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Community pharmacies: promoting health and wellbeing

About

What is covered

This interactive flowchart covers how community pharmacies can help maintain and improve people's physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners.

Updates

Updates to this NICE Pathway

28 August 2020 Community pharmacies: promoting health and wellbeing (NICE quality standard 196) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on how community pharmacies can promote health and wellbeing in an interactive flowchart

What is covered

This interactive flowchart covers how community pharmacies can help maintain and improve people's physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners.

Updates

Updates to this NICE Pathway

28 August 2020 Community pharmacies: promoting health and wellbeing (NICE quality standard 196) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.

Quality standards

Community pharmacies: promoting health and wellbeing

These quality statements are taken from the community pharmacies: promoting health and wellbeing quality standard. The quality standard defines best practice for community pharmacies and should be read in full.

Quality statements

Advice and education

This quality statement is taken from the community pharmacies: promoting health and wellbeing quality standard. The quality standard defines best practice for community pharmacies and should be read in full.

Quality statement

People who have a long-term health condition or those who look for support to improve their health and wellbeing are offered advice and education when they use community pharmacy services.

Rationale

Community pharmacies are well placed to offer health and wellbeing advice and education to everyone in the local community, whether they have a long-term health condition or may benefit from support to improve their health and wellbeing. Community pharmacy teams are in a position to start general conversations about health and wellbeing with people who buy medicines or ask for advice. These informal conversations may encourage people to ask more questions, consider how they feel or how their behaviours may be affecting their health. Community pharmacy teams can offer support with adopting healthier behaviours, including stopping smoking, reducing alcohol consumption, and managing weight. They can also provide more information on mental and physical wellbeing, deliver brief interventions and signpost to other services.

Quality measures

Structure
Evidence of local arrangements to ensure that people who have a long-term health condition or those who look for support to improve their health and wellbeing are offered advice and education when they use community pharmacy services.
Data source: Local data collection, for example, review of community pharmacies’ standard operating procedures submitted through the Community Pharmacy Assurance Framework (dispensing).
Outcome
a) Proportion of people using community pharmacy services who received health and wellbeing advice or education.
Numerator – the number in the denominator who received health and wellbeing advice or education.
Denominator – the number of people using community pharmacy services.
Data source: Local data collection, for example, review of information recorded as part of the Community Pharmacy Patient Questionnaire.
b) Proportion of people using community pharmacy services who were satisfied with the health and wellbeing advice or education they received.
Numerator – the number in the denominator satisfied with the advice they received.
Denominator – the number of people using community pharmacy services who received health and wellbeing advice or education.
Data source: Local data collection, for example, review of information recorded as part of the Community Pharmacy Patient Questionnaire.

What the quality statement means for different audiences

Service providers (community pharmacies) ensure that systems and protocols are in place to offer health and wellbeing advice and education to people who have a long-term health condition or those who look for support to improve their health and wellbeing. They also work with commissioners to ensure that members of staff have the training, skills and confidence to provide health and wellbeing advice and education, including advice on stopping smoking, reducing alcohol consumption, and managing weight. Pharmacies should have a facility that offers privacy to people who would like to discuss their health and wellbeing in more detail.
Community pharmacy teams offer advice and education to people who have a long-term health condition or those who look for support to improve their health and wellbeing. This includes advice on stopping smoking, reducing alcohol consumption, and managing weight. Teams provide relevant information and resources or provide a brief intervention suitable to the person’s circumstances. If they cannot offer the support needed, they offer referrals or signpost to a relevant service. They also record the advice given, the interventions and referrals made.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that relevant training and resources for community pharmacy teams are available, and that all community pharmacies have a facility that allows for private conversations.
People who have a long-term health condition or may benefit from support to improve their health and wellbeing are offered an opportunity to discuss their health and wellbeing with a member of the community pharmacy team. They can ask for information about smoking, alcohol, or weight management, get advice or receive a referral to another service that they may need.

Source guidance

Definitions of terms used in this quality statement

Advice and education
Advice and education should be offered in line with NICE's guideline on behaviour change: individual approaches (see the recommendations on delivering very brief, brief and extended brief advice in NICE's guideline on behaviour change: individual approaches).

Equality and diversity considerations

People should be provided with information that they can easily understand themselves, or with support, so they can communicate effectively with a member of the community pharmacy team. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.

