POM to P contraceptive switch: what’s next for community pharmacy and patient consultations?

Women’s health hit the headlines recently with a proposed landmark change to access to contraceptives. The Medicines and Healthcare products Regulatory Agency’s (MHRA) consulted on a prescription only medicine (POM) to pharmacy medicine (P) switch for two progesterone only contraceptive pills.

The Company Chemists’ Association is fully supportive of plans to provide the public with more access to sexual health services through community pharmacy. Pharmacy teams already provide Emergency Hormonal Contraception (EHC) to women without the need for a prescription. We would not like to see women face barriers to accessing EHC whether that be through cost or local availability.  We have therefore previously called for a nationally commissioned framework for sexual health services in England.

Increasing the number of POM to P switches would be a positive step for the community pharmacy profession, providing more opportunities for pharmacists to use their clinical skills and develop these further. Society has changed, and people want their needs to be met quickly. Pharmacists’ USP is that they are health professionals who can be accessed without an appointment. This is valued by patients’ juggling busy lives with work, childcare, and other demands on their time.

However, convenience does not come at the cost of safety. The safety and efficacy of a POM to P switch is rigorously considered by the Commission on Human Medicines before being consulted on by the MHRA. Nonetheless, it may be a misnomer to simply name medicines switched in this way as a ‘pharmacy medicine.’ There is a significant consultation element required as part of the process, as outlined below.

Before a patient receives any ‘POM to P’ medicines, they will be asked to consent to a consultation. The pharmacist will assess the suitability of the medicine for the patient, provide information about alternative options and make the patient aware of any side effects, contraindications, and dosing instructions. This consultation could take around 10 – 15 minutes.

Additionally, patients will need to be monitored to screen for any issues. This could include abnormal reactions, and a discussion around adherence. If monitoring is to be managed in the pharmacy, then this would be an additional short consultation. In short, this is a service which is being provided in addition to the supply of medicine.

Community pharmacy is moving towards a more clinical service-based model. The Community Pharmacist Consultation Service (CPCS) was launched in October 2019. CPCS directs patients contacting NHS 111 with minor ailments and those requiring an emergency supply of medicines to a community pharmacy.

In November 2020, this service was extended to patients contacting GPs directly for appointments. Where appropriate, patients can be quickly referred to see their community pharmacist for a consultation and use the time their GP appointment would have taken for patients with more complex or serious symptoms.

CPCS has the potential to be a significant part of the NHS’ recovery from Covid-19, with community pharmacy teams supporting primary care with increased demand in appointments and a heavy backlog of undiagnosed conditions. POM to P switches, such as those for contraceptives, add another string to the bow of our competent and able workforce and could release GPs from some of this additional demand.

However, it should be recognised that an important part of the process for providing a contraceptive P medicine is a patient centred consultation, much like those provided under the CPCS. Therefore, whether POM to P contraceptives are funded nationally, or provided as a private service, the need for a consultation with a pharmacist must be factored in.

Rebecca Lucas

Policy and Programmes Manager

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