1.  EXECUTIVE SUMMARY

  This memorandum outlines how pharmacy can help the NHS to address and reduce health inequalities in England. Pharmacies are easily accessible and conveniently located. Pharmacists and their support staff provide a number of services that help to address the health inequality issue. The pharmacy profession needs to become integrated into the NHS at both a national and local level for its full potential to provide benefits to patients and the public can be realised.

2.  INTRODUCTION

  2.1  The Royal Pharmaceutical Society of Great Britain (RPSGB) is the professional and regulatory body for pharmacists in England, Scotland and Wales. It also regulates pharmacy technicians on a voluntary basis, which is expected to become statutory under anticipated legislation. The primary objectives of the Society are to lead, regulate, develop and represent the profession of pharmacy. The Society leads and supports the development of the profession within the context of the public benefit.

  2.2  Our response focuses on the role that pharmacy, and in particularly community pharmacy, can play in helping to reduce health inequalities.

3.1  ACCESSIBILITY

  3.1.1  A key aspect in addressing health inequalities is making services more accessible. Pharmacies are located where people live and work and are often open for extended hours, including evenings and weekends. A recent review by the Department of Health showed that 99% of people can get to a pharmacy within 20 minutes. Changes to the Control of Entry are possible outcomes of the forthcoming Government White paper on Pharmacy, as well as in Lord Darzi's NHS Next Stage Review. The RPSGB hopes that the possible effects of destabilising this pharmacy network and the effect on pharmacies' potential to address health inequalities are being considered.

  3.1.2  Most of the new pharmacies that have opened up in the last two years have been in urban areas which are already well provided with health services. Pharmacists, like doctors, need to be encouraged to develop in deprived areas where there services are probably most required.

3.2  PUBLIC HEALTH

  3.2.1  The Department of Health strategy "Choosing Health Through Pharmacy" clearly identifies and promotes the role that pharmacy could play in addressing health inequalities. Some of the activities that pharmacies provide to address this issue include:

—  Signposting of patients to appropriate health services

—  Stop smoking services

—  Sexual Health services, such as Chlamydia screening and treatment, provision of emergency hormonal contraception

—  Obesity advice and treatment

—  Management of long-term conditions—for example diabetic monitoring and support

—  Support services for drug miusers

—  Minor ailment schemes and availability of medicines out of hours

  3.2.2  Pharmacists are amongst the most visited of all NHS health service providers. This is particularly of benefit in addressing health inequalities as these visits are often by people not accessing the NHS through any other means. Figures show that the average adult visits a pharmacy 12 times a year. Pharmacy has a huge potential role therefore in helping to prevent and manage risks for coronary heart disease and cancer such as physical inactivity, diabetes and hypertension.

  3.2.3  The new community pharmacy contract puts in place a framework to make use of this potential. By 2006 the contract had led to three-quarters of pharmacies installing private consultation areas, making a whole range of new clinical services available. However, pharmacy services are not being adequately commissioned, and where they are commissioned they need to be better integrated with mainstream primary community health services. The All Party Pharmacy Group report the Future of Pharmacy made clear earlier this year, that there is a postcode lottery of access to pharmacy services because local commissioners are not involving pharmacists in planning and delivering services local people want.

3.3  INTEGRATION

  If the potential for pharmacy to deliver on health inequalities is to be met, a number of issues must be addressed. The financial and regulatory framework for community pharmacy must ensure that the existing pharmacy network is maintained, rationalised where appropriate and expanded where desirable. This will be particularly important if GP practices are amalgamated into a smaller number of centres and/or with the creation of polyclinics. Pharmacists must be accepted and developed as a full member of the local health team if their skills are to be effectively used to address health inequalities.

  Primary care Trusts (PCTs) need to undertake a pharmaceutical needs assessment as part of the overall joint strategic needs assessment which will identify gaps in provision of pharmaceutical services.

4.  EXPANDING ROLE

  The role of pharmacists is expanding as more pharmacists take on advanced clinical roles such as independent and supplementary prescribing. Pharmacists with special interests in both the community and secondary care settings are developing.

5.  CONCLUSION

  In conclusion, and in answer to your first question, the RPSGB does believe that the NHS can help to reduce health inequalities. But it needs to have in place a system that makes best use of and consistently invests in the community based services it already has. This is not currently happening in community pharmacy.

January 2008