Deborah Evans shares advice on how to differentiate your service from competitors and let patients know you are the first point of call
Community pharmacy has, for many years, been involved in providing support for sexual health. We sell products ranging from condoms, lubricants, emergency hormonal contraception (EHC), sanitary goods, pregnancy and ovulation tests, herbal supplements for the menopause, treatments for cystitis and thrush and, recently, Viagra® for erectile dysfunction.
Pharmacy is locally commissioned to provide condoms, sexually transmitted infection (STI) screening and treatment, pre-conception support, pregnancy testing, EHC and oral contraception. With the proliferation of Patient Group Directions (PGDs), we are also able to provide treatments to delay periods, antibiotics for urinary tract infections and STIs, oral contraception, EHC out of licence and vaccination to protect individuals against sexually transmitted Hepatitis B and Human Papilloma Virus (HPV).
This range of products and services is not available from any other single provider and so community pharmacy is well-placed to position itself as a one-stop shop for sexual health. However, if community pharmacy is to be seen as a sexual health clinic, there are some important questions to ask including:
- How could community pharmacy effectively position itself as a place where the public can get support for most of their sexual health needs?
- What would influence an individual to access sexual health services from a pharmacy?
- What are the benefits to the community pharmacy of developing a sexual health clinic offer?
- What development would the pharmacist and team require to offer a more complete sexual health service?
- How could pharmacy position its products and services as a comprehensive sexual health offer?
With over three-quarters of EHC now provided from community pharmacies in England, and with the recent launch of sildenafil for erectile dysfunction, the public are becoming more aware of pharmacy’s important role in this area. This article explores what could be incorporated into a pharmacy sexual health clinic.
What is sexual health?
The World Health Organisation (WHO) defines sexual health as a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not just the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. These are important principles for all involved in the provision of sexual healthcare.
Most adults are sexually active and good sexual health matters to individuals and communities. Having good sexual health is linked to our mental and physical wellbeing, and vice versa.
Sexual health needs vary according to factors such as age, gender, sexuality and ethnicity. However, there are certain core needs for all, including easily accessing services where confidentiality can be assured and individuals feel that they will be treated with respect and will not be judged. Additionally, people want evidence-based information and advice so that they can make informed responsible decisions and receive high quality services, treatment and interventions.
The consequences of poor sexual health are significant and, like many issues, are worse in areas of deprivation where health inequalities are higher. These include unintended pregnancies and abortions, the psychological consequences of sexual coercion and abuse, poor educational, social and economic opportunities for teenage mothers, young fathers and their children, HIV, cervical and other genital cancers, hepatitis, chronic liver disease and liver cancer, recurrent genital herpes and pelvic inflammatory disease, which can cause ectopic pregnancies and infertility.
Undetected sexually transmitted infections can bring life-changing consequences for overall health, and in particular for fertility. Pharmacists and their teams are well placed to identify a range of issues and play an important role in safeguarding individuals.
Benefits of a community pharmacy sexual health clinic approach
With sexual health so important to the overall health of an individual, affecting most of the population and with a significant gap in provision, there is a real opportunity for community pharmacy to step into this space. Consumers want to access their health care in ways that are more convenient to them, accessible when they need it and, particularly in the case of sexual health, in an environment which is non-judgemental and where confidentiality can be assured. Pharmacy can offer a person-centred service which delivers against their needs and has a positive impact on population health.
Below is a comprehensive clinic approach offers benefits to both the individual and the pharmacy:
- Access to confidential services, at a time that is convenient
- Being able to access and purchase relevant treatments in addition to services
- Receive support for most, if not all, their sexual health needs, under one roof
- Anonymity if required; access to healthcare without registration
- Potential to receive services free of charge if commissioned services are offered
- Walk-in access to a qualified healthcare professional
- Improved outcomes through screening, earlier diagnosis, protection and treatment
Benefits for the pharmacy
- Pharmacy is seen as offering progressive clinical services in the local community
- Opportunity to link with other providers of sexual health provision
- Promote all relevant services and products as a compelling offer
- Growth in revenue and profit, offsetting NHS supply funding cuts
- Demonstrate to local commissioners that the pharmacy delivers consistently and to a high standard
- The whole team can be involved, providing development and the opportunity to engage in
- Professional development and satisfaction
Setting up a sexual health clinic
Planning effectively for service provision significantly increases success and setting up a sexual health clinic is no exception, even if several aspects are already being delivered.
The areas to concentrate on are:
- Research to evaluate gaps in local provision and the local demographics to ensure there is a market. Include discussions with customers, perhaps in a small focus group, to best understand their needs and how they would like to receive information about your services
- Look at what is currently offered and how this could be better packaged as a sexual health service offer. Then identify, based on the research, what other products and services might be added
- Gain early insight and engagement from the team to get their views and overcome any concerns or issues they might have with being involved in supporting the service. The more they are included in the development of the complete service, the more likely they will be to promote it when it is available
- Identify suppliers for products such as STI testing – some will be offered by the pharmacy, while others will be brought as self-testing kits by the patient to perform at home
- Consider the pharmacy environment and the customer experience from before they walk in to after the service has been delivered
- Many pharmacists find promoting any service their biggest challenge, so seek professional advice or plan from the start how the service will be promoted.
Involving the whole team
Everyone can get involved in developing a pharmacy sexual health clinic from the planning and design through to supporting customers and delivering services. Whoever is included in shaping the service, it’s critical that the customer’s experience is at the centre. Those using the services will want to feel that they are not being judged, that they are receiving quality advice and support that puts their needs first and that their information will be dealt with confidentially and with sensitivity. Training for all should include communication skills on managing sensitive conversations.
An efficient service will use the skills of the whole team including Health Champions, healthcare assistants, pharmacy technicians and the pharmacist. Ideally, the pharmacist will only deliver aspects of the service that only they can do such as vaccination and provision of PGDs, using others to support the paperwork, testing, health promotion and uncomplicated retail sales within their competence.
Community pharmacy already offers a wide range of sexual health support however this is not necessarily packaged as such so that customers know what they can get. With pressure on NHS funding, there is an opportunity to relook at how the sector packages their offer to the public. Being customer responsive and providing them an outstanding experience will be good for them and great for business, and professional satisfaction.
Deborah Evans is managing director of Pharmacy Complete, a training and consultancy company working with pharmacy and the industry