Expertise and services available from community pharmacy teams

This quality statement is taken from the community pharmacies: promoting health and wellbeing quality standard. The quality standard defines best practice for community pharmacies and should be read in full.

Quality statement

Community pharmacies and commissioners work together to raise awareness of the health and wellbeing expertise and services available from community pharmacy teams.

Rationale

Community pharmacies have the potential to play a greater role in health promotion, prevention, early recognition of ill health and managing minor illness. Community pharmacy teams are made up of highly skilled, knowledgeable and easily accessible professionals who provide NHS services. They can also be a link into the wider health and care network. Raising awareness of their skills, knowledge and responsibilities among members of the public and health and social care practitioners should improve confidence in the support they provide. It should also help to overcome barriers to taking full advantage of this valuable resource.

Quality measures

Structure
a) Evidence of local initiatives to raise awareness of the health and wellbeing expertise and services available from community pharmacy teams among members of the public.
Data source: Local data collection, for example, review of activities carried out by partners within the primary care network to raise awareness of the health and wellbeing expertise and services available from community pharmacy teams.
b) Evidence of local initiatives to raise awareness of the health and wellbeing expertise and services available from community pharmacy teams among health and social care practitioners.
Data source: Local data collection, for example, review of the primary care network’s activity to increase awareness of the role of community pharmacies.
Outcome
a) Uptake of referrals into community pharmacy.
Numerator – number in the denominator presenting to community pharmacy after the referral.
Denominator – number of referrals from GP practices and NHS111 into community pharmacy.
Data source: Local data collection, for example, review of pharmacy systems recording inward referrals.
b) Public understanding of the support available from local community pharmacies.
Data source: Local data collection, for example, review of information recorded as part of the Community Pharmacy Patient Questionnaire.

What the quality statement means for different audiences

Service providers (such as community pharmacies, primary care networks, general practices, NHS 111, A&E departments, social care providers, and community and voluntary sector organisations) work together to raise awareness of the health and wellbeing expertise and services available from community pharmacy teams among members of the public and health and social care practitioners. They ensure that they raise the profile of the teams and inspire confidence in the teams as a valuable resource for health and wellbeing support.
Health and social care practitioners (such as community pharmacy teams, GPs, NHS 111 and A&E staff, social care workers, and community and voluntary sector staff) recognise that community pharmacy is often the most appropriate service for people with a minor illness. They are confident that community pharmacy teams have the expertise to provide people with the support they need. They acknowledge community pharmacy teams as a valuable and accessible resource that is key in supporting the health and wellbeing of the local population.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) take proactive steps to ensure that local health and social care providers as well as members of the public understand that community pharmacy teams are highly skilled, knowledgeable and easily accessible professionals providing important health and wellbeing services.
People learn about the services and support they can get from local community pharmacy teams from promotional activities, awareness-raising campaigns, GPs, healthcare professionals or social care workers. They are encouraged to use community pharmacies as the first port of call for advice on health and wellbeing and for minor illness, instead of seeing their GP or going to A&E.

Source guidance

Equality and diversity considerations

Initiatives and activities used to raise awareness of services that can be provided by community pharmacies need to be tailored to the local populations. Pharmacists and their role may be perceived differently by people from different cultural backgrounds. This may influence people’s use of the services offered. Different messages and different languages may be required to ensure that the uptake of services improves. Also, a proactive approach is needed for people who are housebound.

Integrating services into care and referral pathways

This quality statement is taken from the community pharmacies: promoting health and wellbeing quality standard. The quality standard defines best practice for community pharmacies and should be read in full.

Quality statement

Community pharmacies and commissioners work together to integrate community pharmacy services into care and referral pathways.

Rationale

Community pharmacy teams have an important role in supporting the health and wellbeing of local populations. Integrating community pharmacies into local health and social care pathways, through effective partnership working and collaboration, will offer people effective, convenient and easily accessible services. It will also reduce duplication of work and relieve pressure on the wider health and social care system. Within a well-integrated care pathway, community pharmacy teams should not only be able to support people to maintain their health and wellbeing, but also to refer or signpost them to other health services, and services offered by local authorities and organisations in the community and voluntary sectors.

