Jackie Lewis, owner, superintendent pharmacist director and IP at Lewis Pharmacy in Exmouth, Devon, talks to Saša Janković about running a cancer care service.
Service type: Cancer care service.
Name and location of pharmacy: Lewis Pharmacy, Exmouth, Devon.
Name of superintendent pharmacist: Jackie Lewis (co-owner with husband Martyn).
When did you start offering this service?
About six years ago.
Why did you start offering this service?
When I started the service no one in pharmacy seemed to be talking about cancer much at all. It grew into offering in-depth MURs to customers on their cancer-related medication, as well as working with local charities, hospitals and GPs to offer a seamless network of support for people with cancer. We also ran a mole screening service for a while, although our local hospital in Exeter is very good at seeing people for this quickly, so we didn’t continue with that.
I was subsequently diagnosed with breast cancer myself, and since then I have been involved in every stage of the cancer pathway.
How much did it cost to set up the service?
It depends on which parts we are talking about. We got a £10k grant for ‘Not Normal For You?’ but that only covered backfill.
What, if any, training did you or other team members have to undergo?
I have done various training over the years. My aim is that the cancer eLearning hub that I have developed on the British Oncology Pharmacy Association (BOPA) website will help encourage all members of pharmacy teams across the country to learn more about their role in cancer care.
In a nutshell, what does the service involve?
There are lots of things we can do to help our patients, depending on what their needs are. For example, during the pandemic I have been helping patients having chemotherapy understand how to access their Covid vaccinations, because they only have a three-day window during their treatment schedule where this is appropriate. I also keep in touch with all my customers having chemo every couple of weeks to see how they are getting on.
A recent project involved designing a service with a local GP and Macmillan facilitator, Dr Jane Aitken, which we called ‘Not Normal For You?’ which enabled pharmacy staff to engage patients in conversation and refer on those with red flag cancer symptoms. We trained 150 staff to deliver the service in 10 pharmacies in East Devon, but this particular service was time limited and only funded for six months for set-up and evaluation. The next stage is to get the cancer charities, CCGs and LPCs around the table to discuss what we want to happen next.
I’m a member of BOPA, and my latest project has been developing a series of free e-learning modules on cancer for the whole pharmacy team which have been published on the British Oncology Pharmacy Association website.
Ultimately, I want to be known as a cancer hub, hosting support groups in my three consulting rooms and being known as the place to come for advice on everything from finding wigs, to supportive care.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
There is one area: when you are on chemotherapy taking probiotics can interfere with treatment and potentially cause sepsis, so there is a role for pharmacy in helping patients holistically when they can’t access other things, and give advice around vitamins, mineral, herbals – and possibly even CBD for anxiety, which one doctor asked me about recently.
How have patients responded to the service?
Initially, years ago, patients said the secondary care they were getting was great, but over time I noticed they started to come in and ask me more questions, and so do the local GPs.
All our assistants know what red flags to look out for when selling OTC for cough and stomach problems, and we know that these can be life-saving interventions. We had a patient who had been coughing for six weeks and our assistant referred him to his surgery. We later found out he had been diagnosed with cancer, and his wife subsequently called us to let us know he’s in remission.
Roughly how often each month do you carry out the service?
I believe the stats are that community pharmacy will see 32 patients a year who are diagnosed with cancer, but it’s increasing all the time. I see one person a day, pretty much, but this is growing because of Covid and people thinking they can’t see their GP and realising I have this expertise.
How much do you charge for the service?
We charged for the mole-screening service when we ran it, but everything else is free.
Roughly how much a month do you make from offering the service?
I see it as part of the HLP basic contract – it’s not about money, it’s about being in your community and helping your community and whatever follows follows.
Would you recommend offering this service to other contractors?
Absolutely. There’s a lot more scope for pharmacy to get involved in this kind of service now, and it’s more worthwhile than ever, as GPs are closed.