Health Committee - The Government's Alcohol StrategyWritten evidence from Pharmacy Voice (GAS 31)


1. Pharmacy IBAs Identification and Brief Advice (IBA) services delivered through community pharmacies are an effective way of raising awareness of alcohol risks with large numbers of people, including those who are not regular users of other health services

2. Communication Members of the public see community pharmacies as a non-threatening environment in which to seek or receive advice relating to alcohol consumption and other public health issues

3. Public health Alcohol IBAs can be incorporated into wider pharmacy-based public health initiatives, including “Healthy Living Pharmacies”. This builds on the training and experience that pharmacy staff already have

4. Commissioning Some PCTs have commissioned IBAs from pharmacies, and evidence shows that the services are effective, however, there are difficulties in delivering the service consistently because of variations in specifications, accreditation and payment

5. Specification The establishment of Public Health England gives the opportunity to design a single national specification for pharmacy-based IBAs. Using this as the basis for commissioning by local authorities would be more cost-effective and efficient and allow for a wide-scale roll out of IBAs

Pharmacy Interventions and Alcohol Harm Reduction

In this response, we are confining our comments to one specific area of the Government’s Alcohol Strategy. Under the heading “Evidence based action on health harms” [Alcohol Strategy, p15], it says:

3.24Local authorities and clinical commissioning groups will need to work together to meet local needs as identified in the Joint Strategic Needs Assessment. Funding through the public health grant will allow local authorities to commission identification and brief advice, which is proven to be effective in reducing the drinking of people at risk of ill health…

3.25Local areas should work in partnership to support as much integration across clinical pathways as possible, maximising the scope for early interventions…

Pharmacy Voice would like to wholeheartedly endorse this section of the Strategy and we would like to set out evidence that clearly demonstrates how pharmacy can play an active and important part in delivering identification and brief advice (IBA) as part of its role in public health. We also want to set out how this could be made more effective and efficient, through the setting of a national service specification.

Community pharmacies are a place where members of the public feel comfortable asking advice about alcohol consumption. “Can I still drink alcohol while taking these tablets?” is a question that pharmacists hear every day. Pharmacy customers also expect to be asked questions about their own health by pharmacists or pharmacy staff, including on alcohol consumption, and these can lead to suitable “brief advice” conversations.

Pharmacies are perceived as a non-threatening healthcare environment. Customers can seek advice from a pharmacist or trained member of the pharmacy team at a time of their own convenience and without appointment. Many pharmacies are open for extended hours and at weekends.

Pharmacies have extremely high footfalls. Those located within shopping destinations and supermarkets see many customers, such as young women and working age men, who do not regularly visit GP surgeries or other healthcare providers. This provides an opportunity to spread public health messages to a much wider audience.

The ability of pharmacist and their staff to deliver alcohol related IBAs has been proven in a number of studies. Many primary care trusts are already commissioning such services from pharmacies. Details of some of these are given below.

Windsor and Maidenhead

A Pharmacy Brief Advice (PBA) service commissioned by Windsor and Maidenhead Community Safety Partnership was evaluated as part of the South East Alcohol Innovation Programme. The PBA service was one of the top five projects (from an initial range of 23) chosen for a second year of funding and further development.

The PBA project engaged with community pharmacies to provide pro-active alcohol brief advice offering health awareness, understanding units, early identification of possible excess, data capture on awareness and units consumed and signposting/referral for additional support where required. This project sought to raise awareness of safe alcohol consumption among those who are not aware of how much alcohol they are consuming. The project specifically sought to target low- and increasing-risk drinkers.

The evaluation found IBAs provided in pharmacies “are effective interventions directed at patients drinking at increasing or higher risk levels who are not typically complaining about or seeking help for an alcohol problem”. Some issues with delivering the service were identified—such as starting the service in December, pharmacies’ busiest time of year, and attempting to deliver it alongside another pharmacy service—but the evaluation stated that the project “has the potential to succeed” and it is being taken forward locally.


An alcohol IBA forms part of the “Healthy Living Pharmacy” (HLP) project in Portsmouth, which is part of a wider Healthy Living initiative run by the PCT and local authority. The IBA includes the use of “Rethink your drink” scratchcards through which customers can assess their drinking in a non-judgemental way.

