Michael Holden FRPharmS
NPA Chief Executive
Pharmacy and Public Health Forum
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Background
Healthy Living Pharmacy
National Roll-out
Evaluation outcomes
Community Pharmacy
• Over 11,000 community pharmacies in England
• 99% of the population can get to a pharmacy within 20min by car
• 96% by walking or using public transport
• Estimated 1.6 million visits a day
• Average 14 visits per year
Making Every Contact Count
Common
Ailments
Ongoing
adherence
support
Medicines
Optimisation
Promotion
Prevention
Protection
Self care &
Healthy
lifestyle
interventions
PATIENT
and
PUBLIC
Initial
supply and
support
Early
detection
Diagnosis
&
Treatment
referral
Why use pharmacy?
Healthy Living Pharmacy background
Pharmacy White Paper states vision for
pharmacies to become Healthy Living Centres
April 2008
Portsmouth develop HLP concept with support
from DH, Director of Public Health and LPC
Portsmouth HLPs deliver positive interim results.
Minister asks can the results be replicated in differing
demography and geography?
National pharmacy bodies working with DH
March 2011 launch pathfinder programme
April 2013
Evaluation of pathfinder programme
June 2009
Sept 2010
What distinguishes a Healthy Living Pharmacy?
 Consistently delivers broad range of high quality commissioned
services
 Quality, innovation and productivity
 Proactive team ethos
 Health Champion
 Identifiable
Key question
Can the results seen in Portsmouth be replicated
elsewhere with different demography and
geography?
NATIONAL ROLL-OUT
National roll-out
• Pathfinder Support Group – all pharmacy organisations
• Generate evidence and further develop the concept
• Pharmacy and Public Health Forum HLP task group
• Influencing policy
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NHS Plan 2010-2015
Public Health White Paper
Respiratory Strategy
NHS Future Forum report
Public Health Workforce Development consultation
Evaluation aims
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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)?
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Does geography and demography impact on HLP performance?
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What is the effect of HLP services on public-reported experiences?
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What are the benefits of HLP for public, commissioner, contractor,
employees?
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Is each individual service delivered through HLP cost-effective?
SERVICE EVALUATION
Service outcomes: overall
Service outcomes: stop smoking
250
Chart 2: Comparison of the number of people achieving quit before and after
implementing HLP in each area
200
Number of people
No. achieving quit before HLP
150
No. achieving quit after HLP
100
50
0
Birmingham
Dudley
Bucks
Milton Keynes
Area
South Staffs
Lambeth
Sheffield
Service outcomes: sexual health
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Buckinghamshire:
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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 EHC consultations from 1600 to 1848
– 29% increase in chlamydia screening
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East Riding and Hull
– Average EHC consultations in HLP 123, non-HLP 73
– Increased condom distribution (22.6% vs. 16.1%)
• Portsmouth
– Average EHC consultations in HLP 160, non-HLP 85
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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: alcohol awareness
• Pharmacy London initiative
– 24,000 scratch cards
– >43% high risk
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Service outcomes: Substance misuse
• Blackburn with Darwen and East Lancs
– 328 interactions over 4 months
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35.7% made by pharmacist
26.8% made by Health Champion
20% counter assistants
13% technicians
– 60% clients signposted to other services
• 34.5% to pharmacist
• 10.1% to NHS dentist
– 72% of advice was for needle exchange
Service outcomes: Medicines Use Review
Chart 8: Trend in average no. of MURs per pharmacy:
HLP compared to non-HLP pharmacies (BwD & EL)
Average no. of MURs per pharmacy
30.0
25.0
HLP
Non-HLP
20.0
15.0
10.0
5.0
Baseline
0.0
HLPs introduced (October 2011)
Service outcomes: New Medicine Service
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
PUBLIC REPORTED EXPERIENCES
Public satisfaction
(n = 1034)
Were you comfortable to receive
this service in the pharmacy?
99.9%
Were you happy with how you
were treated by the pharmacy…
99.7%
Do you feel you were provided with
enough information by the…
99.6%
Would you recommend this service
to others?
98.3%
Before coming in today, had you
heard of healthy living…
27.0%
0%
20%
40%
60%
80% 100%
Location where service users would have sought help/advice had
this service not been available in the pharmacy (n = 1034)
Doctor
60.2%
A&E
1.6%
Walk-in Centre
5.4%
Internet
3.7%
I wouldn't have done anything
Other (please state)
21.2%
1.3%
0%
20%
40%
60%
80%
Number of service users referred to an additional service in the
pharmacy (n = 1034)
Smoking
Weight…
Alcohol…
EHC
Chlamydia…
Condom…
Sexual Health
STI info
Substance…
Heart Healthy…
Glucose check
MUR
Healthy drinking
Advice about…
NHS health…
Minor Ailments
Healthy eating
Repeat…
NMS
Blood…
250 219
200
149
150
94
100
50
46
29
26
26
50
20
16 3 1 3
13 15 7 0
3 3
1
0
There were 683 referrals/recommendations into other services offered by pharmacy.
Commissioners’ views
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“Becoming an HLP will display to commissioners pharmacy’s commitment to
delivering cost effective and high quality services” [Birmingham tPCT and Solihull]
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“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]
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“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]
WHAT MADE THE DIFFERENCE?
The Enablers
workforce
environment
Quality
Criteria
engagement
2000+ qualified Health Champions
1400+ leadership development
500+ Healthy Living Pharmacies
What next?
Recommendations
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Continued local and national support and leadership
Potential link with national contract
Recognition of HLP status by local commissioners
National consistency and quality assurance of HLP status
Consideration for establishment of national awarding body
National service frameworks
Common performance measures including public reported experiences
Resources to support pharmacists and their teams
Workforce development
Consideration for extending role e.g. Dementia, early detection of cancers
Summary
• 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 a means to the end