Building Capacity for Health and Wellbeing Improvement Community Pharmacy KNOWLEDGE AND SKILLS AUDIT Report compiled by NHS Central Lancashire Healthy Communities Team Gulab Singh MBE Andrea Smith Jenny Ashburner June 2011 1
Contents Forward 3 Executive Summary 4 Acknowledgements 6 Introduction 7 Background to Knowledge and Skills Audit 8 Capacity Building for Health and Wellbeing 10 Knowledge and Skills Audit Results 12 Conclusions 20 Recommendations 22 Appendix 1 The New Health Champion Service for Central Lancashire 24 Appendix 2 Healthy Living Pharmacies 25 2
Forward The public in central Lancashire attach great importance to their health. They expect to be protected against illness and disease, that people s health will improve and that health will be distributed fairly among our society. The public want its neighbourhoods, schools and workplaces to be both safe and health promoting. The public s expectations are that its needs and concerns are dealt with effectively through the development and implementation of public policies. Communities, as part of civic society, wish to play their part in influencing local decisions that impact on their daily lives. Despite the enormous advances made in public health and clinical medicine over the decades in the reduction and treatment of ill health, we still face inequalities in our society with considerable variation in life expectancy, ill health and premature death. These differences are largely between the most advantaged sections of our society compared to those in poorer communities. Fair Society, Healthy Lives (2010), Sir Michael Marmot s review on health inequalities, argues that inequalities are a matter of social justice, a key public health principle. As a starting point I have tasked my healthy communities team to lead on undertaking knowledge and skills audit among key groups to include community pharmacy, following on the successful work completed with the voluntary, community and faith sector and elected members and in the local authority areas that cover NHS Central Lancashire. The findings of this community pharmacy audit will support the important capacity building programme and be the basis for considering introducing the Healthy Living Pharmacy model in Lancashire. The audit outcome will demonstrate the current capabilities among community pharmacy teams in relation to responding to the emerging public health agenda; and collective understanding of how to tackle health inequalities across different population groups / communities. The White Paper Equity and Excellence: Liberating the NHS and the public health White Paper Healthy Lives, Healthy People define the organisational and cultural shift in leadership and responsibility for achieving population health outcomes. These reports have kindled awareness among key health professionals of the potential to improve population health. Above all, we are doing this work as we want to use its findings to mobilise action to achieve a better state of health for our local communities. This is a rapidly evolving agenda and so being confident as we move forward with our understanding of the challenges we face is our priority. There is still considerable work to do to meet the emerging challenges and ensure that we place health literacy at the forefront to help people get a better understanding of their health and wellbeing. Maggi Morris Director of Public Health NHS Central Lancashire 3
Executive Summary The future presents a changing landscape impacting significantly on the health improvement of the population of Lancashire. Our focus on the development of the knowledge and skills of community pharmacy teams has identified the underlying needs and challenges of understanding health and wellbeing in their local communities and be best quipped to meet the challenges we are likely to face with the emerging new public health agenda. We welcome the recognition from NHS Central Lancashire of the public health role within Community Pharmacy. The new public health system is expected to make use of a wider range of professionals to increase capacity and build robust, integrated public health networks operating at the heart of communities. Community pharmacy is ideally placed to help to improve the capacity and effectiveness of services and thus reduce health inequalities and improve health and wellbeing. Raymond Lee, Chairman, LPC We fully support this approach by the Healthy Communities Team in building capacity for health and wellbeing improvement through community pharmacy. This is the foundation step towards developing a network of Health Champions across the community pharmacy network. This is a key component of the development of Healthy Living Pharmacies as a means of delivering high quality and relatively low cost health and wellbeing services that will help the NHS to achieve a significant part of its planned efficiency savings. We are pleased to be working with our cross-sector partners. Liz Stafford, Vice Chair, LPC The opportunity for improving public health through community pharmacy is immense and pharmacists and their staff have a vital role to play in delivering outcomes relating to health improvement, prevention of ill health and healthy life expectancy and preventable mortality. This audit provides the foundations from which we can develop community pharmacies in line with the public health agenda and tackle health inequalities and improve wellbeing in the heart