Andrew Morrison, superintendent pharmacist at Eccleshall Pharmacy, speaks to Rachel Carter about his experience of delivering a locally-commissioned minor ailments service.

Service type: Extended care scheme (Minor Ailments).

Name of pharmacy: Eccleshall Pharmacy, Eccleshall, Staffordshire.

Name of pharmacist: Andrew Morrison.

Why did you start offering the service?

I’ve been offering this service since January 2020. I thought from a commercial point of view that it would be good for us. If we can get the GPs tuned into the service we’re offering, I think they are likely to refer people to us, because they are quite keen to offload a lot of what they class as minor ailments. Certainly, when I spoke to a practice manager about it before we started, she seemed to think it would be a good idea.

How much did it cost to set up the service?

I bought some clinical tools, including a stethoscope and a pulse oximeter - £100 would cover the cost of those. There would also be a cost to any employer for the day’s training, but as a self-employed person I covered that cost myself. The pharmacy was also loaned an otoscope for the service by the LPC, which would otherwise have cost around £300, so that was good.

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

I attended a one-day course, which was led by a GP trainer from a local university. There was some background preparation to do for that, including some research on terminology and the use of otoscopes.

On the course, we covered history taking and gathering information in detail. The trainer told us that you get 80% of the information you need not by examination, but by questioning and hearing what the patient has to say. We also practiced with the otoscopes to understand the best way to use these.

In a nutshell, what does the service involve?

The extended care scheme is a locally commissioned service, and it has two tiers. Tier one covers urinary tract infections, and this is quite straightforward - it is offered by the majority of pharmacies in Staffordshire. For tier two, the LPC has been more selective about who can offer this, to ensure there is a good geographical coverage and that neighbouring pharmacies are not offering the same service. This is not an issue for us because we’re six miles from anywhere else, so we offer both tier one and tier two of the service. Tier two covers ear, nose and throat complaints, skin conditions and insect bites.

The counter staff are the first port of call and they refer the patient on to me. I ask the patient to very briefly give me an idea of their problem, so that I can assess whether or not I would be able to treat it.

If yes, I then get the patient’s consent to participate in the service. I explain that we have the extended care scheme and that I can possibly treat the patient without them having to see their GP. Hopefully, they will say they are interested, and then I will take them into the consulting room.

We get the consent forms signed and I ask the patient to tell me about their medical history. From that, we can maybe narrow down what’s going on. I then examine the patient and if necessary I would prescribe treatment for them. We have the option to prescribe, not prescribe, or to deter. For example, I might say to a patient that it’s unlikely that they will need antibiotics but if it’s still bad after three days then they can come back.

We follow up with the patients after five days to get feedback and ask whether the treatment has been appropriate, or whether they’ve had to seek further treatment from their doctor or other healthcare services. That’s a key part of the scheme. We have to do the five-day follow up to get paid.

For the follow up we can either see them in person, or I tend to take a phone number and ring them to discuss it by phone. In some cases, I have had to refer patients back to the GP to treat conditions not covered by the PGD.

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

The scheme allows us to prescribe, and to refer people to an over the counter (OTC) product if appropriate. In some respects, prescribing is the last option. Patients will come in with a problem and their expectation is often that you will give them antibiotics. Sometimes it is not appropriate to do that, so you have to explain this, and you might sell an OTC item instead.

How have patients responded to the service?

As part of the scheme, patients agree to fill out a questionnaire, telling us whether their feedback is good, bad, or otherwise. I have to say that everybody we’ve seen so far has said that it’s been great and that has been unanimous. They can get treatment easily and not have to bother their GP.

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

I carried out at least seven or eight consultations before the Covid-19 pandemic started, and that’s bearing in mind that the surgeries may not have been up to speed yet with referring patients down to us. It is something that patients don’t always realise that we offer, so it’s still very much in its infancy.

We have been running the tier one part of the service for longer - two or three years at least - and for that we might see 10 or 12 patients a month.

How much do you charge for the service?

If patients pay for their prescriptions normally, they would pay a prescription charge for any item that was prescribed under the service. If they are exempt then you would not charge. OTC products patients would pay for.

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

There are two parts to the payment. We get paid for the medicines we supply, and we get paid for completing the process. In other words, that is for carrying out the initial consultation and the five-day follow up.

I think this service has the potential to be quite lucrative. Last year, we saw a number of patients with infected insect bites, where we knew exactly what they were and the course of antibiotics that was needed. But because we didn’t have tier two in place at the time, we had to refer those up to the surgery. If that situation was going to be mirrored again, then I could see that we would do very well out of it. Also, I think with the surgeries shut [during Covid] and changes in place around how they see patients, there is an opportunity for us as a profession to manage a lot of these minor ailments.

Would you recommend offering this service to other contractors?

I think if the opportunity comes for contractors to enroll in this extended care scheme, which obviously very much depends on funding, I would say, yes, without a doubt. Staffordshire LPC has been very proactive about this service and they are keen to gather enough evidence to roll it out nationally.

As pharmacists, this service is another income stream for the business, and it does enhance our professional standing as well. If you can also help to reduce some GP workload too, then that’s great. I think you’ve just got to be careful about managing time, because it can take a little while to carry out. In the way that we are working at the moment it works very well, but I could imagine that in pre-Covid times you would need to manage your time and workload carefully to be able to spend that time with the patient.