'We make an average of £2,000 a month offering sexual health services'

Zenith Pharmacy has been providing sexual health services to people in Birmingham since 2015, as part of the locally-commissioned Umbrella service.

Service type: Sexual health.

Name of pharmacy: Zenith Pharmacy, Birmingham.

Name of pharmacist: Batul Roowala.

Why did you start offering the service?

I've been offering this service since 2015. We are commissioned by Umbrella, Birmingham’s sexual health provider, to deliver the service, and we were one of the first few pharmacies to take it on.

At the time Umbrella was piloted, back in 2015, we were getting lots of enquiries for free emergency contraception. However, due to the transition from the old Primary Care Trusts to Clinical Commissioning Groups, new pharmacies were not given these services, so we weren’t able to offer it.

The Umbrella service gave us the opportunity to do this [offer free emergency contraception]. It was also quite new and exciting because I think for the first time it meant pharmacists could provide services like contraceptive pills, injections, STI testing kits and chlamydia treatment.

This was more than the day-to-day of sticking on labels and selling OTC medicines, so it was a nice change. Finally, it gave us an opportunity to use our consultation room - when we opened we never used it, but ever since we started offering Umbrella it’s become one of our main income generators.

How much did it cost to set up the service?

Between £700 and £1000. This included paying to have a pharmacist on the premises to cover me when I went on training, and we also printed some posters and leaflets to help promote the service within our local community.

What, if any, training did you or other team members have to undergo?

All the training was free. I completed an online sexual health training with CPPE and a face-to-face training organised by Umbrella over one and a half days. This focused on clinical and consultation skills and it included, for example, some roleplay for the kind of enquiries we would be dealing with, information on chlamydia and other STIs, and how to issue a contraceptive.

In a nutshell, what does the service involve?

Under Umbrella, we are contracted to provide ‘tier one’ and ‘tier two’ sexual health services. This involves providing emergency hormonal contraception (EHCs) and condoms (tier one), but also starting people on the contraceptive pill or injection, giving chlamydia treatment, administering the hepatitis B vaccination, and suppling and initiating testing kits for STIs (tier two).

We first ask the patient exactly what they need from the service, because obviously we can only provide so much. If they need a more comprehensive service, such as on-the-spot STI testing or treatment for gonorrhoea or syphilis for example, then they would need to go to an Umbrella clinic.

The service is meant to be provided throughout the opening hours of the pharmacy - we open seven days a week - but if for any reason we don’t have a trained pharmacist on site, we have to direct the patient to get help elsewhere. The service is usually well-covered in our pharmacy though.

Once we’ve determined that we can help the patient, we ask them to come in. We always ask them to call before they attend, just to make sure the pharmacist is not busy or on lunch, for example, and we also tell them to make sure that they do have 10 minutes to wait and be seen. This is not a takeaway service, where you walk-in and walk out straight away.

Most patients are happy to wait, because the wait for these services elsewhere can be three hours. To make the process quicker for people who can’t wait, we have some pro-forma forms for EHCs and contraceptives. The patient fills in their details and we just have to go through certain contraindications and ensure there are no interactions, before giving them the necessary medicines. So, all in all it can be done in 10 minutes or so.

After providing the service, we have to enter patient records on a dedicated platform and it’s through this we are paid by Umbrella. We are paid a flat rate per consultation, regardless of how long it takes or what you do within that.

Are there any opportunities to sell over the counter or prescription products during the consultation or after it?

Not really - it’s a free service, including condoms.

How have patients responded to the service?

I think patients are just glad it’s available. Some people do abuse the service, they come in for emergency contraception time and again, eg four times in a month, which is ridiculous. I do think there should be more education at school level to reinstate the cons of taking emergency contraception.

Roughly how often each month do you carry out the service?

We’re open seven days a week, some days are quieter than others - but I see an average of eight people per day for this service on a daily basis.

How much do you charge for the service?

The service is free.

Roughly how much a month do you make from offering the service?

We make an average of £2,000 per month from offering this service.

Would you recommend offering this service to other contractors?

As far as Umbrella is concerned, I think it needs more adding to it. There are more contraceptives that could be added to the Patient Group Direction (PGD), for example. It has stagnated in terms of what contractors can offer - I’ve done the same for five years. I think the focus has been on growing the number of contractors who provide the service, but the service itself hasn’t developed much. Patients are still relying on clinics for on-the-spot testing or other sorts of treatment.

Also, more pharmacists are becoming prescribers and this needs to be looked at, because it might change the way the service can be delivered. You wouldn’t necessarily need a PGD anymore, for example. If pharmacists are specialised in sexual health or contraceptives, then we can provide a wide range of sexual health services - not just the ones that need a PGD.