How our pharmacy set up a women's health service

Silas Agyemang launched a women's health service after receiving multiple enquiries about cystitis and uncomplicated urinary tract infections at his pharmacy in Bournemouth.

Service type: Women's health.

Name of pharmacy: Tuckton Pharmacy, Bournemouth.

Name of pharmacist: Silas Agyemang.

Why did you start offering the service?

We partnered with the PGD provider PharmaDoctor for my travel clinic, which started at the same time. It was better and cheaper to expand the PGDs and acquire more, so I picked out a few others that I felt were right for us.

When I took over this pharmacy, they were doing the barest minimum. But there was a huge demand for travel vaccinations locally and in Bournemouth we have a lot of tourists coming during the summer, so we were getting a lot of enquiries about cystitis and uncomplicated urinary tract infections too.

We started offering women’s health in September 2019. We’ve done a lot of advertising through our local magazines and leaflet drops and the news about our services was getting well into the community, but Covid-19 has shut everything down. I’ve got people calling me but we’re not taking any consultations at the moment.

How much did it cost to set up the service?

I bought the ultimate PGD package and I paid around £1,000 for that. There were no additional costs for the women’s health clinic specifically.

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

You have to do an online training based on the PGD and complete the declaration with PharmaDoctor, and then you are ready to go.

In a nutshell, what does the service involve?

Patients either phone or email with an enquiry or walk in and ask. The women’s health clinic includes four different individual services. For each service, we would take the patient into the consultation room.

Period delay

We offer the period delay service as part of a travel health consultation. Sometimes women who will be travelling abroad want to delay their period, so they don’t have a period at all while they are away. If they’ve got time before their trip, we give them the chance of speaking to the doctor because it will be cheaper for them to get the norethisterone tablet that way. But we explain that we can offer it if they want and there’s been a few times where people have made last minute travel plans and it didn’t give them enough time to see the doctor, so they may then use our services.

I’ve developed a questionnaire for this service based on the inclusion and exclusion criteria for the PGD, to help give me an idea of who would be suitable. I go through this with the patient and if it is appropriate we supply.

Oral contraception

This is for women who have not been able to get their prescription or get to the doctor, so it’s a simple case of repeating what they can take. We can’t initiate contraception; they’ve got to be taking the oral contraceptive before we can give a supply under this PGD. If they haven’t had their blood pressure check, I will also need to do this, and then, in line with the NICE guidelines, I can make a decision from there.

Urinary tract infection

There are two types of PGD for this service. One allows us to give an advanced supply of nitrofurantoin. This is for patients who have a history of uncomplicated urinary tract infections (UTI) and have been given medication before. We are allowed to give a three-day supply.

The other PGD is for when we suspect that the patient has a UTI, and we have a kit for taking a urine test for them. I must admit that this one hasn’t really taken off because, due to local demographic, the cost is always something that puts people off. I tend to give people the option to ring a duty doctor first, because then they can usually get it free if they want to.

We also have a PGD for urinary incontinence that we advertise, which is for people who have previously been diagnosed with an overactive bladder. The PGD allows us to supply a few anti-muscuranic medicines, but no one has needed that service through us yet.

Thrush

Finally, we have a PGD that allows us to supply a prescription-only medication for thrush. We sell the over the counter Canesten products too, but there is a stronger, 10% clotrimazole external cream that we can supply with the PGD. This is normally for people who have reoccurring thrush.

How long we spend with a patient depends on the service. For oral contraception it could be 15 minutes, with a discussion about when they last had it and a blood pressure check. For a UTI, sometimes we probe a little bit further, especially if they are my patient and we can look on their records to see if we can find something - so that might be 20 minutes.

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

Aside from the prescription products we supply under the PGDs, there is not a great deal of opportunity to link-sell to over the counter products. Where someone is showing symptoms of a UTI but we find that it is basic cystitis, we may offer some herbal products and powders to mix with water.

How have patients responded to the service?

The response to the period delay service has been good because we have quite a lot of travel consultations, so people were taking that up.

For the contraception service, we’ve definitely seen people but not a great deal. Mostly patients are given a minimum of three, or sometimes six, months’ of contraception, so it’s only very rarely that people will come in wanting an emergency supply. Contraception is also free on prescription, so it’s only those who are desperate or who can afford it who are willing to pay.

We’ve had a huge number of consultations for UTIs, but most of them did not warrant me giving the nitrofurantoin antibiotic - where there is no underlying pain, for example, it’s not necessarily going to benefit patients. Instead, I suggest they can try the herbal products we sell over the counter.

The feedback overall has been good, often people are desperate and so when you can help them they are very grateful. I’ve had people emailing me from other areas too, because they’ve heard that we are offering these services. So, that to me is a positive response.

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

It could be more, but on average probably five or six times a month.

How much do you charge for the service?

I don’t charge a fixed consultation fee, simply because we have all the chains around us and we are an independent, so I try to be competitive both in terms of the price and the quality of services that we offer. For the prescription products themselves, I tend to look at the price of the drug itself and then top it up with something very reasonable, perhaps a £5 mark-up.

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

I haven’t been able to do any reasonable numbers in these services since almost the beginning of the year due to Covid-19, so it’s too early to tell. Normally around this time of year we have a lot of people travelling into town, and because the surgeries don’t like to do temporary registrations, we tend to have a lot of people coming into the pharmacy. So, this period would have given me a better view as to how successful or not the services will be.

Would you recommend offering this service to other contractors?

Yes, I would, but you have to judge carefully [when choosing a service], know your area and demographic well, and look at what services your area is lacking. I used to work in Herne Hill, in London, which is more affluent, so the PGDs I would have done there are different to what is needed here. Also, don’t price yourself out. I believe in quantity and numbers over trying to raise prices.