Key points
1. Public health has moved up the health agenda in
the past couple of years
2. Promoting healthy lifestyles is an essential service in the
new contract. It will include providing opportunistic advice
and involvement
in public health campaigns
3. The signposting essential service will involve referring patients
to a health or social care provider, or another appropriate organisation
4. The support for self-care essential service will involve providing
advice about conditions, non-prescription medicines and lifestyle
5. Records will need to be made of all clinically significant interventions
made as part of these three essential services |
Public health has moved up the agenda in the past few years. So it should
come as no surprise that one of the essential services in the new community
pharmacy contract is “promotion of healthy lifestyles”. Linked
to public health are two other essential services: signposting and support
for self-care. All three are covered in this article.
A White Paper on public health is expected to be published this autumn.
It will be followed next year by a specific pharmaceutical public health
strategy which is expected to develop the themes identified in the
White Paper. The strategy is being developed for the Department of Health
by Pharmacy Health Link, the Royal Pharmaceutical Society, the Faculty
of Public Health and the UK Public Health Association (PJ, 19 June, p761).
In the meantime, one resource that pharmacists might find useful is “Public
health: a practical guide for community pharmacists” jointly produced
by the Pharmaceutical Services Negotiating Committee, the National Pharmaceutical
Association, the Society and Pharmacy Health Link. It can be downloaded
from each of the organisations’ websites.
Promotion of healthy lifestyles
The public health essential service is formed of two components: first,
the provision of
opportunistic advice to patients obtaining prescriptions from the pharmacy
and, second, involvement in public health campaigns.
The aim of this service is to increase public knowledge about key healthy
lifestyle messages. In particular, it is hoped that it will target the “hard
to reach” sectors of the population who are not frequently exposed
to health and social services so might miss health promotion activities.
Under the prescription-linked intervention part of the service, pharmacists
and
pharmacy staff will be expected to give opportunistic advice on specified
public health topics to patients presenting prescriptions. This advice
will be given verbally but could also be backed up with written information,
eg, leaflets, if appropriate. It might also be necessary to refer the patient
to another
health professional or organisation.
Advice given will need to be recorded on the patient’s record held
at the pharmacy. The need for records is two-fold: for follow-up with the
patient and for audit purposes.
The public health topics about which pharmacists will be expected to provide
information are still being finalised but they are likely to include some,
if not all, of the following examples. Smoking cessation is an obvious
area of advice for pharmacists, and this could be targeted at pregnant
women, at those at high risk of coronary heart disease and at young people.
Another topic is reducing CHD risk factors, again targeted at those at
particular risk. Providing advice about obesity and healthy diet presents
many opportunities, for example, highlighting messages such as eating five
portions of fruit and vegetables a day, increasing physical activity,
reducing salt intake and limiting alcohol consumption. Advice on these
topics could be given to people who are overweight, particularly those
who already have other risk factors. A further possibility is advising
people about the need for influenza immunisation.
Pharmacists will also be expected to take part in national and local public
health campaigns. The campaign topics will be decided by primary care trusts,
which will provide support such as briefing packs and patient
literature for the campaigns. During the campaign periods, pharmacists
and pharmacy staff will have to be pro-active in providing public health
information to both patients and
general visitors to the pharmacy. Provision of written information and
in-store displays might also be necessary.
The number of weeks per year that a pharmacy will be expected to participate
in these campaigns is still being finalised. Signposting
Pharmacists already refer people to other health professionals or organisations
and this role is to be formalised as an essential service in the new
contract.
The service will mean that if the pharmacy is unable to provide the support,
advice or treatment that is required, the pharmacy staff will refer the
person to a health or social care provider, or another appropriate organisation
such as a patient group. It might be considered appropriate to provide
written referral notes. If the patient is known at the pharmacy, and the
pharmacist deems the referral to be of clinical significance, then the
referral will be recorded in the patient’s record at the pharmacy.
PCTs will be expected to provide pharmacies with the contact details of
health and social care providers and local patient support groups to whom
patients can be referred. Support for self-care
One of pharmacists’ key roles is to provide patients with advice
and support to enable self-care. It, too, is to be formalised as an
essential service in the new contract.
Through this service, pharmacy staff will provide advice to patients
and carers who
request help with the self-treatment of minor illness and chronic conditions.
This includes providing general information about the management of the
condition. In addition, and when appropriate, advice should be given
about the use of non-prescription medicines. The final part of the advisory
role
will be
to make interventions to promote healthy lifestyles, in a similar manner
to the public health essential service described earlier in this article.
It is expected that both NHS Direct and other health professionals will
refer patients to the pharmacy for self-care advice. And, as for the
signposting service, pharmacy staff will refer patients who need additional
help to
other care providers when appropriate.
If the patient is known at the pharmacy, and the pharmacist considers
the interventions made to be clinical significant, then a record of advice
given, products purchased or referrals made should be added to the
patient’s record at the pharmacy.
Case study: public health
Greenlight Pharmacy in north London has always
had a public health focus. Pharmacist John Foreman explains: “It
was our vision right from the beginning five years ago to use the
pharmacy to deliver
public health.”
Greenlight started with a smoking cessation service followed by adult
education seminars, initially on diabetes and coronary heart disease.
Now the pharmacy offers lifestyle risk assessment and a specific
public health assistant is based at the pharmacy. All the pharmacy
technicians have undertaken a public health training course.
Mr Foreman’s advice to pharmacists is to look at the human
resource requirements needed to deliver public health, in terms of
both training and staff time. “A good exercise to do now is
to think about the public health message you could give every time
you give a prescription out,” he says. |
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The
Pharmaceutical Journal