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Pharmacy health improvement services are recognised and should be expanded
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It is not only pharmacists working in community who are expected to
help the Government achieve its public health targets. Guidance published
by the Department of Health this week details how pharmacists in England
working in all areas of the profession can work together to improve the
health of our nation over the next 10 years.
“This strategy is about pharmacists and their staff in all NHS
sectors,” explains
Gul Root, principal pharmaceutical officer at the Department of Health, “in
the high street, in community pharmacies, in GP surgeries, in hospitals,
in primary care trusts and strategic health authorities.”
The issues highlighted in “Choosing health through pharmacy — a
programme for pharmaceutical public health 2005–2015” will
be familiar to most pharmacists, since they build on the priorities outlined
in the recent public health White Paper “Choosing
health” (PJ,
20 November 2004, p739).
However, the new programme, which has been jointly developed by the Royal
Pharmaceutical Society, the Faculty of Public Health, the UK Public Health
Association and PharmacyHealthLink, focuses specifically on the pharmacy
profession and how it can help, and in many cases already is helping,
to improve public health.
Using available evidence for pharmacy-based health improvement services,
the programme identifies health priorities for pharmacists and recommends
action points to tackle them. The pharmacist’s role in the management
of long-term conditions is also described, and recommendations are made
to implement and further this role at a local and national level.
Case studies of good practice are scattered throughout the document,
giving examples of pharmacists who are already actively involved in improving
public health.
“We hope that this strategy will provide the impetus for the wider
public health community to recognise what pharmacy can do to help improve
health
and reduce health inequalities and include pharmacy in their health improvement
programmes,” Mrs Root says.
The programme identifies 10 key roles for pharmacy in public health which
are based on the 10 key areas of pubic health practice as defined by
the Faculty of Public Health and Skills for Health (see Panel).
Key roles for pharmacy in public health
· Assessing the health and social needs
of the local community
· Acting as public health leaders in their communities
· Recognising all the key influences on health
· Being accessible to all
· Signposting to other services
· Delivering a range of health improvement services
· Working in active partnership with a range of health-promoting
services
· Supporting people with long-term conditions
· Protecting health through safe use of medicines
· Contributing to public health capacity at all levels |
Pharmacy in 2015
The programme outlines a vision of a pharmacy in
2015 in which the public is fully engaged in health issues. This
pharmacy:
· Is a primary source of information and advice
· Provides a range of health improvement services or makes space available
for them
· Identifies people with risk factors for disease
· Works in partnership with the local authority and voluntary organisations
· Is linked with schools, workplaces and other local settings
· Helps people take control of their own health and to shape the services they
need
· Improves the health of people with long-term conditions
· Makes best use of the extended pharmacy team
· Works in partnership with health organisations and the wider public health
community
· Uses a wide range of modern IT and communications technology |
Priorities for pharmacy
Public health priorities for pharmacy are listed in the programme.
These consist of targets previously outlined in the NHS
improvement plan (PJ, 3 July 2004, p5) for which pharmacy contribution is considered
to have a positive impact. Based on the strength of the available evidence
and the importance of the problem, the impact of pharmacy on each target
is classified as “major”, “moderate”, “considerable” or
of “some impact”.
Smoking The Government has pledged to reduce smoking rates to 21 per
cent or less by 2010. Pharmacy intervention is classified as having a
major health impact on smoking. The programme says that, in addition
to providing opportunistic advice, pharmacists should actively participate
in local and national stop-smoking campaigns and become one of the main
providers of specialist NHS stop-smoking services. Primary care trusts
are advised to consider setting up pharmacy-led quit services and it
is recommended that PCT pharmaceutical advisers and hospital chief pharmacists
should consider setting up patient group directions for the pharmacy
supply of nicotine replacement therapy and bupropion.
Heart disease, stroke and cancer National targets for 2010 are to reduce
mortality rates from heart disease and stroke in people aged under 75
years by at least 40 per cent, and reduce cancer mortality rates in this
group by at least 20 per cent. To help meet this target the programme
says that pharmacists should be a source of information and advice, partaking
in national or local campaigns and can undertake secondary prevention
or risk factor monitoring. PCTs are advised to consider involving community
pharmacies in their programmes for tackling obesity, including supply
of anti-obesity medicines where appropriate. The programme also says
that there may be benefits in pharmacists contributing to outreach weight
management programmes in schools and workplaces.
Teenage pregnancy Pharmacists can have a “considerable impact” in
helping achieve the Government’s target of a 50 per cent reduction
in the conception rate of those under the age of 18 by 2010, says the
programme. This includes the supply of emergency hormonal contraception
under patient group directions, the supply of condoms, provision of sexual
health advice, signposting patients to other sources of advice and participation
in screening programmes. The programme recommends that PCTs consider
commissioning sexual health services through pharmacy, particularly in
disadvantaged areas.
Medicines use The safe and effective use of medicines is another priority
for pharmacy that is classified as having a considerable impact on public
health. This includes the reporting of adverse drug reactions, medicines
use reviews and prescription intervention services.
