ANNEXE 1 BRIDGWATER BAY COMMISSIONING LOCALITY - 2018-21 Somerset Pharmaceutical Needs Assessment - Somerset Intelligence
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Somerset Pharmaceutical Needs Assessment 2018-21 Somerset Health and Wellbeing Board ANNEXE 1 BRIDGWATER BAY COMMISSIONING LOCALITY 1
1.1 Bridgwater Bay 1.1.1 Overview The Bridgwater Bay commissioning locality is in the centre of the county. The main settlement is Bridgwater, which has grown significantly in recent years. The locality is the site of Hinkley Point C, the nuclear reactor whose development is expected to have a big impact on the economy and demography of the county. Much of the Hinkley Point workforce is expected to be accommodated in Bridgwater. Health need is taken from the Bridgwater Bay Commissioning Locality Profile for 2016 http://www.somersetintelligence.org.uk/downloads/Bridgwater%20CLoc%2020 16.pdf which should be considered part of the Somerset PNA 2018. 1.1.2 Population & context for health The population registered with GPs in the locality was 76,359 in 2016. The area has slightly more younger people compared to the Somerset average and fewer older people. The Index of Multiple Deprivation for the local area is 22.4 representing higher levels of deprivation compared to the Somerset average of 18.1. Disease prevalence Significantly worse (higher number than expected compared to the county average) for: o Chronic Kidney Disease (18+) o COPD o Coronary Heart Disease o Diabetes (17+) o Hypertension Obesity (16+) o Palliative Care o Stroke The Commissioning Locality has the worst value (highest number compared to the expected based on county average) in the county for: o Chronic Kidney Disease (18+) o COPD o Coronary Heart Disease 2
o Diabetes (17+) Significantly better (lower number than expected compared to the county average) for: o Mental Health The Commissioning Locality has the best value (lowest number compared to the expected based on county average) in the county for: o Mental Health Mortality The ‘death blobs’ for mortality and years of life lost provide a visual indication of the key causes of death in the Bridgwater Bay Commissioning Locality. The proportion of deaths occurring before age 65 years is 14.5% which is the highest in the county. 3
Figure 2: Years of Life Lost 'blobs' for Bridgwater Bay 5
Figure 3: Bridgwater Bay Commissioning Locality (Bridgwater Town shown in Figure 4) 6
Figure 4: Bridgwater Town 7
Screening The commissioning arrangements have changed for the NHS Health Checks programme. Of those eligible, 11.3% received a health check. In the most deprived quintile, 9.4% of the population received a check. Cervical screening rates for those aged 25-49 years old, at 72.8%, are similar to the county average of 72.3%. Practice based rates of chlamydia screening of eligible 15-24 year olds was 2.5%, much lower than the Somerset average rate of 3.0%. Immunisations MMR vaccination rates are above the target for herd immunity of 95%, with 95.7% vaccinated by age 2. Childhood environment Local breastfeeding initiation rates are 74.9% compared to 80.7% in Somerset. Continuation rates at 6-8 weeks are 40.5% compared to 49.4% in the county as a whole. Excess weight According to the underlying model used to assess appropriate childhood weight, only 15% children should be of excess weight. Somerset rates are 22.4% at age 4-5 years and 30.4% at age 10. For this Commissioning Locality, estimated rates are 23.9% and 32.3% for each age group. The percentage of adults in the area who are obese is 10.1% which is above average for the county. Smoking The Commissioning Locality has 17.8% of adults over age 16 recorded as smokers compared to a 12.8% Somerset average. This area has the highest rate of adult smoking in Somerset with only a slight decline in absolute terms. In 2015/16, only 31 per 1000 recorded smokers in Bridgwater went through cessation services compared to 65 per 1000 in 2013-15. This is a lower than average proportion compared to other Commissioning Localities and this number is dramatically down in absolute terms. Drugs and Alcohol Hospital admissions for drug and alcohol related reasons in this area are the highest in Somerset. Alcohol related admissions: Bridgwater 2,062 per 100,000; Somerset 1,894 per 100,000. Drug related admissions: Bridgwater 157 per 100,000; Somerset 137 per 100,000. 8
