Review of the Distribution of Healthy Start Vitamins Through Community Pharmacies

Appendix 2 Community Pharmacy Survey on the distribution of Health Start Vitamins and Drops - Survey Results

Outline of the survey

A survey of community pharmacies in Scotland was conducted between Jan-Feb 2015. The survey aimed to capture their experiences of distributing Healthy Start vitamins and any barriers/challenges they may have faced. The survey was produced by the Scottish Government and the invitation was sent to all community pharmacies by Community Pharmacy Scotland (trade organisation representing the commercial interests of community pharmacies). Respondents were requested to complete a short online survey. Results from the survey are summarised in this section of the report.

Caution should be exercised in interpreting the survey outputs as the response rate to the survey was very low (14.6%)

Response to the survey

182 community pharmacies responded to the survey

Breakdown of response by NHS Health Board

NHS Health Board	Number of respondents
Ayrshire and Arran	14
Borders	3
Dumfries and Galloway	5
Fife	16
Forth Valley	13
Grampian	18
Greater Glasgow and Clyde	40
Highland	23
Lanarkshire	11
Lothian	25
Orkney	1
Tayside	13
Total response	182

Most (77%) respondents were part of a community pharmacy chain, either large (42%) or small (35%). Just under a quarter (23%) were small independent community pharmacies. There were no responses from GP dispensing practices.

Almost all (92%) of the respondents took part in the distribution of health start vitamins and drops. The majority (70%) of respondents took part in the national trial scheme in both 2013/14 and 2014/15. Jut under a quarter (23%) of respondents only took part in 2013/14.

Supplying Healthy Start Vitamin Tablets and Drops

Most (56%) respondents kept the Healthy Start vitamin tablets and drops behind the counter at their community pharmacy and just over a quarter (27%) had them on display. One in seven respondents (14%) ordered Healthy Start vitamin tablets and drops only when needed.

The majority of respondents (66%) stated they had experienced problems with the receipt and/or supply of Healthy Start Vitamin Tablets and Drops. Key difficulties identified by respondents were

• Supply was not in stock from the wholesaler, sometimes for several weeks or months at a time
• Systems for ordering supply doesn't include the vitamin tablets and drops
• Supply was not readily available due to the short shelf life of the products (especially children's drops)

"Suppliers are always out of stock and if you can get stock and order extra they go out of date"

Once the vitamins and drops were supplied by the wholesaler, most (55%) respondents stated they did not experience any problems with keeping the vitamins and drops in the pharmacy. Those respondents who had identified difficulties (43%) said this was due to the stock going out of date. This may contribute to community pharmacies decisions not to have the vitamins and drops always in store where they do not have many requests for them

"The demand from patients has been sporadic and as a result, we have had some stock go out of date. This resulted in us keeping a low stock, which occasionally meant we ran out when patients required them."

Demand for Healthy Start vitamins and drops

Response to the survey indicates Healthy Start vitamins and drops are not regularly dispensed through community pharmacies. The tables below show health start vitamins and drops as not dispensed frequently and are more likely to be sold rather than dispensed thought the healthy start scheme.

Dispense free (%)

	Number of community pharmacies
	daily	weekly	monthly	6 monthly	12 monthly
Healthy Start Vitamins	3	10	28	24	35
Healthy Start Drops	2	11	25	27	35

Health start vitamins and drops tend to be distributed infrequently with around a quarter of most respondents indicating they dispense healthy start vitamins and drops on a monthly or 6 monthly basis and over a third dispensing health start vitamins and drops on an annual basis.

Amounts distributed are very low with majority of respondents indicating 1-2 packets dispensed in any one time period.

Sell vitamins and drops (%)

	Number of community pharmacies
	daily	weekly	monthly	6 monthly	12 monthly
Healthy Start	4	14	32	18	32
Branded	7	21	27	19	26

Just under a third of respondents indicated they sold healthy start vitamins and drops on a monthly or annual basis.

Although respondents indicated they sold branded vitamins and drops, this was less frequently than healthy start vitamins and drops with just over a quarter of respondents selling branded vitamins and drops on either a monthly or annual basis.

As with distributing free healthy start vitamins and drops, amounts sold of both healthy start and branded vitamins and drops were very low with most respondents indicating 1-2 packets in any one time period.

