Views & Experiences of People Accessing Pharmacy Services Report

Background

The North East and North Cumbria Integrated Care System (ICS) is a partnership of organisations including the NHS, local councils, voluntary and community services and education who have come together to provide health and care across our region. This is a new way of working that combines resources, knowledge, and skills, to plan, deliver and join up health and care, with the collective aim to support communities to live longer and healthier lives.

During the transformation of health and care service delivery, new ways of working and initiatives are being implemented to support the recovery of health and care services.

Pharmacy services throughout the years have worked within our communities to ensure patients can easily and safely access the medicines and healthcare advice they need.

As the healthcare needs of the population have evolved, so have community pharmacies. The recent launch of the Pharmacy First service in England is a new initiative to support the rapidly changing demands on health and care, it evidences the growing role that pharmacies can play in the nation’s healthcare.

However, Healthwatch Stockton-on-Tees have been made aware of challenges patients face accessing medication, concerns accessing GP services for prescription amendments and public confusion of new processes and pathways available to support improvements to health and care services.

The Healthwatch Stockton-on-Tees Executive Board made the decision to use its statutory function to carry out Enter & View at local pharmacies throughout the borough, to get a better understanding of pharmacy services in the area, speak to service users, the public and professionals, to raise awareness of new initiatives and gather feedback that can support long term sustainable improvements to pharmacy services.

“Government funding for pharmacies has failed to keep pace with ever-growing NHS workload demands and spiralling costs. The pharmacy network is shrinking, and closures are disproportionately affecting the most deprived communities. Without action, patients will find it harder to access the healthcare, expert advice and vital medicines they need.

“A vibrant pharmacy network can increase patient access, free up GP capacity, and support the NHS as it reduces the care backlog.”

Jane Harvey Service, Implementation & Peer Support Manager
Community Pharmacy Tees Valley

In the coming months Public Health Stockton-on-Tees on behalf of the Health and Wellbeing Board (HWBB) will be reviewing the Pharmaceutical Needs Assessment for the area, we want to ensure that the views of local people help to shape decisions now and in the future.

Executive Summary

Through the Healthwatch Stockton-on-Tees information and signposting function it was brought to our attention that people were having difficulty obtaining some prescribed medications and no longer being able to get repeat medication previously used.

Some of the intelligence we received detailed urgently needed medication required for long-term chronic conditions, and the subsequent challenges accessing GP appointments in a timely manner to address concerns and make appropriate adjustments to existing prescriptions.

This information was shared with the Healthwatch Stockton-on-Tees Executive Board and the decision was made to undertake several Enter & View visits at various pharmacies throughout the Borough. This was considered to be the most effective way of gathering additional intelligence from the public, staff and service users. 

During the planning process we became aware that the government and NHS England had introduced the Pharmacy First scheme to give patients quick and accessible care and ease pressure on GP services. This scheme enables community pharmacists to supply prescription-only medicines, including antibiotics and antiviral medication where clinically appropriate, to treat seven common health conditions without the need to visit a GP. 

In addition to this the ‘Think Pharmacy First’ initiative is also available throughout the North East and North Cumbria, offering advice and treatment for common conditions.

The focus of this workplan item was to find out how effective people felt Pharmacy Services are, if people were aware of additional services pharmacies provide and if people felt there were ways the service could be improved. We also wanted to know from a professional perspective, what opportunities and challenges could be identified to support effective information sharing, collaboration, and service delivery.

Six pharmacies were chosen based on their location, contractual arrangements, and size, to try to gain a broad overview of public and staff experience of pharmacy services. Our engagement took place from January 2024 until April 2024.

The pharmacies we attended were.

• Norton Glebe Pharmacy
• Boots Pharmacy – Thornaby-on-Tees Health Centre
• Synergise Pharmacy – Stockton Town Centre
• Pharmacy World – Roseworth
• Whitworths Pharmacy - Yarm
• Boots Pharmacy - Billingham

As well as using our Enter & View function, we conducted an online survey, carried out one-to-one meetings and gathered case study information to provide added value to this workplan item.

