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Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients and about 90% of the adult population visit a community pharmacy at least once a year. This presents an important opportunity for pharmacists and their staff to motivate and empower their customers to improve their health.

Health Improvement covers a wide range of topics some examples are discussed below and the topics boxes give a little more detail.

Health Improvement targets for Scotland can be found by linking into the Scottish Executive’s website

For further information for pharmacy staff in NHS GGC click here

Stopping smoking

Stopping smoking is one of the most important health improvement interventions. Community pharmacy can supply nicotine replacement therapy or varenicline with behavioural support to help patients stop smoking.

Advice on healthy living

Pharmacists can provide the right advice on healthy living and signpost patients to the best resources to achieve their health improvement goals.

Reduce health inequalities

Community pharmacy offers the Pharmacy First Service (PFS) which encourages people to go to their local pharmacy for support with minor and acute health conditions. Pharmacies undertake a NHS PFS consultation and provide advice, treatment or referral to another healthcare professional if appropriate. 

Managing long term conditions
Many long term conditions require health improvement interventions in addition to medicines which might be prescribed.

Mental health

Good mental health is of key importance to maintaining good general health. Pharmacists should know where to signpost patients for appropriate support as they may need more assistance in managing their daily living requirements. Also patients suffering from poor mental health may need more support to make important lifestyle changes.

For any enquiries regarding Pharmacy Public Health Improvement please contact pharmacyhit@ggc.scot.nhs.uk

Alcohol Awareness

Approximately 1 in 8 men and 1 in 24 women have some degree of alcohol dependence. Excess drinking puts long term health at significant risk. Excessive alcohol consumption is associated with an increased risk of a range of illnesses that collectively contribute to a massive impact on morbidity and mortality.  Please see Alcohol Consumption Questions and the Fast Alcohol Screening Test (FAST

For more information visit

  • Drinkaware A Charity promoting responsible drinking.
  • Alcohol Focus Scotland – is the national charity working to reduce alcohol harm.
  • DrinkSmarter  A Scottish Government practical website with many handy tools, supporting healthier drinking habits. 
  • Glasgow Council on Alcohol (GCA) Providing support, counselling, advice, information, group work and training for those affected by alcohol misuse. 
  • Alcohol Concern   A charity campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems. 
  • Al-Anon Family Groups provide support to anyone whose life is, or has been, affected by someone else’s drinking, regardless of whether that person is still drinking or not.

 Key points for community pharmacy

  • Offer advice on sensible drinking
  • Give advice on prescription and Over the Counter (OTC) medicines about interactions with alcohol.
  • Signpost patients to local services offering support
  • Further Information, Resources and Support (including “Alcohol Before, During and After Leaflet) Alcohol and Pregnancy Leaflet 

Some pharmacies may

  • Offer alcohol brief interventions using a FAST tool
Cancer

It is estimated that 1 in 3 people in Scotland will develop some form of cancer during their lifetime.

This is a wide ranging topic and there are many different types of cancer. Some are more likely to occur in females e.g. cervical and breast cancer while others in men e.g. prostate cancer.

Many forms of cancer can now be successfully treated if they are identified in their early stages and we now have screening for the commonly occurring breast, bowel and cervical cancers.

Some cancers such as melanoma (skin cancer) may be prevented by health protection measures such as avoiding the sun and using sunscreens. Smoking cessation remains one of the most important health improvement measures to avoid developing cancer.

