Independents can provide lots of advice and recommend a wide array of products to their patients during winter, as Kathy Oxtoby explains…

With the start of winter, many people face a variety of health challenges, from common colds and flu to seasonal affective disorder, and exacerbations of chronic conditions such as asthma and COPD.

Pharmacists can support patients by offering advice, treatments, ways to manage their conditions, and information about prevention.

Community pharmacies play “a crucial role in increasing access to the flu and Covid vaccinations, promoting public health through convenient and accessible services across the country”, says Professor Claire Anderson, the Royal Pharmaceutical Society (RPS) president.

Pharmacists are able to offer both the influenza vaccination and the Covid booster jab. 

“The promotion of vaccinations is very important this time of year,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow. 

Ms Thakerar says there is “vaccine hesitancy”, particularly with the Covid vaccine. She advises pharmacists to have one-to-one discussions with people, particularly those who are especially vulnerable - such as older people, or those with underlying medical conditions, or who are immunosuppressed - to update them on the advantages of being vaccinated.

When pharmacist Lindsey Fairbrother and her team at Good Life Pharmacy in Derbyshire check prescriptions, if the patients are over 65, or in a vulnerable clinical group, “we write on the prescription a reminder to speak to them about flu or covid, or whichever is relevant to them”.

“So, anybody giving out a prescription can say to the patient: did you know you are eligible for flu, for instance, this is how you can book it and this is where you can get the vaccine from,” she says.

She says it is also pharmacists’ role to explain to patients what a common cough or common cold is and what remedies they can use. “That helps the NHS as a whole”, because it prevents unnecessary doctors’ appointments.

For those prescribed antivirals for flu or Covid, “pharmacists can help patients understand how to take them correctly and discuss potential side effects”, says Professor Anderson.

Pharmacists also provide expert advice on over the counter medications to manage cold and flu symptoms, “helping patients choose the most effective treatment for what they need”, says Professor Anderson.

There are a large number of products available that pharmacy teams can offer during the winter months to help relieve cold and flu symptoms, including for a headache, runny or blocked nose and cough.

OTC treatment options include Sudafed, Sinutab, Beechams, and Benylin. “Pharmacists can recommend products for whatever combination of symptoms,” says Ms Thakerar.

Steroid nasal sprays can help all year round

To help manage flu and colds Ms Thakerar also advises lots of rest and plenty of fluids. And to help prevent colds, pharmacists can offer advice on maintaining a healthy lifestyle and diet, she says. She also recommends echinacea as a preventative supplement.

Following training for Pharmacy First, “we’ve realised the benefit of steroid nasal sprays beyond the hay fever season”, says Ms Fairbrother.

“Steroid nasal sprays can help all year round. Pharmacy First has enabled us to extend what we can offer to the patient,” she says.

Professor Anderson says: “Pharmacists can also educate the public on preventative measures like washing your hands regularly and wearing masks to reduce the spread of infection.”

Pharmacists can assist patients with respiratory conditions by “helping them prevent exacerbations, providing information and support to help self-management, and ensuring proper adherence to medication. 

“They also offer tailored advice on correct inhaler technique and adjust their guidance based on the patient’s medical history and what they already know about their condition and treatment.”

Olbas brand manager Rachel Anthony says: “As winter approaches, pharmacists are uniquely positioned to assist the public in managing a wide range of seasonal health challenges.

“In addition to their traditional roles, pharmacists have become key players in the prevention and management of colds, flu and Covid. With the demand for OTC healthcare products on the rise, 39 per cent of the public experience cold, flu or Covid symptoms multiple times a year, making access to reliable treatment and preventative measures essential.”

Elizabeth Hughes-Gapper, Jakemans senior brand manager, said: “Winter remedies present a significant opportunity for pharmacies, particularly as demand for OTC products remains high this year and has continued to increase into 2024.

“We know that 93 per cent of people have purchased these products within the past 12 months and over one third of people buy OTC products several times a year.”

Guidance on the correct inhaler technique is also important, says Ms Thakerar. There are many inhalers out there and they can be used in different ways, and patients may also be confused about the difference between treatment and preventative inhalers, she adds.

“This is where a pharmacist’s role is crucial. When a new inhaler is given to a patient it is important for the pharmacist to take time to explain how to use it,” she says.

Lifestyle advice is critical for patients with COPD or asthma

Lifestyle advice is “critical” for patients with COPD or asthma, such as explaining the risks of smoking to having cardiovascular conditions, says Ms Thakerar. Pharmacists can also advise these patients on the importance of Covid and flu vaccinations, she says.

Patients should always have a spare inhaler when travelling, she says. And they should be aware if they have any issues with inhalers or complications with breathing to visit their pharmacy, or if the pharmacy is closed, to call the NHS 111 line and follow their guidance.

“Those who we know are vulnerable and have had exacerbations in the winter in the past, we can encourage them to ask their GP surgery to prescribe a rescue pack – a pre-emptive prescription of antibiotics and steroids – which the patient doesn’t use until they need to,” says Ms Fairbrother.

“If they are suddenly feeling bad, they have that medication there as a rescue for them.” 

Pharmacy First represents an opportunity to encourage more people into their pharmacies for treatment for winter-related sore throat, earache and sinusitis.

“Pharmacists can raise awareness of the services they have to offer through local campaigns, for example on social media.

“They can highlight the convenience of getting fast, effective treatments for sore throat, earache and sinusitis without needing a GP appointment,” says Professor Anderson.

“By educating the public on the range of services available and encouraging patients to use pharmacists as a first point of contact, they can attract more people to use their pharmacy first,” she says.

At Ms Thakerar’s pharmacy, posters from Community Pharmacy England are displayed advising patients that if they have those conditions, they can have a consultation with their pharmacist.

It is also important to ensure counter staff are trained to speak to patients about how Pharmacy First is available for, say, ear pain or a sore throat, she says.

“We train staff to ask patients if they would like the pharmacist to look down their throat or ear or check their temperature,” she says.

“The teams should be very much part of this service, not just the pharmacist,” she says.

When Pharmacy First was introduced, she says, “a lot of patients requested antibiotics for a runny nose and cough, even though they didn’t need them”.

But through education and advice about antibiotics, patients now understand why they are not provided on demand, including for viruses, she says.

Some patients may be reluctant to visit their pharmacy for these conditions and still feel that their first port of call is their GP surgery, even when their GP has referred them, says Ms Thakerar.

“This is where we need to raise patients’ awareness, which should come not only from pharmacists, but also GP surgeries, that pharmacies are able to help with minor illnesses.”

And patients with cold symptoms can be encouraged to self-treat. “If we know it’s a self-limiting cold, and it’s not in a vulnerable person who is at risk, then try and help them to avoid an unnecessary GP visit,” says Ms Fairbrother.

“Give your patient confidence by explaining how remedies work and how they will help them, and how quickly they will see a benefit.”