Working in a small community brings specific challenges — ones that a pharmacy group in rural Wales has tackled head on, Vincent Forrester reports

Fferyllwyr Llŷn – Llŷn Pharmacists – is a small community pharmacy chain on the Llŷn peninsula in Gwynedd, north-west Wales.

Two of the group’s three pharmacies are on the peninsula itself; the third, its newest branch, is about 50 minutes’ drive away in the historic mining town of Blaenau Ffestiniog.

The peninsula, which juts into the Irish Sea, is one of most remote and rural regions of the UK. This has helped it foster a reputation as a bastion of Welsh culture. Indeed, Gwynedd has more Welsh speakers than anywhere else in the country, according to the most recent census.

Will Hughes – one of the five owners of Fferyllwyr Llŷn, four of whom are pharmacists – says these demographics are an important factor in determining the services the pharmacies offer.

The pharmacies are in quite isolated areas. ‘In Nefyn, we are the only pharmacy for seven miles. The Llanbedrog branch is the only pharmacy in the village. The Blaenau Ffestiniog branch has one local competitor,’ Mr Hughes says.

This is one reason they offer services outside the standard remit of community pharmacy. The chain employs 34 people, in part-time and full-time positions. Each pharmacist has their own ‘niche expertise’. This enables Fferyllwyr Llŷn to provide a wide variety of services to a small and disparate community.

Mr Hughes’ specialism is allergy testing. He has run an allergy service for about five years and offers two tests: an environmental test, priced at £50, and a food intolerance test at £80.

Communicate with patients

But not all patients will benefit from a test, says Mr Hughes.

‘People call in saying: “I’ve got a bit of a rash on my torso and I’m convinced it’s down to my chocolate allergy,” or something. Actually, when you have a chat with them, it’s obviously just a bit of eczema.’

‘We get rid of a quarter to a third of consultations at the first stage. I think people have misunderstood allergies to be the answer to everything.’

Those who qualify for a test are booked in for a consultation. If they are taking antihistamines they are asked to stop.

The first part of the consultation is spent discussing the patient’s case history. ‘It’s about building a story because the test is never the full story,’ says Mr Hughes. ‘Was there an event that caused the allergy? Maybe they got food poisoning and, since that time, they’ve had a stomach problem. It could be that this has induced a food intolerance for shellfish, say.’

The tests itself involves taking a small vial of blood using a kit the company buys.

‘It takes me about 25 minutes to test the sample. The patient comes back and I go through the results and their case history and hopefully we can come up with an action plan,’ says Mr Hughes.

Often his advice is lifestyle related, rather than clinical. It could be anything from suggesting a nasal spray to recommending that the patient contact the charity Allergy UK to learn about anti-allergy bedding.

If a dog owner is revealed to have an allergy to their pet’s dander, the simplest solution may be to stop their dog sleeping in the same room as them. For Mr Hughes, running an allergy clinic is as much about problem solving as providing clinical care.

Providing income

He says the service provides a ‘slow and steady’ stream of income that is ‘good in this economic climate’, but it also helps foster valuable long-term relationships with patients.

While the company maintains a website and a Facebook page – and has benefited from ‘a few GP referrals over the years’ – it doesn’t actively promote the allergy service, preferring to rely on word-of-mouth recommendations.

‘You can do a good medicines use review (MUR) in 10 to 15 minutes. The allergy service takes a bit more time than that,’ Mr Hughes says.

‘But you build loyal patients when they’ve had a good service from you. They come back. It’s not just the fee you’ve gained, that £35 or £40 from the allergy test — they become loyal customers to you for a long time.’