The picture of healthcare is changing as more patients are taking greater responsibility for their own health. So what does this mean for pharmacy and diagnostics? 

Over the last decade or so, there has been a huge rise in health literacy. Whereas most patients used to silently and gratefully accept whatever advice or medicine was dished out by a healthcare professional, now they are far more likely to have ideas and opinions of their own, perhaps from internet research or maybe conversations they have had with friends and family, and they won’t shy away from bringing them up during an appointment. This is also the direction in which the NHS is keen to push patients: as people become better educated about their health, they are more able – and likely – to take care of themselves.

This shift towards self-care goes well beyond taking medicines as prescribed and making healthier lifestyle choices. Instead, patients are realising that understanding more about the conditions they are suffering from can be a powerful tool in disease management. So rather than waiting for the next doctor’s appointment to find out the state of their health, individuals are increasingly keen to have more control themselves. This has brought with it an upsurge in interest in diagnostics and monitoring. Pharmacies are ideally placed to help patients explore this area further. Alastair Buxton, head of NHS services at the Pharmaceutical Services Negotiating Committee (PSNC), comments:

“Because community pharmacies operate at the heart of the communities they serve, they can offer high quality services more accessibly than any other health professionals in a discreet but informal setting without the need for an appointment.”

Ashwell Pharmacy in Hertfordshire is doing exactly what Alastair describes. Pharmacist proprietor Brian Deal explains: “We offer blood pressure, cholesterol and diabetes screening individually, but more commonly all at the same time, a bit like a mini-MOT for the body.” There are distinct advantages in offering the services as a package, as Brian goes on to explain: “The results in combination are often more useful than doing just one of the tests in isolation, but there are times when it is more appropriate to do just one – say if we find out during an MUR that a patient has a family history of diabetes, we will offer to screen them for the condition as an add-on service.”

Staff stepping up

While diagnostic and monitoring services have traditionally been the domain of the pharmacist, the whole team is now getting more and more involved. At West Howe Pharmacy in Bournemouth, for instance, pharmacy staff are constantly on the lookout for suitable candidates for their free of charge blood pressure tests. Medicines counter assistant Christine Carpenter says: “The machine we use is fully automated so it is quick and easy to do a test while someone is waiting for their prescription. If their reading is a bit high, I ask if they want to come in again to repeat the test, and I get the pharmacist involved if the result is very high or if the customer has any questions.”

Christine continues: “I find it rewarding, and the customers say they are pleased that they can come in and get their blood pressure checked so easily.” Pharmacist manager Renate Kowalczyk says there are benefits for the business as well: “It builds customer loyalty, with people seeming more likely to come back another time, maybe with a prescription or to buy something over the counter or from the shop floor. They also refer their friends and family here for the checks, which brings in people who might not have come in otherwise.”

Jackie Lewis, superintendent pharmacist at Lewis Pharmacy in Devon, says having pharmacy staff conduct tests means the pharmacy is able to offer a wide range of services, including diabetes screening, asthma assessment, alcohol awareness, smoking cessation, healthy heart checks and a weight management service. “My staff identify and recruit patients, fill out the forms and conduct the tests, many of which involve finger-prick testing,” she says, adding: “The pharmacist is there as a reference to run the results by. It really takes the pressure off, freeing them up to concentrate on actually being a pharmacist.”

Jackie explains that running such services fits with the general ethos of the pharmacy: “Our approach is to treat every patient as a whole person. By speaking to someone for one thing, you might find out that they are interested in something else we can offer. The staff get a lot of satisfaction from it, and as well as customers getting help straight away, it makes them more likely to think of us as a place where they can get healthcare and not just advice or products when they are ill.”

You have to shout about it, making sure you work with local commissioners and GPs so they know they can send patients to you

National picture

The types of screening services that are being provided by many pharmacies are becoming increasingly familiar to patients because of the introduction of NHS Health Checks. Sometimes dubbed a “midlife MOT”, the NHS Health Check is offered every five years to those aged between 40 and 74 years who don’t already undergo monitoring for a circulatory condition. It includes assessments of blood pressure, cholesterol and body mass index (BMI), which are considered in relation to any relevant lifestyle and genetic factors. The idea is to detect potential problems before they develop into something more serious, and give people the opportunity and knowledge to make changes to reduce their risk of problems such as heart attack, stroke and diabetes.

