups each year.

All community pharmacies in Brighton & Hove offered MURs in 2016-17 (apart from the

distance selling pharmacy).

Table 20. Community pharmacies providing Medicine Use Reviews (MURs) 2015-17

Number of

community

pharmacies

Number of

MURs

Number of

pharmacies

providing

service

Average per

month per

pharmacy

2015-16 2016-17 2015-16 2016-17 2015-16 2016-17 2015-16 2016-

17

Brighton &

Hove

60 59 19,627 18,399 58 (97%) 58(98%) 338 317

Kent, Surrey

and Sussex

882 887 272,004 266,207 840(95%) 849(96%

) 323 313

England 11,688 - 3,313,309 - 11,029(94%) - 300 -


Map 11. Distribution of pharmacies providing Medicine Use Reviews, April 2018

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New Medicines Service (NMS)

The New Medicines Service (NMS) provides support for people with long-term conditions who have been newly prescribed a medicine to help improve their understanding and use of their medicine; it is initially focused on particular patient groups and conditions. It has also been found to be a cost effective intervention in comparison to normal practice, increasing patients’ adherence to their new medicine, translating into increased health gain at reduced cost.37 Table 21. Community pharmacies providing New Medicine Services 2015-17

Number of

community

pharmacy

services

Number of NMS Number of

pharmacies

providing service

Average per

pharmacy per

annum

2015-16 2016-17 2015-16 2016-17 2015-16 2016-17 2015-16 2016-17

Brighton & Hove 60 59 4,113 4,479 53(88%) 55(93%) 77 81

Kent, Surrey

and Sussex

882 887 69,172 70,985 748(85%) 789(89%) 92 89

England 11,688 - 821,893 - 9,439(81%) - 87 -

Source: NHS BSA August 2017

Map 12. Distribution of pharmacies providing New Medicine Service, April 2018

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Appliance Use Reviews (AUR)

AURs aim to improve the patient’s knowledge and use of a ‘specified appliance’ e.g. an

asthma inhaler 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 as long as they meet the conditions of service.38 In 2015-17, no pharmacies within Brighton & Hove provided AURs. In England, Kent, Surrey and Sussex only 1% of providers offered AURs during this period.

Stoma Appliance Customisation (SAC)

The SAC service 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.

The service can be provided by pharmacies that normally provide the specified

appliances in the normal course of their business as long as they meet the conditions of

service.39 The number of pharmacies in Brighton & Hove providing SAC has remained

unchanged since 2015-16, with only three pharmacies providing this service.

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Table 22. Community pharmacy and appliance contractors providing Stoma Appliance

Customisation, Brighton & Hove 2015-16

Number of

pharmacies &

SAC contractors

Total SAC services Number of

pharmacies &

appliance

contractors

providing services

Average per

pharmacy and

appliance

contractor

2015-16 2016-17 2015-16 2016-17 2015-16 2016-17 2015-16 2016-17

Brighton & Hove 60 59 71 67 3 (5%) 3 (5%) 23 22

Kent, Surrey

and Sussex

890 896 86,117 93,967 121(14%) 123(14%) 711 763

England 11,798 - 1,237,651 - 1,732(15%) - 715 -


Map 13. Distribution of pharmacies providing stoma appliance customisation,

April 2018

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NHS Urgent Medicine Supply Advanced Services (NUMSAS)

In October 2016 the Department of Health and NHS England announced that as part of

the 2016/17 and 2017/18 community pharmacy funding settlement, money from the

Pharmacy Integration Fund (PhIF) would be used to fund a national pilot of a community

pharmacy Urgent Medicine Supply Service. The service is being commissioned as an

Advanced service until March 2018 (unless NHS England decides to extend or make

the pilot a permanent service).

The service is available to all pharmacies that meet the eligibility criteria to offer an

emergency supply of prescription only medicine. It enables the referral to a community

pharmacist where a patient has run out of regular medicines or appliances both In-

Hours and Out of Hours, as well as a supply of these where appropriate.

The NUMSAS service provided in Brighton & Hove offers an emergency supply of

medicines out of hours between 6.30pm and 8am on weekdays, all weekends and all

opening hours on bank holidays. Patients can self-present or be referred by NHS 111.

To participate in NUMSAS pharmacies need an NHS net email address. Community

pharmacies have reported difficulties with the NHS 111 algorithm, which will not allow

health professionals to contact the call operators directly to query prescriptions.

Approximately a third of those issued by NHS 111 need referring back via the patient.

In August 2017, 20 community pharmacies in Brighton & Hove provided NUMSAS.40

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Map 14. Distribution of pharmacies providing NHS urgent medicine supply

advanced service, April 2018

4.10.3. Locally Commissioned Services (LCS)

Locally commissioned community pharmacy services are contracted by different commissioners including local authorities, CCGs and NHS England local area teams. This section includes LCS commissioned by the CCG and Public Health Department. NHS England does not commission any LCS in Brighton & Hove.

Services commissioned by the CCG

At time of writing Brighton and Hove CCG was commissioning one locally commissioned service from one pharmacy (Asda at Brighton Marina) in order to provide intravenous medications within the community. The service aimed to improve access to intravenous medication to patients when they are required by ensuring prompt access and continuity of supply. The pharmacy delivering the service:

Holds the specified list of medicines required to deliver this service and will dispense these in response to NHS prescriptions presented.

Arranges delivery of IV antibiotics only, to patients via a local taxi service. All other medication is collected either by the patient, their representative or a relevant health care professional.

Ensures that pharmacists and staff involved in the provision of the service have

relevant knowledge and are appropriately trained in the operation of the service.

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Maintains appropriate records to ensure effective ongoing service delivery and

audit.

Public health services commissioned by Brighton & Hove City Council

Brighton and Hove City Council Public Health team commission pharmacies to provide: Sexual health services (Chlamydia Screening and treatment; C-Card condom distribution; Emergency Hormonal Contraception (EHC)); Domiciliary Smoking Cessation Service; Smoking Cessation Service; Healthy Living Pharmacy (HLP level 2) and flu vaccinations from frontline health and social care staff at HLP level 2 pharmacies.

4.10.3.1. Sexual health services

This section shows the number of pharmacies that have been commissioned to provide specified sexual health services in Brighton and Hove. The EHC service through pharmacies provides important access to free EHC for women aged 25 years or younger in the city. Without this service access would only be available via a GP appointment or sexual health clinics which would delay or limit access.

The EHC service was provided by 41 community pharmacies in July 2017.41 In 2016/17, 3,080 1500mg items of EHC (Levonelle) was dispensed in community pharmacies. Pharmacies which provide the EHC service are expected to also provide the C-Card and Chlamydia screening services which are included in the same service specification. The C Card promotes the effective use and provision of free condoms. The main aim of the service is to reduce rates of STIs and teenage pregnancy. At their first visit young people are provided with appropriate training regarding sexual health matters and then issued with a C Card. The C Card can then be presented to any of the service providers who will issue a supply of free condoms. Without this service access would only be available via a limited number of service providers including Sexual Health Service Clinics, some GP surgeries and youth clubs, limiting access to free condoms and advice.

In 2016/17, 857 free condoms were distributed by pharmacies, this is an increase on 2015/16 when 431 free condoms were distributed.

The chlamydia screening programme in the city targets young people aged below 25,

who are at the highest risk of chlamydia infection. Young people who present in various

settings, including pharmacies, are encouraged to take a test which involves providing a

self-taken sample. Anyone requiring emergency contraception following unprotected

intercourse will also require screening for chlamydia infection. Treatment of positive

cases and partner notification is co-ordinated by the chlamydia screening programme.

Nineteen 15-24 year olds were treated by pharmacies for chlamydia in 2016/17.l,42

l This is for Quarter 2- Quarter 4.Treatment of chlamydia only started to be recorded on the Pharm Outcomes system from Q2.

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Map 15. Distribution of pharmacies providing sexual health services, April 2018

4.10.3.2. Substance Misuse Service

Needle and Syringe exchange programme

The main purpose of this service is to reduce the transmission of blood-borne infections by providing free, sterile injecting equipment and advice in line with NICE public health guideline PH18.43 The main beneficiaries are people who inject illicit drugs, including performance and image enhancing drugs.

The local specialist substance misuse service provider coordinates the needle and syringe programme. Commissioned pharmacies supply pre-packed bags containing sterile syringes, needles and other items to adult customers on request. Customers may leave used items, suitably contained in a sharps bin, with the pharmacy for disposal as sharps waste. In July 2017 there were 15 pharmacies in the city providing this service (which is not an LCS) their locations can be seen on map 15.

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Map 16. Distribution of pharmacies providing a needle exchange service, April

2018

Supervised consumption

The local specialist substance misuse service provider co-ordinates a supervised consumption service in the city through a service level agreement with pharmacists that meet accreditation requirements and service standards. The service provides community detox from opiates for over 18s, by the pharmacist supervising the whole process of consumption of prescribed medicines (Methadone and Buprenorphine) at the point of dispensing in the pharmacy, ensuring that the correct dose has been administered to the service user.

In July 2017 there were 21 pharmacies providing supervised consumption of medicine, their locations can be seen on map 16.

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Map 17. Distribution of pharmacies providing supervised consumption of

medicine, April 2018

4.10.3.3. Seasonal flu vaccination

Seasonal influenza vaccinations delivered in pharmacies are commissioned by both Brighton & Hove City Council and NHS England. The former commissions the vaccination of frontline health and social care employees. In 2016, 265 vaccinations were delivered by nine HLP level 2 pharmacies in the city to employees. In 2017, 19 HLP level 2 pharmacies are delivering vaccination to council frontline staff in the city and 7 are also providing an “on site” vaccination service. There were 337 vaccinations given in pharmacies to BHCC frontline health and social care employees in 2017, an increase on 2016.

4.10.3.4. Smoking cessation service

Currently there are 48 pharmacies commissioned to provide stop smoking services in

Brighton & Hove. There are also 8 pharmacies delivering domiciliary stop smoking

services. 25 pharmacies also commission the young people’s service Nicotine

Replacement Therapy (NRT) and 26 E-vouchers. Pharmacies are seen as key

providers of stop smoking services due to their opening hours, accessibility and ability

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to give advice and supply NRT. Map 17 shows the location of pharmacies

commissioned to provide stop smoking service in Brighton and Hove.

Map 18. Distribution of pharmacies providing a smoking cessation service, April

2018

Smoking prevalence among adults in Brighton and Hove is currently estimated to be 20% (2016).44 Table 23 shows that the number of people who have accessed and quit smoking using the stop smoking pharmacy service. In 2013/14 there was a national reduction of people accessing stop smoking services; this could be due to the increase of people using e-cigarettes. 2015/16 saw a higher number of people setting quit dates in pharmacy stop smoking services, and successfully quitting, however in 2016/17 quit rates for pharmacy fell by 28%, resulting in fewer quitters. Nationally the quit rate for pharmacies in 2016/17 was 45% and 50% for the South East.

Table 23. Number of people of have accessed and quit smoking using the stop smoking

pharmacy service, 2013/14 – 2016/17

Year 2013/14 2014/15 2015/16 2016/17

Number of people

setting a quit date

831 498 820 616

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Number of people

quit at 4 weeks

426 51% 408 82% 572 70% 259 42%

Source: Brighton & Hove Stop Smoking Service July 2017.

Although there are currently 48 pharmacies (82%) delivering stop smoking services in

the city it is important to encourage more pharmacies to deliver this service as they are

seen as key providers of stop smoking services in the community due to their opening

hours, accessibility and ability to give advice and supply nicotine replacement therapy

(NRT). HLPs need to be more active in promoting this service by seeking opportunistic

“teachable moments” to deliver very brief advice on smoking cessation. Being involved

in local campaigns, offering free carbon monoxide readings as an incentive and

motivational tool to quit smoking.

Figure 5 compares the quit rate in pharmacies with other settings, and shows that from 2015/16 – 2016/17 it has had the second highest number of quitters after GP practices.

Fig 5. Number setting a quit date and successfully quitting shown by service provider 2015-16 and 2016-17

4.10.3.5. Healthy Living Pharmacies

In 2011 a pathfinder study45 was supported by the Department of Health, to establish

the Healthy Living Pharmacy (HLP) format. The core principles of the framework were

to maximise health promotion campaigns, signpost to appropriate NHS and Local

Authority services and introduce locally commissioned services (LCS) to enhance the

health promotion offer and self-care advice in Community Pharmacies.

In July 2016, the HLP Task Group of the Pharmacy and Public Health Forum developed

a new process for the implementation of Level 1 HLPs.

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In October 2016 NHS England announced changes to the pharmacy contractual

framework. This introduced quality criteria, one of which was a requirement for

pharmacies to become healthy living pharmacies Level 1 using the Royal Society for

Public Health (RSPH) self- assessment tool to become accredited.

This will allow the move from a totally commissioner-led HLP accreditation system to a

profession-led self-assessment process for Level 1 HLPs, based on clear quality criteria

and underpinned by a proportionate quality assurance process

RSPH self-assessment guide sets out the quality criteria that pharmacies must achieve

to gain HLP Level 1 status. Pharmacy teams must be able to provide evidence of their

behaviours and activities as well as the physical environment and this will need to be

recompleted and assessed every 2 years

This is a requirement to secure quality premium funding through NHS England as a

Level 1 healthy living pharmacy.

Currently (December 2017) there are 28 community pharmacies signed up to deliver the

Public Health commissioned Healthy Living Pharmacy level 2 Locally Commissioned

Service (LCS). Locally commissioned services can be commissioned by either CCGs or

local authority public health teams and are not part of the NHS England quality

payments system. The requirements for the Healthy Living Pharmacy LCS (level 2 )

includes training pharmacy staff (Dispensing Technicians and Healthcare Assistants) as

Health Champions (HC) and achieving a Royal Society for Public Health, Understanding

Health Improvement Level 2 qualification. The HCs engage with their local

communities, provide opportunistic healthcare advice and signpost to NHS and local

authority services. The HCs also receive quarterly training to develop their healthcare

knowledge and form links with other health and social care providers in the city. The

location of the Healthy Living Pharmacies is shown in map 19.

