Vivienne Hibberd

Background Healthcare delivery in the UK is shifting towards community-based, preventative, and population-focused care. Community pharmacy is well placed to support this transition. The importance of community pharmacy has been highlighted by national policies alongside the need for strong research foundations within this setting. Despite major changes in community pharmacy and its easy accessibility to wide and diverse communities, research engagement remains limited. Evidence on the barriers to community pharmacy research engagement and how to overcome these is scarce. This project aims to co-develop a toolkit to enhance research engagement in community pharmacy and to widely disseminate findings to key stakeholders to support implementation. Protocol This study will use a Community of Practice (CoP) framework and will draw on the principles of Implementation Mapping (IM). The CoP will include key stakeholders to support the co-development of the research engagement toolkit. Stakeholders will include patients/public members and representatives from pharmacy, primary and secondary care, academia, commissioning, and research delivery professionals. Five meetings will be held online with the CoP (n = up to 15). Meetings will be recorded, transcribed verbatim and thematically analysed to identify common, emerging themes., to support the toolkit co-development. A separate patient and public advisory group will also be established to provide guidance and assistance across the duration of the study. The CoP and patient and public advisory group will advise on the most appropriate dissemination routes to reach the widest audience so that our recommendations help to build community pharmacy research. Discussion Despite its central role in the healthcare system, and its easy accessibility to wider and diverse communities, community pharmacy engagement in research is still limited. A collaborative CoP stakeholder group would better identify how to overcome barriers and to co-develop a toolkit to enhance research engagement and build research capacity, thus supporting greater participation in research.

Background Healthcare delivery in the UK is shifting towards community-based, preventative, and population-focused care. Community pharmacy is well placed to support this transition. The importance of community pharmacy has been highlighted by national policies alongside the need for strong research foundations within this setting. Despite major changes in community pharmacy and its easy accessibility to wide and diverse communities, research engagement remains limited. Evidence on the barriers to community pharmacy research engagement and how to overcome these is scarce. This project aims to co-develop a toolkit to enhance research engagement in community pharmacy and to widely disseminate findings to key stakeholders to support implementation. Protocol This study will use a Community of Practice (CoP) framework and will draw on the principles of Implementation Mapping (IM). The CoP will include key stakeholders to support the co-development of the research engagement toolkit. Stakeholders will include patients/public members and representatives from pharmacy, primary and secondary care, academia, commissioning, and research delivery professionals. Five meetings will be held online with the CoP (n = up to 15). Meetings will be recorded, transcribed verbatim and thematically analysed to identify common, emerging themes., to support the toolkit co-development. A separate patient and public advisory group will also be established to provide guidance and assistance across the duration of the study. The CoP and patient and public advisory group will advise on the most appropriate dissemination routes to reach the widest audience so that our recommendations help to build community pharmacy research. Discussion Despite its central role in the healthcare system, and its easy accessibility to wider and diverse communities, community pharmacy engagement in research is still limited. A collaborative CoP stakeholder group would help better how to overcome barriers and to co-develop a toolkit to enhance research engagement and build research capacity, thus supporting greater participation in research.

Introduction The last decades have witnessed a series of initiatives in the United Kingdom (UK) to enhance patient access to quality care including access to medicine without compromising patient’s safety. Pharmacist independent prescribing is one of the initiatives introduced in 2006 with the intention of making more effective use of the skills and competencies of health professionals. Community pharmacy has a key role in the NHS long-term plan since pharmacies offer convenient and accessible sources of healthcare advice for the public. This role is more evident with the introduction of prescribing for all qualified pharmacists at the point of registration starting 2026. This realist review aims to explore how does independent prescribing in community pharmacy works, for whom, in what circumstances and how. Method and analysis Realist research seeks to explore and explain complex social interventions by utilising programme theories providing causal explanations of outcomes in terms of context-mechanism-outcome configurations. INTEGRATE will progress through six stages. In the first stage, we will partner with Patient, Public, Involvement and Engagement Group (PPIE) and Practitioner Stakeholder Group (SG), to further scrutinise the review’s focus. In stage 2, we will develop initial programme theories for what makes independent prescribing effective in community pharmacy, for whom, in what circumstances and how. In the third stage, we will conduct literature searches to gather secondary data that will help refine our initial programme theories. In stage 4, we will select and appraise identified articles by screening titles, abstracts and full texts against inclusion and exclusion criteria. In stage 5, we will extract, document and code relevant data, followed by realist analysis with contributions from the PPIE and SG. Stage 6 focuses on refining programme theories and identifying key mechanisms that lead to desired outcomes. PROSPERO registration: CRD42023468451