Hospital admission rates To focus on a few indicators, the emergency admission rate for falls in the over 65s is 30 per 1000 as compared to the Somerset average of 31 per 1000. The self-harm admission rate is 208 per 100,000 which is about average for the county. Suggested public health priority areas Increase numbers of smokers referred to stop smoking services Look for opportunities to ask about alcohol use and use the AUDIT screening questions Improve support for breastfeeding Reduce adult and child obesity 9
1.1.3 Details of GP surgeries Code Name Address Post Dispensing Prescribing Total code patients patients L85018 Cannington Mill Lane, Bridgwater TA5 4,624 626 5,250 Health Cannington 2HB Centre L85025 Cranleigh Cranleigh Bridgwater TA6 0 10,196 10,196 Gardens Gardens 5JS Medical Centre L85035 East Quay East Quay Bridgwater TA6 0 14,863 14,863 Medical 4GP Centre L85024 Polden Quarry Bridgwater TA7 7,991 714 8,705 Medical Ground, 9HA Practice Edington L85024 Polden Woolaving- Bridgwater TA7 With With Medical ton Road, 8ED Edington Edington Practice Woolaving- ton L85051 Redgate Weston- Bridgwater TA6 0 6,205 6,205 Medical zoyland 5BF Centre Road L85607 Somerset Stockmoor Bridgwater TA6 0 4,082 4,082 Bridge Park, 6LD Medical Taunton Centre Rd L85042 Taunton 12-16 Bridgwater TA6 0 14,144 14,144 Road Taunton 3LS Medical Road Centre L85612 Victoria Victoria Bridgwater TA6 0 4,629 4,629 Park Park Drive 7AS Medical Centre L85056 North Mill Street North TA6 1,274 4,679 5,953 Petherton Petherton 6LX Surgery 10
L85013 Quantock Nether TA5 3,248 215 3,463 Medical Stowey 1N Centre W 1.1.4 Housing Development Table 1: Bridgwater Bay - Significant housing developments 2018-20 – expected number of dwellings Bridgwater Bay Commissioning Locality Bridgwater 2530 Sites >100 South Bridgwater 120 Wilstock White 250 North East Bridgwater 500 Durleigh Road 120 Haygrove Road 190 Bridgwater Cattle Market 200 Rest of Locality 650 Total 3180 Based on 5 year Based on land Core Strategy supply The scale of development in the Commissioning Locality is generally greater than the county as a whole. This development includes the accommodation that will be needed for the Hinkley Point construction workforce during the period of the PNA. The focus of development is the town of Bridgwater. The overall level of 11
development in the town – 2530 dwellings likely in the period – is comparable to the level at Monkton Heathfield that, combined with issues of accessibility, led to the unforeseen need for additional provision in 2016. The development to the south is served by the Stockmoor Pharmacy, opened in 2015, and it unlikely that further development will require further provision. The development to the north east is of 700 dwellings, well below the level that led to the need for new provision in Monkton Heathfield, is on flat land and is reasonably close to the town centre. 1.1.5 Hinkley Point C Nuclear Power Station Construction of this power station has, after a long period of preparation, been confirmed and the likely workforce and accommodation are summarized in Table 3 below: Table 2 - Hinkley Point C Workforce People peak number of construction workers on site 5,600 will be around 5,600 in about 2020 Home based (ie current residents) (1,900) New residents 3700 On site bed spaces (500) Temporary dwellings on Innovia site, (1,000) Bridgwater Remainder 2,200 Off site 2,200 Tourist accommodation/private rental (400) Remainder 1800 Accelerated housebuilding elsewhere, to 1800 accommodate about 500 in the long term North East Bridgwater 1,000 new dwellings at North East Bridgwater Monmouth Street, Bridgwater 37 dwellings (142 bed spaces) Hopcott Road, Minehead 750 dwellings Source: Thomas Lister for HCA, SDC, TDBC, WSDC State of the Market Assessment For