interviews

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The Royal Society for Public Health’s (RSPH) chief executive Richard Parish outlines the future role of pharmacies in protecting and promoting public health, and whether they should be given powers to refer patients into secondary care.

Pharmacies are significantly underused; they have the potential to serve as an early warning system, drive public health improvements and even refer directly into secondary care.

Driving access to this resource is an important step forward in integrated care and more intelligent use of NHS resources.

The Royal Society for Public Health (RSPH) and the Royal Pharmaceutical Society (RPS) are holding a joint conference to consider the way forward for the two specialties, making the most of available opportunities for the health service.

NHE spoke to RSPH chief executive Richard Parish about maximising the potential of pharmacies as a gateway to the wider NHS.

The conference is to be held on November 7, and will look at the developing and future role of community pharmacy in relation to population health; from how to help people improve their health prospects by either reducing obesity, or for an alcohol problem, knowing where and how to find help.

Pharmacies can also enhance their role of health protection, with increasing involvement in vaccination programmes as long as they have the right mechanisms in place to ensure these are accessible.

C o m m u n i t y confidence

Parish highlighted that community pharmacy was important for a number of reasons, especially due to its accessibility, both physical and psychological.

“It’s immediately accessible because you don’t need an appointment at most pharmacies, or if you do, you can get that at pretty short notice. They’re on the high street or in the village or in the innercity area; 95% of the population are within 20 minutes of a community pharmacy.

“They’re accessible psychologically. People aren’t as intimidated going into a pharmacy and talking to a pharmacist. What’s more, the people in the pharmacy are invariably drawn from the community the pharmacy serves, so they know so many people; that sense of familiarity actually gives a degree of confidence to the people coming into the pharmacy.”

Pharmacies can be in the frontline for public health surveillance, for issues such as pain management, especially for patients selfmedicating who could provide an early indication of any emerging population-wide viral infections.

“We don’t use them anywhere near as well as we should,” he added.

Going direct

It can waste time and resources to continually refer patients to their GP when pharmacists know they should be directed straight into secondary care if they have the symptoms of something potentially more serious.

Parish suggested that this could potentially cut referral times and even increase survival chances for serious conditions such as cancer.

“Why pass the person onto the GP when in most cases the GP is merely going to do what the pharmacist could have done in the first place?” he asked.

“That’s why it’s so important for the RSPH and the RPS to work together. We have a detailed understanding of all the potential that pharmacy can contribute to improving public health; it makes absolute sense for us to work together.”

He added: “I’ll go one stage further and say I think that in a decade’s time, maybe less, pharmacy will be at the heart of what is happening with health in communities, rather than just another player.”

There is a sense that the health service as a whole is only now realising the potential for pharmacies to improve public health through their unique position on the frontline of NHS.

“Now the policy makers, the senior people in the Department of Health and ministers now understand this potential. There is now a gathering momentum, which has been really enforced by the fact that the pharmacy organisations have really got their act together on this.”

Parish suggested this collaboration can be seen through the success of the Healthy Living Pharmacies project, which has gone over and beyond its ambitious targets.

Commissioning clarity

At a time when most resources are shrinking, it is great news to see the possibilities ahead for the health service. However, there is a risk that such good work and understanding could be lost, if the new structure of the NHS does not continue to recognise the potential at stake.

Parish said: “Obviously commissioners need to understand what pharmacy can do. The commissioning agenda is really crowded; there are so many possibilities for a limited amount of money to be spent on. We’ve got to do more to make sure they are really aware.”

The RSPH is planning a series of events to be held around the country, highlighting possible applications for pharmacy intervention. These will be open to commissioners, as well as local government, as responsibility for public health moves from PCTs to local authorities.

Parish described several challenges in moving care further into the community, to reduce pressure on the acute sector, including programmes of education and absolute clarity on responsibility.

He said: “I think we have to make sure that everybody understands what contribution they can make, people are clear about the change in role.”

Pharmacists must have the requisite skills to take on new tasks and responsibilities effectively. If pharmacies are to begin to fulfil a wider community health role, they will need to be resourced for the extra activity they undertake, he clarified.

Moving with the times

This will benefit pharmacies themselves, not just patients, Parish stated, as community pharmacy has to secure their future in the midst of changes with warehouse prescribing and dispensing set to increase.

He said: “If pharmacy doesn’t move with the times it will get left behind. This is not only about serving the public better, its also about ensuring there is a relevant role for pharmacy in a rather different world as we move five, ten, 12 years into the future.”

The staff working in community pharmacies are a “really valuable resource”, he said, with under-utilised skills and knowledge.

He concluded: “There is a potential for all shades of government; they’re all in favour of more of an opportunity for the public to comment and provide feedback on local health services – [there is] a wonderful route through community pharmacies for doing that. They need to be set up in a way to cope with things like that; it could be a conduit for comments back to the Department of Health or back into the health system.”

Despite the wealth of opportunities pharmacies present for improving public health, Parish acknowledged that these were options to consider in the following years rather than features to be immediately implemented.

“I’m conscious of the fact that you can’t swamp the pharmacy with everything in one go so I’m talking about possibilities for the future,” he said.

The application of access

Other potential avenues for expansion include the integration of social and health-related welfare benefits, he suggested, to help local people work their way through a quagmire of regulations and requirements.

There are clearly many options available, some of which will become more practical once the dust has settled from the reforms and staff are clear about the way forwards. For Parish, it all comes back to access and why this will be vital to the public health drive.

He concluded: “The key word for so many of these things here is access; physical and psychological access. Community pharmacies are often open, at least one or two days of the week, for much longer than your local GP would be so you’ve got access out-of-hours.

“People who won’t normally go to their GP will go into a local pharmacy, you’ve got access there; access to information, access to advice about health improvement issues, about vaccination and immunisation programmes. “Pharmacies and the people who work in them make health more accessible."

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