I have been trying to keep track of a gradual change in attitudes about pharmacy and public health and now,18 months on from when the Murray Review was commissioned, find myself asking ‘What does it all mean?’.
In September 2017, several key announcements began with the new Pharmacy Minister Steve Brine who said at the RPS conference that initiatives such as the work of (HLP) and flu vaccination services highlight pharmacy’s role in promoting public health and reducing health inequalities. Also at the Labour party conference, the Pharmacy APPG Chair and Labour MP for Rother Valley, Kevin Barron, said they would like to see the HLP initiative included in the community pharmacy contract as it has a ‘role to play in improving public health’. This was encouraging, so the message must be getting through somehow to those who could influence change and this is backed up by the news that the Public Health England (PHE) report ‘Pharmacy: A Way Forward for Public Health’ has been published.
This new report sets out opportunities for commissioners, some of whom have previously decommissioned such services, to realise community pharmacy’s role in protecting and improving the nation’s health, flagging up growth in the HLP programmes since a quality payment is now available for attaining HLP1 status. The CPPE are supporting this with leadership for HLP workshops and the paper also looks at developing capacity in the workforce to support promoting health through pharmacy settings and lists smoking cessation among the menu of opportunities for community pharmacists to get involved, timely for the PHE Stoptober challenge.
PHE is working with the Pharmacy and Public Health Forum to collect case studies of promising practice to help identify opportunities to build on current learning and scale what is working and has been shown to have impact. Interestingly there is already a move in Scotland (the vision of Achieving Excellence in Pharmaceutical Care) to expand the public health role with evidenced-based interventions, so pharmacy is at the heart of delivering national health and well-being priorities.
A further focus in September was on support for the role of community pharmacists in antimicrobial stewardship, highlighted in the RPS national campaign, and again during World Antibiotic Awareness Week this week.
There was also an article by Professor David Wright (who’s literature review informed the Murray Review) on the potential for revised Medicines Use Reviews (MURs). We must remember that a range of public health interventions are often part of an MUR. This can include looking after the mental health and wellbeing, as well as physical health, of elderly patients who may be lonely, supported by CPPE’s work on mental health. This also offers a chance for pharmacists to fulfil other roles such as in cancer awareness and screening referral.
Making every contact count and documenting public health interventions may be a good place to start and help to develop the evidence base, remembering that the Murray Review stated ‘we should note that the evidence for (or against) specific clinical services within the peer-reviewed literature is often relatively sparse’.
All this is developing within the context of RPS working with PHE and NHS England to promote the role of pharmacists in public health, with the support of the RPS Professional Standards for Public Health Practice for Pharmacy.
So as attitudes are gradually changing and funding of public health services are being considered in terms of the evidence available, I await, with interest, the public consultation I understand is coming soon on the work by NICE on community pharmacy public health interventions. This deals with the evidence, (RCTs as gold standard) therefore relying on documentation of public health interventions such as alcohol, sexual health and of course smoking. After all, community pharmacists I believe have a good track record in helping people stop smoking.