Healthy Living Pharmacies

Healthy Living Pharmacies

The Healthy Living Pharmacy (HLP) framework is a tiered commissioning framework aimed at achieving consistent delivery of a broad range of high-quality services through community pharmacies to meet local need, improving the health and wellbeing of the local population and helping to reduce health inequalities.

For the February 2019 Quality Payments Scheme, 9,535 pharmacies in England declared that they were an HLP Level 1.

HLP as an Essential service requirement in 2020/21
Community pharmacy contractors will be required to become an HLP Level 1 in 2020/21 as agreed in the five-year deal between PSNC, NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC); this reflects the priority attached to public health and prevention work.

PSNC is currently in discussions with NHSE&I and DHSC on the detail of the CPCF requirements which will apply in 2020/21, including changes to the Terms of Service. These discussions are considering the HLP requirements and how they can be applied to Distance selling pharmacies (DSPs). Once a conclusion is reached on this, PSNC will communicate details of this through our normal communication channels.

This does not affect whether DSPs can, at this time, seek to achieve HLP status via the self-assessment route. As with any other pharmacy, it is for a contractor that runs a DSP to determine whether they can meet the HLP requirements as part of the self-assessment process.


Click on a heading below for more information.

Introduction and background

The  HLP concept was developed in Portsmouth in 2009 with support from the Department of Health (DH), the Director of Public Health and the Local Pharmaceutical Committee following the publication of the 2008 White Paper, Pharmacy in England: building on strengths, delivering the future  The White Paper described a vision to develop community pharmacies from being suppliers of medicines to become Healthy Living Centres providing self-care advice and treatment for common ailments and healthy lifestyle interventions, in addition to providing the safe supply and use of prescribed medicines.

The HLP framework was launched and in September 2010, Portsmouth HLPs delivered positive interim results. In March 2011, the national pharmacy bodies started working with DH to launch the HLP pathfinder programme, which resulted in an evaluation being published in April 2013. Following this, Public Health England (PHE) adopted the concept and supported the roll out in pharmacies across the country.

What is an HLP?

HLP is an organisational development framework underpinned by three enablers of:

  1. workforce development – a skilled team to pro-actively support and promote behaviour change, improving health and wellbeing;
  2. premises that are fit for purpose; and
  3. engagement with the local community, other health professionals (especially GPs), social care and public health professionals and local authorities.

The HLP concept provides a framework for commissioning public health services through three levels of increasing complexity and required expertise with pharmacies aspiring to go from one level to the next.

There are three levels of service delivery within the HLP framework:

  • Level 1: Promotion – Promoting health, wellbeing and self-care (in July 2016, Level 1 changed from a commissioner-led process to a profession-led self-assessment process);
  • Level 2: Prevention – Providing services (commissioner-led); and
  • Level 3: Protection – Providing treatment (commissioner-led).

PHE published the below set of infographics in July 2016 to illustrate the role of HLPs in the health and care system. Please note, the number of HLPs has increased dramatically since these infographics were published. For the February 2019 Quality Payments Scheme, 9,535 pharmacies declared that they were an HLP Level 1.

Hlp

Hlp 2

Hlp 3

 

How to become an HLP Level 1 or maintain status as an HLP Level 1 (includes PSNC resources)

The table below gives a summary of what contractors need to do to become an HLP Level 1 or maintain their status (pharmacies need to re-accredit by self-assessment every three years to maintain their HLP status). PSNC Briefing 033/19: How to become a Healthy Living Pharmacy Level 1 (updated October 2019) also provides information on how to achieve HLP Level 1 status.

HLP status of pharmacy Action required
Contractors whose pharmacies have not been previously accredited as an HLP

Contractors will need to meet the requirements of an HLP Level 1 as defined by PHE.

Contractors will need to retain a portfolio of evidence together with the completed assessment of compliance signed by a pharmacist to demonstrate that they meet the HLP Level 1 quality criteria and retain this in the pharmacy.

An Evidence portfolio and the assessment of compliance is available below.

Follow stages 1-3 below.

Contractors whose pharmacies became HLPs more than three years ago (accredited locally or via the profession led self-assessment process)

Contractors will need to meet the requirements of an HLP Level 1 as defined by PHE (if accredited locally) or ensure they still meet the requirements if accredited via the profession-led self-assessment route.

