In the new year, consumers with itchy scalps, flaky skin or unsightly rashes will be able to step straight off the high street and into the chair of a specialist skincare advisor – not in the nearest GP’s surgery, but in Boots the Chemist.
Boots is setting up 95 specialist skincare advice units across the country. They will be staffed by trained advisors selling products new to the UK which fall between pharmaceutical and cosmetic products, so-called cosmeceuticals (MW December 10).
Pharmacies are taking up the slack caused by long queues and staff shortages in the National Health Service. But dermatologists fear the public could be in danger if customers disregard the need to have their complaint first diagnosed by a medical professional.
There is a shortage of dermatologists in the UK. The British Association of Dermatologists executive officer Marilyn Benham says: “There are a smaller number of dermatologists in the UK, because here (as opposed to in the US) dermatologists are rarely involved in cosmetic dermatology.
“Dermatologists are medical specialists, members or fellows of the Royal College of Physicians, and work within the National Health Service.”
The All Parliamentary Group on Skin is considering the future of dermatology in the UK, but the deregulation of dermatology is not on the agenda. This means dermatologists cannot offer their skills commercially outside the public and private health service.
However, they can in the US and the resulting merger of the medical industry and beauty companies has resulted in a burgeoning cosmeceutical approach in US pharmacies. In the UK, Boots has decided not to wait for change any longer and is forging ahead regardless.
Boots recruited new staff to undergo a six-month training course to prepare them for their roles as skincare advisors.
They will offer advice on non-prescription products for three types of skin condition: oily/acne-prone; dry/mild eczema; and sensitive/allergic, as well as scalp conditions.
Boots will stock washes, creams, lotions and bars from three companies, one of which, the French skincare specialist Lutsia, it owns.
Boots acquired Lutsia and the German medical skincare line Hermal Kurt Herman from Merck last year. Through its Boots Contract Manufacturing and Boots Healthcare International subsidiaries, the UK retailing giant is establishing itself as an international manufacturing and marketing brand owner.
The new specialist skincare units will enable Boots to create a UK market for its Lutsia products alongside the other two ranges to be stocked – Johnson & Johnson’s RoC Dermatologic and Pierre Fabre – neither of which are currently available in this country.
The new units are not the first attempt to extend the role of the high street chemist. At the beginning of December, Boots caused a stir when it announced the opening of a drop-in contraceptive advice centre for teenagers at its Glasgow branch.
Lloyds Pharmacy has opened community healthcare and advice units, called CHAT centres, providing written information and backed by local government, the health trust, local schools and the Arts Council.
But dermatologists agree on one thing about the chemist’s role in specialist skincare advice – it must be a non-diagnostic approach and any treatment should come from a medical expert.
Benham of the British Association of Dermatologists says: “People with skin conditions such as acne and eczema should be treated by GPs, who will if necessary refer them to a consultant dermatologist.
“The Boots scheme is obviously aimed at helping people maintain a healthy skin, but we would hope that patients with skin conditions are advised to seek medical care.”
Dr George Rae, chairman of the British Medical Association GP subscribing sub-committee, believes pharmacies wanting to extend their role should themselves seek medical counsel.
“An extension of their role has got to be done with the agreement of the medical profession so there is a sense of ownership and a consensus view about what can be delivered,” he comments.
Rae says if local GPs are not consulted by pharmacies, problems could develop. “Even with the greatest will in the world, if you offer services without the agreement of the medical profession things could go wrong.”
Rae says the medical profession is trying to combat the lack of fast-track dermatological advice by the use of nurses and local trusts. He doesn’t think Boots’ solution to the problem is the way forward.
Professor of Dermatology at University Hospital Nottingham Hywel Williams says Boots’ initiative is fine, as long as the chemist does not stray in to the area of diagnosis.
“If Boots sticks to the grey area of advice on cosmetics and moisturisers, it may take the pressure off dermatologists. But I would not be happy – and this is where the public needs protection – if it moves into skin diagnosis. It may be misleading or they could misdiagnose a skin condition.”
Williams adds: “I have grave concerns where the cut-off point between general skincare and specialist dermatology comes. I would strongly advise the public to go to their GP or dermatologist for advice first.”
He would like to see the Boots skincare areas displaying a notice making it clear to customers that the advice is not diagnostic. Williams believes the public should press for more dermatologists rather than for high street advice.
In his 1995 paper “The extended roles of pharmacists in caring for skin conditions: a welcome development which needs further evaluation”, Williams puts forward the concern of “who will benefit most” if pharmacists publicise treatable skin disease.
He wrote: “The dividing line between providing educational information and actively soliciting customers who previously did not consider themselves to have a ‘skin disease’ into purchasing a skin product is a grey area.”
It is precisely that grey area which Boots has catapulted itself into. A spokeswoman for the company says it expects customers will come to the units having already been diagnosed. Boots’ advisors will have to rely on the customer’s integrity and knowledge of their own condition.