Maximising the role of pharmacists in addressing health inequalities in Scotland

Addressing health inequalities and access to care require us to urgently reimagine the roles of pharmacists within our communities.

Health services have been under pressure since the onset of the COVID-19 pandemic, with pharmacies across the country playing a vital role in the frontline primary healthcare response to the crisis. Withstanding the global outbreak, pharmacists remained accessible and available, not only ensuring the supply of prescribed medicines but taking up new responsibilities and incorporating new services into their practice. This approach continues to help support primary care workforce pressures and the well-publicised lack of availability of General Practitioners. However, pharmacists and their teams could be making further contributions.

The coronavirus pandemic, and indeed the cost-of-living crisis, has acted as a multiplier for health inequalities with younger individuals in deprived areas being four times more likely to die of COVID-19. Interventions that aim to reduce health inequalities should reach beyond health, to its social and economic influences. It is worth noting that, in the UK, the Marmot Review into health inequalities indicated that up to 70% of health outcomes are attributable to socio-economic factors, whereas medical care accounts for only 10%-15%.

These socio-economic factors particularly affect deprived communities where there is a lack of funding, access, and provision of general medical practice services. In contrast, nearly 90% of the population has access to a community pharmacy within a 20-minute walk, and access is greater in areas of highest deprivation. Pharmacists therefore have a key role in supporting the efforts of the multi-disciplinary team in primary care in addressing these socio-economic issues affecting health.

I have been a pharmacist for over 32 years and have worked mainly in the academic sector teaching pharmacy and carrying out research. This research has always been focussed on what is happening in the real world – what pharmacists do, what services are provided and how effective these services are. Through this I have worked with a broad range of healthcare professionals and had the privilege of involving patients and carers. These experiences have helped me understand the significance of addressing social aspects when addressing health inequalities. I also recognise the competence, capability and versatility of pharmacists and their teams and what they can offer – our expertise lies beyond supplying medicines or providing advice on common conditions.

Community pharmacies could further develop local partnerships to help focus on these social issues. A collaborative approach could be fostered between social prescribing practitioners, community link workers, public health providers, and community organisations to effectively work together to improve not just patients’ medical care but also social care. Roles for pharmacy could be expanded to include service co-ordination, informal counselling, health education, community advocacy and social care management support. However, this shift will not just happen. There is a need for research to be carried out to work out precisely how the profession needs to evolve to make informed decisions, influence government policy and consider additional resource allocation to change practice.

Robert Gordon University has long-standing partnerships with the NHS focussing on collaborative interdisciplinary research and co-creation of demand-led courses benefiting the sector and its service users. Given the extreme current pressures on access to health services, there is a need to ‘think differently’ about the focus of healthcare services and who provides them. The way forward involves utilising a whole team approach within primary care and facilitating interdisciplinary working of healthcare professionals to gain maximum benefit from their capabilities. We have a duty to reshape the role of pharmacists to contribute to addressing social issues that affect health. We must research this and strategically upskill the workforce and make the most effective use of our resources to ensure we are providing Scotland’s population with quality care.