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Post-pandemic, there has been a huge increase in travel abroad, despite the cost of living crisis, as people take postponed holidays.

There are around 42 million trips abroad each year where the traveller doesn’t seek any travel health advice, says Pharmadoctor.

This represents a big opportunity for community pharmacies, which already deliver more than 60 per cent of private travel vaccines.

“Less than 10 per cent of GP practices now offer a full travel health service and since the pandemic, it’s become harder to get a GP appointment,” says Graham Thoms, CEO at Pharmadoctor. “Add to that the fact that most travel vaccines are private and few GPs offer all of them, pharmacies can offer a much more comprehensive service to customers, with convenient appointment times. And customers can purchase all their healthcare items for their trip at the same time.” 

At AR Pharmacy in Totton, near Southampton, pharmacist James Tibbs runs a successful travel clinic and says: “Our travel clinic was busy before Covid, but now we’re finding people want to go abroad even more. They are also more aware of disease risks and the importance of vaccines to protect themselves. They also want travel health advice to help prevent disease.”

Running a travel clinic

Thoms offers compelling reasons why pharmacies should consider setting up a travel service.“It generates new business,” he says. “Our Travel Health eTool data shows that some pharmacists are generating over £276,000 of new business a year, and that’s growing by 10 per cent month on month.”

He says the boost in footfall drives demand for other pharmacy services, potentially making businesses less reliant on “dwindling” NHS income. 

This will vary from one provider to another. Pharmadoctor charges £699 for its Travel Health Clinic package. There are then the costs of buying vaccines, malaria tablets and other travel related POMs and retail products.

Valneva provides a free travel health online training course (Neva) which takes about two hours to complete. Training usually culminates in a face to face assessment.

You may want to upgrade the pharmacy’s consultation room, or if possible allocate a dedicated room to your travel clinic. You’ll need space in your fridge to store vaccines, and you will also need an anaphylaxis kit.

“It’s vital to promote your service. Word of mouth is free and one of your best tools. Get your local GPs to refer patients to you. Go to local gyms and leisure centres and travel agents to tell them about it. Put up posters,” says Thoms.

When you sign up to a service package, you will get your clinic listed on the company’s patient-facing website so they can book direct at your pharmacy. Pharmadoctor also provides pharmacies with digital promotional materials they can use.

Shaheen Bhatia, pharmacist at P&S Chemist in Ilford, Essex, says: “When we set up our service 15 years ago, we let all the local GP surgeries know about it. We also have a Facebook page and a website where customers can book an appointment. And we get lots of word of mouth referrals.”

“I’d say the main challenge for pharmacies is being able to carve out the time and necessary resources to deliver the service efficiently,” says Thoms. “It does take time out of your day, but it’s incredibly profitable compared with scripts and retail.” 

Tibbs adds: “Accessibility is key for a pharmacy travel service. We offer a walk-in service as we are lucky to have three pharmacists on duty.”

It’s important that the whole pharmacy team know about the service and can tell customers how it works and what you offer. Keeping a good level of vaccine stock is also important.

Travel clinic case studies

Shaheen Bhatia: P&S Chemist, Ilford, Essex

“We set up our service 15 years ago as we have a large ethnic minority population, with lots of people travelling to Mecca. Local GPs were charging a lot for the MenACWY vaccination and some of our customers asked why we didn’t offer the service, so I decided to do it. We’ve noticed an upturn in business since the pandemic. Those who didn’t travel during the last few years have saved up to go away this year. Our most popular vaccines are hepatitis A, typhoid and MenACWY. Our travel service is now one of the anchors of our business and has become more important in the face of dwindling income from scripts. It’s important to remember it’s not just about vaccines; we also offer anti-malarials and travel kits, plus all the link sales you can make with anti-diarrhoeals, insect sprays, first aid kits and sunscreens.”

Yara Botros: Holdenhurst Pharmacy, Bournemouth

“We set up our service 18 months ago. Our most popular destination is currently Thailand, with the most requested vaccines hepatitis A, tetanus, typhoid, rabies and Japanese encephalitis. What customers like about our service is that most of the time they can get it all done in one appointment. We also give advice on travel insurance, malaria and using insect repellents. We have shorter wait times than GP surgeries, which is very useful for customers who’ve left it until the last minute.”

James Tibbs: AR Pharmacy, Totton, Southampton

“We set up our service 11 years ago. We started off doing 18,000 items and now it’s up to 45,000. We’ve seen a natural growth in our pharmacy business as a result of running the travel clinic. The questions customers used to ask were mainly about cost, but now they ask us what vaccines they need for particular activities. They are more aware that vaccines are not 100 per cent effective and want to know what else they can do to protect themselves. Our most popular vaccines are hepatitis A, typhoid, diphtheria and polio. We also keep in the less popular and harder to source ones, cholera and rabies.”

Travel Health Advice

Which vaccine do I need?

Customers can check which vaccines they need for their destination at NathNAC. The website has details of which vaccines are required for each country.

