Rachel Carter talks to Vivek Shah about his Birmingham pharmacy’s sexual health service
Service type: Sexual health.
Name of pharmacy: Shah Pharmacy, Birmingham.
Name of pharmacist: Vivek Shah.
How long have you been offering this service? Since 2015.
Why did you start offering the service? We initially looked at this service based on our clients and the need for it.
We used to have two pharmacies – one based in Selly Oak, which we sold in 2018, and one on Stratford Road in Sparkhill, which we still have. The Selly Oak pharmacy was right opposite the university, so there was a massive need for sexual health services due to the local population. We used to get a lot of enquiries for it – from patients who were struggling to access either the GP or a walk-in centre for things like the morning after pill or STI testing.
We realised that offering this service is quite lucrative from a commercial point of view as well, and we wanted to be a forward-thinking pharmacy that was not only dispensing, but also the first port of call for any medical needs.
The Umbrella service launched in 2015 and commissions pharmacies to provide tier one (emergency contraception and condoms) and tier two (contraceptive pills and injection, chlamydia treatment and the supply and initiation of STI kits) sexual health services across the city.
We’re part of a group called Pharmacy Midlands, comprised of around 60 independent pharmacies. We tendered for the service as a group of pharmacies rather than individual units purely to stand the best chance of competing against the likes of the large multiples – as geographically our group covers pretty much the whole of Birmingham. As a result, our group won more contracts, and more tier two contracts, than Lloyds or Boots.
How much did it cost to set up the service? There were no start up costs – all training was covered by Umbrella.
However, at our pharmacy in Selly Oak, we did used to get really busy and we would have to get double cover in, so that was an additional cost.
What, if any, training did you or other team members have to undergo? For providing tier one services, there wasn’t much of a requirement to do face-to-face training – the majority of the training was done via CPPE packages and safeguarding programmes, which were all e-learning.
For tier two, there was significantly more training. I did a day of face-to-face training on initiation of regular contraception, on injection technique for the contraceptive injection, some training around STIs because we were initiating the kits on site and how to log information for the service on the PharmOutcomes portal we use. I think in total it was five or six days’ training.
We now also have to complete an annual training update too.
All this training was compulsory and pharmacist-driven, but there was some counter staff training carried out by Umbrella too. This was mainly to discuss and show other members of our team how they can openly talk about sexual health. In the past, it has been a bit of a taboo topic within pharmacies, so it was all about providing staff with confidence on how to discuss the issues.
In a nutshell, what does the service involve? We offer both tier one and tier two services in our pharmacy.
The service is operated on a walk-in basis. The ethos of Umbrella is that there should always be an Umbrella-trained pharmacist on site, which we always provide. We ask patients to grab a seat if the pharmacist is busy or take a seat in the consultation room, which provides a nice, private space.
The consultation involves speaking with the patient about the issue they have and directing them to the correct service, which could be condoms, STI kit initiation, chlamydia treatment, or emergency contraception.
Where possible, we always try and establish a fuller picture – this is the whole point of the Umbrella service. Somebody coming in to access a particular service shouldn’t just be offered that one service, we need to take a holistic approach. For example, if someone comes in for the morning after pill then we would look to establish whether they are on regular contraception, if they’ve had an STI test recently, or whether they need condoms. For every patient, there’s never just one part of the service you can offer – you can normally end up offering two or three parts of it.
I would say 95% of customers leave with the correct treatment or advice. The remaining 5% we haven’t been able to give treatment, perhaps due to contraindications with their existing medication, or other complications. In those cases, we signpost them to an Umbrella clinic in the city centre.
The average consultation takes 10 minutes. All information is recorded on PharmOutcomes and remains completely confidential. There are some instances where it is shared with the GP, if for example a patient has been started on a regular contraceptive pill, or we’ve given the injection.
We purchase the necessary products from our wholesaler – we have to keep a ready supply of everything we give out and STI kits, which we buy at our own cost. We log anything given out to a patient on PharmOutcomes after consultation and we are reimbursed the NHS drug tariff price for the item.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it? No – everything is free to the patient.
How have patients responded to the service? Really well. I think there’s certainly less of a taboo attached now. People wouldn’t necessarily access a sexual health service through pharmacies previously, because they saw it as a place where they might bump into a neighbour or relative, so it was not seen as a very confidential setting. But now, most pharmacies are fitted out quite nicely and they have a private consultation room, so there seems to be a massive uptake for this service.
We tend to see more people between age of 25 and 30, that’s the age bracket that’s most responsive and they are finding us from advertising in branch, through the Umbrella website and through GP surgeries.
Roughly how often each month do you carry out the service? Approximately 150 to 200 patients per month.
How much do you charge for the service? The service is free to the patient.
Roughly how much a month do you make from offering the service? Obviously we don’t make any money on the products because we are reimbursed for the amount we buy them for, but we are paid a professional fee by Umbrella for the consultations we carry out. For the larger consultations, this fee is in the region of £10 to £12, and for the quick and easy consultations, such as condom provision, the fee is around £1.50.
Roughly 60% of the consultations we carry out each month are the larger consultations, so we make around £1000 per month give or take.
Would you recommend offering this service to other contractors? Absolutely, I think it’s a great service. I think Birmingham Council is quite forward-thinking in the services they commission, but councils in a lot of other areas purely don’t have the funding to commission services like this – so it will depend on the council. As far as I’m aware Umbrella is the only service of its kind in Europe and we generally get some good statistics, which in turn help to build a picture for others councils and show that actually a preventative approach is much better than a treatment approach.
However, you could provide these services for a fee, get trained privately and have a PGD for it. Because pharmacists are involved in offering flu vaccinations and all sorts of other services now, a lot of the techniques and skills needed for this service may be ones that they already have.
Offering this service is something new and it’s more interactive with patients. Sometimes the role of the pharmacist can be stuck behind the counter, checking prescriptions – so it can be nice to step out, interact, and use some of the clinical knowledge we’ve learned along our journey.