Community pharmacy services: quality report

This annual statistical release presents information about community pharmacies in Wales in contract with health boards. It supports Welsh Government community pharmacy policy colleagues and the Welsh Government’s long term plan for health and social care A Healthier Wales.

Community pharmacies are those found in cities, towns and villages across the country, for example on high streets, in supermarkets or within GP surgeries. Data for the main services which community pharmacies are accredited to provide are summarised in the statistical release. These include:

• dispensing prescriptions
• medicine use reviews
• discharge medicine reviews
• emergency contraception
• seasonal flu vaccine
• common ailments service

The data in this release and the accompanying StatsWales tables comes from two sources within NHS Wales Shared Services Partnership. Information on the pharmacies accredited to provide advanced and enhanced services comes from the All Wales Pharmacy Database, while the number of pharmacies providing medicine use reviews, discharge medicine reviews, emergency contraception, season flu vaccine, and the common ailments service, and the numbers of each service provided, is compiled on the basis of the pharmacies submitting claims for payment for providing the services. The number providing the services is likely to be lower than the number accredited to provide them as not all pharmacies will provide the services each year.

Community pharmacy statistics relate to services provided by community pharmacies in contract to local health boards to dispense NHS prescriptions. As a result all pharmacies should be accounted for and there are no concerns that any data is missing.

Statistics are presented for financial years (1 April to 31 March).

A full annual statistical release is published through our website. This contains all the data specified in the ‘What are these statistics?' section and has more detailed data included in attached Excel tables.

Data included in the release are published on StatsWales.

A separate statistical release Prescriptions in Wales is also published containing detailed prescribing data. The number of prescriptions dispensed as published in the community pharmacy services in Wales release will differ from the number of prescriptions dispensed in the prescriptions in Wales release for a number of reasons including:

• the community pharmacy release only counts prescriptions dispensed from community pharmacies, whereas the prescriptions in Wales release counts prescriptions from GPs in Wales which are then dispensed from any pharmacy or dispensing GP

The community pharmacy release counts prescriptions dispensed, regardless of where the prescribing GP is located; whereas the prescription in Wales release only counts prescriptions from GPs in Wales.

These statistics will be used in a variety of ways. Some examples of these are:

• advice to Ministers
• to inform debate in the Welsh Parliament and beyond
• to make publicly available data on community pharmacy services in Wales
• monitoring service delivery
• policy development

The main users are:

• ministers, members of the Welsh Parliament, and the Members Research Service in the Welsh Parliament
• NHS organisations including health boards and Public Health Wales
• pharmacists
• the Department for Health and Social Services in the Welsh Government
• other areas of the Welsh Government
• the research community
• students, academics and universities
• individual citizens and private companies

If you are a user and do not feel the above list adequately covers you, or if you would like to be added to our circulation list, please let us know by e-mailing stats.healthinfo@gov.wales.

Strengths

• The outputs provide a statistical overview of the number of community pharmacies in Wales and the levels of activity they offer within their range of services offered.
• Data has excellent coverage and should cover all community pharmacies in contracts with local health boards in Wales.
• Outputs have a clear focus on Wales and have been developed to meet the internal and external user need in Wales. These releases aim to inform Welsh Government policy on the planning and delivery of community pharmacy services.
• The information is processed and published regularly and in an ordered manner to enable users to see the statistics when they are current and of greatest interest.
• Efficient use has been made of administrative data sources to produce outputs including utilising data such as the All Wales Pharmacy Database.
• Detailed statistics are provided via our StatsWales website.

Limitations

• Data on community pharmacy workforce is not available.
• No data is available on the provision of pharmacy services in the Welsh language.
• Summary data is published at local health board level; data could be provided at local authority level if there was demand.
• Local health board data is based on the location of the community pharmacy; no data is available on the resident health board of the service user.
• As community pharmacy policy is a devolved subject and different governments can therefore make different policy decisions, comparisons between other UK countries are limited.
• Prescribing Services, NHS Wales Shared Services Partnership have stated that due to the complex and manual processes involved there may be inaccuracies in capturing prescription information which are then reflected in the data. Internal quality assurance processes exist and currently the prescription processing activity is internally audited for 2019-20 at 99.8% accuracy (i.e. at least 99.8% of prescriptions are processed accurately).

Items dispensed

An item dispensed refers to a single item prescribed by a doctor (or dentist) on a prescription form. If a prescription form includes three items it is counted as three dispensed items. A prescription item may be for a variable quantity for example 14, 28 or 56 tablets.