of local communities. Stephen Gough, Community Pharmacy Adviser, PCT Overview: In order to accomplish our objectives with this audit, community pharmacy teams have been surveyed on their understanding of terminology and language. They have been asked to identify their level of knowledge around the impacts and influences of the determinants of health. A scoring system was used to capture the responses with level one being low and level four being high. To develop future decision making, community pharmacy teams have rated their understanding of health inequalities and profiles in their area and how they use these to work with influences, barriers and incentives for improving health, within their practices. Health education was the most understood health term with 56% of respondents answering level 4 high level, and 40% answering level 3. Overall, there was a good understanding of the factors influencing wellbeing with most respondents answering level 3 (medium-high). 4
The analysis of the findings highlighted that community pharmacy teams understanding of different determinants of health as high with a lower understanding of certain terms and techniques. This could be due to public health jargon rather than a lack of understanding. Regarding the frequency of giving proactive advice on health and wellbeing issues to people presenting prescriptions with a long term condition; 44% of respondents stated they gave proactive advice 1-10 times per month. With regards to proactive advice on health and wellbeing to people presenting for over the counter treatment; 34% stated they provided this advice 1-10 times per month, 32% responded 10-25 times per month and 23% stated they did so between 25-50 times per month. When asking about confidence in providing brief interventions; 52% of pharmacies stated they had confidence in providing brief intervention on smoking cessation at level 4 and 43% on healthy lifestyles at level 4 52% of pharmacies stated they had confidence in providing brief intervention on sexual health and immunisation at level 3 Lower level of confidence was seen in topics such as blood born viruses (80%) and cancer awareness (57%) and alcohol (37%). In terms of willingness to providing public health services in community pharmacies across 10 categories; Overall the survey showed that pharmacists were very willing to provide a range of services in particular the most highly rated were healthy lifestyles, stop smoking, weight management, sexual health and substance misuse Finally, community pharmacy teams have been invited to be involved in the development of a programme to build capacity and to share their preference for a format for that programme. They have also been provided with an opportunity to train up members of staff as health champions and to receive information on the Health Works Award Scheme. 5
Acknowledgements We want to thank the Local Pharmaceutical Committee for their tremendous guidance and support. In particular we would like to express our gratitude to Raymond Lee (Chairman) and Liz Stafford (Vice Chairman) who also helped raise the profile and supported the implementation of the knowledge and skills audit among committee members. We would also like to thank Stephen Gough from the PCT medicines management team who helped to shape the questionnaire design for the audit. Additionally, to Keren Henderson and Louise Karkoszka who took the time to help ensure that the audit was completed in a timely manner. Without the medicines management team s input we are sure the response rate would have been much lower than anticipated. Finally, we would like to thank all the community pharmacy teams who took the time out of their busy schedules to complete the audit, particularly during the busy April bank holiday period. 6
Introduction NHS Central Lancashire is the local primary care trust (PCT), which serves a population of 452,000 people living in the area. The catchments include five local authorities: Lancashire County Council, Chorley, Preston, South Ribble and West Lancashire. In 2007, the Local Government and Public Involvement in Health Act placed a duty on uppertier local authorities and PCTs to undertake a joint strategic needs assessment (JSNA) and produce district locality profiles. The JSNA is defined as a process to identify and understand the current and future health and wellbeing needs of the local population leading to improved outcomes and reductions in health inequalities. NHS Central Lancashire has a diverse population profile in which its geographical catchments have large areas of rural and urban settlements each having different needs for health and wellbeing. There are also considerable variations of demographic profiles across the catchments. Central Lancashire has significant pockets of deprivation in which health inequalities and life expectancy vary. Preston has a younger population structure than the other three districts and has seen a fall in the number of people over 65 years and a 14% rise in 15-24 year olds, much of this linked to the expansion of the University of Central Lancashire. Chorley, South Ribble and West Lancashire have all seen a marked rise (18-24%) in the number of people over 65 years and a fall in the number of 0-14 year olds. At the present time there are more than 11,000 people over 75 living alone in central Lancashire, a figure predicted to rise to more than 15,000 by 2020. Black and minority ethnic (BME) communities make up approximately 5.5% of the PCT total population compared to 9% for England and Wales. In central Lancashire individuals of Indian ethnic origin form the largest BME community. The majority of the BME population live in the inner city areas of Preston, where they account for 14.5% of the total population. The NHS public health White Paper Healthy Lives, Healthy People describes community pharmacy teams as a valuable and trusted public health resource offering a real opportunity to improve health and wellbeing and reduce health inequalities. There are 107 community pharmacies across Central Lancashire PCT catchment as outlined below, which come into contact with a wide range of people on a daily basis. Preston 37 South Ribble 26 Chorley 20 West Lancashire 24 7
