Developing a progressive and sustainable community pharmacy public health promotion service, which will meet the NHS's QIPP (quality, innovation, productivity, prevention) agenda

Abstract

Introduction The evidence base for community pharmacy improving public health (PH) exists in the services of smoking cessation, emergency contraception, flu immunisation and drug misuse1, but there is only limited evidence of pharmacy's public health promotion role. The recent Public Health White Paper2 acknowledged pharmacy's role in improving public health, and the vital part it can play in preventing ill health in the future NHS. This pilot study was designed to understand and identify possible evidence for this future public health role, and the development of community pharmacy to act as a referral booking agent to motivate patient healthier lifestyle decisions. The service design was focussed on whether the progressive evolution of the current pharmacy PH promotion role toward the Portsmouth Healthy Living Pharmacy (HLP) concept could be achieved, while still appreciating the NHS's current economic drive towards quality outcomes and efficiency through QIPP. Method Ten pharmacies responded to an invitation for expressions of interest, and each identified a member of staff to become a Pharmacy Healthy Living Advisor (PHLA). A focus group was used to help design the structure of the pharmacy public health service, to identify pharmacy's strengths and to consider how to overcome any barriers. A pre- and post-intervention period questionnaire was completed by the participants to measure their perceived confidence and skill levels. The quality of the activity and outcomes achieved by the 9 (1 dropped out) PHLAs were measured in this pilot study over a 6 week data collection period (March to April 2011). The number of interventions, topic of intervention, consultation outcome, patient/customer feedback, verification details, and the detail of actual service engagements arranged with PH service providers were recorded by the PHLAs. This is a service evaluation and ethics approval was considered unnecessary. In order to help meet the QIPP agenda aim this study relied on proactive utilisation of current pharmacy resources and customer contacts. It did not involve any promotional marketing as in the HLP and sought to identify quality and modifiable activity outcomes. Results All of the PHLAs achieved a training award in Public Health, and during the six week data collection period 73 interventions and 30 bookings with local PH service providers were made by the 9 PHLAs. The topics of the interventions/bookings covered all of the major PH priorities: smoking cessation 49{%}/53{%}, weight management/lifestyle 14{%}/7{%}, sexual health 6{%}/3{%}, alcohol 6{%}/0{%} and depression 7{%}/7{%}. Feedback questionnaires were returned by 50 customers, 82{%} said 'the information given was useful', 80{%} said 'they would follow the advice provided' and 92{%} said 'they would seek advice from a PHLA again'. The actions identified to address weaknesses and barriers from the focus groups increased the confidence of the PHLAs in their skills, the average rating (1-5 scale) increased from 3.4 to 4.4, and their confidence in their knowledge increased from 3.4 to 4.4. Discussion Community pharmacy can provide a sustainable public health promotion service which provides quality interventions to motivate people into making healthier lifestyle decisions in PH priority areas, while fulfilling the current NHS QIPP agenda. Although this study is small and with self selected pharmacies, it shows that community pharmacy is effective as a referral agent, motivating patient engagement with PH providers. Patient feedback indicates a very high satisfaction with this service.