The Health Overview and Scrutiny Committee met on Friday 10 October 2025 to discuss the Pharmaceutical Needs Assessment and the council's plans for winter pressures. Key decisions included the endorsement of the Pharmaceutical Needs Assessment, which identified no major gaps in pharmacy provision but highlighted areas for improvement in accessibility and service awareness, and the review of the winter plan, which detailed strategies to manage increased demand on health and care services.

Pharmaceutical Needs Assessment

The committee received an overview of the Worcestershire Pharmaceutical Needs Assessment (PNA) for 2025. This statutory document, produced by the Health and Wellbeing Board, assesses current pharmaceutical services, identifies gaps, and makes recommendations to ensure services meet the health needs of the population.

Heidi Boring, a public health registrar who led the development of the PNA, presented the findings. She stated that there are currently 109 pharmaceutical providers in Worcestershire, comprising 88 community pharmacies and 21 dispensing practices. This represents a 6% reduction since the 2022 PNA, with four pharmacies lost in Malvern Hills. Despite this, access is generally good, with 100% of residents living within a 20-minute drive of a pharmacy and 86% within a 30-minute public transport journey.

The assessment identified no formal gaps in pharmacy provision based on agreed criteria, which included residents being within a 20-minute drive of a pharmacy during usual working hours, and within a 20-minute drive of a pharmacy open in the evening and on Saturdays (with a 30-minute allowance for rural areas). Sunday access also showed high coverage.

However, engagement with the public and pharmacy contractors revealed high satisfaction with community pharmacies, citing accessibility and professional staff. Concerns were raised about limited opening hours, waits, and transport issues, particularly in rural areas. Awareness of certain pharmacy services was low, though interest increased when people were informed.

Key recommendations from the PNA include:

• Raising public awareness and trust in pharmacy services.
• Aligning services with local health priorities and supporting staff wellbeing.
• Improving evening access and simplifying commissioning processes.
• Enhancing privacy, accessibility, and tailored communication.
• Ensuring respectful, private care for supervised medicine users.

Councillor Wells raised concerns about access for those without cars, particularly in rural areas like South Malvern Hills, where public transport is limited. Heidi Boring acknowledged that while 86% of the population can access a pharmacy within 30 minutes by public transport, this is not 100%, and acknowledged that public transport availability is a wider issue.

Councillor Ward questioned how evening access could be improved when pharmacies are reducing their core hours. Dr. Lisa McNally, Director of Public Health, explained that this is often a private business matter related to viability, but that the provision of medicines tied to out-of-hours GP providers is currently out to tender and will change in the future. Matt Fung from the public health team clarified that public health led the needs assessment, but NHS England and the Integrated Care Board (ICB) are the commissioners of pharmacy services, and public health has no direct commissioning levers.

Councillor Fordington highlighted travel difficulties in rural areas, particularly on Sundays, and questioned specific provisions. Matt Fung reiterated that while pharmacies are open in all districts, specific provision for rural access on Sundays is likely outside the scope of the PNA assessment.

Councillor Kumar inquired about the preparedness of Worcestershire pharmacies for the new Pharmacy First service, including training and funding, and public awareness of these facilities. Anne Hadley responded that pharmacies providing Pharmacy First have undertaken training, and funding is national. She added that work is being done with GP practices to raise awareness and direct patients to pharmacies, and that local campaigns are planned. Dr. McNally agreed that public awareness is crucial and suggested public health could work with the ICB on a campaign.

Simon Adams, Chair of Healthwatch Worcestershire, shared findings from local engagement, indicating that 48% of people surveyed had heard of Pharmacy First, and 75% would use it if available. He also discussed the convenience of online pharmacy services and the role of GPs in facilitating prescription deliveries.

Councillor Wilde reiterated concerns about accessibility and travel times in Malvern Hills, citing an example of a pharmacy closing for lunch near a GP service, creating difficulties for patients. Matt Fung acknowledged that some communities will find access more difficult and committed to ongoing work with the ICB and other partners to improve pharmacy services within existing constraints.

