Recent research published in Blue Health Screening’s UK Health Gap report found that NHS cervical cancer screening rates have hit a 21-year low, targets for breast cancer screening are also being missed, and more than half of people don’t take up the offer of bowel cancer screening. What’s more, 1.7 million adults have potential symptoms of cardiovascular disease unchecked – 94 per cent have never been screened to assess their risk of developing the disease despite it being the UK’s number one cause of death and the most common cause of heart attacks.
The research asked a nationally representative group of 2,000 adults how they prioritise their health, looking at trends across gender, age and regions of the UK. It uncovered a worrying health gap between ‘health managers’ and ‘health deniers’ – those who take a proactive view of health that it is something to be nurtured and preserved, and those who put health concerns to the back of their mind, cross their fingers and hope for the best.
There was a clear 40/60 split, with the majority firmly in the ‘health deniers’ camp. Only one in five people (21 per cent) said that health was their number one priority and only 40 per cent placed it in their top three priorities.
One way pharmacy could help improve these statistics is by making sure screening and early detection technologies are available in their practices. Another way is by helping customers understand how to use and interpret home test kits correctly.
Omron Healthcare provides medical monitoring technologies including blood pressure monitors, respiratory therapy products, electronic thermometers and body fat monitors, and recently launched a new interactive blood pressure monitoring skill for Amazon Alexa. Users can simply ask Alexa to compare blood pressure over time and flag higher than usual readings, as well as get guidelines and tips to ensure accurate blood pressure measurement.
“Only about a quarter of people in the UK are aware they have high blood pressure,” says Charlie Fox, general manager at Omron Healthcare. “This is creating a huge public health problem because, if left untreated, it can cause a range of serious conditions including stroke, heart attack and dementia, as well as damaging major organs over time.
“The good news is that we can diagnose hypertension and then treat it with lifestyle interventions that address diet, exercise, smoking and alcohol – all of which can be supported by pharmacists,” adds Fox. “Plus you can give customers the added reassurance that if it doesn’t respond sufficiently after that, they can see their doctor for further treatment options.”
A recent test-and-treat intervention has been Healthy.io’s Dip UTI urinalysis kit and smartphone app to detect urinary tract infections – one of the most common bacterial infections seen by family doctors, which accounts for up to 3 per cent of all GP visits. One in two women will experience at least one urine infection in their lifetime and one in three will experience a first UTI before 24 years of age.
The Dip UTI kit combines the traditional dipstick test used by GPs with a proprietary colour-board and a smartphone app – said to be the first time a smartphone camera has been used as a clinical device equivalent to lab-based analysers.
After the user completes the test, she visits any participating pharmacy (Boots and Day Lewis are offering the service) where a pharmacist will assess her condition based on the test results and symptoms. If this indicates she has a bacterial infection, the pharmacist can supply a three-day course of antibiotics under a patient group direction (PGD) without the need to see a GP. The charge for the consultation and medicine is £15.
Asif Aziz, director of pharmacy services and operations at Boots UK, says the service has been “received really well so far”, adding that “the combination of convenient testing and a discussion with a pharmacist helps ensure that antibiotics are only supplied when appropriate which, in turn, will help to combat the rise of antibiotic resistance”.
Boots has trained pharmacists at 50 stores nationwide to trial a private skin scanning service. The service, operated by ScreenCancer at a cost of £65 to assess one skin concern per consultation, gives customers the option to have a ScreenCancer consultant dermatologist review the skin condition, provide advice and recommend further treatment options, including prescription medication if appropriate.
Asif Aziz, director of pharmacy services and operations at Boots UK, says the service has had a successful trial period, with over 500 customers scanned so far. “We have also seen an increase in mole scanning since the launch of skin scanning, with both services currently available in 50 stores,” he says, adding that Boots is “currently looking at opportunities” to add more screening and diagnostic services to its portfolio in the coming year.
With community pharmacy heading in a more service-focused direction, Naresh Rallmil, Numark service development pharmacist, says it is the perfect time for pharmacists to step outside the dispensary to support patients to manage their health.
“Our members are increasingly interested in test-and-treat services such as those for detecting and managing Strep A, urinary tract and sexually transmitted infections,” he says.
“Excitingly, the NHS is seeing the benefits of involving pharmacy in these services. For example, after a successful pilot in 58 pharmacies across Wales, a sore throat test-and-treat service will be rolled out across all seven health boards, hoping to recruit half of all pharmacies in Wales. This could help to reduce GP visits, thereby reducing the financial burden on the NHS and helping to meet antimicrobial resistance (AMR) targets.
