NHS County Durham

and Darlington
Pharmaceutical
Needs Assessment
County Durham 2010-2011

remery
8/4/2010
Contents

Executive Summary 6

1.0 Introduction 8

1.1 Background and Purpose of the PNA 8

1.2 County Durham Overview 9

1.3 NHS County Durham and Darlington’s Five Year Vision 10

1.4 National Targets in Relation to Community Pharmacy 11

1.5 Pharmaceutical Contract 12

1.6 Community Pharmacy Market 13

1.7 PNA Process 14

1.7.1 Communications and Engagement 15

2.0 County Durham Health Need 15

2.1 Lifestyles that impact on health 18

2.1.1 Smoking 19

2.1.2 Alcohol Misuse 20

Page | 2
 2.1.3 Drug Misuse 20

2.1.4 Obesity 21

2.2 County Durham Health Priorities 22

2.2.1 Cardiovascular Disease 22

2.2.1.1 Stroke 22

2.2.1.2 Coronary Heart Disease 22

2.2.2 Diabetes 24

2.2.3 Cancer 26

2.2.4 COPD 27

2.2.5 Mental Health 27

2.2.6 Sexual Health 28

2.2.6.1 Teenage Conception 28

2.2.6.2 Sexually Transmitted Infections 29

3.0 Current Provision 29

3.1 Outside Area Pharmacy Provision 29

Page | 3
3.2 Opening Hours of Community Pharmacies 31

3.2.1 Essential Small Pharmacy Local Pharmaceutical Schemes 31

3.2.2 Core and Supplementary Hours 32

3.2.3 Extended and Out of Hours Cover 32

3.3 Access to Community Pharmacy and Estates Assessment 32

3.4 Essential Services 33

3.5 Advanced Services 33

3.6 Enhanced Services 33

3.7 Pilot Schemes 34

3.8 Dispensing Doctors 35

3.9 Offender Pharmacy Provision 35

3.10 Information Technology 36

3.11 Capacity and Capability 36

3.12 Service User Engagement 36

4.0 Primary Care Provision 38

Page | 4
4.1 GP Practice Opening Hours 39

4.2 Comparable Service Provision (other than pharmacy) 39

5.0 Pharmaceutical Gap Analysis 39

5.1 Current State and Gaps – Access to Pharmaceutical Essential

Services 40

5.2 Current State and Gaps – Advanced and Enhanced Services 41

6.0 Commissioning World Class Pharmacy Provision 43

6.1 Developing the Current Market 43

6.2 Current Process for Pharmacy Development 44

6.3 Further Recommendations 44

6.4 Review Process for PNA 45

References 46

Appendices 47-82

Page | 5
Executive Summary

NHS County Durham and Darlington have developed a Pharmaceutical Needs Assessment (PNA) to
understand what the health need is of the local population and to compare that with the current
provision of pharmaceutical services in the area. The PNA has focused on the five localities which make
up the County (Derwentside, Durham and Chester-le-Street, Sedgefield, Durham Dales and Easington) to
identify any gaps in provision in terms of access or to understand potential areas for service
development within a community pharmacy setting.

County Durham has a population of 504,900 spread over 862 square miles. The county suffers from
some of the worst health levels in the area with some parts of the county falling well below the national
average in terms of age of mortality.

There are 112 community pharmacies and 18 dispensing GP practices, which provide pharmaceutical
services to the local population including dispensing of medications, medicine use reviews and locally
commissioned enhanced services. County Durham has a greater than national average number of
community pharmacies per head count population.

The County Durham PNA 2009-10 will identify the services currently delivered within pharmaceutical
market, identifying provision of essential, advanced and enhanced services in line with the national
contracting framework.

Essential Services

In relation to the essential services provided in the area, the core contract total accounts for just under
£10 million. Community Pharmacies are required to provide essential services such as dispensing,
disposal of unwanted medicines, health promotion and signpost the public to other NHS services.
Community pharmacies are required to open for a minimum of 40 hours per week (except those who
have been granted to operate as an Essential Small Pharmacy Local Pharmaceutical Scheme (ESPLPS)).
There are also pharmacies that have entered the market as 100 hour pharmacies – where they must
open a minimum of 100 hours per week. Some key messages have been identified as a result of the
PNA in terms of essential services provided:
  Better marketing of services required from both the NHS, PCTs and community
pharmacies to raise awareness of services available
 To ensure coverage of dispensing services in line with GP and Primary Care Centre
opening hours e.g. extended and out of hours service provision
 To ensure contingency plans are in place to avoid any situations where pharmaceutical
provision is not available
 To ensure all provider of pharmaceutical services are managed as part of the national
contract in order that services provide value for money and achieve desired outcomes to
contribute to the vision of NHS County Durham and Darlington
 To consult on the local pharmaceutical contracting framework (currently in development
at time of production)

Advanced and Enhanced Services

Advanced services delivered within the pharmaceutical contract framework include medicines use
reviews, appliance use reviews and stoma appliance customisation reviews. Enhanced services are those
which are commissioned locally to meet the health need of the population. Each pharmacy can provide
a maximum of 400 MURs per year, this accounts for up to £1.25 million of the budget a year. The PNA
has identified some key areas for action:

 Commissioners to ensure that all enhanced services are monitored and assessed against
desired outcomes
 To review ongoing pilots and established schemes to ensure value for money against
other service providers
 To ensure MURs are targeted towards those with the greatest need for the service to
achieve the greatest impact on health gain for the local population
 To ensure out of area appliance contractors meet all national and local standards as set
out by the commissioning organisation

Generic Conclusions
 The PNA has indicated that there are enough pharmaceutical outlets within County Durham
 The health needs identified are currently being met by either pharmaceutical or other providers
 Medicine waste should be analysed further and the PCT will look to work with providers and LPC
on future waste management innovations
 Commissioners need to recognise the benefits that community pharmacy can bring to a patient
pathway and the PNA may be used as a tool for future service developments

Page | 7
1.0 Introduction
For the purposes of the Pharmaceutical Needs Assessment (PNA), pharmaceutical services are defined
(as set out in the Directions) as essential, advanced and enhanced services provision. This definition is
detailed in the NHS Health Act 2006.

Community pharmacy plays a vital role in the NHS and is accessed by the vast majority of the
population. Over the years the professionals who operate community pharmacies have been identified
as clinicians in their own right, playing a vital role in not only dispensing prescriptions but also in the
prevention and treatment of long term conditions.

The PNA is a document which supports commissioners in identifying areas for development in terms of
community pharmacy provision. Community pharmacy can be utilised as a vehicle for improving the
health and well being of the local population and thus plays a vital role in local health service provision.
This document is aligned to the local Joint Strategic Needs Assessment (JSNA) (2009) and NHS County
Durham and Darlington’s Five Year Strategic Plan.

1.1 Background and Purpose of the PNA

Pharmacy in England: Building on Strengths – Delivering the Future (2008) sets out the vision for 21st
century pharmaceutical services, helping to drive forward the NHS agenda. Community pharmacy was
highlighted as easily accessible places where the population can draw upon health services at their
convenience. This report sets out a new way of thinking for community pharmacy, encouraging
commissioners to think of this group of professionals as part of overall primary care strategies.

Consequently in 2009 a new health bill (Pharmacy in England: Building on strengths – delivering the
future) was agreed in Parliament which replaced the control of entry process for community pharmacy
applications. As of February 2011, all new pharmacy applications will be scrutinised against the PNA and
decisions will be made based on the needs identified within this document. As a result, the opening of
new and the development of existing community pharmacies will be more needs driven and targeted.

There are four core functions of the PNA which include the identification of health need, current service
provision, any gaps in service as a result and future community pharmacy commissioning intentions.
This provides a holistic picture of community pharmacy within the wider context of healthcare provision
and should be viewed as an element of a patient pathway.

The County Durham PNA will identify the health needs of the local area and identify ways in which
primary care and in particular community pharmacy might be able to bridge that gap.

Page | 8
1.2 County Durham Overview
County Durham has a population of approximately 504,900 over a geographic spread of 862 square miles. As demonstrated (figure 1) the
county includes densely populated areas as well as great expanse of rural land, therefore the needs of the local population are diverse.
Figure 1: Map of rurality within County Durham and Darlington
Part of the process for developing the PNA for County Durham, includes the need to determine
localities. To this end the localities documented are aligned to Practice Based Commissioning clusters
and are the same as those used within the JSNA, they are:

 Derwentside
 Durham and Chester-le-Street
 Sedgefield
 Easington
 Durham Dales

This will help demonstrate the different health needs and inequalities which exist across County Durham
to enable better informed commissioning decision making.

County Durham experiences high levels of health inequalities which include high rates of heart disease
and cancer. Smoking remains the cause of lower life expectancy and high disease rates. Obesity also
poses a major public health challenge and risk to future health, wellbeing and life expectancy. These
form the priorities set by NHS County Durham and Darlington and will be used to shape the content of
the PNA

1.3 NHS County Durham and Darlington’s Five Year Vision

NHS County Durham and Darlington is one of 12 Primary Care Organisations within the North East.
County Durham and Darlington has a population of approximately 600,000, its geography is expansive
with differing health needs across rural and urban areas. Comparatively County Durham has some of
the worst health levels in the country and as such there is a huge demand on NHS services in the area.
NHS County Durham and Darlington have an annual budget of approximately £1.1 billion which is used
to commission services to reduce health inequalities and improve the health outcomes of the
population it serves.

NHS County Durham and Darlington’s aim is “to deliver excellence today for a healthier tomorrow”,
focussing on prevention and reducing the reliance on healthcare services. As outlined in Transforming
Community Service( 2009) primary care will need to take on a greater role in the future in delivering
health advice and interventions in order to prevent lifestyle related disease.

The NHS is currently in a position of zero growth as a result of the worldwide economic climate,
consequently services commissioned have to demonstrate value for money, achieving the greatest
outcomes on investment. Community pharmacy can be used as a vehicle to help deliver this challenge,
where for instance, comparably this sector may provide high productivity and quality services. One
example of this is the need to reduce the number of avoidable hospital admissions and promote care
closer to home, community pharmacy can be one solution to delivering this challenging agenda.

In order to achieve its vision, the PCT has four key objectives:-

 Giving children a better start in life

 Helping to keep our public healthy
 Ensuring high quality care at the most appropriate time and place.
 Helping people get the most out of later life
NHS County Durham and Darlington have adopted a programme approach to delivering these
objectives, working in partnership with clinicians (including community pharmacists and their teams) to
achieve desired outcomes. Throughout the PNA, the focus will be on the four key objectives outlined,
aligning them to what community pharmacy currently delivers as well as their potential attribution in
the future.

1.4 National Targets in Relation to Community Pharmacy

It is also important to understand further the context in which NHS County Durham and Darlington is
required to commission services based on national priorities. Figure 2 shows a list of some of the
national targets where community pharmacy may play a role in helping to deliver services.

VSB05: Smoking Quitters

VSA14: Stroke

VSB08: Under 18 conception rates

VSB10: Immunisation rates

VSB14: Chlamydia screening

Figure 2: NHS National Targets 2009/10 applicable to community pharmacy

Page | 11
1.5 Pharmaceutical Contract
It is important when talking about community pharmacy and the importance of the PNA to
understand what we mean in terms of the definition of pharmaceutical services (figure 3).

The NHS Act 2006 sets out a wider definition for pharmaceutical services. Pharmaceutical
services are generally provided by virtue of Part 7 of the Act. Under section 126(1) – (3),
PCTs are required to secure, on the basis of Regulations made by the Secretary of State,
the provision of services to people in their area of medicines and listed appliances and
"such other services as may be prescribed" (section 126(3)(e)). Prescribed services must
be set out in Regulations. Therefore, these prescribed services, and the dispensing
services referred to in section 126(3)(a) to (d), constitute the core NHS pharmaceutical
services

Section 127 also provides for “additional pharmaceutical services” to be set out in
Directions to PCTs. This facility was originally introduced in the late 1990s to enable
pharmacies to provide other types of service that did not fall within those core services as
defined by Section 126(3). Originally, there were two types of directed service: an “out of
hours” service and advice to care homes. However, since April 2005, the Directions now
include advanced and enhanced services for pharmacy contractors. From April 2010,
further Directions set out the advanced services for appliance contractors.

Figure 3: Pharmaceutical services as defined in the NHS Act 2006

Therefore the County Durham PNA will identify current and future provision in terms of three types of
service:

1. Essential Services – core services which community pharmacies must provide include
dispensing, repeat dispensing, participation in public health campaigns as directed by PCT,
signposting to other providers, disposal of unwanted medicines and providing support for self
care

2. Advanced Services – include Medicine Use Reviews (MURs), Appliance Use Reviews (AURs) and
Stoma Appliance Customisation Service (SAC). All of which can only be delivered by those
community pharmacy teams who demonstrate appropriate competence against the Secretary of
State Directions.

3. Enhanced Services –services which are locally commissioned based on the needs of the
population, community pharmacy teams need to demonstrate a level of competence and meet
requirements as set out within a service specification in order to deliver.

