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Sexual health when travelling aborad
This article on XPOSE includes a contribution from Pharmacy Complete’s Deborah Evans and explores how to take charge of your sexual health in a foreign country.
“Packing for travel health is an important part of planning for your holiday and, just as we think about taking painkillers, antiseptics, plasters, mosquito repellent and antihistamines with us, it’s also important to think about your sexual health.”
Whether you’ve missed your pill or had unprotected sex, remember that each country has its own rules on morning after pill accessibility; in some places you can simply buy it from a pharmacy, and in others you’ll need to speak to a doctor first.
“Ahead of travel, it might be a good time to think about other, more regular forms of contraception, such as taking the pill, having an implant, using the patch or having a coil fitted. If you already have a preferred method of contraception, then make sure you’re up-to-date with supplies before you go away.”
Remember that if you do have unprotected sex, you won’t be protected against getting a sexually transmitted infection, so always pack condoms.
“A pharmacist or other healthcare professional will advise on the best options, and you can always chat to someone before you go away about your concerns.”
Planning for a successful Pharmacy Flu Vaccination service
In the 2017/18 season 77% (8981) of pharmacy contractors in England signed up for the NHS service last year and delivered 1,344,462 flu vaccinations to eligible groups and was worth over £12million in fees to the sector. There was an average of 150 vaccinations per pharmacy, 33% up on 2016/17, with six pharmacies doing more than 1000 and many also providing private flu vaccinations under a separate PGD to non-eligible groups and local employers.
This increased the reach of the whole NHS flu vaccination programme, however overall performance still falls below government targets for at risk groups and over 65s. Community pharmacies are well placed to have a significant impact on the health and wellbeing of the communities they serve through the delivery of an accessible, high quality flu vaccination service.
Start planning now
Start planning now to ensure that implementation and delivery is optimised for the benefit of your community and your future professional business. This is what mainly differentiates those pharmacies which deliver more that the average number of vaccinations from those who deliver less. You can find your performance data and that of the pharmacies and providers in your area on PharmData.
The key steps to a successful service are:
1. Engage your team
Delivering an effective service is a team effort so it is important that everyone understands why it is important to you, your pharmacy, your community and them. Involve the team early in the planning process so that they can help to shape the plan, take on responsibilities and feel ownership. This requires putting aside time together, asking questions and actively listening. Once everyone in the team is on-board, build the plan together and agree who does what and by when, being clear about expectations.
It is also important at this stage to engage the wider healthcare team, e.g. local GP practices. The sooner you have that conversation the less likely there is to be conflict. You have the opportunity to work together to target eligible groups that they struggle to reach – complete, not compete.
2. Understand the service requirements
The service specification and directions for the 2018/19 service have been released with some additions to eligible groups and the opportunity to vaccinate patients in their own homes. There are also some changes to the paperwork and an improved service fee. You should ensure that you and your team understand what is involved and we recommend that you read the PSNC Flu Briefing for the latest information. In some areas your Local Pharmaceutical Committee (LPC) may have negotiated some additional elements for the service such as other eligible groups or additional vaccines, e.g. pneumococcus, so check with your LPC now.
NHS England has issued guidance on the 2018/19 service with pharmacies advised that due to rationed deliveries, they should take a “three-phased prioritisation approach” to vaccinating patients aged over 65. This will require careful planning for recruitment and delivery. The guidance states that the adjuvanted trivalent vaccine (aTIV) should be offered to all patients aged 65 and over. Priority should be given to patients aged over 75 years or those in a care home, followed by those aged 65-74 years in a clinical risk group, then other patients aged between 65 and 74.
Patients in the eligible at risk groups between 18-65 years should receive the quadrivalent vaccine (QIV).
Pharmacies are advised that where the appropriate vaccine is available, and an eligible patient presents at the pharmacy seeking vaccination, they should be vaccinated at that point. The new service specification also allows for vaccination in a patient’s own home.
Public Health England has also issued guidance on vaccine administration and released their latest Vaccine Update newsletter.
3. Develop your team
All pharmacy staff involved in the provision of the Flu Vaccination Service should receive appropriate training relevant to the role they will undertake.
The National Minimum Standards for Immunisation Training and the associated Core Curriculum for Immunisation Training set out the knowledge and skills that healthcare professionals undertaking vaccination services need to have and pharmacists must have completed practical training in vaccination that meets these requirements. The requirement for face-to-face training has been extended to every three years and a Declaration of Competence (DoC) for vaccination which should be reviewed every two years is available on the CPPE website.
The whole team needs to know the basics of the flu service – who is eligible for the NHS service and who you might consider for a private service outside of this, what the important steps in the protocol are and who can and should do what. Many pharmacies have further developed their team members using our Flu Champion course and our Championing Health cards to support the implementation, promotion and recruitment into the service leaving the pharmacist free to complete the clinical elements, this has resulted in increased uptake.
