Are you using your consultation area to the maximum, or is there potential for this resource in community pharmacy to be used to better effect?

Most community pharmacies have a consultation area of some type, where they can speak to patients privately, and this is an increasingly important area for the provision of pharmacy services.

We ask three pharmacists from Avicenna pharmacies about their use of their consultation areas, the benefit this brings and how this could expand in the future.

"Our consultation room is in use all the time"

In Avicenna’s pharmacy in Bristol, the use of the large consultation room is very much a team approach. “Our consultation room is in use all the time, and it’s not just me in here – everyone uses it. The counter assistants and our pre-reg are trained to do smoking cessation, blood pressure and sugar levels, so they are using it a lot,” says pharmacist Mithun Makwana.

Commissioned services include weight management, smoking cessation, alcohol audits and a minor ailments service, and the pharmacy also offers services such as blood sugar testing and asthma reviews.

“We are a healthy living pharmacy, and a range of services, such as medicines use reviews, the new medicine service, flu vaccinations, are all taking place in the consultation room. We’ve do travel vaccinations as well and run a weight management service, funded by Bristol City Council, where we refer patients to either Slimming World or Weight Watchers and follow them up as well.

“We carry out alcohol audits – targeting patients using scratch cards – to work out if they are at an increasing risk of alcohol-related problems, at a higher risk, or even at risk of dependence. That’s a paid service as well. Many people don’t realise that daily drinking – even a couple of units – can be over the allowance.

“I like to do asthma MURs in a bit more detail. I’ve got an incheck dial device in the consultation room – a device used to monitor inhaler technique, which is really useful. If a patient is breathless or not well controlled its usually their inhaler technique that’s not right.”

“We also have a hand-held spirometry device to measure forced respiratory volume, to carry out lung function tests.”

What’s key to the effective use of the consultation area?

“It’s good to have plenty of space in the consultation room, and whatever the size, it’s very important to keep it tidy. I know some pharmacies use the consultation room to store things in as well, but it looks much more clinical when it is clutter-free, with the desk is clear and, obviously, free of confidential patient information.

I think one of the main comments that I get from patients is that our consultation room looks really clinical – and that seems to help put people more at ease.

“We’ve had a refit recently and it feels better for the patient with a good atmosphere. We have a PMR in the consultation room, so I can access patients’ records easily; a large desk; a sink and a shelf where I keep all plasters, EpiPens etc.

“There is one access to our consultation room from the shop floor and another door from the dispensary – so that’s really useful. My counter assistant asks people if they’d like a word with the pharmacist, and then takes them to the room. I just have to join them from the dispensary.”

And do you expect to see services delivered in the pharmacy extend in the future?
“Our consultation room is fully used already, but I think that is the way that community pharmacy is going. We will be even more service-focused in the future.”

"It's a key area of the pharmacy – all about what we do and what we are aiming towards"

“I feel that the whole mind-set of the public has changed in the past decade since we’ve had consultation rooms,” says Mickey Forsyth, pharmacist at Avicenna Pharmacy, based in Talbot Medical Centre in Dorset. The 100-hour pharmacy has been open within a doctor’s surgery for four years.

“In the past, when people came in to collect their prescription medicine, they would buy their lipstick and develop their photographs, and I think the perception then was that pharmacists were shopkeepers. People didn’t even know that we had a degree. With consultation rooms, people do now realise that we are healthcare professionals.”

“I think that the consultation room is a key area – it’s all about what we do and what we are aiming towards. I use it a lot when responding to symptoms. If anyone comes in needing advice – even if they don’t request a private word – we take them to the consultation room, away from the crowds. It’s quiet and we can fully understand their needs, ask questions and establish how we can help.

“Whether it’s someone with a skin complaint or who’s just been given some bad news from the doctor about their health or condition – it’s an area where we can fully focus on them and give them our full attention. It’s a powerful tool – and also a means for pharmacy to wave its flag about the new modern role.

“Our small consultation room is in constant use – we do use it a lot. At quiet times our staff also use it for learning.”