Background to Knowledge and Skills Audit The Wold Health Organisation (WHO) International Healthy Cities movement exists to promote and improve population health at city and town levels. It requires local government and partnership agencies to work in collaboration to make a commitment to improving health and sustainable development, through political leadership, formal structures and active local communities. Preston secured WHO Healthy City status in 2009 and part of this commitment was to work closely with key health professional groups and other sectors to help build capacity and resilience for improving health in the local communities. This provided the opportunity to develop links with other organisations across central Lancashire and work collaboratively on health and wellbeing outcomes. The launch of the Marmot review (February 2010) Fair Society Healthy Lives, places health equity at the forefront of all policy and practice development in understanding the social determinants of health inequalities as a matter of fairness and social justice. Partners across Lancashire are committed to ensuring that these principles are at the heart of action to address health inequalities locally and this is being taken forward in our strategic programme for action, Fair and Healthy Lancashire. The NHS White Paper, Equity and Excellence: Liberating the NHS, which was published on 12 July 2010, also picks up on the Marmot ideas around fairness in public services. The main themes of the White Paper are listed below with the likely implications for change in a new public health system that is systematically implemented with a range of community based services and facilities : The abolition of the primary care trusts, replaced by clinical commissioning groups who will undertake commissioning of most services. The establishment of HealthWatch as a statutory part of the Care Quality Commission to champion service users and carers across health and social care. Local Involvement Networks (LINks) to become local Health Watch bodies, commissioned by Local Authorities. 'The transfer of responsibility for health improvement to local authorities. This includes upper tier local authorities jointly employing the Director of Public Health with Public Health England'. The establishment of Public Health England (public health White Paper Healthy Lives, Healthy People), which will give local authority greater responsibility in five areas 1. Leading JSNA to ensure coherent and coordinated commissioning strategies. 2. Supporting local voice and the exercise of patient choice. 3. Promoting joined-up commissioning of local NHS services, social care and health improvement. 4. Leading on local health improvement and prevention activity. 5. Establishment of Statutory Health and Wellbeing Boards with the primary aim of promoting integration between a range of partners and improving democratic accountability and in the LA bringing partners together to agree priorities for the benefit of patients and taxpayers, informed by local people and neighbourhood needs. The government has set out its long-term vision for the future of public health with a much wider focus on health and wellbeing. As part of this vision local governments will be responsible for improving public health, giving them the freedom and funding to develop their own ways of improving public health and reducing health inequalities in their area. 8
The 2008 Pharmacy White Paper building on strengths delivering the future sets a vision for pharmacies as centres promoting and supporting healthy living and health literacy, offering healthy lifestyle advice and support on self care and a range of pressing public health concerns. The Government recognises pharmacy's role in improving public health and builds on the recommendations within the Pharmacy White Paper. The 2011/12 NHS Operating Framework states that evidence continues to build for the provision of public health services through community pharmacies. Community pharmacy has a vital part to play in preventing ill health, and is a valued and trusted public health resource. The new public health system is expected to make use of a wider range of professionals to increase capacity and build robust, integrated public health networks operating at the heart of communities. Community pharmacy is ideally placed to help to improve the capacity and effectiveness of services and thus reduce health inequalities and improve health and wellbeing. Therefore opportunities exist for community pharmacy to deliver key public health service including NHS Health Checks, tackling drug and alcohol misuse, promoting healthy lifestyles and prevention of long term illness and increasing the uptake of seasonal flu vaccination. It is envisaged that this strategic programme will influence the delivery of community pharmacy services and thereby release the potential benefits and capacity that pharmacy contractors have to offer to improve the health and wellbeing of our population. This will be achieved through training and developing a member of the pharmacy staff to become Health Champions and will culminate in the establishment of Healthy Living Pharmacies, similar to the model that exists in Portsmouth. Further information about Health Champions and Healthy Living Pharmacies is included in Appendix 1 and 2. 9
