Annex 3: Overview of Pharmacy with Reference to Public Health
Pharmacists work in a wide range of sectors. The total pharmacist registered workforce in England is just under 24,000, of whom 79% (i.e. just under 19,000) are actively employed (Hassell 2004). The distribution of the workforce across sectors is:
- 73% in community pharmacy
- 22% in hospital pharmacy
- 8% in primary care
- 4% in industry
- 10% in other sectors (including prisons, universities, veterinary pharmacy)
Technicians, dispensing assistants, medicinescounter assistants and other support staff are an important part of the pharmacy workforce, but no data are collected centrally on their numbers or distribution.
Community pharmacy
There are about 9,800 community pharmacies in England - the average PCT thus has around 40 pharmacies. Most community pharmacies operate, at any one time, with a single pharmacist and support staff. Larger multiples and supermarkets tend to employ a number of part-time pharmacists and locums on a shift basis to cover the longer opening hours.
The provision of public health services in community pharmacy has expanded greatly in recent years. A survey by Keele University and Webstar Health found that in 2004, the figures for PCTs commissioning public health services from community pharmacy were:
- Services for supervised consumption of methadone and other substitute medicines - 83%
- Needle and syringe exchange schemes - 79%
- Stop-smoking advice and support services - 56%
- Opportunistic diabetes screening, e.g. HbA1C, blood glucose - 4%
- Diabetes monitoring and support, e.g. regular tests and reviews - 4%
- Weight management, e.g. Body Mass Index (BMI) assessment and advice on weight control - 3%
- CHD risk assessment, blood pressure & lipid measurement - 3%
- Advice and support on medicines in schools - 3%
- Other services (sexual health, men's health, influenza campaigns, EHC) - 8%
There were wide variations in the level of pharmacy public health activity between Strategic Health Authority areas, suggesting considerable scope for further development of services.
Hospital pharmacy
The roles of hospital pharmacists and their staff are described in section 2.4.
Pharmacy in primary care
Primary care pharmacists are typically based in GP surgeries, health centres and PCTs, but can also provide outreach services from a hospital base. Although they may not currently recognise public health as part of their role, they will almost certainly be providing health advice and services to improve health outcomes.
Pharmacy in prisons
Many prisoners have complex physical and mental health problems. The Department of Health published A Pharmacy Service for Prisoners in 2003b (www.dh.gov.uk/socialcare). Many of the public health services proposed in this strategy, e.g. stop-smoking services, substance misuse services, etc., are particularly relevant to the needs of prisoners.
Veterinary pharmacy
Some pharmacists are involved in the care and treatment of animals and those who care for or house them. They advise on public health issues such as zoonoses (diseases that are passed from animals to people), and the safe storage, use and disposal of animal medicines. They are a source of information on important national issues such as salmonella and foot and mouth disease.
Pharmacy leadership and strategic roles
The roles of pharmacists in Primary Care Trusts and Strategic Health Authorities are discussed in section 6.2.
