Bromley Pharmaceutical Needs Assessment. January 2011

Transcription

1 Bromley Pharmaceutical Needs Assessment January 2011 Made in accordance with the National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendment) Regulations 2010

2 Version Date Owner /01/2011 Tushar Shah Supplementary statements Statement number Date of publication Comments Author 2

3 1. FOREWORD EXECUTIVE SUMMARY Why do a? National background Bromley background The process of developing the PNA Summary of the assessment of current services Future Services INTRODUCTION Background The duty on the PCT Circumstances under which the PNA is to be revised or updated SCOPE OF THE PHARMACEUTICAL NEEDS ASSESSMENT What is excluded from scope of the assessment PROCESS FOLLOWED IN THE DEVELOPMENT OF THE PNA Development process and methods Governance and steering group Involvement and consultation during the development of the PNA Regulatory consultation process and outcomes Localities for the PNA NHS BROMLEY Bromley Context HEALTH NEED IN BROMLEY Population forecast Ethnicity Access Deprivation Infant mortality Burden of disease and ill health Life expectancy Disease prevalence Hospital admissions Smoking Alcohol Exercise and obesity Teenage pregnancy Sexual health

4 8. INSIGHTS FROM PATIENTS AND THE PUBLIC Methodology and results Limitations Results Use of Pharmacies Most Recent Visit to a Pharmacy Access to Pharmacy Services Consultations with Pharmacists Experiences of Getting a Prescription Repeat Prescriptions Problems Experienced with Long-term Medicines Getting help with medicines from pharmacies Getting New Medicines Advice-giving by Pharmacists on Public Health Issues The Range of Pharmacy Services Rating of Pharmacy Service Elements Conclusions THE ASSESSMENT Essential services Advanced Services Enhanced pharmaceutical services Future services APPENDIX 1: POLICY CONTEXT AND BACKGROUND PAPERS APPENDIX 2: MEMBERSHIP OF THE STEERING GROUP APPENDIX 3: PHARMACY CONTRACTORS IN BROMLEY APPENDIX 4: PHARMACY OPENING HOURS APPENDIX 5: PHARMACY SERVICES PROVIDERS APPENDIX 6: PHARMACY CONSULTATION FACILITIES APPENDIX 7: MAP REFERENCES APPENDIX 8: REPORT OF THE CONSULTATION ON THE DRAFT PNA APPENDIX 9: ABBREVIATIONS AND GLOSSARY APPENDIX 10: MAPS TO SUPPORT THE PNA

5 1. Foreword NHS Bromley We are all familiar with our local high street community pharmacies. Today NHS Bromley has 59 pharmacy contractors who form an important network of outlets where the people of Bromley can access a range of services backed up by the expert advice of a pharmacist and the trained staff who work there. We asked local people what they thought about pharmacy services in Bromley. Almost a thousand local residents took the time to tell us about their experience of using pharmacy services in the Borough. Their responses were overwhelmingly positive, with high levels of satisfaction and a clear message that there is potential for pharmacies to offer more services. Pharmacy contractors were questioned about the services they provide and their intentions for the future. The message from them was that pharmacists in Bromley are eager to broaden and extend their service offering and that they are ready to work with the PCT on service developments for the future. NHS Bromley is focused on addressing the challenges present in the population posed by lifestyle choices such as smoking, alcohol consumption, diet, lack of exercise and by ageing. Our pharmacies already contribute to the work we do in these areas through the services we commission from them currently. In the future, we see pharmacies, which are a truly local service, having an even greater role in making a difference to the health of local residents. We are pleased to have found through the research we have done to develop this Pharmacy Needs Assessment (PNA) that local people and local pharmacists agree that there is more they can do together to improve health and quality of life in the Borough. This PNA will form the foundation for our future plans for pharmacy services in Bromley. We have drawn conclusions about our current pharmacy services and highlighted areas where we could focus our efforts in the future to make the most of our pharmacies. Sonia Colwill MRPharmS Director of Prescribing and Quality NHS Bromley January

6 2. Executive Summary NHS Bromley is fortunate to have high quality community pharmacy services across the borough. Community pharmacies and the pharmacists and support staff who work in them provide the population of Bromley with an accessible source of advice and support. Some pharmacies open extended hours to ensure that patients and their carers are able to get the medicines and advice that they need throughout the day, into the evening and at weekends. Pharmacy owners invest significant time, energy and money in their pharmacies to provide services to their communities in a modern healthcare setting. Part of NHS Bromley s responsibility is to ensure that the services commissioned from them meet the needs of Bromley residents and fit with our primary care and health improvement strategies. This document sets out an assessment of the need for pharmaceutical services in Bromley that we have conducted over the past year. It has been developed by a steering group comprising key stakeholders and has also been informed by an exceptionally good response from the public to a postal questionnaire about their local pharmacies and the services they offer Why do a? Because it is now a legal requirement and the duty of all PCTs to produce one. It is also a rigorous and helpful process. The purpose of a (PNA) is: To inform and support the PCT s commissioning plans for pharmaceutical services To inform and support the PCT s decision-making process in relation to market entry, this function requires further enabling regulation which is expected in the autumn of National background This PNA has been prepared at a time of significant change in the NHS, when two important factors will influence the future; The recent White Paper, Equity and Excellence: Liberating the NHS, has set in motion a significant programme of change which will have an impact on how we plan and use pharmaceutical services in the future. It is too early to say how this change will affect the PNA or pharmaceutical services. We expect that some aspects of pharmaceutical services will be managed by the NHS Commissioning Board. At the same time the NHS is being asked to contain rising costs and improve productivity as, following a period of sustained growth over a number of years, resources for the NHS will now effectively stand still. As a result, all areas of NHS spending, including pharmaceutical services will be scrutinised to ensure that money is spent to deliver the outcomes expected by patients and the public and with the greatest possible efficiency Bromley background Pharmaceutical services in Bromley are provided through a network of 59 pharmacy contractors, including four 100 hour contracts. Over the last five years pharmacy services have changed considerably through the development a new national contract and through local commissioning. As a result, patients can access a wider range of services from pharmacies than ever before. Bromley pharmacies now provide a range of national and locally commissioned services to the population including; stop smoking advice, emergency contraception, Chlamydia testing and treatment, needle exchange and supervised drug dependency treatment. 6

7 In undertaking this assessment the PCT has tried to balance the need for a high quality, accessible network of pharmacies with the needs of patients for services when and where they find them most useful The process of developing the PNA The graphic below summarises the steps that we have taken to prepare the Bromley PNA. PNA development process Step 1 Step 1: PCT priorities, health needs Step 2 Step 3 Step 4 Step 2: Pharmacy profile and audit Step 3: Patient experience Step 4: Synthesis and assessment Pharmaceutical Needs Assessment Step 5 Step 5: Consultation and consensus Pharmacy commissioning strategy The development process combines the PCT s strategic plans, draws on the Joint Strategic Needs Assessment that describes the health needs of the population and links these to the commissioning of pharmacy services. The PNA provides a foundation for further work to develop a pharmacy commissioning strategy for the PCT Summary of the assessment of current services This section summarises the main finding from the review of each of these services in the PNA. The PNA regulations require the PCT to consider whether services are: Necessary services these are services that the regulations describe as necessary to meet a current need Relevant services these are services which secure improvements, or better access to pharmaceutical services Each of the services describe here is considered against these definitions. Essential services e.g. Dispensing prescriptions Dispensing of NHS prescriptions is a fundamental service, it is commissioned nationally by the NHS and all pharmacies in Bromley offer this service. Consequently, the PCT considers that essential services, is a necessary service the current need for which is secured through our existing pharmacy contractors. The PCT has concluded that there are no current gaps in essential services but has identified a number of issues which will need to be addressed if a gap in provision is to be avoided in the future, these are described in detail in section 9 of the PNA. 7

8 Advanced services e.g. Medicines Use Reviews which involve a discussion between the pharmacist and the patient that is intended to improve the patient s understanding and use of medicines. Locally commissioned services Needle exchange Exchanging used injecting equipment for clean equipment for injecting drug users Supervised consumption The pharmacist supervises the taking of drug treatment for drug users in a treatment programme Evidence for MUR remains mixed and with limited local levers to control the quality and targeting of MUR the PCT has concluded that it is a relevant service for our population. There are no gaps in provision; however the PNA has highlighted some opportunities to improve the provision of this service. We will work with willing providers in areas of need to ensure that there is provision where there is the greatest demand specifically, Penge and Anerley (particularly Crystal Palace), Mottingham and Chislehurst and The Crays The needle exchange service is an important public health service which reduces risk to drug users and the general population. In Bromley 11 of the 59 pharmacies are commissioned to provide this service. Consequently the PCT has concluded that the provision of the needle exchange service from pharmacies is a necessary service. The current provision is consistent with the needs of the population and the PCT has concluded that there are no gaps in provision. The supervised consumption service performs a critical role in supporting drug users in treatment to manage their treatment programme while minimising the diversion of drug treatment onto the streets. In Bromley 14 of the 59 pharmacies are commissioned to provide this service. The PCT has concluded that the supervised consumption service from pharmacies is a necessary service. The provision is consistent with the needs of the population and the PCT has concluded that there are no gaps in provision. Emergency Hormonal Contraception The pharmacist supplies women with emergency contraception ( the morning after pill ) The EHC service through pharmacies provides important access to EHC for women in Bromley. In Bromley 21 of the 59 pharmacies are commissioned to provide this service. The PCT considers the EHC service is a necessary service. The provision from pharmacies in Bromley is generally good, however there is currently no pharmacy provision in Cray Valley West or Mottingham and Chislehurst North, both wards have high levels of teenage pregnancy. The PCT will work with willing providers to ensure that there is adequate provision in these areas. Smoking Cessation Service The pharmacist provides counselling on giving up smoking and supplies therapy to help smokers to quit The stop smoking service through pharmacies is an important strand of the PCT s efforts to reduce smoking rates among the population. Pharmacy is a unique provider with the ability to provide access to Nicotine Replacement Therapy (NRT) at the point of care. In Bromley 42 of the 59 pharmacies are commissioned to provide this service. The PCT has concluded that the smoking cessation service is a necessary service. There is pharmacy provision of stop smoking services in Bromley, including those areas with high prevalence rates. Pharmacy provision in Mottingham and Chislehurst is limited, rates of smoking are high in this area and it is possible that further pharmacy provision is required in the future. The PCT will keep this under review. 8

9 Chlamydia screening and treatment Pharmacies issue screening tests and offer treatment for Chlamydia The Chlamydia screen and treat service provides an accessible source of advice and screening on the high street to young people. In Bromley 38 of the 59 pharmacies are commissioned to provide this service. However activity has been low and the service has yet to fully develop. The PCT has concluded that the Chlamydia screening and treatment service is a relevant service. The PCT will review the uptake and commissioning of this service to ensure that it continues to meet its objectives. On demand availability of drugs Selected pharmacies maintain a stock of drugs that may be needed urgently in end of life care. NHS Health Checks Some pharmacies are providing a health screening service to identify people at risk of heart disease. Monitored dosage system service Some pharmacies dispense medicines into reminder devices to help patients take their treatment at the right time. This service ensures that patients and their carers can get immediate access to drugs used in end of life care from four strategically located pharmacies. This important service is a necessary service for the population. The provision from the four strategically place providers meets the needs of the population at this time. The NHS Health Check s service has been piloted through community pharmacy and is now being rolled out to pharmacies that have been offered alternative provider status for the NHS Health Checks programme in Bromley At this time, the PCT has concluded, that the NHS Health Check s service is a relevant service for the population. The PCT will revise this assessment as the roll our progresses and more information about the uptake and outcomes of the service are available. The MDS service seeks to reduce unintended errors in dosing and to promote independence for patients. This service is currently under review by the PCT which is seeking to understand how patients who require support with their medicines can be supported while maintaining independence. The PNA has provided some insight into the views of patients and pharmacists which will be used to inform the review process and any subsequent commissioning by the PCT. 9

10 2.6. Future Services This PNA will also inform the PCT s commissioning intentions in the future. The PNA process has included reviewing potential future services to identify some services that should be considered as part of the commissioning process. These include: Minor ailments service Pregnancy testing Flu vaccination Anticoagulation checks Weight management Gluten free foods supply Diabetes monitoring Brief interventions for alcohol use Long term contraception supply COPD management Condom supply Hepatitis C screening The PCT has not identified services not provided in the localities that will, in specified future circumstances, need to be provided in order to meet a need for pharmaceutical services or to secure improvements or better access to pharmaceutical services. These potential services will need to be considered alongside the changes taking place within the NHS and the future role that the PCT will have in commissioning services from pharmacies. 2.7 Next steps Looking at the needs of the population of Bromley and the current provision from pharmacies, the PNA process found that the population enjoys good access to pharmaceutical services with a broad range of services available when and where they are needed. The PNA also highlighted how pharmacy services could be improved and where there are opportunities to develop services in the future. Pharmacies in Bromley provide many local services which are intended to address the challenge of reducing ill health through screening and prevention, however there is scope to do more and use pharmacies to deliver services that help tackle the challenge of long term conditions, maintaining people at home and avoiding hospital admissions. This is our first PNA under the new regulations. The PCT conducted a consultation on a draft of the PNA with a broad cross section of stakeholders. The consultation built on the PCT s significant engagement activity with patients and the public during the development of the PNA. A report of the consultation is provided at Appendix 8. 10

11 3. Introduction NHS Bromley (Bromley Primary Care Trust) is the organisation responsible for health services and health improvement in the London Borough of Bromley, in South East London. The PCT plans and commissions services for Bromley residents. Part of its responsibility is to ensure that residents can access safe, good quality and effective personal pharmaceutical services from a local community pharmacy. This document sets out the PCT s first PNA which has been prepared to meet the legal and regulatory requirements set out in the Health Act 2009 and the subsequent pharmaceutical regulations Background The PNA is a document that records the PCT s assessment of the need for pharmaceutical services in Bromley. This assessment is then used as the basis for planning pharmacy services for the population of Bromley and to inform commissioning priorities and decisions. At this time PCTs are under a duty to prepare a pharmaceutical needs assessment which must be published by 1 st February Further legislation is expected to require PCTs to make commissioning decisions using the PNA, in particular in relation to market entry. The PNA will also help the PCT to shape the future of pharmaceutical services for the population of Bromley by providing a single point of reference for all of the information about pharmaceutical services in Bromley. The PNA differs from other needs assessments in that the contents and manner of preparation are all set out in regulations. In some ways this is similar to the requirement on PCTs to prepare Joint Strategic Needs Assessments (JSNA). However the PNA differs in that there is a PNA specific consultation process and the PNA is also prepared in order to support local market entry decisions. PNAs were first developed in 2005 to assist PCTs in preparing for changes to market entry. Since that time PNAs have been used to support market entry decisions but were not an absolute requirement. The White Paper Pharmacy in England: Building on strengths delivering the future 2 was published by the Department of Health in April It highlighted the variation in the structure and data requirements of PCT PNAs and confirmed that they required further review and strengthening to ensure they are an effective, robust commissioning tool to enable and support PCT decisions. The Health Act 2009 amended the National Health Service Act 2006 to include provisions for regulations to set out the minimum standards for PNAs. The regulations were consulted on in late 2009 and early 2010 and were laid in Parliament on 26 March 2010 and came into force on 24 May Appendix 1 has a detailed description of the policy background and references to further reading on PNAs The duty on the PCT The regulations place a statutory duty on each PCT to develop and publish their first PNA by 1 February The regulations set out the minimum requirements for the first PNA produced under the regulations, and these include such things as data on the health needs of the PCT s population, current provision of pharmaceutical services, gaps in current provision and how the PCT proposes to close these gaps. The PNA should also consider the future needs for services. 1 SI 2010 No.914. The National Health Service (Pharmaceutical Services and Local Pharmaceutical Services) (Amendment) Regulations Available at:

12 The regulations require PCTs to undertake a consultation on their first PNA for a minimum of sixty days, and list those persons and organisations that must be consulted e.g. the Local Pharmaceutical Committee, Local Medical Committee, the LINK and other patient and public groups. The regulations also require the PCT to define localities around which the PNA will be structured so that the comparative needs of different populations can be taken into account Circumstances under which the PNA is to be revised or updated It is important that the PNA reflects changes that affect the need for pharmaceutical services in Bromley. Where the PCT becomes aware that a change may require the PNA to be updated then a decision to revise the PNA will be made. Not all changes to pharmaceutical services will result in a change to the need for services. Where required the PCT will issue supplementary statements to update the PNA as changes take place to the provision of services locally. 12

13 4. Scope of the A is defined in the regulations as: The statement of the needs for pharmaceutical services [in its area] which each Primary Care Trust is required to publish Pharmaceutical services are defined by reference to the regulations and directions governing pharmaceutical services provided by community pharmacies (which may be LPS providers), dispensing doctors and appliance contractors. Whether a service falls within the scope of pharmaceutical services for the purposes of PNA depends on who the provider is and what is provided: For dispensing practices the scope of the service to be assessed in the PNA is the dispensing service. This means that, for the purposes of the PNA, it is concerned with whether patients have adequate access to dispensing services, including where those services are provided by dispensing GPs but not concerned with assessing the need for other services dispensing GPs may provide as part of their national or local contractual arrangements. There are no dispensing practices in Bromley at this time and patients registered with Bromley GPs may not access dispensing services from GPs outside Bromley. For appliance contractors the scope of the service to be assessed in the PNA is the dispensing of appliances and the provision of the recently introduced Appliance Use Review (AUR) service and Stoma Appliance Customisation Service (SAC). This means that, for the purposes of the PNA, it is concerned with whether patients have adequate access to dispensing services, including dispensing of appliances, AURs and SACs where these are undertaken by an appliance contractor but not concerned with other services appliance contractors may provide. There are no appliance contractors in Bromley but people in Bromley do access specialist appliance dispensing providers outside Bromley so this will be taken into account when assessing the needs of the population. For community pharmacy contractors the scope of the services to be assessed in the PNA is broad and comprehensive. It includes the essential, advanced and enhanced services elements of the pharmacy contract 3 whether provided under the terms of services for pharmaceutical contractors or under Local Pharmaceutical Services (LPS) contracts. Pharmaceutical services in relation to community pharmacy contractors are defined as: Essential Services which are set out in the 2005 NHS Regulations, these include: o Dispensing and actions associated with dispensing (e.g. keeping records) o Repeatable dispensing o Disposal of waste medicines o Promotion of healthy lifestyles o Prescription linked interventions o Public health campaigns o Signposting o Support for self care All community pharmacy contractors must provide the full range of essential services. Advanced and Enhanced Services which are set out in the Directions made subsequent to the 2005 Regulations, these include: o Advanced Services, specifically: Medicines Use Review and Prescription Interventions (MURs) Appliance Use Reviews (AUR) Stoma Appliance Customisation Service (SAC) 3 Pharmacy contractors do not have a contract in the legal sense with primary care trusts, they operate under terms of service set out in regulations. These are often referred to as the community pharmacy contract. 13

14 Any contractor may choose to provide Advanced Services. There are requirements which need to be met in relation to premises, training or notification to the PCT. At this time a pharmacy may undertake up to 400 MURs per annum, a limited number of AURs linked to the dispensing of appliances and as many SACs as required. o Enhanced Services, specifically: Anticoagulant monitoring service Care home service Disease specific medicines management service Gluten free food supply service Home delivery service Language access service Medication review service Medicines assessment and compliance support service Minor ailments service Needle syringe exchange service On demand availability of specialist drugs service Out of hours service Patient group directions service Prescriber support service Schools service Screening service Stop smoking service Supervised administration service Supplementary prescribing service The regulations are intended to be permissive and allow PCTs to interpret how any of the above services should be commissioned including their scope and method of delivery. Each PCT must make arrangements for the provision of these services in its area. In the case of Bromley PCT arrangements are in place for the provision of: 14

15 Local enhanced service name Monitored Dosage Service (MDS) Needle exchange service On demand availability of specialist drugs service Emergency Hormonal Contraception Service Chlamydia treatment service Name used in NHS Directions Medicines assessment and compliance support service Needle syringe exchange service On demand availability of specialist drugs service Patient group directions service Patient group directions service Description The PCT commissions a service, whereby patients may receive support for medicines taking in the form of multi-compartment medicines organisers The PCT commissions a needle exchange service whereby the pharmacy provides clean injecting equipment to drug users and takes in used injecting equipment for safe disposal The PCT commissions a service whereby some pharmacies maintain a stock of medicines used in end of life care (palliative care) and make these available during extended hours The PCT commissions a service whereby some pharmacies provide access to emergency contraception under patient group directions Pharmacies provide access to treatment to patients who test positive for Chlamydia through the local screening service Chlamydia screening service Screening service Pharmacies provide access to screening for Chlamydia infection NHS Health Check Screening service The PCT commissions an NHS health checks service through some pharmacies Stop Smoking Service Stop smoking service The PCT commissions a service for the supply of nicotine replacement therapy (NRT e.g. patches, gums, inhalers) and advice and counselling to support smokers to give up. Supervised administration service Supervised administration service The PCT commissions a service whereby patients prescribed drug treatments for addiction can obtain their treatment on a frequent basis, often daily and that this treatment is taken in the presence of the pharmacist. Rota service Out of hours service The PCT commissions a rota service where pharmacies are asked to open at times when there is a specific need for pharmaceutical services. In making its assessment the PCT needs to take account of any services provided to its population which may affect the need for pharmaceutical services in its area. This could include services provided from across a border to people living in Bromley. The PCT has identified dispensing appliance contractors and pharmacies outside Bromley that play a significant role in providing a service to Bromley patients. Some community pharmacy contractors also provide services directly to patients that are not commissioned or funded by the PCT. For example, many pharmacies provide a home delivery service but this is not commissioned or paid for by the PCT. 15

16 4.1. What is excluded from scope of the assessment The PNA has a regulatory purpose that sets the scope of the assessment. However pharmaceutical services and pharmacists are evident in other areas of work in which the PCT has an interest but are excluded from this assessment. These include prison pharmacy and secondary care services where patients may be obtaining a type of pharmaceutical service that is not covered by this assessment Prison pharmacy Pharmaceutical services are provided in prisons by providers that contract directly with the PCT or prison authorities. NHS Bromley has no prisons within its area Secondary care pharmacy NHS Bromley buys secondary care services for its population from five NHS Trusts or Foundation Trusts: South London Healthcare NHS Trust Oxleas NHS Mental Health Foundation Trust King s College Hospital Foundation Trust Guy's and St Thomas' NHS Foundation Trust South London and The Maudsley NHS Foundation Trust The University Hospital Lewisham NHS Trust The PNA makes no assessment of the need for pharmaceutical services in secondary care, however the PCT is concerned to ensure that patients moving in and out of hospital have an integrated pharmaceutical service which ensures the continuity of support around medicines. 5. Process followed in the development of the PNA NHS Bromley s PNA has been developed using a mixture of methods and drawing on a range of information sources and reinforced by the involvement of patients and pharmacy providers. The process was divided into five steps. These are illustrated in Figure 1, below Development process and methods Step 1 Step 2 Step 3 Step 4 PNA development process Step 1: PCT priorities, health needs Step 2: Pharmacy profile and audit Step 3: Patient experience Step 4: Synthesis and assessment Pharmaceutical Needs Assessment The development process combines the PCT s strategic plans, draws on the JSNA which describes the health needs of the population and links this to the commissioning of pharmacy services. Step 5 Step 5: Consultation and consensus Pharmacy commissioning strategy The PNA provides a foundation for further work to develop a pharmacy commissioning strategy for the PCT. Figure 1: Bromley PNA development process 16

17 Each step has a specific function and/or source of data that is described in Figure 2, below. These data have been combined to provide a picture of the current and future health needs of the Bromley population and how the pharmacy network can be used to support the PCT to improve the health and wellbeing of the population. Step Data source(s) Activity Step 1 Strategic Plan JSNA 2009 Analysis and synthesis of relevant data for the PNA. Step 2 Routine contracting and activity data which is held by the PCT A postal survey of pharmacy contractors in Bromley, all 59 of pharmacy contractors responded National benchmarking using NHS Information Centre data Step 3 A postal survey of Bromley residents, to which 1,000 (20.2%) of people responded Step 4 Step 5 Drawing together and synthesis of emerging themes and ideas Drafting of the PNA and synthesis of the assessment and recommendations Responses to our consultation A stakeholder consultation exercise was conducted using the draft PNA Figure 2: Bromley PNA development data sources and activity 5.2. Governance and steering group The development of the PNA was the responsibility of a steering group whose membership was drawn from the PCT s commissioning, primary care and public health, quality and engagement teams. The steering group also included representation from the Local Involvement Network (LINk), the Local Pharmaceutical Committee and community pharmacy contractors. The membership of the steering group is described in Appendix Involvement and consultation during the development of the PNA The following pre consultation involvement processes and activities have contributed to the development of the PNA: A postal survey of 4,900 Bromley residents that achieved a response from 992 people registered with a Bromley GP and equivalent to a response rate of 20.2%. Engagement with community pharmacy contractors through the LPC and a postal questionnaire 17

18 NHS Bromley The voice of the LINk at steering group meetings ensuring that the service users perspective was understood by the group. The PNA regulations require that the PCT now undertakes a formal consultation process with specific named stakeholders Regulatory consultation process and outcomes The PCT conducted a consultation on a draft of the PNA with a broad cross section of stakeholders. The consultation built on the significant engagement activity undertaken with patients and the public during the development of the PNA. Responses to the formal consultation were received from the LPC, fifteen pharmacy contractors and three GPs. A report of the consultation is provided at Appendix Localities for the PNA The PNA regulations require that the PCT divide its area into localities that are then used as a basis for structuring the assessment. For the purposes of the PNA the steering group decided that the PNA should adopt the structure being used to develop the PCT s current primary and community strategy. This divides the PCT area into three large localities (or hubs) which are then further subdivided into a total of eight smaller areas (or spokes), the boundaries of these hubs, with the exception of Orpington, are co-terminous with electoral ward boundaries in Bromley. The relationship between the hubs, spokes and wards is shown below: Hubs Spokes Wards Beckenham & Penge Beckenham Penge & Anerley West Wickham Clock House; Copers Cope; Kelsey Park & Eden Park; Shorltands Crystal Palace; Penge & Cator West Wickham Bromley Central Bromley Bickley; Bromley Common & Keston; Bromley Town; Hayes & Coney Hall; Plaistow & Sundridge Orpington Mottingham & Chislehurst Biggin Hill Central Orpington The Crays Chislehurst; Mottingham & Chislehurst North Biggin Hill; Darwin Chelsfield & Pratt s Bottom; Farnborough & Crofton; Orpington; Petts Wood & Knoll Cray Valley East; Cray Valley West Figure 3: Division of Bromley into Hubs, Spokes and Wards (Note Orpington ward is divided between the Central Orpington and The Crays spokes, for the purposes of analysis in the PNA Orpington Ward has been included in Central Orpington) 18

19 Figure 4: NHS Bromley hub and spoke areas 19

20 6. NHS Bromley Bromley is located in the outer ring of -South East London. The borough covers an area of approximately 150 sq km and is most densely populated to the north and east (being closer to central London) and more sparsely populated to the south and west. The area covered by Bromley has a resident population of approximately 299, Bromley PCT shares a border with: Bexley Care Trust Croydon PCT Greenwich Teaching PCT Lambeth PCT Lewisham PCT Southwark PCT Surrey PCT West Kent PCT NHS Bromley is responsible for planning and buying health care and health improvement services for people in Bromley. To support these decisions the PCT regularly reviews the health needs of the population and then prioritises how resources will be invested in the services for which a need has been identified. There are two key pieces of work that support this process; both are documented. The first is the Joint Strategic Needs Assessment (JSNA) that is prepared in partnership with the Executive of the London Borough of Bromley and contains detailed information about the needs of the population, Some of the JSNA data has been used in developing the PNA. The other is the PCT s Strategy Commissioning Plan (to be replaced in 2011/12 by the Bromley Quality, Innovation, Productivity and Prevention Plan QIPP Plan), that covers a five year forward look period and describes the PCT s plans for investment and outcomes for Bromley. 4 GLA round 2008 Ward Population Projections Low (2008) 20

