Community pharmacy’s role in Health and Well-being

Healthy Living Pharmacies

A presentation for use byLocal Pharmaceutical Committees

Read and then delete this slide

• This slide deck contains information on the Healthy Living Pharmacy programme

• It is designed to be used by LPCs/community pharmacists as the basis for a local presentation to:– local patient groups– local government officers and councillors– CCGs or– other groups that have an interest in community pharmacy– edit it down to suit the audience and – add any local data/information to provide a local context

Presentation outcomes

• The purpose of this presentation is to engage others in the HLP concept; using evaluation from the HLP pathfinder programme

• This presentation can be adapted to meet your local needs

• Define what outcomes you want from this presentation and insert here

Contents

• Introducing community pharmacy• The Healthy Living Pharmacy Concept• The enablers for HLP’s• Next steps

Contents

• Introducing community pharmacy• The Healthy Living Pharmacy Concept• The enablers for HLP’s• Next steps

Community Pharmacy

• Over 11,000 community pharmacies in England• 99% of population can get to pharmacy within 20 minutes by car; 96% by

walking or using public transport• Estimated 1.8 million visits a day• Average 14 visits per year• 84% of adults visit a pharmacy at least once a year, 78%

for health-related reasons• Most frequent users are females; 89% at least once a year• Those with LTCs or disabilities or living in rural areas are more likely to visit

the same pharmacy• Majority (>75%) use same pharmacy all the time

Pharmacy’s strengths

PATIENT and

PUBLIC

PATIENT and

PUBLIC

Self care & Healthy lifestyle

interventions

Making Every Contact Count

Medicines Optimisation

Pharmacy and the NHS

• Pharmacies are independent contractors• Market entry test is linked to PNA and JSNA• Three tiers of service commissioned by NHS England

Essential: all pharmacies have to provide Advanced: all pharmacies can provide Enhanced: locally commissioned by the Area Team

Local Authorities and Clinical Commissioning Groups may also commission services from community pharmacy to meet local needs

Community pharmacy in xxx

• Insert local information:– Number of pharmacies– Brief overview of pharmacy distribution per ward– Local strengths identified from PNA– Local gaps identified from PNA

Community pharmacy’s role in health & well being

Supporting people to live healthier lives

• Advice on healthy lifestyle issues as part of NHS services– As part of essential services– Embedded within MUR and NMS service

• Six public health campaigns per year• And a range of locally commissioned services

– Insert here

Supporting people to live healthier lives

• Advice on healthy lifestyle issues as part of NHS services– As part of essential services– Embedded within MUR and NMS service

• Up to six public health campaigns per year• And a range of locally commissioned services

– Insert here

Contents

• Introducing community pharmacy• The Healthy Living Pharmacy Concept• The enablers for HLP’s• Next steps

Healthy Living Pharmacy background

April 2008

June 2009

Sept 2010

March 2011

April 2013

What distinguishes a Healthy Living Pharmacy?

Consistently delivers broad range of high quality commissioned services

Quality, innovation and productivity Proactive team ethos Has a least one Health Champion Identifiable by the public Achievement of Quality Criteria A quality mark

National support for HLP

• Pharmacy bodies working with Department of Health supported HLP through Pathfinder Support Group Pathfinder Support Group

– 66 PCTs expressed an interest; 30 in 20 pathfinder areas progressed

• Ministers instructed formation of Pharmacy and Public Health Forum HLP Task Group– Accelerating national roll-out of HLP concept a priority

• Strategic intent– NHS Plan 2010-2015– Public Health White Paper– Respiratory Strategy– NHS Future Forum report– Public Health Workforce Development consultation

Key question

Can the results seen in Portsmouth be replicated elsewhere with different demography and

geography?

Evaluation aims

• Is there better uptake and delivery of services in HLPs compared to baseline (i.e. before being an HLP or against other non-HLP pharmacies)?

• Does geography and demography impact on HLP performance?

• What is the effect of HLP services on public-reported experiences?

• What are the benefits of HLP for public, commissioner, contractor, employees?

• Is each individual service delivered through HLP cost-effective?

