What needs to be considered before setting up a travel clinic
Timely advice can prevent holidaymakers from coming home with health problems such as sunburn, malaria or travellers’ diarrhoea. Ailsa Colquhoun describes one way for pharmacists to offer a comprehensive travel service
Having a summer holiday abroad is a great British tradition. Admittedly this year times have been tight — with the recession, swine flu outbreaks and the weak value of Sterling to contend with — but British passports are still being flashed at customs desks worldwide.
Pharmacists can provide a valuable service to those who are jetting off to more exotic climates. Along with selling sunscreen, mosquito repellent and antidiarrhoeals, some also provide privately funded vaccinations or offer comprehensive healthcare advice.
But pharmacists thinking that there is easy money to be made out of travel health should think again, says Charles Michie, a pharmacist who has been actively pursuing the travel market for six years. He says: “It’s not going to be for everyone — only certain pharmacies will be able to make it work.”
Supplementing the NHS
At his pharmacy in Aberdeen, Charles Michie offers a twice-weekly travel clinic as an alternative to local NHS travel vaccine provision. The service started at the request of the local health board, says Mr Michie, after it became apparent that local NHS providers could not cope adequately with the local demand for travel vaccinations.
The pharmacy was already administering influenza vaccinations — one of the first in the UK to do so, Mr Michie believes — and so a private patient group direction was written to allow the pharmacy to offer travel vaccinations and antimalarials.
In addition, a two-day training course was organised for the pharmacists by the local health board (the same training given to local practice nurses).
Despite the economic uncertainty, the clinic remains as busy as ever, Mr Michie confirms (in a rare moment between customers). The clinic takes place in one of the pharmacy’s three consultation rooms and he currently sees around 11 customers per day.
Each is charged £25–£55 (depending on the travel vaccinations required) and receives around 20 minutes of holiday health advice on aspects such as suncare, sexual health and safe eating and drinking.
During the consultation, the pharmacist also takes a medication history. This is in line with recommendations contained within the Department of Health’s ‘Green Book’ on immunisation, and Health Protection Scotland’s Travax travel health advisory service.
This helps the pharmacist to determine the level of advice and the number of vaccinations that the customer requires.
Mr Michie adds: “We consider that a two-week package holiday has a basic travel health requirement. Any travel plans over and above this duration of holiday will have secondary requirements that need to be taken into account.” Such requirements, he explains, may include additional vaccinations (depending on the destination of travel).
Focus on malaria
Over the past three years, the incidence of imported malaria has fallen in the UK. According to the Health Protection Agency, in 2008 there were 1,370 cases of imported malaria, an 11% fall on the previous year.
According to the HPA, the prime “offenders” for imported malaria remain, by far, British residents returning after family visits to their countries of origin.
A new vaccine for malaria is expected to be launched during the next few years. It is expected to add considerably to the overall value of the private vaccinations market. According to a report published by market research firm Renub Research (“World vaccines market 2008–2013: future forecast, critical trends and developments”), the market for malaria vaccination is expected to be worth $419 million by 2025.
Mr Michie believes that the success of his service is down to the support it receives from the local health board — for example, the board assumes responsibility for updating any PGDs. GPs are encouraged by this support, Mr Michie believes, to refer patients they cannot accommodate and they see the clinic as an adjunct to their NHS service, rather than a competitor.
Posters and leaflets, supplied by NHS Grampian, have been circulated to all local travel agents. Window displays and adverts in the local press also help to generate a decent amount of “walk-in” trade.
Plus, the pharmacy benefits from the high number of oil-industry personnel working in the area, many of whom need to travel at short notice.
Even with two pharmacists on hand and multiple consultation areas in which to deliver the service, Mr Michie still has to turn some customers away. High-risk patients (eg, those who are pregnant or immunocompromised) are referred back to their GPs.
Also, the pharmacy is not registered to offer yellow fever vaccinations and it cannot administer vaccines that are unlicensed in the UK, such as those for Japanese encephalitis and, currently, rabies (due to ongoing supply shortages with the UK-licensed product). This latter issue is a concern for the business, Mr Michie admits, since rabies vaccination is commonly requested.
As a result, he has reached a compromise with GPs: he refers customers requesting rabies vaccination back to their doctor to obtain a private prescription for the unlicensed product, against which he can supply the vaccine. However, the customer still needs to return to the surgery to have the vaccine administered by a practice nurse.
James Moore, a nurse consultant who specialises in travel health, says that travel clinics like Mr Michie’s have the potential to become a convenient alternative to existing care options, but only if they supplement whatever service is already available from the NHS.
“They should be driven by the chance to offer a higher level of service and not by the price you can charge for the service,” he suggests. He offers consultancy advice to pharmacists relating to opening a travel clinic (firstname.lastname@example.org).
Mr Moore believes that to offer a thorough travel service pharmacists have to be prepared to spend a good amount of time with patients discussing their travel needs.
“Around 95% of imported health related problems do not have anything to do with vaccine-preventable diseases. They are down to the attitude and behaviour of people while they are away,” he says, citing poor use of mosquito bed nets as a case in point.
“For this reason, my advice is: if you are going to do a travel service, you need to do it properly.”
Ailsa Colquhoun is a freelance writer
Citation: PJ Business Knowledge URI: 10980959
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