By Gul Root
Community pharmacies are well placed to play an important role in supporting people with sexual and reproductive health needs, especially for deprived communities who may not access other conventional NHS settings. The services available at each pharmacy vary depending on what is commissioned, but examples include access to emergency hormonal contraception, chlamydia screening and treatment, condom distribution and pregnancy testing. Some areas also commission additional services such as ongoing contraception and HIV testing, as well as delivering one-to-one advice to prevent Sexually Transmitted Infections and teenage pregnancies.
However, these services are not consistently provided across the country. It is critical that there is a more consistent approach, integrated with other service providers. Commissioners will commission services that are appropriate for local need and will specify the quality of services as well as the skill set required to deliver specified services.
Here are some of the ways in which community pharmacy teams are making, and can continue to make, an important contribution to promoting good sexual and reproductive health across the country:
Improving access to confidential, expert support: Community pharmacies are conveniently located in the heart of communities, with long opening hours and trained staff on site. They provide a safe haven for people seeking anonymous, informal face-to-face advice from a trusted professional without having to make an appointment, something that is especially important for populations living in the most deprived areas.
Over 90 per cent of community pharmacies have a private consultation area, which provides a good environment for people to raise concerns and ask questions about issues that are sometimes embarrassing or private, in a confidential and nonjudgemental setting. This ensures that community pharmacies are places where people can feel confident getting the support they need. Pharmacy teams are well placed to provide face to face contact for vulnerable groups who prefer direct contact.
Making every contact count: Pharmacy teams are a trusted source of advice for the public. They have regular contact with women seeking emergency hormonal contraception and pregnancy testing services, women who are sexually active but not using a barrier method of contraception, men and women in the target age group for chlamydia screening (15-24 Years) and drug users.
All of these encounters offer an opportunity to promote an integrated package of sexual and reproductive health services beyond a single treatment approach. For example, someone visiting a pharmacy seeking emergency contraception could be offered a contraceptive choices consultation, safe sex advice, chlamydia screening/treatment, condoms, preconception health advice and signposting to other services, where appropriate.
Relieving pressure on local service providers: Community pharmacies offer an easy setting to help relieve the pressure on existing local service providers. With the right training, pharmacy teams can deliver sensitive sexual and reproductive health advice, supply both ongoing and emergency contraception following consultation, offer pregnancy testing and annual STI testing services. They can also offer partner notification, as well as encourage onward referral of positive test results to GPs and sexual health clinics, where appropriate.
Increase opportunities for innovative service delivery: The community pharmacy setting provides opportunities for pharmacy teams to work in partnership with commissioners and other providers to deliver an integrated package of sexual and reproductive health services that focus on the whole care pathway. The Community Pharmacy Contractual Framework 2019/20 to 2023/24 announcement has stated that being a level 1 Healthy Living Pharmacies will be an essential requirement for all community pharmacies, by April 2020, reflecting the priority that is attached to public health and prevention. Collaboration with key stakeholders is important to enable seamless delivery of these services, which will reduce inequalities in access, improve patient experience and improve sexual and reproductive health.
Many pharmacy teams are already engaging in the provision of these vital services, although we know that there are variations in service delivery and quality. A more collaborative, whole-systems approach between different commissioners and service providers would ensure quality standards are consistent and that people have access to high quality, comprehensive sexual and reproductive health care when they need it.
For this to happen, commissioners need to recognise the value of pharmacy teams as a key asset for the provision of sexual health, reproductive health and HIV services, working alongside other providers, especially given their convenient position and value within the community.
Local authority commissioners have an opportunity to consider commissioning sexual health services from pharmacies alongside other providers, especially for those that target local populations most at-risk from poor sexual health, such as young people.
Without integration, people will continue to experience fragmented service delivery, resulting in poor sexual and reproductive health, unplanned pregnancies, and subsequent personal and societal costs.
Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England.
This article also appears in the September issue of Pharmacy Business.