A whole range of interventions that could be delivered by pharmacy teams in the primary and community sectors to improve the health of the public in England has been set out in a report
, published on 6 September, by Public Health England (PHE).
The aim of the report, ‘Pharmacy — a way forward for public health’, is to highlight to commissioners the roles that pharmacy can play and encourage commissioners to consider pharmacy, particularly community pharmacies that have achieved Healthy Living status, and pharmacists based in primary care.
Many community pharmacies are already commissioned by local authorities to deliver public health services, including weight management, substance misuse, alcohol interventions, chlamydia screening and treatment, emergency hormonal contraception, falls prevention, stop smoking and NHS Health Check. But concerns have been expressed about a fall in commissioning of pharmacies by local authorities in particular, due to public health cuts. And at this month’s RPS conference a call was made for community pharmacy-led sexual health services to be commissioned nationally.
“Community pharmacy teams are often the public’s first and sometimes only contact with a healthcare professional, especially for deprived communities,” the report emphasises. It adds that 30% of local authorities are commissioning NHS Health Check programme from community pharmacies “and there is clear potential to scale up this approach”, and that “there is increasing interest from the sector to take on a greater role in improving the public’s health”.
Community pharmacy teams are well placed to support patients with long-term conditions collecting prescribed medication to reduce their risks through healthy behaviours, and encourage wider behaviour change across the population through brief interventions, the report says.
Five year forward commitment
NHS England’s ‘Five year forward view’, published in 2014, recognised the potential for pharmacy, highlighting that there should be far greater use of pharmacists in prevention of ill-health, support to self care for minor ailments and long-term conditions, and as part of more integrated local care models. Subsequently, it committed to integrate 1,500 patient-facing pharmacists in general practice by 2020–2021, which the PHE report says “provides further opportunities for these pharmacists to embed public health interventions in their daily practice, especially when dealing with people with long-term conditions”.
The report also suggests that local authorities should consider commissioning more services from Healthy Living Pharmacies, which are accredited through a profession-led self-assessment process led by PHE. Since level 1 status was linked to the quality payment scheme in the revised pharmacy contract, the number of pharmacies accredited or seeking to be accredited has increased from 2,100 to more than 4,000, and the expectation is that the number will again increase significantly at the second assessment point in November this year.
While welcoming “Public Health England’s renewed recognition of the important role pharmacists play in improving the health and wellbeing of patients and the public”, Robbie Turner, Royal Pharmaceutical Society director for England, said: “We remain to be convinced that this report will result in an increase in the services commissioned to be delivered by pharmacists working in general practice or community pharmacies. Our members are reporting that local authorities are decommissioning public health service from pharmacies.”
He added: “We’d like to see PHE using its influence to ensure that the decline in commissioned pharmacy public health services is reversed and look forward to working with them to accomplish this.”
PHE’s report does not require or recommend any national delivery of services or funding. It has been produced to take stock of the opportunities within the sector, and prompt local areas and pharmacies to review the way in which they currently contribute to health improvement, and where they could use their knowledge and expertise to make a difference, a spokesman for PHE said.
Gul Root, lead public health pharmacist at PHE, said: “Pharmacy teams are one of the most accessible health professionals with 1.2 million health-related visits every day to a community pharmacy and pharmacists working in GP surgeries. This new PHE report sets out opportunities for how pharmacy teams in the primary and community sectors can play an even bigger part in helping the public better look after their health.”
Ian Strachan, National Pharmacy Association chairman, said: “We welcome this document, which thoroughly describes pharmacy’s public health role and our potential. Public Health England recognises that community pharmacy is the most accessible part of the NHS, including in deprived areas.
“Because of the footfall in local pharmacies and the fact that care is delivered face to face, there is a huge potential health gain from making every contact count. Health improvement advice cannot be delivered in a jiffy bag, and this is one reason why a thriving network of local community pharmacies — as distinct from online medicines suppliers — is particularly important to the nation’s wellbeing.”