Pharmacy Contraception Service
Published on: 22nd September 2022 | Updated on: 8th December 2023
Webinar series announced
Community Pharmacy England will be hosting a series of webinars to help pharmacy owners and their teams to prepare for the new Pharmacy First service, and changes to the PCS and Hypertension Case-Finding Service.
There are two webinars on the PCS:
Watch the Pharmacy Contraception Service: Initiating contraception webinar – This webinar was aimed at helping pharmacy teams who are already providing the service to expand their offering to include initiating contraception.
Pharmacy Contraception Service: getting going with the service (Wednesday 10th January 2024, 7-8.30pm) – This webinar is aimed at helping pharmacy teams who have not yet started to provide the service to get ready to offer it to their patients.
Click on a heading below for more information
The NHS Long Term Plan (LTP) Chapter 2 highlighted the importance of NHS services complementing the action taken by local government to support the commissioning of sexual health services. A Public Health England resource for commissioners (2019) also highlighted the role community pharmacy can play in supporting ongoing contraception. In line with the agreement of the CPCF in 2019 to “test a range of prevention services’, a tiered pharmacy contraception service was designed. The initial tiered approach proposed was as follows: In 2021, NHS England commenced a pilot involving pharmacies offering repeat supplies of oral contraception to people who had previously had the product prescribed. In the Year 4 and Year 5 CPCF negotiations, the Department of Health and Social Care (DHSC) and NHS England proposed the commissioning of a Pharmacy Contraception Service, as an Advanced service, building on the learning from the pilot service. In April 2023, the Tier 1 service launched. This initially involved community pharmacists providing ongoing management of routine oral contraception that was initiated in general practice or a sexual health clinic. The supplies are authorised via a PGD, with appropriate checks, such as the measurement of the person’s blood pressure and body mass index (BMI), being undertaken, where necessary. In May 2023, NHS England announced The Delivery Plan for recovering access in primary care. This highlighted the ambition to expand the PCS to increase access to and convenience of contraception services in line with the Government’s Women’s Health Strategy for England which had been announced in August 2022. The strategy flagged community pharmacy had a part to play in increasing choice in the ways people can access contraception. Following negotiations between Community Pharmacy England, the Department of Health and Social Care and NHS England, an expansion of the OC service was agreed and announced in November 2023. The expanded service, which removes reference to the original tiered service proposal, enables community pharmacists to also initiate oral contraception, via a PGD, and provide ongoing clinical checks and annual reviews. The service provides another opportunity for pharmacy owners to help address health inequalities by providing wider healthcare access in their communities and signposting service users into local sexual health services in line with NICE guideline NG 102. The objectives of the service are to: The service aims to provide:
The service requirements are included in the service specification and Patient Group Directions (PGDs), which pharmacy owners must read before deciding whether to provide the service. From 1st December 2023, the service incorporates initiation and repeat supplies of contraception. Any pharmacy registering to provide the service must now provide the full service, i.e. both initiation and repeat supplies. Download the service specification and Patient Group Directions (these apply from 1st December 2023) Pharmacies already providing the service (previously described as the Tier 1 service) are operating under the following service specification and PGDs: Download the Tier 1 service specification and Patient Group Directions From 1st December 2023, once those pharmacies are ready to provide the expanded service (i.e. initiation and repeat supply), they must opt-in by making a declaration on MYS. This opt-in must be undertaken by 29th February 2024. Any pharmacies providing the Tier 1 service who do not opt-in by that date will be automatically deregistered from the service (and they will be informed of this by the NHSBSA). Service Directions & Drug tariff determination Download the service pathway for initiation Download the service pathway for ongoing supply Briefing 031/23: Guidance on the Pharmacy Contraception Advanced Service This Community Pharmacy England Briefing provides additional guidance for pharmacy owners and their teams on the service. The service involves community pharmacists providing: The supplies will be authorised via a PGD, with appropriate checks, such as the measurement of the patient’s blood pressure and body mass index, being undertaken, where necessary.
