Steffan John, superintendent pharmacist and IP at Fferyllwyr Llyn Cyf pharmacy in North Wales, talks to Saša Janković about running an Acute Conditions Service.

Service type: Acute Conditions Service.

Name and location of pharmacy: Fferyllwyr Llyn Cyf pharmacy, North Wales.

Name of superintendent pharmacist: Steffan John.

Why did you start offering this service?

I started offering this service in September last year (2019), and it’s being going from strength to strength ever since, although coronavirus has been a bit of a hurdle.

We’ve got four branches and had been looking at what was required in the locality, and the problem we were seeing was lack of GP access. I qualified as an IP three years ago, and I realised that offering the Acute Conditions Service would enable me to use my qualification in the pharmacy, as well as plugging this local gap for rapid access to treatment and advice, which pharmacy is perfectly placed to offer.

How much did it cost to set up the service?

There was a lot of cost involved but we decided it was worthwhile investment.

First, we needed to get our five pharmacists to qualify as IPs. Then, of course, they have to spend 90 hours with a GP, which had to be backfilled. Plus travelling to Cardiff from North Wales to do the course was a trek for them.

We also had a minor illness course to do at Bangor University - a bespoke course specifically for the Acute Conditions Service - which runs once or twice a month over 6 months. This course is funded by the health board, but we still had to backfill. Then there’s a transitional service where newly qualified prescribers have to run the service in a GP practice for 12 sessions, although the backfill for this was funded by the health board.

Finally, we had to buy some diagnostic tools, such as a stethoscope, otoscope, and urine dip sticks, plus a prescription printer.

In a nutshell, what does the service involve?

The service is completely dependent on the prescriber themselves and what they’re competent and comfortable to offer, so it varies from prescriber to prescriber and from day to day. I do a lot of UTIs, skin conditions, shingles, earwax and ear infections, and chest infections was a big part before Covid although I’m not seeing them at the moment. Pain is also a very common area for us: back pain, gout, and migraine in particular.

GP reception staff often book patients in with us as we have certain slots available in my pharmacy, and in our other branches the surgeries tell patients to ring up themselves. Word of mouth referrals are massive for us, and we get lots of walk-ins, which is great because where in the past I would have referred on to the GP, now I can treat these people in the pharmacy myself.

Migraine is one condition we see a lot of, so I’ll give the patient general advice about pain management and painkillers, as well as to keep a migraine diary to identify triggers. If they keep coming back to us, then I’ll refer them on to their GP.

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

Yes - sometimes when we give advice, patients will happily buy over the counter, but the vast majority of consultations end up with a prescription, referral to the surgery or general advice. Not many end up in an OTC sale, as that would fit more with the Common Ailments Service, whereas the Acute Conditions Service picks up more serious conditions where prescription medications are more appropriate.

How have patients responded to the service?

We’ve had a great response from patients saying they really like it and appreciate the accessibility. People don’t like going to GP surgeries – even before Covid – but they do seem to like coming to pharmacies, so this service is a natural addition to what we are doing. We did find, at the very beginning, that our customers were surprised to know we could prescribe and didn’t know what to expect, but now they are getting used to it, and we are seeing a lot of them coming back to use the service again and again.

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

It varies from branch to branch, but probably before Covid I’d see at least six patients a day – so over a hundred every month – and about 25% of these are for pain (lower back, gout, sore throat, headache and migraine).

How much do you charge for the service?

There is no charge for the patient as it is NHS funded. We get a banded payment from the health board for delivering the service, depending if we see 1-4, 5-8, or 9-12 patients per day, and this payment gets reviewed every three months.

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

It varies, but I’d say it had definitely been financially worthwhile for us – a year in; we’ve paid back lots of things that we’ve paid out for.

Would you recommend offering this service to other contractors?

Very much so. It’s very professionally satisfying to get out from the checking bench and do something different using new skills and engaging with patients. The transitional service in particular worked really well as GPs saw what we were doing, which gave them peace of mind that it’s a safe and clinically effective service, and that really strengthened my relationship with the GP surgery. We really are part of the multi-disciplinary team in our local area now.

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