Date of prep: December 2020
Prescribing information and
adverse events reporting
For healthcare professionals only
The Royal College of Obstetricians and Gynaecologists (RCOG) is calling for better joined-up services, as part of its “Better for Women” report. It emphasises the need for national strategies to meet the needs of girls and women across their life course – from adolescence to the middle years and later life.
There should also be a greater focus on moving the UK away from providing a disease intervention service towards a preventative health service, says the report.
The report recommends that one-stop women’s health clinics provide reproductive and sexual healthcare services, such as contraception, STI testing, cervical screening, and treatment and advice about the menopause, in one location and at one time to improve services for women and make savings for the NHS.
The survey found almost half (48%) of women think that a one-stop-shop women’s health clinic for all routine women’s health services could improve their access to these services.
The report states that these clinics should be available in the evenings and at the weekends to improve accessibility for girls and women and will help to address social and economic inequalities.
The report highlights that nearly 4 in 10 women (37%) are unable to access contraception services and 60% of women cannot access unplanned pregnancy services, including abortion care locally. Latest statistics show that abortions are at an all-time high and highlight the unmet contraceptive needs of women. In 2018, there were 200,608 abortions across England and Wales – an increase of 4% on the previous year.
Only half (50%) of women are able to access sexually transmitted infections (STI) services and 56% of women are unable to seek help for menstrual health issues, such as for heavy/painful periods, locally.
Just over half of women (58%) cannot access menopause services, despite almost every woman going through the menopause at some point in life.
The report says that healthcare services must make it as easy as possible for women to attend smear testing and reduce any barriers that may prevent access. It also calls for:
Currently, progestogen-only oral contraceptives and emergency hormonal contraception (EHC) may be supplied by a pharmacist over the counter. One of the recommendations relevant to pharmacy in the report says that access to progestogen-only oral contraceptives and emergency hormonal contraception (EHC) as easy as possible for all women.
The report calls specifically for the Medicines and Healthcare Products Regulatory Agency (MHRA) to reclassify progestogen-only oral contraceptives from ‘prescription-only’ to ‘pharmacy product’.
It also recommends that the MHRA should ensure that oral EHC is reclassified to the General Sales List to enable it to be sold straight off the shelf without consultation. It says that it should also be made free of charge.
Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“It is time for a new and bold approach to transform women’s health services and we look forward to working with many key partners to bring about much-needed changes across the NHS and particularly in the community.
“Many of the barriers to access to women’s healthcare services can be improved by ensuring services are joined up and more responsive to the needs of girls and women. It is important we provide a comprehensive health service for girls and women throughout their lives. We want to empower 51% of the population to be as healthy as possible and ensure no one is left behind.
“This doesn’t need to come at a great financial cost to the NHS. In fact, we believe we can do better for less.”
Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare (FSRH), said:
“I see a patient in my contraception clinic who requires a difficult fitting of the coil. She is also due her cervical smear test. This is the perfect opportunity to provide both services. However, my clinic is not commissioned to provide smears, so I am unable to do so. Instead of having all of her needs met in one go, this woman now has to book two appointments for two different vaginal examinations. It is expensive, frustrating for me as a doctor and unfair for the woman. Something has to change.
“This is why this report is calling for a joined-up approach to the commissioning of sexual and reproductive healthcare services. Cuts to Public Health budgets and a fragmented commissioning system have created barriers for women to access holistic care.
“Collaborative commissioning can improve the quality and availability of sexual and reproductive healthcare services, increase access and reduce inequalities. Collaborative commissioning must become the norm, with enhanced accountability across the system. This would be cost-effective for the NHS in the long-term whilst providing women and girls with high-quality, integrated sexual and reproductive healthcare.”
Kate Brian, RCOG Women’s Voices lead, said:
“It is only by listening to women’s voices that we can improve healthcare services. We are therefore very pleased to have involved the RCOG’s Women’s Network in this ambitious plan to identify key areas of women’s health that require urgent action. Through the RCOG’s Women’s Network, we will continue to work with the profession and other key partners to bring about these much-needed changes to improve the health of girls and women across the country.”
