Pharmacies could do more to help improve everyone's health
Most people aren't aware that high street pharmacies offer much more than dispensing and selling medicines. Many also provide a wide range of services designed to improve public health, like supporting people to stop smoking, providing emergency contraception and testing for sexually transmitted diseases. Some also offer the national NHS Health Check, which identifies people with high blood pressure diabetes and chronic kidney disease and gives them information about the risk of having a heart attack or stroke. This gives people the opportunity to make changes to protect their health.
These services are free to use because they are commissioned and paid for by local government. But not every pharmacy offers the full range of services. It might be surprising but there has been no data collected on the range of these services. We think it is important to know which services are offered in different pharmacies, and how many people have access to each of the services. So we carried out a study to find out.
We found that between April 2014 and May 2015, pharmacies provided over 200,000 consultations for emergency contraception, over 30,000 free condoms and almost 16,000 chlamydia screening kits. More than 55,000 people registered to stop smoking in a pharmacy, almost 30,000 were screened for alcohol use and over 26,000 had an NHS Health Check.
We also found that not all services are offered in all areas of England. Some are offered in most areas, including emergency contraception – almost half of all pharmacies offer this. Smoking cessation is commissioned by nine out of ten local authorities, but in some areas where smoking rates are higher than the national average only a few pharmacies provide support. Studies show these "stop smoking" services have good quit rates and are preferred by many people to other types of support.
Just under a third of local authorities commissioned pharmacies to provide the NHS Health Check, although people think having a one of these in a pharmacy is more convenient than going to a general practice. So you may live in an area where you can get a free NHS Health Check at your local pharmacy, but it's much more likely that you don't. Around half of the areas which do offer this are in London. If you live in an area with a high rate of diabetes, or a high number of deaths from cardiovascular disease, its unlikely that you can get an NHS Health Check at your local pharmacy.
Some areas pay pharmacies to provide lots of different services, while others can offer only a few. For example, pharmacies were paid to provide free emergency contraception and support to stop smoking in Birmingham and Wolverhampton, and in Walsall a small number were also paid to offer free NHS Health Checks. But not too far away in Dudley, pharmacies were paid to provide all these plus free Chlamydia screening tests, screening for excess alcohol use, weight management and testing for HIV. Many of the local authorities which commissioned lots of different services are in London, so people elsewhere are less likely to have access to these from a pharmacy.
What our study shows is that the extent to which services are offered doesn't match up with what people need. So in some areas where local people could potentially benefit, pharmacies can't provide these services because they aren't commissioned by local authorities. But, we didn't find out why there are such big differences between areas of England in the range and extent of services that pharmacies are commissioned to provide.
In 2015, NHS England decided to allow community pharmacies to offer free flu vaccinations to people at high risk. Pharmacies in all areas did this, so anyone could take advantage of the greater convenience this offers. Almost 600,000 people did so from 2015 to 2016 and over 950,000 the following year.
Pharmacy services are popular, so perhaps local authorities could be making better use of them to help improve public health.