sexual health service by community pharmacists kate kinsey nhs manchester
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Sexual Health Service by Community Pharmacists
Kate Kinsey
NHS Manchester
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Background
• December 24th 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
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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
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Local Drivers• Target in NHS Manchester’s Strategic Commissioning plan to reduce teenage pregnancy
• 1 in 80 people aged 16-24 in GM has Chlamydia
• Access to services
• Reducing health inequalities
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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
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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
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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
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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
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Findings
6 sites (only 4 active sites) 0809 0910
EHC Number supplied = 7696 8013
ChlamydiaNumber treated = no data 553
OC number presenting = 1010 1799 number prescribed= 979 (97%) 1759
(98%)
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What is provided? 0809 0910• 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%)
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Age Range of Clients
• 0809 0910• Under 16 > 0% (only 2 clients) Under 16 0%
(2)• 16-19 27% 16-19 23%• 20-29 66% 20-29 69%• 30-39 6% 30-39 7%• 40-49 1% 40-49 1%• >49 0% >49
0%
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Under 19s supply
• 0809 Total= 269 0910 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%)
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Days of the week (0809)
0
50
100
150
200
250
300
350
MondayTuesdayWednesdayThursdayFridaySaturdaySundaynot recorded
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Ethnicity
• White British 84% • Asian/Asian British 8%• Black/Black British 4%• Chinese, Middle Eastern 1%• Mixed race 2%• Not recorded 1%
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Consultations when OC not suppliedReason not supplied
0809 0910
Migraine 11 23
Unexplained bleeding
2 1
Referral 1 5
Other 17 11
Total 31 40
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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
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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
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AwardsEHCWinner 1999 Pharmaceutical Journal for EHCWinner Regional Health & Social Care Awards 2000Runner up National Health & Social Care Awards 2000
Chlamydia –test / treat & traceWinner Greater Manchester NHS Awards 2006 Runner up:Pharmaceutical Care Awards – 2006Health & Social Care Awards – 2006
Oral ContraceptionPharmaceutical Care Awards 2008
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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)?
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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