INTRODUCTION AND EXECUTIVE SUMMARY

  Alliance Boots is Europe's largest pharmacy-led health and beauty group, created following the merger in 2006 of Alliance UniChem and Boots Group. We operate over 2,300 pharmacies across the UK, through our Boots stores.

  This submission outlines how pharmacy contributes to tackling health inequalities, activity Boots is undertaking to help improve public health and the potential for pharmacy's role to be enhanced.

The extent to which the NHS can contribute to reducing health inequalities, given that many of the causes of inequalities relate to other policy areas eg taxation, employment, housing, education and local government;

  1.  Pharmacy is a core part of the NHS primary care family, providing medicines, healthcare services, information and advice to NHS patients and customers. At national campaign level, Change One Thing Schools is an example of a cross-cutting community initiative Boots is running in 2008. This free web-based resource for secondary school teachers is based on the Change One Thing New Year's health campaign, which for the third year running is helping thousands of Boots customers stick to their New Year's resolution. COT Schools bridges the gap between health and education, by encouraging 11-14 year olds to develop the skills to make healthy lifestyle choices, focusing on healthy eating; being active; and understanding the effects of smoking. This resource, which provides curricula-linked classroom activities and interactive action plans for pupils, is available to all secondary schools. Our pathfinder schools for the programme, for example, include a City Academy and a Special Educational Needs class, thereby improving health promotion in potentially hard-to-reach groups. As well as educating pupils in healthy choices from a young age, there could also be an impact on parents who may benefit from the information and skills their children are bringing home. COT Schools (www.bootschangeonethingschools.com) runs from early January and we aim to obtain feedback on improvements in the healthy choices and well-being of participating pupils.

The distribution and quality of GP services and their influence on health inequalities, including how the Quality and Outcomes Framework and Practice-based Commissioning might be used to improve the quality and distribution of GP services to reduce health inequalities;

  2.  A key strength of the Boots pharmacy offer is its accessibility, on high streets and in local communities. In areas where GP provision needs improving, Boots can be ideally placed to offer premises. We are currently engaged in PCT-led discussions in a number of locations across the country about the potential for hosting GP practices in over 100 stores. In Poole, Dorset we have worked in partnership with the PCT to establish an NHS Healthcare Centre, which is a satellite GP surgery, in our Boots store in the town shopping centre. This has been running since February 2007, with positive feedback from patients about the convenient location, transport links and facilities.

  3.  Limited out-of-hours access is a recognised problem with GP services. Pharmacy is ideally placed to plug this gap in healthcare provision. With evening and weekend opening hours, plus over 60 Boots Midnight Pharmacies and a 24-hour "Ask your Boots pharmacist" telephone helpline, patients have the reassurance of being able to access information, advice and treatment from a health professional. This can be particularly valuable in areas where GP out-of-hours provision is very limited.

  4.  There could be an opportunity to improve GP services in order to reduce health inequalities by linking more closely the contractual arrangements underpinning GP and pharmacy services. This could strengthen collaborative approaches to primary care provision and drive the development of clinical community pharmacy, shifting care further to communities for accessible and cost effective care. Where appropriate and where patients express a preference, this could involve some clinical tasks traditionally undertaken by the GP being transferred to the local pharmacy.

  5.  Greater collaboration between health professionals and more pharmacist involvement is also important for effective practice-based commissioning. The process would benefit from pharmacists joining practice-based commissioning teams where possible. In addition, as recommended by the All-Party Pharmacy Group's "Future of Pharmacy" report (June 2007), the Department of Health should provide guidance to PCTs and commissioning groups on how transparency and equity is to be achieved in practice-based commissioning.

The effectiveness of public health services at reducing inequalities by targeting key causes such as smoking and obesity, including whether some public health interventions may lead to increases in health inequalities; and which interventions are most cost-effective;

  6.  In 2006, Boots helped over 60,000 people to quit smoking through the NHS smoking cessation services on offer in our pharmacies. Patients could benefit more uniformly across the country from increased commissioning by PCTs of this Enhanced Service of the Pharmacy Contract. Our Change One Thing annual New Year's health campaign also helped 500,000 people to quit smoking in the same year. Our smoking cessation activity continues, and this year's Change One Thing campaign in stores and online (www.bootschangeonething.com) will also have a particular focus on achieving and maintaining a healthy weight. This national marketing approach, which provides customers with information, support and personalised action plans, has a broad reach to thousands of people, easily accessible on the high street and in local communities. Indeed Change One Thing was endorsed as the inspiration for the Government's "Small Change Big Difference" public health initiative, in the "Partnerships for Better Health" report published by the Department of Health in June 2007.

  7.  There are also best practice examples of pharmacy-led public health interventions at local level. In 2007-08, our UK wholesale business UniChem has been leading an obesity management pilot programme in association with Coventry Teaching Primary Care Trust, run in ten community pharmacies including Boots. The targeted programme, endorsed by the Department of Health, has since January 2007 been providing a weight management service for 150 patients in the Coventry area with a body mass index of 30 to 35 and at least one diagnosed or established risk factor (including hypertension, type-2 diabetes and increased waist circumference). The 12-month pilot scheme's objectives are to facilitate a weight loss of at least 5% in obese patients; identify obese patients at risk of developing long-term conditions; and educate patients in healthy living. Each patient attends eleven consultations over the twelve-month period, during which they are offered practical guidance and support tailored to individual need. We would be happy to provide details of the impact of the scheme once the pilot is over.

  8.  In providing drugs misuse and needle exchange services, pharmacies are also heavily involved in helping this group of individuals who are less likely to access the mainstream NHS, as well as playing a role in improving the wider community environment.

  9.  Sexual health is another public health issue that can be the result of local inequalities. The NHS London chlamydia screening pilot was launched in Boots stores in 2005, running until April 2008. It provides a free service for 16-24 year olds. Boots also runs its own national chlamydia screening service, available in over 1000 stores for a fee of £25 for a screen and £19 for treatment. 36% of those using the test kits to date have been male, a higher figure than the equivalent for the NHS service.[158] Availability of the service online may explain their relatively high uptake of the offer, with men traditionally less frequent users of health care.

The success of NHS organisations at co-ordinating activities with other organisations, for example local authorities, education and housing providers, to tackle inequalities; and what incentives can be provided to ensure these organisations improve care;

  10.  Variable PCT commissioning of Enhanced Services of the Pharmacy Contract is creating a fragmented system of postcode services across the country. This could be resolved if more pharmacy services were made available on a nationally defined and consistently available basis, shifting from the Enhanced to the Advanced tier of the Pharmacy Contract. Examples of such services include sexual health screening and advice; diabetes screening; and weight management. Pharmacy representation should be invited on all PCT professional executive committees (PECs).

CONCLUSION

  Community pharmacy recognises its responsibility to communicate clearly with PCTs. However, PCTs must also engage adequately with community pharmacy, which in many cases simply does not happen. We would like to see more local leadership at PCT level, expressing what they want and expect from pharmacy and thereby creating an environment in which those objectives can be met through collaborative working.

  We hope to further enhance the public health promotion role of community pharmacy, including plugging gaps in provision in the areas with most need and being accessible to all patients and the public, including hard-to-reach groups.

January 2008