Agenda item

To receive an update on Pharmaceutical Services in Wokingham Borough.

David Dean, Chief Officer, Community Pharmacy Thames Valley, and Karen Buckley, Consultant Public Health, updated the Committee on Pharmacy Services in the Borough.

During the discussion of this item, the following points were made:

·       There had been concerns regarding the permanent and temporary closures of pharmacies in the Borough.

·       David Dean commented that the Lloyds pharmacies in Sainsburys had been removed.  Other pharmacies that remained were coping well with the uplift in patient numbers.  The supermarket pharmacies had had low patient numbers but had had extended opening hours, which was an issue which might need to be revisited with the ICS in the future.

·       Lloyds pharmacies in the Borough had now been sold to other existing pharmacies.

·       Recent challenges in pharmacy had included workforce, although this had improved substantially with improved availability of locums.  A new intake of newly qualified pharmacists was anticipated in the next few weeks, which would hopefully help to plug gaps in the market.

·       Supply chain remained a national issue.  There were ongoing issues around the supply of certain medications and the national pharmacy were in negotiations with the Government to try to alleviate this. 

·       David Dean was of the opinion that pharmacy was in a much better place than previously and were currently making plans for winter and the vaccination campaigns.

·       Karen Buckley indicated that the Council via Public Health was required to look at and assess the level of need.  A Pharmaceutical Needs Assessment (PNA) was produced every three years.  Should there be significant changes such as the closure of Lloyds, the data would be reviewed and any potential implications for residents assessed.  It had been assessed that the closure of Lloyds did not have significant implications.  Karen Buckley explained that the PNA used national guidance and methodology.  Factors such as the demographics for the local population and the future projections of the population, were considered.  Residents were surveyed for their views and expectations, and providers were consulted with on their capacity to meet current and future need.

·       In terms of assessing need, there were three main criteria.  With regards to accessibility, residents were expected to have a pharmacy within a 1-mile radius of their home or a 20 minute walk (in rural areas a 20 minute drive).  Some residents did not meet this.  There were 20 pharmacies within the Borough and 22 located within a mile of the border.  There was sufficient provision in terms of accessibility.  Provision and type of services was another factor which was taken into consideration.  Opening hours was another key factor.

·       Currently, there was a good level of provision in the Borough.

·       A Member indicated that there two pharmacies in Woodley, Boots and Day Lewis.  Both had seen increased patients following the closure of Lloyds, and she had received complaints from residents regarding long queues.  Some patients had taken their business online as a result.  She also expressed concern that Boots had announced that it would be closing some stores, and questioned whether this would impact the Woodley store.  David Dean indicated that the Woodley store was unlikely to be impacted.  He had not received any information from the stores about being overly busy but would look into the matter to help support them.  He was an advocate of supporting community pharmacy.

·       A Member commented that when some medications were in short supply, pharmacies worked on a supply and demand basis and that pharmacists were not being paid the same amount as that which they had to pay to supply the medication.  David Dean suggested that Members contact their MP and let them know that their local pharmacies were experiencing these issues.  This was a national issue.

·       With regards to medication shortages, Members questioned whether these were made in the UK or brought in, or if they had a short shelf life.  David Dean responded that it was a mixture of medications.  Issues included suppliers being paid more for the medication in other countries and shortage of certain ingredients.  Following the pandemic there was no longer a buffer of spare medication.  David Dean indicated that the Government had banned the export of certain drugs for Strep A, following an outbreak.  This action may be needed more in the future.  The supply chain as it was, was broken and the Government was being actively encouraged to make changes. 

·       A Member referred to the increased focus on the use of pharmacy services to help reduce pressure on GP services, and whether this was impacted by workforce issues, or created further issues with staff taking time out from dispensing medication, to deal with queries.  David Dean responded that it helped to give patients greater choice.  Nationally there was a £645million investment coming in from the Government to help see patients with minor conditions, which would help alleviate GP wait lists.

