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Running a pharmacy travel health service

Travel health can be an important focus area for pharmacy as exemplified by the number of successful pharmacist-run clinics currently in operation across the UK. Jackie Lewis, pharmacist director at Lewis Pharmacy in Exmouth, provides some useful insights into setting up and operating a travel health service in the local community.

Jackie Lewis decided to offer travel health services so she could take her clinical skills in a new direction and generate private income away from dwindling NHS funding streams for the pharmacy.

Jackie outlines the training she completed before embarking on the endeavour. “Initially I enrolled on a patient group direction website, then switched to another and undertook their training. I also did the CPPE immunisation training and will be doing their travel health course shortly. 

“I am moving towards prescribing travel medication privately. I need to stay abreast of the Green Book chapters and SPCs for each vaccine and also the TravelHealthPro news from the National Travel Health Network and Centre [NaTHNaC]. To set up the pharmacy as a yellow fever centre, a very interesting day at NaTHNaC was required, followed by subsequent e-learning every year to two years.”

On the issue of upfront costs and key challenges to be aware of, Jackie says the biggest thing to consider, and the reason she changed PGD provider, is how workable the website is when the patient is sat in front of her. “It seems that too many have been developed with scant regard to the customer –us – or the patient. It is very stressful if [the website] is not good enough.”

The costs of the PGDs themselves also need to be considered, she says. “Can you get access to the patient records long-term if you do not stay with the provider? It is good practice to attach the travel consultation documents to a patient’s records in the PMR, to be able to print a copy out for the patient and to email the vaccines given with consent to the patient’s surgery in the hope they will go onto their summary care record.”

Although she has not yet found a suitable offering that works for her, Jackie recommends pursuing a specialist pharmacy qualification in travel health. She also notes that working with the Medical Advisory Service for Travellers Abroad (MASTA) could be worthwhile as it can help with recruiting patients into the service, although – in her personal experience – the associated costs are proving too high at the moment. 

Providing a profitable service

The travel clinic at Lewis Pharmacy offers a range of key services including injections, antimalarial medications (malarone, malarone paediatric, atovaquone/proguanil, Lariam and doxycycline) and the antidiarrhoeal antibiotic rifamizin, as well as other pertinent travel-related advice. 

In addition to being a certified yellow fever vaccination centre, the pharmacy provides innoculations against hepatitis A and B, Japanese encephalitis, rabies, typhoid, tetanus and tick-borne encephalitis. Customers can also get advice on everyday travel health issues such as sun protection, insect bite avoidance and treatment, first aid, pain relief and jet lag, as well as more niche concerns such as diarrhoea treatment/rehydration, period delay and altitude sickness. 

The reaction of the local community to the service has been positive, says Jackie. “Customers like it and feel well looked after. They are pleased to be seen quickly and to have a local clinic.” 

On the issue of fees, Jackie says she charges for each injection/medication given and that people are happy to pay once they agree with the need for a vaccine. “I will ask them to think about their need for individual vaccines if they are undecided by accessing the TravelHealthPro website.

“I learnt quickly that people are not happy to pay for the consultation, especially if referred by a surgery and only need free NHS vaccines from the surgery. In fact, a consultation to establish their travel health needs is not time-consuming and I like to think most people will come back or use the pharmacy again.”

The model is profitable, says Jackie, but she acknowledges that it is sometimes challenging to fit travel services into the normal running of the pharmacy. “You need to be organised and have accuracy checking technicians. A stand-alone clinic would not be profitable. The model works because we have the pharmacy open and this is extra to our core business.”

Overcoming barriers

As she touched upon earlier, Jackie cites PGD website issues as one of the main hurdles to providing the service. “I have not yet found one that suits me. They are a safety net but can be long-winded to use with a patient in front of you,” she says. 

Vaccine stock shortages and price rises are other potential stumbling blocks. “These were never great but have been much more numerous since Covid. I have the consultation and compile a list of people waiting for a particular vaccine, then phone round when it is back in stock,” she explains. 

“Patient cancellations and missed appointments are standard when running a clinic, unfortunately. I will phone to rearrange. Our [business] model works to accommodate these but a stand-alone clinic would suffer.”

Jackie points out that because of the training involved and the fact that working in the clinic requires experience, “other pharmacists I employ are not able to provide this service at present. In addition, each pharmacist would need to be paid for to use the PGDs on my premises”.

Looking to the future 

Discussing potential plans to expand the Lewis Pharmacy travel health service, Jackie says she is increasing publicity on the pharmacy website and working with the local GP surgeries. “I would like to source additional items such as mosquito nets and water purifying tablets but have been unable to secure a supply to date.”

For pharmacists considering setting up a similar service, Jackie offers some important advice. “It is very interesting and rewarding as you get to grips with it. It uses clinical skills and you meet many happy people of all ages. The free TravelHealthPro website is excellent for helping you talk through options with patients. 

“Ultimately, it provides profits for the pharmacy outside of the NHS and complements the GP service, but diligence and good record-keeping are certainly required,” she concludes.

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