Once a pharmacy owner has decided they wish to provide the service, Community Pharmacy England’s implementation checklist will guide them through the steps they need to take to prepare to provide the service. Download the Pharmacy Contraception Service implementation checklist Pharmacies must have a consultation room in order to be able to offer this service, which meets the requirements in the Terms of Service. The consultation room must also have IT equipment accessible within the room to allow contemporaneous records of the consultations provided as part of this service. If a pharmacy owner has had agreement from NHS England that their pharmacy is too small for a consultation room, then they are not able to provide the service solely on a remote basis. If the pharmacist and individual agree that the service can be carried out remotely, this should be carried out via telephone, or another live audio link or a live video link in circumstances where the conversation cannot be overheard, except by someone whom the individual wants to hear the conversation. That may, for example, mean the pharmacist uses the consultation room to undertake the remote consultation. NHS Guidance to support community pharmacy teams can help to plan for this. Further information on remote consultations can be found on our website. In some cases, a blood pressure reading and a BMI, will need to be recorded, according to the PGD protocol. Pharmacy owners will, therefore, need to ensure that they have the necessary equipment required to undertake blood pressure readings, measure an individual’s weight and height. Pharmacy owners must ensure all equipment used to carry out these measurements for individuals within the pharmacy are accurate and fit for purpose in line with the GPhC standards. Equipment that is to be used to undertake clinic blood pressure checks in the service must be validated by the British and Irish Hypertension Society (BIHS), so pharmacy owners must use a ‘normal’ BP meter which is included on one of the two following BIHS lists: Validated BP Monitors for Home Use Validated BP Monitors for Specialist Use For further considerations regarding selection of blood pressure monitoring devices, please consult the ‘BP meters to be used in the service’ section of our Hypertension Case-Finding Service hub page. To meet the service specification requirements, validation, maintenance and recalibration of clinic blood pressure monitors should be carried out periodically according to manufacturers’ instructions. Infection control measures and cleaning must be carried out in line with the instructions of the manufacturer or supplier and in line with current infection control guidance. Detergent and disinfectant wipes can damage plastic surfaces of medical devices if they are not compatible with the surface material. In line with MHRA’s guidance, pharmacy owners are advised to only use cleaning products that are compatible with the device. The standard operating procedure (SOP) for the service must include the processes for cleaning, maintenance, validation and recalibration of the equipment used. Pharmacy owners can access additional guidance from the MHRA’s Managing Medical Devices guide. Pharmacy owners must use an NHS-assured clinical IT system to make their clinical records and payment claims for the service and, where the person has consented, to send messages containing the individual’s consultation outcomes to their general practice. Details of the IT solutions available to support the service can be found on our Pharmacy services IT requirements webpage. Pharmacy owners providing the service, will need to consider which system they want to use and will then need to enter into a contract with that supplier. Pharmacy owners must have an SOP for the service, which all staff participating in provision of the service must be familiar with and follow. The SOP must include the process for maintenance and validation of the equipment used. Pharmacy owners must ensure that pharmacy staff providing any aspect of the service are competent to do so in line with the specific skills and knowledge in the service specification and the relevant PGDs. This may involve completion of training. Pharmacy owners need to keep documentary evidence that all pharmacy staff involved in any aspect of provision of the service are competent with regards to the specific skills and knowledge outlined in the service specification and the relevant PGDs. Pharmacists providing the service will be personally responsible for remaining up to date with the skills and competencies identified in the service specification and associated PGDs. To provide the service, the pharmacist should have evidence of competence in the clinical skills and knowledge covered in the below listed training modules on the Centre for Pharmacy Postgraduate Education (CPPE) and/or the Health Education England e-learning for healthcare (elfh). CPPE also has a list of the modules and other useful tools and resources on the NHS PCS page of their website. Note – packages that are highly recommended are indicated by an asterisk * Pharmacists providing the service must have completed one of the recommended Safeguarding level 3 training materials OR have direct access to professional advice from someone who can advise on Safeguarding at Level 3. OR OR the following four subsections of: OR the following four subsections of AND one subsection in the The whole pharmacy team can proactively promote this service. Teams should be briefed on the service and coached on how to best