Contractors will need to retain a portfolio of evidence together with the completed assessment of compliance signed by a pharmacist to demonstrate that they meet the HLP Level 1 quality criteria and retain this in the pharmacy.

An Evidence portfolio and the assessment of compliance is available below.

Stage 1 – Key requirements that must be met before becoming an HLP Level 1

The following requirements must be met before a pharmacy can be registered as an HLP Level 1, therefore contractors should ensure that they meet the requirements before they start working their way through the quality criteria:


Stage 2 – How to achieve HLP Level 1

In July 2016, the HLP Task Group of the PPHF developed a new process for the implementation of Level 1 HLPs. The intention was to move from a totally commissioner-led HLP accreditation system to a profession-led self-assessment process for Level 1 HLPs, based on clear quality criteria. PHE has published a letter explaining this in more detail.

PHE has published the self-assessment guide, which sets out the quality criteria that pharmacies must achieve to gain HLP Level 1 status. Pharmacy teams must be able to provide evidence of their behaviours and activities as well as the physical environment. The quality criteria have been endorsed and ratified by the PPHF.

Below is a checklist of the 27 quality criteria which pharmacy teams need to achieve to gain HLP Level 1 status:

HLP Level 1 checklist (Word)

HLP Level 1 checklist (PDF)

An HLP Level 1 Evidence Portfolio Workbook which pharmacy teams can use to guide them through the HLP quality criteria and assist them with recording their evidence to show they have met the HLP quality criteria.

HLP Level 1 Evidence Portfolio Workbook (Word)

HLP Level 1 Evidence Portfolio Workbook (PDF)

A flow chart detailing the process to follow to achieve HLP Level 1 is available below:

HLP Level 1 flow chart (Word)

HLP Level 1 flow chart (PDF)

Holding a health promotion event/campaign

Holding health promotion events/campaigns and documenting details of these are a way for pharmacy teams to demonstrate that they meet several of the quality criteria that pharmacy teams need to meet to achieve and maintain HLP Level 1.

PSNC Briefing 032/19: Healthy Living Pharmacy – Holding a health promotion event/campaign

To assist pharmacy teams when planning a health promotion event/campaign, a suggested checklist can be found below:

Checklist for holding a health promotion event campaign (Word)

Checklist for holding a health promotion event campaign (PDF)

Pharmacy teams may wish to use a questionnaire to help them evaluate their health promotion event/campaign and to make improvements to future events/campaigns. A template questionnaire can be found below:

Event campaign questionnaire (Word)

Event campaign questionnaire (PDF)

Health promotion ideas

Our health promotion ideas for pharmacy teams hub page contains links to different topics which pharmacy teams can use as a focus for their HLP Health Promotion Zone or they can be used in other health promotion work within and outside the pharmacy depending on the needs of the local community.


Stage 3 – Action once a contractor has met the requirements for HLP Level 1 

Once a contractor has met all the requirements for HLP Level 1, they should complete an assessment of compliance and retain this in the pharmacy:

Assessment of compliance (Word e-form)

Assessment of compliance (PDF)

This form must be completed by a pharmacy professional (pharmacist or pharmacy technician) in the pharmacy, who must provide their General Pharmaceutical Council registration number.

Part 1 of the assessment of compliance should then be completed which relates to the key requirements that the pharmacy must have in place before HLP Level 1 status can be granted and the HLP logo displayed. Pharmacy professionals must be able to indicate YES to all statements. by ticking the appropriate boxes to be compliant.

Part 2 of the assessment of compliance should then be completed, which is the section of the framework that asks the pharmacy professional to state the evidence they possess in the pharmacy, which they can use to demonstrate compliance with the requirements. Evidence must be provided against all requirements.

Part 3 requires the pharmacy professional to declare compliance with the HLP Level 1 quality criteria and to retain this in the pharmacy (they do not need to register as an HLP with an external organisation). The assessment of compliance does not need to be submitted routinely to NHS England and NHS Improvement (NHSE&I).

Royal Society for Public Health register and quality assurance visits

Previously, the Royal Society for Public Health (RSPH) was commissioned by PHE to maintain an HLP register and conduct quality assurance visits. The RSPH register of HLPs still exists, but it is not being maintained and the associated quality assurance process has ceased. Any quality assurance of pharmacies claiming to meet the HLP requirement, would in future be undertaken as part of normal contract monitoring activity conducted by NHSE&I regional teams.

