the central services agency (csa) · (2.7.1) dentists - comparisons summary 38 (3) general...

2

This report has been produced by statisticians seconded from the Northern Ireland Statistics and Research Agency (NISRA) to the Information and Research Unit of Family Practitioner Services (FPS) in the Central Services Agency (CSA).

THE CENTRAL SERVICES AGENCY (CSA)

Established in 1973, the CSA was preceded by the Northern Ireland Health Services Board that had been in operation since the inception of the NHS in 1948. The CSA is an integral part of the Health and Social Services in Northern Ireland, supporting the activities of the Department of Health, Social Services and Public Safety (DHSSPS), Health and Personal Social Services (HPSS) Boards, Trusts and Agencies through provision of a wide range of regional services. Employing over 600 staff at 14 sites throughout Northern Ireland, the Central Services Agency delivers these services through a number of strategic business units:- Regional Supplies Service (RSS); Family Practitioner Services (FPS); Legal Services; Counter Fraud Unit (CFU); Research and Development Office; Equality Unit; Finance and Administration; Human Resources; NICARE.

FAMILY PRACTITIONER SERVICES (FPS)

The FPS Directorate provides a range of support functions on behalf of the Health and Social Services (HSS) Boards to General Medical Practitioners, General Dental Practitioners, Community Ophthalmic Practitioners and Chemist Contractors. The Directorate’s main functions include:

� Registration of patients and maintenance of patient lists � Maintenance of statutory lists of practitioners � Processing and payment of claim forms � Checking entitlement to exemption from statutory charges � Providing information to Boards, the professions and the DHSS&PS � Medical - Calculation of the Global Sum and making payments to GPs � Dental - Approval of treatment; monitoring of treatment patterns; examination of

patients by Dental Officers � Ophthalmic - Organisation of continuing education � Pharmaceutical - Processing and payment of prescription items; Drug/Appliance testing;

production of information to promote the monitoring of dispensing

INFORMATION AND RESEARCH UNIT

Formally set up in April 2001, the Unit plays a key role within Family Practitioner Services (FPS) providing services to a wide customer base. The Unit includes staff seconded from the Northern Ireland Statistics and Research Agency (NISRA), highly-skilled staff from within FPS and placement students. The Unit has a Service Level Agreement (SLA) with HPSS Boards which is reviewed on an annual basis to reflect changing customer needs and what can be delivered within resources. The Unit aims to provide support, information and advice to both internal and external customers in relation to the provision of General Medical, Dental, Ophthalmic and Pharmaceutical services. The Unit also provides a range of services to the Counter Fraud Unit (CFU) including information management, systems development and statistical support.

NORTHERN IRELAND STATISTICS & RESEARCH AGENCY (NISRA)

NISRA was established as an Executive Agency within the Northern Ireland Department of Finance and Personnel (DFP) on 1 April 1996. NISRA is the principal source of official information on population and socio-economic conditions in Northern Ireland. The Agency provides statistical and social research services, undertakes the Northern Ireland census of population and administers the civil registration of births, deaths and marriages.

1

Introduction

2

CONTENTS

(1) GENERAL MEDICAL SERVICES

(1.1) Introduction 7

(1.2) Summary Points 7

(1.3) General Practitioners 9

(1.3.1) GP & Patient Registration Data by Board 9 (1.3.2) GP Age/Gender Analysis by Board 11 (1.3.3) GP Age/Gender Analysis 12 (1.3.4) GP Working Patterns by Gender & Board 13 (1.3.5) GP Withdrawals 14 (1.3.6) GP Additions 14 (1.3.7) GPs by Place of Graduation 14 (1.3.8) Average Practice & GP List Sizes by Board & Trust for

Registered Patient Lists & Global Sum Weighted Lists 15

(1.4) Registrations 16

(1.4.1) Registered Patients on GP Lists by Age Group, Board & Trust 16 (1.4.2) Resident & Registered Persons by Board 17 (1.4.3) Average List Size of Practice by Number of GPs 18 (1.4.4) Most Popular Names as Registered with GPs in NI 18

(1.5) Practices 19

(1.5.1) Number of GPs in a Practice by Board 19 (1.5.2) Number of Practices by List Size & Board 20 (1.5.3) % Patients living 3 or more miles from their GP Practice by Board 21 (1.5.4) Practices by Average Registered Patient Distance to Nearest 22

A&E/MIU by Board

(1.6) Migration 23

(1.6.1) Persons in Northern Ireland Transferred From/To GPs Elsewhere 23 (1.6.2) Persons in NI Transferred From/To GPs in GB & The Isle of Man 23

(1.7) Costs 24

(1.7.1) Cost of General Medical Services 24 (1.7.2) Net Cost and Quality Preparation Payment of General 25 Medical Services

(1.8) UK Comparisons (Northern Ireland, Scotland, England and Wales) 2003 26

(1.8.1) GP Comparisons Summary 26 (1.8.2) Percentage of GPs by Age 27

3

Contents

(2) GENERAL DENTAL SERVICES



(2.3) Dentists 30

(2.3.1) Dentists by Age & Gender 30 (2.3.2) Number of Dental Practices, Sub-Contracts & Dentists by Board,

Trust & Population 31 (2.3.3) Examination of Patients by Dental Officers 32

(2.4) Registrations 32

(2.4.1) Number of Registered Patients by Age Group & Area of Residence 32 (2.4.2) Average List Size of Practice & Dentist 32 (2.4.3) Number of Treatments by Age Group & Board 33 (2.4.4) Dental Treatments per 1,000 Persons by Population & Registered 34

Patients

(2.5) Practices 35

(2.5.1) Number of Dental Practices by Number of Sub-Contracts in Each 35

(2.6) Costs 36

(2.6.1) Cost of General Dental Services Treatments 36 (2.6.2) Remissions & Repayments of Charges by Board 36 (2.6.3) Dental Payments - Cost of General Dental Services by Board 37


(2.7.1) Dentists - Comparisons Summary 38

(3) GENERAL OPHTHALMIC SERVICES



(3.3) Optometrists 40

(3.3.1) Number of Ophthalmic Medical Practitioners, Ophthalmic Opticians (Optometrists) & Dispensing Opticians 40

(3.3.2) Optometrist Practices by Board & Population 40 (3.3.3) Optometrists Attending Refresher Courses 40 (3.3.4) NHS Testing of Sight & Supply or Replacement of Optical Appliances 41 (3.3.5) Number of Ophthalmic Forms 41

(3.4) Costs 42

(3.4.1) Cost of Ophthalmic Services 42 (3.4.2) Patient Contributions & Total Cost of Ophthalmic Services 42

(3.5) UK Comparisons (Northern Ireland, Scotland, England and Wales) 2003/04 43

(3.5.1) Optometrist Comparison Summary 43

(4) PHARMACEUTICAL SERVICES



(4.3) Prescriptions 46

(4.3.1) Prescription Items Dispensed, Gross Cost & Frequency of 46 Prescriptions (4.3.2) Prescription Items Dispensed by Dispensing Doctors & Cost 47 (4.3.3) Prescription Charges 47 (4.3.4) Prescription & Pre-Payment Certificate Costs 48

(4.4) Pharmacists/Pharmacies 49

(4.4.1) Number of Pharmaceutical & Appliance Contractors & Premises by Board 49

(4.4.2) Number of Dispensing Doctors, Practices & Patients by Board 49 (4.4.3) Ratio of Pharmacies to Population by Board & Trust 50

(4.5) Costs 51

(4.5.1) Payments made to Pharmacists Dispensing Doctors & 51 Appliance Suppliers (4.5.2) Therapeutic Class BNF Chapters 52 (4.5.3) Therapeutic Class BNF Chapters 53 (4.5.4) Top 5 BNF Chapters by Total Number of Prescription Items 54 (4.5.5) Top 5 BNF Chapters by Total Ingredient Cost 54 (4.5.6) Top 5 BNF Chapters by Average Cost of Prescription 55 (4.5.7) Therapeutic Class BNF Chapters by Board 56


(4.6.1) Pharmacy Comparison Summary 57

(5) GLOSSARY, FURTHER INFORMATION & CONTACT DETAILS 59

(5.1) Glossary 59 (5.2) Useful Links 61

(5.3) Contact Details 61

Where Population figures are quoted throughout it refers to NISRA 2003 Mid-Year Estimates.

