Pharmacy playing a pivotal role in prevention and public health

Pharmacy teams working in all sectors have an important role to play in prevention and embedding public health practice in their everyday roles, says Gul Root. In this article he explains how pharmacists can play a transformative role in improving public health

This is an edited version of an article that first appeared on the Public Health Matters website.

Community pharmacies are one of the most frequented health care settings in England, with 1.2 million health-related visits every day. With their presence in most high streets, many rural communities, and in the places where we shop, access healthcare and enjoy our leisure time, community pharmacies are a local health and social asset interwoven with our daily lives in a way that few other professions can claim.

Pharmacy teams working in all sectors have an important role to play in prevention and embedding public health practice in their everyday role. Their importance was re-emphasised in the NHS Long Term Plan, which refers to the ‘essential role’ of pharmacists in delivering the various initiatives it proposes for the next ten years.

What are opportunistic interventions?

Alongside their role in optimising the use of medicines, community pharmacy teams are increasingly delivering a wide range of public health interventions, from stopping smoking to sexual health services, alcohol interventions, ‘flu immunisations and more.

There are now more than 9,500 Healthy Living Pharmacies (HLPs) in England. One of their key distinctions is having a qualified ‘health champion’ on site, who uses every interaction as an opportunity for a health-promoting intervention. This approach of ‘Making Every Contact Count’ (MECC) can improve and protect health, reduce premature mortality and help to reduce health inequalities.

This article explores how pharmacy teams can play a role in prevention through opportunistic interventions and commissioned services in relation to six public health challenges.

1. Cardiovascular disease (CVD)

The NHS Health Check is a check-up for adults aged 40-74 in England, designed to spot early signs of heart disease, stroke, kidney disease, type 2 diabetes or dementia.

Whilst the programme is mostly provided in primary medical care settings, community pharmacy teams can also deliver these checks, particularly for hard-to-reach groups that may not access GP practices. Pharmacy teams can also help to maximise the programme’s impact by:

• directing eligible people for a check if the service is not available on site;
• providing lifestyle interventions to people who have had a check, or those with moderate-to-high blood pressure;
• directing people to local behaviour change support services (if they do not provide these services themselves) and/or to a GP or the pharmacist in the GP practice, for appropriate clinical management.

Pharmacy teams can also play an important role in identifying people with undiagnosed high blood pressure by offering opportunistic blood pressure and pulse rhythm testing.

The NHS Long Term Plan sets out that the NHS will support pharmacists in primary care networks to case find and treat people with conditions that put people at high risk of developing CVD, so that preventative treatments can be offered in a timely way.

2. Smoking

Tobacco use continues to be one of the most significant public health challenges and the largest single cause of premature death in England.

NICE guidance on stop smoking interventions and services recommends the involvement of pharmacy teams in various activities associated with supporting smokers to quit. Community pharmacy-delivered stop smoking interventions offer an effective and cost-effective way to support smoking cessation.

Pharmacy teams can further support smoking cessation by:

• providing very brief advice for stopping smoking opportunistically;
• routinely discussing stopping smoking with people presenting prescriptions related to e.g. chronic obstructive pulmonary disease, diabetes, heart disease or high blood pressure, or when selling relevant over-the-counter medicines;
• supporting national stop smoking campaigns. 

3. Sexual health, reproductive health and HIV

Pharmacy plays a critical role in the access and provision of sexual health, reproductive health and HIV services across England. The services available at each pharmacy vary depending on what is commissioned. Examples of commissioned services include:

• access to emergency hormonal contraception;
• chlamydia screening and treatment as part of the National Chlamydia Screening Programme for 15-24-year olds;
• condom distribution;
• pregnancy testing.

Some areas also commission additional services, such as ongoing contraception and HIV testing.

Encounters between pharmacy teams and people seeking a service offer opportunities to provide an integrated package of sexual health and reproductive health services, going beyond a single treatment approach.

You can read more about this in The pharmacy offer for sexual health, reproductive health and HIV – PHE’s resource for commissioners and providers.

4. Healthy ageing

Productive, healthy ageing entails increased independence and resilience to adversity, the ability to be financially secure, engagement in social activities, being socially connected with enhanced friendships and support, and enjoying life in good health.

To support this agenda, PHE has recently published a Menu of Interventions for Productive Healthy Ageing – a tool that pharmacy teams working in different healthcare settings can use to support older people to lead more independent lives and improve their health.

The menu suggests opportunistic, evidence-based interventions that can help provide benefits for healthy ageing, focused on:

• preventing falls;
• dementia;
• physical inactivity;
• social isolation and loneliness;
• mental public health.

5. Mental health

With up to 1-in-4 of the population experiencing mental illness, many people accessing pharmacies will be affected by mental health problems or social conditions that put their mental health at risk. Pharmacy teams can help by using every opportunity to have conversations and offer brief advice to people who they think may be experiencing mental wellbeing issues.

Pharmacy staff trained as mental health champions can also make a positive contribution in creating mentally healthy pharmacies and communities, advocating for the mental health needs of local people and the role of HLPs in promoting individual and community wellness.

Furthermore, community pharmacies can set an example by being mentally healthy workplaces that adopt organisational approaches that assess and manage demands, job control, relationships and more.

6. Vaccination

Since 2015, community pharmacists have been offering the seasonal ‘flu vaccination as an advanced service of the community pharmacy contractual framework, complementing the service provided by GP practices.

Pharmacists who vaccinate people for seasonal ‘flu have been trained to administer the vaccine safely and also to deal with adverse situations such as anaphylaxis.

The number of seasonal ‘flu vaccinations provided by community pharmacists has increased year-on-year. Between September 2018 and March 2019, pharmacists provided 1,431,538 ‘flu vaccinations, helping to reduce pressure on GP practices and increase patient choice.

In some areas of the country pharmacists have been commissioned locally to provide the shingles vaccine. Where they are not commissioned, pharmacy teams can opportunistically remind eligible people to get vaccinated.

It is evident that pharmacy teams play a pivotal role in improving the public’s health and are a prominent social and health asset within all communities. The examples presented here are just a few of the many areas that pharmacy teams provide opportunistic health-promoting interventions for. Many of these public health challenges are preventable, yet continue to drive morbidity, premature mortality and health inequalities, placing a substantial burden on individuals and their families, communities, the NHS and the economy.

As such, for as long as these public health challenges persist, pharmacies will remain a valuable and vital asset to preventing them and promoting health.