SOUTHWARK AND LAMBETH

Contraception in Community Pharmacy

Jo HolmesHead of Primary Care

Judith ParsonsProgramme Manager for Contraception

National drivers and levers• Our health, our care, our say – patients needs and wishes for care closer to home

• National Sexual Health Strategy and Implementation plan (2001)

• Contraceptive choices for young people (Faculty of Family Planning, 2004)

• MEDFASH standards (2005)

• Improving Patient’s access to medicines – A guidance to implementing Nurse and Pharmacist Independent prescribing within the NHS in England (Department of Health, 2006)

• Pharmacists with special interests - A Framework for developing - 2008

• Pharmacy white paper – Pharmacy in England, Building on strengths- delivering the future

Local drivers• High teenage pregnancy rates in Lambeth in Southwark

• Sexual health strategy and model outlined clear commissioning intentions to develop and commission a range of services from community pharmacy

• High levels of utilisation of EHC through community pharmacy, which offers an opportunity for pharmacists and service users to be able to assess and potentially meet women’s contraception needs

• Service users requesting access to contraception from a range of community venues

Southwark Service model in Community Pharmacy – ( Lambeth similar!)

Level 1 – 34 pharmacies

EHC ( with Free condoms), Chalmydia screening, distributors of condom card.

o Compliant with essential services contracto Young Person Friendly statuso CRB checkedo 30 pharmacies initially o Aim 70% coverage

Level 2 – 6 pharmaciesLevel 1 services plus Chlamydia treatment and c- card service, some are participants in oral contraceptive pilot

o Approved consultation roomo Located close to teenage pregnancy

‘hotspots’o 6 pharmacies

AimsAims:• Increase access to oral contraception and including LARC• Decrease EHC use• Contribute to a decrease in unintended pregnancies

Main target group:• Young women with high EHC use• Young women who would not otherwise access contraception

Service delivery• October 2009 – one Southwark pharmacy and two Lambeth

pharmacies began service provision (now one Lambeth pharmacy)

• Pharmacists provide oral contraception (14 varieties of COC, four varieties of POP) and information on/referral for LARC

• Pharmacists offer consultation to all women over 16 who request EHC, and all women over 16 who request the service

• ‘On the spot’ service where possible. If not, appointment made

• Monthly data is collected and the service modified on a continual basis

Key strategic enablers

• Modernisation Initiative paved the way for further innovation in sexual health service provision

• History of quality sexual health service provision in community pharmacy

• Local clinical champions

Key stakeholders2008 - steering group established with key stakeholders:

• Sexual and Reproductive Health Consultants

• Primary care and sexual health commissioning

• Medicine’s Management

• Local Pharmaceutical Committee

• Community pharmacy

• King’s College London

• Public Health and Health Promotion

• Teenage Pregnancy

Clinical governance

• Development of patient group directive (PGD)

• Development of clinical pathway

• Development of patient record documentation

• Establishment of clinical placements as part of the training

• Pharmacists receive an on-call clinical support service

• Development of training and education to support service delivery

Education and training• Partnership established with Department of Pharmacy and Florence Nightingale School of

Nursing and Midwifery at King’s College London

• MSc level module developed (15 credits)

• Module run one day a week for five weeks (April – May 2009)

• 20 hours of clinical placements

• Portfolio submission

• Seven pharmacists successfully completed the module in September 2009

• Pharmacists will attend sexual health update training together with doctors

• Pre-course work – CPPE – Contraception, Child protection, emergency contraception (16.5 hours )

• Web based learning tool ( KCL) inc Communications framework, clinical and legal governance, anatomy, physiology and patho-physiology of women

Funding and costs• Funding was initially received from Guy’s and St Thomas’ Charity through the

Modernisation Initiative. The pilot is now funded by the Department of Health through NHS London

• Training costs (including covering locum cost) have been around £3,000 per pharmacist

• Pharmacies involved in the pilot were paid a lump sum of £4,000 to provide a maximum of 150 consultations over a one year period, and participate in evaluation

• Other costs have included project management time, advertising and evaluation

• Pharmacists will be paid per consultation for continued service after the pilot period

Media and advertising• BBC national News aired exclusive coverage of the service in

December 2009

• This was followed by positive coverage in many national papers

• The service was advertised in participating pharmacies from December 2009

• Leaflets and posters advertising the service were sent to targeted local venues in early 2010

Consultation dataOctober 2009 to April 2010 – 214 contraception consultations conducted. Provisional data for this period shows:

Breakdown of contraception consultations Oct 09 - Apr 10

181

13

118 1

Initial pill supply

Repeat pill supply

General referral

LARC referral

Under 16 referral

•91% of consultations resulted in the provision of oral contraception

•5% resulted in a general referral

•4% resulted in a referral for LARC

•0.5% in an under 16 referral

•28% of initial supplies of oral contraception were given to first time pill users

