Overview

The NHS England pilot has been running since October 2021, giving people the option of accessing their next supply of oral contraception directly from their community pharmacist rather than their GP or sexual health clinic. They can be either referred or simply signposted to the service.

The aim is to create additional capacity across primary care and sexual health clinics, as pharmacies take on more responsibility for providing patients with a supply of their ongoing oral contraception, with improved and more convenient access for patients. This allows GPs and sexual health clinics to spend more time focusing on more complex cases.

Background

Priya Littler, Pharmacist at Lalys Pharmacy, Guildhall Walk Branch, explained that they went live with the pilot at the beginning of 2022. The pharmacy has seven branches across the Portsmouth area, and all participated.

She said that the training for pharmacists was extensive, covering topics such as general consultation skills, the service level agreement and PGDs for combination and progesterone only, as well as information around sexually transmitted infections and other areas that may come up during consultations.

Priya’s pharmacy branch is on a high street near to a university campus, meaning she sees both students and young families. “Some of our clients may find it difficult to get an appointment with their GP”, she said, “so we wanted to make contraceptive pill services more accessible. It was also an interesting pilot for our teams to join, to expand their skills and knowledge.”

Improving patient trust in community pharmacists’ ability to deliver the confidential clinical consultations necessary for a repeat prescription and recognition of their clinical skills was also important to Priya and the wider pharmacy team.

Other branches outside of Portsmouth are now working on the training required in preparation for inclusion in the national service.

Addressing the challenges

Priya and her team went out to train their colleagues in the pharmacy group’s six other sites across Portsmouth, making sure they understood the booking system and how appointments would work.

“Both of our regular pharmacists have been trained on service provision and are actively providing the service,” explained Priya. “This enables good service availability across our group. Other relief pharmacists can also provide the service as they have completed the training. In the unlikely event that a pharmacist on duty is not accredited, we have several other branches within Portsmouth that we can signpost patients to. ”Priya adds that communication is key. “One of the challenges we had was managing patient experience, with many walking in expecting to be seen straight away. While we try to accommodate these patients where we can, ordinarily we run an appointment system so we balance our workload.”

Patients are booked in for appointments in advance where possible, to help the practice manage the service and workload better. Staff are aware to book patients in for slots during the week when they call or pop in requesting their next supply. The teams advise all patients not to run out of tablets completely and to try to make an appointment when they are roughly half-way through their last strip, so they can be booked in before they completely run out. Staff are aware of the booking system and have been trained on this local process.

“We also have to spend time managing the care of those who don’t meet the criteria for repeat contraception from a pharmacy,” said Priya, “For example people with high blood pressure or high BMI, who we have to handle sensitively and signpost back to the GP.

“We have educated all team members as to the conversations to have and how to handle them.”

Raising awareness of the service can also be a challenge. Priya’s pharmacy has two private consultation rooms available and after promoting the service to local GP practices and sexual health clinics, they are now seeing a lot of people being referred and signposted. They also attach leaflets about the service to prescription bags, display them on the counter and put up posters in the pharmacies.

Another challenge can be people forgetting to return for repeat visits, so Priya and the team are looking at upgrading their booking system in the future so they can remind people when they are next due.

Key benefits and outcomes

Priya said: “We work with a wide range of GP practices and sexual health clinics, who signpost patients to us, with some simply passing patients on without seeing them themselves. We have had a very positive response, as the service means they can focus on more complex needs.

“In the south east region we have done more than 400 consultations since going live. We’ve had very positive feedback with people saying they are finding it much easier to access ongoing contraceptive supplies. They say they can come in when it’s convenient, sometimes on weekends. Our teams are becoming more confident to answer questions, and the patient doesn’t feel rushed, but has an opportunity to raise any concerns.”

Priya added that it’s key to their success that the wider staff team is more involved with increased opportunities to use their skills and the chance to interact face to face with patients. “The service is being provided through our whole organisation, and we’re showing that it can be run effectively in community pharmacies, with many returning patients.”

All the Laly’s branches in Portsmouth have now signed up to tier two of the pilot, where the pharmacy can start a patient on a number of different contraceptives, which is going well so far, and Community Pharmacy South Central is helping to roll information out to GP practices and sexual health clinics. Priya says they are waiting to see the numbers to decide if they need to make any changes to service delivery.

Take away tips for implementation

• You will need to raise awareness with GP practices and sexual health clinics initially. It can be slow to get practices on board, but it is helpful to send out emails and other messages to practice managers. You can also text relevant patients directly.
• Having an appointment system is working well, as is using the pharmacy technicians to help with clinical measurements (BP, height and weight) – getting everyone in the team involved.
• It is important to spend time with teams, for example in service meetings, to help everyone understand the system for delivering the service. If you have a number of sites, it can be quite difficult to coordinate with everyone for these meetings due to workload and leave. It is worth arranging second visits as needed to get everyone on board.
• It’s helpful to ensure that GP practices understand the PGD and who can and can’t access the service.
• Use the skills of your team but also provide education, support and reassurance that they can take part in providing the service.
• Educate patients during the initial consultation to come back when they are on their last strip or seven days before they run out of pills. If they run out and skip days, they will need to go back to their GP again or visit a Tier 2 registered pharmacy.
• Overcome increases to workload by making sure the staff schedule includes the right team members at any point to deliver the service and that all staff are aware of how to manage the service internally.

“Finally, it’s really important to inform people that you’re offering the service,” said Priya. “If you’re relying on word of mouth or people just walking in, it will be a very slow start – patients will only be coming back every 3, 6 or 9 months, so that’s a long gap. You need a team effort across the local health service to ensure success, engage and recruit people.

“We communicated with GP practices and sexual health clinics by email and also made phone calls to the leads to discuss the service further and explore ways of working collaboratively. In addition, we sent SMS texts to female patients (aged from their first period (menarche) to up to 50 years) registered at Lalys pharmacy, Guildhall Walk to inform them about this service and to get in touch if they’d like to access it.

“This was successful as it highlighted the new service and helped us to recruit patients that were already receiving supplies of their contraceptive pill.”