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Page 1: Sexual Health Service by Community Pharmacists

Sexual Health Service by Community Pharmacists

Kate Kinsey

NHS Manchester

Page 2: Sexual Health Service by Community Pharmacists

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

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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

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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

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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

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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

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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

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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

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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%)

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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%)

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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%

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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%)

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Days of the week (0809)

0

50

100

150

200

250

300

350

MondayTuesdayWednesdayThursdayFridaySaturdaySundaynot recorded

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Ethnicity

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

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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

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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

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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

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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

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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)?

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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