For more information visit

  •  Scottish Cancer Index provides links to cancer related websites specific to Scotland.  
  • Cancer Research UK  Helpline 0808 800 4040  Mon – Fri 9-5pm
  • Bowel cancer UK providing support and advice. Telephone: 020 7940 1760
  •  Encourage completion and return of Bowel Screening Kits information at this website
  • Breast Cancer Care providing information and assistance for those affected by breast cancer. Freephone Helpline 0808 800 6000 Textphone 0808 800 6001  
  • Cancer Support Scotland  Cancer Support Scotland offers counselling, support groups and complementary therapies to anyone affected by cancer, including family members and carers: before, during and after treatment.
  • Sun Smart   This Cancer Research UK website provides a wealth of information including, information on skin cancer, sunburn and how it damages your skin, advice on protective measures to take – applying sunscreen, staying in the shade, wearing protective clothing and sunglasses, and advice on protecting children from the sun.    
  • British Lung Foundation provides advice on all diseases affecting the lungs including lung cancer. Helpline: 03000 030 555
  • Leukaemia Care provides support for people with leukaemia, lymphomas and related disorders. Tel: Helpline: 08088 010 444 or chat via WhatsApp on 07500068065
  • Lymphoma Action provides support for those affected by Hodgkin’s disease and non-Hodgkin’s lymphoma. Tel. Helpline no: 0808 808 5555
  • Macmillan Cancer Support is a national charity providing expert care and support for people living with cancer. Tel. Helpline: 0808 808 0000
  • Maggies Centre provides support organisation for those affected by cancer. One of the centres is in Glasgow.   
  • Marie Curie Cancer Care. Dedicated to the cure of people affected by cancer and the enhancement of their quality of life through its caring services, research and education.  Telephone Support Line: 0800 090 2309
  • Oesophageal Patients Association Telephone: 0121 704 9860 (Mon – Fri 9am – 5pm)
  • Orchid: Fighting Male Cancer  Good range of leaflets on testicular and prostate cancer.  National male cancer helpline: 0808 802 0010
  • Prostate Cancer UK Telephone:  Helpline: 0800 0748383 

 Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Many quality, free resources can be ordered to support from Quick Guide for Community Pharmacies on where to access Patient Resources 
  • Be alert to red flag symptoms such as a persistent cough which might suggest a patient should be referred to their GP for investigation.
  • Encourage patient’s participation in national screening programmes e.g. cervical screening whenever possible.
  • Only sell a minimum of SPF 15 sun protection products. 
Healthy Lifestyle… at any age

Many factors go together to improve an individual’s health. Their health needs change through life as they get older and different issues might impact on men’s and women’s health. However, a healthy lifestyle is important at any stage of an individual’s life.

Diet and nutrition, exercise, smoking cessation and managing alcohol intake are modifiable lifestyle factors that can be addressed to improve health.

Other factors may not be readily addressed by individuals but rely upon society working together to promote healthy living and working environments.

Health inequalities arise when individuals or communities are not empowered to make healthy lifestyle choices.

For more information visit

 Child Health

 Health in older age

 Healthy Living 

Community Pharmacy – Signpost patients to appropriate support organisations.

Beware of your patients particular needs. Check out your locality’s health profile.

Long Term Health Conditions

The effective management of long term health conditions (LTHC) can greatly improve a patient’s health and wellbeing. Examples of these conditions include epilepsy, cardiovascular disease, diabetes asthma and chronic obstructive pulmonary disease (COPD).

In addition to taking appropriate medication LTHC patients are often asked to make lifestyle changes such as smoking cessation or alcohol reduction. But at the same time they may be struggling with psychological issues caused by the impact of their diagnosis.

So in addition to understanding the clinical management of patients and the guidelines that are in place for these it is important to consider the patient as a whole and understand their attitudes to their condition and its management.  

For more information visit

Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Know when to call for medical assistance in the event of a heart attack and how to deliver basic resuscitation (CPR) for patients who have collapsed. Details of suitable courses may be found at St Andrews Ambulance Brigade
  • Advise on use of inhaler devices for asthma and COPD patients

 Some pharmacies may

  • Offer health screening such as blood pressure or glucose monitoring
Mental Health

Mental health is a complex topic affecting a significant percentage of people in the UK at any one time. Issues might include depression (including postnatal depression) bipolar affective disorders, stress, anxiety disorders, phobias, eating disorders, schizophrenia and others. Some individuals may suffer from a combination of symptoms.