approach people about the service. A pharmacy team briefing and a guide on how to recruit people is available to assist pharmacy owners to engage and coach their team members. Pharmacy staff who are going to provide blood pressure measurements and BMI calculations must have the necessary training required to undertake blood pressure readings and measure an individual’s weight and height. These staff need must: Pharmacy owners must notify NHS England that they intend to provide the service by completion of an electronic registration through the NHSBSA’s MYS portal. The pharmacy’s NHS website profile must be updated to indicate that the service is provided. Guidance on how to edit NHS website pharmacy profiles is available on the NHS website page of the Community Pharmacy England website. Update your pharmacy’s service details on the NHS website using NHS Profile Manager. This will allow your pharmacy to be identified by the public and by other healthcare professionals as providers of the service. Details on how to do this are available on the NHS Profile Manager page of our website. There is no specific requirement within the service specification for pharmacy owners to engage with local general practices, local sexual health clinics and/or PCN colleagues prior to provision of the service. However, as the service can receive signposted referrals from local general practices and sexual health clinics (or equivalent), to maximise service opportunities, it is good practice to make them aware the pharmacy is participating in this service. A letter / email template to support pharmacy owners to notify GP practices and local sexual health clinics (or equivalent) that the pharmacy will be providing the service is available. Pharmacy owners should identify the hours and/or days they will provide this service and confirm the availability of the service as part of local conversations with stakeholders if they intend to receive referrals. Download the general practice and sexual health clinic letter / email service notification template (Microsoft Word) Where practices and sexual health clinics (or equivalent) wish to use this facility, pharmacy owners should agree any local process by which referrals can be received. On receipt of a referral, a member of the pharmacy team will agree with a referred person, the date and time of their consultation. A briefing to provide information for general practice teams and local sexual health clinics (or equivalent) on the service is available to assist pharmacy owners to engage their local colleagues. Download the Briefing for general practice and sexual health clinics (or equivalent) teams (PDF) If the pharmacy owner wishes to stop providing the service, they must notify NHS England that they are no longer going to provide the service via the MYS platform, giving at least one months’ notice prior to the cessation of the service. Pharmacy owners may be asked for their reason for withdrawal from the service. If a pharmacy owner de-registers from the service or ceases trading within 30 days of registration, they will not qualify for the £400 set up fee. In this event, if the £400 fee has already been paid to the pharmacy owner, this money will be claimed back, subject to agreement with the pharmacy owner. Pharmacy owner checklist
Consultation room
Equipment to be used in the service
Equipment maintenance, calibration & cleaning
IT requirements
Standard Operating Procedure
Competency and training requirements
Mandatory training
Recommended training modules
Initiation of contraception
Other training to support clinical practice
Pharmacy team training
Sign up to provide service
NHS Profile Manager
Engagement with local GP practices, local sexual health clinics and/or PCN colleagues
Withdrawal from providing the Service
Individuals can access the service by any of the following routes: Note: for the purposes of this service, a referral includes active signposting to attend the pharmacy to receive the service. The pharmacy must respond to anybody requesting the service as soon as is reasonably possible. Following discussion, if the pharmacy is unable to offer a consultation within the time needed to meet the person’s contraception need, they should be signposted to an alternative pharmacy or other service for a consultation. The service specification lists the following inclusion and exclusion criteria for the service: To be eligible to access this service a person must: A person will not be eligible for this service if: Additional inclusion and exclusion criteria are listed in the PGDs and as such, pharmacy owners should refer to both the service specification and the PGDs to confirm the full inclusion and exclusion criteria for the service. Where people are not eligible for the service, pharmacy team members can signpost them to other appropriate local services. If practices or sexual health clinics (or equivalent) want to refer individuals to the service, then pharmacy owners should work with their practices and local sexual health clinic (or equivalent) to agree a local process by which this will work; there are no specific requirements set for this process. Pharmacy owners who will be providing the service can use resources such as a poster, flyers, a service leaflet and, where facilities exist, digital marketing resources to advertise the availability of the service in the pharmacy. Download the poster (PDF) (This will be uploaded once available from NHS England) Download the digital marketing resources (PDF) (This will be uploaded once available from NHS