pharmacy, nhs five year future and public health masterclass
DESCRIPTION
A session which addresses the future potential of pharmacy for public health, including the NHS Five Year Future issues, as part of a series of public health masterclasses between the University of Hertfordshire and Hertfordshire Public Health ServiceTRANSCRIPT
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Future of Pharmacy in Public Health: Some prospects for population health
27th October 2014
University of Hertfordshire
Jim McManus
Director of Public Health, Hertfordshire County Council
Visiting Senior Clinical Fellow, University of Hertfordshire
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http://psnc.org.uk/wp-content/uploads/2013/08/Community_Pharmacy_at_the_heart_of_public_health_V1.pdf
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Products from Pharmacy and Public Health Forum Nationally• Developing Pharmacy’s contribution to Public Health: A
progress report from the Pharmacy and Public Health Forum
• Professional Standards for Public Health Practice for pharmacy
• Consolidating and developing the evidence base and research for community pharmacy’s contribution to public health
• Health on the high street: rethinking the role of community pharmacy
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NHS England 5 Year Forward View
• Simon Stevens, 23 October
• Do more to tackle the root causes of ill health. The future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. The Forward View backs hard-hitting action on obesity, alcohol and other major health risks.
• Commit to giving patients more control of their own care, including the option of combining health and social care, and new support for carers and volunteers.
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Continued…
• The NHS must change to meet the needs of a population that lives longer, for the millions of people with long-term conditions, and for all patients who want person centred care. It means breaking down the boundaries between family doctors and hospitals, between physical and mental health and between health and social care. The Five-Year Forward View sets out new models of care built around the needs of patients rather than historical or professional divides.
• Action needed to develop and deliver the new models of care, local flexibility and more investment in our workforce, technology and innovation
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What this means
• Recognition that we must prevent as much as we treat, if not more so.
• We cannot afford our system any more
• Burden of avoidable disability and death
• Associated mental ill-health and poor resilience
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How?
• A strategic shift to prevention
– Primary, Secondary and Tertiary
• Reconceptualising pathways and services
• Reconceptualising the relationship between public health services and primary care
• Reconceptualising the role of pharmacy
• Pathways
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What it means for NHS Services
• Preventive services in every patient pathway
• Levels and competencies from brief intervention onwards
• Preventive services in clinical services link up to community services (referral for leisure and behavioural interventions)
• Commissioning for self-management in chronic disease
www.hertsdirect.orgSo why 2,00 premature deaths a year?
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Challenge
2,200 early avoidable deaths annually
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Four main causes Risk factors
• Cancer
• Heart disease and stroke
• Lung disease
• Liver Disease
• Smoking
• Alcohol
• Inactivity
• Poor Diet
• Poor self management in diagnosed
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But...
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More detail
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Yet more detail
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Upshot
• Early avoidable deaths decrease with affluence and increase with deprivation
• Not the whole story but important for planning
• The role of pharmacy working with primary care
• Some worrying trends....
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JSNA http://jsna.hertslis.org/
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The Pharmaceutical Needs Assessment
• Out to consultation till 7th December.
• Have your say here
• http://www.hertsdirect.org/your-council/hcc/partnerwork/hwb/
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What the PNA does• Pharmacies in Hertfordshire and the services they currently provide
• Other local pharmaceutical services, such as dispensing GP surgeries.
• Relevant maps relating to Hertfordshire and providers of pharmaceutical services in the area
• Services in neighbouring Health and Wellbeing Board areas that might affect the need for services in Hertfordshire
• Potential gaps in service provision that could be met by providing more pharmacy services
• Likely future needs for pharmaceutical services
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Interactive pharmacies map
• http://atlas.hertslis.org/IAS/dataviews/report/fullpage?viewId=1215&reportId=538&geoId=595&geoReportId=6304
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Need, supply and demand 2
Field 1: Services needed but not demanded or suppliedField 2: Services demanded but not needed or suppliedField 3: Services supplied but not demanded or neededField 4: Services needed and demanded but not suppliedField 5: Services supplied and demanded but not neededField 6: Services needed and supplied but not demandedField 7: Services needed, demanded and supplied
Source: Stevens, Raftery et al http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/HCNA/index.aspx
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Need, Supply and demand
• Need can be defined as “the ability to benefit from the (pharmaceutical) intervention”.
• The availability of an intervention may not necessarily indicate a need, similarly a demand for an intervention may not indicate a need
• “supply induced demand” or an intervention wanted (demanded) by patients but which has no evidence to indicate benefit, are not misinterpreted as a need for a pharmaceutical service.
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The big policy drivers• Austerity
• Future waves of long term conditions
• Priority to keep our population healthier to retain functional health, quality of life
• Reducing cost
• A culture of prevention
• A culture of self-management
• Integrated care around the person, not the system
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The Big Strategic Challenges for Hertfordshire
Health Improvement
Health Protection
Service Quality
Imms
Vaccs
TB
HCAI
Environment
•Avoidable disease and death
•Public Mental Health
•Development
•Ageing
Health Care QualityPublic Service Outcomes
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The Opportunity for Herts
• The conditions for everyone to be healthy
• The conditions for the poorest and worst off to be healthier
• Public services which put this at the core of their business
• People thriving and prosperous
• Healthy workforce, prosperous County
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• So where does pharmacy fit in then?