Since RSPH is no longer commissioned to provide the HLP register and conduct quality assurance visits, this also means that pharmacies will not be sent an HLP certificate or HLP logo to display in their pharmacy.

List of PSNC resources

Other resources for pharmacy contractors and their teams

National Institute for Health and Care Excellence – Community pharmacies: promoting health and wellbeing (August 2018)

Presentation at the Pharmacy Show: Healthy Living Pharmacy – How to get started and how to go big – Sandie Hall (October 2017) (If prompted, the password is: pharmacy17)

RSPH and PHE have published Everyday Interactions, a toolkit which can help healthcare professionals record and measure their impact on public health. This toolkit can be used by pharmacy team members to record and collate their interactions with patients and add to the pharmacy’s portfolio of evidence of meeting HLP standards.

The toolkit contains impact pathways relating to different public health topics such as obesity, alcohol consumption, smoking and sexual health. RSPH and PHE have also created a short e-learning resource to support you to use the toolkit.

e-Learning for Healthcare: West Midlands Making Every Contact Count e-learning – A web-based learning resource for frontline staff. It has been developed by Health Education England’s local team in the West Midlands in collaboration with Public Health England West Midlands.

Action plan template – A template that can be used to outline actions that need to be achieved, by whom and by when to achieve HLP Level 1 status.

Making it happen – This document provides guidance for LPCs and contractors on the things that work well and the things learned along the way by those already involved in establishing HLPs.

The role of the Health Champion – This document provides more information on the role of the Health Champion, who can become a Health Champion and the training available.

Pharmacy staff that wish to become a Health Champion have to have undertaken the RSPH Level 2 Award in Understanding Health Improvement.

The Professional Standards for Public Health Practice for Pharmacy provide a framework to help pharmacy teams, commissioners and those contracting services to design, implement, deliver and monitor high-quality public health practice through pharmacy.

PHE publishes a quarterly e-newsletter to provide updates on national HLP development and share innovative practice from across the country.  To sign up to receive future quarterly issues, please email hlpnewsletter@phe.gov.uk.

Past editions:

Training providers

There are several organisations that provide HLP training for pharmacy staff and those that PSNC has been made aware of are listed below for information (listing on this website does not constitute an endorsement of the course or provider by PSNC):

AAH

Buttercups Training Ltd

Centre for Pharmacy Postgraduate Education

Mediapharm

Metaphor Development

National Pharmacy Association

Numark

Pharmacy Complete

Royal Society for Public Health

The Practical Leadership Training Company Ltd

VirtualOutcomes Ltd

Resources for LPCs

Hampshire & Isle of Wight LPC has produced an HLP guide to provide contractors with all the detail they need to understand the changes in HLP criteria and process, and the development of HLPs in Hampshire.

generic HLP prospectus has been produced by West Midlands LPN and Michelle Dyoss.

Making it happen – This document provides guidance for LPCs and contractors on the things that work well and the things learned along the way by those already involved in establishing HLPs.

A PowerPoint presentation for LPCs on HLPs can be used by LPCs/community pharmacists as the basis for a presentation on the HLP concept to:

  • local patient groups;
  • local government officers and councillors;
  • CCGs;  and
  • other groups that have an interest in community pharmacy.

Resources for commissioners

The why, the how and the what – This document provides more information on HLPs.

Information for CCGs and General Practices – Further information on HLPs aimed specifically at Clinical Commissioning Groups (CCGs) and General Practices.

Information for LAs – Further information on HLPs aimed specifically at local authorities.

The Professional Standards for Public Health Practice for Pharmacy provide a framework to help pharmacy teams, commissioners and those contracting services to design, implement, deliver and monitor high-quality public health practice through pharmacy.

Gul Root (Pharmaceutical Public Health Adviser in PHE’s Health and Wellbeing Directorate) is the strategic lead for HLP and commissioners can contact her to discuss HLP.

PHE publishes a quarterly e-newsletter to provide updates on national HLP development and share innovative practice from across the country.  To sign up to receive future quarterly issues, please email hlpnewsletter@phe.gov.uk.

