A travel health service is a staple for many pharmacies across the UK; an opportunity to tap into the lucrative sun care and gastro health products market, as well as put pharmacists’ vaccination skills to use, for a guaranteed source of income all year round.

However, these pharmacy services essentially “fell off a cliff” in March 2020 when the COVID-19 pandemic hit and put holidays and travel on hold for the best part of two years.

C+D spoke to three pharmacists to ask how they have adapted their travel health services over the years and their plans to capitalise post-pandemic.

 

From a novelty service to a pharmacy essential

 

Robert Bradshaw (pictured above) is pharmacist manager and lead clinical pharmacist at Frosts Pharmacy Group, which operates two bricks-and-mortar pharmacies in Oxford, as well as the Oxford Online Pharmacy. The group started offering a travel health service eight years ago and has seen it go from strength-to-strength.

“We set up our first travel clinic back in 2014 when it was quite a novelty, really. We’ve built it up from there and refitted the store in Marston so we’ve got a bigger consulting room with a proper couch in it," he says. "It’s important to have the right facilities if you’re going to do it successfully.”

Frosts offers a wide range of travel vaccinations, including hepatitis B and typhoid, and has a registered pharmacist to do specialist yellow fever services as well, Mr Bradshaw explains.

“That’s for travel to South America and Africa, for example, and has proved extremely popular because of the limited number of places that do it. A few GP surgeries or private hospitals do, but otherwise people really struggle,” he says.

Frosts offers vaccines to all age ranges, from children to adults, which Mr Bradshaw says is “important because you get a lot of families travelling right down to taking babies to go and visit grandparents abroad”.

Being able to offer travel vaccinations to children has also paved the way for the pharmacy group to offer other routine childhood vaccinations, which Mr Bradshaw says they have seen “a big demand” for, particularly the chicken pox vaccine.

“We had a big run on the meningitis B vaccine,” he explains. “Then we do occupation health for healthcare workers, so hepatitis B and so on, so it’s a wide range. You have to be quite flexible and look at what people are asking for."

 

Things to consider when setting up a travel health service

 

Mr Bradshaw says he had small consulting rooms when the travel clinics were first installed, but he has now extended these in both pharmacies to meet the increased demand for the service.

“You need a minimum space to get a couch in there – even if it’s a fold-up one – in case someone’s feeling faint,” he advises.

“The room needs to be professional and clean. You also need the room to be available, so it needs to be separate, ideally, from one the normal pharmacy team would be using, otherwise you’re trying to fit your appointments in and around day-to-day things like blood pressure readings or walk-ins looking to talk to the pharmacist.”

Then there is the initial investment. The Frosts group decided to set up its travel services using PharmaDoctor, which offers a full suite of travel vaccination services, Mr Bradshaw explains.

“We also bought an off-the-shelf travel clinic software system so we can book in appointments, but it also does the clinical records, so we do the full consultation.

It’s time consuming and expensive, but people really value being able to have a proper consultation.”

 

Read more: What pharmacists should advise returning travellers

 

As for the vaccines themselves, he says “it’s really important you keep enough stock because you tend to get walk-ins and you don’t know what they need”.

“It’s a case of keeping a full range in [the pharmacy] just in case.”

Training also has to be considered, Mr Bradshaw explains.

“In the early days, PharmaDoctor provided the training sessions. You must do face-to-face vaccination training, but you also need to find a good online travel consultation training package.

“Once you’ve got the staff trained up and you’ve got some software for booking, you open up the slots and review it every day to see what appointments you’ve got.”

Like many others, Frosts’ travel clinic was hit hard by the COVID-19 pandemic.

“We took a big hit there,” Mr Bradshaw admits. “We looked at doing COVID-19 vaccinations,  but you need big premises for that.

“We did have a really good PCR testing service by the pharmacist. Once you’ve done travel clinics, it’s really easy to take on a service like that so it opens up other avenues. But now travel has come back with a vengeance and all the appointments are booked out for a couple of weeks.”

 

Natural progression from the flu service

 

George Wickham (pictured above), director of Luxtons Pharmacy in Exeter, set up his travel clinic seven years ago.

“We’d done flu for the first time a year or so before that so it seemed a natural progression to try and use the injecting skill we’d been using for an all-year-round business. That’s what led us into travel,” he tells C+D.

“We began working with Medical Advisory Service for Travellers Abroad (MASTA) and it proved very quickly to be successful. Over time, we’ve expanded and run an independent travel clinic now too using PharmaDoctor, which we run alongside our MASTA patients.”

Of the vaccines on offer, he says: “We offer rabies, Japanese encephalitis, hepatitis B, but then sometimes we also find ourselves doing the NHS things like hepatitis A, typhoid and tetanus because of waiting lists.

“When we first started, we worried about treading on the GPs’ toes, but now it’s completely the opposite: they happily send us as many [patients] as they possibly can. We also do yellow fever and we’re getting more requests from much further afield because many clinics are no longer doing it.”

