The Company Chemists’ Association (CCA), the National Pharmacy Association (NPA), the Royal Pharmaceutical Society (RPS) and the Faculty of Sexual and Reproductive Healthcare (FSRH) are calling for a National Emergency Hormonal Contraception (EHC) service. This should be commissioned FREE (at the point of access) to women of all ages through community pharmacies in England. The service would not only transform access to care for all women, but directly tackle health inequalities and vastly improve health outcomes.
For decades, community pharmacy has played an integral role in women’s health, offering convenient healthcare and advice, without the need for an appointment. Pharmacies’ accessibility and extended opening hours, coupled with safety-netting and clinical advice are highly valued by women [1].
More recently, NHS England commissioned a Pharmacy Contraception Service, allowing women to access the oral contraceptive pill free of charge, expanding pharmacies’ role in women’s health.
The incidence of unplanned pregnancies increases in areas of higher deprivation [2,3]. Girls, adolescents, and women in the most deprived areas are more than two times more likely to have a termination than those in the least deprived [4]. It is known that access to healthcare is scarcer in more deprived areas where the need is often greater (the inverse care law) [5]. Unplanned pregnancies are also linked to increased risk of adverse health outcomes [2,3].
However, contrary to other healthcare providers, there are more community pharmacies in areas with higher levels of deprivation [6], meaning that they offer an essential tool in tackling health inequalities Evidence shows that pharmacies in more deprived areas, offer greater numbers of commissioned EHC consultations [7].
National EHC services have been commissioned in Scotland and Wales for many years. In both nations, significantly fewer women attend General Practice for EHC, preferring the convenience of community pharmacies [4,8]. The ubiquitous nature of the service has undoubtably contributed to comparably lower levels of abortion per 10,000 female population [4,8].
EHC services are already widely commissioned by an estimated 90% of local authorities in England, but only around 48% of community pharmacies are included in these services [9]. Variance in local service design, such as restrictions on patient usage, means this there is no standard offer for patients across England. Furthermore, there are cases of pharmacies having to determine what level of care they can offer to a woman by literally asking her for her postcode. Patchy and inconsistent local commissioning has created a postcode lottery of access for a service which clearly has significant national demand.
The CCA, NPA, RPS and FSRH are calling for an end to the postcode lottery and for women of all ages to be able to access a nationally commissioned EHC service from their local community pharmacy.
The current arrangements are inadequate for women:
• There is an incomplete understanding of the availability of free at-the point access EHC services.
• As services are commissioned by local authorities, they cannot be promoted nationally.
• There are currently no national standards to underpin the service.
• There are no national training requirements for pharmacists and pharmacy teams.
All of these issues could be transformed through the commissioning of a nationwide EHC service, mirroring the successful approaches adopted in Scotland and Wales.
Access is important and there are a growing number of innovative routes to purchase EHC through pharmacies, including online private pharmacies. However, the greatest barrier to EHC, and tackling health inequalities, is the cost barrier. NHS commissioned services, free at the point of use, would ensure that women who need the service, can access it with ease, irrespective of their personal circumstances.
We are calling on the government and the NHS to follow the example of Wales and Scotland, and commission a national advanced EHC service in England. Additional investment in the commissioning of EHC and contraception services through community pharmacy will support the recently published Women’s Health Strategy, whilst also dramatically improving access, and setting higher standards of care across the country.
References:
1 Seston, E.M., Elliott, R.A., Noyce, P.R. et al. Women’s preferences for the provision of emergency hormonal contraception services. Pharm World Sci 29, 183–189 (2007). https://doi.org/10.1007/s11096-006-9068-9
2 Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann 2008;39:18–38.
3 Wellings K, Jones KG, Mercer CH, et al. The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third national survey of sexual attitudes and lifestyles (Natsal-3). Lancet 2013;382:1807–16.
4 Department of Health & Social Care. Abortion statistics. England and Wales, 2020.
5 Hart JT. The inverse care law. Lancet 1971;1:405–12.
6 Todd A, Copeland A, Husband A et al. The positive pharmacy care law: an area-level analysis of the relationship between community
pharmacy distribution, urbanity and social deprivation in England. BMJ Open 2014; 4: e005764.
7 Thayer N, White S, Frisher M. Use of path analysis to predict changes to community pharmacy and GP emergency hormonal contraception (EHC) provision in England. BMJ Open 2022; 12: e059039
8 Public Health Scotland. Data and Intelligence. 2018.
9 Mackridge AJ, Gray NJ, Krska J. A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England. BMJ Open 2017; 7: e015511