Hinkley Point Housing Zone April 2016 The bulk of the new population will be working age (and male). It seems likely that the current private rental and tourist accommodation market will not be able to take on all expected increase in demand, so some people will need to stay beyond the immediate West Somerset and Sedgemoor area. Source: Peter Brett for HCA Analysis of Housing Demand: Hinkley Housing Zone Final Report May 2016 The bulk of the increase in population is likely to be accommodated in existing centres such as Bridgwater and Minehead, and potential gaps to be considered under housebuilding plans. However, 5,600 people are expected to be on the site during construction, of whom 12
500 will be accommodated on site. The nearest pharmacy is 9 miles away in Williton, although there are dispensing practices in Nether Stowey and Cannington, both about 5 miles away. 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 Figure 5 Projected Hinkley Point Workforce – approximate dates Source: Thomas Lister for HCA, SDC, TDBC, WSDC State of the Market Assessment For Hinkley Point Housing Zone April 2016. Years added and approximate. 13
Figure 6: Hinkley Point site and nearest services 14
1.1.6 Necessary services: current provision Pharmacy Code Contract Trading Address Electronic Of which Name Name Prescription Access to NHSmail Number of items on Elastic Post- 100 Service Summary address as prescription electronic Hosiery code Hour available Care Record at 2-6-17 fees paid prescriptions items Asda Asda TA6 FXH81 stores ltd Stores Ltd East Quay 5AZ Yes Yes Yes 44781 21690 6 Boots Boots UK 34-38 Fore TA6 FDG35 pharmacy Ltd Street 3NG No Yes Yes 62063 32998 0 Unit R3, Local Yes John Stockmoor Centre, TA6 (NUMSAS FWV70 Ware Ltd pharmacy Nokoto Drive 6WU No Yes Yes OK) 12939 4474 0 L Rowland East Quay & Co Lloyds Medical (Retail) Pharmacy Centre, East TA6 FJ653 Ltd Ltd Quay 4GP No Yes No 222215 151259 39 LRowland & Co Lloyds Yes (Retail) Pharmacy 14-16 Taunton TA6 (NUMSAS FPY74 Ltd Ltd Road 3LS No Yes Yes OK) 120980 81826 22 15
Code Contract Trading Address Electronic Of which Name Name Prescription Access to NHSmail Number of items on Elastic Post- 100 Service Summary address as prescription electronic Hosiery code Hour available Care Record at 2-6-17 fees paid prescriptions items LRowland & Co Lloyds Yes (Retail) Pharmacy Sainsbury's, TA6 (NUMSAS FF835 Ltd Ltd The Clink 4AB No Yes Yes OK) 45279 20022 2 LRowland Redgate & Co Lloyds Health Centre, Yes (Retail) Pharmacy Weston- TA6 (NUMSAS FE929 Ltd Ltd zoyland Road 5BF No Yes Yes OK) 120167 11478 0 Jhoots Victoria Park Health- Jhoots Community care Ltd pharmacy Centre, Yes (was (was Victoria Park TA6 (NUMSAS FP760 Lloyds) Lloyds) Drive 7AS No Yes Yes OK) 69459 18885 2 Jhoots Stockmoor Yes Health- Jhoots Park, Taunton TA6 (NUMSAS FWM88 care Ltd pharmacy Road 6LD No Yes Yes OK) 59761 5903 2 Cranleigh Cranleigh Gardens Yes Shavarath Gardens Medical TA6 (NUMSAS Centre, FG551 Ltd pharmacy 5JS Yes Yes Yes OK) 162766 109251 8 Cranleigh 16
Code Contract Trading Address Electronic Of which Name Name Prescription Access to NHSmail Number of items on Elastic Post- 100 Service Summary address as prescription electronic Hosiery code Hour available Care Record at 2-6-17 fees paid prescriptions items Gardens Super- drug Super-drug TA6 FY731 Stores plc pharmacy 19 Fore Street 3NH No Yes No 46773 29210 2 Lloyds 105 Fore Yes Pharmacy Lloyds Street, North TA6 (NUMSAS FC171 Ltd Pharmacy Petherton 6RY No Yes Yes OK) 87198 24848 0 An application for a pharmacy in Woolavington was granted in 2017 and confirmed at appeal in 2018. 17
