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The essence of community pharmacy

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The essence of community pharmacy

A. Karim’s Chuckery Pharmacy collected Pharmacy Team of the Year in last year’s Independent Pharmacy Awards. Steve Bremer visited the Walsall business to discover how it has become an integral part of its local community

Naz Khideja is proud that her pharmacy is named after her grandfather, Abdul Karim, who died aged 110 after living a full life that included winning a Military Cross while serving in the British army in Burma. And it is a particularly suitable name for a pharmacy, given that Karim means ‘benevolent’ or ‘generous’ in Arabic.

Abdul Karim would also have been a similar age to the original pharmacy at this site, which dates back to Victorian times. The family link gets stronger still, because this is where Naz did her work experience 20 years ago. The previous pharmacy relocated four years ago, leaving the neighbourhood of Chuckery without a pharmacy for two and a half years.

Having been told that a pharmacy wasn’t necessary in Chuckery, Ms Khideja successfully applied for a 100-hour contract. “It was a bit daunting at first to open for 100 hours, but I wanted to back my convictions. Now our biggest complaint is that we don’t open enough hours!” The old PCT has been proved wrong in its assessment of local pharmaceutical need, because the new pharmacy reached its targets for establishment payments within three months of opening, and business has increased by 35 per cent since last year.

The November 2012 opening of A. Karim’s Chuckery Pharmacy was announced by the town’s mayor and celebrated with an event attended by over 200 local people. One of Ms Khideja’s first acts on purchasing the business was to remove a wall between the shop and dispensary and a long medicines counter in order to eliminate barriers between patients and pharmacist. “It’s very difficult to talk to people about their health if you haven’t established a rapport with them first. That’s the biggest stepping stone.”

A Damien Hirst exhibition at the Walsall art gallery gave Ms Khideja the inspiration for the pharmacy’s décor. “He’s done so much art based on pharmacy I thought it would be nice to have a pharmacy based on art. I think it makes the pharmacy look quirky, more welcoming and less clinical.” Hirst’s famous coloured spot theme adorns the pharmacy’s exterior signage, while inside there is a spot print, wallpaper from Hirst’s Pharmacy Restaurant, body part models and the shelving is laid out Hirst-style to create a modern, spacious feel.

Success from the outset

The key to Chuckery Pharmacy’s early success has been the high level of pharmaceutical service it offers, which sets it apart from the competition, says Ms Khideja. New patients are offered a domiciliary pharmacist visit that includes medicines reconciliation and a stock-take, as well as a discussion about pharmacy services. This gives the pharmacy an up-to-date list of actual medicines and information about compliance issues, as well as achieving a concordant relationship from the start. A second pharmacist enables domiciliary visiting two days a week.

The relationship continues as the pharmacist proactively maintains communication. “Too many patients have become isolated in their own homes by services such as collection and delivery, which limit the pharmaceutical interaction necessary to recognise side-effects and develop patient rapport.”

It is important to involve patients in their own care and provide as many opportunities for them to ask questions as possible, says Ms Khideja. To this effect, a regular pharmacist ‘mobile clinic’ communicates changes to medication, messages from GPs, and continues the ongoing relationship that starts with the initial domiciliary visits.

Although marketing activities were undertaken at launch, now all new business comes via word-of-mouth. “We’re providing a unique and comprehensive service. Patients get to feel part of their care.”

Ms Khideja honed her clinical knowledge during a varied academic career prior to the pharmacy opening. Her experience in academia has included stints with CPPE in Manchester, a teacher practitioner role at the University of Wolverhampton, and lecturing at Keele and Hertfordshire universities. Her specialist subject was addiction sciences.

Ms Khideja has also worked as a professional development pharmacist with South Staffordshire PCT, where she was part of the team that developed the pharmaceutical needs assessment and was also medicines management lead for EPS. Prior to her academic career, Ms Khideja was the clinical services lead for an independent chain, where she ran the local PCT’s first pharmacy smoking cessation pilot.

The pharmacy team includes Ms Khideja’s husband and the pharmacy’s business manager, Mohammad Bilal, two apprentice technicians – Sophie Bartlam and Saba Ghani, two liaison drivers and a pre-registration pharmacist. Ms Khideja’s father, Mohammed Sabir, is also closely involved with the business, helping with deliveries and marketing.

