Population Needs. Background
Population Needs. 1.1 National/local context and evidence base Obesity and overweight are a global epidemic. The World Health Organisation (WHO) expects that approximately 2.3 billion adults worldwide will be overweight by 2015 and more than 700 million will be obese. The prevalence of obesity in England is one of the highest in the European Union. In England: Just over a quarter of adults (26% of both men and women aged 16 or over) were classified as obese in 2010 (Body Mass Index (BMI) 30kg/m2 or over). Using both BMI and waist circumference to assess risk of health problems, 22% of men were estimated to be at increased risk; 12% at high risk and 23% at very high risk in 2010. Equivalent figures for women were: 14%, 19% and 25%. There has been a marked increase in the proportion (doubling) that are obese, a proportion that has gradually increased over the period from 13.2% in 1993 to 26.2% in 2010 for men and from 16.4% to 26.1% for women. BMI Definition BMI range (kg/m2) Underweight Under 18.5 Normal 18.5 to less than 25 Overweight 25 to less than 30 Obese 30 to less than 40 Obese I 30 to less than 35 Obese II 35 to less than 40 Morbidly obese/obese III/severe 40 and over Overweight including obese 25 and over Obese including morbidly obese 30 and over Obesity is directly associated with many different illnesses, chief among them insulin resistance, type 2 diabetes, metabolic syndrome, dyslipidaemia, hypertension, left atrial enlargement, left ventricular hypertrophy, gallstones, several types of cancer, gastro-oesophageal reflux disease, non-alcoholic fatty liver disease (NAFLD), degenerative joint disease, obstructive sleep apnoea syndrome, psychological and psychiatric morbidities. It lowers life expectancy by 5 to 20 years. Direct costs of obesity are estimated to be £4.2 billion (Department of Health). As BMI increases the number of obesity-related comorbidities increases. The number of patients with ≥ 3 comorbidities increases from 40% for a BMI of < 40 to more than 50% for BMI 40-49.9 to almost 70% for BMI 50-59.9 and ultimately to 89% for BMI > 59-9. The treatment of obesity should be multi-component. All weight management programmes should include non-surgical assessment of patients, treatments and lifestyle changes such as improved diet, increased physical activity and behavioural interventions. There should be access to more intensive treatments such as pharmacological treatments, psychological support and specialist weight management programmes. Surgery to ai...
Population Needs. National/local context and Evidence Base Hypertension is persistently raised arterial blood pressure (BP). It is one of several risk factors for diseases such as heart failure, myocardial infarction, stroke, and chronic kidney disease. Hypertension should be suspected if clinic systolic BP is sustained above or equal to 140 mmHg, or diastolic BP is sustained above or equal to 90 mmHg, or both. (NICE 2018) High blood pressure affects more than one in four adults in England, and is the second biggest risk factor for premature death and disability. Improvements in tackling blood pressure in the last decade have prevented or postponed many thousands of deaths, but at present only four in ten of all adults with high blood pressure are both aware of their condition and managing it to the levels recommended. People from the most deprived areas are 30% more likely than the least-deprived to have high blood pressure and the condition disproportionately affects some ethnic groups including black African and Caribbean. Therefore a focus on blood pressure has potential to address health inequalities and variation in outcomes (PHE 2014). Public Health England (PHE) published Tackling high blood pressure: from evidence into action (PHE 2014). This document provides evidence-based advice on how local government, the health system and others can effectively identify, treat and prevent high blood pressure. Actions identified included: • Clinical Commissioning Groups (CCGs) should consider the case for local investment in Enhanced community pharmacy services to provide better information and support about blood pressure management; to introduce opportunistic screening in some areas; and to use the Medicines Use Review (MUR) service to review the blood pressure of those on anti- antihypertensive medication and others at high risk of developing high blood pressure • Healthcare professionals, including pharmacists and their teams, should take the opportunity of client engagement to test the blood pressure of all adults regularly and carry out pulse checks as part of blood pressure measurement The General Practice Forward View acknowledges that ‘Pharmacists remain one of the most underutilised professional resources in the system and we must bring their considerable skills in to play more fully’ (NHSE 2016, p7). This sentiment is shared in the Community Pharmacy Forward View. (PSNC 2016). General Practice registered population for Hull and East Riding CCGs for January 2018 was ...
