Michael Holden FRPharmS NPA Chief Executive Pharmacy and Public Health Forum

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

Common Ailments Promotion Prevention Protection Early detection Diagnosis & Treatment referral Initial supply and support Ongoing adherence support PATIENT and PUBLIC Self care & Healthy lifestyle interventions Making Every Contact Count Medicines Optimisation

Why use pharmacy?

Healthy Living Pharmacy background Pharmacy White Paper states vision for pharmacies to become Healthy Living Centres 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 launch pathfinder programme Evaluation of pathfinder programme April 2008 June 2009 Sept 2010 March 2011 April 2013

Consistently delivers broad range of high quality commissioned services Quality, innovation and productivity Proactive team ethos Health Champion Identifiable What distinguishes a Healthy Living Pharmacy?

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 – NHS Plan – Public Health White Paper – Respiratory Strategy – NHS Future Forum report – Public Health Workforce Development consultation

Evaluation aims 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)? Does geography and demography impact on HLP performance? What is the effect of HLP services on public-reported experiences? What are the benefits of HLP for public, commissioner, contractor, employees? Is each individual service delivered through HLP cost-effective?

SERVICE EVALUATION

Service outcomes: overall

Service outcomes: stop smoking

Service outcomes: sexual health Buckinghamshire: –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 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 19

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 20

Service outcomes: alcohol awareness Pharmacy London initiative –24,000 scratch cards –>43% high risk 21

Service outcomes: Substance misuse Blackburn with Darwen and East Lancs – 328 interactions over 4 months 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

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)

Location where service users would have sought help/advice had this service not been available in the pharmacy (n = 1034)

Number of service users referred to an additional service in the pharmacy (n = 1034) There were 683 referrals/recommendations into other services offered by pharmacy.

Commissioners’ views “Becoming an HLP will display to commissioners pharmacy’s commitment to delivering cost effective and high quality services” [Birmingham tPCT and Solihull] “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] “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 environment engagement workforce Quality Criteria

2000+ qualified Health Champions leadership development 500+ Healthy Living Pharmacies

What next?

Recommendations 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