Setting up a travel health clinic
Multiple approaches
Superdrug has opted for nurse-led immunisation clinics, now in 19 stores, with their pharmacists offering travel health advice as a follow-up. And NPA information pharmacist Phil Sharratt agrees that the easiest way to run a travel health clinic from your pharmacy could be to rent out a consultation room to another healthcare professional, though he notes there are professional rewards to be had by delivering the service yourself.The alternative is for pharmacists to undertake suitable training to provide the immunisations themselves, and this has the added bonus of skills overlap with other increasingly popular pharmacy services involving the administration of vaccines, such as flu jabs.This is the route Sainsbury’s has taken with a service that was trialled across 90 stores last summer. Roll-out has not yet been progressed, but a Sainsbury’s spokesperson says it is exploring the training that will be required. “The trial was a success and it’s something we want to progress but it’s a completely new service that is going to require a lot of training for our pharmacists, so it’s not something we can do straight away,” the spokesperson explains.And last September, Lloydspharmacy extended its online doctor initiative to travel health. Customers log onto the site, ask questions about their health and travel destination and receive information from a GP about suitable vaccines and the necessity (or not) for anti-malarials. The customer then chooses the vaccines they would like and a prescription is sent to one of 260 participating Lloydspharmacy branches, where vaccines are administered by a trained pharmacist.Superdrug also envisages its pharmacists carrying out progressively more of the service themselves, says superintendent Martin Crisp. He hopes customers’ “very, very positive” response to the travel health clinics will contribute to a “cultural change” in the public’s perception of the pharmacy’s role. “It’s already become our biggest service,” Mr Crisp says. “Hopefully that’s opening the door for people to see that you can sit down in a pharmacy and for the pharmacist to become more and more involved.” He adds that the service appeals to a younger clientele than Superdrug’s traditional customer base – its target demographic of 18- to 45-year-olds – and that the multiple is exploring “something specific” for students.
Practical considerations
But bear in mind, warns Mr Sharratt, the demands a travel health clinic could have on a pharmacist’s time. “This isn’t a service you could just do ad hoc between prescriptions,” he says. “Patients are going to need to be booked in and time is going to need to be spent with them.”Once you’ve decided on the format for your service, you’ll need to consider its setting. As a minimum, advises Mr Sharratt, there should be a designated area for the service – a consultation or treatment room – where the customer and pharmacist can sit down. Given this, he says, and the fact that travel health consultations could be fairly lengthy, you should think about the time you can afford to give the travel health clinic in terms of the use of space also required for carrying out MURs and any other services you may run. “You’ll need to balance the professional and financial return against the opportunity loss on other services,” he explains.As well as considerations such as waste disposal and sinks for your travel health clinic area, Mr Sharratt points out the necessity for online access to information resources, and anaphylactic kits. And, of course, you should have a robust business plan for the service. Mr Sharratt says: “It really is up to the individual to do their homework and ensure what they’re going into is costed out correctly before they do anything.”One set-up cost could be registration with the Care Quality Commission (CQC). Pharmacists have expressed confusion about whether or not a pharmacy-based, private travel health clinic would need to be registered with the health services watchdog – and the answer is that it depends on who is administering the vaccinations and under what agreement.If a nurse or doctor is administering the vaccines, then the clinic would need to be CQC-registered, as it would if a pharmacist was carrying out the jabs under a PGD. But if the pharmacist was administering the vaccines as a pharmacist prescriber, then registration with the CC would not be required. A CQC spokesperson says: “If a provider was unsure as to whether they were required to register in order to legally provide services, then they should contact the CQC to seek clarification.”
Small steps
For those not quite prepared to take the plunge of setting up a full-blown travel clinic, Mr Romanes believes he may have come up with the perfect “halfway house”. His Romanes Pharmacy in Duns “takes ownership” of customers’ travel health preparations, organising immunisations, and anti-malarials, but doesn’t actually carry out the vaccinations itself. “People seem to appreciate that you’ll take some of the stress off them and make sure they have got the right stuff,” he says. And although the service is provided free of charge, this set-up reaps benefits in linked sales of insect repellents, needle kits and mosquito nets. As Mr Romanes says: “You have got to do a selling job.”Mr Sharratt agrees. It goes without saying, he says, that you would recommend your travel health clinic customers products for travel sickness, diarrhoea and vomiting, and DVT. “It’s an essential part that you will be able to build into your consultation and make those link sales.“Vaccines and anti-malarials are not the only weapons in your armoury – take a holistic view of a travel health clinic.”
How the multiples are tackling travel health
LloydspharmacyPrivate online doctor service – the patient answers questions online, a remote GP recommends vaccines and anti-malarials where suitable, a prescription is sent to one of 260 participating pharmacies and a pharmacist administers prescribed vaccines.Sainsbury’sTrialled private pharmacist-led travel health clinics in 90 branches last year; training to prepare for roll-out currently being explored.SuperdrugPrivate nurse-led immunisation clinics in 19 branches, plus pharmacist travel health advice.
The expert view
There is an opportunity an for greater pharmacist involvement in travel health, says Professor Larry GoodyerOne of the most interesting clinical developments for community pharmacists has been in the provision of vaccination services, and a growing number have been providing influenza and HPV immunisations.A natural extension of these activities is to provide a travel vaccination service, and there has been some very successful pilot work in Scotland on pharmacist-led travel clinics. A number of multiples as well as independent pharmacies are beginning to take an interest in what could eventually become a mainstream pharmacy activity.Much of travel medicine is about preparation for travel overseas by obtaining the correct advice, prophylaxis or immunisations, and health-related supplies. Arguably, community pharmacy is the ideal setting for obtaining such a public health-related service, being an accessible environment that most people will be visiting at some point before a trip overseas.There is also an argument to be made that travel medicine should be a totally private service not funded by the NHS, and this may eventually prove to be the case.One word of warning is that a travel medicine service is not just a question of vaccines and anti-malarial tablets but a process that involves a risk assessment and construction of a management plan for the traveller. Community pharmacists have long given advice and provided health-related supplies to travellers and a reasonable CPD plan should be sufficient for that type of provision. If embarking on a full travel medicine service through implementing PGDs or non-medical prescribing, though, a far greater level of involvement and education is required.Pharmacist vaccination services are becoming mainstream in the US and Canada and a new initiative by the International Society of Travel Medicine (ISTM) is linking up pharmacists from around the world who have an interest and practice in travel medicine. It would be of advantage to many UK-based pharmacists developing an interest in this area to join and participate in the Pharmacist Professional Group (PPG) of the ISTM. This will certainly link pharmacists in to a range of resources and expertise from all over the world.Professor Larry Goodyer is head of the Leicester School of Pharmacy and a travel health expertFor further informationInternational Society of Travel MedicinePharmacy Professional Groupwww.istm.org British Travel Health AssociationParticularly recommended if new to the area of travel medicine www.btha.org The Faculty of Travel Medicine, Royal College of Physicians and Surgeons of Glasgow tinyurl.com/cn5e6yThe Care Quality Commission www.cqc.org.ukThe Foreign and Commonwealth Officetinyurl.com/cds4s8
How to advise patients taking medicines abroad tinyurl.com/medsabroad
CPD Reflect • Plan • Act • EvaluateTips for your CPD entry on health policyReflect How can I improve my travel health service?Plan Identify what services I offer now and what I want to provideAct Train staff and market services to the publicEvaluate Has the service been delivered and has it benefited the public?
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