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Winter is coming

Australia has experienced a particularly severe strain of flu in recent months. The country’s flu season usually lasts from May to October, with a peak in August. However, laboratory-confirmed cases were higher than usual early on this year and there was a significant peak in July. 

By 8 September 2019, 662 flu-associated deaths had been reported to Australia’s National Notifiable Diseases Surveillance System during 2019. As a comparison, by 9 September 2018 only 42 flu-associated deaths had been reported during 2018. 

Leading health experts suggest that the UK will also have a moderate to severe winter this year. Here, the flu season tends to be between December and March, although outbreaks can occur between October and May. Emergency departments are already struggling to cope with consultations and admissions and there are fears that this will become an increasing challenge during the busy winter months once the flu season hits.

In August 2019, NHS England and NHS Improvement published the latest combined performance figures. These revealed the highest number of A&E attendances ever – 4 per cent higher than July last year. A&E performance against the four-hour target had been sitting around the current 86.5 per cent for the past three months.

The Royal College of Emergency Medicine’s 2018/9 Feverish Child National Quality Improvement Project, published in July 2019, found that emergency departments are struggling to assess children presenting with fever symptoms within a reasonable time. The results revealed that 31 per cent of children presenting with fever required admission, but only 65 per cent of these could be admitted within four hours. 

“The NHS is at its busiest over the winter months and bed closures due to flu or norovirus have a significant impact on performance and waiting times for patients,” says Miriam Deakin, NHS Providers director of policy and strategy. “Trusts will be doing all they can to reduce this risk by encouraging as many staff as possible to take up flu vaccinations to protect themselves and patients.

This summer has been particularly tricky for the NHS with record levels of demand for urgent and emergency care. We need to reduce pressure on these services by supporting people to access care in the most appropriate setting, often closer to their home or in the community.”

Expanding pharmacy role

Many self-limiting winter ailments, such as acute sore throat, coughs and colds and nasal congestion, can be treated without seeing a GP. The NHS Community Pharmacist Consultation Service (CPCS) is being launched on 29 October 2019. Participating community pharmacies will receive referrals from NHS 111 for minor illnesses (such as coughs and colds) or an urgent supply of medicines. 

“Community pharmacies have a key role to play in winter healthcare,” says Alastair Buxton, PSNC’s director of NHS services. “Located where people live, work and shop, pharmacies are often open when GP practices are not. Pharmacy teams should make sure any advertising or service promotion makes clear just how convenient and accessible they are. PSNC expects that this service will mark the start of a change in public perceptions of pharmacies as healthcare hubs as the sector moves towards a more services-based contract.”

The new CPCS service is expected to strengthen the role that pharmacists play within primary care and support greater self-care within the community, as set out in the 2019 NHS Long Term Plan. It is hoped that eventually the service will include referrals from GP practices, NHS 111 online, urgent treatment centres and possibly A&E.

“Community services, primary care and pharmacies have an important role to play in delivering the vision of the longer-term plan and shifting care away from hospitals,” says Ms Deakin. “High street pharmacists are trained and skilled professionals who can support patients to seek the right treatment. However, these services also face the same challenges in terms of the need for greater investment and the need to secure the right workforce to meet demand.”

Ade Williams, lead pharmacist at Bedminster Pharmacy in Bristol, advises that the whole pharmacy team refresh their knowledge of the category before this year’s cold and flu season begins to ensure they are as ready as possible for an influx of customers. “Everyone should be encouraged to do CPD, look at any new evidence, guidelines and new products and understand the differences between colds and flu,” he says. “This is especially important if there have been any new staff in the past six months as this may be their first cold and flu season in the local area. Look at the pharmacy’s unique selling point and how to communicate it well to customers. Promote the pharmacy using a positive approach, such as offering a free one-to-one premium service.”

Flu vaccinations are essential to prevent outbreaks and complications in at-risk groups. According to NHS England, the annual flu programme saves thousands of lives every year and reduces GP consultations, hospital admissions and pressure on A&E. The only change in eligibility for this winter is the extension to Year 6 school children, which means that all primary school-aged children will now be offered the vaccine for the first time in England. 