4

5

Contents

FIGURES

GENERAL MEDICAL SERVICES

Fig 1.3.1a Proportion of Patients on GP Lists by Board 10Fig 1.3.1b Proportion of GPs by Board 10Fig 1.3.1c Proportion of GP Practices by Board 10

Fig 1.3.2 GP Age/Gender Analysis 11 Fig 1.3.3 Change in GP Age Ranges 2003 To 2004 12 Fig 1.3.4 GP Gender Split 2003 & 2004 13 Fig 1.4.1 Registered Patients on GP Lists by Age Group 17 Fig 1.4.2 Persons Resident & Registered with a GP by Board 17 Fig 1.5.3 % of Practices and their % of Patients Living 3 or More

Miles from their GP Practice by Board 21 Fig 1.5.4 % of Practices Average Patient Distance (Miles) to

Nearest A&E/MIU by Board 22 Fig 1.8.1a GP Gender 26

Fig 1.8.1b Number of GPs per 100,000 Population 2003 26 Fig 1.8.1c Average Practice list Size 27 Fig 1.8.1d Average WTE GP List Size 27 Fig 1.8.2 % of GPs by Age 28

GENERAL DENTAL SERVICES

Fig 2.3.1 Dentist Age/Gender Analysis 30 Fig 2.4.3 Number of Dental Treatments by Board 33 Fig 2.5.1 % Dental Practices by Board 35 Fig 2.6.1 Net Fees (£) Payable 36 Fig 2.7.1a Dentists by Gender 38 Fig 2.7.1b Number of Dentists per 100,000 Population 38 Fig 2.7.1c Population & Registrations per Dentist 38

GENERAL OPHTHALMIC SERVICES

Fig 3.3.5 Ophthalmic Forms 41 Fig 3.5.1a Opticians by Gender 43 Fig 3.5.1b Number of Opticians per 100,000 Population 43 Fig 3.5.1c Population per Optician 43

PHARMACEUTICAL SERVICES

Fig 4.3.1 % Prescription Items Dispensed by Board 46Fig 4.3.4 Prescription Cost 48 Fig 4.5.4 Top 5 BNF Chapters by Number of Prescriptions 54 Fig 4.5.5 Top 5 BNF Chapters by Total Ingredient Cost 54 Fig 4.5.6 Top 5 BNF Chapters by Average Cost of Prescription 55 Fig 4.6.1a Population per Pharmacy 57 Fig 4.6.1b Pharmacies per 100,000 Population 57 Fig 4.6.1c Number of Prescriptions per Head of Population 58 Fig 4.6.1d Ingredient Cost per Prescription Item 58

7

(1) GENERAL MEDICAL SERVICES

(1.1) INTRODUCTION

FPS Medical Services are responsible for the payment of General Practitioners (GPs), the maintenance of the statutory Performers List and the maintenance of the index of patients registered with GP practices. A wide range of information is also provided to Health and Social Services Boards, the professions and the Department of Health, Social Services and Public Safety.

NB: GP refers to Unrestricted Principals or Equivalents (UPEs).

(1.2) SUMMARY POINTS

GENERAL PRACTITIONERS

� Between 1994 and 2004 the total number of GPs increased by 9% from 985 to 1,078 respectively.

� In 2004 there were 63 GPs per 100,000 resident population.

� In 2004, just over a third (35%) of GPs were female, compared with just over a quarter (26%) in 1994.

� 58% of GPs in 2004 were aged between 40 and 54. In the under 35-age range, 57% of GPs were female while in the over 55 range 17% were female.

� In 2004, 80% of GPs working in Northern Ireland also gained their Primary Medical Qualification there.

� In 2004, 18% of GPs worked part-time, over three quarters (79%) of them were female.

REGISTRATIONS

� In 2004, Northern Ireland had 1,792,239 GP-registered patients.

� The Board with the largest share of registered patients was the Eastern Board (40%), followed by the Northern Board (24%), the Southern Board (19%) and the Western Board (17%). These figures reflect the population structure of NI.

PRACTICES

� There was virtually no change (0.1%) in the average practice list size from 2003 (4,902) to 2004 (4,897).

� In 2004, half of the practices had either 2 or 3 GPs, 30% had 4 or more GPs and 20% were single-handed GP Practices.

� In 2004, almost 14% of practices had at least half of their patients living 3 or more miles away.

� Patients in 40% of practices had, on average, less than 3 miles to travel to their nearest Accident & Emergency or Minor Injuries Unit, whereas, patients in 5% of practices had, on average, at least 15 miles to travel to their nearest A&E/MIU.)

� In 2004, one third of practices were located within the 20% of the most deprived wards in NI. This included 43% of practices in the Eastern Board.

� Just over one fifth (21%) of practices were located in the 20% of the least deprived wards.

MIGRATION FLOW

� 19,647 patients transferred from outside NI to GPs in NI in 2003/04, 6.5% (1,207) more than those who transferred out of NI.

7

Medical Services

� From 2002/03 to 2003/04 there was a 2% increase in patients who transferred in and a 3.6% increase in patients who transferred out of NI.

� Of those patients who transferred into NI in 2003/04, 60% were from GB & Isle of Man, 37% were from abroad and the remainder were HM Forces.

� Of those patients who transferred out of NI in 2003/04, 73% were to GB & Isle of Man, 22% were to abroad and the remainder were HM Forces.

� 7,298 patients were transferred to GPs in NI from abroad in 2003/04. This was 3,173 (77%) more than those transferred out of NI.

� 13,535 patients were transferred from GPs in NI to GB & Isle of Man in 2003/04. This was 1,622 (13%) more than those transferred into NI.

COSTS

� The cost of General Medical Services in Northern Ireland in 2004 was £96.9m.

� There was also an additional Quality Preparation Payment in 2004 of £3.4m paid to GP practices to help them prepare for the new GMS Contract.

UK COMPARISONS

� In 2003, the average gender split of GPs throughout the UK was 64% male and 36% female. Scotland had the highest percentage of female GPs (39%) followed by England (36%), Northern Ireland (34%) and Wales (31%).

� Scotland had the highest number of GPs per 100,000 population in the UK in 2003 at 75, followed by Northern Ireland (63), Wales (61) and England (57).

� In 2003, Northern Ireland had the lowest average practice size in the UK at 4,902 patients per practice, followed by Scotland (5,111) and Wales (5,914) with England having the highest average at 5,968 patients per practice.

�

8

In 2003, England had the highest average WTE GP list size of 1,908, followed by Wales (1,841), Northern Ireland (1,792) and Scotland (1,508)

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Medical Services

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Fig 1.3.1a: % Registered Patients on GP Lists by Board(October 2004)

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Fig 1.3.1b: Proportion of GPs by Board(October 2004)

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Fig 1.3.1c: Proportion of GP Practices by Board(October 2004)

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10

(1.3.2) GP AGE/GENDER ANALYSIS BY BOARD: October 2004

* % may not total to 100 due to rounding

EASTERN NORTHERN SOUTHERN WESTERN NI TOTAL GP AGEGROUP M F M F M F M F M F No. Col.%

All Ages 269 160 170 88 125 76 133 57 697 381 1,078 *100

% withinArea 63 37 66 34 62 38 70 30 65 35

Under 30 1 3 0 1 0 0 0 0 1 4 5 0

30-34 14 18 12 15 4 10 9 6 39 49 88 8

35-39 39 23 25 23 15 23 15 14 94 83 177 16

40-44 42 38 23 20 19 20 32 10 116 88 204 19

45-49 63 25 25 17 34 14 26 14 148 70 218 20

50-54 48 35 34 6 28 6 36 9 146 56 202 19

55-59 47 13 40 5 16 2 9 2 112 22 134 12

60-64 10 4 9 1 7 1 5 2 31 8 39 4

65 and over 5 1 2 0 2 0 1 0 10 1 11 1

Fig 1.3.2: GP Age/Gender Analysis (October 2004)

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11

Medical Services

(1.3.3) GP AGE/GENDER ANALYSIS: 2003 & 20041

1Data from November 2003 and October 2004.

MALE FEMALE TOTAL GP AGE GROUP

2003 2004 2003 2004 2003 2004

Under 30 4 1 2 4 6 5 30-34 41 39 57 49 98 88 35-39 95 94 79 83 174 177 40-44 129 116 83 88 212 204 45-49 155 148 69 70 224 218 50-54 143 146 54 56 197 202 55-59 97 112 14 22 111 134 60-64 31 31 8 8 39 39 65 and over 11 10 1 1 12 11 Unknown 1 0 2 0 3 0

Total Number of GPs 707 697 369 381 1,076 1,078

Row % 66 65 34 35 100 100

BOARD EASTERN 274 269 155 160 429 429 NORTHERN 172 170 82 88 254 258 SOUTHERN 126 125 77 76 203 201 WESTERN 135 133 55 57 190 190

Fig 1.3.3: Change in GP Age Ranges 2003 to 2004

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12

(1.3.4) GP WORKING PATTERNS BY GENDER AND BOARD: November 2003

* % may not total 100 due to rounding

1/2 TIME 3/4 TIME FULL

TIME

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SHARE TOTAL

BOARD

M F M F M F M F M F WTE

EASTERN 12 24 7 41 250 88 5 2 274 155 396

NORTHERN 7 13 7 16 156 52 2 1 172 82 237.25

SOUTHERN 3 15 3 17 119 42 1 3 126 77 187

WESTERN 1 18 2 10 131 24 1 3 135 55 175.5

Totals 23 70 19 84 656 206 9 9 707 369 686.25 309.5

Total (M&F) 93 103 862 18 1,076 995.75

Row % 9 10 80 2 *100

Fig 1.3.4: GP Gender Split (2003 & 2004)

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13

Medical Services

(1.3.5) GP WITHDRAWALS: October 2003 – September 2004

BOARD RESIGNED RETIRED DECEASED TOTAL

NI 23 18 1 42

EASTERN 10 4 1 15

NORTHERN 4 8 0 12

SOUTHERN 8 1 0 9

WESTERN 1 5 0 6

(1.3.6) GP ADDITIONS: October 2003 – September 2004

BOARD MALE FEMALE TOTAL

NI 20 25 45

EASTERN 6 10 16

NORTHERN 5 10 15

SOUTHERN 4 3 7

WESTERN 5 2 7

(1.3.7) GPs BY PLACE OF GRADUATION

TOTAL PLACE OF GRADUATION NUMBER OF

MALES NUMBER OF

FEMALES Number %

All Places of Graduation 696 382 1,078 *100

NI 556 305 861 80

Rest of British Isles 134 69 203 19

Elsewhere 3 1 4 0.40

Unknown 3 7 10 0.90

* % may not total 100 due to rounding.

