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Record learning outcomes
Since its launch in September 2021, as of October last year 66 community pharmacists had delivered nearly 1,500 consultations under tier 1 of the NHS England Community Pharmacy Contraception Management Service pilot.
The pilot has freed up capacity in primary care and sexual health clinics by offering patients continuation of supply of oral contraception that has been initiated by a sexual health clinic or a GP.
Ben Morris, pharmacist at Meir Hay Pharmacy in Stoke on Trent in Staffordshire, has been part of the pilot since February 2022, and is preparing to step up to offering tier 2 of the service. This will enable him to initiate supply to eligible patients up to the age of 55 years.
After a slow start seeing just one or two patients a month, Ben briefed a couple of his local GP surgeries about the pilot service to let them know that they could refer any pill checks straight to the pharmacy. “Things rocketed from there,” he says, “but to make the service work you’ve got to get the knowledge out there to the public and get local GPs on board to provide the referrals.
“One of the reasons GPs have been so keen to refer is that they don’t get any payment as such for doing pill checks, so they are happy to pass patients onto us. So far we have seen 90 patients use the service, with 35 in the last month alone.”
Another way the pharmacy highlighted the service to customers was through staff noting any prescriptions for the pill that came in and letting the patients know that they didn’t have to go back to their GP for a further repeat as the pharmacy could supply it for them instead.
“Since patients often get 12 months’ supply of the pill at a time, we haven’t seen many repeat prescriptions yet,” says Ben, “but maybe six or seven people have taken us up on this so far. As we always recommend a long-term form of contraception to those we see as part of an EHC consultation, we can also initiate patients via this route once we are in tier 2 of the pilot.”
As with any pilot, participants report back on any parts of the process that aren’t working so well, and for Ben that was the recording element of the service. “I have fed back that one small downside of the pilot stage has been that the consultation module we use for the service creates a follow-up notification for the patient’s GP, which currently involves you typing it out manually to send to the surgery.
“I’m almost at a point now where I can spend five to eight minutes on a consultation but then there is the paperwork on top of that, so hopefully the national service will use existing systems for recording and notification purposes like most of the other advanced services do, as that would make things even more streamlined for us.”
Team involvement
Pharmacy team members are often the first point of contact when it comes to informing patients about the contraception service. Ashleigh Pearce, a pharmacy technician from Newington Pharmacy in Hull, helped get the service up and running in her pharmacy and is part of the team that has delivered the highest number of consultations for the pilot, as well as delivering presentations about the service on behalf of the local NHSE area team.
“We saw our first customer for the service in February 2022 and soon realised we needed to be really proactive as a team to let people know about it,” she says. “We did a search on our PMR system to find when patients’ repeats would be due and called them to let them know about the service and how it worked. Most were already returning every three and six months for their repeats, but once they knew they could get their supply directly from us, they used the pharmacy service and have kept coming back.”
As a pharmacy technician Ashleigh is not directly involved in delivering the service other than informing customers about it, but says the whole team is aware of what’s happening and can explain it to patients.
“After we went to the local GP practice to tell them about it, they have also been really keen to send patients to the pharmacy,” she says.
The only problem Ashleigh sees with the service as it gears up for national rollout is a potential lack of wider coverage. “Not every pharmacy will be offering the service, which might mean that patients have to go to a pharmacy that isn’t their usual one to access their contraception,” she points out.
“We can do walk-ins but operating on an appointment basis works better for us as sometimes we have locums who are not trained to offer the service.”
“Giving patients an appointment time enables us to know when to expect someone and stops anyone from being disappointed.”
As the pharmacy gears up to offer tier 2 of the service, Ashleigh says the lack of an integrated reporting mechanism back to the patient’s GP surgery is a hurdle that needs to be addressed. “The surgery told us that it doesn’t necessarily need to know but it feels like the system is missing a step here,” she says.
“On the plus side, our patients definitely love the service as it effectively saves everyone time – as they have to come to us to get their prescription for the pill anyway.”
Great appeal
The appeal of the contraception service from a pharmacy perspective is clear – women don’t need a referral to access it and it is straightforward to administer.
“It is a relatively simple service to provide and pharmacists shouldn’t be put off by thinking it will take too much time to deliver,” says Ashleigh Pearce.
It has also proved popular with patients, she says. “Yes, doctors can refer people to the pharmacy for the service but we have got more people in by looking at our own patient records and contacting people to come to us that way – and every one of them has come back as it worked well for them and they are happy to use the service again.”
Ben Morris would certainly recommend pharmacists get involved in the national service, saying that “patient feedback has been really positive all the way through because of the ease and accessibility that pharmacy offers.” His only caveat is that, as with any service offering, it does put more pressure on an already busy workforce.
“Tier 2 of the service will increase the number of patients we are seeing, so time and staffing are things to consider,” he says. “We have a full-time accuracy checking technician but one of the things going forward is that, although pharmacy is getting more services, we also need funding for staff so we can cope with the extra work.”
While the training requirements needed to offer the service could “initially appear quite daunting” for pharmacists, “if you look at what you have already done in your career, you’ll find you have managed a lot of it already. So don’t be put off – it works well and it definitely makes you feel you are providing more clinical care.”
Having effective conversations about erection problems
There is plenty that pharmacy teams can do to encourage men to talk about their sexual health and, indeed, their health in general.
Approximately 5 million men in the UK are affected by erection problems (EPs), yet only 4 per cent have spoken to their pharmacist, according to Viatris. And it’s not just older men – a quarter of men under 40 years of age are thought to be affected by EPs. “Erection problems can have a big impact on a man’s wellbeing and self-esteem, causing 31 per cent to feel ‘inadequate’ and 27 per cent to feel like ‘a failure’,” according to Viagra manufacturer Viatris.
Erectile dysfunction can sometimes be improved with lifestyle changes, such as weight loss, smoking cessation, reducing alcohol consumption, regular exercise and stress management. However, with over 20 years of clinical experience, Viagra Connect (sildenafil) provides an OTC management option offering good tolerability, efficacy and ease of purchase.
A wide range of learning resources supporting sales of Viagra Connect are available on the Pharmacy Magazine website including a guide to having effective conversations with customers, practice scenarios and ways of overcoming potential barriers to purchase.
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