Councillor Turner questioned the system's ability to adapt to changing pharmacy models, comparing it to the ease of ordering food delivery. Anne Hadley explained that community pharmacy contracts are national and that staffing is a significant issue, leading to reduced opening hours. She noted that while home delivery exists, a funded delivery service for medicines is not currently available.

Councillor Wells asked about the criteria, application process, and payment for home delivery services for the 14% of the population without access to public transport or a car. Simon Adams explained that GPs can arrange for prescriptions to be delivered, and that distance-selling pharmacies cover postage costs, but there is no funded delivery service.

Councillor Frye sought clarification on pharmacy numbers and asked about covering patients who are carers and unable to leave the house. Matt Fung suggested this falls more under social support rather than the PNA's scope. Councillor Fry also asked about learning from best practices in other authorities. Anne Hadley mentioned collaboration with Herefordshire and Coventry Warwickshire, and participation in Midlands-wide ICB pharmacy integration meetings.

Councillor McSweeny raised concerns about cross-border pharmacy access, noting the inclusion of a Herefordshire pharmacy in the report. Matt Fung confirmed that travel times were assessed with a buffer zone, and that the PNA considers provision from neighbouring areas.

Councillor Ward inquired about how online medication delivery and access from any pharmacy interacts with prepayment plans and free prescriptions. It was explained that online pharmacies would ask about prescription payment status, and exemptions would be declared online.

Councillor Kumar returned to the issue of workforce shortages, asking about plans to recruit and retain pharmacists. Anne Hadley stated that while training numbers are nationally controlled, Worcestershire is working to increase foundation year places. She acknowledged the lack of a local pharmacy school as an issue. Dr. McNally highlighted the national crisis in community pharmacy, with a significant percentage of pharmacies facing closure, and urged national lobbying efforts. Councillor Turner agreed that the system appears broken and needs fixing.

The committee agreed to invite a representative from the local pharmaceutical committee to the next meeting and requested that future reports address workforce challenges, pharmaceutical education in Worcester, and best practices from neighbouring authorities.

Planning for Winter

The committee received an update on the Worcestershire health and care system's approach to mitigating winter pressures in urgent and emergency care. Representatives from the HWICB, WAHT, HWHCT, and Worcestershire County Council presented the winter plan.

Mari Gay from the HWICB outlined the system's approach, which focuses on ensuring the right patient receives the right care in the right place. She noted improvements in performance over the first part of the year, including reduced ambulance delays and ED waiting times, but acknowledged that recent weeks have seen challenges due to the onset of winter and a small resurgence of COVID-19.

Key priorities for winter 2025 include:

• Continued reductions in ambulance handover delays, aiming for no waits over 45 minutes.
• Improvements to emergency department waiting times and Emergency Access Standards (EAS) performance.
• Reductions in corridor care.
• Improved experience for frail and end-of-life patients.

Interventions include increasing primary care capacity with 30,000 additional same-day urgent appointments, expanding the vaccination programme through multiple sites and outreach vehicles, and enhancing the Pharmacy First service. Urgent dental care appointments have also been commissioned, with 12,970 allocated for Herefordshire and Worcestershire.

Focus is also being placed on frailty and end-of-life care, with efforts to identify and support individuals in their last year of life to reduce unnecessary admissions. A 24/7 mental health helpline has been enhanced.

Demand on services has increased, with a rise in walk-in attendances at EDs and Minor Injury Units (MIUs). Kidderminster MIU's overnight closure is being maintained due to low attendances and cost-effectiveness.

Stephen Collman from Worcestershire Acute Hospitals NHS Trust (WAHT) discussed internal improvements, including bed reconfiguration for trauma and orthopaedics, leading to a 40% improvement in time to theatre for hip fracture patients. He also highlighted work on frailty services, the hospital-at-home model, and efforts to improve patient flow and reduce length of stay.