Mr Williams suggests that pharmacies look at their previous year’s flu vaccination figures when planning this year’s flu jab service. “In particular, look at last year’s uptake in certain groups, such as pregnant women, those with comorbidities and elderly patients, and see how this could be increased for this year,” he says. “If the pharmacy offers a private flu vaccination service, remind previous patients when this year’s service will be available.”

According to Mintel’s OTC Analgesics and Cough, Cold and Flu Remedies – UK report, published in May, only 4 per cent of cold/flu sufferers and 7 per cent of cough/sore throat sufferers sought professional help for their condition in the previous year. This may be due to the combination of NHS cutbacks and campaigns to reduce the use of A&E and GP services by people suffering routine illnesses. Pharmacy advice is becoming increasingly important as cold and flu sufferers aim to manage their symptoms themselves. 

The Mintel report revealed that many people are taking painkillers to treat their cold and flu symptoms and choosing the lowest-priced and most accessible products rather than specialised, higher margin options. Therefore, the pharmacy team may need to highlight the benefits of specific cold and flu remedies, for example to reduce congestion.

According to GSK, the total cold and flu category is worth £483 million so is hugely important to the pharmacy channel, yet 40 per cent of shoppers don’t realise that pharmacy-only medicines are also available to them over the counter. On-shelf signposting can help prompt shoppers to have the conversation with pharmacists that they may normally avoid. 

A first in pharmacy

This cold and flu season, GSK is introducing a pharmacy-strength decongestant nasal spray, Otrivine Extra Dual Relief, which is the first adult P-line nasal spray in the decongestant category. “Until now the cold and flu category has lacked an adult pharmacy-strength nasal spray,” says Christie Matthews, brand manager at GSK. “The xylometazoline hydrochloride and ipratropium bromide in Otrivine Extra Dual Relief help relieve nasal cold symptoms fast, ensuring that those suffering a cold can better manage their symptoms and get back to their daily routines with minimal impact.”

Jakemans will be supporting 2019/20 seasonal demand with a media spend of about £1.9m to drive sales and increase awareness of the Jakemans range. Elizabeth Hughes-Gapper, Jakemans brand manager, says variety is something consumers look for when choosing products. “Research shows that 30 per cent of consumers made their purchase choice of sweets based on the product having assorted flavours,” she says. “Pharmacies should consider stocking a range of flavours to help encourage sales of cough and sore throat sweets during the winter months.”

The annual flu programme saves thousands of lives every year and reduces GP consultations and pressure on A&E

Fisherman’s Friend will also be investing heavily in marketing this year. The campaign will include 13 different TV idents, featuring the iconic Original Extra Strong and second best-selling Blackcurrant alongside the most recently launched addition to the range, Spearmint. 

According to Jon R White, regional business manager for Fisherman’s Friend in the UK, the brand’s wide range of fruity and mint variants appeals to shoppers who want the benefits of menthol but with a more subtle, softer flavour. “Given that pharmacy shoppers are reluctant to spend a long time browsing the fixture, it’s essential for retailers to ensure they are stocking recognisable and cost-effective products that consumers know and trust,” he says. “If well-known and trusted brands are positioned near the till point this helps to maximise opportunities among shoppers looking for quick relief from minor ailments, and will help retailers to capture those all-important impulse purchases.”

For the 2019/2020 season, Covonia has launched two new products and a new pharmacy training guide on treating sore throats, including practical advice for the whole pharmacy team. New Covonia Medicated Sore Throat 5mg/1mg Lozenges have a dual-action formula that numbs pain and fights infection. Covonia Sore Throat Spray is now available in a new lemon flavour. 

According to Andrew Wormald, brand manager for Snufflebabe, the baby and child decongestant category is in strong growth year on year and Snufflebabe is growing by 2.5 per cent. The brand recently added a Vapour Bath Bubbles product that contains essential oils to the range. “Community pharmacies are an excellent channel for the Snufflebabe range,” he says. “The purchase of our products is often of a distress nature with the shopper, often new parents, looking for advice and reassurance, which can be provided by the local, friendly and knowledgeable nature of community pharmacy.”