The management of patients suffering mental health problems may range from self help approaches to in patient care at a psychiatric specialist hospital or facility.

Regardless of how patients are managed, good mental health is underpinned by a healthy lifestyle. Good diet, smoking cessation, exercise, sleep hygeine and alcohol management will not necessarily cure a patient but they will significantly contribute to their recovery.

For more information visit

  • General Local  Mental Health Care For extensive information on mental health care available in Greater Glasgow and Clyde.   
  • NHS24 Tel 111. Can provide or source help for a patient in crisis when their GP is not available
  • Breathing Space Scotland Tel: 0800 83 85 87. Free, confidential phone and web based service for people in Scotland experiencing low mood, depression or anxiety.
  • Mind Tel 0300 123 3393. Mental Health Charity aimed to ensure anyone with a mental health problem has somewhere to turn to for advice and support, and offer useful leaflets and publications.
  • Samaritans Provide confidential emotional support 24/7 to those experiencing despair, distress or suicidal feelings.


Key points for community pharmacy

Palliative Care Services

This service is provided by a network of 70 pharmacies across the NHS Greater Glasgow & Clyde area. These pharmacies maintain

  • a stock of specific core medicines
  • provision of advice and useful contact numbers for specialist palliative care advice
  • a support network to other pharmacies within their localities. 

Some participating pharmacies are available to dispense out-of-hours urgent prescriptions. This can be arranged through NHS 24. A courier service protocol is available to ensure timely supplies of medicines to palliative care patients in emergencies. The aim is for the first pharmacy contacted (regardless of being a part of the Palliative Care network or not) to ascertain the urgency of the prescription and resolve any supply issues, in order to avoid patients, carers, or nurses needing to phone or visit multiple pharmacies. All community pharmacies are provided with a list of the network pharmacies for this purpose and the specific core medicines list. For more details on the Palliative Care Service, click here  or contact: Palliative Care Specialist Pharmacists on the below telephone numbers: 07876 478140 or 07880 786659 or 07775 012560

Quit Your Way

NHS GGC are responsible for a wide range of tobacco projects including the “Quit Your Way” Pharmacy Service.

Suitable pharmacotherapy (Nicotine Replacement Therapy [NRT] or varenicline) together with personalised advice and support is provided from the community pharmacy for usually up to 12 weeks.

For further details, please contact any participating pharmacy or the Quit Your Way Pharmacy Team (T:0141 201 4945 or e: pharmacyhit@ggc.scot.nhs.uk)

To access the list of Pharmacies involved in Quit Your Way please click here

Click here to access the Guidance Notes for Service Delivery.

Click here to access Quit Your Way Questions & Answers (for Community Pharmacy)

Resources

View and order resources

This aspect of Pharmacy Public Health deals with the planning for, and managed introduction of new medicines. The Scottish Medicines Consortium  is responsible for providing advice on the clinical and cost-effectiveness of all new medicines and important new indications for existing medicines.

The NHS GGC prescribing website provides useful links to the local Medicines Formulary, medicines policies and associated resources.  

Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients. This is particularly important for those issues which can have high media attention e.g. introduction of a new vaccine or an outbreak of an infectious disease.

Further information and advice can be found in the Health Protection Topics section of this website.  Examples of topics included are:-

Infection Control

Knowledge of infection control principles is important to protect yourself and your patients.

And

Immunisation and Storage of Vaccines

Advice on safe storage of vaccines which must be stored in the ‘cold chain’ between  2oC and 8oC at all times.

Communicable Disease, Outbreak Control and  Emergency Planning

Pharmacists can recognise symptoms of a notifiable disease in order to appropriately refer patients

Understand how an outbreak is being managed to be able to offer appropriate advice and reassurance to the public.

Maintain Business Continuity Plans to ensure minimal impact on the delivery of patient care in the event of an emergency situation.

