Case study: mole scanning

Denise Whitehead, pharmacy advisor at Boots’ flagship store in the Victoria Centre in Nottingham, conducted a Mole Scanning Service in collaboration with ScreenCancer for around three years. While her particular pharmacy is no longer involved, 50 Boots pharmacies around the UK currently include it as part of their enhanced service offering.

This private teledermatology service triages people aged 18 or over who are concerned about their moles and helps to identify any signs that needs further investigation. On arrival, customers complete a consent form, provide some personal data and answer some questions about their skin. The mole, or moles, are then scanned in a quick and painless process using a high-quality imaging camera called a SIAscope, and the images are sent off to ScreenCancer for expert analysis. The company contacts the individual directly with the results and follow up advice, which may include referral for further investigation and treatment if melanoma is detected.

Denise says that due to the way the results are confidentially provided, the pharmacy isn’t involved after the initial scan and so they often don’t know the results. However, she received positive feedback from many customers. “One lady who I scanned had to have her mole removed at the local hospital and she came in to tell me how pleased she was that she had been in to see us initially as it was a speedier process,” Denise explains. “In the present climate of waiting times at doctors’ surgeries or to see a specialist, I feel the scanning service provides a swift and accessible process to alleviate anxiety, offer reassurance and give accurate advice on a customer’s next steps to be taken, if any, in a pleasant atmosphere.”

The service is booked through an online system and Denise says that patients travel from far and wide for appointments. “I think this service is such a winner. It brings people into the stores, like the other services do, and the speed is so important as well. You might have to wait a couple of weeks for a GP appointment and with our services you can just make a booking online or direct with us, without having to wait so long,” Denise explains.

A new study published in the Journal of Pharmacy highlights the important role community pharmacy can play in triaging patients, identifying suspicious moles and supporting diagnoses of malignant melanoma earlier through this service.

Almost 10,000 moles were scanned in the study, the majority of which (88 per cent) required no follow up, giving patients peace of mind. Of those referred for additional follow up, 0.7 per cent of scans led to a confirmed diagnosis of malignant melanoma. Early detection of melanoma hugely increases the success rates of treatment, with melanoma being removed with no recurrence in 80-90 per cent of cases.

Researchers concluded that had this service not been available, these patients may have accessed their GP, demonstrating the support that community pharmacy can give the NHS on services such as this.

Case study: health checks

Jane Tate, non-pharmacist manager at LloydsPharmacy in Lyme Regis, Dorset, conducts both NHS Health Checks and private annual Vitality HealthChecks. “We do the Vitality HealthChecks for people who register with PruHealth for life insurance, to reduce their monthly premiums,” she says. “They are referred to their nearest pharmacy and I’ve been offering this testing service for six or seven years.”

The pharmacy team has a set list of tests and questions to ask customers. “We talk about their smoking habits and use of nicotine replacement therapy, and check their height and weight,” says Jane. “We also check their blood pressure and cholesterol and blood glucose levels with a fingerprick test. We input the data and send it back to PruHealth.”

The Vitality HealthCheck results are discussed during a consultation with a Vitality GP, rather than in the pharmacy. But if Jane notices that a customer’s test results could be improved, she may offer the customer a free NHS Health Check as well. “We’ve been doing the free NHS Health Checks at the pharmacy since around April 2019,” she says. “If I notice a customer’s cholesterol level is slightly high, for example, I’ll check where they live and whether they’re eligible for our NHS service.”

The NHS Health Check programme was first launched in 2009, offering cardiovascular risk assessment and management advice to adults aged 40 to 74 years. “We have a script on the screen and, depending on the answers and results, we can refer them to their GP or offer advice,” says Jane. “If their cholesterol is high, for example, we can suggest ways to amend their diet. If they are overweight, we can suggest they exercise more and reduce what they’re eating. We once had one blood pressure check that told us to call 999, so it’s good that we’re attached to a doctor’s surgery.”

LiveWell Dorset refers people to the pharmacy for the NHS Health Checks, but customers can also refer themselves. “We have an excellent social media noticeboard for the town, so we advertise on there,” Jane explains. “Some people don’t know what their blood pressure and cholesterol levels are and using the word ‘free’ certainly helps to bring people in. Many people come in for NHS Health Checks because they don’t want to bother their GP, but then will make a GP appointment if we suggest it afterwards.”

Case study: HIV antibody testing

Coventry HIV Point of Care Testing is a locally-commissioned pilot pharmacy service screening for the HIV antibody. If customers get positive results, they will need a further blood test through sexual health services to have their HIV diagnosis confirmed. 

Gurbaksh Singh, superintendent pharmacist at Vantage Chemist in Coventry, has been conducting the HIV Point of Care Testing for around six years. “We are a student-populated area, so there are a lot of people who don’t know how to look after their sexual health,” he says. “When we provide emergency contraception, we ask if they want an HIV test as well. Some people call up and ask if we do the testing, and others just come in when they want the service.”

The pharmacy always has someone on-site who is trained to do the testing, which means customers don’t need to make an appointment in advance. It’s a fast and easy test, which Gurbaksh says is good for the customer’s peace of mind. “They spend less time hanging around and worrying about the results than if they went to a clinic,” he explains. “Before doing the test, we make sure customers understand how accurate it is, discuss the implications of having a positive test, and check their risk for HIV, such as if they’ve had unprotected sex. The whole process takes around 20 minutes; 10 minutes to go through the consent forms, a minute or so for the test results, and then aftercare of around 10 minutes.”

If the test is positive, customers are given the phone number of a local sexual health clinic. If it is negative, they are asked to come back, as it can take as long as three months after exposure to HIV to get a positive result. “The clinic receives all of the details, so it can follow up if someone doesn’t get in touch with them,” explains Gurbaksh. “It’s important to make sure patients get the right treatment, and this is something we stress. We also talk about the importance of safe sex. We offer to sign them up to the free C-Card scheme for free condoms, and also advise them to have a full sexual health check at the sexual health clinic.”

Gurbaksh says the service benefits the pharmacy and local area in many ways. “It helps us build a relationship with customers, many coming back every three months for another test,” he says. “It also helps with safeguarding. If someone needs help with an abusive partner, we can refer them to the safeguarding team. And it builds on our reputation as a hub for health services – the more services we offer, the more people come back.”