· Features

Health and wellbeing: Healthcare provision - Healthy competition

Employers are increasingly using community pharmacists in an effort to keep their workers healthy - spurring other healthcare providers to improve their offerings.

Recessions are officially bad for employees' health. According to Aviva's recently published 'Health of the Workplace' study, almost half of UK employees say the downturn is making them feel stressed and driving them to drink and drugs.

Worse still is that while employers say they recognise the need to invest in the wellbeing of their staff, they admit it is hard to justify the extra costs of health benefits in the current economic climate. The report reveals that just 1% of British businesses plan to introduce additional employee health benefits in 2009, and 62% describe workplace healthcare investment as a 'luxury few businesses can afford'.

So where does this leave the health insurance and health cash-plans market, and what are the prospects for staff wishing to access health and wellbeing services? One unlikely saviour could be the UK's network of community pharmacies, of which there are around 10,000. In recent years, the NHS has drafted them in to support its work on smoking cessation, weight loss, health assessment and alcohol reduction.

It has also pushed them as an alternative source of the medical advice usually provided by GPs' surgeries. Medicines previously only available by prescription - such as Flomax, the treatment for prostate problems, for example - can now be bought over the counter. Thanks to their capacity to offer convenience and access to a healthcare professional cost-effectively, the NHS now sees pharmacies as an attractive healthcare provider.

Businesses are favouring the services provided by pharmacies too (see box, below) so will they become a serious competitor to the wellness products on sale in the private sector?

Boots already does business with a number of private partners on the basis that NHS services, such as NHS health checks, are subject to restriction. Currently the NHS health check is only available to people aged between 40 and 74, and only every five years. Flu vaccinations also tend to be available only to those aged over 65, or those with certain serious medical conditions.

Likewise, NHS chlamydia-testing and weight-loss services are subject to restriction. "Customers often seek additional support if they fall outside of the age bracket or have differing testing requirements," says Boots' pharmacy services manager, Stephen Pemberton.

Boots also partners with corporate employers, who use its expertise to provide healthcare services for workers too busy or ineligible for NHS care. To reduce absence and improve productivity, employers directly commission the pharmacies to provide services such as smoking cessation support, health checks and flu vaccinations, either at a local pharmacy or in the workplace.

Community pharmacies can offer private services because they operate as independent contractors within the NHS, and their remit extends to medical consultations and prescription dispensing, usually for drugs currently not available on the NHS. They also run clinics offering cosmetic beauty treatment, travel advice, podiatry, physiotherapy, massage and hypnotherapy - some areas that are also covered by cash-plan operators.

But is this a threat to cash-plan providers? Healthshield, for one, does not limit where a cash-plan service can be delivered, and sees pharmacies as potential service providers, as long as its policy terms are met. Yet healthcare providers are having to ensure their services are not seen to be less convenient than pharmacy provision.

In 2008, Healthshield redesigned its wellness product portfolio to offer benefits with separate annual maximums. Marketing manager Lara Rendell says offering separate annual maximums has boosted product take-up. "It fulfils an employer's duty-of-care obligations and shows it is trying to look after employees. Our wellness provisions are, therefore, reviewed every year, and we add to them regularly," she explains.

Among the providers looking to help companies maximise their employee health spend is Westfield Health. It offers employees access to a 24-hour counselling line as well as up to six face-to-face counselling sessions under its Employee Assistance Programme. Jill Davies, chief executive at Westfield Health, says these features - especially the advice line - will give employees more freedom than relying on pharmacies alone.

It is uncertain, then, whether it is the pharmacies or the health service providers that have the upper hand. Government advisors are clear that businesses have a vested interest in ensuring employee health, but spending cuts in the NHS and pharmacy system are a likely result of recession. A combination of the two may be the answer, but for the moment employers wishing to take advantage of pharmacies will still have to pay for it.


Aviva (formerly Norwich Union Healthcare) is launching a health-screening service, called MyHealthCounts, designed to reward individual policyholders for improving their lifestyle. In 600 pharmacies across the country, including those at Tesco, staff will measure Aviva clients' biometrics, including resting heart rate, blood pressure and cholesterol to produce a 'wellness score'. The initiative aims to highlight where policyholders can make lifestyle changes and, if these are implemented successfully, to reward them with a reduced policy premium.

Aviva's clinical spokesman, Doug Wright, says pharmacies were chosen as a partner because of their unique positioning as high-street healthcare professionals. He adds: "Pharmacies have a significant amount of training and work in a controlled, regulated environment. They are also located in an environment that is easily accessible and which is non-confrontational. It is government policy for pharmacies to take on a greater role in preventive healthcare - this is a practical way of making national policy happen."

But, of course, the state of the nation's health is not just a government concern, and employers have sound commercial reasons to keep their employees as well as possible - they stand to save around £100 billion, according to government policy advisor Dame Carol Black in 2008.

Wright comments: "Employers see the need to improve productivity and manage absence costs. That is why our commercial policies are increasingly centred on being a direct business support activity and not just an employee perk."


In 2005, British Gas introduced back-care workshops, involving a self-management programme designed to help employees manage back pain and take responsibility for their health and fitness. Almost 300 employees participated, and the company realised a 43% reduction in absence related to back pain. This amounted to a business benefit of £1,660 per participating employee, or a return of £31 for every £1 invested.

And recently, pharmaceutical company AstraZeneca offered employees counselling and one-on-one support as part of a broader package of health and wellbeing activities. As a result, the group benefited from an 8.5% reduction in absence and a saving of £1.2 million in related costs.