Since qualifying as a pharmacist in 2019, I have spent most of my career leading a large Boots pharmacy in the centre of Derby — a role that has required me to manage a busy dispensary and care services department, while leading the on-site COVID-19 vaccination centre.
Being born and raised in Derby, I know the city well and the challenges it faces: the city comprises wards that are in the 10% least deprived in the country, while conversely contains several wards that are within the top 10% most deprived. This translates into vast disparities. For example, a child born in the northern, affluent area of Allestree could expect to live up to 12 years longer than a child born in the Arboretum, which lies south of the city centre, according to Derby and Derbyshire’s Pharmaceutical Needs Assessment for 2022–2025.
Growing up and residing in the Arboretum area, I feel saddened knowing there is such inequality within my city, but there is work being done to close this gap.
The Derbyshire Health Inequalities Partnership (DHIP) was founded in 2020 to engage and consult with local communities on how to reduce health inequalities. The unique aspect of DHIP is that the board is a mix of public health officials and members of the local community, including myself and its co-chair Amjad Ashraf, a community leader who ensures that decisions are representative of the population.
During my time with DHIP, I have built a strong relationship with Community One, a local volunteer charity responsible for many initiatives, such as providing food for homeless people, culturally-tailored food banks, school holiday clubs and various sports sessions.
It is against this backdrop that I created the ‘Community Hypertension Outreach Programme’.
During the NHS’s drive to commission pharmacies to provide the ‘NHS community pharmacy hypertension case-finding service’, which was commissioned as an advanced service in October 2021, I noticed a common pattern. The service requires patients to actively come into a pharmacy to either ask for a blood pressure reading or for the pharmacy staff to ask patients if they would like one. However, it made me wonder about the demographic who will not enter a pharmacy out of reluctance, denial or lack of accessibility. Would people from Arboretum access this service? And, more specifically, as a British Pakistani myself, is the Pakistani community aware of this service?
While discussing my observations with Amjad at DHIP, we quickly realised that, to reach the target population, we would have to take the service to their doorstep.
The plan we devised aimed to provide blood pressure checks to Pakistani people aged over 40 years at Arboretum’s local Pakistan Community Centre over a 4-week period.
The service was aimed at not only taking the patients’ blood pressure readings, but also treating them holistically. This led us to create culturally-specific learning materials. Very often, NHS lifestyle advice is extremely broad and generic, so this was tailored to make it relatable to the South Asian community, such as suggesting healthy chapatti flour alternatives.
All information was presented to patients in English and Urdu, with leaflets offered in both languages. Posters advertising the service were created and distributed via social media and put up on local notice boards in mosques.
At each outreach session, a pharmacist offered to read patients’ blood pressure, followed by providing a consultation and referral, where appropriate. Once the blood pressure check was complete, a sports coach would lead 15 minutes of exercise, such as indoor football and yoga, which was aimed to educate patients on how to engage with realistic exercise they could replicate at home or in the park. We also provided each service user with a hot meal made with healthier alternatives, such as curry made with a healthier oil and chapattis made with wholegrain flour.
Over the four-week period, we conducted more than 300 blood pressure readings. Of these, just under 100 patients had never had their blood pressure read, while just over 30 patients had readings that meant they needed to be referred either to the GP or to a community pharmacy for ambulatory monitoring.
Looking back, one case stands out: every week, I would ask the same person at the community centre if he would like his reading conducted, but he was reluctant and refused. On the last week of the service, he agreed to having his reading done and had a reading of 150/100. When the patient was advised that he would need a referral for further monitoring, he was so glad he plucked up the courage to have his reading done. He also said he would never have gone to have his blood pressure measured had we not been in the Pakistan Community Centre.
An initiative of this nature would not be successful without the amazing work of individuals and collaboration of organisations. Alongside Amjad, the assistance of Alyssa Dela-Cruz, a trainee pharmacist, was pivotal in creating the learning materials and providing support at the clinic.
Overall, Derby still has a long way to go to reduce health inequalities; however, a difference is made one step at a time. Owing to the success of this initiative, the NHS Derby and Derbyshire Integrated Care Board is looking at how to roll out this service throughout the city. The notion of pop-up hypertension centres across Derby is something I would be extremely proud to see.