The challenge of tackling social isolation among older people through community pharmacy

Ageing Better in Camden, London, is one of 14 Big Lottery Fund Ageing Better programmes across England that are working to tackle social isolation and loneliness among older people by drawing on existing skills and resources in the local community. Here, we share what we learned as part of a two-year programme working with pharmacies across the borough to identify socially isolated older people and connect them with their community.

Camden’s Community Connectors help Camden residents aged over 60 years to connect with their local community by discussing their interests, finding activities that might suit them, and supporting them to help others connect with their community.

In October 2015, Ageing Better in Camden commissioned 13 local pharmacies in the borough to identify older people who were lonely or isolated and refer them to Community Connectors. Pharmacies were paid £5 for a referral from a quick conversation and form, or £36 for a referral that required a more comprehensive consultation. Additionally, a series of events took place in pharmacies and supermarkets to encourage new referrals through face-to-face marketing and by building rapport with the community. A total of 14 events were held over three months.

In year one, the pharmacy project produced 25 referrals from 13 pharmacies. The lack of referrals led to a review of the process, during which feedback was gathered from pharmacies and the community connectors.

In year two, Ageing Better in Camden worked with the local pharmaceutical committee to develop a scratch card for older people to quickly give their personal details if they were interested in being contacted by the Community Connectors. Following a relaunch and the introduction of the scratch card programme, the project produced 100 referrals from 13 pharmacies.

Out of the 100 referrals in year two, 73 were from scratch cards, 20 from the self-assessment form, 3 from the longer form and 4 from the short form. Out of 100 referrals collected in year two, only three clients engaged with activities in Camden following support from the Community Connectors. Around 97% of referrals were unsuccessful owing to: Community Connectors being unable to contact clients, inappropriate referrals such as clients living outside of the borough, and the client getting over their period of illness or mobility issues.

The number of referrals received increased by 400% from year one to year two, but of the total referrals received in year two, only 3% were successful in connecting an older client to their community. This project ended after two years.

Engagement levels from pharmacies were very varied. A ‘one path fits all approach’ did not work owing to different management styles and the available time, space and staff in individual pharmacies. Positive feedback collected from lead pharmacists across the programme did not correlate with the challenges expressed by the Community Connectors, nor did it mirror the reduction in quantity and quality of referrals received throughout year two. The pharmacy business is competitive and challenging, so the Ageing Better project was often overlooked as an ‘add on’.

Owing to time constraints, the majority of pharmacies gave customers scratch cards. People did not always include their contact details, which — as well as difficulty in reading information on the cards — made communication between Community Connectors and clients challenging. Some pharmacies had large amounts of custom from Camden hospitals. Many older people who lived outside of the borough, and were therefore ineligible for the programme, were referred to Community Connectors. Often older people who were eligible did not remember that they had filled in the scratch card when they were contacted by Community Connectors.

Ageing Better in Camden’s message was often lost within pharmacies as materials were competing for space alongside a number of other relevant leaflets. Boxes branded with Ageing Better in Camden enabled better engagement with older people and allowed pharmacy staff to start conversations about social isolation and loneliness. However, customers were dubious about referring themselves without a clearer idea of what they were being referred to. Additional materials on activities were needed. The project must be instantly relevant or appealing to community groups; for example, through the use of relevant images and language to attract the Bengali community.

The footfall in pharmacies during the events was slow, and customers were of varying ages. Many customers took leaflets and information for friends or families, rather than associating the project with themselves. People were reluctant to discuss personal issues or fill in a scratch card in a shop environment around strangers. Those who wanted to discuss issues and problems often needed signposting to other areas for support.

Local pharmacies are an important part of the local community as both a business and the community face of the health system. They work as social connectors at a community level with local community groups and centres. However, trying to commission social connection at a borough level by mirroring health service commissioning of interventions such as smoking cessation ignored the primary rationale of pharmacies as being a healthcare providers, and was not successful.

Local community groups and centres should try to build links with pharmacies on an individual level to promote healthy living activities and to encourage a free flow of opportunities within the local community from flu jabs to Tai Chi classes. Rolling out social connection pharmacies at a borough level would require a development worker to build the relationships between community groups and their individual local pharmacies.

Lydia Shellien-Walker, communications and influencing officer, Ageing Better in Camden