Scott Parker from Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT) detailed specific funding for winter, focusing on accelerating flow through community hospitals and supporting patients awaiting packages of care. He also mentioned progress in mental health services, with no inappropriate out-of-county placements for 150 days.

Dr. Lisa McNally, Director of Public Health, emphasised the importance of prevention, highlighting the expansion of family hubs for parents with young children and the Healthy Worcestershire programme, which addresses issues like falls and social isolation among older people. She also mentioned a pilot for home visits to high-risk individuals. Dr. McNally also raised concerns about the ambiguity surrounding COVID-19 booster eligibility and the need for strong messaging on flu vaccinations.

Councillor Fordington shared a personal experience of long waits in corridors at Worcestershire Royal Hospital and questioned the clarity of the 111 service's guidance on service availability, particularly regarding Kidderminster MIU. Mari Gay clarified that the 111 service has a directory of services and that Kidderminster MIU's overnight closure is well-established.

Councillor Wilde raised concerns about carers not being included in COVID-19 booster eligibility and the risk of hospital-acquired infections. She also questioned the consistent implementation of mask-wearing policies in hospitals. Stephen Collman acknowledged the challenges of hospital-acquired infections and stated that the plan is to treat patients in the most appropriate setting and discharge them quickly. He also addressed the mask-wearing issue, noting that it is a live conversation with regional triggers and that the trust is vigilant.

Councillor Wells praised the council's efforts in engaging with communities and raised questions about collaborative approaches to end-of-life care, referencing Manchester City Council's reduction of council tax implications for those in similar circumstances. He also inquired about support for individuals with poor mental health during winter months, particularly veterans. Dr. McNally committed to reviewing grant funding for veteran charities.

Councillor Ward sought clarification on whether the increased urgent dental appointments are NHS-funded or private. It was confirmed that the provision is for NHS dental care.

Councillor Turner questioned the role of volunteers within the NHS and the incentivisation of voluntary sector work. Mari Gay explained that the voluntary sector is considered first in commissioning, and that Age Concern and Life After Stroke services are examples of effective partnerships. She noted that while resource is provided to some commissioned services, there is no direct payment for volunteers.

Councillor Kumar raised concerns about the impact of potential COVID-19 surges on hospital capacity and the collaboration between acute trusts and GP surgeries regarding patient management. Stephen Collman explained the Hospital at Home model, where patients are cared for at home under consultant supervision, and that GPs are kept informed of treatment plans. He also discussed efforts to tighten the link between primary and secondary care for early warning signs.

Councillor Harrison asked for clarification on the number of Urgent Community Response (UCR) teams and the base numbers for vaccination uptake targets for care home staff and healthcare workers. Scott Parker stated there are 12 UCR teams and provided figures for vaccination uptake, noting a national drop in rates.

Councillor Wilde asked for further explanation of modern general practice and how its implementation is monitored. The presenter explained that it involves a variety of practitioners, online access, and collaboration through Primary Care Networks, with contract monitoring in place.

Councillor Turner inquired about the possibility of other health authorities using Worcestershire's facilities if spare capacity exists. Stephen Collman explained that this would typically only happen by agreement and that systems are in place to prevent the import of ambulances from other areas if they are struggling.

The committee noted actions to strengthen communications regarding vaccinations for carers and veterans, and to develop a clear protocol for communication between primary and secondary care regarding the Hospital at Home service. They also requested data on the effectiveness of winter initiatives in preventing serious illness and deaths.

Refresh of the Scrutiny Work Programme 2025/26

The committee reviewed its draft work programme for 2025/26. Items already scheduled include an update from the Integrated Care Board, an overview of common neurological conditions, and an update on access to GP appointments and services. The committee also noted ongoing scrutiny of patient flow, adult mental health rehabilitation, routine immunisation, maternity and newborn services, community paediatric services, stroke services, end-of-life care, eye services, frailty, cancer pathways, acute dermatology services, and performance indicators. The committee agreed to retain flexibility to address urgent issues as they arise.