Page | 12
1.6 Community Pharmacy Market
Community pharmacies have been independent contractors to the NHS since 1948. A pharmacy can
only dispense NHS prescriptions under contract with a primary care organisation. By law, a pharmacy
must be owned by a pharmacist or a company that employs a designated superintendent pharmacist.
Community pharmacies can be categorised into five types, according to the number of outlets and type
of premise; supermarket, multiple (200+), large chains (20-200), small chains (2-20) and independents
(less than 5). The current market picture for County Durham will be explored as part of the assessment
of current state within the PNA.

Competition on non-prescription items has increased dependence on NHS funding; pharmacies now
derive at least 80% of their income from the NHS. Some of this income also now derives from any locally
commissioned enhanced services. Since 1948 there has been a shift in what community pharmacies
deliver from simply dispensing medicines to providing a whole host of clinical interventions as part of
patient pathways. This ideology forms the basis of the recent pharmacy white paper.

Figure 4 shows the current community pharmacy market within County Durham. The greatest market
share within County Durham currently sits within the independent community pharmacies. There are
four supermarkets which are spread across the county - two in Durham and Chester-le-Street, one in
Derwentside and one in Sedgefield locality.

Figure 4: County Durham Community Pharmacy Market as at August 2010

Page | 13
1.7 PNA Process
The detail of the process for developing the County Durham PNA is shown in appendix 1 as part of the project plan. Figure 5 shows the key milestones
relating to the process of the development and production of County Durham’s PNA for 2010-11.

Figure 5: Overview of County Durham PNA Process 2010-11

Page | 14
1.7.1 Communications and Engagement

A Communications and Engagement Plan outlines a programme of internal and external communications
and engagement activity which aims to:

 Raise awareness of the PNA among internal and external key audiences.
 Encourage responses to and involvement in pre-consultation engagement activity and the formal
consultation
 Promote the engagement opportunities and the consultation via all appropriate communications
channels.
 Effectively manage and co-ordinate stakeholder engagement.

The plan ensures the key activity required around issuing a copy of the draft PNA to identified
stakeholders, including required consultees, and meeting with the LPC, LMC, LINk and any other
appropriate groups identified to discuss the draft PNA, respond to questions and facilitate consultation
responses.

2.0 County Durham Health Need

County Durham has a population of around 504,900 residents, 9.3% of this total live in rural areas. The
Office of National Statistics (ONS) 2006 based population projections show that over the next five years
the total population of the County will experience a rise of 2.3%, the increase nationally is much larger
at 4%.

Figure 6: Projected Population Change 2007-2012

Page | 15
 Birth rates in County Durham have climbed steadily since 2001 and are currently at a level last seen in
the late 1960s. Figure 7 shows the predicted increase in population by 2021 using additional births as a
marker. This shows that the fastest growing area may be Easington locality with an extra 2,800
residents by 2021.

County Durham and

Derwentside Easington Sedgefield Durham Dales
Durham Chester-le-St
7,526 739 1,950 2,800 -624 2,629
Figure 7: Population Gain by 2021 Implied by Additional Births

In common with the rest of the country, County Durham’s age distribution is becoming older. The
numbers of people in the retirement age group are predicted to peak in the year 2037, and the numbers
of those aged 85+ will peak in 2056.

Figure 8: Population increase by age group

Male and female life expectancy in Durham is significantly lower than the national figure, particularly for
females.

Male Female
County Durham 76.70 80.50
England 77.93 82.02
Figure 9: Life expectancy within County Durham and Darlington and the national average

Health inequalities exist between the populations of County Durham and Darlington and the rest of
England. The analysis shows health inequalities across County Durham and Darlington are persistent and
pervasive.

Page | 16
The higher the index is, the higher the level of deprivation in that area. The highest ranked index in the country is 48.26. In 2007 County
Durham had an index of 27.13 and was ranked 52 out of 152; Darlington had an index of 24.16 and was ranked 72.

The analysis also shows that there are significant health inequalities between communities in County Durham and Darlington. The map below
shows the areas of highest health inequalities within each of the districts of County Durham and Darlington.

Figure 10: Deprivation Scores across County Durham and Darlington

Page | 17
 In common with the rest of the country, County Durham’s age distribution is becoming
top heavy. Improving this distribution will take a long time as the numbers of people in
the retirement age group are not predicted to peak until the year 2037, and the
numbers of those aged 85+ will not peak until 2056.

2.1 Lifestyles that impact on health

This section identifies particular lifestyle choices that impact on overall health and wellbeing of the
population of County Durham. The lifestyle choices which are highlighted and have data available
within the PNA are; smoking, alcohol, drug use, obesity level. The following chart is taken from the
national 2009 Community Health Profiles for County Durham and Darlington. The areas identified
particularly focus on health needs which may be met through pharmaceutical service provision.

Page | 18
 2.1.1 Smoking
Smoking is the principal avoidable cause of premature death and ill-health in England. “There are still
over 8 million people in England who smoke; half of them may be expected to die prematurely if they do
not quit. In 2008 over 80,000 people died from a smoking related illness “(A smokefree future: A
comprehensive Tobacco control strategy for England, DoH 2010).

Smoking is the main contributor to Durham’s low life expectancy when compared to England. It is a
major cause of death from CVD, chronic lung disease and cancer – the major diseases contributing to
this life expectancy gap. Smoking is a major health inequality issue within the county, contributing to
half the life expectancy gap between more and less deprived wards.

Smoking
Estimated Smoking Estimated Smoking
Locality Attributable Mortality
Prevalence Population
per 100,000
Durham and Chester-le-
26.9 31336 278
Street
Derwentside 30.6 21058 315
Easington 37.3 27797 326
Sedgefield 31.6 22009 323
Durham Dales 29.2 20290 266
County Durham 30.7 122490 298
England 24.1 - -
Figure 11: Smoking Prevalence in County Durham as at 2008

Within County Durham, smoking prevalence is estimated to be highest in Wear Valley and Sedgefield.
Smoking prevalence varies between population groups, and its distribution within communities is
unequal. It is more common in areas of greater deprivation. There are some population groups who are
more at risk than others. Routine and manual workers are more likely to smoke than those in office and
managerial based jobs; also smoking is more prevalent in the female population. These areas may
require targeted intervention.

Between 2000-2005 around 1000 people (aged 35+) per year died from smoking related illnesses in
County Durham. Quit rates via NHS Stop Smoking Services in County Durham (51%) are similar to those
in the North East (50%). Smokers like stop smoking clinic settings with easy access at varied and
locations.

Access to Stop Smoking Services (as a proportion of estimated smoking population) varies across County
Durham. The relative inequality gap in access between the most and least deprived wards is highest in
Durham Dales (68%) compared to a low of 10% in Easington. Ideally this inequality gap should reflect the
gap in smoking prevalence.

Page | 19
2.1.2 Alcohol Misuse
Alcohol is a lifestyle factor which affects health and is seen by NHS County Durham and Darlington as a
priority area for prevention strategies. Drinking above the sensible drinking levels, particularly over an
extended period of time, causes risks to health and contributes to crime and disorder. (Safe. Sensible.
Social 2007). As figure 12 shows within County Durham, admission rates are highest in Sedgefield, Wear
Valley and Easington.

Alcohol-attributable hospital Alcohol-specific hospital

admission rates admission rates
Male Female Male Female
Chester-le-Street 127.3 75.5 38.6 21.5
Derwentside 133.8 80.4 41.3 24.1
Durham 118.6 66.1 36.4 16.9
Easington 152.4 94.1 47.0 27.9
Sedgefield 134.8 86.6 42.5 29.7
Teesdale 99.9 61.1 29.9 19.2
Wear Valley 136.0 84.6 42.4 27.3
North East 159.2 91.8 58.3 30.0
England 117.1 65.6 36.9 17.6
Figure 12: Admission rates (per 10,000) to hospital for alcohol-specific and alcohol-attributable causes, 2006/07

2.1.3 Drug Misuse

2006/07 2007/08
People in treatment 1734 1936
Retention 81% 80%
Care plan in place 79% 91%
Figure 13: Number of people accessing drug treatment, percentage retention in treatment and percentage with a care plan
(County Durham)

 The percentage of young people reporting that

they take drugs rose to 4.7% in 2008/09 from
4.2% in 2007/08.

 The number of people accessing drug

treatment increased from 1734 in 2006/07 to
1936 in 2007/08 (11.6%).

Page | 20
2.1.4 Obesity
Definition of obesity: An excess accumulation of body fat that predisposes a person to ill health,
increased disability and reduced life expectancy. (Obesity Report March 2009).

Obesity poses a major public health challenge and risk for future health, wellbeing and life expectancy in
County Durham; a risk arguably second only to that from tobacco for children and young people. The
Government is committed to tackling obesity in both adults and children and set up a new long-term
ambition in October 2007. “Our ambition is to reverse the rising tide of obesity and overweight in the
population, by enabling everyone to achieve and maintain a healthy weight. Our initial focus will be on
28 children: By 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels”.
(Obesity Report March 2009).

Locality Reception Year 6

Chester-le-Street 8.4% 20.5%
Derwentside 9.5% 22.7%
Durham 8.4% 19.9%
Easington 11.2% 20.6%
Sedgefield 9.5% 20.1%
Teesdale 10.6% 20.8%
Wear Valley 9.5% 21.7%
County Durham 9.6% 20.9%
England 9.6% 18.3%
Figure 14: National Childhood Measurement Programme, Department of Health

Estimated adult obesity rates are worse than the England average (23.6%) for County Durham as a
whole (25.3%) and for each of the seven districts. Rates are highest in Easington (28.9%) and Sedgefield
(27.2%). Figure 14 shows the percentage of estimated obese adults in County Durham, this shows the
highest prevalence of adult obesity in Easington.

Page | 21
  Rates of obesity in County Durham are rising in
children and adults and are higher than the England
average.

 In Easington, 11.2% of Reception Year children are

obese and in Derwentside 22.7% of Year 6 children
are obese. Both these figures are above the national
average of 9.6% and 18.3% respectively.

2.2 County Durham Health Priorities

NHS County Durham and Darlington have outlined their strategic objectives and priority health focus
areas. The following section specifically looks at high priority disease areas and the prevalence of those
for County Durham.

2.2.1 Cardiovascular Disease

Cardiovascular disease (including coronary heart disease and stroke) is one of the biggest killers in
County Durham.

2.2.1.1 Stroke
A stroke is a blood clot or bleed in the brain which can leave lasting damage, affecting mobility,
cognition, sight or communication. Stroke, like other vascular diseases such as heart disease, is often
preventable, and there are now more treatment options available.Figure 15 indicates that Durham and
Chester-le-Street have the highest number of emergency secondary care admissions attributable to
stroke.

Stroke Emergency
Locality Admissions *
(SUS data 2007/08)
Derwentside 228
Durham and Chester-le-Street 321
Easington 239
Sedgefield 212
Durham Dales 207
Figure 15: Stroke Emergency admissions and deaths per annum by locality

Source National Centre for Health Outcomes Development

2.2.1.2 Coronary Heart Disease

Coronary heart disease (CHD) kills more than 110,000 people in England every year. More than
1.5million people suffer from angina and 275,000 people have a heart attack annually. Figure 16 and 17
shows that there is still a significant gap between mortality rates for this disease as a comparison with
national figures for both males and females

Page | 22
 Figure 16: premature mortality rates for coronary heart disease (males)

Figure 17: premature mortality rates for coronary heart disease (females)

Between 1993 and 2007, the premature mortality rate for males has reduced by 60%, and by 65% for
females in England overall, compared to reductions of 67% for males and 70% for females in County
Durham.

Page | 23
2.2.2 Diabetes

There are two main types of diabetes:

 Type 1: people with Type 1 diabetes are unable to produce insulin due to destruction of insulin
producing cells in the pancreas. It is the less common of the two main types of diabetes and
accounts for about 5 per cent of people with diabetes. Type 1 diabetes often starts in childhood.
 Type 2: in Type 2, insufficient amount of insulin is produced by the pancreas and there may be a
resistance to the effects of insulin by cells of the body. Type 2 diabetes is the most common type of
diabetes making up about 95 per cent of people with diabetes in the UK.

Number Prevalence (%)

County Durham PCT 20,444 3.9

England & Wales 1,961,976 3.7

Figure 18: Prevalence diagnosed diabetes (type 1 & 2 in adults 17 year and over). Source: QMAS 2006/7

About 3.7 per cent of the UK population currently live with diabetes. However, with about 75 per cent of
people with diabetes diagnosed annually, it is estimated that there are about 2.35 million people with
diabetes nationally, equating to a prevalence of 4.7 per cent. It is estimated that by 2010 it will have
increased to 5.05 per cent, a doubling in prevalence in the last ten years.

The increase in the number of people with diabetes is largely as a result of the rising levels of obesity
and an ageing population. An increasing proportion of diagnosed diabetes can be attributed to better
case finding resulting from the Quality and Outcome Framework (QOF) in general practice.

