Rachel Carter asks Mahyar Nickkho-Amiry about how Dears Pharmacy's weight loss service keeps patients fit and healthy
Name of pharmacy: Dears Pharmacy, Edinburgh and Fife.
Name of pharmacist: Mahyar Nickkho-Amiry. Mahyar is managing director and co-owns the pharmacy group with founder Barrie Dear.
How long have you been offering this service? Since 2017.
Why did you start offering the service? It was part of an overall review of what we were doing. When I joined the group in 2015, we looked at how we could essentially move away from our income relying predominately on dispensing prescriptions and NHS services, to how we could shift some of our income to come from other streams, such as private services.
We came up with several areas that we wanted to explore and start to offer, weight loss was one of them, in addition to travel vaccinations and other private services.
How much did it cost you to set up the service? We have 10 pharmacies in the group and it cost us approximately £1,000 per pharmacy. That £1,000 covers the Patient Group Direction (PGD) package, which we purchased from PharmaDoctor, some training time and cover for staff undertaking training, and some of the materials that we would use to support the service, such as scales.
What, if any, training did you or other team members have to undergo? The approach that we took was to initially train the pharmacists to do the PGD, so they did a combination of the online training provided by PharmaDoctor, as well as some additional face-to-face training that I carried out myself with them.
We then trained other staff members in how to carry out the health checks, which are the first part of the service, and then essentially how to promote the service.
We also engaged with our local GP surgeries and did a little bit of light training for them, just letting them know what our weight loss service is.
In a nutshell, what does the service involve? A patient would come in, they would be taken to our consultation room and we would go through our health check with them. This includes some lifestyle questions, carrying out some measurements of height, weight and body mass [with their consent], and a cholesterol and diabetes check. We carry out the health check because it gives patients a better overall picture of their health and we find this information better motivates people for actually carrying out the weight loss.
Based on the patient’s results, we would then have a chat with them about the different options available. We offer three different treatment options:
The Lipotrim drink, which is a weekly supply and part of a pharmacy programme from the makers of Lipotrim. There is no PGD for this option, but pharmacists carry out additional training from Lipotrim - they all have a folder of information and a standard operating procedure and protocol that they have to follow.
The other two options are Mysimba, a dual combination weight loss tablet, or the Saxenda injection. The PharmaDoctor PGD allows us to supply both of these.
The Saxenda injection is self-administration, but we provide the patient with all the kit that goes with it and we walk them through the advice on how to carry it out. The company provides us with a very good weblink and paper materials to give to patients to support them, as do the makers of the Mysimba tablet.
We talk through each of these options with the patient and allow them to arrive at a decision as to which they would prefer. If none of these treatment options are suitable, we contact the patient’s surgery and complete a referral for them to take to their GP, who can explore what options the NHS could offer with them.
We generally find that one of these three options works for a patient, but we make it very clear throughout our process that this is not just about taking a tablet, an injection or a drink, it is also a combination of diet and exercise - so we go through some suggested lifestyle changes as well. It’s not about getting the patient in and out, and we don’t treat it as a transaction, we treat the process as we’re supporting them as part of a journey to reach their desired weight goals.
The follow-up appointments depend on the treatment selected. With the Lipotrim drink it would be each week. With our weight loss tablet or injection, patients usually receive a monthly supply, so we would check on the patient within the first few days, just to see how they are getting on. Following this, we check in with them at regular intervals during the month to ensure everything has gone okay.
We also give our contact details to all patients using the service so they can get in touch with us if they have any questions. Our long-term involvement varies from patient to patient - some might try the service for a month and decide that, actually, it’s not for them, while others have been with us for three or six months.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it? The patient could decide that they just want to have standard meal replacement drinks, so we do sell Slimfast, which can be purchased without any consultation.
We also sell a range of products to support patients, including bluetooth digital scales, a blood pressure monitor, a fitness tracker, and sport supports for those who are going to be exercising and are worried about joint issues or a flare up.
How have patients responded to the service? The general feedback has been that patients are surprised to see a pharmacy offering so many of these services - they didn’t think that was the case.
They all appreciate the ‘no appointment necessary’ element - you can walk in to see a pharmacist when we’re open and the same applies to our services. They are also happy that they can access these services without having to go and see a GP.
We’ve seen some very good success stories with patients where they have lost a good amount of weight. For each person it’s relative, it depends on what they wanted to look at. For some people they are looking at weight loss overall, while others want to improve their quality of life so they can walk further, for example.
Roughly how often each month do you carry out the service? In each pharmacy we carry out anything up to 15 consultations per month.
How much do you charge for the service? The consultation is free but there is a charge for the treatment. If the patient wants to have the diabetes and cholesterol check, then we also charge £10 for this, but that fee is waived if the patient chooses to go ahead with the service. The Lipotrim drink is a weekly supply, so the patient is charged per week for this, whereas for Mysimba and Saxenda it’s a monthly fee. The cost of the treatment to the patient equates to between £5 to £10 per day, depending on what option they choose.
Roughly how much a month do you make from offering the service? It varies. Across our full range of private services, we are making an average profit of anything between £3,000 and £5,000, per pharmacy, per month.
Would you recommend offering this service to other contractors? Yes. My advice to any pharmacy is to go away and do some research, see if any pharmacies nearby are offering this service and then have a chat with them.
Don’t be afraid to try anything, you might get it right, it might not work, but if you can move your reliance on most of your income coming from the NHS to some of it coming from private means, it will stand you in better ground.