Development, implementation and roll-out of the Healthy Living Pharmacy concept in England
Submitting InstitutionUniversity of Wolverhampton
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
Healthy Living Pharmacies (HLPs) represent a new concept in community
pharmacy services designed to meet public health needs through a
nationally agreed but locally commissioned tiered framework. The White
Paper, Pharmacy in England: Building on strengths, delivering the
future, published in April 2008 described the role community
pharmacy could play in supporting public health: "Pharmacies will become
healthy living centres: promoting and supporting healthy living and health
literacy; offering patients and the public healthy lifestyle advice,
support on self care and a range of pressing public health concerns;
treating minor ailments and; supporting patients with long-term
conditions". A national framework for HLPs was developed then ratified by
the National Public Health Leadership Forum for pharmacy (PHLFP) in
January 2010. This was tested in Portsmouth Primary Care Trust. Findings
of the project led to the HLP concept being rolled out across England in
2012 to 20 pathfinder sites (areas, regions, site sounds like an
individual pharmacy) involving 100 pharmacies. As of March 2013, there
were 478 HLPs across 28 areas and presently there are 721 HLPs in over 35
areas. There are a range of impacts that can be demonstrated from this
research including changes to community practice and government policy;
increase in public use of pharmacies and improved patient outcomes.
This work was conducted by Professor Paul Rutter (University of
Wolverhampton), Professor David Brown (Portsmouth University) and
Professor Jane Portlock (University College, London). The work was
undertaken on behalf of NHS South Central which was commissioned by the
Department of Health. The research team reported to the National
(Government) Research Group for HLP.
1. Development of the national framework
The research team conducted a systematic analysis of international
published research on the potential for and impact of delivery of HLP
services (Section 3, reference 1), which informed the initial Portsmouth
HLP framework, later referred to nationally as the `Portsmouth model'.
This work allowed research evidence to inform the services to be offered
in the framework and how these services could be delivered that fitted
with a `tiered commissioning' philosophy. Commissioning of health
promotion and prevention services followed three `levels' of service —
level 1 being the entry point to become a HLP. Initial services offered in
Portsmouth centred on provision of smoking cessation, weight management,
emergency hormonal contraception and harm reduction (e.g. alcohol
This work informed the local delivery of HLPs in the Portsmouth area (see
below). The `Portsmouth model' was amended by the PHLFP subsequent to
research findings prior to pathfinder site roll out. This then became the
2. Implementation and analysis of the HLP concept in Portsmouth
All community pharmacies were sent a HLP prospectus and invited to become
involved in the project. The prospectus detailed the minimum level of
service and staff training required to gain HLP level one status. The
credentialing of pharmacies was undertaken by Portsmouth PCT. This
involved pharmacists undertaking leadership training and at least one
member of non-pharmacist staff becoming a `health champion' by completing
The Royal Society of Public Health Level 2 Health Improvement Award. On
achieving HLP status, each pharmacy could display an approved logo to
highlight to the public that they were a HLP.
The research team gathered data on pre and post HLP service activity,
staff and service user opinion. Data was collated from April 2010 onwards
through to April 2012.
2.1 Initial evaluation (6 months into the collection period) showed HLPs
had higher levels of service activity compared to when they were non-HLPs.
They also out performed those pharmacies that had decided not to become
HLPs for all services commissioned under the framework. Initial evaluation
of staff opinion working in HLPs showed a positive attitude toward the HLP
concept. (section 3, reference 2)
2.2 Final evaluation allowed initial findings to be compared with a full
set of financial year data (2011-2012). HLP pharmacies outperformed
non-HLPs in every service (except provision of emergency hormonal
contraception, where there were no significant differences) for the
- A significantly higher median number of clients received medicine
reviews for asthma and identified more patients with poor asthma
- Significantly more clients set smoking cessation dates and were still
non-smokers at 4 and 12 week follow-up.
- 20 clients completed a 26 week weight loss programme through HLPs
compared to none in non-HLPs. Nineteen had lost weight with 14 of these
(70%) achieving a 5-10% loss in body weight.
- Significantly more alcohol awareness consultations were undertaken
through HLPs however there was no difference in the level of uptake by
clients regarding subsequent interventions.
2.3 Interviews with staff revealed a positive impact on service
development in HLPs, largely engineered through revision of skill mix and
additional training of non-pharmacist staff. Sustainability beyond the
initial implementation period was proven.
2.4 Public awareness of HLPs was low throughout the study period despite
targeted media campaigns. This was attributed to the lack of difference in
outward appearance of HLPs compared to non-HLPs (Section 3, reference 3)
2.5 Work is on-going in the Portsmouth region to determine if
sustainability as a Level one HLP can be translated in to Level two HLPs —
this `tier' allows the HLP to provide extended services compared to a
level one HLP (forming part of a PhD study).
