Pharmacist and IP Fiona McElrea, owner of Whithorn Pharmacy in Dumfries and Galloway, talks to Saša Janković about offering pain management advice as part of Scotland’s new Pharmacy First service.

Service type: Pain management.

Name of pharmacy: Whithorn Pharmacy, Dumfries and Galloway.

Name of pharmacist: Fiona McElrea.

Why did you start offering this service?

We’ve offered advice on pain management since NHS Scotland’s Minor Ailment Service was introduced in 2006, and subsequently since the new NHS Pharmacy First Scotland service launched in July. In addition, from September 2020 community pharmacists who are IPs can lead an extended version of the Pharmacy First service – called NHS Pharmacy First Plus – which is great news for me as I have just qualified as an IP.

We see people dealing with pain all the time in community pharmacy and we wanted to help. The Minor Ailment Service was only available to certain patient groups, so it’s great that we have moved on to the Pharmacy First service, because that covers everyone resident in Scotland.

In a nutshell, what does the service involve?

People come to us presenting with all levels of pain, from general pain to headache or dental pain, muscle and sciatic pain. Even side effects from other medications can cause certain pain, so I talk to them to establish what’s causing the pain, how we can treat it and who we can refer them onto if necessary, as well as giving advice on any pain relief they’ve already been prescribed. For me it’s a whole bigger picture of pain management which involves delving deeper and asking the most appropriate questions.

If necessary, I then refer people on, within the NHS and the private sector, depending on what I feel is the best option. This could be anything from referring them to their GP, a physio, pain management clinics, sports therapists – and I’ve even done dietary referrals for people who have pain in their feet.

I’m always on the lookout for red flags, and there’s also the angle of addiction to be aware of. We see people getting dependent on OTC products, so it’s about having discreet conversations with them if we feel they are buying too often, and referring them on to the appropriate help.

How much did it cost to set up the service?

NHS Pharmacy First Scotland is fully funded so there is no cost to me. However, when the Minor Ailment Service first started a key part was that we had to have a consultation room, so way back then we had to redesign our pharmacy to make a private space for patients.

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

Delivering Pharmacy First and PF Plus is very much a team effort, which starts with the counter assistant dealing with patient when they first come in, and then being able to refer back to me.

My IP training was funded by CP Scotland, so they backfilled us for the time I spent at university, and for Pharmacy First they offered a range of training for the whole team. Before Covid they were having road shows and since then it’s been online with whole team training in the pharmacy.

The extra consultation time and clinical skills that pharmacists now have mean we have to delegate some of our traditional roles to our team, which has opened up opportunities for dispensers, technicians and accuracy checkers to train up and take on more of what would traditionally have been my role. This has incurred a cost to us in time and money, but there are small grants available to cover this. I think it’s well worth the investment, because if you look back about 15 years the role of the pharmacist and the pharmacy team was so different then, and now at last we are all trained to do what we should be doing.

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

Yes, there are. With Pharmacy First we have now got a national prescribing formulary so for each condition – such as pain – we have a list of medicines we can prescribe on PF which will be reimbursed on NHS, so there is no cost to patient. If they want a branded medicine – for example, a melt-in-the-mouth painkiller – they have to buy it, but the advice is always free.

How have patients responded to the service?

Overall, we’ve had a very positive response from patients because they know we are always open, we have a private consultation space, and they don’t necessarily need an appointment. People can chat to us for longer and in more detail about their pain, and don’t have to rush like they often feel when they see their GP. In a place like this, with small population, you get to know your patient and they trust you. They see us as a first port of call and come to us for specialist for advice about medicines.

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

I see people every day for pain.

How much do you charge for the service?

There is no charge, unless the person wants to buy a particular product not covered by the Pharmacy First formulary.

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

Pharmacy First is funded by the Scottish government, which pays a monthly base payment [of £1,250] – like a retainer – for providing the service, plus another payment depending on the number of patients who access it each month.

Would you recommend offering this service to other contractors?

Helping people with pain management can make a huge difference to their lives, and I would definitely recommend becoming an IP as well, because it enables you to add yet another layer of service to your customers.