Dispensing Appliance Contractors Fees for Specified appliances requiring home delivery Appliances requiring measuring and fitting Of which items on electronic prescriptions Electronic Prescription Service available Number of prescription fees paid Stoma Appliance Customisations Appliance Use Reviews Elastic Hosiery items Contractor Pharmacy Postcode Address FH767 Great 3c Robins Bear Drive, TA6 Health Bridgwater Yes 46580 25970 0 Y 0 Y Y 4DL care Ltd Great Bear Health Care runs the Nightingale DAC in Bridgwater. This serves a market across England, and so its activity, including AURs do not relate exclusively, or even primarily, to Somerset. Dispensing doctors Practice Practice Code Name Address Postcode Opening Hours Type L85018 Canning Mill Lane, TA5 Monday-Friday, 8.00-18.30 dispensing ton Health Cannington 2HB GP practice Centre L85024 Polden Quarry TA7 Monday-Friday 8.30-18.30; dispensing Medical Ground, 9HA Saturday 8.30-12.30 GP practice Practice Edington 18
L85056 North Mill Street, TA6 Monday 8.30-19.45; Tuesday- dispensing Petherton North 6LX Friday 8.30-18.00; Saturday GP practice Surgery Petherton 09.00-11.30 alternate L85013 Quantock Nether TA5 Monday-Friday, 8.00-18.00; dispensing Medical Stowey 1NW Saturday 8.30-10.00 GP practice Centre L85024 Woolavin- 2 Bitham TA7 Monday-Friday 8.30-18.30; dispensing gton Walk, 8JQ Saturdays 8.30-12.30 GP practice Surgery Woolaving- branch ton An application has been received by NHS England for a pharmacy to be opened in Woolavington, currently served by a dispensing practice branch. Notable provision from outside the locality Most provision is likely to be within the locality. 19
Pharmacies and Items per head Per Items Items per Number Patients 10,000 dispensed head Pharmacies 12 59219 2.0 1054381 17.8 Doctors' 5 17140 390528 dispensaries 2.9 22.8 Bridgwater Bay total 17 76359 2.2 1444909 18.9 Somerset total 127 563342 2.3 10862687 19.3 The numbers of total outlets is similar to the county average; the number of items dispensed per head is somewhat lower, despite the generally greater health needs of the locality. It should be noted that these are indicative, as dispensing practices’ and pharmacies’ prescribing is not identical; dispensing patients can also use community pharmacies; and there is no requirement for a particular number of pharmaceutical providers per head. Transport/access assessment The population weighted score for the locality on the Barriers to Housing and Services domain of the Index of Multiple Deprivation is 21.8 compared to a Somerset average of 25.2, making it less deprived than the Somerset average on this basis. There is, though, a contrast between the urban and rural areas. 20
Opening hours coverage Bridgwater Bay – Weekday opening 24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bridgwater Asda pharmacy, FXH81 East Quay Not Mon Boots pharmacy, FDG35 34-38 Fore Street Cranleigh FG551 Gardens pharmacy, Jhoots pharmacy, FWM8 Stockmoor Park, 8 Taunton Road Lloydspharmacy, FPY74 14-16 Taunton Road Lloyds pharmacy, FP760 Victoria Park Community Centre, Lloyds pharmacy, FE929 Redgate Health Centre, Westonzoyland Road Lloyds pharmacy, FF835 Sainsbury's, The Clink 21
24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Core Fri Th/ Fri Th/ Fri Rowlands FJ653 pharmacy, East Quay Medical Centre, East Quay Stockmoor FWV70 pharmacy, Unit R3, Local Centre, Nokoto Drive Superdrug FY731 pharmacy, 19 Fore Street Core None At least one outlet open N Bridgwater Total None At least one outlet open N North Petherton Lloyds pharmacy, FC171 105 Fore Street N. Petherton North Petherton L85056 Surgery Villages with Dispensing Practices only Cannington Cannington L85018 Health Centre Edington Polden Medical L85024 Practice 22
24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Nether Stowey Quantock Medical Centre Woolavington Woolavington Surgery Bridgwater Bay Core None At least one outlet open N Total None At least one outlet open N 23
Bridgwater Bay – Saturday opening 24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bridgwater Asda pharmacy, FXH81 East Quay Boots pharmacy, FDG35 34-38 Fore Street Cranleigh FG551 Gardens pharmacy, Jhoots pharmacy, FWM88 Stockmoor Park, Taunton Road Lloyds pharmacy, FPY74 14-16 Taunton Road Lloydspharmacy, FP760 Victoria Park Community Centre, Lloyds pharmacy, FE929 Redgate Health Centre, Westonzoyland Road Lloyds pharmacy, FF835 Sainsbury's, The Clink Rowlands FJ653 pharmacy, East Quay Medical Centre, East Quay 24