14

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N

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Row

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Row

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N

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Row

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N

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Row

%

N

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Row %

TO

TA

L

PE

RSO

NS

RE

GIS

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RE

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NI

104,94

55.927

7,64

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.576

8,67

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9

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5,35

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0

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9,06

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62,134

34,990

11,164

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8

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th &

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11

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32,489

92,237

43,174

14,639

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9

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57,572

39,065

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8,28

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10

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27,248

93,410

46,400

16,670

12,098

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7

NO

RT

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RN

24

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5.9

64,687

15.3

176,54

141

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422,49

4

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015

,983

43,484

24,547

8,41

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0

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18,982

48,704

133,05

773

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23,718

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TH

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N

21,979

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ry &

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STE

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51,480

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d 7,65

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29,268

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65,60

11,87

212

8,00

7

16

(1.4.2) RESIDENT & REGISTERED PERSONS BY BOARD: October 2004

BOARD RESIDENT IN REGISTERED WITH A GP IN

NI 1,771,583 1,792,239

EASTERN 691,699 714,420

NORTHERN 407,804 422,494

SOUTHERN 373,961 346,652

WESTERN 298,119 308,673

NB: Resident In < Registered In due to missing/incorrect postcodes, therefore unable to match persons to a Board of residence.

Fig 1.4.2: Persons Resident & Registered with a GP byBoard

0

200,000

400,000

600,000

800,000

EASTERN NORTHERN SOUTHERN WESTERN

No.

of P

erso

ns

Resident In Registered with a GP in

Fig 1.4.1: Registered Patients on GP Lists by Age Group(October 2004)

0

200

400

600

800

1000

0-4 5-15 16-44 45-64 65-74 75-84 85+

Age Group

No.

of P

atie

nts

('00

0)

17

Medical Services

(1.4.3) AVERAGE LIST SIZE OF PRACTICE BY NUMBER OF GPs: October 2004

NUMBER OF GPS IN PRATICE BOARD AVERAGE

LIST SIZE 1 2 3 4 5+

NI 4,897 2,025 3,289 4,956 6,873 8,967

EASTERN 4,827 1,914 3,299 4,892 7,022 8,960

NORTHERN 5,090 1,900 3,254 5,026 6,866 9,229

SOUTHERN 4,561 2,402 3,374 5,086 6,791 8,394

WESTERN 5,232 1,910 3,136 4,739 6,581 9,036

(1.4.4) MOST POPULAR NAMES AS REGISTERED WITH GPs IN NI: October 2004

SURNAME MALE FORENAMES FEMALE FORENAMES RANK Name Number Name Number Name Number

1 Kelly 17,386 John 72,691 Mary 74,4292 Campbell 16,978 William 62,093 Margaret 55,5743 Wilson 16,729 James 57,685 Elizabeth 37,1624 Johnston 15,627 Robert 42,152 Sarah 29,2165 O'Neill 14,417 David 39,483 Kathleen 19,1296 Brown 13,652 Thomas 38,104 Catherine 18,1507 Moore 13,620 Patrick 31,313 Annie 14,7518 Thompson 13,570 Michael 31,125 Patricia 12,5139 Doherty 13,140 Paul 22,533 Emma 11,339

10 Smyth 13,106 Samuel 21,006 Anne 10,644

18

(1.5) PRACTICES

(1.5.1) NUMBER OF GPs IN A PRACTICE BY BOARD: 2003 & 20041

NUMBER OF GPS 1 2 3 4 5+ TOTAL

PRACTICES

2003

EASTERN 31 39 32 22 24 148

NORTHERN 8 24 26 8 15 81

SOUTHERN 13 28 18 8 9 76

WESTERN 15 9 11 8 16 59

Total 67 100 87 46 64 364

Row % 18 27 24 13 18 *100

2004

EASTERN 31 40 31 21 25 148

NORTHERN 12 20 29 6 16 83

SOUTHERN 17 23 18 9 9 76

WESTERN 13 11 11 8 16 59

Total 73 94 89 44 66 366

Row % 20 26 24 12 18 *100 1 Data from November 2003 and October 2004. * % may not total 100 due to rounding.

19

Medical Services

(1.5

.2)

NU

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ER

OF

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31

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16

% o

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20

(1.5.3) PERCENTAGE OF PATIENTS LIVING 3 OR MORE MILES FROM THEIR GP PRACTICE BY BOARD: October 2004

EASTERN NORTHERN SOUTHERN WESTERN NI % OF REGISTERED

PATIENTS No. Col % No. *Col % No. Col % No. Col % No. *Col %

<10% 21 14 2 2 1 1 9 15 33 910-19% 57 39 29 35 17 22 4 7 107 2920-29% 36 24 18 22 25 33 11 19 90 2530-39% 16 11 17 20 10 13 13 22 56 1540-49% 10 7 7 8 8 11 5 8 30 850-59% 6 4 9 11 6 8 10 17 31 860-69% 2 1 0 0 8 11 6 10 16 470-79% 0 0 1 1 1 1 1 2 3 1Total 148 83 76 59 366

* % may not total 100 due to rounding

Fig 1.5.3: % of Practices with % of Patients living 3 ormore miles from their GP Practice

0%

10%

20%

30%

40%

<10% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69% 70-79%

% of Patients living 3 or more miles from Practice

% o

f Pra

ctic

es


21

Medical Services

(1.5.4) PRACTICES BY AVERAGE REGISTERED PATIENT DISTANCE (MILES) TO

NEAREST ACCIDENT & EMERGENCY OR MINOR INJURIES UNIT BY

BOARD: October 2004

EASTERN NORTHERN SOUTHERN WESTERN NI

MILES No. *Col % No. *Col % No. Col % No. Col % No. Col %

< 3 110 74 19 23 12 16 5 8 146 403-5.99 22 15 15 18 27 36 20 34 84 236-8.99 5 3 11 13 17 22 5 8 38 109-11.99 8 5 24 29 10 13 11 19 53 1412-14.99 3 2 6 7 6 8 13 22 28 815-17.99 0 0 7 8 3 4 4 7 14 418+ 0 0 1 1 1 1 1 2 3 1Total 148 83 76 59 366


(EG: In the Eastern Board 110 practices have an average patient distance of less than 3 miles to the nearest A&E or MIU)

Fig 1.5.4: % of Practices with Average Registered Patient

Distance (Miles) to Nearest A&E / MIU by Board

0%

20%

40%

60%

80%

< 3 3-5.99 6-8.99 9-11.99 12-14.99 15-17.99 18+

Distance (Miles)

% o

f Pra

ctic

es


22

(1.6) MIGRATION

(1.6.1) PERSONS IN NORTHERN IRELAND TRANSFERRED FROM/TO GPs ELSEWHERE

GREAT BRITAIN &

ISLE OF MAN

ABROAD & EIRE

HM FORCES

DEPENDANTSOF HM

FORCES TOTAL

PERIOD From To From To From To From To From

(into NI) To

(out of NI)

1st Quarter (Apr-Jun 02) 3,178 2,962 1,122 920 42 254 116 149 4,458 4,285

2nd Quarter (Jul-Sep 02) 3,250 3,147 2,035 1,146 51 42 72 172 5,408 4,507

3rd Quarter (Oct-Dec 02) 2,736 4,235 1,921 956 46 50 79 93 4,782 5,334

4th Quarter (Jan-Mar 03) 2,546 2,639 1,972 836 54 55 44 132 4,616 3,662

Total Year (2002/03) 11,710 12,983 7,050 3,858 193 401 311 546 19,264 17,788

1st Quarter (Apr-Jun 03) 2,355 2,381 1,409 869 42 46 116 122 3,922 3,418

2nd Quarter (Jul-Sep 03) 3,312 2,658 1,516 1,341 43 20 45 152 4,916 4,171

3rd Quarter (Oct-Dec 03) 2,893 4,318 2,333 1,042 26 57 64 107 5,316 5,524

4th Quarter (Jan-Mar 04) 3,353 4,178 2,040 873 45 69 55 207 5,493 5,327

Total Year (2003/04) 11,913 13,535 7,298 4,125 156 192 280 588 19,647 18,440

(1.6.2) PERSONS IN NORTHERN IRELAND TRANSFERRED FROM/TO GPs IN GREAT BRITAIN & THE ISLE OF MAN

ENGLAND SCOTLAND WALES ISLE OF MAN

TOTAL (GREAT BRITAIN &

ISLE OF MAN) PERIODFrom To From To From To From To

From (into NI)

To (out of NI)

