Rachel Carter asks George Wickham about how he runs Luxton Pharmacy’s travel health service in the student town of Exeter
Name of pharmacy: Luxton Pharmacy
Name of pharmacist: George Wickham.
How long have you been offering this service? Since 2015.
We initially started offering it as a member of the MASTA travel service, and then we took on the PharmaDoctor package alongside this about two years ago.
Why did you start offering the service? Generally, we were looking for opportunities to use the skills that we had in the pharmacy, make more of the consultation room space, and where we could provide healthcare services that weren’t available or would be beneficial. Travel health fits in quite well with things like flu vaccination, which we were already doing. I’d heard about other pharmacists doing it, so it seemed worth exploring.
How much did it cost you to set up the service? The training and Patient Group Directions (PGDs) cost in the region of £500 to £600 – that’s what you end up paying, whether that’s for MASTA or for Pharmadoctor. The rest of it we generally already had, eg sharps disposal we had already for the flu vaccination service.
What, if any, training did you or other team members have to undergo? For MASTA we did two days off-site, face-to-face training. It also involved other staff members completing an assistant course, which a couple of mine did.
For PharmaDoctor you did it all yourself, entirely online and it probably took around three or four hours in total. I also completed one of the CPPE courses on vaccinations, which is something you can do in two or three evenings.
In a nutshell, what does the service involve? For the Pharmadoctor Travel Health service, patients come to us in different ways – some do walk into the pharmacy and ask because they’ve seen our poster in the window, but a lot of enquiries come over the phone first of all. A customer phones up and my team pass them to me directly if I’m free, or if not they will take the details and I will ring the patient back.
We do a quick screening service to find out where the patient is going and what their timescales are. Sometimes clients are going to destinations that require no travel vaccinations at all, or they are leaving tomorrow and what they need is actually really complicated – so it’s important to clarify this information.
If we’re going ahead, we then book the patient into a session using a Google diary, typically allowing about 10 to 15 minutes per consultation. We have the most common vaccines in stock as we’ve learned what we need to keep.
The patient comes into the consultation room and we go onto the PharmaDoctor e-clinic system, which we use to fill out all the patient’s details. This includes their personal details, medical history, their trip destination and departure date. The system then works through an algorithm that gives you the recommendations of vaccinations required for that particular destination. The system walks you through the whole process from beginning to end, and it’s good because it suggests vaccines that are ‘strongly advised’, as well as those that may or may not be necessary or ones required only if the patient is doing something unusual.
The patient then selects the vaccinations they want to have and we administer them. The PharmaDoctor system also gives patients their own log-in, so they can look at the vaccines they’ve had and if they go anywhere else in the future they can check whether they are already covered – it’s like a portable record.
For the MASTA Travel Health service, the patients are told what vaccinations they are having and what the cost is, and they come in expecting to be given them. So all we do is confirm that nothing has changed and administer the vaccinations, as per the MASTA travel health plan. We know what they are having and it’s very much a supply-only role.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it? We always stress the importance of patients taking some basic health essentials with them on their trip, such as anti-diarrheals, rehydration salts, sun tan lotion and insect repellant. We sell a lot more insect repellant than we ever did before – because we have to stress the importance of the fact that although we can vaccinate against many things, there are still plenty we can’t, like dengue fever, for example. That is causing real problems around the world and there is no vaccination against it, so the best defence is having a really good repellant.
We also sell mosquito nets, tic removers, a range of anti-histamines, bite relief, and a really good reusable drinking bottle called Aquapure, which costs around £35. You can basically put anything in it – river water, hotel water – and it purifies the water, so for people going off for six months backpacking, for example, it’s a much better way of having safe water and much greener than buying bottled water.
We find that because people are already spending money on the vaccinations, then they are generally more relaxed about spending money in the pharmacy. Patients also value that we’ve screened these products to ensure they are suitable.
How have patients responded to the service? Patients are very supportive and we get a lot of repeat custom. We tend to find that there are a cohort of patients that are always travelling. We do virtually no local advertising because we don’t need to, it’s all by word of mouth. For example, we find every year that we vaccinate lots of school groups who are going off to Africa or Tanzania, and then other family members or friends come to us.
Local GPs have been very supportive as well. I was concerned at first that we might be treading on their toes, but actually they are quite relieved to offload their patients and refer into us. If someone is entitled to get the vaccinations on the NHS then we will just refer them back, but sometimes it’s a matter of timing. Some GPs could have waiting lists of six to eight weeks and that can be too long for some patients if, for example, they are leaving sooner. So even if they are entitled to the vaccinations on the NHS they come to us and have it privately. GPs value that because at the least the patients are getting vaccinated and being protected.
Roughly how often each month do you carry out the service? It’s very seasonal, so from the beginning of January to April or May, we see one patient every day, or we have an enquiry from at least one patient per day, and sometimes we have multiple enquiries. It lulls in the mid-summer when people are actually off on their travels, and then starts again in September time when people are planning for their winter breaks. When I looked at last year, we’d seen about 160 patients over the 12 month period – that’s for both services combined.
How much do you charge for the service? It’s really hard to say because there is no typical consultation. We don’t charge a consultation fee – we just give the advice and then hope that if the patient needs the service they will use it – so we just charge a mark up on the vaccines.
In the past, we looked at what everyone else was charging and then charged a little bit less. But we discovered that it didn’t make any difference and we were just cutting our own margins. If we’re accessible then people come to us – it’s the accessibility that attracts patients, so we charge the same rate as others now.
The most common consultation is someone coming in for tetanus, hepatitis A and typhoid vaccinations, and we would charge approximately £110 for that. The total cost of the vaccines to us is about £30, so that gives you an idea of the mark up.
Roughly how much a month do you make from offering the service? I don’t think I’ve ever calculated that – all I know is that I make sure every consultation runs at a profit, and most clients bring in around £50 to £55 profit each. The service covers its costs and is a very useful contributor to the pharmacy.
Would you recommend offering this service to other contractors? Yes, certainly. If contractors have got a good continuity of pharmacists who are interested in travel to deliver the service, then it fits in well with those sorts of skills.
It’s also a service that deals with well people, which is quite nice after spending most of our time dealing with unwell people. People are usually excited about their trip and it’s quite a different demographic to what we’re used to. It brings in a good, new income stream and so I don’t think there is any reason not to offer it.
In one of my pharmacies, we didn’t necessarily think it would work well because it’s quite a low income area, but you’d be surprised how many people travel. These days people are much more mobile, they have family and friends abroad, or jobs that take them abroad, and therefore they require travel health services.