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Hot footing it to pharmacy

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Hot footing it to pharmacy

More people live within easy walking distance of a community pharmacy than a GP surgery, so should pharmacy take on an even greater public health role?

Previous research has shown that in England, approximately 90 per cent of the population can access a community pharmacy within a 20-minute walk and, in the areas of highest deprivation, that figure increases to almost 100 per cent – the so-called ‘positive pharmacy care law’.

Now, the first study to map out the distribution of GPs in England, and make a direct comparison with community pharmacies, has shown that pharmacies are more accessible by foot than GPs in almost all areas (urban, suburban, deprived and affluent).

The research, led by Dr Adam Todd from Durham University school of medicine with colleagues from the department of geography, found that 89 per cent of the population of England live within a 1.6km radius of a community pharmacy – a distance that can be covered in 20 minutes at a walking pace of three miles (4km) per hour – compared with 85 per cent whose homes are located within the same distance of a GP surgery.

In suburban areas, 80 per cent of residents can walk to a pharmacy in 20 minutes or less, compared with 68 per cent for a GP, while in urban areas the figures rise to 98 and 94 per cent respectively.

Only in rural areas are GPs located slightly closer to people’s homes than pharmacies (19.4 per cent compared with 18.9 per cent). According to Dr Todd, the findings show that “the oftenquoted inverse care law, where good medical care is most available to those who need it least, does not apply”. Indeed, nearly 100 per cent of people in the most deprived areas have easy access to a community pharmacy and 98 per cent live within walking distance of a GP.

Tackling inequalities

While the authors acknowledge that proximity does not necessarily equate to access, they argue that pharmacies’ greater physical accessibility, particularly in deprived areas, combined with their convenient opening hours and informal approach, presents a strong case for commissioning more public health services through pharmacy.

In making the case for pharmacy, the researchers refer to a recent King’s Fund report, which suggests various factors why general practice may struggle to tackle health inequalities alone. For instance, difficulties recruiting GPs to work in areas of high deprivation; uncertainty over whether GPs feel equipped or motivated to tackle the wider determinants of health; and concerns that addressing public health issues such as obesity and smoking could “damage the doctor-patient relationship if done at the wrong time in the consultation process”.

“There are major public health issues which are putting huge pressures on the health service, and GPs in particular, such as obesity, smoking and alcohol dependence,” says Dr Todd. “More people die from these conditions in deprived areas compared to affluent communities and the gap in life expectancy between these areas has widened. “Community pharmacies are well-placed to help tackle some of these major public health concerns, working alongside GPs.”

Flu jabs: access denied?

The study, ‘Access all areas?’, which is published in BMJ Open, highlights flu vaccinations as an example of a public health service that pharmacists can provide to help reduce health inequalities.

However, area teams in Derbyshire, Nottinghamshire, Staffordshire and Shropshire have announced that they will only be commissioning the NHS flu vaccination service from pharmacies for ‘at risk’ patients under 65 years during the 2015/16 flu season, denying patients over 65 the chance to receive their flu jab from their pharmacy, even though it may be more accessible than their GP.

Mimi Lau, Numark director of pharmacy services, points out: “Targets for vaccinating ‘at risk’ groups are not being met nationally. So the only way to get more people vaccinated is to increase awareness and access to the service. By reducing access, we almost inevitably reduce awareness.”

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