1st Quarter (Apr-Jun 02) 2,364 2,095 686 723 93 75 35 69 3,178 2,962

2nd Quarter (Jul-Sep 02) 2,516 2,443 612 554 96 117 26 33 3,250 3,147

3rd Quarter (Oct-Dec 02) 2,113 2,661 504 1,415 81 121 38 38 2,736 4,235

4th Quarter (Jan-Mar 03) 1,917 1,919 514 607 77 86 38 27 2,546 2,639

Total Year (2002/03) 8,910 9,118 2,316 3,299 347 399 137 167 11,710 12,983

1st Quarter (Apr-Jun 03) 1,793 1,807 481 477 65 67 16 30 2,355 2,381

2nd Quarter (Jul-Sep 03) 2,490 2,098 683 406 100 108 39 46 3,312 2,658

3rd Quarter (Oct-Dec 03) 2,206 2,968 561 1,223 89 94 37 33 2,893 4,318

4th Quarter (Jan-Mar 04) 2,545 3,507 658 514 109 124 41 33 3,353 4,178

Total Year (2003/04) 9,034 10,380 2,383 2,620 363 393 133 142 11,913 13,535

23

Medical Services

(1.7) COSTS

(1.7.1) COST OF GENERAL MEDICAL SERVICES: Payments made by the CSA in 2003/04

£ '000 Basic Practice Allowance 9,604 Initial Practice Allowance 31 Standard Capitation Fees (Under 65) 31,066 Standard Capitation Fees (Over 65) 3,378 Standard Capitation Fees (Over 75) 5,361 Registration Fee 545 Child Health Surveillance 1,437 Deprivation Payment 3,134 Assistants' Allowances 28 Fees for Visits / Night Consultations 3,771 Night Consultation Allowance 387 Childhood Immunisations (Target payments) 4,588 Other Vaccination and Immunisation Fee 2,341 Cervical Cytology Tests (Target payments) 2,276 Contraceptive Services 2,708 Health Promotion 3,666 Temporary Residents 399 Emergency Fees 129 Superannuation Contributions 4,509 Single Handed Locum Allowance 8 Practice Viability Scheme 48 Dental Haemorrhage Fees 0 Minor Surgery Procedure 1,442 Rural Practitioners' Fund 1,993 Infectious Diseases Notifications 19 Medical Maternity Services 4,279 Seniority Payments 4,708 Associates Allowance 163 Postgraduate Education Allowance 3,082 Doctors Retainer Scheme 423 Sickness & Confinement Payments 698 Extended Study Leave 43 Leave Payment (Recoverable) 979 Sterile Needles and Syringes (issues) 40 QUB - Undergraduate Medical Students 169 Sustained Quality Scheme 748 Delayed Retirement Scheme Payment 208 Leave Payment (Recovered) -990Amount Recovered from NICPMDE -169 Stock Order Abatement -394 Practice # 38 Net Cost of Service 96,894 Quality Preparation Payment 3,357

24

(1.7.2) NET COST AND QUALITY PREPARATION PAYMENT OF GENERAL MEDICAL SERVICES: 2003/04

BOARD NET COST (£ '000)

QUALITY PREPARATION PAYMENT

(£ '000)1

EASTERN 38,515 1,345

NORTHERN 22,683 789

SOUTHERN 18,401 645

WESTERN 17,295 578

NI 96,894 3,357 1 See glossary

25

Medical Services

(1.8) NI COMPARISON WITH THE REST OF THE UK: 2003

(1.8.1) GP COMPARISONS OCTOBER 2003 SUMMARY

NI SCOTLAND ENGLAND WALES UK TOTAL

Male GPs 707 2,300 18,424 1,233 22,664

Female GPs 369 1,501 10,144 550 12,564

Total GPs 1,076 3,801 28,568 1,783 35,228

% Male GPs 66 61 64 69 64

% Female GPs 34 39 36 31 36

GPs/100,000 Population 63 75 57 61 59

Average Practice List size 4,902 5,111 5,968 5,914 5,846

Average GP (WTE) List

Size 1,792

Fig 1.8.1b: Number of GPs per 100,000

Population: UK

63

75

57 61

0

20

40

60

80

Northern Ireland Scotland England Wales

No

. o

f G

Ps

Fig 1.8.1a: GP Gender: UK

66 61 64 69

34 39 36 31

0

20

40

60

80

100

NorthernIreland

Scotland England Wales

% o

f GP

s

Male Female

26

1,508 1,908 1,814 1,860

(1.8.2) PERCENTAGE OF GPs BY AGE


*GP AGE (%) COUNTRY

Under 30 30-44 45-59 60 & Over

NI 1 44 51 5

SCOTLAND 2 48 47 3

ENGLAND 1 44 48 7

WALES 1 45 48 7

Fig 1.8.2: Percentage of GPs by Age

0

10

20

30

40

50

60

Under 30 30-44 45-59 60 & Over

% o

f GP

s


Fig 1.8.1c: Average Practice List Size: UK

4,902 5,111

5,968 5,914

0

2000

4000

6000

8000


Ave

rage

Lis

t Siz

e

Fig 1.8.1d: Average WTE GP List Size: UK

1,792

1,481

1,845 1,829

0

500

1000

1500

2000

NorthernIreland

Scot land England W ales

Lis

t S

ize

27

Medical Services

29

Dental Services

(2) GENERAL DENTAL SERVICES

(2.1) INTRODUCTION

FPS Dental Services are responsible for the monthly payments to General Dental Practitioners (dentists) for Health Service treatment provided, the maintenance of the list of patients registered with dentists, examination of patients at centres throughout NI and maintenance of the statutory Dental List. It carries out its functions in accordance with the General Dental Services Regulations (NI) 1993 (copies available from HMSO).


DENTISTS

� In a decade, the total number of dentists increased by 29% from 569 in 1994 to 734 in 2004.

� In NI there were 43 dentists per 100,000 resident population in 2004.

� 60% of dentists in 2004 were aged under 40, 32% aged between 40 and 54 and 8% aged 55+.

� In 2004, 42% of dentists were female.

REGISTRATIONS

� In 2004, the average practice list size was 2,513 registered patients while the average list size of a dentist was 1,239.

� In 2004, almost a third (30%) of registered dental patients were children under the age of 18, 60% were aged between 18 and 64 and the remainder (10%) were over 65 years old.

PRACTICES

� In 2004, Northern Ireland had 362 Dental practices.

� The majority of practices were within the Eastern Board (44%), followed by the Northern Board (23%), the Western Board (17%) and the Southern Board (16%).

� In 2004, 61% of practices had 1 or 2 dentists, 35% had 3 to 5 dentists and the remainder had 6 or more dentists.

COSTS

� In 2003/04, the cost of Dental Treatments was £52.3m, almost a third (32%) of which was borne by the patient.

� In 2003/04, 40% of the cost of dental treatment was attributed to the Eastern Board, 23% to the Northern, 19% to the Western and 18% to the Southern Board.

� The gross cost of Dental Payments in 2003/04 was £66.9m, 15% of which was for Capitation, 7% for Continuing Care and 78% for Treatments.

� The net cost of Dental Payments in 2003/04 was £50.2m.

UK COMPARISONS

� In 2003, NI had the highest number of Dentists per 100,000 population (41) followed by Scotland (37), Wales (34) and England (33).

� Northern Ireland also had the highest percentage of Female dentists in the UK (42%) in 2003, followed by Scotland (36%), England (32%) and Wales (30%).

30

(2.3) DENTISTS

(2.3.1) DENTISTS BY AGE & GENDER: November 2004

DENTISTS TOTAL AGE GROUP

Male Female Number Col %

All Ages 427 307 734 *100

Row % 58 42

Under 30 49 97 146 2030-34 67 76 143 1935-39 88 64 152 2140-44 84 37 121 1645-49 56 23 79 1150-54 30 7 37 555-59 35 3 38 560-64 16 0 16 265 and over 2 0 2 0.3


Fig 2.3.1: Dentist Age/Gender Analysis (Nov 2004)

0

40

80

120

Under

3030

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65+

Age Groups

No.

of D

enti

sts

Male Female

31

(2.3.2) NUMBER OF DENTAL PRACTICES, SUB-CONTRACTS & DENTISTS BY BOARD,

TRUST & POPULATION: November 2004

BOARD / TRUST

NUMBER OF

DENTAL

PRACTICES

NUMBER OF

DENTAL

SUB-

CONTRACTS

NUMBER

OF

DENTISTS

WORKING

IN AREA

POPULATION

NUMBER OF

DENTISTS

PER 100,000

POPULATION

NI 362 872 7341 1,702,628 43

EASTERN 156 370 3362 663,911 51

Down & Lisburn 31 63 62

North & West Belfast 42 97 86

South & East Belfast 52 136 127

North Down & Ards 31 74 70

NORTHERN 84 201 1862 432,834 43

Causeway 21 53 47

Homefirst 63 148 146

SOUTHERN 59 167 1432 319,026 45

Armagh & Dungannon 19 57 52

Craigavon & Banbridge 22 54 52

Newry & Mourne 18 56 45

WESTERN 63 134 1152 286,857 40

Foyle 35 77 68

Sperrin Lakeland 28 57 49 1 This is the total Headcount for Dentists in Northern Ireland (excluding duplicates). (Total of Boards (780) – Duplicate (46) dentists working in separate Trusts in other Boards under different contracts).

2 This is the total Headcount for Dentists in the Board (excluding duplicates). (Total of Trusts (804) - Duplicate (24 (i.e. 9 in (E), 7 in (N), 6 in (S) and 2 in (W)) dentists working in separate Trusts within the same board).

