Michael Holden
GOVERNMENTS in the UK and across the world are facing financial challenges, plus increased and ageing populations, and health inequalities. The need for cost effective treatment and keeping those who are ill out of hospital is a common theme and, with medicines being the most frequent clinical intervention, optimising the value of the effective use of those medicines as part of the system cost is increasingly a focus of attention, rather than just reducing their cost.
Pharmacies are an integral part of the community, and so are well placed to offer services that improve the public’s health and there is increasing evidence of the value of these interventions.
NHS England’s Five Year Forward View states:
“Helping patients get the right care, at the right time, in the right place, making more appropriate use of primary care, community mental health teams, ambulance services and community pharmacies”
However, we must also step up investment in prevention and protection measures to stop people becoming ill. This includes educating the public, supporting ownership of population and individual health, and offering accessible, effective interventions on healthy lifestyles, such as: smoking; healthy diet; physical activity; healthy weight; sexual health; alcohol and harm reduction; and vaccination services. To support this, the Five Year Forward View goes on to state that:
“The sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. The NHS will therefore now back hard-hitting national action on obesity, smoking, alcohol and other major health risks.”
Why Healthy Living Pharmacies?
Evaluations, of Healthy Living Pharmacies (HLP) to date demonstrate an increase in successful smoking quits, extensive delivery of alcohol brief interventions and advice, emergency contraception, targeted seasonal flu vaccinations, common ailments, NHS Health Checks, healthy diet, physical activity, healthy weight and pharmaceutical care services. The reports also indicate that the HLP model is working in areas with different demography and geography.
An example of improved pharmaceutical care is for people with asthma or COPD who had a medicines use review with their pharmacist. This identified a need for improved inhaler technique, and the majority of those who were smokers accepted help to stop smoking. Early data shows improvement of symptom control on return to the pharmacy six months later, and an impact on hospital admissions. The NHS Confederation has published Healthcare on the High Street with a number of pharmacy case studies.
Public Health England has committed their support for extending the role of community pharmacy in the delivery of public health services and accelerating the roll out of the HLP programme. Northern Ireland has adopted the principles of the model under its Health+ Pharmacy initiative and there is now increasing interest in the concept globally. The Local Government Association has published Community Pharmacy: Local government’s new public health role which contains a number of case studies.
The organisational development and ethos principles of HLP could also be applied to pharmacy in all areas of practise, other healthcare professionals and any worker who interfaces with the public.
What is a Healthy Living Pharmacy?
Healthy Living Pharmacy (HLP) is a concept that was initially developed in Portsmouth. The initiative has its origins in a Government ambition in the 2008 White Paper, Pharmacy in England: building on strengths, delivering the future. This policy document aimed to move community pharmacies from being just suppliers of medicines to become Healthy Living Centres providing self care advice and treatment for common ailments, healthy lifestyle interventions in addition to the safe supply and use of prescribed medicines.
There are currently over 1,850 HLPs either accredited or nearing accreditation in England and Public Health England has committed their support for extending the role of community pharmacy in the delivery of public health services and accelerating the roll out of the Healthy Living Pharmacy programme. Northern Ireland has adopted the principles of the model under its Health+ Pharmacy initiative and there is now increasing interest in the concept globally.
Pharmacies are well placed to support the health and wellbeing of the population due to their accessibility and the skills within the pharmacy team. HLPs have the public’s health at the heart of what they do and have a proven track record of delivering high quality self care and public health services such as smoking, obesity, sexual health, alcohol and harm reduction. By offering a range of high quality services, HLPs can contribute towards improving access to supported self care and to reducing health inequalities.
How does a community pharmacy become a Healthy Living Pharmacy?
Before being awarded the HLP ‘quality mark’ a pharmacy must have at least one qualified Health Champion and demonstrated that they meet a set of quality criteria which are set around workforce development, premises and engagement. The pharmacy also has to demonstrate consistent delivery of commissioned services to a high level, e.g. medicines support services and health improvement services.
A pharmacy must demonstrate a healthy living ethos and a proactive approach to health and self care before being issued their HLP status.
What are Health Champions?
Within a community pharmacy, Health Champions (HCs) are members of the pharmacy team who are trained and accredited to provide customers with health and wellbeing advice. The key role of an HC is to provide customers with information about their health and signpost them to other community services (such as commissioned NHS Enhanced Services) that will help them to adopt healthier lifestyles and access the support they need to do so. HCs have achieved the Royal Society for Public Health (RPSH) Understanding Health Improvement Level 2 award.
Why are Health Champions needed?
It is a key requirement for any pharmacy wishing to become an HLP to have at least one HC as part of their pharmacy team. However, if not an HLP, HCs can also effectively support recruitment into and delivery of many pharmacy services and local health promotion events. Evidence shows that this role is beneficial to the individual, the pharmacy and the population it serves.
Who can become a Health Champion?
Any member of the pharmacy team can become an HC. The HC training course will increase the communication skills of the individual and enable them to pro-actively enhance and promote health and wellbeing effectively. This can benefit the pharmacy business as well as the individual personally.
What training is available for Health Champions?
There are many national and local organisations that provide accredited HC courses including the core Royal Society for Public Health’s Understanding Health Improvement’ Level 2 qualification. This course consists of four modules followed by a Multiple Choice Question assessment:
• Inequalities in health
• How effective communication can support health messages
• Importance of promoting improvements in health and wellbeing
• Impact of behaviour change on health and wellbeing
In addition the RSPH offer other qualifications to further develop the skills and knowledge of a Health Champion.
What are the benefits to the health and public health systems?
70 per cent of people who visit pharmacies do not regularly access other health care services so HLPs can provide health and wellbeing support to people in their community. Improved choice and access to early interventions on issues such as common ailments, optimal medicines use, obesity, alcohol, sexual health and smoking could improve outcomes in the longer term and therefore positively impact cost of care in the future.
Michael Holden is principal consultant at MH Associates and a fellow of the Royal Pharmaceutical Society
Follow Michael @Michaelwsh