Kristi Hussain, pharmacist manager at Everetts Pharmacy in West End, Southampton, talks to Saša Janković about the benefits of private PGDs.

Service type: Private PDGs

Name and location of pharmacy: Everetts Pharmacy, West End, Southampton

Name of pharmacist: Kristi Hussain

When did you start offering this service? July 2021

Why did you start offering this service?

Sometimes as a community pharmacist when you are not a prescriber it can be frustrating when a patient walks in with a straightforward issue and you know what they need but you have to send them back to their doctor to get a prescription.

Offering private PGDs is pretty new to us as I've always focused on NHS services, but we started because we saw a gap in the market because of this, and because of how stretched GP services have been, and how long it’s taking patients to get assessed, diagnosed and get prescriptions.

How much did it cost to set up the service?

Our superintendent found a provider who offers the training for free under the Patient Access umbrella, and then we pay each time we do a consultation under the PGD, plus a small monthly fee for the necessary software.

What, if any, training did you or other team members have to undergo? The training follows the same format for each PGD and you get a certificate for each condition. An online PowerPoint takes you through what symptoms you are looking for, what patient groups are affected, differential diagnoses – for example, for rashes – inclusion and exclusion groups for the drug, when appropriate to prescribe and when not, and what the doses should be. There’s a test of your learning at the end, and if you pass you get a certificate and then access to the PGD.

There are plenty to choose from and it only takes me an afternoon to do the training. Just recently I had a situation where a woman was asking about norethisterone for period delay as she was going on holiday the following week. I didn’t have the PDG but I knew I would be able to complete the training quickly so I said if she came back the next day I would be able to supply it.

In a nutshell, what does the service involve?

Patients attend either because they have booked online or through the Patient Access app. Sometimes they will phone and ask for something we can do this way, or walk in and ask for help, and out of hours and at weekends is often when we see patients taking the PGD option.

The training from Patient Access offers almost as many PGDs as you can think of, so we chose the ones that best meet our patient population need and what we see day in day out. Contraception, EHC, impetigo, oral thrush and hayfever are big ones for us. As long as the patient meets the symptom and inclusion criteria and has nothing on the list of exclusions – such as another medicine which interacts, age, complex conditions – we can give it there and then.

Are there any opportunities to sell OTC or prescription products during or after the consultation?

Some conditions have an OTC or prescription-only PGD option. A good example is oral thrush: most groups can buy Daktarin oral gel OTC at £7 for a 15g tube, but that’s not enough to get them through a 7-day course, or we can give them an 80g tube for virtually the same total price on a private PDG. And if a patient is on blood thinner we can’t sell Daktarin but can give them Nystatin on the PGD instead, which saves them having to go back to the GP for a prescription.

Sometimes the PGDs enable us to link sell an item – such as recommending paracetamol, or a multivitamin if someone is run down – but there’s not much overlap with other services.

How have patients responded to the service?

I’ve never had anyone turn it down when I've presented it as an option. The only downside is that my area is a village with quite an elderly population so there’s not as much opportunity as if we were in a city centre pharmacy with a young or working professional population.

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

About 5-10 a month at the moment, but there is a lot more room to grow into it because we haven’t really advertised yet.

We’ve just had a refit so it’s a really good time to use the new pharmacy to advertise new services to our customers. We now have a big purpose-built consultation room which allows me to do a much better job for doing consultations with patients in a structured way, and this will enable us to push this service more.

How much do you charge for the service?

Because it’s essentially a private prescription we need to cover the cost of the item, and we charge a small fee for the consultation of £10. If it’s a drug that costs us pennies we might roll it into the consultation cost, but if it’s a branded drug we charge for it. The consultation fee is only for the first consultation, so patients can pay for just the medicine again if nothing has changed the next time they come back.

Would you recommend offering this service to other contractors?

Yes, definitely, but I’d advise others to do their research with the PGD provider. If you are paying through the nose for every PGD, whether you use it or not, that will make or break your profit. Costs aside, it’s a great way to show what we are capable of, and a good way to relieve pressure from GPs and help patients get treatment more easily.