Rachel Carter speaks to Jusmin Chandaria from Egerton Pharmacy in north London about the minor ailments service on offer.
Service type: Minor ailments.
Name of pharmacy: Egerton Pharmacy, Islington.
Name of pharmacist: Jusmin Chandaria.
Why did you start offering the service?
We’ve been offering this service since 2019. We wanted to provide more services to our customers and enable people to have more access to healthcare, because there is such a barrier to getting GP appointments for minor ailments. Obviously people have to pay for this service, but for those that are able to afford it, it is more convenient.
How much did it cost to set up the service?
The initial set-up costs are quite high. We purchased a whole bundle of PGDs from Pharmadoctor, including other services like travel health, which cost between £1200 and £1500. There was the cost of printing marketing materials, such as leaflets, which was around another £1000. We also pay in the region of £200 to £300 per month to keep our website and any Google adverts actively maintained, and £150 per month to Healthpoint TV, which allows us to advertise our services on the screens in the pharmacy.
What, if any, training did you or other team members have to undergo?
All the training was online. It involved self-study of the relevant materials and a self-declaration, to say that you feel competent enough to provide the services. If you get stuck on anything you can give Pharmadoctor a call.
In a nutshell, what does the service involve?
If we take throat infection as an example, the first thing we would always do if a patient comes in complaining of a sore throat is use the front counter. This is the traditional way of speaking to a customer, asking how long they have had the symptoms and what they have tried already. We would not signpost them to the service straight away. Most throat infections are viral so a patient does not need a strep test, but also we want to encourage self-care, not PGD use. The PGDs really come into play if self-care hasn’t worked.
Once you’ve determined what the patient has already tried, then we can explain that we have the service and ask if they would like to be tested. We say that if the result is positive we may be able to prescribe antibiotics, but we never say we will definitely prescribe, because at the end of the day it still has to be the pharmacist’s decision and what they think is best.
If the patient chooses to go ahead with the next stage of testing and treating, we invite them into the consultation room. We use the appropriate diagnostic test to take a swab. While the test is taking place and we’re waiting for the results, the patient can fill out the risk assessment form. Each PGD has its own individual risk assessment form that must be completed, and only when the necessary criteria are met would we proceed or supply any medicine.
If the criteria are met and the test result is positive, then for a throat infection we may prescribe penicillin, or if the patient is allergic, clarithromycin.
Finally, there is an option for the patient to tell us if they would like their GP informed that they’ve received the service. In an ideal situation you would want to inform their GP anyway, but due to GDPR, we must get consent.
In terms of a follow-up, it depends on the PGD criteria. If it’s for a throat infection, I will normally say to the patient please come back and we’ll see how you’re getting along. Other services, such as UTIs for example, require a follow-up appointment. We invite the patient back for a second dipstick test after three days, to see if the antibiotics are working for that particular UTI.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it?
Yes – there are a range of over the counter remedies that a patient might choose to aid getting better. For throat infection, we might offer something like a Difflam spray to help soothe the symptoms, so that at least they can swallow and eat properly. We could also offer ibuprofen and paracetamol.
How have patients responded to the service?
Very positively. However, the fact that this is a chargeable service does create a barrier – it’s only accessible to patients who are able to afford it.
Roughly how often each month do you carry out the service?
It varies – but on a weekly basis we’ve usually seen five or six patients.
How much do you charge for the service?
For any of the minor ailments services that require what we call the ‘test and treat’ element, we charge £20. This is because the kits are quite expensive for us to buy in and also it can take up to 20 minutes of our time to provide this service. If it’s just a consultation service, such as ear infection where we will not be undertaking any diagnostic testing, then we charge £10.
Would you recommend offering this service to other contractors?
I would – but by the time you put all the costings in, it is very expensive and it won’t suit everyone. Contractors will need to consider whether it’s appropriate in terms of their footfall, the demographics of the area, and affordability. It is very dependent on who can afford it – but if the NHS were to commission pharmacies to deliver this service, we would all be very busy.