Rachel Carter speaks to Andrew Hodgson about his minor ailments service.
Service type: Minor ailments.
Name of pharmacy: Andrews Pharmacy.
Name of pharmacist: Andrew Hodgson.
Why did you start offering the service?
I've been offering this service since 2005. The Primary Care Trust, as it would have been then, wanted to commission it. It’s a valuable service, it takes the pressure off A&E, GPs and out-of-hours services and it brings a potential income stream into the pharmacy.
How much did it cost to set up the service?
No financial costs, but a cost in staff time of attending CPD sessions.
What, if any, training did you or other team members have to undergo?
When the service launched, there were some evening sessions organised by the PCT. There have been training updates that we need to complete since, which are largely around safeguarding. Obviously we also need to keep ourselves up to date with any changes in the terms of the service - the choice of antibiotics on some of the PGDs have changed, for example.
In a nutshell, what does the service involve?
The service includes four PGDs covering impetigo, urinary tract infections (UTIs) and cystitis, conjunctivitis in babies, and oral thrush in infants.
We did have a lot more POM PGDs in the past, but they were decommissioned. In common with other areas, there has been a shift towards decommissioning these types of services. We started off with a few PGDs, similar to what we have. Around 2010, we had nearer to 10 PGDs covering a variety of conditions. Most of these have since been decommissioned because of a lack of activity and because of the move on a national footing towards decommissioning enhanced services locally.
We currently see the most activity for the UTIs and cystitis PGD. If we take that as an example, we invite the patient into the consultation room and go through their symptoms, check for red flags and see what action they’ve taken already. We follow the PGD in terms of that consultation - if they have suitable inclusion criteria and no exclusions, we would then supply advice and antibiotics. The first line is normally a three day course of Nitrofurantoin.
There is no follow-up, but we advise the patient that if the antibiotics aren’t effective, infection re-occurs, or gets worse, then they should see their GP.
Each consultation usually takes between 10 and 15 minutes and they are all recorded on PharmOutcomes, which informs the patient’s GP that they have received the service at our pharmacy.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it?
Possibly, but there are not significant opportunities.
How have patients responded to the service?
The patient response has been really good. The service means they don’t need to go to their GP, they don’t need to take that time out, it’s a walk-in service. If you don’t pay for prescriptions you don’t pay for this service, and if you do pay then you would pay for the service, so it’s like getting a script.
Roughly how often each month do you carry out the service?
At most we see one patient per week.
How much do you charge for the service?
The service is free if patients don’t pay for their prescriptions.
The back of the consultation form is like the back of a prescription, so the patient either pays £9 down, or ticks an exemption.
Roughly how much a month do you make from offering the service?
The clinical commissioning group (CCG) pays us a £10 fee per consultation, plus the cost of the item dispensed, and we do three to four per month.
I would say there is a bigger potential [for this service] out there. If you look at the number of consultations that the CCG has for urinary tract infections, for example, GPs are still seeing a lot of them, so there is a potential for pharmacy to do more. It’s about getting consistency in the delivery - it’s not currently consistently delivered across all of the pharmacies in the area.
Would you recommend offering this service to other contractors?
It’s a useful add-on to what we do, but it wouldn’t support the business and replace the main income stream we have from dispensing. I would like to see the volume up - all of these services need to bring in a similar level of income to replace what we already do. So, I don’t mind doing four minor ailments consultations per month, but there needs to be a much bigger range of income streams outside of dispensing to sustain pharmacies.