Serving the needs of a diverse community

‘Cultural competence’ in healthcare service delivery is a term we all need to become familiar with and understand.

Most pharmacists may feel they already act in a culturally competent way, but there is much more that can be done.

Put simply, cultural competence is the ability to interact with people from different cultures and respond to their health needs; and creating a working culture that recognises, respects, values and harnesses difference for the benefit of the organisation and individuals.

A related concept is ‘inclusive professional practice’, about which the focus has recently been on Black, Asian and Minority Ethnic (BAME) groups, given the disproportionate impact of Covid-19 on BAME people.

A Public Health England report showed that people of BAME backgrounds have a 10–50% higher risk of death from Covid-19 compared with those of white ethnicity when other factors (such as age, deprivation and region) were controlled for.

What does this all look like in a community pharmacy? And how can pharmacy teams better support the diverse communities they serve? InPharmacy has been finding out:

Bola Sotubo, is a Primary Care Pharmacist at Mile End Hospital and also a co-contractor at A-Z Pharmacy in West Croydon, London. In the pharmacy she is responsible for setting up clinical services and the development of staff.

She says around 90 per cent of the local community she serves in West Croydon are from a BAME background.

“We understand the cultural differences and we try and adapt the way we communicate with a patient.

“We are surrounded by a mosque and several churches. We’re also members of the business community here too, where our job has been helping people to understand healthcare services but also the work we do in our pharmacy.”

Combined together, Bola and her staff speak eight different languages – something which has become a vital asset in their day to day work.

“If people come in and we need to get a message across, we try and speak the local dialect and language by bringing the appropriate member of staff forward to have that conversation with them. There are people who visit the pharmacy based on the fact that they know someone here from their own culture or background, that speaks their language.”

One of the discussions Bola is having with patients at the moment is around vaccine hesitancy.

“We’re not just giving them leaflets but we are having individual conversations where people are going away and understanding the development of the vaccine better,” explains Bola.

“We’ve got our staff vaccinated so that they are confident to pass on the message to the community.”

A-Z Pharmacy has been part of the fabric of West Croydon for 20 years and Bola believes it is important they continue to adapt and meet the needs of their patients.

She says: “We tailor our messages to meet the needs of the local community. I think it’s very important because there are times that might impact how they self-care and how they might use their medicines or take up healthcare services.”

She adds that pharmacists have an important role to play in dispelling myths and creating trust within communities.

“By understanding their culture and being able to explain the benefits of a service or why they should do something, this will impact on how they take responsibility for their own care,” she says.

This same sentiment is echoed by Atul Patel community pharmacist and independent prescriber at Lincoln Pharmacy in St Paul’s Way, East London.

He believes it’s “absolutely paramount” that healthcare professionals are aware of the nuances of the communities they serve.

Atul used to take on pupils from the nearby secondary school, St Paul’s Way Trust, and have them working in his pharmacy during the weekends.

“Some of these kids went on to become pharmacists, lawyers and teachers.”

Atul’s work ethic and tenacious attitude for change prompted Lord Andrew Mawson, a social entrepreneur and peer, to invite him to join the St Paul’s Way Transformation Project (SPWTP) in 2006.

The project is tasked with bringing together, in a joined-up project, the physical improvements along St Paul’s Way, which is one of the most deprived areas in East London and in the midst of Europe’s largest regeneration area.

“As pharmacist and GPs, we get stuck in treating people’s symptoms and we don’t address the cause,” says Atul.

“The cause is we don’t spend more time with people. That’s why we’ve done what we’ve done in our pharmacy. We have three consultations rooms and a robotic system – this makes it easier for all my staff to prioritise their time with patients rather than focusing on medicine management. We need to help in making people aware of the role they’re playing in creating their own circumstances.”

Atul often does assemblies at the local school about health and entrepreneurship, facilitates work experience, and does mock interviews for students applying to study pharmacy or medicine in university.

“The makeup of the school is diverse with many of the children of Bangladeshi origin. Because some of their parents had poor educational backgrounds, they had inherited limitations aspirations.

“We had to change that mindset and so we went on journey which we are now 18 years into.

“In the pharmacy we have a structured work experience programme where kids come in for two weeks. Some want to desperately stay with me so they return as part time workers and gain more experience in communications skills. I now have four apprentices, between two practises, who are doing pharmacy technician courses and want to stay on. We’ve created an environment where they can flourish.

“It’s about embracing local talent and nurturing them, which was needed.”

Hasmita Patel, a pharmacist for K&W Healthcare Limited in Brent, West London says one of the most pressing issues she has noticed is the need to build trust in communities.

She currently works in a Covid vaccination centre in the BAPS Shri Swaminarayan Mandir Hindu temple in Neasden.

As project manager, her main role has been managing pharmacists in the centre and the vaccinations process. She is also promoting the uptake of the vaccine in BAME groups.

“In terms of promoting we have been speaking to radio channels about the vaccine uptake and we supported an imam coming onto the clinic to do a video, so he could promote it to the Muslim community too.

“It’s really important to raise awareness. We’re in an area that’s got a very diverse population but the people coming in are not necessarily representative of the population we cover, so more needs to be done.”

Ade Williams, Director and Superintendent Pharmacist of the M J Williams Pharmacy Group and the Lead Prescribing Pharmacist at Bedminster Pharmacy in Bristol, says building trust has been a key element in the work he has been doing.

“I ask patients, ‘who do you trust?’ Your local pharmacist down the road or some guy on Facebook or on a Whatsapp message?” he says.

In January Ade organised a pop up flu vaccination service in a local mosque.

“We had evidence showing that there was a low flu vaccine uptake in those communities,” says Ade.

“There was this correlation where those people who not had the flu vaccination were more likely to not take the Covid vaccine.

“If we didn’t do something about breaking barriers regarding the flu, then we were going to have a double barrier with the Covid jab. So we went in the mosque and set it up.”

Ade explained that he “had to be proactive” and start building confidence in those communities around the vaccinations.

“By doing this, it also opened up the conversation about what more we could be doing and how we can be moving forward. As a follow up we’re hoping to open up a Covid vaccination clinic in the mosque soon.”

Ade has also been involved with broader engagement work around vaccinations in Bristol. He wants to use his skills and experience to make a positive contribution to the wider health system in Bristol, as Associate Non-Executive Director of the North Bristol NHS Trust.

He says: “One of my roles is to speak to that narrative of what brings us together. We have to be united as a city to tackle some of the issues around health inequalities that exist.

“Sadly, the pockets of health inequalities are linked to areas of social deprivation and they often have the largest concentration of minority communities.

“It’s not about making anyone feeling guilty; but to highlight the issue and talk about the broader reason as to why they exist and what we can do about it.”