Jagjeet Singh, superintendent pharmacist at Selbys Pharmacy in Lindfield, West Sussex, tells to Saša Janković why continuing to run his EHC service has been so important during the pandemic.
Service type: Emergency Hormonal Contraception (EHC) supply.
Name of pharmacy: Selbys Pharmacy, Lindfield, West Sussex.
Name of superintendent pharmacist: Jagjeet Singh
Why did you start offering this service?
When we started running the EHC supply service over 10 years ago it was a commissioned service and we were the pioneers of this in our area – alongside offering gluten-free foods on prescription, which we are also still doing.
How much did it cost to set up the service?
It didn’t cost us anything to set up the service, and we already had a consultation room, so it was very straightforward to get going.
What, if any, training did you or other team members have to undergo?
My initial training was with a private PGD from West Sussex County Council, and I went on to do more training with CPPE. Up until recently we had to do a yearly update session, and I have also done training on safeguarding issues as well, as you have to be aware of this during the EHC consultation process.
In a nutshell, what does the service involve?
Patients are referred to us or find us through word of mouth – and because the free EHC service is for the 14-21 year old age bracket, the schools and school nurses know that we offer it, as well as the local family planning clinics.
I will take the patient in our consultation room and try to make them feel at ease by explaining that I have to go through some personal questions with them, but that the process is confidential, just like when they see their doctor.
There’s a questionnaire to fill in, which includes an anonymous demographic survey of the first three characters their postcode for national database, and I’ll talk through the whole scenario that has brought them here – when it happened, what extra precautions they had been using, whether it was a condom failure – and check whether they are taking any other medications. If they meet the requirements and it’s appropriate, I then issue the pill to be taken then and there in front of me – and explain all the precautions that need to be taken, and that if she is sick, she will have to come back and we will need to start again.
If they haven’t been using condoms then I will give them a pack, and we also offer a self-test kit for chlamydia which they can do at home, post off and get the result texted back to them – and we will be starting hepatis screening as well soon.
The tricky situations are the ones where the patient is aged 14-16 because of course they are underage, so we use the Fraser Guidelines to make sure they are mature enough to consent to treatment. We also have to follow safeguarding guidelines to find out if they find themselves in this situation under duress or if they have come to any harm. If there is a safeguarding issue, we refer them on via the appropriate pathways.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
If the patient is not in the age bracket for free supply of EHC then we can offer the same service as a paid-for option.
How have patients responded to the service?
It’s often a sensitive topic, but we do find some people will open up to us about things and ask for further advice. One of the questions I have to ask patients is what part of their menstrual cycle they are in. I find quite a lot have no idea, so I can explain how to work that out and why it’s important to know.
Roughly how often each month do you carry out the service?
Pre-Covid I was seeing about five or six people a month for EHC, and now it’s two or three a month. However, since schools closed in December it’s gone up again, as young people have more time on their hands.
How much do you charge for the service?
It’s free for those aged 14-21, and outside that age bracket the cost is £20.
Roughly how much a month do you make from offering the service?
Figures not available.
Would you recommend offering this service to other contractors?
Yes, I think all pharmacists should offer EHC, and as it’s so straightforward everybody should be able to do it. I’ve kept the service going during the pandemic because how could we stop it? GPs have closed their surgery doors so where else would these patients go? Very often these patients need lots of psychological support and reassurance – and for the young women this is often their very first interaction with community pharmacy, and comes at an important time in their lives.