England) Download small flyers to use on prescription bags, etc (Microsoft Word) Download a template leaflet to promote the service (Microsoft Word) When a person attends the pharmacy to collect an NHS repeat prescription for OC or makes contact for other services, e.g. to access a supply of emergency oral contraception, the service can be highlighted to them to consider their ongoing contraception requirements. A pharmacy team introductory briefing sheet and a guide on how to successfully recruit people using some of the insights from pilot sites is available as part of the briefing for pharmacy teams on the service. Download the Briefing for pharmacy teams on the service A service finder, on the NHS website, lets members of the public and healthcare professionals search for a pharmacy that offers the contraceptive pill without a prescription as part of the PCS. The pharmacy contraception service finder Prior to provision of the service, verbal consent must be sought from the individual by the pharmacist and recorded in the clinical record for the service. Pharmacy owners also need to ensure that the individual is made aware that the following sharing of information will take place: However, if the person does not consent to sharing information with their general practice or they are not registered with a general practice, the consultation can still proceed, and a notification to the practice will not need to be sent. The General Pharmaceutical Council’s Guidance on Consent provides information on consent for pharmacists and their teams. A list of the information that must be sent to the individual’s general practice is available in Annex B of the service specification. A list of the dataset that is extracted from the pharmacy clinical records and submitted to the NHSBSA is available in Annex B of the service specification. Either party may request / offer a chaperone to be present during the consultation. More information regarding use of a chaperone can be found in the Clinical Governance section of our website. During the consultation, if the pharmacist is concerned about a potential safeguarding issue, then appropriate action should be taken, where necessary, in line with local safeguarding processes. If the individual is less than 16 years of age, an assessment based on Fraser guidelines must be made and documented. If the individual is less than 13 years of age, the pharmacist should speak to the local safeguarding lead and follow the local safeguarding policy. Before supply of an OC can be made, in some cases, a blood pressure reading and a BMI, will need to be recorded, according to the PGD protocol. Blood pressure, a BMI reading, or an individual’s height and weight can be provided by the person accessing the service and may be accepted where the pharmacist feels this is clinically appropriate. Any self-reported measurements will need to be recorded as such. Where BMI and blood pressure measurements are performed within the pharmacy, these can be conducted by the pharmacist as part of the consultation or by suitably trained and competent pharmacy staff in advance of the pharmacist consultation. The provision of a blood pressure check (clinic check) should be carried out in line with NICE guidelines. A visual guide that can be used to support suitably trained and competent pharmacy staff providing this is included as a standalone reference source. Download the clinic blood pressure guide (PDF) To support the calculation of body mass index, the NHS website provides an online BMI calculator which can be accessed via the following link: BMI calculator (www.nhs.uk) A template pre-consultation questionnaire has been developed to allow people who will attend the pharmacy, or who are in the pharmacy for the service, to provide information which can then be used by the pharmacist during the consultation. The pre-consultation questionnaire may assist pharmacy owners in reducing the pharmacist/service user contact time, if their chosen IT system does not offer any pre-consultation solutions. Download the pre-consultation questionnaire template (Microsoft Word) Download the pre-consultation questionnaire template (PDF) The clinical appropriateness of a supply of OC will be determined by the pharmacist, as part of a consultation with the individual, following the guidelines in the PGD. The following should take place during the consultation and reference to the PGD should be made: To assist individuals in obtaining further information, the pharmacist can signpost individuals to other information sources, such as NHS.UK, to obtain additional information and advice to improve their understanding about contraception and sexual health. Below are links to some examples of information and resources which may be appropriate to signpost individuals to as part of this service. Pharmacists are advised to make themselves familiar with the content on these sites which can also be used as shared decision-making contraception consultation tools: Aims to give practical information to everyone who wants to know more about contraception, or who may have a question about the method they use or are thinking about using. A range of posters and online content developed by a team of doctors, nurses and researchers from University College London in collaboration with women aged 15 to 30. Aims to help women and couples decide which method of contraception might suit them best. The site provides honest information on the advantages and disadvantages of each method, and tackles concerns directly. A website produced