Rob Alman, owner and pharmacist at Hillside Pharmacy in Church Stretton and Wenlock Pharmacy in Much Wenlock in Shropshire, talks to Saša Janković about being part of an osteoarthritis project.
Service type: Osteoarthritis project
Name and location of pharmacy: Hillside Pharmacy, Church Stretton and Wenlock Pharmacy, Much Wenlock
Name of pharmacist: Rob Alman
When did you start offering this service?
Why did you start offering this service?
We were approached by Keele University to see if we wanted to get involved with their JIGSAW-E (Joint Implementation of osteoarthritis guidelines across Western Europe) service, which aims to improve the quality of care and support given to people about self-management for osteoarthritis in line with NICE guidance. The JIGSAW-E approach includes a consultation, training for professionals delivering the care, a patient osteoarthritis guidebook and quality indicator recording and measurement tools, which can be delivered in the way that best suits the local healthcare context.
I worked with Dr Colin Stanford – a retired local GP who now works with the JIGSAW-E project at Keele University – to put together a pilot for pharmacy. We met with Arthritis Care groups in our community to get a flavour of how we could pitch the service and what we needed in terms of information and booklets for patients to back it up, as well as how to measure and share our results. The service is currently only in Shropshire but we are hoping to expand across the Midlands and eventually make it a national initiative.
What, if any, training did you or other team members have to undergo?
There were a couple of training evenings for some pharmacists in the county to get on board, and we were supplied with leaflets, posters and Keele University’s Guide for People Who Have Osteoarthritis handbooks to give to customers. I make sure our staff understand the service and know to give out the handbook.
In a nutshell, what does the service involve?
Our customers are of the more mature demographic and osteoarthritis is a major issue for some, but it’s not a given that they will need surgery if they exercise, lose weight, and quit smoking. With this in mind, we opportunistically ask patients who are asking for heat rubs or heat packs and painkillers if they are having trouble with their joints. If they are being treated by their GPs we will not interfere, but if not then we can start the conversation about osteoarthritis and what can help.
As part of the pilot, we got a module put onto PharmOutcomes which helps with the consultation, and we also use the guidelines for healthcare professionals from Versus Arthritis. We give customers a copy of Keele’s handbook as it doesn’t go into too much detail about the inflammatory side of things but has lots of practical information about diet and exercise that is useful for most people. We advise them to start small with what they can do, and progess from there.
I have a personal interest following a car accident 20 years ago, after which I was told I would never walk again, and so arthritis and pain relief is very close my heart. Having worked on it since then I know first-hand that exercise and diet definitely works, and I am able to share my experiences with our customers. We are also trying to develop a list of organisations and physios that can help people with exercises.
We used to be able to direct people to our own smoking cessation and weight management services which were very successful, but these have both been pulled, which is very unfortunate as they are desperately needed right now, more than ever.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
We might make an extra sale of paracetamol or ibuprofen and heat rubs, but that’s not our aim.
How have patients responded to the service?
I got involved with the local Arthritis Care group and I met a lot of people there who I was able to follow up with in the shop to see how they are getting on, and the results are good – they notice a difference.
However, there is often initial resistance because if you tell someone they just need to do some exercise or lose weight the first thing they say is they can’t as they can hardly walk. Swimming is also great, but people are often put off by that as well. We have to encourage them to try small things first, working out how far they can actually walk, or bend, or swim, and then try little by little to do more.
Roughly how often each month do you carry out the service?
We see about half a dozen people a month, although the pandemic has obviously had an impact on this, but it is picking up again now.
How much do you charge for the service?
It is free for the patient.
Roughly how much a month do you make from offering the service?
We get a small consultation fee from some NHS England development money from the LPN, but it is minimal and barely covers the time we spend on the consultation.
Would you recommend offering this service to other contractors?
Yes, definitely. It’s a very holistic service approach and although you don’t get a reasonable return on your time spent, if you play the long game and look at the bigger picture you can’t put a price on the goodwill and respect that comes from it.
Further resources on osteoarthritis:
Keele University, Guide for People Who Have Osteoarthritis https://www.keele.ac.uk/media/keeleuniversity/ri/primarycare/OA_Guidebook.pdf
Versus Arthritis osteoarthritis information booklet