Quality measures

Structure
a) Evidence of community pharmacies and commissioners working together to integrate community pharmacy services into care and referral pathways.
Data source: Local data collection, for example, review of actions taken by commissioners, primary care networks and community pharmacies to facilitate integration.
b) Evidence of defined referral pathways between community pharmacies, primary care networks, health, social care and support service providers.
Data source: Local data collection, for example, review of arrangements agreed locally between community pharmacies, primary care networks, health, social care and support service providers.
c) Evidence of key performance indicators (KPIs) being agreed for the pathways defined between community pharmacies, primary care networks, health, social care and support service providers.
Data source: Local data collection, for example, review of KPIs agreed locally between community pharmacies, primary care networks, health, social care and support service providers.
Outcome
Proportion of community pharmacy team members satisfied with the availability of referral pathways.
Numerator – the number in the denominator satisfied with the availability of referral pathways.
Denominator – the number of community pharmacy team members.
Data source: Local data collection, for example, information collected through surveys of community pharmacy teams.

What the quality statement means for different audiences

Service providers (such as community pharmacies, primary care networks, general practices, NHS trusts, social care providers, and community and voluntary sector organisations) work together to establish effective referral pathways in their local areas. They work on improving understanding of expertise available from community pharmacy teams and building confidence in the referral pathways that are being established. They also set up information-sharing practices to reduce multiple assessments and waiting times, and offer people effective, convenient and accessible services.
Health and social care practitioners (such as community pharmacy teams, GPs, social prescribing link workers, social care workers, and community and voluntary sector staff) recognise the value of integrated working and the skills available within community pharmacy teams. They develop and use local referral pathways and information-sharing practices to ensure that people in the local area receive effective, convenient and accessible services.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) work with community pharmacies to integrate community pharmacies into the local health and care system. They take actions that support implementation of the community pharmacy contractual framework, including establishing and using referral pathways in local areas. This allows community pharmacy teams to accept as well as make referrals to the service most appropriate for the person, without the need for the GP to be involved unless appropriate. They also develop local health and care records that can be used by partners.
People who use community pharmacies receive the support they need from a community pharmacy team or, if they need more help, they are referred directly to a relevant health or care service without the need to go back to a GP unless appropriate.

Source guidance

Equality and diversity considerations

Referrals to health and wellbeing services may not always be suitable for people in rural communities because of issues with access and transport. Commissioners may need to work with community pharmacies to ensure that the services can be delivered through local community support groups, activity groups or clubs.

Health inequalities

This quality statement is taken from the community pharmacies: promoting health and wellbeing quality standard. The quality standard defines best practice for community pharmacies and should be read in full.

Quality statement

Community pharmacies and commissioners work together to agree health and wellbeing interventions to support people from underserved groups.

Rationale

Community pharmacy teams are often well established within the community, have good relationships with the local population, and a good understanding of their needs and challenges. People from underserved groups, such as some minority ethnic groups, people who are homeless or have no permanent address, and those unlikely to use other healthcare services, can get support when they need it without making an appointment. This knowledge and expertise within community pharmacies can inform commissioning of health and wellbeing interventions that are most relevant to the local population and will have the biggest impact on health inequalities.

Quality measures

Structure
a) Evidence of actions taken locally between community pharmacies and commissioners to agree health and wellbeing interventions needed to support people from underserved groups.
Data source: Local data collection, for example, review of arrangements between community pharmacies and primary care networks agreed locally.
b) Evidence of local commissioning agreements for provision of health and wellbeing interventions according to local need.
Data source: Local data collection, for example, review of local contracts with relevant commissioners.
Outcome
Proportion of community pharmacy team members who agree that the health and wellbeing services that they are commissioned to deliver reflect the needs of the local population.
Numerator – the number in the denominator who agree that the health and wellbeing services that they are commissioned to deliver reflect the needs of the local population.
Denominator – the number of community pharmacy team members.
Data source: Local data collection, for example, information collected through surveys of community pharmacy teams.

What the quality statement means for different audiences

Service providers (such as community pharmacies, primary care networks, GP practices, social care providers, and community and voluntary sector organisations) use their knowledge of the needs of the local population and of the gaps in services, captured by the pharmaceutical and joint strategic needs assessments, to address local health inequalities. Because people from underserved groups may be more likely to use NHS services if they are provided by community pharmacies, providers agree which specific health and wellbeing interventions community pharmacies should offer to address local health inequalities.
Community pharmacy teams use their skills and knowledge to support people from underserved groups who access their services. They tailor health and wellbeing interventions to suit individual needs and preferences and to maximise their impact.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that they commission services that reflect the health and social care needs and priorities of the local population. They work with service providers to gain a better understanding of priority areas, to identify local underserved populations and to agree health and wellbeing interventions to support people from underserved groups.
People from underserved groups are able to access many of the health and wellbeing services they need from local community pharmacies.