for the National Health Promotion Programme for Sexual and Reproductive Health Brook is a charity supporting people with their sexual health and wellbeing. They offer a range of services to support their mission of helping people to live healthier lives. If the assessment criteria are met, supply of an OC can be made. The FSRH UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) calculator may support pharmacists in making a clinical decision on the most appropriate choice of contraceptive. The UKMEC helps clinicians decide what contraceptives they can safely recommend based on the medical conditions of patients in their care. On initiation, the quantity of OC supplied should not exceed 3 months. Where a person is initiated on an OC, pharmacists should use their professional discretion as to the appropriate choice of product, from those included in the PGD. Local formularies/restrictions should be referred to and followed accordingly. Pharmacists should refer to their local integrated care board (ICB) formulary for further information. Following initiation, ongoing supplies of up to 12 months duration can be made, and unless there are reasons not to, such a duration of supply should be considered in line with the FSRH guidance. Restricting the length of supply could result in unwanted discontinuation of the method and an increased risk of pregnancy for the person. Ongoing supplies should be made in line with the person’s previous supply, e.g. in the instance that a branded product has been supplied for clinical reasons such as an allergy to product constituents, the repeat supply should be made from an equivalent brand/generic equivalent of OC, that follows any medicines formulary requirements of the local ICB. Supplies should be in appropriately labelled original packs. Clinical record systems should prompt the recording of all the required information listed in the PGD. Where necessary, supplementary written information, links to online resources, or signposting to other support services should be given. Records should also be made of any advice and signposting provided. If a supply of OC is not deemed clinically appropriate, the pharmacist should explain why this is the case to the person and refer them to their general practice or sexual health clinic (or equivalent). Clinical record systems should prompt the recording of: Where a blood pressure reading and/or a BMI are needed, according to the PGD protocol, and these are undertaken in the pharmacy, the outcomes of these should be discussed with the person. The person’s results should be provided in a format that best suits them. The person may prefer to have their readings written on a printed leaflet, it may be completed electronically by the pharmacist and emailed to the person or the person may prefer to take a photo of their readings using their phone. Download a leaflet to support provision of readings (Microsoft Word) Download a leaflet to support provision of readings (PDF) In line with the principle of Making Every Contact Count, the pharmacist should encourage the individual to discuss their lifestyle/behaviours and appropriate lifestyle advice should be provided where applicable. Local initiative and services that may assist the person should be signposted to. Examples of resources which may be appropriate to support the individual or raise awareness are detailed in the Patient advice – Providing the service section of the Hypertension Case-Finding Service hub page. Pharmacy owners should record any advice provided and any signposting in the clinical record. Where a person is not registered with a GP practice, information should be provided to assist the person to do this. If the person provides consent to share the outcome of the consultation with their general practice, a notification should be sent via NHSmail or other secure digital mechanism. This message must clearly prompt general practice staff to add details of the consultation to the person’s clinical record upon receipt. The information to be sent to the general practice can be found in Annex B of the service specification. If the person does not consent to sharing information with their general practice or they are not registered with a general practice, the consultation can still proceed, and a notification to the practice will not need to be sent. Pharmacy owners should maintain appropriate clinical records to ensure effective ongoing service provision and audit. Clinical records of service provisions should be retained for an appropriate period. Records of the reimbursement data reported to the NHSBSA’s MYS portal should be retained for three years for PPV purposes (See Annex B of the service specification). As pharmacy owners are the data controller, it is for each pharmacy owner to determine what the appropriate length of time is, beyond three years that the clinical records are kept for. Decisions on this matter should be documented in the SOP and should be in line with Records Management Code of Practice for Health and Social Care. The data which is submitted to the MYS portal via the application programming interface (API) will be used by the NHSBSA for payment and PPV purposes. Some of this data, which has been anonymised, will be shared with NHS England for service evaluation and research purposes. Details of the data to be reported from clinical systems to MYS are listed in Annex B. The pharmacy is required to report any patient safety incidents related to the service in line with the approved particulars for patient safety for pharmacies.