(2.3.3) EXAMINATION OF PATIENTS BY DENTAL OFFICERS1: 2003/04

PRE-TREATMENTPOST-

TREATMENT

Sessions Held 172 176

Patients requested to attend for

examination 1,063 3,602

Patients attending for examination 721 1,340

% Attendance 68 37 1 See glossary

Dental Services

32

(2.4) REGISTRATIONS

(2.4.1) AVERAGE LIST SIZE OF PRACTICE & DENTIST: November 2004

NB: by location of dentist (includes some non-resident patients. eg: students)

(2.4.2) NUMBER OF REGISTERED PATIENTS BY AGE GROUP & AREA OF RESIDENCE: November 2004

AGE GROUPS OF REGISTERED DENTAL PATIENTS BOARD/TRUST

0-2 3-5 6-12 13-17 18-64 65 and over All Ages

NI 15,597 41,594 124,760 88,806 532,079 84,815 887,651

Row % 2 5 14 10 60 10 *100

EASTERN 5,896 14,678 44,237 32,500 209,967 38,589 345,867

Down & Lisburn 1,721 4,345 13,230 9,043 52,607 8,113 89,059

North & West Belfast 1,153 3,143 10,001 7,629 43,296 6,926 72,148

North Down & Ards 1,417 3,385 9,356 7,218 51,208 9,856 82,440

South & East Belfast 1,605 3,805 11,650 8,610 62,856 13,694 102,220

NORTHERN 3,972 10,997 32,467 21,967 137,632 21,775 228,810

Causeway 836 2,632 7,553 5,277 33,682 5,649 55,629

Homefirst 3,136 8,365 24,914 16,690 103,950 16,126 173,181

SOUTHERN 3,263 8,649 25,596 17,894 105,373 15,753 176,528

Armagh & Dungannon 1,080 2,982 9,134 6,409 35,815 5,480 60,900

Craigavon & Banbridge 1,213 3,127 8,914 6,323 38,848 6,275 64,700

Newry & Mourne 970 2,540 7,548 5,162 30,710 3,998 50,928

WESTERN 2,374 7,054 21,389 15,437 73,606 7,865 127,725

Foyle 1,140 3,807 11,870 9,147 48,630 4,727 79,321

Sperrin Lakeland 1,234 3,247 9,519 6,290 24,976 3,138 48,404

UNKNOWN 92 216 1,071 1,008 5,501 833 8,721 * % may not total 100 due to rounding.

BOARD AVERAGE DENTAL PRACTICE LIST SIZE

AVERAGE DENTIST LIST SIZE

NI 2,513 1,239EASTERN 2,365 1,098NORTHERN 2,707 1,223SOUTHERN 3,066 1,265WESTERN 2,100 1,151

33

(2.4.3) NUMBER OF TREATMENTS (FILLINGS, CROWNS & EXTRACTIONS) BY AGE

GROUP & BOARD: 2003/04

AGE GROUPS

TREATMENT BOARD 0-2 3-5 6-12 13-17 18-64

65 and

over All Ages

FILLINGS

NI 9 161 50,573 115,127 722,945 89,098 977,913

EASTERN 2 68 18,800 42,637 283,253 42,239 386,999

NORTHERN 7 34 12,877 29,430 196,135 24,917 263,400

SOUTHERN 0 18 9,664 21,495 136,177 13,997 181,351

WESTERN 0 41 9,232 21,565 107,380 7,945 146,163

CROWNS

NI 0 2 92 1,771 77,396 9,038 88,299

EASTERN 0 0 38 790 31,336 4,378 36,542

NORTHERN 0 2 15 418 21,136 2,442 24,013

SOUTHERN 0 0 12 257 13,343 1,388 15,000

WESTERN 0 0 27 306 11,581 830 12,744

EXTRACTIONS

NI 16 1,672 26,679 22,032 106,959 22,777 180,135

EASTERN 10 532 9,736 8,906 43,627 10,179 72,990

NORTHERN 2 507 7,420 5,685 26,568 5,800 45,982

SOUTHERN 1 306 4,794 3,607 19,172 4,305 32,185

WESTERN 3 327 4,729 3,834 17,592 2,493 28,978

Fig 2.4.3: Number of Dental Treatments by Board

0

100,000

200,000

300,000

400,000

500,000

Fillings Crowns Extractions

No

. o

f T

ra

etm

en

ts


Dental Services

34

(2.4.4) DENTAL TREATMENTS PER 1,000 PERSONS BY POPULATION & REGISTERED PATIENTS: 2003/04

CHILDREN (0 - 17)

ADULTS (18 AND OVER) TREATMENT BOARD

Population Registered Patients Population Registered

Patients FILLINGS

NI 375 613 644 1,316EASTERN 379 613 649 1,267NORTHERN 383 638 686 1,456SOUTHERN 353 550 651 1,211WESTERN 380 651 561 1,370

CROWNS NI 4 7 69 140EASTERN 5 8 71 139NORTHERN 4 7 73 155SOUTHERN 3 5 64 119WESTERN 4 7 60 147

EXTRACTIONS NI 114 186 103 210EASTERN 118 191 107 209NORTHERN 123 205 100 213SOUTHERN 99 154 102 189WESTERN 109 188 98 239

NB: 61% of children and 49% of Adults were registered with a dentist.

35

(2.5) PRACTICES

(2.5.1) NUMBER OF DENTAL PRACTICES BY NUMBER OF SUB- CONTRACTS IN EACH: November 2004

NUMBER OF PRACTICES BY NUMBER OF SUB-CONTRACTS1 DENTAL PRACTICES

BOARD 1 2 3 4 5 6 7 8 Number

Number of Sub-

Contracts

NI 108 114 75 33 20 7 3 2 362 872

EASTERN 49 46 38 9 9 2 2 1 156 370

NORTHERN 21 31 17 12 1 1 0 1 84 201

SOUTHERN 14 15 12 7 8 2 1 0 59 167

WESTERN 24 22 8 5 2 2 0 0 63 134 1 This shows that in Northern Ireland there were 108 single handed dental practices, 114 practices with 2

dentists, etc…

Fig 2.5.1: % Dental Practices by Board (November 2004)

WESTERN17%

EASTERN44%

NORTHERN23%

SOUTHERN16%

Dental Services

(2.6) COSTS

(2.6.1) COST OF GENERAL DENTAL SERVICES TREATMENTS: 2003/04

BOARD COST OF

TREATMENTS (£’000)

PATIENTS’ CONTRIBUTIONS

(£’000)

% COST BOURNE BY PATIENTS

NET FEES PAYABLE

(£’000)

Total 52,322 16,627 32 35,695

EASTERN 21,762 7,299 34 14,463

NORTHERN 12,691 4,711 37 7,980

SOUTHERN 9,369 3,047 33 6,322

WESTERN 8,500 1,570 18 6,930

(2.6.2) REMISSIONS & REPAYMENTS OF CHARGES FOR GENERAL DENTAL SERVICES: 2003/04

REMISSIONS1 REPAYMENTS1

BOARD Number Cost (£) Number Cost (£)

NI 275,965 3,860,373 1,089 58,323

EASTERN 106,778 1,527,725 325 17,686

NORTHERN 58,094 807,080 303 18,652

SOUTHERN 54,906 721,144 282 13,641

WESTERN 56,187 804,424 179 8,345 1 Payable to patients who qualify in respect of charges for treatment.

SOUTHERN18%

WESTERN19%

NORTHERN23%

EASTERN40%

Fig 2.6.1: General Dental Services – Net Fees (£) Payable by Board

36

37

(2.6

.3)

DE

NT

AL

PA

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EN

TS

- T

OT

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OF

GE

NE

RA

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: 2

00

3/0

4

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NO

RT

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WE

ST

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N

NI

Nu

mb

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ss

Cost

£'0

00

Nu

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Gro

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Cost

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00

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Cost

£'0

00

Nu

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Cost

£'0

00

Nu

mb

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Cost

£'0

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Ca

pit

ati

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hil

d)

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tien

ts (

Ma

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04

) 10

7,44

93,61

570

,696

2,41

856

,607

1,94

849

,887

1,71

428

4,63

99,69

5

Pa

id T

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84,430

5,05

553

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2,62

440

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1,95

641

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2,58

822

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,224

To

tal

8,67

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23,90

44,30

221

,919

Con

tin

uin

g C

are (

Ad

ult

)

Pa

tien

ts (

Ma

rch

20

04

) 27

2,49

12,02

716

4,88

71,23

912

7,08

894

690

,439

680

654,90

54,89

3

Pa

id T

rea

tmen

ts

389,81

316

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218,37

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162,14

37,39

411

8,18

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8,52

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To

tal

18,635

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8,34

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8 (

Ma

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) 21

818

119

793

426

419

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47

18

& O

ver

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581

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694

152,25

878

6,33

719

9

To

tal

2,45

399

1,26

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787

192,52

297

7,03

124

6

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ss T

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16,348

12,263

10,894

66,910

Pa

tien

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trib

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94,71

13,04

71,57

016

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Net

To

tal

20,105

11,637

9,21

69,32

450

,283

Average G

ross

Cost

per

Ca

pit

ati

on

Trea

tmen

t 59

.87

48.81

48.09

61.86

55.38

Average G

ross

Cost

per

Co

nti

nu

ing

Ca

re T

rea

tmen

t 42

.61

45.95

45.60

49.20

44.85

Dental Services


(2.7.1) DENTISTS COMPARISONS SUMMARY


Number of Dentists 696 1,891 16,379 988 19,954

% Male Dentists 58 64 68 70 65

% Female Dentists 42 36 32 30 35

Dentists per 100,000 Population 41 37 33 34 34

Population per Dentist 2,446 2,545 2,995 3,197 2,985

Registered Patients per Dentist 1,302 1,398 1,459 1,490 1,450

1 Data from March

Fig 2.7.1c: Population & Registrations perDentist: UK

2,4462,674

3,044 2,974

1,4901,4591,3981,302

0

800

1,600

2,400

3,200

NorthernIreland


Per

sons

Population / Dentist Registrations / Dentist

Fig 2.7.1b: Number of Dentists per 100,000Population: UK

41 37 33 34

0

15

30

45

NorthernIreland


No.

of D

enti

sts

Fig 2.7.1a: Dentists by Gender: UK

58 65 69 70

42 35 31 30

0

20

40

60

80

100

NorthernIreland


% o

f Den

tist

s

Male Female

38

39

(3) OPHTHALMIC SERVICES

(3.1) INTRODUCTION

FPS Ophthalmic Services are responsible for the payment of community ophthalmic practitioners, and the maintenance of the statutory Ophthalmic List. A wide range of information is also provided to Health and Social Services Boards and the professions.


