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Retail Clinic Idea Reaches Europe

by Scott MacStravic

In a story appearing Mar 3, it was reported that an idea that is roughly thirty years old in the US has reached Europe, at least to the extent that the UK is recognized as part of Europe despite its maintaining its own currency. This idea is that of the kind of retail medical clinic called “urgent” or “convenience” care when it began in the 1970s here. I remember when one of my students at the University of Washington initiated the first one in the Seattle area after graduation, and later sold out to a large firm for a handsome profit.

The kind of clinic that recently opened in the Manchester, England area, in a Sainsbury supermarket is unlike the ones that have opened in drugstores, supermarkets and superstores such as Wal-Mart here. It is staffed by physicians, and is strictly an “after-hours” option, open only on Tuesday and Thursday evenings 6:30 to 9:30 PM, and Saturday 11:00 AM to 3:00 PM. Here, they are usually staffed by nurse practitioners rather than physicians, and are open during the day as well as after hours. [J. Werdigier “Combining Grocery Shopping with Doctors’ Appointments” New York Times, Mar 3, 2008]

It works by appointment, and will serve only patients who are already registered with local general practitioners, otherwise could not be paid by the National Health Service. It will function as a “covering” service for these GPs, as well as a convenience for those who have trouble getting away for an appointment during working hours. It is called “Doctors in Store”, and was created by Dr. Mohammed Jiva, after finding that his patients were often requesting evening appointments.

Like patients in superstores in the US, patients at Sainsbury’s will get pagers so they can shop rather than wait for the physician if running late, and can get their prescriptions filled in the store immediately after their visit. The location also makes it safer for physicians than if they had to lock up their own offices at night in what are sometimes rough neighborhoods. And it will certainly be convenient for patients as well. [J. Reid “Shoppers to Be Seen In-Store by GPs” Sky News, Mar 3, 2008]

The story in Sky News noted that this is not the first clinic where GPs make their services available in a store, since there are already two examples in Boots drug store chain stores, but these are only open during normal office hours. And a reader commenting to the story reported that there is already an after-hours example in Dublin, though Ireland is no longer part of the UK, of course. The need to be pre-registered with a local GP and the in-store clinic, and to make appointments, as well as the fact that they are staffed by GPs rather than NPs, makes their operation quite different from the US examples, though the idea of adding an option for convenience reasons is the same.

Another reader commented that if the GP in Sainsbury’s recommends a healthier diet to any patients, they will have to skip right by the many unhealthy food and drink options filling the shelves in the store, from sugary drinks to pork pies to alcohol. Though a similar challenge faces all patients served in supermarkets and superstores in the US, it is not nearly as big a challenge as the general one facing the shopper population at large. Judging by the growing rates of obesity in both the UK and the US, it has been a challenge not won by healthy over “comfort food”.

If the first example in Manchester proves successful, it is expected to be repeated in other Sainsbury stores later this year. And if the US example is a good predictor, it might also be repeated in other supermarket chains such as Tesco, which has an ever larger share of the market than does Sainsbury’s. These clinics normally provide classic symbiotic benefits to their host stores, by driving added general traffic shoppers, as well as promoting use of their pharmacy in particular.

In an effort to improve the overall availability and convenience of GPs, the British NHS had already opened a few walk-in centers in railroad stations around London, though these have been weakly promoted, and suffer from lack of continuity of care and patient records with such “drop-in” patients’ GPs. A proposal to extend the hours of GPs, generally, has been rejected by the British Medical Association, making the after-hours model that much more competitive in the UK.

While this development is thirty years late, compared to the US, it does suggest that British patients have similar kinds of concerns over the inconveniences of traditional medicine. The retail clinics in the UK are thoroughly within the realm of traditional physician practices, with added convenience of place and time, and it should be interesting to watch what happens there.

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