Health and Social Care Committee
Inquiry into the contribution of community pharmacy to health services in Wales
CP 42 – Family Planning Association
November 2011
FPA submission to the Health and Social Care Committee Inquiry into Community Pharmacy
1. Executive summary
1.1 FPA is one of the UK’s leading sexual health charities, with over 80 years’ experience of providing the UK public with accurate sexual health information, education and advice services.
1.2 FPA represents a national voice on sexual health, working with and advocating for the public and professionals to ensure that high quality information and services are available for all who need them.
1.3 FPA delivers a community sex and relationships education project to groups of vulnerable young people in community settings throughout North Wales. Jiwsi has been in operation since 2002 and works with groups of vulnerable young people which can include looked-after children, children with disabilities, excluded young people and young offenders.
1.4 We support pharmacy provision of sexual health services such as provision of emergency hormonal contraception (EHC) as it is important to offer women a choice of where they can access EHC from. We warmly welcomed the recent announcement that EHC would be available for free of charge from pharmacies in Wales.
1.5 We would also support the provision of other sexual health services through pharmacies, such as condom distribution through a local C-Card Scheme.
1.6 However, we think that increased provision of sexual health services through community pharmacies in Wales must be delivered alongside high quality training and guidance to enable pharmacists to signpost people to other sexual health services if they need them.
FPA welcome the opportunity to respond to the Health and Social Care Bill Committee Inquiry into Community Pharmacy and will restrict our comments to our areas of expertise.
2. The effectiveness of the Community Pharmacy contract in enhancing the contribution of community pharmacy to health and wellbeing services
2.1 Emergency contraception has a vital role to play either when contraception has failed or after unprotected sexual intercourse, and increasing access to EC is important as it recognises that no method of contraception is 100 per cent reliable. EC is an important “back-up” contraceptive for women seeking to avoid an unintended pregnancy, although it should not be used instead of a regular form of contraception, because it is less reliable than other forms of contraception used correctly and consistently.
2.2 We are aware that some people have expressed concerns that emergency contraception acts to induce an abortion. However, medical research and legal opinion are quite clear that EC (hormonal or IUD) prevents pregnancy and cannot cause an abortion. This was most recently clarified in a case at the High Court in 2002 during which the judge ruled that “there is no established pregnancy prior to implantation”[1] Pregnancy begins at implantation and abortion can only take place after a fertilised egg has implanted in the womb.
2.3 FPA supports pharmacy provision of emergency hormonal contraception (EHC), as we believe that enabling women to obtain EHC quickly from pharmacies is a measure that safeguards women’s health. We welcomed the recent announcement that provision of EHC through pharmacies in Wales will be free of charge.
2.4 In 2008/09, 42 per cent of all women who had used EHC had obtained it directly from a chemist or pharmacy.[2] This clearly demonstrates the importance of pharmacy provision in promoting access to EHC.
2.5 We do believe, however, that pharmacy provision of sexual health services like EHC should complement, rather than replace, access to EHC through other services and pharmacists must be able to signpost women to these services if they want to access them. It is crucial that women have a choice of where to access EHC as not all women will want to access it from the same source.
3. The scope for further provision of services by community pharmacies in addition to the dispensing of NHS medicines and appliances, including the potential for minor ailments schemes
3.1 FPA calls for more widespread advanced prescribing of EHC for women who may need it. Advance provision is appropriate for women who are worried about their contraceptive method failing, or who cannot get emergency contraception easily. Some studies[3] have shown that women are more likely to use EHC after unprotected sex if they have it in advance rather than having to visit a health professional. They also show that advance supply is safe, effectively used by women and does not increase the incidence of unprotected sex or lead to repeated use of the method. We believe that community pharmacies can play a role in more widespread advanced distribution of EHC.
3.2 We believe that community pharmacies in Wales are ideally placed to be involved in other sexual health initiatives in addition to the provision of EHC. For example, community pharmacies could be a useful and easily accessible distribution point for a local C-Card Scheme.
3.3 A C-Card Scheme is a co-ordinated free condom distribution network. It aims to give young people the opportunity to seek advice and ask questions about sexual health issues in a confidential environment from people such as youth workers. An example of a C-Card Scheme that is already running in Wales in the Torfaen C-Card Scheme.
3.4 If young people want to, youth workers can sign them up to the C-Card Scheme which means that the young person would be able to collect free condoms from local distribution points. The youth workers will have a discussion with the young person and ensure they have all the information they need before signing them up to the C-Card Scheme. We believe that local community pharmacies are ideally located to become one of the distribution points for a local C-Card Scheme which would enable more young people in Wales to have access to free condoms and confidential sexual health information.
3.5 Although we see a clear role for community pharmacies in Wales as a local distribution point for a C-Card Scheme we believe that there must be clear guidance available to pharmacists on distributing condoms to young people on the scheme. They should also be able to demonstrate that they can signpost people to local contraception services and sexually transmitted infection (STI) testing services and be able to inform people of how they can access these services.
3.6 We also believe that for community pharmacies to play a meaningful role in a C-Card Scheme there must be high quality training available to them on contraception and STIs. This will enable pharmacies to give young people high quality and accurate information about sexual health if they have any questions.
3.7 We believe that increasing access to EHC and free condoms through community pharmacies provision in Wales will go towards meeting public health objectives such as decreasing new diagnoses of STIs and the rate of under 18 conceptions.
For more information please contact:
Clare Laxton
Policy and Parliamentary Manager
FPA
50 Featherstone Street
London
EC1Y 8QU