Our main findings were that people value pharmacy services, and staff were considered helpful and polite. In certain areas people felt access was a challenge, particularly with medication shortages and the need to attend one or more pharmacy service to collect a complete prescription. Some people described difficulties in walking to their local pharmacy due to ill health or frailty.

There was little knowledge of the additional services that pharmacy can provide, with the perception that pharmacists could not provide specialist health care advice, of an equal standard to that of a GP.

Those that had accessed Pharmacy First found the process useful, saving time and avoiding challenges accessing GP appointments.

A clear, joined up approach to communication is needed to ensure the public have the correct information and feel informed about available health and care pathways.

All the feedback gathered has helped to inform recommendations for the local area with the support of Community Pharmacy Tees Valley and will be shared widely at regional and national levels.

Survey Findings: Summary

What matters most to people in Stockton-on-Tees?

Most people we spoke to regularly access pharmacy services either weekly or monthly, we were told quite often medication is not available the first time they attend to collect a prescription, sometimes having to go to another pharmacy or return later to collect missing items. People felt this was becoming an issue more frequently with some medications not available at all.

“I quite often have to make a couple of trips to get a full prescription.”

Some people told us that access was an issue, particularly when having to attend alternative pharmacies due to lack of medication availability. Reference was made to people who may not have transport and the costs associated with travel expenses, in general people living in rural locations found access more difficult. 

However, most people felt they could easily access pharmacy services and did so either on foot or in a car.

We wanted to know what people felt that pharmacy services did well, there was overwhelming feedback that pharmacy staff were friendly and helpful, being honest about the availability of some medication and challenges with supply.

“The staff are very helpful, supportive and caring. They are very busy but always take the time to make sure you’re ok.”

Text services were described as a positive and useful way to be made aware a prescription is available for collection, saving time and improving efficiency.

As the demand on health and care services increases and recovery plans are implemented, we wanted to know if the public had awareness of other services pharmacies could support with.

40% of people were aware that pharmacies could provide advice about new medication and managing minor ailments, but only a small proportion of the people that we spoke to were aware of Sexual Health Services, Stop Smoking advice/service and the supply of a limited amount of medication in an emergency.

People told us that they would access these services if they had known, rather than contacting 111 or their GP as they felt services were stretched and access to GP services was becoming more difficult.

“I was not aware of all the other services; it is good know so I don’t have to put pressure on other services.”

There was concern raised about the privacy of discussions with pharmacists, people told us that they did not like their personal details being called out.

Most people told us that they would talk about general ailments or concerns but did not feel comfortable asking for advice on more personal matters. Some people we spoke to did not see the role of the pharmacist as a specialist service and felt greater reassurance with a GP.

Throughout the Enter & View process there was increasing observation of the demand on pharmacy services, this view was reflected by the public in the feedback we gathered.

“I feel sorry for them, they are so busy.”

We asked what other services people felt would be helpful to access at a pharmacy, we were told.

• Access to the voluntary and community sector via signposting.
• Health checks – including height and weight, results to be saved on a central system that other health professionals can access, avoiding unnecessary time in hospital appointments.
• Long-term chronic condition advice and support – avoiding repeat hospital visits.
• Vitamin B12 injections.
• Planned regular blood testing for those managing long term health conditions.

We wanted to use this opportunity to find out what areas of pharmacy services the public felt could be improved, privacy was raised regularly as an ongoing concern.

Better communication between pharmacy services and GP practices, would be viewed as helpful, with increased staffing and extended opening hours.

Some pharmacies in the borough offer a text service, this was seen as a very useful way to communicate and avoid lengthy waits and wasted visits.

Pharmacy First Survey Summary

During this workplan item we were made aware of a new government initiative called Pharmacy First. The decision was taken by the Healthwatch Executive Board to use this opportunity to gather additional information from the public and professionals, to determine how this was working and the impact it was having in the community.

62% of people we spoke to had heard of Pharmacy First, but many were unaware of what the service did. However, some people told us that they had been referred to the pharmacy by their GP as waiting times for GP appointments were getting significantly longer.