21 6.1. Bromley Context This section sets out the key themes arising from the JSNA (2009) and the Commissioning Strategy Plan ( ) both of which shape the direction of travel for all services in Bromley, including community pharmacy. This section also highlights the influential work going on to redesign services in Bromley to develop the capacity and infrastructure to provide more services closer to home and to ensure the population has the ability to get services when and where they are most accessible and useful to them JSNA Bromley s JSNA (published in 2009) provides a comprehensive analysis of the key health and social care data informing the PCT s commissioning intentions for the residents of the Borough. The following key points are from the JSNA: The total population of Bromley is projected to rise, especially the newly retired group and those younger than 16 years. This demographic feature suggests that the PCT needs to focus on disease prevention across all ages and on the management of chronic diseases, which are more common as people age. Inequalities in health and well-being exist within Bromley and are manifest as substantial differences in life expectancy, CVD and CHD mortality between different geographical areas of the Borough. The main causes of ill health are heart disease, stroke, cancer, respiratory disease and diabetes, all diseases that may be subject to reduction by prevention or the modification of certain risk factors in the population. The incidence of some diseases has continued to rise, e.g. breast and colorectal cancer, heart failure and dementia, as well as diabetes and sexually transmitted infections. Again, the risk of developing these diseases may be reduced by modifying risk factors, and increasing the effectiveness of early detection programmes. Given the main causes of death and illness in Bromley, the risk factors on which the PCT needs to focus include smoking, harmful alcohol consumption, physical inactivity and poor diet. Llevels of obesity appear to be rising, which may account for the rise in diabetes. MMR vaccinations are below national target levels. The PCT needs to focus on improving uptake of the vaccine so that there is a greater level of protection in the population, particularly for the most vulnerable groups such as small babies and those who are less able to fight disease once acquired (such as those who are immunosuppressed). Addressing inequality remains a key focus and the magnitude of inequality in Bromley makes it a major priority for the coming years. Bromley is in the top decile nationally for the gap in life expectancy between the best and worst area. The gap in life expectancy at birth between different populations is a good indicator of health inequalities. A reduction in life expectancy is not simply a case of dying a few years earlier but reflects increased mortality in all age groups under the age of 75 years (from infancy onwards) and indicates a poorer health experience throughout life for the population in an area of low life expectancy. Key factors contributing to low life expectancy are high CVD and CHD mortality rates. These are influenced by levels of risk factors in the population. The most significant risk factors for CVD and CHD are hypertension, high cholesterol, smoking and obesity. Taking into account the relevance of these risk factors, the focus needs to be on primary and secondary prevention of CVD and CHD as detailed in the PCT s own key initiatives and the linked Health Care for London programmes. In order to maximise the impact of these initiatives, the focus will be on the worst wards and the PCT has also set stretch targets to reduce smoking, CVD mortality and increase life expectancy. 21

22 Commissioning Strategy Plan NHS Bromley s Commissioning Strategy Plan (CSP ) describes the PCT s ambitions for improving health and well being in Bromley and achieving the strategic outcomes for Bromley. To be succeeded from 2011/12 onwards by the Quality, Innovation, Productivity and Prevention Plan QIPP Plan), the strategic plan aims to deliver the PCT s vision which is that the people of Bromley will live longer, healthier lives supported by a world class health system. The vision is underpinned by five strategic goals and three programme areas: Programme areas Health and well-being programme Polysystems programme Acute care pathways programme Strategic Goals Reduce inequalities in health and wellbeing Improve and maintain health Improve access to services Improve quality Develop better care pathways The CSP is summarised in the diagram below One of the underpinning elements of the CSP is the development of primary and community care services in Bromley. This will see the alignment of clinical commissioning and the PCT s plans to develop three hubs and eight spoke areas to deliver a networked system of providers of primary care services and facilitate the movement of appropriate services out of hospital into settings in the community. 22

23 The influence that this will have on pharmacy services include: Development of networks in pharmacy to mirror the hub and spoke arrangements Identification of pharmacy providers to support the hub and spoke activity, including ensuring access at the right time and in the right place to medicines and advice Development of services to deliver or support the delivery of care outside of hospital The PNA is a resource for planning and informing commissioning decisions relating to pharmaceutical services and the development of the hub and spoke network in Bromley. In the light of the recent White Paper the PCT is undertaking a review of the out of hospital service strategy to understand and confirm that there is an ongoing, supported rationale for implementing these plans. 23

24 7. Health need in Bromley This section explores a summary of the evidence for health need in Bromley that is relevant to the PNA Population The resident population according to GLA projections is approximately 300,000, this population is distributed across the eight localities as shown in the table below. With approximately 100,000 population in each hub but a considerable variation in spoke populations from 14,173 in West Wickham to 73,341 in Central Bromley. Hub or Spoke Population Beckenham and Penge (hub) 97,730 Beckenham 55,524 Penge and Anerley 28,033 West Wickham 14,173 Bromley (hub) 98,511 Central Bromley 73,341 Mottingham and Chislehurst 25,170 Orpington (hub) 103,118 Biggin Hill 15,101 Central Orpington 57,319 The Crays 30,698 Bromley 299,359 Figure 5: Population by spoke and hub (2009) Source: Greater London Authority (GLA) RND 2008 Ward Population Projections Low The PCT has a registered population of 330,000, the registered population is based on the number of patients that are registered with Bromley GPs. 24

25 Age profile Bromley s population is broadly similar in age structure to that of England with a slightly lower proportion of the population aged between 20 and 30 years and a higher proportion aged between 30 and 45 years. Figure 6: Bromley population pyramid (Bromley: Columns / England: Line Data Source: Office for National Statistics mid-2008 estimates What this means for the PNA Older people and people with children are higher users of pharmacy services and are more likely to need regular access to pharmacies. A nationally representative survey of the population in England showed that people aged over 40, female and those with long term conditions were more likely to visit pharmacies once a month or more. Men, younger adults and those in employment were less likely to visit pharmacies regularly. The PNA survey of pharmacy users received higher responses from women and people aged over 50 years of age, suggesting that pharmacy services are more relevant to this demographic. 25

26 Population structure by locality The age profile varies across the PCT, the wards with the highest proportion of older people are Chislehurst, West Wickham and Farnborough and Crofton. Wards Percentage of population aged over 74 yrs Spoke Chislehurst 11.3% Mottingham and Chislehurst West Wickham 10.8% West Wickham Farnborough and Crofton 10.7% Central Orpington Shortlands 10.4% Beckenham Bickley 10.1% Central Bromley Hayes and Coney Hall 9.9% Central Bromley Orpington 9.8% Central Orpington Petts Wood and Knoll 9.4% Central Orpington Kelsey and Eden Park 8.5% Beckenham Chelsfield and Pratts Bottom 8.4% Central Orpington Figure 7: Top 10 wards for population aged over 74 yrs Source: GLA Round Mid 2008 projections low The wards with the highest proportion of younger people are Cray Valley West, Mottingham and Chislehurst North and Penge and Cator. Ward name Percentage of population aged under 20 yrs Spoke Cray Valley West 30.0% The Crays Mottingham and Chislehurst North 27.5% Mottingham and Chislehurst Penge and Cator 26.5% Penge and Anerley Biggin Hill 26.2% Biggin Hill West Wickham 25.8% West Wickham Chelsfield and Pratts Bottom 25.8% Central Orpington Bromley Common and Keston 25.5% Central Bromley Kelsey and Eden Park 24.8% Beckenham Hayes and Coney Hall 24.3% Central Bromley Orpington 24.1% Central Orpington Figure 8: Top 10 wards for population aged under 20 years Source: GLA Round Mid 2008 projections low The variation in ward population age structure is masked when the wards are aggregated up to spoke and hub level. When aggregated, all three hubs haveing similar levels of younger and older people, the greatest variation can be seen in Beckenham and Penge hub where there is the lowest proportion of older people. Three spokes, West Wickham, Mottingham and Chislehurst and Central Orpington have higher proportions of older people than found in Bromley generally. 26

27 Figure 9: Population structure by locality (over 74s) Source: GLA Round Mid 2008 projections low Penge and Anerley, West Wickham and The Crays have higher proportions of younger people. Figure 10: Population structure by locality (under 20s) Source: GLA Round Mid 2008 projections low What this means for the PNA Caution is needed when using the spoke and hub level population profiles as these mask variation at ward level. The factor most associated with demand for pharmacy services is the size of the proportion of the population aged over 60, there are wards with significantly greater proportion of older people than in the rest of the spoke or hub area. The West Wickham, Mottingham and Chislehurst and Central Orpington spokes have notably larger older populations. Note that West Wickham appears in the top ten list for both older and younger populations. 27

28 7.1. Population forecast Population forecasts by the GLA predict that the population of Bromley will grow by 0.9% by 2014 and by 1.5% by This moderate growth is expected to be accompanied by a slight growth in the population aged under 16 and a slight growth in the population aged over 65 with a consequent slight decline in the population of working age. Also, residential development planned in central Bromley over the next 5 10 years will lead to approximately 5,000 new residents in central Bromley. The current economic circumstances have slowed or delayed some developments and it is not possible to predict accurately how quickly these developments will progress. What this means for the PNA The forecast periods described exceed the scope of the PNA which is expected to be updated regularly and completely refreshed every 3 years. However it is important to note the predicted trend in Bromley is for moderate growth with an increase in population at both ends of the age spectrum and a small decline in the relative size of the population of working age Ethnicity The 2001 census recorded Bromley as having a less diverse population than England with only 8.4% of the population being non-white (England 9.1%). More recent projections from the GLA put Bromley s non-white population at 12%, with growth in the black and Asian populations contributing to this change. The data relating to population projections for ethnicity are not available at ward level. The table below shows the top ten wards by proportion of the population from an ethnic minority community. Penge and Anerley, Beckenham and Central Bromley spokes feature prominently. % nonwhite % Chinese or other % % % Ward Asian black mixed Spoke Crystal Palace 24.9% 3.3% 14.8% 1.6% 5.3% Penge and Anerley Penge and Cator 21.7% 4.0% 12.2% 1.3% 4.2% Penge and Anerley Clock House 13.9% 2.8% 7.4% 0.9% 2.8% Beckenham Bromley Town 9.7% 3.5% 2.2% 1.6% 2.4% Central Bromley Copers Cope 9.3% 3.3% 2.4% 1.5% 2.1% Beckenham Plaistow and Sundridge 8.9% 3.1% 2.8% 1.2% 1.9% Central Bromley Bickley 8.6% 4.1% 1.5% 1.6% 1.4% Central Bromley Kelsey and Eden Park 8.3% 2.7% 2.6% 0.9% 2.1% Beckenham Shortlands 8.0% 3.7% 1.0% 1.6% 1.7% Beckenham Chislehurst 8.0% 3.9% 1.0% 1.5% 1.5% Figure 11: Top 10 wards by ethnicity (2001 census) Mottingham and Chislehurst Bromley has a significant Gypsy and Traveller community which is settled mainly in The Crays. This community is not included in the non-white ethic minority groups and so may be excluded when considering the needs of this population. A recent health needs assessment for this group showed the high levels of satisfaction with local health services which reflects the levels of integration into the local communities, however there remain challenges in particular relating to lifestyle, especially smoking, cardiovascular disease and mental health. 28

29 What this means for the PNA NHS Bromley There is correlation between health inequalities and the levels of diversity in the population. Ethnic minority communities are exposed to a range of health challenges, from low birth weight and infant mortality through to higher incidence of limiting illnesses like diabetes and cardio vascular disease. The population of Bromley is becoming more diverse but there is limited empirical data to identify where the growth in this population has taken place, from the last census showed that the Penge and Anerley Beckenham and Central Bromley spoke areas had large ethnic populations. This will influence the need for services in these areas. The presence of the gypsy and traveller community in The Crays will also be a focus of a specific need that the PNA will need to address Access Car ownership is recorded in the census that was completed 9 years ago. At that time of the last census 23% of Bromley households did not have access to a car. This was more acute in the North West of the Borough with the Beckenham and Penge hub having the lowest levels of car ownership. However, The Crays also had a significant low level of car ownership among households. % of households with Spoke / Hub no access to a car Beckenham 23.4% Penge and Anerley 41.1% West Wickham 16.6% Beckenham and Penge (Hub) 27.9% Central Bromley 21.5% Mottingham and Chislehurst 22.2% Bromley (Hub) 21.7% Biggin Hill 9.0% Central Orpington 16.3% The Crays 28.7% Orpington (Hub) 19.2% Bromley Council 23.0% London SHA 37.5% ONS Cluster 24.7% England 26.8% Figure 12: Car ownership by hub and spoke area (Census 2001) 29

30 7.4. Deprivation The PCT is sub-divided into discrete areas for the purposes of national statistics and census analysis. These areas (called super output areas) do not change and provide a consistent basis for tracking changes in the population over time. These areas can be aggregated up to ward level, however, ward boundaries do change occasionally as electoral boundaries are redrawn. The national index of multiple deprivation (IMD) provides a comparative measure of the deprivation experienced by a population based on their circumstances which can then be applied to a piece of geography. The index provides a score for each output area and ranks areas relative to each other. The relative level of deprivation experienced by a population has a direct correlation with health outcomes for that population. Analysis of the IMD for the lower level super output areas in Bromley shows that each of the localities, perhaps with the exception of West Wickham has some levels of deprivation. Penge and Anerley and The Crays have the highest concentration of deprivation, with Biggin Hill and West Wickham being the least deprived of the spokes. Figure 13: Distribution of LSOAs by quintile of deprivation in Bromley. Source IMD

31 The table below shows the average IMD score of the LSOAs making up each electoral ward this highlights the higher levels of deprivation in the Penge and Anerley and The Crays which feature in four of the top five most deprived wards. Average IMD Score Spoke Ward Penge and Anerley Crystal Palace The Crays Cray Valley West Penge and Anerley Penge and Cator Mottingham and Chislehurst Mottingham and Chisleh. North The Crays Cray Valley East Central Orpington Orpington Central Bromley Bromley Common and Keston Central Bromley Plaistow and Sundridge Beckenham Clock House Central Bromley Bromley Town Biggin Hill Darwin Beckenham Copers Cope Mottingham and Chisleh Chislehurst Beckenham Kelsey and Eden Park Biggin Hill Biggin Hill 8.30 Central Bromley Bickley 7.66 Central Orpington Farnborough and Crofton 7.41 Central Bromley Hayes and Coney Hall 7.20 West Wickham West Wickham 6.43 Central Orpington Petts Wood and Knoll 6.23 Beckenham Shortlands 6.23 Central Orpington Chelsfield and Pratts Bottom 6.09 Figure 14: IMD at ward level 31

32 7.5. Infant mortality Reducing rates of infant mortality is a national and local priority. Infant mortality is influenced by a range of factors and can be used as a proxy indicator for child and maternal health. Infant mortality rates are generally higher in deprived urban areas and among women from ethnic minority groups. Bromley PCT has lower rates of mortality in newborns and infants than the ONS cluster, London SHA and England, Data for infant mortality is not available at ward level. Name Perinatal Mortality Rate (1 week) Neonatal Mortality Rate (4 weeks) Infant Mortality Rate (1 year) England ONS Cluster London SHA Bromley Figure 15: Infant mortality Infant mortality per 1000 live births Time period: Data Source: Compendium of Clinical and Health Outcomes. Additional Information: Data not available at ward level What this means for the PNA Infant mortality is linked to maternal health. Improving maternal health and providing appropriate antenatal care contribute to reducing infant mortality. Early access to antenatal care is considered an important element of improving child and maternal health. Pharmacy pregnancy testing services linked to antenatal referral for women who are pregnant can contribute to widening access to antenatal care, particularly among harder to reach groups. Pharmacies in East London provide an early pregnancy testing service in order to encourage women who are pregnant into the antenatal care system as early as possible in the pregnancy Burden of disease and ill health Bromley has lower levels of self reported long term limiting illness (LTLI) and self reported poor health (both census measures) than England but slightly higher than for the ONS peer group. The spoke areas with the highest levels of reporting for LTLI are The Crays (18.5%), Mottingham and Chislehurst (16.8%) and Penge and Anerley (15.5%). The highest areas for self reported poor health are also found in these spokes. Name % reporting LTLI 32 % reporting poor health Beckenham 13.7% 6.3% Penge and Anerley 15.5% 8.5% West Wickham 13.4% 5.7% Beckenham and Penge (Hub) 14.2% 6.9% Central Bromley 14.8% 6.6% Mottingham and Chislehurst 16.8% 7.9% Bromley (Hub) 15.3% 6.9% Biggin Hill 12.7% 5.8% Central Orpington 14.8% 6.4% The Crays 18.5% 9.1% Orpington (Hub) 15.6% 7.1% Bromley Council 15.0% 7.0% London SHA 15.5% 8.3% ONS Cluster 14.1% 6.7% England 17.9% 9.0% Figure 16: LTLI and self reported poor health at spoke and Bromley level Census General Health and LTLI aggregated from OA level.

33 The top five wards for the frequency of LTLI are found in The Crays spoke areas, Penge and Anerley, Mottingham and Chislehurst and Central Orpington. Spoke Ward % reporting LTLI % reporting poor health The Crays Cray Valley West 19.8% 9.9% Mottingham and Chisleh. Mottingham and Chisleh.Nth 18.1% 9.4% The Crays Cray Valley East 17.0% 8.3% Central Orpington Orpington 16.9% 7.5% Penge and Anerley Crystal Palace 16.1% 9.0% Mottingham and Chisleh. Chislehurst 15.8% 6.9% Central Bromley Plaistow and Sundridge 15.5% 7.1% Central Orpington Farnborough and Crofton 15.3% 6.4% Penge and Anerley Penge and Cator 15.1% 8.2% Central Bromley Hayes and Coney Hall 15.0% 6.3% Central Bromley Bromley Common and Keston 14.9% 6.7% Beckenham Kelsey and Eden Park 14.6% 6.4% Biggin Hill Darwin 14.5% 6.7% Central Bromley Bickley 14.5% 6.5% Beckenham Copers Cope 14.3% 6.6% Central Bromley Bromley Town 14.1% 6.4% Central Orpington Chelsfield and Pratts Bottom 13.6% 5.9% West Wickham West Wickham 13.4% 5.7% Central Orpington Petts Wood and Knoll 13.1% 5.4% Beckenham Shortlands 13.0% 5.3% Beckenham Clock House 12.8% 6.6% Biggin Hill Biggin Hill 11.9% 5.4% Figure 17: LTLI and self reported poor health at ward level Census General Health and LTLI aggregated from OA level Life expectancy Life expectancy is a measure of how long a person born in an area would be expected to live by reference to current observed rates of mortality. The gap in life expectancy between the best and worst helps illustrate how inequalities affect the population differently. Life expectancy in England is 81.3 years for women and 76.4 years for men. In Bromley the equivalent figures are 82.5 years and 77.7 years, better than the national figure. However this good overall figure masks inequalities within Bromley. The gap between the best and worst areas in Bromley is a key measure of the challenge facing the PCT. Male Female Min Max Gap Min Max Gap Beckenham & Penge Bromley Orpington Figure 18: Life expectancy at hub level Source: ONS. Life expectancies have been averaged to give higher level summaries 33

34 Penge and Cator has the lowest life expectancy for men and Mottingham and Chislehurst North for women. Biggin Hill has the highest life expectancy for males and Shortlands has the highest life expectancy for women. Ward Male Life Expectancy Female Life Expectancy Penge and Cator Lowest Crystal Palace Cray Valley West Copers Cope Mottingham & Chislehurst North Kelsey and Eden Park Petts Wood and Knoll Chelsfield and Pratts Bottom Shortlands Biggin Hill Highest Figure 19: Highest and lowest male and female life expectancy in Bromley Source: ONS. Life expectancies have been averaged to give higher level summaries It is notable that in the north of the borough there is a gap of more than seven years for men and six years for women. The gap in life expectancy is closely linked to social inequalities. Closing the gap in life expectancy requires efforts across the health and social care systems. What this means for the PNA Closing the gap in life expectancy is a key outcome for the PCT, this requires a targeted effort focusing on communities that have the worst outcomes. Efforts on public health measures are the most likely to have an impact on these Examples of pharmacy services which have the potential to impact life expectancy include: Smoking cessation, vascular risk assessment, alcohol interventions, healthy living advice and medicines use review. 34

35 7.8. Disease prevalence Data collected by GP practices provides a measure of the prevalence of a disease on practice registers. Due to the way these data are collected they can under represent actual prevalence. Rates of long term conditions (LTCs) in Bromley are broadly similar to those found in England. Each of these conditions is managed using prescribed medicines which presents an opportunity to ensure that pharmacists are in a position to support patients to get the most from their treatment. Disease England Bromley PCT Hypertension Prevalence 13.1% 13.5% Asthma Prevalence 5.9% 5.3% Diabetes Prevalence (17+) 5.1% 4.6% CKD Prevalence (18+) 4.1% 4.0% Diabetes Prevalence (QOF) 4.1% 3.7% CKD Prevalence (QOF) 3.2% 3.1% CHD Prevalence 3.5% 3.0% Stroke & TIA Prevalence 1.7% 1.6% Atrial Fibrillation Prevalence 1.3% 1.4% COPD Prevalence 1.5% 1.2% Mental Health Prevalence 0.75% 0.73% Heart Failure Prevalence 0.70% 0.70% Dementia Prevalence 0.43% 0.46% Figure 20: Disease prevalence in Bromley Source: QMAS 2008/09 Prevalence rates vary by locality with The Crays, Mottingham and Chislehurst and Central Orpington having higher prevalence rates for most of the disease areas examined. = % of practice population above Bromley rate Beckenham Penge and Anerley West Wickham Central Bromley Mottingham and Chislehurst Biggin Hill Central Orpington The Crays Hypertension Prevalence Asthma Prevalence Diabetes Prevalence (17+) CKD Prevalence (18+) Diabetes Prevalence (QOF) CKD Prevalence (QOF) CHD Prevalence Stroke & TIA Prevalence Atrial Fibrillation Prevalence COPD Prevalence Mental Health Prevalence Heart Failure Prevalence Dementia Prevalence Figure 21: Disease prevalence by locality. Source: QMAS 2008/09 35

36 7.9. Hospital admissions Measures of admissions also help us to understand which diseases are responsible for causing admissions and how admissions rates vary by locality. Admission rates in Bromley (191.5 per 1,000 population) are lower than in England with (200.6 per 1,000 population) Central Orpington and The Crays have the highest rates of admissions. Admission rate Beckenham Penge and Anerley West Wickham Beckenham and Penge (Hub) Central Bromley Mottingham and Chislehurst Bromley (Hub) Biggin Hill Central Orpington The Crays Orpington (Hub) Bromley Council London SHA ONS Cluster England Figure 22: Admissions rate per 1,000 population Source HES 2007/08 Admission by ICD-10 groups show that Genitourinary, Neoplasms (Cancers), Digestive and Circulatory admissions account for 65% of all admissions in Bromley. Disease Bromley PCT England All Chapters Genitourinary (N00 to N08) Neoplasms (C00 to D48) Digestive (K00 to K93) Circulatory (I00 to I99) Musculoskeletal (M00 to M99) Respiratory (J00 to J99) Eye and adnexa (H00 to H59) Nervous system (G00 to G99) Skin and subcutaneous tissue (L00 to L99) Blood and blood-forming organs (D50 to D89) Endocrine, nutritional and metabolic diseases (E00 to E90) Infectious and parasitic diseases (A00 to B99) Ear and mastoid process (H60 to H95) Figure 23: Admissions rate per 1,000 population by ICD-10 group Source HES 2007/08 36

37 Analysis of admissions by locality shows that The Crays, Central Orpington and Mottingham and Chislehurst have the highest rates in most ICD-10 groups including the top two contributors to admissions in Bromley. = admissions rate > Bromley rate Beckenham Penge and Anerley West Wickham Central Bromley Mottingham and Chislehurst Biggin Hill Central Orpington The Crays All Chapters Neoplasms (C00 to D48) Digestive (K00 to K93) Genitourinary (N00 to N08) Circulatory (I00 to I99) Musculoskeletal (M00 to M99) Respiratory (J00 to J99) Eye and adnexa (H00 to H59) Skin and subcutaneous tissue (L00 to L99) Nervous system (G00 to G99) Endocrine, nutritional and metabolic diseases (E00 to E90) Blood and blood-forming organs (D50 to D89) Infectious and parasitic diseases (A00 to B99) Ear and mastoid process (H60 to H95) Figure 24: Admissions by locality Source HES 2007/08 What this means for the PNA Pharmacy services are an important, but often overlooked part of the long term conditions pathway. One in three people have a long term condition and most long term conditions are treated or managed using medicines. Ensuring that medicines are used safely and effectively improves outcomes and reduces the risk of hospital admission. It is estimated that around 20% of all admissions to hospital are medicines related, so while the above admissions categories may be disease specific one in five is likely to be related to a failure or unintended consequence of using prescribed medicines. Non-adherence is a silent but significant challenge in managing long term conditions, the WHO estimates that between one third and one half of all dispensed medication is not taken as intended. This has the double negative impact of denying the patient of the benefit of the treatment while costing the health system to drugs that are essential wasted as a result. Pharmacy has a role in ensuring patients, clinicians and carers can obtain the maximum benefit from medicines while reducing risks associated with treatment. For example, targeted MURs on discharge from hospital may assist in reducing readmissions by identifying medicines related risk factors in the community. 37

38 7.10. Smoking One of the most important determinants of health is whether a person smokes. Rates of smoking have fallen in recent years, however it remains a focus for health services to reduce rates further, especially among harder to reach groups. Smoking prevalence is estimated from a small scale survey which is then used to develop estimates at MSOA level. The table below shows the estimates for smoking prevalence in the MSOA with the lowest estimate, the MSOA with the highest estimate and the average of all MSOAs. The table below shows that a sixth of all adults in Bromley smoke. Minimum Smoking Estimate Maximum Smoking Estimate Average Smoking Estimate England London Bromley Figure 25: Proportion of adults who smoke Data source: Health Profiles There is a correlation between deprivation and smoking rates among the population. Analysis at MSOA level (See map below) suggests that in some of the most deprived communities smoking prevalence is as high as a third of all adults. The highest rates are found in Penge and Anerley, The Crays, Mottingham and Chislehurst and Central Bromley. What this means for the PNA Pharmacies already play an active role in providing support for smoking cessation. The role of community pharmacy is two-fold; providing access to Nicotine Replacement Therapy (NRT) and providing advice from pharmacists and staff trained as level 2 counsellors. Pharmacy is a unique provider, in that pharmacies have access to NRT at the point of care, they also provide a walk in service across extended hours of service. 38

39 7.11. Alcohol The methodology for estimating binge drinking behaviour in the population is similar to that used in smoking. Estimates show that around one in seven adults drink to harmful levels. Minimum Binge Drinking Estimate Maximum Binge Drinking Estimate Average Binge Drinking Estimate Name England London Bromley PCT Figure 26: Binge drinking estimate (percentage of population) Data source: Local Alcohol Profiles 2010 The map below shows that the rate of binge drinking is higher in the north of the Borough and in Beckenham and Penge and The Crays, particularly. What this means for the PNA Pharmacies have a small but evolving role in providing brief interventions in alcohol use. Pharmacies in Merseyside provide a brief intervention service designed to identify, support and refer patients into alcohol services. 39

40 7.12. Exercise and obesity Estimates of the levels of physical activity among the population of Bromley show that rates are similar to national rates and rates for the PCT s peer group. % adults 3 hours Name exercise per week England 21.8% ONS Cluster 20.9% London 20.3% Bromley PCT 21.8% Figure 27: Adults reporting greater than 3 hours exercise per week (percentage of population) Data source: Sport England N /08 Obesity rates in Bromley are in line with the SHA and lower than England. Minimum Obesity Estimate Maximum Obesity Estimate Average Obesity Estimate Name England London Bromley Figure 28: Obesity estimate (percentage of population) Data source: Health Profiles Obesity rates are higher in the east and south of the Borough, particularly The Crays and in part of Beckenham, Central Bromley and Biggin Hill. What this means for the PNA Pharmacies provide advice and support for healthy lifestyles as part of their core contract. Pharmacies in Coventry have offered a comprehensive weight management service since 2006 which includes a risk assessment and motivational interviewing to support people to lose weight. The service is successful in attracting men who are often more difficult to reach through traditional weight management services. 40

