A model where pharmacists provide contraceptive services on the high street could ‘broaden choice for women’, the Faculty of Sexual and Reproductive Healthcare (FSRH) has said.

The faculty made the statement in response to a recent study, which found that allowing community pharmacists to supply women with a course of the progestogen-only pill (POP) along with emergency contraception (EC) increases overall use of effective contraception.

The study, published in The Lancet last month (14 November), looked into the long-term impact of community pharmacies supplying women with an additional three-month supply of the POP at the time of providing EC, to see whether pharmacists’ intervention at this stage would increase subsequent use of contraception.

In its statement, the FSRH said the approach used in the study ‘harnesses an otherwise missed opportunity for initiation of contraception by pharmacists in a retail setting and could reach individuals who do not access effective contraception in other settings and may be at risk of unplanned pregnancy’.

It added that the approach could potentially be adapted to include provision of ‘bridging POP after ulipristal acetate EC’ and provision of other methods of contraception by the pharmacist.

‘In future, a model in which pharmacists provide contraceptive services on the high street could broaden choice for women,’ the statement said.

‘Enhanced role for pharmacy’

Dr Diana Mansour, vice president of the FSRH, which is part of the Royal College of Obstetricians and Gynaecologists, told the Pharmacist she believes pharmacies could have an ‘enhanced role’ in the supply and distribution of sexual and reproductive healthcare (SRH) care services in the community.

‘This is why FSRH has extended qualifications in SRH care to the pharmaceutical profession, enabling pharmacists to access high-quality training to deliver the best advice,’ she explained. ‘With the right training, pharmacists could provide counselling to women on the range of contraceptive methods.’

The current advice for women in the UK - issued by the FSRH - is that they should start regular hormonal contraception immediately after taking EC. This is because women who have unprotected sex after receiving a course of EC are up to three times more likely to get pregnant than women who do not.

However, most women in the UK cannot access ongoing contraception from their pharmacy as pharmacists cannot currently supply regular hormonal contraception without a prescription from a GP. Therefore, most women have to instead visit a contraceptive provider, such as their GP or a sexual health clinic, which the researchers of The Lancet study said may disincentive women.

This is why the FSRH is pushing for pharmacies to have a larger role in the provision of hormonal contraceptives, Dr Mansour said.

‘Pharmacies offer a local, confidential and accessible setting for individuals seeking advice. For some individuals, particularly in deprived areas, pharmacies are their only contact with healthcare professionals,’ she explained.

‘A positive outcome of the changes to service provision during the Covid-19 pandemic is increased collaboration between pharmacies, GP practices, and sexual and reproductive healthcare clinics. Maintaining and improving these links is vital to ensure that women can continue to access contraception during and after the Covid-19 pandemic.

Reclassifying the POP

In September, the All-Party Parliamentary Group (APPG) on Sexual and Reproductive Health in the UK also recommended that the progestogen-only pill be reclassified as an over-the-counter medicine (OTC).

The authors of the APPG report, Women’s Lives, Women’s Rights, said that there was a significant opportunity to expand the role of community pharmacists in supplying the pill.

The report said that making the drug available OTC without the need for a prescription would not only benefit women and the provider, but it would also ‘encourage the use of contraception and as a result, may help reduce unintended pregnancies’.

An MHRA spokesperson told the Pharmacist that the regulatory body welcomes applications to enable ‘wider access to a medicine’ but said such applications are confidential and they could not confirm whether it is currently considering making POP an over-the-counter medicine.

The spokesperson said they would consider any reasonable application to make medicines more available and easily accessible to the public ‘such as supply under the supervision of a pharmacist without the need for a medical prescription, where it is safe to do so’.

They added: ‘The legal criteria that need to be met include that the medicine can be used appropriately and safely, without medical supervision, and that any inappropriate use would not introduce risks to health, such as significantly delaying other important medical diagnosis or treatment.’

Dr Mansour told the Pharmacist that regulatory change is ‘essential’ and that the FSRH ‘endorses work’ being undertaken by the MHRA to reclassify POP from ‘prescription-only’ to ‘pharmacy product’ to improve access for women.

‘We support the urgent reclassification of POP to help alleviate the pressure on contraceptive services in general practice and the community during and post-Covid-19,’ she added.