Capacity Building for Health and Wellbeing The PCT has developed knowledge and skills audit assessment to identify key skills and gaps present in order to ascertain the most suitable method of bespoke training. Key health professionals and local authorities face a changing landscape in the context of health improvement, improving health outcomes and public health across our local population. With new and increased responsibility, these individuals play a key role in assisting NHS Central Lancashire in raising the emerging policy directives and the changing roles of PCTs and local authorities. This audit was led and undertaken by NHS Central Lancashire Healthy Communities Team in collaboration with the Local Pharmaceutical Committee and the PCT medicines management team. It is recognised that stakeholders will require various levels of support to address health inequalities and deliver the health and wellbeing agenda. The knowledge and skills audit was carried out through a short online questionnaire, Survey Monkey. A scoring system was used to capture the responses with level one being low and level four being high. The findings have the potential to be rolled out across the remaining districts that constitute a pan Lancashire footprint to ensure that other community pharmacies are also supported and prepared for the new emerging public health agenda. The key purposes of the knowledge and skills audit were for public health to gain an insight into: 1. Pharmacy contractors understanding of public health terminology; 2. Pharmacy contractors understanding of their role in the delivery of public health services, particularly those which influence health and wellbeing; 3. The skills that pharmacy staff will need to deliver public health services; 4. The level of interest amongst pharmacy contractors to train and develop staff to become Health Champions and deliver the Healthy Living Pharmacy concept. By implementing this exercise, it is expected the following outputs and outcomes will be achieved: 1. Use the findings to compile a list of skills required to ensure health equity is at the forefront of service delivery; 2. Establish a baseline of pharmacy contractor s knowledge and understanding of their involvement to influence health and wellbeing and address health inequalities; 3. Scope the range of briefing papers and training events required to build knowledge and skills; 4. Enable pharmacy staff to champion health issues and deliver improved outcomes through integrated and collaborative working. Methodology A covering letter was sent out electronically to 107 pharmacies which outlined the emerging policy perspective and rationale for the knowledge and skills audit. This included a hyperlink to the survey. In addition, a hardcopy of the survey and supporting materials were posted out for those opting to complete paper returns. In order to track the responses received, pharmacies were requested to provide their address and a LPC contact name and number was provided in case further calcification was needed. All participants were asked to complete and submit the knowledge and skills questionnaire by a given deadline date. A three week turn around period was used and most challenging was the timing. In order to keep the momentum of this project it was agreed to use a prescheduled community pharmacy workshop (10 th May 2011) to provide a summary of the 10
key findings from the data analysis. For this reason, the audit was implemented during a busy Easter and bank holiday period. Response rate 107 Pharmacies received the audit questionnaire which received an outstanding 72% response rate, particularly considering the timescales for implementation. District No of Pharmacies Completing Audit Response Rate Preston 26 72% South Ribble Borough Council 22 88% Chorley Borough Council 14 63% West Lancashire District Council 16 66% Total 78 72% 11
Knowledge and Skills Audit Community Pharmacy Teams Total number of Community Pharmacy Teams [CPTs] in central Lancashire 107 Respondents Total: 78 (72%) Survey Date: April to May 2011 Survey Questions: 1. Terminology and language: How well do you understand the following health related terms? (1 = low level and 4 = high level) How well do you understand the following health related terms? 50 45 40 35 30 25 20 15 10 5 0 4 (High Level) 3 2 1 (Low Level) Health Inequalities Health Equity Health Impact Assessment Wellbeing Social Determinants Public Health Health Improvement Health Education Social Marketing Health education - was the most understood health term with 56% of respondents answering level 4 high level, and 40% answering level 3; Health Improvement, Public Health and Wellbeing were equally well understood terms with most respondents rating their understanding at levels 3 and 4; Health Equity, Health Impact Assessment and Social Marketing respondents had a lower level of understanding of these health terms. Health Equity: 28% answered level 1 and 42% level 2 Health Impact Assessment: 17% level 1 and 47% level 2 Social Marketing: 21% level 1 and 39% level 2 This is not surprising as CPTs are unlikely to use these skills in expediting there services. 