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Future-proofing pharmacy with new standards for public health practice

The Royal Pharmaceutical Society has this week published new public health standards for pharmacy. Janna Lawrence finds out what they mean for the profession

Safe supply of medicines is the pharmacy profession’s bread and butter. But a renewed emphasis is being placed on pharmacy’s already well-established role in public health. Whether it is smoking cessation or influencing local formularies in hospitals, pharmacists have been providing public health services for decades. Despite this, until now there has been no national, profession-wide, agreement of what good-quality public-health practice looks like in pharmacy.

To rectify this, the Royal Pharmaceutical Society, in partnership with the Pharmacy and Public Health Forum, has produced professional standards for public health practice for pharmacy. The task group that developed the standards was led by Helen Gordon, RPS chief executive. She told The Journal that the standards fit in with the much broader health policy of keeping people well and out of hospital: “It is essential that healthcare professionals contribute to the wellness of patients in order to better use resources in the NHS.”

She said that she hoped the standards would build the calibre and breadth of public health practice in pharmacy. “I appreciate for some that economic restraints make it difficult to develop services, but I hope that the standards aid discussions with commissioners, strengthening the pharmacist’s position,” she explained. Pharmacy needs to grasp the moment, she continued, there is a real appetite for investment in the public’s health in NHS and local government and it is a chance to maximise pharmacy’s role.

Nine core areas of public health practice

It is envisaged that the standards, which were launched on 14 March 2014, will help pharmacists at all levels and in all sectors of the profession. Additionally, the standards have been designed to be used by the whole pharmacy team, as well as by patients and the public, and service commissioners. The task group included experts from the Faculty of Public Health and Public Health England, including Gul Root, principal pharmaceutical officer at the Department of Health, who is currently seconded to PHE part-time.

She argues that publication of the standards is one of the most significant developments for public health practice and for pharmacy teams. “The standards align with the Faculty of Public Health’s nine core areas of public health practice and I hope that this helps to further embed and integrate pharmacy teams within the rest of the public health workforce,” she said.

Mrs Root’s colleague Kevin Fenton, director of health and wellbeing at PHE, added: “[The standards] present a unique opportunity for the pharmacy community to take a leading role in improving people’s health and ultimately save lives.” Mrs Root told The Journal that PHE will raise awareness of the standards with relevant stakeholders such as local authority directors of public health, PHE centre directors, and chief knowledge officers across England, Health Education England and internally within PHE.

Rob Darracott, chief executive of Pharmacy Voice, believes outside involvement in the standards is important. He told The Journal: “Nobody in the future can suggest that pharmacy is not delivering public health services that meet the standards of public health professionals.”

Supporting themes explored

There are nine standards each with a “high level” principle (see Figure). Under each principle the supporting themes are explored, for example, service-design and accuracy. In turn, best practice is described for each supporting theme. 

Public health infographic

“The standards act as a framework or a tool. Pharmacists might want to start with one standard and see how their practice matches up,” explains Ruth Wakeman, head of professional support at the RPS. “We know from the hospital standards that this exercise helped pharmacists identify areas where they could improve their practice, most of the time they already knew these were areas that needed work and it confirmed this.” Each standard is also supported by relevant examples of public health practice.

Traditionally, public health has been viewed as the domain of the community sector, but practice examples are included from community pharmacy, hospital pharmacy and for pharmacists working in primary care and local authorities. Mrs Gordon hopes public health interventions will form part of the whole patient journey, from acute care to community. “We want there to be robust public health practice across the profession and I would like to see the standards used in the hospital setting as well as community. Each contact with a patient is an opportunity to improve their health,” she told The Journal.

Mrs Root added: “If pharmacy staff, working in sectors including community, hospital, industry or academia at all levels of practice, adopt and adapt these standards, it will hugely contribute towards assuring the public and commissioners that public health services delivered through pharmacy are of a consistently high quality across the country.”

This message was welcomed by the UK Clinical Pharmacy Association. Ann Page, UKCPA vice-chairman, praised the standards for their emphasis on collaboration between pharmacy sectors. “I would encourage pharmacists wanting to work with colleagues from other sectors … to use the new standards as a blueprint for partnership working.” In addition, she recommends connecting with other pharmacists using local professional networks and RPS local practice forums.

She continued: “Improved transfer of care between sectors and the safe use of high-risk therapies are all areas in which increased collaboration can benefit patients.” She added: “These standards will signpost new ways in which [hospital pharmacists] can become involved in supporting public health objectives.”

