Sunil Lakhani, pharmacist and owner of Sai Pharmacy in Newham, London, talks to Saša Janković about setting up a clinic to help the rising number of people with latent TB in the area.
Service type: Latent TB testing.
Name and location of pharmacy: Sai Pharmacy, Newham, London.
Name of pharmacist: Sunil Lakhani, owner.
Why did you start offering this service?
I started offering this service in 2018. Newham is unusual in its demographic mix and has a hugely transient population. It is the second most densely populated borough in the country, and East Ham station has 60,000 people using it every day – making it one of the most widely used tube stations outside central London.
Public health officials had noticed we had an increased incidence of TB in the borough, which was affecting people across all levels of our demographic. We have a young population from outside the EU that travels a lot and who were coming back as carriers at TB and not being treated. For the last ten years there has also been an increase of antivaxxers generally, so not all of the population have been vaccinated against a variety of preventable illness including TB.
The biggest difficulty with TB treatment is the duration of time that the medication has to be taken for, which is six to nine months. There can also be side effects, which affects compliance. The idea was to develop a service that could facilitate better compliance and hence work towards better treatment and the possible eradication of this illness. It’s an NHS service which, I think, is unique to Newham: it is a joint approach between a number of pharmacies and some of the commissioners who saw TB as an increasing problem and potentially an increased burden on secondary care, especially if the disease took hold and started to spread.
The service has also coincided with PHE’s Tuberculosis in England report, which showed that 19 people per 100,000 of the population had TB, but in Newham it was 40 per 100,000 – 2.1 times the national average.
How much did it cost to set up the service?
It didn’t cost us anything to set up, as fortunately the cost for the service was covered by the borough.
What, if any, training did you or other team members have to undergo?
The team did some CPPE training on understanding TB and the treatment, and had to pass the training before they could carry out the service.
In a nutshell, what does the service involve?
People are diagnosed with TB through a specific test carried out by a GP or hospital. They then get referred directly back to the GP for a prescription for treatment every two weeks, but the problem was in their compliance.
The way our service works is that at the start of treatment and every two weeks (or month) thereafter we see the patient to check a urine sample to make sure they are taking the meds, and that the disease is being controlled by that medication. Before the GP issues any further prescriptions we carry out the sample analysis, and send the results to the GP to say there is evidence that the patient is taking the medication as we can see the breakdown of those drugs within their urine, whether the patient is or isn’t experiencing side effects, and that the disease is being well controlled. We then make an appointment to see the patient in another two weeks (or month), and ask the GP to issue another prescription. This continues through the full duration of their treatment – up to nine months.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
They can’t get their next prescription issued unless they have attended the service, and under normal circumstances, if a patient misses an appointment we try and chase them up and pass on the DNA to the GP practice.
How have patients responded to the service?
Very well. They like the interaction, and I think they see it is a valuable service as we were assisting them to ensure compliance.
Roughly how often each month do you carry out the service?
We see about 10 patients every week, and each appointment takes about 15-20 minutes, although this has gone down to about three people a week during Covid because a lot of people ‘fell off’ the service for a number of reasons.
We didn’t run the service at all during lockdown as we didn’t want to be face-to-face with someone with a respiratory condition, plus those with latent TB shouldn’t have been going out anyway as they were considered in the ‘vulnerable’ category as their lungs are already impacted. Instead, during lockdown we asked them to send in urine samples with a third party so we could carry out the urine tests that way.
As restrictions have eased, I am hopeful that patients will now start to come back into the pharmacy once more, but I think a proportion of them who were either working or studying here have returned to their home countries because of the pandemic.
How much do you charge for the service?
Would you recommend offering this service to other contractors?
It has to be in response to a local need, but if you are in area where TB appears to be on the rise then yes. If you have a population that is not protected by virtue of having had the TB vaccine, alongside an elderly population that has never been vaccinated and are at risk, then putting in place a programme where community pharmacy is involved is great.
People talk to pharmacists all the time about not taking their medicines, and in conditions like TB where a patient doesn’t necessarily show any symptoms they don’t believe they are ill until it’s too late. Being a community pharmacy is about understanding the role of medication in community healthcare and ensuring we a correctly positioned to provide health advice and clinical treatment where applicable for our local population.
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