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Offering an ear, nose and throat service: ‘Our local surgeries have really got behind it’

By Rachel Carter

26 Aug 2020

Nitin Lakhani, contractor at Jaysons Pharmacy, tells Rachel Carter about the eye, ear, nose and throat (ENT) service on offer at his pharmacy.

Name of pharmacy: Jaysons Pharmacy, Long Eaton and Wollaton.

Name of pharmacist: Nitin Lakhani.

Why did you start offering the service?

I started offering this service in 2019. It was a new service commissioned in our area to relieve pressure on GPs for extended minor ailments. It was an ideal service for us because we’re all clinically minded here and we do other clinical services, so it matched up with our own policies and strategy as a pharmacy too.

How much did it cost to set up the service?

The only cost was going on the training. The first pharmacist to go on the training was paid for by the Clinical Commissioning Group’s area team, and then the training of subsequent pharmacists was paid for by ourselves.

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

You go for one day’s training, where they go through the normal processes of how to deliver the service. We looked at consultation skills, such as history taking, the theories behind it, and a template for a way to think about it. This was followed by examination, red flags and differential diagnosis. Finally, we looked at giving medication – both antibiotics and over the counter – following up with patients and logging the details on PharmOutcomes.

In a nutshell, what does the service involve?

This is an eye, ear, nose and throat service. We’ve created a summary sheet that details the inclusion and exclusion criteria. There is one at the GP surgery – so if the patient is over a certain age or has certain red flags, then the surgery shouldn’t be referring to us. Similarly, we’ve made a simple chart for the pharmacy staff side, which enables them to check if the patient is eligible for the service. The staff check this, and then if appropriate they will let the pharmacist know that the patient would like an ENT consultation.

The pharmacist takes the patient into the consultation room, completes the history taking and does any required examinations. The consultation is logged on the patient medication record and on PharmOutcomes. Under the PGD, we can prescribe certain medications, or recommend patients buy any over-the-counter medicines.

If the consultation takes place at our Wollaton branch, we may be able to supply OTC medicines under the Pharmacy First scheme. That’s it – the patient is asked to sign three forms, one for consenting to the consultation, one for consenting to their information being shared with the doctors, and a patient feedback form.

If a patient presents with an eye condition or a throat condition, then under the current circumstances [coronavirus], we have a notice up in the window, advising patients to please not come into the pharmacy if they have a temperature or new persistent cough. They will be asked the same questions regarding those symptoms over the counter, and the same safety net would be done by the pharmacist before they take you into the consultation room.

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

Following diagnosis, the pharmacist has four choices:

  1. If the condition is self-limiting, we provide information and reassure the patient not to worry about it and it will go away in so many days. But we will safety net it to say – should it deteriorate by all means come back to the pharmacy or go to the GP, and these are the things to look out for.
  2. All the patient needs is, for example, some lozenges because it’s nothing serious. But those aren’t available on this scheme, so we advise that if they wish they can buy a lozenge or cough mixture over the counter.
  3. Patient needs paracetamol or a particular medication that is available on the Pharmacy First scheme. We don’t have this at our Long Eaton branch, but at our Wollaton branch we can give the medication under that.
  4. The condition has deteriorated, tonsils are red and inflamed, and the glands are large. The PGD and service level agreement will tell us which antibiotic to prescribe, and I will prescribe that antibiotic.

How have patients responded to the service?

The feedback from patients is excellent – both face to face, from the forms they fill in, and at the LPC meetings where feedback is summarised for the whole area and given to us. Most patients say it’s convenient, very thorough, gets the job done quickly, saves waiting for the doctors and saves the doctors the appointment times. At Wollaton surgery, the GPs say it is fantastic and it’s saving so many appointments.

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

At our Long Eaton branch, 40 times a month, and at Wollaton 60 to 80 times.

At Wollaton, the local surgeries have really got behind it, they can see how much difference it has made. At Long Eaton we’re not getting as many GP referrals, it’s more patients walking in – over the period of time it’s been running, they’ve got to know this new service through different avenues.

How much do you charge for the service?

If we are prescribing and the patient pays for their prescriptions, then there is a prescription charge, but if they are exempt then there’s no charge.

We are reimbursed for the products we supply (at cost) and we also get a professional fee per consultation.

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

Figures not available.

Would you recommend offering this service to other contractors?

Definitely – on two grounds. One is it helps you balance the books. At the end of the day you’re a business, like any GP practice or NHS plc, so you have to make ends meet.

Secondly, it is strategic to do so. Students spend five years of training in pharmacy and they specialise so much on clinical areas, but in the old days we were not called out to help the NHS. Now those clinical skills are being used more, we are integrating with other healthcare professions and understanding each other much better.

It’s become a foundation for rolling out more services, such as travel vaccinations, flu, sexual health, independent prescribing and so on. So, it’s the direction of travel. All of my pharmacists and all of our services are clinical services, and everything – including our staffing structure, premises, IT systems and operating procedures – have all been geared up towards that.

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