Equality impact assessments are public documents. Equality impact assessments accompanying reports going to county councillors for decisions are published with the committee papers on our website and are available in hard copy at the relevant meeting. To help people to find completed equality impact assessments we also publish them in the Equality and Diversity section of our website. This will help people to see for themselves how we have paid due regard in order to meet statutory requirements.
- Name of directorate and service area - Health and Adult services, Public Health
- Lead officer and contact details - Naomi Smith
- Names and roles of other people involved in carrying out the equality impact assessment - Dan Atkinson – Public Health Manager (Tobacco Control portfolio) Angela Hall – Public Health Manager (Substance Use portfolio) Naomi Smith – Head of Health and Adult services Planning, Project Sponsor Katya Coldwell – Project Manager Advice sought from Equalities specialists
- How will you pay due regard? e.g. working group, individual officer - continual review by project team
- When did the due regard process start? - May 2023 (Screening equality impact assessment)
Section 1. Please describe briefly what this equality impact assessment is about.
This equality impact assessment relates to the review of services and the procurement of new contracts for the provision of a number of Public Health Primary Care Services across North Yorkshire which provide vital local access to public health services, thereby improving and protecting population health. These local services relate to substance use, sexual health, tobacco control and NHS health checks. The current approved provider list arrangements with local General Practices (GPs) and community pharmacies expire on 31 March 2025.
Section 2. Why is this being proposed?
The purpose of this project is to review the provision of Public Health Primary Care Services across North Yorkshire. The current arrangements for providing public health primary care services for substance use, sexual health, tobacco control and NHS health checks were extended under the emergency Covid-19 regulations, however a procurement exercise must now be carried out to implement new contracts from 1 April 2025 and ensure continuity of provision for local residents. The new Primary Care contracts are being procured under the new Health Care Services (Provider Selection Regime) Regulations 2023 (the ‘PSR’), which came into force on 1 January 2024.
Mandated services are sexual health and NHS health checks. However, all services included in the project provide vital local access to high quality public health interventions as part of a wider system of support, thereby improving and protecting population health.
The proposals for the new contracts have been developed following an in-depth review of each service area. This was informed by a range of information including existing provision and coverage, base lining and benchmarking with other areas, national evidence and data, local performance information and feedback from the market and the wider local health system.
In the development of service specifications, consideration has been given to the quality of behaviour change interactions and its effectiveness, as well as ensuring that we reach our CORE20PLUS population groups to maximise impact on reducing health inequalities. A key priority across all service areas will be to maintain/increase coverage to ensure that residents across North Yorkshire can access provision within their local communities.
Tariffs for all services have been modelled based on previous activity, benchmarking against other areas, national requirements and feedback from the provider market. £100k savings are proposed from a total current investment of £1.8m from the public health grant across a range of budget lines, based on this modelling, whilst noting that these services are demand-led. Evidence base shows that all services provide a good return on investment across the wider public sector / health and care system – and are therefore a cost-effective use of public money.
The proposal is to procure services through Direct Award Option B under the Provider Selection Regime. This option requires the authority to direct award our requirements to all eligible providers (those who meet the qualification criteria, local requirements and satisfy the specification). Under Direct Award Option B, the pool of providers will be open for the full contract term, so providers can request to join at any point.
The key changes to service specifications/provision are outlined below.
Section 3. What will change? What will be different for customers and/or staff?
Sexual health
- No proposed changes to service delivery. Providers may change depending on the outcome of the procurement exercise
NHS health checks
- No proposed changes to service delivery. Providers may change depending on the outcome of the procurement exercise
Tobacco control
- North Yorkshire Council will no longer commission GP Practices or Community Pharmacies to provide support, advice and guidance on behalf of Living Well Smokefree. This is due to limited take up from providers in recent years and evidence of better outcomes being achieved by the Living Well Smokefree service, which will be further strengthened through forthcoming Smokefree Generation additional government funding (subject to appropriate grant decision-making). North Yorkshire Council’s Living Well Smokefree will continue to provide support for anyone wishing to stop smoking within North Yorkshire, which can be accessed directly or via a referral from a partner organisation (including primary care services). Other primary care services for tobacco control will still be in place, i.e. the customers will still be able to use their GPs as the first point of contact to be referred to the Living Well Smokefree service.