2. Determinants of Health: To what extent do you understand the following elements of health? Overall, there was a good understanding of the elements of health, 55% of respondents rated their understanding of the different elements of health at level 3; Social Most respondents (48 out of 78) voted level 3 a medium/high level. Cultural and Emotional These two determinants had a rating of 17% at level 2; Psychological This term had a rating of 15% understanding at level 2; 12
De te rmina nts o f He a lth: T o wha t e xte nt d o yo u und e rsta nd the fo llo wing e le me nts o f he a lth? 60 50 40 30 20 4 (High level) 3 2 1 (Low level) 10 0 Social Environmental Cultural Emotional Psychological 3. Determinants of Health: To what extent do you understand the following factors which influence wellbeing? Overall, there was a good understanding of the factors influencing wellbeing with most respondents answering level 3 (medium-high). Determina nts o f He alth: T o what exte nt d o you understand the fo llowing factors which influence wellbe ing? 50 45 40 35 30 25 20 15 10 5 0 Social Environmental Cultural Emotional Psychological 4 (high level) 3 2 1 (Low level) 4. Data and Evidence to inform decision making: Please rate your understanding / skill in relation to the following: Questions asked: 1. Ways of engaging effectively with individuals 2. Ways of engaging effectively with communities on health 3. Awareness of ways of communicating with different groups of people about their wellbeing 4. Role of community pharmacy in promoting health & wellbeing 5. Role of local authority in promoting health & wellbeing 6. Role of NHS Commissioning Board in promoting health & wellbeing 7. Role of GP Consortia* in promoting health & wellbeing (*now clinical commissioning groups) 8. Role of Industry in promoting health & wellbeing 9. Role of Media in promoting health & wellbeing 10. Other people and agencies you need to influence and collaborate with to improve 13
communities' wellbeing 11. Other people and agencies you need to influence and collaborate to protect communities' wellbeing 12. How major government policies impact on health and wellbeing within communities 13. The impact of media on public perceptions Of the 13 categories in this questions, the response demonstrated a high understanding across most, and this was reflected level 3 (medium - high level); It is not surprising that the lower scores are all focus around the emerging proposed new systems such as NHS Commissioning Boards and Clinical Commissioning Groups. 14
60 50 40 30 20 10 0 Develo ping Hea lth & Wellbe ing in Communities: Ple a se rate yo ur unde rsta nd ing / skill in re la tio n to the fo llo wing 4 (High level) 3 2 1 (Low level) 15 Engaging with individuals Engaging with communities Communicating about wellbeing Role of community pharmacy Role of local authority Role of NHS Commissioning Board Role of GP Consortia Role of Industry Role of Media Improve communities' wellbeing Protect communities' wellbeing How major government policies impact on health and wellbeing within communities The impact of media
5. Current provision of Health & Wellbeing advice: How frequently do you give proactive advice on health and wellbeing issues to people presenting prescriptions with a Long Term Condition? 44% of respondents stated they gave proactive advice on health and wellbeing to people presenting prescriptions with a LTC 1-10 times per month 40% stated 10-25 times per month Only 5% stated they always gave proactive advice on health and wellbeing issues to people presenting prescriptions with a LTC Curre nt p ro visio n o f Health & W e llb e ing a d vice : How fre q ue ntly d o yo u g ive p ro a ctive a d vice o n he a lth a nd we llb e ing issue s to p e o p le p re se nting p re scrip tio ns with a Lo ng T e rm Co nd itio n? 10% 5% 1% 40% 44% Never 1-10 times per month 10-25 times per month 25-50 times per month Always Based on the number of overall response to this question, considerable opportunity presents itself for increasing health promotion and health education activity as part of the service provsion. 6. Current provision of Health & Wellbeing advice: How frequently do you give proactive advice on health and wellbeing issues to people presenting for over the counter treatment and advice? Curre nt p ro vision o f Health & W ellb e ing a d vice : Ho w fre q ue ntly d o yo u g ive p roa ctive a d vice o n he a lth a nd we llb eing issue s to p e o p le p re se nting fo r o ve r the co unte r tre a tme nt a nd a d vice? 10% 1% 23% 34% Never 1-10 times per month 10-25 times per month 25-50 times per month Always 32%