Promoting up-take of health start vitamins and drops

Promotional material on healthy start was limited in community pharmacies. Just under a third of respondents (31%) reported displaying posters in their community pharmacy and just over a third (37%) displayed leaflets. A large minority (43%) of respondents stated they do not have any information available and on display on Healthy Start in their pharmacy.

Most respondents provided verbal information to pregnant women on how to take the Healthy Start vitamins and drops (69%) and who is entitled to Healthy Start (67%). Respondents also provided information on why the vitamins and drops are important (58%). A smaller number of respondents provided information on how to apply for Healthy Start (46%).

Half (50%) of respondents stated that customers did not experience any problems with redeeming the Healthy Start Vitamins and Drops coupons (although 36% of respondents stated they did not know if their customers had any problems). Of the respondents who said customer had experienced problems (14%), the majority of problems concerned

• confusion over whether they were entitled to get the vitamins and drops for free
• stock being unavailable
• customers requesting the healthy start vitamins and drops without the coupon

"Patients don't realise they need a coupon to receive them free of charge."

"Very few people seem to have received coupons for healthy start although we are in impoverished area of [NHS Health Board] with many mothers and toddles , hence the lack of supply also I locum in several branches of this multiple and the staff and pharmacists seem unaware of how to redeem the coupons."

Support for implementing the pilot

Just over half (55%) of respondents stated they had not experienced any problems with reimbursement for distributing healthy start vitamins and drops (although 43% did not know if there had been a problem or not). It may be that either respondents were not responsible for this side of the business or that the amounts were so small they did not recall whether they were reimbursed or not.

Some respondents noted diffulties in completing the reimbursement process as patient did not always provide the coupon:

"Pharmacy told we would get a coupon from the patient and then we would write a CPUS for the product(s) required...this has happened few and far between....patients tend to buy if they want to and patients who would have been eligible seem to not access the service at all"

Less than half of respondents (45%) had received support from their local NHS Health Board about the Healthy Start scheme. Respondents identified the following forms of support:

• information, posters, leaflets, particularly at the start of the scheme
• Information and communication up-dates
• Visits and phone contact from their local NHS Health Board

Suggestions to improve the distribution of vitamins and drops

The survey received many suggestions from respondents on how the distribution of Healthy Start vitamins and drops could be improved. Key improvements are identified below:

1. Simplify dispensing system: Respondents thought the current coupon system for reimbursing the coupons is overly complicated, time consuming and not streamlined with existing administrative systems. Many respondents sighted problems with women not having the coupons when requiring vitamins and drops, having to write out a separate prescription and returning the script and the coupon. Many respondents thought the scheme needs to be included as part of the electronic minor injuries scheme^[6].

"The scheme is time consuming for pharmacists to administer - when a coupon is presented then a prescription [CPUS form] has to be handwritten. It would be much better if the coupons could be send for payment without the need for a prescription to be written. Alternatively being able to write and label a prescription electronically (as the Minor Ailment Service operates) would save a lot of time."

The system was made more difficult as due to infrequency of requests for the vitamins and drops with community pharmacies having to recall what the system was for reimbursement.

"Don't make it such a complicated process with tokens / having to write prescriptions [CPUS form] etc. Trust pharmacists that they can just give supplies to those that qualify and allow us to supply it through the minor ailments (needs to be re-named) service. This allows you to capture all sorts of details about the patients receiving it (eg postcode areas, age etc). I work in the most socially deprived area of [NHS Health Board], yet the uptake of Healthy Start vitamins had been minimal. To the point that when a request is made, staff always ask 'what do we do here, again?' Because requests are so few and far between. We supply children's paracetamol by the 'bucket load' through the minor ailments scheme which is well used in our area. So it makes complete sense to supply the Healthy Start vits via this route."

2. Improved supply of vitamins and drops: Many respondents commented on difficulties with ensuring they had supplies of vitamins and drops in stock. Problems were identified with wholesalers having vitamins and drops in stock which was compounded by the short shelf life of the products and the infrequency of requests.

"Get them into full and regular supply - we can't successfully promote something we can't freely get - it's really that simple"

3. Improve understanding and awareness of the scheme: Respondents also thought the process for claiming Healthy Start vitamins and drops was confusing and overly complicated for women; requiring them to understand whether they are entitled to free vitamins and drops, how to apply for coupons, remembering to take the coupons into the community pharmacy.

"Could we provide them free of charge with no coupon as people end up buying them as they do not want to apply for the coupon or they are not entitled to the coupon?"