Substance use
- proposal to stop North Yorkshire Council funding for the ‘alcohol pharmacological abstinence therapy supervision service’ (‘alcohol stepdown service’). This service funds GP’s to offer time limited prescribing for people on their practice register who have completed a medically assisted alcohol withdrawal (detoxification) with the separate specialist adult drug and alcohol service – North Yorkshire Horizons – following referral from one of the North Yorkshire Horizons clinicians. These medications are clinically effective in preventing relapse and promoting sustained recovery, and national guidance recommends that these are available within locally commissioned arrangements. Only a small proportion of North Yorkshire practices are currently signed up to deliver the service (20), despite significant efforts by the Public Health Team, Local Medical Committee and former NHS Clinical Commissioning Groups to promote GP engagement with the service when it was established, which was supported by a bespoke training offer delivered through GP Protected Learning Time arrangements by the clinical provider within North Yorkshire Horizons. his proposal is contingent on North Yorkshire Council maturing a discussion with NHS integrated care board colleagues on the overall alcohol care offer – and reviewing and agreeing respective responsibilities/ co-commissioning arrangements - as part of the delivery of the draft NY Substance Use Strategy. The proposal to cease funding this offer will undoubtedly have an impact if executed without an alternative agreed pathway/ arrangement. North Yorkshire Horizons will have to absorb this prescribing, and this will impact on their clinical capacity to treat people. This will also potentially impact on the experience and outcome(s) for the person, as this pathway offers an opportunity to promote their engagement with their GP for wider healthcare support.
- in mitigation of the above, we are taking forward discussions with integrated care board colleagues to explore options for continued provision of prescribing within primary care and will review in June 2024.
The focus of the remaining sections of this equality impact assessment is on the services where there is a proposed change in offer/specification compared to current primary care services, namely tobacco control provision of stop smoking advice and substance use alcohol step down service.
Section 4. Involvement and consultation
A request for information questionnaire was published in Summer 2023 for the market to respond to. Eight responses were received, including seven from individual GP Practices and one from a GP Federation. These were considered as part of the in-depth review of each service area along with a range of information including existing provision and coverage, base lining and benchmarking with other areas, national evidence and data, local performance information and feedback from the wider local health system.
Further communication with the market will take place as procurement proceeds.
Stop smoking advice
Managers for the Living Well Smokefree service were included in discussions for the decision-making process around the approved provider list. This was to ensure that the service would be able to meet the additional demand of supporting the individuals who wish to stop smoking, but would no longer be able to access support or advice via their GP or local pharmacy.
This engagement has formed part of a wider programme of work with Living Well Smokefree linked to new funding that the government have announced to create a ‘Smokefree Generation’. Over the last few months work has been underway with staff, leaders and the local wider system to understand how best to implement this new funding, initially. The intention is to then, over the first year of funding, to work with the service to gather feedback, thoughts and views from those wishing to stop smoking to ensure that the service remains as accessible as possible.
Substance use (alcohol stepdown service)
The proposal is contingent on North Yorkshire Council maturing a discussion with integrated care board colleagues on the overall alcohol care offer – and reviewing and agreeing respective responsibilities/ co-commissioning arrangements - as part of the delivery of the draft North Yorkshire Substance Use Strategy. A representative of the North Yorkshire integrated care board has now been nominated so that discussions can progress, with support from the joint North Yorkshire integrated care board /Public Health Head of Population Health role. Work is also underway to ensure that the needs of populations covered by West Yorkshire integrated care board (Craven) and Lancashire and South Cumbria integrated care board (Bentham and Ingleton) are considered as part of this development.
Section 5. What impact will this proposal have on council budgets? Will it be cost neutral, have increased cost or reduce costs?
In total the transformation of the Primary Care Public Health Services aims to achieve a reduction in costs to the council of circa £100,000.
Section 6. How will this proposal affect people with protected characteristics?
Age
Make things better and make things worse
Why will it have this effect?
Living Well Smokefree service
Make things better. Digital offer will be available for all age groups, alongside the existing offer of face-to-face appointments. This hybrid offer will ensure a choice-based service offer that empowers anyone wishing to stop smoking with the opportunity to determine how they wish to engage with support.
Alcohol stepdown service
Make things worse if the pathway was no longer delivered in primary care - it could then impact on the experience and outcome(s) for older people as primary care pathway offers an opportunity to promote their engagement with their GP for wider healthcare support as older people are more likely to have other conditions and require holistic care. 44% of adults engaged with North Yorkshire Horizons for support with alcohol only in 2022-23 were over 50 (source: NDTMS.net - View It).
