Located in the north-east corner of Scotland, NHS Grampian has a mixed urban and rural population of 526,000 people, approximately 10% of the population of Scotland. It has only two major hospitals, in Aberdeen and in Elgin, yet it has 14 community hospitals.
Following the introduction of a new NHS community pharmacy contract for Scotland, NHS health boards have a duty to secure the provision of pharmaceutical care services (PCS) in their respective areas. This presents a number of challenges for NHS Grampian – it has to secure the delivery of pharmaceutical services across a wide geographic area, whilst addressing the needs of a population living in remote, rural areas as well as urban areas; and it has to ensure the adequate provision of special services such as the supply of bottled oxygen.
NHS Grampian has developed an evidence-based planning toolkit in which a geographical information system (GIS) is a key component. As a member of the One Scotland Mapping Agreement (OSMA), NHS Grampian has access to detailed geographic information (GI) from Ordnance Survey.
When patient statistics are combined with OSMA data NHS Grampian gains a greater understanding of the needs and the location of patients. For example, Code-Point® is used to mesh with patient postcodes already in the system in order to highlight the geographic spread of service need and identify any gaps in service provision, particularly in rural areas.
GI has also been used in this way to focus specifically on patient care, for example, to highlight where oxygen-dependent patients live in relation to the nearest pharmacy providing this special service.
On average, there are two to three requests a week for information from the geographical analysis team and GI is used throughout the organisation. OS Street View® is often used as the detailed background when the in-house team prepares maps of residential areas to present at decision-making meetings. Boundary-Line™ is used specifically for ward level detail that relates to national statistics and census data.
In addition, Ordnance Survey data, combined with other statistical information, has enabled NHS Grampian to analyse whether patients in acute hospitals could have been treated by a GP or in a smaller local hospital rather than in an acute hospital.
GI has enabled the easy identification of under- and over-provision of services, patient travel times and clusters of illness.
Delivery distance to patients in need of bottled oxygen has been minimised through analysis of their location in relation to the pharmacies designated to provide this service.
Use of acute hospitals is being optimised following an analysis of intermediate care, which revealed that on one ‘snapshot’ occasion, 434 valuable bed spaces were taken up in acute hospitals by patients whose condition could have been treated locally.
The risk of service disruption is being minimised and NHS Grampian can demonstrate that it is meeting the terms of the NHS Community Pharmacy Contract as required by the Scottish Government.