I knew very little about population health when I joined the first cohort of national population health fellows in February 2020 but I was excited about learning and developing skills in reducing health inequalities, improving the wellbeing of populations and preventing long term conditions.
The nation went into lockdown only a few weeks into the fellowship and neither I nor my educational supervisor were sure about how best to use my skills as a pharmacist in a local authority setting at a time when there was much uncertainty about nearly everything. Although the fellowship was halted, it became quickly apparent that there was a need for people to continue getting their medicines, if they couldn’t get a delivery or go to a pharmacy themselves, because of shielding or other reason for vulnerability. I worked with my host organisation and Director of Public Health at Sheffield City Council to develop a mechanism for supporting medicine deliveries. This involved close collaboration with the CCG’s Medicines Management team and the Local Pharmaceutical Committee.
I also worked with the More team to develop a resource in the form of a printed booklet called Active at Home, which was developed to support people to find ways to stay active at home during lockdown; particularly people who are digitally excluded and clinically vulnerable. Following this Sheffield-based project, we worked with Public Health England to create a national version of the booklet. These were distributed in food boxes for vulnerable people via DEFRA and copies were made available for Local Authorities to distribute in their areas. It was an unprecedented time- a phrase that was used in many conversations, but it now seems there was never a better time to develop population health competencies in healthcare professionals from multi-professional backgrounds.
The Covid-19 pandemic highlighted the inequalities that existed prior to the pandemic and there was a need for the NHS to respond by ensuring that efforts are made to reduce inequities in healthcare access and delivery, particularly in some demographic groups. I took on a role as Regional Health Equity Improvement Manager for the North East and Yorkshire. The national population health fellowship equipped me with transferrable skills for the role. Some of my duties included acting as an ambassador for health equity improvement across the health and care sector, advocating the rights of potentially disadvantaged and marginalised communities, providing challenge to existing or proposed new practices within a range of different forums.
This exciting role gave me the opportunity to work across systems and sectors using the CORE20PLUS5 framework which is a national NHS England and NHS improvement approach to support the reduction of health inequalities at both national and system level. The approach targets a population cohort- the ‘Core20PLUS’- and identifies ‘5’ focus clinical areas requiring accelerated improvement. One of such areas is hypertension case-finding.
My most recent role as Pharmacy Integration Lead in NHS England is vital in facilitating the role that pharmacists can play in applying population health approaches to tackle health inequalities. A good example of this is in cardiovascular disease prevention and particularly in developing a new service for community pharmacists to opportunistically identify patients aged over forty with previously unidentified high blood pressure. High blood pressure significantly increases the risk of having a heart attack or stroke, but early detection and treatment can help people live longer, healthier lives.
Using a population health approach to reduce health inequalities and improve wellbeing of populations will require an understanding of data to help design services. I am learning that data quality is just as important, and every healthcare professional can play a role to support this. An example would be to improve and maintain accurate records, for example, the recording of information such as ethnicity, age and date of birth can help with understanding what segment of the local population have more recordings of high blood pressure readings. With this information we can target intervention to the right population group. Community pharmacists are in the heart of their local communities and often have established good relationships with people and by extension, engaging with the local populations to understand local need can provide insight into the local context and co-created local services which will benefit people in the area.
A systems approach is required to reduce health inequalities and improve population health. Therefore, my role involves working across systems and organisations such as health and social care, the local authority, public health colleagues, voluntary, charity and faith organisations. All clinicians can benefit from this approach to actualize an integrated care system that truly puts the patient at the centre of care.