Source guidance

Definitions of terms used in this quality statement

Underserved groups
Adults and children from any background are 'underserved' if their social circumstances, language, culture or lifestyle (or those of their parents or carers) make it difficult for them to access health services or attend healthcare appointments.
Many of these groups may be more likely to go to a community pharmacy than a GP or another primary care service. As an example, this includes people who are housebound, homeless or people who misuse drugs or alcohol, and some people from minority ethnic groups, including Gypsy, Traveller and Roma people. A full list can be found in the equality impact assessment for the NICE guideline on community pharmacies.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Underserved groups

Adults and children from any background who are 'underserved' if their social circumstances, language, culture or lifestyle (or those of their parents or carers) make it difficult to access health services or attend healthcare appointments.
Many of these groups may be more likely to go to a community pharmacy than a GP or another primary care service.
They include:
  • people who are housebound
  • people in care homes or sheltered accommodation
  • older people in rural communities
  • carers
  • men
  • people from black and minority ethnic groups
  • people who are homeless or sleep rough
  • people who misuse drugs or alcohol
  • asylum seekers
  • Gypsy, Traveller and Roma people
  • people with learning disabilities
  • young people leaving long-term care.

Rationale and impact: creating health and wellbeing hubs

Rationale

The current NHS STPs and the Five Year Forward View both aim to improve the integration of healthcare services in the UK. The committee agreed that, as part of this, community pharmacies need to gradually become part of existing health and care pathways. This would mean they could act as health and wellbeing hubs, with inward and outward referrals established and consistently managed.
This will ensure they are aware of what services are offered locally and where formal referrals can be set up. But because it is not clear how to effectively refer in and out of pharmacies to improve people's care, the committee made the following research recommendation: Is referral from a community pharmacy within a formal local care pathway framework more effective and cost effective than signposting alone in improving access to, and uptake of, services by underserved groups and the general population?

Impact

Once community pharmacies are integrated with other local health and care services, the idea is that they can operate as neighbourhood health and wellbeing centres (health and wellbeing hubs). This means they would become the first place that people go to for support, advice and resources on staying well and healthy. It may involve working closely with community leaders to identify local resources and needs, develop related interventions and services and collect data on impact and outcomes.
Some investment may be needed to carry out these activities and to set up a formal referral process within community pharmacies. But this is in line with the movement towards better integration of health and care services within the NHS, and national resources are being put in place to support this. For example, the Pharmacy Integration Fund was established to support clinical pharmacy integration within the NHS and the community.
Full details of the evidence and the committee's discussion are in the evidence discussion for sections 1.1 and 1.2.

Rationale and impact: approach to interventions

Rationale

Use an integrated approach
Community pharmacies offer a socially inclusive, easily accessible service for all members of the public and, as such, should be the first place people go for help with a non-urgent health issue. A key way to encourage more people to use services is to ensure they are fully integrated within the health and care system – including with other pharmacies.
Better integration of community pharmacies in the wider health care system will have a positive impact on patient choice and result in better health outcomes for people in both primary care and the community.
Ensure consistent, high-quality services
The committee agreed that if more people are to use the interventions on offer they need to know what they can expect, regardless of which pharmacy they visit, so a consistent standard of service is important.
A typical community pharmacy is staffed by people with various levels of training and competencies in health promotion services. Healthy Living Pharmacies also have qualified health champions who take responsibility for the healthy living programme.
But there is a lack of research on how the training or other characteristics of the person delivering a health and wellbeing intervention influence its effectiveness or cost effectiveness. This includes a lack of research on whether using a recognised behaviour change competency framework (see NICE's guideline on behaviour change: individual approaches) has an impact on this. So the committee made the following research recommendation: How do the professional characteristics of pharmacy staff affect the effectiveness and cost effectiveness of delivering information, advice, education or behavioural support to underserved groups and the general population? (Characteristics include, for example, job roles such as health champion, as well as competencies and level of training.)
Evidence showed that people are more likely to trust information resources that are clear, professional and free of any commercial links. The latter is particularly important because it makes it clear that there is no profit motive behind any information given.
Address health inequalities
An expert pointed out to the committee that because of their accessibility, community pharmacies could address health inequalities. In England, 90% of people (99% in the most deprived communities) live within a 20-minute walk of a community pharmacy.
But more research is needed to determine whether community pharmacies are better than other health services at reaching underserved groups. In addition, there is no evidence on how these services should be tailored to benefit different groups. (People from different ethnic or socioeconomic groups, or of different ages, may gain more or less from the services on offer.) So the committee made the following research recommendation: What are the barriers to and facilitators for increasing access to community pharmacy services by underserved groups? How should health and wellbeing interventions be tailored to increase service uptake in underserved groups?