24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Stockmoor FWV70 pharmacy, Unit R3, Local Centre, Nokoto Drive Superdrug FY731 pharmacy, 19 Fore Street Core None At least one outlet open None Bridgwater Total None At least one outlet open None North Petherton Lloyds pharmacy, FC171 105 Fore Street N. Petherton North Petherton L85056 Surgery Villages with Dispensing Practices only Cannington Cannington L85018 Health Centre Edington Polden Medical L85024 Practice Nether Stowey Quantock Medical Centre Woolavington 25
24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Woolavington Surgery Bridgwater Bay Core None At least one outlet open None Total None At least one outlet open None 26
Bridgwater Bay – Sunday opening 24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Bridgwater Asda pharmacy, FXH81 East Quay Boots pharmacy, FDG35 34-38 Fore Street Cranleigh FG551 Gardens pharmacy, Jhoots pharmacy, FWM88 Stockmoor Park, Taunton Road Lloyds pharmacy, FPY74 14-16 Taunton Road Lloyds pharmacy, FP760 Victoria Park Community Centre, Lloyds pharmacy, FE929 Redgate Health Centre, Westonzoyland Road Lloyds pharmacy, FF835 Sainsbury's, The Clink Rowlands FJ653 pharmacy, East Quay Medical Centre, East Quay 27
24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Stockmoor FWV70 pharmacy, Unit R3, Local Centre, Nokoto Drive Superdrug FY731 pharmacy, 19 Fore Street Core At least one open Bridgwater Total At least one outlet open North Petherton Lloyds pharmacy, FC171 105 Fore Street N. Petherton North Petherton L85056 Surgery Villages with Dispensing Practices only Cannington Cannington L85018 Health Centre Edington Polden Medical L85024 Practice Nether Stowey Quantock Medical Centre Woolavington 28
24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Woolavington Surgery Core At least one open Bridgwater Bay Total At least one outlet open 29
Key to Opening Hours diagrams Community Pharmacies Open for whole hour - Core Open for first part of hour (usually 30 minutes) - Core Open for second part of hour (usually 30 minutes) - Core Open for whole hour – Supplementary Open for first part of hour (usually 30 minutes) – Supplementary Open for second part of hour (usually 30 minutes) - Supplementary Dispensing GP Practices Open for whole hour, all or most weekdays Open for first part of hour (usually 30 minutes), all or most weekdays, or Saturday Open for second part of hour (usually 30 minutes), all or most weekdays, or Saturday Open for whole hour, minority of days per week Open for first part of hour (usually 30 minutes), minority of days per week Open for second part of hour (usually 30 minutes), minority of days per week These diagrams are simplifications of sometimes complex opening times, in which several days in a week may have their own schedules. The definitive list of opening times is shown in Appendix 5 (http://www.somersetintelligence.org.uk/files/PNA2018App5.xlsx . 30
31 Pharmacy Asda Boots Jhoots Gardens Cranleigh pharmacy, pharmacy, pharmacy, pharmacy, 8 Contractor FG551 FXH81 FWM8 FDG35 Address1 Street, East Quay, 34-38 Fore Bridgwater Bridgwater Bridgwater Bridgwater Taunton Road, Stockmoor Park, Medicines Use Reviews New Medicines Service interventions Appliance Use Reviews Stoma Appliance Customisations Fees for appliances requiring home delivery Appliances requiring measuring and fitting Flu Vaccinations Specialist Medicines Enhanced Service Supervised Admin of Medication Emergency Hormonal Contraception 16-17 Chlamydia screening Advanced Services and Locally Commissioned Services (Somerset Public Health and Somerset CC CCG) Needle exchange NHS health checks Smoking Cessation (Champix) Smoking Cessation (1:1 support) Minor Ailments Service
Lloyds FPY74 14-16 Taunton pharmacy, Road, Bridgwater Lloyds FP760 Victoria Park pharmacy, Community Centre, Bridgwater Lloyds FE929 Redgate Health pharmacy, Centre, Westonzoyland Road, Bridgwater Lloyds FF835 Sainsbury's, The pharmacy, Clink, Bridgwater Rowlands FJ653 East Quay pharmacy, Medical Centre, East Quay, Bridgwater Stockmoor FWV70 Unit R3, Local pharmacy, Centre, Nokoto Drive, Bridgwater Superdrug FY731 19 Fore Street, pharmacy, Bridgwater 32