41 7.13. Teenage pregnancy Teenage pregnancy rates in Bromley are relatively low but have been increasing very slightly over the last 10 years. The target for Bromley by 2010 was to achieve a rate of 1.8% (17.7 per 1000 women), the rate in 2007 was 3.4% (34 per 1000). Area Rate conceptions per population England 4.8% ONS Cluster 3.4% East of England 3.3% Bromley PCT 3.8% Figure 29: Under 18 conception rates Source: ONS The wards with the highest rates are shown in the table below, the top five wards are all above the England average (4.8%). Spoke name Ward Name % under 18 conceptions Central Orpington Orpington 6.8% The Crays Cray Valley East 5.7% Biggin Hill Biggin Hill 5.2% Central Bromley Hayes and Coney Hall 5.2% Mottingham and Chislehurst Mottingham and Chislehurst North 4.9% The Crays Cray Valley West 4.8% Beckenham Kelsey and Eden Park 4.7% Penge and Anerley Penge and Cator 4.5% Central Orpington Farnborough and Crofton 4.3% Central Bromley Bromley Common and Keston 4.2% Central Bromley Plaistow and Sundridge 3.9% Central Orpington Chelsfield and Pratts Bottom 3.5% Central Orpington Petts Wood and Knoll 3.4% West Wickham West Wickham 3.3% Central Bromley Bickley 3.0% Penge and Anerley Crystal Palace 2.6% Figure 30: Teenage Conceptions Source: ONS What this means for the PNA Pharmacies in Bromley provide access to Emergency Hormonal Contraception through a Patient Group Direction (PGD). The service is free of charge to women using the service. Pharmacies are seen as a safe, accessible and non-judgemental provider of EHC services, some women, particularly younger women prefer to use town centre pharmacies as these offer a sense of anonymity when compared to local pharmacies. 41

42 7.14. Sexual health Bromley has lower rates of sexually transmitted infections (STIs) among the population when compared to England but marginally higher rates when compared to England rates. Name STIs - 15 to 19 STIs - 20 to 24 STIs - 25 to 34 STIs - 35 to 44 STIs - 45 to 64 England London Bromley PCT Figure 31: Sexually transmitted infection rates Source: Health protection agency This is mirrored in Chlamydia infection rates across all age groups. Name Chlamydia Infections - 15 to 19 Chlamydia Infections - 20 to 24 Chlamydia Infections - 25 to 34 Chlamydia Infections - 35 to 44 Chlamydia Infections - 45 to 64 England London Bromley PCT Figure 32: Chlamydia infection rates Source: Health protection agency What this means for the PNA Pharmacies in Bromley offer a Chlamydia screening and treatment service which is aimed at young people, the service provides easy access to screening kits and the option for the client to use pharmacy as a source of treatment in the event of a positive test. 42

43 8. Insights from patients and the public An important element of any needs assessment is to capture the view of current and potential services users to understand their perspective and to identify actions which will ensure the successful implementation of services from their point of view. NHS Bromley applied a postal questionnaire in December 2009 which achieved a response from 992 people (20.2%) out of a selected sample of 4,900 people aged over 15 years and registered with a Bromley GP. The questionnaire covered the current use of pharmacy services, preferences for, and satisfaction with services, use of prescription medicines and access to pharmacies. The responses provided a valuable insight into the views of patients that can be used immediately to inform and shape the PCT s plans for pharmacy services in the future. The key themes emerging from the survey included: High levels of satisfaction with pharmacy services across all parts of the Borough. The results showed that ensuring adequate privacy in pharmacies remains a challenge even though most pharmacies have consultation areas. This suggests that there is work that needs to be done to change the way in which pharmacies make use of their private areas. There is good knowledge of some pharmacy services, particularly the smoking cessation service, but lower levels of knowledge of other extended services. There is strong willingness from patients to use pharmacies for newer services, particularly minor ailments, NHS health checks and medication reviews. This suggests there is more that can be done to exploit their willingness to use pharmacies in new ways. Very few people experienced problems accessing pharmacy services. 86% were satisfied with the opening hours of their pharmacies. Most problems accessing pharmacy services occurred during the day time, and most were resolved by going to an alternative pharmacy. There is a significant group of people in Bromley that are not getting the best from their medicines. This suggests that there are opportunities to explore how more pharmacists could help more patients with the practical problems that they experience Methodology and results 992 (20.2%) people responded to a survey exploring the frequency and nature of their visits to local pharmacies, and their wider experiences and opinions of pharmacy services. Most of the data is presented as percentages of the total number of respondents answering a particular question: some questions have also been subject to comparisons of groups (e.g. by gender). Findings deemed significant are all measured at the level p<0.05. Respondents were asked to provide their postcode. This was used to determine the electoral ward and locality where they live. Of the 992 respondents 883 (89.0%) gave a valid Bromley postcode. The results show that the respondents were well distributed across the PCT with Penge and Anerley and Mottingham and Chislehurst under represented and Central Orpington over represented. There were respondents from every ward in Bromley. 43

44 Figure 33: Respondent location by spoke area vs. Bromley population by spoke area The survey group was intended to be randomly distributed across an age stratified sample. This stratification was administered by the PCT using the registered population in Bromley. The results showed that the respondents were skewed towards older people, who are generally known to be better responders to this type of questionnaire. Figure 34: Respondent age profile vs. Bromley age profile In order to obtain a representative sample, the respondents were weighted by age to achieve an age profile reflecting the population of Bromley. Of the 992 respondents, 26 (2.6%) did not provide their age, the remaining 966 were subject to weighting to achieve an age balanced sample for analysis. The ethnicity of respondents fits well with the ethnicity of the population estimated by the GLA at Respondents from non-white groups were under represented in the results. With Black and Asian ethnic groups making up around half of the number of respondents expected. 44

45 White Black Asian Chinese Other Bromley (All persons) 89.5% 5.0% 3.6% 0.7% 1.2% Respondents 92.0% 2.1% 2.2% 1.5% 2.0% Figure 35: Respondent ethnicity vs. Bromley ethnicity (*Source: GLA 2007 PLP Low Ethnic Group Projections) Men were under represented in the respondents, making up only 33% of respondents compared to making up 48% of Bromley s population. (GLA Round 2008 LOW) Limitations The questionnaire method used has some limitations which need to be considered when using the results to inform the PNA. These include: the paper based nature of the questionnaire which limits access to respondents that are literate and confident in reading English, the distribution method which used registered patient lists which therefore excludes those that are not registered and the response rate which had over-representation from older people. It should be noted that the PCT has not relied solely upon the results of the questionnaire is making its assessment. The results of the questionnaire should not be used in isolation but considered alongside other evidence of need Results In terms of general demographics, one third of the respondents were male and 67% female. Almost 28% of respondents were aged 60 years or over, and almost half did not pay for prescriptions (47%). Overall, the respondents rated their health as good or fairly good (62% and 31% respectively). A significant minority of the sample classed themselves as carers of someone in their or another household (26%), and 6% as cared for by someone who was not a professional carer. Almost all the respondents were white (92%) Use of Pharmacies Almost half of respondents stated that they used the same pharmacy all the time (46%). In later analysis, this group will be referred to as one-pharmacy users. Only 8% of the sample indicated that they used different pharmacies, and none more frequently than any others. 17% of respondents believed that the pharmacist knew a great deal about them and their care. Almost another third (28%) indicated this to some extent, and 55% of respondents felt that the pharmacist was not engaged in their care (many of whom said that they did not usually see the same pharmacist). One-pharmacy users were significantly more likely to report that the pharmacist knew a great deal about them and their care (24% vs. 9%), and were more likely to see the same pharmacist (10% vs. 24% for not seeing the same pharmacist). 45

46 When asked about location factors that influenced pharmacy choice, most respondents used a pharmacy close to their home (40%), or close to their GP practice (35%) Location factor important to respondent % (n=810) It is close to my home 39.8 It is close to my doctor s surgery 35.2 It is close to other shops I use 14.0 It is easy to park nearby 6.6 It is close to my work 3.1 It is near to the bus stop or train station 10.8 Other 0.4 Figure 36: Location factors influencing choice of pharmacy When asked about service factors that influenced pharmacy choice, most respondents indicated that a quick service (36%) or the pharmacy stocking their medication (26%) were the most important to them (Figure 36). One-pharmacy users were more likely than others to cite the pharmacist/staff knowing them (15% vs. 8%) and the collection-delivery service (12% vs. 4%) as important factors. Other users were more likely than one-pharmacy users to cite evening and weekend opening hours as a reason for use (5% vs. 12%). Service factor important to respondent % (n=815) The service is quick 36.1 The pharmacy usually has my medicines in stock 25.5 The pharmacist or staff knows about me and my medicines 11.7 The pharmacy is open late or at weekends 8.3 The pharmacy offers a prescription collection and delivery service 7.5 There is some privacy when I want to speak to the pharmacist 6.8 Other 4.1 Figure 37: Service factors influencing choice of pharmacy 8.5. Most Recent Visit to a Pharmacy Two-thirds of respondents had visited a pharmacy within the last month for a health-related service and 24% had visited in the last week. Only 14% had not visited a pharmacy in the last six months. Sixty-seven percent of respondents had visited the pharmacy for themselves. The most frequent reason given for this visit was to obtain medicine/s on prescription (74% - Figure 37), and this was more likely to be the reason for one-pharmacy users than other users (85% vs. 65%). Reason for using the pharmacy % (n=824) To get medicine(s) on a prescription 74.1 To buy medicine(s) from the pharmacy 20.6 To get advice at the pharmacy 4.4 Can't remember 0.5 Other 0.3 Figure 38: Reasons for which respondents most recently visited a pharmacy 46

47 Most of the respondents had visited a pharmacy that they used regularly (80%). Most accessed the pharmacy by walking there (40%) or by car (33%) Access to Pharmacy Services In the last twelve months, only 4% of respondents reported problems finding a pharmacy to get a medicine dispensed, to get advice or tobuy medicines. One-pharmacy users were significantly less likely than other users to have a problem. The majority of respondents (86%) were satisfied with the opening hours of their pharmacy. One-pharmacy users were significantly more likely to be satisfied than other users. When asked, however, whether they had experienced problems accessing their usual pharmacy, or the pharmacy closest to them, 30% responded that they had, and for 10% of people it had happened on several occasions. One-pharmacy users were significantly less likely to have a problem than other users. Number of times unable to use regular or closest pharmacy % (n=945) Not at all 66.4 Once or twice 21.0 Three or four times 6.5 Five or more times 3.0 Can't remember 3.1 Figure 39: Access problems with local pharmacies Most respondents (48%) indicated that the problem was on a normal week day, and 30% had a problem over the weekend. Half of access problems (51%) were cited during normal opening hours 8am to 6pm, with fewer during the evening, and very few overnight. Time % of respondents who answered the question Weekday Saturday n=155 n=31 Sunday & Bank Holidays n=88 8am noon Noon 2pm pm 6pm Total Daytime pm midnight Midnight 8am Total Night time Figure 40: Access problems during normal hours and out of hours Written comments associated with these questions revealed that people wanted more weekend/evening opening hours, and that there were problems finding a pharmacy in the out-ofhours period: It was 2 o'clock in morning and I did not know of any pharmacist which was open. Visited my doctor with my baby and was told about pharmacy open in the evening but when I arrived they were closed. After 7pm and weekends. Almost two-thirds (63%) of the sample needed the pharmacy visit for themselves, and most needed a medicine on prescription (58%). Over one-third (37%) considered the situation urgent. As a result, almost half (44%) went to another pharmacy, and a similar number (43%) waited until the pharmacy was open again. 47

48 In terms of how they found the alternative pharmacy, 56% said they already knew which one would be open; almost 18% drove around to find a pharmacy; and a smaller minority called NHS Direct, looked on the internet, or found out by either telephoning, or receiving information from a friend or family member Consultations with Pharmacists In the last twelve months, a minority of respondents (16%) had had a consultation with a pharmacist: Some of these had been medicine-related (5%). There was no difference in incidence between one-pharmacy users and other users. Respondents aged 60 and older were significantly more likely than others to report a consultation. Most were initiated by the patient (80%), rather than the pharmacist (16%). The pharmacist was more likely to have initiated the discussion for one-pharmacy users than other users (27% vs.7%), perhaps reflecting an understanding of the patient s history that encouraged the pharmacist to be more proactive. The varying subjects discussed were reflected in the associated written comments: To check over the counter medicine is safe with my prescribed medicine. The pharmacist phoned me to confirm I took both warfarin and aspirin which is unusual. I ve taken both for 20 years. To find out when items would be in stock. To talk about foil pack on some tablets and capsules. (Difficult to open). Doctors gave me wrong microlet twice. He phoned them for me. Almost three-quarters of consultations (72%) were carried out at the pharmacy counter, 10% in a separate room, and 10% in a quiet part of the pharmacy shop. Respondents rated the pharmacist highly in the consultation in terms of listening, time spent, confidence and trust, and being treated with dignity and respect although a significant minority felt this to some extent. Question (n=) Did the pharmacist listen carefully to you? (n=194) Were you given enough time with the pharmacist? (n=193) Did you have confidence and trust in the pharmacist? (n=195) Did the pharmacist treat you with dignity and respect? (n=195) Figure 41: Perceptions of the consultation % Yes, definitely Yes, No to some extent Most respondents (75%) said the pharmacist definitely provided useful information, 21% said it was useful to some extent, and 4% considered the advice or information not to be useful. 97% of respondents felt able to ask as many questions as they wanted. 82% said the pharmacist answered all of the questions they asked, but 8% indicated the pharmacist had answered only some of their questions. 48

49 8.8. Experiences of Getting a Prescription As stated earlier, most respondents had made their most recent visit to a pharmacy to get medicine/s on prescription. The majority (71%) said that a member of staff had explained how long their prescription would take: 19% said that they were not told, and did not mind, but 8% were not told how long their prescription would take, and they would have liked to have been informed. Over two thirds of respondents (69%) waited in the pharmacy for their prescription. Of those who waited, 80% waited up to ten minutes: only 6% had to wait more than twenty minutes. The majority of respondents (90%) got all the medicines they needed on their last visit to the pharmacy. Of those who did not, 84% said the main reason for incomplete prescriptions was stock shortage at the pharmacy. Over half of respondents had received their owing medicine within a day of the visit (57%), but a significant minority of 6% waited more than a week for their prescription to be completed. The other reasons given for not getting all the medicines needed included the following written explanatory comments: It took just over a week to get my prescription and I had to go to the pharmacy twice on the day I collected, as it was not ready the first time. It was a mistake at the GP's end, not the pharmacy. There was a mistake with dosage that I picked up and was rectified. Yes - unusually for me I ran out of two medicines, and the surgery very kindly texted my whole prescription through to the pharmacist and I picked it up within two hours Repeat Prescriptions Over half of the respondents (57%) had a repeat prescription. Most people (56%, n=543) ordered it themselves by visiting the surgery, but there was a range of ordering methods. Ordering Method % (n=543) I visit my doctor s surgery to order the repeat prescription 55.7 I call or visit the pharmacy to ask then to order the repeat prescription from my doctor 12.7 I post an order for the repeat prescription to my doctor s surgery 12.2 The pharmacy automatically orders my repeat prescription from my doctor 8.6 I telephone my doctor s surgery to order the repeat prescription 5.4 I my doctor s surgery to order the repeat prescription 4.6 Figure 42: Repeat prescription ordering methods Most respondents collected their prescription from the surgery and took it to the pharmacy (61%), but over a third had it collected by the pharmacy (35%), and almost 4% had it posted to them by the surgery. When asked for ideas for improvements to their repeat prescription service, there were many comments. Most reflected a feeling that the system was good as it currently exists. Others wanted longer repeat supplies, a system to avoid visits to the surgery unless needed, and more ways of ordering their repeat. 49

50 Fine as it is. 3monthly instead of 1 monthly supply By having the prescription passed to the chemist for collection. I think all repeat prescriptions should be linked to the pharmacy to avoid doctor s visit for them unless one needs to see the doctor. To be able to request a repeat prescription by telephone or . I have only recently learned that I can leave my prescription at the pharmacy and collect it within a week from them. I like this arrangement. On their last dispensing, 93% of respondents said that they got exactly what they needed on their repeat. A minority of 5% did not get all the medicines needed, and four people (1%) said that they got some medicines that they did not need at the time Problems Experienced with Long-term Medicines Many of the respondents (57%) had been taking prescribed medicines for three months or more. Almost half (45%) stated that they had had no problems with their medicines, and 45% did not report any problems, but a significant minority of 101 people (11%) reported up to six problems. The most common medication problems were changes to colour or shape of the medicine, and getting medicines out of the packaging. Problem experienced with a medicine % (n=966) Remembering to take my medicines 4.7 Getting my medicine out of the package 3.1 Changes to colour or shape of the tablet 2.8 Reading the information leaflet 1.6 Reading the label 1.4 Swallowing or using my medicines 1.2 Confused by medicines that look similar 0.9 Figure 43: Types of problems experienced with long-term medicines The most common adherence problems were discontinuing medicines if they made them feel worse and forgetting to take medicines sometimes, and (Figure 43). One-pharmacy users were significantly less likely than other users to stop the medicine if feeling worse (17% vs. 27%) or better (11% vs. 20%), but there were no significant differences for the other adherence problems. Adherence problem reported % (n=565) Stopping the medicine if it made them feel worse 22.2 Forgetting to take medicines sometimes 19.5 Stopping the medicine when they feel better 15.9 Careless at times about taking the medicine 4.4 Figure 44: Types of adherence problems reported with long-term medicines 50

51 8.11. Getting help with medicines from pharmacies Respondents were asked whether they were getting different types of help with medicines from pharmacies, and whether they would like these types of help from pharmacies. % (n=966) Type of Help Already get Would like to get Collecting my prescription from the doctor Put a label on my medicines that is easy to read Order my prescription from the doctor Deliver the prescription to my home Put my medicines in a container that is easy to open Put my medicines in an organiser to help me remember to take them Give me a chart to help me remember when to take medicines Someone at the pharmacy to explain medicines to me Not asked 2.6 Figure 45: Help with medicines both received and desired from pharmacies The most frequently reported and desired help related to the mechanics of the medicine supply process (ordering through to delivery), but some respondents reported actual and desired help with enhanced labelling and adherence aids. There was modest demand for explanations of medicines from someone at the pharmacy (2.6%) Getting New Medicines Over a third of the respondents (40%) stated that they had had a new medicine on prescription in the last 12 months. The extent to which respondents felt that the pharmacist had explained different aspects of use of the new medication is reported in the table below. Did the pharmacist explain...in a way you could understand? (n=) Yes, completely Yes, to some extent No Did not need it What the medication was for (n=393) Possible side-effects of the medication (n=393) How to use this medication (n=393) When to use this medication (n=391) What other medicines, drinks or foods you should avoid (n=394) Figure 46: Perception of explanations about new medicines The table shows that, in each case, around 30% of respondents felt that they did not need an explanation of this aspect of use. Of those who did, many felt that the pharmacist gave a complete explanation about how to use the medication, and when to use it. Respondents felt more strongly that the pharmacist had not given a clear explanation of what the medication was for, side-effects and other medicines and drinks or foods to avoid. Most respondents (72%) felt able to ask as many questions as they wanted about the new medication. On this occasion, one-quarter (26%) of respondents felt the pharmacist answered all of their questions, but 66% had stated that they had not asked any questions. 51

52 8.13. Advice-giving by Pharmacists on Public Health Issues The survey asked respondents whether the pharmacist had ever discussed four important public health issues with them: stopping smoking; weight control; alcohol consumption; and risk of heart disease. Has the pharmacist ever talked to you about...? (n=) Yes No, and I would like advice No, and I don t need advice I don t smoke / drink Stopping smoking (n=819) Drinking alcohol (n=814) Weight control (n=814) N/A Your risk of heart disease (n=8137) N/A Figure 47: Reports of the pharmacist discussing public health issues The table shows that most respondents did not perceive a need to get advice from the pharmacist about these health issues, and a very low level of such discussions taking place. Comparison of groups showed that pharmacists had spoken to more men than women about smoking and heart disease. There was some interest in getting advice about weight control (12.5%) and risk of heart disease (23.2%) from the pharmacist. More men than women wanted heart health advice. Respondents up to 39 years old were more likely to want stop smoking advice than older people The Range of Pharmacy Services Respondents were asked if they knew of, and had used, several NHS pharmacy services which are commissioned in Bromley. % (n=850) Service Had heard of service Had used service Stop smoking help Healthy heart check ups Medicine reviews The morning after pill without prescription Chlamydia testing and treatment Figure 48: Knowledge and use of existing NHS pharmacy services in Bromley pharmacies 52

53 Respondents were also asked whether they had used, or would use, a wider range of services from local pharmacies. Service % (n=966) Service % (n=966) Treatment on the NHS for a minor illness 35.8 Condoms on the NHS 12.5 Healthy heart check-ups 25.5 Pregnancy testing 11.9 Flu vaccination 17.0 Treatment on the NHS for head lice 9.1 Help watching your weight The morning after pill without a 17.0 prescription 7.8 Advice about diet and/ or exercise 16.9 Chlamydia testing and treatment 4.2 Monitoring how your medicines are Anticoagulation checks 16.7 working 3.9 Advice about leading a healthy life 14.5 Disposal of injecting equipment 3.9 Diabetes check ups 13.5 Stop smoking help 4.1 Medicine reviews 12.4 Gluten free foods 2.6 Contraception medicines without a prescription 12.7 Figure 49: Predisposition to use services, if available, from local pharmacies An NHS minor ailment service and healthy heart check-ups were the two most popular services. Further analysis of responses regarding the healthy heart check-up showed that this service could be targeted to a particularly receptive group of men and women aged years. Age (years) Male Female All (n=247) % 15.1% 18.3% % 28.3% 32.0% % 21.7% 20.2% Total 32.6% 22.3% 25.7% Figure 50: Further analysis of groups wanting healthy heart advice When data were analysed to explore women s awareness of, and intention to use, EHC services, the results also showed how the service could be targeted. The youngest women (aged 16-19) showed good knowledge and intention to use: further marketing to women aged and might be needed. % of respondents (women only) who: Age (years) Know service is available Have used service in past Would use it in the future Total Figure 51: Further analysis of women s knowledge and intention regarding an EHC service 53

54 Further analysis of respondents awareness of, and intention to use, Chlamydia testing services showed show extremely low levels of awareness, past use and intention to use. % of respondents (women only) who: Age (years) Know service is available Have used service in past Would use it in the future Total Figure 52: Further analysis of women s knowledge and intention regarding a Chlamydia testing service % of respondents (men only) who: Age (years) Know service is available Have used service in past Would use it in the future Total Figure 53: Further analysis of men s knowledge and intention regarding a Chlamydia testing service High percentages in specific age bands are likely to be caused by low numbers of respondents in this range leading to high weighted percentages. In a final question regarding respondents perception of the range of pharmacy services, 15% of respondents stated that they wished pharmacies could provide more services, and 75% were satisfied with current service provision (n=814). One-pharmacy users were significantly more likely to report satisfaction with the range than multi-pharmacy users (80% vs. 70%). 54

55 Respondents were asked what was good about pharmacies and what could be improved. Good points included many comments about good pharmacists and staff. Other good points reflected themes in the wider survey: location; repeat prescription systems; stock; access, and waiting time. Helpful and friendly staff. Late night opening. Large range of goods. Positive pharmacist with excellent customer service skills. Situated near our doctor. It s fine when I don't have to wait a long time for my medicines. The arrangement of the pharmacy collection of repeat prescriptions from the doctor. They are indeed very helpful, delivering my medicines making it so much easier for me. Staff are efficient with the needs, changes or meds; and names of residents for elderly people. If I or my residents have any queries the staff are very helpful. Suggestions for improvement were mainly the reflection of the good points: people citing problems with staff, opening hours, location, stock and access. It was notable, however, that several people sought more information and support with medicines, and another small minority wanted services such as anticoagulation services., closer to home and available at pharmacies. Dispense drugs on time, double check prescription items and quantity, if items out of stock call to inform patient. Access for disabled people. More privacy. I think some of the pharmacies near us are late opening. Is this information contained online? If not I think it would be useful to be - so when late opening required you can find out where is open quickly. More staff to make collection of medicine faster. I d like to be encouraged to say how I'm coping with taking my medicines. Yes. I would like to have my warfarin levels checked at the pharmacy, which would be far quicker than going to the hospital and having my blood taken by needle. It is situated right in the middle of a supermarket. I think it would be better nearer to the entrance. It would be good if local pharmacies could provide a minor health check clinic. I do not like to trouble my doctor over odd moles, fungal infections, and minor ailments. 55

56 8.15. Rating of Pharmacy Service Elements Respondents were asked for rating of different aspects of pharmacy services within the survey. The chart below combines the answers to these questions to explore and compare results across these elements of the pharmacy service. Figure 54: Respondent rating of pharmacy service elements (% of respondents who answered the question) When this analysis was run with one-pharmacy users only, ratings of excellent increased for each aspect. 56

57 Using a Pharmacy: Overall, 77% of the sample rated their most recent experience of using a pharmacy as excellent or very good. Only 2% rated their last experience of using a pharmacy as very poor or poor. Getting a Prescription: Overall, 67% of the respondents rated their experience of getting their prescription as either excellent or very good on their last visit. Only 4% rated their experience as poor or very poor. Privacy in the Pharmacy: Only one-third (34%) of the sample rated the level of privacy as excellent or very good, nearly half of respondents (45%) rated the privacy of the consultation as fair or worse. Only 20% of respondents were offered the choice of having the consultation somewhere where they could speak privately. Written comments from respondents reflect their feelings about this issue: It wasn't private. I am sure privacy would have been offered if required. Too public. Access to a pharmacy: When people had found their normal pharmacy closed and had to find an alternative, they were still fairly positive in their rating of the experience. 10% rated it excellent, two-thirds very good or good, and 22% rated it fair or worse Conclusions The results show that there is generally good satisfaction with pharmacy services among respondents. This positive view extends across the factors assessed in the survey, however respondents that had a consultation with the pharmacist rated privacy lower than other service factors. This presents a challenge to pharmacists and pharmacies who must do more to ensure that patients have the privacy they require during a consultation. Access to pharmacies was generally considered good and most respondents were satisfied with the opening hours of their pharmacies. Patients knowledge of some enhanced services was good and for others it was poor. However, they demonstrated a strong propensity to use services at pharmacies in the future which go beyond those traditionally associated with dispensing. In this category are services particularly focused on disease prevention, like weight management and heart health. The poor knowledge of some existing services strongly suggests that any new services need to be marketed actively to patients to ensure that they have the knowledge to capitalise their use of them. A significant minority of patients taking prescribed medicines reported problems in using or taking medicines. This suggests that there is a silent, but significant group that is not fully realising the benefits of their prescribed medication. The WHO estimates that between 35 and 50% of all prescribed medication is not taken as intended. The survey confirms that the challenge of nonadherence is evident in Bromley and merits active consideration. 57

58 9. The assessment This section describes the current provision of pharmaceutical services from pharmacy contractors using the following sources of data: Results of a postal questionnaire of pharmacy contractors in Bromley which was conducted in June 2010 Benchmarking data from the NHS information centre, this information is published each November, the last published data set relates to 2008/09. Data collected or held by NHS Bromley in relation to the planning and delivery of pharmaceutical services. It draws together relevant supporting data from the health needs section and patient questionnaire together with supporting national evidence. The regulations governing the development of pharmaceutical needs assessments require the PCT to consider the need for pharmaceutical services in terms of: Services currently commissioned that are necessary to meet a current need Services that are currently commissioned which secure improvements or better access to services these are referred to as relevant services in the regulations The PCT may also consider: o Services not currently commissioned that may be necessary in specified future circumstance o Services not currently commissioned that may be relevant in the future because they would secure improvements or better access to pharmaceutical services In reaching conclusions the PCT is expected to explain where it has taken account of other services which have influenced its assessment Essential services In order to assess the provision of essential services against the needs of the population the PNA examines the distribution of pharmacies, their opening hours and the provision of dispensing services. These three factors are considered to be the most important in determining the extent to which the current provision of essential services meets the needs of the population Distribution of pharmacies by locality NHS Bromley has 59 pharmacy contractors who together provide pharmaceutical services to the population. The pharmacy contractors include four 100 hour pharmacies. This type of pharmacy contractor must open for at least 100 hours each week and may be required to provide certain specified local services by the PCT. 58

59 The distribution of the four 100 hour pharmacy contractors is shown in the table below and on the map at Figure hour HUB LOCALITY SPOKE LOCALITY All Pharmacies pharmacies Beckenham and Penge Beckenham 12 1 Penge and Anerley 6 West Wickham 3 Beckenham and Penge Total 21 1 Bromley Central Bromley 12 Mottingham and Chislehurst 3 Bromley Total 15 Orpington Biggin Hill 3 Central Orpington 14 2 The Crays 6 1 Orpington Total 23 3 Bromley 59 4 Figure 55: Distribution of community pharmacies by locality Distribution of GP practices Bromley has 51 GP practices and 3 branch practices, there are no dispensing practices in Bromley. Hub locality Spoke locality GP Practices Branch Practices Beckenham and Penge Beckenham 6 Penge and Anerley 6 West Wickham 3 Beckenham and Penge Total 15 Bromley Central Bromley 11 2 Mottingham and Chislehurst 4 Bromley Total 15 2 Orpington Biggin Hill 2 Central Orpington 11 1 The Crays 8 Orpington Total 21 1 Bromley 51 3 Figure 56: Distribution of GP practices by locality 59

