1. SOUTHWARK AND LAMBETH Contraception in Community Pharmacy Jo Holmes Head of Primary Care Judith Parsons Programme Manager for Contraception

2. 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

3. 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

4. Southwark Service model in Community Pharmacy – ( Lambeth similar!) Level 1 – 34 pharmacies EHC ( with Free condoms), Chalmydia screening, distributors of condom card. oCompliant with essential services contract oYoung Person Friendly status oCRB checked o30 pharmacies initially oAim 70% coverage Level 2 – 6 pharmacies Level 1 services plus Chlamydia treatment and c- card service, some are participants in oral contraceptive pilot oApproved consultation room oLocated close to teenage pregnancy ‘hotspots’ o6 pharmacies

5. Aims Aims: 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

6. 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

7. 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

8. Key stakeholders 2008 - 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

9. 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

10. 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

11. 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

12. 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

13. Consultation data October 2009 to April 2010 – 214 contraception consultations conducted. Provisional data for this period shows: Breakdown of contraception consultations Oct 09 - Apr 10 181 13 11 8 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

14. Consultation data

15. 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

16. Demographics - age 95% aged 30 and under 70% 24 and under 25%19 and under

17. 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%

18. 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)

19. 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”

20. 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

21. Evaluation – mystery shoppers Quotes “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.”

22. Achievements We 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

23. Achievements We have achieved a decrease in EHC uptake

24. 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

25. 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

26. 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