Services

Under the pharmaceutical services contractual framework services are divided into three categories:

• essential services which must be provided by all community pharmacies
• advanced services which all community pharmacies can choose to provide dependent on them meeting certain criteria
• enhanced services which are commissioned locally by Health Boards to reflect the needs of the local population

Further details are available via NHS Wales.

Essential services

Essential services are those that must normally be provided by all community pharmacy contractors. They are nationally agreed services and are not generally open to local arrangement. These services include dispensing, repeat dispensing, disposal of unwanted medicines, promotion of healthy lifestyles and support for self-care.

Advanced services

Medicine use reviews

Pharmacy premises must be accredited and pharmacists trained and registered to be able to provide Medicines Use Reviews (MURs). The MUR involves the pharmacist reviewing the patients’ use of their medicines to improve their understanding of how they should be taken and any potential side effects.

Discharge medicines reviews

The Discharge Medicines Review Service (DMR) was introduced in Wales on 1 November 2011. The DMR service aims to provide support to patients recently discharged from hospital by ensuring that changes made to their medicines are enacted as intended in the community.

'Appliance user reviews' and the 'stoma customisation service' are also advanced services.

Enhanced services

Additional hours services (includes extended hours and Bank Holiday rota)

The provision of pharmaceutical services during an extended period of opening to ensure that people have prompt access to medicines during the out of hours period (whether for the whole or part of that period).

Blood borne virus screening service

Involves blood spot screening for people at risk of blood borne viruses such as hepatitis C and referral to treatment services.

Common ailments service

Involves the provision of advice and support to people on the management of common minor ailments, including where appropriate, the supply of medicines for the treatment of that ailment, for those people who would have otherwise gone to their GP for advice or a prescription.

Directly observed therapy

The observation of patients taking specified prescribed medicines to ensure adherence to an agreed treatment plan, typically for medicines where the problems associated with poor adherence have been shown to be significant (e.g. in treatment of tuberculosis).

Independent prescribing service

Involves the provision of advice and support to people for a range of conditions where the pharmacist is able to prescribe as well as supply treatment.

Inhaler review service

Involves the provision of advice and support to people using inhalers for the management of their respiratory illness (e.g. asthma or COPD) and includes checking inhaler technique and advising on changes to inhaler devices to improve the outcomes of treatment.

Medicines management in domiciliary care (formerly Medicines assessment and compliance support service (including the provision of Medication Administration Records (MAR Charts))

The provision of a range of services which support patients and carers to ensure medicines are taken safely and effectively, and may include the provision of medicines administration record (MAR) charts and/or compliance devices; and the provision of additional MURs commissioned by health boards as enhanced services.

Minor ailment/injury schemes

The provision of advice and support to people on the management of minor ailments including minor injuries, including where necessary, the supply of medicines or dressings for the treatment of the minor ailment, for those people who would have otherwise used their GP or other NHS service. Includes ‘triage and treat’ where minor, superficial injuries are treated in the pharmacy rather than having to visit a doctor or an A&E Department. The types of injuries that can be treated under this service might include minor abrasions, superficial cuts and wounds, sprains and strains and minor burns.

Pharmaceutical advice to care homes

The provision of advice and support to the residents and staff within a care home to ensure the proper and effective ordering of medicines and appliances, their safe storage, supply and administration, proper record keeping and measuring and taking action to reduce the prevalence of use of specified medicines in patients at risk of medicines related harm.

Palliative care ‘Just in Case’ scheme

The provision of palliative care medicines for patients for whom it is anticipated that their medical condition may deteriorate into the terminal phase of illness.

Palliative care out-of-hours services

Retaining stocks of agreed specialist medicines which can then be dispensed for patients receiving palliative care without undue delay; the demand for such medicines may be urgent and/or unpredictable.

Provision of emergency contraception

The provision of emergency contraception and sexual health advice through a community pharmacy.

Respiratory rescue medicines service

The supply of a ‘Rescue Pack’ of medicines for patients with Chronic Obstructive Pulmonary Disease (COPD) or asthma typically containing a short supply of a corticosteroid an antibiotic to be used in keeping with a patients COPD or asthma self-management plan.

Seasonal flu vaccination service (SFV)

The provision of NHS vaccination against seasonal influenza for persons over 65 or in an at risk group by a pharmacist.

Smoking cessation level 2

The provision of nicotine replacement therapy (NRT) to patients wishing to stop smoking and who are participating in behavioural support services.

Smoking cessation level 3

The provision of one to one behavioural support and advice to people who want to give up smoking.

Sore throat test and treat

Involves the assessment of people presenting at the pharmacy with a sore throat, including where appropriate an examination and swab of the throat to detect whether a patient has a bacterial infection. Where necessary antibiotics are supplied.

