As pharmacists continue to innovate in service delivery and extend their public health role, the pharmacy is no longer the only place to deliver services. But as they reach out to their community, pharmacists best consider the implications of operating outside registered premises

With the growing use of mobile communications and the internet to bring people together, bricks and mortar premises are increasingly seen as just one of many venues from which pharmacists can deliver healthcare services.

Many pharmacists run clinics from GP surgeries, but often the best way to get health messages across to difficult-to-reach groups is to go out into the community and meet them on their own territory. This can be a highly effective way to spread public health messages and raise the profile of pharmacy services.

By involving themselves in the local community, pharmacists can proactively raise the profile of their pharmacy and the services they provide, says Hilary Cunningham, Numark’s information pharmacist. ‘But, before investing time and money in any external promotional activity, it is important to consider the immediate and ongoing benefits to your business and ensure that it is reaching the right people and maintains a professional image,’ she advises.

Pharmacists need to ensure that any potential venue has the necessary facilities and suits their purpose. So, for example, there must be sufficient space and it may need to have a sink and washing facilities, as well as a private consultation area. Other activities taking place at the same venue should also be considered.

‘It is unlikely that a local weight loss group will appreciate a pharmacist promoting their weight management service at the same venue, but they may appreciate a more holistic approach with the pharmacy promoting a blood glucose, cholesterol or blood pressure monitoring service.’

Services should be tailored to the audience, so that a mother and toddler group may appreciate a discussion on weight loss services or blood pressure testing, a travel agent could benefit from a conversation about travel medicines and local businesses should understand the availability of flu vaccination services.

‘For the vast majority of cases, private indemnity will cover out-of-the-pharmacy activities but pharmacists should always check with their individual professional indemnity insurance provider to ensure that they are covered. It may be necessary to check whether the premises’ insurance covers the provision of pharmacy services.’

Reaching out to the community can be a useful way for pharmacies to raise awareness of their offering locally, says an NPA spokesman. The NPA supports members to do this by providing a variety of materials, including talk notes and presentations to enable them to speak at various community groups such as Women’s Institute meetings or schools and colleges. Members can also access materials such as social media updates and press release templates to help them engage with the media and local community. The NPA suggests that support staff also get involved in such activities.

Consider the risks

If an employer asks a pharmacist to do something outside the pharmacy then they still have some vicarious liability for their employee, but the Pharmacists’ Defence Association advises that all pharmacists should have their own insurance. The PDA always makes the distinction between vicarious liability, under which the employer has a loose liability for the actions of their employees (which does not abrogate the employee from their own liability), and personal insurance. ‘Relying on your employer is a personal choice – but will the employer cover your negligent actions if you don’t follow their SOPs, for instance?’ considers John Murphy, PDA director.

If a self-employed person is operating a service outside the pharmacy, they should have their own cover, says Mr Murphy. They should not trust their insurance to the discretion of someone who is contracting their services.

Pharmacists’ roles are developing all the time, and alongside this so are the associated risks. ‘Whereas the roles in community or hospital are relatively defined, new roles outside the pharmacy and the provision of more services within the pharmacy confines are creating more risks. As a defence association and an insurer we ask that, whenever pharmacists take up a new role or provide a new service, they start from a mindset of putting in place certain risk strategies minimise their risks by taking into consideration certain factors.’

Questions to consider are:

• Have I clearly defined the role and my objectives/patient outcomes?
• Is the role within my sphere of competence?
• What are my protocols/guiding principles for carrying out procedures within the role that will stand up to scrutiny should ything go wrong?
• Am I continuously updating my knowledge and skills to keep up with leading-edge practice?
• What are my support structures should I need a fall-back?
• How can I set up a peer assessment network to establish that I am doing the right thing?
• Will my records and audit trails be sufficient for assessment by the necessary authorities should they investigate me?

The PDA will cover most roles that a pharmacist can now expect to perform as a member of a wider healthcare team, says Mr Murphy. But some roles’ protocols and procedures will vary in risk and the insurance premium will vary to reflect this. ‘Pharmacists should contact our insurance department to check that what they are doing can be covered by our policies, and any advice/support required can be sought from the team in the same way as for other members.’

Pharmacists should be wary of providing certain services or supplying medicines from premises that are not registered, whether there is a PGD in place or not, says Mr Murphy.

A success story

James Tibbs, pharmacist manager at AR Pharmacy, a Numark member in Totton, has been involved in a number of outreach events that he believes have significantly boosted his business.

He runs a stand at nearby Totton College as part of its health training events several times a year. The most recent event was about alcohol awareness, and one of the activities on his stand involved asking students and teachers to pour out what they thought was a unit of alcohol. He has also been involved in a peer mentoring scheme at the college. He trained six students in sexual health matters, gave them sponsored T-shirts, and other students are encouraged to go to them for advice. The scheme works because students feel more comfortable discussing such issues with their peers.

Often the best way to get health messages across to difficult-to-reach groups is to go out into the community and meet them on their own territory

The pharmacy has provided services to the local travelling community in the nearby New Forest. In conjunction with a local charity, the Forest Bus, Mr Tibbs and his pharmacist wife and business partner have carried out blood pressure checks and discussed medicines use with the travellers. Funding from Hampshire County Council enabled him to carry out about 45 flu vaccinations in addition.

The flu vaccination funding was a rare success he says, with resources from both the CCG and local council usually proving difficult to access. ‘Getting these services is like getting blood out of a stone sometimes. But as long as you’re enthusiastic and have a good business case you’re in with a chance,’ he says.

Indemnity insurance covered the pharmacists to deliver the flu vaccinations, which were given at a community centre. The private PGD also allowed this, providing they had carried out a risk assessment first. But he points out that the PGD for NHS flu vaccinations does not allow off-site delivery.

His local LPC put Mr Tibbs onto a diabetes awareness day held in a nearby town hall. He ran a stand promoting pharmacy’s role, which was one of 15 stands run by various organisations.

Most of these outreach events have not been funded and run purely with the intention of raising awareness of AR Pharmacy services. They have proved highly successful, with prescription numbers up 10 per cent in the two years since the pharmacy has been running the services, alongside an increase in retail sales. ‘We’re making ourselves more visible – that’s the only thing that’s different.’ People are now coming from the town centre to visit the pharmacy, admitting that they had previously been unaware of its existence.

Tips for other pharmacists considering outreach services are straightforward: ‘perseverance – just get yourself known and chat to people. Don’t be scared off by consultants – at the end of the day we’re all professionals. And have faith in your abilities and go with it.’