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Erectile dysfunction service: ‘We found a massive gap in the availability of treatment’

overprescribing

By Rachel Carter

19 Aug 2020

Pharmacist Sailesh Pindolia says offering an erectile dysfunction service helps build rapport with patients, which in turn leads to more custom for the pharmacy.

Name of pharmacy: Bush Pharmacy, Hammersmith and Fulham, London.

Name of pharmacist: Sailesh Pindolia.

Why did you start offering the service?

I’ve been offering this service for about seven years. I wanted to change the pharmacy’s approach to pharmacy, and what I mean by that is I didn’t want to become a retail offering on a high street. Obviously, there is a retail element to what we do, but I wanted to do more clinical work, and just by chance the erectile dysfunction service was available through a provider. There wasn’t an initial reason behind choosing this particular service, it was one of many things that I did at the time, but when I looked into it, I could see a place for it in the pharmacy and for my patients.

I found there was a massive gap at the time – erectile dysfunction treatment was only available on the NHS and to get the medication patients had to meet a very stringent set of criteria. I was having people who didn’t satisfy the criteria come to me and ask if they could buy it, and I was having to say no. So, I could see that it wasn’t a service that would go nowhere if I did it. It had potential and although doing more clinical work was my main focus for choosing to do it, there was a business opportunity too.

I think people also overlook the fact that this is quite a debilitating condition and has quite an impact on people. When they come and see me for a treatment and I can’t give it to them, and the GP didn’t give it because they didn’t satisfy the NHS criteria, then it does impact on their mental health. They get quite down, and you won’t see them again. There is a lot to gain – apart from the obvious – by getting the treatment, so that’s why I started.

How much did it cost to set up the service?

The PGD cost around £50 to £60 and I spent a couple of hundred pounds on advertising too. I had a TV in the window and paid an advertising company to upload adverts to it and paid for some leaflet and poster printing.

There is also a time cost in terms of staff training. The pharmacist is the one who is authorised to do the service, but to recruit the patients you can’t always be there because you’re not always patient-facing, so I had to spend some time training staff on what to look out for and how to approach people.

What, if any, training did you or other team members have to undergo?

Erectile dysfunction can be a difficult subject to approach so for the training with my staff I used one of the CPPE modules on ‘dealing with difficult discussions.’ I did the module with them and we talked about how to discuss the subject, how to be sensitive and how to empathise with patients.

As the pharmacist, I have completed online training with the PGD provider to deliver the service. Through university, we already have a good understanding [as pharmacists] of the treatment, what it entails and how it works, but the PGD training gives more detail on interaction with other medications, for example. I have to complete a refresher course annually.

In a nutshell, what does the service involve?

The patient will be referred to me via the staff and due to the nature of the issue I will take them into the consultation room to discuss further.

We talk about what they want and why, and go through an assessment form for the service, which is provided by the PGD provider. One thing on the form that is very good is the severity indicator test. Depending on the answers, the patient gets a score and if they score between 8 and 15, then they qualify for the treatment, providing the other criteria are met. There are quite a few exclusion criteria, such as certain medical conditions and age group. We also do a blood pressure check to ensure it falls within the safe parameters.

The treatment options available are sildenafil, vardenafil, and tadalafil. A lot of people tend to know what they want when they come in, so our job is to ascertain if it is suitable for them. I don’t call people to follow up and ask if the treatment was okay as a matter of routine – apart from in a few cases where we’ve had patients who have been particularly worried, they want the tablet but they are scared of the tablet for example. Generally, if people like the service, then they will come back to you and that is your follow-up.

Are there any opportunities to sell over the counter or prescription products during the consultation or after it?

I wouldn’t say there is a link-selling opportunity, because there isn’t really anything to link this service too. Someone may sometimes buy a blood pressure monitor, but I don’t link those to the service. What will happen though is, if you see a patient that you’ve not seen before and you are able to give them what they’ve not been able to get, which is the medication, then you find they will come back to you. Or having spent 10 minutes in a room with you, they’ll talk to you about something else, so you’ll get another sale out of it – but not because of the erectile dysfunction treatment, it’s because you’ve built up the rapport. That’s the beauty of these kind of services, it’s like a gateway – you start with one thing and then so many other things can come of it.

How have patients responded to the service?

If their smile is anything to go by when we say they can have the tablet, then the response is pretty good. I think patients are happy. In the earlier years of doing the service you would get a lot more feedback, because they’d have had such difficulty in getting treatment. But it’s not such a rarity to be able to get it from a pharmacy now, and there’s a low-dose product that can be bought over the counter without the PGD too. Patients are still grateful though.

Roughly how often each month do you carry out the service?

I see five or six patients on average each month, but it varies. There are some peak months where you get more: December is often a busy time.

How much do you charge for the service?

We don’t charge anything for the consultation. These PGDs are marketed as ‘you could charge a consultation fee and then charge a fee on top for the medication’, that’s where the profitability is in the service. But, personally, I don’t want to do that, for me it’s about the long game. As long as I can afford the time then it’s okay – I might give some free advice if I spend five or 10 minutes with somebody, but at least I retain their loyalty and they will buy from me again. I’m not coming to the pharmacy to give a consultation; I’m there anyway, is how I see it. I think people like that the consultation is free.

The price for treatment depends on what tablets a patient has and the strength of those, but it ranges from £7 for a pack of four, to around £24.

Roughly how much a month do you make from offering the service?

Figures not available.

The money side is not a massive driving factor because I don’t think I, or anyone, can make huge amounts directly from this service itself – but you do make the money from other things that the person comes back to you for.

Would you recommend offering this service to other contractors?

Yes, 100% you should do it if you can. If it was just the service and selling a pack of tablets for £6 or £7, and then nothing else happened after that, I would not be so sure. But because you increase your value and get more from the patients in the long run, then that makes it worth your while.


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