Community pharmacy is leading the way in the promotion of healthy living messages to the public, the Royal Society for Public Health’s Shirley Cramer tells P3. Since joining the organisation last year she says she has been very impressed by the willingness of pharmacy to try new ways of working. ‘When I’m talking to pharmacy, it’s really great to see how willing they are to be part of the public health agenda.’
As an example, she believes that there is potential for the healthy living pharmacy (HLP) programme to continue to develop at a blazing pace. ‘I think 2014 will be very important to see real acceleration for HLP across pharmacy. Today we have 722 accredited healthy living pharmacies and I am anticipating double that number by the end of March 2014. We need to see this doubling every six months – and it would be great to see that rate of growth continuing.’
The RSPH has been particularly involved with the growth of healthy living pharmacy, including the training for the scheme’s health champions. Past chief executive of the organisation Richard Parish is chair of the National Pharmacy and Public Health Forum, for which HLP is a key work stream.
Healthy living pharmacy is a very ‘cost-effective and sensible’ way of supporting and improving the public’s health, says Ms Cramer. ‘If you want different outcomes, you have to do things differently. Healthy living pharmacies are really the first new way of doing something that’s a movement and pharmacy should rightly be heralded as showing a new way in public health.’
There are currently more than 2,000 health champions qualified and working in community pharmacies. As well as accessibility and the number of people who visit pharmacy, being based at the heart of communities puts pharmacy teams in the right place to have conversations about people’s health and lifestyles, she says.
‘Patients and customers tend to trust the pharmacy and the people who work there – and pharmacy teams have the opportunity to strike up conversations that wouldn’t work anywhere else. It’s a unique opportunity to have those conversations because of the relationship they have. It’s great that people working in pharmacy are developing the confidence to have these interactions with the public.’
Once trained, any members of the team can get involved. ‘We know that people who work in pharmacies who take a training programme, such as Level 2 understanding health improvement or behaviour change training, are just as effective as the pharmacist to have healthy living conversations.’
While outcomes from the HLP programme have already been positive, she expects to see more to come.
‘Post the implementation of healthy living pharmacies, we have seen a 140 per cent increase in smoking quits in pharmacies compared with the year before. That’s quite a lot. In terms of smoking cessation, we know that a smoker going into a healthy living pharmacy is at least twice as likely to set a quit date for stopping smoking than if walking into a non- healthy living pharmacy – it’s quite important. More evidence is likely this year, she says. ‘The emerging evidence is really exciting and I think that it offers real hope for the role of community pharmacy. I am sure that, as time goes on, there will be much more to say about this [as the evidence grows].’
She is also optimistic that these positive outcomes from pharmacy will catch the attention of a greater number of commissioners.
I think pharmacy should rightly be heralded as showing a new way in public health - Shirley Cramer
‘We hope that clinical commissioning groups and others start to see the real potential of community pharmacy for making a difference to the public’s health.’ She emphasises that she would like commissioners to be supporting HLP as ‘normal practice’.
‘Obviously, it’s a challenging time and the changes haven’t settled yet. However in times of change you do get lots of innovation, such as this... and I think this is one that’s here to stay.’
‘We need a much wider group of people involved in improving the public’s health. Pharmacy has shown the way in that and can be helpful with others to show how they’ve done it.
‘I would urge people who are not yet trained to consider being part of this,’ she adds.
Ms Cramer has joined the RSPH at a time when the importance of public health is rapidly expanding: refocusing the NHS towards the prevention of ill health, and targeting growing ongoing health concerns such as obesity and long term conditions.
A programme for developing a network of community-based Health Trainers, with expertise to motivate people in healthier behaviour and lifestyles, is well under way. The aim is to train people already working in the community in different roles, who can spread the word.
A recent review across England has shown ‘significant improvements’ in individuals engaging in health trainer services across a variety of measures, including diet, alcohol consumption and self-confidence, especially among the most deprived communities, says RSPH. It’s report found 56 per cent of 1,000 active Health Trainers were recruited from the most deprived communities, where there is the most potential to tackle problems of health inequality.
Clearly, a current challenge is how to cost- effectively deliver programmes and signpost programmes, says Ms Cramer. And producing a greater number of healthy trainers will be an important factor. ‘One of the main challenges is training up more people in pharmacies – and in other places such as leisure centres. This gives more people with contact with the public who can have that healthy living conversation, say, about mental health, alcohol use, quitting smoking, diet or diabetes or a medicines use review. The health trainer programme is a really important aspect of what’s happening in healthy living pharmacy and is something that we see could be happening in many different places in the community.
‘We’d like to see more and wider workforce training – the way to prevent chronic long term conditions is by people taking more responsibility and to do that we need more support in the community.’ And that’s not just about support from healthcare providers, she says. The whole community can get involved.
Cultural change There is a need for cultural change on a massive scale, she says. ‘Here’s an example. Nine per cent of our five-year-olds are obese. By the time they are aged 11, 19 per cent are obese and 14 per cent are overweight – one-third of children are overweight – and it’s not easy to lose weight once you are on that track. We need to prevent these things happening, and that’s about food and diet and education in those early childhood years. So there’s a lot to be done, but to have the GP as the only one responsible is, I think, impractical.’
There is more to come, she says. ‘The potential for community pharmacy is really quite enormous. We think that community pharmacy has a very special and influential role. If HLP carries on growing the way it’s going, then I think we are looking at a very interesting future.’
She says that the programme is being evaluated as it goes along and that she expects that more information will be coming out by the end of next year.
Pharmacy is a group prepared to step up to the challenges faced by the NHS, she says. ‘They see themselves as part of the solution. I have met so many enthusiastic pharmacists – it’s been great.’
She is keen to thank pharmacies that have been involved with healthy living pharmacy. ‘I say well done. They are doing a terrific job in engaging the public, and that’s what it’s really all about. For those who are not yet involved, do go and talk to someone who is already doing it, and see the advantages. It’s an exciting thing to be involved with.’
The Royal Society for Public Health has more than 6,000 members. Chief executive Shirley Cramer invites people from pharmacy to join the Royal Society for Public Health. ‘We have some pharmacy members and we are setting up a range of special interest groups. We would love to have more pharmacist members within the RSPH, because I think it says something about the role of pharmacy. We are a multi-disciplinary organisation – with members such as epidemiologists, academics, pest controllers, people involved in water, hand hygiene and behaviour change – we have a very wide group of members. That makes for very interesting conferences and sharing information across disciplines. www.rsph.org.uk