There are currently an estimated 20,444 people with diagnosed diabetes in County Durham, this
equates to 3.9% of the total population. Based on the Diabetes Prevalence Model (PBS model), a
significant percentage of people with diabetes remain undiagnosed in County Durham and Darlington.
The model estimates that about 17 per cent of people with diabetes in Durham and Chester-le-Street
area are undiagnosed while 49 per cent may be undiagnosed in Easington. It is estimated that there are
about 5,000 cases of undiagnosed diabetes across County Durham and Darlington.

Figure 19 shows the diagnosed prevalence of diabetes in County Durham by locality, this suggests that
Durham Dales has the highest prevalence within the county.

Page | 24
 2004/05 2005/06

Locality number Prevalence number Prevalence

Durham Dales 3377 3.8 3608 4.1

Derwentside 3235 3.8 3450 4.0

Durham and Chester-le-

4776 3.2 5176 3.4
Street

Easington 3365 3.4 3566 3.6

Sedgefield 3397 3.6 3621 3.8

Figure 19: Prevalence of diagnosed diabetes in County Durham

There is a gap between the number who are diagnosed and the estimated prevalence (based on national
statistics). Figure20 shows the estimated prevalence of 1 and 2 type diabetes in County Durham.

Estimated Prevalence type 1 and type 2 (%)

Persons Male Female 0-29 y 30-59 y 60+ y

Durham Dales 5.07 4.06 6.01 0.31 3.40 14.75

Derwentside 4.91 3.97 5.79 0.31 3.33 14.82

Durham & Chester- 3.97 3.29 4.63 0.33 2.99 12.83

Le-Street

Easington 5.36 4.40 6.26 0.32 3.67 16.68

Sedgefield 4.86 3.97 5.70 0.31 3.41 15.11

Figure 20: estimated prevalence of diabetes in County Durham and Darlington, source: PBS model. Yorkshire & Humber Public
Health Observatory

 Reduces of life expectancy by 10 to 15 years

 The largest single cause of blindness in people of working age
 Accounts for 9 per cent of hospital costs and 5 per cent of all NHS costs
 Leads to a four to five fold increase in risk of heart disease
 Up to 80 per cent of deaths in people with diabetes are due to cardiovascular disease
 Prescriptions for diabetes cost nationally £561 million in 2006 or 7% of all prescription costs.

Page | 25
2.2.3 Cancer
The prevalence for cancer in County Durham (2007/08) is equal to the England average of 1.1% of the
total population. This equates to approximately 6000 of the County Durham population.

Figure 2.3o

Figure 21 shows the number and prevalence of cancer patients per locality for 2009/10. This shows that
the greatest prevalence of cancer is in Derwentside at 1.6%.

Locality Number of Cancer Patients Prevalence

Derwentside 1399 1.6%

Durham & Chester-le-St 2246 1.4%

Durham Dales 1382 1.5%

Easington 1490 1.5%

Sedgefield 1439 1.5%

Total 7956 1.5%

Figure 21: Source: QoF register 2009/10

Page | 26
2.2.4 COPD

Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic bronchitis, emphysema or
both – conditions where airflow to the lungs is restricted.COPD is the UK’s fifth biggest killer and is the
second most common cause of emergency admissions. Nationally there are 3.7 million people with
COPD; 2.8 million of these are undiagnosed. This indicates that there is a huge gap in actual diagnosed
cases compared to prevalence figures.

Recent estimates show that County Durham has 11,995 people who are diagnosed with COPD (QoF
2006/07 NHS Information Centre). This equates to 2.3% of the total population which is significantly
higher than the national average (1.4%). In 2005 COPD accounted for 17% of all premature deaths in
County Durham. Between 2004/05 and 2006/07 approximately 1,055 registered patients from County
Durham and Darlington were admitted to hospital with COPD.

Figure 22: Mortality rates for COPD 2005/07 for County Durham

2.2.5 Mental Health

The Mental Health Foundation estimates that one in four people at any one time will experience a
mental health problem. The most common of these conditions are anxiety, stress and depression.
Certain groups are at a disproportionate risk of developing mental health problems including people in
poor living conditions, those from ethnic minority groups, unemployed people, and people with
disabilities, homeless people and people in the Criminal Justice System (Mental Health Foundation
2008). The Department of Health (2007) also recognises that people in the lesbian, Gay and Bisexual
(LGB) community are at a higher risk of mental health problems, suicidal behaviour and deliberate self
harm. This heightened risk has been linked to experiences of discrimination.

Page | 27
 Practice Number of
Primary Care Trust
Population patients on SMI Prevalence
Register
Durham Dales 88,181 464 0.53%
Derwentside 85,544 433 0.51%
Durham and Chester-le-
151,779 735 0.48%
Street
Easington 98,506 632 0.64%
Sedgefield 95249 382 0.40%
Source: www.gpcontract.co.uk
Figure 23: Number of people on GP practices Severe Mental Illness (SMI) Registers as at March 2006 in County Durham

Figure 23 shows that the highest prevalence of mental illness is in Easington locality at 0.53% of the total
population on the SMI register.

2.2.6 Sexual Health

2.2.6.1 Teenage Conception

Teenage pregnancy is strongly associated with the most deprived and socially excluded young people.
Having children at a young age can be harmful to young women’s health and wellbeing and severely
limit their education and career prospects.

1998-2000 2001-2003 2004-2006 2005-2007

Chester-le-Street 37.1 36.9 39.0 38.5
Derwentside 47.1 49.9 52.2 57.1
Durham 37.9 37.8 38.0 33.3
Easing ton 66.1 58.8 58.0 56.1
Sedgefield 55.4 56.3 49.6 51.9
Teesdale 35.3 26.3 26.9 29.6
Wear Valley 68.5 52.2 52.3 53.9
County Durham 51.7 48.7 48.1 48.6
England 45.0 42.5 41.2 41.2
Figure 24: Conception Rates per 1000 female population aged 15-17 – by Locality Area
Source: Office for National Statistics and Teenage Pregnancy Unit, Feb 2009 (Data for 2007 are provisional)

Although figure 24 shows that conception rates have reduced between 1998 and 2007, the figures are
still higher than the national rate.

Page | 28
 2.2.6.2 Sexually Transmitted Infections
2000 2001 2002 2003 2004 2005 2006 2007
Infectious Syphilis 2 8 2 9 9 9 21 20
Gonorrhea 75 115 163 136 103 89 86 94
Chlamydia 603 531 645 800 867 1301 1443 1402
Anogenital herpes 102 72 76 94 90 107 151 201
Anogenital warts 549 604 693 696 798 742 784 886
Total New
1331 1330 1579 1735 1867 2248 2449 2603
Diagnoses
Figure 25: Number of new cases of selected sexually transmitted infections diagnosed by County Durham and Darlington NHS
Foundation Trust 2000 – 2007 (based on GUM KC60 data)
Source: Annual Report of the Director of Public Health 2007/08

Figure 25 shows that the number of sexually transmitted infections has increased between 2000 and
2007, particularly Chlamydia has increased. Chlamydia is of particular concern as it often causes no
symptoms and infections remain undiagnosed. Chlamydia can cause serious chronic complications
including pelvic inflammatory disease, tubal infertility and ectopic pregnancy.

3.0 Current Provision

Figure 26 shows the current community pharmacies in County Durham who are delivering against the
pharmaceutical services regulations, in total there are 112 community pharmacies serving the
population of County Durham. The map also shows that there are 18 dispensing doctor practices.
Dispensing provision is shown against the total number of GP practices within the area. The map shows
provision against the five localities defined (section 1.2).

Within the following section of the PNA we will identify current provision in terms of community
pharmacy for the three areas outlined: essential, advanced and enhanced service delivery. Other
primary care provision will also be mapped out for the health needs identified as part of the JSNA and
indeed those reflected within this PNA.

Page | 29
Figure 26: Map of County Durham showing dispensing practices, community
pharmacies and GP practices as at August 2010

Page | 30
 3.1 Outside Area Pharmacy Provision
Appendix 5 shows the pharmaceutical services which contribute towards meeting the need of the
population of County Durham which are outside of the boundary area. This shows the dispenser names
and postcodes attributable to prescribers within each of the localities during 2009-10. The activity is
based on those dispensing over 300 items (those under 300 items have been excluded for the purposes
of the PNA, as level of significance is minimal). During 2009-10 there were 100 out of area providers
dispensing over 300 items each.

3.2 Opening Hours of Community Pharmacies

Community pharmacies are contractually obliged (under the pharmaceutical services regulations,
2005) to open for a minimum of 40 hours per week, unless permission has been granted by the
PCT. The only exceptions to this rule are those pharmacies that have applied and opened as a 100
hour pharmacy and those classed as Essential Small Pharmacy Local Pharmaceutical schemes
(ESPLPS).

Number of 40 hours = 101

Number of 100 hour pharmacies = 7

Figure 27: Breakdown of pharmacies in County Durham

3.2.1 Essential Small Pharmacy Local Pharmaceutical Schemes

Essential Small Pharmacy Local Pharmaceutical schemes (ESPLPS) were introduced in 2006 and
replaced those pharmacies that were originally classed under the Essential Small Pharmacy
Scheme (ESPS). Entry to this scheme has now closed however there are some existing
pharmacies which fall into this category. There are restrictions on these pharmacies in terms of
the amount of items they are allowed to dispense per annum. The PCT are required to ensure
that unless under special consideration, no pharmacy is opened within a one kilometre range of
the ESPLPS. The Department of Health are currently reviewing the scheme.

There are four community pharmacies within County Durham which are classed as ESPLPS
(figure 28).

Page | 31
 ESPLPS
FR810 John Low T/a Moorside Pharmacy, Consett Park Terrace,
Moorside, Consett Co Durham DH8 8ET

FLX61 Dixon & Hall, 6 Standerton Terrace, Craghead, Stanley, Co

Durham DH9 6DD

FCJ51 Dixon & Hall, 60 York Road, Peterlee, Co Durham, SR8 2DP

FTA07 AD Phillips,15 Commercial Street, Trimdon Colliery, Trimdon

Station, Co Durham,
TS29 6AD
Figure 28: Address List of ESPLPS in Durham

3.2.2 Core and Supplementary Hours

For those community pharmacies that are regulated as a 40 hour pharmacy, any amendments
have to be made to the core hours with the agreement of the PCT. For supplementary hours
these can be changed by giving 90 days notice to the relevant PCT. Appendix 6 shows the core
and supplementary hours carried out by community pharmacies across County Durham.

3.2.3 Extended and Out of Hours Cover

NHS County Durham and Darlington have historically commissioned provision for Sunday
opening and extended hours/ out of hours cover from a limited number of 40 hour pharmacies.
This PNA has highlighted that there is no longer a need for these community pharmacies to
open during these periods as the areas are covered by the seven 100 hour pharmacies in County
Durham. The North East Family Health Services Agency currently administers the rota for bank
holiday pharmacy provision. This process is managed by NHS County Durham and Darlington to
ensure access to community pharmacy across the county.

3.3 Access to Community Pharmacy and Estates Assessment

NHS County Durham and Darlington currently commissions services from 462 community premises, 124
of these are community pharmacies. Although community pharmacies are provider owned there are
standards which the estate has to meet to ensure buildings are fit for purpose and safe. As part of the
Transforming Community Services (TCS) policy agenda, each PCT was required to develop a
Commissioning Investment and Asset Management Strategy (CIAMS) which included an assessment of
all community estate. The LPC sought advice from the national bodies in relation to this strategy and
decided to delay participation until further information was available. NHS County Durham and
Darlington are committed to work in partnership with pharmaceutical providers to support the
development of their estate in line with future commissioning intentions.

Page | 32
3.4 Essential Services
All community pharmacies delivering against the national contractual framework must provide essential
services which include those highlighted in section 1.5. Figure 29 shows the number of community
pharmacies by locality, average population served per pharmacy, the number of items dispensed in each
locality, the total cost and dispensing cost per head population.

Av.
Dispensing Cost
No. of Population No. of Items
Locality Total Cost per Head Pop.
Pharmacies served per Dispensed
(approx)
pharmacy
Durham and
29 4,877 2,761,166 £22,060,229.10 £156
Chester-le-Street
Durham Dales 19 4,514 2,013,650 £15,471,296.75 £180
Derwentside 18 4,727 2,098,303 £14,845,848.43 £174
Easington 25 3,760 2,430,245 £17,606,013.69 £187
Sedgefield 21 4,154 2,118,606 £15,768,477.60 £181
Total 112 Av=4,406 11,428,422 £85,846,967.33 Av= £176
Figure 29: Community Pharmacy dispensing information

The national average for the number of community pharmacies per 100,000 is 20, this equates to one
pharmacy per 5000 population. All localities within County Durham have a higher than average number
of pharmacies per population served. This suggests the current number of community pharmacies
within County Durham is adequate to meet the needs of the population within this area.