60 Map of each locality showing pharmacies, GPs against population Figure 57: Map of localities and pharmacies 60

61 Analysis of distribution of pharmacies The provision of pharmacy services in Bromley can be set into context by comparing the provision using national benchmarks which are available. This chart shows that Bromley is below the SE London median of 21.4 pharmacies per 100,000 population. However Bromley has less in common with some of its neighbours, particularly Southwark and Lambeth. Figure 58: Pharmacies per 100,000 population in SE London Source: NHSIC 2009 Within the ONS peer group the median is 19.6 pharmacies per 100,000 population, Bromley (19.5) is in line with the median suggesting that the number of pharmacies at a Bromley level is in line with those in other similar areas. Figure 59: Pharmacies per 100,000 population in ONS cluster Source: NHSIC

62 These data suggest that at a Bromley level the level of pharmacy provision is consistent with that found in the ONS peer group and is slightly low when compared to neighbouring PCTs. Analysis by locality shows that there are more pharmacies per head of population in the Beckenham and Penge and Orpington hubs with less in the Bromley hub. The most significant deviation from the Bromley median is in Mottingham and Chislehurst where there are 11.9 pharmacies per 100,000 population. Mottingham and Chislehurst also features prominently in terms of poorer health outcomes (higher disease prevalence, hospital admissions and lower life expectancy) and in terms of lifestyle factors (higher levels of smoking, binge drinking and obesity). Figure 60: Pharmacies per 100,000 population by locality Source: Bromley PCT and ONS Choice The PCT is asked to consider the benefits of having a reasonable choice with regard to obtaining pharmaceutical services. PCTs are required to consider whether there is reasonable choice when assessing applications for pharmacy services. At this time it is not known how PCTs will be required to deal with the concept of choice under market entry using PNAs however the question of choice can be considered in relation to our PNA using the current regulations. It is up to the PCT to determine what weight the choice factor should be given in any case, therefore there is no qualification that can be applied to the question of choice. Judicial reviews of decisions made by PCTs have helped to clarify the question of choice in determining application. Choice can only exist where there is more than one provider available to the population. However there can be choice where some or all providers are located outside the area in question. In Bromley each locality has more than one pharmacy provider with most centres of population having a choice of two or more providers. It is also clear that the population can access services in neighbouring localities with reasonable ease Patients views When asked about the location of pharmacy services, respondents to the PNA survey preferred to use a pharmacy close to their home (40%), or close to their doctor s surgery (35%). When asked about service factors that influenced their choice, 36% preferred pharmacies with a quick service 62

63 and 26% having their medicines in stock. Most respondents (96%) had not had a problem finding a pharmacy in the last 12 months Conclusions on distribution The analysis of pharmacy distribution shows that there is a good distribution of pharmacies in Bromley at a PCT level, with similar levels of provision among peer PCTs. Within the hub and spoke areas it is apparent that there is variation in distribution and that there is lower provision in Mottingham and Chislehurst specifically. This area has a community that is characterised by a larger older population and a relatively large population of children. These are both population groups that rely heavily on pharmaceutical services. The PCT intends to keep the provision in Mottingham and Chislehurst under review to ensure that it remains appropriate for the needs of the local population Essential Small Pharmacies Scheme One pharmacy in Bromley has been granted ESPLPS (Essential Small Pharmacies Local Pharmaceutical Services) status. The scheme provides pharmacy contractors located more than 1km from the nearest pharmacy with a guaranteed minimum income The purpose of the scheme is to secure provision in areas where a pharmacy would otherwise not be viable. This nationally designed and locally managed scheme has recently been reviewed and extended by the Department of Health and will end in March ESPLPS Pharmacy: Elmers Pharmacy 172 Upper Elmers End Road Beckenham Kent BR3 3DY Hub: Beckenham and Penge Spoke: Beckenham Opening Hours Mon, Tue, Thu and Fri 09:00-17:30 Wed, Sat 09:00 13:00 Sunday Closed Services Smoking cessation On demand availability of speciality drugs Monitored dosage system Chlamydia screening & treatment Analysis of opening hours Pharmacies are required to open between specific times by their terms of service. A visual representation of pharmacy opening hours by ward and locality is provided in Appendix Weekday opening hours The 100 hour pharmacies are located in Beckenham and Penge (1) and Orpington (3) hub areas. There is no 100 hour pharmacy in the Bromley hub. Pharmacy Name Postcode Spoke Hub Paydens Pharmacy BR3 3PR Beckenham Beckenham and Penge Tesco Extra BR6 0NH Central Orpington Orpington Petts Wood Pharmacy BR5 1DQ Central Orpington Orpington Tesco Superstore DA14 5BN The Crays Orpington Figure 61: 100 hour pharmacy locations 63

64 Five pharmacies also open extended hours (after 8pm on weekdays): Pharmacy Name Postcode Close Spoke Hub Paydens Pharmacy BR3 3PR 22:00 Beckenham Beckenham and Penge Boots the Chemist BR1 1DN 21:00 Central Bromley Bromley Tesco Extra BR6 0NH 22:30 Central Orpington Orpington Petts Wood Pharmacy BR5 1DQ 22:00 Central Orpington Orpington Tesco Superstore DA14 5BN 22:30 The Crays Orpington Figure 62: Pharmacies opening after 8pm on one or more days (Mon Fri) Saturday opening hours Of the 59 pharmacies in Bromley, 58 are open on a Saturday with 48 remaining open after 1pm. Each of the spoke areas has pharmacy provision until 5pm. Spoke Pharmacies Open on Sat Open after 1pm Open after 3pm Open after 5pm Open after 7pm Beckenham Penge and Anerley West Wickham Central Bromley Mottingham and Chislehurst Biggin Hill Central Orpington The Crays Bromley Figure 63: Opening of pharmacies on Saturdays Lunchtime closures The patient questionnaire highlighted the issue of patients being unable to find a pharmacy when they needed one because the pharmacy was closed in the middle of the day. Some pharmacies close at lunchtime to allow the pharmacist to take a rest break. Others remain open but the pharmacist is not on the premises. During these times the services available from the pharmacy may be limited. The opening hours analysis set out in Appendix 4 provides a visual representation of opening hours which make gaps easier to see. This analysis has highlighted that in the following ward it would be beneficial to co-ordinate closure times such that they are staggered to improve access for patients: Crystal Palace: there are three pharmacies, all three close from 1pm 2pm Farnborough and Crofton: there are three pharmacies, two of these close from 1pm 2pm There may be other opportunities to improve the pattern of lunchtime closures which can be explored with local contractors on a case by case basis. 64

65 Sunday opening hours Thirteen pharmacies in Bromley open on a Sunday, most (10) open for 6 hours to comply with Sunday trading regulations for pharmacies based in shopping centres or supermarkets. Spoke Pharmacies Open on Sunday Beckenham 12 2 Penge and Anerley 6 1 West Wickham 3 2 Central Bromley 12 2 Mottingham and Chislehurst 3 0 Biggin Hill 3 1 Central Orpington 14 4 The Crays 6 1 Bromley Figure 64: Opening of pharmacies on Sundays hour pharmacies The four 100 hour pharmacies perform an important function providing access to pharmacy services across an extended hours period. This includes some enhanced services as shown in the table below. TRADING NAME POSTCODE Needle exchange Supervised administration of opiates EHC Smoking cessation On demand availability of speciality drugs MDS Chlamydia screening & treatment NHS Health Check WARD Paydens Pharmacy BR3 3PR Y Y Y Y Kelsey and Eden Park Petts Wood Pharmacy BR5 1DQ Y Y Y Petts Wood and Knoll Tesco Extra BR6 0NH Y Orpington Tesco Superstore DA14 5BN Y Y Y Cray Valley East Figure 65: Services provided by 100 hour pharmacies in Bromley The PCT plans to review the current commissioning from these pharmacies to ensure that their extended hours are used to ensure patients have access to enhanced services when and where they are needed Bank Holidays Pharmacy opening hours on Bank Holidays are non-contractual. There can, therefore, be times on Bank Holidays when pharmacy services are limited or difficult to plan effectively. There are eight designated Bank Holidays each year for which the PCT must plan. A key consideration on these Bank Holidays is how to ensure there is cover for our Urgent Care Centres (see 9.2.7) which open between 8am and 8pm 365 days a year. To address this challenge the PCT has begun to explore the use of Local Pharmaceutical Services (LPS) contracts to include securing the provision of pharmaceutical services in Bromley on Bank Holidays. In order to allow time for the PCT to work up its plans, the PCT has designated three 65

66 areas, which together cover the entire Bromley PCT area. If the PCT decides to progress with this approach then the LPS will be developed and procured by the PCT in the future Out of hours services The Carson Review (2004) placed the responsibility on the out of hours provider for ensuring that patients receive medicines and not on the patient. Out of hours provision in Bromley is provided by the EMdoc service which is part of the Bromley Community Provider Unit. Patients may receive telephone advice, a home visit or be asked to attend a consultation at a local primary care centre. When a medicine is required then the patient is issued with a prescription to be dispensed the next day. If the medication is required before pharmacies re-open then the EMdoc service has a stock of common urgently needed medicines which can be supplied by the clinician at the time of the assessment Urgent Care Centres / Walk in Centres The PCT has two Urgent Care Centres, both provide services from 8am to 8pm 365 days each year. The Urgent Care Centres are located at: Beckenham - Beckenham Beacon hosts an Urgent Care Centre and also a GP led Health Centre Orpington An Urgent Care Centre is based at the Princess Royal University Hospital in Orpington Patient views The majority of respondents to the PNA questionnaire (86%) were satisfied with the opening hours of their pharmacies. When asked about problems accessing services from their usual pharmacy around 30% had found that their usual pharmacy was closed when they needed pharmacy services. Around one third (37%) considered the reason to be urgent. Written comments associated with these questions revealed that people wanted more weekend/evening opening hours, and that there were problems finding a pharmacy in the out-of-hours period Conclusions on opening hours The analysis of opening hours shows that while there is good provision across the week and throughout the day, including at weekends, there are improvements that could be made. The views of patients suggest that more could be done to ensure that lunchtime closures are staggered and that patients who go to a pharmacy that is closed are clearly signposted to pharmacies that are open late or at weekends. We are exploring the use of LPS to secure the provision of pharmaceutical services on Bank Holidays in Bromley and in particular for our two Urgent Care Centres. In relation to our 100 hour pharmacy contractors the PCT has considered the current provision from these contractors and the potential for them to apply to reduce their hours in the future based on the PNA. The PCT has concluded that our current 100 hour contractors perform an important role in opening up access in the evening and at weekends, which we will seek to retain. 66

67 Dispensing services Pharmacies in Bromley dispense an average of 4,966 prescription items per month (NHS IC: 2008/09), this compares with an median of 6,129 in England and 4,958 in South East London. Figure 66: Pharmacy dispensing activity compared to SEL cluster Source: NHSIC 2009 Within the ONS cluster group Bromley is in line with the median (5,055 per month in the ONS group) for the number of prescription items dispensed each month. Figure 67: Pharmacy dispensing activity compared to ONS peer group Source: NHSIC

68 There is a good correlation between dispensing volumes at spoke level and the distribution of pharmacies per head of population and the chart below illustrates. Figure 68: Pharmacy dispensing and distribution by spoke area Source: NHS Bromley Analysis of cross border dispensing Pharmacies dispensing significant numbers of prescriptions for Bromley patients that are located outside Bromley are a significant source of pharmaceutical services to the population. Pharmacy contractor Address Postcode Type PHARMACY2U LTD 1 HAWTHORN PARK LS14 1PQ Internet LLOYDS PHARMACY LTD WEST HILL DA1 2AU West Kent SECURICARE (MEDICAL) LTD CAVELL HOUSE HP10 9QY Appliance ADATIA A 2 HOLLYTREE PARADE DA14 6RJ Bexley BOOTS UK LTD WHITGIFT CENTRE CR0 1UP Croydon COLOPLAST LTD UNIT 1 THE LINKS PE2 6BJ Appliance RAJKEL LIMITED 20 BYWOOD AVENUE CR0 7RA Croydon BOOTS UK LIMITED SOUTH MALL DA9 9SJ West Kent Figure 69: Cross border dispensing Data Source: epact, Dec 2009 These dispensing contractors include a combination of pharmacies, internet pharmacies and appliance contractors. When combined these pharmacies dispense less than 2% of all prescriptions issued by Bromley GPs. 68

69 Patient views The most common reason for visiting a pharmacy in Bromley is to get a prescription dispensed; around 70% of respondents visited to get a prescription dispensed on their last visit. Most (90%) were satisfied with the experience. This perhaps reflects the fact that 10% of respondents were not able to get their prescription dispensed in full on their visit. For most of these (84%) the reason was a shortage of stock at the pharmacy, most of these (57%) were able to obtain the owing medication within one day, but 6% had to wait for more than a week for the pharmacy to obtain stock Conclusions on dispensing services Patients rely upon the network of community pharmacies to get prescriptions dispensed. This service works well with an appropriate balance between the needs of the population and the infrastructure to meet those needs. There is a current and known issue with the supply of common medicines which is related to supply chain changes taking place nationally. This is the subject of a national focus involving the Department of Health, pharmaceutical manufacturers, wholesalers and pharmacy owners. The PCT will monitor the outcome of these discussions to understand if there is any local action that could be taken to improve the supply of medicines to patients. The three factors which have been explored in some depth; distribution, opening hours and dispensing provide a good basis for assessing the provision of essential services in Bromley Essential Services conclusions Dispensing of NHS prescriptions is a fundamental service, it is commissioned nationally by the NHS and provides a network of pharmacies through which the population can obtain prescribe medicines in a safe and reliable manner. Consequently, the PCT considers that access to essential services, specifically dispensing services, is a necessary service the current need for which is secured through our existing pharmacy contractors. The PCT has concluded that there are no current gaps in this service but has identified a number of issues which will need to be addressed if a gap in provision is to be avoided in the future, NHS Bromley will: review the provision in Mottingham and Chislehurst to ensure that it continues to meet the needs of local people who rely particularly heavily on pharmaceutical services work towards the co-ordination of lunchtime closures, particularly in Crystal Palace and Farnborough and Crofton wards where most or all pharmacies close at the same time during the working week ensure better signposting to pharmacies that are open late and on weekend days so that patients are easily able to find a pharmacy when their usual pharmacy is closed. review the current commissioning from our 100 hour pharmacies to ensure that we make the most of their long opening hours to deliver enhanced services to support the development of unscheduled care in Bromley e.g. the GP led health centre and the Urgent Care Centres. maintain the current provision of 100 hour pharmacy contractors to secure access in the evening and at weekends, for the population 69

70 9.2. Advanced Services Since 2005 community pharmacies have been able to provide medicines use reviews / prescription interventions (MUR/PI) under the Advanced Services within the community pharmacy contract. Contractors may choose to provide MURs and must make a declaration to the PCT of conformity with the requirements to provide. The MUR/PI service is intended to improve patients' understanding of their medicines; highlight problematic side effects & propose solutions where appropriate; improve adherence; and reduce medicines wastage, usually by encouraging the patient only to order the medicines they require. The provision of Advanced Services is linked to the provision of consultation areas within pharmacies. This was explored in some depth in the pharmacy contractor questionnaire. Where respondents chose not to answer specific questions these data are marked DNR in the tables and charts presented Premises and consultation areas As pharmacy has become more active in the delivery of new services there has been a focus on premises as an asset to support delivery. Most community pharmacies provide a consultation area to enable a private discussion to take place with patients. Research has shown that patients consider having a private area in a pharmacy an important pre-requisite to extending the role of community pharmacists. 5 The patient questionnaire also explored patient s perceptions of privacy during a consultation with their pharmacist. Distribution of consultation areas across the PCT is good with 57 of the 59 pharmacies having a consultation area and the two pharmacies (one in Central Bromley and one in Central Orpington) without an area planning to introduce one in the next 12 months. Consultations taking place in the pharmacy setting are often spontaneous. Only 20% of patients who had a consultation with the pharmacist reported that they were offered the choice of having the consultation somewhere where they could speak privately. One-third (34%) of the sample rated the level of privacy as excellent or very good, nearly half of respondents (45%) rated the privacy of the consultation as fair or worse. This suggests that there is more that could be done to encourage pharmacists to make better use of their consultation areas and to ensure that in the course of their consultations with patients they offer the option of a private area, something nearly all pharmacies in Bromley are able to do. Hub / Spoke Pharmacies Consultation area Plan to More than one introduce in area in next 12 pharmacy months Beckenham Penge and Anerley 6 6 West Wickham Beckenham and Penge Central Bromley Mottingham and Chislehurst Bromley Biggin Hill 3 3 Central Orpington The Crays Orpington Bromley Figure 70: Consultation areas current and planned in Bromley Source: Bromley PNA Pharmacy Contractor Questionnaire June Patients Association Community Pharmacists Here to help. 70

71 Five pharmacies reported having more than one consultation area suggesting that there is demand in some pharmacies to use private areas concurrently. Two of these pharmacies currently allow other practitioners to use their consultation areas and all five would be willing to do so in the future. Of the 57 pharmacies with a consultation area, 56 of these have been notified to the PCT as meeting the requirements for advanced services (signposted, conversations cannot be overheard and seating for patient and pharmacist). The general picture of provision is good across Bromley. The Crays has the largest gap in provision with two pharmacies relatively close together unable to provide a consultation area for MUR (See Appendix 6). Hub / Spoke Pharmacies Consultation area Registered for MUR Beckenham Penge and Anerley West Wickham Beckenham and Penge Central Bromley Mottingham and Chislehurst Bromley Biggin Hill Central Orpington The Crays Orpington Bromley Figure 71: Pharmacies with consultation areas registered for MUR Source: Bromley PNA Pharmacy Contractor Questionnaire June 2010 Consultation areas in pharmacies take many forms. To provide the MUR/PI service in the pharmacy the pharmacy must have an area that is clearly signposted, has space for the patient and pharmacist to sit down and where their conversation cannot be overheard. These standards have become the defacto minimum standards for pharmacies to adopt although many pharmacies in Bromley have areas which exceed these standards. The questionnaire explored features of consultation areas as described in the table below. Feature Benefit / purpose Percentage of Bromley Pharmacies Computer Terminal Allows pharmacist to make a contemporaneous electronic record 75% Internet Access Allows pharmacist to access online resources during a consultation 75% Wheelchair Access Allows patients in a wheelchair to access the consultation area 74% Sink / Hot water supply Hand washing facilities for services that require examination or samples to be taken 72% PMR Access Allows the pharmacist to look up recent medication history from the consultation area 68% Telephone 33% Allows the pharmacist to offer a broader range Examination Couch of services Figure 72: Consultation area facilities Bromley PCT Source: Bromley PNA Pharmacy Contractor Questionnaire June % 71

72 At spoke level the differences are more marked with some spoke areas having much lower levels of wheelchair access (Mottingham and Chislehurst) and Sink & Hot Water (Penge and Anerley, West Wickham and Mottingham and Chislehurst). Provision in Biggin Hill (which has only three pharmacies) is consistently good across all facilities. Figure 73: Current consultation areas facilities spoke level Source: Bromley PNA Pharmacy Contractor Questionnaire June

73 Eleven (20%) of the 54 pharmacies with a consultation area allow other practitioners to use the area to provide services. A further 24 (45%) would be willing to allow other practitioners to use the area in the future. Hub / Spoke Currently allow Would be willing to allow Beckenham 2 8 Penge and Anerley 1 2 West Wickham 1 1 Beckenham and Penge 4 11 Central Bromley 1 4 Mottingham and Chislehurst 2 0 Bromley 3 4 Biggin Hill 1 Central Orpington 2 5 The Crays 2 3 Orpington 4 9 Bromley Figure 74: Current and future use of consultation areas by other practitioners Source: Bromley PNA Pharmacy Contractor Questionnaire June Assessing provision of advanced pharmaceutical services Advanced services were introduced in 2005 and currently consist of one service, the Medicines Use Review / Prescription Intervention (MUR) service. The following analysis describes the current provision of the service to the population Distribution of providers of advanced services by locality Almost all pharmacies provide the MUR service, providing good coverage across Bromley. Fifty three pharmacies are actively providing this service. Pharmacies providing Hub / Spoke MUR Beckenham 10 Penge and Anerley 5 West Wickham 3 Beckenham and Penge 19 Central Bromley 11 Mottingham and Chislehurst 2 Bromley 13 Biggin Hill 3 Central Orpington 14 The Crays 5 Orpington 21 Bromley 53 Figure 75: Pharmacies providing MUR Source: Bromley PCT MIS (2010) 73

74 Analysis of advanced services activity by locality Each pharmacy may choose how many MURs to undertake up to a maximum of 400 per annum. In practice more pharmacies undertake around half this number and activity is variable as the following table shows. MURs in 2009 Hub / Spoke Not active All pharms Beckenham Penge and Anerley West Wickham Beckenham and Penge Central Bromley Mottingham and Chislehurst Bromley Biggin Hill Central Orpington The Crays Orpington Bromley Figure 76: MUR activity in pharmacies 2009 Source: Bromley PCT MIS (2010) Benchmarking provision Benchmarking data from the NHS Information Centre shows that Bromley has relatively high provision of MUR with 92% of pharmacies actively providing in 2008/09. This compares well with the ONS peer group median of 88% of pharmacies. Figure 77: MUR provision in ONS peer group Source: NHSIC (2009) Activity among active pharmacies in Bromley is comparatively low with the average provider undertaking 166 MURs in 2008/09 while the peer group median was

75 Figure 78: MUR activity in ONS peer group Source: NHSIC (2009) The provision at ward level mapped to proxies for need can help to highlight gaps, if any, in provision. The table below shows the provision of MUR and the number of pharmacies that have conducted more than 10 MURs 2009/10. The following proxies for need related to MUR are used, namely; Proportion of the population of older people Disease prevalence Hospital admissions Wards falling into the upper quintile for each are highlighted in the table. Provision of MUR is well matched to these proxies for need in most areas with the exception of Penge and Anerley where only one of the three pharmacies in Crystal Palace is active in MUR and also in Mottingham and Chislehurst where only one of the three pharmacies in the spoke is active. 75

76 All pharmacies Conducting more than 10 MURs % Older people % with LTLI Hospital Admissions Spoke Locality Ward Beckenham Copers Cope 5 3 Kelsey and Eden Park 6 5 Shortlands 1 1 Penge and Anerley Crystal Palace 3 1 Y Penge and Cator 3 2 West Wickham West Wickham 3 2 Central Bromley Bickley 2 2 Bromley Common and Keston 1 Bromley Town 4 3 Hayes and Coney Hall 3 3 Plaistow and Sundridge 2 1 Mottingham and Chislehurst Chislehurst 2 1 Y Mottingham and Chislehurst North 1 Y Biggin Hill Biggin Hill 3 3 Y Y Central Orpington Chelsfield and Pratts Bottom 3 3 Farnborough and Crofton 3 3 Y Y Orpington 5 5 Y Y Y Petts Wood and Knoll 3 3 Y The Crays Cray Valley East 5 3 Y Y Cray Valley West 1 1 Y Y Total Figure 79: Provision of MUR mapped to proxies for need Source: Bromley PCT MIS (2010), ONS Census 2001 and HES 2007/08. 76

77 Patient views Over half of the patients who responded to the PNA questionnaire (57%) had one or more medicines on repeat prescription. Around one in five patients had stopped taking their medicine because of side effects in the past, a similar proportion occasionally forgot to take their medicine. Respondents prescribed a new medicine (40%) in the last 12 months highlighted the areas where they would like more information about their medicine. Around half (49%) would have liked information about possible side effects and what to do if one occurs, one third (32%) would have liked an explanation of what the medicine was for and about a quarter in each case would have liked information about how to use the medicine, when to use it and what other medicines to avoid Advanced services (e.g. Medicines Use Review) - conclusions The purpose of Medicines Use Review (MUR) fits well with the PCT s strategic aims, particularly improving outcomes for patients with long term conditions. Evidence for the effectiveness of MUR is not yet well developed although some early studies show that the service can improve self-reported rates of adherence among patients 6. This is important given the problems with adherence highlighted by the patient questionnaire. The PCT has concluded that it is a relevant service for our population and that there are no gaps in provision. However the PNA has highlighted some opportunities to improve the provision of this service. We will work with willing providers in areas of need to ensure that there is provision where there is the greatest demand specifically, Penge and Anerley (particularly Crystal Palace), Mottingham and Chislehurst and The Crays 6 The Pharmaceutical Journal, 2010; 284:178 77

78 9.3. Enhanced pharmaceutical services Bromley PCT currently commissions the following enhanced services: Needle exchange Supervised consumption Emergency hormonal contraception Smoking cessation On demand availability of specialist drugs Monitored Dosage Service Chlamydia screening NHS Health Checks This section explores the provision of these services in Bromley and draws on the results of the pharmacy contractor questionnaire to describe willingness to provide among pharmacies not currently commissioned to provide any of these services. The analysis also includes national benchmarking data, where this is available, to compare Bromley to PCTs in the ONS peer group Needle Exchange The aim of the needle exchange service is to minimise harm associated with the use of injecting equipment by drug users. The service provides clean injecting equipment and takes in used equipment for safe disposal. The service also provides an opportunity to signpost users to other services and also to convey health promoting messages. LBB has a Drug Action Team (DAT) which co-ordinates the local strategy for drug and alcohol treatment. Drug treatment and harm minimisation services directly address an important strand in the DAT s strategic plan. Although the numbers of people affected are small, the impact on the wider community can be significant if not properly managed with consequences for blood borne disease, health and safety and drug related crime. Needle exchange services are commissioned by 83% of PCTs in Bromley s ONS peer group Current commissioning Current commissioning aims to ensure that there are strategically located needle exchange sites across Bromley. Provision of this service is focused in Beckenham and Penge and central Bromley. Around 20% of pharmacies in Bromley provide this service. There is a notable absence of significant pharmacy providers in the Orpington hub. However the PCT hopes to remedy this through existing pharmacy contractors willing to provide this service. As the table overleaf shows 11 of the 59 pharmacies provide this service and 18 would be willing to do so. The PCT requires all 100 hour pharmacies to offer the needle exchange service. The PCT will be working with these contractors and the DAT to co-ordinate this provision. 78

79 Hub / Spoke Pharmacies Currently Willing to be commissioned commissioned Beckenham Penge and Anerley West Wickham Beckenham and Penge Central Bromley Mottingham and Chislehurst 3 1 Bromley Biggin Hill Central Orpington The Crays Orpington Bromley Figure 80: Provision of needle exchange service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June Needle Exchange Service conclusions Needle exchange service is an important public health service which reduces risk to drug users and the general population. Consequently the PCT has concluded that the provision of needle exchange service from pharmacies is a necessary service. The current pattern of provision is consistent with the needs of the population and the PCT has concluded that there are no gaps in provision. The PCT will continue to work with the 100 hour contractors and the DAT to ensure that there is adequate provision throughout Bromley and in particular in Orpington. 79

80 Supervised administration The aims of the supervised consumption service are to provide support to drug users in treatment and assurance to drug treatment teams about the use of prescribed treatment. The pharmacist supervises, often daily, the taking of drug treatment by clients in the pharmacy. The service is part of the national framework for drug treatment services and is commissioned by the Drug and Alcohol service. Supervised administration is commissioned by 67% of PCTs in Bromley s ONS peer group Current commissioning Current commissioning aims to ensure that there is a comprehensive network of supervised consumption sites across the PCT so that clients in drug treatment are able to use a service close to where they live or work. As the table below shows 14 of the 59 pharmacies provide this service and 21 would be willing to do so. Hub / Spoke Pharmacies Currently Willing to be commissioned commissioned Beckenham Penge and Anerley West Wickham Beckenham and Penge Central Bromley Mottingham and Chislehurst 3 2 Bromley Biggin Hill Central Orpington The Crays Orpington Bromley Figure 81: Provision of supervised consumption service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June Supervised administration conclusions The supervised consumption service performs a critical role in supporting drug users in treatment to manage their treatment programme while minimising the diversion of drug treatment onto the streets. The PCT has concluded that the supervised consumption service from pharmacies is a necessary service. The pattern of provision is consistent with the needs of the population and the PCT has concluded that there are no gaps in provision. 80