Eligibility
Inclusion criteria
Exclusion criteria
General practice and sexual health clinic (or equivalent) referrals
Promoting the service
Signposting patients
Consent
Safeguarding
Blood pressure and BMI checks
Pre-consultation
Consultation
Additional advice & signposting
Organisation
Resources
NHS UK
Your contraception guide
Contraception Choices website -University College London
Contraception Choices
Sexwise
Advice on:
Brook
Advice on:
Outcomes
Criteria met
Criteria not met
Information for service users (including healthy lifestyles)
Service user’s measurements
Healthy lifestyle advice
Communicating with GP practices
Record keeping and data management
The following fees have been agreed for the service: A consultation fee is claimable irrespective of the outcome of the consultation. Where a pharmacy owner is commissioned to provide any related services, e.g. the Hypertension Case-Finding Service (incorporating BP clinic measurement), the pharmacy owner may not claim twice for the same activity. The product price for the OC supplied will be reimbursed in accordance with the Drug Tariff determination. Any purchase margin by pharmacies relating to contraceptives supplied as part of this service would be included in the calculation of allowed purchase margin that forms a part of agreed NHS pharmacy funding. Where a price concession has been granted for specific strengths of a product, this concession will apply to those specific strengths of products supplied as part of this service. Concessions will only apply to the month in which they are granted according to the usual Drug Tariff arrangements. Out of pocket expenses cannot be claimed as part of this service. Prescription charges are not relevant to the provision of this service and an appropriate patient declaration is not required. Data from the NHS-assured IT system will be submitted to the MYS portal via an application programming interface and will be used by the NHSBSA to populate a payment claim within the MYS portal. The pharmacy owner needs to review this payment claim and then submit it. Claims for payment for this service should be made monthly, via the MYS portal and no later than three months from the claim period for the chargeable activity provided. Claims which relate to work completed more than three months after the claim period in question, will not be paid. Funding
Claiming
Visit the Pharmacy Contraception Service Frequently Asked Questions (FAQ) page for FAQs on the service requirements.
Download the service pathway for initiation (PDF) Download the service pathway for ongoing supply (PDF) Download guidance on measuring clinic blood pressures in line with NICE (PDF) Download the clinic blood pressure flow chart (PDF) Slide deck for use by LPCs at local events (PowerPoint) Slide deck for use by LPCs at local events (PDF) Pharmacy Contraception Service implementation checklist (PDF) GP or sexual health clinic letter / email service notification template (Microsoft Word) Briefing for general practice and sexual health clinics (or equivalent) teams (PDF) Service poster (PDF) (This will be uploaded once available from NHS England) Service digital marketing resources (PDF) (This will be uploaded once available from NHS England) Small flyers to use on precription bags, etc (Microsoft Word) Template patient leaflet to promote the service (Microsoft Word) Briefing for pharmacy teams on the service (PDF) Pre-consultation questionnaire template (Microsoft Word) Pre-consultation questionnaire template (PDF) Patient leaflet to support provision of readings (Microsoft Word)