“A spokesperson for the Welsh Government reported that the initial evaluation of 3,655 consultations provided through the sore throat test-and-treat service indicated that antibiotics were supplied in just 21 per cent of the consultations.”
“With the new pharmacy contractual framework in England, there may be the opportunity for more NHS screening services to be made available from pharmacies, which is likely to increase uptake,” says Asif Aziz, “and, of course, by working together in partnership with other healthcare professionals, [pharmacists] can support this awareness and opportunity for care even further.”
One timely and topical way in which this can be achieved is through strong engagement with primary care networks (PCNs). “By using PCNs to set out who can lead on services like screening and how to make best use of the wider healthcare team, pharmacists can ensure they are integrating with colleagues to deliver the best for patients,” says Naresh Rallmil. “There are similar structures in Scotland and Wales such as local health and care partnerships and primary care clusters. These are important ways in which pharmacists can engage with the health needs of their local populations.”
Pharmacists should help people to understand how to use and intepret home test kits correctly
Taking part in the Community Pharmacist Consultation Service (CPCS) is another way to engage with patients through treating minor conditions and also offering screening services as well.
Graham Thoms, chief executive officer at PharmaDoctor, points out that private services can marry up with many of the conditions that patients who are referred to pharmacy via the CPCS are suffering from. What does he have in mind?
“NHS 111 will direct patients with, for instance, sore throat, suspected UTIs or flu to pharmacy and you can recommend OTC products. But if you have an enhanced service package you can also offer them treatments via a PGD. Yes, you will still make £14 from the referral and be able to sell, say, analgesics to the customer. However, you could also offer a more comprehensive service that is great for the patient and the NHS, saving them from having to go to their local GP or A&E.”
The new contractual framework in England gives pharmacy real impetus in terms of starting general conversations with people about their health, according to pharmacist training consultant Liam Stapleton. “With all pharmacies required to become healthy living pharmacies, that gives a great opportunity to engage people with screening via public health promotions,” he says.
“Hypertension is a fabulous public health promotion to do as it is really straightforward. You can train team members to do the measurement and the pharmacist can give customers the advice after that. Eventually, people coming into pharmacy via the CPCS will act as a driver for pharmacists to say ‘can I take your blood pressure while you are here?’, whether they are in for a cough or an eye problem.
“If you can screen and identify people where action needs to be taken, that is a massive win for the NHS. And because pharmacists are the healthcare professionals who will end up seeing these patients the most, you end up with a service-based income stream. It will also increase your links within PCNs because, if you have a customer who needs a screening service you don’t run, you can offer to book them in with a GP practice that does.”
This type of joined-up thinking still recognises that there are ongoing pressures within community pharmacy. But engagement with patient services and supporting customers to maintain and improve their own health continues to be a clear area of need for patients and the NHS, says Naresh Rallmil. “Along with the pain of change comes opportunities. Right now community pharmacy has a great chance to show what it can deliver for patients.”
And this most certainly means an expanded role in screening for illness and supporting customers with both self-testing and using mobile health apps so they can better manage their own health.
Dears Pharmacy & Travel Clinic has 10 pharmacies in Edinburgh and Fife, and runs all the services on offer from private clinical services provider PharmaDoctor including travel and vaccination clinics, enhanced minor ailments schemes and screening services.
If pharmacies are going to operate this way, however, they need to make sure they have the staff and space available to make it work. “Because all our services are ‘no appointment necessary’, we had to ensure we wouldn’t get overloaded,” says managing director and superintendent pharmacist Mahyar Nickkho-Amiry.
“We upskilled members of our dispensary team and all our pharmacies have accuracy checking technicians, so our pharmacists are freed up to lead services such as sore throat test-and-treat. Others, such as the health check service, can be done by other members of the pharmacy team. Each pharmacy also has two consulting rooms – one for the pharmacist-led services and one for those that are non-pharmacist-led, so that we always have capacity to see customers in both.”
Customer feedback has been positive. “Overall, they tell us they love the chance to come in and access these services without an appointment,” says Mahyar. The staff are also seeing the benefits. “We know our staff need to be supported at all times so that we can grow our services and not be completely reliant on NHS income,” he adds, “so we spend five-figure sums every year training them. They all get allocated training time each week to make sure they feel they are progressing as we evolve as a group. They tell us that they love that they are doing more, so this is a great boost for staff morale and retention.”