Community pharmacy-led sexual health services should be commissioned nationally, conference hears

Community pharmacies are ideally placed to be the first port of call for women requiring comprehensive and convenient contraceptive and sexual health services. This was the conclusion of a discussion at the Royal Pharmaceutical Society (RPS) 2017 annual conference in Birmingham, UK.

The conference session tied in with the launch of a new health policy report from the London School of Economics, which highlighted that, in England, one in every seven women strongly believed that accessing contraception could be made more convenient for them^[1]
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“Pharmacy bodies should get together to look at [sexual health services],” said David Taylor, professor emeritus at University College London and one of the authors of the report. “It is an important springboard for getting it right for the whole of healthcare provision from community pharmacy.”

Taylor went on to say that there had been many good examples of community pharmacies being able to provide comprehensive contraceptive services across the country, but questioned how that experience could now be built on.

“Do we follow the line supported by [NHS England chief executive] Simon Stevens, that we should have local initiatives and walk away from national commissioning, or should there be national services that specify what should be available in each locality?”

The LSE report ‘Improving access to contraception’, launched on 4 September 2017, analyses the development of contraception services for women in the UK and offers recommendations of how further improvements in NHS care and support, including community pharmacy, should be pursued.

Its key message is that every child that is born should be wanted and have their basic needs taken care of, both materially and emotionally. The number of unwanted conceptions among younger women in their teens and early twenties remains higher in Britain than anywhere else in Europe, the report points out.

It also says that sexual health services are key to preventing and effectively treating sexually transmitted infections (STIs) such as HIV and chlamydia, which alone accounted for just under half of all new STIs reported in England in 2015.

In respect to community pharmacy, the report acknowledges that pharmacists have long been involved in supplying contraceptives such as condoms as well as pregnancy tests and folic acid pills.

The report says that evidence from the UK and abroad shows that with the help of patient record systems and clinical decision aids, NHS community pharmacists could safely do more in this area, enabling GPs and practice nurses to focus on more specialist services such as intrauterine device (IUD) insertions.

Sanjeev Panesar, from Umbrella, which provides sexual health services in Birmingham as part of University Hospitals Birmingham NHS Foundation Trust, said he felt strongly that community pharmacy was an underutilised profession.

“Community pharmacies have excellent opening hours. They’re convenient, accessible and can provide confidential consultations,” he said.

“We need to make sexual health services a national service rather than locally commissioned. Patients would have greater choice and improved access to a greater variety of sexual health services.”

However, he said that to promote change, the public perception of pharmacies also needed to change so that pharmacies were seen as the first port of call for sexual health services.

Catherine Duggan, director of professional development and support at the RPS, said that women and men needed to feel empowered to own their own sexual health.

“The point at which somebody requires contraception tends to be an awkward conversation — to out that with a professional who might be feeling awkward too, is a tricky situation to be in,” she said.

“We want access to be much more empowering and not be pushed under the counter and spoken about in nuanced language.”

Ash Soni, president of the RPS, highlighted a pilot in Lambeth, south London, where pharmacies provided emergency hormonal contraception (EHC) and demand for the contraception dropped by about 50% as patients were more likely to initiate contraception following a consultation with a pharmacist and to continue with that method.

“There should be a nationally commissioned [sexual health] service — contraception doesn’t change across the country, the demand will always be there,” he said.

However, the report highlights that before this happens, some issues needed to be resolved. For example, deciding whether it is in the public interest to make progesterone-only pills and combined oral hormonal contraceptives pharmacy (P) as opposed to prescription-only medicines (POM).

It also said that some community pharmacies still did not want to move away from traditional dispensing roles and some doctors were opposed to extending pharmacy’s part in providing contraception. To strengthen their role as healthcare professionals the report concludes that community pharmacists need to demonstrate their ability to work constructively with service users and other service providers.