Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 Health and wellbeing hubs

This recommendation is for local authorities, clinical commissioning groups, health and wellbeing boards, community pharmacies and their representatives.

1.1.1 Work together to help all community pharmacies gradually integrate into existing care and referral pathways as health and wellbeing hubs. This could include arrangements for inward and outward referrals (see recommendation 1.6.1).

To find out why the committee made the recommendation on health and wellbeing hubs and how it might affect practice, see rationale and impact.

1.2 Overarching principles of good practice for community pharmacy teams

Use an integrated approach

1.2.1 Work with local health and social care organisations to ensure community pharmacy interventions are delivered according to local need and as part of wider services in the local area.

Ensure consistent, high-quality services

1.2.2 Use a tailored approach when providing community pharmacy health and wellbeing interventions to maximise their impact and effect.

1.2.3 Local providers should ensure interventions are carried out only by staff members with the skills and competencies to do so. For example, follow NICE's recommendations on training in the guidelines on:

1.2.4 When possible, the same member of staff should deliver all sessions of an intervention (if multiple sessions are needed) to promote continuity of care.

1.2.5 Use information, resources and support aids available from statutory, community and voluntary sector organisations (for example, Healthwatch and Public Health England). Ensure the materials used are:

  • not based solely on commercial interests or incentives

  • clear and professionally produced.

Address health inequalities

1.2.6 Address health inequalities by working with other agencies to identify underserved groups. Tailor health and wellbeing interventions to suit their individual needs and preferences and maximise their impact. For example:

  • use knowledge of the local community (particularly from staff who live in the community where they work) to take into account the context in which people live and work (their physical, economic and social environment)

  • make use of the skills staff members already have (for example, if they speak languages commonly used in the area)

  • take into account other personal factors such as gender, identity, ethnicity, faith, culture or any disability that may affect the approach taken (for example, provide information in an appropriate format for people who may have difficulty reading).

Promote community pharmacies

1.2.7 Consider promoting community pharmacies. For example:

  • Local commissioners could make it clear that community pharmacies are an integral part of NHS primary care services and offer people a link into the local health and care network.

  • Individual pharmacies could publicise the skills and competencies of their staff to increase the public's knowledge of and confidence in the health and wellbeing services on offer.

Proactively seek opportunities

1.2.8 Proactively seek opportunities to promote people's physical and mental health and wellbeing. This includes: awareness raising and information provision, advice and education, behavioural support and referral and signposting to other services. Describe the interventions on offer and the benefits. Do this for example, when someone:

  • Regularly buys over-the-counter medicines, such as painkillers. For example, if relevant offer advice on other ways of reducing lower back pain including self-management and exercise. (See recommendations on non-invasive treatment in NICE's guideline on low back pain and sciatica.)

  • Regularly collects a prescription for themselves or someone they care for. For example, provide education and advice on how improving their diet, being more physically active or reducing alcohol intake may help the condition and improve their physical or mental health and wellbeing.

  • Regularly uses the pharmacy for over-the-counter medication or one-off prescriptions and, where appropriate, routine or occasional non-healthcare purchases. For example, offer behavioural support for stopping smoking (see NICE's guideline on stop smoking services); or information on effective sun protection (see NICE's guideline on sunlight exposure).

  • Is planning a pregnancy or is pregnant. For example, raise awareness of the benefits of, and provide information on, folic acid and other supplements (see NICE's guidelines on maternal and child nutrition and on vitamin D: supplement use in specific population groups).

To find out why the committee made the recommendations on overarching principles of good practice for community pharmacy teams, and how they might affect practice, see rationale and impact.

1.3 Awareness raising and providing information

1.3.1 Ensure any pharmacy awareness raising campaigns or information is in line with NICE's guidelines on behaviour change: individual approaches (in particular, the first bullet of recommendation 9) and behaviour change: general approaches (particularly principle 6).

1.3.2 Tell people what the purpose of the health information is that you want to give them. For example:

  • when handing out leaflets explain their content and importance

  • point out the relevance of any posters that are displayed or highlight how people can easily get further information on the topic (for example, using QR codes)

  • if distributing leaflets with dispensed medicines, explain to the person collecting them – such as a carer, family member, friend or delivery person – why they are included and how to find out more, so they can pass this information on.

To find out why the committee made the recommendations on awareness raising and providing information and how they might affect practice, see rationale and impact.

1.4 Advice and education

1.4.1 Offer advice and education as the opportunity arises in line with NICE's guidelines on: behaviour change: individual approaches (see the recommendations on delivering very brief, brief and extended brief advice).

1.4.2 When someone uses pharmacy services to manage a long-term condition, use this as an opportunity to advise them on how to improve their general health and wellbeing. For example, follow recommendations on advice and education in NICE's guidelines on:

  • diabetes in adults (type 1, and type 2) and diabetes in children and young people (type 1 and type 2)

  • hypertension in adults for people with, or at risk of, hypertension (see the sections on lifestyle interventions and patient education and adherence to treatment).