Background: This study investigated NHS Health Check programme delivery before and after the Covid-19 pandemic response, with a focus on support services and referral methods available to Health Check attendees. The NHS Health Check is an important part of England’s Cardiovascular Disease (CVD) prevention programme. Methods: Public health commissioners from all 151 local authorities responsible for commissioning the NHS Health Check programme were surveyed in 2021, using an online questionnaire to capture detail about programme delivery, changes in delivery because of the pandemic response, and monitoring of programme outcomes. Four-point rating scales were used to obtain level of confidence in capacity, accessibility and usage of follow-on support services for Health Check attendees. A typology of programme delivery was developed, and associations between delivery categories and a range of relevant variables were assessed using one-way analysis of variance. Results: Sixty-eight responses were received on behalf of 74 (of 151) local authorities (49%), across all geographical regions. Our findings suggest a basic typology of delivery, though with considerable variation in who is providing the Checks, where and how, and with continued changes prompted by the Covid-19 pandemic. Support for risk management is highly varied with notable gaps in some areas. Local authorities using a model of delivery that includes community venues tended to have a higher number of services to support behaviour change following the Check, and greater confidence in the accessibility and usage of these services. A minority of local authorities gather data on referrals for Health Check attendees, or on outcomes of referrals. Conclusions: The Covid-19 pandemic has prompted continued changes in delivery, which are likely to influence patient experience and outcomes; these need careful evaluation. The programme’s delivery and commissioners’ intentions to follow through risk communication with appropriate support is challenged by the complexity of the commissioning landscape.

Background: The National Health Service Health Check in England aims to provide adults aged 40 to 74 with an assessment of their risk of developing cardiovascular disease and to offer advice to help manage and reduce this risk. The programme is commissioned by local authorities and delivered by a range of providers in different settings, although primarily in general practices. This project focused on variation in the advice, onward referrals and prescriptions offered to attendees following their health check. Objectives: (1) Map recent programme delivery across England via a survey of local authorities; (2) conduct a realist review to enable understanding of how the National Health Service Health Check programme works in different settings, for different groups; (3) provide recommendations to improve delivery. Design: Survey of local authorities and realist review of the literature. Review methods: Realist review is a theory-driven, interpretive approach to evidence synthesis that seeks to explain why, when and for whom outcomes occur. We gathered published research and grey literature (including local evaluation documents and conference materials) via searching and supplementary methods. Extracted data were synthesised using a realist logic of analysis to develop an understanding of important contexts that affect the delivery of National Health Service Health Checks, and underlying mechanisms that produce outcomes related to our project focus. Results: Our findings highlight the variation in National Health Service Health Check delivery models across England. Commissioners, providers and attendees understand the programme’s purpose in different ways. When understood primarily as an opportunity to screen for disease, responsibility for delivery and outcomes rests with primary care, and there is an emphasis on volume of checks delivered, gathering essential data and communicating risk. When understood as an opportunity to prompt and support behaviour change, more emphasis is placed on delivery of advice and referrals to ‘lifestyle services’. Practical constraints limit what can be delivered within the programme’s remit. Public health funding restricts delivery options and links with onward services, while providers may struggle to deliver effective checks when faced with competing priorities. Attendees’ responses to the programme are affected by features of delivery models and the constraints they face within their own lives. Limitations: Survey response rate lower than anticipated; review findings limited by the availability and quality of the literature. Conclusions and implications: The purpose and remit of the National Health Service Health Check programme should be clarified, considering prevailing attitudes about its value (especially among providers) and what can be delivered within existing resources. Some variation in delivery is likely to be appropriate to meet local population needs, but lack of clarity for the programme contributes to a ‘postcode lottery’ effect in the support offered to attendees after a check. Our findings raise important questions about whether the programme itself and services that it may feed into are adequately resourced to achieve positive outcomes for attendees, and whether current delivery models may produce inequitable outcomes. Future work: Policy-makers and commissioners should consider the implications of the findings of this project; future research should address the relative scarcity of studies focused on the end of the National Health Service Health Check pathway. Study registration: PROSPERO registration CRD42020163822. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR129209).

Background: This study investigated NHS Health Check programme delivery before and after the Covid-19 pandemic response, with a focus on support services and referral methods available to Health Check attendees. The NHS Health Check is an important part of England’s Cardiovascular Disease (CVD) prevention programme. Methods: Public health commissioners from all 151 local authorities responsible for commissioning the NHS Health Check programme were surveyed in 2021, using an online questionnaire to capture detail about programme delivery, changes in delivery because of the pandemic response, and monitoring of programme outcomes. Four-point rating scales were used to obtain level of confidence in capacity, accessibility and usage of follow-on support services for Health Check attendees. A typology of programme delivery was developed, and associations between delivery categories and a range of relevant variables were assessed using one-way analysis of variance. Results: Sixty-eight responses were received on behalf of 74 local authorities (49%), across all geographical regions. Our findings suggest a basic typology of delivery, though with considerable variation in who is providing the Checks, where and how, and with continued changes prompted by the Covid-19 pandemic. Support for risk management is highly varied with notable gaps in some areas. Local authorities using a model of delivery that includes community venues tended to have a higher number of services to support behaviour change following the Check, and greater confidence in the accessibility and usage of these services. A minority of local authorities gather data on referrals for Health Check attendees, or on outcomes of referrals. Conclusions: The Covid-19 pandemic has prompted key innovations in delivery, which are likely to influence patient experience and outcomes; these need careful evaluation. The programme’s delivery and intention to follow through risk communication with appropriate support is challenged by the complexity of the commissioning landscape.