Community pharmacy is often the first port of call for patients looking for answers. Here we examine the services that are back up after Covid, plus brand new ways to help customers
Community pharmacies have been involved in diagnostics for decades, offering a range of in-store services, from pregnancy testing and blood pressure checks to mole inspections and anticoagulant monitoring.
Many diagnostic services in pharmacies involve more than simply asking customers to take a test, with the pharmacy team involved in giving treatment advice and support as well.
After reduced in-store services for nearly two years, thanks to the pandemic, many community pharmacies are now gradually increasing the range of services available to their customers. "Covid stopped the in-store diagnostic pharmacy services, especially with the pressures of Covid vaccinations," says Peter Badham, superintendent pharmacist and managing director of Badham Pharmacy, which has 23 branches in and around Gloucester. "But we are hoping to resume services from now on. Pre-Covid, we always had blood pressure testing, weight management and cholesterol testing, referring patients back to their GP if they were out of the acceptable ranges, and identifying those at an increased risk of a possible stroke."
NHS England announced in October 2021 that community pharmacies will now be offering free blood pressure checks to the over-40s (the NHS Community Pharmacy Hypertension Case-Finding Advanced Service) and from January this year, community pharmacies could also make referrals to the NHS Digital Weight Management Programme. In addition, 44 pharmacies in England will be piloting the NHS Community Pharmacy Contraception Management Service, which gives patients greater access to ongoing oral contraception.
The pandemic has also opened up new opportunities for paid-for diagnostic services. Last month, for instance, LloydsPharmacy announced a contract with testing company MyHealthChecked to stock its Fit to Fly antigen tests for travellers, while Well Pharmacy is also offering pre-departure PCR testing in selected branches.
Jane Hingley, superintendent pharmacist for Pharmacy Direct GB and director at M E J Hingley & Co Ltd, says that community pharmacy has tremendous scope for diagnostic services and is ready, willing and able to do so. Unfortunately, however, funding is often an obstacle. "We operate in deprived areas, so it’s more cost effective for people from poorer incomes to have tests performed by their GP," she says.
"Obviously, community pharmacy can’t perform services for free, and often the areas which require the services are ones where patients either will not or cannot pay for them. These services also require investment. The special blood pressure monitors [for the NHS Community Pharmacy Hypertension Case-Finding Advanced Service] are approximately £1,000 each, and contractors need to purchase or rent these prior to offering the service."
John Bell & Croyden pharmacist Hallam Wiltshire says it’s not just funding that’s the problem for many pharmacies. "The pharmacy skillset is definitely there, but it’s having the dedicated time and space to do it," he says. "We are fortunate to have a large pharmacy, but smaller pharmacies may struggle with space and time if they only have one pharmacist who is also the manager. Each of our holistic health checks, for example, can take 20 to 30 minutes, plus follow ups."
Case study: John Bell and Croydon, London
John Bell & Croyden offers a range of in-store diagnostic services, including Covid-19 PCR, antigen and antibody testing, blood pressure, type 2 diabetes and cholesterol (both via a finger prick), and blood testing services. Diagnostic and treatment clinics are also offered via a large suite of patient group directions (PGDs) for acute infections, such as flu, sore throat and urinary tract infections.
With Covid-19 testing, safety is a key issue in the pharmacy. "Customers can book the Covid test online, where we have disclaimers to stress that they shouldn’t attend if they have any Covid symptoms," says pharmacist Hallam Witshire (pictured, right). "When they come in, we check their details, take payment and confirm (again) that they don’t have any symptoms.
"With this type of testing, people want to have a negative test (such as before they travel), unlike with the NHS Covid-19 PCR testing, when they are expecting to test positive because they have Covid symptoms. The staff wear full PPE – apron, mask, shield and gloves – to do the swabs, and afterwards, the customer leaves the premises. We sanitise everything and dispose of the PPE items."
Holistic health checks are a new clinic offered by John Bell & Croyden, and are advertised on the pharmacy’s website as well as in store. They involve checks for diabetes, cholesterol, blood pressure, BMI, and a baseline blood test for a range of measurements, including vitamins, minerals and hormones.
"Many other pharmacies offer cholesterol and blood pressure testing, but our holistic health check takes this further," says Hallam. "It involves a discussion with one of our nutritionists or pharmacists. Before doing the tests, we explain what we could test for and create a bespoke plan for that individual.
"The full blood testing takes 48 hours to get the results, and then I sit with a nutritionist to go through the results and draw up a plan using nutritional and clinical input. A follow-up consultation with the customer will take place to discuss the results and any appropriate products or further services. We can refer customers to their GP if necessary, and we always ask if they want a copy of the test results to take away with them.
"We try to take a holistic approach as not everything needs to be treated with medicines, such as statins in the case of high cholesterol. If cholesterol is slightly raised, for example, we go through their diet and may suggest a supplement that could be useful.
"Customers using the service tend to be those who have recently changed their diet and aren’t sure if they are doing the right things. Or they may have had other blood tests elsewhere, for cardiovascular disease risk, for example. Middle-aged people may be thinking more about their risk of heart disease, stroke and diabetes, so they’ve come in for advice."
Blood pressure checks
A survey by patient-centric online health community TalkHealth, in September-October 2020, revealed that 62 per cent of people would be very likely to take up the offer of getting a free blood pressure check at their local pharmacy.
