The Healthy Living Pharmacy (HLP) concept was first developed in Portsmouth in 2009 with Department of Health support; the first HLPs being accredited in June 2010. Early indications from Portsmouth showed that HLPs delivered more and better quality health and wellbeing interventions and services than pharmacies that were not HLPs.
These promising local results led to a national pathfinder work programme (implemented in 30 areas across England), funded by the national pharmacy bodies and demonstrating that the results seen in Portsmouth could be replicated in other areas of different demography and geography. HLP has now been adopted in over 50% of LPC areas in England and there are now over 3000 either accredited or on their way. HLP has also been used as an exemplar case study in many government, health and public health policy documents. The leadership responsibility for HLP now resides with Public Health England (PHE) who are supporting national implementation and acceleration of the concept.
Underpinning the HLP concept are the Quality Criteria which define the requirements for a pharmacy to demonstrate they have the ethos and capability required to be awarded the HLP quality mark. After an extensive review, PHE has now launched a revised set of Quality Criteria which are underpinned by the RPS Professional Standards for Public Health Practice in Pharmacy. PHE has also announced that these Quality Criteria and compliance with them, now forms part of a profession-led self assessment process to become an HLP (level 1).
This is an important landmark for the programme as now any community pharmacy in England has the opportunity to become an HLP provided they follow and meet the requirements set out in the Quality Criteria and comply with the self-assessment declaration process. It also means that there will be a nationally consistent entry into the HLP quality mark which, in due course, means that members of the public and others will know what to expect from their pharmacy showing the HLP logo. The logo itself is due for a rebrand as part of the programme update.
In October 2016, as part of a range of proposed reforms, the Government announced that HLP Level 1 would form a significant part of a new Quality Payment Scheme worth an estimated £1280 per contractor per year as part of their overall remuneration.
The Quality Criteria mentioned previously are the enablers of change with a focus on developing and motivating the pharmacy team, the pharmacy environment and how the team engage with and become an integral part of the community they serve and other providers of health and care services.
Fundamental to the success of HLP has been the change management that takes a pharmacy from a predominantly reactive supply model to one where pro-active health promotion and delivery of services is an integral part of day-to-day activity within the pharmacy. When the concept was initially developed in Portsmouth, change management principles and strong leadership were established as critical to implementation, recognising that cultural and behavioural change were required within the team if service performance (numbers and quality) were to increase and changes in behaviours demonstrated. As a result of the awareness created by the HLP programme, leadership development is now recognised as an important core skill.
A pivotal role in HLP is the Health Champion – a specific role and title given to someone who has undertaken and passed the Royal Society for Public Health’s Understanding Health Improvement Level 2 Award. It is estimated that there are over 4000 Health Champions in community pharmacies in England, a role that never existed in the sector before HLP was conceived. Health Champions proactively champion a health and wellbeing ethos both within the pharmacy team by leading on health promotion campaigns but also out of the pharmacy in the community.
Ensuring that the pharmacy depicts a healthy promoting environment is an important aspect of an HLP. This includes a health promotion zone where campaign displays create some theatre around key health and wellbeing issues and, where possible, matching window displays. The choice of merchandise sold by the pharmacy and the quality of the consultation room (many HLPs have more than one with some as many as five), equipment and information. However, an HLP is more about the way it feels and the quality experience the customer has when in the pharmacy than the way it looks.
The final element within the criteria relates to how the pharmacy team engages with their community; how it understands the needs of their local population, other providers and commissioners of health and care.
Over the past 7-8 years, despite all the changes in government, the NHS and the public health landscape, HLPs has survived and has often been seen as the only positive goal for many owners and members of the pharmacy team. Those who have embraced the core principles and ethos that underpins HLPs have seen the benefits that come from doing the right things with the right people. The acknowledgement that it will be part of the pharmacy contractual framework in England is recognition that those who have invested time, effort and money in the initiative should be rewarded for their innovation and leadership and we anticipate that the majority of community pharmacies will now do the same.
HLP has not stopped at the borders of England with other countries across the world viewing it as an innovative business development model that will make a difference to population health.
Michael Holden FRPharmS