The Adult Social Care & Health Select Committee met to discuss dentistry and oral health, community pharmacies, and the pharmaceutical needs assessment (PNA). Councillors agreed to the scrutiny priorities for the municipal year, and to develop a detailed work programme. The committee noted that the 18 September meeting would need to be rescheduled to allow scrutiny of the Safeguarding Adults' Executive Board Annual Report.

Dentistry and Oral Health

The committee discussed measures to address oral health issues in children and adults, with a focus on prevention and early intervention.

Anna Raleigh, Director of Public Health, highlighted the importance of partnership working between the council, NHS North West London (NWL) Integrated Care Board (ICB), Local Dental Committee, and NHS England.

Councillors heard that in 2018-19, 24% of five-year-old children in Kensington and Chelsea suffered from tooth decay, slightly above the England average of 23% but below the London average of 27%.

Councillor Josh Rendall, Lead Member for Adult Social Care & Public Health, noted that RVKC still faces challenges, especially for those under five. He mentioned programmes run by the public health team, such as the 'Keep Smiling' programme, and work with schools like Colville Primary School, where they teach students how to brush their teeth.

A representative from the local Dentistry Committee, Dr Zara, explained that formal registration with an NHS dentist ceased on 1 April 2006, meaning there is no obligation for a dentist to see a patient again after a course of treatment. She added that dental practices are contractually required to update their status on NHS choices, but this may change daily.

Dr Zara also noted the difficulties faced by dentists setting up new practices, as there are no reimbursements for rent or staff. Contracts are only issued if the ICB decides there is a need for more dental coverage in the area and has the funds to issue a contract.

Dr Zara stated that Kensington and Chelsea is not one of the boroughs she would worry about in terms of access to an NHS dentist and capacity, and that the snapshot of when someone is able to see an NHS patient is important, as April is when new funding comes along.

Councillor Anne Cyron, Vice Chair, Adult Social Care & Health Select Committee, questioned the contracted units of dental activity (UDA) and whether it was appropriate for the population. A representative from the local Dentistry Committee, Jeremy, explained that contracts are not based on need or population, but are a financial exercise. Dentists are not constrained to see patients from a certain area and can see anyone from anywhere in England.

Jeremy also noted that dental, optometry and pharmacy services do not have a registration requirement and are not constrained to delivering services to people who live in a borough or a particular area. He added that the movement to ICBs means nothing, because the contract is exactly the same as it was when NHS England were the monitors of it.

Kelly, Regional Lead, discussed a pilot for looked after children, but said that only two local authorities really moved on it. She added that it ended up being utilised by the children of asylum seekers, because they did not discriminate.

May, Clinical Director for the Community Dental Service, said that they are gathering intelligence around the need in care homes, and that they are working closely with the local authority to collect more data.

Community Pharmacies

The committee received an update on community pharmacies, including the national contract, closures, and the Pharmacy First service.

Fiddish Patel, CEO of Kensington, Chelsea and Westminster of BC, provided an update on the national contract for community pharmacy, noting that the funding for the current year was welcome, but long-term uplift is needed to make pharmacies financially secure. He said that pharmacies are struggling and can't rely entirely on the NHS, but that pharmacies in Kensington and Chelsea are slightly lucky in the sense that they can diversify into private services.

Fiddish Patel also discussed the decision by Tesco to close, noting that it was a national decision to close a number of their 100-hour pharmacies¹. He added that the local network is still very strong, but there are still dangers to pharmacies closing. He noted that high rents and rates are major issues for pharmacies in RBKC.

Fiddish Patel said that activity levels for the Pharmacy First service are very low, and the uptake and increase of activity remains a priority for the LPC.

Councillor Portia Thaxter, Adult Social Care & Health Spokesperson, asked how the council can encourage pharmacies to opt into the new contraception access that's coming in. Councillor Josh Rendall said that most pharmacies will opt in to provide that service from October, as it is a relatively easy service to provide clinically.

Councillor Portia Thaxter asked what target efforts are being made to address the reporting health literacy gap among vulnerable groups. Councillor Josh Rendall said that most pharmacies have easy access for disabled groups, but for residents who can't afford medication, there is a pharmacy scheme in other parts of London where patients on universal credit can get certain medications free of charge.