Impact

Establishing links to integrate community pharmacies with other health and care organisations may result in upfront costs such as the time it takes to develop pathways and make a referral. But this may be offset by:
  • more efficient use of resources in the wider system
  • better continuity of care
  • quicker access to the right treatment (including for underserved or underprivileged communities).
It may not always be practical or feasible for the same member of staff to deliver all sessions of an intervention, but where it is possible this will reduce variation in current practice.
Identifying underserved groups and tailoring interventions to suit an individual's needs and preferences may increase service uptake in these groups and help community pharmacies to potentially address health inequalities.
Promoting community pharmacies by highlighting the services on offer and the skills of pharmacy staff may have some resource impact. But this may be offset by an improvement in health outcomes resulting from more people using the services.
It may not always be practical or feasible to seek opportunities to promote health and wellbeing services within the pharmacy. But if staff are trained to identify opportunities to offer services then there should be no significant cost implications. The Making Every Contact Count initiative offers training for health and social care staff on how to identify opportunities to talk to people about their health and wellbeing and deliver brief interventions. Some funding to support or implement this training may be available.
General health and wellbeing advice is covered in general pharmacy training and some pharmacists and pharmacy technicians are trained in core public health priorities. Some staff will also have the Royal Society for Public Health Level 2 award in improving health. Some pharmacy staff may need additional training in effective behaviour change techniques, which may incur a small resource cost. Some free behaviour change training may be available, for example from Health Education England and the Centre for Pharmacy Postgraduate Education.
Full details of the evidence and the committee's discussion are in the evidence discussion for sections 1.1 and 1.2.

Rationale and impact: promoting health and wellbeing services

Rationale

Promote community pharmacies
Another way to encourage the public to make full use of community pharmacy interventions could be to make them aware that many staff are qualified or specialists in certain areas. This could improve the public's perception of the pharmacy as a trusted source of health and wellbeing advice and support.
Proactively seek opportunities
Community pharmacy interventions to help improve people's physical and mental health and wellbeing are usually delivered as the opportunity arises – when people come in for prescriptions, buy other products or make general enquiries.
The committee agreed that identifying opportunities to provide interventions and referrals should be encouraged. It would mean that more people using pharmacies could get support, either from the pharmacy itself or from other local multidisciplinary teams, to prevent health problems from developing or deteriorating. This, in turn, would reduce the burden on other areas of health and care.

Impact

Establishing links to integrate community pharmacies with other health and care organisations may result in upfront costs such as the time it takes to develop pathways and make a referral. But this may be offset by:
  • more efficient use of resources in the wider system
  • better continuity of care
  • quicker access to the right treatment (including for underserved or underprivileged communities).
It may not always be practical or feasible for the same member of staff to deliver all sessions of an intervention, but where it is possible this will reduce variation in current practice.
Identifying underserved groups and tailoring interventions to suit an individual's needs and preferences may increase service uptake in these groups and help community pharmacies to potentially address health inequalities.
Promoting community pharmacies by highlighting the services on offer and the skills of pharmacy staff may have some resource impact. But this may be offset by an improvement in health outcomes resulting from more people using the services.
It may not always be practical or feasible to seek opportunities to promote health and wellbeing services within the pharmacy. But if staff are trained to identify opportunities to offer services then there should be no significant cost implications. The Making Every Contact Count initiative offers training for health and social care staff on how to identify opportunities to talk to people about their health and wellbeing and deliver brief interventions. Some funding to support or implement this training may be available.
General health and wellbeing advice is covered in general pharmacy training and some pharmacists and pharmacy technicians are trained in core public health priorities. Some staff will also have the Royal Society for Public Health Level 2 award in improving health. Some pharmacy staff may need additional training in effective behaviour change techniques, which may incur a small resource cost. Some free behaviour change training may be available, for example from Health Education England and the Centre for Pharmacy Postgraduate Education.
Full details of the evidence and the committee's discussion are in the evidence discussion for sections 1.1 and 1.2.

