How to set up a travel clinic in your pharmacy


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16 Aug 2017

Running a travel clinic can be profitable for a pharmacy and provides a much-appreciated service. Wojtek Bereza explains how to get started

Key learning points

• Check your area’s cultural demographic to see if there will be demand for particular vaccines

• More people are travelling abroad, so this is a good time to enter the market

• Various profit-sharing models exist – consider which is right for you

For the past seven years, I have run an independent travel clinic in a pharmacy in North London. It has not only been financially fruitful, but also professionally rewarding.

Once I finished my pre-registration training, I was a little disheartened at the thought of becoming an automaton putting labels on boxes for the rest of my life; I had a thirst for more.

My previous work experience had mainly been in the catering sector and I loved talking to clients and creating something bespoke for them. I now get this feeling when talking to patients about travel. I find it very rewarding to listen to their stories of where they will go. The passion and excitement to see the world is often infectious and I am a willing recipient.

I have found the main benefits of running a pharmacy-based travel clinic to be as follows:

• Increased patient accessibility to a much-needed service – around one in four people who go abroad from the UK do not get the vaccines they need. In addition, last year, 2,000 UK citizens contracted malaria from abroad, resulting in 20 deaths.

• Professionally rewarding – during each consultation you will need to create a bespoke travel regimen.

Financially rewarding – I am trying to balance the NHS income I lost to funding cuts by increasing my private services. So far, it has proved extremely successful. According to your specific demographic (you can find out here), you can tell whether there are Muslim populations in your area, which may create a demand for Hajj and Umrah meningitis vaccinations.

However, there are a few other things you should do to check whether a pharmacy travel clinic is likely to be successful in your area. I always do the following strengths, weaknesses, opportunity and threats (SWOT) analysis when evaluating a new endeavor. Here’s what I considered for my travel clinic.

Strengths

• Opportune moment – now is the best time to open a pharmacy travel clinic. Many early adopter pharmacists have already started up and have a head start. However, there is still capacity in the market. In addition, more people are going abroad from the UK than ever, so now is a great time to capture this opportunity.

• Complementary service – you may already be running a flu clinic, and patients are becoming more familiar with receiving vaccines from their local pharmacist, so travel is just a short step away. Also, the services can dovetail – there is no reason not to give a flu vaccine with travel vaccinations.

Weaknesses

• Change in direction – if you feel you have specialised in other areas, such as weight loss or men’s health clinics, running a travel clinic may take away your focus from these.
A rule I tend to live by is to try to maintain your specialisation instead of becoming
a jack of all trades and master of none.

• Cost – the cost of set-up can vary greatly. Patient group direction (PGD) services cost
in the region of £400 to £2,000 to start.

Opportunities

• Check your local GP for travel services – many GPs in the UK are discontinuing their travel clinic provision because of financial constraints in the NHS. In my experience, doctors are happy to welcome pharmacists into this area as they lose the ability to prescribe vaccines and antimalarials on FP10. They like to have a low-cost alternative they can recommend to a patient.

Threats

• Do a Google search – from a survey of hubnet.io members, we found that 60% of patients who come to a travel clinic do so because they have performed a Google search for a local travel clinic. Why not do the same? Find out if there is competition in your area. If not, that’s a signal that you will probably be successful.

Getting started

So there are numerous benefits to running a travel clinic, but how do you get started?

In my opinion, there are three main ways:

1 Become an independent prescriber (IP) specialising in travel medicine.

2 Get yourself trained in PGD protocols and offer the service from your pharmacy.

3 Find a travel health-trained pharmacist (either IP or PGD) and use them for walk-in and booked appointments.

The first option, becoming an IP, allows you to work outside the confines of a PGD and gives you control of your own competency. However, the downsides are many – especially as the course takes time to complete and can be quite costly (near £2,000).

I did an IP course myself as I managed to procure funding from my local GP and the local pharmaceutical committee (LPC), but they did not fund my time, so I had to take a sabbatical. King’s College London, where I did the course, required me to do a 90-hour shadowing stint.

I came out the other end pretty confident in the legalities and practicalities of prescribing. However, I felt that my knowledge of travel medicine was not fully up to scratch, so I went on a course with the Royal College of Physicians and Surgeons in Glasgow.

The other, in my opinion, easier way to start a clinic is to use PGDs. A PGD is a prescription written for a defined group of people. A prescription is a legal contract between a prescriber and patient saying the prescriber is an authority and deems this to be a suitable treatment.

By signing the document, the doctor is putting his name on the line if something goes wrong, so there is a direct line of responsibility saying that this doctor wrote this prescription for this person.

A PGD defines a cohort of people that can be supplied with a particular medicine under certain conditions, say occupational health professionals who need a Hepatitis B injection or patients at risk of contracting flu.

So, essentially, a PGD is when a POM is supplied without the need for a patient-specific direction such as a prescription.

I have had more than 10 years of experience training pharmacists in vaccinating protocols, and have learnt that everyone has different starting points of competence.

There are numerous companies supplying PGDs, they greatly differ in price, quality and revenue that you keep. When shopping around for PGDs, the ideal scenario is to find the following:

• High-quality training – enabling you to become autonomous, ideally, the training should be led by a pharmacist who has had direct experience running a clinic.

• Little to no revenue share of patient consultations – some PGD suppliers take
40% of your revenues; others do not take a cut.

• Good clinical support – even though you should be confident enough, you will always need a place to refer to if you get stuck. Whilst the National Pharmacy Association (NPA) offers an excellent helpline, it often does not have a specialist on hand for the more complex issues.

For example, someone who has been administering influenza vaccines for the past eight years would have a higher initial competence than someone who has done fewer. Therefore I recommend
this pathway:

• Season 1 – administer flu vaccinations and become anaphylaxis and cardiopulmonary resuscitation qualified.

• Season 2 – increase your capabilities by providing other vaccines, such as hepatitis B and potentially branch out to using the malaria PGDs. You could potentially offer this in combination with the meningitis Hajj PGD.

• Season 3 – branch out into travel. Take it slowly initially and use the array of etools we have available from the PGD provider.

Training is of the utmost importance. Many a time I have seen pharmacists opt for a cheap training provider who trains for generic non-pharmacist-led clinics.

Although the pharmacist is then able to start a travel clinic, they do so half heartedly and often fold before they renew their subscription. My advice is to use an experienced, pharmacy-based training provider that can not only give you the skills but also the confidence to start a successful travel clinic.

Wojtek (Mike) Bereza is managing director and chief pharmacist at Voyager Medical

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