3.5 Advanced Services

Advanced services are those which are detailed in section 1.5. Currently there is an accreditation
process within NHS County Durham and Darlington to ensure that providers of Medicines Use Reviews
(MURs) are qualified to a standard level. Community pharmacies that provide advanced services must
have a consultation room which meets the standards set out within the pharmaceutical regulations
(2005). Within county Durham there are 114 community pharmacies who are MUR accredited. MURs
provide service users the opportunity to discuss their usage of medicines, supporting them with
concordance. Each community pharmacy that provides this service is limited to 400 MURs per year as
set by the PCT. This service is particularly beneficial to those with a long term condition.

3.6 Enhanced Services

NHS County Durham and Darlington currently commission a range of enhanced services from
community pharmacy providers. Figure 30 shows an overview of the enhanced service provision within
community pharmacy across County Durham.

Page | 33
 Enhanced Service DCLS Durham Dales Derwentside Easington Sedgefield

Smoking cessation
(level 2)
(7) (1) (8) (7)

Nicotine
Replacement
Therapy (NRT) (28) (18) (17) (25) (21)
Minor ailment
scheme
(28) (14) (17) (25) (21)
Emergency Oral
Hormonal
Contraception (22) (17) (14) (17) (20)
(EOHC)
Chlamydia screening

(18) (12) (7) (14) (15)

C-Card scheme

(17) (13) (11) (10) (13)

Needle exchange

(1) (2)
Supervised
administration of
methadone (12) (7) (8) (11) (13)
Warfarin monitoring

(2) (3)

Figure 30: Overview of enhanced services delivered in pharmaceutical services across County Durham

3.7 Pilot Schemes in Pharmacy

There are a number of pilots ongoing a range of community pharmacy providers across County Durham,
they are; CVD screening, weight no more and alcohol related brief advice (from 1st September 2010).
These services will be evaluated to assess outcomes achieved and to measure value for money.

Page | 34
3.8 Dispensing Doctors
Figure 31 shows the number of patients allocated to each dispensing doctor in County Durham as at
December 2009 it also shows the average number of prescriptions dispensed each month. There are 18
GP practices across County Durham who dispenses prescriptions who serve approximately 6 % of the
total population of County Durham.

AV. MONTHLY
PRACTICE DISPENSING NO. OF
PRACTICE NAME QUARTER
CODE PATIENTS PRESCRIPTIONS
DISPENSED
A83001 Sensier And Partners 31/12/2009 1203 401
A83014 Belmont And Sherburn Surgery 31/12/2009 1657 552.3333333
A83021 Auckland Medical Group 31/12/2009 2561 853.6666667
A83022 Yule And Partners 31/12/2009 1658 552.6666667
A83024 Sartoris And Partners 31/12/2009 1033 344.3333333
A83032 Waller And Neville 31/12/2009 1262 420.6666667
A83033 Tyson And Partners 31/12/2009 882 294
A83035 The Weardale Practice 31/12/2009 1629 543
A83037 Ferguson And Partners 31/12/2009 1639 546.3333333
A83043 Old Forge Surgery 31/12/2009 1639 546.3333333
A83046 White And Partners 31/12/2009 3923 1307.666667
A83060 Pickworth And Pickworth 31/12/2009 2169 723
A83061 Neville And Waldin 31/12/2009 3114 1038
A83617 Nagi Ss 31/12/2009 159 53
A83618 Levick Jf 31/12/2009 1708 569.3333333
A83622 The Haven Surgery 31/12/2009 1286 428.6666667
A83626 Said Jr 31/12/2009 1600 533.3333333
A83637 Pelton Fell Group 31/12/2009 412 137.3333333
Figure 31: Dispensing Doctors Information

3.9 Offender Pharmacy Provision

Pharmacy services will be procured during 2011 by a Principal Provider (contract to be awarded January
2011). A service specification has already been completed. All 8 prison pharmacy services in the NE will
go out to tender. Expressions of interest from a number of providers including existing service providers
have already been received. A detailed assessment of all prison pharmacies in the NE has been
undertaken and action plans developed.

Page | 35
3.10 Information Technology
Information technology in pharmaceutical services plays an important role in the services delivered by
this sector, particularly in relation to prescribing of medicines. The Electronic Prescription Service (EPS)
improves convenience for the patient and reduces the risk of patient safety incidents through the
elimination of hand written prescriptions. The EPS is an essential service which has to be delivered by all
community pharmacies as part of the contractual framework.

3.11 Capacity and Capability

Pharmacists are required to undertake undergraduate, postgraduate and professional examinations in
order to work in a community pharmacy setting. This level of training covers the capabilities required to
dispense prescriptions and carry out all essential services. However pharmacists are increasingly being
seen as clinicians in their own right with more taking an interest in prescribing qualifications as well as
training as pharmacists with special interests. Commissioners are able to offer greater potential for the
type of services community pharmacy are able to deliver as skill sets develop within this sector.

3.12 Service User Engagement

NHS County Durham and Darlington have undertaken a process of pre-engagement with a range of
stakeholders and focus groups which have been identified as part of the Equality Impact Assessment
(EQIA) (appendix 2). As part of this process, briefing letters were sent to a range of voluntary and
community groups as well as dedicated focus group sessions, which included Durham LINK. Group
sessions included discussions on the current use of community pharmacy including issues around access
and the specific services used. Discussions also covered the formal consultation process of how and
what people would like to be consulted on in terms of the PNA. Figure 32 highlights the key
themes/discussion points as a result of the dialogue. These comments will feed into future pharmacy
commissioning intentions.

Area of Concern Comments/Questions

Access All pharmacies should show opening times on doors
Tripping hazards in premises e.g. floor mats
Emphasis on the size of pharmacies and the feeling that some were
“claustrophobic” and the lack of products in front of the counter was off
putting.
Some pharmacies have inadequate seating areas
Late opening is important for people who work late and also flexibility for
people who don’t have a car
“opening hours are key to how good a pharmacy is”
Like Saturday opening (especially next to a surgery)
Too many queues and nowhere to wait comfortably
“the pharmacy is too busy and there is no information on when the quieter
times are”

Page | 36
 Area of Concern Comments/Questions
“Why can’t there be an intercom between the GP practice and pharmacy
where they are co-located?”
Co-location in supermarkets was a good thing - convenient
Supermarkets aren’t always easy to get to
Pharmacies should be located near houses as well as next to GP practices
Good to have pharmacies near homes for young mothers
More pharmacies would be good but understand financial viability
Some consultation rooms take over space in pharmacy

Services delivered The general public require further information on services provided through
better publicity e.g. disposal of waste medicines, delivery of meds, flu jabs,
MURs
People didn’t mind subsiding services that they may have otherwise received
from the GP e.g. one comment related to the purchase of a swine flu
immunisation from a community pharmacy
People would like to see more services delivered by pharmacy to relieve the
pressure on GP services
There was a comment that’s someone had experienced a good MUR at a local
pharmacy
Collecting prescriptions from GP’s good idea
Standards of Service Discussions in consultation rooms can be overheard in some pharmacies
Example of people receiving methadone were held in areas that could be
overheard and were not private and does not protect privacy and dignity
Is there a standard definition of a consultation room? One person said there
was a room with no seat.
Concerns over seeing different pharmacist on each visit to pharmacy –
continuity very important especially if you need advice
A personal relationship is important between patient and pharmacist
Pharmacist says name and address out loud in pharmacy which makes people
feel uncomfortable
There is no clearly advertised complaints procedure
What do people do when they have been prescribed a wrong item? No clarity
Where a person is prescribed a high risk drug they were made to feel like a
criminal as the pharmacist made various phone calls to check it was a genuine
prescription – pharmacists should be aware of the personal nature
Concerns about variations in standards
Like over counter meds instead of going to GP
Consultation Process The process should include local mental health services like MIND, day
services and Stonham Housing
Questionnaires should be tick boxes
Questionnaire should only be 1-2 pages long as people
Make the questionnaire easy to read

Page | 37
 Area of Concern Comments/Questions
Attach a freepost envelope onto questionnaire for people to return
Web based questionnaire more accessible
Provide cardboard boxes in pharmacies so people didn’t they couldn’t be read
by staff
One person said they could attend the professional version of the
consultation meetings as they were a lay member on a pharmaceutical group
Support for generic consultation meetings to explain in simple terms
Need to join up with local authority i.e. “Talking Together”
Need to add incentives to improve participation
Invite pharmacies to events to talk about their services although an issue in
terms of competition and touting for business
One event to bring all focus groups together in one area
Encouraged to engage with Royal Mail and British Telecom veteran groups
Tie into an existing focus group meeting or event so you have a captive
audience
Need to advertise in local media i.e. Northern Echo or free newspapers
Figure 32: Pre-engagement comments with member so focus groups across County Durham and Darlington

4.0 Primary Care Provision

It is important to understand the levels of primary acre provision in County Durham so that
pharmaceutical services can be aligned to them. The following section identifies GP practice operational
hours and the levels of service provision which can compare with current enhanced service delivery.
There are currently 106 GP practices across County Durham; the number of community pharmacies
across the county mapped against this suggests that coverage of pharmaceutical services is good.

Page | 38
 4.1 GP Practice Opening Hours

Appendix 7 shows GP practice opening hours in terms of those which are standard to their contract and
also those which are classed as “extended hours”. It is important to ensure that there is access to
pharmaceutical services during these opening hours so that prescriptions can be dispensed within a
reasonable timescale to the public. From the table we can identify that there are extended hours of
availability across all five localities. By analysing the provision of pharmaceutical services versus the
number of GP practices who offer extended hours access, it is clear that there is enough existing
pharmaceutical coverage available from the 100 hour pharmacies to cope with demand. The existing
100 hour pharmacies are vital in enabling these access levels to be maintained.

4.2 Comparable Service Provision (other than pharmacy)

Figure 33 shows the various enhanced services which are delivered by GPs across County Durham and
the comparable services or pilots in existence within community pharmacy.

NHS Pharmacy
Other Contracts Managed by Primary Care GP Contracts
Contracts/Pilots
DES – Alcohol 71 Pilot to start 01/09
DES – Anti coagulation 36 As below
DES – CVD Risk 7
DES – Drug Misuse 3 (needle exchange)
11 51 (methadone sup.)
DES – Near Patient Testing 65 5
DES – Smoking Cessation 81 (NRT)
23 (level 2)
NES – Sexual Health 90 (EOHC)
66 (Chlamydia)
12 64 (C-Card)
LES – Alcohol 53 Pilot to start 01/09
Figure 33: Comparable pharmaceutical enhanced services delivered in Primary Care

5.0 Pharmaceutical Gap Analysis

The pharmacy White Paper (April 2008) gives a clear direction of travel for pharmacy services shifting
the emphasis from dispensing medicines to providing clinical services, provision of a wider range of
services through community pharmacy and making greater use of the clinical skills of pharmacists. The
County Durham PNA demonstrates the range of services currently available within community
pharmacy. By triangulating the health need of the population, the PCTs Five Year Strategic Plan and
mapping current pharmacy provision, commissioners are able to build a picture of gaps in provision.
The following section of the document demonstrates how pharmaceutical service provision may
develop as a result of the key points within the PNA.

Page | 39
5.1 Current State and Gaps – Access to Pharmaceutical Essential
Services
 The average number of pharmacies per 5000 population is higher than the national average
(one per 5000 population) which indicates that access to pharmaceutical services across County
Durham is adequate at this time.
 The PNA has highlighted the fact that there is enough current pharmaceutical coverage for out
of hours e.g. Sunday opening from existing 100 hour contracts and therefore any other local
arrangements for extended hours may be decommissioned
 Better marketing of services required from both the NHS, PCTs and community pharmacies to
raise awareness of services available
 To ensure coverage of dispensing services in line with GP and Primary Care Centre opening
hours e.g. extended and out of hours service provision
 To ensure contingency plans are in place to avoid any situations where pharmaceutical provision
is not available
 To ensure all provider of pharmaceutical services are managed as part of the national contract
in order that services provide value for money and achieve desired outcomes to contribute to
the vision of NHS County Durham and Darlington

Page | 40
5.2 Current State and Gaps – Enhanced and Advanced Services
Figure 34 shows the current pharmacy provision against the strategic objectives and goals as set out in the Vision for NHS County Durham and
Darlington, where pharmaceutical services either currently do or could contribute towards. There are however enhanced services currently being
delivered which do not match the five year vision these include the minor ailment scheme, Chlamydia screening, c-card scheme, needle exchange and
supervised administration of methadone. These services have been commissioned as enhanced services for community pharmacy to deliver and will be
reviewed at a later date to establish value for money and understand outcomes achieved.

