Many community pharmacies sell DIY health tests and devices but many prefer to concentrate on specific services that they can offer

Community pharmacies offer a wide range of in-store health checks and diagnostic services to customers. In September 2017, Public Health England (PHE) published its ‘Pharmacy: A Way Forward for Public Health’ report, outlining the intervention services that local authorities could commission from pharmacies that are able to deliver them.

The report covers 14 ways in which community pharmacies can improve public health, including blood pressure checks, smoking cessation, weight management services and Dementia Friends training. Many community pharmacies sell DIY health tests and devices, with an everexpanding range of cholesterol kits, blood pressure monitors, weighing scales, digital thermometers, activity trackers, coeliac disease tests, paternity tests and blood sugar checks.

Recent launches include the A1cNow Self Check test, which enables people with diabetes to check their longterm blood glucose (HbA1c) levels at home, and the Cholchecker home cholesterol testing kit from Perfect Vascular Natural.

However, many community pharmacists prefer to concentrate on services that they can offer in the pharmacy, so that customers benefit from their professional expertise. As technology advances, the NHS is looking at more ways to expand the role of primary healthcare professionals in diagnosing and monitoring chronic conditions. This may involve targeting patients directly to encourage more self care, but also improving the range of diagnostic services available from GP surgeries and community pharmacies.

Atrial fibrillation
In August 2017, NHS England announced that millions of people are to be offered atrial fibrillation checks at GP surgeries and pharmacies to prevent heart disease and early deaths. Half a million people have undiagnosed atrial fibrillation, leaving them at high risk of a debilitating or lifethreatening stroke. Arrhythmia Alliance recently undertook a freedom of information request to determine if manual pulse rhythm checks – as recommended in the NHS Health Check – are being offered to patients. The request found that nearly 75% of local health authorities in England recommend GPs offer a manual pulse rhythm check as part of the NHS Health Check.

However, very few mandate or commission this. An NHS England-commissioned pilot in London over the last year, as part of NHS England’s ‘test-beds’ programme, involved testing patients aged 65 and over in the pharmacy for atrial fibrillation. The pilot is a collaboration between Care City, North East London Local Pharmaceutical Committee, Barts Health NHS Trust, Waltham Forest CCG and Sonar Informatics. It uses the Kardia Mobile handheld device from AliveCor, which can spot AF in 30 seconds. Those with an abnormal result receive a rapid referral to a One Stop AF Clinic at Whipps Cross University Hospital. The whole process takes two to three weeks, compared to a national average of 12 weeks. Nearly 700 patients have been screened by the plot study so far. Of these, around 7% have been diagnosed with atrial fibrillation.

Hi-tech help
One of NHS England’s Internet of Things (IoT) ‘test-beds’ programmes, called Technology Integrated Health Management (TIHM) for dementia, aims to transform support for people with dementia and their carers. TIHM for dementia is for people with mild to moderate dementia who live at home in Surrey or North East Hampshire and who have a regular carer who is also willing to be involved. Small internet-connected devices are installed around the person’s home. Some operate in the background, collecting data (such as movement or GPS tracking), while others require interaction (such as weighing scales or a blood pressure cuff).

The technology it is trialling is intended to help healthcare professionals to remotely monitor someone’s health and wellbeing. This will allow them to take prompt action to support someone if they are unsafe, ill or on the verge of becoming unwell. Diabetes Digital Coach, launched in 2017, is another IoT test bed project being led by the West of England Academic Health Science Network. The aim is to see how technology can enable more people to manage their diabetes (types 1 and 2) more efficiently, reducing the risk of complications in the long term. People with diabetes are being offered an online service, available via PC, smartphone and tablet.

People sign in, answer some questions about their health and lifestyle and how they currently manage their diabetes. The coach then directs them to the best digital tool to suit their individual needs. The service offers a range of five different digital tools. These provide varying degrees of support, covering health and wellbeing, structured education, dietitian support, optimising physical activity and insulin management. Data comes from users via their smart phones, tablets, glucometers and wearable tech. This helps patients track their progress and spot any patterns or trends, so they can make decisions about their care with the support of their healthcare professionals, family and carers.

 

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Broadway Pharmacy in Fulwood, Preston, was commissioned locally in 2016 to deliver the free NHS Health Check in Lancashire. “We have since checked hundreds of people,” says pharmacist Michael Ball. “At first, it was mainly people who were acutely or chronically unwell, as we tackled this opportunistically, targeting people as they came in. But the NHS Health Check targets people who think they are healthy, so we realised we needed to market the services elsewhere.”

The pharmacy team has concentrated on finding local people fitting the criteria at a time when they can be easily engaged for 15 to 20 minutes. “We have embraced social media, with websites and microsites for specific services like our travel clinic and our health checks,” says Ball. “We visit our local leisure centre, looking at when certain classes are on so we target the right people. We can deliver the health check there and then, or signpost them to the pharmacy. We also visit local rugby clubs on Saturdays and Sunday mornings – and not just the adult sessions but also we target the parents of the junior teams. We have also targeted garden centres!”

Pharmacy staff insert printed information about the key health services it offers into every prescription bag. Other services on offer include smoking cessation, weight management, hair loss and erectile dysfunction.

“We also provide food intolerance, food allergies and inhaled allergies testing,” adds Ball. “If people have persistent gastro symptoms, for example, we can check for food intolerance. If they have rashes or headaches, we can focus on food or inhaled allergens. We hold regular events collaborating with local charities and usually offer pharmacy services, or launch a new service, at the same time.”

Broadway Pharmacy is also this year’s winner of the Independent Pharmacy Team of the Year award.