| With Scotland’s reputation as “the sick man of Europe”,
it is no surprise that public health is a big issue for the Scottish
Executive. A quick search of the executive’s website reveals hundreds
of targets relating to public health.
And there are signs that things are beginning to turn around — not
least since the ban on smoking in enclosed public places in March 2006,
which has resulted in an increased number of smokers asking for help
to quit. In a recent report on health improvement in Scotland, health
minister Andy Kerr described the ban as “the single biggest advance
in public health in a decade”. He added: “There is now a
real sense of optimism about the future and our ability to change our
nation’s health for the better.”
Where does this leave pharmacy? The commitment to public health is demonstrated
within the new community pharmacy contract in Scotland. One of its four
core services is a public health service (PHS). This comprises two tiers:
the basic service, which all pharmacies have to provide, and an optional
second tier. The basic service involves adopting a health promoting philosophy,
taking part in national health promotion campaigns and providing health
promotion materials. The second tier involves using pharmacy windows
or shop frontages to display health promotion messages. Details of how
this will work are still being negotiated.
But pharmacy’s role does not end there. Many pharmacists are involved
in local initiatives and it is two of these schemes that this article
will examine. There are many more, some of which are outlined in NHS
Education for Scotland’s recent publication “Flavours of
pharmaceutical public health”,1 a distance learning package. One
Scottish Executive initiative that is currently getting going is “Prevention
2010”. Its aim is to prevent ill health through screening in areas
with deprived populations.
Such initiatives demonstrate pharmacy’s value in public health.
However, some health boards are not involving pharmacists in even the
most basic public health services like smoking cessation or emergency
hormonal contraception. This results in a patchy service and frustrated
pharmacists. One way around the problem would be to incorporate these
roles into PHS. Otherwise, the Scottish Executive must find a way to
ensure better service provision across Scotland.
Healthy North Ayrshire
In North Ayrshire, health “MOTs” have been provided through
community pharmacies since April 2006. The programme is about primary
prevention of ill health and targets 15 postcode areas with deprived
populations.
Elaine Ward, programme pharmacist, Healthy North Ayrshire, explains that
the MOT involves two parts. First, a structured questionnaire which examines
lifestyle issues like smoking, diet, exercise, family history, current
physical health and mental health. Second, blood pressure is measured,
and
fingerprick blood tests are conducted for
glucose and cholesterol. “All of the information is taken together
to calculate cardiovascular risk,” she explains. One of the keys
to the service’s success is the involvement of the entire pharmacy
team. “Pharmacy assistants are trained to carry out the vast majority
of the work with the pharmacist coming in at the end to provide the clinical
input,” she adds.
Every patient who has an MOT is given individualised lifestyle advice.
Some, depending on the results of the assessment, are referred to other
services. These can include referral to a GP (eg, patients with hypertension
or high risk of cardiovascular disease), to a pharmacy-based smoking
cessation service, to a leisure centre (with vouchers to reduce the costs
of using the facilities) or to a commercial slimming club (with vouchers).
This month sees the launch of a new weight management service from community
pharmacies. It will involve lifestyle advice, a reduced calorie diet
and regular weighing for three months then, if weight loss has not been
achieved, the addition of drug therapy (orlistat) by the pharmacist via
a patient group direction.
How did Healthy North Ayrshire get started? William Malcolm, specialist
in pharmaceutical public health, NHS Ayrshire and Arran, explains that
the funding came from “regeneration money” rather than health
funding. “One of the principle objectives of regeneration is to
improve health,” he says. The pharmacy scheme fits into North Ayrshire
Community Planning Partnership’s regeneration plan and, as a result,
has secured ring-fenced funding for three years. “I was of the
opinion that community pharmacy could contribute a great deal since pharmacies
are at the heart of communities and have a different relationship with
the public than other parts of the NHS,” says Mr Malcolm.
Pharmacists and staff each received five days’ training, with costs
to replace the workforce paid. Pharmacies are paid £40 per MOT,
which each takes 20 to 30 minutes to complete. So far, 700 MOTs have
been provided through 22 pharmacies. Figures to December 2006 show that
there had been 57 referrals to GPs for blood pressure management, 54
for lipid management and 23 for raised glucose. Smoking cessation services
received 97 referrals, leisure centres 103 and weight management 95 referrals.
In addition, 81 patients were given books about mental health. Sexual health services in Fife
Sexual health is another topic high on the public health agenda, and
it is something in which a number of Scottish pharmacists are playing
a growing role. One such pharmacist is Peter Cook, of Robertson Chemists,
Dunfermline. He explains: “We started by offering emergency hormonal
contraception via a patient group direction. It was primarily to target
teenage pregnancy, although it is open to all women. Then we opportunistically
tagged on to that free chlamydia screening for anyone aged under 25
years.” The next step — which is expected to happen within
the next few months — is to make the chlamydia testing available
as a stand-alone service so that anyone, particularly young men, can
access it.
Jane Appleton, of nearby Co-op Pharmacy in Abbeyview, Dunfermline,
adds: “What
surprised me was the number of women who know very little about their
menstrual cycle. So EHC consultations provide an opportunity to talk
to them not just about contraception but also about their cycle in general.” Free
condoms can be provided as part of the service. The EHC service is now
well established, having been offered for five years. Pharmacists are
paid £17 per consultation, plus £5 if a pregnancy test is
required plus £5 if EHC is supplied.
If someone opts to have chlamydia testing, the pharmacist issues a urine
sample bottle and asks the patient to return it to the pharmacy. It is
then sent to a laboratory in Fife for testing. The patient can either
get the results from the pharmacy, or from the local genitourinary medicine
clinic.
“In our experience, all patients want to come back to the pharmacy
because it is accessible and there is no stigma attached,” says Mr
Cook. If the result is positive, the pharmacist can provide antibiotic
treatment
(azithromycin or erythromycin) via a patient group direction. Pharmacists
are paid £5 for initiating a test, and £10 for providing
the result and treatment (plus reimbursement for drug costs).
These services show how valuable pharmacy is in public health: now is
the time to see that recognised across Scotland.
Reference
1. NHS Education for Scotland. Flavours
of pharmaceutical public health |
The
Pharmaceutical Journal