Current Pharmacy Provision Other Primary Gap in Provision

Strategic Objective Strategic Goal Essential Services Advanced Enhanced Care Provision
Services Services
1. to give children a To reduce Participation in public health EOHC As part of core
better start in life teenage campaigns as directed by PCT contract for
conception Signposting to other providers GPs
– need up-to-date directory of
service to be distributed
2. to help keep our Reduce smoking Participation in public health NRT DES Smoking
public healthy campaigns as directed by PCT cessation
Signposting to other providers Smoking There is current
– need up-to-date directory of cessation inequity across
service to be distributed level2 County Durham
Support for self care within pharmacy
re: level 2
Reduce alcohol Participation in public health Pilot to start Alcohol LES To review pilot
misuse campaigns as directed by PCT Sept 10. and evaluate
Signposting to other providers outcomes,
– need up-to-date directory of ongoing
service to be distributed commissioning
Support for self care to be
determined
Reduce obesity Participation in public health To review current provision
campaigns as directed by PCT across primary and identify any
Support for self care opportunities
41
 Current Pharmacy Provision Other Primary Gap in Provision
Strategic Objective Strategic Goal Essential Services Advanced Enhanced Care Provision
Services Services
3. To ensure high Better Self Participation in public health MURs CVD screening CVD DES
quality care at the Management of campaigns as directed by PCT pilot
most appropriate long term Support for self care AURs Warfarin Anti-
time and place conditions SACs Monitoring coagulation
Dispensing and repeat services
dispensing
Early detection Participation in public health
and campaigns as directed by PCT
intervention Signposting to other providers
– need up-to-date directory of
service to be distributed
Improve urgent Signposting to other providers
care services – need up-to-date directory of
service to be distributed
4 To help people get Reduce illness in Dispensing and repeat MURs
the most from the elderly dispensing
later life Signposting to other providers AURs
– need up-to-date directory of SACs
service to be distributed

Figure 34: Current pharmacy provision aligned to other primary care provision and NHS County Durham and Darlington’s Five Year Strategy

42
6.0 Commissioning World Class Pharmacy Provision
A series of toolkits was published for commissioners in relation to the High Quality Care for All agenda, one of
which was specifically in relation to pharmaceutical services. Within this it describes how world class
pharmacies are commissioned and delivered. This gives some recommendations in order to do this which can
be demonstrated as part of the PNA development process and the recommendations and actions following
this. Some of the key themes from this are detailed below in terms of stages in the process.

Consultation

 Local people agree that the local NHS is improving pharmaceutical services by reflecting the vision set
out in the PNA and listening to the general public
 Proactive engagement has been demonstrated particularly with the Links, driving commissioning
decisions
 The LPC are engaged in the PNA process and help to set the strategic direction of the pharmaceutical
agenda

Commissioner Themes

 Pilots are reviewed to assess value for money and outcomes achieved
 All current providers have been mapped as a result of this process
 Outcomes identified are managed via a contract management framework

Provider Themes

 Providers are informed by the PNA, which influences their strategic plans
 Pharmacy providers can recruit high calibre staff

6.1 Developing the Current Market

NHS County Durham and Darlington will continue to understand the current provider landscape in terms of
pharmaceutical services as part of the ongoing management of the PNA. In relation to future development of
pharmaceutical services NHS County Durham and Darlington will stimulate the market – both to increase the
number and range of potential providers and also the range of potential services which this sector may
contribute towards. Service commissioning leads will be encouraged to involve community pharmacy
representatives in clinical discussions regarding patient pathway development as well as considering this
sector as part of appropriate market stimulation processes.

Although some enhanced services do not align directly with the organisations strategic goals there is still a
need to maintain such services. All enhanced services will be reviewed to assess outcomes and value for
money.

There is potential for other services to be commissioned in the future but not in the current timescale due to
changing landscape off the NHS, particularly in relation to commissioning organisations and responsibilities.

43
6.2 Current Process for Pharmacy Development
NHS County Durham and Darlington have adopted a programme approach to developing future service
provision for the area. The programmes are based on the strategic objectives of the organisation (figure 35)
which are aligned to four key themes. Pharmaceutical services may be developed across all four of these
programmes as community pharmacy may be seen as an element of care pathway development.

1. To give children 2. To help keep 3. To ensure high quality 4. To help people

a better start in our people care at the most get the most
life healthy appropriate time and from later life
place

PHARMACY DEVELOPMENT

Figure 35: Where pharmacy developments fit into the programme approach of NHS County Durham and Darlington

6.3 Further Recommendations

There are a number of recommendations which have evolved for the commissioning organisation to take
forward as a result of the development of the PNA for County Durham (2010-11) they are;

 To designate a document manager and adopt a version control system for the PNA
 Future PNAs to be appended to the JSNA for better alignment of the processes, timescales and
content of both documents
 To highlight through existing forums i.e. LPC where Any Willing Provider schemes are put out to
procurement and where community pharmacy may be able to provide
 To develop and consult on the contract monitoring framework for pharmaceutical services
 To conduct regular searches on out of area dispensing
 To ensure that essential and advanced services are carried out effectively e.g. ensuring that MURs are
targeted to the needs of the population, by regular monitoring from the PCT
 Commissioners to ensure that all enhanced services are monitored and assessed against desired
outcomes
 To review ongoing pilots and established schemes to ensure value for money against other service
providers
 To ensure MURs are targeted towards those with the greatest need for the service to achieve the
greatest impact on health gain for the local population

44
  To ensure out of area appliance contractors meet all national and local standards as set out by the
commissioning organisation
 To conduct a de-brief following the final production of the first PNA to understand issues and how
they were overcome and to highlight lessons learnt

6.4 Review Process for PNA

In line with the pharmaceutical services regulations (2010) NHS County Durham and Darlington will make a
revised assessment as soon as is reasonably practicable after identifying changes since the publication of the
PNA, where significant changes are required. NHS County Durham and Darlington have a sponsor executive
director who will oversee the development of the PNA and the ongoing management of the document. The
PCT will assign a document manager who will hold responsibility for updating and version control to ensure
the PNA is reflective of the ongoing need and provision of pharmaceutical services within its area. Although
the document will be “live” and updated as and when necessary figure 36 shows the formal review dates over
the next five years (until 2016). After the third year of the initial publication, there will be a full stage review
which will include formal consultation and sign off by the relevant commissioning executive board.

Review Date
Wednesday 1st February 2012
Friday 1st February 2013 **denotes full stage
review date
Monday 3rd February 2014**
Monday 2nd February 2015
Monday 1st February 2016
Figure 36: Review Dates of PNA

45
References

Association of Public health Observatory and Department of Health, (2010) Health Profile: County Durham,
www.healthprofiles.info

BMA, NHS Employers & PSNC, (2010) The community pharmacy – a guide for general practitioners and
practice staff, www.nhsemployers.org

Department of Health and NHS Primary Care Contracting (2009) World class commissioning: Improving
Pharmaceutical Services

Department of Health (2009) Transforming Community Services

DotEcon (2010) Evaluating the impact of the 2003 OFT study on the Control of Entry regulations in the retail
pharmacies market

Hughes, A & Visscher, M. (2008) Community Pharmacy Use: Quantitative and Qualitative Research, Market
Research Report Department of Health

NHS County Durham Annual Report Including Operating and Financial Review 2009/10 (2010)

NHS County Durham and Darlington NHS County Durham and Darlington Five Year Strategic Plan 2009/10-
2013/14, January 2010

NHS County Durham and Durham County Council (2009-10) County Durham Joint Strategic Needs Assessment,
2nd edition

NHS Employers (2009) Developing Pharmaceutical Needs Assessments: A Practical Guide

www.nhsemployers.org

Prepared by: Medicines, Pharmacy and Industry – Pharmacy Team with the assistance of the Advisory Group
on the NHS (Pharmaceutical Services) Regulations (2010) Pharmacy in England: Building on strengths –
delivering the future –Regulations under the Health Act 2009: Pharmaceutical Needs Assessments,
Department of Health

Richardson, R. & Pollock, A. M., (2010) Community pharmacy: moving from dispensing to diagnosis and
treatment, BMJ 2010;340:c2298

46
Appendix 1

47
Appendix 2
EQUALITY IMPACT ASSESSMENT FORM

Name of function/strategy/policy/service …… Pharmaceutical Needs Assessment …

Date of Review…………July 2010………………..…… …………………

a) Please provide a brief description of the function/strategy/policy/service:

The white paper “Pharmacy in England: building on strengths – delivering the future” sets out a vision for
improved quality and effective pharmaceutical services with a wider contribution to public health.

Providers of community pharmaceutical services are crucial to improving the health of local communities and
are normally the first point of contact. The world class commissioning programme, aims to deliver better
health and wellbeing of the population and therefore there is a need to optimize the contribution made by
pharmaceutical service contractors.

Health commissioners are driven by the joint strategic needs assessment (JSNA) of which the Pharmaceutical
Needs Assessment (PNA) is a key component. The guidelines for this assessment are covered in the
“Pharmaceutical Needs Assessment (PNAs) as part of world class commissioning” document produced by NHS
Employers – January 2009. The PNA is a key tool for identifying what is required at local level to support
commissioning intentions and community pharmaceutical services which in turn will fully integrate
community pharmaceutical services into the wider NHS. This will enable community pharmaceutical services
to demonstrate high quality, accessible services which are responsive to local needs. In summary this
assessment will identify what is provided, where it is provided and whether all of the local population has the
same access to all of the services provided.

The PNA involves the following mapping processes:

 Pharmacy Provision within the community

 Dispensing General Practitioner Surgeries
 Reviewing enhanced services provided within pharmacies e.g. smoking cessation, obesity

The PNA in turn will identify the information above with a view to identifying the future state of
pharmaceutical needs required for the local population. In order to achieve this, the equality impact
assessment will review any perceived adverse impact on equality target groups as underpinned by equality
legislation. This PNA will be developed over the next six months by listening to and working with pharmacies,
patients, carers, the public, clinicians, practice based commissioners and other key local stakeholders and
partners through a wide ranging programme of engagement. It is underpinned by our Single Equality Scheme
and the NHS Constitution to embed the principles of equality and accessibility.

48
This is backed up by legislation in the form of the National Health Service (Pharmaceutical Services and Local
Pharmaceutical Services) (Amendment) Regulations 2010.

An internal steering group has been developed to progress the PNA and equality impact assessments for both
NHS County Durham & NHS Darlington. A project plan is attached for further information.

b) What Type of positive and negative equality & diversity implications are you aware of that arise
from your function/strategy/policy/service?
In order to carry out the PNA we must be aware of the effect of any findings and outcomes from the
assessment work and ensure that the information both reflects the needs of the communities which we serve
and also that it does not negatively affect any person or groups within the local population.

The initial scoping for this assessment suggests that we need to consider the effect on a person’s cultural
differences including age, disability, race, religion or belief, sexual orientation and gender. We also need to
consider the geographical issues which may affect individuals who live in the more rural parts of county
Durham and Darlington.

Rurality is a major factor in the decision making process for pharmacy applications. It is envisaged that the
PNA will identify the positive elements of community pharmacy service provision and take action if any
loopholes are identified to enable a consistent approach in service provision across the area. This will ensure
that the service is consistent and equitable across county Durham and Darlington and that no member of the
community is disadvantaged.

Work has started to address service needs via a pre-engagement process and will be followed by a wider
consultation period. The feedback from these consultative processes will also form implications both positive
and negative which will contribute to the developing PNA.

c) In line with our statutory duty under equality legislation do your

functions/strategies/policies/services make reference to equality wherever relevant?
 . If yes - provide examples of how they aim to:
 If no – what action is required:
The PNA guidance has been nationally developed by NHS
employers and therefore has already been equality
In line with the Race Equality Duty to
impact assessed. Therefore it is the findings of the PNA
eliminate discrimination, harassment,
and the outcomes required which must be reviewed in
promoting equality of opportunity and good
line with the six strands of equality as described in section
relations between people of different racial
b plus the effect of the Human Rights Act 1998, which will
groups
require local consultation in order to avoid any potential
In line with the Disability Equality Duty to
promote positive attitudes towards disabled

49
persons and encourage participation by discrimination.
disabled people

In line with the Gender Equality Duty to

Equality & Diversity (including the Single Equality Scheme)
eliminate unlawful discrimination and
is part of our organizational values and as such underpins
harassment & promote equality of
this process together with a project plan which is being
opportunity between men and women
progressed by the PNA Steering group. There is also a
Other relevant equality legislation/best
PNA working group focusing upon delivery of the project
practice?
plan together with a communications plan identifying the
actions required for consultation and communication
purposes.

What relevant groups have a legitimate interest in the function / strategy / policy / service?
Does it impact differently on particular minority groups?

If Yes – Which Groups are affected, and how are they affected?

Group Impact

Externally:

All community groups have a specific interest in pharmaceutical services together with pharmaceutical
providers. These providers consist of General Practitioners, Community and National Pharmaceutical outlets
such as Boots the Chemist. There is no evidence to suggest that anyone within the population we serve has an
adverse impact to pharmaceutical services presently.

Pharmacy services are consistent in approach however there may be certain pharmacy providers offering
more add on services that others such as smoking cessation, obesity and for that reason these issues will be
highlighted during the PNA.

d) Please outline below any work you have carried out to assess, monitor, address and review the equality
implications of your function / strategy / policy / service and identify additional work that needs to be
carried out to meet requirements of our statutory duties.