First aid for travel

All travellers should carry a first aid kit, but what it contains will depend on their destination.

For those travelling to areas where there is a concern about the quality or availability of medical equipment, a sterile medical kit should be considered in addition to a regular first aid kit. This is for the traveller to give to a nurse or doctor in a medical emergency.

A regular first aid kit should contain: wound care items such as bandages, scissors and antiseptic; preventative items such as hand sanitiser and condoms; medicines such as analgesics and anti-diarrhoeals; and other useful items, like a copy of any prescriptions and a travel insurance certificate. 

DVT Prevention

Long distance travel increases the risk of blood clots. Prolonged periods of immobility slows blood flow in the veins, increasing the risk of DVT. Those at risk of DVT include anyone with a history of the condition, patients with blood clotting disorders, over-60s, pregnant women and individuals taller than 1.9m or shorter than 1.6m.

Advise customers to move around as much as possible during their journey, and to keep a clear space in front so they can extend their legs. For those at higher risk of DVT, you can recommend compression hosiery. It’s important they wear the correct type and size and know how to use them properly.

Preventing insect bites

Mosquitoes can infect with malaria, dengue fever and yellow fever. As well as having vaccinations and taking anti-malarials if needed, it’s important for customers to know how to prevent insect bites, such as through appropriate clothing or the use of mosquito nets.

Insect repellents help stop mosquitoes from landing on and biting skin. They should be applied to all areas of exposed skin. Advise customers to apply these after sunscreen and to reapply regularly. There are several types of insect repellent, which come in different strengths. The higher the strength, the longer it will protect against bites. DEET is the most effective active ingredient. A concentration of 20-50 per cent should be used, with 50 per cent in malaria areas. Alternative products include picaridin and lemon eucalyptus (PMD). 

Sun safety advice

Despite growing awareness of the dangers of sun exposure, rates of skin cancer continue to rise. It is estimated that one in five people in the UK will develop non-melanoma skin cancer
at some stage, while melanoma incidence has increased by
32 per cent in the last decade, says Cancer Research UK. Currently, there are around 16,700 new cases a year, making it the fifth most common cancer in the country. It’s believed that 86 per cent of melanoma skin cancer cases are preventable.

It’s important to pass on the message to customers that they need to protect themselves from sun damage at home – not just when they’re abroad. A survey by the British Skin Foundation found that 45 per cent of over-50s rarely use sunscreen during the summer in the UK. And as UVA and UVB rays can be a factor in eye disease (especially cataracts), it is advisable to wear glasses with a UV filter. Sunglasses should have a CE mark to ensure they comply with European standards. There is also a British Standard BS EN 12312-1 to look out for.

Choosing and using sunscreen

Dr Adil Sheraz, consultant dermatologist and British Skin Foundation spokesperson says: “It doesn’t matter if you choose a cream, lotion or invisible spray. What matters is that you choose the right product that will give you adequate photoprotection for your skin which is then applied correctly. Choose SPF30+ and one that protects from UVA and UVB rays. Spray sunscreens are popular, but many people apply only a quarter of the required amount. When using a spray, each body area should be sprayed for up to six seconds. All sunscreens should be reapplied after sweat-inducing activity or two hours in the sun. There is no sunscreen that is once a day.”

Dr Bindi Gaglani, a senior clinical fellow in dermatology, says: “Customers should be advised that sunscreen is really a supplementary tool to protect skin from damage. They should primarily seek out shade and wear appropriate clothing to protect their skin from the sun. UV rays are most intense between 10am and 2pm, so limit exposure during those times.”

Views from the P3pharmacy panel

I’m an independent prescriber and we run a travel clinic service in our pharmacy, so this is a really important area and a good source of income for us. I feel that sun care has mostly slipped away from pharmacies and most people now buy it in supermarkets. However, travel health is something that we can excel at. Our clinic is really popular and local GPs send patients to us for vaccinations and advice. Insect repellent is a popular product in our pharmacy, and I usually recommend a high DEET content one, such as Ben’s Insect Repellent.

This is becoming more popular. Patients are looking for the best protection from the sun, bugs, and also infections whilst they travel abroad. Top sellers for our pharmacy include Nivea Sun, as well as DEET-based bug sprays. People are more aware of the permanent effects of sun damage and I see more queries regarding higher SPFs rather than patients coming in for burn after care – although this is still prevalent. Displays in waiting areas or alongside queues are useful as patients usually come in for scripts and quickly pick up some necessities for holidays.

This is a seasonal ‘must’ category. We do however make sure there is a small area devoted to this section year-round to cater for winter sun holidays. We generally look for a suncream range on offer from our wholesaler each year to keep the section fresh. We always try to stock medications for a travel kit that require no water (e.g. Imodium Instant Melts and liquid paracetamol). Use promotional materials from manufacturers to draw the eye to the section. It is also essential to be competitive on price because the supermarkets often discount heavily.

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