Article Text
PDF
Abstract
Objectives To (1) explore the clustering of community pharmacies in England and (2) determine the relationship between community pharmacy clustering, urbanity and deprivation.
Design An area-level analysis spatial study.
Setting England.
Primary and secondary outcome measures Community pharmacy clustering determined as a community pharmacy located within 10 min walking distance to another community pharmacy.
Participants Addresses and postal codes of each community pharmacy in England were used in the analysis. Each pharmacy postal code was assigned to a lower layer super output area, which was then matched to urbanity (urban, town and fringe or village, hamlet and isolated dwellings) and deprivation decile (using the Index of Multiple Deprivation score).
Results 75% of community pharmacies in England were located in a ‘cluster’ (within 10 min walking distance of another pharmacy): 19% of community pharmacies were in a cluster of two, while 56% of community pharmacies were in clusters of three or more. There was a linear relationship between community pharmacy clustering and social deprivation—with clustering more prevalent in areas of higher deprivation: for community pharmacies located in areas of lowest deprivation (decile 1), there was a significantly lower risk of clustering compared with community pharmacies located in areas of highest deprivation (relative risk 0.12 (95% CI 0.10 to 0.16)).
Conclusions Clustering of community pharmacies in England is common, although there is a positive trend between community pharmacy clustering and social deprivation, whereby clustering is more significant in areas of high deprivation. Arrangements for future community pharmacy funding should not solely focus on distance from one pharmacy to another as means of determining funding allocation, as this could penalise community pharmacies in our most deprived communities, and potentially have a negative effect on other healthcare providers, such as general practitioner and accident and emergency services.
- public health
- health policy
- primary care
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors CB and AT designed the study, led on data interpretation and supervised all stages of the research. KT led on the GIS modelling and AK conducted statistical analysis. AT led the drafting of the manuscript with input from CB, KT and AK. AT is guarantor of the work.
Funding CB is a member of Fuse (funding reference MR/K02325X/1). Funding for Fuse comes from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, and is gratefully acknowledged (RF150334)
Disclaimer The views expressed in this paper do not necessarily represent those of the funders or UKCRC.
Competing interests None declared.
Patient consent Not required.
Ethics approval Ethical approval was not required for this work as this study used non-patient identifiable secondary data; patients were not actively involved in this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All of our raw data are available through the open access Geo-healthcare database: http://collections.durham.ac.uk/files/fq977t77k#.WJSlsRicZBw
Correction notice The funding statement has been updated since publication and this article has changed to CC BY license
Open data All data have been made publicly available and can be accessed at http://collections.durham.ac.uk/files/fq977t77k#.WJSlsRicZBw