With the obesity crisis putting pressure on the NHS, community pharmacists can provide a solution, says Vincent Forrester
The word ‘crisis’ is bandied about to refer to everything from halloumi shortages to Arsenal’s lack of depth at centre back. However, when it comes to the impact of obesity on healthcare in Britain, it is used without exaggeration.
The statistics that illustrate the obesity crisis make for troubling reading – and get worse every year. The UK is now the most obese country in western Europe, according to a 2017 report by the Organisation for Economic Co-operation and Development.
Almost 30% of people in Britain have a BMI of 30 or above, a figure that is expected to rise to 50% by 2050. Obesity-related hospital admissions doubled between 2013 and 2017, from 292,000 to 617,000. Alongside smoking, obesity is one of the two main drivers of the biggest causes of death: cancer, heart attack, stroke and diabetes.
Public Health England says it costs the NHS £6.1bn a year. The World Obesity Forum predicts that associated healthcare costs in the UK will rise from £14bn a year to £23bn a year in 2025 if the problem is not addressed more aggressively.
How can pharmacy help?
The tremendous pressure this places on the NHS and overstretched GPs means community pharmacy is ideally placed to take some of the strain by offering targeted weight-management services.
Gavin Birchall, a pharmacist and marketing expert who was formerly the operations director of the pharmacy chain MedicX, believes the scale of the problem means such a service would almost certainly be relevant to most pharmacies. ‘There’s probably not many communities around the country where there isn’t a need for this service,’ he says.
For Graham Phillips, the managing director and superintendent pharmacy at Manor Pharmacy Group in Hertfordshire, it is crucial to communicate the message that community pharmacy is willing and able to fulfil this role. ‘
Despite the extensive Health Living Pharmacy (HLP) network, the perception in the mind of the public still tends towards a pharmacy as a place where some nice, friendly people will help you get your medicines,’ he says.
‘Yes, that’s true, but the way to defend the community pharmacy network itself is for the public, the NHS and politicians to see it as an invaluable, easily accessible public-health network. If you see it in that light, it radically changes the value of it.’
What should a community pharmacy weight-management service look like?
The guidelines outlined by Nice are broad, stating among other things that a service for overweight or obese adults should be part of an integrated approach that involves pharmacy; should be respectful, non-judgmental and aware of the potential stigma around weight; should prevent weight regain; and should raise awareness of associated lifestyle services for weight management.
According to the PSNC, commissioned or otherwise supported weight-management services are available (or have recently been available) in 12 local pharmaceutical committees (LPCs).
These range from a year-long programme that includes a patient group directive (PGD) for orlistat alongside face-to-face consultations for 24 weeks and follow-up appointments (Kent LPC/NHS England) to a simple GP referral for patients with a BMI above 50 (Avon LPC/Bristol council). Evidently, commissioners agree that there is more than one way to approach weight management.
As far as Mr Phillips is concerned, though, the central tenet of such a service should be the promotion of a healthy lifestyle, as opposed to a strict diet. He recently soft-launched PRO_Longevity, a weight-management service aimed at patients with diabetes and pre-diabetes.
Throughout the eight-week programme, patients’ blood glucose levels are monitored. Based on these readings, Mr Phillips implements changes to patients’ diets, substituting foods for alternatives based on their glycaemic index, sugar content and other factors. He says the results have been ‘stunning’: some of his patients have reversed type 2 diabetes between two and four weeks, he says.
‘Health professionals are overwhelmingly ignorant about nutrition or they get their information from the pharma industry or the food industry,’ he says. ‘You’ve got to go beyond a few words about calories and commit yourself to it, which a number of pharmacies have done very successfully.’
Focus on health, not weight
Lucy Morris, the services facilitator at the community pharmacy network Numark, agrees that an obsession with weight loss is not helpful. ‘Where an individual has recognised that they want to achieve a healthy BMI, that is not necessarily just about losing weight – that’s about supporting lifestyle changes so that it’s sustainable,’ she says.
‘It’s seeing a service where an individual will come in and have the opportunity to have a face-to-face conversation with a healthcare professional to identify what their needs are. That may be a medicine under a PGD or it may be dietary advice. But it’s about having that support on an ongoing basis.’
This is what sets pharmacy apart from big-budget weight-loss schemes, Mr Birchall says. ‘What is special about a pharmacy-based service as opposed to Weight Watchers [now known as WW] or all the other options people have to lose weight?
We have one strong positioning tool in our box in that we are healthcare professionals: our aim should be to deliver weight-management services that help you lose weight healthily and sustainably and in a way that’s integrated with your lifestyle.’
Integration should apply to the service itself, too, from ensuring the whole pharmacy teams is clued up on weight management to communicating with local GPs and healthcare groups to encourage referrals and raise awareness.
‘It’s quite a sensitive area, so it’s really important that the broader teams understands the soft skills around those conversations,’ says Ms Morris. ‘If you’re offering [a service] under a PGD, you need to have the appropriate training and clinical knowledge and be really confident of the eligibility criteria.’
Mr Phillips says this ties in to the idea of pharmacy being part of a public-health network. ‘We’ve always had very strong links with local GPs. They get everyone’s problems dumped on their plate. No wonder they’re demoralised. Pharmacy needs to be – and be seen as – a solution.
‘We’ve got the whole team involved: across my branches, all the pharmacists and all the staff have been personally trained by me. It’s about communicating in the right way and then offering a service.’
When it comes to communicating and marketing, weight management is no different from any other service, according to Birchall. It is important to understand your area, identify the patients you would like to reach and craft an effective message to do so.
‘What are the competition doing? What services already exist for that kind of patient in the area?’ he says. ‘Lots of different providers are competing for the attention of a patient who needs that kind of care, so think about what you can do that’s different from what’s available.’
How much should I charge for the service?
When it comes to setting a price for your service, the advice is similar: consider your market, your competition and your bottom line. Take Mr Phillips’ service, for example. When it is rolled out fully, it will be priced at £995, but this factors in the location of his pharmacies – Hertfordshire is one of the wealthiest counties in England – and the cost of the equipment and his time.
‘Eight weeks of sensors is about £250 and the patients get really intense one-on-one support. I look after all the patients on the PRO_Longevity service personally, I give them a lot of time. It’s not just “do this, do that”; it’s very education and I share lots of videos and tricks and tips.’
While this price point will not be viable everywhere, Mr Birchall says you may be able to charge more than you think. ‘You can look at a cost-base analysis – how much does it cost to deliver the service? – and add a percentage on top, which is an approach most people take. But you might be leaving some money on the table.
‘If you can genuinely deliver a service that will really help people, and you can prove that through evidence, then patients may perceive a higher value in that.’
Vincent Forrester is a freelance journalist