“I am here by appointment to see someone, I went to the GP and could not get in. They referred me to the pharmacy as they did not see me as an emergency, and it would take three weeks before I could get an appointment. I am at a loss as to how I access the GP, it might not be urgent to them, but the last time I was like this I ended up in hospital for three weeks.”

Most people we spoke to were using the prescription service, only 8% of people were accessing the Pharmacy First service.

During our discussions we raised awareness of the service and asked for feedback. Although some people would still prefer to access their GP, others felt that it would be much quicker and easier to access Pharmacy First. 71% of people said they would use the service and recommend it to friends and family.

Those that were accessing Pharmacy First, described it as a good service, which was particularly useful for children and when it is difficult to get a GP appointment.

“This has saved me so much time, I have struggled to get a GP appointment for three days, I keep missing emergency appointments.”

The average waiting time to be seen using the Pharmacy First service was between 30 minutes – 1 hour. There were people accessing the service using a booking system, people told us that they found this approach helpful and that it felt efficient and more effective than trying to access their GP practice.

“I was seen and referred to Urgent Care, I was home within an hour. Go to the GP and it takes forever and that’s after waiting days for an appointment.”

Although most people spoke of the positive impact of Pharmacy First, there is a lack of confidence and perception that pharmacists are not able to provide health advice as effectively as a GP.

Following our conversations 72% of people said they would now access Pharmacy First before contacting their GP practice with 21% stating they would still access their GP practice first, as they preferred to see a GP.

“GPs should do the job they are paid to do and not pass it off to pharmacists. GPs get paid far too much money and they won’t even see people face to face, it wrong to pass them on to pharmacy.”

Overwhelmingly people praised the role of the Pharmacy First service, more awareness of all the services that can be accessed via pharmacy would be useful. There is concern about the capacity of the service as demand increases, pharmacists may be over stretched and unable to keep pace with effective service delivery.

Feedback from Professionals

Professionals told us they were concerned at the pace that Pharmacy First had been rolled out throughout the network. Communication methods appear to be inconsistent and could be confusing to the public.
Recruitment was, in places, a challenge and additional training was needed to ensure staff felt confident and effective in their role.

The pharmacists we spoke to shared concerns about the demand on the service and the contractual specification, which could impact service delivery. We were told that payment for assessment became payable if the pharmacist made a referral to another health service e.g. Urgent Care, A&E or back to the patient’s own GP. It was felt that consideration was not given to the rapidly growing demand for advice and information. Additionally, this way of funding may lead to inappropriate referrals. Further clarity around funding is needed to alleviate growing concern.

Communication was also viewed as a challenge, increasingly it is becoming more difficult to contact other health services via the telephone. Pharmacists have experienced lengthy delays in contacting GP practices or similar to refer patients on. This time further increases pressure on service delivery.

Clarity would be welcomed about the process for assessment for access to Sexual Health Services. We were told of incidences that there had been refusal to assess due to cultural barriers, such as access to emergency contraception.

There was additional concern about medication and cost implications. It is perceived that some larger pharmacies actively choose not to stock more expensive medications, instead referring patients to smaller practices who may have stock. This is beginning to feel unfair, as the cost implications increase for smaller pharmacies. There is further concern about the potential negative impact this could have on accessibility requirements such as travel or cost implications for patients.

The pharmacy funding system is complex, with various pricing mechanisms. As of the 1st May 2024 The Department of Health and Social Care (DHSC) confirmed imposed changes to pricing. This has been strongly opposed by Community Pharmacy England who is continuing to warn Government and the NHS that putting further pressure on pharmacies to dispense at a loss will have very serious consequences for the sector, patients, and the wider primary care system.

Responses

North East & North Cumbria Integrated Care Board (NENC ICB)

“Thank you for sending us your latest report, which provides lived experience and insight from service users, carers and professionals on their concerns regarding accessing pharmacy services.

“We will review the existing messages and information available to the public to ensure that it is consistent and clear.

“The findings of the report are valuable, and we will consider these findings when looking to promote pharmacy services in the future.

