Pharmacy teams in all settings are ‘crucial’ to providing accessible health care, the Royal Pharmaceutical Society (RPS) has said in a new guide to tackling health inequalities.
The advice outlines ways in which pharmacy teams can improve access and outcomes for people suffering from healthcare inequality.
Claire Anderson, president of Royal Pharmaceutical Society said that ‘brilliant examples’ of pharmacy teams providing care to improve health inequalities ‘shine through’ in the paper.
She added that pharmacy could ‘now build on these examples of best practice, using this paper as a resource to support their development, to ensure no-one feels excluded or unable to access care.
‘As pharmacists, we need to think differently, proactively seek out people who may not be accessing our services, ensure we are welcoming and ultimately ensure that everyone can benefit from our support and care.’
The position paper, published today, shared the ‘stark reality’ of the ‘worsening picture’ of health inequalities since 2010, and follows a keynote speech from Sir Michael Marmot, Director of the Institute for Health Equity, at the RPS annual conference in November 2022.
It highlighted that life expectancy has stalled since 2010, which Sir Michael said was linked to social determinants of health.
For instance, in England, male mortality rates were nearly twice as high in the most deprived areas compared to the least, and there was a difference in life expectancy of around 10 years for women in the most deprived areas compared to the least.
Andrew Carruthers, chair of the RPS Scottish Pharmacy Board, said that tackling health inequalities was particularly important right now because of the increasing cost of living.
‘This paper aims to stimulate pharmacists’ thinking about how they provide care. It brings together resources that they can then dip into over time to make improvements with the ultimate aim of delivering accessible pharmaceutical care to everyone’, he said.
The RPS paper suggested that health inequalities could be influenced by factors such as:
- socio-economic factors like deprivation, power, education, language and employment
- geography (region, urban/rural, neighbourhood)
- protected characteristics (ethnicity, sex, age, disability, sexual orientation, gender reassignment, religion, pregnancy, being married or in a civil partnership)
- determinants of health (poverty, housing, education, community)
- groups vulnerable to being excluded (homeless, traveller communities, sex workers, drug dependence, modern slavery)
- a lack of diverse representation and cultural awareness in decision making and policy setting
- an active avoidance of engaging with health services (low self-worth, tolerating health conditions).
The RPS said that pharmacy teams should seek to understand their population served by their service in order to tackle health inequalities.
In addition to accessing demographic data, which may be available via NHS public health teams, pharmacy teams should also engage with people directly, the RPS recommended.
This could include approaching local community or faith groups, seeking views from patients or gaining insight from pharmacy staff members.
Pharmacy teams should then explore whether the patients accessing their service were representative of the population locally, or whether there were gaps in users or service provision, and seek to reach people not currently accessing health services.
The RPS added that this review may need to be conducted across settings including community, hospital, primary care and specialist services, and that a cross-setting approach would only work ‘if there are effective referral mechanisms in place and services are still accessible for patients’.
The paper also recommended that pharmacy teams seek to overcome their own unconscious bias, which may make patients hesitant to use services or drive them away, and ensure that patients from all backgrounds were informed about, and offered choice in how they access services.
And recent figures from NHS Digital found that the number of cancers diagnosed at stages 1 and 2 in the most deprived areas of England was significantly lower than those caught early in the least deprived areas, at 47% in the most deprived areas compared to 55% in the least.
How can pharmacy teams improve access to services?
The RPS said that some of vulnerable individuals might experience stigma when using pharmacy services, for example, people who use drugs or who are homeless, the RPS said.
It also said that pharmacy teams should be aware of certain barriers that might affect different groups. For instance, some patients would consider the privacy of a consultation room essential, while for others, entering a private consultation room with a pharmacist of the opposite sex would not be considered appropriate or in line with some individuals’ beliefs.
The RPS recommended a series of questions to ask of a pharmacy service to determine whether it was accessible to people from different backgrounds with different needs.
The paper also said that pharmacy teams should consider whether the culture of their service was welcoming and accessible to patients, suggesting that improving communication skills would help patients feel listened to and improve engagement.
Pharmacy teams could consider additional training, such as in trauma-informed care, to reduce barriers to access and improve outcomes for patients, the paper suggested.
It also said that patients could be empowered to take an active role in their own care by ensuring that services and were well advertised and patients knew about them and how to use them.
For instance, the RPS suggested that a pharmacy team member could undertake outreach visits, such as to local community centres, and build relationships with the local community. It said that this could be particularly effective if people were able to engage with a pharmacy staff member who lives in or comes from their community.
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