Helen Whittaker, support pharmacist at The Pharmacy Galleria in Pensnett, Dudley, talks to Saša Janković about running an emergency hormonal contraception service.
Service type: Emergency hormonal contraception (EHC).
Name of pharmacy: The Pharmacy Galleria, Pensnett, Dudley.
Name of pharmacist: Helen Whittaker.
Why did you start offering this service?
When I came to work at this pharmacy nine years ago they didn’t have an EHC service, but I had run one at my previous pharmacy and as we are in a socioeconomically deprived area with a lot of teenage pregnancies I encouraged my boss to add it here.
In a nutshell, what does the service involve?
Most people who access our service either ring us first – if they are embarrassed – or come in and tell us they need the morning after pill. Sometimes we do get men calling up to say they need it for someone, so of course we have to explain that we can only talk to the woman herself and supply it to her directly.
Under normal circumstances, when the woman comes in I’ll take her into the consultation room, make sure she has time for the discussion, and explain about the PGD and what it involves. I’ll work through the questions and guidelines on PharmOutcomes, asking if she is taking any prescribed medication, as well as anything OTC or herbal, and get her health history. Any problems with malabsorption due to things like Crohn’s disease or bowel disorders can affect the effectiveness of the medication.
Dudley only supplies Levonelle on the PGD, and the woman only has 72 hours post-intercourse in which to take it. We can sell them ellaOne if they prefer, and this can be taken within a five-day window, but whatever they choose I encourage them to take it in the consulting room, so we know they’ve done it. I advise them that if they physically vomit within two hours of taking the tablet, or have excessively bad diarrhoea, they have to assume the tablet may not have been absorbed so will need to return for a second dose. I make sure they know our opening hours and where else they can go if we are shut.
I always follow on with a conversation about future contraception, and have to offer them choice to be referred on to have a coil fitted as emergency contraception, as many women don’t know this is an option. We also offer HIV testing in our pharmacy, and under 25s can get a chlamydia test.
How much did it cost to set up the service?
The service is funded so there is no cost to us, and we already had a decent sized consulting room anyway, so there weren’t any extra set-up costs.
What, if any, training did you or other team members have to undergo?
I did my initial training with the CPPE packages on contraception and sexual health, and have followed up with the necessary refreshers, and I took my staff to our local Brook sexual health services clinic where we discussed EHC and chlamydia treatment. As safeguarding has become more of an issue in recent years, we have to do those packages too, and one of the most hard-hitting bits of training I’ve done was about child exploitation, run by the Loudmouth theatre company.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it?
No, because it’s a free service. However, I do advise women using the EHC service that if they haven’t had a period within three weeks they should do a pregnancy test, and some come back to buy those from us.
How have patients responded to the service?
Women give us really good feedback about the service because they feel supported by us at a time that is, for many of them, very stressful. The important thing for me is that for so many years pharmacists were seen as suited and booted, but hopefully our customers now feel we are more approachable and laid back.
Roughly how often each month do you carry out the service?
About eight a month, although the Covid-19 situation has put some barriers up for this. We can’t take women into the consultation room right now, but we still do the service if they come in and ask for it. We’ll set up a call with them to talk it through and make sure they are somewhere they can’t be overheard, and then they can come back to the counter for the supply.
How much do you charge for the service?
Roughly how much a month do you make from offering the service?
We are probably only making a couple of hundred pounds a month at the moment.
Would you recommend offering this service to other contractors?
Definitely – not just as a service, but because it gives women – especially young women – a point of contact in the pharmacy, and they feel they have someone friendly they can trust. I’ve often shared my own personal history of repeated miscarriages, which has ended up with me talking to some women about fertility tracking. I could get pregnant easily but couldn’t stay pregnant, so I learned all about how to map my cycle, and it’s astonishing how many women I see who have no idea how to tell when they are ovulating, how long a window for conception they have, or how long sperm lasts in their body. I definitely know of one woman who got pregnant after we had a conversation about this, and I’m a big believer that we need to be open and talk about exactly these kinds of things.