OPTOMETRISTS & PRACTICES

� In a decade, the total number of Optometrists more than doubled from 247 in 1994 to 534 in 2004.

� The Eastern Board had the highest number (16) of Ophthalmic practices per 100,000 population in 2004, followed by the Northern and Southern Boards (12) and the Western Board (11).

OPHTHALMIC SERVICES

� In a decade the number of sight tests increased by 90% from 181,839 in 1994 to 345,966 in 2004.

� The number of vouchers issued increased by almost a quarter (22%) from 138,842 in 1994 to 169,209 in 2004.

� The number of repairs/replacements increased slightly (2%) from 28,701 in 2003 to 29,163 in 2004.

� Just over a fifth (20.3%) of the total population in Northern Ireland received sight tests in 2003/04, while just under a tenth (9.9%) received vouchers and 1.7% received replacements/repairs of glasses.

COSTS

� In 2003/04 the total cost of Ophthalmic Services in Northern Ireland was £14.2m.

� Vouchers accounted for just over half of the cost (52%), followed by sight tests (42%) and repairs/replacements (5%) with the remainder being the cost of domiciliary visits.

� The percentage cost of Ophthalmic services has been increasing by over 5% year on year since 2000.

UK COMPARISONS

� In 2003/04, Northern Ireland had the highest number of optometrists (29) per 100,000 population, followed by Wales and Scotland (21), and England had the lowest (17).

� In 2003/04, Northern Ireland had the lowest population per optometrists (3,440), followed by Wales (4,671), Scotland (4,798) and England (5,984).

Ophthalmic Services

40

(3.3) OPTOMETRISTS

(3.3.1) NUMBER OF OPHTHALMIC MEDICAL PRACTITIONERS, OPHTHALMIC OPTICIANS (OPTOMETRISTS) & DISPENSING OPTICIANS: October 2004

OPHTHALMIC MEDICAL

PRACTITIONERS

OPHTHALMIC OPTICIANS

(OPTOMETRISTS)

DISPENSINGOPTICIANS

TOTAL PRACTITIONERS

October 2004 19 490 25 534

(3.3.2) OPTOMETRIST PRACTICES BY BOARD & POPULATION: October 2004

BOARD POPULATION NUMBER OF PRACTICES

NUMBER OF OPHTHALMIC

PRACTICES PER 100,000 POPULATION

NI 1,702,628 231 13.6

EASTERN 663,911 107 16.1

NORTHERN 432,834 54 12.5

SOUTHERN 319,026 39 12.2

WESTERN 286,857 31 10.8

(3.3.3) OPTOMETRISTS ATTENDING REFRESHER COURSES: 2003/04

COURSE DURATION NUMBER OF ATTENDEES

The Ageing Eye Half Day 85

Ophthalmic Dispensing Half Day 77

Paediatric Care Half Day 122

Diabetic Eye Disease Half Day 123

Managing the Red Eye 7pm-10pm 120

Paediatric Care Full Day 129

41

(3.3.4) NHS TESTING OF SIGHT AND SUPPLY OR REPLACEMENT OF OPTICAL APPLIANCES: 2003/04

SIGHT TESTS REPLACEMENT OR REPAIR OF GLASSES

SPECTACLE VOUCHERS ISSUED

BOARDNumber % of

Population Number % of Population Number % of

Population

NI 345,966 20.3 29,163 1.7 169,209 9.9

EASTERN 143,825 21.7 11,096 1.7 65,479 9.9

NORTHERN 81,823 18.9 7,185 1.7 36,556 8.4

SOUTHERN 61,916 19.4 5,739 1.8 32,785 10.3

WESTERN 58,050 20.2 5,138 1.8 34,171 11.9

PRISON 352 5 218

(3.3.5) NUMBER OF OPHTHALMIC FORMS PER YEAR

YEAR REPAIR/REPLACEMENT FORMS

SIGHT TEST FORMS

VOUCHER FORMS

TOTAL FORMS

2000/01 28,762 306,503 160,372 495,637

2001/02 25,612 325,998 165,198 516,808

2002/03 26,838 334,012 167,822 528,672

2003/04 29,163 345,966 169,209 544,338

Fig 3.3.5: Ophthalmic Forms

0

100,000

200,000

300,000

400,000

Repair Sight Test Voucher

No.

of F

orm

s

2001 2002 2003 2003/04

Ophthalmic Services

42

(3.4) COSTS

(3.4.1) COST1 OF OPHTHALMIC SERVICES: 2003/04

EASTERN NORTHERN SOUTHERN WESTERN NI TYPE OF SERVICE

£'000 £'000 £'000 £'000 £'000

Sight Tests 2,472 1,391 1,077 1,021 5,961Vouchers 2,898 1,539 1,427 1,547 7,412Domicilary Fees 119 14 35 16 184Repairs and Replacements 292 160 141 129 721

Total Costs 5,781 3,104 2,679 2,713 14,278Row % 41 22 19 18 100

1 Includes patient contributions. Also, totals may not equal sum of parts due to rounding. NB: CSA recoup the cost of the prison service – it is therefore cash neutral.

(3.4.2) PATIENT CONTRIBUTIONS & TOTAL COST OF OPHTHALMIC SERVICES

YEAR PATIENT CONTRIBUTION (£)

AMOUNT CLAIMED & PATIENT

CONTRIBUTION

% INCREASE YEAR ON YEAR

(PATIENT CONTRIBUTION)

2000/01 7,238 12,042,381 -

2001/02 10,057 12,747,750 39

2002/03 14,812 13,487,768 47

2003/04 14,651 14,277,539 -1

43

(3.5) NI COMPARISON WITH THE REST OF THE UK: 2003 & 20041

(3.5.1) OPTOMETRIST COMPARISONS SUMMARY


Optometrists 476 1,030 7,734 594 9,834

OMPs 19 24 597 35 675

Total Optometrists 495 1,054 8,331 629 10,509

% Male 47 48 56 56 52

% Female 53 52 44 44 48

Optometrists per 100,000 Population 29 21 17 21 34

Population per Optometrist 3,440 4,798 5,984 4,671 5,667 1 UK data from December 2-03, NI data from March 2004.

Fig 3.5.1c: Population per Optometrist: UK

4,6715,984

4,7983,440

0

2,000

4,000

6,000

NorthernIreland


Pop

ulat

ion

F ig 3 .5 .1a : O ptom etrists by G ender: U K

47 48 56 56

53 52 44 44

0

20

40

60

80

100

N orthern Ireland Scotland E ngland W ales

% o

f Opt

icia

ns

% M ale % Fem ale

Fig 3.5.1b: Number of Optometrists per 100,000 Population:UK

2921 17 21

0

10

20

30

NorthernIreland


No.

of O

ptic

ians

Ophthalmic Services

45

(4) PHARMACEUTICAL SERVICES

(4.1) INTRODUCTION

FPS Pharmaceutical Services process prescriptions and other payment claims submitted on a monthly basis by pharmaceutical contractors, appliance contractors, dispensing doctors and oxygen concentrator contractors. In addition to calculating payments to contractors, Pharmaceutical Services provide information on dispensing, prescribing and other statistics.


PRESCRIPTIONS

� In 2003/04, the average cost per prescription item was £13.60, an increase of 46% over a decade from £9.32 in 1994.

� The average number of prescription items per person for 2003/04 was just under 15, an increase of a third over the decade from 1994 when it was 11.

� In 2003/04, over 94% of prescriptions were exempt from statutory charges (these do not include patients exempt due to pre-payment certificates).

� The highest proportion of prescriptions dispensed was within the Eastern Board (41%), followed by the Northern Board (23%), the Southern Board (19%) and the Western Board (17%).

PHARMACISTS / PHARMACIES

� In 2003/04, there were 282 Pharmacists on the Northern Ireland Pharmaceutical List providing services from 511 Pharmacies. In addition to which there were 3 Appliance Contractors.

� There were on average 30 Pharmacies per 100,000 people in 2004.

COSTS

� The Gross Cost of Pharmaceutical payments in 2003/04 was £362.4 Million.

� The Total Net Ingredient Cost (NIC) in 2003/04 was £316.6 Million. (see NIC definition in Glossary)

� The Gross Cost per Person in 2003/04 was £203.35.

UK COMPARISONS

� In 2003, Northern Ireland had the highest number of pharmacies per 100,000 population (30) in the UK, followed by Wales (24), Scotland (23) and England (20).

� Wales had the highest number of prescriptions items per head (17.36) in the UK in 2003, followed by Northern Ireland (15.56), Scotland (14.23) and England (13.03).

