Community pharmacy

What is community pharmacy and what services does it offer?

Ade WilliamsInterview

We interviewed Ade Williams, Community Pharmacist at Bedminster Pharmacy, Bristol, to find out more about community pharmacy and the services it offers.

What is community pharmacy and what services do you offer?

Community pharmacy is the most accessible NHS care location in the country, with over 11,500 pharmacies in England, people can go to have their prescriptions dispensed, receive advice from experts in medicines, and support from the team to help them make healthier lifestyle choices. 96% of the population can reach a pharmacy within 20 minutes by walking or using public transport, 1.8 million people visit a pharmacy each day with 14 visits a year being the average per person.

Community pharmacy services help to prevent ill health and protect the public through provision services such as health checks, smoking cessation, seasonal influenza vaccination programmes and emergency hormonal contraception. Many community pharmacies offer extended opening hours and weekend services helping to provide a first port of call for people seeking health and self care advice.

Pharmacists undertake five years of mandatory training before become regulated professionals working in partnership with their colleagues across the wider NHS and care system to care for patients. We are experts not only on the safe and effective use of medicines but in the differential diagnosis and management of a variety of conditions. We are also able to signpost people to the appropriate service that will cater for their particular needs.

As a community pharmacist, what support can you give people with chronic health conditions such as headache?

Community Pharmacy is ideally placed to support people with chronic health conditions such as headaches. Most headaches, including migraine which is very distressing, can be correctly diagnosed with appropriate over the counter remedies and or self care advice provided in a community pharmacy by the community pharmacist and their healthcare team. Most community pharmacies have a private consultation room which allows us privacy and space to discuss through the symptoms, to understand the type of headache a customer has and to recommend the best treatment. We are aware that research shows that migraine is under-diagnosed and under treated in at least half of patients and that one-third of people with the condition can experience significant disability as a result of their migraines at some stage of their lives.

The recently published Community Pharmacy Forward View highlights that one of our 3 key sector led focuses for the future is to become the facilitator of personalised care for people with long-term conditions. The document highlights good practice from what some individual pharmacist are already doing and also from our collective role in improving patient outcomes with conditions such as asthma and high blood pressure. For long term conditions such as headache, we are advocating a responsibility for community pharmacists and their teams supporting patients and carers by providing a one-stop hub for advice, treatment and coordination of care related to medicines. This will include diagnosis, monitoring and adjusting treatment according to defined outcomes outlined and agreed with the patient and other professionals e.g GP involved in their care. Community Pharmacists already daily use their clinical knowledge to promote evidence-based and cost effective use of medicines to help relieve patients suffering from headaches. We empower patients to manage their own health with the right diagnosis, advice, treatment and where applicable support them through necessary life style changes.

What are the most effective over the counter treatments for migraine and headache?

Painkillers such as paracetamol, NSAIDs (aspirin, ibuprofen and diclofenac) and combined analgesics containing paracetamol can be used as first-line treatment to relieve pain from all headaches. There are also treatments that can be combined with paracetamol, such as buclizine and prochlorperazine to treat the nausea especially associated with migraine headaches. If the patient is nauseous a soluble painkiller may be recommended as these are absorbed quicker from the stomach.

Sumatriptan can also be recommended over the counter to people with migraine if ordinary painkillers are not helping to relieve the migraine. As well as relieving the pain associated with migraine, sumatriptan also relieves nausea and sensitivity to light.

All over the counter treatments have legal licence specifications which the pharmacy must adhere to. This may sometimes be different from that which applies when the same medication is written on a prescription. With sumatriptan for example pharmacies have to follow a sales protocol which excludes certain patients such as under 18 or over 65 years of age, patients with other medical conditions such as epilepsy, high blood pressure, kidney or liver disease amongst other. We would have to refer you to your doctor. Other examples where referral is applicable include all pregnant patients with migraine symptoms, symptoms suggestive of cluster headaches as over the counter medications will not relieve that or any other symptoms that are suggestive of severe head injury, stroke, meningitis, brain tumour or any signs of a more serious problem. We would however encourage you to speak with us so we can talk through your symptoms and advise accordingly.

What other advice would you give someone who was looking for treatment for their headaches?

Pharmacists always approach treatment with a holistic approach, looking at causative factors and what good lifestyle changes can help enhance any medicines used to treat. Lifestyle changes, such as getting regular sleep, eating regularly, reducing stress and staying well hydrated, reducing alcohol intake, regular excercise, excluding carbon monoxide poisoning, ensuring sufficient light when reading or working to prevent straining of the eyes, regular eye tests to ensure corrective lenses worn would be considered when treating headaches. We would explore and refer accordingly if headaches in women are caused by hormones, especially if they notice a link with their periods. For people with migraine we also educate them on how to bring their condition under control by keeping a migraine diary to identify triggers.

How would you support someone who you noticed seemed to need more painkillers than usual?

All pharmacists have a professional responsibility to prevent medication overuse. As such, we are trained to intervene when we suspect that a patient has or is at risk of developing medication-induced headache. This results from taking painkillers too often. Our role is to stop the sale but also offer support and advice in a non censorious manner referring the patient to their GP. We proactively educate people buying pain killers that taking opioids e.g. codeine and dihydrocodeine longer than three days can lead to dependence. We also counsel on how to take prescribed medications to prevent developing medication-induced headache.