Sexual Health Service by Community Pharmacists Kate Kinsey NHS Manchester

Background December 24 th 1999 saw the launch of the EHC scheme for Manchester, Salford and Trafford (19 pharmacists trained) To date trained in excess of 1000 pharmacists 1000 – 1200 requests for EHC per month in Manchester Chlamydia screening launched in Lloyds pharmacy Fallowfield, November 2005

Drivers - National key indicators Under 18 conception rate An appointment at GU clinic within 48 hours Setting up a Chlamydia screening programme Pharmacy White Paper- Pharmacy in England, Building on strengths- delivering the future

Local Drivers Target in NHS Manchester ’ s Strategic Commissioning plan to reduce teenage pregnancy 1 in 80 people aged in GM has Chlamydia Access to services Reducing health inequalities

Objectives To enable clients to have greater access to EHC, Chlamydia testing / treat/ trace and oral contraception To be able to supply clients and their partners with appropriate, timely medication by an accredited pharmacist Reduce health inequalities by providing the service in wards with high teenage conception and abortion rates

The Scheme (currently) When the client requests for EHC they are offered the following, working to protocols: EHC Testing for C. trachomatis infection if <25 years, treatment and tracing of partners. Oral contraception first supply / repeat oral contraception

Training The pharmacists already EHC trained. The pharmacists undertook training with a GP with special interest in sexual health and RU Clear. The pharmacist completed CPPE packs contraception, EHC, safeguarding. PGD training Skilled in understanding all forms of contraception

Training extension Update session held in March 2009 covered a more in depth examination of contraceptive choices Extended the training packs to include: CPPE - Dealing with difficult discussions CPPE - Sexual Health, testing and treating

Findings 6 sites (only 4 active sites) EHC Number supplied = Chlamydia Number treated = no data 553 OC number presenting = number prescribed= 979 (97%) 1759 (98%)

What is provided? First COC = 599 (62%) First COC = 811 (46%) First POP = 102 (10%) First POP = 108 (6%) Repeat COC= 249(25%) Repeat COC= 737(42%) Repeat POP = 29 (3%) Repeat POP = 93 (5%)

Age Range of Clients Under 16 > 0% (only 2 clients) Under 16 0% (2) % % % % % % % >49 0%

Under 19s supply 0809 Total= Total= 414 First COC = 182(69%) First COC = 190(46%) First POP = 25 (10%) First POP = 25 (6%) Repeat COC= 51(19%) Repeat COC= 187(44%) Repeat POP = 5 (2%) Repeat POP = 12 (3%)

Days of the week (0809)

Ethnicity White British 84% Asian/Asian British 8% Black/Black British 4% Chinese, Middle Eastern 1% Mixed race 2% Not recorded 1%

Consultations when OC not supplied Reason not supplied Migraine 1123 Unexplained bleeding 21 Referral 15 Other 1711 Total 3140

Payments Consultation with supply = £25 Consultation with no supply = £10 Pregnancy tests = £5 Chlamydia Postal kits = £2 Kits returned =£3 Consultation with treatment = £10 Consultation with no treatment = £5

Challenges Consultations with the clients was taken to a higher more intimate level where probing of sexual histories and partners had to be discussed. Competing priorities in the new contract e.g. Medicine Use Reviews (MUR) Customer perception

Awards EHC Winner 1999 Pharmaceutical Journal for EHC Winner Regional Health & Social Care Awards 2000 Runner up National Health & Social Care Awards 2000 Chlamydia –test / treat & trace Winner Greater Manchester NHS Awards 2006 Runner up: Pharmaceutical Care Awards – 2006 Health & Social Care Awards – 2006 Oral Contraception Pharmaceutical Care Awards 2008

What could the future hold? More pharmacists trained National service for EHC and oral contraception Agreed training and accreditation Extension for LARCS Advance supply of EHC (NICE)?

Special thanks to: Philippa James – NHS Manchester GP & Lead Karen O’Brien, Suzanne Cliffe and Maureen Balfe –NHS Manchester Margaret Kingston & Helen Hodgson: Manchester Centre for Sexual Health Central Manchester & Manchester Children’s Hospital Asha Kasliwal & Carol Bailey:, Consultants NHS Manchester All the pharmacists in the scheme RU Clear