Getting serious about prevention through pharmacy Professor Kevin Fenton National Director, Health and Wellbeing Public Health England Twitter: @ProfKevinFenton Email: Kevin.Fenton@phe.gov.uk February 2017

Content Why we must focus on prevention, public and population health Pharmacy – Health and Wellbeing Hubs and a key to success PHE’s commitments, actions and priorities for community pharmacies Conclusions Getting serious about prevention through pharmacy

The public health system PHE’s key stakeholders and place in the public health system: The plan describes our place in the Public Health system and describes our key stakeholders. 3 Getting serious about prevention through pharmacy

PHE’s role Our functions and the things we deliver to our stakeholders: We do this through world-class science, advocacy, partnerships, knowledge and intelligence, and the delivery of specialist public health services. It considers the breadth of our functions and the things we deliver to our stakeholders: Protection from infectious disease Protection from environmental hazards Preparing for, and responding to, emergencies Improving health and wellbeing and reducing inequalities Supporting the NHS Protecting and improving global health Supporting and developing the public health system We do this through world-class science, advocacy, partnerships, knowledge and intelligence, and the delivery of specialist public health services. 4 Getting serious about prevention through pharmacy

Our seven priorities Getting serious about prevention through pharmacy

Why prevention matters 6 Getting serious about prevention through pharmacy

Life expectancy for England and EU Between 1990-2013, life expectancy in England saw a 5.4 year increase from 75.9 to 81.3 years (one of the biggest increases in EU15+ countries). This is mainly due to falls in the death rate from CVD, stroke, COPD and some cancers. This slide shows life expectancy at birth by gender in Australia, Sweden, Italy, England, Finland, Portugal and US, and compares LE in 1990 and 2013. Women continue to have a longer LE than men, but overall LE has increased. 7 Getting serious about prevention through pharmacy Getting serious about prevention through pharmacy

Leading causes of death in England Source: http://www.statista.com/chart/3643/what-kills-english-people/ 2013 figures http://www.statista.com/chart/363/what-kills-english-people/ 8 Getting serious about prevention through pharmacy Getting serious about prevention through pharmacy

Global Burden of Disease Burden of disease attributable to leading risk factors for both sexes in 2015, expressed as a percentage of England disability-adjusted life-years: 9 Getting serious about prevention through pharmacy

Our work on CVD prevention Last year PHE published an overview of our work on CVD prevention – here are a few examples of current activity: Local Tobacco Control Profiles Change4Life One You NHS Health Check programme National Cardiovascular Intelligence Network (NCVIN) Government Buying Standards for Food and Catering Services Local Alcohol Profiles for England (LAPE) NHS Abdominal Aortic Aneurysm Screening Programme Healthier You: NHS National Diabetes Prevention Programme 10 Getting serious about prevention through pharmacy

Getting serious about prevention through pharmacy

Focus on blood pressure The Global Burden of Disease 2015 highlights that high blood pressure is the second biggest known global risk factor for disease after poor diet. In the UK, high blood pressure is the third biggest risk factor for disease after tobacco smoking and poor diet. High blood pressure is, however, the largest single known risk factor for cardiovascular disease and related disability and increases the risk of: heart failure coronary artery disease stroke Getting serious about prevention through pharmacy

Disease burden and lifestyle changes Lifestyle changes can make a significant contribution to reducing risk of disease, improving health outcomes, reducing premature death and improving mental wellbeing: stopping smoking improving diet and nutrition increasing physical activity reducing alcohol consumption 40% of disability adjusted life years lost in the UK are attributable to smoking, hypertension, alcohol, weight or physical inactivity. Healthy behaviours can improve many long term conditions and reduce the risk of disease, complications and early death. Health professionals can play an important part in supporting people to make small but sustainable changes that improve their blood pressure and improve overall health. Getting serious about prevention through pharmacy

Why pharmacy? 11,688 community pharmacies in England 1.2 million health-related visits every day – massive opportunities for health promoting interventions Community pharmacies are embedded in local communities, often in disadvantaged and challenging areas, and often offering longer opening hours than other healthcare settings plus weekend access. 79% of people have visited a community pharmacy in the past year, and 37% in the past month; 87% trust health advice from a pharmacist. More than 90% of community pharmacies have a private consultation area to provide confidential one-to-one advice to customers and patients. Five Year Forward View: need to maximise the potential of community pharmacy in the prevention of ill health, support for healthy living, self care, medication review and as part of integrated care models. Getting serious about prevention through pharmacy

Public health services through pharmacy Many pharmacies across the country are already engaged in delivering public health interventions. The profession is ready and willing to deliver more public health interventions. However, there is significant variation across the country in the level of integration of pharmacy into clinical pathways and public health service provision. About a third of local authorities commission NHS Health Checks from community pharmacies and just under half of upper tier authorities are using pharmacies to deliver chlamydia screening. Most public health services are commissioned through individual local authority contracts and there is significant variation across the country in contract tariff and content. Getting serious about prevention through pharmacy