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Future of Pharmacy in Public Health
• Pharmaceutical Needs Assessment (PNA) as a commissioning tool
• Consultation currently open till 7th December
– Commissioning decisions & how to decide which services should be commissioned locally
– How PH works with Members?
– Advice on how to use the PNA to plan a successful business case to provide those services.
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Some big challenges for pharmacy• Smoking
• Alcohol
• Sexual Health
• Seasonal Death (‘flu vaccine, winter warmth)
• Physical Activity
• Self Management
• Medicines Use
• Minor Ailments
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Concepts
Source: Medway school of pharmacy http://www.msp.ac.uk/research/cpp-team/clinic-prof-pract-services.html
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The powerhouse which is pharmacy• 247 community pharmacists Hertfordshire
• 84% of adults visit a pharmacy at least once a year.
• Over 75% of adults always use the same pharmacy.
• Over 90% of pharmacies now have a private consultation room (n=230 in Hertfordshire). Pharmacists use these rooms to undertake medicine use reviews (MURs) and new medicine review services (NMS).
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Pharmacy public health imact
• In Hertfordshire over 64,000 MURs were carried out in 2013/14 and almost 18,000 NMS.
• Many pharmacists have taken on a wider public health role eg running weekly clinics to help people lose weight, stop smoking or to monitor blood pressure or cholesterol.
• Pharmacies increasingly seen as a referral mechanism to GPs for patients with possible symptoms of cancer.
• 16 Healthy Living Pharmacies (HLPs), with their on-site health champions in Hertfordshire
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Prediction
forecast / target services
Secondary Prevention
Pri
ma
ry P
reve
ntio
n
Un
ive
rsal
& W
ell-
be
ing
LOWMODERATE
SUBSTANTIAL CRITICAL
Reduce numbers of people coming into high-cost services and
moving along threshold banding
Intensive Home Support
Residential Care
Motivation, Support
Skills, Services
Tertiary Prevention
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Some issues to address
• How do services contribute to strategic plans/policies?
– Eg: smoking cessation, EHC, Chlamydia screening
• Future planning in PH
– potential for new services eg: HIV testing, Health Checks
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Wins and delivery toolsFive big wins
1. Shift up clinical complexity in primary care
2. Step up secondary prevention of complex cases and
3. Step up self care and self management in chronic disease
4. Commission secondary prevention pathway
5. Commission primary prevention for key risk groups
Policy and Delivery Tools
• Pathways and structured care approached
• Health and social care integration
• Behavioural sciences
• Health Checks and public health services
• Brief interventions
• Pharmacy
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Future of Pharmacy in Public Health
• Healthy Living Pharmacy
– Demonstration of best practice
– Proactive provision of PH interventions
– Network development to use peer support to increase numbers.
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Future of Pharmacy in Public Health
• New Developments
– Alcohol IBA
– Pilot with 28 CPs across 5 districts
– Scratch card & more detailed intervention
– But a more systematic engagement is needed
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Future of Pharmacy in Public Health
• Health Psychology & CP
– Behaviour change
– Health Promotion
– Consultation skills standards
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Lifecourse approaches in Pharmacy
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Public Health in three dimensions – the opportunity for pharmacy
It’s not just about whether it works per se, but who it works for, in what context and so on
A three dimensional model of intervention, stage of lifecourse, level of intervention and domains of community safety
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Three dimensional approaches to public health
Z Axis : TimeframeShort – long term
Y axis : Level of complexity
EnvironmentalLegal/RegulatorySocialBehaviouralBiological
Adapted from Dettels et al (2009)In Oxford Textbook of Public Health
X axis : Lifecourse Stage
Pre-conceptionInfancyEarly yearsAdolescenceYoung adulthoodAdulthoodMid lifeOlder adulthoodFurther detail on conceptual models can be found in Healthier Herts: the public health
strategy for Hertfordshire 2013-17http://www.hertsdirect.org/docs/pdf/p/phstrat.pdf
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Three dimensional approaches to public health
Z Axis : TimeframeShort – long termWe often miss!
Y axis : Level of complexity
EnvironmentalLegal/RegulatorySocialBehaviouralBiological
Adapted from Dettels et al (2009)In Oxford Textbook of Public Health
X axis : Lifecourse Stage
Pre-conceptionInfancyEarly yearsAdolescenceYoung adulthoodAdulthoodMid lifeOlder adulthood
Further detail on conceptual models can be found in Healthier Herts: the public health strategy for Hertfordshire 2013-17http://www.hertsdirect.org/docs/pdf/p/phstrat.pdf
Z Axis: InterventionTimeframe
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Applying the three dimensions to a new strategy with pharmacy roles
Time Phase
Short -medium Medium - long
Layer
Biological, Psychological Societal, Environmental, Legal
Lifecourse Stage
Pre conception Old Age
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Problems
• Start of a journey
• What can we do now
• We have barely articulated the agenda for a strategic shift to prevention
• Healthy Living pharmacies are one thing, a system wide re-appraisal of pharmacy is needed and will take time
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Some big challenges for pharmacy• Smoking
• Alcohol
• Sexual Health
• Seasonal Death (‘flu vaccine, winter warmth)
• Physical Activity
• Self Management
• Medicines Use
• Minor Ailments
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From here...
• Consult on the PNA
• Have we got it right for all populations? Students, areas of high burden of disease?
• PNS, Public Health, CCGs and Social Care need to have a conversation together about where we do