Community pharmacies are often the first port of call for women planning a pregnancy, pregnant women and mothers with children up to the age of 3 years[1–3]. Pharmacists can provide valuable preconception advice and support relating to diet, lifestyle and genetic and pre-existing conditions, that will ultimately help reduce the future burden on other healthcare services.
A pilot service, Pharmacy4Mums2B, was introduced in 30 community pharmacies in North West London between February 2018 and June 2019 to support these women, with the aim of reducing preterm birth, low birth weight, nutritional deficiencies, childhood infectious diseases and poor oral health, as well as maximising childhood growth and development. The service is therefore aligned with the World Health Organization policy of continuity of care in this critical period and the ‘NHS Long Term Plan’ to make greater use of the skills of community pharmacists[4–6].
Health profiles for North West London describe high deprivation; children aged under 16 years from low-income families; high rates of smoking and alcohol use; and a tooth decay rate in children above the London average.
National Institute for Health and Care Excellence (NICE) guidance recommends that antenatal booking should start from week ten of pregnancy, but studies show a significant number of women do not attend at this stage[8–10]. Community pharmacy is recognised as a place where expectant mothers, and mothers with children aged up to 3 years, could potentially receive a special package of care.
The Middlesex Group of Local Pharmaceutical Committees (LPCs) secured funding from Health Education North West London to set up a pilot in Brent, Harrow and Hillingdon. Objectives included improving the health of women from preconception until the birth of the child, and for the first 1,000 days; improving women’s knowledge at this crucial time; demonstrating that community pharmacies can be recognised as places to provide this support; and securing remuneration to extend the service.
In total, 35 pharmacists and 44 health champions attended in-person training provided by Imperial College London. The service registered 222 women, with many others receiving advice. The service was provided without remuneration for the pharmacists and support was provided by local midwives, antenatal clinic leads, health visitors, children’s commissioners and public health leads. Data collected was stored on the Sonar platform, with Sonar Informatics building a website specifically for the project, Pharmacy4Mums2B.
As part of the service, advice was provided on antenatal care (e.g. vitamin D and folic acid intake); vaccinations (e.g. flu, pertussis, MMR); diet and lifestyle (e.g. smoking); over-the-counter and prescribed therapy (e.g. for nausea); advice on feeding (e.g. breastfeeding and baby milk); oral hygiene; and vitamin supplements (e.g. through the Healthy Start vitamin programme).
A mixed methods approach was used for evaluation, with data recorded on the Pharmacy4Mums2B website during registration for client demographics and current practices. This was accompanied by questionnaires for clients and pharmacies.
Of the 222 women who registered, 49 completed the questionnaire, with 94% (n=46) indicating that the service was “very useful” or “useful” and that, without the service, 57% (n=28) would have gone to their GP. All participants indicated that they would recommend the service to others, with some indicating that they would rather access the service than seek healthcare elsewhere.
Overall, 17 pharmacists provided feedback via a questionnaire: 59% (n=10) felt that Pharmacy4mums2B had made a real difference to women using the service. Pharmacists and health champions, who completed training, demonstrated an improvement in knowledge on related health advice through completion of assessment. Knowledge in the former cohort improved from 28% to 81%, and from 33% to 78% in the latter.
An analysis of knowledge and perceptions of the women registered with the service and questionnaire responses found that the service has demonstrated potential to: reduce pressures on other healthcare providers, including GPs and maternity services; signpost women for early antenatal booking; improve neonatal outcomes; and reduce the financial burden on other healthcare services. For example, the average cost of a GP consultation is £30 and A&E attendance is £138[11,12]. In this scheme, savings made, if reported intentions were followed through, would be in the order of £1500.
Pharmacy4Mums2B provides an accessible service for expectant and new mothers, and children aged under 3 years. Women were given new, valuable health information and pharmacy teams increased their clinical knowledge. This service has the potential to reduce time and financial pressures on other healthcare services.
To extend the service to other areas, the service needs to be commissioned. The LPC is currently seeking funding support from commissioners. A copy of the full evaluation can be found here.
Vasundra Tailor, LPC consultant pharmacist, Middlesex Group of Local Pharmaceutical Committees; Michael Levitan, chief executive officer, Middlesex Group of Local Pharmaceutical Committees; Shivali Lakhani, LPC consultant pharmacist, Middlesex Group of Local Pharmaceutical Committees.
- 1NHS England. ‘Stay Well Pharmacy’ campaign. NHS England. 2018.https://www.england.nhs.uk/primary-care/pharmacy/stay-well-pharmacy-campaign/ (accessed 23 Apr 2021).
- 2Root G, Varney J. Pharmacy: A Way Forward for Public Health. Public Health England. 2017.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/643520/Pharmacy_a_way_forward_for_public_health.pdf (accessed 23 Apr 2021).
- 3Hassell K, Noyce PR, Rogers A, et al. A pathway to the GP: the pharmaceutical ‘consultation’ as a first port of call in primary health care. Family Practice 1997;14:498–502. doi:10.1093/fampra/14.6.498
- 4NHS England. NHS Long Term Plan. NHS England. 2019.https://www.longtermplan.nhs.uk/ (accessed 23 Apr 2021).
- 5NHS England. National Maternity Review. NHS England. 2015.https://www.england.nhs.uk/mat-transformation/implementing-better-births/mat-review/ (accessed 23 Apr 2021).
- 6World Health Organization. Care of the preterm and low-birth-weight newborn. World Health Organization. 2018.https://www.who.int/maternal_child_adolescent/newborns/prematurity/en/ (accessed 23 Apr 2021).
- 7Public Health England. Public Health Profiles. Public Health England. 2018.https://fingertips.phe.org.uk/search/oral%20health#page/0/gid/1/pat/6/par/E12000007/ati/102/iid/92785/age/1/sex/4/cid/4/tbm/1 (accessed 23 Apr 2021).
- 8Haddrill R, Jones GL, Mitchell CA, et al. Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy Childbirth 2014;14. doi:10.1186/1471-2393-14-207
- 9National Institute for Health and Care Excellence (NICE). Routine antenatal care for healthy pregnant women. National Institute for Health and Care Excellence (NICE). 2018.https://www.nice.org.uk/guidance/cg62/resources/routine-antenatal-care-for-healthy-pregnant-women-pdf-254938789573 (accessed 23 Mar 2021).
- 10Hollowell J, Oakley L, Vigurs C, et al. Increasing the early initiation of antenatal care by Black and Minority Ethnic women in the United Kingdom: a systematic review and mixed methods synthesis of women’s views and the literature on intervention effectiveness. . Oxford: National Perinatal Epidemiology Unit 2012. https://www.npeu.ox.ac.uk/assets/downloads/infant-mortality/Infant-Mortality—DIVA-final-report-Oct-2012.pdf (accessed 23 Apr 2021).
- 11NHS England. Missed GP appointments costing NHS millions. NHS England. 2019.https://www.england.nhs.uk/2019/01/missed-gp-appointments-costing-nhs-millions/ (accessed 23 Apr 2021).
- 12Department of Health. Reference costs 2015-2016. Department of Health. 2017.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/577083/Reference_Costs_2015-16.pdf (accessed 24 Mar 2021).