Developing relationships with trusted practitioners has been key to making the Health Dispensary's pain management service a success, says superintendent Ali Sparkes.

Service type: Pain management.

Name of pharmacy: The Health Dispensary, Neath, Wales.

Name of superintendent pharmacist: Ali Sparkes.

Why did you start offering the service?

We opened a wellness clinic next door to the pharmacy in 2012 - at the time we opened it as a separate entity and started offering a range of complementary therapies, providing advice for people above and beyond their NHS prescription. Four years later, we knocked through the two buildings and that was the start of The Health Dispensary brand. Now we consider ourselves to be an integrated pharmacy and healthcare practice.

I guess it was the reverse to how some pharmacies set up these types of services - sometimes pharmacies put consultation rooms in and then think how to fill them. But we came at it from completely the other direction. We wanted to consider ourselves a health brand, within which sits a pharmacy.

My passion is self-care, but from a personal perspective I’d also had a long situation with back pain and I found things like acupuncture and other therapies enormously helpful. That was after going down the route of medical care and x-rays and all sorts, whereas now I’m symptom free because I’ve used therapies to improve the situation, so I know it works.

I also did a Masters in the early 2000s and wrote a thesis on self-care. This was interesting because it flagged up how when the NHS came along it was seen as the magic bullet - but as a result, we lost a lot of self-care skills and the knowledge that is passed through families, and came to rely very heavily on medicine to sort out every ill instead. Now we’re coming full circle to realise that this puts us in a dangerous position in a way, because it can’t sort out everything we have. The NHS is struggling to sustain services and we should be putting more focus on self-care and prevention.

So, the service was born really from a personal passion and we’ve worked really hard to develop strong relationships with practitioners we trust, monitor what we’re offering, and work well together as a team.

How much did it cost to set up the service?

It would be difficult for us to put it into costs in terms of solely pain management, because the 2016 refit was for the whole pharmacy.

Integrating the two sides of the business has involved physical alterations, new computer systems in terms of the ability to make appointments, send reminders, and get feedback, staff training, finding like-minded people and attracting the right practitioners to work with us, and marketing the services.

So, it depends where you’re starting from. Something like software can be a few hundred pounds per month, but if it’s refitting or kitting out a room, you’re probably look at five figures. But pain is the biggest thing we deal with, whether that’s physical or emotional pain, so if you’ve nailed it down for one subject area, then you can adapt that template for other services as well.

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

The service has happened as a by-product of what we were doing already really - I did a postgraduate qualification in wellness coaching, and my other pharmacist has done lots of courses in holistic therapies. I’ve also done some lecturing in pain management in the past because it’s been an interest of mine, but I haven’t been down the clinical route in terms of doing a pain management course. Our approach is more around general self-care and how pain sits within the self-care environment and sector.

In a nutshell, what does the service involve?

This is not a formalised pain management service in terms of including anything offered by the NHS. What we do is offered through pharmacist consultations - it’s all about building relationships and trying to create space and time to chat to people for that little bit longer and see how we can help. So, it could be that the pharmacist does this as part of a Medicines Use Review, through over the counter advice, or during a phone call.

The first step is a quick pharmacist assessment, to find out if the person is happy just chatting, or if they want a more in-depth discussion. If the patient wants something more in-depth, then we go into the consultation room. We would then look to see whether they are an existing patient, what pain medication they are on, and have a conversation to really gain an understanding of their day-to-day lives and how the pain is affecting them.

The next step would be to see whether they would be interested in trying a complementary therapy - we have therapists offering osteopathy, acupuncture, reflexology, aromatherapy and reiki, as well as two counsellors and a psychologist - because even things like that can help to manage pain.

We would ask the patient whether they’ve tried any of these, ever considered them, or whether they’re interested in them. If they want to go down that route, we can then go onto discuss what might be best. For example, even though acupuncture doesn’t hurt, some people are so afraid of needles they wouldn’t want to go near that - or some people don’t like their feet being touched, so reflexology wouldn’t be an option. We’ve very customer-focused, so it’s all about trying to find out what the patient preference is.