Rationale and impact: awareness raising campaigns and information

Rationale

The way community pharmacies provide information on health and wellbeing varies across the UK, as does the way they present and use these resources.
Evidence showed that providing information to raise people's awareness of an issue is the first step to helping them change their behaviour. Evidence also showed that it is most effective to give people information as part of a discussion, rather than just handing them a leaflet or other resource.
But there is limited evidence on its effectiveness and cost effectiveness for specific issues such as alcohol or drug misuse, diabetes, falls, smoking, cancer, and mental health and wellbeing. So the committee made the following research recommendation: How effective and cost effective are awareness raising, advice and education or behavioural support interventions delivered by community pharmacy teams to improve health and behavioural outcomes in underserved groups and the general population?

Impact

Speaking to people about the information you want to give them before you hand it out may involve a small amount of additional staff time (to explain why the information is relevant). But this cost could be offset by improved health outcomes and resource savings elsewhere in the health or care system. For example, the person might, as a result, seek advice or receive other support that prevents them from becoming ill or generally improves their health.
Some pharmacy staff, such as those who have become health champions, are competent to provide information in this way.
In addition, pharmacists and pharmacy technicians receive or have access to training in communication and consultation skills as part of their undergraduate, postgraduate and pre-registration training programmes. They can also get free training in these skills from The Centre for Pharmacy Post Graduate Education (funded by Health Education England).
Full details of the evidence and the committee's discussion are in evidence review 1: providing information on health and wellbeing.

Rationale and impact: advice and education

Rationale

Community pharmacies are well placed to offer health and wellbeing advice and education to everyone in a local community, whether they have a long-term health condition or need help to adopt a healthier lifestyle. However, there is significant variation in what is offered.
Evidence showed that pharmacy staff can provide effective advice and education to people with diabetes and hypertension. It also showed that brief advice can help people stop smoking. There was limited evidence that the use of photo-ageing software to support such advice was effective and cost effective. But based on their experience, the committee agreed that it could be worth trying if resources were available on the premises.
In addition, advice and education can potentially help people reduce their alcohol consumption. But further research is needed to see if it is effective in: improving cancer awareness and people's sexual health and mental health and wellbeing, or preventing drug misuse and falls. So the committee made the following research recommendation: How effective and cost effective are awareness raising, advice and education or behavioural support interventions delivered by community pharmacy teams to improve health and behavioural outcomes in underserved groups and the general population?

Impact

These recommendations should reduce variation in current practice.
General health and wellbeing advice is covered in general pharmacy training. Some pharmacists and pharmacy technicians are also trained in core public health priorities. Some staff will have gained the Royal Society for Public Health Level 2 award in improving health.
A lot of free training is available for pharmacy staff (such as the smoking cessation training provided by the National Centre for Smoking Cessation and Training). But some may involve a small cost. So pharmacy teams that currently provide the least health and wellbeing advice and education are likely to have the biggest expenditure as a result of implementing the recommendations.
Full details of the evidence and the committee's discussion are in evidence review 2: offering advice or education to promote health and wellbeing.

Rationale and impact: behavioural support

Rationale

The type of behavioural support offered by community pharmacy teams varies across the UK, so the committee recommended that they follow NICE guidelines for the relevant issue or condition.
Evidence showed that certain behavioural interventions, specifically interventions to help people stop smoking or manage their weight, are effective and cost effective when provided by community pharmacy teams.
Some evidence suggests that interventions delivered in community pharmacies that involve people setting their own health goals may help people improve their patient activation. However, more research is needed to support this and to show how delivering these interventions in community pharmacies can be used to improve people's health. So the committee made the following research recommendation: How effective and cost effective is advice, education or behavioural support offered by community pharmacy teams to improve patient activation and measures of behaviour and health changes, particularly in areas where activation levels are lower? This includes evaluating factors such as frequency, intensity and duration of the intervention.
Further research is also needed before behavioural interventions can be recommended in pharmacies for: improving cancer awareness, sexual and mental health and orthopaedic conditions, and preventing alcohol or drug misuse, diabetes and falls. So the committee made the following research recommendation: How effective and cost effective are awareness raising, advice and education or behavioural support interventions delivered by community pharmacy teams to improve health and behavioural outcomes in underserved groups and the general population?
The committee agreed that written information or support aids given alongside behavioural support may be beneficial. They also agreed that it is worth referring people to other services in the local care network for behavioural support if the pharmacy doesn't provide this itself.