·       David Dean outlined action being taken to highlight the benefits of working in pharmacy services.

·       In response to a Member question regarding enhanced services being offered by pharmacies, David Dean commented that there was currently a GP to pharmacy referral service in place.  The number of pharmacies involved would increase as practices gained confidence in what pharmacies could do, and pharmacies upskilled their teams for managing these referrals.  Members were informed that there was a blood pressure service which helped to identify hypertension, which was running across the Borough.  A new medicines service for antidepressants was being trialled in Frimley, and an early cancer diagnosis pilot in Oxfordshire.

·       A Member questioned how pharmacies were inspected and was informed that they were inspected every 2-3 years by the General Pharmaceutical Council, and that all visits were available in the public domain.  In addition, an annual self-regulation questionnaire was required to be completed to ensure robust governance.  The NHS regional team could also undertake visits.

·       Difficulties around the supply of HRT were highlighted.

·       A Member highlighted that some local pharmacies, including Wokingham Medical Centre, Boots and Morrisons were very busy and questioned how they could be best supported to meet their increasing workloads.  He was of the view that some of the premises were overly small for what was required.  David Dean commented that community pharmacy needed support and that funding had not increased over the last 9 years.  However, rents and the cost of living had increased.  He reminded Members that the pharmacies had remained largely open during the pandemic.

·       A Member went on to ask about the consultation arrangements around the closure of Lloyds pharmacy within Winnersh Sainsburys as many residents had been unhappy with its closure.  David Dean emphasised that the regional team had worked with Lloyds to ensure a minimal impact on residents.  However, the closure date had been brought forward by 3 months.  The pharmacy contract had been for 100 hours a week which was difficult to run at a profit.

·       Members highlighted the lack of health amenities in the Arborfield and Barkham areas and queried how new development was taken into account.  Karen Buckley indicated that around 10,000 residents were not within 1 mile of a pharmacy, however, all were within a 20 minute drive, which met national standards.  With regards to planning for the impact of new development, the ICB would work with the Local Pharmacy Committee.  David Dean added that if the need for pharmaceutical services increased significantly, this would form part of the PNA.  When the PNA had been produced a need had not been identified in this area at that time.

·       A Member commented that he had been asked by residents about the process involved in opening a new pharmacy.  He was informed that there were pathways in place, but that if an application was made it would not succeed as there was not a need identified in the PNA.  Collectively, in line with national guidance, the Borough had sufficient provision in place.  Potentially a tipping point would be reached in the future, but it was not at this point yet.

·       Members commented that residents were expressing dissatisfaction with accessibility, but provision met national guidelines.  Ingrid Slade commented that whilst she appreciated residents’ frustrations, it was a hugely complex issue, not just relating to the number of pharmacies. 

·       The PNA was due for review in approximately 18 months’ time.  The Committee was reminded that the PNA was a statement of need and did not lead to direct action in itself.  Pharmacies were private businesses and could decide whether or not to come to the Borough.

·       A Member questioned whether geographical factors were taken into account when calculating the distance to nearest pharmacies, noting that the Thames was between Remenham and pharmacies in Henley.  It was confirmed that they were.

·       In response to a Member question regarding long term repeat prescriptions, David Dean indicated that many pharmacies used an electronic repeat dispensing programme, and that 28 days was selected to minimise impact on the supply chain.

·       A Member questioned what more could be done to get the message out around the increasing use of pharmacy.  Ingrid Slade indicated that the possibility of a local campaign could be looked at.

·       The Committee asked for an update on the steps involved in opening a new pharmacy.

·       The Committee asked for a future update regarding issues around the supply chain.  Ingrid Slade suggested that the ICB as commissioners also be invited the next time that the Committee received an update on pharmacy services.

RESOLVED:  That the presentation on pharmacy services in Wokingham Borough be noted and David Dean and Karen Buckley be thanked for their presentation.