Gill Harrington, pharmacist manager and IP at Right Medicine Pharmacy in Kyle of Lochalsh, talks to Saša Janković about running a chronic pain and palliative care service.
Service type: Chronic pain and palliative care service.
Name of pharmacy: Right Medicine Pharmacy, Kyle of Lochalsh, Scotland.
Name of pharmacist manager and IP: Gill Harrington
Why did you start offering this service?
I did my IP in 2011 and chose to focus on chronic pain as I see so many patients every day asking questions about pain – and lots of the same people time after time – but there wasn’t more I could give them. I started the chronic pain and palliative care clinic in 2013 when I was working for a project relating to a community based system of supporting chronic pain and palliative care with Macmillan.
So many people are self-medicating with painkillers or are repeat users prescribed by the GP but finding that these aren’t working. A lot of people with chronic pain also become very removed from society, which is worse at the moment because of Covid. I have seen one lady in her 30s who wouldn’t leave the house because she felt people were looking at her as she couldn’t walk without sticks.
Lots of the advice I give out is about lifestyle changes, encouraging people to look at what’s important to them in terms of how they want to live their lives. A good example is a lady with very severe rheumatoid arthritis on lots of painkillers, who really wasn’t managing. Talking to her, I found out she had three jobs working seven days a week, up to 10pm some nights, but she didn’t actually have a financial need to work this much, she’d just got in the habit. Her original job had been in hairdressing, and she decided to go back to that three mornings a week, which reduced a lot of her pain and meant she was also able to reduce her medication.
How much did it cost to set up the service?
There was no cost to me. The costs for the courses in the first place were paid by my employer at the time, and Macmillan paid the cost of some of the training I did with them.
What, if any, training did you or other team members have to undergo?
I’ve done my IP training, palliative care courses and clinical assessment courses. I make sure I keep up to date with any new pain information that comes out, plus we have to do revalidation every year.
In a nutshell, what does the service involve?
Originally it started with GPs referring patients to me, and once I went into community pharmacy full time the word got around. Covid has had an effect because there is less access to GPs, but people still want someone to talk to about their pain issues.
In recent months I’ve seen more patients wanting to come off strong opioid painkillers because they feel it’s affecting their lives. People have become aware that they have got into that slide of medication that starts with wanting something that works for their pain, and if it doesn’t they ask for the next thing along, and only when they look at it over time do they realise it’s not working for the pain plus they have side effects too.
I do far less prescribing that I do support. Asking questions and listening is how I help. There are lots of physical reasons for pain but these are augmented by psychological reasons, so if you can address those as well it helps. People want to be heard and taken seriously, and if they feel that you are doing that they open up to you, which helps you work out what you can do for them. Some of my best information has come after 30 minutes of general chat with the person, and just as they are leaving they’ll throw something important out there.
I can suggest reduction plans to help patients come off medication, including speaking to their GP and getting their support, and referring to OTs. I can give their GPs information about alternative medications they can think about using that don’t have the side effects of opioid medications. I’m also involved in the local NHS pain clinic which covers the whole of the Highlands and is inundated with patients.
We have recently started trialling Nurokor bioelectronic pain relief treatment in the pharmacy, as we were looking for other things we could add to our pain service. This is non-intrusive, doesn’t seem to have any side effects, and can aid lifestyle changes because builds up muscle stamina and reduces inflammation which helps people move more.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
Yes – as and when it’s appropriate. In Scotland we have Pharmacy First, so that’s an opportunity to prescribe and be able to give people the advantage of using OTC products without having to pay the cost for it.
How have patients responded to the service?
Really well, although there will always be some you never see again, if they don’t want to make the changes you suggest or accept what can be difficult advice for them.
Roughly how often each month do you carry out the service?
We see people every day for pain and there are always interventions I can make, whether over the counter, or via consultations with patients for something more in-depth.
How much do you charge for the service?
Roughly how much a month do you make from offering the service?
There may be some advantage to the pharmacy’s bottom line but I don’t think it’s a cost enhancing service, it’s part of what is the right thing to do. It’s the word of mouth that is the advantage for the business, to get people to come into the pharmacy.
Would you recommend offering this service to other contractors?
Yes. You build up a strong relationship with people because you see them at very difficult points in their lives. And it’s not just a benefit for customers but for me too, because it’s always so nice to be able to do something for someone else and see them get an improvement from it.