81 Emergency Hormonal Contraception Supply NHS Bromley commissions an Emergency Hormonal Contraception (EHC) Service from individual community pharmacies who must have at least one trained and accredited pharmacist. The aim of the EHC service is to provide a safe and accessible route for women wishing to obtain emergency contraception. It forms part of the PCT s strategic plan for avoiding unwanted pregnancy and reducing teenage pregnancy. The service was first commissioned only for women aged under 16 and was subsequently extended to women under 25 years. Teenage pregnancy rates in Bromley are relatively low but have been increasing very slightly over the last 10 years. The target for Bromley is to achieve a rate of 1.8% (18 per 1000 women) by (The rate in 2007 was 3.4% (34 per 1000)). This service is commissioned by 67% of PCTs in Bromley s ONS peer group Current commissioning About a third of pharmacies in Bromley are commissioned to provide this service. Provision is focused in Central Orpington and Central Bromley where around half of all pharmacies provide this service. In addition to pharmacies and GP practices (where EHC can be obtained on prescription), EHC is also available from the following non-pharmacy sites in Bromley: Clinic Ward Bromley Young People's Clinic Bromley Town 17 Ethelbert Road, Bromley, Kent, BR1 1JA Downham Contraceptive and Reproductive Health Clinic Plaistow and Sundridge Downham Health & Leisure Centre 7-9 Moorside Road, Bromley, Kent, BR1 5EP Mottingham Contraceptive and Reproductive Health Clinic Mottingham and Chislehurst North Kimmeridge Road, Mottingham, London, SE9 4EB Beckenham Beacon Contraceptive and Reproductive Health Clinic Kelsey and Eden Park Outpatients Department, Beckenham Hospital Croydon Road, Beckenham, Kent, BR3 3QL Addington Road Contraceptive and Reproductive Health Clinic Hayes and Coney Hall 77 Addington Road, West Wickham, Kent, BR4 9BG Penge Contraceptive and Reproductive Health Clinic Penge and Cator 17 Oakfield Road, Penge, London, SE20 8QA Figure 82: Non-pharmacy sites where emergency hormonal contraception can be obtained in Bromley Note these sites do not offer walk in services but clinics operating at specific times. 81

82 The table below shows the current commissioning of the EHC service in Bromley from community pharmacies. The ward names highlighted are those with the highest rates of teenage pregnancy. Wards marked with an * also have a non-pharmacy site (e.g. Contraceptive and Reproductive Health clinics) where EHC can be obtained. Spoke Beckenham Ward All pharmacies Currently commissioned Copers Cope Kelsey and Eden Park* Shortlands Crystal Palace Willing to be commissioned Penge and Anerley Penge and Cator* West Wickham West Wickham Bickley Central Bromley Mottingham and Chislehurst Bromley Common and Keston Bromley Town* Hayes and Coney Hall* Plaistow and Sundridge* Chislehurst Mottingham and Chislehurst North* Biggin Hill Biggin Hill Central Orpington Chelsfield and Pratts Bottom Farnborough and Crofton Orpington Petts Wood and Knoll Cray Valley East The Crays Cray Valley West Figure 83: Provision of emergency contraception service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June Patients views The PNA survey of patients asked about respondent s knowledge of, past use and willingness to use enhanced services. When data relating to the EHC service were analysed to explore women s awareness of, and intention to use, EHC services, the results also showed how the service could be targeted in the future. The target group, which is women aged up to 25 years, showed good knowledge and intention to use this service in the patients questionnaire. 82

83 % of respondents (women only) who: Age (years) Know service is available Have used service in past Would use it in the future Total Figure 84: Further analysis of women s knowledge and intention regarding an EHC service Emergency Hormonal Contraception Service conclusions The EHC service through pharmacies provides important access to EHC for women in Bromley. Without this service access would be limited and only available via appointments at a GP practice or sexual health service clinic. This would limit access considerably when compared to including pharmacy as an outlet for EHC. Consequently, the PCT considers the EHC service is a necessary service. The provision from pharmacies in Bromley is generally good, with 21 providers and 20 additional pharmacies willing to provide. However there is currently no pharmacy provision in the two wards of Cray Valley West and Mottingham and Chislehurst North. Both of these wards have high levels of teenage pregnancy. The PCT will work with willing providers to ensure that there is adequate provision in these areas. 83

84 Smoking cessation NHS Bromley commissions a Stop Smoking Service from community pharmacies. The service includes the provision of advice on stopping smoking and supply of nicotine replacement therapy (NRT). A key differentiator of pharmacy stop smoking services from other providers is the ability to supply medicines at the point of care. Pharmacies are seen as key providers of stop smoking services due to their opening hours, accessibility and ability to advise and supply NRT. The stop smoking service directly addresses a key outcome measure for the PCT. Stopping smoking is the single most effective health care intervention that can be made. Rates of smoking are highest in areas of deprivation. This service is commissioned by 83% of PCTs in Bromley s ONS peer group. Community pharmacy contractors also sell a broad range of over the counter Nicotine Replacement Therapies (NRT) which can be used by smokers intending to stop smoking to manage their own quit attempt. It is estimated that up to half of all quitters stop smoking without using a smoking cessation service; many of these will use NRT bought over the counter Current commissioning The aims of the smoking cessation service are to support smokers to quit and to provide access to NRT for clients being seen by other services. The service contributes towards the reduction in smoking rates in the population. Pharmacies deliver around 16% of the four week quitters in Bromley. Around 70% of pharmacies currently provide this service as the table below shows, the ward spoke areas highlighted in red are spokes with MSOAs in the top two quintiles for smoking rates. The highest rates are found in Penge and Anerley, The Crays, Mottingham and Chislehurst and Central Bromley. Hub / Spoke Pharmacies Currently Willing to be commissioned commissioned Beckenham Penge and Anerley 6 6 West Wickham 3 2 Beckenham and Penge Central Bromley Mottingham and Chislehurst 3 1 Bromley Biggin Hill Central Orpington The Crays Orpington Bromley Figure 85: Provision of smoking cessation service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June Patient views The survey of patients asked about respondent s knowledge of, past use and willingness to use enhanced services. When data relating to the stop smoking service were analysed, they showed that the service was the best known of all the pharmacy enhanced services with 26% of patients aware of the service, perhaps reflecting the national advertising of stop smoking services generally. Around 4% of respondents said that they would use the pharmacy service in the future, this compares to an estimated prevalence of 21% which suggests around 1 in 5 smokers would be willing to use the pharmacy service. 84

85 Smoking Cessation Service conclusions NHS Bromley The stop smoking service through pharmacies is an important strand of the PCT s efforts to reduce smoking rates among the population. Pharmacy is a unique provider with the ability to provide access to NRT at the point of care. Given this and the priority placed on reducing smoking rates in Bromley the PCT has concluded that the smoking cessation service is a necessary service. The PCT notes that most quitters in Bromley quit using other services, so the absence of pharmacy provision is not an absence of provision for that population. The PCT also notes that around half of all quitters stop smoking without using NHS services. The commissioning analysis shows that there is pharmacy provision of stop smoking services in each spoke area, including those with high prevalence rates. However, it is apparent that the provision in Mottingham and Chislehurst is limited. The PCT will keep this under review as rates of smoking are high in this spoke area and it may be that further provision is required in the future. The PCT has concluded that the network of current providers together with willing providers are sufficient to meet the needs of the population at this time. 85

86 Chlamydia screening and treatment NHS Bromley commissions a Chlamydia Screening and Treatment service from pharmacies. The service allows pharmacies to offer the option of a Chlamydia test to the target population and to then offer treatment if the test is positive. Increasing screening, education and treatment are key priorities for the PCT, the target age group is young people aged years, however there is also evidence that STI rates are rising in the older population. The aim of the Chlamydia screening service is to promote screening for Chlamydia in the year old age group and to provide advice and signposting to services for at risk people. No direct benchmarking is available however 33% of PCTs in Bromley s ONS peer group commissioned a screening service Current commissioning This service is commissioned from 60% of pharmacies in Bromley. The table below shows the provision by spoke area, broken down at ward level. The wards with the highest proportion of younger people are highlighted) SPOKE LOCALITY WARD All pharmacies Currently commissioned Willing to be commissioned Copers Cope Beckenham Kelsey and Eden Park 6 6 Shortlands 1 1 Penge and Crystal Palace Anerley Penge and Cator 3 2 West Wickham West Wickham 3 3 Bickley 2 1 Bromley Common and Keston 1 1 Central Bromley Bromley Town Hayes and Coney Hall Plaistow and Sundridge Mottingham Chislehurst 2 and Chislehurst Mottingham and Chislehurst North 1 1 Biggin Hill Biggin Hill 3 2 Central Orpington Chelsfield and Pratts Bottom 3 3 Farnborough and Crofton 3 2 Orpington Petts Wood and Knoll 3 2 Cray Valley East 5 4 The Crays Cray Valley West Figure 86: Provision of Chlamydia screening service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June

87 Patient views The survey of patients asked about respondent s knowledge of, past use and willingness to use enhanced services. Further analysis of respondents awareness of, and intention to use, Chlamydia testing services showed show extremely low levels of awareness, past use and intention to use. % of respondents (women only) who: Age (years) Know service is available Have used service in past Would use it in the future Total Figure 87: Further analysis of women s knowledge and intention regarding a Chlamydia testing service Awareness among men was particularly low. % of respondents (men only) who: Age (years) Know service is available Have used service in past Would use it in the future Total Figure 88: Further analysis of men s knowledge and intention regarding a Chlamydia testing service High percentages in specific age bands are likely to be caused by low numbers of respondents in this range leading to high weighted percentages Chlamydia screening and treatment conclusions The Chlamydia screen and treat service has yet to fully develop. The experience in Bromley is mirrored in other PCTs where uptake, generally, has been low. However in areas where pharmacy is situated in a destination for young people, like town centres, the service works well The PCT has concluded that the Chlamydia screening and treatment service is a relevant service for the population and one which pharmacy, alongside other providers, makes a valuable contribution towards delivering. The data from the patient questionnaire suggests that the success of the pharmacy screening service will be dependent upon pharmacies actively targeting patients and / or local marketing of the service to the target population. The PCT will review the uptake and commissioning of this service to ensure the best fit with the objectives and to fit with other screening programmes. 87

88 On demand availability of specialist drugs NHS Bromley commissions an important service for patients and healthcare professionals which ensures that there is ready access to advice and supply of palliative care drugs for end of life care. Making these drugs available, and having a network of pharmacies that undertake to hold stock of these unusual, but urgently needed drugs, assists patients who choose to die at home. The aims of this service is to provide access to drugs used in specific circumstances e.g. end of life care. The pharmacies participating undertake to hold stock of these medicines and to be available to supply these to patients and clinical staff who may need then urgently. This service is commissioned by 50% of PCTs in Bromley s ONS peer group Current commissioning Four pharmacies sited strategically across the PCT are commissioned to provide this service. Hub / Spoke Pharmacies Currently Willing to be commissioned commissioned Beckenham Penge and Anerley 6 3 West Wickham 3 1 Beckenham and Penge Central Bromley Mottingham and Chislehurst 3 1 Bromley Biggin Hill 3 2 Central Orpington The Crays 6 4 Orpington Bromley Figure 89: Provision of on demand drugs service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June On demand availability of drugs conclusions This important service is a necessary service for the population. The provision from the four strategically place providers currently meets the needs of the population. 88

89 NHS Health Checks NHS Bromley currently commissions an NHS Health Checks service from GPs. Pharmacies are commissioned to provide the service where there are gaps in provision by GPs. The service is aimed at patients aged years of age. The aim of the service is to deliver NHS Health Checks from community pharmacies in Bromley in areas where the GP does not wish to provide the service to their local population. A pilot was conducted in three pharmacies and has resulted in pharmacies being offered alternative provider status for the roll out of NHS Health Checks in Bromley. Nine pharmacies have confirmed their interest in providing the service Current commissioning The service is currently commissioned from three pharmacies. There is strong willingness to provide this service, with 39 pharmacies willing to take part if required. Hub / Spoke Pharmacies Currently Willing to be commissioned commissioned Beckenham Penge and Anerley West Wickham 3 Beckenham and Penge Central Bromley Mottingham and Chislehurst 3 Bromley Biggin Hill 3 2 Central Orpington The Crays 6 3 Orpington Bromley Figure 90: Provision of NHS health checks service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June Patient views The NHS Health Checks service was the second most recognised pharmacy service, 11% of respondents were aware of the service. This perhaps represents an example where patients confuse NHS commissioned services with services provided and promoted by pharmacies independently. However the level of awareness is a good base from which to extend the service. Around 25% respondents said that they would be willing to use this kind of service from a pharmacy in the future. Further analysis of responses regarding the healthy heart check-up showed that this service could be targeted to a particularly receptive group of men and women aged years. Age (years) Male Female All (n=247) % 15.1% 18.3% % 28.3% 32.0% % 21.7% 20.2% Total 32.6% 22.3% 25.7% Figure 91: Further analysis of groups wanting healthy heart advice 89

90 NHS Health Checks Conclusions The NHS Health Checks service has been piloted through community pharmacy and the result has supported the case for pharmacy to be offered alternative provider status for the roll out of NHS Health Checks. As the rollout is currently taking place, it is too early to make any concrete assessment of its status for the PNA. At this time, therefore the PCT has concluded that the NHS Health Checks service is a relevant service for the population. The PCT will revise this assessment as more information on uptake and outcomes of the service is available. 90

91 Monitored dosage system service NHS Bromley commissions a monitored dosage system service from some community pharmacies. The aim of the monitored dosage system (MDS) service is to support patients and their carers to manage taking medicines effectively in the home setting. The service seeks to reduce unintended errors in dosing and to promote independence for patients. This service is currently under review by the PCT which is seeking to understand how patients who require support with their medicines can best be supported while maintaining independence Current commissioning The service is commissioned from 63% of pharmacies in Bromley. Hub / Spoke Pharmacies Currently Willing to be commissioned commissioned Beckenham Penge and Anerley West Wickham 3 2 Beckenham and Penge Central Bromley Mottingham and Chislehurst 3 3 Bromley Biggin Hill 3 2 Central Orpington The Crays Orpington Bromley Figure 92: Provision of MDS service from pharmacies and willingness to provide Source: Bromley PNA Pharmacy Contractor Questionnaire June Patient views Respondents were asked whether they received or would like help with medicines from pharmacies. The most common form of support from pharmacies is the collection of prescription service. The most frequently reported and desired help related to the mechanics of the medicine supply process (ordering through to delivery), but some respondents reported actual and desired help with enhanced labelling and adherence aids. There was modest demand for explanations of medicines from someone at the pharmacy (2.6%). % (n=966) Type of Help Already get Would like to get Collecting my prescription from the doctor Put a label on my medicines that is easy to read Order my prescription from the doctor Deliver the prescription to my home Put my medicines in a container that is easy to open Put my medicines in an organiser to help me remember to take them Give me a chart to help me remember when to take medicines Someone at the pharmacy to explain medicines to me Not asked 2.6 Figure 93: Help with medicines both received and desired from pharmacies 91

92 Monitored dosage system service - conclusions NHS Bromley The MDS service seeks to reduce unintended errors in dosing and to promote independence for patients. The service is currently under review by the PCT which is seeking to understand how patients who require support with their medicines can best be supported while maintaining independence. The PNA has provided some insight into the views of patients and pharmacists which will be used to inform the review process and any subsequent commissioning by the PCT. 92

93 9.4. Future services The PNA has highlighted some areas that will be considered as part of the PCT s commissioning plans for pharmacy services in the future Other services commissioned by peer PCTs PCTs within Bromley s ONS peer group also commission the following services; 50% medication review service 67% out of hours service 33% MAS 33% care homes 33% language access service 33% home delivery The PNA contractor questionnaire asked community pharmacists to consider a list of potential enhanced services and to indicate if they would be willing to provide these services if commissioned. These have been categorised for the purposes of analysis into the following high level groups: Public health services aimed at promoting positive health behaviours or improving the public health by intervention or treatment Long term conditions (LTCs) services aimed at improving the management of long term conditions Access services aimed at improving access to health services Screening services aimed at screening for undiagnosed disease Waste services aimed at reducing waste, particularly in relation to medicines 93

94 Some services may fit under more than one heading so a pragmatic approach has been taken in allocating each service to a corresponding heading. Service Category Prescription collection service Access Minor Ailments Service Access Prescription delivery service Access Gluten free food prescribing Access Antiviral distribution Access Flu vaccination Access Mobility aids supply Access Blood pressure monitoring LTC INR testing LTC Management of COPD LTC Medication review in the pharmacy (not MUR) LTC Falls prevention service LTC Medication review in patients home LTC Supply of MDS to care homes LTC Hospital discharge planning LTC Training care home staff LTC Weight Management Service Public health Condom distribution Public health Long term contraception supply Public health Free Pregnancy testing Public health Brief intervention for alcohol Public health Supply of NHS healthy start milk Public health Hepatitis B and C screening and Hep B immunisation Public health Diabetes testing Screening Spirometry Screening Specials monitoring service Waste Not dispensed service Waste Figure 94: Allocation of enhanced services to categories Support for services from contractors: Contractors responding to the questionnaire were asked to consider whether they would be willing to provide each enhanced service listed were the PCT to commission. Support for services from contractors was generally consistent across the hub and spoke areas. The top 10 services supported by contractors were: Blood pressure monitoring Prescription collection service Weight Management Service Minor Ailments Service Prescription delivery service Diabetes testing Condom distribution INR testing Gluten free food prescribing Long term contraception supply The detailed results are shown on the table overleaf. 94

95 Beckenham Penge and Anerley West Wickham Beckenham and Penge Central Bromley Mottingham and Chislehurst Bromley Biggin Hill Central Orpington The Crays Orpington Bromley Category Blood pressure monitoring LTC Prescription collection service Access Weight Management Service Public health Minor Ailments Service Access Prescription delivery service Access Diabetes testing Screening Condom distribution Public health INR testing LTC Gluten free food prescribing Access Long term contraception supply Public health Free Pregnancy testing Public health Spirometry Screening Management of COPD LTC Med. review in the pharmacy (not MUR) LTC Antiviral distribution Access Flu vaccination Access Falls prevention service LTC Medication review in patients home LTC Brief intervention for alcohol Public health Mobility aids supply Access Supply of MDS to care homes LTC Supply of NHS healthy start milk Public health Specials monitoring service Waste Not dispensed service Waste Hospital discharge planning LTC Training care home staff LTC Hep B & C screening and Hep B imms Public health Figure 95: Willingness to provide enhanced services in the future Source: Bromley PNA Pharmacy Contractor Questionnaire June

96 Patient views Patients were also asked to consider which services they would be willing to use from a community pharmacy in the future. The table below shows the results from this question. Service % (n=966) Service % (n=966) Treatment on the NHS for a minor illness 35.8 Condoms on the NHS 12.5 Healthy heart check-ups 25.5 Pregnancy testing 11.9 Flu vaccination 17.0 Treatment on the NHS for head lice 9.1 Help watching your weight The morning after pill without a 17.0 prescription 7.8 Advice about diet and/ or exercise 16.9 Chlamydia testing and treatment 4.2 Monitoring how your medicines are Anticoagulation checks 16.7 working 3.9 Advice about leading a healthy life 14.5 Disposal of injecting equipment 3.9 Diabetes check ups 13.5 Stop smoking help 4.1 Medicine reviews 12.4 Gluten free foods 2.6 Contraception medicines without a prescription 12.7 Figure 96: Predisposition to use services, if available, from local pharmacies Synthesis These are explored in this section using a framework which links pharmacy contractor willingness to provide with patient s views and the priorities for the PCT. We have also included services prioritised by the LPC for consideration by the PCT. 96

97 Service in top 10 Minor ailments service Flu vaccination Weight management Diabetes monitoring Long term contraception supply Condom supply Pregnancy testing Anticoagulation checks Gluten free foods supply Support from patients % (rank) Additional services prioritised by the LPC Support from pharmacy contractors % (rank) Link to PCT priority areas 36% (1) 85% (3) Strategic goal: Improve access to services 17% (3) 61% (12) Health and Well-being programme: Immunisations 17% (3) 86% (2) Health and Well-being programme: Obesity 14% (7) 81% (4) Polysystem programme: Diabetes pathway 13% (9) 69% (8) Strategic goal: Improve access to services 13% (9) 80% (5) Strategic goal: Improve access to services 12% (10) 68% (9) Strategic goal: Improve access to services Acute Care Pathway Redesign: Maternity and Care of the Newborn 4% (14) 78% (6) Strategic goal: Improve access to services Priority health outcome: CVD /CHD mortality 3% (17) 71% (7) Strategic goal: Improve access to services Brief interventions for alcohol use Not asked 61% (12) Strategic goal: Improve access to services Priority health outcome: CVD /CHD mortality Hepatitis C screening Not asked 48% (18) Strategic goal: Improve access to services COPD management Not asked 63% (11) Strategic goal: Improve access to services Figure 97: Prioritised list of enhanced services 97

98 Future services conclusions The PNA will inform the PCT s commissioning intentions in the future. The analysis of future services has identified some options which could be considered as part of the commissioning process. These may include: Minor ailments service Flu vaccination Weight management Diabetes monitoring Long term contraception supply Condom supply Pregnancy testing Anticoagulation checks Gluten free foods supply Brief interventions for alcohol use COPD management Hepatitis C screening The PNA will need to be considered alongside the changes taking place within the NHS and the future role that the PCT will have in commissioning services from pharmacies. The PCT has not identified services not provided in the localities that will, in specified future circumstances, need to be provided in order to meet a need for pharmaceutical services or to secure improvements or better access to pharmaceutical services. 98

99 Appendix 1: Policy context and background papers A Vision for Pharmacy in the New NHS (July 2003) The pace of change for NHS community pharmaceutical services over the last 10 years has been more rapid than at any other time in the last 60 years. Community pharmacy has featured more prominently in the NHS s efforts to improve services with recognition of their ability to respond innovatively and creatively can be better utilised. A Vision for Pharmacy in the New NHS identified and aligned the ambitions for pharmacy alongside the wider ambitions for the NHS as a whole. Choosing health through pharmacy Choosing Health was launched in 2004 and set out a programme of action to enable people to improve their own health. As part of this programme, the Government published a strategy for pharmaceutical public health (Choosing Health Through Pharmacy) which expanded the contribution that pharmacists, their staff and the premises in which they work can make to improving health and reducing health inequalities. This strategy recognised that pharmacists work at the heart of the communities they serve and enjoy the confidence of the public. Every day, they support self care, provide health messages, advice and services in areas such as diet, physical activity, stop smoking and sexual health. A new contractual framework for community pharmacy As part of the Vision for Pharmacy a new community pharmacy contractual framework was launched in April It comprises three tiers of services; essential, advanced and local enhanced services. Essential services are those which every pharmacy must provide, including dispensing. Advanced services are those which, subject to accreditation requirements, a pharmacy contractor can choose to provide. At present, there is one advanced service - the Medicines Use Review (MUR) - where a pharmacist discusses with a patient their use of the medicines they are taking and whether there are any problems which the pharmacist can help resolve. Essential and advanced services are determined nationally. Local enhanced services, commissioned locally by PCTs. Our health, our care, our say 2006 Launched in January 2006, Our health, our care, our say set out a new strategic direction for improving the health and well-being of the population. It focused on a strategic shift to locate more services in local communities closer to people s homes. The vital role that community pharmacies can offer both in providing services to patients with long term conditions and making treatment for minor illnesses accessible and convenient was recognised in this policy document. NHS Next Stage Review 2008 The NHS Next Stage Review sets out a vision for an NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart. The changes mean that services will be delivered closer to home, with a much greater focus on helping people stay healthy and a stronger emphasis on the NHS working with local partners. Pharmacy has a key role to play in delivering this vision, particularly as a provider of services which prevent ill-health, promote better health for all and improve access to services within communities. Pharmacy in England - Building on strengths delivering the future 2008 Pharmacy in England sets out a vision for building on the strengths of pharmacy, using that capacity and capability to deliver further improvements in pharmaceutical services over the coming years as part of an overall strategy to ensure safe, effective, fairer and more personalised patient care. 99

100 Pharmacy in England has put forward a broad range of proposals to build on progress which has succeeded in embedding community pharmacy s role in improving health and well-being and reducing health inequalities. These include proposals for how pharmacies will, over time: become healthy living centres promoting health and helping more people to take care of themselves; offer NHS treatment for many minor ailments (e.g. coughs, colds, stomach problems) for people who do not need to go to their local GP; provide specific support for people who are starting out on a new course of treatment for long term conditions such as high blood pressure or high cholesterol; offer screening for those at risk of vascular disease an area where there are significant variations in access to services and life expectancy around the country; use new technologies to expand choice and improve care in hospitals and the community, with a greater focus on research; and be commissioned based on the range and quality of services they deliver. For PCTs this presents a timely opportunity to take stock of progress with the development and integration of pharmacy services and to prepare a strategy to deliver the vision over the next 3-5 year period. Equity and Excellence: Liberating the NHS The recent White Paper, Equity and Excellence: Liberating the NHS, has set in motion a significant programme of change which will have an impact on how pharmaceutical services are planned and in the future. The White Paper makes specific reference to pharmacy and pharmaceutical services: The community pharmacy contract, through payment for performance, will incentivise and support high quality and efficient services, including better value in the use of medicines through better informed and more involved patients. Pharmacists, working with doctors and other health professionals, have an important and expanding role in optimising the use of medicines and in supporting better health. Pharmacy services will benefit from greater transparency in NHS pricing and payment for services. While the White Paper proposes that some aspects of pharmaceutical services will be managed by the NHS Commissioning Board there will also be opportunities for greater local commissioning through public health and GP consortia in the future. The following documents provide some background to the PNA development process, the relevant policy and guidance available to PCTs. Pharmacy in England: building on strengths - delivering the future Developing pharmaceutical needs assessments guidance This guidance and individual supporting guides explain why PNAs are important and how they fit into PCTs' planning cycles. It outlines how to produce a new PNA or revise an existing one. 100

101 e.aspx Pharmacy-based stop smoking services guidance Provides guidance to PCTs when commissioning 'world class' pharmacy-based stop smoking services. The NHS (Pharmaceutical Services) Regulations: information for primary care trusts - revised September 2009 This guidance assists PCTs in the assessment and determination of applications to provide NHS pharmaceutical services. It incorporates reforms effective from 1 April 2005 to the regulatory system and subsequent amendments to the Regulations since. This includes the amendments which came into force on 17 September SI 2009/2205. It also incorporates supplementary information for Primary Care Trusts on the NHS Pharmaceutical Services (Fees for Applications) Directions 2008 which give Primary Care Trusts the ability to charge for certain applications for inclusion on their NHS pharmaceutical services lists World class commissioning: Improving Pharmaceutical Services This is a practical guide to support PCTs in commissioning pharmaceutical services. Local pharmaceutical services (LPS) LPS is a tool available to PCTs to enable them to contract locally for provision of pharmaceutical and other services, including those not traditionally associated with pharmacy, within a single contract. rmaceuticalservices/lpspermanenceguidance/index.htm Advisory Group on the NHS (Pharmaceutical Services) Regulations Following the publication of the White Paper Pharmacy in England: Building on strengths - delivering the future, a consultation was held in the autumn 2008 on proposals for legislative change. The DH has now published the revised guidance and regulations. The regulations were laid in parliament on 23 rd March 2010 and will came into force on 24th May The updated guidance and regulations can be accessed at: sset/dh_ pdf 101

102 102 NHS Bromley

103 Appendix 2: Membership of the steering group Sonia Colwill (Chair) Jill Webb Agnes Marossy Ann Coppinger David Whittaker Piyush Amin Director of Prescribing & Quality (Chair) - NHS Bromley Associate Director of Primary Care - NHS Bromley Consultant in Public Health Medicine NHS Bromley Communications Director NHS Bromley GP & Local Medical Committee Representative Community Pharmacist & Bexley, Bromley & Greenwich Local Pharmaceutical Committee Representative Raj Matharu Joint Chief Officer - Bexley, Bromley & Greenwich Local Pharmaceutical Committee Gianpiero Celino Tushar Shah Jane Waldeck Sam Paice GP Prescribing leads to receive minutes and attend when required Elaine Morgan - To receive minutes and attend when required Webstar Health Community Pharmacy Adviser NHS Bromley PA to Director of Prescribing & Quality NHS Bromley Bromley LINk Practice Based Clusters Finance 103