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Map 19. Distribution of pharmacies providing Healthy Living Pharmacy level 2

Locally Commissioned Service, April 2018

4.11. Innovation with community pharmacy

4.11.1. Electronic Prescription Service

The Electronic Prescription Service (EPS) enables prescriptions to be sent electronically

from the GP practice to the pharmacy and then on to the Pricing Authority for payment.

It has been deployed through two key releases. Release 1 (R1) in which the barcoded

paper prescriptions form remains the legal prescription.

Release 2 which support the transmission of electronic prescriptions; e-repeat

dispensing (eRD); patient nomination of their selected pharmacy; GP cancellation of e-

prescriptions; and the electronic submission of reimbursement claims to the Pricing

Authority. Currently, prescribers can only issue an electronic NHS prescription where it

is being sent electronically to a patient’s nominated pharmacy.46

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http://www.psnc.org.uk/dispensing-supply/eps/eps-release-1/

http://psnc.org.uk/dispensing-supply/eps/dispensing-in-eps-release-2/electronic-repeat-dispensing/

http://psnc.org.uk/dispensing-supply/eps/dispensing-in-eps-release-2/electronic-repeat-dispensing/


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4.11.2. Better Care Pharmacy Services

Better Care pharmacists originated as part of the Proactive Care pilot project and have been offering a service since 2015. The service is managed by Brighton & Hove CCG. There is one WTE pharmacist per GP Practice cluster. The six pharmacists carry out clinical medication reviews with frail patients at risk of hospital admissions. The majority of reviews are home visits but some patients are seen in their GP practices. Their role includes providing extra help to manage patients’ long-term conditions, such as helping to manage a patient’s high blood pressure to prevent cardiovascular disease; advice for patients on taking multiple medications; and offering better access to health checks. The aim is to deliver quicker access to clinical advice for patients and allows GPs to spend time with patients who have more complex needs. Five GP Practices piloted this national scheme in 2015: Charter Medical Centre, Brighton and Hove Wellbeing Centre, Mile Oak Surgery, Benfield Valley Hub and St Peter’s Medical Centre. It is now offered to GP practices in all clusters. Currently GP Practices engage with the service to different degrees. Better Care pharmacists work with them to agree criteria for identifying patients for pharmacist reviews e.g. those on the frailty index or with 15 or more medications. Community pharmacies are a useful resource for Better Care pharmacists because of the continuity of contact with the patient they have, and they can offer assistance if the patient is having difficulties receiving their medication.

4.11.3. Improving environmental sustainability

Between 2015 and 2016, Brighton & Hove CCG and Glaxo Smith Klein ran the “Breathe Better Waste Less” campaign, to reduce the wastage caused by inhalers. Nationally 63% of inhalers end up in landfill and many are discarded when they are only partially used. The aim of the campaign was to train community pharmacists in the correct inhaler technique; the checking of patient inhaler technique at Medicine Use Reviews and the provision of inhaler recycling facilities in pharmacies. Analysis of the returned inhalers found 82%were partially full or full.

Brighton & Hove has also been running a “Green Bag” scheme via its community pharmacies, since 2015. This encourages patients to carry all their current medication in a special green bag when they are admitted to hospital or a care home, to reduce medication errors and waste

Recommendations

All community pharmacies that have existing NHS net emails should share these

with GP Practices and the CCG should encourage GPs to use these email

addresses for communicating with pharmacies

Where pharmacies are offering the Stop Smoking LCS but are not achieving a

50% quit rate, or have a 15% lost to follow-up rate, the following steps should be

taken:

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- An action plan should be developed to address this with the Royal Sussex County Hospital (RSCH) Smoking Cessation lead and BHCC commissioner - Pharmacies must attend 2 out of 3 smoking cessation update and development

sessions a year

-All pharmacy stop smoking advisors must complete the National Centre for Smoking Cessation and Training (NCST) online level 2 training and assessment

-All smoking cessation advisors to be trained in pharmacy safeguarding policies

and be supported to obtain an enhanced Disclosure and Barring Service (DBS)

check.

- PharmOutcomes (the reporting tool used) must be updated to show when an

advisor has a DBS check

BHCC to review the payment schedule for smoking cessation to reflect the effort

of advisors, needs of clients and reduce rates of lost to follow up clients.

5. Patient/public surveys and feedback

This section details the findings from:

a city wide survey, the City Tracker, which is completed annually

reports produced by voluntary sector groups on use of pharmacies in the city

summer 2017

a survey with patients and the public to inform this PNA

5.1. City Tracker Survey

The City Tracker survey is a city-wide telephone survey conducted with residents aged

18 and over. The survey aims to find out what residents think of Brighton and Hove as a

place to live and to track key performance indicators including, satisfaction with key

services. The survey includes a random sample of 1,000 residents and has been

conducted annually in the autumn since 2012.

Within the survey there are two questions related to pharmacy services “Have you used

your local chemist in the last 12 months? and “Taking everything into account, how

satisfied or dissatisfied are you with the following organisations in your local area? –

Your local pharmacy.”

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Results from the most recent survey in 2016 reveal that more than nine out of ten

residents (94%) are very or fairly satisfied with their local chemist. More than four out of

five residents (86%) had used their local chemist in the previous 12 months, and in this

group, satisfaction with their local chemist rises slightly to 96%. User satisfaction with

your local chemist has been at 95% or above in four out of the last five years falling to

90% in 2014.

5.2. Amaze / Parent Carer’ Council (PaCC) – Pharmacies and management of

medicines survey, August 2107.

Amaze is Brighton and Hove ‘one stop shop’ for parent carers of children with disabilities and additional needs, providing a variety of information, advice and support. Amaze also manages the Compass Database and the Compass Card, a free leisure incentive card for 0 to 25 year olds with significant disabilities or special needs who live or go to school in Brighton & Hove. In 2015/16, there were 1,927 children and young people recorded on the register in the city.

The PaCC, hosted by Amaze, is a city-wide engagement group with over 320 members

who are parent carers who have children and young people with disabilities, complex

health problems or other additional needs. The consultation looked into the use of

pharmacies, their role around prescription and management of medicines and how

parent carers and their children could be more included in this. An online questionnaire

was sent to parent carers who are on the Compass Register and 67 completed

questionnaires were received.

5.2.1. Summary of findings

Four out of five parent carers (80%) who completed the online questionnaire were happy with explanation of what medicines are for, what they do and possible side effects. However, considering that many parents and their children take multiple medicines they would like more information and also to know more about interactions between different medications.

Parent carers are confident enough to ask their pharmacist for more information about the medicines, and 79% of parent carers reported that they can easily find and use an open pharmacy when they need one. Some parent carers suggest improving the quality of information and advice from the pharmacy and provision of some confidential and private space where to talk about the medicines.

Most of the people who responded to the on line questionnaire are aware of the different services that a pharmacy can provide but only approximately 40% knew that the pharmacist can review and help manage their medications and/or provide health checks.

Overall the majority of parent carers, 80% are satisfied with the pharmacy services and some rely on alternative remedies. However parent carers find the management of repeated prescriptions very challenging. Better communication between GP and

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pharmacy, and co-ordination of the different agencies involved could resolve some of those issues.

5.3. Friends Families & Travellers (FFT). Medicines Report. 2017

FFT is a national charity working on behalf of Gypsies and travellers. Between May and

August 2017 it under took some engagement work with Brighton & Hove Gypsies and

travellers for the CCG, concerning their knowledge of medicine, pharmacies and NHS

costs. The study included 50 respondents to an online questionnaire (68% female, 32%

male) and 30 qualitative interviews (60% female, 40% male).


Responses to the online survey that were relevant to community pharmacies included:

30% (15) knew about pharmacist medication reviews

54% (27) knew about checks at pharmacies

54% (27) knew pharmacies can dispose of unwanted medicine

Responses to the qualitative interview relevant to the community pharmacies included:

33% would ask a pharmacist if they had a problem with their medication

31% (9) get their medication reviewed

40% (12) know about medication reviews

47% (14) don’t know where to safely dispose of unwanted medicine

53% (16) know about checks at pharmacies e.g. diabetes

5.4. Age UK. Medicines. Older People’s Experience in Brighton & Hove

As part of the CCG Health Engagement consultations in 2017, Age UK volunteers

interviewed 43 people with an average age of 80 years in their own homes about their

experience of medicines.


Responses that related to community pharmacies included:

40% would ask a pharmacist if they had problems with their medication

11% would see a pharmacist if they had a bad reaction to medication

33% had not been offered an assessment or review when starting new

medication

49% only went to community pharmacies to collect prescriptions.

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5.5. Use of Medicines in Culturally and Ethnically Diverse Communities. TDC and

Hangleton and Knoll Project August 2017.

During the summer of 2017 a consultation was carried out with 62 participants of BME

groups in the city, concerning their use of medicines and pharmacies. The participants

came from: the Chinese Elders group; BME 50 plus group; Moulsecoomb Bangladeshi

Women’s group; Hangleton & Knoll Multicultural Women’s group and Bevendean BME

Residents group.


52 out of 62 people (84%) knew the pharmacist could review their medicines and

help them manage them.

36 out of 62 people (58%) did not know that certain checks were available at

pharmacies. One of the 62 people was aware of interpreting services at

pharmacies.

The BME 50 Plus group would ask the pharmacist if they had a problem or

question about their medicine. The majority of the Hangleton & Knoll Multi-

Cultural Women’s group would ask their GP or pharmacist

The BME 50 Plus group, Bevendean BME residents, Hangleton & Knoll multi-

cultural women’s group use the pharmacist for over the counter medicines, to

collect prescriptions and for minor conditions advice.

5.6. Carers Centre Medicines Optimisation Study

During the summer of 2017 the Carers Centre consulted with 15 carers on their

experience of taking medicine and how they access pharmacies. Consultation was

conducted jointly with Amaze through completion of an online survey.


Responses to the online survey that were relevant to community pharmacies were:

73% (11) would talk to a pharmacist if they had problems with their medication

86% (13) strongly agreed or agreed that they could usually find an open

pharmacy if they needed one

The three services the public would most like pharmacies to provide were NHS

Health Checks (60% (9)), urgent medicine out of hours ( 53%( 8)), Medicine Use

Checks (46%( 7))

60% (9) of people didn’t know their pharmacist could carry out Medicine Use

Reviews or some health checks

86% (13) were fairly or very satisfied with pharmacy services in Brighton & Hove

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5.7. Possability People. Medicines and Community Pharmacy Report August 2017

During the summer of 2017, 73 members and non-members aged 21 to 92 years of

Possability People’s Get Involved Group responded to a consultation on the topic of

medicines and community pharmacies. Methods used included an online survey,

telephone survey, postal mail out and focus group.


Responses relevant to community pharmacies were:

35 people (25%) would talk to their local pharmacy if they had a problem with

their medication and 94% (48) said they would be comfortable talking to a

pharmacist if they had concerns about the medication they were taking.

47 said they used their local pharmacy to get their medicines

29 said they used their local pharmacy to get advice about their medicines

65 (90%) people said that their local pharmacy was accessible enough to meet

their needs

72% (51) of respondents had not had a medicines use check with a pharmacist.

63% ( 23) of this group would consider asking their pharmacist for a medicine

use check

The main three services used that were offered by pharmacies were: free home

delivery of medication (22); disposal of unused medicines (16); flu vaccination

(16).

The three most popular responses for improving community pharmacy service for

people with disabilities/additional needs were: hearing loops, more space, lower

counters, ramps and electronic doors (6); more staff (5); awareness raising for

staff of people with invisible disabilities (4).

5.8. LGBTQ Peoples Experiences of Medicines and Prescriptions. Research

Report July 2017.

Brighton & Hove CCG and BHCC commissioned the LGBT Health and Inclusion Project

and LGBT Switchboard to undertake a consultation on the use of medicines and

community pharmacies by the LGBTQ community. 82 people responded to an online

and paper survey.


The responses reported were that:

72% (49) of people visited the pharmacist to collect a prescription/repeat

prescription; 62% (42) to buy over the counter medicine;29% (20) for advice on

treatment of minor conditions and healthy living

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56% (38) knew the pharmacist could carry out medication reviews

54% 37) knew they could have certain health checks at pharmacies

91% (62) had not experienced challenges as an LGBTQ person accessing

services or advice from a pharmacy

5.9. Mental Health Engagement Project. LiVE Project and YMCA Right Here.

Consultation Report on Medication. August 2017

Consultation work was carried out in the summer 2017, to which 127 people over the

age of 16 years responded to two online surveys about the use of medicines and

pharmacies.


No young people were currently getting their information about medication from

pharmacies. Over (9) 25% of young people would like to get this information from

pharmacists. 95% of respondents used a pharmacist to collect prescriptions or non-

prescribed medication. 63% were unsure of what other services they could get from a

pharmacy.50% knew about health checks available at pharmacies. People were more

used to and confident in discussing general health issues with pharmacists but were

less sure about discussing mental health issues and medication. Many respondents

also flagged lack of privacy within pharmacists as a major factor in not using their

pharmacist more often for health advice. Some people also identified a need for clarity

in the role pharmacists can play in supporting people

5.10. Young People & Medicines. Consultation Summary Report. YMCA Right

Here. August 2017.

Consultation work was carried out in the summer 2017, with Right Here’s Young Health

Champions about young people’s use of medicines and prescriptions. 95 people

responded to an online survey and 19 people were participants in focus groups.


Most of the findings related to GP practices. One question asked where they got most of

their medication from, many cited Boots, Kamsons or Sussex University Chemists.

5.11. Report on Medicines Optimisation and Community Pharmacy Services.

Consultation with people with learning disabilities. Speak Out. 2017.

During the summer 2017, Speak Out carried out a consultation with people with learning

disabilities about medicines management and community pharmacies. 40 people

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participated in the consultation, which include group meetings and 27 individual

interviews. Participants were aged from 16 to 80 years old.


21 out of 40 people spoken to had used a community pharmacy. Findings relevant to

community pharmacies included:

A lack of awareness of what community pharmacies can offer people with

learning disabilities.

Many of the services on offer would be valuable to those who have little or no

support.

A safe place to discuss medication, side effects or over the counter remedies is

vital.