34% of pharmacies offer proactive advice on health and wellbeing to people presenting for over the counter treatment and advice 1-10 times per month 32% of pharmacies offer proactive advice on health and wellbeing to people presenting for over the counter treatment and advice 10-25 times per month 23% stated they did so between 25-50 times per month 7. Identifying Training Needs: Please rate your confidence to provide a brief intervention for the following topics Questions asked: 1. Healthy lifestyles 2. Stop smoking 3. Alcohol 4. Weight management 5. Sexual health 6. Substance misuse 7. Blood born viruses 8. Cancer awareness 9. Immunisation & seasonal flu Id entifying T ra ining Ne e d s: Ple a se ra te yo ur co nfid e nce to p ro vid e a b rief inte rve ntio n fo r the fo llo wing to p ics 45 40 35 30 25 20 15 10 5 0 4 (High level) 3 2 1 (Low level) Healthy lifestyles Stop smoking Alcohol Weight management Sexual health Substance misuse Blood born viruses Cancer awareness Immunisation & seasonal flu 52% of pharmacies stated they had confidence in providing brief intervention on smoking cessation at level 4 and 43% on healthy lifestyles at level 4 52% of pharmacies stated they had confidence in providing brief intervention on sexual health and immunisation at level 3 At level 1 and 2, pharmacies stated they had a lower level of confidence in providing brief intervention on the following: blood born viruses (80%) and cancer awareness (57%) and alcohol (37%) 17
8. Please rate your willingness to provide the following services Questions asked: 1. Health Champion 2. Healthy lifestyles Pharmacy 3. Stop smoking 4. Alcohol 5. Weight management 6. Sexual health 7. Substance misuse 8. Screening for blood born viruses 9. Cancer awareness 10. Immunisation & seasonal flu Ple ase ra te yo ur willingness to pro vide the fo llowing services 70 60 50 40 30 20 4 (High level) 3 2 1 (Low level) 10 0 Health Champion Healthy lifestyles Pharmacy Stop smoking Alcohol Weight management Sexual health Substance misuse Screening for blood born viruses Cancer awareness Immunisation & seasonal flu In terms of providing public health services in community pharmacy provision, there were 10 categories to choose from. All pharmacies were willing to provide services across the 10 categories; however, it reflected a lower level of range of confidence in some categories. 9. Are you willing to get involved in a capacity building programme to increase your knowledge and skills? Overwhelmingly 70% respondents said they were willing to get involved in a capacity building programme 10. Are you happy to share any knowledge / skills you have in relation to this area? 24% of pharmacies were willing to share any knowledge and skills they may have (12 pharmacy names have been submitted on the survey results 2 names were omitted due to double entry) 18
11. What format would best suit you in developing your knowledge and skills for health and wellbeing? (Please rank 1 = Low and 4 = High preference). W ha t forma t would b est suit yo u in de ve lo p ing your kno wled ge a nd sills for he alth a nd wellb e ing? (Plea se ra nk 1 = low and 5 = hig h pre fe rence) 30 25 20 15 10 5 5 (High) 4 3 2 1 (Low) 0 Briefing / Awareness session (1-1.5 hours) Training / Workshops (1.5-2.5 hours) Briefing Paper (No more than 4 sides of A4) Fact Sheet (1 side of A4) Web based resource Health & Wellbeing Guide Book A Fact Sheet and, Web based resource or Health & Wellbeing Guide Book are the most popular formats for respondents; Surprisingly the Web based resource has scored quite high considering this was a paper based report 12. A healthy pharmacy needs a healthy workforce - would you like to hear more about how you can improve your employee's health in the workplace? 44% of pharmacies are interested in hearing more about how to improve employee s health in the workplace 13. If you have any further general comments you wish to make, please take opportunity to do so here: Comments received include: - What is a Capacity Building Programme? - I answered no to question 11 because I do not feel I have too much knowledge and relevant skills on topics at the moment. I am certainly eager to learn! - Have to make sure we are properly funded and supported. 19
Conclusions This is the fourth knowledge and skills audit that has been implemented with different disciplinary professional groups and again it has shown to be a very useful exercise in a number of ways. Firstly it provided an opportunity to brief CPT in central Lancashire on the emerging public health approach to be considered as part of tackling health inequalities. Even for those CPT who chose not to complete the audit, it highlighted some of the themes associated with health and wellbeing. Secondly it has provided the PCT with useful insight on the knowledge and skills held by CPT in each of the four districts in preparation for the new public health agenda, to deliver better population health and reduce health inequalities. This provides a mandate for supporting CPT to begin to think about and consider the Department of Health pilot Healthy Living Pharmacy. It additionally serves as a point of reflection on whether their business could benefit from the Health Works Award Scheme. Both models provide a good foundation for CPT to gear themselves up to a changing landscape of services with a public health focus. Thirdly, to use the audit as a basis, to build capacity and capabilities for public health skills within that setting. In addition, CPT were invited to nominate a member of their staff to access training funded by the PCT. This would allow a member of staff to be trained as a Health Champion (level 2) by the Royal Society of Public Health to enable them to expedite public health advice and health promotion support. The analysis of the findings highlighted a high level of understanding of different determinants of