Tanya Critchley, assistant brand manager at Potter’s Herbals, says that customers value a choice of natural cough and cold remedies alongside other familiar brands. “Some cough and cold remedies contain ingredients that interact with other medications, so it is useful to be aware of – and stock – remedies whose ingredients are not likely to interact with prescription medicines,” she says. “This can include traditional herbal ingredients found in Potter’s cough and cold remedies. Potter’s remedies have a long history and its cough and cold products offer a natural, scientifically proven alternative. Potter’s Echinacea & Elderberry Tincture is believed to be one of the most potent on the market used to relieve the symptoms of the common cold and influenza-type symptoms exclusively based on long-standing use as a traditional remedy. There’s also Potter’s Liquorice Syrup, a botanical product to help soothe the upper respiratory tract and help keep the airways clear. Pharmacists should make themselves aware of these products to be able to offer a wider choice to their customers and patients.”

Natural relief

Once a cold has taken hold, natural supplements may help to relieve symptoms and boost the immune system. “Zinc is important for a healthy immune system and may also interrupt the ability of various pathogens to reproduce and spread within the body,” says Frankie Brogan, senior nutritionist for Pharma Nord UK, which produces InfluZinc lozenges, which contain zinc and vitamin C. “In a paper published in The Lancet, zinc lozenges were shown to reduce the duration of colds by almost 50 per cent. Much like zinc, vitamin C contributes to a normal healthy immune system and helps protect the body from oxidative stress. It also supports healthy energy metabolism and the reduction of tiredness and fatigue.”

Well-known and trusted brands positioned near the till point helps shoppers looking for quick relief 

According to the Mintel report, the growing consumer trend towards holistic health means prevention and recovery are becoming increasingly important. Products designed to support the immune system or to aid with stress relief could help to prevent pain or illnesses in the first place. 

Pharma Nord UK believes it’s important to separate preventive products (to be taken in advance of any infection) from reactive products (to be taken once an infection has been caught). The pharmacy team should understand how the immune system works and what can be done to enhance it, with a focus on useful nutrients and supplements. Pharma Nord’s combination supplement – Bio-Glucan Plus – includes 1,3/1,6 beta glucans, vitamin D3 and selenium and is aimed at boosting immune systems throughout the autumn and winter months when colds and flu are more prevalent.

P3pharmacy Category Panel View

Fiona McElrea, Whithorn Pharmacy, Dumfries & Galloway

“This is a huge category for us. We do a pre-season order to get good prices from our wholesaler. We will change the location of the category during the season to give it more prominence. Good sellers include Lemsip, Sudafed, Beechams, Vicks and Night Nurse/Day Nurse. I’ve noticed that manufacturers bring out new and ‘better’ products, but with the same ingredients as the previous products. This is confusing and there is a risk people will buy the new product and the older one. We use display units and remerchandise to make products stand out better on our store.”

 

Sarina Mughal, Day Lewis, London SW1

“This is an important category for us. Popular sellers are manuka honey and liposomal vitamin C sachets, which deliver a high dose of vitamin C. For cold and flu, Day Nurse and Night Nurse are popular. Herbal products are also popular, especially the French product Oscillococcinum. Other good sellers are Yourzooki liposomal vitamin C and omega-3 sachets. It’s important to place cold and flu preventer products alongside the remedies and give them a prominent site during the season. Make sure you have plenty of promotional signs up for your flu vaccination service.”

 

Yasmeen Afsar, Well Pharmacy, Hartlepool

“Winter remedies is a top category for us. The best sellers are Day and Night Nurse, Lemsip, Tyrozets, Strepsils and the Robitussin range. Oral analgesics, decongestants and cold sore treatments also do well. It is crucial to promote services such as the flu vaccine and to stock a large range of products for various ailments. As this is a large category, it is easy to create designated areas within the store. Displays should always have items grouped together giving various options for symptoms, and dummy boxes should be available for P products.”




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