Service outcomes: stop smoking

Service outcomes: stop smoking

Service outcomes: stop smoking

Service outcomes: sexual health

• Buckinghamshire:– Pre-HLP, 75% of EHC through pharmacy– Post-HLP, 86% through pharmacy– Increase in condom distribution by 13%– Increase in Chlamydia screening discussion by 6%

• Stoke on Trent: – Increase in consultations from 1600 to 1848– 29% increase in chlamydia screening

• East Riding and Hull– Average consultations in HLP 123, non-HLP 73 – Increased condom distribution (22.6% vs. 16.1%)

• Portsmouth– Average consultations in HLP 160, 85 in non-HLPs (p<0.001)

• Lambeth– Decrease in consultations*

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Service outcomes: minor ailment scheme

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Service outcomes: alcohol awareness

• Dudley– 55 interventions prior to HLP; 280 after

• Milton Keynes– Non-HLP 31 per pharmacy– Working towards HLP 38 per pharmacy– HLPs 59 per pharmacy

• Portsmouth– Non-HLP 90 per pharmacy– HLPs 218 per pharmacy

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Service outcomes: Medicines Use Review

Service outcomes: New Medicine Service

Service outcomes

Cost effectiveness

Cost effectiveness

• Contractor survey gives rich insight into how PH services are delivered• Evaluation has affirmed important role of non-pharmacist staff in delivery• Clear evidence that pharmacy staff are engaged and enthused by

opportunities to make a difference; potential to spill over to better service outcomes

• Stop smoking services delivered by non-pharmacist staff perform at least as well as pharmacists– Service can be delivered more effectively i.e. making best use of each staff

member’s skills– And more cost effectively i.e. pharmacist’s time has a higher business cost– Academic evidence shows that stop smoking services are cost effective

Making optimal use of each staff member’s time, without necessarily risking ability to generate positive health outcomes, indicates the potential of service delivery in the HLP context.

Commissioners’ views

• “Becoming an HLP will display to commissioners pharmacy’s commitment to delivering cost effective and high quality services” [Birmingham tPCT and Solihull]

• “Future commissioning can be targeted and offered to those pharmacies that we know will deliver. So this has become a great organisational tool to target commissioning more cost effectively” [Portsmouth]

• “Public health commissioners see the HLP initiative in a very positive manner, public health teams are now keen to involve community pharmacies and in particular the HLPs in their service developments. They have volunteered to give on-going training to HLCs re information and signposting” [Dudley]

The Chief Medical Officer said …

“HLPs work!”

“They improve choice and we must ensure they are

embedded in the new NHS”

“Inspirational concept!”

Dame Sally Davies

Public reported experiences

Public engagement (n = 1034)

How would you rate the service provided? (n = 1034)

Location where service users would have sought help/advice had this service not been available in the pharmacy, shown as a percentage

(n = 1034)

Number of service users referred to an additional service in the pharmacy (n = 1034)

There were 683 referrals/recommendations into other services offered by pharmacy.

Provider engagement

Since becoming an HLP, how would you describe the public's demand for services? (n=152)

Have you had to invest in your premises to become an HLP? (n=150)

If your NHS service income has gone up, please estimate by how much (n=64)

What impact has becoming an HLP made on your staff?’ (n=151)

Do you feel that becoming an HLP has been a worthwhile investment for your business? (n=152)

Do you feel that becoming an HLP has been a worthwhile investment for your staff's development? (n=153)

Since implementing HLP, what has happened to your average monthly prescription volume? (n=153)

National roll-out of HLP concept

• 1500 + Health Champions• 1200 + leadership development

• 500 + Healthy Living Pharmacies

• 20 pathfinder areas; 10 second-wave

What made the difference?

Contents

• Introducing community pharmacy• The Healthy Living Pharmacy Concept• The enablers for HLP’s• Next steps

The Enablers

Quality Criteria

Strong leadership

Role of the Health Champion in community pharmacy

• Has the RSPH Understanding Health Improvement Level 2 award

• Engage proactively with the public• Understand what’s available locally• Signpost to local health and wellbeing services and national

support• Establish and maintain health promotion zone• Put in place health promotional activities• Outreach into the local community• Deliver health and wellbeing services (optional)

Contents

• Introducing community pharmacy• The Healthy Living Pharmacy Concept• The enablers for HLP’s• Next steps

Evaluation report recommendations

• Continued national support and leadership• Potential support within CPCF• Recognition of HLP status by local commissioners• National consistency and quality assurance of HLP status• Consideration for establishment of national awarding body• National HLP service specifications• Common performance measures including public reported experiences• Resources to support pharmacists and their teams• Develop competency frameworks• Further development of Health Champions• Consideration for extending role of HLPs e.g. Dementia, early detection of

cancers

Process steps for successful implementation

Local next steps

• Open up discussion for Q&A • What benefits HLP might deliver locally?• Identify any barriers to success?• Agree next steps

– What – When– How– Who

In summary, Healthy Living Pharmacy…

• Provides a commissioning framework

• Is an organisational development tool

• Is a Quality mark

• Is about the pharmacy team

• Has a common vision & goal

• Has a brand the public can

recognise

• Is the means to the end

Acknowledgements

• Department of Health• Pharmacy and Public Health Forum HLP Task Group• Pathfinder and non-pathfinder areas

– Commissioning organisations– Local Pharmaceutical Committees– All the pharmacies that have engaged and taken the leap

of faith!

• NPA, CCA, RPS, PSNC and CPPE