Impact

These recommendations should reduce variation in practice and ensure commissioners focus on behavioural support activities that have been shown to be both effective and cost effective.
Some pharmacy staff may need training in effective behaviour change techniques and this may incur a small resource cost. However, local authorities may provide their own training. In addition, some free behaviour change training may be available for pharmacy staff from, for example, Health Education England and the Centre for Pharmacy Postgraduate Education.
Full details of the evidence and the committee's discussion are in evidence review 3: offering behavioural support to promote health and wellbeing.

Rationale and impact: referrals and signposting

Rationale

Referrals
Members of the public may need to be directed to other services for support, advice or treatment if it cannot be provided by the community pharmacy.
Formal referrals, involving an agreed process with another provider, may be more effective than signposting (giving people information on other organisations that can help). But often community pharmacy services are not part of a formalised care pathway. That means they cannot always make formal referrals to, or accept them from, other services. It also means that other services may not know what community pharmacies can offer.
An expert told the committee that links with other health and care providers were key to ensure effective continuity of care and to ensure people gain the most benefit from the system. The committee agreed this is particularly important for people who may not use other healthcare services for example, people from underserved groups.
The committee recommended that if community pharmacy teams do offer such a service, fast referrals will be needed for people at risk. In addition, it will be important to ensure people referred on are not reassessed as a matter of routine when they enter the care pathway. (Reassessment is a waste of resources and could also undermine the pharmacist's credibility.)
Based on their experience, the committee agreed it was useful to provide examples of the types of issues that community pharmacy teams could make referrals on, including to GPs, local authorities and social services.
Some evidence showed that people are more likely to take up the offer of a referral if they are given clear details about why they are being referred and what they can expect to happen. The committee also agreed that it was important for pharmacy staff to be fully informed when they accept a referral, so that assessments are not duplicated and people can enter at the correct point in the care pathway.
Some evidence showed that referral by community pharmacy teams increased service uptake more than signposting, but more evidence is needed to support a formal referral process. Establishing cost-effectiveness evidence for this in pharmacies is also important. That's because there may be cost implications for the time needed to make or accept individual referrals and for setting up the overall process, compared with signposting. So the committee made the following research recommendation: Is referral from a community pharmacy within a formal local care pathway framework more effective and cost effective than signposting alone in improving access to, and uptake of, services by underserved groups and the general population?
Signposting
If it is not possible to introduce a formal referral process, signposting people to other organisations is still important because it can increase the likelihood of people using the services. But committee members agreed with the evidence that formal referrals are more effective than signposting for increasing the uptake of services.
Record keeping, auditing and monitoring
Recording and sharing information will prevent duplication in the care pathway, build relationships between service providers and encourage collaboration. Auditing could also help improve efficiency and quality and inform the work of other organisations. But this can only be achieved if the service providers involved have a shared understanding of what data should be recorded and used for analysis (that is, the minimum data sets) and why.

Impact

Integrating community pharmacy interventions into health and care pathways will have a positive impact on patient choice and result in better health outcomes for people in both primary care and the community.
Signposting is currently the standard approach within community pharmacies. But clear methods of referral to and from community pharmacies should make it easier for people to access services and increase uptake. Effective referrals will also encourage people to choose the pharmacy as their first point of contact with healthcare professionals, potentially reducing pressure on A&E and GP practices.
In the long term these benefits may offset any upfront costs such as the time it takes to develop pathways and the time it takes to make the referral.
In terms of resource impact, it may not be practical to record every intervention, but it is something that is covered by professional practice, so there is no potential resource impact.
Full details of the evidence and the committee's discussion are in evidence review 4: signposting and referral to other services and support.

Glossary

(a smoking cessation intervention in which photos of participants are digitally aged so they can see images of themselves as a lifelong smoker and a non-smoker)
sustainability and transformation partnerships
(referral can include an agreed process with another organisation, which involves sending people for consultation, review, or further action)

Paths in this pathway

Pathway created: August 2018 Last updated: August 2020

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