5.12. Combined recommendations from the voluntary sector engagement surveys

for the CCG

i. Pharmacists should provide information and advice on medication aids and

medications, including side effects and drug interactions. In particular this advice

(or training where appropriate) should be given to people with complex needs,

including older people, and those with mental ill health, long term conditions and

carers.

ii. Pharmacists should provide advice on paying for prescriptions for people on a low

income or benefits.

iii. Provision should be made available in pharmacies for private discussions with the

pharmacist.

iv. The efficiency of the repeat prescribing process should be improved.

v. The CCG and BHCC should co-ordinate a city-wide awareness campaign around

services that can be accessed at pharmacies, and how to access out-of-hours

services. This should include the provision of information on services in accessible

formats e.g. Easy Read for people with low literacy levels and information on how

to request specialist provision such as an interpreter, BSL, braille, home visit.

vi. Communication systems should be improved around the process of discharge from

hospital pharmacies to community pharmacies and communication around the co-

ordination of Medicine Use Reviews.

vii. Where patients consent, GPs and community pharmacies should share summary

care records.

viii. Pharmacists should have the knowledge to signpost patients to alternative sources

of support and advice in the community.

ix. Pharmacies should receive training in disability awareness (including learning

disability), LGBTQ awareness, and the needs of BME groups to make their

services more accessible to these equalities groups.

x. Better feedback systems about medicines and pharmacy services should be

developed for people with learning disabilities, mental ill health, older people and

those with complex needs, and for staff, carers and advocates.

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5.13. PNA Community survey

A targeted self-selecting survey was conducted to better understand the views of local

patients and residents regarding pharmacy services in Brighton & Hove. Where

questions are comparable to the PNA 2014 community survey, reference will be made

in the corresponding sections below.

5.13.1. Key findings

More than four out of five respondents (87%) are satisfied with the pharmacy service

in Brighton & Hove with only 3% dissatisfied.

Similar to what was seen in 2014 (78%), three quarters of respondents (76%) agree

that they can find and use an open pharmacy when they need one with only 5%

disagreeing.

Higher than seen in 2014 (83%), for nine out of ten respondents (90%) the opening

times of the pharmacy they use most often meets their needs with only 10% saying

they do not.

Most respondents (64%) use a pharmacy for a health reason between once a month

and every three months.

A majority of respondents (75%) would be happy to give consent to their GP to

share information about their condition and medication with a pharmacist of their

choice. A sixth of respondents (16%) would not be happy to share information.

More than four out of five respondents agree that the staff (85%) and the pharmacist

(84%) at the pharmacy they use most often are helpful.

From a list of 20 pharmacy services, for 18 of the services 67% of respondents

would be very likely or fairly likely to use the service again if they needed to. For

nine services the percentage is above 90%.

Twelve percent of respondents who currently have repeat prescriptions were not

aware that you can order repeat prescriptions online among this group 48% would

be very of fairly likely to order prescription online.

Respondents with a health problem or disability, those aged 65 or older and or those

providing unpaid care are also most likely to agree that it is important that pharmacy

staff know them well and most likely agree that they prefer to see the same

pharmacist.

5.13.2. Response & respondents

In total 727 completed questionnaires were received and included in the analysis.

Due to the high proportion of respondents (between 7 and 28%) who chose not to

answer the individual demographic questions included in the survey, care needs to be

used when determining how representative respondents are of all Brighton & Hove

residents. However, the following group are likely to be over or under represented.

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Survey Brighton & Hove age 16 and over

Over represented

Females 64% 50%

White British / UK ethnicity 87% 81%

Aged 55 or older 62% 27%

With a long term health problem or disability 46% 19%

Providing unpaid care 23% 10%

Under represented

Males 36% 50%

Black & Minority Ethnicity 13% 19%

Aged 16 to 54 38% 73%

Without a long term health problem or disability 54% 81%

Not providing unpaid care 76% 90%

Reflecting the age profile of respondents, only 43% of respondents are employed either

full or part time, the figure for Brighton & Hove is 74%.

Nearly nine out of ten respondents (88%) have repeat prescriptions. The proportion of

patients registered with a local GP that have repeat prescriptions is unknown but the

figure is likely to be far lower.

Given the number of respondents who did not respond to the demographic questions

and the small number of respondents in some categories, analysis of the data by

demographic groups is difficult therefore only where there is a difference (at leas10% or

double the percentage and at least 10 responses) will reference be made to

demographic difference in this report.

5.13.3. Overall satisfaction

Overall, more than four out of five respondents (87%) are very satisfied or satisfied with

the pharmacy service in Brighton & Hove with only 3% dissatisfied or very dissatisfied

(Figure 6).

Three quarters of respondents (76%) also strongly agree or agree that they can find and

use an open pharmacy when they need one with only 5% disagreeing (Figure 7). In

2014, 78% agreed and 9% disagreed.

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Fig.6: Overall satisfaction with pharmacy services in Brighton & Hove

Base: All respondents who answered the question (n=695 of 727)

Fig.7: Usually find and use an open pharmacy in Brighton & Hove


5.13.4. Use of pharmaceutical services

For most respondents (61%) the pharmacy they use most often is the one nearest their

home. Nearly a fifth (18%) uses the pharmacy nearest their GP most often with 5%

each using the pharmacy nearest their work and at the supermarket. For 7% of

respondents it varies and only two respondents use an internet pharmacy most often.

46%

41%

9%

2%

1%

1%

Very satisfied

Fairly satisfied

Neither satisfied nor dissatisfied

Fairly dissatisfied

Very dissatisfied

Don't know / not sure

29%

48%

12%

5%

0%

6%

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Don't know / not sure

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For nine out of ten respondents (90%) the opening times of the pharmacy they use most

often meets their needs with only 10% saying they do not. In 2014, 83% of respondents

agreed that the pharmacy opening hours meet their needs. Among those who

commented on the opening hours not meeting their needs (62 respondents out of 68)

nearly all comments related to restricted opening hours (59 respondents) particularly not

open on a Saturday (28 respondents), not open week day evening (22 respondents)

and not open Sundays (14 respondents). Other mentioned pharmacies closing at lunch

time (8 respondents), opening hours not coinciding with GP opening hours (5

respondents) and pharmacies not opening early enough in the morning (5 respondents).

“It would be helpful if it were not shut at lunch times and open at weekends at least on a Saturday”

Some demographic groups are more likely to agree that opening hours meet their

needs;

Respondents aged 25 to 34 (100%) and residents aged 55 to 84 (95%) compared to

residents aged 16 to 24 (79%), 35 to 54 (83%) and respondents aged 85 and over

(86%).

Two thirds of respondents (68%) would like to be able to use a pharmacy during a

weekday daytime with a half (51%) wanting to use one on a weekday evening (Table

25). Nearly three out of four would like to use a pharmacy on a Saturday (58%) and a

third on a Sunday (34%). Around a quarter would also like to use a pharmacy on

weekday lunchtimes (27%), early morning on a weekday (26%), on a Bank Holiday

(25%) and late at night during the week (22%).

Table 24: When would you like to be able to use pharmacy services?

Number of responses

Percentage of respondents

Early morning before 9.00am on weekdays 182 26%

Lunchtime 12.00pm – 2.00pm weekdays 193 27%

Daytime 9.00am – 5.00pm weekdays 486 68%

Evenings 5.00pm – 8.00pm weekdays 363 51%

Late night 8.00pm – 12.00am weekdays 154 22%

Saturday 411 58%

Sunday 244 34%

Bank holidays 176 25%


During the last 12 months more than three out of five respondents (63%) had used a

pharmacy service on a Saturday with 26% also having used one on a Sunday. A half

had used a pharmacy between 8pm and midnight with nearly a fifth also having used a

pharmacy on a Bank Holiday.

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There are differences in the way different demographic groups have needed to use a

pharmacy in the last 12 months;

Late night 8pm to midnight: More than a half of respondents aged 16 to 34 (53%)

had needed to use a pharmacy on between 8pm and midnight compared to 34% or

45 to 64 year olds and only 10% of those respondents aged 65 or older. A third of

respondents providing unpaid care (33%) compared to only 23% of those not

providing unpaid care. A third of respondents who work full or part time (35%)

compared to only 18% of those not currently employed or retired.

On a Saturday: Three quarter of respondents with a non White ethnicity (74%)

compared to respondents with a White ethnicity (63%). Nearly three quarters of

respondents (73%) with a health problem or disability that affects their activity ‘a lot’

compared to 62% of respondents with no health problem or disability or one that

only affects their activity ‘a little’.

On a Sunday: A third of respondents aged 16 to 64 (34%) compared to only 13% of

those aged 65 or older. More than a third of BME respondents (37%) compared to

23% of White UK/British respondents. A third of respondents working full or part time

(34%) compared to only 19% of those not currently working or retired (19%).

On a bank holiday: Nearly a fifth of respondents aged 16 to 65 (23%) compared to

only 10% of those aged 65 or older.

Most respondents (64%) use a pharmacy for a health reason between once a month

and every three months. However, more than one in ten (12%) uses a pharmacy for a

health reason at least once a week (Table 25). A fifth of respondents (20%) never use

a pharmacy other than for a health reason. However, nearly a half (46%) uses a

pharmacy a least once a month for shopping for products such as toiletries.

Table 25: How often do you visit a pharmacy?

Health reason (n=720)

Other reason (n=721)

Once a day 1% 0%

2/3 times a week 2% 3%

Once a week 9% 9%

Once a fortnight 14% 13%

Monthly 38% 21%

Every 2-3 months 26% 17%

6 monthly 5% 10%

Yearly 3% 7%

Never 3% 20% Base: All respondents who answered the individual questions.

Certain demographic groups are more likely to use the pharmacy, at least once a

fortnight, for health reasons;

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Two out of five respondents (43%) who provided unpaid care compared to 20% of

those not providing unpaid care.

A third of respondents (33%) with a health problem or disability compared to 19%

without a health problem or disability

A third of respondents (32%) not currently employed or retired compared to 17% of

those working full or part time

5.13.5. Repeat prescriptions

Nearly nine out of ten respondents (88%) are currently provided with repeat

prescriptions by their GP, with a further 4% having had repeat prescription in the past.

Only 6% of respondents have not had repeat prescription at some point.

More than four out of five respondents (82%) are aware that you can order repeat

prescription on-line from their GP. This rises slightly to 83% among those who currently

have repeat prescriptions.

Among all respondent who have had repeat prescriptions and are aware of the online

service, two out of five (44%) had ordered repeat prescriptions online. This rises slightly

to 46% among those who currently have repeat prescriptions.

While of 84% of respondents aged 16 to 44 and 45 and older who currently have repeat

prescriptions are aware that they can order repeat prescriptions online, only 45% of

those aged 45 and older have done so compared to 62% of these aged 16 to 44.

Among all respondents, if they needed a repeat prescription, more than a half (54%)

would be very or fairly likely to order it online. Among the 75 respondents who currently

have repeat prescriptions but who were not aware of the online service nearly a half

(48%) would be very or fairly likely to use the online prescription service.

While more than two thirds of respondents (70%) aged 16 to 44 are very or fairly likely

to order prescriptions online this falls to only a half (51%) of those aged 45 or older.

5.13.6. Prescription delivery service

A fifth of all respondents (22%) have had prescribed medicines or appliances delivered

to their home in the last 12 months, rising slightly to 24% among those who currently

have repeat prescriptions. In 2014, 15% of respondents had their medicines delivered to

their home.

Some demographic groups are more likely than others to use a delivery service;

More than two out of five respondents (44%) with a health problem or disability that

affect their activity ‘a lot’ compared to 24% with a health problem or disability that

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affects their activity ‘a little’ and only 13% of respondents without a health problem or

disability.

Two out of five respondents (41%) aged 75 or older compared to only 17% of those

aged 16 to 74.

A third of respondents (37%) who provide unpaid care compared to 17% who

provide no un-paid care.

Less than one in ten (7%) of respondents who work full or part time compared to

30% of those not currently employed or retired.

Two out of five respondents (44%) who use the service do so because they are unable

to leave their home, 17% do so because they are unable to get to a pharmacy during

opening times. Seventy one respondents gave other reasons with 24 mentioning

mobility/health or reason relating to old age, 13 mention the convenience and 13 also

mentioned that when items are out of stock the pharmacy would deliver the outstanding

items from a prescription. Eight respondents took advantage of the service simply

because it was offered and five respondents mentioned for the delivery of large/heavy

items or a large number of items with another five mentioning difficulties with parking

near the pharmacy.

Just over third of respondents (36%) agree and just over a third of respondents (37%)

disagree that the prescription delivery service is important enough to them that they

would be willing to pay for the service. The rest (27%) neither agreed nor disagreed or

did not know or were unsure.

5.13.7. Unwanted or unused medicines

Just over two thirds of respondents (68%) have taken unwanted or unused medicines to

a pharmacy for safe disposal. In 2014 the figure was 50%. Thinking about their last lot

of unwanted or unused medicine three out of five (60%) took them to the pharmacy for

disposal, 14% threw them in the bin and 4% flushed them down the toilet. Only six

respondents (1%) gave them to someone else. In 2014, less than a half (42%) took

their last lot of unwanted or unused medicines to a pharmacy for disposal.

5.13.8. Sharing patient information

Three quarters of respondents (75%) would be happy to give consent to their GP to

share information about their condition and medication with a pharmacist of their choice

if it makes it easier for doctors and pharmacist to provide a good service. A sixth of

respondents (16%) would not be happy to share information and one in ten (9%) don’t

know or are unsure.

Older people are most likely to be happy for information to be shared between their GP

and their pharmacist. Nine out of ten respondents (91%) aged 75 or older would be

happy to share information compared to only 73% of 35 to 74 year olds and 84% of 16

to 34 year olds.

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One hundred and eighty respondents were unhappy or unsure about sharing

information and 162 (90%) made comments about why. The most dominant theme 88

respondents (54%) related to confidentiality of information (access by staff,

intrusion/privacy information. IT security/data hacking/confidentiality breach, know staff

or they live locally). Sixteen respondents also mentioned that there was no need for the

pharmacist to know or it was not necessary and 11 mentioned that the prefer privacy

with regard the medical condition.

