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Community pharmacies are a valuable

and trusted public health resource. With

millions of contacts with the public each

day, there is real potential to use

community pharmacy teams more

effectively to improve health and wellbeing

and reduce health inequalities.

Healthy lives, Healthy People: Our strategy for

public health in England, DH 2010.

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“The science and art of preventing

disease, prolonging life and

promoting and improving health

through the organised efforts of

society.”

Sir Donald Acheson, 1988

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The Three Key Domains of Public Health

Health Improvement

Health Protection

Health Services

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Health Improvement

education,

housing,

employment,

family/community,

Lifestyles and

surveillance and monitoring of specific

diseases and risk factors.

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Health Protection

Infectious diseases

Chemicals and poisons

Radiation

Emergency response

Environmental health hazards

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Healthcare Public Health

Commissioning, Planning, Audit and Evaluation of services

Quality improvement and clinical governance,

Equity of service provision

Prioritisation of health and social care.

Patient safety

Efficiency

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Public Health Approach

Emphasise the collective responsibilities for health improvement and the prevention of disease.

Recognise the key role of the state and the importance of the underlying socio-economic and wider determinants of health as well as disease.

Multidisciplinary, incorporating quantitative as well as qualitative methods.

Emphasise partnerships with all those who contribute to the health of the population.

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Public Health priorities

1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol

2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency

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Public Health priorities

3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics

4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme

5. Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

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Health and

Wellbeing

Directorate

Health

Impact

Priorities

Tobacco Control and

Smoking Cessation

Accounts for 20% of new cases of cancer (23%M and16%F)Tobacco causes nearly 1 in 5 deaths in England annuallyFor each death, 20 more suffer tobacco-related illnesses

Alcohol Moderation

and Drug Recovery

Much of the cost of drug and alcohol misuse occurs to the criminal justice system. The main costs to society from drug an alcohol is from related crime.

HIV, Sexual Reproductive

health

By the end of 2012 likely more than 100,000 PLWHA in the UK. Late diagnosis a major problem with 50% diagnosed with CD4<350

While supporting and ensuring progress

against the PHOF, the Directorate will provide enhanced focus on the

major drivers of mortality and morbidity in England where further gains may be made by

scaling known, effective strategies

Health Impact PrioritiesHealth and Wellbeing Directorate

Well being and Mental

Health

Mental disorder accounts for largest burden (23%) of diseases in England and affects >1 in 4 of the population at any time

Diet, Obesity, and

Physical Exercise

All major causes of CVD and cancer. Obesity increases risk of type II diabetes (5-13 times), hypertension (2-3 times) and colorectal cancer (3 times) in men.

Why Pharmacy?

The community pharmacy setting offers:

1. Easy accessibility including for people from deprived communities who cannot or do not wish to access other conventional NHS services.

2. Long opening hours and convenience.

3. A health resource on the high street, in supermarkets, in every shopping centre.

4. Anonymity, where appropriate.

5. Flexible setting within an informal environment.

6. Local businesses well connected to their local communities.

7. Pharmacy staff tend to reflect the social and ethnic backgrounds of the population they serve.

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Healthy Lifestyles

Healthcare services have been estimated to contribute only a third of the improvements that could be made in life expectancy. Changing people’s lifestyles and removing health inequalities contribute the remaining two thirds.

Four behavioural risk factors contribute to preventable disease:

Tobacco use, physical inactivity, excess alcohol consumption and poor diet.

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Stop smoking services

Smoking remains the leading cause of preventable and premature

deaths in England.

1 in 5 adults still smoke and it was estimated that almost 1 in 5 deaths

in England of people over 35 years of age were due to smoking.

Over a 1/3 of all deaths from respiratory diseases and almost 3/10 of all

deaths from cancers in the over 35’s population are estimated to be

caused by smoking.

Evidence indicate that community pharmacy based stop smoking

services that are provided by trained pharmacy staff are effective and

cost-effective in helping smokers to quit.

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Weight Management

The prevalence of obesity in England has increased steadily during the last 50 years and has tripled since 1980.

The Health Survey for England, 2008 data shows that nearly 1in 4 adults, and over 1 in 10 children aged 2-10, are obese. Currently, over 60% are overweight.

Obesity is the 2nd most common preventable cause of death in Britain after smoking and is responsible for increasing the prevalence of diabetes, cancer and heart disease and for more than 9,000 premature deaths/year in England.

Evidence indicate community pharmacy based weight management programmes appear to show promise but more studies are required to support investment in this service.

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Alcohol and drug misuse

About 26% of all adults in England, approximately 10.5m people, are drinking at hazardous and harmful levels.

A further 1.1m people are showing signs of alcohol dependence.

Heavy drinking can lead to future health problems, including cirrhosis of the liver, many types of cancer and mental problems.

Heavy drinking is also associated with a wide range of social issues such as domestic violence, suicide and deliberate self-harm, child abuse and child neglect.

Evidence support the effectiveness of identification and brief advice (IBA) to reduce and prevent harm from alcohol use in primary-care settings.

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Alcohol and drug misuse

Poly-substance abuse is increasingly the norm among substance misusers and this dependence commonly involves alcohol as well as drugs.

Infections are common among injecting drug users with around ½ of injecting drug users have been infected with hepatitis C and 1/6 with hepatitis B.

Pharmacies already provide drug misuse services, including supervised daily doses of substitute medication, needle exchange schemes, alcohol interventions and vaccination and screening services.