If they do opt to have treatment with one of our practitioners, then after every session they get a text asking for feedback. This enables us to monitor the service, and we’re always very keen to hear how it’s helped too. If the patient is unable to afford private treatment, or doesn’t want to go down that route, then we can refer them to an NHS physio walk-in service, a wellbeing hub in the town, or some local GPs offer a musculoskeletal service. If someone is suffering intense chronic pain, we’re likely to have to refer them on.

We just make ourselves available - whether it’s walk-in, by phone, or even on social media - and we just try and assist in whichever ways we can and that we’re comfortable with. If someone is coming for regular treatment, then obviously we’re able to see how they’re getting on and monitor that.

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

All the time - obviously there’s a business reason for doing so, but our ethos is very much about trying to find as much as we can to help people, or at least give the option. So we’ll obviously look at things like simple painkillers, heat patches, and supplements. We really take a very holistic view of the person in front of us so that they can hopefully find something that is a benefit to them. I do recognise that sometimes this is trial and error, but even with prescription drugs it’s very often trial and error too. We know that 100% of drugs do not work for 100% of people. So, if we’re offering sensible advice and making the customer fully aware of the information, current evidence and opinion, then we are doing a good professional job.

How have patients responded to the service?

The feedback has been brilliant. Sometimes you get the odd negative, but we get a lot of five-star reviews back on Google. If the therapists were anything less than really good, then we would be following up on that. You might find one in a 1000 people who doesn’t like it or doesn’t want it, but generally I would say our feedback ratio is probably 98% positive.

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

We probably carry out the service every day - pain is so prevalent, whether it’s headaches, backaches and so on. It might not be the full consultation, but certainly in terms of mini-consults over the counter, or even offering other alternatives to co-codamol, for example - we’re doing that every day.

How much do you charge for the service?

The consultation in the pharmacy is free. The independent practitioners all charge a fee themselves - the average treatment cost would be £40 per hour.

If patients can’t afford to go down the treatment route, we do have the common ailments scheme in Wales - so the other thing we can do is access that and give advice and prescribe some painkillers, for example. Back pain comes under that, so it’s a good option to be able to give people as well and means at least they can have access to some pain relief. We also get paid a fee from the NHS for providing that service, even if we’re just offering advice.

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

It would be hard to put a figure on it. We make some profit in terms of gaining customers, because existing patients refer new customers so we’ll pick up on prescription charges [as a result of that]. The therapists also all pay us a fee for using the rooms. But I think the biggest thing for us is the fact that we do offer so many services and we get good word of mouth referral, so we maintain that longevity of looking after generations of families.

Would you recommend offering this service to other contractors?

I think it depends on your circumstances and on your business plan. I’m not a great believer in all pharmacies doing everything. I’m very passionate about what I do and very interested in it, so that always makes life a lot easier. I’m happy if it gains us new customers that we can look after. But I think if you’re going to run it as a dedicated clinic the only advice I could give is a) you’d be doing a fantastic service for your community, but b) you really need to look at where you are now - what do you already have in terms of staff and resources. See if it fits and see if it’s something you can do reasonably easily. If not, then you need a pretty good business plan to make it work. It’s such a complicated area, I don’t think it can be just a bolt-on.

I started offering services back in the 90s - so by the time we got to where we are now, we could do appointments easily, we’ve got the IT, we’ve got the phone systems, we’ve got the staff - so it’s not such a big uplift for us to slot in new services. Certainly pharmacists are more than capable of doing it, we have so many prescriptions coming through for pain relief and it’s obviously being targeted now with the world crises around opium addiction, for example, so we do need to be looking at helping and managing pain.

If it feels right and feels like something you can do, then it is worthwhile. I went into pharmacy because I wanted to help people, that was my driving force - so for me it’s lovely if a person who could hardly crawl up the stairs is virtually skipping out. We’ve seen a lot of people over the years who we’ve been able to help very successfully and that is enormously worthwhile to me.

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