Luxtons has had a consultation room on site since 1999 so had everything in place for a travel clinic.

“Since then, we’ve taken over an adjoining premises and we have put two consultation rooms in because we’ve found the demand for services is increasing,” Mr Wickham says.

But there were up-front costs, he explains.

“With MASTA, it was a two-day course, round about £700-£800 plus locum costs so it was quite an expensive operation, then an ongoing cost of patient group directions (PGDs) every year around £700.

“With PharmaDoctor, there’s no requirement to do anything externally so you can do it online yourself, because they use e-tools and algorithms.”

As for the day-to-day running of the clinic, Mr Wickham says his staff run the normal pharmacy alongside the travel clinic, but he notes that some days are much busier than others: “Mondays are busy because everyone spends the weekend looking at their Sunday supplements and booking holidays. Then Monday mornings they worry about their jabs and the phone rings with travel queries!”

 

Adapting the service during the pandemic

 

Luxtons was also rocked by COVID-19, and Mr Wickham admits “the travel service fell off a cliff”.

“Luckily, we tend to keep a minimal stock and turn it over fast, so we didn’t have to throw away too much.

“We did a bit of occupational health during COVID-19 instead, so we vaccinated police officers, funeral directors, sewage workers, and quite a few nurses returning to practice who needed hepatitis B.

 

Read more: The pharmacies losing thousands of pounds from paused services

 

“That’s not an inconsiderable part of the business because there is a constant stream of medical tattooists, normal tattooists, aesthetics practitioners, people working in sewage, dental student nurses for hepatitis B, and each of them brings in a reasonable revenue. And some of those ultimately become travellers themselves and come back to you to use travel services,” Mr Wickham explains.

Now the Luxtons travel clinic is picking up “massively” again, and many are turning to the pharmacy for typhoid vaccinations in particular when patients can’t get hold of them from their GP, Mr Wickham says.

“Five years ago, I would never have imagined the travel clinic would grow to this, where we needed more space to do it,” he says.

 

Setting up a travel clinic seemed “daunting” at first

 

Olivier Picard (pictured above), owner of Newdays Pharmacy, tells C+D that three of his four pharmacies in southeast England have travel clinics, the first of which was introduced in 2013.

He is now implementing another in the fourth pharmacy as the group has seen increased demand for the service.

Explaining his initial journey with travel health, he says: “I had been looking to do a travel vaccine service, but I found it really daunting because the learning is so huge and also because of the record keeping.

“So I spoke to a colleague and he said that he was using a company called MASTA and said it worked really well.”

Mr Picard contacted MASTA and initially installed a travel service in two of the four pharmacies.

"They do the online advertising and get the footfall and an online assessment of the patient over the phone, and then they send the patient to a pharmacy nearby and the patient will be booked into my diary,” he explains.

“I would do a consultation with them and do all the vaccinations. The deal was, you have to buy your vaccines from MASTA and they’re charging you money as a partner to refer patients to you.”

As the travel clinic went well, Mr Picard realised within six months that he could actually also run an independent travel clinic, which he set up alongside his MASTA patients.

“We offer typhoid, hepatitis, Japanese encephalitis, [and] rabies,” he says.

 

Read more: Lloydspharmacy to roll out travel vaccination clinics to 120 branches

 

In some cases, Mr Picard explains, patients come in for one vaccine and realise they need others too. “One lady was traveling who came in for her yellow fever and walked out with four vaccines and some malaria tablets,” he says.

Of practical considerations, Mr Picard explains: “As long as you have a consulting room, you can do it. I’ve put a fridge in the consulting room in my busiest pharmacy, as it allows the pharmacist to know what they have and not leave the patient in the room on their own. Some vaccines are harder to source than others or go out of stock for a little while – you don’t want to disappoint patients.”

You need to print and sign your PGDs in case there are any queries about the schedule of vaccines or exclusion, he adds, but “it’s within the grasp of any community pharmacist to learn about the schedule of vaccines quite easily”, he says.

As for costs, he says that he buys his vaccines from MASTA, directly from Pfizer, and from wholesalers.

“In order to dispense a prescription, you need to buy the stock in in the first place, so it’s exactly the same with travel vaccines.

Because most pharmacies already vaccinate for flu, it’s the same: you need an anaphylaxis kit, you need a computer and a consulting room and I’d imagine most pharmacies have that. Then you need your stock, [and] some syringes and needles, because some vaccines need to be reconstituted.”

 

Making the most of the service post-COVID-19

 

Like other pharmacies, Newdays’ travel clinics were hit hard when COVID-19 struck.

“Our appointments reduced to nothing,” Mr Picard says. “We had to write off some vaccines that hadn’t been used. For a period of a year to 18 months, we barely saw anyone.

“But since the beginning of 2022, we have been so busy. All those frequent travellers that are travelling now are looking to have a typhoid vaccination. And when they come in, they realise other vaccines have expired.

So, our travel clinics are currently very busy.”