COPD screening service: 'People are always keen to have the intervention done' -

Tony Schofield, superintendent pharmacist and owner of Flagg Pharmacy in South Shields, Tyne and Wear, tells Saša Janković about the local need for his COPD screening service.

Service type: COPD screening.

Name of pharmacy: Flagg Pharmacy, South Shields.

Name of superintendent pharmacist: Tony Schofield.

Why did you start offering this service?

I started offering this service in spring 2019. COPD is universally underdiagnosed due to lack of availability of spirometry, and the area we are in was historically heavily industrialised with coal mining and ship building – as well as being a traditionally heavy drinking and smoking area – so I knew there were potentially lots of people here who had an occupational reason why they might have developed COPD.

A lot of people who had worked in the coal mines would most likely already be in treatment by now, but I felt we could still help those who weren’t getting inhalers who we thought were at risk, as well as customers buying smoking cessation or accessing our smoking cessation service.

Another group was our opiate patients, because with regard to drug users all of them smoke cigarettes and cannabis, and some use crystal meth. I learned very early on that if you try to pigeonhole people under one condition, rather than looking at dual diagnoses, you realise you’ve got very few patients to talk to. They all have multiple problems, so you can’t just look for people to screen in one particular cohort; it’s always got to be across the board. Once we started screening these patients with the microspectrometer we found a very significant number of them – and surprisingly young ones at that – we ended up referring on for having COPD.

How much did it cost to set up the service?

It didn’t cost us anything as the CCG gave us everything – the mouthpieces and microspirometers – and referrals come through PharmOutcomes, which we already had.

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

Louise Lydon – a pharmacy contractor in South Tyneside, who is also LPC secretary for Gateshead and South Tyneside LPC – organised an evening of CPPE training by GP Dr Anji Curry for a group of pharmacists and some technicians, where we were shown how to use the microspectrometry kit.

Although my technicians didn’t do it at that point, I think the CPPE that they can access is excellent, so I wouldn’t mind them doing the training in future so they can take part in offering the service too, so it’s not just me.

In a nutshell, what does the service involve?

We usually find patients by looking at the PMR for who is getting smoking cessation support, perhaps with some comorbidities, as well as our customers who we know are using illegal drugs.

We take the person into the consultation room and get them to blow into the microspirometer. The results give us parameters that we can put into a formula which then tells you whether they need to be screened for COPD. If this is necessary, we are able to do an electronic referral back to their GP. There is no further clinical involvement on our part, although if they then end up with a prescription for an inhaler, we can then show them how best to use it, and they become our regular patients.

This is, of course, under normal non-Covid circumstances, because for now you don’t want people blowing into a microspectrometer in a small consulting room, but we aim to have this service back up and running again as soon as we can.

Are there any opportunities to sell OTC or prescription products during or after the consultation?

To some extent we can talk about our smoking cessation service, but I feel distinctly uncomfortable in looking for opportunities to sell products via any of our services. I've always worked in a very deprived area, and my priority is the health of our patients. We do, however, get a fee from the CCG per patient.

How have patients responded to the service?

People are always quite keen to have the intervention done and pleased with the referral. Even though a diagnosis of COPD is obviously not the news they want to hear because they will never get back to ‘normal', at least if their GP starts them on the inhalers that improves things.

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

Pre-Covid we’d see about three people a week.

How much do you charge for the service?

Nothing – it’s a free service.

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

Figures not available.

Would you recommend offering this service to other contractors?

Absolutely. It makes a huge difference in finding people who have breathing difficulties, and if you can then point them in the right direction it can help them immensely.