Community pharmacy’s role in Health and Well-being Healthy Living Pharmacies

A presentation for use by Local 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

Medicines Optimisation

Making Every Contact Count

Common Ailments Ongoing adherence support Promotion Prevention Protection

PATIENT and PUBLIC

Initial supply and support Early detection Diagnosis & Treatment Self care & Healthy lifestyle interventions

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

Multi-party Pharmacy White Paper Pharmacies states vision for pharmacies to become Healthy Living Centres NHS Portsmouth and County Council develop HLP concept with support from DH. Director of Public Health and LPC-led Portsmouth HLPs deliver positive interim results; Lord Howe asks can the results be replicated elsewhere in differing demography?

March 2011 National pharmacy bodies working with DH launch pathfinder programme; target 100 HLPs in 4 areas April 2008 June 2009 Sept 2010 April 2013 Evaluation of pathfinder programme across 14 areas with different deprivation indices shows results can be replicated, high public approval and services delivered cost-effectively

What distinguishes a Healthy Living Pharmacy?

  Quality, innovation and productivity  Consistently delivers broad range of high quality commissioned services 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

700 600 500

Chart1: Comparison of the number of people setting quit dates before and after implementing HLP in each area

No. setting quit before HLP 400 300 200 100 No. setting quit after HLP 0 Birmingham Dudley Bucks Milton Keynes Area South Staffs Lambeth Sheffield

Service outcomes: stop smoking

250

Chart 2: Comparison of the number of people achieving quit before and after implementing HLP in each area

200 150 No. achieving quit before HLP No. achieving quit after HLP 100 50 0 Birmingham Dudley Bucks Milton Keynes Area South Staffs Lambeth Sheffield

Service outcomes: stop smoking

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Chart 3: Comparison of the quit rates before and after implementing

Birmingham Dudley Bucks

HLP in each area

Milton Keynes Area Quit rate before HLP Quit rate after HLP South Staffs Lambeth Sheffield

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* 26

Service outcomes: minor ailment scheme

27

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 28

Service outcomes: Medicines Use Review

30,0 25,0 20,0 15,0 10,0 5,0 0,0 Baseline

Chart 8: Trend in average no. of MURs per pharmacy: HLP compared to non-HLP pharmacies (BwD & EL)

HLP Non-HLP HLPs introduced (October 2011)

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) Were you comfortable to receive this service in the pharmacy?

Were you happy with how you were treated by the pharmacy… Do you feel you were provided with enough information by the… Would you recommend this service to others?

Before coming in today, had you heard of healthy living… 27,0% 0% 20% 99,9% 99,7% 99,6% 98,3% 40% 60% 80% 100%

How would you rate the service provided? (n = 1034) Excellent Good 17,4% Ok 1,5% Poor 0,0% 0% 20% 80,6% 40% 60% 80% 100%

Location where service users would have sought help/advice had this service not been available in the pharmacy, shown as a percentage (n = 1034) Doctor A & E 1,6% Walk-in Centre 5,4% Internet I wouldn't have done anything 3,7% 21,2% Other (please state) 1,3% 0% 20% 60,2% 40% 60% 80%

Number of service users referred to an additional service in the pharmacy (n = 1034) 250 200 150 100 50 0 219 149 26 16 3 1 3 26 20 29 1 46 13 15 7 0 50 3 3 94 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) 70,0% 60,0% 50,0% 40,0% 30,0% 20,0% 10,0% 0,0% 37,5% 61,8% There is no difference They are asking for services more 0,7% They are asking for services less

Have you had to invest in your premises to become an HLP? (n=150) 80,0% 70,0% 60,0% 50,0% 40,0% 30,0% 20,0% 10,0% 0,0% 32,7% 67,3% Yes No

If your NHS service income has gone up, please estimate by how much (n=64) 80,0% 70,0% 60,0% 50,0% 40,0% 30,0% 20,0% 10,0% 0,0% 75,8% 12,1% 7,6% 1,5% Over 100% Between 50% and 100% Between 25% and 49% Up to 25%

What impact has becoming an HLP made on your staff?’ (n=151) 90,0% 80,0% 70,0% 60,0% 50,0% 40,0% 30,0% 20,0% 10,0% 0,0% 80,1% 19,9% They are more productive 0,0% They are less productive There has been no change in productivity

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) 100,0% 91,5% 80,0% 70,6% 60,0% Business Staff development 40,0% 24,8% 20,0% 0,0% Yes 3,9% No 3,3% 5,2% Maybe

Since implementing HLP, what has happened to your average monthly prescription volume? (n=153) 70,0% 60,0% 50,0% 40,0% 30,0% 20,0% 10,0% 0,0% 32,7% 6,5% 60,8% It has gone up It has gone down It has stayed the same

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

workforce environment

Quality Criteria

engagement

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

Stakeholders • Director of Public Health sponsorship • Establish multi-disciplinary stakeholder group including public representatives • Engage pharmacy stakeholders Project management • Establish project manager • Core project team • Define goals and scope Pharmacy engagement • Engage and inspire whole pharmacy teams • Include area managers, store managers, LPC-led • Celebrate success and maintain momentum Enablers • Workforce development – Health Champions and Leadership/change management • Engagement with local community and other health & social care providers

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