1.4.3 Offer brief advice and education as the opportunity arises, on stopping smoking and reducing alcohol consumption:

  • For smoking cessation, follow NICE's guideline on stop smoking interventions and services (in particular see recommendation 1.3.9 on giving very brief advice, and the sections on commissioning and providing stop smoking interventions and services to meet local needs, monitoring stop smoking services, engaging with people who smoke, and advice on e‑cigarettes).

  • For alcohol issues, follow the recommendations on brief advice in NICE's guideline on alcohol-use disorders. In particular see recommendation 5 on resources for screening and brief interventions and recommendation 10 on brief advice for adults.

1.4.4 Use support materials and approaches to aid these discussions, if available. (For example, advice and education on smoking could be supported by photo-ageing software, if it is available.)

To find out why the committee made the recommendations on advice and education and how they might affect practice, see rationale and impact.

1.5 Behavioural support

1.5.1 Offer behavioural support in line with NICE's guidelines on:

1.5.2 Help people to stop smoking by offering behavioural support programmes in line with NICE's guideline on stop smoking interventions and services (see recommendations 1.1 to 1.7) and the recommendation on behavioural support in NICE's guideline on smoking: harm reduction.

1.5.3 Help people to manage their weight by offering behavioural support programmes in line with NICE's guidelines on:

1.5.4 Consider referring people to other behavioural support services within the local health and care network (for example, to voluntary or community services) for interventions that are not available in the pharmacy (see section 1.6).

To find out why the committee made the recommendations on behavioural support and how they might affect practice, see rationale and impact.

1.6 Referrals and signposting

Referrals

1.6.1 Local commissioners and pharmacies could consider establishing a formal referral process with other pharmacies and service providers. This includes GP services and those offered by local authorities and organisations in the community and voluntary sectors. Specifically:

  • Consider basing pharmacy assessments, triage activities and referrals on agreed tools that support continuing treatment.

  • Consider designing triage activities to reduce multiple assessments and waiting times after people are referred. For example, after identifying harmful or dependent alcohol consumption, consider providing access to alcohol services that does not require reassessment and a return to the start of the treatment pathway. (Harmful and dependent alcohol consumption could be identified using the AUDIT tool or another threshold used locally.)

1.6.2 Consider referring people to other services and triage within the agreed local care or referral pathway to give fast access to an appointment if needed. For example, refer people to:

  • GPs or other healthcare providers for:

    • ongoing contraception

    • assessment for sleep apnoea if agreed local assessment tools are in place

    • support for high risk or dependent alcohol consumption

    • drug misuse recovery support

    • weight reduction services

  • local authority, NHS or community and voluntary sector organisations for:

    • weight loss programmes or support groups

    • mental health and wellbeing support

    • specialist treatment and recovery support for drug misuse and dependence

    • support for carers

  • adult and children's social care.

1.6.3 When making a formal referral to another service, explain to the person why they are being referred, where they are being referred to and the service they can expect. Provide them with written information about the service if it is available.

1.6.4 When the pharmacy accepts a formal referral from another service:

  • ensure all relevant information has been provided so that care can start at the first opportunity without the need for a reassessment

  • offer care as a walk-in service or, if this is not available or suitable, agree an appointment time and date with the person and give them the name of the staff member they will see.

Signposting

1.6.5 If the community pharmacy cannot support specific needs or offer a formal referral, signpost people to other local services. For example:

  • sexual health services

  • stop smoking services

  • social care services

  • mental health and wellbeing support

  • other community services such as: Citizens Advice; housing, benefits or employment advice; support services for carers; and government and third sector debt advice websites.

Record keeping, auditing and monitoring

1.6.6 Consider using minimum data sets and summary care records to encourage record keeping and auditing, particularly when exchanging information through formal referrals in the local care network.

To find out why the committee made the recommendations on referrals and signposting and how they might affect practice, see rationale and impact.

Terms used in this guideline

This section defines terms that have been used in a specific way for this guideline. For other public health and social care terms, see the Think Local, Act Personal Care and Support Jargon Buster.

Photo-ageing

A smoking cessation intervention in which photos of participants are digitally aged so they can see images of themselves as a lifelong smoker and a non-smoker.

Underserved groups

Adults and children from any background are 'underserved' if their social circumstances, language, culture or lifestyle (or those of their parents or carers) make it difficult to access health services or attend healthcare appointments.

Many of these groups may be more likely to go to a community pharmacy than a GP or another primary care service. As an example, this includes: people who are housebound, homeless or sleep rough; people who misuse drugs or alcohol; and Gypsy, Traveller and Roma people. A full list can be found in the equality impact assessment for this guideline.

  • Public Health England
  • National Institute for Health and Care Excellence (NICE)