104 Appendix 3: Pharmacy contractors in Bromley NHS Bromley Beckenham and Penge Hub Area FCS CODE TRADING NAME ADDRESS 1 ADDRESS 2 ADDRESS 3 POSTCODE WARD SPOKE LOCALITY HUB LOCALITY FE112 Beckenham Pharmacy High Street Beckenham Kent BR3 1AH Copers Cope Beckenham Beckenham and Penge FPA70 Beckenham Pharmacy 70 High Street Beckenham Kent BR3 1ED Copers Cope Beckenham Beckenham and Penge FQ322 Blackwells Chemist 245 Croydon Road Beckenham Kent BR3 3PS Kelsey and Eden Park Beckenham Beckenham and Penge FKG02 Boots the Chemist 182 High Street Beckenham Kent BR3 1EW Copers Cope Beckenham Beckenham and Penge FJC01 Elmers Pharmacy 172 Upper Elmers End Beckenham Kent BR3 3DY Kelsey and Eden Park Beckenham Beckenham and Penge FDN35 Lotus Pharmacy 119 Croydon Road Beckenham Kent BR3 3RA Kelsey and Eden Park Beckenham Beckenham and Penge FY725 Macks Pharmacy 2 Eden Park Avenue Beckenham Kent BR3 3HN Kelsey and Eden Park Beckenham Beckenham and Penge FKM27 Park Langley Pharmacy 90 Wickham Road Beckenham Kent BR3 6QH Kelsey and Eden Park Beckenham Beckenham and Penge FAD85 Paydens Pharmacy Croydon Road Beckenham Kent BR3 3PR Kelsey and Eden Park Beckenham Beckenham and Penge FNL39 Peters Chemist 15 Bromley Road Beckenham Kent BR3 5NT Copers Cope Beckenham Beckenham and Penge FJV12 Rowlands Pharmacy 121 Westmoreland Rd Bromley Kent BR2 0TY Shortlands Beckenham Beckenham and Penge FG099 Superdrug Pharmacy High Street Beckenham Kent BR3 1EA Copers Cope Beckenham Beckenham and Penge FQD55 Boots the Chemist 5 Colman House, High Penge London SE20 7EX Penge and Cator Penge and Anerley Beckenham and Penge FA819 Hamlet Pharmacy 45 Anerley Road Anerley London SE19 2AS Crystal Palace Penge and Anerley Beckenham and Penge FA767 Kamsons Pharmacy 121 Anerley Road Anerley London SE20 8AJ Crystal Palace Penge and Anerley Beckenham and Penge FRH46 Macks Pharmacy 165 High Street Penge London SE20 7PF Penge and Cator Penge and Anerley Beckenham and Penge FX117 TT Pharmacy 174 Croydon Road Penge London SE20 7YZ Crystal Palace Penge and Anerley Beckenham and Penge FYA22 United Pharmacy 5 The Parade, Croydon Penge London SE20 7TJ Penge and Cator Penge and Anerley Beckenham and Penge FQN66 Boots the Chemist 90 Station Road West Wickham Kent BR4 0PU West Wickham West Wickham Beckenham and Penge FRD37 Lloyds Pharmacy 108 High Street West Wickham Kent BR4 0LT West Wickham West Wickham Beckenham and Penge FL891 Westchem 89 Station Road West Wickham Kent BR4 0PX West Wickham West Wickham Beckenham and Penge 104

105 Bromley Hub Area FCS CODE TRADING NAME ADDRESS 1 ADDRESS 2 ADDRESS 3 POSTCODE WARD SPOKE LOCALITY HUB LOCALITY FD505 Day Lewis (Bromley) 195 Widmore Road Bromley Kent BR1 2RG Bickley Central Bromley Bromley FT918 Gordon Davie Chemist 195 Southborough Lane Bromley Kent BR2 8AR Bickley Central Bromley Bromley FTK32 Wallace Pring & Co 40 Chatterton Road Bromley Kent BR2 9QE Bromley Common and Keston Central Bromley Bromley FAH85 Boots the Chemist High St Bromley Kent BR1 1JY Bromley Town Central Bromley Bromley FM350 Boots the Chemist 40 The Glades Bromley Kent BR1 1DN Bromley Town Central Bromley Bromley FKE53 Caxton Pharmacy 3 Widmore Rd Bromley Kent BR1 1RL Bromley Town Central Bromley Bromley FVR97 Scotts Pharmacy 7 High Street Bromley Kent BR1 1LF Bromley Town Central Bromley Bromley FFA94/FRBoots the Chemist 15 Station Approach Hayes Kent BR2 7EQ Hayes and Coney Hall Central Bromley Bromley FG145 Coney Hall Pharmacy 5 Kingsway, Coney Hall West Wickham Kent BR4 9JB Hayes and Coney Hall Central Bromley Bromley FT602 Day Lewis (Hayes) 5 Station Approach Hayes Kent BR2 7EQ Hayes and Coney Hall Central Bromley Bromley FCA86/FDBoots the Chemist 125 Burnt Ash Lane Bromley Kent BR1 5AB Plaistow and Sundridge Central Bromley Bromley FAQ83/FRLondon Lane Pharmacy 84 London Lane Bromley Kent BR1 4HE Plaistow and Sundridge Central Bromley Bromley FVF13 L M Williams High Street Chislehurst Kent BR7 5AG Chislehurst Mottingham and Chislehurst Bromley FVN52 Lloyds Pharmacy 59 High Street Chislehurst Kent BR7 5AF Chislehurst Mottingham and Chislehurst Bromley FH398 Lloyds Pharmacy 4/6 Cranley Parade, Beaconsfield Road Mottingham London SE9 4DZ Mottingham and Chislehurst North Mottingham and Chislehurst Bromley 105

106 Orpington Hub Area FCS CODE TRADING NAME ADDRESS 1 ADDRESS 2 ADDRESS 3 POSTCODE WARD SPOKE LOCALITY HUB LOCALITY FVR91 Boots the Chemist Main Road Biggin Hill Kent TN16 3JZ Biggin Hill Biggin Hill Orpington FWA21 Day Lewis (Biggin Hill) 136 Main Road Biggin Hill Kent TN16 3BA Biggin Hill Biggin Hill Orpington FXM78/FMLloyds Pharmacy 3 Roundways Biggin Hill Kent TN16 3XZ Biggin Hill Biggin Hill Orpington FE693 Lloyds Pharmacy 13 Windsor Drive, Chelsfield Orpington Kent BR6 6EY Chelsfield and Pratts Bottom Central Orpington Orpington FL057 Rowlands Pharmacy 10 Crescent Way Orpington Kent BR6 9LP Chelsfield and Pratts Bottom Central Orpington Orpington FMK62 Stevens Chemist 5 High Street, Green Street Green Orpington Kent BR6 6BG Chelsfield and Pratts Bottom Central Orpington Orpington FN052 Crofton Pharmacy 1 Place Farm Ave Orpington Kent BR6 8DG Farnborough and Crofton Central Orpington Orpington FLK72 Sainbury s Pallant Way, Locks Bottom Farnborough Kent BR6 8NZ Farnborough and Crofton Central Orpington Orpington FM963 Village Pharmacy 131 High Street Farnborough Kent BR6 7AZ Farnborough and Crofton Central Orpington Orpington FDF35 Boots the Chemist 216 High Street Orpington Kent BR6 0LS Orpington Central Orpington Orpington FKV60 Eldred Drive Pharmacy 25 Eldred Drive Orpington Kent BR5 4PE Orpington Central Orpington Orpington FRC25 Farncray Ltd 330 High Street Orpington Kent BR6 0NQ Orpington Central Orpington Orpington FJK92 Superdrug Pharmacy High Street Orpington Kent BR6 0PS Orpington Central Orpington Orpington FX096 Tesco Extra 9 Augustus Lane Orpington Kent BR6 0NH Orpington Central Orpington Orpington FC864 Boots the Chemist 77 Queensway Petts Wood Kent BR5 1DQ Petts Wood and Knoll Central Orpington Orpington FGG04 Farrants Chemist 13 Station Square Petts Wood Kent BR5 1LY Petts Wood and Knoll Central Orpington Orpington FR247 Petts Wood Pharmacy 83 Queensway, Petts Wood Orpington Kent BR5 1DQ Petts Wood and Knoll Central Orpington Orpington FJ793 Cray Valley Pharmacy 55 High Street, St Mary Cray Orpington Kent BR5 3NJ Cray Valley East The Crays Orpington FQF14 Lloyds Pharmacy 34 Marion Crescent, St Paul's Cray Orpington Kent BR5 2DD Cray Valley East The Crays Orpington FTM53 Priory Pharmacy 8 Carlton Parade Orpington Kent BR6 0JB Cray Valley East The Crays Orpington FR366 Silversands Ltd 1 Kent Road, St Mary Cray Orpington Kent BR5 4AD Cray Valley East The Crays Orpington FPK91 Tesco Superstore Edgington Way Sidcup Kent DA14 5BN Cray Valley East The Crays Orpington FTK80 Crayhill Chemist 88 Cotmandene Crescent, St Paul's Cray Orpington Kent BR5 2RG Cray Valley West The Crays Orpington 106

107 Appendix 4: Pharmacy opening hours The next seven pages display the pharmacy opening hours for each pharmacy in Bromley. Each day is displayed on a separate sheet 107

108 MONDAY 06:00 09:00 Noon 15:00 18:00 21:00 Map FCS Code Pharmacy name Postcode Open Close Lunch Lunch 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30 00:00 Ward Spoke Hub Ref Close Open 1 FE112 Beckenham Pharmacy BR3 1AH 09:00 18:00 13:00 14:00 Copers Cope Beckenham Beckenham and Penge 51 FG099 Superdrug Pharmacy BR3 1EA 08:30 18:00 Copers Cope Beckenham Beckenham and Penge 19 FKG02 Boots the Chemist BR3 1EW 09:00 17:30 Copers Cope Beckenham Beckenham and Penge 42 FNL39 Peters Chemist BR3 2NT 09:00 17:30 Copers Cope Beckenham Beckenham and Penge 2 FPA70 Beckenham Pharmacy BR3 1ED 09:00 19:00 14:00 14:30 Copers Cope Beckenham Beckenham and Penge 41 FAD85 Paydens Pharmacy BR3 3PR 07:00 22:00 Kelsey and Eden Park Beckenham Beckenham and Penge 37 FDN35 Lotus Pharmacy BR3 3RA 09:00 18:00 13:15 13:45 Kelsey and Eden Park Beckenham Beckenham and Penge 23 FJC01 Elmers Pharmacy BR3 3DY 09:00 17:30 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 40 FLA26/ FJ6 Park Langley Pharmacy BR3 6QH 09:00 18:00 Kelsey and Eden Park Beckenham Beckenham and Penge 3 FQ322/FQ3Blackwells Chemist BR3 3PS 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 38 FY725 Macks Pharmacy BR3 3HN 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 45 FJV12 Rowlands Pharmacy BR2 0TY 09:00 18:00 13:00 13:20 Shortlands Beckenham Beckenham and Penge 28 FA767 (wa Kamsons Pharmacy SE20 8AJ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 27 FA819 Hamlet Pharmacy SE19 2AS 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 32 FX117 TT Pharmacy SE20 7YZ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 13 FQD55 Boots the Chemist SE20 7EX 09:00 17:30 Penge and Cator Penge and Anerley Beckenham and Penge 39 FRH46 Macks Pharmacy SE20 7PF 09:00 18:00 12:00 14:00 Penge and Cator Penge and Anerley Beckenham and Penge 56 FYA22 United Pharmacy SE20 7TJ 09:00 19:00 Penge and Cator Penge and Anerley Beckenham and Penge 59 FL891 Westchem BR4 0PX 09:00 18:30 West Wickham West Wickham Beckenham and Penge 57 FQN66 Boots the Chemist BR4 0PU 09:00 18:00 12:00 13:30 West Wickham West Wickham Beckenham and Penge 31 FRD37 Lloyds Pharmacy BR4 0LT 09:00 19:00 West Wickham West Wickham Beckenham and Penge 6 FD505 Day Lewis (Bromley) BR1 2RG 09:00 18:00 Bickley Central Bromley Bromley 26 FT918 Gordon Davie Chemist BR2 8AR 09:00 19:00 13:00 14:15 Bickley Central Bromley Bromley 58 FTK32 Wallace Pring & Co BR2 9QF 09:00 18:00 13:00 14:00 Bromley Common and Keston Central Bromley Bromley 7 FAH85 Boots the Chemist BR1 1JY 08:30 17:30 14:00 15:00 Bromley Town Central Bromley Bromley 14 FKE53 Caxton Pharmacy BR1 1RL 09:00 18:00 Bromley Town Central Bromley Bromley 8 FM350 Boots the Chemist BR1 1DN 08:30 18:00 Bromley Town Central Bromley Bromley 48 FVR97 Scotts Pharmacy BR1 1LF 08:30 18:00 Bromley Town Central Bromley Bromley 5 FFA94/FR5 Boots the Chemist BR2 7EQ 09:00 19:00 14:00 14:30 Hayes and Coney Hall Central Bromley Bromley 15 FG145 Coney Hall Pharmacy BR4 9JB 09:00 19:00 Hayes and Coney Hall Central Bromley Bromley 21 FT602 Day Lewis (Hayes) BR2 7EQ 08:00 19:00 14:00 15:00 Hayes and Coney Hall Central Bromley Bromley 36 FAQ83/FRWLondon Lane Pharmacy BR1 4HE 09:00 19:00 Plaistow and Sundridge Central Bromley Bromley 4 FCA86/FDXBoots the Chemist BR1 5AB 09:00 18:00 13:30 14:00 Plaistow and Sundridge Central Bromley Bromley 29 FVF13 L M Williams BR7 5AG 08:30 18:30 Chislehurst Mottingham and Chislehurst Bromley 34 FVN52 Lloyds Pharmacy BR7 5AF 09:00 19:00 Chislehurst Mottingham and Chislehurst Bromley 35 FH398 Lloyds Pharmacy SE9 4DZ 08:30 18:30 Mottingham and Chislehurst North Mottingham and Chislehurst Bromley 9 FVR91 Boots the Chemist TN16 3JZ 08:30 19:00 13:30 14:30 Biggin Hill Biggin Hill Orpington 10 FWA21 Day Lewis (Biggin Hill) TN16 3BA 09:00 18:00 Biggin Hill Biggin Hill Orpington 30 FXM78/FMLloyds Pharmacy TN16 3XZ 09:00 19:00 12:00 13:00 Biggin Hill Biggin Hill Orpington 33 FE693 Lloyds Pharmacy BR6 6EY 09:00 19:00 Chelsfield and Pratts Bottom Central Orpington Orpington 46 FL057 Rowlands Pharmacy BR6 9LP 09:00 18:00 14:00 14:20 Chelsfield and Pratts Bottom Central Orpington Orpington 50 FMK62 Stevens Chemist BR6 6BG 09:00 18:00 13:00 14:00 Chelsfield and Pratts Bottom Central Orpington Orpington 47 FLK72 Sainbury s BR6 8NZ 08:00 20:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 55 FM963 Village Pharmacy BR6 7AZ 09:00 18:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 18 FN052 Crofton Pharmacy BR6 8DG 09:00 18:30 Farnborough and Crofton Central Orpington Orpington 12 FDF35 Boots the Chemist BR6 0LS 09:00 17:30 Orpington Central Orpington Orpington 52 FJK92 Superdrug Pharmacy BR6 0PS 08:30 17:30 Orpington Central Orpington Orpington 22 FKV60 Eldred Drive Pharmacy BR5 4PE 09:00 18:00 13:00 14:30 Orpington Central Orpington Orpington 24 FRC25 Farncray Ltd BR6 0NQ 09:00 18:00 Orpington Central Orpington Orpington 53 FX096 Tesco Extra BR6 0NH 08:00 22:30 Orpington Central Orpington Orpington 11 FC864 Boots the Chemist BR5 1DQ 09:00 19:00 13:00 14:00 Petts Wood and Knoll Central Orpington Orpington 25 FGG04 Farrants Chemist BR5 1LY 09:00 17:30 13:00 13:30 Petts Wood and Knoll Central Orpington Orpington 43 FR247 Petts Wood Pharmacy BR5 1DQ 08:00 22:00 Petts Wood and Knoll Central Orpington Orpington 16 FJ793 Cray Valley Pharmacy BR5 3NJ 09:00 19:00 Cray Valley East The Crays Orpington 54 FPK91 Tesco Superstore DA14 5BN 08:00 22:30 Cray Valley East The Crays Orpington 20 FQF14 Lloyds Pharmacy BR5 2DD 08:30 18:30 Cray Valley East The Crays Orpington 49 FR366 Silversands Ltd BR5 4AD 08:45 18:30 13:00 14:30 Cray Valley East The Crays Orpington 44 FTM53 Priory Pharmacy BR6 0JB 09:00 18:30 Cray Valley East The Crays Orpington 17 FTK80 Crayhill Chemist BR5 2RG 09:00 18:00 Cray Valley West The Crays Orpington 108

109 TUESDAY 06:00 09:00 Noon 15:00 18:00 21:00 Map Lunch Lunch FCS Code Pharmacy name Postcode Open Close Ward Spoke Hub Ref Close Open 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30 00:00 1 FE112 Beckenham Pharmacy BR3 1AH 09:00 18:00 13:00 14:00 Copers Cope Beckenham Beckenham and Penge 51 FG099 Superdrug Pharmacy BR3 1EA 08:30 18:00 Copers Cope Beckenham Beckenham and Penge 19 FKG02 Boots the Chemist BR3 1EW 09:00 17:30 Copers Cope Beckenham Beckenham and Penge 42 FNL39 Peters Chemist BR3 2NT 09:00 17:30 Copers Cope Beckenham Beckenham and Penge 2 FPA70 Beckenham Pharmacy BR3 1ED 09:00 19:00 14:00 14:30 Copers Cope Beckenham Beckenham and Penge 41 FAD85 Paydens Pharmacy BR3 3PR 07:00 22:00 Kelsey and Eden Park Beckenham Beckenham and Penge 37 FDN35 Lotus Pharmacy BR3 3RA 09:00 18:00 13:15 13:45 Kelsey and Eden Park Beckenham Beckenham and Penge 23 FJC01 Elmers Pharmacy BR3 3DY 09:00 17:30 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 40 FLA26/ FJ69Park Langley Pharmacy BR3 6QH 09:00 18:00 Kelsey and Eden Park Beckenham Beckenham and Penge 3 FQ322/FQ3Blackwells Chemist BR3 3PS 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 38 FY725 Macks Pharmacy BR3 3HN 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 45 FJV12 Rowlands Pharmacy BR2 0TY 09:00 18:00 13:00 13:20 Shortlands Beckenham Beckenham and Penge 28 FA767 (waskamsons Pharmacy SE20 8AJ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 27 FA819 Hamlet Pharmacy SE19 2AS 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 32 FX117 TT Pharmacy SE20 7YZ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 13 FQD55 Boots the Chemist SE20 7EX 09:00 17:30 Penge and Cator Penge and Anerley Beckenham and Penge 39 FRH46 Macks Pharmacy SE20 7PF 09:00 18:00 12:00 14:00 Penge and Cator Penge and Anerley Beckenham and Penge 56 FYA22 United Pharmacy SE20 7TJ 09:00 19:00 Penge and Cator Penge and Anerley Beckenham and Penge 59 FL891 Westchem BR4 0PX 09:00 18:30 West Wickham West Wickham Beckenham and Penge 57 FQN66 Boots the Chemist BR4 0PU 09:00 18:00 12:00 13:30 West Wickham West Wickham Beckenham and Penge 31 FRD37 Lloyds Pharmacy BR4 0LT 09:00 19:00 West Wickham West Wickham Beckenham and Penge 6 FD505 Day Lewis (Bromley) BR1 2RG 09:00 18:00 Bickley Central Bromley Bromley 26 FT918 Gordon Davie Chemist BR2 8AR 09:00 19:00 13:00 14:15 Bickley Central Bromley Bromley 58 FTK32 Wallace Pring & Co BR2 9QF 09:00 18:00 13:00 14:00 Bromley Common and Keston Central Bromley Bromley 7 FAH85 Boots the Chemist BR1 1JY 08:30 17:30 14:00 15:00 Bromley Town Central Bromley Bromley 14 FKE53 Caxton Pharmacy BR1 1RL 09:00 18:00 Bromley Town Central Bromley Bromley 8 FM350 Boots the Chemist BR1 1DN 08:30 18:00 Bromley Town Central Bromley Bromley 48 FVR97 Scotts Pharmacy BR1 1LF 08:30 18:00 Bromley Town Central Bromley Bromley 5 FFA94/FR57Boots the Chemist BR2 7EQ 09:00 19:00 14:00 14:30 Hayes and Coney Hall Central Bromley Bromley 15 FG145 Coney Hall Pharmacy BR4 9JB 09:00 19:00 Hayes and Coney Hall Central Bromley Bromley 21 FT602 Day Lewis (Hayes) BR2 7EQ 08:00 19:00 14:00 15:00 Hayes and Coney Hall Central Bromley Bromley 36 FAQ83/FRWLondon Lane Pharmacy BR1 4HE 09:00 19:00 Plaistow and Sundridge Central Bromley Bromley 4 FCA86/FDX Boots the Chemist BR1 5AB 09:00 18:00 13:30 14:00 Plaistow and Sundridge Central Bromley Bromley 29 FVF13 L M Williams BR7 5AG 08:30 18:30 Chislehurst Mottingham and Chislehurst Bromley 34 FVN52 Lloyds Pharmacy BR7 5AF 09:00 19:00 Chislehurst Mottingham and Chislehurst Bromley 35 FH398 Lloyds Pharmacy SE9 4DZ 08:30 18:30 Mottingham and Chislehurst North Mottingham and Chislehurst Bromley 9 FVR91 Boots the Chemist TN16 3JZ 09:00 19:00 13:30 14:30 Biggin Hill Biggin Hill Orpington 10 FWA21 Day Lewis (Biggin Hill) TN16 3BA 09:00 18:00 Biggin Hill Biggin Hill Orpington 30 FXM78/FMLloyds Pharmacy TN16 3XZ 09:00 19:00 12:00 13:00 Biggin Hill Biggin Hill Orpington 33 FE693 Lloyds Pharmacy BR6 6EY 09:00 19:00 Chelsfield and Pratts Bottom Central Orpington Orpington 46 FL057 Rowlands Pharmacy BR6 9LP 09:00 18:00 14:00 14:20 Chelsfield and Pratts Bottom Central Orpington Orpington 50 FMK62 Stevens Chemist BR6 6BG 09:00 18:00 13:00 14:00 Chelsfield and Pratts Bottom Central Orpington Orpington 47 FLK72 Sainbury s BR6 8NZ 08:00 20:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 55 FM963 Village Pharmacy BR6 7AZ 09:00 18:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 18 FN052 Crofton Pharmacy BR6 8DG 09:00 18:30 Farnborough and Crofton Central Orpington Orpington 12 FDF35 Boots the Chemist BR6 0LS 09:00 17:30 Orpington Central Orpington Orpington 52 FJK92 Superdrug Pharmacy BR6 0PS 08:30 17:30 Orpington Central Orpington Orpington 22 FKV60 Eldred Drive Pharmacy BR5 4PE 09:00 18:00 13:00 14:00 Orpington Central Orpington Orpington 24 FRC25 Farncray Ltd BR6 0NQ 09:00 18:00 Orpington Central Orpington Orpington 53 FX096 Tesco Extra BR6 0NH 06:30 22:30 Orpington Central Orpington Orpington 11 FC864 Boots the Chemist BR5 1DQ 09:00 19:00 13:00 14:00 Petts Wood and Knoll Central Orpington Orpington 25 FGG04 Farrants Chemist BR5 1LY 09:00 17:30 13:00 13:30 Petts Wood and Knoll Central Orpington Orpington 43 FR247 Petts Wood Pharmacy BR5 1DQ 08:00 22:00 Petts Wood and Knoll Central Orpington Orpington 16 FJ793 Cray Valley Pharmacy BR5 3NJ 09:00 19:00 Cray Valley East The Crays Orpington 54 FPK91 Tesco Superstore DA14 5BN 06:30 22:30 Cray Valley East The Crays Orpington 20 FQF14 Lloyds Pharmacy BR5 2DD 08:30 18:30 Cray Valley East The Crays Orpington 49 FR366 Silversands Ltd BR5 4AD 08:45 18:30 13:00 14:30 Cray Valley East The Crays Orpington 44 FTM53 Priory Pharmacy BR6 0JB 09:00 18:30 Cray Valley East The Crays Orpington 17 FTK80 Crayhill Chemist BR5 2RG 09:00 18:00 Cray Valley West The Crays Orpington 109

110 WEDNESDAY 06:00 09:00 Noon 15:00 18:00 21:00 Map Lunch Lunch FCS Code Pharmacy name Postcode Open Close Ref Close Open 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30 00:00 Ward Spoke Hub 1 FE112 Beckenham Pharmacy BR3 1AH 09:00 18:00 13:00 14:00 Copers Cope Beckenham Beckenham and Penge 51 FG099 Superdrug Pharmacy BR3 1EA 08:30 18:00 Copers Cope Beckenham Beckenham and Penge 19 FKG02 Boots the Chemist BR3 1EW 09:00 17:30 Copers Cope Beckenham Beckenham and Penge 42 FNL39 Peters Chemist BR3 2NT 09:00 13:00 Copers Cope Beckenham Beckenham and Penge 2 FPA70 Beckenham Pharmacy BR3 1ED 09:00 19:00 14:00 14:30 Copers Cope Beckenham Beckenham and Penge 41 FAD85 Paydens Pharmacy BR3 3PR 07:00 22:00 Kelsey and Eden Park Beckenham Beckenham and Penge 37 FDN35 Lotus Pharmacy BR3 3RA 09:00 18:00 13:15 13:45 Kelsey and Eden Park Beckenham Beckenham and Penge 23 FJC01 Elmers Pharmacy BR3 3DY 09:00 13:00 Kelsey and Eden Park Beckenham Beckenham and Penge 40 FLA26/ FJ69Park Langley Pharmacy BR3 6QH 09:00 18:00 Kelsey and Eden Park Beckenham Beckenham and Penge 3 FQ322/FQ3Blackwells Chemist BR3 3PS 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 38 FY725 Macks Pharmacy BR3 3HN 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 45 FJV12 Rowlands Pharmacy BR2 0TY 09:00 18:00 13:00 13:20 Shortlands Beckenham Beckenham and Penge 28 FA767 (waskamsons Pharmacy SE20 8AJ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 27 FA819 Hamlet Pharmacy SE19 2AS 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 32 FX117 TT Pharmacy SE20 7YZ 09:00 17:30 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 13 FQD55 Boots the Chemist SE20 7EX 09:00 17:30 Penge and Cator Penge and Anerley Beckenham and Penge 39 FRH46 Macks Pharmacy SE20 7PF 09:00 18:00 12:00 14:00 Penge and Cator Penge and Anerley Beckenham and Penge 56 FYA22 United Pharmacy SE20 7TJ 09:00 19:00 Penge and Cator Penge and Anerley Beckenham and Penge 59 FL891 Westchem BR4 0PX 09:00 18:30 West Wickham West Wickham Beckenham and Penge 57 FQN66 Boots the Chemist BR4 0PU 09:00 18:00 12:00 13:30 West Wickham West Wickham Beckenham and Penge 31 FRD37 Lloyds Pharmacy BR4 0LT 09:00 19:00 West Wickham West Wickham Beckenham and Penge 6 FD505 Day Lewis (Bromley) BR1 2RG 09:00 18:00 Bickley Central Bromley Bromley 26 FT918 Gordon Davie Chemist BR2 8AR 09:00 19:00 13:00 14:15 Bickley Central Bromley Bromley 58 FTK32 Wallace Pring & Co BR2 9QF 09:00 18:00 13:00 14:00 Bromley Common and Keston Central Bromley Bromley 7 FAH85 Boots the Chemist BR1 1JY 08:30 17:30 14:00 15:00 Bromley Town Central Bromley Bromley 14 FKE53 Caxton Pharmacy BR1 1RL 09:00 18:00 Bromley Town Central Bromley Bromley 8 FM350 Boots the Chemist BR1 1DN 08:30 18:00 Bromley Town Central Bromley Bromley 48 FVR97 Scotts Pharmacy BR1 1LF 08:30 18:00 Bromley Town Central Bromley Bromley 5 FFA94/FR57Boots the Chemist BR2 7EQ 09:00 19:00 14:00 14:30 Hayes and Coney Hall Central Bromley Bromley 15 FG145 Coney Hall Pharmacy BR4 9JB 09:00 19:00 Hayes and Coney Hall Central Bromley Bromley 21 FT602 Day Lewis (Hayes) BR2 7EQ 08:00 19:00 14:00 15:00 Hayes and Coney Hall Central Bromley Bromley 36 FAQ83/FRWLondon Lane Pharmacy BR1 4HE 09:00 19:00 Plaistow and Sundridge Central Bromley Bromley 4 FCA86/FDX Boots the Chemist BR1 5AB 09:00 18:00 13:30 14:00 Plaistow and Sundridge Central Bromley Bromley 29 FVF13 L M Williams BR7 5AG 08:30 18:30 Chislehurst Mottingham and Chislehurst Bromley 34 FVN52 Lloyds Pharmacy BR7 5AF 09:00 19:00 Chislehurst Mottingham and Chislehurst Bromley 35 FH398 Lloyds Pharmacy SE9 4DZ 08:30 18:30 Mottingham and Chislehurst North Mottingham and Chislehurst Bromley 9 FVR91 Boots the Chemist TN16 3JZ 09:00 20:00 13:30 14:30 Biggin Hill Biggin Hill Orpington 10 FWA21 Day Lewis (Biggin Hill) TN16 3BA 09:00 18:00 Biggin Hill Biggin Hill Orpington 30 FXM78/FM Lloyds Pharmacy TN16 3XZ 09:00 19:00 12:00 13:00 Biggin Hill Biggin Hill Orpington 33 FE693 Lloyds Pharmacy BR6 6EY 09:00 19:00 Chelsfield and Pratts Bottom Central Orpington Orpington 46 FL057 Rowlands Pharmacy BR6 9LP 09:00 18:00 14:00 14:20 Chelsfield and Pratts Bottom Central Orpington Orpington 50 FMK62 Stevens Chemist BR6 6BG 09:00 18:00 13:00 14:00 Chelsfield and Pratts Bottom Central Orpington Orpington 47 FLK72 Sainbury s BR6 8NZ 08:00 20:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 55 FM963 Village Pharmacy BR6 7AZ 09:00 18:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 18 FN052 Crofton Pharmacy BR6 8DG 09:00 18:30 Farnborough and Crofton Central Orpington Orpington 12 FDF35 Boots the Chemist BR6 0LS 09:00 17:30 Orpington Central Orpington Orpington 52 FJK92 Superdrug Pharmacy BR6 0PS 08:30 17:30 Orpington Central Orpington Orpington 22 FKV60 Eldred Drive Pharmacy BR5 4PE 09:00 18:00 13:00 14:00 Orpington Central Orpington Orpington 24 FRC25 Farncray Ltd BR6 0NQ 09:00 18:00 Orpington Central Orpington Orpington 53 FX096 Tesco Extra BR6 0NH 06:30 22:30 Orpington Central Orpington Orpington 11 FC864 Boots the Chemist BR5 1DQ 09:00 19:00 13:00 14:00 Petts Wood and Knoll Central Orpington Orpington 25 FGG04 Farrants Chemist BR5 1LY 09:00 17:30 13:00 13:30 Petts Wood and Knoll Central Orpington Orpington 43 FR247 Petts Wood Pharmacy BR5 1DQ 08:00 22:00 Petts Wood and Knoll Central Orpington Orpington 16 FJ793 Cray Valley Pharmacy BR5 3NJ 09:00 19:00 Cray Valley East The Crays Orpington 54 FPK91 Tesco Superstore DA14 5BN 06:30 22:30 Cray Valley East The Crays Orpington 20 FQF14 Lloyds Pharmacy BR5 2DD 08:30 18:30 Cray Valley East The Crays Orpington 49 FR366 Silversands Ltd BR5 4AD 08:45 13:00 Cray Valley East The Crays Orpington 44 FTM53 Priory Pharmacy BR6 0JB 09:00 13:00 Cray Valley East The Crays Orpington 17 FTK80 Crayhill Chemist BR5 2RG 09:00 18:00 Cray Valley West The Crays Orpington 110