An initial assessment by the PCT found that pharmacies which were part of the HLP scheme delivered almost four times more IBAs than those not in it. A key part of the HLP project is enhanced “health champion” training for pharmacy staff. The PCT has long-term plans to develop the IBA to include behaviour change counselling and, eventually, structured care plans for higher-risk alcohol users and cancer risk assessments.

The HLP project is currently being extended through a pathfinder programme in 30 PCT areas. Over 200 pharmacies have so far been accredited to HLP status.

North West England

A range of pharmacy-based IBA services are being run by seven PCTs in the North West. A formal evaluation of these services is being undertaken by Liverpool John Moores University and University of Central Lancashire, sponsored by Lundbeck UK Ltd and is expected to be published in September 2012. We would be pleased to update the Committee when this information is available.

Feedback from Pharmacy Voice members who have pharmacies delivering the service provides pointers to why the service is generally successful:

Alcohol IBAs can easily be integrated with other public health services, such as smoking cessation or weight management.

The training that pharmacy staff receive on behaviour change, such as for smoking cessation, can readily be applied to alcohol management.

The public are becoming familiar with the public health role of pharmacies and see this approach as part of that.

Community pharmacy staff, who normally live in the local area, are regarded as “peers” by local people. This supports and adds weight to the intervention. Pharmacy staff are motivated by supporting the health of their own communities.

However, the experience of Pharmacy Voice members with the commissioning of IBAs in the North West gives a clear flavour of the difficulties pharmacies experience across the country:

Wirral PCT, one of the originators of the pharmacy IBA has decommissioned the service.

Sefton and Blackpool PCTs have gone from pilot to full commissioning.

Warrington PCT has gone live with an IBA service.

Despite the existence of a standardised North West service specification, there are at least three variations of it in use.

Dealing with these variations increases the costs for pharmacy businesses. Some services require specific training or accreditation, which may be difficult to acquire or renew, especially for locums. This restricts the pool of qualified staff, making service continuity more difficult than necessary. Services can require different levels of reporting or result in differing payments.

It is also important to ensure that pharmacies that are providing IBAs are linked into wider care networks and pathways, so that patients identified as being at high risk can be referred for appropriate support.

Pharmacy Voice believes that the establishment of Public Health England gives an ideal opportunity to implement a single national service specification for pharmacy-based IBAs. Designing such a service once, at a national level, using all existing experience and evidence, would enable local authorities to roll out this highly effective service quickly. Local authorities should focus their attention on the scale and location of alcohol-related issues—identified in their Joint Strategic Needs Assessment—and commission in response to this. Service redesign at a local level is inefficient and should be avoided wherever possible. Having a single service model should also help simplify referral pathways.

Evidence from the Scottish pharmacy contract, where key services are commissioned nationally, shows what an impact this can have. Supplies of emergency hormonal contraception quickly rose four-fold after the introduction of a national service in 2008. More than half of all NHS-funded attempts to stop smoking in Scotland now happen in pharmacies (leaving aside the thousands of self-funded attempts that use products purchased from pharmacies).

Therefore, Pharmacy Voice recommends to the Committee that Public Health England should set out a single national service specification for pharmacy-based IBAs and that local authorities should only use the national specification when commissioning IBAs from pharmacies. Where appropriate, alcohol IBAs should from part of wider Healthy Living Pharmacy initiatives.

About Pharmacy Voice

Pharmacy Voice (PV) represents community pharmacy owners. Its founder members are the Association of Independent Multiple pharmacies (AIMp), the Company Chemists’ Association (CCA) and the National Pharmacy Association (NPA). The principal aim of Pharmacy Voice is to enable community pharmacy to fulfil its potential and play an expanded role as a healthcare provider of choice in the new NHS, offering unrivalled accessibility, value and quality for patients and driving forward the medicines optimisation, public health and long term conditions agendas.

Pharmacy Voice creates a stronger, unified voice for community pharmacy. We are pleased to have the opportunity to provide written evidence to the inquiry on the Government’s Alcohol Strategy.

May 2012

Prepared 21st July 2012