Make things better if we are able to develop agreed pathways delivered by a greater number of primary care providers in discussion with the integrated care boards.
Disability
Make things better and make things worse
Why will it have this effect?
Living Well Smokefree service
Make things better. Full hybrid offer (both digital and face-to-face appointments) of service delivery means that individuals can determine how they wish to access support to stop smoking from Living Well Smokefree. This digital offer for groups with disability issues may support where accessibility might be a challenge. Work is being done to enhance the range of community venues available to provide in-person clinics across North Yorkshire to mitigate any travel issues.
Alcohol stepdown service
Make things worse if the pathway was no longer delivered in primary care - it could then impact on the experience and outcome(s) for disabled people as primary care pathway offers an opportunity to promote their engagement with their GP for wider healthcare support as disabled people are more likely to have other conditions and require holistic care. In England, among people aged 15 to 49 years, alcohol is the leading cause of ill-health, disability, and death (source). Local people entering alcohol treatment in 21-22 were recorded as being more likely to be disabled (45% vs 29%. Source: NDTMS.net - Commissioning Support Packs – restricted access).
Make things better if we are able to develop agreed pathways delivered by a greater number of primary care providers in discussion with the integrated care boards
Sex
No impact
Why will it have this effect?
Living Well Smokefree service
Full hybrid offer (both digital and face-to-face appointments) of service deliver means that individuals can determine how they wish to access support to stop smoking from Living Well Smokefree. A range of community settings are utilised to provide accessible interventions across communities in North Yorkshire. Settings are chosen to be safe spaces. Priority population groups will be targeted as prevalence can be higher within these groups and can contributed to poorer health outcomes as a result.
Alcohol stepdown service
Other than the general impacts of the proposal which are outlined in section 3 above, there are no specific impacts identified for this group of the population based on protected characteristic. More men than women were engaged with North Yorkshire Horizons for support with alcohol only in 2022-23 (source: NDTMS.net - View It), however this does not necessarily mean that need is greater in men than women’s are typically under-represented in treatment service statistics nationally.
Race
No impact
Why will it have this effect?
Living Well Smokefree service
Full hybrid offer (both digital and face-to-face appointments) of service deliver means that individuals can determine how they wish to access support to stop smoking from Living Well Smokefree. A range of community settings are utilised to provide accessible interventions across communities in North Yorkshire. Settings are chosen to be safe spaces. Priority population groups will be targeted as prevalence can be higher within these groups and can contributed to poorer health outcomes as a result.
Alcohol stepdown service
Other than the general impacts of the proposal which are outlined in section 3 above, there are no specific impacts identified for this group of the population based on protected characteristic. More local people entering alcohol treatment in 21-22 were recorded as White British (95% vs 82%. Source: NDTMS.net - Commissioning Support Packs – restricted access).
Gender reassignment
No impact and make things worse
Why will it have this effect?
Living Well Smokefree service
Full hybrid offer (both digital and face-to-face appointments) of service deliver means that individuals can determine how they wish to access support to stop smoking from Living Well Smokefree. A range of community settings are utilised to provide accessible interventions across communities in North Yorkshire. Settings are chosen to be safe spaces. Priority population groups will be targeted as prevalence can be higher within these groups and can contributed to poorer health outcomes as a result.
Alcohol stepdown service
Make things worse if the added vulnerability relates to the need for holistic care for people who are more likely to have other healthcare needs (eg some Trans people who may be on hormone treatment)
Sexual orientation
No impact
Why will it have this effect?
Living Well Smokefree service
Full hybrid offer (both digital and face-to-face appointments) of service deliver means that individuals can determine how they wish to access support to stop smoking from Living Well Smokefree. A range of community settings are utilised to provide accessible interventions across communities in North Yorkshire. Settings are chosen to be safe spaces. Priority population groups will be targeted as prevalence can be higher within these groups and can contributed to poorer health outcomes as a result.
Alcohol stepdown service
Other than the general impacts of the proposal which are outlined in section 3 above, there are no specific impacts identified for this group of the population based on protected characteristic
Religion or belief
No impact
Why will it have this effect?
Living Well Smokefree service
Full hybrid offer (both digital and face-to-face appointments) of service deliver means that individuals can determine how they wish to access support to stop smoking from Living Well Smokefree. A range of community settings are utilised to provide accessible interventions across communities in North Yorkshire. Settings are chosen to be safe spaces. Priority population groups will be targeted as prevalence can be higher within these groups and can contributed to poorer health outcomes as a result.