The NHS Community Pharmacy Hypertension Case-Finding Advanced Service was announced on 24 August 2021 as part of the Year 3 Community Pharmacy Contractual Framework.
"As a pharmacist, I am delighted that this service is being rolled out across England," says Helen Williams, national specialty advisor for Cardiovascular Disease Prevention at NHS England and NHS Improvement. "Community pharmacies are ideally placed to deliver blood pressure checks, being accessible within local communities and regularly used by most adults. This service will enable people with high blood pressure to be identified and treated early and will encourage conversations about lifestyle change to help people live healthy lives for longer."
The NHS Community Pharmacy Hypertension Case-Finding Advanced Service aims to identify pharmacy customers over 40 who have not previously been diagnosed with high blood pressure. Pharmacies offering the service can provide free blood pressure checks to customers, with no appointment necessary, from a trained member of the pharmacy team.
"This is not only a blood pressure check," says Jane. "If a person is found to have high blood pressure, the pharmacist fits them with a special blood pressure monitor which they wear while going about their usual business for 24 hours. On returning to the pharmacy, the results are uploaded and shared with the patient’s GP. There are referral pathways if the patient is found to have dangerously high blood pressure during the process."
Three in five adults in England are overweight, with more than one in four living with obesity.
In January this year, NHS England announced the launch of its NHS Digital Weight Management Programme. Evidence from the NHS Digital Diabetes Prevention Programme shows that digital and remote weight management services are more likely to be accessed by younger (working age) people, and that they deliver comparable results to face-to-face weight management services.
Trained community pharmacy teams can now refer eligible adults to the 12-week online NHS weight management programme. Customers will be able to start the programme within 10 days of visiting their local pharmacy, with support for some people including one-to-one coaching from a weight loss expert. Adults living with obesity and high blood pressure or diabetes (or both) will qualify for the service, which they can access online, or via an app on their smartphone.
"Obesity is a significant threat to the nation’s health," says Dr Bruce Warner, deputy chief pharmaceutical officer at NHS England. "It increases the chance of dying from Covid and puts you at greater risk of stroke, cancer and other deadly disease. The NHS's radical action plan means it is now easier for people to take control of their health – adults with obesity can now walk into any high street community pharmacy to take the first step on a life-changing weight loss journey."
“Adults with obesity can now walk into any high street community pharmacy to take the first step on a life-changing weight loss journey”
Last month, NHS England and NHS Improvement (NHSE&I) published guidance to support commissioners and community pharmacy contractors to develop clinical services that use point of care testing (POCT) in community pharmacy settings. This follows the commitment made by NHSE&I as part of the Community Pharmacy Contractual Framework agreement 2019 to 2024 to explore the use of POCT to help support efforts to tackle antimicrobial resistance.
Research published in March 2020, in the journal JAC-Antimicrobial Resistance, found that a community pharmacy-led UTI test-and-treat service was an effective way to assess the suitability of women with lower urinary tract infections (UTIs) for antibiotic treatment.
The service used Public Health England UTI guidance to clinically assess women before confirming their eligibility to buy a dipstick test (for £9.99) and download a free app designed by health tech company Healthy.io. Pharmacy staff were able to triage the women and give the most appropriate support and advice, depending on the type and severity of the symptoms.
Following the results of this pilot, Healthy.io has teamed up with NHS Lincolnshire CCG and the Lincolnshire Co-op Pharmacy chain. Lincolnshire Co-op pharmacies are now offering a new NHS UTI Test & Treat Service to women aged 16 to 64 who fit certain criteria (including not being pregnant, not having diabetes or recurrent UTIs, and having a suitable smartphone).
A smartphone app turns a mobile phone camera into a medical scanner. The service involves the Dip UTI test and using the smartphone app, then returning to the pharmacy to discuss the results. If a customer requires antibiotics, they will have to pay the standard NHS prescription charge or get them for free if they are entitled.
The NHS Community Pharmacist Consultation Service (CPCS), launched by NHS England and NHS Improvement in October 2019, supports urgent care referrals to community pharmacies as a first port of call for various minor ailments and infections.
A new pharmacy walk-in consultation service, managed by Pharmaoutcomes, has been commissioned in Cornwall until March 2022. The service involves face-to-face assessments for a wide variety of minor ailments, and NHS treatment as required. Patients can self refer or be informally referred by another healthcare provider. Cornwall & Isles of Scilly LPC is promoting this new service, hoping that it will reduce health service pressures.
Case study: Badham Pharmacy, Bishops Cleeve, Cheltenham
"Because of Covid, there haven’t been a lot of diagnostic services here since April 2020," says Jackie Wakefield, registered pharmacy technician at Badham Pharmacy, Bishops Cleeve, Cheltenham. "Customers have definitely missed our services and there’s been a big gap locally.
"Before Covid, we were getting in a broad range of customers who wanted our blood pressure, cholesterol and weight management services, from younger, fitter people to the elderly. Some wanted reassurances that they were doing the right things to improve their health, while others were worrying and wondered whether they should make an appointment with their GP.
"When the GP surgeries stopped doing cholesterol and blood pressure checks, the doctors and nurses were telling patients to come to the pharmacy, but we couldn’t do anything either. There was nothing else on offer. Our services will be starting again very soon, but we’re still finalising the details."