Relationships with commissioners

As well as supporting collaboration between pharmacy sectors, the standards are intended to help develop the relationship between pharmacy and commissioners. “There is fantastic synergy between local government and pharmacy,” said Graham Jones, chairman of the pharmacy local professional network in the NHS Thames Valley and also a councillor on West Berkshire Council.

He gave The Journal some insight into local government: “Local authorities have had a massive financial squeeze and are having to withdraw a lot of community-based services. I think pharmacy can help fill that public health void and more.” He said that pharmacists need to pick up the baton and meet the public health standards because it “will help us to sell ourselves”. “There needs to be a framework that gives commissioners confidence in the services that pharmacy can deliver,” he explained.

Furthermore, he recommends involving local government councillors in discussions and inviting them into the pharmacy. Councillors are likely to want to get involved. PHE will soon publish area-level public health data for each ward, he explained, and councillors will be accountable for their area’s performance. He recommends that interested pharmacists study the plans of the local health and wellbeing board, which will help explain the public health priorities in the area.

Developing the necessary skills

Another useful document is the joint strategic needs assessment, said Mike Holden, chief executive of the National Pharmacy Association. Pharmacists can use this information to make sure they and their teams have the skills to meet those public health needs. Mr Holden is chairing the next workstream of the PPHF on workforce development.

He explained why the public health standards are so important: “We wanted the standards to be there to provide a foundation for this work. By mapping the existing provision of public health training against the standards, we can identify any gaps.” It will help inform training at all pharmacy levels, including undergraduate, postgraduate and training of the community pharmacy team, making sure the skills are there for pharmacy to embrace public health practice, said Mr Holden.

He added that the forum has put a lot of work into getting a commitment from PHE to actively support the extended role of community pharmacy in public health and the ongoing roll out of healthy living pharmacies (HLPs).

The HLP programme is a flagship for pharmacies in England that are focused on public health. Experience from the HLP programme has helped inform the new public health standards, said Deborah Evans, who leads the HLP pathfinder programme. “Conversely, the professional standards will help inform the development of HLP quality criteria and how the HLP model moves forward. It gives us a sound platform,” she said, adding that, because the standards are principle-based, they can be adapted to different situations.

However, she warned that the standards can only be as good as how they are implemented and that a big question for the profession is how to get broad engagement and awareness. Despite this, Ms Evans thinks the standards have been well timed: “We’re in a very important place with pharmacy in public health right now.”  

Primarily for England and Wales

Mrs Gordon explained that the need for standards in public health has been highlighted by RPS members for some time and it was also clearly spelt out as a priority in the objectives of the PPHF. The standards are primarily for England and Wales, because in Scotland it is intended that public health will be part of the integrated approach to developing pharmaceutical care, as set out in “Prescription for excellence”, said Mrs Gordon. However, there was input from Scotland to the standards so they will hopefully be helpful to the ongoing developments there, she said.

Ann Hinchcliffe, consultant in pharmaceutical public health at Public Health Wales, also sat on the standard’s task group. She thinks the standards will raise the profile of public health within pharmacy itself. “It is important to recognise that pharmacy already makes a big contribution to public health,” she said. Not all pharmacists and pharmacy teams may realise this because many of the services and campaigns that pharmacy currently delivers are not identified under the banner of public health, she explained.

Standards are only the first step

But in England, queries have been raised by Duncan Jenkins, a specialist in pharmaceutical public health at Dudley Office of Public Health. He argues that, although the standards are a good starting point, they could have taken a broader perspective of what public health practice means. He pointed out that there was no mention of social marketing — which looks at specific groups of the local population and how to make services accessible for these people.

Responding to Mr Jenkins’s concerns, Mrs Wakeman encouraged Mr Jenkins to get in touch with the RPS and said that the standards are only the first step. She explained: “The standards are about describing what excellence in public health practice looks like. The RPS will be providing more resources and help to support with implementation of the standards. We hope that feedback from those using the standards will help with developing these.”

Teething problems aside, it is reasonable to conclude that if all community pharmacies deliver public health services to the level described in the standards, the profession will take a huge leap forward. Mrs Root, one of the most influential pharmacists in England, puts it this way: “The standards are a ground-breaking first for pharmacy teams, who will now, I hope, aspire to satisfy these standards in their everyday public health practice.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11135798

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