Alcohol stepdown service
Other than the general impacts of the proposal which are outlined in section 3 above, there are no specific impacts identified for this group of the population based on protected characteristic
Pregnancy or maternity
Make things better and make things worse
Why will it have this effect?
Living Well Smokefree service
Make things better. Working across Humber and North Yorkshire within the centre for excellence, there are stronger links being forged between Living Well Smokefree and local NHS trusts. These local NHS trusts lead on the delivery of the long-term plan, which includes the development of the maternity offer. Living Well Smokefree will be one of the community delivery partners of this maternity offer moving forward.
Alcohol stepdown service
Make things worse if the pathway was no longer delivered in primary care - it could then impact on the experience and outcome(s) for the pregnancy/maternity category as primary care pathway offers an opportunity to promote their engagement with their GP for wider healthcare support.
Make things better if we are able to develop agreed pathways delivered by a greater number of primary care providers in discussion with the integrated care boards.
Marriage or partnership
No impact
Why will it have this effect?
Living Well Smokefree service
Full hybrid offer (both digital and face-to-face appointments) of service deliver means that individuals can determine how they wish to access support to stop smoking from Living Well Smokefree. A range of community settings are utilised to provide accessible interventions across communities in North Yorkshire. Settings are chosen to be safe spaces. Priority population groups will be targeted as prevalence can be higher within these groups and can contributed to poorer health outcomes as a result.
Alcohol stepdown service
Other than the general impacts of the proposal which are outlined in section 3 above, there are no specific impacts identified for this group of the population based on protected characteristic
Section 7. How will this proposal affect people who…
..live in a rural area?
Make things better and make things worse
Why will it have this effect?
Living Well Smokefree service
Make things better. The expansion of the Living Well Smokefree offer will include extra availability for remote sessions as well as in-person so providing more options for those living in rural areas to access the services.
Alcohol stepdown service
Make things worse if we can't secure ongoing primary care offer, this may impact people living in rural areas more, who would need to continue to travel to a North Yorkshire Horizons service location for this intervention
..have a low income?
Make things better and make things worse
Why will it have this effect?
Living Well Smokefree service
Make things better. The expansion of the Living Well Smokefree offer will include extra availability for remote sessions as well as in-person so providing more options for those living on low income to access the services.
Potential for telephone appointments rather than having to travel into GP surgeries, reducing travel costs.
Potential for use of council buildings which may be closer to home for some users.
Alcohol stepdown service
Make things worse if we can't secure ongoing primary care offer, this may impact people on a low income more, who would need to continue to travel to a North Yorkshire Horizons service location for this intervention
..are carers? (Unpaid family or friends)
Make things better and make things worse
Why will it have this effect?
Living Well Smokefree service
Make things better. The expansion of the Living Well Smokefree offer will include extra availability for remote sessions as well as in-person so providing more options for those with caring responsibilities to access the services, e.g. potential for telephone appointments rather than having to travel into GP surgeries.
Alcohol stepdown service
Make things worse if we can't secure ongoing primary care offer, this may impact people in the caring role if they or their loved one needs to travel (e.g. if they needed to find alternative support for their loved one, or if the loved one needed support from the carer to access a North Yorkshire Horizons service location for this intervention)
..are from the Armed Forces Community? (Unpaid family or friends)
No impact
Why will it have this effect?
Living Well Smokefree service
The service will be delivered via a hybrid model offering both digital and face to face interventions. A range of community settings are utilised to provide accessible interventions across communities in North Yorkshire. Settings are chosen to be safe spaces. Priority population groups will be targeted as prevalence can be higher within these groups and leads to poorer health outcomes as a result.
Alcohol stepdown service
Other than the general impacts of the proposal which are outlined in section 3 above, there are no specific impacts identified for this group of the population based on protected characteristic.
Section 8. Geographic impact
North Yorkshire wide
Living Well Smokefree service
Better reach through a combination of continuing with the face to face offer and developing a new digital offer
Alcohol stepdown service
Currently there is coverage (albeit low – 20 practices across the county are contracted to deliver this offer). We (North Yorkshire Council) are taking forward discussions with integrated care board colleagues to explore options for continued provision of this service within primary care across North Yorkshire.
