Sexual Health Service by Community Pharmacists

Kate Kinsey

NHS Manchester

Background

• December 24th 1999 saw the launch of the EHC scheme for Manchester, Salford and Trafford (19 pharmacists trained)

• To date trained in excess of 1000 pharmacists

• 1000 – 1200 requests for EHC per month in Manchester

• Chlamydia screening launched in Lloyds pharmacy Fallowfield, November 2005

Drivers - National key indicators

• Under 18 conception rate• An appointment at GU clinic within 48 hours• Setting up a Chlamydia screening programme• Pharmacy White Paper- Pharmacy in England,

Building on strengths- delivering the future

Local Drivers• Target in NHS Manchester’s Strategic Commissioning plan to reduce teenage pregnancy

• 1 in 80 people aged 16-24 in GM has Chlamydia

• Access to services

• Reducing health inequalities

Objectives

• To enable clients to have greater access to EHC, Chlamydia testing / treat/ trace and oral contraception

• To be able to supply clients and their partners with appropriate , timely medication by an accredited pharmacist

• Reduce health inequalities by providing the service in wards with high teenage conception and abortion rates

The Scheme (currently)

When the client requests for EHC they are offered the following, working to protocols:

• EHC

• Testing for C. trachomatis infection if <25 years, treatment and tracing of partners.

• Oral contraception first supply / repeat oral contraception

Training

• The pharmacists already EHC trained.• The pharmacists undertook training with a GP

with special interest in sexual health and RU Clear.

• The pharmacist completed CPPE packs contraception, EHC, safeguarding.

• PGD training• Skilled in understanding all forms of

contraception

Training extension

Update session held in March 2009 covered a more in depth examination of contraceptive choices

Extended the training packs to include: CPPE - Dealing with difficult discussions CPPE - Sexual Health, testing and treating

Findings

6 sites (only 4 active sites) 0809 0910

EHC Number supplied = 7696 8013

ChlamydiaNumber treated = no data 553

OC number presenting = 1010 1799 number prescribed= 979 (97%) 1759

(98%)

What is provided? 0809 0910• First COC = 599 (62%) First COC = 811 (46%)

• First POP = 102 (10%) First POP = 108 (6%)

• Repeat COC= 249(25%) Repeat COC= 737(42%)

• Repeat POP = 29 (3%) Repeat POP = 93 (5%)

Age Range of Clients

• 0809 0910• Under 16 > 0% (only 2 clients) Under 16 0%

(2)• 16-19 27% 16-19 23%• 20-29 66% 20-29 69%• 30-39 6% 30-39 7%• 40-49 1% 40-49 1%• >49 0% >49

0%

Under 19s supply

• 0809 Total= 269 0910 Total= 414• First COC = 182(69%) First COC = 190(46%)

• First POP = 25 (10%) First POP = 25 (6%)

• Repeat COC= 51(19%) Repeat COC= 187(44%)

• Repeat POP = 5 (2%) Repeat POP = 12 (3%)

Days of the week (0809)

0

50

100

150

200

250

300

350

MondayTuesdayWednesdayThursdayFridaySaturdaySundaynot recorded

Ethnicity

• White British 84% • Asian/Asian British 8%• Black/Black British 4%• Chinese, Middle Eastern 1%• Mixed race 2%• Not recorded 1%

Consultations when OC not suppliedReason not supplied

0809 0910

Migraine 11 23

Unexplained bleeding

2 1

Referral 1 5

Other 17 11

Total 31 40

Payments

• Consultation with supply = £25• Consultation with no supply = £10• Pregnancy tests = £5• Chlamydia Postal kits = £2• Kits returned =£3• Consultation with treatment = £10• Consultation with no treatment = £5

Challenges Consultations with the clients was taken to a

higher more intimate level where probing of sexual histories and partners had to be discussed.

Competing priorities in the new contract e.g. Medicine Use Reviews (MUR)

Customer perception

AwardsEHCWinner 1999 Pharmaceutical Journal for EHCWinner Regional Health & Social Care Awards 2000Runner up National Health & Social Care Awards 2000

Chlamydia –test / treat & traceWinner Greater Manchester NHS Awards 2006 Runner up:Pharmaceutical Care Awards – 2006Health & Social Care Awards – 2006

Oral ContraceptionPharmaceutical Care Awards 2008

What could the future hold?

• More pharmacists trained• National service for EHC and oral contraception• Agreed training and accreditation• Extension for LARCS• Advance supply of EHC (NICE)?

Special thanks to:• Philippa James – NHS Manchester GP & Lead

• Karen O’Brien, Suzanne Cliffe and Maureen Balfe –NHS Manchester

• Margaret Kingston & Helen Hodgson: Manchester Centre for Sexual Health Central Manchester & Manchester Children’s Hospital

• Asha Kasliwal & Carol Bailey:, Consultants NHS Manchester

• All the pharmacists in the scheme

• RU Clear