1 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM EHC ESTABLISHED IN LSL IN 2000 ONE OF THE FIRST TO IMPLEMENT EHC AND RAN THE GAUNTLET OF THE PRESS SHORTLY AFTER THE SERVICE STARTED LEVONELLE WAS INTRODUCED AS AN OTC PRODUCT SERVICE WAS EXTENDED IN MORE PHARMACIES SERVICE BECAME THE BIGGEST PROVIDER OF EHC ACROSS LSL. WHEN PCTS WERE INTRODUCED THIS WAS STILL THE CASE AND REMAINS SO IN LEWISHAM.

2 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM LEWISHAM HAS BEEN LOOKING AT THE SERVICE AND ITS “REPEAT USERS” FOR SOME TIME. HOW COULD WE BEGIN TO HANDLE WOMEN THAT HAD BEGUN TO USE THE SERVICE ON A REGULAR BASIS. “REPEAT USERS” MONIES FROM THE DH AND NHS LONDON WERE AN IDEAL OPPORTUNITY TO LOOK AT HOW THIS COULD BE ACHIEVED. THERE WAS SUPPORT FROM WITHIN THE PCT AND THE SRH TEAM FOR THE NEW SERVICE.

3 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM AIMS & OBJECTIVES OF THE POP SERVICE: TO EXTEND THE PROVISION OF ORAL CONTRACEPTIVES BY BEING PROVIDED BY COMMUNITY PHARMACISTS AS AN EXTENSION OF THE EMERGENCY CONTRACEPTION SERVICE. THIS WOULD ALSO CAPTURE THOSE WOMEN WHO REGULARLY ATTEND PHARMACIES FOR EHC AND WHO ARE UNWILLING OR UNABLE TO ATTEND THEIR GP OR A SEXUAL HEALTH CLINICS. TO PROVIDE ADDITIONAL ENHANCED SERVICES IN COMMUNITY PHARMACY IN ACCORDANCE WITH THE PHARMACY WHITE PAPER.

4 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM ENSURE THAT ALL PROVIDERS HAVE RECEIVED APPROPRIATE TRAINING TO BE ABLE TO PROVIDE THE SERVICE. ASSESS AND MONITOR THE UPTAKE OF THE SERVICE AND HAVE METHODS TO REVIEW THE SERVICE. EVALUATE THE SERVICE. THE PHARMACY PGD SERVICE WOULD OPERATE WITHIN SPECIFIED CRITERIA AGREED BY LOCAL CLINICIANS.

5 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM ANY WOMEN WHO FALL OUTSIDE THE AGREED CRITERIA WILL BE SIGNPOSTED AND REFERRED TO THE MOST APPROPRIATE LOCAL SEXUAL HEALTH SERVICES. WOMEN WILL BE ABLE TO OBTAIN INFORMATION AND ADVICE REGARDING THE DIFFERENT TYPES OF CONTRACEPTIVE METHODS AND BE ABLE TO MAKE AN INFORMED DECISION IF AN ORAL CONTRACEPTIVE IS THE APPROPRIATE METHOD FOR THEM TO USE.

6 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM THE TARGET WAS WOMEN 16 TO 40. THIS IS BECAUSE THE PCT HAS A LARGE PROPORTION OF WOMEN IN THE UPPER AGE LIMIT WHO USE THE EHC SERVICE. WE HAVE NOT CURRENTLY LOOKED AT UNDER 16s DUE TO THE SAFEGUARDING CHILDREN ISSUES.

7 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM FROM THE START OF THE PROCESS THERE WERE A NUMBER OF INDIVIDUALS IN THE PCT WHO WERE CHAMPIONING THE SERVICE FROM THE SRH CONSULTANT, THE COMMISSIONING TEAM, PUBLIC HEALTH INCLUDING MEDICINES MANAGEMENT AND THE LPC. THERE WAS MUCH DISCUSSION INTERNALLY IT WAS DECIDED THAT THE PCT WOULD TAKE A SLOW AND CAUTIOUS APPROACH TO THIS PROJECT. WE WANTED TO TEST IF WOMEN WOULD TAKE TO THIS TYPE OF SERVICE VIA PHARMACIES.

8 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM THE CHOICE OF DESOGESTREL (CEREZETTE) ONLY FOR THE SERVICE WAS BASED ON: –IT BEING A “SAFE” CHOICE AS NO SERIOUS SIDE EFFECTS –HAS A 12 HOUR WINDOW AS OPPOSED TO 3 WITH OTHER POPs –PHARMACISTS WOULD NOT NEED SUBSTANTIAL TRAINING AS THIS PILL DID NOT NEED TO HAVE BLOOD PRESSURE TESTING AND HAD FEWER CONTRA INDICATIONS AND EXCLUSIONS SO WAS SIMPLER TO ADMINISTER. I.E. CAN BE USED BY WOMEN OVER 35 AND SMOKERS.

9 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM HOWEVER IT WAS RECOGNISED THAT NOT ALL WOMEN WOULD FAVOUR THIS TYPE OF PILL AND THE PHARMACIST WOULD NEED TO ENSURE THAT THIS WAS THE MOST SUITABLE FOR THE WOMEN, IF NOT THEN A REFERRAL WOULD BE MADE, IE FOR COC AND LARC ALTERNATIVES. WITHIN THE PACKS SUPPLIED REFERRAL MATERIAL WAS PROVIDED, INCLUDING A SATURDAY LARC SERVICE.

10 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM AS THE SERVICE WOULD BE AN EXTENSION OF THE EHC SERVICE AND ONLY UNDERTAKEN AFTER AN EHC CONSULTATION IN THE FIRST INSTANCE ALL THE EHC PROVIDERS WERE INVITED TO ATTEND THE TRAINING AND PARTICIPATE IN THE SERVICE. ONE DAY TRAINING FOR ALL PHARMACISTS FOLLOWED BY AN MCQ AND CPPE COURSES IN EMERGENCY CONTRACEPTION, CONTRACEPTION & SAFEGUARDING CHILDREN. FURTHER TRAINING MAY BE CONSIDERED IF WE DECIDE TO EXTEND THE SERVICE TO OTHER FORMS OF CONTRACEPTION. WE WOULD ALSO BE CONDUCTING SOME PIER REVIEW WITH LOCAL PHARMACISTS.

11 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM CURRENTLY 19 PHARMACISTS IN 12 PHARMACY PREMISES ARE PROVIDING THE SERVICE. SOME PHARMACISTS WERE SLOWER THAN OTHERS AT COMPLETING THEIR CPPE ASSESSMENTS, SO NOT ALL WERE READY TO START IN SEPTEMBER. THERE WERE 127 INITIAL (3 MONTHS SUPPLY) AND 16 SUBSEQUENT (6 MONTHS SUPPLY) CONSULTATIONS BETWEEN SEPTEMBER 2009 TO MARCH CURRENTLY LOOKING AT ADDING PHARMACIES TO THE EHC SERVICE AND THIS WILL ROLL OUT TO THE POP SERVICE AS WELL.

12 The best possible health and well being for people in Lewisham POP SERVICE IN NHS LEWISHAM WHAT IS DIFFICULT TO ASSESS IS THE NUMBERS OF WOMEN WHO HAVE TAKEN THE FIRST PACK VIA THE PHARMACY AND HAVE THEN GONE ON TO EITHER A GP OR SRH FOR ANY FURTHER SUPPLIES. WE WILL BE EVALUATING THE SERVICE AND LOOKING AT POSSIBILITY OF WIDENING THE SCOPE OF THE SERVICE.