health but a lower understanding in certain public health terms and techniques. This could be attributed to public health jargon rather than a general low level of understanding. There is a need, therefore, for a fuller understanding of public health philosophy, concepts, terminology and approaches used in identifying population health outcomes. Developing knowledge on the determinants of health in particular around culture, emotional and psychological health could also help CPT to prepare for the delivery of healthy living Pharmacy programme. The lower scores around decision making (question 4) focusing around emerging systems such as NHS Commissioning Boards and Clinical Commissioning Groups were expected. CPT were asked to consider their current provision of health and wellbeing advice for people presenting prescriptions with a long term condition. The response showed that 44% of pharmacies did this between 1-10 times per month. In reality this equates to 34 pharmacies out of 78. Bearing in mind the average pharmacy in central Lancashire will dispense over 2000 prescriptions per month. When asked a similar question for over the counter treatment and advice the response was even lower. Considerable opportunity therefore presents itself for increasing health promotion and health education activity as part of the pharmacy core service provision. It must be acknowledged that if community pharmacies are going to contribute and or deliver the outcomes described in recent government public health White Paper, Healthy Lives, Healthy People: Our strategy for public health in England, then pharmacists and their teams must provide proactive health and wellbeing advice at every appropriate opportunity as a matter of course. Brief intervention advice across a range of topics forms part of the public health offer from CPT with additional funding made available to support this activity. The audit has demonstrated a wide variation in the level of confidence in delivering certain topics. This audit highlights that the basic skills already exist; however, there is a need to build up that confidence. This could potentially be addressed through a range of initiatives such as healthy living pharmacy and provision of health champions. 20
In terms of providing public health services within community pharmacies, all pharmacies were willing to provide services across the 10 categories. There was a keen interest in healthy lifestyles, stop smoking, weight management, sexual health, and substance misuse. Whilst there is a willingness to provide these services, the findings showed a need to develop confidence in some areas. Lower levels of confidence were evident in health champions, alcohol, screening for blood born viruses, cancer awareness and immunisation and seasonal flu. This could be attributed to the fact that not all pharmacies have these schemes in place as part of the service provision. The respondents demonstrated a willingness to build capacity to enhance their knowledge and skills and fully engage with the emerging public health agenda. There were a range of suggestion for developing this knowledge and skills including using a web base resource and fact sheets. 21
Recommendations NHS Central Lancashire recognises the expertise that already exists across community pharmacy teams (CPT) in many areas in dealing with health and wellbeing and primary prevention within the community setting. There are a total of seventeen recommendations divided into short and long term work as listed below. These recommendations are set out in two stages short term with a view to be implemented over the next 12 months to take account of the remaining period of the PCT; and long term with a view of some aspirational recommendations in moving CPT into the new public health agenda. Short Term: The healthy communities team of NHS Central Lancashire to: 1. Produce a Knowledge and Skills Audit Report for CPT to include key recommendations by July 2011. 2. Disseminate report to all CPT and members of the LPC, Clinical Executive Commissioning Committee, emerging Clinical Commissioning Groups, Strategic Health Authority and PCT Commissioning Leads. 3. Disseminate information on the Health Works Award Scheme to all CPT and support their involvement in the scheme. 4. Produce a short briefing paper on the role of health champions in different settings and its impact in tackling health inequalities in both workplace and neighbourhood settings. 5. Identify individuals within CPT to be trained up at Level 2 RSPH health champions and provide free training and include these in the health champions networks. 6. Work with EmpowerMe to undertake a review of the health champions in CPT to identify what impact on public health has been achieved through this programme. 7. As part of the launch of the north west decade of wellbeing (2011) promote a fact sheet for CPT on the five ways to wellbeing and its benefits to individual / communities. 8. Disseminate a quick guide for GPs and health professionals on health and wellbeing to raise awareness and understanding of public health and health and wellbeing agenda. Local Pharmacy Committee in collaboration with the medicines management team in NHS Central Lancashire to: 1. Work and engage with CPTs to increase the provision of opportunistic health and wellbeing brief intervention advice through adhoc visit to contractors and through the LPC and PCT pharmacy newsletters. 2. Work with the healthy communities team and jointly produce a briefing on key stages of the Healthy Living Pharmacy model and disseminate this to all CPT in central Lancashire. 3. Provide a training programme to support and enhance brief intervention advice as a core offer to CPT through a range of initiatives such as Healthy Living Pharmacy and health champions provision. 4. Establish a health champions network within community pharmacy and use the network to disseminate key public health campaigns. Long term: 22