So if many pharmacies are already offering the screening tests conducted during an NHS Health Check, why don’t the two become one and the same thing? Ash Soni, vice chair of the Royal Pharmaceutical Society’s English Pharmacy Board and a member of Public Health England’s expert clinical and scientific advisory panel for NHS Health Checks, says: “When this was first set up, it was commissioned as a GP service, so in some areas GPs are seen as the main providers. In other areas, pharmacy is seen as a good alternative, but this has made pharmacy provision of NHS Health Checks inconsistent across the country.”

Another overlap between the diagnostics offered by many pharmacies and national priorities is the healthy living pharmacy (HLP) framework, which aims to get pharmacies delivering high quality and consistent services that meet the needs of the local community. Again, this initiative is not evenly spread across the country, but Leyla Hannbeck, head of pharmacy services at the National Pharmacy Association, says that pharmacies in areas where the HLP model is not being widely participated in should not feel discouraged about offering diagnostic services.

Similarly, while in some areas clinical commissioning groups seem keen on paying pharmacies for screening and monitoring patients for various conditions, in others there is little investment. But this does not act as a deterrent to all. Brian Deal, for example, says that although the services provided by Ashwell Pharmacy have to be paid for by customers at the moment, it gives him and his staff valuable experience and puts them in a good position to be commissioned should funding become available in the future.

However, training staff up to perform screening tests and investing in the required equipment is only half the job, Leyla points out. “You have to shout about it, making sure you work with local commissioners and GPs so they know they can send patients to you… Word of mouth from patients themselves will only go so far.” Lewis Pharmacy in Devon has this down to a fine art, says Jackie: “We have signs everywhere and have made our own fliers that go into people’s prescription bags, including those that we deliver, and on the counter – wherever we think people who might be interested may see them.”

Back to basics

With so many pharmacies providing near-patient testing, it is easy to overlook the origins of such services: home testing kits. Not so long ago, home pregnancy tests would have been all that most pharmacies were offering, and they are still the backbone of many diagnostics fixtures. Now, however, the shelves probably also feature ovulation testing kits, blood pressure monitors and blood glucose meters as a minimum.

With so many products available from wholesalers, stock decisions can be tricky, but there are various ways to narrow the selection criteria. Ashwell Pharmacy’s Brian Deal advises opting for blood pressure monitors that are approved by the British Hypertension Society, for example (a list is available here) and suggests carrying digital pregnancy and ovulation tests, as some people can find the colour-changing models trickier to interpret. When it comes to deciding which blood glucose meters to keep in stock, Jackie Lewis of Lewis Pharmacy suggests finding out if your local CCG has struck a deal with particular suppliers. “It’s no good trying to sell machines that GPs won’t prescribe test strips for,” she points out.

Providing advice on when and how to use such equipment is something that pharmacy can and should do well, so it is worth taking the time to read product literature. Manufacturers often have training packages for pharmacy staff, or may be willing to run a training session, and can also supply pharmacies with product literature which can then be given to customers who are buying machines. The cash-strapped state of the NHS is one of the reasons why the UK healthcare system has been trying to adjust people’s thinking from illness to wellness. PSNC’s Alastair Buxton points out:

“Most people working in the NHS are by now aware that the health service is in financial difficulties – while demand for care and the number of patients with long-term conditions escalate, the economic situation means money is tight… Screening and monitoring can play an important part in helping patients to look after themselves and avoiding the need for expensive hospital and secondary care services.”

As well as the benefits to patients and the wider NHS, diagnostics present a great opportunity for pharmacy staff to gain new skills and become more involved in patient care. Such services also offer the perfect way for pharmacists and their staff to promote exactly how they can help people look after their health, for example, by having a stand at a local festival, or giving a talk at a local business or school. This is just one of many reasons why the time is right for pharmacies to get into diagnostics if they haven’t already taken the plunge.