111 THURSDAY 06:00 09:00 Noon 15:00 18:00 21:00 Map FCS Code Pharmacy name Postcode Open Close Lunch Lunch Ref Close Open 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30 00:00 Ward Spoke Hub 1 FE112 Beckenham Pharmacy BR3 1AH 09:00 18:00 13:00 14:00 Copers Cope Beckenham Beckenham and Penge 51 FG099 Superdrug Pharmacy BR3 1EA 08:30 18:00 Copers Cope Beckenham Beckenham and Penge 19 FKG02 Boots the Chemist BR3 1EW 09:00 19:00 Copers Cope Beckenham Beckenham and Penge 42 FNL39 Peters Chemist BR3 2NT 09:00 17:30 Copers Cope Beckenham Beckenham and Penge 2 FPA70 Beckenham Pharmacy BR3 1ED 09:00 19:00 14:00 14:30 Copers Cope Beckenham Beckenham and Penge 41 FAD85 Paydens Pharmacy BR3 3PR 07:00 22:00 Kelsey and Eden Park Beckenham Beckenham and Penge 37 FDN35 Lotus Pharmacy BR3 3RA 09:00 18:00 13:15 13:45 Kelsey and Eden Park Beckenham Beckenham and Penge 23 FJC01 Elmers Pharmacy BR3 3DY 09:00 17:30 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 40 FLA26/ FJ6Park Langley Pharmacy BR3 6QH 09:00 18:00 Kelsey and Eden Park Beckenham Beckenham and Penge 3 FQ322/FQ Blackwells Chemist BR3 3PS 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 38 FY725 Macks Pharmacy BR3 3HN 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 45 FJV12 Rowlands Pharmacy BR2 0TY 09:00 18:00 13:00 13:20 Shortlands Beckenham Beckenham and Penge 28 FA767 (wa Kamsons Pharmacy SE20 8AJ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 27 FA819 Hamlet Pharmacy SE19 2AS 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 32 FX117 TT Pharmacy SE20 7YZ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 13 FQD55 Boots the Chemist SE20 7EX 09:00 17:30 Penge and Cator Penge and Anerley Beckenham and Penge 39 FRH46 Macks Pharmacy SE20 7PF 09:00 18:00 12:00 14:00 Penge and Cator Penge and Anerley Beckenham and Penge 56 FYA22 United Pharmacy SE20 7TJ 09:00 19:00 Penge and Cator Penge and Anerley Beckenham and Penge 59 FL891 Westchem BR4 0PX 09:00 18:30 West Wickham West Wickham Beckenham and Penge 57 FQN66 Boots the Chemist BR4 0PU 09:00 18:00 12:00 13:30 West Wickham West Wickham Beckenham and Penge 31 FRD37 Lloyds Pharmacy BR4 0LT 09:00 19:00 West Wickham West Wickham Beckenham and Penge 6 FD505 Day Lewis (Bromley) BR1 2RG 09:00 18:00 Bickley Central Bromley Bromley 26 FT918 Gordon Davie Chemist BR2 8AR 09:00 19:00 13:00 14:15 Bickley Central Bromley Bromley 58 FTK32 Wallace Pring & Co BR2 9QF 09:00 18:00 13:00 14:00 Bromley Common and Keston Central Bromley Bromley 7 FAH85 Boots the Chemist BR1 1JY 08:30 17:30 14:00 15:00 Bromley Town Central Bromley Bromley 14 FKE53 Caxton Pharmacy BR1 1RL 09:00 18:00 Bromley Town Central Bromley Bromley 8 FM350 Boots the Chemist BR1 1DN 08:30 21:00 Bromley Town Central Bromley Bromley 48 FVR97 Scotts Pharmacy BR1 1LF 08:30 18:00 Bromley Town Central Bromley Bromley 5 FFA94/FR5Boots the Chemist BR2 7EQ 09:00 18:00 14:00 14:30 Hayes and Coney Hall Central Bromley Bromley 15 FG145 Coney Hall Pharmacy BR4 9JB 09:00 19:00 Hayes and Coney Hall Central Bromley Bromley 21 FT602 Day Lewis (Hayes) BR2 7EQ 08:00 19:00 14:00 15:00 Hayes and Coney Hall Central Bromley Bromley 36 FAQ83/FRWLondon Lane Pharmacy BR1 4HE 09:00 19:00 Plaistow and Sundridge Central Bromley Bromley 4 FCA86/FDXBoots the Chemist BR1 5AB 09:00 18:00 13:30 14:00 Plaistow and Sundridge Central Bromley Bromley 29 FVF13 L M Williams BR7 5AG 08:30 18:30 Chislehurst Mottingham and Chislehurst Bromley 34 FVN52 Lloyds Pharmacy BR7 5AF 09:00 19:00 Chislehurst Mottingham and Chislehurst Bromley 35 FH398 Lloyds Pharmacy SE9 4DZ 08:30 18:30 Mottingham and Chislehurst North Mottingham and Chislehurst Bromley 9 FVR91 Boots the Chemist TN16 3JZ 09:00 20:00 13:30 14:30 Biggin Hill Biggin Hill Orpington 10 FWA21 Day Lewis (Biggin Hill) TN16 3BA 09:00 18:00 Biggin Hill Biggin Hill Orpington 30 FXM78/FMLloyds Pharmacy TN16 3XZ 09:00 18:00 12:00 13:00 Biggin Hill Biggin Hill Orpington 33 FE693 Lloyds Pharmacy BR6 6EY 09:00 19:00 Chelsfield and Pratts Bottom Central Orpington Orpington 46 FL057 Rowlands Pharmacy BR6 9LP 09:00 18:00 14:00 14:20 Chelsfield and Pratts Bottom Central Orpington Orpington 50 FMK62 Stevens Chemist BR6 6BG 09:00 18:00 13:00 14:00 Chelsfield and Pratts Bottom Central Orpington Orpington 47 FLK72 Sainbury s BR6 8NZ 08:00 20:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 55 FM963 Village Pharmacy BR6 7AZ 09:00 13:00 Farnborough and Crofton Central Orpington Orpington 18 FN052 Crofton Pharmacy BR6 8DG 09:00 18:30 Farnborough and Crofton Central Orpington Orpington 12 FDF35 Boots the Chemist BR6 0LS 09:00 17:30 Orpington Central Orpington Orpington 52 FJK92 Superdrug Pharmacy BR6 0PS 08:30 17:30 Orpington Central Orpington Orpington 22 FKV60 Eldred Drive Pharmacy BR5 4PE 09:00 18:00 13:00 14:00 Orpington Central Orpington Orpington 24 FRC25 Farncray Ltd BR6 0NQ 09:00 18:00 Orpington Central Orpington Orpington 53 FX096 Tesco Extra BR6 0NH 06:30 22:30 Orpington Central Orpington Orpington 11 FC864 Boots the Chemist BR5 1DQ 09:00 19:00 13:00 14:00 Petts Wood and Knoll Central Orpington Orpington 25 FGG04 Farrants Chemist BR5 1LY 09:00 17:30 13:00 13:30 Petts Wood and Knoll Central Orpington Orpington 43 FR247 Petts Wood Pharmacy BR5 1DQ 08:00 22:00 Petts Wood and Knoll Central Orpington Orpington 16 FJ793 Cray Valley Pharmacy BR5 3NJ 09:00 19:00 Cray Valley East The Crays Orpington 54 FPK91 Tesco Superstore DA14 5BN 06:30 22:30 Cray Valley East The Crays Orpington 20 FQF14 Lloyds Pharmacy BR5 2DD 08:30 18:30 Cray Valley East The Crays Orpington 49 FR366 Silversands Ltd BR5 4AD 08:45 18:30 13:00 14:30 Cray Valley East The Crays Orpington 44 FTM53 Priory Pharmacy BR6 0JB 09:00 18:30 Cray Valley East The Crays Orpington 17 FTK80 Crayhill Chemist BR5 2RG 09:00 18:00 Cray Valley West The Crays Orpington 111

112 FRIDAY 06:00 09:00 Noon 15:00 18:00 21:00 Map FCS Code Pharmacy name Postcode Open Close Lunch Lunch Ref Close Open 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30 00:00 Ward Spoke Hub 1 FE112 Beckenham Pharmacy BR3 1AH 09:00 18:00 13:00 14:00 Copers Cope Beckenham Beckenham and Penge 51 FG099 Superdrug Pharmacy BR3 1EA 08:30 18:00 Copers Cope Beckenham Beckenham and Penge 19 FKG02 Boots the Chemist BR3 1EW 09:00 19:00 Copers Cope Beckenham Beckenham and Penge 42 FNL39 Peters Chemist BR3 2NT 09:00 17:30 Copers Cope Beckenham Beckenham and Penge 2 FPA70 Beckenham Pharmacy BR3 1ED 09:00 19:00 14:00 14:30 Copers Cope Beckenham Beckenham and Penge 41 FAD85 Paydens Pharmacy BR3 3PR 07:00 22:00 Kelsey and Eden Park Beckenham Beckenham and Penge 37 FDN35 Lotus Pharmacy BR3 3RA 09:00 18:00 13:15 13:45 Kelsey and Eden Park Beckenham Beckenham and Penge 23 FJC01 Elmers Pharmacy BR3 3DY 09:00 17:30 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 40 FLA26/ FJ6 Park Langley Pharmacy BR3 6QH 09:00 18:00 Kelsey and Eden Park Beckenham Beckenham and Penge 3 FQ322/FQ3Blackwells Chemist BR3 3PS 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 38 FY725 Macks Pharmacy BR3 3HN 09:00 18:00 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge 45 FJV12 Rowlands Pharmacy BR2 0TY 09:00 18:00 13:00 13:20 Shortlands Beckenham Beckenham and Penge 28 FA767 (waskamsons Pharmacy SE20 8AJ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 27 FA819 Hamlet Pharmacy SE19 2AS 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 32 FX117 TT Pharmacy SE20 7YZ 09:00 19:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge 13 FQD55 Boots the Chemist SE20 7EX 09:00 17:30 Penge and Cator Penge and Anerley Beckenham and Penge 39 FRH46 Macks Pharmacy SE20 7PF 09:00 18:00 12:00 14:00 Penge and Cator Penge and Anerley Beckenham and Penge 56 FYA22 United Pharmacy SE20 7TJ 09:00 19:00 Penge and Cator Penge and Anerley Beckenham and Penge 59 FL891 Westchem BR4 0PX 09:00 18:30 West Wickham West Wickham Beckenham and Penge 57 FQN66 Boots the Chemist BR4 0PU 09:00 18:00 12:00 13:30 West Wickham West Wickham Beckenham and Penge 31 FRD37 Lloyds Pharmacy BR4 0LT 09:00 19:00 West Wickham West Wickham Beckenham and Penge 6 FD505 Day Lewis (Bromley) BR1 2RG 09:00 18:00 Bickley Central Bromley Bromley 26 FT918 Gordon Davie Chemist BR2 8AR 09:00 19:00 13:00 14:15 Bickley Central Bromley Bromley 58 FTK32 Wallace Pring & Co BR2 9QF 09:00 18:00 13:00 14:00 Bromley Common and Keston Central Bromley Bromley 7 FAH85 Boots the Chemist BR1 1JY 08:30 17:30 14:00 15:00 Bromley Town Central Bromley Bromley 14 FKE53 Caxton Pharmacy BR1 1RL 09:00 18:00 Bromley Town Central Bromley Bromley 8 FM350 Boots the Chemist BR1 1DN 08:30 18:00 Bromley Town Central Bromley Bromley 48 FVR97 Scotts Pharmacy BR1 1LF 08:30 18:00 Bromley Town Central Bromley Bromley 5 FFA94/FR5 Boots the Chemist BR2 7EQ 09:00 19:00 14:00 14:30 Hayes and Coney Hall Central Bromley Bromley 15 FG145 Coney Hall Pharmacy BR4 9JB 09:00 19:00 Hayes and Coney Hall Central Bromley Bromley 21 FT602 Day Lewis (Hayes) BR2 7EQ 08:00 19:00 14:00 15:00 Hayes and Coney Hall Central Bromley Bromley 36 FAQ83/FRWLondon Lane Pharmacy BR1 4HE 09:00 19:00 Plaistow and Sundridge Central Bromley Bromley 4 FCA86/FDXBoots the Chemist BR1 5AB 09:00 18:00 13:30 14:00 Plaistow and Sundridge Central Bromley Bromley 29 FVF13 L M Williams BR7 5AG 08:30 18:30 Chislehurst Mottingham and Chislehurst Bromley 34 FVN52 Lloyds Pharmacy BR7 5AF 09:00 19:00 Chislehurst Mottingham and Chislehurst Bromley 35 FH398 Lloyds Pharmacy SE9 4DZ 08:30 18:30 Mottingham and Chislehurst North Mottingham and Chislehurst Bromley 9 FVR91 Boots the Chemist TN16 3JZ 09:00 20:00 13:30 14:30 Biggin Hill Biggin Hill Orpington 10 FWA21 Day Lewis (Biggin Hill) TN16 3BA 09:00 18:00 Biggin Hill Biggin Hill Orpington 30 FXM78/FMLloyds Pharmacy TN16 3XZ 09:00 19:00 12:00 13:00 Biggin Hill Biggin Hill Orpington 33 FE693 Lloyds Pharmacy BR6 6EY 09:00 19:00 Chelsfield and Pratts Bottom Central Orpington Orpington 46 FL057 Rowlands Pharmacy BR6 9LP 09:00 18:00 14:00 14:20 Chelsfield and Pratts Bottom Central Orpington Orpington 50 FMK62 Stevens Chemist BR6 6BG 09:00 18:00 13:00 14:00 Chelsfield and Pratts Bottom Central Orpington Orpington 47 FLK72 Sainbury s BR6 8NZ 08:00 21:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 55 FM963 Village Pharmacy BR6 7AZ 09:00 18:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 18 FN052 Crofton Pharmacy BR6 8DG 09:00 18:30 Farnborough and Crofton Central Orpington Orpington 12 FDF35 Boots the Chemist BR6 0LS 09:00 17:30 Orpington Central Orpington Orpington 52 FJK92 Superdrug Pharmacy BR6 0PS 08:30 17:30 Orpington Central Orpington Orpington 22 FKV60 Eldred Drive Pharmacy BR5 4PE 09:00 18:00 13:00 14:00 Orpington Central Orpington Orpington 24 FRC25 Farncray Ltd BR6 0NQ 09:00 18:00 Orpington Central Orpington Orpington 53 FX096 Tesco Extra BR6 0NH 06:30 22:30 Orpington Central Orpington Orpington 11 FC864 Boots the Chemist BR5 1DQ 09:00 19:00 13:00 14:00 Petts Wood and Knoll Central Orpington Orpington 25 FGG04 Farrants Chemist BR5 1LY 09:00 17:30 13:00 13:30 Petts Wood and Knoll Central Orpington Orpington 43 FR247 Petts Wood Pharmacy BR5 1DQ 08:00 22:00 Petts Wood and Knoll Central Orpington Orpington 16 FJ793 Cray Valley Pharmacy BR5 3NJ 09:00 19:00 Cray Valley East The Crays Orpington 54 FPK91 Tesco Superstore DA14 5BN 06:30 22:30 Cray Valley East The Crays Orpington 20 FQF14 Lloyds Pharmacy BR5 2DD 08:30 18:30 Cray Valley East The Crays Orpington 49 FR366 Silversands Ltd BR5 4AD 08:45 18:30 13:00 14:30 Cray Valley East The Crays Orpington 44 FTM53 Priory Pharmacy BR6 0JB 09:00 18:30 Cray Valley East The Crays Orpington 17 FTK80 Crayhill Chemist BR5 2RG 09:00 18:00 Cray Valley West The Crays Orpington 112

113 SATURDAY 06:00 09:00 Noon 15:00 18:00 21:00 FCS Code Pharmacy name Postcode Open Close Lunch Lunch 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30 00:00 Ward Spoke Hub Close Open FE112 Beckenham Pharmacy BR3 1AH 09:00 17:30 13:00 14:00 Copers Cope Beckenham Beckenham and Penge FG099 Superdrug Pharmacy BR3 1EA 08:30 18:00 Copers Cope Beckenham Beckenham and Penge FKG02 Boots the Chemist BR3 1EW 09:00 19:00 Copers Cope Beckenham Beckenham and Penge FNL39 Peters Chemist BR3 2NT 09:00 17:30 Copers Cope Beckenham Beckenham and Penge FPA70 Beckenham Pharmacy BR3 1ED 09:00 17:30 14:00 14:30 Copers Cope Beckenham Beckenham and Penge FAD85 Paydens Pharmacy BR3 3PR 07:00 20:00 Kelsey and Eden Park Beckenham Beckenham and Penge FDN35 Lotus Pharmacy BR3 3RA 09:00 16:00 13:15 13:45 Kelsey and Eden Park Beckenham Beckenham and Penge FJC01 Elmers Pharmacy BR3 3DY 09:00 13:00 Kelsey and Eden Park Beckenham Beckenham and Penge FKM27 Park Langley Pharmacy BR3 6QH 09:00 17:00 Kelsey and Eden Park Beckenham Beckenham and Penge FQ322/FQ39Blackwells Chemist BR3 3PS 09:00 17:30 13:00 14:00 Kelsey and Eden Park Beckenham Beckenham and Penge FY725 Macks Pharmacy BR3 3HN 09:00 16:00 Kelsey and Eden Park Beckenham Beckenham and Penge FJV12 Rowlands Pharmacy BR2 0TY 09:00 17:30 13:00 13:20 Shortlands Beckenham Beckenham and Penge FA767 (was Kamsons Pharmacy SE20 8AJ 09:00 18:00 13:00 14:00 Crystal Palace Penge and Anerley Beckenham and Penge FA819 Hamlet Pharmacy SE19 2AS 09:00 13:00 Crystal Palace Penge and Anerley Beckenham and Penge FX117 TT Pharmacy SE20 7YZ Crystal Palace Penge and Anerley Beckenham and Penge FQD55 Boots the Chemist SE20 7EX 09:00 17:30 Penge and Cator Penge and Anerley Beckenham and Penge FRH46 Macks Pharmacy SE20 7PF 09:00 17:30 13:00 14:00 Penge and Cator Penge and Anerley Beckenham and Penge FYA22 United Pharmacy SE20 7TJ 09:00 13:00 Penge and Cator Penge and Anerley Beckenham and Penge FL891 Westchem BR4 0PX 09:00 16:00 West Wickham West Wickham Beckenham and Penge FQN66 Boots the Chemist BR4 0PU 08:45 17:45 12:00 13:00 West Wickham West Wickham Beckenham and Penge FRD37 Lloyds Pharmacy BR4 0LT 09:00 17:00 West Wickham West Wickham Beckenham and Penge FD505 Day Lewis (Bromley) BR1 2RG 09:00 16:00 Bickley Central Bromley Bromley FT918 Gordon Davie Chemist BR2 8AR 09:00 13:00 Bickley Central Bromley Bromley FTK32 Wallace Pring & Co BR2 9QF 09:00 17:30 13:00 14:00 Bromley Common and Keston Central Bromley Bromley FAH85 Boots the Chemist BR1 1JY 09:00 18:00 14:00 15:00 Bromley Town Central Bromley Bromley FKE53 Caxton Pharmacy BR1 1RL 09:00 17:00 Bromley Town Central Bromley Bromley FM350 Boots the Chemist BR1 1DN 08:30 18:00 Bromley Town Central Bromley Bromley FVR97 Scotts Pharmacy BR1 1LF 09:00 17:30 Bromley Town Central Bromley Bromley FFA94/FR570Boots the Chemist BR2 7EQ 09:00 17:30 Hayes and Coney Hall Central Bromley Bromley FG145 Coney Hall Pharmacy BR4 9JB 09:00 17:30 Hayes and Coney Hall Central Bromley Bromley FT602 Day Lewis (Hayes) BR2 7EQ 09:00 17:00 Hayes and Coney Hall Central Bromley Bromley FAQ83/FRW London Lane Pharmacy BR1 4HE 09:00 12:00 Plaistow and Sundridge Central Bromley Bromley FCA86/FDX7 Boots the Chemist BR1 5AB 09:00 17:30 13:30 14:00 Plaistow and Sundridge Central Bromley Bromley FVF13 L M Williams BR7 5AG 09:00 17:30 Chislehurst Mottingham and Chislehurst Bromley FVN52 Lloyds Pharmacy BR7 5AF 09:00 17:30 Chislehurst Mottingham and Chislehurst Bromley FH398 Lloyds Pharmacy SE9 4DZ 09:00 17:30 Mottingham and Chislehurst North Mottingham and Chislehurst Bromley FVR91 Boots the Chemist TN16 3JZ 09:00 18:00 13:30 14:30 Biggin Hill Biggin Hill Orpington FWA21 Day Lewis (Biggin Hill) TN16 3BA 09:00 13:00 Biggin Hill Biggin Hill Orpington FXM78/FMWLloyds Pharmacy TN16 3XZ 09:00 17:00 12:00 13:00 Biggin Hill Biggin Hill Orpington FE693 Lloyds Pharmacy BR6 6EY 09:00 17:30 Chelsfield and Pratts Bottom Central Orpington Orpington FL057 Rowlands Pharmacy BR6 9LP 09:00 17:30 14:00 14:20 Chelsfield and Pratts Bottom Central Orpington Orpington FMK62 Stevens Chemist BR6 6BG 09:00 16:00 13:00 14:00 Chelsfield and Pratts Bottom Central Orpington Orpington FLK72 Sainbury s BR6 8NZ 08:00 20:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington FM963 Village Pharmacy BR6 7AZ 09:00 13:00 Farnborough and Crofton Central Orpington Orpington FN052 Crofton Pharmacy BR6 8DG 09:00 14:00 Farnborough and Crofton Central Orpington Orpington FDF35 Boots the Chemist BR6 0LS 09:00 17:30 Orpington Central Orpington Orpington FJK92 Superdrug Pharmacy BR6 0PS 08:30 17:30 Orpington Central Orpington Orpington FKV60 Eldred Drive Pharmacy BR5 4PE 09:00 13:00 Orpington Central Orpington Orpington FRC25 Farncray Ltd BR6 0NQ 09:00 13:00 Orpington Central Orpington Orpington FX096 Tesco Extra BR6 0NH 06:30 22:00 Orpington Central Orpington Orpington FC864 Boots the Chemist BR5 1DQ 09:00 18:00 13:00 14:00 Petts Wood and Knoll Central Orpington Orpington FGG04 Farrants Chemist BR5 1LY 09:00 16:00 Petts Wood and Knoll Central Orpington Orpington FR247 Petts Wood Pharmacy BR5 1DQ 08:00 23:00 Petts Wood and Knoll Central Orpington Orpington FJ793 Cray Valley Pharmacy BR5 3NJ 09:00 17:00 Cray Valley East The Crays Orpington FPK91 Tesco Superstore DA14 5BN 06:30 22:00 Cray Valley East The Crays Orpington FQF14 Lloyds Pharmacy BR5 2DD 09:00 13:00 Cray Valley East The Crays Orpington FR366 Silversands Ltd BR5 4AD 09:00 12:00 Cray Valley East The Crays Orpington FTM53 Priory Pharmacy BR6 0JB 09:00 17:00 Cray Valley East The Crays Orpington FTK80 Crayhill Chemist BR5 2RG 09:00 16:00 Cray Valley West The Crays Orpington 113

