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Key public health messages should be promoted by pharmacists
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Guide for pharmacists
A public health guide for community pharmacists,
produced by the Pharmaceutical Services Negotiating Committee,
National Pharmaceutical
Association, Royal Pharmaceutical Society and PharmacyHealthLink
is available on each of the consortium members’ website (PDF 1MB). |
Pharmacists have real opportunities to offer health messages and advice
on
issues such as diet and smoking, and how people can look after their
own ailments, since they work in the heart of the communities they serve.
So states the Government’s White Paper on improving public health
in England, “Choosing health”, published this week. However,
pharmacists will have to wait for the launch of the Department of Health’s
pharmaceutical public health strategy early next year for a more detailed
picture of how their future role in public health will develop.
Informed patient choice and addressing health inequalities are key themes
in the White Paper, as is multidisciplinary working. The paper states: “Real
progress depends on effective partnerships across communities, including
local government, the NHS, business, advertisers, retailers, the voluntary
sector, communities, the media, faith organisations and many others.”
The paper details the Government’s plans to improve the health
of England, focusing in particular on the following issues.
Smoking The Government says that it intends
to introduce smoke-free places through a staged approach. By the end
of 2006, all Government departments and the NHS will be smoke free.
By the end of 2007, all enclosed public places and workplaces, other
than licensed premises and those specifically exempt will, subject
to legislation, be smoke-free. By 2008 arrangements will be in place
to ban smoking in restaurants and all bars and public houses preparing
and serving food. The Government also wants to widen the use and availability
of nicotine replacement therapy and aims to reduce the number of smokers
in England by 2 million by 2010.
Sexual health The White Paper promises new funding to modernise NHS
sexual health services, making them more accessible and providing faster
access to treatment. It says that by March 2007 a national screening
programme for chlamydia will cover all areas of England and, by 2008,
patients referred to a genitourinary medicine clinic will be able to
have an appointment within 48 hours. It says that in the future sexual
health services will be delivered through a flexible multidisciplinary
workforce in a range of settings and calls for the extension of the roles
of other health workers, including pharmacists, to include elements of
sexual health.
Obesity By 2007 the National Institute for Clinical Excellence will produce
guidance on the prevention, identification and treatment of obesity.
The Government says it will develop support tools for NHS staff to assess
risk in overweight people and provide guidance, and will work with the
independent sector to develop alternative approaches in behaviour change.
The Government has set a target to halt year-on-year obesity among children
aged under 11 years by 2010.
Alcohol The Government says that it will build on the Alcohol Harm Reduction
Strategy for England by ensuring that professionals receive more training
to enable them to identify alcohol problems early. It will pilot targeted
screening approaches in primary care and hospital settings, and ensure
that alcohol treatment needs are met alongside drug misuse treatment
needs in people who come before the courts. The Government also intends
to develop a new campaign to tackle the problems of binge drinking and
ensure that appropriate information is placed on alcohol containers and
in outlets selling alcohol. Reminders about responsible drinking will
appear on alcohol advertisements.
Mental health The Department of Health will work through the National
Institute for Mental Health in England to support people with mental
health problems with employment and mainstream social contact. New approaches
will be developed to help people with mental illness manage their own
care. More information will be made available to these people on all
aspects of health.
Greenlight’s contribution highlighted
in White Paper
The Government says in the public health White
Paper that it will put in place measures which make the most
of the contribution that
pharmacists can make. “The strategy for pharmaceutical public
health, to be published in 2005, will demonstrate how pharmacists
and their staff can contribute to improving health and reduce inequalities
and how we can develop new services in the places they work,” it
adds.
There are, of course, many examples of pharmacists already making
a positive
contribution to public health (PJ, 19 June, p761).
The White Paper uses such a pharmacy in one of its examples of
good
practice. Under the heading of “meeting demand for health
by providing convenient services”, Greenlight Pharmacy in
Euston, London, is singled out for transforming its basement into
a local health education and meeting centre for local ethnic minority
populations. The pharmacy provides regular
health education sessions to the Bangladeshi community, including regular smoking cessation
services (PJ, 21 July 2001, p77). |
The White Paper states: “Every member of NHS staff has the potential
to increase their role in raising people’s awareness of the benefits
of healthy living — as part of the wider NHS responsibility to
patients to improve health, not just provide healthcare for the sick.” It
says that NHS staff are among the most respected and valued people in
England, whom people trust and listen to.
The Government therefore pledges to support NHS staff to make the most
of this opportunity. “We will develop a National Health Competency
Framework, which will include new programmes to give NHS staff the training
and support they need to develop their understanding and skills in promoting
health,” it says.
David Pruce, director of practice and quality improvement at the Royal
Pharmaceutical Society, said: “Public health needs pharmacy if
it is to meet the enormous challenges that the NHS is facing. Pharmacists
are already developing innovative ways in which they can improve the
health of the people in England, Scotland and Wales. We must continue
to utilise this expertise and support the NHS at a local and national
level.”
For example, health screening is becoming increasingly common in community
pharmacies, although the White Paper points out that inequalities exist
in the type of people who come forward for these tests. “Primary
care trusts will need to use health equity audits to build a better understanding
of why some people or groups of people are less likely to use the range
of available opportunities for screening and then act to promote take
up,” it says.