Supervised administration of prescribed medicine (substance misuse)

The supervision of patients when taking specified prescribed medicines to ensure adherence to an agreed treatment plan and prevent the diversion of medicines with the potential to be misused (e.g. opiates).

Syringe and needle exchange

The provision of sterile needles and syringes, injecting paraphernalia and sharps containers for return of used equipment.

Tuberculosis medicine compliance services

This service requires the pharmacist to supervise the consumption of anti-tuberculous medicines at the point of administration in the pharmacy, ensuring that the dose has been administered to the patient. 

Waste reduction scheme

Involves ensuring that at the point of dispensing the pharmacy supplies only those medicines required by the patient.

Other services

Services provided by fewer than 5 pharmacies.

Appliance contractor

Each community pharmacy and appliance contractor has an arrangement with a local health board to dispense NHS prescriptions. The arrangement specifies both the premises and the named contractor. Community pharmacies can dispense the full range of drugs and appliances, but appliance contractors are limited to the supply of appliances as listed in Part IXA/B/C of the monthly Drug Tariff published by the Prescription Pricing Division of the NHS Business Services Authority.

Control of entry regulations

Control of entry regulations require that any pharmacy in Wales wishing to obtain an NHS contract to dispense NHS prescriptions must satisfy the Health Board that it is either ‘necessary’ or ‘desirable’ to grant the application to secure the adequate provision of pharmaceutical services in a particular neighbourhood. Permission is also required for minor relocations and changes of ownership. Minor relocations cover pharmacies wishing to relocate over a short distance within the same neighbourhood. Changes of ownership are granted only if the same services will be provided as before, there is no interruption in service provision and no relocation involved. Note that pharmacy service regulations came into force in Wales on 10 May 2013.

Controlled locality

An area determined by the relevant local health board to be rural in character for the purpose of determining applications to provide NHS pharmaceutical services in accordance with regulation 9 of the NHS Pharmaceutical Services (Wales) Regulations 1992/662 as amended or regulation 6 of the NHS Pharmaceutical Services (Wales) Regulations 2013/898.

Data collection

Details of the services provided by each community pharmacy are provided by NHS Wales Shared Services Partnership from the All Wales Pharmacy Database.

Prescribing data, including the number of pharmacies and prescriptions issued within each local health board are obtained from Primary Care Services, NHS Shared Services Partnership, along with more detailed information on the provision of the seasonal flu vaccine and emergency contraception, and the consultations offered under the ‘Common Ailments Scheme’.

Information on applications to open a community pharmacy plus a count of the openings and closures within each local health board is supplied via the PHS1W form by NHS Wales Shared Services Partnership.

Data is submitted on Excel spreadsheets via Afon, the Welsh Government secure web data transfer system.

Validation checks are performed by Welsh Government statisticians and queries referred to NHS Wales Shared Services Partnership where necessary. These validations checks will include steps such as:

• all community pharmacies are present in all data extracts
• the services provided in previous years are included in the latest years’ data
• ensuring any new services are included and requesting clarification on what the new service includes
• aggregates are in-line with what might be expected based on previous years data and any contextual information
• any changes to the pharmacy clusters, and updating details if necessary.

Once validated, data is published in line with statement on confidentiality and data access which is informed by the trustworthiness pillar contained in the Code of Practice for Statistics, in September each year.

Statistics are currently published in an html webpage with brief analysis and commentary, in addition to open data format tables which are published on StatsWales and supplementary summary tables published in Excel.

Disclosure and confidentiality

Data is published at aggregated local health board and national, with minimal risk of disclosing information about any individual or pharmacy. Checks still performed and suppression of small numbers in specific will take place if required.

No personal information pertaining to details such as first name, surname or date of birth are received by Welsh Government in this dataset.

Symbols and rounding conventions

Where figures have been rounded there may be an apparent discrepancy between the sum of the constituent items and the total. The following symbols are used in the tables:

..  The data item is not available

.  The data item is not applicable

-  The data item is not exactly zero, but estimated as zero or less than half the final digit shown

*  The data item is disclosive or not sufficiently robust for publication

Statistics published by Welsh Government adhere to the Statistical Quality Management Strategy which supplements the Quality pillar of the Code of Practice for Statistics and the European Statistical System principles of quality for statistical outputs. This statistical release aims to meet these quality principles in the following ways:

Principle 11: Relevance

The statistics produced support community pharmacy services policy decisions and the Welsh Government’s long term plan for health and social care: Healthier Wales.

Statistics also support analysis of key topics like emergency contraception and the seasonal flu vaccine.

