Select Committee on Health Appendices to the Minutes of Evidence


Letter from Andy Murdock, Director of Pharmacy, Lloydspharmacy (PH 58)

  In response to the Health Select Committee's announcement of an inquiry into Public Health, I am writing with Lloydspharmacy's view of the role of pharmacies in supporting public health within communities by working with local bodies such as councils and health authorities, and within new organisational arrangements such as Health Action Zones, Education Action Zones and Healthy Living Centres.

  I hope this will provide some insight into the way that these bodies and arrangements work while suggesting, as your terms of reference put it, an "alternative model" of public health provision: in our view, this being one which gets better value out of pharmacists than at present.

  In this respect, I also hope you will consider formally extending your examination of the co-ordination between public bodies and structures to those elements of the private sector which exist in the main to service the public sector, pharmacy being a leading example.


  Lloydspharmacy is the largest community operator in the UK, with over 1,300 pharmacies located mainly in community and health centre locations. Without sister pharmaceutical wholesaling company, AAH Pharmaceuticals, which as 17 warehouses across the UK, we have a combined turnover of £4 billion and 18,000 employees nationwide.

  Our growth strategy is based on delivering superior personal healthcare advice and service in communities, working together with local groups to maximum effect. We offer:

    —  a unique awareness of "social pharmacy";

    —  active support for Government disease priorities;

    —  a first-class dispensing service;

    —  prescription counselling advice to encourage medicines compliance;

    —  a prescription collection and delivery facility for the housebound/disabled;

    —  pharmaceutical care to 1,800 nursing/residential homes, covering 45,000 beds;

    —  a broad range of 25,000 items, including own brand products and "homecare" products for people with disabilities; and

    —  a solution to providing GPs with new practice facilities, incorporating an integral pharmacy.

  We are industry leaders in pharmacists' training programmes and community health initiatives, and the leading community pharmacy providers in health centres.


  There is a great deal that pharmacies can do to bring those concerned with public health and to help new public health arrangements to work. Local health and well being would benefit from greater recognition of this role. Encouraging pharmacies to provide a wide range of health and social information and advice would also help ensure consistency between the health messages given to people of different backgrounds.

  Lloydspharmacy is probably unique in its focus on "social pharmacy". We believe pharmacists' training and positioning in local communities equip them to do more for people's health than dispense medicines, important though this is with accompanying advice and counselling. The concept of medicine management, orchestrated and facilitated by pharmacists, will allow maximisation of the drugs budget and deliver cost effective health gains. However, pharmacists are also equipped to play a greater role with other groups working to improve public health.

  "Social pharmacy" works. It adds value to other public health efforts and creates new possibilities. We would thus urge the Committee to recommend the following steps to the Government:

  Formally include pharmacy as a matter of course among the key local bodies which work together to support public health.

  This would enable a wider variety of health and social messages to be communicated to the public. In many areas, pharmacy has to fight to get its voice heard where others simply stroll to the table. This is effectively a misuse of resource, which can be very easily rectified.

  Incentivise pharmacists to provide a wide range of health and social information and advice by re-engineering the pharmacy remuneration system.

  Sadly, Lloydspharmacy's "social pharmacy" approach is the exception rather than the rule; a response to our feeling that someone has to demonstrate pharmacy's potential. As, effectively, an experiment, a pilot study of the "social pharmacy" theory in practice is not a contributor to the bottom line profits, it cannot continue indefinitely within the current remuneration system. The current system rewards pharmacists for keeping patients on long-term medication rather than helping them in other ways. Unless this system is changed, the opportunity to spread the "social pharmacy" approach and reduce pressure on GPs will eventually be lost.

  Support prevention by encouraging early testing in pharmacies: this would require financial support to encourage wider provision and take-up.

  Good public health results largely from effective prevention. Most people who visit a GPs surgery are already ill. To encourage prevention, those who are well need to have easier access to, and encouragement to undertake, tests which enable disease to be detected and treatment given at an earlier stage. This will both reduce pressure on GPs and result in long-term secondary care savings.

  Pharmacies provide an obvious point of access to this early testing. Currently, most testing is paid for by the patient and is, therefore, neither offered nor taken up as widely as it might be.


  Social, economic and environmental factors all affect people's health. Lloydspharmacy believes that the best way of dealing with them is through multi-disciplinary team working. Community pharmacies have a major role here. Not only do they provide a non-threatening, accessible environment for the public, but they can also bring together a range of interests.

  Yet this role is not generally accepted. The result is under-utilisation of highly qualified members of the healthcare team. Pharmacists undergo five years of training before they qualify: a four-year undergraduate course, followed by a year's postgraduate experience. Besides the fundamentals, such as chemistry and pharmacology, their courses increasingly focus on social issues; for example, the interaction with the healthcare team and how to encourage customers to talk about their condition to ensure they are given the right treatment.

  There is much the Government could do to achieve better use of pharmacists, starting with the recommendations we make above.

  In the absence of formal action to date, however, Lloydspharmacy has decided itself to undertake what is effectively a unique experiment in "social pharmacy" (the term we use to describe the involvement of pharmacies in a multi-agency approach to improving public health). Our aim is to show in practice the benefits of involving pharmacists more closely in the work of local bodies on improving public health.

  In the appendix to this letter, taken from Lloydspharmacy's own experience, we show social pharmacy working together with other healthcare players such as Government departments, local councils, the NHS and schools to achieve an improved level of public health.

  I hope the Health Select Committee will find the ideas set out here of interest to its work. Please do not hesitate to contact me if you would like further details on any aspect of this submission.


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11 July 2000

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