Clare Murphy, Director of External Affairs at British Pregnancy Advisory Service said:
“We absolutely support this sensible, evidence-based call from the RCOG. Women can safely use both medications for early medical abortion at home following a consultation with a healthcare professional. Telemedical services that enable women to access care without physically attending a clinic will particularly benefit women who struggle to obtain the help they need.
“Many women live considerable distances from clinics and can find it challenging to travel to appointments, while women in abusive relationships who cannot easily leave their homes in secrecy will also benefit from being able to seek the help they need in confidence. We agree with the RCOG that abortion needs to be decriminalised so we can deliver the most effective woman-centred care possible in line with the highest clinical standards.”
The British Pregnancy Advisory Serice (bpas) have said they would like to see progestogen-based emergency contraception reclassified as a General Sales List medication, so it can be sold directly from the shelf without a consultation at a more “affordable price”.
Bpas have said that the mandatory consultation serves little clinical purpose and can act as a barrier to access. A recent poll conducted by bpas showed 64% of women would like to see it made available without a consultation. At present, only a third of women use emergency contraception after an episode of unprotected sex. While emergency contraception is not a silver bullet to unwanted pregnancy, it is a significantly under-utilised resource.
Clare Murphy continued:
“The sale of the morning after pill for £3 illustrates just how cheap this medication is, but women are still having to pay vastly over the odds for this pill at their time of need. We believe emergency contraception belongs on the shelf of the pharmacy, not hidden away at the back, accessible only after a consultation.
“The progestogen pill is extremely safe, can be used as often as needed, and gives women a second chance of avoiding an unwanted pregnancy that may risk their physical and mental health. There is simply no reason why we should restrict access in the way we do when the stakes for women are so high – women know when they need it and should be trusted to use it.”
Commenting specifically on the call from the Royal College of Obstetricians and Gynaecologists for emergency hormonal contraception to be available ‘off the shelf’ and without a consultation with a pharmacist, President of the Royal Pharmaceutical Society Sandra Gidley said:
“Having a consultation with a pharmacist is focused on helping women who need emergency contraception. There are several methods of emergency contraception available to women and as well as supporting the choice that’s best for her situation, pharmacists can advise on future use of contraception and the risk of sexually transmitted infections.
“Cost is a barrier to accessing medicines so we fully support NHS schemes that allow women to access emergency contraception free of charge through community pharmacies. These services already exist in Scotland and Wales and it’s unacceptable that women in England still have to pay. We want to see this scheme extended across England so women get better access to emergency contraception.”
In Scotland, emergency hormonal contraception is available for free after a consultation with a pharmacist. Policy and Development Pharmacist Adam Osprey from Community Pharmacy Scotland commented:
“In Scotland, we are proud to have a free, accessible and safe EHC service, accounting for the overwhelming majority of assessment and supply in the country. The service is delivered across the entire network of 1,257 pharmacies which are situated in the hearts of Scotland’s communities.
“We recognise the Royal College of Obstetricians and Gynaecologists’ findings that despite pharmacists generally providing a non-judgemental service, some women struggle to access emergency contraceptive services. We are keen to work with stakeholders to explore the stated barriers further and work to address them but would stop short of supporting the reclassification of EHC to a GSL medicine as the solution to these problems.
“EHC is not suitable for everyone, but more importantly than that, the service is about more than the supply of a pill, with safeguarding measures and general sexual health advice built-in. Only by having this in place in pharmacies can we keep people safe and build the offering even further, supporting other policy areas such as sexual assault and human trafficking.
“Insufficient access to long-term contraception is an issue we are aware of and would be supportive of a POM-P switch for POP medicines. We also see this as another natural evolution of the EHC service, as pharmacists would be able to supply EHC and enough long-term cover to ensure that the patient was able to make an appointment or reach a drop-in centre to arrange the most appropriate ongoing contraceptive option for themselves.
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.