Rachel Carter speaks to Keyworth Pharmacy's contractor Dharminder Singh about his pharmacy's hay fever service

Name of pharmacy: Keyworth Pharmacy, Nottingham.

Name of pharmacist: Dharminder Singh.

How long have you been offering the service? Since June 2019.

Why did you start offering the service? Due to customer demand. Where we are located is a village setting, with lots of fields, and hay fever was just terrible for people last year due to the high pollen counts. In the 11 years I’ve been here we’ve probably had maybe two people asking for this type of service, but this year I had lots of people asking for help.

Also, the NHS no longer funds prescription-only hay fever medication, namely fexofenadine, and so there is a group of patients who can no longer get what they used to from their GP. A patient came to me who had paid £180 for a 20 minute consultation with a private doctor to get a prescription for this medication, and I had to charge her a further £10 for dispensing it.

After that I looked into whether there was anything I could do to help.

How much did it cost you to set up the service? Around £100. PharmaDoctor, our online Patient Group Direction (PGD) provider, had the training we require and it’s a reasonable price. Assuming you are already competent in administering injections and you’re up-to-date with your life support training, then you can complete PharmaDoctor’s online training.

What, if any, training did you or the other team members have to undergo? Only the pharmacist completed the training. It’s an online learning tool, which includes information to read and reflect on, sources for other background reading and then you take a test. Once PharmaDoctor are happy you know what you’re doing, they authorise you to carry out the service.

In a nutshell, what does the service involve? The service involves a clinical assessment and the treatment options of prescription-only tablets, nasal sprays, or an injection (which is only used for the most severe cases).

If we are presented with a patient who potentially seems suitable for the service, we then conduct a consultation where we do a clinical assessment of them. This assessment is based on the PGD guidelines - we go through a pro-forma and consult with the patient to ensure that they are a suitable candidate.

Once we ascertain that they are, we will then go through all the risks and benefits with them of the treatment, the likely outcome, and side effects.

If the injection is the appropriate treatment then we also advise that this is administered in the buttock, and we normally have a chaperone present for that. There are some minor expected side effects of the injection, so patients are given instructions on how to manage those if they occur.

We keep records and if there are any adverse drug reactions or side effects, then the patient is advised to contact us and we can report it as necessary. At the patient’s request, we can inform their GP and ask that their medical record is updated to say that they’ve had this procedure.

Are there any opportunities to sell over the counter or prescription products during the consultation or after it? There are opportunities. However, I am a pharmacist and not a sales person, so I’ll always offer the gold standard of service, ie things that would be helpful based on the patient’s condition. If that leads to a sale, then fine, but we’re not trying to sell anything particularly. We like to have a holistic approach, as opposed to focusing on one aspect, so we will always make people aware of ancillary products, because we want them to have the full service.

What response have you had from patients? Because the treatment is effective, patients have been over the moon. You’re just returning them back to normal - before the treatment they had streaming eyes, it was affecting them going outside, they were trapped as prisoners in their own home, so getting back to normal is a victory. That’s the main reason I started this, people were struggling and there was no outlet for them.

Roughly how often a month do you carry out the service? It’s a seasonal service, so over the summer I did four injections. I also provided the prescription-only medication to a further four patients.

How much do you charge for the service? The treatment options range from £15 (for the tablets) to £55 for the injection.

Roughly how much a month do you make from offering the service? Approximately £280, so it covered my start-up costs and I made some profit. It’s not a big money maker, it’s obviously seasonal and depends where you’re located, but it’s a community service. If I’ve got two people lined up then that covers the cost of it, anything else is a bonus.

Would you recommend offering this service to other contractors? Yes, I definitely recommend it because patients don’t have access to these medicines anymore.