What would PHE like to see? Greater consistency of quality and delivery of public health interventions through community pharmacies Healthy Living Pharmacies (HLPs) provide a great model for consistently delivering high quality public health interventions underpinned by enablers: Qualified health champions Pharmacist or manger has completed leadership course Premises facilitate health promoting interventions Local stakeholder engagement All HLPs must satisfy quality criteria disseminated by PHE in summer 2016 The new profession-led self assessment process for Level 1 HLPs and the quality payment announced by NHS England should help with accelerated roll-out of HLPs across the country Qualified health champions have completed the RSPH level 2 award – Understanding health improvement, reaching out to local communities to improve health Getting serious about prevention through pharmacy

Examples of good practice West Yorkshire Pharmacy teams go out of their way to support vulnerable people Established a patient participation group (PPG), which drives development of new services such as a weight management group Organised ‘family and friends’ health walks Healthy cook book written with recipes from the PPG Marton Pharmacy, Teeside Provides a Healthy Heart service and dietary advice Encourages the public to get active, for example by attending Park Run Provides stop smoking services and an alcohol brief advice service Getting serious about prevention through pharmacy

Examples of good practice Bedminster Pharmacy, Bristol One of the first HLPs in the South West The pharmacy team is actively engaged in providing healthy lifestyle advice to empower people to make positive changes to improve their health Focused on men’s health including services tailored to young people. Lead pharmacist uses the talents and resources of his diverse team to serve his community, with support from the local council Getting serious about prevention through pharmacy

Action from PHE so far National leadership for public health action through community pharmacy. Advocate and champion pharmacy's public health role, as a critical community hub and a valuable health and social asset with links to diverse and vibrant communities. Secretariat support to the Pharmacy and Public Health Forum, established by Ministers, following transfer of accountability to PHE. Strategic leadership for the development and acceleration of the HLP programme, supported by the HLP Task Group, including funding a pilot quality assurance process for profession-led Level 1 self-assessment. Support the mobilisation of community pharmacy to promote national PHE campaigns such as Stoptober, Be Clear on Cancer, One You, Stay Well This Winter and Change4Life. Getting serious about prevention through pharmacy

Action from PHE so far Supported the mobilisation of community pharmacy to promote specific PHE priority programmes such as blood pressure prevention, early detection and management, NHS Health Checks and smoking cessation. PHE’s menu of preventative interventions was published in November 2016 to support local Sustainability and Transformation Plans, and outlined evidence-based public health and preventative interventions that can help to improve people’s health and reduce demand on health and care services in the short to medium term. The menu specifically highlights a role for pharmacy in: Cardiovascular secondary prevention Improving management of people with high blood pressure Deliver effective and brief advice on physical activity in clinical care Raising public awareness about reducing the risk of dementia Alcohol identification and brief advice Getting serious about prevention through pharmacy

PHE priorities for pharmacy for 2017-19 Provide system leadership to ensure pharmacy teams play a pivotal role in improving the health of people in England. Continue to support the Pharmacy and Public Health Forum to develop, and implement, public health practice through pharmacy. Continue to provide strategic leadership for the HLP programme, while helping to improve the quality and reach of the HLP delivery model. Maintain and develop national strategic leadership for public health pharmacy and strengthen integration with PHE Centre system leadership. Work with PHE Centres to support realising the potential of pharmacy in local systems, especially through STP and devolution partnerships. Getting serious about prevention through pharmacy

PHE priorities for pharmacy for 2017-19 Embed community pharmacy more visibly as an integrated solution across PHE’s priority areas through cross-team working such as the blood pressure and wider CVD programme, sexual health and physical activity. Support NHS England’s work programme to improve the quality of clinical and public health practice through pharmacy. Support the work of clinical pharmacists in GP practices, to ensure that public health interventions are embedded in their daily practice. Getting serious about prevention through pharmacy

A new report from Pharmacy Voice I am delighted to announce that Pharmacy Voice is today launching, Tackling high blood pressure through community pharmacy, part of its commitment to the Blood Pressure System Leadership Board to get greater engagement of pharmacy in the blood pressure programme Pharmacy teams can play a critical role in tackling prevention, early detection and management of high blood pressure. This includes pharmacy teams in community pharmacies as well as clinical pharmacists working in GP practices. Tackling high blood pressure through community pharmacy has been supported by PHE and other stakeholders It is great to see that the commitment that PV made to the Blood Pressure System leadership Board is coming to fruition today Getting serious about prevention through pharmacy

Conclusion Prevention matters – if the public were fully engaged in managing and improving their health, £30 billion could be saved. Lifestyle changes can make a significant contribution to improving physical and mental health and reducing risk of disease and early death. High blood pressure should be a key focus as the third biggest risk factor for disease and with 5 million people still undiagnosed. Pharmacy offers a huge opportunity for health promoting interventions with 1.2 million health-related visits to 11,688 pharmacies every day. PHE will promote pharmacy’s pivotal role in improving the public’s health by: Embedding pharmacy more visibly as part of cross-team work on blood pressure, sexual health, physical activity etc. Continuing to provide strategic leadership for the development and accelerated roll-out of HLPs We must all work together to take forward the recommendations put forward by Pharmacy Voice to help improve the prevention, early detection and management of high blood pressure in England. Getting serious about prevention through pharmacy

Thank you Professor Kevin Fenton National Director, Health and Wellbeing Public Health England Twitter: @ProfKevinFenton Email: Kevin.Fenton@phe.gov.uk February 2017