This team effort undoubtedly contributes to Chuckery Pharmacy’s success, but Ms Khideja is clear where the key really lies. “There’s no secret to our success, it’s just hard work. The other thing is being able to embrace innovation.”

Customer reviews from the NHS Choices website

  • “Extremely clever pharmacist always gives the best advice. I’m used to never seeing a pharmacist when I go to a pharmacy, it’s nice for the pharmacist to be so available as normally I feel shy to ask because I think they’re too busy to speak to me.”
  • “Not only do the staff have a positive and cheerful approach to dealing with customers, they are also prepared to go the extra mile. They actually called my GP to dispute an issue where I needed some backup and got it resolved.”
  • “It does not take long to realise that here we have a pharmacist who is extraordinary. They provide a different type of service to that which we have come to expect in our modern hurried and worried world. With their wealth of knowledge they are prepared to get to know you as a patient so that they can give advice that suits you as a unique individual. They are exactly what the NHS needs in these difficult times.” 

The service agenda

Services available include an integrated pregnancy, EHC and chlamydia test, minor ailments and smoking cessation. Flu and meningitis vaccinations are available via a private PGD. Ms Khideja also provides travel health advice via a hotline to clients of the family-owned travel business.

Chuckery Pharmacy may also soon be providing a needle exchange service. Although the local CCG claims that the pharmacy is not in an ‘at-risk’ area for drug abusers, steroid users have been requesting clean needles on a regular basis.

Following a meeting with a local gym, Ms Khideja is considering how to develop the service. “I’ve got to consider how to move forward without being patronising to the users as they don’t consider themselves drug abusers. But the key here is harm reduction.”

A health trainer is about to start offering appointments from the consultation room two mornings a month. The trainer, from the public health department of the health and wellbeing board, will discuss healthy eating and exercise with pharmacy and non-pharmacy patients.

The Damien Hirst inspired pharmacy exterior

The pharmacy is open from 8am until 8pm, Monday to Thursday, then from 8am on Friday until midnight on Sunday. It is the only pharmacy in Walsall open overnight on Friday and Saturday, serving patients through a hatch on the side of the building when the main premises are closed. People travel from up to 40 miles away to access this service.

Although not officially a palliative care provider, Ms Khideja works with the palliative care consultant at the local Manor Hospital and with Macmillan nurses because of her overnight opening. These extended hours have also fostered a good relationship with local out-of-hours doctors.

The community ethos

The ethos of A Karim’s Chuckery Pharmacy is to be part of an active community spirit that puts health at the heart of the community. Its team is widely involved with community projects, and the venue is used as a meeting place for local voluntary groups.

Community participation includes offering a tailored service in conjunction with the local mosque for diabetics during Ramadan – providing dietary advice and day diaries to maintain glucose control. And the pharmacy team provides health checks as part of Chuckery’s annual community festival. Services include blood pressure checks, glucose testing, BMI calculation, carbon monoxide monitoring and health promotion advice. Ms Khideja is working with the SureStart scheme to promote the pharmacy’s minor ailments service in order to engage with local parents.

"The essence of community pharmacy should be community. To be part of the community you need to do something for that community"

Chuckery is classed as a low super output area, indicating a deprived neighbourhood. This categorisation is used as an indicator in the PNA and JSNA, and is a local measure that all pharmacists should be aware of, says Ms Khideja. “That’s the sort of jargon pharmacists need to be speaking if they want to identify more with public health. Pharmacists should know their JSNAs inside out if they want to tender for services.” Ms Khideja is particularly familiar with PNAs, having been part of the team that wrote the document for South Staffordshire PCT during her academic career.

Ms Khideja is passionate about the importance of pharmacies to their local communities. “Pharmacies all tend to be moving closer to GP surgeries, but the essence of community pharmacy should be community. To be part of the community you need to do something for that community and you need to be active in that community.”

Ms Khideja hopes that her pharmacy is helping to revive the local community spirit. Chuckery used to have “a shop on every corner” but they all closed. Since the pharmacy re-opened another shop has opened, perhaps indicating that the trend is reversing.

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