Area of Work
Work already carried out / Work Required Timescales
Measures in Place

Consultation

Pre-engagement commenced Identify whether focus groups

are inclusive? If not source other
50
 July 2010 with focus groups
Monitoring & A project plan is in placed and
Target Setting being monitored by the PNA
steering group and work is being
progressed via the PNA working
group.
An audit has started of what
services are currently being
provided by community
pharmacies and to see if these
demonstrate value for money.
Some details are already
collated regarding the type of
dispensed drugs and diagnosis
patterns.
Access to Communications plan under
Information & development to demonstrate
Services how people can access
information.
Marketing & Information leaflets provided on
Promotion community pharmacy services
across the county.
Organisational Underpinned by 5 year strategic
development plan.
ways of communicating with
underrepresented groups
60 day consultation begins
Sept 2010
Formal consultation questions
can be uploaded onto website as Sept 2010
a questionnaire in order to target
hard to reach groups.
Development of patient
questionnaire re pharmacy
services provided and patient
choices.
Further work required on
communicating with hard to
reach groups and by what
processes.
PNA briefing document stating
what patients can expect from
every pharmacy
Commissioners will have facts to
make informed decisions and
51
 justify using public money.

Pharmacy panels in operation.

Providers of services will have

possible areas for development
to ensure consistent standards in
service delivery.

Training / Briefing Staff skilling up may be required

staff in order to have consistent
service provision across the
Employment county depending on the
issues outcome of the PNA.

Review &
Evaluation
The PNA has commenced with Milestones as follows:
milestones identified.

1st PNA by end aug 2010.

60 day consultation.

Final draft by feb 2011.

Determination of regular review

and scrutiny arrangements
following PNA completion.

WHERE APPROPRIATE, ACTIONS AND TARGETS DESCRIBED HERE SHOULD BE EVIDENT IN SERVICE AREA
PLANS

52
Appendix 3

Pharmaceutical Needs Assessment

Communications and Engagement Plan

Introduction

This document outlines the communications and engagement plan for the development of and consultation on
the Pharmaceutical Needs Assessment for NHS County Durham and Darlington.

In developing their first and subsequent PNAs, PCTs should include and have reference to patient experience
data, including the views of patients, carers, the public and local stakeholders on their current experience of
pharmaceutical services and their aspirations for the future.

In addition, under the draft Regulations, PCTs will be required to consult at least once on a draft of their PNA
during the process and this consultation must last for a minimum of 60 days.

Additional advice around communication and engagement in PNAs is contained within the NHS Employers
guidance Developing Pharmaceutical Needs Assessment – a Practical Guide, in particular Guide 3: Involving
patients and the public and Guide 5: Developing a communication plan. PCTs need to effectively engage a wide
range of stakeholders throughout the development of their PNA and thorough engagement will also reduce
the risk of services, gaps, needs and / or developments being overlooked. Guide 4: Engaging with practice
based commissioners is also of relevance.

Background

In April 2008 the White Paper, Pharmacy in England: Building on Strengths – Delivering the Future was
published, setting out the Government’s programme for a 21st century pharmaceutical service and identifying
ways in which pharmacists and their teams could contribute to improving patient care through delivering
personalised pharmaceutical services in the coming years.

Following consultation in autumn 2008, two clauses were included in the Health Act 2009:
53
  to require Primary Care Trusts to develop and publish pharmaceutical needs assessments (PNAs); and
 then to use PNAs as the basis for determining market entry to NHS pharmaceutical services provision.

Subsequently, the Department of Health launched a Consultation on 01 December 2009 on Pharmacy in

England: Building on Strengths – Delivering the Future – Draft Regulations under the Health Act 2009:
Pharmaceutical Needs Assessment.

The Consultation ended on 28 February 2010, and, following this, the NHS (Pharmaceutical Services)
(Amendment) Regulations 2010 were published on 01 April 2010 and will come into force on 24 May 2010.
Primary Care Trusts (PCTs) will be required to produce their first PNA by February 2011 and will be required to
publish a revised assessment within three years of publication of their first PNA.

It is intended that a system of commissioning based on PNAs will help PCTs target specific local needs and
focus subsequent commissioning on local priorities.

National Guidance

Pharmacy in England: Building on Strengths – Delivering the Future – Regulations under the Health Act 2009:
Pharmaceutical Needs Assessments –Information for Primary Care Trusts has been published to assist PCTs in
the development of their first and subsequent PNAs produced under the new statutory duty set out in the NHS
(Pharmaceutical Services) Regulations 2005, as amended.

In developing their PNA, Regulation [3G] outlines a series of matters that PCTs must have regard to, these are
summarised as:

 the Joint Strategic Needs Assessment (JSNA);

 the needs of different patient groups;
 the demography of the PCT area;
 the benefits from having a reasonable choice in obtaining services;
 the different needs of the localities;
 the effect of pharmaceutical services provided under arrangements with neighbouring PCTs;
 the effect of dispensing services or other NHS services provided in or outside its area; and
 likely future needs.

The draft Regulations with regards to PNAs define “pharmaceutical services” and make clear that PNAs
include:

54
  Essential Services;
 Advanced and Enhanced services set out in Directions;
 pharmacy contractors;
 dispensing appliance contractors;
 dispensing doctors and local pharmaceutical services (LPS) contractors where they provide a level of
pharmaceutical services.

Timescales

The NHS (Pharmaceutical Services) (Amendment) Regulations 2010 will come into force on 24 May 2010. This
means that PCTs will be required to produce their first PNA by February 2011.

In addition, PCTs will be required to:

 publish a revised assessment within three years of publication of their first assessment
 produce a revised assessment or Supplementary Statement (as appropriate) as soon as is reasonably
practical after identifying changes to the availability of pharmaceutical services since publication of the
PNA, where these changes are relevant to the granting of applications to open new or additional
premises.
 Undertake a small-scale update of their PNAs every year, for commissioning decisions.

Consultation on the draft PNA

It is recommended that PCTs share their timetable for the development of their PNA with identified local
stakeholders as early on in the process as is possible, to facilitate their contribution to the consultation. Where
possible, the timescale should be tailored around meetings of the Local Pharmaceutical Committee (LPC), Local
Medical Committee (LMC) and Local Involvement Network (LINk) to enable them to agree and submit their
response.

The Regulations state that PCTs will be required to consult at least once on a draft of their PNA during its
development (regulation [3f (2)]) and this consultation must last for a minimum of 60 days (regulation [3F(3)]).
The minimum 60 day consultation starts on the day that the initial list of consultees are served with a draft.
Convention is that the PNA is deemed to have been received two days after being served.

Regulation [3F(1)] lists those persons who must receive a copy of the draft PNA and be consulted on it. As a
minimum, these are as follows:
55
 any Local Pharmaceutical Committee for its area (including one for its area and that of one or more other
PCTs);
 any Local Medical Committee for its area (including one for its area and that of one or more other PCTs);
 the persons on its pharmaceutical lists and its dispensing doctors’ list (if it has one);
 any LPS chemist with whom the PCT has made arrangements for the provision of any local pharmaceutical
services;
 any person with whom the PCT has made arrangements for the provision of dispensing services;
 any relevant local involvement network, and any other patient, consumer or community group in its area
which in the opinion of the PCT has an interest in the provision of pharmaceutical services in its area;
 any local authority with which the PCT is or has been a partner PCT, including any relevant Overview and
Scrutiny Committees;
 any NHS trust or NHS foundation trust in its area;
 any neighbouring PCT.

PCTs are also required to publish in their PNA a report on the consultation including analysis of the
consultation responses and reasons for not acting upon any issues raised.

Development of the PNA

Prior to consulting local stakeholders on the draft PNA as outlined above, PCTs should ensure that the views of
local people inform the development of their initial and subsequent PNA. The PNA Regulations do not impose
a minimum (or maximum) period for this engagement activity, although reference is made in the guidance to
the 12 week period recommended in the Government’s Code of Practice on Consultation.

However, the Guidance does make clear that PCTs should use the Joint Strategic Needs Assessment (JSNA) as a
starting point to identifying existing evidence of views and mechanisms for involvement, and that a variety of
mechanisms for capturing views should be used as appropriate to the local population.

Legislative Context for Communication and Engagement

Section 244 of the consolidated NHS Act 2006 (which replaced Section 7 of the Health and Social Care Act
2001) requires NHS organisations to consult relevant Overview and Scrutiny Committees on any proposals for
a substantial development of the health service in the area of the local authority, or a substantial variation in
the provision of services.

A substantial variation is not defined in Regulations – Section 244 applies to any proposal where there is a
major change to services experienced by patients. It is not anticipated that the introduction or implementation

56
of PNAs would constitute a formal consultation, however, the involvement of all relevant Overview and
Scrutiny Committees will be sought

In producing a report of the engagement activity to inform the draft PNA, and in reporting on the 60 day
consultation, NHS County Durham and Darlington will ensure adherence to the new NHS Duty to Report on
Consultation, which came into force from 01 April 2010. NHS County Durham and Darlington will produce a
report on the PNA engagement activity and on the consultation on the draft PNA, which will cover:

 the persons who have been consulted;

 what information was provided to those persons;
 what matters those persons were consulted about;
 the result of the consultation, including a summary of the differences expressed by those consulted; and
 details of the decisions or changes made following the consultation and the influence the results of the
consultation had on that decision / change.

Communications and engagement objectives

A programme of internal and external communications and engagement activity needs to be in place to:

 raise awareness of the PNA among key audiences – internal and external.
 encourage responses to and involvement in pre-consultation engagement activity and the formal
consultation
 promote the engagement opportunities and the consultation via all appropriate communications
channels.
 effectively manage and co-ordinate stakeholder engagement

Overview

NHS Employers Guide 7: Timetable for Pharmaceutical Needs Assessment Process indicates that involvement
activity should take place across all stages of the PNA process:

 mapping need and provision

 synthesising data
 prioritising developments
 developing commissioning intentions
 publishing final PNA
57
It is important that patient experience data, specifically information about local peoples’ views on current
pharmaceutical services and aspirations for the future, are taken into account when developing the PNA.
These views need therefore to inform the Baseline Assessment (locally July– August 2010). Following this, a 60
day consultation on the draft PNA needs to take place (locally September– October 2010).

The communication and engagement plan will therefore be in two key stages:

 pre consultation involvement activity to inform the baseline assessment

 60 day consultation on the draft PNA

Note – individual PNA documents will be prepared for NHS County Durham and NHS Darlington.

Mechanisms

As part of consultation on the draft PNA the following mechanisms will be utilised:

 a copy of the draft PNA will be sent to identified stakeholders, including required consultees, with a reply
form for the submission of views
 a number of individuals and organisations will be contacted to verify receipt of the draft PNA, including the
LPC, LMC and LINk
 appropriate NHS County Durham and Darlington representatives will meet with the LPC, LMC, LINk and any
other appropriate groups identified to discuss the draft PNA, respond to questions and facilitate
consultation response
.

58
Communications and engagement activity
Activity/product
Pre consultation involvement activity
Develop key messages and
question areas
Raise awareness of the PNA
and engagement
opportunities through existing
communications mechanisms
Brief PALS team
Task Who’s responsible Timescale
 Liaise through PNA task and finish group to develop: MB – lead July 2010
- Briefing paper
- Letter offering to attend meeting T&F Group
 Send Briefing Paper outlining PNA (including timetable) plus MB -lead July 2010
letter offering to attend a meeting and pointing to future
consultation MD-W
 Make information available via website
 Include information in stakeholder briefing to range of key
partners including MPs, OSCs, partners, councillors, community
based contacts, voluntary groups etc.
 Include information in independent contractor briefing
 Supply information to PBC newsletter
 Identify stakeholders who should receive a copy of the PNA
timetable
 Prepare key messages and question areas for inclusion in
communication with identified stakeholders and awareness-
raising with members of the public
 Provide information and timetable MB / MD-W July 2010
59
Communications with staff
General engagement activity
 Issue information through InTouch MB - lead July / August 2010
 Provide information – based on above – for communications
teams within neighbouring NHS Trusts, local authorities, key
relevant charities and housing associations
 Focus group events to engage with and seek the views of MD-W - lead July / August 2010
Community Pharmacists, other pharmaceutical professionals
and those who interact with pharmaceutical services
 Identify 6-8 key groups which whom meetings will be arranged
with identified voluntary and community sector organisations,
including those working with individuals / groups who may be
termed ‘easy to overlook’ and who may provide insight into
areas of local public health concern
 Involvement of the two local LINks, including reviewing
documents / statements, such as about local peoples’
willingness to travel to services
 Work with engagement team to access hard to reach groups,
including BME / elderly / travellers / deaf and blind / teenagers
at school via councils / youth groups etc.
 Meetings with identified key stakeholders and required
consultees including LPC, LMC, LINk
 Engagement with Practice Based Commissioning (PBC) Groups
through the PBC Leads
 Dales ICO Groups (including Lay Members)
 Health Network Groups – update via letter and offer to visit
 Develop tailored presentation(s) as required.
 Area Action Partnerships
 Involvement/Engagement staff at District Council
 Develop / check full stakeholder list during this period for formal
consultation (for inclusion in Service Spec for consultation.
60
Activity to seek and record  To use existing information from a market research report MD-W – lead July / August 2010
views of patients, carers and produced by the DoH on community pharmacy use for the
the public 2010/11 PNA RE – co-ordination
 To explore the opportunity of using the JSNA process to
understand patients perception and usage of pharmacy of
pharmacy
To develop a plan for 2011/12 to establish in-depth views of
patients, public and carers on pharmacy. To ensure the PNA is an
iterative process, which is constantly refreshed.