Screening for Health Protection  

Pharmacists can encourage uptake of screening programmes against several cancers e.g. cervical, breast cancer and  bowel. More information may be found on the Health Screening website.   

For any enquiries regarding health protection please contact:

liz.mcgovern@ggc.scot.nhs.uk or val.reilly@ggc.scot.nhs.uk

Blood Borne Virus

Three blood borne viruses are the main cause for concern in Scotland, Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C.

There is an effective vaccine only for Hepatitis B.  However, there are few effective treatments for Hepatitis C and HIV.  

More information

Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Prevent accidental transmission of disease by following Infection Control Guidelines in practice.
  • Promote vaccination against Hepatitis B.

 Some pharmacies may

  • Offer support for dried blood spot testing for Hepatitis C and HIV.
  • Dispense antiviral medicines for Hepatitis C.
  • Provide ‘Injecting Equipment’ to prevent spread of disease.
Communicable Disease

The Public Health Protection Unit (PHPU) in NHSGGC has a key role in monitoring and responding to the incidence of notifiable diseases e.g. meningitis.

For more information visit

 Key points for community pharmacy

  • Recognise and refer patients with symptoms suggesting a serious or notifiable disease to the GP or acute services as necessary.
  • Compliance with prophylactic therapy e.g. tuberculosi
Community Pharmacy & Infection Control

The NHS GGC Community Pharmacy Infection Control Guidelines  provide basic advice.

To reduce the incidence of infection due to antimicrobial resistance in the population, NHSGGC has launched antimicrobial guidelines to be followed in primary care and the prescribing support team has developed a non-prescription pad to encourage patients to seek non antibiotic remedies for viral infections.

More Information

 Key points for community pharmacy

  • Provide antibiotic stewardship.
  • Offer advice to patients on appropriate infection control techniques to reduce spread of disease such as norovirus or influenza.
Health Screening

The NHS GGC Public Health Screening Unit is responsible for a range of health screening programmes.

  Key points for community pharmacy

  • Encourage patients to participate in screening programmes.
Immunisation Programmes

Immunisation is one of the most effective health interventions.

There are several formal immunisation progammes in the UK. They are Childhood, Adult and Seasonal Influenza.

More Information

 Key points for community pharmacy

  • Encourage patients to engage with national and childhood programmes.  

 Some pharmacies may

  • Offer travel and influenza vaccination clinics.
Outbreak Control

Public Health Specialists from NHS GGC Public Health Protection Unit are involved in identifying and managing outbreaks of disease. They will liaise with infection control teams for example in the case of a norovirus outbreak in an institution or with local authorities if an outbreak is linked to a food supplier in an E. coli outbreak. 

Chemical Biological Radiological and Nuclear (CBRN) outbreaks

Local authorities and health boards are required to have plans in place to manage accidental events such as major oil or chemical spills or deliberate terrorist acts. A specialist on line training module is available from TOXBASE

More Information

  Key points for community pharmacy

  • Provide reassurance to patients.
  • Keep Business Continuity Plans up to date.
Patient Group Directions (PGDs)

Patient Group Directions (PGDs) are legal documents that enable suitably qualified healthcare professionals to administer and supply medicines (P or POM) in a defined clinical situation where the patient may not be individually identified before presenting for treatment. The individual using the PGD must have signed and been authorised to use the PGD prior to administering or supplying any medicines named in the document.

NHS GGC uses PGDs to allow nursing staff and Health Visitors to administer vaccines for the routine child immunisation programme and travel in specialist clinics. 

More Information

  • Information about working under PGDs National health Education Scotland NES

 Key points for community pharmacy

  • Community pharmacy PGDs authorised for use in NHS GGC may be obtained from the Community Pharmacy Development team or GGC PGD administration at Clarkston Court, 56 Busby Road, Clarkston, Glasgow G76 7AT
    Telephone No. 0141 232 1728.
Seasonal Influenza

Individuals are most likely to catch influenza in the winter months. The season runs from October to the end of February occasionally into March, peaking in December/January.

