How we worked together to develop a unique community pharmacy oral health service

The world of pharmacy is constantly changing as new healthcare challenges and opportunities arise. As future pharmacists we should be equipped with the skills required to decipher new information and to use this information to provide the best care to our patients. This is the basis of the module, Advancing Practice through Science, that final year MPharm students at University College London undertake.

As part of this module, our group was tasked with developing a novel pharmaceutical service. We were allowed to choose our own groups and had to identify an area within oral health in which pharmacists could improve public health. The brief included writing a proposal, and preparing a ‘pitch’ and short film to be presented to an expert panel of healthcare professionals.

We proposed an Oral Health Check Service to be implemented in pharmacies. The service aims to identify individuals at risk of tooth decay and gum disease, using saliva testing. We would use the SiLL-Haâ„¢ machine, a saliva testing tool, which measures seven salivary biomarkers to assess the patient’s risks. The procedure is non-invasive and once the saliva sample is taken, results are available in five minutes. The pharmacist would explain these results to the patient and use their clinical knowledge to provide evidence-based and tailored advice. Alternatively, the patient is referred to the dentist if appropriate.

The main aim of the service is to reduce the prevalence of tooth decay and gum disease in the general population through early detection and treatment where necessary. It specifically targets these oral conditions as they are two of the most common oral diseases that affect people worldwide and are largely preventable with good oral hygiene measures.

To help us come up with this service, we firstly researched areas in oral health that need addressing. NHS dental treatment is free for all under 18s yet about 40% of children do not go for annual check-ups. Therefore, we wanted to ensure that we came up with a service that would provide information to patients on their oral health, but would also utilise and promote the skills of a pharmacist in improving public health. Additionally, we wanted a service that could strengthen ties between pharmacy and dentistry and reduce NHS spending through early intervention. Currently, salivary testing for oral health is not being used in pharmacies and we believe that it is a reliable yet fast means to provide advice to patients.

In our proposal we included the complications associated with poor oral health, and how our pharmacy service could tackle this issue. We discussed the scientific validity of the machine and explained the feasibility of the service via its costs as well as the incentives for pharmacies to implement this service.

Preparing for the presentation required a lot of individual and group practice as each team member covered a particular aspect of the service. The presentation was put together in a logical manner with the problem (i.e. the prevalence of oral diseases in the country) being mentioned first and followed by our solution to the problem — the Oral Health Check service. We also made a film that explained our service, with a focus on the patient journey.

We had already extensively researched the topic in order to write our proposal, so we focused on highlighting the key aspects of our service during the presentation. A major part of preparing for the preparation was learning how to maximise our time, as we had 10 minutes to deliver our pitch to the panel. In order to achieve this, we practised our presentation multiple times and timed ourselves. We made a list of potential questions we could be asked to ensure we were well equipped to answer them. The entire preparation process was fun, and we developed valuable skills, such as teamwork.

Our group presented to three panellists. They were Helga Mangion, pharmacist and policy manager for the National Pharmacy Association, Duncan Craig, director at UCL School of Pharmacy and Dhiraj Modha, pharmacist and pharmacy owner. The panel thought our group was spirited and particularly enjoyed our short role play at the beginning of the presentation. They thought that we presented a good business case which could be rolled out into practice because it is a quick and reliable way to give patients tailored advice and information about their oral health, and it can prevent damaging complications such as tooth loss. They liked that we identified the link between poor oral health and mental health and suggested that we could explore partnering with mental health service providers.

The panel provided useful feedback concerning the service costing and fee for patients. We estimated our start-up cost by including the price of the SiLL-Haâ„¢ machine, the cost of marketing the service and training of the pharmacists. The cost of running the service included the costs of materials such as pipettes and saliva testing strips, and compensation to the pharmacist for their time. From this we were able to come up with a fee that we would charge patients who are not considered as high-risk groups and are therefore not eligible for a potentially free service covered by the NHS.  We estimated that after seeing 352 patients, the pharmacy would break-even. However, the panel thought that this is quite a long time before breaking even and we should reconsider our price as pharmacies are unlikely to implement the service if it may initially cause a financial strain.

Overall, the project was a great learning experience and it showed us that there is so much more a pharmacist can do. With direct access to the public, we have the potential to prevent, identify and manage many more conditions than we are currently confronting.  Writing a business proposal was new to all of us, but it reminded us that as a healthcare professional we not only need to be thinking clinically, but need to put on our business hats if we want to implement changes.

Coming together as a group to develop a unique and original oral health service was challenging as we had never worked with each other before.

Although we had to put our business idea on hold to prepare for our final exams, our ultimate goal would be to collaborate with the relevant bodies to allow pharmacists to be at the forefront in tackling oral health conditions.