The role of pharmacies in digital prevention: A conversation with Zoe Long

The NHS 10 Year Health Plan presents an ambitious and urgent challenge: shifting from treating sickness to prevention, and improving lives for generations to come. We believe in the power of bringing together our experts, NHS leaders, and communities to solve problems once thought unsolvable. Our Q&A series supports this mission by bridging the gap between policy and practice, turning vision into action.

These insights, alongside a survey of senior leaders, shape our digitally-powered prevention report.

In your view, what are the biggest challenges to achieving the government’s digital prevention agenda?

The fact that there has been no single strategy for primary care and/or prevention has led to a patchwork of responsibilities. Some prevention work sits with councils and health and wellbeing boards, while some of it sits with national public health. There’s no clear responsibility, accountability, or action plan – and there has also not been enough of a financial incentive to drive the prevention agenda. We would like to see more clarity on the responsibility of who does what and a plan for prevention. It doesn’t necessarily have to be one person or one organisation responsible and accountable, but it’s got to be clear and understood.

What makes pharmacies so central to the delivery of digital prevention?

The big advantage that pharmacies have is that they are closer to people’s homes than other healthcare settings, and see people more regularly than other healthcare providers. Those regular contact points are ideal for preventative healthcare. We saw through COVID-19 that when pharmacies have the incentives in place, they can really ramp up their offering, including in the prevention space. Most NHS vaccination targets aren’t being hit, for example, and we could improve that. Commissioning prevention services at a national level, and allowing self-referrals, would make it a lot easier. It doesn’t make sense that to get smoking cessation advice, you’ve got to get a referral from someone else, for example.

We’ve got just over 10,000 community pharmacies which is a phenomenal network across England: local healthcare centres that could be used for preventative healthcare. So, you need people who understand pharmacy and the value they bring to be part of conversations. But there’s no mandate for emerging local health structures to talk to community pharmacies. Pharmacies feel they almost have to fight for a seat at the table, and even when they do get a seat, pharmacists can’t close their pharmacy premises to attend meetings during the working week. That’s a real barrier to pharmacy for ongoing engagement, networking, and being part of local systems and structures.

Could digital tools and data-sharing enhance key prevention initiatives?

Community pharmacies are healthcare hubs, and what they can offer should be supported by digital interventions. The new medicine service, for example, is regularly done via telephone. A first consultation is generally in-person, but a second is often via telephone. You don’t need to be in-person every time.

One thing that many pharmacies do now is provide a smoking cessation service. However, the nationally commissioned smoking cessation service isn’t available on a walk in-basis. People are referred by somebody in another healthcare setting. One of the barriers with getting people to engage in preventative measures is psychological behavioural change, so making everything open and as easy as possible to access makes sense. The same goes for vaccinations.

Digital is the answer to connection in terms of interoperability between systems. It’s frustrating that pharmacies can see summary care records, but can’t view or alter patient records directly when they make an intervention. We can’t see if someone’s been to hospital, or if they’re a smoker. If we had this information, we could intervene. If we can get different providers to view and input data in the same place to manage a person’s care, that would be a big step towards connection. Digital also helps with engagement, and eases capacity for community pharmacies. Apps in the preventative healthcare space could also nudge people towards preventative strategies, and remind people to engage with healthcare professionals.

What would give you confidence that the digital prevention agenda can be successfully achieved?

We’re very supportive of the NHS App and would like to see more functionality rolled out – that would be a clear sign of digital progress.

A commissioning plan for prevention would also be a sign of progress and hopefully that shifting funding streams was going to happen. We’re keen on the idea of a suite of nationally-defined services that local areas could commission as needed, reducing duplication of effort in the commissioning process. It’s easier to roll out things that are consistent, particularly for pharmacies in different areas: it doesn’t make sense to have different versions of the same service. Ultimately what we want to see are plans are being put in place,services commissioned and the funding streams changing. If it’s not paid for, it’s not going to happen, and there won’t be people with the capacity to deliver preventative healthcare.