� Scotland had the highest ingredient cost (£12.54) per prescription item in the UK in 2003, followed by Northern Ireland (£12.48), England (£11.56), and Wales (£10.58). (see glossary for definition of Ingredient cost)

Pharmaceutical Services

(4.3

) PR

ESC

RIP

TIO

NS

(4.3

.1) P

RE

SCR

IPT

ION

IT

EM

S D

ISP

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SED

, GR

OSS

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ND

FR

EQ

UE

NC

Y O

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ION

S (I

nc N

umbe

r &

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tock

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2003

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AV

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AG

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NU

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1,79

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926

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362,

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316,

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092

14.8

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Fig

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Pre

scri

ptio

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tem

s D

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nsed

by B

oard

(200

3/04

)

46

47

(4.3

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L

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S (£

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RE

CE

IPT

S A

S P

RO

PO

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F G

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F

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1997

/199

8 6,60

6,88

417

7,60

11,20

5,39

87,98

9,88

3236,746,481

3.4%

1998

/199

9 6,85

2,96

715

4,52

01,27

1,54

88,27

9,03

5248,844,611

3.3%

1999

/200

0 8,01

7,41

016

5,18

41,61

6,75

79,79

9,35

1266,535,449

3.7%

2000

/200

1 8,39

0,47

810

8,64

91,80

2,61

010,301,738

278,405,480

3.7%

2001

/200

2 8,99

0,06

184,111

1,97

7,43

111,051,603

303,489,420

3.6%

2002

/200

3 9,47

4,10

812

3,33

82,20

5,75

811,803,204

327,045,352

3.6%

2003

/200

4 9,72

4,52

961,593

2,33

6,18

612,122,308

362,400,531

3.3%


(4.3.4) PRESCRIPTION & PRE-PAYMENT COSTS (PER ITEM / CERTIFICATE)

PRE-PAYMENT CERTIFICATE COSTS (£) YEAR

4 Months 1 Year 1996 28.50 78.40 1997 29.30 80.50 1998 30.10 82.70 1999 30.80 84.60 2000 31.40 86.20 2001 31.90 87.60 2002 32.40 89.00 2003 32.90 90.40 2004 33.40 91.80

Sale of Pre-Payment Certificates taken over by Chemists on 1st October 1996.

Increases in charges for prescription items and pre-payment certificates occurs on 1st April.

YEAR PRESCRIPTIONCOST (£)

1990 3.05 1991 3.40 1992 3.75 1993 4.25 1994 4.75 1995 5.25 1996 5.50 1997 5.65 1998 5.80 1999 5.90 2000 6.00 2001 6.10 2002 6.20 2003 6.30 2004 6.40

Fig 4.3.4: Prescription Cost

0

2

4

6

8

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Year

£ (P

resc

ript

ion

Cos

t)

48

49

(4.4) PHARMACISTS / PHARMACIES

(4.4.1) NUMBER OF PHARMACEUTICAL & APPLIANCE CONTRACTORS & PREMISES BY BOARD: October 2004

BOARD

GENERAL PRACTICE

PHARMACISTS (CONTRACTORS)1

APPLIANCE CONTRACTOR

(PREMISES) PHARMACIES TOTAL

CONTRACTORSTOTAL

PREMISES

NI 282 3 511 285 514

EASTERN 127 2 220 129 222

NORTHERN 57 1 109 58 110

SOUTHERN 51 0 91 51 91

WESTERN 47 0 91 47 91 1 A contractor may own more than one pharmacy (e.g. Boots PLC)

(4.4.2) NUMBER OF DISPENSING DOCTORS, PRACTICES & PATIENTS BY BOARD: October 2004

BOARD DISPENSING DOCTORS1

DISPENSING PRACTICES1

DISPENSING PATIENTS1

NI 18 11 15,650

EASTERN 0 0 0

NORTHERN 5 2 3,576

SOUTHERN 4 3 5,129

WESTERN 9 6 6,945 1 See glossary


50

(4.4.3) RATIO OF PHARMACIES TO POPULATION BY BOARD & TRUST: October 2004

BOARD/TRUST NUMBER OF PHARMACIES POPULATION

NUMBER OF PHARMACIESPER 1000,000

POPULATION

POPULATIONPER

PHARMACY

NI 511 1,702,628 30 3,332

EASTERN 220 663,911 33 3,018

Down & Lisburn 48

North & West Belfast 59

North Down & Ards 40

South & East Belfast 73

NORTHERN 109 432,834 25 3,971

Causeway 30

Homefirst 79

SOUTHERN 91 319,026 29 3,506

Armagh & Dungannon 34

Craigavon & Banbridge 32

Newry & Mourne 25

WESTERN 91 286,857 32 3,152

Foyle 50

Sperrin Lakeland 41

51

(4.5

) CO

STS

(4.5

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3 1,

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330

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0,54

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350

1.74

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928

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May

200

31,

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26,7

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913

28,6

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31,

779,

330

1,27

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62,

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410

1.58

23,4

438,

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31,4

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3 1,

781,

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7,55

62,

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518

1.93

28,9

003,

641

32,5

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231

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1.37

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200

3 1,

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1.78

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3 1,

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1.74

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27,6

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425

32,1

1885

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124

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Jan

2004

1,

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4,41

52,

362,

430

1.77

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946

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1.75

24,7

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27,9

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1.76

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52

(4.5.2) THERAPEUTIC CLASS BNF CHAPTERS: 2002/03

PRESCRIPTION

ITEMS

INGREDIENT

COST THERAPEUTIC

CLASS BNF

CLASSIFICATION Number % £'000 %

AVERAGE COST

/ PRESCRIPTION

ITEM

NI 26,493,398 *100 330,575 *100 12.48

1 Gastro-Intestinal

System 2,472,149 9.3 35,454 10.7 14.34

2 Cardiovascular System 5,509,241 20.8 78,377 24 14.23

3 Respiratory System 2,209,955 8.3 30,798 9.3 13.94

4 Central Nervous System 6,316,376 23.8 68,340 20.7 10.82

5 Infections 2,048,578 7.7 11,002 3.3 5.37

6 Endocrine System 1,563,542 6 24,724 7.5 15.81

7 Obstetrics, Gynaecology

and Uninary-Tract

Disorders

574,205 2.2 8,584 2.6 14.95

8 Malignant Disease

and For

Immunosuppression

103,120 0.4 9,317 2.8 90.35

9 Nutrition and Blood 878,213 3.3 11,131 3.4 12.67

10 Musculoskeletal and

Joint Diseases 1,279,104 4.8 16,838 5.1 13.16

11 Eye 427,763 1.6 2,401 0.7 5.61

12 Ear, Nose and

Oropharynx 415,740 1.6 2,031 0.6 4.89

13 Skin 1,754,608 6.6 11,695 3.5 6.67

14 Immunological

Products and Vaccines 53,964 0.2 3,153 1 58.43

15 Anaethesia 10,299 0.04 130 0.04 12.62

18 Preparations Used in

Diagnosis 240 0.001 5 0.001 20.83

19 Other Drugs and

Preparations 3,361 0.01 21 0.01 6.25

20 Dressings 345,627 1.3 5,125 1.6 14.83

21 Appliances 122,951 0.5 2,198 0.7 17.88

22 Incontinence Appliances 26,622 0.1 880 0.3 33.06

23 Stoma Appliances 30,018 0.1 2,205 0.7 73.46

99 Unclassified 347,722 1.3 6,166 1.9 17.73

* % may not total 100 due to rounding error. NB: Number of Prescriptions and Ingredient Cost included Hospices in the BNF table.

53

(4.5.3) THERAPEUTIC CLASS BNF CHAPTERS: 2003/04

PRESCRIPTION

ITEMS

INGREDIENT

COST THERAPEUTIC

CLASS BNF

CLASSIFICATION Number % £'000 %

AVERAGE COST /

PRESCRIPTION

ITEM

NI 26,758,481 *100 340,539 *100 12.73

1 Gastro-Intestinal

System 2,491,978 9.3 35,598 10.5 14.29

2 Cardiovascular System 5,661,435 21.2 81,881 24 14.46

3 Respiratory System 2,208,756 8.3 31,364 9.2 14.20

4 Central Nervous

System 6,357,500 23.8 70,573 20.7 11.10

5 Infections 2,017,443 7.5 11,126 3.3 5.52

6 Endocrine System 1,601,119 6 25,598 7.5 15.99

7 Obstetrics,

Gynaecology and

Uninary-Tract

Disorders

580,678 2.2 8,857 2.6 15.25

8 Malignant Disease

and For

Immunosuppression

104,704 0.4 9,512 2.8 90.85

9 Nutrition and Blood 893,065 3.3 11,770 3.5 13.18

10 Musculoskeletal and

Joint Diseases 1,296,387 4.8 17,647 2.5 13.61

11 Eye 432,702 1.6 2,462 0.7 5.69

12 Ear, Nose and

Oropharynx 421,218 1.6 2,091 0.6 4.97

13 Skin 1,764,478 6.6 11,985 3.5 6.79

14 Immunological

Products and Vaccines 54,619 0.2 3,145 0.9 57.57

15 Anaethesia 10,680 0.04 136 0.04 12.77

18 Preparations Used in

Diagnosis 241 0.001 5 0.001 19.75

19 Other Drugs and

Preparations 2,936 0.01 21 0.01 7.24

20 Dressings 348,539 1.3 5,397 1.6 15.48

21 Appliances 121,487 0.5 2,283 0.7 18.79

22 Incontinence

Appliances 27,118 0.1 889 0.3 32.78

23 Stoma Appliances 30,127 0.1 2,299 0.7 76.31

99 Unclassified 331,271 1.2 5,898 1.7 17.80

* % may not total 100 due to rounding error. NB: Number of Prescriptions and Ingredient Cost included Hospices in the BNF table.