HLP evaluations

HLP pathfinder sites evaluation

The evaluation of the HLP pathfinder sites was launched on the 22nd April 2013 and the key findings were:

  • early results seen in Portsmouth can be replicated in other areas of the country as the benefits of the scheme were shown not to be dependent on levels of local health need and deprivation;
  • the HLP concept was consistent with increased service delivery and improved quality measures and outcomes;
  • 21% of people surveyed wouldn’t have done anything if they hadn’t accessed a service or support in the HLP so would have missed out on the benefit of getting advice to improve their health and wellbeing;
  • 60% of people surveyed would have otherwise gone to a GP;
  • public feedback was positive with 98% saying they would recommend the service to others and 99% were comfortable to receive the service in the pharmacy;
  • more people successfully quit smoking in HLPs than non-HLPs or prior to becoming an HLP;
  • the number of people who accessed sexual health services and were provided with additional sexual health advice was greater than in non-HLPs;
  • the acceptability of community pharmacy as a location for clients to receive an alcohol service and the relatively high levels of activity seen in HLPs compared with non-HLPs showed that HLPs could have an important contribution to this harm reduction service;
  • HLPs were effective at delivering increased support for people taking medicines for long term conditions, through both Medicines Use Reviews and the New Medicine Service. Activity was higher for both services in HLPs than non-HLPs or before HLP implementation in all but one site; and
  • pharmacies were also positive about the scheme; 70% of the contractors surveyed said it had been worthwhile for their business.

Duncan Selbie, Chief Executive of PHE, highlighted the results from the HLP evaluation in his weekly message on 26th April following the evaluation launch:

‘Pharmacies have a major role to play in helping improve the public’s health, with 1.8 million people visiting a pharmacy each day. On Monday, the evaluation of the Healthy Living Pharmacy Programme was launched at the Royal Pharmaceutical Society. Led by a collaboration of all the national pharmacy bodies and supported by the Department of Health and the public health organisations, there are now 508 Healthy Living Pharmacies in England. The results are really impressive. The public ‘strongly’ approved of the pharmacies which have signed up, with over 98% saying they would recommend them. Results have been equally encouraging in Stop Smoking services, with the Healthy Living Pharmacies delivering a significant improvement in the number of quits. The public and patients have also been much more positively engaged in other lifestyle areas where advice and support have been given by pharmacy Health Champions accredited by the Royal Society for Public Health’.

HLP evaluation executive summary

HLP evaluation (full document)

Other evaluations on HLPs

University of Bradford – Evaluation of the West Yorkshire Healthy Living Pharmacy Programme (January 2014)

Teeside University – An evaluation of the Tees Healthy Living Pharmacy Pilot Scheme (August 2013)

FAQs

Q. My pharmacy does not have a consultation room, how do I achieve HLP status?
PSNC is currently in discussions with NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC) on the position of pharmacies that cannot install a consultation room due to premises constraints; once a conclusion is reached on this point, PSNC will communicate details of this through our normal communication channels. The broad expectation is that contractors will be expected to fit consultation rooms into their pharmacies (if they do not currently have one) to allow them to meet the HLP requirement in 2020/21.

Q. How often (if at all) will the leadership and RSPH training need to be repeated?
There is no reference to the need for repeated training in the HLP quality requirements, so as long as a contractor has staff in post that have undertaken the relevant training, that will meet the requirements.

Q. The HLP quality criteria framework has a criterion which states that the pharmacy team actively works in collaboration with other community organisations to deliver pharmacy outreach and/or services. Can this be done in the pharmacy, as part of the health promotion event that is required to be held every four months or do the pharmacy staff have to deliver an event/service away from the pharmacy premises?
The outreach work needs to be carried out off the pharmacy premises, so while it would be good to have collaborative working on the premises, collaborative working off-premises would satisfy that requirement. HLPs have previously done that via attendance at local roadshows for the public, stands in shopping centres, visits to schools and care homes to take part in health promotion work.

Q. What constitutes a full-time equivalent (FTE) member of staff?
FTE is the hours worked by one employee on a full-time basis. The GOV.UK website states there is no specific number of hours that makes someone full or part-time, but a full-time worker will usually work 35 hours or more a week.

To read about the Working Time Regulations, please visit the GOV.UK website.

Q. Is attendance at face-to-face RSPH training a requirement to qualify for HLP Health Champion training?
The requirements to qualify for HLP Health Champion training will depend on the training provider that the contractor has chosen to use and how their course has been designed to meet the RSPH Level 2 Award in Understanding Health Improvement (the course that needs to be completed for someone to become a Health Champion). Therefore, depending on the course provider, face-to-face training may be required as part of their course. However, it is not stipulated that training must be provided face-to-face in the HLP Level 1 quality criteria guidance published by Public Health England.



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