Evidence indicate that there is high attendance at community pharmacy based supervised methadone administration services and that this service is acceptable to users.

Evidence also indicate that community pharmacy achieve high rates of returned injecting equipment and the service is cost-effective.

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Chronic disease management and prevention

The NHS Health Check programme

National initiative targeting adults aged 40-74 years to enable them to identify and manage their CVD risk.

Emerging evidence base suggests that pharmacies can effectively target hard to access groups that use GPs’ services very infrequently.

There is strong evidence of improvements in lipid levels that were sustained for at least one year in both primary and secondary prevention of CHD.

Community pharmacies can make an important contribution to the management of people with diabetes in terms of screening, improved adherence to medicine and reduced blood glucose or HbA1c levels.

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Sexual Health

England has the worst rates of sexually transmitted infections (STIs) and they are still rising.

Chlamydia is the most common diagnosed STI in the UK.

The national Chlamydia Screening Programme, targeting 15-24 years olds, includes services commissioned thorough community pharmacy to extend choice and access.

Teenage pregnancy, although declining is still the highest in Europe. Access to emergency hormonal contraception (EHC) is provided via the community pharmacy.

There is good evidence that community pharmacy based EHC services provide timely access to treatment and are highly rated by women who use them.

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Healthy Living Pharmacies

New concept to meet public health needs.

One of the key distinctions of a HLP is having trained champions on site.

98.3% of people who attended this service said they would recommend it to others.

1 in 5 said they would not have gone anywhere else for the health and wellbeing support they received in community pharmacy.

Most of the others said they would have gone to GPs suggesting the use of pharmacy is likely to lead to transfer of workload from general practice.

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Healthy Living Pharmacies

Effectiveness of the Healthy Living Pharmacy

Self reported 4 weeks quit rate was similar to the national average and in some cases well above it.

Stop smoking services delivered by non-pharmacist staff performed at least as well as those delivered by a pharmacist.

A high proportion of individuals receiving a chlamydia screening service or EHC were also provided with additional relevant information such as advice on safe sex and use of condoms.

Staff providing the alcohol service felt they were well equipped to open further dialogue on alcohol consumption and were able to sign post people to further services.

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Healthy Lifestyles

Weigh-2-Go 8 pharmacies in Kingston have been trained to provide this

programme. Weigh-2-Go is a weight management support service for adults who would like to achieve a healthier weight with one-to-one support at their local pharmacy.

To provide this programme, pharmacies need to meet certain criteria, such as having a confidential space to talk to patients and attend the training to provide this service.

This service is also provided in some GP practices and in the 2012/13 year 31% of participants achieved 5% weight loss or more demonstrating clinical effectiveness

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Healthy Lifestyles

Kingston's new Adult Weight Management by Referral programme

The Public Health Department intend to role this very new

service out to local pharmacies this Summer to increase

patient choice. It includes:

◦ Weigh-2-Go (in some GP practices and local pharmacies), ◦ Discounted referrals to Rosemary Conley weight management

programme, Weight Watchers and Slimming World.◦ Fit as a Fiddle (for over 50's) and ◦ Get Active Exercise Referral (for structured exercise).

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Healthy Lifestyles

Stop Smoking Programme

This programme has been provided successfully in large number of Kingston community pharmacies.

Communications Pharmacies are contracted to run 6 health campaigns each

year but we will be looking to work with pharmacies more closely to monitor impact of these and assess how we could support these campaigns in local pharmacies more effectively.

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Pharmacy – Substance Misuse Services

Needle Exchange - is a Public Health intervention designed to reduce the spread of blood borne viruses and other harms associated with the sharing or reuse of injecting equipment. The scheme operates through 13 community pharmacies and provides injecting drug users with sterile needles and syringes in addition to sharps boxes and other paraphernalia whilst also providing a collection point for returned equipment allowing for their safe destruction.

Supervised Consumption - is a scheme where individuals in receipt of a prescription for opiate substitution therapy such as methadone or buprenorphine can have the consumption of their medication witnessed in a community pharmacy. This provides benefits to both the prescriber and the client and adds an additional level of safety to the care provided. 12 pharmacies in Kingston provide this service.

Alcohol Brief Interventions – pharmacists have a brief conversation around alcohol awareness, levels of consumption and discuss units of alcohol with patients. This is delivered within 13 pharmacies in Kingston.

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Sexual Health Services in Pharmacy

FREE sexual health services delivered to all young people under 25

years of age

Confidential advices and information on all aspects of Contraception

and Sexual Health

Emergency Hormonal Contraception (EHC)

Chlamydia and Gonorrhoea Screening

Chlamydia treatment and Partner Notification

Condom distribution scheme

Currently 9 Pharmacies in Kingston providing these services.Others in the process of training/ becoming accredited

What works well - Open access, walk in, long opening hours

Problems - Where no toilet facilities, screening kits taken away, often not returned to lab. Uptake of Chlamydia + Gonorrhoea screens in EHC consultations very low.

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The NHS Health Check Programme

Two pharmacies have been providing this programme for 3 years and additional 3 pharmacies will be delivering the programme in 2014/15.

The performance of community pharmacies will be stepped up from this year and the long term ambition is to create a service that matches the service delivered by general practice.

The programme is delivered by trained staff who provide help and advice to people on how to reduce their CVD risk and adopt a healthier lifestyle.

Kingston offered the health checks to more than 17,000 people and over 7,000 health checks were delivered in 2013/14.

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