“I would want to know what confidentiality and security measures were

in place and be assured that only the pharmacist would have access”.

Other comments include (5 or more people);

Unhappy to share / not sure (10)

Management of info to keep it confidential / how info shared (9)

Health info for GP to know (9)

No privacy at pharmacy (8)

Choose / control / consent what to share (7)

Data may be used for Profit / Commercial (6)

No trust with pharmacist (6)

Use different pharmacies (6)

Pharmacist doesn't have training or knowledge of GP (5)

Relationship with GP (5)

5.13.9. Pharmacy used most often

Respondents were asked how much they agreed or disagreed with four statements

about the pharmacy they use most often. Figure 7 summarises their responses.

More than four out of five respondents strongly agree or tend to agree that the staff

(85%) and the pharmacist (84%) at the pharmacy they use most often are helpful. Less

than one in twenty (4%) disagrees.

Nine out of ten respondents (90%) agree they can get in and out and move around their

pharmacy. Less than one in twenty disagree.

More than three out of five respondents (63%) strongly agree and a quarter (27%), tend

to agree that they travel a short distance to the pharmacy they use most often. Only

than one in twenty (5%) disagree.

The results for all four questions are similar to those seen in 2014.

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Fig.8: How much do you agree or disagree with the following…

Base: All respondents who answered the individual questions.

More than a half of respondents (56%) walk to the pharmacy they use most often, while

nearly a third (30%) travels by car. Less than one in ten (9%) use public transport and

3% use other transport including taxis, mobility scooter and wheel chairs. Most older

people aged over 74 travel to the pharmacy by car (41%) with only 38% walking.

When asked for comments about the pharmacy they use most, 35% of respondent (254

people) did so. The most common theme (91 respondents, 36%) was ‘good customer

service skills’ (helpful, friendly, efficient, approachable, listening and pleasant) of

pharmacy staff. Only seven respondents mentioned poor customer service skills. A

quarter of respondents (20%, 51 people) who made comments also mentioned a ‘good

and professional service’ (good and knowledgeable advice, competent pharmacist).

“Our pharmacist is very helpful. He has a lot of knowledge and keeps

up to date with things as new studies are being carried out. He is very

understanding about the severity of mental illness that some people

can suffer. He is not judgmental He tries to make sure that the best

care is given for the best quality of life and health with the least but

most effective dose of pharmaceuticals.”

57%

57%

62%

63%

28%

27%

28%

27%

12%

12%

6%

5%

2%

2%

4%

3%

1%

2%

1%

1%

The staff who work at my pharmacy are helpful(n=695)

I find my pharmacist helpful (n=687)

I can get into and out of and move around mypharmacy easily (n=715)

I travel a short distance to use my pharmacy(n=695)

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree

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However, 33 respondents did express concerns with the dispensing of prescriptions

(need for more efficiency, long wait/slow service, pharmacist having to chase GPs,

incomplete).

Other comments include (5 or more people);

Its convenience (10)

Difficulties in having private conversation with the pharmacist (6)

Good relationship with GP (6)

Pharmacy internal environment needs improving (6)

Repeat prescription service is excellent (5)

The same question was asked in a recent Healthwatch survey where 171 people made

comments. The most common theme (61 people, 35%) was that ‘no improvements

were needed’. Twenty seven people (16%) also mentioned the need to promote

awareness of the services available at pharmacies.

Similar to the PNA survey 22 people mentioned problems with the prescription service

(reduce wait, improve repeat prescription ordering, better system).

Other comments in the Healthwatch survey include (5 or more people);

Private consultation area (9)

More staff (9)

Treat and prescribe like nurse practitioners to alleviate GP workload (5)

Over a fifth of respondents (22%, 161 people) made comments about how their local

pharmacy could be improved. Comments were varied with no specific themes. Most

respondents (12 people) mention ‘nothing to improve’. Other comments made by more

than five people concern;

Improve opening hours (7)

Improve internal environment (6)

Improve customer service skills (6)

Improve disability access (5)

More staff (5)

5.13.10. Pharmacy services used in the last 12 months

Minor conditions advice (55%) and medicine use checks (47%) are the two services

respondents have used most in the last 12 months (Table 26). Fifteen percent of

respondents had not used any of the services in the last 12 months. In 2014 the same

two services were again the most used (minor conditions advice 55% and medicines

use cheeks 35%).

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For all services (with the exception of assessing the risk of diabetes and the c-card

scheme) at least two thirds of respondents (67%) would be very likely or fairly likely to

use the service again if they needed to. For nine services the percentage is above

90%.

Table 26: Pharmacy services used in the last 12 months and likelihood of using the service again

Service

Used in the last 12 months

How likely or unlikely you would be to use the service again if you needed to.

(n) (%) Very or

fairly likely Neither

Fairly or very

unlikely

Don't know / not

sure

Minor Conditions Advice – e.g. sore throat, hay fever

343 55% 98% 0% 2% 1%

Medicines Use Check – the Pharmacist offering advice on your medication

295 47% 93% 3% 3% 1%

Urgent medicines out of hours – overnight or weekends

91 15% 91% 3% 3% 2%

New Medicine Service e.g. new medication prescribed for asthma

85 14% 94% 1% 4% 1%

Advice about managing your condition - e.g. diabetes, asthma, high blood pressure

84 13% 96% 1% 3% 0%

Immunisation/Vaccination Jabs - e.g. Flu 79 13% 99% 0% 1% 0%

NHS Health checks - Cholesterol and blood pressure checks

50 8% 96% 0% 4% 0%

Advice about other NHS and council services

31 5% 93% 0% 7% 0%

Mental Health support – advice and information

28 4% 92% 4% 4% 0%

Smoking advice and cessation 22 4% 86% 0% 14% 0%

Help with your weight 18 3% 81% 6% 13% 0%

Emergency Contraception – sometimes known as the Morning After Pill

15 2% 79% 14% 7% 0%

Assessing risk of diabetes 11 2% 25% 19% 46% 10%

Chlamydia Screening Services 8 1% 80% 0% 20% 0%

Alcohol support – advice and information 8 1% 86% 0% 14% 0%

C-Card scheme 5 1% 50% 0% 50% 0%

Supervised consumption of methadone or buprenorphine

5 1% 80% 0% 20% 0%

Treatment for Chlamydia infection 4 1% 67% 0% 33% 0%

Substance misuse support - advice and information

4 1% 75% 0% 25% 0%

Needle exchange 3 0% 67% 0% 33% 0%

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Base: All respondents who had used or not used any of the services in the last 12 months and all respondents who

answered the question about using the service again if needed.

There are demographic differences in the way respondents have used pharmacies in

the last 12 months;

Nearly a fifth (18%) of females used urgent medicines out of hours compared to only

9% of males

Nearly a fifth of respondents (18%) aged 65 to 74 had an NHS health check in a GP

Practice (currently NHS Health Checks are delivered through GP Practices)

compared to only 6% of all other age groups.

Three out of five respondents (60%) aged 65 or older had a medicine use check

compared to only two out of five respondents (41%) aged 16 to 64.

A quarter of BME respondents (25%) used the New Medicine Service compared to

only 12% of White British/UK respondents.

More than three out of five respondents (62%) with a health problem or disability that

affects their activity ‘a lot’ had used the medicine use check service compared to

47% of all other respondents.

A fifth of respondents (19%) with a health problem or disability had advice about

managing their condition compared to only 10% of those without a health problem or

disability.

A fifth of respondents (21%) who provide unpaid care used the urgent medicines out

of hours service compared to 13% of those who don’t provide unpaid care.

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5.13.11. Pharmacy service priorities

From a list of services respondents were asked to select the three services they most

wanted pharmacies to provide. Table 27 summarises their responses.

Table 27: Pharmacy services most wanted

Service (n) (%)

Minor Conditions Advice – e.g. sore throat, hay fever 414 63%

Medicines Use Check – the Pharmacist offering advice on your medication

317 48%

Urgent medicines out of hours – overnight or weekends 305 47%

NHS Health checks - Cholesterol and blood pressure checks 160 24%

Immunisation/Vaccination Jabs - e.g. Flu 106 16%

New Medicine Service e.g. new medication prescribed for asthma 99 15%

Advice about managing your condition - e.g. diabetes, asthma, high blood pressure

82 13%

Advice about other NHS and council services 81 12%

Mental health support – advice and information 67 10%

Emergency Contraception – sometimes known as the Morning After Pill

59 9%

Help with your weight - Advice on healthy eating and physical activity

34 5%

Assessing risk of diabetes 33 5%

Smoking advice and cessation 20 3%

Other, please give details below 19 3%

Needle exchange 10 2%

Substance misuse support - advice and information 10 2%

Supervised consumption of methadone or buprenorphine 8 1%

Chlamydia Screening Services 7 1%

Alcohol support – advice and information 5 1%

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Treatment for Chlamydia infection 4 1%

C-Card scheme 3 0%

Base: All respondents who selected three or fewer services (n-654 of 727).

Minor conditions advice is the service most respondents (63%) would like pharmacies to

provide. Nearly a half would also like pharmacies to provide medicines use checks

(48%) and urgent medicines out of hours (47%). A quarter would like NHS Health

Checks provided (24%). However, there are some differences by different demographic

groups;

A quarter of respondents (26%) aged 16 to 44 prioritised an emergency

contraception service compared to 10% of those aged 45 to 64 and only 2% of those

aged over 64.

Eight respondents (28%) aged 25 to 34 prioritised mental health support compared

to just 9% of all other age groups. A fifth of respondents (19%) with a health problem

or disability that affects their activity ‘a lot’ also prioritised mental health services

compared to only 8% of all other respondents.

Only a half of respondents (50%) with a health problem or disability that affects their

activity ‘a lot’ prioritised minor conditions advice compared to over two thirds of

respondents (69%) with no health problem or disability.

In 2014 respondents were not restricted to choosing just three services. However, the

same four services in the same order were the services that most respondents wanted

pharmacies to provide.

5.13.12. Interpreting services

For only nine respondents (1%) English is not their first or preferred language. Three

respondents said that the pharmacy they use most often always make arrangements to

communicate in their preferred language. Five respondents said that they never did and

one did not respond. Six of the nine respondents for who English was not their first or

preferred language thought that it would be very or fairly helpful to have an interpreter

when visiting the pharmacy. Three respondents thought it would be not at all helpful.

The languages spoken by those respondents who thought an interpreter would be

helpful were;

British Sign Language

French, Polish, German

Spanish

Italian

Arabic

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5.13.13. Pharmacist used most often

Fig.9: How much do you agree or disagree with…

Base: All respondents who answered the individual questions

Nearly nine out of ten respondents agree that they can trust the advice of the

pharmacist (89%) they use most often and would expect to be given advice on their

prescriptions (87%). However, only a half (50%) agrees that they prefer to see the

same pharmacist each time. While nearly three out of five respondents (58%) agree

that they can speak to the pharmacist without being overheard a quarter (25%) disagree

that they can (Figure 9). More than a half of respondents (57%) also agreed that it was

important that pharmacy staff know them. However, some demographic groups are

more likely to agree than others;

Respondents with a health problem or disability, older respondents and those

providing unpaid care are most likely to agree that it’s important that pharmacy staff

know them (with a health problem or disability that affects their activity ‘a lot’ (80%),

affect their activity ‘a little’ (63%), no health problem or disability (46%), aged 65 or

older (71%), aged under 65 (47%), provided unpaid care (70%), don’t provide

unpaid care (45%)).

Similarly respondents with a health problem or disability, older respondents and

those providing unpaid care are also most likely to agree that they prefer to see the

same pharmacist (with a health problem or disability that affects their activity ‘a lot’

(68%), affect their activity ‘a little’ (56%), no health problem or disability (40%), aged

50%

57%

58%

87%

89%

36%

31%

17%

10%

9%

14%

12%

25%

3%

2%

I prefer to see the same pharmacist eachtime (n=674)

It is important the pharmacy staff knowme (n=686)

I can speak to my pharmacist withoutbeing overheard (n=677)

I would expect my pharmacist to giveadvice on my prescriptions (n=680)

I trust my pharmacist’s advice on medicine usage (n=679)

Strongly agree or agree Neither Disagree or strongly disagree

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65 or older (57%), aged under 65 (45%), provided unpaid care (67%), don’t provide

unpaid care (44%)).

In 2014;

A similar proportion of respondents trusted the pharmacist’s advice (88%) and

expects advice on their prescription (85%).

Fewer respondents (45%) thought it was important pharmacy staff know them

Fewer respondents (38%) preferred to see the same pharmacist.

More respondents (30%) could not speak to the pharmacist without being overheard.

5.13.14. Final comments

At the end of the survey respondents were asked for any final comments they had about

the pharmacy service in Brighton & Hove. A fifth of respondents (21%, 151 people)

made comments.

The most common theme, made by a third of those who responded (51 respondents),

related to them experiencing a good pharmacy or good pharmacy staff. A further 11

respondents also mentioned the service as convenient or useful. Only 12 respondents

mentioned a poor service or poor staff.

“As I have become ill, I have found the pharmacy a life-line and so

convenient - next door to GP”

A quarter (37 respondents) mentioned the need for late night, early morning or weekend

opening with 16 respondents also mentioning the difficulties of accessing some

pharmacies, particularly out of hours pharmacies, due to their location in city. While 12

respondents mention a long wait for meds or meds not being available.

Recommendations Brighton & Hove City Council and community pharmacies to increase

awareness of the opening hours of pharmacies in areas with a high

concentration of young people, by signposting them to this information on the

NHS Choices website.

To increase the public’s awareness of services community pharmacies can

offer, the CCG and Brighton & Hove City Council to co-ordinate a city wide

awareness campaign around services that can be accessed at pharmacies.

Data sharing of patients’ records between GPs and pharmacies will be

addressed as part of the Empowering Patients, Carers, and Families to use

Technology Project’s Domain 2 work – Share Health & Care Information. This is

a multi-agency project being developed across the health network in Brighton &

Hove, Horsham Mid Sussex and Crawley CCG, High Weald Lewes Havens,

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BSUH and Digital Brighton & Hove. CCG, NHSE and BHCC to support

communications with patients and providers to improve data sharing.

