Allie Anderson talks to Graham Phillips about his pharmacies’ ProLongevity – ‘Live Healthy for Longer’ diabetes prevention and healthy living service
Name of pharmacy: Letchworth, Newington and Pierremont Pharmacies
Name of pharmacist: Graham Phillips.
How long have you been offering this service? Since 2019.
Why did you start offering the service? I’ve had a research interest in type 2 diabetes going back 10 years, and my interest in preventative public health spans my entire professional career. In pharmacy, we’ve been seeing more people with type 2 diabetes and prediabetes every year and handing out more medication. But that doesn’t seem like the best solution if the causes of type 2 diabetes – poor diet and a sedentary lifestyle – aren’t addressed. In short, we are supressing symptoms and not addressing the root causes
So we developed a service that combines blood sugar monitors and apps, combined with our experience to interpret that information and develop a programme specifically tailored to each individual’s biology. That way, we can recommend and support lifestyle changes that can help people to lose weight, feel better, lower the chances of developing cancer, cardiovascular disease and dementia, and even reverse prediabetes as well as type 2 diabetes.
How much did it cost you to set up the service? It didn't cost much money, but it took around five years of research. I spent more time studying this than I did my pharmacy degree. The investment into brand creation, website development and digital marketing was about £10,000.
What, if any, training did you or other team members have to undergo? I run it by myself at this stage but as it grows, we're going to start training other pharmacists as well as bringing nutritionists on board. In the pharmacy, a certain level of healthy living advice can be given by others but fundamentally it must be overseen by a pharmacist or someone who is suitably trained and qualified.
The training required would depend on their knowledge baseline. For example, a GP and a nutritional therapist are both interested in delivering the service, but they have different qualifications and base-level knowledge.
Anyone running the service would need to fully understand everything I've learned about diabetes and the numerous factors that affect cardio-metabolic disease and metabolic syndrome, like diet, lifestyle, exercise and sleep. There are plenty of specific courses pharmacists can do to up-skill.
In a nutshell, what does the service involve? ProLongevity is an eight-week programme aimed primarily at helping people who have prediabetes or hyperinsulinemia, who are at risk of diabetes, or who have been diagnosed with diabetes. However, it has broader benefits around metabolic syndrome and even cancer prevention. It aims to help people develop a healthier lifestyle by addressing their diet, exercise habits, stress levels, sleep patterns and supplementation.
When patients come into the service, they are asked to fill in a questionnaire that asks them about all of those lifestyle factors.
We also examine the results of a panel of standard tests that any GP would normally offer – liver function, lipid profile and HbA1c – which, combined with their questionnaire answers, will indicate whether or not the patient is suitable for the programme. Only If I think we can help them, will I sign them up.
The initial consultation lasts up to two hours and can be done face to face or virtually, via Skype for example. I marry up their test results and questionnaire answers with the patient’s objectives. It may be that they have with polycystic ovarian syndrome (PCOS) and can’t get pregnant or that they struggle to control their hypertension. Or, it may be simply a patient who’s reached a certain age and they’re thinking about long-term preventative health strategies.
The patient is given a continuous glucose monitor (CGM), which they wear for eight weeks. They also keep a diary in that time of all their meals, drinks and physical activity. All the information and results are monitored via an app, which makes correlations between diet and blood sugar levels.
After a fortnight, we can establish which foods are healthy for that individual and which aren’t, and work out some lifestyle changes for the patient to implement. They are typically a series of small, incremental changes, like replacing foods that spike that person’s blood sugar with others that don’t, and adopting healthier bedtime routines and sleep patterns.
Over the remaining six weeks, the patient continues to wear a CGM as they embed those changes into their everyday life. The results continue to be monitored while their blood sugar and insulin levels normalise, and their energy levels stabilise. They gradually begin to notice the pay-off – for example, they might lose weight, their blood pressure will come down, their HbA1c will fall and other symptoms of metabolic syndrome will decrease. Normally, this correlates with a boost in mood, energy and general health and well-being.
Importantly, everything is personalised to the individual and I always work with the patient’s GP. For the duration of the eight-week programme, patients can contact me as frequently as they want either in person or through Skype or WhatsApp – whichever medium they prefer. At the end of the programme, they are given a whole resource of information so they can go away and manage everything for themselves.
Are there any opportunities to sell over-the-counter or prescription products during the consultation or after it? If a patient’s medications need to be changed or reviewed, I or another pharmacist will do a standard NMS or MUR consultation. As part of ProLongevity, we recommend specific prebiotics, probiotics, vitamin D and magnesium supplements to certain people, because it’s almost impossible to get adequate levels through the diet. Other than that, I don’t try to sell lots of supplements because our message is simple: ‘eat real food’.
How have patients responded to the service? Generally, very well indeed. For example, an NHS GP who signed up for the service described the positive results he achieved as ‘a miraculous metamorphosis’. A year after signing up, his HbA1c was normal, his gout had resolved, his psoriasis had improved, and he reported that his concentration was far better. Those kinds of testimonials are typical. But generally, the more engaged the patient is, the better their outcomes, and it also depends on their starting point.
Roughly how often each month do you carry out the service? I see about 20 different patients each month, each of whom I’d be in contact with a few times in that period.
How many patients do you see in a month? The maximum would be about 20, who I'd see a few times in that period. Last year, around 100 people went through the service.
How much do you charge for the service? Currently it’s discounted to £750. For that, patients get four continuous glucose monitors (CGMs) – each one can be worn for two weeks – all the tests and analysis via the app, an unlimited amount of input from me, as often as they need, and a resource of information to refer to and reflect on at the end of the eight weeks.
Roughly how much a month do you make from offering the service? Let’s just say that the income we've received from ProLongevity significantly exceeds all other forms of enhanced income. We're making more from it than MUR and NMS.
Would you recommend offering this service to other contractors? Yes. We are currently in the process of data analysis and we ultimately plan to offer it to the NHS and make it available more widely via selected, high-quality, independent pharmacies.