Sunil K Kochhar speaks to Rachel Carter about his men's health project, otherwise known as 'Man in the Town', which comprises a range of services.

Service type: Men’s health.

Name of pharmacy: Regent Pharmacy, Kent.

Name of pharmacist: Sunil K Kochhar.

Why did you start offering the service?

I started offering this service, called 'Man in the Town', in September 2019.

We know that men especially are sometimes very afraid to come into any healthcare environment, or they are embarrassed or not sure how to approach this. A lot of my friends who are non-clinicians always find it hard to approach the subject of any health issue and tend to ignore issues.

The way it all started was I read an article about how men tend to open up to their barber. Having read that article, I asked the local barbers if they have men who do open up and tell them things, and it seemed that was the case.

It was around the same time that a friend of mine committed suicide, and it was the mental health side of this that made me want to go into it. I wasn’t necessarily trying to get someone off smoking or anything like that, it was about finding out where do men open up and where can they release mental health issues, and wanting to do something to support them. So, with reading that article and speaking to barbers myself, it just exploded from there.

How much did it cost to set up the service?

There have been some costs for marketing materials, but the real cost is time, because we are doing a lot of it on free time - it’s my time speaking to them and then seeing where services may fit in.

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

The staff have motivational interviewing and behavioural support training and that comes from the services that we already deliver through the local NHS trust, such as stop smoking and NHS health checks. All those skills were learned through that training. On top of that, I use a platform called Canvas and create bespoke training for my staff. They do that training and every two months they hand in a CPD for me, so that’s something we’ve created in our environment. We’ve done that for Man in the Town because the focus is basically on one gender coming in, but the rest of the training they’ve already done. The foundation was there, we are just marketing it for a particular gender because we believe there is a need there for the health outcomes.

Because I’m an independent prescriber it makes it easier for us, so as long as [an issue or required treatment] is within my scope I can do it. If it’s not in my scope, then I go and do a CPD and training to make sure I can.

In a nutshell, what does the service involve?

This is a new project that we’ve set up. We had to stop it because of Covid-19, but we will be reintroducing it when it’s possible to do so. It is focused on the men who work in town, for example manual labourers, and all those who still find it difficult to come into the pharmacy for health issues.

There are three touchpoints for the service. The first touchpoint is the barbers - if a man is having their haircut or beard time, the barber will have their usual chat, and explain that they’re linking up with our pharmacy. They tell the person that if they have any concerns the barber can speak to us for them, or they provide the client with a flyer to bring to the pharmacy.

The point of the flyer is so that the man can feel confident that they don’t need to explain. Handing in the flyer explains 'I’m here for this service', and then everyone knows, so there’s no embarrassment or questioning.

The second touchpoint is a personal trainer we’ve teamed up with, Elliot, who is also an osteopath. If he has a client who needs some health advice, then he will refer to me. We have an online referral form, which will send me the person’s details and what the issues are, and I can contact them.

The third touchpoint would be if someone came straight into the pharmacy.

When the man comes in for his appointment, I would take him into the consultation room and carry out a ‘health MOT’ - this is a process of general questions, history taking, and then looking at what they need to improve their health. We also check if they are eligible for an NHS health check.

From there, I would signpost to local services. For example, if they want to join a walk then there’s a local healthy living centre run by the council that we work quite well with, and I can give them a voucher for a free personal training session with Elliot. If they are already at the gym, then we don’t tend to give the voucher, but we give the phone number for advice.

We spend around 15 to 20 minutes with the person for the health MOT, but clients also have the option of a paying for a more in-depth consultation. We’ve created something called functional pharmacy care, where we’re trying to embed and bring together pharmacy care and functional medicine.

If the client chooses to do this, we spend an hour with them going through a ‘root cause analysis’ on their issue. We use two platforms - Medichecks and Cambridge - if we need to do any blood tests. For example, if someone is high risk for diabetes, we can do in-house HbA1c testing to see where they are on the diabetes scale, offer advice and, if necessary, refer onto the GP. 

Eating habits, respiratory issues, lifestyle and fitness, and stopping smoking have been some of the key issues we’ve picked up among the majority of people we’ve seen so far. Smoking was something that was really prevalent, and we have a successful stop smoking programme anyway, so we are able to enrol people onto that. As an independent prescriber, my initial speciality was respiratory, and we’ve looked at trying to do early screening for COPD. We’ve recently won a commissioned service locally to provide Champix too.

We’ve also had a lot of men who want to speak about their sexual health, erectile dysfunction and premature ejaculation. Hair loss has also come up.

We were lucky with the premises and are quite fortunate that we have five consultation rooms, so we have other therapists coming in that we can refer to. This includes a chiropodist, a physiotherapist and an allergy tester, and we’re also now working with a nutritionist who offers virtual consultations.

With this service, there’s a whole spiderweb of treatments and so many angles we can come from, but it’s all tailored to the personal need. That’s the good thing about pharmacy - we have the ability to do quite a lot.

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

Yes, but this is all down to whether it’s needed or not, and whether in doing so, we would be able to get good outcomes for them. Hair loss is one example - we can sell a high strength hair loss product, which is called ‘In Clinic’ and made by Nourkin. Also, because we have an aesthetic clinic, we can tell them about the hair loss treatment we offer through that as well.

How have patients responded to the service?

It’s been really good. We have a business WhatsApp and people tend to like the fact that once they have been through the system with us and become a client, they get access to that. So, they can just text if they have an issue. They know if it’s urgent they need to ring the pharmacy, but otherwise that text comes straight to my phone and when I get a moment I can reply. It gives them a sense of security knowing that they have someone they can text, and also if it’s something they feel is embarrassing they can have that pre-chat beforehand and it’s all “bagged”, like picking up a prescription.

As well as social media and word of mouth, Google has worked really well for us too. We’ve used Google to do a messaging service for the business and we’ve had some men message through that. Most of the time, it’s to do with erectile dysfunction.

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

Before Covid-19, we would definitely see four or five men in a week for this service. Probably three clients each month would take a private service or pay for a one-to-one consultation. We get some that have their health MOT, we give them information and advice and then we don’t seem them again - but at least I have done my duty to put them on the right track.

How much do you charge for the service?

We have a menu of services, with prices ranging from £15 to £95.

The health MOT is free. If we enrol a client into our stop smoking service, for example, or if they are eligible for a free NHS health check, then we get paid a fee for doing that because those are locally commissioned services.

If a client did not meet the eligibility criteria for an NHS health check, but this was something that they wanted to do, then there would be a £30 charge.

The functional pharmacy care part of it - where we spend an hour doing the root cause analysis consultation on a particular issue - costs £95.

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

The 'Man in the Town’ work-stream involves supporting people with existing commissioned and private services, but where people have come to us directly through that route, we’re probably looking at around £1,500 a month.

Would you recommend offering this service to other contractors?

I would say something like this would be more for those who have already got services in place - it’s not something you can jump straight into. We’ve built different services over the 20 years we’ve been here, and each of those services has been built on demand. You need to have your basics right and have experience doing the non-pharmacological aspects. It’s not all about medicines and responding to symptoms: it’s about behaviour, and how to get the best out of people so they can make changes.

This type of service is excellent if you’re an independent prescriber because you would have the skills, but if you don’t do anything like minor ailments, blood pressure, health checks or healthy living in place, you can’t jump to this. My advice would be to do those steps first, and build and establish them, because eventually all of it builds up like a pyramid and becomes one service. When you have a consultation, you’re not thinking ‘stop smoking’ or ‘erectile dysfunction’, you’re thinking about all sorts of things and in a holistic way, and that’s why we’ve called it functional pharmacy care.

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