Councillor Portia Thaxter asked how the committee is going to reconcile the conflicting narrative that the PNA report states that there are no current or future gaps in pharmaceutical service, but the LPC report says there are AI life services uptake and operational risks. Fiddish Patel said that most of pharmacies provide all these services and they're just waiting for patients to come and make themselves available to these services.

Councillor Anne Cyron asked if an uplift in the investment to bring it in line with other similar boroughs would help with the early access issue and the awareness building. Fiddish Patel said that it would, and that it would take pressure off GP services.

Councillor Anne Cyron asked if there were any specific wards or specific pharmacies that were at more risk than others, and what could be done to keep those open. Fiddish Patel said that the LPC is engaging with all the pharmacies in RBKC and Westminster to see how ready they are for providing these extra services like pharmacy first service.

Councillor Anne Cyron asked how income generating Pharmacy First is for a pharmacy. Fiddish Patel said that it is useful income, but dispensing will still account for 85% of the turnover and the services would just be about 15%.

Councillor Gerard Hargreaves, Chair, Audit & Transparency Committee, said that the PNA report states that there are no current or future gaps in pharmaceutical service, and asked if Fiddish Patel was telling the committee that there are too many pharmacies. Fiddish Patel said that even within those pharmacies, the amount of NHS services that have been provided at the moment, especially pharmacy first service, hasn't developed as much as they would have both.

Councillor Gerard Hargreaves asked if there was any way of tracking or finding out how much business pharmacy is doing for private. Fiddish Patel said that the LPC is not in a position to map if there are residents who are in need of services who are not getting the services, and that they have no way of tracking that.

The committee agreed to make a recommendation to the ICB to review effectiveness of Pharmacy First and GP referrals and patient awareness, and to share the light on the data that states have made the pictures.

Pharmaceutical Needs Assessment

The committee considered an updated Pharmaceutical Needs Assessment (PNA).

Councillor Josh Rendall said that the point of the PNA is to look at things like demographics, change of population, where some of the health concerns may be far or wide, and capturing views all people may not see.

Anna Raleigh said that the PNA controls the entry of new pharmacies into an area, and that because the council says its pharmaceutical needs are met, that means there isn't the opportunity for new pharmacies to move in and have a contract.

Councillor Portia Thaxter asked what support the council could be exploring to support pharmacies so that much of what has been spoken about today might work better, and so that the council might be able to deliver more additional services across the borough.

Colin Brodie, said that the council also has the opportunity to commission services from local pharmacies, such as stop smoking services, substance misuse services, and sexual health services. He added that the council has got quite a strong relationship with the local integrated neighbourhood team, and that Usman Khan, the deputy director of public health for RBKC, is now the co-chair of the West kind of IMT group.

Colin Brodie said that he is keen to explore with NHS colleagues what are the opportunities around maximising the pharmacy first offer in those pharmacies, too, and building up quite a strong picture around that.

Councillor Portia Thaxter asked if the sample of 37 local residents and workers that responded to the public survey was robust enough that there's no gaps in access or quality. Colin Brodie said that the survey ended up being right for a much shorter time than they would have liked to, and that the conversations took such a long time, that by the time the survey went on, it went on for a very short time.

Colin Brodie said that they recognise in the document that it isn't enough to make absolutely robust statements about the quality of some of the access, and that it's part of the picture.

Councillor Portia Thaxter asked what steps will be taken to ensure future PCA engagement more meaningful with seldomly heard voices, groups and vulnerable residents. Colin Brodie said that that certainly would be something that they'd like to promote, and that they are welcoming suggestions about how they can promote it and request use of existing comms channels.

Councillor Gerard Hargreaves asked if there were any gaps in the resources from this exercise that were identified at all that need flagging, and thoughts about how those gaps might be addressed. Colin Brodie said that it's not generally within scope of the PNA, and that basically what they're saying is that they have sufficient pharmacy services in place to meet the local needs.

The committee agreed that it would be great if the committee could receive the feedback.