As a pharmacist, I see patients daily, many of whom have a long-term condition. Hardly surprising since 15 million people in England have at least one[1]. But, what if we could break the cycle of simply prescribing pills, and replaced them with a prescription for an improved diet or increased physical activity? Surely, it’s better to prevent people from developing these conditions – which often require lifelong treatment and frequent monitoring from doctors, pharmacists and nurses – by advising people on how to improve their health.

In 2012, the NHS spent £11.718 billion on the treatment of type 2 diabetes, with £2.522 billion of that money spent on drugs alone[2]. In 2012/13, the NHS spent £6.9 billion on treating cardiovascular disease (CVD)[3]. Imagine if this money was used for public health and encouraging patients to live a healthier life. Imagine what could be achieved.

Despite that for every £1 spent on public health, £14 is saved by the NHS[4], it appears that the government does not aim to allot public health more than £4 billion a year out of the annual NHS budget of over £100 billion[5]. It isn’t just about the financial savings. Think of all the people who could have ended up with a non-communicable disease (NCD) who instead received advice on how to improve their health. They could have been spared a lifelong sentence of an NCD such as cardiovascular disease or diabetes.

 

Pharmacies as public health hubs?

Pharmacies are excellent hubs for engaging with patients and the public about health, and they’re everywhere! As of 2016, there were 11,688 pharmacies in England[6] and 99% of people live within a 20-minute drive of a pharmacy. 96% can access their local pharmacy by public transport or walking[7]. Plus, there’s no need to make an appointment to see your pharmacist. Can’t get out of the house? Give us a ring!

If pharmacists could spend as much time discussing with people how to prevent ending up on medicines for NCDs as we do dispensing those medicines, think of how effective a public health campaign that would be.

Many will say that with pharmacies receiving less money from the government[8], we are already having to do more work with fewer resources. Pharmacies have to do six public health campaigns per year as part of their contract with the NHS, as well as the annual reviews we do that include lifestyle advice. Enough is being done, right?

Well, I disagree. Pharmacists have the knowledge and capability to assist the public with addressing issues such as unhealthy diets, physical inactivity and smoking, all of which are known to contribute to NCDs[9]. We could be that go-to place for people to maintain and improve their health. Some patients with NCDs have reported to me that by changing their diet, they have gone from taking three medicines a day to none at all. I’ve seen patients lose considerable amounts of weight and have the numbers of medicines they take reduce as a result.

I appreciate that there is no-one-size-fits-all solution. It is very easy to show a patient the eat-well plate, whilst giving them a list of the local gyms in the area. The majority of patients I meet who have long-term conditions are elderly, with ailments such as arthritis or other pain-related conditions. Some of my patients must sit down and rest after they come and collect their prescription because they are out of breath from the walk as a result of their COPD. Others suffer from arthritis so badly that they cannot manage the walk from home to their chemist; somebody collects their medication for them. But there are always small improvements that everyone can make and pharmacists can help to make that easier for people.

 

What are Healthy Living Pharmacies?

Healthy living pharmacies (HLPs) are commissioned to promote health services to the public. They are proactive in promoting health and wellbeing, and may be commissioned to deliver services and treatment such as advice on alcohol intake, health checks and healthy weight services. In HLPs, the health champions are integral members of the pharmacy team who provide people with information about their health, as well as helping provide some services[10]. The changes to the pharmacy contract offer payments to encourage pharmacies to become healthy living pharmacies, which will probably encourage more pharmacies to enrol for it.

I think that if more pharmacies became healthy living pharmacies with health champions, alongside more advanced training and services that patients can be directed to e.g. local leisure centres, cooking classes etc., pharmacy professionals could take the time to give people practical, tailored advice on how they can incorporate healthy living into their everyday routines, with incredible results. However, this can only be achieved with training, support and, ultimately, funding.

Obviously, this will need to be done in collaboration with other solutions. However, it’s a proven solution to addressing a serious issue of the prevalence of NCDs.

 

[1] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf

[2] http://www.diabetes.co.uk/cost-of-diabetes.html

[3] https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwje6fzBzIHWAhWsLsAKHZNCBX8QFggoMAA&url=https%3A%2F%2Fwww.bhf.org.uk%2F~%2Fmedia%2Ffiles%2Fresearch%2Fheart-statistics%2Fbhf_cvd-statistics-2014_web.pdf&usg=AFQjCNFAVoYrCpiio9Q1gC5nvSlIgZbDFA

[4] http://www.bmj.com/company/newsroom/every-1-spent-on-public-health-in-uk-saves-average-of-14/

[5] https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/spending-public-health

[6] http://content.digital.nhs.uk/searchcatalogue?productid=23420&q=title%3a%22General+Pharmaceutical+Services+in+England%22&topics=1%2fPrimary+care+services%2fCommunity+pharmacy+services&sort=Relevance&size=10&page=1#top

[7] http://archive.psnc.org.uk/pages/about_community_pharmacy.html

[8] http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7811#fullreport

[9] http://www.who.int/gho/ncd/risk_factors/en/

[10] http://psnc.org.uk/services-commissioning/locally-commissioned-services/healthy-living-pharmacies/