4. Review your premises
The GPhC standards and the NHS flu service specification are clear about requirements for provision of this clinical service. However, it is important that the whole pharmacy reflects a professional environment, including the consultation room, and meets all clinical and information governance requirements.
5. Promote the service
- We mentioned earlier the importance of building collaborative working relationships with local GP practices so that you can work together towards a common goal. Explore how you can give patients flexibility, choice and a better experience to achieve a higher uptake during this flu season.
- Ask your team to start promoting the flu service during the late summer in every contact they have with a customer – simply mentioning the service and asking ‘Have you had or booked your flu jab yet?’ will raise awareness and promote what you do.
- Set up a flu campaign in your pharmacy using materials provided by NHS England and Public Health England, the 2018/19 leaflet is available here. There may also be materials available from your vaccine manufacturer. Make sure that you also run the campaign out in your community to reach people you would not otherwise see.
- Make contact with local groups such as carers and self-help groups for people with conditions which are eligible for the NHS service.
- Promote through your website and social media to make your patients and customers aware of what you have to offer.
- Analyse your PMR database for those you vaccinated last year and those in eligible groups then use bag stuffers, stickers and direct invitations (assuming you have their consent).
- Use other services such as MURs and NMS as an opportunity to check whether a patient has had their flu jab this year.
Summary
It is clear that there is much to be done to implement and deliver an effective flu vaccination service, but many pharmacies have seen both direct and indirect benefits from engaging the team, putting a clear plan in place, with assigned actions and timelines. Do remember to review progress regularly and celebrate success.
Some pharmacies have built on their successful flu vaccination service and leveraged the acquired skills to develop a profitable private vaccination business including occupational health services to local businesses, other condition protection vaccines and a travel health clinic. Look carefully at your local market opportunity and explore the private PGD and training options available to you.
One thing is certain, it won’t happen by itself so start planning now.
Good luck!
Back to the Future
What next for community pharmacy?
This article I wrote for Pharmacy Magazine a couple of years ago explored what pharmacy might look like in the future. I speculated on two potential models which I called Nirvana and Amazonia. At the time I challenged the profession to create its own future and not be led by government and others to a place where we, and most patients, don’t want to go whilst being realistic when we operate in a healthcare ecosystem is changing at an increasingly rapid rate.
More recently, I played this back in one of our Viewpoint articles, Here and Now. With Amazon entering the pharmacy space in the United States with its recent acquisition of PillPack and some wholesalers, and rumours that it is in conversations with Pharmacy2U in the UK, it is very much here and now!
Doing the same thing and expecting a different outcome is not going to happen…
NICE Guidance on promoting health and wellbeing in Community Pharmacies
NICE have launched this guidance – Community Pharmacies: promoting health and wellbeing.
It is important that pharmacy owners, pharmacists and pharmacy teams, particularly Health Champions, and local commissioners of both health and wellbeing services understand what the recommendations are and what this means for them.
Overview
This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners.
Summary of key recommendations
- Local commissioners, Health & Wellbeing Boards, community pharmacies and their representatives (e.g. LPCs) should work to integrate community pharmacy into existing care and referral pathways as health and wellbeing hubs.
- Interventions should be focused on local needs, be consistently of high quality, tailored to the individual, use professionally produced support materials and pharmacy team members delivering them should have the right skills and knowledge, e.g. in line with NICE guidance on behaviour change.
- Local commissioners should promote community pharmacy as an integral part of NHS primary care services.
- Community pharmacies should publicise their skills and services to increase the public’s knowledge and confidence in those services.
- Community pharmacies should proactively seek opportunities to promote people’s physical and mental health and wellbeing. This includes raising awareness, providing information, advice and support, and signposting or referral to and from other services. This could happen when responding to requests for advice, selling OTC medicines or supplying prescription medicines and supporting a patient with a long-term condition such as diabetes or hypertension. The brief interventions could include the self-management of mild to moderate back pain, physical activity, smoking, healthy weight and diet, and alcohol consumption. A minimum dataset should be used to capture these interventions and referrals.
What does this mean for community pharmacies?
We believe that the guidance is a very good fit with the objectives and ethos of the Healthy Living Pharmacy (HLP) model which we have supported since its conception. So those pharmacies that are already accredited HLPs and maintained their capability and activity in line with the HLP Criteria will be well placed to meet most or all of these recommendations.
At Pharmacy Complete we have gone beyond the core HLP criteria with our award-winning Health Champion development programme that we have created for pharmacy teams which includes our Knowledge into Action workshop, the RSPH Applied award in Health Improvement and the Supporting Behaviour Change Level 2 award plus Making Every Contact Count (MECC). We have also developed our Health Campaign service which uses only evidence-based, professional materials plus a topic knowledge piece and hints and tips to support the provision of the required minimum of six campaigns a year.
There will undoubtedly be some work for local public health, NHS and CCG commissioners to do on the integration and publicity recommendations; LPCs and Local Healthwatch should be holding them to account on this.