“The ICB is working closely with our partners in local Health and Wellbeing Boards and with Local Pharmaceutical Committees around patients' access, sustainability and pharmacy resourcing. The ICB welcomes such feedback to ensure all vulnerable groups are well served.”

To download the full response from NENC ICB, please click here: NENC ICB Response to HWS Experiences & Views of Accessing Pharmacy Services Report

Jen Coe, Strategic Head of Involvement & Engagement, NENC ICB
 

Community Pharmacy Tees Valley (CPTV)

“Thank you to Healthwatch Stockton for sharing the report with Community Pharmacy Tees Valley and to those patients who took the time to respond to the survey and discussions within the pharmacies.

“Prior to the pandemic there was a large cut in funding to Community Pharmacy which has had an impact on the number of pharmacies that are now trading within the Tees Valley. Over the past few years, it has been very difficult for Pharmacy Teams working across the area as it has for everyone with the cost-of-living crisis as well as availability and changes to the healthcare environment. During the pandemic when they were the only provider who did not change the ability for members of the public to access their healthcare offer and medications. Flexible services were made available to ensure that members of the public could access vaccine services, medicines deliveries and support within their geographical area.

“Despite the challenges across the Community Pharmacy network the teams have remain determined in their delivery of good customer experiences with quality interactions key to this goal. This is reflected in the report with the positive feedback received and the enter and view team finding staff helpful and polite. There was a recognition of the volume of work that pharmacies are dealing with by patients.”

To download the full response from CPTV, please click here: CPTV Response to HWS Experiences & Views of People Accessing Pharmacy Services Report.

Sandie Keall, Chief Officer, Community Pharmacy Tees Valley
 

Stockton-on-Tees Borough Council Public Health Team

“Healthwatch Stockton-on-Tees would like to thank Joanne Linton, Pharmaceutical Advisor and colleagues for their valuable input during the finalising of this report.”

Recommendations

This focused engagement work has highlighted areas that could help to improve the awareness of services that pharmacies are now able to offer, supporting recovery plans and helping to build healthy and sustainable communities.

Valuable feedback received has informed the following recommendations:

Communication – Throughout this work plan item it has become apparent that clear and consistent information is not yet available. People did not feel informed about the additional role of pharmacies and services available. Equally the understanding of the professionalism of a pharmacist was sporadic, resulting in a lack of confidence.

Focus to be given to ensuring clarity of key messages to support the public in accessing the right service at the right time.

Referral Pathways – Once assessed, and if considered appropriate pharmacists can refer to other health services, with the intention of improving access and reducing waiting times. However, increasingly it is becoming more difficult and time-consuming for pharmacists to communicate via telephone, impacting negatively on service delivery. Consideration to be given to alternative referral methods, for example emails or alternative contact telephone numbers to be made available to pharmacists to support a smooth transition between services.

Review of allocation of stock medication – Information given to us detailed concerns of larger pharmacies actively choosing not to maintain stock of more costly medication and signposting patients to smaller pharmacies. The cost implication was considered unfair. Further clarity to be gathered to help to alleviate any concerns.

Resource – As recovery plans begin to take place, it is vital that adequate resource is made available for the sustainable future growth of pharmacy services. In places staff retention and development is proving challenging. To ensure pharmacy services can continue to support the health of our communities effectively, priority needs to be given to the rapidly changing demand on services.

Accessibility – Some people we spoke to told us of the challenges attending pharmacy services due to ill health or frailty, and the need to attend one or more pharmacy to receive prescribed medication. Improved knowledge of delivery services available would be helpful, along with better use of text messaging services when prescriptions are ready to collect. Consideration to be given to improving the use of these services. We were also made aware of physical access concerns due to heavy doors and steps, identification of these locations should be included in the planning of the Pharmaceutical Needs Assessment, along with potential issues patients may have needing to access alternative pharmacies.

Reassurance is sought from the Pharmaceutical Needs Assessment that there are adequate pharmaceutical services in the locality to meet the needs of the population.

Sexual Health Services - It has been identified that due to cultural requirements, some assessments and access to emergency contraception is denied. Clarity to be sought around policy and subsequent referral pathways.