Overview

The Fairway Pharmacy joined the NHS England tier one pilot in October 2021 to give local people the option of accessing their ongoing supply of oral contraception directly from their community pharmacist rather than their GP or sexual health clinic.

The idea is to create additional capacity for ongoing oral contraception access that is more convenient for patients through longer opening hours or drop-in services, for example. The service moved from pilot to a national advanced pharmacy service in April 2023. This means all pharmacies in England can now choose to participate.

Background

Ben Morris is Community Pharmacy Manager at Fairway Pharmacies, a local pharmaceutical committee member and a lead community pharmacy PCN pharmacist in Stoke-on-Trent. The pharmacy completes around 12,500 prescription items in total a month, and they sign up to all the advanced services they can. It serves a population who predominantly live in a residential estate with a mix of people including young families and the retired.

Ben undertook the clinical training to deliver the tier one contraception service pilot and said that once that was complete, the local GP practices were happy to be involved.

“I completed the e-learning which was suggested in the service specification,” he said. “It took around 10 hours to do all the modules and complete the relevant assessments. The training gave me more of an in-depth knowledge about the circumstances in which the different type of pills would suit different patients.

“Following the training I delivered a briefing for the eight part time staff in our wider team, giving them an overview of the service, how we would deliver it together and the conversations to have with customers who had a repeat prescription for oral contraceptives.

“There was no formal training for the staff team as such. I mainly asked them, when handing out any prescriptions for contraception, to make patients aware that they could come back to the pharmacy for review and issue of an ongoing supply (where clinically appropriate), instead of the GP practice or sexual health clinic.”

Ben says that while the pharmacy currently runs the service on a walk-in basis, it’s proving so popular that they may need to introduce an informal appointment system where people call in advance to check availability.

Key benefits and outcomes

The tier one pilot started in autumn 2021 and the pharmacy began consultations in January 2022. Ben says that when they first started, each would take around 10-15 minutes but now they are comfortable with the system and what it involves, they are able to deliver the consultations in five or six minutes.

“Even with the combined pill, where we need to take blood pressure, height and weight, it’s quick, including when people first register,” he said. “When it’s progesterone only, where we don’t have to do the tests like with the combined pill, it’s even quicker. It’s basically a case of now we’re used to it, we can deliver it more quickly. Where the patient consents, we also complete an anonymised returning patient message to the GP which adds about another five minutes”.

As of January 2023, Ben had completed around 100 consultations. He says that there was a fairly slow start up to June 2022, but that the take-up increased from August 2022 after they had worked hard to increase links with local GP practices.

“We have close links with five or six practices in the local area and we ran the pilot in partnership with one particular PCN and have driven it from there,” he explained. “The list we’ve got on board now is around 100 individual patients who we can give up to 12 months’ supply of contraception.

“I sent information and contacted all our local practice managers and PCN pharmacists to make them aware of the service and asked them to cascade the information to all the relevant practices.

“I would say 90 per cent of our clients come from GP signposting and the remaining 10 per cent from word of mouth and advertising within the pharmacy.”

The pharmacy hasn’t yet started gathering formal patient feedback, however anecdotal responses are mainly around the improved access through drop-ins and local location. “Feedback has been overwhelmingly positive: the ease of access and our service delivery is also giving people more general confidence in us to use the other services we offer.”

“Rather than having these patients arrange a GP appointment, surgeries are now simply passing queries directly to us. We’re pleased that by working together, we have cemented their trust in us to deliver the confidential consultations in our private rooms and that we have the clinical expertise necessary to provide a repeat prescription.”

The pharmacy doesn’t currently deliver any specific follow up, however they do check if there are any issues during the consultation and can refer patients back to their GP if needed.

It signed up to the tier 2 pilot in October 2022. This gives pharmacists the opportunity to initiate contraception for the first time. Current plans are to keep this as a walk-in service.

Take away tips for implementation

• Keep your blood pressure kit handy and be ready to take height and weight – you’d be surprised how many people aren’t sure how tall they are.
• In the advanced service the blood pressure check and BMI calculation can be done by a suitably trained pharmacy technician. So, you could plan for this to be done before you carry out the consultation.
• The consultation tool can look daunting at first, but you will get into a rhythm of the questions to be asked. For example, you might ask some questions while taking measurements.
• It’s important to educate your whole team on the new service; this doesn’t have to be complicated. Talk through the conversations they can have with patients and ensure they understand how to refer on to the service.
• Arranging pharmacist time is the most challenging – balancing it with the other services provided and the dispensing role. Ensure the team is aware what they need to pick up when the pharmacist is consulting.
• A qualified pharmacist is needed to deliver the service, so look at getting enough on board to cover all your opening hours. That’s something we are currently working on. Those community pharmacists will have to complete the same clinical training to be able to deliver the service.
• Spread the word locally with GP practices, clinics and council services, and local support groups – always tell people receiving the service to let others know.