A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England

Objectives: This study aims to provide a national picture of the extent and nature of public health services commissioned by Local Authorities (LAs) from community pharmacies across England in financial year 2014/15. Design: Cross-sectional survey of public health services commissioned in community pharmacies by LAs, gathered via Freedom of Information requests and documentary analysis. Setting and Participants: All 152 Local Authorities in England. Results: A total of 833 commissioned services were reported across England (range 3-10 per LA). Four services were commissioned by over 90% of LAs: emergency hormonal contraception (EHC), smoking cessation support, supervised consumption of methadone or other opiates, and needle and syringe programmes (NSPs). The proportion of pharmacies commissioned to deliver these services varied considerably between LAs from <10% to 100%. This variation was not related to differences in relevant proxy measures of need. NHS Health Checks and alcohol screening and brief advice were commissioned by fewer LAs (32% and 15% respectively), again with no relationship to relevant measures of need. A range of other services were commissioned less frequently, by fewer than 10% of LAs. Supervised consumption and NSPs were the most frequently used services, with over 4.4 million individual supervisions and over 1.4 million needle packs supplied. Pharmacies provided over 200,000 consultations for supply of EHC, over 30,000 supplies of free condoms and almost 16,000 chlamydia screening kits. More than 55,000 people registered to stop smoking in a community pharmacy, almost 30,000 were screened for alcohol use and over 26,000 NHS Health Checks were delivered. Conclusions: There is significant variation in commissioning and delivery of public health services in community pharmacies across England, which correlate poorly with potential benefit to local populations. Research to ascertain reasons for this variation is needed to ensure that future commissioning and delivery of these services matches local need.