Consultation data

Breakdown of consultations (Oct 09 - Apr 10)

3 410 5 10 8 11

1122 15 21

2133

7

21

3

7

1

5 31

1

1

21 2 1

11

0

10

20

30

40

50

Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10

Month

Nu

mb

er o

f co

nsu

ltat

ion

s Under 16 referral

LARC referral

General referral

Repeat supply

Initial supply to established pilluser

Initial supply to first time pill user

Demographics - locality•96% of consultations were with Southwark and Lambeth residents

•Of those who completed a service user questionnaire (n=72), 81% reported that the pharmacy they had accessed was their local pharmacy

Demographics - age

•95% aged 30 and under

•70% 24 and under

•25%19 and under

Percentage of consultations per age group (Oct 09 - Apr 10)

Under 16 years0%

16-19 years24%

20-24 years45%

25-30 years26%

31-40 years3%

Over 40 years2%

Demographics - ethnicity• Black African/ British/ Caribbean/ other – 59%• White British/ Irish/ other – 20%• Mixed white & black African or Caribbean/ mixed other – 4%• Asian British/ Indian/ Bangladeshi /other – 3%• Other ethnic group – 3%• No data – 10%

Precentage of females aged 15-24 per ethnic group (Lambeth and Southwark average)

58%

15%

9%

6%

12%

White

Black African

Black Caribbean

Black British

Other ethnic groups

24%

20%

14%

11%

8%

3%

3%1%1%1%1%1%0%0%0%0%

10%Black African

Black British

Black Caribbean

White British

White other

Other ethnic group

Mixed White and Black Caribbean

Mixed White and Black African

Asian British

Indian

Chinese

Black other

Bangladeshi

Asian other

Mixed other

White Irish

No data

Percentage of consultations per ethnic group (Oct 09 - Apr 10)

Evaluation

• Baseline data – focus groups with service users and questionnaires with pharmacists

• Evaluation of training and clinical placements

• Pharmacist evaluation session

• Service user questionnaires

• Mystery shopper visits

• Service user phone interviews (to come)

• Full evaluation report (to come)

Evaluation - service user questionnaires

• 83% (60/72) reported LARC discussion

• 82% (59/72) very satisfied with the service; and 11% (8/72) satisfied

• 94% (68/72) very comfortable or comfortable talking to the pharmacist

• 93% (42/45) would recommend the service to a friend

Comments from service users included:

• “I felt very comfortable and at ease talking with the pharmacist”

• “I am very delighted with this service… I will definitely be using it again”

Evaluation – mystery shoppers• Visits conducted by local mystery shoppers aged 16-18

Positive aspects

• 93% found the pharmacist knowledgeable or very knowledgeable on oral contraception

• 85% found the pharmacist knowledgeable or very knowledgeable on LARC

• 88% very satisfied or satisfied with the service they received

• 100% thought it was a good idea to provide oral contraception in pharmacy

Areas for improvement

• Obtaining a consultation

• Counter staff knowledge about the service

Evaluation – mystery shoppersQuotes

• “It is more convenient for young people and you could reach more young people through this method.”

• “It’s in areas that young people find to be close to them, easier access and it’s not a long wait.”

• “They offered information about other types of contraception which meant I didn’t have to ask specifically, showing that they are being thorough in the service in they deliver and making sure young people know all their options.”

• “It was brilliant, I felt completely confident in the service.”

AchievementsWe are reaching our target group

• 70% of service users are under 25, and 25% are 19 or under

• 96% of service users live locally

• 28% of initial supplies of oral contraception were given to first time pill users

• 10% of those completing service user questionnaires stated that they would not have asked for contraception at another service

• Anecdotally, pharmacists have reported individual service users who were repeat EHC users but are now using oral contraception and no longer request EHC

Achievements

We have achieved a decrease in EHC uptake

EHC consultations in one pharmacy providing oral contraception, April 09 - April 10

0

50

100

150

200

250

Month

Nu

mb

er

of

co

ns

ult

ati

on

s

Challenges

• Pharmacists not completing training or leaving employment

• Difficulty providing a consistent drop-in service in sites with a single pharmacist

• Providing appointments is mainly unsuccessful

Main learning points• Establishing early partnerships with all stakeholders is key

• Training a minimum of two pharmacists to provide the service in each pharmacy is optimum, in order to provide a consistent service

• Ensure there is a contingency plan to allow for pharmacists not completing training or leaving their place of employment

• Monthly monitoring of oral contraception provision

• Providing the service in pharmacies where EHC provision is high has proved successful in reaching our target group

• Providing the service as a drop-in is essential, as service users do not always return for appointments

Next steps• Expand Lambeth and Southwark service to further targeted pharmacies

• Produce full evaluation report

• Focus on increasing and improving LARC referrals

• Support other London PCTs in the development of similar services

– Finalise toolkit

– Some PCTs moving ahead

– Pan-London contraception meetings