The UK has an ageing population that is projected to rise in the future, but older people are not making the most of the help that community pharmacy offers. We find out why, and ask what pharmacies can do to address this

The 2011 Census revealed that 8,660,529 older people lived in England, including four million living in their own home with limited day-to-day activities owing to a longstanding health condition or disability.

Ready access to high-quality local healthcare is important to older people, but a recent Populus survey for Saga found that three-quarters (73 per cent) of respondents will head straight to their GP if they feel ill.

Local community pharmacies offer a valued source of health advice and support for older people, and by helping them with their medicines and minor ailments, advising them on staying healthy and signposting them to other sources of support, pharmacy teams play a vital role in helping older people stay independent and in their own homes for longer.

However, Dr Richard Preece, medical director of Saga, says that community pharmacies could do more. ‘Our research has shown that over 50s trust their GP more than any other profession so they may not choose to see a pharmacist, even for what might appear to be a less pressing concern.’

Price and perception

'At the moment there’s no easy way for an older person to know that their pharmacist has specific training and expertise in managing medical conditions and identifying symptoms of potentially serious conditions that are common in older age groups'

‘Older people benefiting from free prescriptions wouldn’t want to incur cost for things they wouldn’t have to pay for if they were prescribed by their doctor and they would want access to all the other services available via their GP. As long as it was clear that additional services provided there were of a high quality and dependable then pharmacies could play an increasingly important role,’

Heidi Wright, English practice and policy lead at the Royal Pharmaceutical Society, agrees that signposting is an issue. ‘Many older people are not aware of what pharmacy can currently offer [or] the expertise pharmacists have on medicines, so don’t consider them as a point of contact for advice on their medicines,’ she says. ‘Again though – and I know this from personal experience when I was doing my pre-reg in a community pharmacy – once the patients do know they can get good advice from the pharmacist they tend to go back there for more.’

The patient perspective

So what do older patients want from community pharmacy in the future?

Norman Niven, pharmacist and pioneer of teleenabled monitored dosage systems at Protomed, has recently set up Protelhealth, to help more people live independently in their own homes using health technology. He says: ‘Patients don’t always know what they want because they aren’t aware of the full array of products and services that could be supplied to them, and they certainly aren’t aware of the latest technological developments.’

From his point of view, ‘the last thing we should do is ask patients what they want from pharmacy because, whatever they come up with, you can be fairly certain it won’t be financially viable.’

‘Instead, we need to think about creating a business model that enables pharmacies to provide products and services that the elderly need which – crucially – someone will pay for. It is also essential that if anyone supplies this free of charge, they are excluded from the system. Only then will we have sustainable services that will benefit the elderly.’

The cost challenge

Another issue of cost around the issue relates to pharmacy, which Mimi Lau, Numark’s director of pharmacy services, recognises. ‘We can always do more to help older people and no one is suggesting that this should stop, but if pharmacy takes on a more formal role in monitoring the elderly, it must be remunerated.

‘There may even be a role for pharmacy in linking with social services under the current integrated care initiative. This plays to the strengths of community pharmacy, but the dilemma for both contractors and the government is how to take advantage of the accessibility of pharmacists in improving the quality of older people’s lives, while making it profitable.’

Good foundations

On the other hand, there are many examples of new working in the wider healthcare arena that are making a difference and are being funded, plus pathways for the expected intervention of all health care providers to be mapped out and include pharmacy.

‘There are not many diseases where medicines aren’t central to the management, so why wouldn’t you have pharmacy involved?’ says Alastair Buxton, head of NHS Services at PSNC. He cites examples of co-working that include the British Lung Foundation website, with a plan for COPD with MURs in it; work on domiciliary MURs in Croydon – commissioned initially by the CCG, then by the council – which has showed a positive reduction in the likelihood of readmission to hospital and improved adherence that keeps patients living at home for longer; and work around reablement using community pharmacy for domiciliary visits, particularly on the Isle of Wight, ‘which has been very successful, saving nearly 9,000 bed days in that group of patients, and £1.8 million in cost’.

‘As well as looking after older people, support for their carers is also important, and we are working with the Carers Trust on this. There is a prevalence of caring and if those people stop doing that, we’ve got one almighty crisis on our hands. For example, carers are eligible for a carer’s healthcheck – like the NHS Health Check, something that pharmacies in Devon are now offering – and we’d like to see that pushed out further, so that carers are made aware there is help out there when times get tough.

‘We need more of these kinds of things, including building pharmacy into care plans, but this requires a conversation at CCG level to do that. CCGs look at redefining the care pathway a lot, and pharmacy often gets left out. So primary care colleagues also need to champion pharmacy.’

Steps forward

One aspect of getting older is that people develop more health issues, which is where Mr Buxton thinks there is further reflection needed on future service development in terms of how to treat people with long term conditions in a holistic way.

‘Pharmacy can make a start on the management of long term conditions with GP practices, but the holistic approach needs to include collaborative care with the patient themselves. ‘Collaboration in terms of the pharmacist and the patient, and the pharmacist and the GP, is very important,’ he says. ‘We’ve probably been a bit better at that than our GP colleagues in the past, as we see people as people not just patients, and we shouldn’t lose sight of that.’

‘Pharmacy has some great opportunities over the next few years, but the challenge is that the NHS is running out of money. However, it’s a vicious circle because there just isn’t the innovation and transformation money in the NHS right now. We need money in the tough times to be more innovative, and people are telling us they can see what they need to do but don’t have the staff resource to spend the time reinventing the area to become more efficient. If you’re going to have these services commissioned you can develop your workforce to take over some bits for you, but if you can’t drive the income to pay for these staff then it’s not a sustainable business, which remains an ongoing challenge for local commissioners.’

Mr Niven agrees that limited NHS and public funding is holding pharmacy back when it comes to helping older people. ‘While statutory bodies such as the NHS and social services have a vital role in helping people to live in the community in their own home, the reality is that resources are stretched, limited in range and accessibility, and vary regionally.

‘Against the backdrop of reducing profitability of scripts, the [pharmacy] business model is changing and pharmacists need to develop new income streams.

‘The truth is, pharmacy already does too much for the elderly in an unstructured way and for little return,’ he says. ‘We should be asking not what pharmacy can do for care, but what care can do for pharmacy.’