NICE says community pharmacy needs embedding in NHS pathways – something the sector has been saying for years

Community pharmacy has long been heralded as the saviour of the NHS, by the sector itself, naturally, and Government minister after Government minister has said the same…although funding and policy has not always been in line with these proclamations, particularly in England. Now something has happened that may be the final push needed.

The National Institute for Health and Care Excellence (NICE) has issued guidance saying that commissioners and pharmacies must work together to make this vision a reality. Even more, the organisation is championing the sector to the public.

This significant document goes under the unremarkable title ‘Community pharmacies: promoting health and wellbeing’. This rather underplays the strength of the arguments that underpin the recommendations, which are contained in the ‘Rationale and impact’ section. There can be found such nuggets as calling for investment to be made in order for pharmacies to become fully embedded into health and care pathways. The reasons are obvious and many, as far as NICE is concerned:

• The easily accessible and socially inclusive nature of pharmacies means they should be the first port of call for all members of the public who have non-urgent health needs, not only improving patient choice and health outcomes, but also making better use of resources across the NHS estate
• The remarkable position the sector is in with regards to addressing health inequalities, as 99 per cent of people in deprived communities live within a 20-minute walk of a pharmacy
• The interventions that are delivered – without the need for an appointment – that improve people’s physical health and wellbeing
• The training in communication and consultation skills that is on offer to pharmacy professionals that complements their knowledge and practice, and the breadth of education available to support staff on a wide range of topics, from smoking cessation to behaviour change
• The potential for NHS savings and better patient outcomes if rapid formal referrals are allowed, not just from pharmacies into other NHS services, but also into pharmacies from other healthcare providers, as an extension of the signposting that already takes place.

Not all one way

It isn’t a one-way street, however. The advisory committee behind the report – chaired by Paul Lincoln, former chief executive of the policy and advocacy think tank, UK Health Forum, and including individuals from the pharmacy profession only as experts or for providing or evaluating evidence – makes several recommendations for the sector itself, including:

• Consistency across the network in terms of service provision and standards, while still making sure local health needs are pinpointed and met
• Providing information that is clear, informative and relatively free of commercial links in order to gain more trust from the public and raise professional standing
• Identifying more opportunities for interventions that can improve health and wellbeing.

With pharmacy waking up to the importance of gathering evidence to prove the worth and value of what it does, it is helpful that NICE has identified some research gaps that need filling, such as:

• The effectiveness of referral pathways compared to signposting
• The impact of awareness raising, advice and education or behavioural support delivered by pharmacy teams
• The barriers to and facilitators for increasing access to community pharmacy services by under-served groups because of (e.g.) social factors, language, culture or lifestyle
• The factors that influence how and why particular interventions are more effective than others
• How the professional characteristics of staff – for example, job role and competencies – affect the impact of the advice and services they provide.

NICE urges the public to make the most of local pharmacies, saying: “Many of us live within easy reach of a pharmacy but many people don’t know about the full range of services on offer.”

The organisation goes on to describe how pharmacists and their staff can provide information and support on ways to keep fit and healthy, deal with a range of health issues including new and existing conditions, and recognise when someone needs referring to another provider for further help, as well as handling medicines.

NICE points out something that the sector has known for many years, but which has not perhaps been commended for the extra insight it brings about: “Pharmacy staff often live locally, so they understand the issues people living in the area face.”

This is no small piece of work by NICE. It is over two years in the making, and includes consideration of information from academics, representatives from independent and multiple pharmacies, and Government health departments.

The document notes the financial outlay that some of its recommendations may incur but stresses how, ultimately, these will be offset by savings in terms of wider NHS resources – something that nobody should argue with given the current political and economic climate.