Independent pharmacies lead the way in public health delivery, but there are still numerous barriers to overcome, says a new report

Independent pharmacies are more likely to provide public health services, but several barriers prevent all pharmacies reaching their full potential in this area, according to a joint report by the Royal Society for Public Health and Public Health England.

Pharmacy’s role in promoting public health has never been more important, but independents and multiples take different approaches, says the report. In some multiples, for example, “there seems to be a disconnect between the enthusiasm and willingness of pharmacy teams, and the understanding and awareness of those in head office”.

One health champion is quoted as saying: “I think some companies are massive barriers. I do work for a large multiple myself. It is hard for me, the top of my chain, for them to understand what HLP is.”

The ‘Building Capacity’ report is partly based on a survey which found that 70 per cent of staff based in large multiples do not deliver chlamydia screening, 39 per cent do not provide stop smoking services and 17 per cent do not offer emergency hormonal contraception. This compares with 36 per cent, 20 per cent and 7 per cent, respectively, in independents. And while 62 per cent of independent respondents were based in an HLP or working towards HLP status, only 38 per cent of those working in multiples said the same.

The report examines the views of pharmacy teams, LPC chief officers and commissioners on pharmacy’s role in public health, and uncovers several key themes. These include ongoing capacity issues of pharmacy teams in terms of staff numbers and training, pharmacy’s comparative exclusion from the commissioning landscape, and the lack of awareness about pharmacy services among the public, commissioners and other healthcare professionals.

It demonstrates pharmacy teams’ appetite for a greater public health role, and the support of commissioners, particularly in local authorities, for achieving this. But it also highlights the strong feeling among pharmacy teams and commissioners that pharmacy is currently under-utilised.

What commissioners think

Most commissioners (55 per cent of whom were from local authorities, 20 per cent from CCGs and 13 per cent from NHS England) view pharmacy as an effective provider. While 58 per cent think community pharmacy provides flu vaccinations effectively, 74 and 64 per cent, respectively, think it effectively provides emergency hormonal contraception and substance misuse services.

Pharmacy team members feel they also have the support and trust of the public, with over three-quarters saying that the public views them as either ‘somewhat’ or ‘completely’ capable. And well over half think that CCG and local authority commissioners, GPs and NHS local teams view them in the same way.

We’ve got no official place at any table

Around half of pharmacy team respondents feel that insufficient staff numbers are a barrier to public health service delivery, and a lack of trained staff and suitable training courses may also be an issue. Almost four out of five commissioners claim that skills and training are primary concerns when making their decisions, compared to three quarters who say that location and accessibility are primary concerns.

Readiness of facilities also seems to be an issue, with just under a third of respondents feeling that lack of space may be a challenge and several interviewees saying that some pharmacies’ IT infrastructures are inadequate.

Representation lacking

Exclusivity and lack of integration in the commissioning process, and the variety of commissioners, presents challenges for pharmacy. An LPC chief officer says: “We’ve got no official place at any table, be it NHS England, be it county council, and we’re not on CCGs”.

Less than one in five commissioners say their local health and wellbeing board has a pharmacy representative, whereas 59 per cent say it has a GP representative, 47 per cent a social care representative, 20 per cent housing professionals and 19 per cent allied health professionals.

Pharmacy team members view relationships with commissioners and other healthcare professionals as generally positive, but GPs’ pre-eminence in commissioning structures is a challenge. Roughly 30 per cent of pharmacy team members have experienced ‘push-back’ from GPs, although this was mainly in relation to flu vaccination. In contrast, only 12 per cent of respondents see local authority commissioners as ‘uncooperative’.

More than a third of pharmacy respondents, however, do not feel their LPC champions their interests. Several interviewees, from both pharmacy teams and commissioning, felt that the voice of pharmacy can feel fragmented.

A local authority commissioner is quoted as saying: “You need the right skills to have the right conversations, to be able to understand how to lead, and unfortunately there is a lack of skills within the LPC to be able to do this”.

The survey was conducted in the months immediately following the announcement of pharmacy funding cuts, which may have influenced the results.

• Commissioners should recognise pharmacy as a local health asset and enhance their understanding of the profession.
• Local authority directors of public health and commissioners should consider healthy living pharmacies’ contribution, and increase the number of pharmacies seeking accreditation.
• Every community pharmacy should have at least one health champion.
• Greater joint working and integration between pharmacy teams and GPs.
• Improved leadership from LPCs and greater engagement with local commissioners and other stakeholders.
• Pharmacy leaders should ensure the profession contributes to the Five Year Forward View.