From screening to health advice to treating minor ailments, pharmacies are embracing their new role as partners in the drive to improve public health
Traditionally regarded by many in the healthcare profession as a peripheral provider, the pharmacy profession is preparing itself to take a central role in public health. Pharmacies have a seat at the table of Lord Darzi's next stage review and both the health secretary and prime minister are encouraging them to play a greater role in providing accessible primary care services.
Darzi advisory board member Andy Murdock is pharmacy director of Lloydspharmacy, the UK's largest community-based healthcare company. He believes the profession is up for the challenge.
"The sector is underused as a highly accessible healthcare resource, particularly in areas of health inequality and in under-doctored areas," he says.
"We believe that without reforming access to primary health services, the government will fail to meet the public health challenges of the future. There is a unique relationship between a pharmacist and the customer - based on trust and familiarity - that is currently under-exploited.
"The retail environment means pharmacies can provide excellent access to healthcare. We are local, open for extended hours and often over weekends, which makes us convenient for many people, especially those who work some distance from their GP or who have limited mobility."
The government has acknowledged many deprived areas are under-serviced by healthcare professionals yet have a higher prevalence of cancer, coronary heart disease and obesity. One way of tackling this is to use the pharmacy network as a partner.
Earlier this year, the Birmingham health and well-being partnership (three Birmingham primary care trusts with voluntary and community partners) wanted to provide 10,000 "at risk" men over 40 in Birmingham with access to screening for weight, body mass index, cholesterol, blood pressure and blood glucose checks.
As well as health and community centres, Lloydspharmacy pharmacists participated in screening clinics at the city's two biggest football clubs and the Millennium Point visitor centre. All were at evenings and weekends.
Of those screened during a pilot phase of the programme, 49 per cent were referred to their GP, 28 per cent had a "high" cardiovascular disease risk and 2 per cent had not previously been registered with a GP. These are all people who may not have recognised any symptoms or risks in their health.
The entire UK community pharmacy network has the potential to support the NHS in tackling health inequality and improving health literacy, which is key to improving health outcomes.
Research by the Picker Institute shows health literacy is fundamental to patient engagement. Personalised written information, used with professional consultation and advice, has been shown to improve health knowledge and recall.
Limited progress has been made on implementing a health information strategy in recent years. More could be delivered through community pharmacies, for example with "information prescriptions" that point patients to useful information about their condition, delivery of the health assessment questionnaire NHS Life Check, support for self-care, and contribution to the expert patient programme.
The fact that pharmacies have a long-established relationship with customers is particularly relevant. Screening is available in clinics, practices and hospitals but will only be taken up by those sufficiently concerned about their health to search for it. Pharmacies can play a wider role in supporting the government's declared aim of sharpening the focus on prevention and personalised care.
Lloydspharmacy's asthma medicines support service was developed from the basic medicines use review concept. It identifies patients who are experiencing difficulties with controlling their asthma and combines a few questions with a focused medicines use review.
Of those patients reviewed, over half (52 per cent) needed further patient education and 26 per cent were referred to their GP practice, of whom 42 per cent were prescribed add-on therapy, 14 per cent had a change in therapy, 14 per cent had their inhaler type altered and 30 per cent received changes to their prescription directions.
Participants were contacted again to reassess asthma control. The proportion of patients whose asthma was "well controlled" increased from 5 to 9 per cent, those whose condition was "reasonably controlled" increased from 36 to 46 per cent and those who felt their condition was "not controlled" dropped from 59 to 45 per cent.
If self-care and minor ailment services were provided by community pharmacies rather than a GP practice, it would save GPs at least an hour a day. This alone represents a cost saving of£1.5bn in GP time, as currently 18 per cent of all GP consultations are for minor ailments.
"I'd like doctors to see pharmacists as a part of the team from the hospital to the community," says Mr Murdock. "The NHS is still very GP and nurse-oriented. I know there are moves to change this, but it will take a long-term plan.
"To deliver effective primary care, we need to see several things: healthcare professionals adopting a new mindset about the breadth of the team and delivering robust IT which supports collaborative working and contractual realignment in support of the government's aspirations for our well-being."