Agenda item

Report of the Designate Director of Public Health

The Director of Public Health introduced the report, underlining the joint work with partner agencies and the finding that there was a good level of provision in the Borough.  The Sub-Committee welcomed Mike Leviton, Chief Executive of the Local Pharmaceutical Committee, who gave a presentation on pharmacy services in the area.  He had been impressed by the Pharmaceutical Needs Assessment (PNA)for the Borough which compared well with other areas he covered; this regulatory document was important in facilitating NHS England carrying out its functions.  Mr Levington acknowledged the impact of budget cuts on Council services and confirmed that, ideally, he would wish to see links between the PNA and the Public Health Report.  Traditionally, there had been a good supply of pharmacies in Harrow (and in nearby Brent), but there were certain parts of the Borough where demand was higher.  Mr Levington underlined the value of this clinical service in a “normal” environment and the fact that a pharmacy provided this service on an “open-door” basis over long hours and in convenient locations; a pharmacy could also make a referral to other health services if a condition was deemed serious enough.

Mr Levington referred to a pilot project across 30 pharmacies in Harrow, Hillingdon and Brent providing support for infants and early years children; it had links to Imperial College London and to Professor Blair at Northwick Park Hospital.  The project sought to improve the health and care of families in antenatal and postnatal periods and in a child’s early years and it benefited from good support from public health staff in the three borough councils.  Its impact would be evaluated over the next year. 

Mr Levington spoke about the challenges presented by the reduction of remuneration to pharmacies and the shortage of certain medicines.  He went on to explain the “Prescribing Wisely” initiative by the North West London CCG which sought to discover more about medicines purchased over the counter at pharmacies and elsewhere, and the prices charged.  There was also interest in addressing the issues of the over-ordering of medicines and patient confidentiality in the arrangements for the delivery of medicines. 

Mr Levington concluded by referring to the surprising exclusion of pharmacies from the STP review in North West London, particularly given the level of NHS spend on medicines. 

In discussion of the report and presentation, the following principal points were made:

a)            In terms of addressing gaps in services, it was anticipated that NHS commissioning would reflect the expected increase in housing developments over the next three years and this would form part of the next PNA.  The current trend was towards combined GP and pharmacy services on the same site.  It was not expected that significant pharmacy service gaps would develop. 

b)            There was potential for greater use of pharmacies to take the pressure off A&E and primary care services.  Traditionally, CCGs would not commission services to deal with “minor ailments” and there were issues around the limitations on prescriptions.  A study by Professor Blair had revealed thousands of attendances by children under four years of age at GP services and A&E which had led to no requirement for treatment and medication.  These cases could have been satisfactorily dealt with in community pharmacy services where the option of referral to other services existed.  Mr Levington agreed that the support of the Council and the Joint Health Overview and Scrutiny Committee for North West London (JOSC) would be welcomed in recommending the NHS to promote the use of pharmacies more assertively.  The Chair suggested that this be raised in the JOSC after the local elections. 

c)            It was considered that the number of pharmacies in the Wealdstone area was sufficient at present, although the impact of the regeneration schemes would be assessed.  The NHS was carrying out pharmacy quality checks and it was understood almost all Harrow pharmacies were involved.  Mr Levington offered to circulate relevant data; he also referred to initiatives on dementia support and sepsis. 

d)            In response to a questions, Mr Levington reported that the service for pregnant women involved “health champions” offering support and advice and that the areas his responsibilities covered were Harrow, Brent, Hillingdon, Ealing, Hounslow, Barnet, Enfield, Haringey and Hammersmith & Fulham. 

e)            It was acknowledged that the Health Help app was very useful, but other options had to be provided for those who did not use online data.

f)             Dr Merali underlined the immensely-underused professional resource of pharmacies and the views of GPs that it would be much more effective if pharmacists managed minor ailments.  He regretted that the funding streams did not facilitate this.  Mr Levington advised that even the most conservative estimates were that 16% of GP attendances could be handled effectively by pharmacies, and that the boroughs with a minor ailments service included Enfield, Ealing, Haringey and Hillingdon. 

RESOLVED:  That the report be noted.