Awareness-raising of the PNA  Establish spokespeople from PCT and local LPC MB / comms team July 2010
and engagement  Issue press release
opportunities through local
media

Develop draft PNA for  Complete an Equality Impact Assessment (EIA) for the PNA to MD-W / Complete by late
consultation inform development and implementation. August 2010
 Analyse data to inform draft DNA
 Review existing evidence of the local populations’ views around
pharmaceutical services including through previous engagement
activity, the JSNA and Patient Advice and Liaison Services (PALS) /
Complaints data
 Review the results of the community pharmacy satisfaction
survey carried out by all local pharmacies
 Develop draft PNA for consultation

61
Specification to external
organisation to deliver pre-
consultation activity and
formal consultation
60 day Consultation
Send out draft PNA to key
stakeholders
Consultation period
 Prepare and issue specification to external organisations MB - lead July / August 2010
 Agree timelines for:
- Planning
- Response mechanisms and handling
- Questionnaire and document design and print
- Advertising
- Direct Mail to stakeholders
- Full handling of 6 meetings
- Response handling, analysis and reporting
 Prepare covering letter and response form DE – lead 28th August 2010
 Identify list of stakeholders identified in the regulations as
consultees MB / RE – support
 Indicate deadline for responses as 31st October 2010
 Provide full list of consultees, stakeholders and contacts
SEE SPECIFICATION FOR DELIVERY DE – lead 1st September - 31st
October
To include: MD-W/MB / RE –
support
- Response mechanisms and handling
- Questionnaire and document design and print
- Advertising
- Direct Mail to stakeholders
- Full handling of 6 meetings
- Response handling, analysis and reporting
62
Post consultation
Reporting
Awareness-raising of the PNA
consultation outcomes
through local media
Final PNA
Publish final PNA
Communications with staff
2011 PNA engagement activity
 Make report available on website MB - lead November 2010
 Include information in stakeholder briefing
 Include information in independent contractor briefing
 Supply information to PBC newsletter
 Identify stakeholders who should receive a copy of the report
directly
 Issue press release reporting on outcomes and when final report MB - lead November 2010
will be available
 Ensure consultation report is included in PNA RE – lead By 31st January 2011
 Make information available via website
 Include information in stakeholder briefing to range of key MB - support
partners including MPs, OSCs, partners, councillors, community
based contacts, voluntary groups etc.
 Include information in independent contractor briefing
 Supply information to PBC newsletter
 Identify stakeholders who should receive a copy of the final PNA
document
 Issue information through InTouch MB - lead By 31st January 2100
 Provide information – based on above – for communications
teams within neighbouring NHS Trusts, local authorities, key
relevant charities and housing associations
63
Activity to seek and record  Develop a survey to capture patient / service user views on MD-W - lead March / April 2011
views of patients, carers and current experiences of pharmaceutical services and future
the public aspirations, for completion online at www.haveasay.org.uk and
distributed directly to identified local stakeholders (including
required consultees) listed at appendix 1 and through local
pharmacies
 Develop a survey to capture the views of professionals and
services who interact with pharmaceutical services for
completion online and distributed directly to identified local
stakeholders (including required consultees) listed at appendix 1
 Include information re questionnaire in stakeholder, PBC, staff
and independent contractor briefings

Feedback to stakeholders  Provide feedback on outcomes of questionnaire and related MD-W – lead May 2011
involvement and how these have been used to inform the PNA
via a ‘You said, we did’ stakeholder briefing MB - support
 Include invitation to participate in consultation on next draft PNA

64
Monitoring and evaluation

The evaluation process should ensure sufficient feedback is received to:

 Help steer the content of future communications by capturing the needs of the internal and external
audiences
 Ensure that information being communicated is understood by the intended audience/s
 Gauge any misunderstanding or confusion about the project.

There are a number of ways to evaluate the success of communications and engagement.

 Awareness of the number amongst local population, through stakeholder surveys and research.
 Awareness of the number amongst NHS staff, through stakeholder surveys and research.
 Use of the number.
 Media coverage, through cuttings evaluation.

Resources

Task and finish group

Debbie Edwards – project lead

Michael Fleming – public health lead

Rachel Emery – project co-ordination

Mary Bewley – communications and engagement

Mark Dunne –Willows – engagement and involvement

Linda Neely – pharmacy lead

Mary-Claire Barker – corporate improvement support

Alison Ayres - commercial manager

Denise Jones – primary care

Project Support

Dawn Calvert

Lesley Craggs

Karen Dunn

Susan Hood

65
 NHS County Durham and Darlington Pharmaceutical Needs Assessment

Key Stakeholders for Communication and Engagement

(including required consultees)

1. Overview and Scrutiny Committees (OSCs)

 County Durham Overview and Scrutiny Panel
 Darlington Overview and Scrutiny Panel

2. Local Involvement Networks (LINks)

 County Durham LINk
 Darlington LINk

3. Ward Councillors
 County Durham
 Darlington

4. MPs
 Darlington
 City of Durham
 North West Durham
 North Durham
 Easington
 Sedgefield
 Bishop Auckland

5. Local Strategic Partnerships (LSPs)

 County Durham Health and Wellbeing Partnership
 Darlington Partnership – Healthy Darlington

6. Area Action Partnerships

 4 Together Partnership
 Three Towns Partnership
 Bishop Auckland & Shildon AAP
 Chester-le-Street & District AAP
 Derwent Valley AAP
 Durham AAP
 East Durham AAP
 East Durham Rural AAP
 Great Aycliffe & Middridge Partnership
66
  Mid Durham AAP
 Spennymoor AAP
 Stanley AAP
 Teesdale AAP
 Weardale AAP

 Local Committees in County Durham and Darlington, Tees, North Yorkshire and Cumbria
 Local Medical Committees
 Local Pharmaceutical Committees

7. Volunteer Development Agencies (VDAs) *

8. Voluntary and Community Groups - Patient, Consumer or Community Groups with an interest in
pharmaceutical services *
 Age Concern
 Carers
 Diabetes
 MIND
 Rural Community Groups

* Additional groups identified as having an interest will also be included

9. Prisoners and Offender Institutions

10. Practice Based Commissioning Clusters

11. Internal Stakeholders

 Board
 Clinical champions
 Staff
 Programme Groups

12. Service Providers and Staff

 Pharmaceutical Services Providers
 Community Pharmacists (including head office of multiples)
 Hospital Pharmacists
 Dispensing Doctors / GP Practices

67
  Dispensing appliance contractors (including those outside of the PCT area who are accessed by the
PCT’s patients)
 Mail-order internet pharmacies (outside of the PCT area but providing services to patients within
area)
 LPS Chemists
 Other Pharmacy Providers (including cross-border commissioning of services for patients
registered with a GP practice that is in contact with the PCT, but the patient lives out of the PCT
area)
 Head office(s) of pharmaceutical companies with local branches in the PCT area
 Other Independent Contractors and Staff
 Dentists
 GPs
 Opticians
 Community-based health care staff, including Community Matrons
 County Durham and Darlington Community Services
 Acute and Specialist
 County Durham and Darlington NHS Foundation Trust
 Tees, Esk and Wear Valleys NHS Foundation Trust
 Community-based social care staff

13. Neighbouring PCT clusters

 NHS Tees
 NHS South of Tyne
 NHS North Yorkshire and York
 NHS Cumbria

14. Local Authorities including Social Services

 Darlington Borough Council
 Durham County Council

15. Care Homes and Nursing Homes across County Durham and Darlington

16. Parish and Town Councils

17. Schools and Colleges across County Durham and Darlington

 Primary Schools
 Secondary Schools
 Further and Higher Education Centres

18. North East Strategic Health Authority

68
 Appendix 4
DETERMINATION OF RURALITY ie controlled locality Regulation 31

Definition: Controlled locality is defined as rural in character

Note: LMC, LPC and PCT can request determination of rurality at any time and the request does not have to be linked to
any other application. PCTs must undertake a site visit

PCTs are required to publish maps of their areas clearly delineating areas that are rural in character
(regulation 31(7) (b))

Application received from LMC or LPC for determination or re-determination

or PCT decides to determine or re-determine in isolation or in response to an
application for inclusion in the list

Has a
determination
been made in the
last 5 years?
No
Yes

Notify LPC, LMC and interested parties

and invite representations within 30 days
(regulation 31(5))
Has there been a
Yes substantial change in
the circumstances of
the area?
Make or review determination taking
into account relevant factors including
effect on existing medical and
pharmaceutical services and publish
map

No

Notify LPC, LMC and interested parties

Reject Application (Regulation 31(9))
with outcome of determination with
precludes consideration of the application
reasons and set out rights of appeal
(regulation 32)

Adapted from templates by Guildford and

Waverley (now Surrey PCT) 2005

69
 Key Determinants (Regulation 31)

A controlled locality is an area that is “rural in character”. This is the definition given in the NHS (Pharmaceutical
Services) Regulations 2005 that govern the PCTs processes in these cases.

There is no prescribed way to define what is rural in character. Each case must be judged on individual
circumstances and will depend on a variety of factors. Individual factors are not decisive and need to be viewed in
the context of their surroundings. However, the following criteria should be considered when forming a view:

Number and variety of amenities/facilities/services available to the population

Transport services (bus, rail)/Quality of roads

Planning applications pending

Population density

Open countryside

Number of schools

Population statistics
Adapted from templates by Guildford and
Council
Waverley (now Surrey definition
PCT) 2005

Number of churches

Environmental factors such as land use (agricultural)

Size and patterns of settlements/Density of housing/Type of housing

Street light spacing

Employment (agricultural)

If the PCT receives an application to dispense NHS prescriptions from a pharmacist or doctor, rurality needs to be
considered for any area affected by the application.

70
Appendix 5 - Out of Area Pharmacies
Dispenser Dispenser Dispenser Dispenser Address Dispenser Address Dispenser
Name Code Address Line 2 Line 3 Postcode
Line 1
Durham Dales
BOOTS UK FLA75 47-53 NORTHGATE DARLINGTON DL1 1TT
LIMITED
SAINSBURY'S FGQ36 150 VICTORIA ROAD DARLINGTON DL1 5YJ
SUPERMARK
ETS LTD
BOOTS UK FJ493 23 HIGH DARLINGTON DL3 7QW
LIMITED ROW
SECURICARE FYR20 CAVELL KNAVES BEECH WAY LOUDWATER HP10 9QY
(MEDICAL) HOUSE
LTD
FITTLEWORT FPP56 FITTLEWO ROOMS 1 & 3, CARNFORTH LA5 9EX
H MEDICAL RTH WARTON ROAD
LTD HOUSE
CORDIA FTD28 UNITS TRADING ESTATE WORSLEY ROAD M28 3PT
HEALTHCARE 61&62
LIMITED OAKHILL
BOOTS UK FMF10 UNITS 46- CAMERON WALK THE NE11 9YQ
LIMITED 52 METROCENTRE
BCA DIRECT FT468 3 HOLMAN HENRY ROBSON WAY SOUTH SHIELDS NE33 1RL
LIMITED COURT
COLOPLAST FLV51 UNIT 1 THE BAKEWELL ROAD ORTON PE2 6BJ
LTD LINKS SOUTHGATE
DONALD FGD92 RATTON HANLEY STOKE-ON-TRENT ST1 2HH
WARDLE & STREET
SON
BOOTS UK FTR30 UNIT B, 58 PARK STREET WALSALL WS1 1NG
LIMITED 1ST FLOOR
Durham and Chester-le-Street
WR EVANS FTW31 1225 ALVASTON DERBY DE24 8QH
(CHEMIST) LONDON
LTD ROAD
FRANK FHH45 1-2 HOUGHTON-LE- TYNE & WEAR DH4 4AN
JONES NEWBOTTL SPRING
(CHEMIST) E STREET
LTD
BOOTS UK FFC81 13 WESTBOURNE TERRACE SHINEY ROW DH4 4QT
LIMITED
KEPIER FCG10 KEPIER LEYBURN GROVE HOUGHTON-LE- DH4 5EQ
PHARMACY MEDICAL SPRING
PRACTICE