The management of the repeat prescribing and dispensing process is being

reviewed nationally and locally by CCGs, with a view to implementing more

efficient practice. A 25% target for electronic prescriptions to be converted to

electronic repeat dispensing (eRD) has been included in the national General

Medical Services contract. Currently Brighton & Hove achieves a 21%

conversion rate and will need to increase this.

Community pharmacies to be reminded of the need to keep counter discussions

discreet and to offer the use of private consultation rooms where appropriate

6. Community pharmacy survey

The 58 community pharmacies open in Brighton and Hove at the start of the PNA

process were invited to participate in the survey which mainly included questions on

service provision, pharmacy premises, information technology, staff working with GPs

and practices and opportunities for maximising the role of pharmacy to improve health

and reduce health inequalities. A similar survey was undertaken in 2014 and where

appropriate comparisons will be made to these results.

6.1. Key findings

None of the pharmacies had any plans to extend opening hours to meet increased demand following GP practices having to offer 7 day, 8am to 8pm opening.

Only 60% of respondents were aware of the NHS interpreting service.

Of the pharmacies providing a prescription delivery service (92%), none have plans to stop the service. One pharmacy has tentative plans to start charging for the service with the others having no plans to start charging.

Two thirds of respondents (68%) said they or other pharmacists in their pharmacy have daily contact with GPs in their area, up from 44% in 2014.

Nine out of ten respondents (92%) work with their GPs on considering how best to address their patient’s needs, up from 74% in 2014.

Nearly two third of pharmacies (64%) would be interested in stocking saline to be accessed by health care professionals providing community services.

Of the 12 Healthy Living level 2 accredited pharmacies ten, (83%) strongly agree or tend to agree that the service is beneficial to patients.

Only eight respondents (32%) were aware of Better Care Pharmacists

Only 11 respondents (44%) were aware of the Making Every Contact Count agenda.

6.2. Results

In total there were 26 responses to the community pharmacy survey, 46% of all

pharmacies in the city. It should be noted that one respondent replied on behalf of four

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pharmacies (Bridgmen, Ross, Watts and Co and Westons) but for the purpose of this

report they are considered as an individual respondent for each pharmacy.

The position held by respondents were:

Position Number

Pharmacist manager 11

Pharmacy / general manager 4

Pharmacist director / owner 3

Dispenser 2

Pharmacist 1

Professional service manager 1

Counter staff 1

6.2.1. Opening hours

None of the pharmacies had any plans to extend opening hours to meet increased demand following GP practices having to offer 7 day, 8am to 8pm opening. 6.2.2. Pharmacy facilities

All 26 pharmacies have a separate consultation room on the premises which complies with the service specification for provision of advanced services. One pharmacy also has another consultation area off site that complies and another area on the premises that does not comply.

Twenty five pharmacies are willing to undertake domiciliary consultations for advanced services if funding is available. One pharmacy is not.

Twenty four pharmacies have a computer in the consultation area with access to patient’s medical records. Two do not, with one planning to in future years.

Twenty five pharmacies premises comply with the 2010 Equality act. One pharmacy did not respond.

Twenty four pharmacy premises have easy access for disabled customers including wheelchairs. Two do not.

Twenty pharmacy premises have hand washing facilities in the consultation area. Six do not.

Only four pharmacies (15%) have patient accessible toilet facilities. Twenty two pharmacies do not.

Twenty five pharmacies have a display area for health promotion material with one pharmacy planning to do so by 31 July 2017.

6.2.3. Development constraints

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Sixteen pharmacy premises are not situated in a listed building. Ten pharmacies did not respond.

One pharmacy is in a conservation area, 16 are not, with nine pharmacies not responding.

Ten pharmacies have limited room for expansion, six pharmacies do not and ten pharmacies did not respond.

6.2.4. Car parking facilities Eight pharmacies (30%) have car parking facilities, with six having disabled car parking. One pharmacy only has disabled parking facilities and 17 pharmacies have no parking facilities. 6.2.5. Information technology

Two pharmacies (10% of those who responded) only have one computer that has full access to patient’s medical record. Ten pharmacies have 2-3 computers, seven pharmacies have 4-5 computers one has six and one has ten.

Three pharmacies (14% of those who responded) only have one printer for labelling/endorsing. Twelve pharmacies have 2-3, five pharmacies have 4-5 and one pharmacy has ten printers for labelling/endorsing.

One pharmacy has no printers used for patient’s services with six pharmacies only having one. Ten pharmacies have 2-3, two have 4-5 and one has ten computers for patient’s services.

Five pharmacies (20% of those that responded) only have one computer with access to email. Eight pharmacies have 2-3, six have 4-6 and one has ten computers with access to email.

Two pharmacies (10% or those that responded) only have one computer with full access to the internet. Ten pharmacies have 2-3, eight have 4-6 and one has ten computers with access to the internet.

Two pharmacies (8% of those who responded) only have one computer that is EPSr2 enabled. Fifteen pharmacies have 2-3, eight have 4-5 and one has more than 10.

Seventeen pharmacies (65% of those that responded) only have one pharmacist that has a Smart Card. Six pharmacies have 2-3 and three pharmacies have four pharmacists with a Smart Card.

Six pharmacies (26% of those that responded) have no technicians with a Smart Card. Seven pharmacies have 1-2, eight have 3-4 and one pharmacy has six technicians with a Smart Card

The majority of pharmacies (17 out of 26) use ProScript medical record software. Other software used are Nexphase (two pharmacies) and one pharmacy each use Analyst, Cegedim Pharmacy Manager, Post Script Link and Rx Systems.

6.2.6. Pre-registration practices Eleven pharmacies (42%) are registered as a pre-registration training site with eight of these pharmacies (73%) having a pre-registration tutor based at the practice. Six of the

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pharmacies registered as training sites had one pre-registration graduate and four pharmacies had no graduates (one pharmacy did not reply). 6.2.7. NHS interpreting service More than a quarter of respondents (28%) were not aware of the NHS interpreting service, with a further three respondents (12%) unsure. Only 60% of respondents were aware of the service. Only three of the 15 respondents who were aware of the NHS interpreting service had used the service. Their experience however was very positive with one describing it as amazing, another as brilliant with the third saying it was easy to use and that they would use it again. Only one respondent was aware of another interpreting service, this being Brighton & Hove Connect. 6.2.8. Contact with GP Two thirds of respondents (68%) said they or other pharmacists in their pharmacy has daily contact with GPs in their area, with a further three respondents (12%) having weekly contact. In 2014 only 44% had daily contact with pharmacists with a further 33% having weekly contact. A high proportion of respondents described the quality of contact with both GPs (85%) and other practice staff (88%) as very good or good (Figure 9). In 2014 the figures were 77% and 81% respectively. Figure 9: How would you describe the quality of current professional contact with GPs and other practice staff?


48%

32%

12%

4%

4%

56%

32%

8%

4%

0%

Very good

Good

Neither god nor poor

Poor

Very poor

Contact with GPs (n=25) Contact with other practice staff (n=25)

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Nine out of ten respondents (92%) work with their GPs on considering how best to address their patient’s needs, with only two respondents (8%) that do not. In 2014 only 74% worked with GPs. Four in five respondents (80%) thought that the best way for GPs to contact them was by phone, with three respondents (12%) thinking in person was best, and with two thinking a combination of both was best. Fifteen respondents made comments about what prevents them from working more closely with GPs. There were two themes, time constraints and access to GPs. Nine respondents mention a lack of time and time away from the pharmacy to meet with GPs. Six respondents mentioned not having access to GPs with three mentioning having to communicate via receptionist instead. Fourteen respondents made comments on ways working with general practice could be improved. Seven mention better/easier communications with three suggesting meeting on joint interests. Three respondents mentioned backfill funding/cover to allow pharmacist to visit GP practices during the day. Twelve respondents made comments about what prescribing support pharmacists could provide to GPs. Most comments (n=8) related to advice on availability of medicines including stock availability, alternative medications and cost effective prescribing. Ten respondents made comments about what prevents them from making brief interventions or checking that patients are taking their medications correctly. Most respondents mentioned a lack of time/work load (n=7). Two mentioned inaccessibility of GPs and two mentioned having a delivery service means that they do not see patients face to face. Seven respondents made comments about how the provision of community pharmacy services in care homes could work better between GP practices and pharmacies. Five respondents mentioned funding to allow pharmacists to visit care homes, attend GP practice meetings and or training. Two mentioned more/better communications. 6.2.9. Smoking cessation and flu immunisation services Ten pharmacies (38%) work with GP practices to deliver smoking cessation and flu jabs. These ten pharmacies work with GPs by sharing information with patients about the services available and referring patients as appropriate. 6.2.10. Current and future service provision The most common service currently provided is Medicines Use Review, provided by 92% of pharmacies (Table 28). More than four out of five pharmacies also provide a new medicine service (89%), deliver medicines to patients at home (85%), immunisation / vaccination (85%), smoking cessation (81%) and supervised consumption of prescribed medicines (81%). No pharmacies provide an anti-viral collection point, however 17 pharmacies (65%) would be willing to provide the service with further training, changes to their premises and or the appropriate equipment.

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Table 28: Services provided by pharmacies

Service Currently

provide Service

Those not currently providing the service

Willing to provide under certain conditions *

Would not provide

Don’t know / no response

(n) (%) (n) (%) (n) (n)

Medicines use reviews 24 92% 0 0% 0 2

New medicines service 23 89% 1 33% 0 2

Services to patients in their own homes - delivery of medicines (unfunded)

22 85% 1 25% 1 1

Immunisation / Vaccination e.g. Flu 22 85% 3 75% 0 1

Smoking cessation 21 81% 2 40% 0 3

Supervised consumption of prescribed medicines

21 81% 3 60% 1 1

Help with weight – healthy eating and physical activity

18 69% 5 63% 0 3

Long term conditions advice 17 65% 6 67% 0 3

C-card scheme 16 62% 6 60% 0 4

Emergency hormonal contraception

16 62% 8 80% 0 2

Minor conditions advice 16 62% 8 80% 0 2

Alcohol support – advice and information 16 62% 7 70% 1 2

Chlamydia screening 12 46% 11 79% 1 2

Treatment for chlamydia 12 46% 11 79% 1 2

Care homes, medicines management advice and support

11 42% 10 67% 2 2

Urgent Medicines out of hours – overnight or weekends

9 35% 10 59% 4 3

Mental health and wellbeing advice and information

9 35% 13 76% 2 2

Needle exchange 8 31% 8 44% 4 6

Patient's own homes-medicines management advice and support

5 19% 12 57% 3 4

Palliative care – access to medication 4 15% 17 77% 3 2

Long term conditions management (including prescribing)

3 12% 18 78% 0 5

Monitoring the duration of anti-microbial prescribing

2 8% 17 71% 1 6

Hepatitis testing and case detection 1 4% 17 68% 3 5

Appliance use reviews 1 4% 15 60% 2 8

Customisation of stoma appliances

1 4% 13 52% 2 10

NHS Health check 1 4% 20 80% 0 5

Monitoring antimicrobial prescribing

1 4% 18 72% 3 4

Anti-viral collection point 0 0% 17 65% 1 8

Base: All respondents to the survey inc. those who did not respond to some of the individual questions (n=26)

* would be willing to provide the service if they had sufficient training, made changes to their premises and or had the appropriate equipment.

Other services that pharmacist would be willing to provide;

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Any that are required by our local population

Funded community pharmacy visits to care homes

Healthy living

Minor ailment scheme (3 pharmacies)

NHS health checks

Sore throat and infections of throat testing and treatment

UTI Testing and treatment

Sixteen pharmacies (64%) would be interested in stocking saline to be accessed by health care professionals providing community services. Two pharmacies would not be interested, seven are unsure and one pharmacy did not respond. When asked if there was funding available what would be the top two priority pharmacy services, there was a mixed response (Table 29) Five respondents mentioned NHS health checks, three minor ailment services and two each mentioned smoking cessation and funding community pharmacist visits to care homes. Table 29: Top two priority pharmacy services

Service Number of responses

NHS health checks 5

Minor ailment service 3

Funded community pharmacist visits to care home 2

Smoking cessation 2

Anticoagulation monitoring 1

antibiotics 1

Appliance use reviews 1

Asthma review 1

Breast cancer screening/information 1

Deliveries 1

Hepatitis testing 1

Long term conditions advice 1

Managing chronic conditions 1

Mental health and wellbeing advice and information 1

Monitoring Antimicrobial 1

NUMSAS- expansion of current service with detailed staff training

1

Palliative care and Just in case box 1

Sore throat and infections of throat testing and treatment

1

UTI testing and treatment 1 Base: Number of pharmacies responding (n=15 of 26)

6.2.11. Health Living Pharmacy Scheme Twenty two respondents (96%) are aware of the Healthy Living Pharmacy (HLP) level 1 and 23 respondents (92%) are aware of HLP level 2. Twelve of the 21 pharmacies who responded to the question are accredited HLP level 1 while a further 7 would like to become accredited, Twelve of the 23 pharmacies who

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responded to the question are HLP level 2 accredited while a further nine would like to become accredited. One pharmacy would like more information before deciding. Of the 12 HLP level 2 accredited pharmacies ten, (83%) strongly agree or tend to agree that the service is beneficial to patients. One neither agrees nor disagrees and one pharmacy does not know or is unsure Fifteen respondents made comments about how healthy living services benefit patients. All comments related to making the provision/access to information/services and advice about healthy/better lifestyle choices. Two respondents made comments about why healthy living services are not a benefit to patients, these related to not being able to offer the support needed due to available resources. Fifteen respondents made comments about how the HLP programme could be improved. Responses were varied, however four respondents mentioned adding additional services to the scheme (minor ailments, health checks, more activities at gym pools), three respondents mentioned training (can be erratic, identify mental health condition and offer psychological support, more days) and three respondents also mentioned allowing more pharmacies to become accredited. 6.2.12. Better Care Pharmacists Only eight respondents (32%) are aware of Better Care Pharmacists. Eleven respondents are unaware and 6 don’t know or are unsure. Of the eight respondents that are aware, six understand the role fairly well and two not very well. 6.2.13. Making Every Contact Count (MECC) Two out of five respondents (44%) are aware of the MECC agenda, seven (28%) are not and seven respondents (28%) don’t know or are unsure. 6.2.14. Prescription delivery service Twenty four pharmacies (92%) provide a prescription delivery service. Only one pharmacy does not. Of the pharmacies providing a delivery service, none have plans to stop the service. One pharmacy has tentative plans to start charging for the service with the others having no plans to start charging. 6.2.15. Additional services The non NHS funded service provided most by pharmacies (Table 30) are flu vaccinations (100%), monitoring dosage for patients at home (88%), blood pressure measurement (88%) and inhaler technique/asthma checks (88%).