54

(4.5.4) TOP 5 BNF CHAPTERS BY TOTAL NUMBER OF PRESCRIPTION ITEMS: 2003/04

RANK CHAPTER DESCRIPTION

1 4 Central Nervous System

2 2 Cardiovascular System

3 1 Gastro-Intestinal System

4 3 Respiratory System

5 5 Infections

(4.5.5) TOP 5 BNF CHAPTERS BY TOTAL INGREDIENT COST: 2003/04


1 2 Cardiovascular System

2 4 Central Nervous System

3 1 Gastro-Intestinal System

4 3 Respiratory System

5 6 Endocrine System

Fig 4.5.5: Top 5 BNF Chapters by Ingredient Cost

0

20

40

60

80

100

2 4 1 3 6

BNF Chapters

Mil

lio

n £

Fig 4.5.4: Top 5 BNF Chapters by Number of Prescription

Items

0

1

2

3

4

5

6

7

4 2 1 3 5

BNF Chapters

Mil

lio

n P

resc

rip

tio

ns

(4.5.6) TOP 5 BNF CHAPTERS BY AVERAGE COST OF PRESCRIPTION: 2003/04


1 8 Malignant Disease and for Immunosuppression

2 23 Stoma Appliances

3 14 Immunological Products and Vaccines

4 22 Incontinence Appliances

5 18 Preparations Used in Diagnosis

Fig 4.5.6: Top 5 BNF Chapters by Average Cost ofPrescription

0

20

40

60

80

100

8 23 14 22 18

BNF Chapters

£ (A

vera

ge C

ost)

55


56

(4.5

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57


(4.6.1) PHARMACIES COMPARISON SUMMARY


Number of Pharmacies 509 1,151 9,748 704 12,112

Population per Pharmacy 3,345 4,394 5,114 4,173 4,719

Pharmacies per 100,000 Population 30 23 20 24 20

Prescription Items per Head 15.56 14.23 13.03 17.36 13

Ingredient Cost per Prescription Item (£) 12.48 12.54 11.56 10.58 11.62

Fig 4.6.1a: Population per Pharmacy: UK

4,173

5,114

4,394

3,345

0

2,000

4,000

6,000


Pop

ulat

ion

Fig 4.6.1b: Pharmacies per 100,000 Population:UK

3023 20

24

0

10

20

30

40

NorthernIreland


No.

of P

harm

acie

s


58

Fig 4.6.1c: Number of Prescriptions per Headof Population: UK

16 14 1317

0

5

10

15

20

NorthernIreland


No.

of P

resc

ript

ions

Fig 4.6.1d: Ingredient Cost per PrescriptionItem: UK

10.5811.56

12.5412.48

0

5

10

15

NorthernIreland


(£)

59

(5) GLOSSARY, FURTHER INFORMATION & CONTACT DETAILS

(5.1) GLOSSARY

Appliance Contractor Appliance Contractors are a specific sub-set of NHS pharmacy contractors but they specialise in the supply (on prescription) of appliances only, notably stoma and incontinence appliances. Appliance suppliers are subject to different remuneration arrangements but must follow the same procedures to become an NHS contractor by applying for entry to an NHS Board’s pharmaceutical list, and thereby are subject to the same terms of service as detailed in regulations. However, they are not subject to any formal standards or quality assurance in the way that pharmacists are bound by Royal Pharmaceutical Society requirements.

Capitation General Dental Services for those patients aged under 18. There is a requirement for a dentist to secure and maintain oral health and to provide a treatment plan and emergency cover.

Continuing Care General Dental Services for those patients aged 18 and over. There is a requirement for a dentist to secure and maintain oral health and to provide a treatment plan and emergency cover.

Dental Officer There is a legal duty to ensure that dental treatment in the NHS is carried out to a satisfactory standard and that any treatment carried out is actually necessary. Patients are randomly selected and invited to attend an examination by a Dental Officer, who is a qualified and experienced dentist, to achieve this. A patient’s own dentist is informed when the patient is selected.

Dental Sub-Contract Each Dentist has a contract which permits them to provide dental services with a separate sub-contract for every practice in which they work.

Dispensing Opticians Dispensing opticians do not test eyes for glasses but make up, fit and sell glasses or contact lenses from the optometrists’ prescriptions. They follow a three or four year course to qualify.

Dispensing Patients These are patients to whom dispensing doctors are permitted to dispense drugs either at the Health Centre, Branch Surgeries or in the patients' homes.

Dispensing Practices & Doctors Dispensing doctor practices usually exist in remote areas where the population density is considered too low to support a pharmacy or areas where there is sufficient need identified. Dispensing Doctors may dispense drugs to dispensing patients. The number of these is on the decline in Northern Ireland. Practices & Doctors receive extra fees for providing this service.

Domiciliary Visits These are for those patients who require treatment but are unable to leave their residence due to illness or disability and thus are visited in their home by the relevant practitioner.

Forms (General Ophthalmic Services) These are forms completed by Ophthalmic Practitioners for services rendered (e.g.: sight tests; domiciliary visits). If a patient is entitled to free or subsidised eye care, they must present evidence of this to the practitioner who will then submit a claim form for the services provided which is signed by both the practitioner and the patient for the processing of payment.

Glossary

Global Sum Weighted Lists The Department bases its figures on a Weighted List Registered population for the allocation of resources under the new General Medical Services Contract as agreed with the BMA. This is intended to be a more accurate reflection (rather than simple headcount) of the service provided where figures are based on the list registered population per GP weighted for factors that influence relative need. The 6 key determinants of practice workload used for weighting are: gender & age; additional needs due to morbidity & mortality; newly registered patients who generate more workload in the first year; patients in nursing and residential homes who generate longer consultations, partly due to travel time; costs of delivering services in rural areas and costs of living via a Market Forces Factor (MMF).

List Size Number of patients registered to a practitioner or practice.

Ophthalmic Medical Practitioner (OMP) A registered medical practitioner with a qualification in ophthalmology who is employed to work in the premises of an optometrist to carry out medical eye examinations and prescribe glasses. In order to work as an ophthalmic medical practitioner a doctor must be on the Central List of the Ophthalmic Qualifications Committee. This is a statutory list that is administered by the British Medical Association. OMPs are often trainees who work to supplement their income.

Optometrist (Ophthalmic Optician) Optometrists (historically known as ophthalmic opticians) are health professionals who test eyes for defects in sight and prescribe and fit glasses or contact lenses as required. They examine eyes for disease and also general health problems and refer to the general medical practitioner or hospital eye service if necessary. Optometrists study for 3 years at university followed by a year of supervised training and professional examinations with the College of Optometrists. They must be registered with the General Optical Council to practice and are governed by the Opticians Act. The majority of optometrists work in a community setting but some work in Hospital Eye departments and often specialise in paediatrics, contact lenses, low vision and sports vision.

Net Ingredient Cost In Pharmaceutical Services in Northern Ireland the Net Ingredient Cost is the cost of medicines AFTER discounts. In England and Wales it refers to the cost of the drug BEFORE discounts and does not include any dispensing costs or fees. It does not include any adjustment for income obtained where a prescription charge is paid at the time the prescription is dispensed or where the patient has purchased a pre-payment certificate.

Pharmaceutical Receipts Payments in lieu of prescription charges received from patients for Pharmaceutical Services.

Population Figures Throughout this document this refers to NISRA 2003 Mid-Year Estimates for Northern Ireland.

Quality Preparation Payment This a payment under the terms of the new GMS Contract which came into effect on 1st April, 2004 for entering the quality and outcomes framework and was guaranteed to all practices in 2003/04. Implementing the quality framework will take time for practices. In recognition of this, substantial quality preparation payments will be made in 2003/04, 2004/05 and 2005/06. These payments are not conditional on achievement but they will enable practices to collect initial data to establish their current position in the framework. This will assist them in determining their aspiration for achievement in the following year. These will be made on a practice weighted population basis using the Carr-Hill formula. The payment amounts to an average of £9,000 per practice in each of the three years and is paid at the beginning of the financial year.

Vouchers (General Ophthalmic Services) Vouchers towards the cost of glasses or contact lenses are available to those who qualify (e.g. under 16s, people in receipt of income support…). A patient should mention their entitlement to their optician before the glasses/contact lenses are made and will be given a claim form to complete. Applications should be made before treatment is sought on a form available from Social Security Offices / Jobs & Benefits Offices.

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Abbreviations

A&E Accident and Emergency

BNF British National Formulary

CSA Central Services Agency

DFP Department of Finance and Personnel

FPS Family Practitioner Services

GP General Practitioner

MIU Minor Injuries Unit

NI Northern Ireland

NIC Net Ingredient Cost

NISRA Northern Ireland Statistics and Research Agency

SLA Service Level Agreement

UPE Unrestricted Principal and Equivalent

WTE Whole Time Equivalent

(5.2) Useful Links:http://www.centralservicesagency.com http://www.dh.gov.uk http://www.show.scot.nhs.uk http://www.isdscotland.org http://www.nisra.gov.uk http://www.dhsspsni.gov.uk http://www.dpb.nhs.uk

(5.3) Contact Details:Central Services Agency (CSA) 2 Franklin Street Belfast BT2 8DQ Tel: 028 9032 4431 Fax: 028 9023 2340

Family Practitioner Services (FPS), CSA Tel: 028 9032 4431 and ask for the Department of the Service you require.

Information & Research Unit, FPS, CSA Tel: 028 9053 5589

Glossary

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Notes

Information & Research Unit, Family Practitioner Services Directorate,

Central Services Agency, 2 Franklin Street, Belfast BT2 8DQ.

Tel: 028 9053 5589 Email: [email protected]

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