Community pharmacies could be making more of a difference to public health in local communities and stamping out inequalities in access to services like advice for alcohol, NHS Health Checks, stopping smoking, and sexual health services. But studies have found that inconsistency in commissioning these services across England, including where the services are offered, is holding it back.
Looking to expand on existing research, Liverpool John Moores University (LJMU) and the Medway School of Pharmacy (The Universities of Kent and Greenwich), have produced the first baseline map of service commissioning by local authorities (LAs) in community pharmacies across England. This means that there is now a map of LA commissioned public health services from community pharmacies so data can be gathered to work out where key services are required. This will help to inform discussions about service provision between commissioners and community pharmacy, highlighting the disparity between service commissioning and apparent local need.
Published in the BMJ Open, the study is the most comprehensive picture of public health services commissioned through community pharmacies by local authorities.
For some people, the local pharmacy will be their first point of contact, or their only contact, with a health care professional, so they play a pivotal role in leading public health programmes, such as early detection and management for diseases like heart attacks and stroke. With almost 90% of the population living within a 20-minute walk of a community pharmacy, which rises to 99.8% in the most deprived decile, they can help to provide greater access to people living in areas of higher deprivation.
Dr Adam Mackridge, co-author and Reader in Public Health Pharmacy at LJMU explains: "With in excess of 1 million people visiting a community pharmacy every day, they have long been championed as a potential setting for the delivery of public health services to the local communities in which they are located. At the moment this is not matched well enough to potential need and so we may be missing opportunities to support health and wellbeing. For example we know that the NHS Health Checks and screening for risky alcohol use are not available in many areas with significant potential to benefit from these services. If we commission the right services in the right areas using local pharmacies we could provide better value for money for the NHS and improve the health of local communities. There needs to be a better link between local health needs and use of pharmacies to address this, particularly where there are gaps in current provision.”
Helga Mangion of the National Pharmacy Association commented: “It is very helpful to have a map of commissioned public health services from community pharmacies. It is not unsurprising to see variation in commissioning by local authorities, and that this correlates to factors other than population need. Local pharmacies have a long track record of health improvement, but we want to be engaged more thoroughly to address identified need, including in deprived communities. We agree with the authors of the study that a more strategic approach needs to be taken by commissioners, to really unlock the sector’s potential. Pharmacies have all the attributes to be the front door to good health across the country, especially unparalleled access”.
Professor Janet Krska, Professor of Pharmacy Practice at Medway School of Pharmacy and leader of the study, commented: “It is somewhat surprising that data such as we have gathered are not routinely available. Our findings demonstrate the significant extent to which community pharmacies already contribute to public health improvement, but also illustrate how much better the many services they can offer could be distributed. We hope that our study will be of use to local authorities in developing their Pharmaceutical Needs Assessments, as for the first time they will be able to compare the services they commission to those provided across England.”
Royal Pharmaceutical Society Director of England Robbie Turner said: "This study reveals a mismatch between the health needs of local populations and the services commissioned which is concerning. England has wide variations health outcomes across local authority areas and commissioners need to work with local pharmacists to provide a clear strategy of where the greatest health gains can be made by providing services that meet the needs of local populations.
"Pharmacy teams can make an impact on public health when population health needs and services are aligned. The Healthy Living Pharmacy a successful model aimed at achieving consistent delivery of a broad range of services to reduce health inequalities. Better public health has a vital role in reducing costs to the NHS and social care and the accessibility and reach of pharmacies mean they can make a unique contribution to improving health outcomes. Unfortunately, public health services are being reduced in some areas as local authority budgets are squeezed which could see health inequalities worsen to the detriment of individuals and society as a whole."