References to the research
1. Brown D, Portlock J, Rutter P. Review of services provided by
pharmacies that promote healthy living. Int J Clin Pharm 2012;34:399-409,
peer reviewed journal article submitted to REF in 2014.
3. Brown D, Portlock J, Rutter P. From Community Pharmacy to Healthy
Living Pharmacy: Early Experiences from Portsmouth, England. Res Social
Adm Pharm DOI:10.1016/j.sapharm.2013.04.014, peer reviewed journal article
submitted to REF in 2014.
Note: the journals targeted for this work were selected on the basis that
they are international journals that specialise in publishing pharmacy
Details of the impact
The impact of our research can be seen from two inter-related
1. Influence on Government Policy
With positive interim findings (on level of service activity and staff
attitudes) and prior to the completion of the study, Lord Howe
(Parliamentary Under Secretary of State), wished to see if the same
results could be achieved in different areas of England that had different
demography and geography.
In response, the national pharmacy bodies (Company Chemist Association,
National Pharmacy Association, Pharmaceutical Services Negotiating
Committee, Royal Pharmaceutical Society) working together with the
Department of Health and Centre of Pharmacy Postgraduate Education
collaborated to form a Pathfinder Support Group (PSG) to roll-out the
concept nationally. This was a direct result of the findings from our
Expressions of interest to become a pathfinder site were issued in 2011.
The intention was to recruit 20 sites involving 100 pharmacies to
determine if the Portsmouth experience was scalable. The research team
provided expert advice and opinion in to the output measures to be
collected. The collation of data from pathfinder sites was overseen by the
professional body for pharmacists, The Royal Pharmaceutical Society. Their
report on findings from pathfinder sites broadly replicated our findings
from Portsmouth PCT and demonstrably shows `proof of concept'.
The HLP concept has now gone beyond the scope of the initial pathfinder
programme and is now becoming established as an England-wide model for
delivery of public health through pharmacies.
This can be exemplified as there were (as of 31/3/2013) 458 accredited
HLPs in 28 regions across England, which has further risen to 721 HLPs by
October 2013. This number is set to continue to increase as more regions
have expressed a desire to introduce the HLP concept.
The likelihood of sustainability (given the final findings from our
research) and the growing number of areas delivering the HLP concept has
led to the development of a national training programme offered through
The Centre for Postgraduate Pharmacy Education — a government funded
training provider for pharmacists (http://www.cppe.ac.uk/learning/Details.asp?TemplateID=HLP-E-00&Format=E&ID=29&
EventID=42721) and The National Pharmacy Association hosting
dedicated webpages for HLPs (http://www.npa.co.uk/Business-Management/Service-Development-Opportunities/Healthy-Living-Pharmacy/).
2. Impact on the pharmacy profession and health and wellbeing of the
Our findings (which have subsequently been replicated elsewhere in
England) have shown that:
a. Uptake of services through HLPs is higher compared to non-HLPs.
b. Patient outcomes are better (or the same in the case of emergency
hormonal contraception) for services delivered through HLPs.
c. Pharmacy teams working in HLPs feel more empowered motivated and
better able to deliver public health interventions.
As detailed in reference 3, section 3 and reference 5 in section 5.
The expansion of the HLP concept from 17 pharmacies in Portsmouth in 2009
to 721 across England by 2013 shows that the concept is now a reality. The
scalable health benefits to the population at large will mean that HLP
pharmacies are contributing to the health of the nation in a more
meaningful and demonstrable way than before their introduction.
Sources to corroborate the impact
- Department of Health, 2008. Pharmacy in England: building on
strengths, delivering the future. http://www.official-documents.gov.uk/document/cm73/7341/7341.pdf.
- Department of Health, 2010. Healthy lives, healthy people: our
strategy for public health in England.
- Evans D, Holden M, Morgan L. Pharmacies as healthy living centres: how
far down the line have we come? Pharmaceutical Journal 282: 771.
ve_we_come and further reported at http://www.govtoday.co.uk/pharmacy/15666-public-highly-approves-of-healthy-living-pharmacies-concludes-evaluation-report
- Portlock J, Evans D, Bowhill J, Brown D, Rutter P, Bowhill S. Current
thinking on healthy living pharmacies (CPD Module 192) Pharmacy Magazine
2011; 17(10): S1-8.
- Evans D, Kennington E, Shepherd E, Duggan C, Leach R, Root G, Holden
M. Evaluation of the Healthy Living Pharmacy Pathfinder Work Programme
- Aston University Healthy Living Pharmacy (HLP) Study. Available at:
Demonstrating that HLPs at different sites are coming under independent
research scrutiny to add to the body of evidence.