Other priorities Services for substance misusers such as supervised methadone
consumption and needle and syringe exchange schemes are also priorities
for pharmacy that are classified as having a considerable impact on public
health, as are immunisation services. The pharmacist’s contribution
to immunisation services includes identifying and referring patients
for appropriate vaccines, offering floor space to other professionals
and, in the future, directly administering vaccines to patients.
Skin cancer prevention, reducing obesity among children, improvement
of outcome of people with long-term conditions, reduction in suicide
rates, asthma management, men’s health, children and young people
and reduction of harm from alcohol are also targets for pharmacy.
The programme says that health inequalities should be tackled by investment
in health improvement services in pharmacies in areas with the worst
health indicators.
“Working at the heart of the communities that they serve, pharmacists
are already doing a lot by supporting self care, giving healthy lifestyle
messages, and being involved in stop- smoking and emergency hormonal
contraception, and services for substance misusers,” says Mrs Root. “We
want to build on this excellent work to ensure that pharmacy is engaged
in such development across England. We would like pharmacy to start thinking
about how they can contribute to the wider determinants of health, especially
in deprived areas, where people do not access other health services.”
The concept of NHS-accredited health trainers was introduced in the public
health White Paper last year. The pharmaceutical programme suggests ways
in which pharmacists can support these trainers. These include putting
people in touch with the trainers, identifying local people who would
be suitable to train as a trainer or using the pharmacy premises for
the training sessions.
Jim McEwen, chairman of PharmacyHealthLink, commented: “The publication
of this strategy is just what pharmacy needs. For years our charity has
been producing evidence of the great work that pharmacists and their
staff have been doing in their communities to improve the public’s
health, but it has not been formally acknowledged in a national strategy,
until now.” He added: “These next few years will show a dramatic
change in the delivery of local health care so we will all need to work
in a far better joined-up environment if delivery is to be effective.
Many pharmacists have already done this and are significant players in
their local communities.”
How hospital pharmacists can contribute to
public health
The guidance notes that, according to the
Royal Pharmaceutical Society’s
workforce census, 22 per cent of pharmacists work in hospitals and
should be regarded as part of the “health-promoting NHS” workforce.
The guidance suggests that hospital pharmacists could expand their
public health roles in the future in the following ways:
· Expanding their role in offering patients information on making
healthy lifestyle choices, whether the patients are inpatients
or outpatients and during both admission and discharge processes
· Participating in public health interventions by clinical teams
and in long-term care pathways, for example cardiac rehabilitation
and diabetes management
· Participating in training offered by the hospital for health
professionals, such as stopping smoking and self care for long-term
conditions
· Leading on work with other NHS colleagues to offer advice and
support to NHS employees on making healthy lifestyle choices
· Providing outreach services, telephone help lines and health
information support for other professionals, patients and carers
· Liaising with, and providing appropriate follow-up to, community
and primary care-based pharmacy services to ensure seamless care
on discharge
The programme adds that hospital pharmacy design should include
the provision of space for confidential discussions and for the
display of information, including online access to information. |
Delivering the programme
According to the programme, a range of different skill mixes can be
used to achieve the goals for the next 10 years, with various combinations
of directly employed and shared staff.
“Individual pharmacists and their staff, trained to deliver specialist
services, such as stop-smoking or weight management, could be wholly
employed within the pharmacy, or shared between pharmacies, or shared
with the PCT, or with local primary care and hospital sectors,” it
says.
The guidance recommends that PCT specialists in pharmaceutical public
health and pharmaceutical advisers ensure that pharmacy staff in all
settings are aware of the importance of their public health role and
are included in public health development development programmes. “Pharmaceutical
advisers need to develop their leadership skills further to ensure their
visibility, and they should work closely with their directors of public
health and the wider public health team,” it advises.
The guidance also notes that “Standards for better health”,
a new performance framework being introduced by the Healthcare Commission,
includes public health as one of its standards and could therefore be
used as a platform to integrate pharmaceutical public health into PCTs’ delivery
plans.
PCTs are advised to review their public health teams and ensure that
pharmacy is included within their workforce development programmes.
The programme recommends that pharmaceutical public health training should
begin with the undergraduate curriculum, be closely linked with the Faculty
of Public Health and should feature strongly in continuing professional
development.
David Taylor, professor of pharmaceutical and public health policy at
the University of London School of Pharmacy, told The Journal that although
the new programme draws together a lot of valuable material and is good
starting point for the expansion of pharmacists’ public health
role, there remain concerns about where the funding will come from and
the cost effectiveness of some of the activities suggested. “There
are still major issues regarding the time and resources available to
undertake the activities recommended and their ultimate cost effectiveness,” he
points out. “The real test will perhaps be when the National Institute
for Clinical Excellence looks critically at the extent to which pharmaceutical
public health interventions provide good value for NHS money.”
Professor Taylor adds that there are still uncertainties about what members
of the public want from their pharmacists. “Many questions about
how the pharmacist’s role in community and other settings is going
to evolve, and the extent to which it can securely move away from the
direct dispensing of medicines, still need to be resolved.”
The full programme can be accessed here |
The
Pharmaceutical Journal