Selby
Living Well Smokefree service: No GPs delivering in Selby, so expansion of Living Well Smokefree will be a positive for these residents.
Section 9. Will the proposal affect anyone more because of a combination of protected characteristics?
Living Well Smokefree service
No groups with a combination of protected characteristics will be affected. By offering more venues to access the service and a combination of fully accessible face to face and digital access, we will be enhancing the existing service, which will be more accessible to all groups regardless of their protected characteristics.
Substance use / Alcohol stepdown service
If we can't secure an ongoing primary care offer, this may impact on the experience and outcome(s) for people with a combination of protected characteristics, as primary care pathway offers an opportunity to promote their engagement with their GP for wider healthcare support (see section 6). We (North Yorkshire Council) are taking forward discussions with NHS integrated care board colleagues to explore options for continued provision of prescribing within primary care and will review in June 2024.
Section 10. Next steps to address the anticipated impact
No adverse impact - no major change needed to the proposal. There is no potential for discrimination or adverse impact identified.
Adverse impact - adjust the proposal - The equality impact assessment identifies potential problems or missed opportunities. We will change our proposal to reduce or remove these adverse impacts, or we will achieve our aim in another way which will not make things worse for people.
Explanation of why option has been chosen.
Living Well Smokefree service
Option 1. No potential for adverse impact; the service will be more accessible to all groups, including those with protected characteristics and the priority populations as has been outlined by the government.
Substance use
Option 2. Potential challenges identified but working with integrated care board partners to mitigate the impact and re-evaluate in June 2024.
Section 11. If the proposal is to be implemented how will you find out how it is really affecting people?
Living Well Smokefree service:
- regular project board meetings
- regular review meetings between Living Well Smokefree team and public health lead.
- service review meetings each quarter with Living Well Smokefree
- service user feedback / evaluation following engagement with Living Well Smokefree
- GP and pharmacy referral data.
Substance use:
- regular project board meetings
- regular briefings with directors of public health
- service and performance data
Section 12. Action plan.
Work with integrated care boards to establish alternative pathways/funding for primary care alcohol stepdown service to mitigate impact of proposed changes and review progress to confirm any further mitigations required.
Lead
Public health lead, Joint Strategic Lead for Health Inequalities
By when
June 2024
Progress
Colleagues within Humber and North Yorkshire Health integrated care board have been identified to begin discussions. Working to identify leads from other integrated care board areas.
Monitoring arrangements
Ensure specifications and performance monitoring arrangements include relevant data to monitor impact.
Lead
Public Health leads
By when
Legal review of specifications to be completed by 30 April 2024
Progress
Finalised specifications reviewed by procurement and sent to legal 21 March 2024
Monitoring arrangements
Procurement processes
Review geographical coverage of providers under the new arrangement and identify targeted action to address any issues with level of provision in particular geographical areas
Lead
Public Health leads, procurement
By when
Summer / autumn 2024
Progress
NA
Monitoring arrangements
Procurement processes and via project board
Ongoing monitoring of service performance data to review impact, and update equality impact assessment as required
Lead
Public Health leads
By when
From April 2025
Progress
NA
Monitoring arrangements
Performance reporting process
Section 13. Summary
Living Well Smokefree service
There is no potential for adverse impact; the service will be more accessible to all groups, including those with protected characteristics and the priority populations as has been outlined by the government. We will monitor the service delivery as outlined in section 11 and ensure we capture and mitigate any variation to this assessment.
Alcohol stepdown service / Substance Use
The proposal to stop North Yorkshire Council funding for the ‘alcohol pharmacological abstinence therapy supervision service’ (‘alcohol stepdown service’) is contingent on North Yorkshire Council maturing a discussion with integrated care board colleagues on the overall alcohol care offer. This is being addressed by Public Health Lead (Substance Use) and Strategic Lead Population Health and Inequalities, integrated care board. The mitigations outlined in section 3 will be reviewed in June 2024 and, if required, alternative arrangements will be considered.
Section 14. Sign off section
This full equality impact assessment was completed by:
Name:
Dan Atkinson – Public Health Manager (Tobacco Control portfolio)
Angela Hall – Public Health Manager (Substance Use portfolio)
Naomi Smith – Head of HAS Planning, Project Sponsor
Katya Coldwell – Project Manager
Advice sought from Equalities specialists
Completion date:
Authorised by relevant Assistant Director (signature): Louise Wallace, Director of Public Health
Date: 1 May 2024