Do you see more patients in the consultation room as you are based in a GP surgery?

Close working with the practice has allowed the pharmacy to grow over time, feels Ms Forsyth. “We do work very much together with the practice, and they have a full understanding and appreciation of what pharmacists do.

It’s a real privilege working alongside the doctors, and we do provide a complete service for the patients. “It’s been a great experience for me. I have been a pharmacist for 30 years, but I absolutely love the changes that we have made in the pharmacy. I think having a consultation room has actually contributed to these changes and made it a really positive experience.

The GP practice has recently joined with another, giving a combined total of about 23,000 patients, and additionally looks after the transient student population of Bournemouth University.

What do you use the area for?

Being based with a GP practice has helped drive use of the pharmacy facilities, says Ms Forsyth. “Patients will often come to us first and that’s one of the reasons why we use the consultation room a lot. Over the years, patients from the practice have learned that if they come and talk to us first in the pharmacy we can often help out. If they have a side effect, say, we can maybe have a chat with a doctor and there might be no need for a GP appointment.”

As an independent prescriber, Ms Forsyth uses the consultation room particularly intensively. “I am sometimes a triage point when the surgery is under pressure with large numbers of people requesting emergency appointments. For patients who don’t pay the prescription charge, I specialise in the treatment of minor conditions, and am able to examine them and provide a prescription for them, with all of my required records. That’s all done in the consultation room.”

“I’ve always been a pharmacist who likes to be at the front of the pharmacy. I believe that the pharmacist’s place is at the reception talking to the public about their medicines and helping staff as necessary. I am promoting the services and everything else by being there at the front and I think that this is the greatest advert that you can make for the profession.”

“We are involved in flu vaccination and medicines reviews, and we provide stop smoking service and EHC. People come in for BP checks, and we supply travel medicines, anti-malarials and travel advice, for example.

Does the consultation room allow you to offer better care?

“I find that having a consultation room has improved the services that we offer to young people, who can be shy or feel embarrassed about their problems. We have to open our eyes and read the body language – when we see a young person standing at the back of the queue very often we will approach them and ask if they want to chat privately,” says Ms Forsyth.

“I also have customers who have impaired hearing, and who come with an interpreter. It’s so much easier to have that conversation in a private area. The consultation room has given me the opportunity to provide a better service to less able customers.

“I had a lady who is registered blind came in to ask for my help. She just wanted to fill up her first aid box, but she wanted products that she could identify by touching them; it was helpful to establish what she needed in a quiet place. So, use your consultation room when you have a partially-sighted or impaired hearing patient.”

"As we get more services, I'm sure we might need to expand to an extra room"

In Wickford in Essex, Avicenna pharmacist Ahmed El-Dabbagh couldn’t be without the consultation room, as it gives him space without distractions to focus on the patient.

“Every half an hour or so I go to the consultation room for something or other. You are not distracted in the consultation room: you are giving all your time to the patient, are able to listen clearly and can give advice clearly. With the patient more relaxed to talk more about their history and illness, it’s easier to build rapport and to ensure concordance.”

An important tool in the consultation room for Ahmed is a tablet computer, to use when explaining things to patients and for looking things up quickly.

“If the pharmacists use computers or tablets, it stops the room from being cluttered with paper files. I use a tablet, which gives me quick access to information in a second, for example if I need to check something for malaria advice. I think that ventually everyone will use one in pharmacy.”

Can you see services in the pharmacy expanding further?

“As time goes by and as we get more services, I’m sure that we might need to expand to an extra room in this pharmacy,” says Mr El-Dabbagh.

“I’d be keen on a nurse room or a blood testing room. Blood testing is only done in one locality around here and people have to queue. It would be easier for patients to come to the pharmacy to have a blood test, and get checked straight away. That would save everyone a lot of time.”

Do you think that all pharmacies should be using their consultation room to the full?

“Ethically and professionally we have to use the consultation room. It shows the patient that you are interested in listening to them and that you want to help them.”