Lloyds FC171 15 Fore Street, pharmacy, N. Petherton Locality 33
Hospital pharmacies, walk-in centres, private pharmacies There is a community hospital and minor injuries unit in Bridgwater. The construction of Hinkley Point C nuclear reactor is described in Workers on the construction site at Hinkley Point will be provided for privately by EDF. 1.1.7 Necessary services: gaps in provision Although the health needs of Bridgwater Bay are somewhat greater than the average for the county, the main types of ill health are similar, and pharmacies are concentrated in the urban area of Bridgwater town and so close to the main areas of deprivation. The rural areas are served by four dispensing GP practices and a branch. The 2015 Somerset PNA did not identify a gap in the provision of necessary services in the locality. Since then an unforeseen benefits application has been granted for Woolavington, indicating a current need which will be met by the granted application. Although there has been considerable growth since 2015 it has not been at a level or location that has created a gap in provision. We note that the population to the south of Bridgwater, where there has been much housebuilding, is now served by the Stockmoor pharmacy, which opened when the 2015 PNA was published. During the week, the population is served from 7AM to 11PM by core hour opening, and this is extended by one hour with supplementary opening at Asda in Bridgwater. On Saturdays the core hour opening is from 7AM to 10.30PM; Sunday core hours are from 10AM to 4PM, supplemented to be from 8AM to 9PM at Cranleigh Gardens. These indicate reflect very lengthy availability, seven days a week. All pharmacies in the locality provide MURs and NMS, and one pharmacy provides the access to specialist medicines enhanced service. On the basis of the information we have, we therefore conclude that there is no current gap in the provision of necessary services in Bridgwater Bay. There will be a future need for necessary services in Woolavington if the application which has been granted lapses without a pharmacy opening. The level of housebuilding expected in the next three years is higher than the county as a whole, with a concentration in Bridgwater. As discussed above, the development to the south of Bridgwater has recently been supplemented by Stockmoor Pharmacy, and we do not expect this area to have a gap in provision during the period of the PNA. The development to the north east of Bridgwater is of approximately 650 dwellings, and given its proximity to existing providers in the town (notably the 100 hour pharmacy in Asda) we not expect that this would lead to a gap if development is at the expected level and the accessibility of the developed sites is reasonable. 34
The bulk of the additional housing associated with Hinkley Point C construction is included within these figures, and the workers accommodated on site will be provided for by the contractors. On the basis of the information we have, we conclude that if the expected level of development in Bridgwater Bay takes place then there will be no gap in provision of necessary services. Improvements or better access: gaps in provision We note that all advanced services, apart from Appliance Use Reviews, are provided from pharmacies in the locality. We note that AURs are available in Bridgwater Bay from Distance Appliance Contractors, including one based in the Commissioning Locality. On the basis of the information we have, we do not assess there to be a current gap in other relevant services in Bridgwater Bay. The growth in population will not create demand for any entirely new service, although with the likely growth in the number of transient workers associated with Hinkley Point C we would urge Somerset County Council Public Health to ensure the continued availability of sexual health services through pharmacies. On the basis of the information we have, we do not assess there to be a future gap in other relevant services in Bridgwater Bay. 35
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