1. Re audit CPT after the community health champions network has been established and evaluate the role of health champions by comparing the percentage of opportunistic health and wellbeing advice offered during presentation of prescriptions and OTC sales. 2. Integrate the role of health champions into care pathways linked to PCT service Lines. 3. Once the CPT health champions model has demonstrated health outcomes and further public health services begin to be commissioned and delivered in community pharmacy, clinical commissioning croups, local authorities should be encouraged to purse and commission the Health Living Pharmacy model across pharmacies in NHS Central Lancashire. 4. A wide distribution of Healthy Living Pharmacies across Lancashire County Council footprint based on need. 5. Improved delivery of integrated public health Initiatives such as Choose Well and flu vaccinations. 23
Appendix 1 Social Action for Health - The New Health Champion Service for Central Lancashire - Briefing Social Action for Health is an important public health empowerment process to tackle the social determinants of health through health improvement, health literacy and aiming at better outcomes for health. Empowerment is important as it directly improves individual s ability to control, which leads to higher esteem. Better qualifications and skills lead to better paid employment and a better quality of life; and improved social skills. The model is based on recruiting individuals from a number of settings including; workplace, neighbourhoods, community groups, business and young people informal and formal settings. Social Action for Health in Practice Central Lancashire Health Trainer Service was decommissioned on the 31 December 2010 by The PCT. A key recommendation arising from the evaluation of health trainers was to consider a revised model of delivery that is cost effective, responsive to priorities, locally sensitive and quality assured. From this, a health champion service was developed. Following a full procurement process, in March 2011 Empowerme was awarded the contract to deliver two new health champion services developed across the four localities within the central Lancashire footprint for Preston, South Ribble, Chorley and West Lancashire. These include: Adult health champion/asset based community development service in workplace and community settings; and Young people's health champion/ asset based community development service across a range of formal and informal youth settings. Health Champion Coordinator will be Anthony Speakman, based at Empowerme (Galloways Society for the Blind, Penwortham) and the service has been commissioned until 31 March 2014. Adult Health Champion/Asset Based Community Development Service will: work with existing health champions and seek to recruit and train new health champions who will play a valuable role in promoting health and wellbeing and helping people access NHS and community based health services; be trained up to Royal Society of Public Health Level 2 Award (Understanding Health Improvement); continue to be informed of the new and emerging work programmes and the ongoing development and delivery of the new services. As part of this process they will receive ongoing support, training and development opportunities within both workplace and community settings; Establish a health champion network for each of the four localities within the central Lancashire footprint to encourage information sharing. Ensure sufficient capacity of health champions in work place and community settings Epowerme contact: Anthony Speakman anthony.speakman@empowerme.org.uk 01772 744050 24
Appendix 2 Healthy Living Pharmacies The Healthy Living Pharmacy (HLP) initiative was launched in Portsmouth just over two years ago. In February, national pharmacy bodies agreed to work collaboratively to promote the HLP concept to community pharmacies in order to achieve greater uptake and it is envisaged that a number of pathfinder sites across England will be established. What distinguishes a Healthy Living Pharmacy? The key differential of a HLP is the ethos of health and wellbeing with continuous delivery on a range of health and wellbeing services. A Healthy Living Pharmacy: consistently delivers broad range of commissioned services to high quality; promotes healthy living and wellbeing as core activity; has team proactive in supporting health & wellbeing, the community s health at centre of what it does; has a health champion; will be identifiable to the public and other healthcare professionals. A HLP framework has been developed nationally underpinned with evidence and ratified by the Public Health Leadership Forum for pharmacy. This framework can be used to match local health needs with the capabilities of pharmacies to deliver. All pharmacies should have the opportunity to become HLPs however commissioning of services will depend on needs mapped out in the PNA. 25