Population Needs. 1.1 Nationalllocal context and evidence base This Specification sets out the commissioning requirements of South Devon and Torbay CCG and Devon Adult Social Care for a Rapid Response care service that will support the Local Multiagency Teams (LMATS). The service will apply and/or support evidence-based practice and will be informed by national and local drivers for change for example: • Current DoH policy and guidelines, delivery of national key targets & NSF & NICE guidelines • CQC registration requirements • Gold Standards Framework and the priorities for care of the dying person • Essence of Care • Infection Control Standards e.g. hand hygiene audits • Locality commissioning plans and locally agreed care pathways • The Devon Joint Strategic Plan (2008) and subsidiary action and operational plans • The integration of health and social care delivery in Devon through the continuing development of localities and clusters This commissioning specification is supported by the aims of South Devon and Torbay CCG’s strategic plan and the local targets and national conditions of the Better Care Fund: • Supporting people to stay at home and active promotion of care closer to home with a single point of access • Ensuring care, sensitivity and dignity at the end of life • 0% increase in admissions • Reduction in delayed transfers of care • Reduction in long term admissions to care homes • Protecting social services • 7 day community services to support discharge from hospital and prevent unnecessary admissions at weekends • Safe and secure sharing of data in the best interests of people who use the service, supporting safe, seamless care • Carer specific support and prevention of admission to hospital for the people they care for
Population Needs. 1.1 National Context & Evidence Base Recent proposals for improving urgent and emergency care services in England indicate that a model which supports self-care, helps people with urgent care needs to get the right advice or treatment in the right place, first time and provides a highly responsive urgent care service outside of hospital, is key to ensuring that we have a successful and long-lasting urgent care model. Only by building the right system, and better supporting patients and the public to use it effectively, will we achieve improved outcomes for urgent and emergency care in the NHS and truly deliver high quality care for all, and ensure the same for future generations. The NHS England evidence base report on the urgent care review (June 2013), highlighted the role that pharmacies could play in providing accessible care and helping many patients who would otherwise visit their GP for minor ailments. It concluded that: “community pharmacy services can play an important role in enabling self-care, particularly amongst patients with minor ailments and long term conditions.” NHS England highlighted that self-care for minor ailments can reduce dependence on emergency services. There is a need to improve awareness among patients about how to access self-care support services. There is a need to ensure such services are used consistently by patients and those services are delivered consistently by pharmacies. There is an enormous potential for pharmacies to provide capacity for accessible healthcare services through the provision of minor ailment schemes (MAS). MAS have a very good evidence base in the NHS and are being rolled out in many English regions. There are national schemes in Scotland and Wales. Community Pharmacies are highly trained competent professionals and are ideally placed to provide help and advice to patients with minor ailments and to address patient health needs through promotion of self-care. This serves to increase patient choice to access primary care in alternative settings. Evidence suggests that patients in more deprived areas are less likely to purchase over the counter medicines, but rely on charge-exempt prescriptions to obtain medicines. 1.2 Local Context The MAS, available through community pharmacies, provides the patients accessing pharmacy with advice and access to medicines where appropriate, supporting integration of the urgent care system and self-care. Equitable access to MAS will meet the needs of a diverse popula...
Population Needs. SDB1.1. Introduction Doncaster Metropolitan Borough Council (the “Authority”) made a decision to reshape drug and alcohol services in Doncaster and procure a ‘whole system’ recovery focused Substance Misuse service; the Adult Substance Misuse Recovery System (the “System”). Rotherham Doncaster and South Humber NHS Foundation Trust (the “Trust”) submitted a bid in partnership with The Alcohol and Drug Service (“ADS”) to deliver the System, in which they were successful. In order to effectively deliver the System, the Trust and ADS will sub-contract with various organisations for the delivery of supervised consumption services.
