Should your pharmacy offer travel health services?

Is there demand for a pharmacy travel clinic?

Yes, and the public health data says the need is growing. UKHSA reported 2,106 cases of imported malaria in the UK in 2023, 26% more than the 1,555 cases in 2022 and the highest total since 2001. Six people died. Of the UK residents who caught malaria abroad, 74% had been visiting friends and relatives. Among cases with a known history, 89% had taken no chemoprophylaxis at all.

Those figures describe the people a travel clinic exists to reach: families flying to Nigeria, Ghana or Sierra Leone at short notice, often without seeing a GP first. A pharmacy that can see them the same day fills a gap nobody else is filling.

The NHS side of travel health is thin. GP practices provide a small set of travel vaccines free under the GP contract: hepatitis A, typhoid, cholera and the combined tetanus, diphtheria and polio booster. Everything else is private, including yellow fever, rabies, Japanese encephalitis, tick-borne encephalitis and hepatitis B for travel. Private clinics and the national chains have taken much of that business. An independent pharmacy can take a share, and several have, as private services carry more of the sector's income.

What does the law let a pharmacist supply?

Any travel vaccine or prescription-only antimalarial, provided a patient group direction covers it. Vaccines are prescription-only medicines under the Human Medicines Regulations 2012, so a pharmacist cannot administer them without a prescription or an exemption. The PGD is the exemption. Regulation 213 defines a PGD as a written direction, signed by a doctor or dentist and by a pharmacist, for supplying and administering a class of medicine to persons generally.

Regulation 233 is the one that matters for a private clinic. It lets a person conducting a retail pharmacy business supply and administer under a PGD made through an arrangement with a listed body. For NHS work that body is an NHS trust, an integrated care board, NHS England, a local authority or UKHSA. For private work it is an authority or person carrying on the business of an independent hospital, an independent clinic or an independent medical agency. The PGD must then be signed by or on behalf of the registered provider and, where there is one, by the relevant manager. That is why commercial PGD packages come from a registered clinic or medical agency rather than from a lone doctor.

Every PGD must contain the 17 particulars in Schedule 16 Part 1. They include the period the direction has effect, the clinical criteria for eligibility, the exclusions, the dose, route and frequency, the warnings, referral arrangements and the records to keep. Schedule 16 Part 4 lists who may work under one: pharmacists, nurses, paramedics and, since 26 June 2024, registered pharmacy technicians. Each person must be designated in writing for that PGD. Unregistered staff cannot use one.

NICE's medicines practice guideline MPG2 sets the professional expectation. The Specialist Pharmacy Service summarised it on 1 April 2026. Do not use PGDs to manage long-term conditions or when uncertainty remains about the diagnosis. Do not use one where the care pathway gives a prescriber the opportunity to prescribe individually. Travel vaccination is the textbook case for a PGD: a standard product, fixed criteria and a one-off decision. Our guide compares PGDs and independent prescribing for services that need more than that.

One change is new. The Human Medicines (Amendment) Regulations 2026, SI 2026/381, were made on 26 March 2026 and came into force on 31 March 2026. They rewrote regulation 233(8) so that it covers vaccination against an infectious disease, rather than only coronavirus and influenza. Regulation 233(8) switches off regulation 220, the rule that medicines not on general sale are sold or supplied only at a registered pharmacy by or under the supervision of a pharmacist. In plain terms, a pharmacy's PGD vaccination no longer has to happen inside the pharmacy. A workplace hepatitis B clinic or a pre-Hajj MenACWY session in a community hall now stands on the same footing as a flu clinic, provided the PGD's own conditions are met. The same instrument also created vaccine group directions for public health bodies.

How does a pharmacy become a yellow fever vaccination centre?

By registering with NaTHNaC, the National Travel Health Network and Centre, which UKHSA commissions to designate centres in England, Wales and Northern Ireland. In Scotland, registration runs through Public Health Scotland instead. Yellow fever vaccine, sold as Stamaril, may only be given at a designated centre. The reason is the International Certificate of Vaccination or Prophylaxis issued with it, a legal document under the International Health Regulations. The certificate becomes valid ten days after vaccination and lasts for life.

Registration has conditions. NaTHNaC requires its own yellow fever training before it approves a site, and charges a registration fee. Centres must follow its code of practice, which the MHRA also points vaccinators to. A 2021 case study in The Pharmacist, from Harlow Town Pharmacy in Essex, described an online test, a one-day course, further exams with NaTHNaC and annual mandatory training. It put the training at £200, first-year registration at £265 and renewal at £145 a year. Fees change, so check NaTHNaC's current schedule before you budget. A second case study, from Coopers Pharmacy in Sutton in 2022, described NaTHNaC training every two years.

The clinical bar is higher than for other travel vaccines. Stamaril is a live vaccine. On 16 April 2019 the MHRA issued a Drug Safety Update after two fatal adverse reactions. It said the vaccine must not be given to people who may be immunosuppressed. For those aged 60 and over, it should only be given where there is a significant and unavoidable risk of acquiring the infection. Your PGD, your screening questions and your record all have to reflect that.

What training do travel clinic staff need?

Three layers: immunisation training, travel health competence and PGD-specific training. UKHSA's National Minimum Standards and Core Curriculum for Vaccination Training set the baseline. First published in February 2018, the standards were reissued in June 2025 as a single document covering registered practitioners and healthcare support workers. They call for comprehensive foundation training, regular updates, supervision and support for everyone with a role in delivering vaccination. Basic life support and anaphylaxis management sit inside that.