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Table 30: Pharmacies providing non NHS funded services

Responses

Percent of respondents

Flu vaccination 24 100%

Monitored dosage for patients in their homes 21 88%

Blood Pressure Measurement 21 88%

Inhaler technique / Asthma checks 21 88%

Anti-malarial e.g. Malarone 13 54%

Monitored dosage for care homes 10 42%

Weight Management 9 38%

Erectile Dysfunction Patient Group Direction 8 33%

Travel vaccination 3 13%

Mole screening 2 8%

Diabetes screening 1 4%

Other 4 17%

Base: All respondent who answered at least one of individual questions (n=24 of 26)

Other services…

INR testing, Smoking cessation, Private prescribing

Anticoagulation service.

Carpal tunnel splint fitting and advice service

ONPOS dressings service, Anticoagulation monitoring service.

6.2.16. The dispensing of appliances Similar to 2014, three quarter of pharmacies (76%) dispense all types of appliances (Table 31). Only one pharmacy does not dispense any type of appliance. Table 31: Pharmacies dispensing appliances.

Appliance types Number %

All types 19 76%

Excluding stoma appliances 1 4%

Just dressings and hosiery 3 12%

Just hosiery 1 4%

None 1 3% Base: All respondents who answered the question (n=25 of 26)

Recommendations With the advent of 8am-8pm GP opening hours, commissioners of pharmacy

services (NHSE, CCH, BHCC) should consider whether pharmacy services are

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needed to match their opening hours with neighbouring GP opening hours. The

PNA Steering Group will review the impact of extended GP opening hours.

Brighton & Hove City Council and CCG to increase awareness of the interpreting service, including the BSL service for the deaf, amongst community pharmacies

CCG to promote the understanding of the role of Better Care pharmacists

amongst community pharmacists in each GP Practice cluster.

Public Health to promote the uptake of MECC training amongst community

pharmacies.

7. GP and non-medical provider survey

All GPs and medical prescribers in all 37 practices in Brighton and Hove were invited to

respond to the PNA GP and non-medical prescribers’ survey which included questions

on their experience of community pharmacy services and opportunities for maximising

the role of pharmacy to improve health. A similar survey was undertaken in 2014 and

where appropriate comparisons will be made with these results.

7.1. Key finding

Nine out of ten respondents (91%) rated the provision of dispensing services as very

good or good, with no respondents rating the service as poor or very poor. In 2014,

only 66% rated the service as very good or good with 10% rating it as poor or very

poor.

Similar to 2014, for the pharmacy they use most often, around a half of respondents

did not know or were unsure of the adequacy of the disposal of unwanted medicines

service (50%), the signposting service (45%), healthy lifestyle service (53%), minor

condition advice (48%) and the support for self-care service (53%).

A majority of GPs and non-medical prescribers are unaware of the adequacy of

essential, advanced and locally commissioned services.

When asked what other services GPs would like pharmacies to provide, more than

two thirds of respondents (70%) mentioned help with weight (healthy eating and

physical exercise) and alerting GPs to patient’s deteriorating health and well-being.

Levels of professional contact between GPs and pharmacists were mixed with a

quarter having daily contact and four respondents (13%) having no contact or only

once a year.

More than three quarters of respondents (77%) would value the development of

more joint health promotion campaigns with pharmacies.

7.2. Results

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Thirty four GPs and non-medical prescribers responded to the survey. Seventeen of 37

practices (46%) in the city were represented. One respondent worked at Brighton &

Hove CCG.

Unless otherwise directed respondents were asked to respond to the questions about

pharmacy thinking about the pharmacy they use most. The pharmacy used most by

respondent’s are listed below in Table 32. It is not possible to work out what proportion

of the city’s pharmacies are represented as not all respondents provided enough detail

to clearly identify the pharmacies concerned.

Table 32: What is the name of the pharmacy you work with most?

Pharmacy Number of responses

Kamsons (not specified) 7

Kamsons St James' Street 4

Ross Pharmacy 3

Charter Pharmacy 2

Coldean Pharmacy 2

Trinity Pharmacy 2

Well's Pharmacy (not specified) 2

Paydens St James and Lloyds Wellsbourne 2

Across the city 1

Boots, North Street 1

Gunns 1

Kamsons Preston Road 1

Kamsons, Beaconsfield Rd 1

Lloyds & Coldean Pharmacy 1

Traherne 1

Trinity Pharmacy & Boots George Street 1

Well Pharmacy Oxford Street 1

Well Pharmacy Oxford Street, Westons and Ashtons

1

Total 34

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7.2.1. Essential pharmacy services

Respondents were asked to rate the adequacy of essential services provided by the

pharmacy they work with most in meeting patient’s needs. Figure 10 below summarises

their responses.

Figure 10: Rating the adequacy in meeting patient needs for the pharmacy they

work with most.


Nine out of ten respondents (91%) rated the provision of dispensing services as very

good or good, with no respondents rating the service as poor or very poor. In 2014,

only 66% rated the service as very good or good, with 10% rating it as poor or very

poor.

Similar to what was seen in 2014, around a half of respondents did not know or were

unsure of the adequacy of the disposal of unwanted medicines service (50%), the

signposting service (45%), healthy lifestyle service (53%), minor conditions advice

(48%) and the support for self-care service (53%). No respondents rated the disposal

of unwanted medicines services and the healthy lifestyles service as poor or very poor

and only one respondent rated the signposting, minor conditions advice and support for

self-care services as poor or very poor.

38%

39%

41%

45%

47%

91%

6%

9%

6%

6%

3%

3%

3%

3%

3%

53%

48%

53%

45%

50%

6%

Support for self-care (n=34)

Minor conditions advice (n=33)

Promotion of healthy lifestyles (n=34)

Signposting (n=33)

Disposal of unwanted medicines (n=34)

Provision of dispensing services (n=34)

Very good or good Fair Poor or very poor Don't know / not sure

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7.2.2. Essential, advanced and locally commissioned services

Respondents were asked to rate the adequacy of essential, advanced and locally

commissioned services that might be provided by the pharmacy they work with most, in

meeting patient’s needs. Figure 11 below summarises their responses.

Figure 11: Rating of the adequacy in meeting patient needs for the pharmacy they

work with most.

Base: All respondents who answered the individual questions excluding those who stated ‘not

available’.

For 12 out of the 14 services mentioned, a majority of respondents did not know or were

unsure of the adequacy of these services. Only two respondents rated the Urgent

Medicines service as poor or very poor and only one respondent rated the new

medicine, EHC and monitoring the duration of antimicrobial prescribing services as poor

or very poor.

GPs and non-medical prescribers being unaware of the adequacy of essential,

advanced and locally commissioned services was also observed in the 2014 survey.

4%

7%

7%

10%

17%

20%

23%

27%

27%

33%

40%

45%

45%

4%

7%

3%

7%

9%

0%

10%

10%

6%

3%

3%

3%

9%

3%

100%

96%

93%

89%

87%

76%

80%

70%

63%

55%

67%

50%

45%

45%

Customisation of stoma appliances (n=29)

Treatment for Chlamydia infection (n=28)

Chlamydia screening (n=29)

Needle exchange (n=27)

Monitoring the duration of antimicrobial prescribing(n=30)

Appliance use reviews (n=29)

Condom supply (n=30)

Emergency hormonal contraception (n=30)

New medicines service (n=30)

Urgent Medicines out of hours – overnight or weekends (n=22)

Supervised consumption of methadone or buprenorphine(n=27)

Smoking cessation (n=30)

Seasonal Flu Vaccine (n=29)

Medicines use reviews (n=31)

Very good or good Fair Poor or very poor Don't know / not sure

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7.2.3. Comments and observations about working with pharmacies

The free text comments (n=88) that GP and non-medical prescriber respondents

provided within section 7.2.2, highlighted the variation in satisfaction between different

pharmacies / pharmacist and certain pharmacy services in the city. Comments also

highlighted that many GPs do not know what services pharmacies offer and when the

do they have little idea of the standard of service provided. Problems with prescriptions

are highlighted particularly repeat prescriptions with items on repeat prescriptions that

are not required by the patient being a particular issue. A good / better working

relationship is mentioned as being required and desired with good / better

communications being an important part of this relationship.

With regards to Healthy Living Pharmacies, 13 respondents made comments with 10

not knowing what they are or not enough about them. Two thought that they were a

good idea but that they need to get the basics right first, follow guidance and the need

for more evidence of activity/benefit. One thought they should not sell Lucozade!

7.2.4. Medicines Use Reviews (MUR)

Similar to what was seen in 2014, only 4 respondents (13%) said no when asked if they

get feedback from pharmacists following MURs. Thirteen (43%) responded yes and 13

(43%) responded sometimes. Free text comments and observations (n=13) were

mostly positive;

Useful and informative

Identify issues and errors which we are able to act upon

However concerns were also raised;

Duplication of the work done by GPs

Pharmacists insisting that patients have one

Not ideal as there is no access to patients records. Preference for changes to be

actioned in patients notes.

7.2.5. Best way for pharmacist to contact GPs about patients

Views were mixed about how best pharmacists could contact GPs with five respondents

mentioning by fax. By phone, email and letter were each mentioned four times and

three respondents mentioning in person. Other respondents mentioned a mix of the

above, it being dependent on the situation, and via patient’s records.

7.2.5. Professional contact with pharmacist and pharmacies

More than three out of five respondents (63%) have weekly professional contact with a

pharmacist at the pharmacy they use most, with a quarter (27%) having daily contact. A

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further quarter (23%) have contact at least monthly while four respondents (13%) have

no contact or contact only once a year.

Three quarters of respondents (76%) describe the quality of their contact with the

pharmacists at the pharmacy they use most often as very good or good. Only three

respondents (10%) describe the contact as poor or very poor. This is an improvement

compared to 2014 when only 59% described the contact as very good or good and 23%

describing it as poor or very poor.

Four respondents (13%) said they had difficulties working with the pharmacy they use

most. Two mentioned the difficulty in getting through to the pharmacy on the phone,

one mentioned patients complaints about medications not being in stock and one

mentioned difficulties in making relationships due to the high turnover of staff.

Twenty three respondents made comments about how working with pharmacies could

be improved. More than a half (16 people) mentioned communication or improved

relationships, including more use of e-communications and having pharmacists work in

GP practices / joint working (e.g. as part of the proactive care teams, clinical teams or

other multidisciplinary teams). Improvements could also be made by pharmacies

offering particular services (e.g. pulse checking, blood pressure monitoring and having

more contact with patients with minor ailments).

Eighteen respondents provided comment on pharmacies providing prescribing support.

Most comments (n=10) highlighted pharmacists undertaking medication/medicine

reviews and five mentioned the identification of alternative medications/medicines or

sources of medication/medicines when what is prescribed is not available.

When asked what other services they would like pharmacies to provide, more than two

thirds of respondents (70%) mentioned help with weight and alerting GPs to patient’s

deteriorating health and well-being (Figure12 below). The ‘other’ mentioned was

signposting to the third sector and community based providers and events.

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Figure 12: What other services you would like pharmacies to deliver in the future?

Base: All respondents who selected at least one of the services mentioned (n=30)

7.2.6. Joint health promotion campaigns

More than three quarters of respondents (77%) would value the development of more

joint health promotion campaigns with pharmacies. No respondents would not value the

development of campaigns with seven respondents (23%) unsure.

Recommendations Review the systems of notification to ensue all GPs, non-medical prescribers and

care homes are informed of the outcomes of medicine reviews and any

medication changes.

To improve GPs’ and non-medical prescribers’ knowledge and understanding of

the services offered by community pharmacies the CCG and Brighton & Hove

City Council should develop a local information campaign to ensure they are

aware of, understand and have easy access to up to date information about

what, when and where services are provided by pharmacies. This should help to

alleviate the pressure on GPs by directing suitable patients to access pharmacy

services instead.

70%

70%

47%

43%

43%

43%

40%

37%

37%

33%

3%

Help with weight – healthy eating and physical activity

Alerting GPs to a patient's deteriorating health andwell-being

Monitoring the duration of antimicrobial prescribing

Alcohol support – advice and information

Long term conditions advice

NHS Health check

Mental health and wellbeing advice and information

Long term conditions management (includingprescribing)

Hepatitis testing and case detection

Immunisation / Vaccination e.g. Flu

Other

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Public Health to investigate the possibility of Healthy Living Pharmacies giving

neighbouring GP Practices the opportunity to link with them on any health

promotion campaigns they are running and to roll this out to all community

pharmacies if successful.

8. Care home survey

All care homes in Brighton & Hove (n=89) were invited to participate in a survey about

the services and support they receive from the pharmacy that they use most often.

8.1. Key findings

All five respondents that were dissatisfied with the pharmacy they used most worked

in care homes providing nursing care.

More than four out five of respondents thought that the pharmacy they use most was

very or fairly good at providing advice on the use of medicines (85%), dispensing

medicines (81%) and dispensing repeat medicines (81%).

Two out of five respondents said that they would like their pharmacy to provide

urgent medicines out of hours (44%) and new medicine advice (40%).

Over half of respondents (56%) only occasionally or seldom get informed by

pharmacists about changes to prescribed medicines following a medicine use

review.

8.2. Results

More than a quarter (29%) of care homes responded to the survey. In total 26 care

homes responded with two responses received from one care home. Of those care

homes responding 13 provided nursing, 12 provided no nursing and one provided care

both with and without nursing. Among those completing the survey 25 held a

managerial position, one was head of care and one was a team leader.

