Guidance
Context
Key facts and figures
Community pharmacy contractors dispense NHS prescriptions under the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013. As well as dispensing, community pharmacy contractors are required to:
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promote healthy lifestyles
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participate in 6 public health campaigns a year
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dispose of unwanted medicines
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provide support for self-care
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signpost members of the community to appropriate services.
As of 7 November 2017, there were 11,699 community pharmacies in England (NHS Digital General Pharmaceutical Services in England – 2007/08 to 2016/17).
Most prescription items are dispensed by community pharmacies. In 2016/17, for example, they dispensed 91.6% of the 1,000 million plus items dispensed in the community ('General Pharmaceutical Services in England – 2007/08 to 2016/17'). In 2016, the net cost of prescriptions dispensed in the community was £9,205 million. Of the prescriptions dispensed, 89.4% were dispensed free of charge, with 61% provided free to people aged 60 and over (NHS Digital Prescriptions dispensed in the community, Statistics for England 2006 to 2016).
Community pharmacies are well positioned to promote health and wellbeing to their local community, including those from underserved groups, because 90% of people in England (including more than 99% of people in the most deprived communities) live within a 20‑minute walk of one. The location of community pharmacies, unlike other healthcare outlets, does not comply with the usual 'inverse care law' in that there is a greater concentration of community pharmacies in areas of deprivation. (The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England Todd et al. 2014).
The risk of many health conditions can be reduced by people adopting healthier behaviours. These include: type 2 diabetes, cardiovascular disease, respiratory diseases such as chronic obstructive pulmonary disease, and other conditions related to obesity and smoking.
Community pharmacies can help raise awareness of health conditions, improve physical and mental health, and reduce both health inequalities and individual health risks by providing advice and services to everyone entering their premises. This includes people who do not visit GPs or other healthcare services. In addition, they may support other primary care services, such as GP practices.
Current practice
The Community Pharmacy Contractual Framework is a negotiated agreement between NHS England and the Pharmaceutical Services Negotiating Committee, which represents community pharmacy contractors. The framework includes a range of health-promoting services that community pharmacies should provide (Essential service 4 'Promotion of healthy lifestyles' and Essential service 5 'Signposting').
As part of the framework, pharmacies must participate in up to 6 public health campaigns each year at the request of NHS England (Public health [promotion of healthy lifestyles] Pharmaceutical Services Negotiating Committee).
In May 2018, there were over 9,400 Healthy Living Pharmacies and at least 9,400 health champions. There is a profession-led self-assessment process for Level 1 Healthy Living Pharmacies. Levels 2 and 3 are led and implemented by local authorities (see Commissioning section). Public Health England's Healthy Living Pharmacies: Level 1 quality criteria sets out the enablers and quality requirements for this level. The framework for Level 2 services is being updated.
Policy and commissioning
Policy
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The NHS Five Year Forward View (NHS England) states that a 'radical upgrade in prevention' is needed to achieve financial stability for the NHS. It sets out how the NHS could improve the way it promotes wellbeing and prevents health conditions. Options include making greater use of pharmacies in preventing ill health, support for healthy living, supporting self-care for minor ailments and long-term conditions, medication review in care homes, and as part of more integrated local care models.
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Public Health England's 7 priorities include obesity, smoking and alcohol (From evidence into action: opportunities to protect and improve the nation's health).
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The community pharmacy offer for improving the public's health: a briefing for local government and health and wellbeing boards (Local Government Association and Public Health England) describes how health and wellbeing boards, local authorities and commissioners can work with community pharmacies to promote health and wellbeing.
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Public Health England's Pharmacy: a way forward for public health. Opportunities for action through pharmacy for public health sets out opportunities for how pharmacy teams in the primary and community sectors can play a bigger part in helping people to better look after their health.
Commissioning
The Community Pharmacy Contractual Framework describes national commissioning arrangements for services to promote health and wellbeing. NHS England's regional teams commission all services in the framework.
The Community Pharmacy Contractual Framework includes specific mention of services to promote health and wellbeing, such as increased support for healthy living. This is to ensure there is a Royal Society of Public Health trained health champion in every community pharmacy, and that each community pharmacy obtains the Healthy Living Pharmacy Level 1 status.
Local authorities commission a range of public health services provided by community pharmacies, such as stop smoking, contraceptive and weight management services. Levels 2 and 3 of the Healthy Living Pharmacy framework are also commissioned by local authorities.
Local authorities and clinical commissioning groups can ask NHS England to commission services from community pharmacies on their behalf, such as advice services for people who are misusing drugs.
Most community pharmacies now have an up-to-date record of their Declaration of Service which details the services they offer following the Quality Payment Scheme incentive.