The White Paper also acknowledges that the new pharmacy contract will
reflect the public health role of pharmacists both within the essential
services component that all pharmacists will provide and the locally
commissioned enhanced services.
Other priorities in the paper include better food labelling, so that
by the beginning of 2006 people will be able to understand at a glance
which foods will, or will not, make a positive contribution to a healthy
diet. By 2007 the Government also intends to have secured a strategy
to restrict the advertising and promotion to children of food and drinks
that are high in fat, salt and sugar.
The paper introduces the idea of NHS-accredited health trainers who will
provide advice and practical support to members of the public on how
they can look after their own health.
This will include advice on healthy eating, practising safe sex, dealing
with stress and tackling social isolation. These trainers will also help
people access support from their local community or from specialised
services such as NHS smoking cessation services.
The trainers will come from the local community and work as part of the
NHS primary care service. The Government will provide a national core
curriculum and training modules to ensure standardisation, although the
arrangements for the precise role of the trainer will differ in different
communities.
In addition, a new health information service, Health Direct, will be
available from 2007 and will provide links to existing services.
The White Paper can be accessed here
Coinciding with the launch of the White Paper is the development of the
Department of Health’s pharmaceutical public health strategy, the
final version of which is expected to be launched early next year (see
Panel below).
What the draft pharmaceutical public health strategy has in store
for pharmacists
Jointly developed by PharmacyHealthLink, the
Royal Pharmaceutical Society, the Faculty of Public Health and
the UK Public Health Association,
the pharmaceutical public health strategy is currently in draft form
and is expected to build on the momentum generated by the White Paper, “Choosing
health”.
Speaking at a conference in London just before the launch of the
White Paper, Jenny Griffiths, project director for the Department
of Health strategy, outlined the draft contents, but noted that its
detail and structure may change depending on the focus of the White
Paper.
The current draft is split into five sections: aims and purpose of
the strategy; understanding public health and pharmacy; pharmacy
as a major public health resource; framework for action; and key
recommendations.
According to Ms Griffiths the heart of the strategy is the third
section, pharmacy as a major public health resource. She explained
that it comments on the importance of balance in the role of pharmacy
between individual choice and a population-based approach. It is
also important to ensure that the public are more aware of the role
pharmacists have in the provision of health advice.
The evidence-base for effective pharmaceutical public health interventions
will be updated for the strategy and although it will concentrate
in particular on community pharmacy, Ms Griffiths pointed out that
it is transferable to the hospital sector. The rest of this section
will flag key roles for each sector for each issue.
Public health priorities for pharmacy are outlined under the headings “health
protection” (which includes safety of medicines, pharmaceutical
health surveillance and influenza immunisation) and “secondary/tertiary
prevention” (including a systemic approach to care for people
with long-term conditions building on national service frameworks
and National Institute for Clinical Excellence guidelines). There
are specific sections on coronary heart disease and diabetes.
Under the heading of health improvement, priorities for pharmacy
are listed as: smoking cessation services; sexual health; services
for substance misusers; weight reduction; health literacy and education;
community development through partnerships; and factors influencing
wider determinants of health (such as debt advice and fuel poverty
referrals).
The section on framework for action covers key implementation issues
under the following headings: local leadership and support; human
resources management; education and training; regulation and recognition;
finance; IT; premises/performance management; and evaluation, research
and development. For each heading the document will outline why the
issue is important, the key messages and an action plan.
Ms Griffiths stressed that the strategy is a 10-year plan. To summarise
the key steps to a fully engaged health-promoting pharmacy in 2005–15
the draft is likely to outline the following advice:
· Recognise your current contribution, implement the new community
pharmacy contract, build local relationships
· Tackle major health improvement priorities at individual and population
level
· Become the main provider of health education, offer a choice of
other services
Also being developed for the strategy are 10 “key roles for
pharmacy in public health” which aim to match the Department
of Health’s Vision
for Pharmacy (PJ, 26 July 2003, p111). The
roles as they stand in the draft are as follows:
· Be involved in needs assessment
· Recognise all the key influences on health
· Work in partnership with other agencies
· Involve users in planning and evaluating services
· Communicate health information clearly and promote health literacy
· Protect health through promotion of safe use of medicines
· Work with primary care teams on long-term conditions
· Act as an advocate on behalf of others on health issues
· Take systematic action on some of the major health priorities
· Ensure you are trained and evaluate your services
Following consultation with various focus groups including pharmaceutical
advisers, primary care trusts, hospital pharmacists and public health
representatives, the draft strategy is expected to be presented to
ministers next month. |
Jim Smith, chief pharmaceutical officer for England, says
that the public health strategy will provide huge benefits for pharmacists
and for the
Government. “For pharmacy it is a historic opportunity to take
a central role in public health and further enhance the professional
role of its staff. On the Government’s side it is an opportunity
to tap that resource and use those skills to improve public health,” he
says.
Dr Smith adds: “For the first time ever a substantial public health
role is built into the new pharmacy contract, and it is an essential
service. It is a fairly modest start, but a significant one.”
David Hunter, chairman of the UK Public Health Association, says that
the interface between the public health workforce and pharmacy is underdeveloped. “We
need to build on this and encourage the development of community-based
partnerships in which primary care trusts are major players.” He
adds: “Pharmacy needs to take its place with other bodies responsible
for public health.” |
The
Pharmaceutical Journal