Pharmacist and IP Jon Smith talks to Saša Janković about running a medicines withdrawal service at Mayberry Pharmacy in Newport.
Service type: Medicines withdrawal service.
Name of pharmacy: Mayberry Pharmacy, Newport.
Name of pharmacist: Jon Smith.
Why did you start offering this service?
I have offered this service since November 2019. I had wanted to become an IP for a long time, but I hadn’t managed to find a medic to be my tutor. So, when the Welsh government made funding available for community pharmacists to train as IPs I approached our health board (Aneurin Bevan University Health Board) – who said they were going to call and offer it to me anyway, so what would I like to do. Most people were training to be IPs in common ailments, but I’ve always had an interest in pain and addiction – particularly helping people addicted to prescribed medicines as there is no service for them – so that’s what I chose.
I was lucky enough to do my IP course with Dr Julia Lewis, consultant addiction psychiatrist at Gwent Specialist Substance Misuse Service, along with pain consultant Dr Sue Jeffs. This enabled me to learn about the pain management process from the point of view of how people get addicted to pain medication, as well as how to help them, by working with the patient to uncover their story and find out what events have occurred in their life that that put them in that position.
How much did it cost to set up the service?
It’s been completely cost neutral as my IP training was funded through Pathfinder funding with the health board, which paid the set up costs, and backfilled with a locum for over half of my time. The only thing needed from me was my time, so I used my annual leave to go to university for the training.
What, if any, training did you or other team members have to undergo?
I’m lucky that I’ve already got a very high skilled team, so the training for them has revolved more around supporting the patients we have coming in to the pharmacy to access the service. People find they get labelled in general as ‘drug addicts’, so the training for staff was around how to help patients change their perception of this. Staff can have these kinds of conversations while the patients are waiting to see me, which is a great way for people to feel they are building relationships with our whole team.
In a nutshell, what does the service involve?
People come to our service through a mix of referrals, and us simply noticing that something might be going on with our customers. We get a lot of GP referrals because most of them have a list of patients they know have a problem, so we work through that list with them, plus we all look out for people who are frequently buying pain killers or chasing their next prescription before its due.
Our objective could be the complete removal of the drug from treatment, which is very slow and patient guided, or it might just be dose reduction. Another option is if the treatment people are on is not effective for their pain, we can do the switch for the GP. Each individual is given the choice about what next step down they want to take, and they can take my prescription to any pharmacy.
Patients see me every two weeks, or sometimes it’s by phone call if they can’t come in to the pharmacy. It’s a patient-centred approach so I start by assessing their anxiety levels around their pain and withdrawal, to understand their fear of giving up. At each point in the reduction schedule I do pain scores with them, we chat about what’s going well and what they struggle with.
It’s very patient oriented and that was the key for me. It’s not a rigid service that people have to fit in, the service has to fit around the patient need and it takes as long as it takes. Some people get through it in eight weeks – which is four appointments – and others take eight months.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it?
There are opportunities but the only extras we would sell are things that help people in pain, such as heat sprays, supports, or mobility aids.
How have patients responded to the service?
So far, all the people we’ve helped wanted to come off their medication, and we’ve got some lovely patient stories. For example, we see a lot of people on huge does of gabapentin who feel like zombies. One lady told me she had spent three years walking round as if the lights were off, but after going through our service she has no increase in pain and can enjoy life now.
Roughly, how often each month do you carry out the service?
We aim for 16 appointments a week, and we see everyone once every two weeks, so at any one time I’ll have 32 people on my list. We do have a waiting list as well, which usually has about six or seven people on it.
How much do you charge for the service?
It’s a health board service, so there is no charge to the patient.
Roughly, how much a month do you make from offering the service?
The idea is that I devote eight hours a week to this, for which the health board pays us £400 a week.
Would you recommend offering this service to other contractors?
Absolutely. The psychosocial benefit to patients who are addicted to prescription drugs is profound. Their lives revolve around their addiction and it becomes an all-consuming process, but we have a real opportunity to make a significant impact on people’s lives. IP services in whatever guise are the way forward, and services like this clearly show how many people can be helped, and how rewarding it is.