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Travel health: ‘Most of the local GPs refer their patients to our service’

By Rachel Carter

21 Sep 2020

Rachel Carter talks to Chris Mulimba about the travel health service offered at his pharmacy in Sleaford, Lincolnshire.

Name of pharmacy: The Riverside Pharmacy, Sleaford, Lincolnshire.

Name of pharmacist: Chris Mulimba.

Why did you start offering this service?

I started offering this service in 2015. There was a level of demand, with people asking for it, and I had a personal interest in it as well.

How much did it cost to set up the service?

I would say around £1,000, but maybe a bit higher. There were training and PGD costs initially. We did a bit of marketing and advertising as well.

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

I did two residential training courses and some online training with CityDoc, the PGD provider, and yellow fever training with the National Travel Health Network and Centre in London. I still felt I needed more training personally, so I did the Certificate in Travel Medicine with the Royal College of Surgeons and Physicians in Glasgow as well. This was a residential course for a few days and then it was some online training, it took about six months to complete. I also have to do annual updates just to keep up to date.

My pharmacist doesn’t do any travel vaccinations as such, but I’ve been keeping him updated so if he does develop an interest in travel he can easily switch and do the training. He knows the procedures and how the PGD works, so if I’m not here he can book people into my clinics for when I return.

In a nutshell, what does the service involve?

CityDoc is our PGD provider for the service, but I’ve also done my independent prescribing qualification, so I do both [offer the service through both routes]. If anybody presents without going through CityDoc, and it’s something I’m confident in, like hepatitis A vaccination for instance, then because of my training I can actually go through a risk assessment and if appropriate, I could prescribe the product that is suitable for that client.

The first step is to make an appointment for the patient, because I need to have time for them, and I usually offer the service when there is another pharmacist on the premises. When the patient comes in, I ask them to provide their vaccination history and we go through a comprehensive risk assessment. This includes finding out where they’re going, how long for, what activities they will be involved in, and what type of accommodation they have arranged – because all that impacts on their risk.

We go through their medical and medication history, and then look specifically at the risks for the country they are going to, to see what is required for that area. Length of stay is important, because the risk is less if you’re going for a week rather than four weeks, for example. As is accommodation, because backpacking risks tend to be more than if you’re staying in a five-star hotel. We go through all the risks in the country, what the risk is to the patient personally and look at what is being recommended using up-to-date sources of information like NaTHNaC. We then decide what vaccines the patient might require.

If I am prescribing the vaccines, then I would prescribe, my pharmacy team would dispense and check it, and then give it back to me to administer. After administering the vaccines, I ask the patient to wait a few minutes, just to make sure everything is fine before they leave the premises – 10 minutes is generally good. During that time, we make a record and do all the paperwork.

For CityDoc we have an online consultation template, so we fill in all the details and that is kept confidential. I will issue a vaccination certificate and advise when boosters, where necessary, would be due. I also give other information that might be relevant for the area they’re visiting or that is specific for that client. Most of my clients are happy to take the certificate and update their GP in their own time, but if they wish for me to contact the GP then I can do that.

Are there any opportunities to sell over the counter or prescription products during the consultation or after it?

Yes – insect repellant is one. I do keep some on show in the consultation room. I don’t push it, but I just show it to clients and say that it is a product I would recommend, and it is available from any pharmacy. Most of them choose to buy it from me, but they don’t have to. Some clients also ask for specific things, like diarrhoea tablets.

How have patients responded to the service?

The feedback has been very positive. Patients tend to come to me when they can’t get into their GP surgeries. Unless it is a vaccine that is not available on the NHS, like Japanese Encephalitis, most of the GPs around here actually do refer their patients to me. If a patient can’t get into their GP surgery and they need to travel and they need the vaccine, they find that we provide convenience and a service that would otherwise not be there. So, they are quite appreciative of the fact that we can see them at short notice.

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

I carry out the service every day when I’m on duty. When there is another pharmacist on duty as well, it becomes more feasible and flexible to see more patients, so some days I will see as many as 10 patients in a day.

How much do you charge for the service?

The full list of CityDoc charges for travel health services are available on their website. If patients come directly to me as an independent prescriber, I can be more flexible, and could charge a little bit less.

Roughly how much a month do you make from offering the service?

Figures not available.

Would you recommend offering this service to other contractors?

Well if contractors have got the demand and the time for it, then yes why not. It gives the opportunity to offer customers something that they wouldn’t otherwise get without giving eight weeks’ notice to the GP first. If they are travelling at short notice, in two weeks’ time, and they go to the GP then the GP is not interested, whereas we are. So, we can offer something that perhaps there is a gap for, and we should take advantage of that.

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