Joint pain service: 'This could lead to tremendous savings for the NHS' -

Pharmacist Robert Alman says this service is all about informing, advising and educating patients to give them an idea of how they can manage pain themselves.

Service type: Joint pain.

Name of pharmacy: RE&CO Alman Ltd, Shropshire.

Name of pharmacist: Robert Alman.

Why did you start offering the service?

We've been offering this service since 2018. The Joint Pain in Pharmacy (JPiP) service is an extension of a pan-European project called Jigsaw-E, which Keele University is involved with.

A local retired GP, Colin Stanford, came to us about two years ago, wanting to extend this project into the community. At the time, I had three pharmacies in the Shropshire area, and he wanted us to run a pilot scheme. We ran this in the spring of 2018 over two separate monthly periods.

We devised a record sheet to give fairly basic information on the number of people we saw. It was difficult to get outcomes, but this gave us a broad indication of how we could take the service forward. We were learning on the hoof really because it hadn’t been done in community pharmacy before.

It was rolled out to other contractors in July 2019 and there are now nine pharmacies in the Shropshire area offering this service.

How much did it cost to set up the service?

There were no start-up costs - only our time.

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

Everybody interested in the project had to attend an evening meeting, which provided a broad overview of the service. There was also an online training package. The content was set deliberately at a fairly basis level, because in a way we’re still learning and piecing together how best to help people.

One of the things I also requested right at the beginning, was that all contractors are provided with a directory of services. This includes local community groups across the county and people organising exercise walks, for example, which we as contractors can refer patients to.

In a nutshell, what does the service involve?

We take the patient through to the consultation room first of all. If they are one of our patients, then we will be able to bring up their drug history and see what medications they are on. But we’re not trying to interfere with anything that they are doing at the GP surgery. This is very much an add-on to help the patient. We would only informally contact the GP regarding the patient’s medication if there was something glaringly obvious that needed to be flagged.

Our consultation is about getting an understanding of the patient’s position, what the pain is, what they feel, how they understand their condition, and then trying to advise and help. A very good organisation called Versus Arthritis, formally Arthritis Research, has supplied us with a lot of information booklets and leaflets, which we give to patients and talk through with them.

We also signpost to local self-help organisations and physiotherapists, wherever possible. Our role is to inform, advise and educate - and give the patient an idea of how they can manage the pain themselves. People tend to have been told that eventually they’re going to have to have surgery, that’s the end game. But that’s not always the case, it is possible to control it.

The message we want to get across is that even in some of the later stages of joint pain, surgery is not a given and there is still an awful lot you can do to improve the situation. Exercise and lifestyle management is what it’s down to. It sounds very basic but that’s what the service is about at this stage.

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

If appropriate, we might sell support bandages for knee, ankle, or elbow support, heat or cold packs, and there’s also anti-inflammatories we can turn to. But we’re being very careful here not to use this as a ‘cash cow’ - it’s not about sending people out with a basket full of goodies just to hear the till ring. We will only recommend these things where it’s appropriate to do so.

How have patients responded to the service?

Initially, patients give you the look of ‘I’ve heard all this before’, but when you talk it all through with them, they very much appreciate this support.

The one weakness of this service is trying to quantify outcomes - I don’t think it’s really possible. If it was rolled out on a greater level, I think eventually through the statistics GPs provide you would maybe see a downtrend in the number of people going for hip or knee replacement surgery, for example. You might think it can’t be that good, but we’re finding so far that it can be.

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

Across the nine pharmacies delivering the service in Shropshire, there have been 81 interventions to date.

How much do you charge for the service?

The service is free.

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

Not a lot - it’s not lucrative. When the service started out, we had a huge amount of help from the service development manager at the Shropshire Local Pharmaceutical Committee and she identified a small pot of money that is used to reimburse contractors for the amount of time spent on these consultations. We can claim back £14 per consultation.

Would you recommend offering this service to other contractors?

We would love to roll this service out nationally. We could argue there is an amount of benefit here that could lead to tremendous savings for the NHS.