Travel health competence is separate. The Royal College of Physicians and Surgeons of Glasgow, home of the Faculty of Travel Medicine, recommends a minimum of two days of initial training. It and the Royal College of Nursing both publish competency frameworks. That is the account given in a Pharmaceutical Journal learning article on 30 January 2025, which puts a documented travel consultation at 15 to 30 minutes.

PGD training is the third layer. Each PGD names the training the health professional must have completed, and the provider usually supplies it. Regulation 233 requires each person administering under the PGD to be designated in writing for that purpose. A locum cannot work under your PGD until they have done the training and been designated. Under GPhC standard 2.2, staff must have the appropriate skills, qualifications and competence for the tasks they carry out.

What premises and equipment do you need?

A private room, a validated fridge and the kit to deal with anaphylaxis. GPhC standard 3.1 requires premises to be safe, clean, properly maintained and suitable for the services provided. Standard 3.2 requires them to protect the privacy, dignity and confidentiality of patients. A consultation room with a door, a chair or couch, hand-washing and a sharps bin meets that. Vaccines must be kept between +2°C and +8°C in a pharmaceutical refrigerator, not a domestic one. Record the maximum and minimum temperatures at least once a day, name a person responsible and write a procedure for a cold-chain breach. Green Book chapter 3 sets those expectations, and a data logger makes them cheap to evidence.

Keep adrenaline with the vaccines, and make sure every vaccinator has current training in using it. GPhC standard 1.6 requires the records needed for safe provision, and the last of the 17 PGD particulars specifies what you record about each supply. A PMR service record that captures the PGD used, batch number, injection site, expiry date and the patient's consent covers both. Book the follow-up doses at the first visit; rabies and hepatitis B courses fail when the second or third dose is missed. Our guide to adding online booking to a pharmacy website covers the practical side.

Check your cover before the first patient. The GPhC says a pharmacy owner must have appropriate indemnity arrangements for the services provided at the registered pharmacy or any associated premises. A change in practice may mean reviewing the cover or taking out new cover. Tell your insurer about the clinic, and again if you add yellow fever or off-site sessions. Our insurance guide explains what to look for.

Which antimalarials can you supply?

All of them, but by different routes. UKHSA's malaria prevention guidelines for travellers from the UK are updated every year. They record that Maloff Protect, a brand of atovaquone plus proguanil, can be bought from UK pharmacies by adults aged over 18 weighing more than 40 kg. That is a pharmacy medicine sale, with no PGD needed. The guidelines also note that Paludrine and the Paludrine/Avloclor travel pack have been discontinued, so proguanil is no longer available in the UK. Doxycycline and mefloquine remain prescription-only, so you need a PGD or a prescriber. PGDs carry exclusion criteria, so expect to refer pregnant women, young children and patients on interacting medicines to a prescriber.

The malaria figures show why this matters. Nine in ten UK cases with a known history had taken no prophylaxis. Three in four of the UK residents affected had been visiting friends and relatives, mostly in West Africa. These travellers rarely book a travel appointment. A pharmacy that asks where the customer is flying to can hand over Maloff Protect or a PGD supply of doxycycline the same day. That does more for malaria prevention than most clinics.

How much does a travel clinic make?

Enough to matter once volume covers the fixed costs, but it builds slowly and it is seasonal. No official data on private travel income exists, so the best evidence is what pharmacies have said in public. Coopers Pharmacy in Sutton told The Pharmacist in 2022 that it had paid about £300 for its PGDs, with training on top, when it set up in 2012. It saw about 200 people in July 2022. Harlow Town Pharmacy said in 2021 that its yellow fever registration paid for itself after two or three vaccinations.

Those prices are five years old and from one pharmacy. Use them for structure, not for your price list. Most of the revenue is per dose, not per consultation, so a three-dose rabies course is worth more than three single-shot patients. A consultation fee, £10 at Harlow and nothing at Coopers, mostly pays for time spent with people who then go elsewhere. A clinic run one afternoon a week from a room you already have carries little fixed cost beyond the PGDs, registration and the fridge.

The costs that catch people out are wastage and time. Short-dated stock bought for one traveller, and vaccines ordered for patients who never return, erode the margin. So does a 30-minute consultation given free. Price the consultation, credit it against the first vaccine if you like, and book the whole course at the first visit. Whether a service is exempt or standard-rated for VAT depends on who provides it and what it is for; our VAT guide covers the tests.

Should you do it?

Do it if you have a pharmacist who wants the work, a room, and a catchment that travels. Coopers' advice was that location is critical: a saturated market makes the service hard to sustain, an underserved one keeps it viable. Look at who lives near you. Communities that fly home to malaria-endemic countries generate demand all year. Business parks generate hepatitis B and corporate contracts, and since 31 March 2026 you can deliver those on site.

Do not do it if the pharmacist has no protected time. A travel consultation is 15 to 30 minutes of uninterrupted clinical work, and a yellow fever consultation is longer. If the responsible pharmacist is also the only checker, the clinic will lose to the dispensary every time. Either bring in a second pharmacist for clinic sessions, or plan around the supervision changes due from 10 December 2026, which will let a pharmacy technician run more of the dispensary.

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