114 SUNDAY 06:00 09:00 Noon 15:00 18:00 21:00 Map FCS Code Pharmacy name Postcode Open Close Lunch Lunch 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30 00:00 Ward Spoke Hub Ref Close Open 1 FE112 Beckenham Pharmacy BR3 1AH Copers Cope Beckenham Beckenham and Penge 51 FG099 Superdrug Pharmacy BR3 1EA Copers Cope Beckenham Beckenham and Penge 19 FKG02 Boots the Chemist BR3 1EW 09:00 19:00 Copers Cope Beckenham Beckenham and Penge 42 FNL39 Peters Chemist BR3 2NT Copers Cope Beckenham Beckenham and Penge 2 FPA70 Beckenham Pharmacy BR3 1ED Copers Cope Beckenham Beckenham and Penge 41 FAD85 Paydens Pharmacy BR3 3PR 08:00 20:00 Kelsey and Eden Park Beckenham Beckenham and Penge 37 FDN35 Lotus Pharmacy BR3 3RA Kelsey and Eden Park Beckenham Beckenham and Penge 23 FJC01 Elmers Pharmacy BR3 3DY Kelsey and Eden Park Beckenham Beckenham and Penge 40 FLA26/ FJ69Park Langley Pharmacy BR3 6QH Kelsey and Eden Park Beckenham Beckenham and Penge 3 FQ322/FQ3Blackwells Chemist BR3 3PS Kelsey and Eden Park Beckenham Beckenham and Penge 38 FY725 Macks Pharmacy BR3 3HN Kelsey and Eden Park Beckenham Beckenham and Penge 45 FJV12 Rowlands Pharmacy BR2 0TY Shortlands Beckenham Beckenham and Penge 28 FA767 (waskamsons Pharmacy SE20 8AJ Crystal Palace Penge and Anerley Beckenham and Penge 27 FA819 Hamlet Pharmacy SE19 2AS Crystal Palace Penge and Anerley Beckenham and Penge 32 FX117 TT Pharmacy SE20 7YZ Crystal Palace Penge and Anerley Beckenham and Penge 13 FQD55 Boots the Chemist SE20 7EX 11:00 17:00 Penge and Cator Penge and Anerley Beckenham and Penge 39 FRH46 Macks Pharmacy SE20 7PF Penge and Cator Penge and Anerley Beckenham and Penge 56 FYA22 United Pharmacy SE20 7TJ Penge and Cator Penge and Anerley Beckenham and Penge 59 FL891 Westchem BR4 0PX West Wickham West Wickham Beckenham and Penge 57 FQN66 Boots the Chemist BR4 0PU 10:00 16:00 West Wickham West Wickham Beckenham and Penge 31 FRD37 Lloyds Pharmacy BR4 0LT 10:00 16:00 West Wickham West Wickham Beckenham and Penge 6 FD505 Day Lewis (Bromley) BR1 2RG Bickley Central Bromley Bromley 26 FT918 Gordon Davie Chemist BR2 8AR Bickley Central Bromley Bromley 58 FTK32 Wallace Pring & Co BR2 9QF Bromley Common and Keston Central Bromley Bromley 7 FAH85 Boots the Chemist BR1 1JY Bromley Town Central Bromley Bromley 14 FKE53 Caxton Pharmacy BR1 1RL Bromley Town Central Bromley Bromley 8 FM350 Boots the Chemist BR1 1DN 11:00 17:00 Bromley Town Central Bromley Bromley 48 FVR97 Scotts Pharmacy BR1 1LF Bromley Town Central Bromley Bromley 5 FFA94/FR57Boots the Chemist BR2 7EQ Hayes and Coney Hall Central Bromley Bromley 15 FG145 Coney Hall Pharmacy BR4 9JB Hayes and Coney Hall Central Bromley Bromley 21 FT602 Day Lewis (Hayes) BR2 7EQ 11:00 15:00 Hayes and Coney Hall Central Bromley Bromley 36 FAQ83/FRWLondon Lane Pharmacy BR1 4HE Plaistow and Sundridge Central Bromley Bromley 4 FCA86/FDX Boots the Chemist BR1 5AB Plaistow and Sundridge Central Bromley Bromley 29 FVF13 L M Williams BR7 5AG Chislehurst Mottingham and Chislehurst Bromley 34 FVN52 Lloyds Pharmacy BR7 5AF Chislehurst Mottingham and Chislehurst Bromley 35 FH398 Lloyds Pharmacy SE9 4DZ Mottingham and Chislehurst North Mottingham and Chislehurst Bromley 9 FVR91 Boots the Chemist TN16 3JZ 10:00 16:00 Biggin Hill Biggin Hill Orpington 10 FWA21 Day Lewis (Biggin Hill) TN16 3BA Biggin Hill Biggin Hill Orpington 30 FXM78/FM Lloyds Pharmacy TN16 3XZ Biggin Hill Biggin Hill Orpington 33 FE693 Lloyds Pharmacy BR6 6EY Chelsfield and Pratts Bottom Central Orpington Orpington 46 FL057 Rowlands Pharmacy BR6 9LP Chelsfield and Pratts Bottom Central Orpington Orpington 50 FMK62 Stevens Chemist BR6 6BG Chelsfield and Pratts Bottom Central Orpington Orpington 47 FLK72 Sainbury s BR6 8NZ 10:00 16:00 13:00 14:00 Farnborough and Crofton Central Orpington Orpington 55 FM963 Village Pharmacy BR6 7AZ Farnborough and Crofton Central Orpington Orpington 18 FN052 Crofton Pharmacy BR6 8DG Farnborough and Crofton Central Orpington Orpington 12 FDF35 Boots the Chemist BR6 0LS 10:00 16:00 Orpington Central Orpington Orpington 52 FJK92 Superdrug Pharmacy BR6 0PS Orpington Central Orpington Orpington 22 FKV60 Eldred Drive Pharmacy BR5 4PE Orpington Central Orpington Orpington 24 FRC25 Farncray Ltd BR6 0NQ Orpington Central Orpington Orpington 53 FX096 Tesco Extra BR6 0NH 10:00 16:00 Orpington Central Orpington Orpington 11 FC864 Boots the Chemist BR5 1DQ Petts Wood and Knoll Central Orpington Orpington 25 FGG04 Farrants Chemist BR5 1LY Petts Wood and Knoll Central Orpington Orpington 43 FR247 Petts Wood Pharmacy BR5 1DQ 08:00 23:00 Petts Wood and Knoll Central Orpington Orpington 16 FJ793 Cray Valley Pharmacy BR5 3NJ Cray Valley East The Crays Orpington 54 FPK91 Tesco Superstore DA14 5BN 10:00 16:00 Cray Valley East The Crays Orpington 20 FQF14 Lloyds Pharmacy BR5 2DD Cray Valley East The Crays Orpington 49 FR366 Silversands Ltd BR5 4AD Cray Valley East The Crays Orpington 44 FTM53 Priory Pharmacy BR6 0JB Cray Valley East The Crays Orpington 17 FTK80 Crayhill Chemist BR5 2RG Cray Valley West The Crays Orpington 114

115 Appendix 5: Pharmacy services providers FCS CODE TRADING NAME POSTCODE 100 hour Needle exchange Supervised administration of opiates EHC Smoking cessation On demand availability of speciality drugs Monitored dosage system Chlamydia screening & treatment NHS Health Check SPOKE LOCALITY HUB LOCALITY FE112 Beckenham Pharmacy BR3 1AH Beckenham Beckenham & Penge FPA70 Beckenham Pharmacy BR3 1ED Beckenham Beckenham & Penge FKG02 Boots the Chemist BR3 1EW Beckenham Beckenham & Penge FNL39 Peters Chemist BR3 5NT Beckenham Beckenham & Penge FG099 Superdrug Pharmacy BR3 1EA Beckenham Beckenham & Penge FQ322 Blackwells Chemist BR3 3PS Beckenham Beckenham & Penge FJC01 Elmers Pharmacy BR3 3DY Beckenham Beckenham & Penge FDN35 Lotus Pharmacy BR3 3RA Beckenham Beckenham & Penge FY725 Macks Pharmacy BR3 3HN Beckenham Beckenham & Penge FKM27 Park Langley Pharmacy BR3 6QH Beckenham Beckenham & Penge FAD85 Paydens Pharmacy BR3 3PR Beckenham Beckenham & Penge FJV12 Rowlands Pharmacy BR2 0TY Beckenham Beckenham & Penge FA819 Hamlet Pharmacy SE19 2AS Penge and Anerley Beckenham & Penge FA767 Kamsons Pharmacy SE20 8AJ Penge and Anerley Beckenham & Penge FX117 TT Pharmacy SE20 7YZ Penge and Anerley Beckenham & Penge FQD55 Boots the Chemist SE20 7EX Penge and Anerley Beckenham & Penge FRH46 Macks Pharmacy SE20 7PF Penge and Anerley Beckenham & Penge FYA22 United Pharmacy SE20 7TJ Penge and Anerley Beckenham & Penge FQN66 Boots the Chemist BR4 0PU West Wickham Beckenham & Penge FRD37 Lloyds Pharmacy BR4 0LT West Wickham Beckenham & Penge FL891 Westchem BR4 0PX West Wickham Beckenham & Penge 115

116 FCS CODE TRADING NAME POSTCODE 100 hour Needle exchange Supervised administration of opiates EHC Smoking cessation On demand availability of speciality drugs Monitored dosage system Chlamydia screening & treatment NHS Health Check SPOKE LOCALITY HUB LOCALITY FD505 Day Lewis (Bromley) BR1 2RG Central Bromley Bromley FT918 Gordon Davie Chemist BR2 8AR Central Bromley Bromley FTK32 Wallace Pring & Co BR2 9QE Central Bromley Bromley FAH85 Boots the Chemist BR1 1JY Central Bromley Bromley FM350 Boots the Chemist BR1 1DN Central Bromley Bromley FKE53 Caxton Pharmacy BR1 1RL Central Bromley Bromley FVR97 Scotts Pharmacy BR1 1LF Central Bromley Bromley FFA94 Boots the Chemist BR2 7EQ Central Bromley Bromley FG145 Coney Hall Pharmacy BR4 9JB Central Bromley Bromley FT602 Day Lewis (Hayes) BR2 7EQ Central Bromley Bromley FCA86 Boots the Chemist BR1 5AB Central Bromley Bromley FAQ83 London Lane Pharmacy BR1 4HE Central Bromley Bromley FVF13 L M Williams BR7 5AG Mottingham and Chislehurst Bromley FVN52 Lloyds Pharmacy BR7 5AF Mottingham and Chislehurst Bromley FH398 Lloyds Pharmacy SE9 4DZ Mottingham and Chislehurst Bromley 116

117 FCS CODE TRADING NAME POSTCODE 100 hour Needle exchange Supervised administration of opiates EHC Smoking cessation On demand availability of speciality drugs Monitored dosage system Chlamydia screening & treatment NHS Health Check SPOKE LOCALITY HUB LOCALITY FVR91 Boots the Chemist TN16 3JZ Biggin Hill Orpington FWA21 Day Lewis (Biggin Hill) TN16 3BA Biggin Hill Orpington FXM78 Lloyds Pharmacy TN16 3XZ Biggin Hill Orpington FE693 Lloyds Pharmacy BR6 6EY Central Orpington Orpington FL057 Rowlands Pharmacy BR6 9LP Central Orpington Orpington FMK62 Stevens Chemist BR6 6BG Central Orpington Orpington FN052 Crofton Pharmacy BR6 8DG Central Orpington Orpington FLK72 Sainbury s BR6 8NZ Central Orpington Orpington FM963 Village Pharmacy BR6 7AZ Central Orpington Orpington FDF35 Boots the Chemist BR6 0LS Central Orpington Orpington FKV60 Eldred Drive Pharmacy BR5 4PE Central Orpington Orpington FRC25 Farncray Ltd BR6 0NQ Central Orpington Orpington FJK92 Superdrug Pharmacy BR6 0PS Central Orpington Orpington FX096 Tesco Extra BR6 0NH Central Orpington Orpington FC864 Boots the Chemist BR5 1DQ Central Orpington Orpington FGG04 Farrants Chemist BR5 1LY Central Orpington Orpington FR247 Petts Wood Pharmacy BR5 1DQ Central Orpington Orpington FJ793 Cray Valley Pharmacy BR5 3NJ The Crays Orpington FQF14 Lloyds Pharmacy BR5 2DD The Crays Orpington FTM53 Priory Pharmacy BR6 0JB The Crays Orpington FR366 Silversands Ltd BR5 4AD The Crays Orpington FPK91 Tesco Superstore DA14 5BN The Crays Orpington FTK80 Crayhill Chemist BR5 2RG The Crays Orpington 117

118 Appendix 6: Pharmacy consultation facilities FCS Code Name Postcode Spoke Hub Consultation area FE112 Beckenham Pharmacy BR3 1AH Beckenham Beckenham and Penge FPA70 Beckenham Pharmacy BR3 1ED Beckenham Beckenham and Penge FQ322 Blackwells Chemist BR3 3PS Beckenham Beckenham and Penge FKG02 Boots the Chemist BR3 1EW Beckenham Beckenham and Penge FJC01 Elmers Pharmacy BR3 3DY Beckenham Beckenham and Penge FDN35 Lotus Pharmacy BR3 3RA Beckenham Beckenham and Penge FY725 Macks Pharmacy BR3 3HN Beckenham Beckenham and Penge FKM27 Park Langley Pharmacy BR3 6QH Beckenham Beckenham and Penge FAD85 Paydens Pharmacy BR3 3PR Beckenham Beckenham and Penge FNL39 Peters Chemist BR3 5NT Beckenham Beckenham and Penge FJV12 Rowlands Pharmacy BR2 0TY Beckenham Beckenham and Penge FG099 Superdrug Pharmacy BR3 1EA Beckenham Beckenham and Penge FQD55 Boots the Chemist SE20 7EX Penge and Anerley Beckenham and Penge FA819 Hamlet Pharmacy SE19 2AS Penge and Anerley Beckenham and Penge FA767 Kamsons Pharmacy SE20 8AJ Penge and Anerley Beckenham and Penge FRH46 Macks Pharmacy SE20 7DS Penge and Anerley Beckenham and Penge FX117 TT Pharmacy SE20 7YZ Penge and Anerley Beckenham and Penge FYA22 United Pharmacy SE20 7AA Penge and Anerley Beckenham and Penge FQN66 Boots the Chemist BR4 0PU West Wickham Beckenham and Penge FRD37 Lloyds Pharmacy BR4 0LT West Wickham Beckenham and Penge FL891 Westchem BR4 0PX West Wickham Beckenham and Penge MUR More than one consultation area 118

119 FCS Code Name Postcode Spoke Hub Consultation area FCA86 Boots the Chemist BR1 5AB Central Bromley Bromley FFA94 Boots the Chemist BR2 7EQ Central Bromley Bromley FAH85 Boots the Chemist BR1 1JY Central Bromley Bromley FM350 Boots the Chemist BR1 1DN Central Bromley Bromley FKE53 Caxton Pharmacy BR1 1RL Central Bromley Bromley FG145 Coney Hall Pharmacy BR4 9JB Central Bromley Bromley FD505 Day Lewis (Bromley) BR1 2RG Central Bromley Bromley FT602 Day Lewis (Hayes) BR2 7EQ Central Bromley Bromley FT918 Gordon Davie Chemist BR2 8AR Central Bromley Bromley FAQ83 London Lane Pharmacy BR1 4HE Central Bromley Bromley FVR97 Scotts Pharmacy BR1 1LF Central Bromley Bromley FTK32 Wallace Pring & Co BR2 9QE Central Bromley Bromley FVF13 L M Williams BR7 5AG Mottingham and Chislehurst Bromley FVN52 Lloyds Pharmacy BR7 5AF Mottingham and Chislehurst Bromley FH398 Lloyds Pharmacy SE9 4DZ Mottingham and Chislehurst Bromley MUR More than one consultation area 119

120 FCS Code Name Postcode Spoke Hub Consultation area FVR91 Boots the Chemist TN16 3JZ Biggin Hill Orpington FWA21 Day Lewis (Biggin Hill) TN16 3BA Biggin Hill Orpington FXM78 Lloyds Pharmacy TN16 3XZ Biggin Hill Orpington FC864 Boots the Chemist BR5 1DQ Central Orpington Orpington FDF35 Boots the Chemist BR6 0LS Central Orpington Orpington FN052 Crofton Pharmacy BR6 8DG Central Orpington Orpington FKV60 Eldred Drive Pharmacy BR5 4PE Central Orpington Orpington FRC25 Farncray Ltd BR6 0NQ Central Orpington Orpington FGG04 Farrants Chemist BR5 1LY Central Orpington Orpington FE693 Lloyds Pharmacy BR6 6EY Central Orpington Orpington FR247 Petts Wood Pharmacy BR5 1DQ Central Orpington Orpington FL057 Rowlands Pharmacy BR6 9LP Central Orpington Orpington FLK72 Sainbury s BR6 8NZ Central Orpington Orpington FMK62 Stevens Chemist BR6 6BG Central Orpington Orpington FJK92 Superdrug Pharmacy BR6 0PS Central Orpington Orpington FX096 Tesco Extra BR6 0NH Central Orpington Orpington FM963 Village Pharmacy BR6 7AZ Central Orpington Orpington FJ793 Osbon Pharmacy BR5 3NJ The Crays Orpington FTK80 Crayhill Chemist BR5 2RG The Crays Orpington FQF14 Lloyds Pharmacy BR5 2DD The Crays Orpington FTM53 Priory Pharmacy BR6 0JB The Crays Orpington FR366 Silversands Ltd BR5 4AD The Crays Orpington FPK91 Tesco Superstore DA14 5BN The Crays Orpington MUR More than one consultation area 120

121 Appendix 7: Map references Map Refs Trading name Address 1 Address 2 Address 3 Postcode 1 Beckenham Pharmacy High Street Beckenham Kent BR3 1AH 2 Beckenham Pharmacy 70 High Street Beckenham Kent BR3 1ED 3 Blackwells Chemist 245 Croydon Road Beckenham Kent BR3 3PS 4 Boots the Chemist 125 Burnt Ash Lane Bromley Kent BR1 5AB 5 Boots the Chemist 15 Station Approach Hayes Kent BR2 7EQ 6 Day Lewis (Bromley) 195 Widmore Road Bromley Kent BR1 2RG 7 Boots the Chemist High St Bromley Kent BR1 1JY 8 Boots the Chemist 40 The Glades Bromley Kent BR1 1DN 9 Boots the Chemist Main Road Biggin Hill Kent TN16 3JZ 10 Day Lewis (Biggin Hill) 136 Main Road Biggin Hill Kent TN16 3BA 11 Boots the Chemist 77 Queensway Petts Wood Kent BR5 1DQ 12 Boots the Chemist 216 High Street Orpington Kent BR6 0LS 13 Boots the Chemist 5 Colman House, High Street Penge London SE20 7EX 14 Caxton Pharmacy 3 Widmore Rd Bromley Kent BR1 1RL 15 Coney Hall Pharmacy 5 Kingsway, Coney Hall West Wickham Kent BR4 9JB 16 Cray Valley Pharmacy 55 High Street, St Mary Cray Orpington Kent BR5 3NJ 17 Crayhill Chemist 88 Cotmandene Crescent, St Paul's Cray Orpington Kent BR5 2RG 18 Crofton Pharmacy 1 Place Farm Ave Orpington Kent BR6 8DG 19 Boots the Chemist 182 High Street Beckenham Kent BR3 1EW 20 Lloyds Pharmacy 34 Marion Crescent, St Paul's Cray Orpington Kent BR5 2DD 21 Day Lewis (Hayes) 5 Station Approach Hayes Kent BR2 7EQ 22 Eldred Drive Pharmacy 25 Eldred Drive Orpington Kent BR5 4PE 23 Elmers Pharmacy 172 Upper Elmers End Rd Beckenham Kent BR3 3DY 24 Farncray Ltd 330 High Street Orpington Kent BR6 0NQ 25 Farrants Chemist 13 Station Square Petts Wood Kent BR5 1LY 121

122 26 Gordon Davie Chemist 195 Southborough Lane Bromley Kent BR2 8AR 27 Hamlet Pharmacy 45 Anerley Road Anerley London SE19 2AS 28 Kamsons Pharmacy 121 Anerley Road Anerley London SE20 8AJ 29 L M Williams High Street Chislehurst Kent BR7 5AG 30 Lloyds Pharmacy 3 Roundways Biggin Hill Kent TN16 3XZ 31 Lloyds Pharmacy 108 High Street West Wickham Kent BR4 0LT 32 TT Pharmacy 174 Croydon Road Penge London SE20 7YZ 33 Lloyds Pharmacy 13 Windsor Drive, Chelsfield Orpington Kent BR6 6EY 34 Lloyds Pharmacy 59 High Street Chislehurst Kent BR7 5AF 35 Lloyds Pharmacy 4/6 Cranley Parade, Beaconsfield Road Mottingham London SE9 4DZ 36 London Lane Pharmacy 84 London Lane Bromley Kent BR1 4HE 37 Lotus Pharmacy 119 Croydon Road Beckenham Kent BR3 3RA 38 Macks Pharmacy 2 Eden Park Avenue Beckenham Kent BR3 3HN 39 Macks Pharmacy 165 High Street Penge London SE20 7PF 40 Park Langley Pharmacy 90 Wickham Road Beckenham Kent BR3 6QH 41 Paydens Pharmacy Croydon Road Beckenham Kent BR3 3PR 42 Peters Chemist 15 Bromley Road Beckenham Kent BR3 2NT 43 Petts Wood Pharmacy 83 Queensway, Petts Wood Orpington Kent BR5 1DQ 44 Priory Pharmacy 8 Carlton Parade Orpington Kent BR6 0JB 45 Rowlands Pharmacy 121 Westmoreland Rd Bromley Kent BR2 0TY 46 Rowlands Pharmacy 10 Crescent Way Orpington Kent BR6 9LP 47 Sainbury s Pallant Way, Locks Bottom Farnborough Kent BR6 8NZ 48 Scotts Pharmacy 7 High Street Bromley Kent BR1 1LF 49 Silversands Ltd 1 Kent Road, St Mary Cray Orpington Kent BR5 4AD 50 Stevens Chemist 5 High Street, Green Street Green Orpington Kent BR6 6BG 51 Superdrug Pharmacy High Street Beckenham Kent BR3 1EA 52 Superdrug Pharmacy High Street Orpington Kent BR6 0PS 53 Tesco Extra 9 Augustus Lane Orpington Kent BR6 0NH 54 Tesco Superstore Edgington Way Sidcup Kent DA14 5BN NHS Bromley 122

123 55 Village Pharmacy 131 High Street Farnborough Kent BR6 7AZ 56 United Pharmacy 5 The Parade, Croydon Road Penge London SE20 7TJ 57 Boots the Chemist 90 Station Road West Wickham Kent BR4 0PU 58 Wallace Pring & Co 40 Chatterton Road Bromley Kent BR2 9QF 59 Westchem 89 Station Road West Wickham Kent BR4 0PX NHS Bromley 123

124 Appendix 8: Report of the consultation on the draft PNA Introduction This report provides a summary of the stakeholder consultation undertaken by NHS Bromley on its draft (PNA). Background NHS Bromley prepared a draft (PNA), the draft PNA was prepared in order to satisfy the requirement in regulations which require each PCT to publish a PNA by 1 st February A steering group was established to guide the development of the draft PNA which was published for consultation on 21 st October 2010, the consultation ended on 20 th December Consultation process A list of stakeholders to be consulted on the PNA was developed by following the regulations relating to the development of PNA. These regulations set out the minimum requirement for the individuals and groups that each PCT must consult. Each stakeholder was sent a full copy of the draft PNA together with a covering letter and consultation questions. The list of stakeholders consulted during the consultation is shown at Figure 1. All pharmacy contractors Bexley Bromley and Greenwich Local Pharmaceutical Committee Bromley Local Medical Committee London Borough of Bromley South London Healthcare NHS Trust Oxleas NHS Trust Bexley Care Trust Croydon PCT Greenwich PCT Lambeth PCT Lewisham PCT Southwark PCT Surrey PCT West Kent PCT Bromley LINk Figure 1: Organisations and individuals consulted on the draft PNA 124

125 Results of the consultation Responses to the formal consultation were received from the following individuals and organisations: Organisation Ran Pharmacy Limited Scotts Pharmacy Sainsburys Pharmacy Caxton Pharmacy Park Langley Pharmacy Boots the Chemist Macks Pharmacy Rowlands Pharmacy Crofton Pharmacy & Village Pharmacy V Patel Lloyds Pharmacy Kamsons Pharmacy Paydens Pharmacy Blackwell s Chemist Bexley, Bromley and Greenwich LPC Manor Road Surgery Forge Close Surgery Bank House Surgery Type Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Pharmacy contractor Representative organisation for pharmacy contractors in Bromley GP GP GP Nature of the responses Most respondents agreed with the findings of the PNA in relation to the current commissioning, the following table highlights the issues raised by respondents and the response or outcome agreed by the steering group. This list is not exhaustive but deals with all the substantive issues raised during the consultation. The list excludes changes related to error or omissions in the draft PNA e.g. opening hours. Issue A number of responses from pharmacy contractors and the LPC proposed that MUR should be a necessary service and not a relevant service. Some respondents suggested that the PCT should commission specific enhanced services. The services mentioned included: alcohol interventions, minor ailments and Response / outcome The steering group considered this issue carefully and concluded that at this time there was insufficient evidence to support the proposed change. The PCT has highlighted in the PNA where potential enhanced services could contribute to meeting the needs of our population. These ideas will be considered within the 125

126 weight management A number of responses from pharmacy contractors and the LPC proposed that the Chlamydia service should be a necessary service and not a relevant service. A number of responses from pharmacy contractors and the LPC proposed that the inclusion criteria for the EHC service should be extended beyond the year old age group. Some respondents were concerned that the NHS Health Checks service is not open to more pharmacy contractors and that there is a lack of plurality in provision. Some respondents proposed that the PCT should explore the benefits of the MDS service and that the service should be classified as a necessary service. A number of comments were related to the maps in the PNA. Some would like more mapping; others wanted to see the maps improved. One respondent raised a concern about the wording used by in the draft PNA to describe how the PCT would fill gaps or improve provision of services. Specifically the LPC was concerned that this would constitute a fettered discretion Some respondents felt that the PNA did not adequately consider how pharmaceutical services could help to address inequalities Some respondents felt that the draft PNA did not explain the terms necessary and relevant in relation to pharmaceutical services. Some respondents felt that the draft PNA did not clearly state the limitations of the patient questionnaire. PCTs commissioning plans. The steering group also noted the direction of travel set by the White Paper which signalled the division of pharmacy commissioning between Local Authorities, GP Consortia and the NHS Commissioning Board. The steering group considered this issue carefully and concluded that it is not possible to accurately target needs with this service and while the service has improved access to screening this has not resulted in significant levels of screening through pharmacy. There are no plans to change the inclusion criteria for this service at this time. The steering group considered this issue and noted that the service is currently commissioned from pharmacies where there is limited capacity in General Practice. It is unlikely that the PCT will extend commissioning before assessing the performance of the programme in practices. The PCT is still in the process of reviewing this service and will update the PNA when the results of this review are known. The steering group agreed that mapping for the PNA should be reviewed and as better maps become available these will be included in the PNA by way of a supplementary statement. The wording of the draft PNA intended to convey that the PCT would look to the market through the any willing provider route to meet any gap in provision. The wording in the draft PNA will be amended to reflect this. The steering group felt that the PNA explored inequalities in Bromley in some depth and that the current and potential future services assessment reflected this. The wording in the draft PNA will be amended. The wording in the draft PNA will be amended. 126

127 Changes to the draft PNA Each response received by the PCT was reviewed and analysed to identify any issue raised which was then considered in relation to the draft PNA. The draft PNA was amended to reflect any changes arising from the consultation. The consultation did not result in any substantive changes to the draft PNA, however it did raise issues which would be considered by NHS Bromley through the commissioning process. 127

128 Appendix 9: Abbreviations and Glossary BMI Body Mass Index LSOA Lower Super Output Area BP Blood Pressure LTC Long Term Condition CHD Coronary Heart Disease LTLI Long Term Limiting Illness CKD Chronic Kidney Disease MDS Monitored Dosage System COPD CPPQ Chronic Obstructive Pulmonary Disease MSOA Middle Super Output Area Community Pharmacy Patient Questionnaire MUR/PI Medicines Use Review / Prescription Intervention CT Care Trust NHSIC NHS Information Centre CVD Cardio Vascular Disease NRT Nicotine Replacement Therapy EHC Emergency Hormonal Contraception ONS Office of National Statistics EPS Electronic Prescription Service PCT Primary Care Trust GLA Greater London Authority PMR Patient Medication Record GP General Practitioner PNA HbA1c Glycosylated haemoglobin PWP Pharmacy White Paper HES Hospital Episode Statistics QOF Quality and Outcomes Framework HF Heart Failure RD Repeat Dispensing JSNA Joint Strategic Needs Assessment SCP Strategic Commissioning Plan LMC Local Medical Committee SHA Strategic Health Authority LPC Local Pharmaceutical Committee SSP Strategic Services Plan LPS Local Pharmaceutical Services NHS appeals authority Community pharmacy contract Consultation facilities / area Market entry A special health authority that was responsible for determining control of entry appeals. Subsequently replaced by the NHS Litigation Authority. The community pharmacy contract is a contractual framework made up of three service levels: Essential Services, Advanced Services and Enhanced Services. Most community pharmacies now have an area in the pharmacy where the patient and pharmacist can have a private consultation. The design and specification of these facilities varies from pharmacy to pharmacy. Market entry (in relation to community pharmacy) is the system that controls whether a pharmacy may open to provide NHS services. New pharmacies must, currently, satisfy a test to be entered onto the pharmaceutical list for a specific premises. Only pharmacies on the list may provide NHS services in an area from those premises. 128

129 Medicines Use Review ONS Cluster Pharmacist Pharmaceutical Services Pharmacy Prescription item(s) Quartile Quintile Repeat Dispensing Secondary Care Tertiary Care A discussion between the pharmacist and patient with the aim of improving understanding and medicines use by patients PCTs which are grouped according to local social and economic factors. A registered pharmacist has typically completed five years (which includes a degree at Masters level) of training which includes a degree and post graduate training. These are services available from pharmacies and dispensing appliance contractors and dispensing GPs. A registered pharmacy premises that is regulated by the Royal Pharmaceutical Society and appears on the Care Trust s list. Each medicine on a prescription is counted as one item. A prescription may have many items. One of four division which divide a series of data into four equal parts One of five division which divide a series of data into five equal parts Repeat dispensing is a mechanism by which the patient s GP may issue the pharmacist with a prescription to dispense at agreed intervals for on-going treatment. Hospital based care Specialist hospital care 129

130 Appendix 10: Maps to support the PNA 130