8.2.1. Overall satisfaction

Three quarter of respondents (76%) were very or fairly satisfied with the pharmacy they

use most often with one in five (20%) fairly or very dissatisfied. All five respondents that

were dissatisfied with the pharmacy they used most worked in care homes provided

nursing care. The data collected does not indicate a reason why care homes that

provide nursing care are likely to be less satisfied with the pharmacy they use most

often.

When asked how working with the pharmacy could be improved, 12 respondents made

comments, with the key themes around the need for better communications / contact

and issues around the slow / late delivery of routine and urgent prescriptions and meds.

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8.2.2. How well pharmacy services and support meet care home needs

Respondents were asked to rate how well a list of pharmacy services meet their needs.

Figure 13 below summarises their responses.

Figure 13: Thinking about the pharmacy you use most how well do the following

pharmacy services meet your needs.

Base: All respondents who answered the individual options excluding those stating ‘not

applicable’.

More than four out of five respondents thought that the pharmacy they use most was

very or fairly good at providing advice on the use of medicines (85%), dispensing

medicines (81%) and repeat medicines (81%). One respondent thought that

pharmacies were very poor at dispensing medicines and three thought that they were

fairly poor at dispensing repeat medicines.

Where applicable, more than two thirds of respondents did not know or were unsure

how well public health campaigns (83%), appliances use reviews (75%), stop smoking

(75%) and stoma appliance customisation (67%) services meet their needs.

More than three out of five respondents (63%) thought that pharmacies were very or

fairly good at the disposal of unwanted medicines. Only three respondents (13%)

thought the service was fairly poor and no respondents thought it was very poor.

More than two out of five respondents thought the flu vaccination (44%) and signposting

(42%) services provided by pharmacies were very or fairly good with no respondents

saying they were fairly or very poor.

5%

5%

42%

44%

63%

81%

81%

85%

10%

6%

14%

10%

50%

19%

21%

12%

15%

15%

15%

11%

14%

10%

13%

8%

4%

75%

83%

67%

75%

8%

38%

4%

Appliance use reviews (n=20)

Public health campaigns e.g cancer symptoms…

Stoma appliance customisation (n=21)

Stop smoking services (n=20)

Signposting to appropriate sources of help (n=26)

Flu vaccination (n=16)

Disposal of unwanted medicines (n=24)

Dispensing of medicines (n=26)

Dispensing of repeat medicines (n=26)

Advice on the use of medicines (n=26)

Very or fairly good Neither good nor poor Fairly or very poor Don't know / not sure

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8.2.3. Required services

From a list of pharmacy services respondents were asked which services the pharmacy

they use most often provide and which they would like them to provide. Table 33 below

summarises their responses

Table 33: Thinking about the pharmacy your care home uses the most, which of

following services does it provide and which would you like it to provide?

Service Already provide

Would like them to provide

Don't know / not

sure

Urgent medicines out of hours (n=25) 52% 44% 4%

New medicines advice (n=25) 56% 40% 4%

Medicine training for the care home (n=25) 72% 28% 0%

Minor conditions advice (n=25) 56% 24% 20%

Collection and delivery of prescriptions (n=25) 96% 4% 0% Base: All respondents who answered the individual options

Nearly all respondents (96%) said that the pharmacy they use most provides a

prescription collection and delivery service. However, two out of five respondents said

that they would like their pharmacy to provide urgent medicines out of hours (44%) and

new medicine advice (40%). Two pharmacies also mentioned that they would like face

to face medicine training rather than online training and one pharmacy would like to see

an electronic prescribing/dispensing service.

8.2.4. Changes to prescribed medicines

Only one in ten respondents (11%) said that they always get informed by pharmacists

about changes to resident’s prescribed medication following a medicine use review. A

further third (32%) said they mostly get informed while over a half (56%) said they only

occasionally (28%) or seldom (28%) get informed. No respondent never gets informed.

Recommendation

Communication needs to be improved between Better Care pharmacists, the

Nursing Home Medication Review Team, Nursing Home staff and community

pharmacies concerning any changes made to medication.

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9. Formal consultation feedback This summary of the consultation feedback only includes responses to comments made about pharmaceutical services provision, rather than prescribing practises, because the latter falls outside the remit of the PNA. The statutory consultation period for the PNA report took place between 17 October and

17 December 2017. There were 16 responses to the consultation survey and one

response via email. Analysis of the responses was carried out and discussed with the

PNA steering group. The report was amended and updated in line with

recommendations made. Respondents to the survey were from: Brighton & Hove

residents (10), health and social care professionals (4), local business (1) and

unidentified (1). The email response was from the East Sussex Local Pharmaceutical

Committee

Few respondents made comments to substantiate their responses with the only key

theme being that the PNA was too long. The following amendments were made to the

report.

A redrafting of the executive summary, including explanations for all abbreviations

The recommendations were bullet pointed and a reference made to the appropriate

page within the report for the full recommendation.

Twelve respondents (75%) agreed that the purpose and background to the PNA had

been clearly explained with 2 respondents (13%) disagreeing. Eleven respondents

(69%) agreed that the information contained in the draft PNA was clearly explained and

understandable and the layout was good. None of those responding thought that the

information was unclear or the layout poor.

In relation to the provision of pharmacy services.

Three respondents (20%) thought that there were unidentified gaps in service

provision, however non made comments identifying where these gap were.

Three respondents (19%) disagreed that the PNA reflects the needs of the city

Five respondents (31%) thought that there were services that could be provided in a

community pharmacy setting that had not been highlighted in the wider PNA.

Among service gaps identified support for addictions (smoking, drink drugs),

contraception, weight management and minor ailments were services already

provided by pharmacies and an action relating to better advertising of the services

provided by pharmacies had already been included in the PNA. Hearing tests were

considered by the steering group.

The responses from the two neighbouring Health and Wellbeing Boards (East and West

Sussex) raise issues that resulted in changes to the report.

Rewriting of the explanation of the NUMSAS scheme to reflect the wording on PSNC

website

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A clarification of the difference between level 1 quality payment and level 2 Locally

Commissioned Service

Draft recommendations 3 and 5 summarised as a single recommendation.

The recommendation regarding HLP coverage in Saltdean was removed and

amended to say it was identified early on as in the PNA process as an issue and 4

new HLPs have been recruited.

Both Neighbouring Health and Wellbeing boards were satisfied that the report had

considered pharmaceutical services within their areas that have an impact on the

population of Brighton and Hove and also agreed that the information in the report was

accurate.

10. Recommendations and conclusions These recommendations are based on the findings of the community, GP and non-medical prescribers, pharmacy, carers and third sector surveys, as well as areas for development identified in the demographic and health profiles. 10.1. Access to pharmaceutical services

1) Recommendation: The population demographics, housing projections and distribution of community pharmacies in Brighton & Hove suggest that the current level of pharmacy services will be sufficient to meet current need until the next PNA is published in 2021. However, where housing developments are completed and/or pharmacies have a change in contract which may result in their closure within the lifetime of this PNA, further consideration may be required.

2) Recommendation: Brighton & Hove City Council and community pharmacies to

increase awareness of the opening hours of pharmacies in areas with a high

concentration of young people, by signposting them to this information on the

NHS Choices website.

3) Recommendation: The CCG and Brighton & Hove City Council to co-ordinate a

city wide awareness campaign around services that can be accessed at

pharmacies, and how to access out-of-hours services and interpreting services,

including BSL for deaf people. The campaign should include the provision of

information on services in accessible formats e.g. Easy Read for people with low

literacy levels and information on how to request specialist provision such as an

interpreter, BSL, braille, home visit.

4) Recommendation: With the advent of 8am-8pm GP opening hours,

commissioners of pharmacy services (NHSE, CCG, BHCC) should consider

whether pharmacy services are needed to match their opening hours with

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neighbouring GP opening hours. The Pharmaceutical Needs Assessment

Steering Group will review the impact on pharmacies of extended GP opening

hours.

5) Recommendation: Pharmacies should receive training in disability awareness

(including learning disability), LGBTQ awareness, and the needs of BME groups

to make their services more accessible to these equalities groups.

6) Recommendation: Better feedback systems about medicines and pharmacy

services should be developed for people with learning disabilities, mental ill

health, older people and those with complex needs, and their staff, carers and

advocates.

10.2. Service Quality Improvements

7) Recommendation: The Caring Together Partnership Board should strengthen its links with community pharmacies.

8) Recommendation: To improve GPs’ and non-medical prescribers’ knowledge and

understanding of the services offered by community pharmacies the CCG and

Brighton & Hove City Council should develop a local information campaign to

ensure they are aware of, understand and have easy access to up to date

information about what, when and where services are provided by pharmacies.

This should help to alleviate the pressure on GPs by directing suitable patients to

access pharmacy services instead

9) Recommendation: Pharmacists should provide information and advice on

medication aids and medications, including side effects and drug interactions. In

particular this advice (or training where appropriate) should be given to people

with complex needs, including older people, and those with mental ill health, long

term conditions and carers.

10) Recommendation: As part of essential service provision pharmacists should

provide advice on paying for prescriptions for people on a low income or benefits

10.3. Improving outcomes: Public Health Services provided by community

Pharmacies

11) Recommendation: In view of the higher rates of self-harm, suicide, depression

and anxiety in Brighton & Hove compared to England, it is recommended mental

health first aid is included initially as part of the Healthy Living Pharmacies

training. HLPs should also be provided with the information to be able to signpost

patients to community based mental health and wellbeing services. If this is

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successful extend the training to all pharmacies. Currently HLPs have the

opportunity to run mental health campaigns in May and December.

12) Recommendation: In view of the projected increase in the proportion of older

people living in the city, it is recommended that all community pharmacies are

trained in communicating with older people.

13) Recommendation: Public Health to investigate the possibility of Healthy Living

Pharmacies giving neighbouring GP Practices the opportunity to link with them

on any health promotion campaigns they are running and to roll this out to all

community pharmacies if successful.

14) Recommendation: Public Health to promote the uptake MECC training amongst

community pharmacies.

15) Recommendation: In view of the higher rates of smoking amongst adults and

young people in Brighton & Hove compared to England, the 48 pharmacies

offering stop smoking services to increase Making Every Contact Count, to

engage more clients with the service and ultimately increasing support for people

to quit through stop smoking services.

16) Recommendation: Pharmacies offering the stop smoking LCS but not achieving

a 50% quit rate or 15% lost to follow up rate

(i) Should develop an action plan with the Royal Sussex County

Hospital (RSCH) Smoking Cessation lead and BHCC commissioner

to address this.

(ii) Must attend 2 out of 3 smoking cessation update and development

sessions a year

(iii) Complete the National Centre for Smoking Cessation and Training

(NCST) online level 2 training and assessment

(iv) All smoking cessation advisors to be trained in pharmacy

safeguarding policies and be supported to obtain an enhanced

Disclosure and Barring Service (DBS) check. PharmOutcomes (the

reporting tool used) must be updated to show when an advisor has

a DBS check.

17) Recommendation: BHCC to review the payment schedule for smoking cessation

to reflect the effort of advisors, needs of clients and reduce rates of lost to follow

up clients.

18) Recommendation: When making commissioning decisions the CCG, NHS

England and BHCC should take into consideration the role of community

pharmacies in addressing the needs of patients with long term conditions.

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10.4. Medicines optimisation service: the safe and effective use of medicines to

enable the best possible outcomes

19) Recommendation: Increase the conversion of electronic prescriptions to electronic repeat dispensing (eRD) - The management of the repeat prescribing and dispensing process is being reviewed nationally and locally by CCGs, with a view to implementing more efficient practice. A 25% target for electronic prescriptions to be converted to electronic repeat dispensing (eRD) has been included in the national General Medical Services contract. Currently Brighton & Hove achieves a 21% conversion rate and will need to increase this.

20) Recommendation: Review the systems of notification to ensure all GPs, non-

medical prescribers and care homes are informed of the outcomes of medicine

reviews and any medication changes.

21) Recommendation: CCG to promote the understanding of the role of Better Care

pharmacists amongst community pharmacists in each GP Practice cluster.

22) Recommendation: Communication to be improved between Better Care

pharmacists, the Nursing Home Medication Review Team, Nursing Home staff

and community pharmacies concerning any changes made to medication.

23) Recommendation: Communication systems should be improved around the

process of discharge from hospital pharmacies to community pharmacies and

communication around the co-ordination of Medicine Use Reviews.

10.5. Information Management Tools

24) Recommendation: Data sharing of patients’ records between GPs and

pharmacies to be improved, where appropriate. This will be addressed as part of

the Empowering Patients, Carers, and Families to use Technology Project’s

Domain 2 work – Share Health & Care Information. This is a multi-agency project

being developed across the health network in Brighton & Hove, Horsham Mid

Sussex and Crawley CCG, High Weald Lewes Havens, BSUH and Digital

Brighton & Hove. The CCG, NHSE and BHCC to support communications with

patients and providers to improve data sharing.

25) Recommendation: Greater use should be made of digital communications by

community pharmacies and GP Practices to aid joint working between primary

care providers and others. All community pharmacies that have existing NHS net

emails, should share these with GP Practices and the CCG should encourage

GPs to use these for communicating with pharmacies.

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10.6. Other

26) Recommendation: Community pharmacies to be reminded of the need to keep

counter discussions discreet and to offer the use of private consultation rooms

where appropriate.

27) Recommendation: The Community Pharmacy Postgraduate Education (CPPE) to

be approached by Brighton & Hove City Council to provide mental health

consultation skills e-learning to registered pharmacists and technicians.

