Bina Patel’s personal experience with severe pain prompted her to set up a pharmacy service that would help others facing the same issues.
Service type: Pain management.
Name of pharmacy: Kalsons Chemist, Southend-on-Sea.
Name of pharmacist: Bina Patel.
Why did you start offering the service?
I started offering this service in 2007.
I was in a car crash in 2000 and I was in severe pain, but the doctor could only offer me painkillers. Working in a pharmacy, I couldn’t take strong painkillers because I couldn’t focus and I’m not allowed to take NSAIDs, so that left me with no options. I had to go for alternative treatment and physiotherapy.
This experience made me realise that there was a lack of knowledge out there on alternative methods and good regimes to help manage pain, so I decided I wanted to help others facing the same issues.
I also previously worked as a specialist pharmacist in pain management in a hospital setting, so I felt confident about offering this type of service.
How much did it cost to set up the service?
There were no costs. I had the clinical experience and I was already qualified as an independent prescriber, so if I needed to I could prescribe.
What, if any, training did you or other team members have to undergo?
I worked in the hospital for 23 years, during which time I completed my clinical diplomas. For the last seven years of that period, I worked in specialist roles in pain management and I had experience of working in multi-disciplinary acute and chronic pain teams. In 2007, I also began teaching at a local university, on topics including pain management and prescribing, which required me to regularly research relevant topics.
I have maintained links with my multi-disciplinary team from the hospital, so whenever I feel that I need a refresher, I shadow them.
In a nutshell, what does the service involve?
It’s basically a consultation – where we discuss the patient’s expectations, problems, worries and what are the key factors that are causing them pain.
Pain is multi-dimensional and complex, so I don’t look at it in terms of drugs. We do discuss drugs and I will review their medication where appropriate, but the only thing I would maybe consider prescribing is co-codamol. I won’t prescribe controlled drugs. I feel that even though I’m an independent prescriber I don’t want to touch those drugs unless I have set up a good system with the GP practice. Without that, there’s a risk of duplication and of people obtaining drugs from both myself and the GP. You also need to be registered as a controlled drugs provider to prescribe these privately.
I will look at what the GP has prescribed, and speak to the surgery and make alternative recommendations where appropriate. I have a good relationship with the surgery and they are open to me referring patients to them. If I think there is something we can change, then I will always speak to the GP.
Offering this service is very much about how we can empower a person to get control of their life before the pain takes over – my approach is holistic.
I worked with one woman, for example, and her biggest concern was that she could not walk out of the house to take her son to school. We focused on things that would help ease her pain, the psychological issues, managing her weight, and what success would look like for her. We worked on the basis of ‘each day, you will take one step more, and by the end of the month you’ll be able to walk to your gate and see your son off’. Slowly we worked on it and now she’s walking him to school – and she’s lost two stone.
I also refer patients elsewhere as well – to counsellors, physiotherapists and for personal training. I worked with a personal trainer when I was in pain, so I asked him to hire a specialist physiotherapist in stroke and rehab and she now works in his gym, and I have started referring patients to her where I think they would benefit. If I feel that it’s more of a psychological support issue then I will refer the patient to the counsellor, and I provide some counselling too.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it?
It’s mainly NSAIDs and I would prescribe co-codamol, at a stretch.
I try and use whatever is at hand from the OTC side to help them as well – this could include heat packs, tens machines for nerve stimulation, ultraviolet lamps, and any rubs or patches. I also recommend massage regularly.
How have patients responded to the service?
I’ve had good stories, good success, and I’ve had people come back who have told others about the service. This has a knock-on effect because it brings new customers into the pharmacy for other things, such as infection or sinusitis, and those who want support with managing their conditions.
Roughly how often each month do you carry out the service?
I see probably 10 patients each month.
How much do you charge for the service?
I only charge for the consultation if I prescribe as part of it. The charge would be in the region of £15 to £20, which includes time for the consultation and the prescription cost. If I carry out a consultation that involves offering some OTC products and support then I won’t charge for that. I also sometimes carry out this service as part of an MUR, and in that case I wouldn’t charge for that either, because the MUR pays for whatever intervention I’ve done.
Roughly how much a month do you make from offering the service?
It’s not raking in money but it gives me professional satisfaction – I feel like I’ve done something – and it helps build a good reputation for the pharmacy.
Unfortunately when it comes to pain people don’t want to pay. Patients often say ‘well I get my prescription free on the NHS’, but it’s not about that. This is a separate service, and that’s sometimes the hurdle you have to jump over. If it was a properly commissioned service, it would be more profitable. But there is a lot we can do here and it’s about helping these people and understanding them.
Would you recommend offering this service to other contractors?
I think if contractors have an interest then there’s a lot they could do to start. It might be small steps, but with confidence you can build up a good service.
There is a gap in the market when it come to pain. Not so much in terms of ‘oh yes we can sell something here’, but actually I think that the NHS has failed to recognise that this is a key problem, it’s badly managed and it’s not understood by a lot of people.
GPs don’t have time in six minutes to do a full consultation to look at the psychological and lifestyle aspects of someone’s pain. But giving someone that 20 or 30 minutes to do that kind of work, to build a proper consultation and explore the issues will help people to empower themselves. As pharmacists we can do that and offer advice.