The statistics presented can inform public debate and scrutiny.

Background information about statistics and sources is published for users and encourage users of the statistics to contact us to let us know how they use the data.

We consult with key users prior to making changes, and where possible publicise changes on the internet, at committees and other networks to consult with users more widely. We aim to respond quickly to policy changes to ensure our statistics remain relevant.

Principle 12: Accuracy and reliability

Most of the data included comes from administrative sources which are used in the management of the service and are part of a contractual framework.

Prescribing Services, NHS Wales Shared Services Partnership have stated that due to the complex and manual processes involved there may be inaccuracies in capturing prescription information which are then reflected in the data. Internal quality assurance processes exist and currently the prescription processing activity is internally audited for 2019-20 at 99.8% accuracy (i.e. at least 99.8% of prescriptions are processed accurately).

Principle 13: Timeless and punctuality

Statistics are published as soon as possible after the relevant time period. Data for the financial year are generally supplied in late summer/early autumn and an annual release is published in October.

All outputs adhere to the Code of Practice by pre-announcing the date of publication through the upcoming calendar. Furthermore, publication dates are announced well in advance and any delays are communicated via notices on our website. Any revisions or postponements to outputs follow the Revisions, Errors and Postponements policies published online.

Principle 14: Coherence and comparability

The data in this release is based on data collection systems and definitions that are consistent across all local health boards in Wales.

StatsWales data on the number of community pharmacies is provided as far back as 1998-99 at a Wales level and 2004-05 at local health board level.

Data on certain advanced and enhanced services is provided from the year at which they were offered by community pharmacies.

Note that health service provision for residents of Bridgend local authority has moved from Abertawe Bro Morgannwg to Cwm Taf on 1 April 2019. The health board names were confirmed in a written statement with Cwm Taf University Health Board becoming Cwm Taf Morgannwg University Health Board and Abertawe Bro Morgannwg University Health Board becoming Swansea Bay University Health Board.

Similar data for other UK countries is available here:

England, general pharmaceutical services

Scotland, pharmacy and prescribing data and intelligence

Northern Ireland, pharmacists statistics

The majority of data for Wales can be compared with England, however there are some instances where it cannot be. The following data items are comparable:

• community pharmacy counts
• community pharmacy dispensing activity
• community pharmacy ownership including the definitions of an independent and a multiple contractor
• medicine use reviews
• appliance use reviews and stoma appliance customisation
• local enhanced services

The following data items are not comparable:

• community pharmacy applications – these are different as the Wales data is based on the NHS (Pharmaceutical Services) Regulations 1992 and the England data is based NHS (Pharmaceutical Services) Regulations 2005 legislation.
• appeals – these are also comparable as they are based on the pharmacy applications regulations applicable.
• discharge medicines reviews - Wales introduced the service in 2011 and England did not introduce the service.
• New medicines service - England introduced the service in 2011 and Wales did not introduce the service.

Principle 15: Accessibility

The statistics are published in an accessible, orderly, pre-announced manner on the Welsh Government website at 9:30am on the day of publication. An RSS feed alerts registered users to this publication. Simultaneously the releases are also published on the National Statistics Publication Hub.

Statistical releases are publicised on Twitter and all releases are available to download for free.

From 2020 the statistical release is published in html format. Alt text is provided for all charts and tables so that they can be read with a screen-reader.

Data is published StatsWales (a free-to-use open data platform that allows visitors to view, create and download tables).

Plain English is used in our outputs as much as possible and all outputs adhere to the Welsh Government’s accessibility policy.

All our webpage headlines are published in Welsh and English.

National Statistics status

The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Statistics.

National Statistics status means that official statistics meet the highest standards of trustworthiness, quality and public value.

All official statistics should comply with all aspects of the Code of Practice for Statistics. They are awarded National Statistics status following an assessment by the UK Statistics Authority’s regulatory arm. The Authority considers whether the statistics meet the highest standards of Code compliance, including the value they add to public decisions and debate.

The continued designation of these statistics as National Statistics was confirmed in June 2012 following a compliance check by the Office for Statistics. These statistics last underwent a full Regulation Statistics on Health and Personal Social Services in Wales against the Code of Practice in 2012.

Since the latest review by the Office for Statistics Regulation, we have continued to comply with the Code of Practice for Statistics, and have made the following improvements:

• published the statistical release in html format, with more open data published on our StatsWales website
• updated the quality report and refreshed commentary in the release

Dissemination

Given the strengths and limitations listed above, community pharmacy data are of sufficient quality to justify publication. A brief statistical release is published with high level summaries and linked to detailed Excel data tables. Further interactive data tables are published on StatsWales.