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Table of Abbreviations Acronym Description APHO Association of Public Health Observatories

AUR Appliance Use Review

BHCC Brighton & Hove City Council

BME Black and Minority Ethnic Group

BSA Business Service Authority

BSUH Brighton & Sussex University Hospitals NHS Trust

CCG Clinical Commissioning Group

CHD Coronary Heart Disease

CKD Chronic Kidney Disease

COPD Chronic Obstructive Pulmonary Disease

CPCF Community Pharmacy Contractual Framework

CPPE Community Pharmacy Postgraduate Education

CSTS Community Short Term Service

CVD Cardiovascular Disease

DAC Dispensing Appliance Contractor

DLA Disability Living Allowance

EHC Emergency Hormonal Contraception

EPiC Extended Primary integrated Care

EPS Electronic Prescription Service

eRD Electronic Repeat Dispensing

ERPHO Eastern Region Public Health Observatory

FFT Friends Families & Travellers

GP General Practitioner

HC Health Champion

HLP Healthy Living Pharmacies

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130

HIV Human Immunodeficiency Virus

HWB Health and Wellbeing Board

IC24 Integrated Care 24

IMD Index of Multiple Deprivation

IMT Information Management and Technology

INR International Normalised Ratio

IT Information Technology

IV Intravenous

JSNA Joint Strategic Needs Assessment

KSS Kent Surrey and Sussex

LCS Locally Commissioned Service

LGB Lesbian Gay and Bisexual

LGBTQ Lesbian Gay Bisexual Trans Queer

LiVE Listening to the Voice of Experience

LPS Local Pharmaceutical Services contract

LTC Long Term Condition

MECC Making Every Contact Count

MSK Musculoskeletal

MUR Medicine Use Review

NICE National Institute for Health and Care Excellence

NHS National Health Service

NMS New Medicine Service

NRT Nicotine Replacement Therapy

NUMSAS NHS Medicine Supply Advanced Service

ONPOS Online Non Prescription Ordering Service

ONS Office for National Statistics

PaCC Parent Carers’ Council

PIS Prescribing Incentive Scheme

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131

PhAS Pharmacy Access Scheme

PH Public Health

PHE Public Health England

PNA Pharmaceutical Needs Assessment

QOF Quality Outcomes Framework

RSPH Royal Society for Public Health

SAC Stoma Appliance Customisation

SCFT Sussex Community NHS Foundation Trust

SAWSS Safe and Well at School Survey

SHALAA Strategic Housing Land Availability Assessment

SPFT Sussex Partnership NHS Foundation Trust

STI Sexually Transmitted Infection

STP Sustainability and Transformation Partnership

TIA Transient Ischaemic Attack

UK United Kingdom

UTI Urinary Tract Infection

WTE Whole Time Equivalent

YMCA Young Men’s Christian Association

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Appendix 1: Brighton & Hove Health Profile 2017

Domain Indicator Brighton & Hove

England average

Measure Period Notes

Ou

r C

om

mu

nit

ies

1 Deprivation 23.4 21.8 % 2015 1

2 Children in low income families (under 16s) 17.9 20.1 % 2014 2

3 Statutory homelessness 2.7 0.9 CR1 2015/16

4 GCSEs achieved (5A*- C including English & Maths) 60.3 57.8 % 2015/16 3

5 Violent crime ( violent offences) 22.7 17.2 CR2 2015/16

6 Long term unemployment 2.5 3.7 CR3 2016

Ch

ild

ren

& Y

ou

ng

peo

ple

’s h

ea

lth

7 Smoking status at time of delivery 6.3 10.6 % 2015/16 4

8 Breastfeeding initiation 87.9 74.3 % 2014/15 5

9 Obese Children (Year 6) 13.8 19.8 % 2015/16 6

10 Hospital stays for alcohol-specific conditions (Under 18s) 58.2 37.4 CR4 2013/14-15/16

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England average


11 Under 18 conceptions 25.2 20.8 CR5 2015

Ad

ult

s’

he

alt

h a

nd

life

sty

le

12 Smoking prevalence 19.9 15.5 % 2016 7

13 Percentage of physically active adults 68.4 57.0 % 2015 8

14 Excess weight in adults 52.6 64.8 % 2013-15 9

Dis

eas

e a

nd

po

or

hea

lth

15 Cancer diagnosed at early stage 50.2 52.4 % 2015 10

16 Hospital stays for self-harm 306.2 196.5 DSR1 2015/16

17 Hospital stays for alcohol-related harm 581 647 DSR2 2015/16

18 Recorded diabetes 4.1 6.4 % 2014/15 11

19 Incidence of TB 7.3 12.0 CR6 2013-15

20 New sexually transmitted infections (STI) 1,387 795 CR7 2016

21 Hip fractures in people aged 65 and over 605 589 DSR3 2015/16

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England average


22 Estimated dementia diagnosis rate (aged 65+) 64.0 67.9 % 2017 12

Lif

e e

xp

ec

tan

cy

an

d c

au

se

d o

f d

ea

th

23 Life expectancy at birth (male) 79.3 70.5 Average Years

2013-15

24 Life expectancy at birth (female) 83.5 83.1 Average Years

2013-15

25 Infant mortality 3.8 3.9 CR8 2013-15

26 Killed and seriously injured on roads 54.0 38.5 CR9 2013-15

27 Suicide rate 15.2 10.1 DSR4 2013-15

28 Smoking related deaths 312.7 283.5 DSR5 2013-15

29 Under 75 mortality rate: cardiovascular 67.4 74.6 DSR6 2013-15

30 Under 75 mortality rate: cancer 146.4 138.8 DSR7 2013-15

31 Excess winter deaths 16.3 19.6 Ratio 01/08/12-31/7/15

13

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135

Key

Worse than England average

Similar to England average

Better than England average

Not compared

CR1 Crude rate per 1,000 households

CR2 Crude rate per 1,000 population

CR3 Crude rate per 1,000 population aged 16-64.

CR4 Crude rate per 100,000 population under 18

CR5 Crude rate per 1,000 females aged 15-17


CR7 Crude rate per 100,000 population 15-64

CR8 Crude rate per 1,000 live births


DSR1 Directly age sex standardised rate, per 100,000 population

DSR2 Directly age standardised rate per 100,000

DSR3 Directly age standardised rate per 100,000 population 65 and over

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136

DSR4 Directly age standardised rate per 100,000

DSR5 Directly age standardised rate per 100,000 35+

DSR6 Directly age standardised rate per 100,000 under 75

DSR7 Directly age standardised rate per 100,000 under 75

Notes

1. % of people in this area living in 20% most deprived areas in England, 2015. 2. % of children in low incomes families ( children living in families in receipt of out of work benefits or tax credits wherer their

reported income is <60% median income) for u-16s only. 3. % key stage 4, 2015/16. 4. % of mothers known to be smoking at delivery as a percentage of all deliveries 5. % of all mothers who breastfeed their babies in the first 48 hours after delivery, 2014/15 6. % of school children in Year 6 ( age 10-11), 2015/16 7. % of adults aged 18 and over 8. % of adults achieving at least 150 minutes of physical activity per week, 2015. 9. % of adults classified as overweight or obese, Active People Survey 10. % of invasive malignancies of breast, prostate, colorectal, lung, bladder, kidney, ovary and uterus, non-Hodgkin lymphomas and

melanomas of skin, diagnosed at stage 1 or 2 11. % of QOF recorded cases of diabetes registered with GP Practices aged 17+ 12. % of patients aged 65+ registered with a GP with a diagnosis of dementia 13. Ratio of extra deaths from all causes that occur in the winter months compared with the expected number of deaths, based on the

average of the number of non-winter deaths.

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Appendix 2: List of community pharmacies in Brighton & Hove

FA088 Asda Pharmacy Crowhurst Road, Off Carden Avenue, Hollingbury, Brighton BN1 8AS

FA342 Asda Pharmacy The Marina, Brighton, East Sussex BN2 5UT

FRA14 Ashtons Late Night Pharmacy 98 Dyke Road, Brighton BN1 3JD

FLJ30 Blake's Pharmacy 91 Blatchington Road, Hove BN3 3YG

FAA02 Boots 67-68 Boundary Road, Hove, East Sussex BN3 5TD

FE408 Boots 119-120 London Road, Brighton BN1 4JH

FKQ90 Boots 10 & 11 Queens Parade, Applesham Avenue, Hove BN3 8JG

FNM61 Boots 105 St.Georges Road, Kemp Town, Brighton BN2 1EA

FR198 Boots 57-61 George Street, Hove, East Sussex BN3 3YD

FTJ19 Boots 17-19 St James Street, Brighton, East Sussex BN2 1RF

FTM51 Boots 129 North Street, Brighton, East Sussex BN1 2BE

FYA88 Boots 4 The Parade, Hangleton Rd, Hove BN3 7LU

FWK92 Bridgman Pharmacy 116 Cowley Drive, South Woodingdean, Brighton BN2 6TD

FHP05 Burwash Pharmacy 9 Burwash Road, Hove BN3 8GP

FHM77 Charter Pharmacy 88 Davigdor Road, Hove, East Sussex BN3 1RF

FG739 Church Road Pharmacy 181 Church Road, Hove BN3 2AB

FJM92 Coldean Pharmacy 16 Beatty Avenue BN1 9ED

FG241 Gunn's Pharmacy 108 Western Road, Brighton BN1 2AA

FM259 Harper's Pharmacy 12 Hollingbury Place, Brighton BN1 7GE

FN182 Healthy-U Pharmacy 59 Lustrells Vale, Saltdean, Brighton BN2 8FA

FCQ88 Kamsons Pharmacy 50 The Highway, Moulsecoomb, Brighton BN2 4GB

FG542 Kamsons Pharmacy 74-76 Elm Grove, Brighton, East Sussex BN2 3DD

FG804 Kamsons Pharmacy 1A Lewes Road, Brighton BN2 3HP

FHG58 Kamsons Pharmacy 88-90 Beaconsfield Road, Brighton BN1 6DD

FJD49 Kamsons Pharmacy 191 Portland Road, Hove, East Sussex BN3 5JA

FKE94 Kamsons Pharmacy 128 St James Street, Brighton BN2 1TH

FMN73 Kamsons Pharmacy 25-26 Whitehawk Road, Whitehawk, Brighton BN2 5FB

FN225 Kamsons Pharmacy 94 Preston Drove, Brighton, East Sussex BN1 6LB

FW676 Kamsons Pharmacy 175 Preston Road, Brighton, BN1 6AG

FW387 Lane And Stedman 100 Western Road, Hove, East Sussex BN3 1GA

FHG68 Leybourne Pharmacy 9 Leybourne Parade, Brighton BN2 4LW

FC453 Lloyds Pharmacy 2-4 West Street, Rottingdean, East Sussex BN2 7HP

FGA02 Lloyds Pharmacy Sainsbury's Superstore, Lewes Road, Brighton BN2 3QA

FMY59 Lloyds Pharmacy 9 Longridge Avenue, Saltdean, Brighton BN2 8LG

FNP21 Lloyds Pharmacy County Oak Medical Centre, Carden Hill, Brighton BN1 8DD

FJ161 Lloyds Pharmacy Wellsbourne Health Centre, Whitehawk Road, Brighton BN2 5FL

FDX45 Matlock Pharmacy 12 Matlock Road, Brighton BN1 5BF

FM158 O'Flinn Pharmacy 77-78 Islingword Road, Brighton BN2 9SL

FNC37 Parris And Greening Pharmacy 105 Church Road, Hove BN3 2AF

FMA84 Patcham Pharmacy 37 Ladies Mile Road, Patcham, Brighton BN1 8TA

FVN19 Paydens Ltd 24 St James Street, Brighton BN2 1RF

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FQP94 Portland Pharmacy 83 Portland Road, Hove BN3 5DP

FL613 Ross Pharmacy 3 York Place, Brighton, East Sussex BN1 4GU

FT435 Sharps Pharmacy 26 Coombe Road, Brighton, East Sussex BN2 4EA

FAR24 Superdrug Pharmacy 78 Western Road, Brighton BN1 2HA

FK278 Traherne Pharmacy 13 Hove Park Villas, Hove, East Sussex BN3 6HP

FG739 Trinity Pharmacy 3 Goldstone Villas, Hove, East Sussex BN3 3AT

FFE73 University Pharmacy Health Centre Building, Uni of Sussex, Lewes Rd, Brighton BN1 9RW

FXA38 Watts & Co Chemist 110 Dyke Road, Brighton BN1 3TE

FLP47 Well Brighton 10 Oxford Street, Brighton BN1 4LA

FJL77 Well Hove Superstore, Neville Road, Hove BN3 7PZ

FDF27 Well Portslade Mile Oak Clinic, Chalky Road, Portslade BN41 2WF

FHK15 Well Portslade Health Centre Portslade Health Centre, Church Road Portslade, Brighton BN41 1LX

FVP55 Well Woodingdean 13 Warren Way, Woodingdean, Brighton BN2 6PH

FTE26 Westons Pharmacy 5 6 & 7 Coombe Terrace, Lewes Road, Brighton BN2 4AD

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Appendix 3: Equality Act 2010 “Statement of Due

Regard”

As a council, we have a legal duty under the Equality Act 2010 to show that we have identified

and considered the impact and potential impact of our activities on all people with ‘protected

characteristics’ (age, disability, gender reassignment, pregnancy and maternity, race/ethnicity,

religion or belief, sex, sexual orientation, and marriage and civil partnership).

In this needs assessment and its recommendations we have paid due regard to the council’s

duties, including to:

Remove or minimise disadvantages suffered by equality groups,

Take steps to meet the needs of equality groups,

Encourage equality groups to participate in public life or any other activity where

participation is disproportionately low and

Consider if there is a need to treat disabled people differently, including more

favourable treatment where necessary

We have also considered how we can foster good relations between people who share a

protected characteristic and those who do not.

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2 Browne K. Count Me In Too: Academic Findings Report. University of Brighton. 2007.

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http://www.bhconnected.org.uk/sites/bhconnected/files/Health%20Counts%20Report%201992-2012%20FINAL.pdf 4 Brighton & Hove City Council. City Tracker Survey.

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http://www.official-documents.gov.uk/document/cm73/7341/7341.pdf

http://www.official-documents.gov.uk/document/cm73/7341/7341.pdf

http://psnc.org.uk/services-commissioning/essential-services/dispensing-of-appliances/

http://psnc.org.uk/services-commissioning/essential-services/dispensing-of-appliances/

http://psnc.org.uk/services-commissioning/advanced-services/murs/

http://psnc.org.uk/services-commissioning/advanced-services/aurs/#conditions

http://psnc.org.uk/services-commissioning/advanced-services/sac/

https://www.nice.org.uk/guidance/PH52

http://psnc.org.uk/dispensing-supply/eps/

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