Pharmacist Alex James from Devonport Pharmacy in Plymouth tells Rachel Carter how his private hay fever service works

Service type: Hay fever.

Name of pharmacy: Devonport Pharmacy, Plymouth.

Name of pharmacist: Alex James.

How long have you been offering this service? Since July 2019.

Why did you start offering the service? It was a decision from above - the company wanted to offer new services and more private services. We decided to go for the full package of PGDs from Pharmadoctor, and hay fever was included within that. Also, before I joined this pharmacy, they ran a clinical trial here for the Dymista nasal spray, which is on the PGD. The results were very promising - so the two together work well and the hay fever service is one we’re looking to push more.

How much did it cost to set up the service? The whole package of PGDs costs around £1,000 for one year. We also built and developed a new website purely for the private services, and we pay a £200 subscription for that each year.

What, if any, training did you or other team members have to undergo?

There wasn’t much additional training needed, other than reading the PGDs and understanding the medicines. I’d previously done other training in terms of vaccinations, for example, and so I just reviewed some of the medicines I wasn’t familiar with like Dymista and the Kenalog injection. I looked at more information around what they are and how they work. I also looked at their costs, which enabled me to come up with a price list for the service.

In a nutshell, what does the service involve? The first step is the patient makes contact with the pharmacy and we will discuss an appointment time. We try and do all the services on an appointment basis just so we can fit patients in at quieter times and make sure there are no interruptions. We book people in on our website, which allows for text notifications that keep people up to date as to when their appointment is, send a reminder before and ask for feedback afterwards.

When the patient comes in, I give them part of the risk assessment form to fill out. This takes their name, details, and some health background. We then go into a deeper discussion about what their main symptoms are, what they’ve used before, if anything, and what prescriptions they may have had.

The majority of patients interested in this service have used something on prescription before, or bought it. If they haven’t, we generally make an over-the-counter sale and tell the patient that if it doesn’t work we can offer them slightly more expensive, but more effective, items through the service.

We then talk through what’s the best mix for them and come to a decision, whether it’s a nasal spray, tablets or the injection. The injection is a last resort really, partly because of the cost, but mainly because we want to know that the other treatments have failed [to help the patient]. On the PGD there are Fexofenadine tablets, the Kenalog injection, and four different nasal sprays available - Dymista, Rhinolast, Nasonex and Beconase.

The consultation normally lasts 15 to 20 minutes. The first five minutes is the patient completing the forms, and then 10 to 15 minutes for discussing symptoms and taking their full history. If patients require a follow-up appointment then the prices differ slightly, because it doesn’t take anywhere near as long. We usually have a five to 10 minute chat - this includes going back over the risk assessment to make sure nothing has changed with their medical history, and discussing how they’ve been getting on with the products and what they’d like to do as their next step - if anything at all.

Are there any opportunities to sell over the counter or prescription products during the consultation or after it? There are other OTC products we can sell - so there are other nasal sprays such as Sterimar, which is really popular and we recommend that to everyone, or last year we also had a gel spray available called Prevalin.

We also sell Beconase over the counter. It’s on the PGD, but that’s a larger bottle and there is no price benefit for the patient to get it through that route, because we do charge that little bit extra. So generally, if someone comes in and they’ve not used any nasal spray before, we try Beconase as an OTC first of all. It’s much more efficient for us and for the patient. If they find that really works then they can get larger quantities through the PGD, or if they find it had no or only a mild benefit, then we can try one of the slightly stronger sprays, or the combination products, available through the service.

How have patients responded to the service? It’s definitely positive - it’s all about the convenience in terms of not having to go to the doctors. A lot of patients are finding it difficult to get an appointment to discuss hay fever with their GP, so they are coming to us because they have been referred by the doctor. We’ve discussed how we can get prescription products for them, and people have been fairly happy.

Roughly how often each month do you carry out the service? We see one or two patients each month during peak season. But we only started in July last year, which is the later part of the hay fever season, so this summer will be the real test in terms of how much we do.

How much do you charge for the service? There is no consultation fee, so if we went through it with someone, found that they’d tried all the products we offer, and there wasn’t anything else we could do to help, there wouldn’t be a charge. The other prices are as follows:

  • The Kenalog injection is £35.
  • The nasal sprays range from Nasonex at £15 to Dymista at £25.
  • One pack of 30 Fexofenadine tablets is £12.

The prices reduce by a couple of pounds on repeat, just because it takes less time and there is less work involved with the follow-up appointments.

Roughly how much a month do you make from offering the service? Figures not available.

Would you recommend offering this service to other contractors? Yes, I would definitely say it’s beneficial. We see lots of people coming through OTC sales who are repeatedly buying a hay fever medication, but are not getting the full benefit from it. So, this gives us an opportunity to better support our patients, as well as make a bit more money.