Seasonal influenza can affect anyone. It is an acute viral infection of the respiratory tract. There are three types of influenza virus: A, B and C. Influenza A and influenza B are responsible for most clinical illness.

It is difficult for an individual to develop long term immunity to influenza as the make up of the viral strains change slightly on a regular basis. So vaccination against seasonal influenza has to be undertaken annually.

More Information

The government resource Immunisation against infectious disease – ‘The Green Book’

In the United Kingdom immunisation for influenza for certain groups including ‘at risk’ patients is provided on the NHS and in Scotland the Chief Medical Officer (CMO) will send a letter detailing which groups are eligible for vaccination. Letters from the CMO are available here

Egg allergy isn’t always an absolute contraindication for receiving flu vaccine. The British Society for Allergy and Clinical Immunology website advises on managing individuals with egg allergy

An e learning course for healthcare professionals undertaking immunisation is available. Registration is required to undertake this course.

NHS Inform has key patient information on all types of immunisation

NHS GGC: Immunisation

 Key points for community pharmacy

  • Encourage at risk patients to attend for vaccination
  • Advise on management of symptoms
  • Some pharmacies offer private flu vaccination clinics
Sexual Health

Sandyford co-ordinates a wide range of sexual health services in NHS GGC.

The Free Condoms web-site provides, support for practitioners involved in condom distribution, information on how to sign up as a distribution point, where to find condom distribution points and general advice on condom use and products offered

It is important that pharmacists and their staff understand what they should do if they have any concerns about a child and sexual health issues. Access information at NHS GGC Child Protection Unit’s website 

More Information

  Key points for community pharmacy

  • Be able to recognise and differentiate between symptoms of sexually transmitted diseases.
  • Refer all men consulting with symptoms of discharge or thrush infections to Sandyford or their GP.
  • Be aware that there is no charge for vaccine supplied by a Sandyford Clinic.
  • Supply of emergency hormonal contraception or bridging contraception under PGD.
Substance Misuse

Pharmacists play an important part in providing information and advice about substances liable to misuse controlling the availability of medicines, and the associated risks and in providing harm reduction programmes e.g. methadone and the supply of injection equipment.  

More Information

 Key points for community pharmacy

  • Give advice on wound care and management, safer injecting practices and remind clients of the importance of safe disposal of syringes.
  • Know which pharmacies are ‘Injecting Equipment Providers’
  • Be able to sign post clients to other services as necessary.
  • Know how to deal with needle stick injuries
Travel

Two websites are highly recommended for those living in Scotland seeking travel health guidance. Fit for Travel which gives the most up to date information for the public and the professional site TRAVAX.

Access to TRAVAX requires registration but it is free for Community Pharmacists in Scotland to register.

More Information

Key points for community pharmacy

  • Provide patients with pre-travel advice.
  • Encourage the use of sunscreen with a minimum SPF15. 
  • Advise on the carriage and storage of medicines abroad e.g. insulin. 
Vaccine Storage

NHS GGC Guidelines on Vaccine Storage and Handling are available in the NHSGGC Guidelines Repository

More Information

 Key points for community pharmacy

  • Remind patients collecting travel vaccine of the storage requirements. It is preferable that they collect vaccine immediately before their appointment for administration.

Welcome to the Pharmacy Public Health website.  This website is specifically aimed at pharmacists and their staff who work in the NHS Greater Glasgow and Clyde area but will be helpful to all who are active in public health improvement and health protection.   It provides information on health improvement and health protection topics which relate to community pharmacy practice and today’s public health agendas, giving detailed advice and contacts useful in delivering these agendas.

Please click on any menu item for more information.

We are very keen to keep improving and expanding the website. Please direct all helpful suggestions or comments to the website editor by emailing the Public Health Pharmacy mailbox PharmacyPublicHealth@ggc.scot.nhs.uk