Population Needs. The National Insulin Resistant Diabetes Service provides a multidisciplinary outpatient clinic at Cambridge University Hospitals NHS Foundation Trust (CUH) plus inpatient stays for initiation of therapy when indicated. The aim of the service is to provide diagnostic, therapeutic and educational support for both patients and their local clinical carers, and to establish and disseminate evidence-based recommendations for the therapy of this severe group of conditions. The purpose of the service is to improve outcomes for these patients through the following mechanisms: • by providing a precise diagnosis wherever possible • by the provision of targeted specialist delivered treatment interventions including both dietary and pharmacological therapies • by educating patients, their relatives (where this is appropriate) and local health carers • by raising the profile of severe insulin resistance/lipodystrophy as a clinical problem in order to improve access to optimal care for affected patients. 1.1
Population Needs. 1.1 National/Local Context and Evidence Base North Lincolnshire smoking prevalence is approximately 23% and accounts for more than 330 preventable deaths each year and there exists a strong evidence base to support the combination of NL healthy lifestyle service with pharmacotherapy to reduce this prevalence. Further information is contained in Public Health England and National Centre for Smoking Cessation Training "Local Stop Smoking Services - Service and delivery guidance 2014". xxxx://xxx.xxxxx.xx.xx/usr/pub/LSSS_service_delivery_guidance.pdf The North Lincolnshire Council’s (NLC) Director of Public Health is seeking to commission a service for Provision of Nicotine Replacement Therapy (NRT) via a NRT e-Voucher digital service to support the existing Healthy Lifestyle Stop Smoking Service (SSS). This service will be delivered via a range of locally based Providers to ensure full equitable access to this option across the area. Patients participating in this service will initially be assessed for suitability by the existing SSS and referred into this e-voucher service to enable product supply. Referrals to this service will only be accepted from the current SSS via PharmOutcomes. The provider will send and receive information to and from the Healthy Lifestyle Stop Smoking Service in line with the patient journey pathway identified in appendix A2.
Population Needs. 1.1 National/local context and evidence base Primary central nervous system (CNS) tumours are uncommon. The most numerous involve the brain and account for only 1.5% of cancers in England. The variety of pathological primary tumour types is large. However, metastases to CNS from other sites are also common. CNS tumours include all tumours inside the cranium or in the central spinal canal. They arise due to abnormal and uncontrolled cell division, either in the CNS itself, in the cranial nerves, in the meninges, skull, pituitary pineal gland, or spread from cancers primarily located in other organs (metastatic tumours). Any CNS tumour can be inherently serious and life-threatening because of its expansive character in the limited space of the intracranial cavity and spinal canal. Brain tumours or intracranial neoplasms can be malignant or benign; however the definitions of malignant or benign neoplasms differ from those commonly used for other types of cancerous or non-cancerous neoplasms in the body. The danger level depends on the combination of factors like the type of tumour, its location, its size and its growth rate. Because the brain is well protected by the skull, the early detection of a brain tumour only occurs when diagnostic tools are directed at the intracranial cavity. Primary (true) CNS tumours are commonly located in the posterior cranial fossa in children and in the cerebral hemispheres in adults, although they can affect any part of the brain in either group. The following four important characteristics of tumours in the CNS determine why the terms ‘malignant tumour’ (often equated with ‘cancer’) and ‘benign tumour’ lack validity when applied to this clinical setting. • The cranium, which surrounds the brain, is a rigid box, so that even a small, slowly growing tumour can cause severe symptoms and detrimental (even fatal) effects when it results in raised intracranial pressure. • Slowly growing tumours in the brain can infiltrate extensively into adjacent normal tissue, which makes excision impossible. • Retaining the vital functions of the brain, in which these tumours arise, poses a particular challenge during surgical excision. • A slowly growing tumour may undergo progression and transformation to an aggressive tumour. Therefore the tumours are graded I-IV by World Health Organisation (WHO), Grade I tumours being very slow growing and Grade IV tumours generally very rapidly proliferating. The grade of the tumour may increase over time....
Population Needs. 1.1. The purpose of this Service Specification is to describe the Provider’s responsibilities for the delivery of the NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) (the Services). This Service Specification provides a consistent and equitable approach across England and this common national service specification must be used to govern the provision and monitoring of abdominal aortic aneurysm screening services.
