By Prof Mahendra Patel
Recent figures from Diabetes UK show that diabetes (type 1 and type 2) in the UK has increased from 1.9 million to almost 3.7 million in the last two decades.
Furthermore, taking into account those additional people living with type 2 diabetes who are undiagnosed, then as many as 4.6 million people, in reality, are believed to be living with diabetes in the UK. If no further action is taken, this is expected to reach five million by 2025.
Pharmacy has a pivotal role to play in the care of this vulnerable group.
With more than 12 million people across the UK at risk of developing type 2 diabetes, and notably in areas of high deprivation and among those of South Asian origin, community pharmacy is ideally placed in supporting its prevention, early identification, and long-term management.
Moreover, by offering greater detection services, promoting the wider use of Healthy Living Pharmacies to support health and well-being, and encouraging increasing use of technology, will all help to reach out to more patients more effectively.
Not surprisingly, the Royal Pharmaceutical Society in conjunction with Diabetes UK earlier this year introduced its national policy, ‘Using pharmacists to help improve care for people with type 2 diabetes.’
It emphasised the need for greater pharmacy input and for pharmacists to play an active role in optimising medicines, improving the health, wellbeing and safety of people with type 2 diabetes across the NHS.
This comes at a time when technology is set to feature prominently in supporting wider healthcare provision and greater improvement in access to services. Equally timely in coinciding with the community pharmacy contract now in place, will be recognising the value pharmacy can add in the prevention, early detection and better management of long-term conditions in helping improve health outcomes.
Additionally, the NHS Long Term Plan also highlights the vital role of pharmacists especially through their clinical skills in supporting patients to achieve better health outcomes, improve patient safety and in reducing medication errors.
It translates the latest evidence into practice focusing on helping people to live longer and lead healthier lives, whilst ensuring safe and effective use of medicines through improved adherence and medicines optimisation.
It also highlights the need to support services within and across different care settings, typically where pharmacists can make significant and meaningful contributions in improving health outcomes.
The Primary Care Networks and the growing maturity of local Integrated Care Systems is highly encouraging, providing unparalleled opportunities for people to receive better access to their pharmacists, more personalised support, and joined-up care at the right time in the optimal care setting.
The RPS policy showcases examples of collaborative working and improved health outcomes, and the importance of pharmacists being integrated within a specialist diabetes multidisciplinary team to provide added value and synergy across care pathways as part of routine daily practice.
Significant numbers of people fail to meet the nationally recommended treatment targets in reducing risk of complications associated with type 2 diabetes. Many are not understanding their condition nor adhering to their prescribed treatment.
It is often seen that language, culture, religion, beliefs and attitudes are barriers to accessing wider healthcare services in some communities. Engaging with local communities, schools, places of worship, and the likes of supermarkets, and providing education and point-of-contact testing is crucial in these instances.
There is clearly a lot of scope to make more effective use of the extensive clinical skills of the pharmacist and the added diversity of pharmacy workforce across primary care and beyond.
The Community Pharmacy Contractual Framework with a commitment to spending £2.592 billion over the next five financial years urges pharmacy to target all patients presenting with diabetes to have annual foot and eye checks, with subsequent referrals as appropriate.
Pharmacists will now be able to help reduce the frequent, and often avoidable, foot and toe problems leading to amputations caused through diabetes. Similarly, allowing pharmacist referrals for regular eye checks that help to prevent blindness associated with diabetic retinopathy.
The health and well-being of the community is an important feature of community pharmacy services today, and the new contract is hugely in favour of these services. By pledging to make every community pharmacy a Level 1 Healthy Living Pharmacy (HLP) and having greater up-skilling of staff through trained health champions, better utilisation of the wider pharmacy workforce and greater access to services offered will be more achievable.
This will additionally allow increased interventions to be made for the prevention of type 2 diabetes and associated risk factors including heart and circulatory disease as well as mental health problems. Furthermore, maintaining healthy lifestyle through offering smoking cessation, weight management, wellbeing and self-care advice, and signposting people to other relevant services would be a feature of every community pharmacy.
The way forward is certainly one that will ensure a truly integrated and joined up service, with pharmacists working alongside other healthcare professionals and being an integral member of the wider multidisciplinary team in helping to improve the care of diabetes and other long-term conditions.
Professor Mahendra Patel is RPS national board member and treasurer
This article also appears in the December/January issue of Pharmacy Business.