71
 Dispenser Dispenser Dispenser Dispenser Address Dispenser Address Dispenser
Name Code Address Line 2 Line 3 Postcode
Line 1
SECURICARE FYR20 CAVELL KNAVES BEECH WAY LOUDWATER HP10 9QY
(MEDICAL) HOUSE
LTD
BULLEN CS FQ588 CONSTANC LIVERPOOL LIVERPOOL L3 8HL
LTD E STREET
CORDIA FTD28 UNITS TRADING ESTATE WORSLEY ROAD M28 3PT
HEALTHCARE 61&62
LIMITED OAKHILL
BOOTS UK FHM40 150 ELDON SQURE NEWCASTLE UPON NE1 7DQ
LIMITED NORTHUM TYNE
BERLAND
STREET
BOOTS UK FDF09 HOTSPUR ELDON SQUARE NEWCASTLE UPON NE1 7XE
LIMITED WAY TYNE
BOOTS UK FNK51 UNIT 9 TEAM VALLEY GATESHEAD NE11 0BD
LIMITED TRADING EST
SAINSBURY'S FMG80 ELEVENTH TEAM VALLEY NE11 0NJ
SUPERMARK AVENUE TRADING EST
ETS LTD
ASDA FVM83 MAPLE METROCENTRE GATESHEAD NE11 9YA
STORES LTD ROW
BOOTS UK FMF10 UNITS 46- CAMERON WALK THE NE11 9YQ
LIMITED 52 METROCENTRE
BCA DIRECT FT468 3 HOLMAN HENRY ROBSON WAY SOUTH SHIELDS NE33 1RL
LIMITED COURT
DARLING JM FY061 433 SOUTH SHIELDS TYNE & WEAR NE33 4QY
& W LTD STANHOPE
ROAD
ASDA FW190 ASDA NORTH ROAD BOLDON COLLIERY NE35 9AR
STORES LTD STORES
ASDA FMP96 WASHINGTON CENTRE WASHINGTON NE38 7NF
STORES LTD
BOOTS UK FCP48 UNIT 80 THE GALLERIES WASHINGTON NE38 7RT
LIMITED
LLOYDS FXR97 35 THE GALLERIES WASHINGTON NE38 7SB
PHARMACY
LTD
WOODLAND FTC98 VIGO LANE RICKLETON VILLAGE WASHINGTON NE38 9EJ
S PHARMACY
COLOPLAST FLV51 UNIT 1 THE BAKEWELL ROAD ORTON PE2 6BJ
LTD LINKS SOUTHGATE
BOOTS UK FTY64 45 THE SUNDERLAND TYNE & WEAR SR1 3LF
LIMITED BRIDGES
AMCARE LTD FPY18 AMCARE 10 STOCKTON ROAD SUNDERLAND SR1 3NW
HSE,SUND
ERLAND

72
 Dispenser Dispenser Dispenser Dispenser Address Dispenser Address Dispenser
Name Code Address Line 2 Line 3 Postcode
Line 1
CTR

BOOTS UK FYR17 UNITS 2-3 PARK LANE SUNDERLAND SR1 3NX

LIMITED
DONALD FGD92 RATTON HANLEY STOKE-ON-TRENT ST1 2HH
WARDLE & STREET
SON
Derwentside
BOOTS UK FFC81 13 WESTBOURNE TERRACE SHINEY ROW DH4 4QT
LIMITED
L ROWLAND FXR15 31 NORTH BEDALE NORTH YORKSHIRE DL8 1AF
& CO END
(RETAIL) LTD
SECURICARE FYR20 CAVELL KNAVES BEECH WAY LOUDWATER HP10 9QY
(MEDICAL) HOUSE
LTD
BOOTS UK FHM40 150 ELDON SQURE NEWCASTLE UPON NE1 7DQ
LIMITED NORTHUM TYNE
BERLAND
STREET
BOOTS UK FDF09 HOTSPUR ELDON SQUARE NEWCASTLE UPON NE1 7XE
LIMITED WAY TYNE
BOOTS UK FNK51 UNIT 9 TEAM VALLEY GATESHEAD NE11 0BD
LIMITED TRADING EST
SAINSBURY'S FMG80 ELEVENTH TEAM VALLEY NE11 0NJ
SUPERMARK AVENUE TRADING EST
ETS LTD
ASDA FVM83 MAPLE METROCENTRE GATESHEAD NE11 9YA
STORES LTD ROW
BOOTS UK FMF10 UNITS 46- CAMERON WALK THE NE11 9YQ
LIMITED 52 METROCENTRE
FURNESS G H FE708 13 CHOPWELL TYNE & WEAR NE17 7HU
LTD DERWENT
STREET
BREWERY FHA36 BREWERY PONTELAND NEWCASTLE UPON NE20 9NH
LANE LANE,MAI TYNE
PHARMACY N STREET
LTD
BOOTS UK FAQ61 7 THE DARRAS HALL PONTELAND NE20 9PW
LIMITED BROADWA
Y
CENTRE FRV74 14 PONTELAND NEWCASTLE UPON NE20 9PX
CHEMISTS MERTON TYNE
LTD WAY
BCA DIRECT FT468 3 HOLMAN HENRY ROBSON WAY SOUTH SHIELDS NE33 1RL

73
 Dispenser Dispenser Dispenser Dispenser Address Dispenser Address Dispenser
Name Code Address Line 2 Line 3 Postcode
Line 1
LIMITED COURT

BOOTS UK FYK96 34 STATION ROAD ROWLANDS GILL NE39 1PZ

LIMITED
R G YOUNG FCX29 BEACON BEACON LOUGH ROAD GATESHEAD NE9 6YS
VIEW
HEALTH
CENTRE
COLOPLAST FLV51 UNIT 1 THE BAKEWELL ROAD ORTON PE2 6BJ
LTD LINKS SOUTHGATE
DONALD FGD92 RATTON HANLEY STOKE-ON-TRENT ST1 2HH
WARDLE & STREET
SON
Easington
BOOTS UK FFC81 13 WESTBOURNE TERRACE SHINEY ROW DH4 4QT
LIMITED
SECURICARE FYR20 CAVELL KNAVES BEECH WAY LOUDWATER HP10 9QY
(MEDICAL) HOUSE
LTD
BULLEN CS FQ588 CONSTANC LIVERPOOL LIVERPOOL L3 8HL
LTD E STREET
CORDIA FTD28 UNITS TRADING ESTATE WORSLEY ROAD M28 3PT
HEALTHCARE 61&62
LIMITED OAKHILL
BOOTS UK FDF09 HOTSPUR ELDON SQUARE NEWCASTLE UPON NE1 7XE
LIMITED WAY TYNE
BOOTS UK FMF10 UNITS 46- CAMERON WALK THE NE11 9YQ
LIMITED 52 METROCENTRE
LLOYDS FJH08 2 ST JOHNS HEBBURN TYNE & WEAR NE31 1LQ
PHARMACY PRECINCT
LTD
BCA DIRECT FT468 3 HOLMAN HENRY ROBSON WAY SOUTH SHIELDS NE33 1RL
LIMITED COURT
EILBECK JF FA276 105 GATESHEAD TYNE & WEAR NE8 1PU
(CHEMIST) BENSHAM
LTD ROAD
COLOPLAST FLV51 UNIT 1 THE BAKEWELL ROAD ORTON PE2 6BJ
LTD LINKS SOUTHGATE
LLOYDS FRW42 50 HENDON SUNDERLAND SR1 1AE
PHARMACY BOROUGH
LTD ROAD
FITTLEWORT FAA96 SUITE LOW STREET SUNDERLAND SR1 2JR
H MEDICAL 1,WYLAM
LIMITED WHARF
BOOTS UK FTY64 45 THE SUNDERLAND TYNE & WEAR SR1 3LF
LIMITED BRIDGES

74
 Dispenser Dispenser Dispenser Dispenser Address Dispenser Address Dispenser
Name Code Address Line 2 Line 3 Postcode
Line 1
BOOTS UK FYR17 UNITS 2-3 PARK LANE SUNDERLAND SR1 3NX
LIMITED
ASDA FXD93 ASDA LEECHMERE RD IND GRANGETOWN SR2 9TT
STORES LTD SUPERSTO EST
RE
SAINSBURY'S FH945 SAINSBURY SILKSWORTH LANE SILKSWORTH SR3 1PD
SUPERMARK S J PLC
ETS LTD
AMCARE LTD FJM24 39B PALLION TRADING SUNDERLAND SR4 6SN
PALLION ESTATE
WAY
NORCHEM FNW79 UNIT 9, PENNYWELL SUNDERLAND SR4 9AS
HEALTHCARE PENNYWEL
LIMITED L CENTRE
DONALD FGD92 RATTON HANLEY STOKE-ON-TRENT ST1 2HH
WARDLE & STREET
SON
BOOTS UK FRJ37 UNIT TEESIDE RETAIL PARK STOCKTON-ON- TS17 7BW
LIMITED 21B,GOOD TEES
WOOD
SQUARE
BOOTS UK FG487 58-63 HIGH STREET STOCKTON-ON- TS18 1BE
LIMITED TEES
BOOTS UK FCP08 ANCHOR MARINA WAY HARTLEPOOL TS24 0XR
LIMITED RETAIL
PARK
ASDA FXW36 ASDA MARINA WAY HARTLEPOOL TS24 0XR
STORES LTD SUPERSTO
RE
SUPERDRUG FVK57 133-134 SHOPPING CENTRE HARTLEPOOL TS24 7RD
STORES PLC MIDDLETO
N GRANGE
BOOTS UK FMP53 89 MIDDLETON GRANGE HARTLEPOOL TS24 7RW
LIMITED SHOPPING
CENTRE
BISHOP C M FFX51 38A(2)MID SHOPPING CENTRE HARTLEPOOL TS24 7RY
DLETON
GRANGE
TESCO FRR40 TESCO BELLEVUE HARTLEPOOL TS25 1UP
STORES SUPERSTO
LIMITED RE
LLOYDS FEH08 136 YORK HARTLEPOOL TS26 9DA
PHARMACY ROAD
LTD
L ROWLAND FXX89 6 TANNERS WARRINGTON CHESHIRE WA2 7NJ
& CO LANE

75
 Dispenser Dispenser Dispenser Dispenser Address Dispenser Address Dispenser
Name Code Address Line 2 Line 3 Postcode
Line 1
(RETAIL) LTD

MR N FL377 GOMPELS NUTRICIA CEVA WAINWRIGHT WR4 9FA

GOMPELS HOMEWA LOGISTICS ROAD
RD
PHARMAC
Y
Sedgefield
BOOTS UK FLA75 47-53 DARLINGTON DL1 1TT
LIMITED NORTHGA
TE
E MOSS LTD FPT36 MORRISIO MORTON PARK WAY MORTON PARK DL1 4PJ
NS
SUPERMAR
KET
BOOTS UK FJ493 23 HIGH DARLINGTON DL3 7QW
LIMITED ROW
SECURICARE FYR20 CAVELL KNAVES BEECH WAY LOUDWATER HP10 9QY
(MEDICAL) HOUSE
LTD
FITTLEWORT FPP56 FITTLEWO ROOMS 1 & 3, CARNFORTH LA5 9EX
H MEDICAL RTH WARTON ROAD
LTD HOUSE
BOOTS UK FMF10 UNITS 46- CAMERON WALK THE NE11 9YQ
LIMITED 52 METROCENTRE
COUNTRYWI FRF82 32 NETHERFIELD NOTTINGHAMSHIR NG4 2FR
DE SUPPLIES MEADOW E
LTD ROAD
COLOPLAST FLV51 UNIT 1 THE BAKEWELL ROAD ORTON PE2 6BJ
LTD LINKS SOUTHGATE
AMCARE LTD FPY18 AMCARE 10 STOCKTON ROAD SUNDERLAND SR1 3NW
HSE,SUND
ERLAND
CTR
BOOTS UK FL798 88-90 THE CLEVELAND MIDDLESBROUGH TS1 2JZ
LIMITED LINTHORP CENTRE
E ROAD
BOOTS UK FRJ37 UNIT TEESIDE RETAIL PARK STOCKTON-ON- TS17 7BW
LIMITED 21B,GOOD TEES
WOOD
SQUARE
BOOTS UK FG487 58-63 HIGH STREET STOCKTON-ON- TS18 1BE
LIMITED TEES
TESCO FTV83 DURHAM STOCKTON ON TS21 3LU
STORES ROAD TEES
LIMITED

76
 Dispenser Dispenser Dispenser Dispenser Address Dispenser Address Dispenser
Name Code Address Line 2 Line 3 Postcode
Line 1
ASDA FXW36 ASDA MARINA WAY HARTLEPOOL TS24 0XR
STORES LTD SUPERSTO
RE
BOOTS UK FMP53 89 MIDDLETON GRANGE HARTLEPOOL TS24 7RW
LIMITED SHOPPING
CENTRE
LLOYDS FEH08 136 YORK HARTLEPOOL TS26 9DA
PHARMACY ROAD
LTD

77
Appendix 6 – Core and Supplementary Hours
Durham Dales

78
Derwentside

79
Sedgefield

80
Easington

81
Durham and Chester-le-Street

82
Appendix 7 – GP Opening Hours
Durham Dales

83
Sedgefield

84
Easington

85
Durham and Chester-le-Street

86
Derwentside

87
Appendix 8 - Map showing rurality classification

88