Community pharmacies are often seen as the front desk of the NHS. We can have a significant impact on the health and wellbeing of the communities we serve, but not all people see that, both within and outside of pharmacy.

Understanding how we can use the whole pharmacy team to optimise the opportunities and outcomes for the population, the health and care systems and for community pharmacy itself is critical if we are to take our rightful place in the future of a struggling NHS, public health and social care systems.

The challenge

Let’s start by understanding what this challenge looks like from a number of perspectives.

1. Health

The World Health Organization defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. As you can see, this goes far beyond the absence of physical illness and so our interventions, whether advice, support and/ or treatment, must reflect this. The best outcomes will be achieved by considering the holistic needs of the person, going beyond the medicine they take or the symptoms they may portray.

There are several dimensions of health that act and interact in a way that contributes to quality of life, both internal and external.

The impact and priorities of the internal dimensions will vary from person to person. Individuals have some degree of, control and choice over them, but they are also influenced by the external dimensions, with upbringing, education, financial deprivation and the environments in which they live and work all having a potentially significant impact on their health.

Sir Michael Marmot’s report Fair Society, Healthy Lives from 2010 talks about the social determinants of health (social class or socioeconomic status, gender, ethnicity, income, environment and lifestyle factors), and it is as relevant today as it was then, possibly more so. The report made the following recommendations.

• Give every child the best start in life
• Enable all children, young people and adults to maximise their capabilities and have control over their lives
• Create fair employment and good work for all
• Ensure a healthy standard of living for all
• Create and develop healthy and sustainable places and communities l Strengthen the role and impact of ill-health prevention.

While pharmacy cannot solve all of these societal issues, the last two are certainly within our scope.

2. Public health

Former chief medical officer Sir Donald Acheson defined public health as “the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society”.

It includes:

• Health improvement – improving people’s lifestyles and reducing health inequalities
• Health protection – immunisation and reducing the risk of spreading infectious diseases
• Improving services – improved planning and efficient service delivery with measured outcomes.

In 2014, the King’s Fund highlighted that the four most significant unhealthy lifestyles (smoking, alcohol consumption, obesity and physical inactivity) cost the NHS at least £14 billion a year; the overall cost to society is much more. This is the scale of the challenge we face in health improvement.

3. Making every contact count

Making every contact count (MECC) is an approach to behaviour change that utilises the millions of interactions that occur every day between people to support them making positive changes to their physical and mental wellbeing. MECC enables the opportunistic delivery of consistent and brief lifestyle information and allows individuals to engage in conversations about their health.

MECC focuses on the lifestyle issues that, if addressed, will make the greatest improvement on an individual’s health:

• Stopping smoking
• Drinking alcohol within recommended limits
• Healthy eating l Being physically active
• Maintaining a healthy weight
• Improving mental health and wellbeing.

The NHS Five Year Forward View calls for a radical upgrade in prevention and public health. Community pharmacies, particularly those that have fully embraced the Healthy Living Pharmacy ethos, are well placed to play a major role in this. An estimated 1.6 million people walk into community pharmacies in the UK every day seeking health advice, but do we make every contact count by converting our interactions into intervention opportunities or are they merely transactions? Whether it is opportunistic brief advice on the back of a prescription supply or the sale of a medicine, or whether it is a more structured intervention, such as a medicines use review or another service, the potential positive impact of making every contact count in a pharmacy is considerable.

4. Customer experience

Consumer expectations are constantly increasing and £1 in every £5 is now spent online. This is likely to double in the next five years. Yet pharmacy has barely changed, other than being busier, with an increase in prescription numbers of 48 per cent over the past 10 years and funding and technology that have not kept pace with this change. To be relevant in the future, we must embrace change to reflect the demands of both customers and commissioners and differentiate ourselves from Amazon and other online providers by creating an enhanced experience for the people who use our services.

Think about what takes you back to your favourite restaurant. The food, yes, but it’s also the quality of the service, how engaging and welcoming the staff are and the atmosphere and appearance of the restaurant itself.