The government has rejected five proposals in the Menopause and the Workplace Report by the Women and Equalities Committee but has said that the HRT prepayment certificate will be introduced from April 2023, subject to the necessary consultation with professional bodies.

The rejected recommendations include piloting a specific ‘menopause leave’ policy and producing model menopause policies (such as around flexible working, sick leave and education, training and cultural change) to assist employers.

The government also rejected a recommendation to introduce mandatory menopause training for GPs, saying ‘it is not necessary’ and not within its remit to require that every GP surgery has training on menopause.

Prepayment HRT certificate to be implemented from April

While the government committed to introducing a prepayment certificate for HRT, campaign group Menopause Mandate expressed concerns that ‘some of the wording around the plan is rather ambiguous’, highlighting that it is still subject to consultation with professional bodies.

The Department of Health and Social Care (DHSC) told The Pharmacist today that it is ‘committed to reducing the cost of HRT prescriptions through a bespoke pre-payment certificate for HRT’.

‘We will introduce this from April 2023, subject to the necessary consultation with professional bodies,’ a DHSC spokesperson added.

England chair of the Royal Pharmaceutical Society (RPS), Thorrun Govind, said that there was frustration among pharmacists about the lack of clarity.

‘There will be people who are seeing this coverage and they’ll be asking pharmacy teams when this is happening,’ she told The Pharmacist.

She added: ‘It feels like not enough is being done to support women with their HRT really.’

Ms Govind said that if pharmacists were given the power to amend prescriptions, they could help women access different formulations of HRT during supply issues.

She also said that the RPS was continuing to campaign for all prescriptions to be made free for patients in England.

Currently, a prescription for HRT costs £9.35 or £18.70 if a woman needs two types of hormones. This is often only provided by GPs on a short-term basis, which means that the cost has to be paid regularly - once a month or every three months.

However, in November last year, the government announced that it would work with NHS England to look at implementing longer prescribing cycles, in line with NICE guidelines.

This would reduce the need to pay frequent prescription charges, meaning that women could save up to £205 a year by only paying one charge every 12 months.

In November, the Pharmaceutical Services Negotiating Committee (PSNC) told The Pharmacist that it was ‘concerned’ that the implementation of the proposed HRT prepayment certificates ‘may cause additional workload and risks for community pharmacy teams.’

PSNC has been approached for an updated comment.

The Women and Equalities Committee had also asked the Government to act ‘urgently’ to ensure that lower cost HRT prescriptions were being issued and dispensed.

It said: ‘Over the next three months the Government should communicate widely to ensure GPs and patients know about both the current NICE guidelines permitting a 12-month prescription, and the forthcoming single-cost prepayment certificate.’

But the Government responded saying it has ‘no plans at this time’ to encourage GPs to issue 12-month prescriptions, given the planned introduction of the HRT PPC which will reduce costs of HRT prescriptions and because this could have a detrimental impact on the current supply situation for HRT medicines.

No mandated menopause training for general practice staff

The menopause and the workplace report, published in July 2022, had recommended that the Royal College of General Practitioners makes training on menopause a mandatory aspect of continuing professional development requirements for GPs, and that all GP surgeries should ensure that at least one member of their clinical staff ‘has received specific training around menopause.’

But yesterday the government responded: ‘GPs are responsible for ensuring their own clinical knowledge remains up-to-date and for identifying learning needs as part of their continuing professional development. Menopause care is a core competency of all qualified GPs.

‘The Royal College of General Practitioners regularly review training provision and requirements for GPs.

‘The Government cannot respond on behalf of the RCGP; however, the RCGP position is that mandating menopause training is not necessary.’

The Government also rejected the committee’s recommendation there should be a menopause specialist or specialist service in every CCG area, saying: ‘It is not within the remit of central government to commission specialist health services.

‘Integrated Care Boards are responsible for commissioning services that meet the health needs of their local population and have discretion to determine what priority needs are required in their area and can commission and implement specialist services where appropriate, including services for menopause.’

Menopause not made a protected characteristic

The report also recommended that the government launch a consultation on amending the Equality Act 2010 to make menopause a protected characteristic. Campaign groups such as Menopause Mandate have argued that current protected characteristics of age, sex and disability don't cover enough scenarios and protect enough women.

Emma Hammond, employment partner at Gunnercooke LLP says: 'The law presently requires women to frame their circumstances into age, sex or disability discrimination claims, which is far from satisfactory. It is extremely disappointing that the government is refusing to even entertain a consultation period, as the Committee suggests, into the question of introducing menopause as a protected characteristic.

‘Such a period would allow all of their concerns to be properly addressed, including by the Employment Lawyers Association, so that a properly informed decision can then be taken. Instead, we are met with a blanket refusal.’

In October, the former president of the British Menopause Society (BMS) told The Pharmacist that pharmacists are ‘very well suited’ to support patients experiencing menopause, but more awareness is needed.

Haitham Hamoda, who now leads the menopause service at King’s College Hospital, said pharmacists are well placed to spot the symptoms of the menopause, correct misinformation, help their patients make an informed decision about treatment options and in some circumstances, prescribe medication.

However, he said that more awareness was needed across the profession, saying that although ‘there are lots of pharmacists who want to do it’, ‘they don't know how to go about it’.

The BMS has a range of resources for clinicians, including pharmacists and prescribers, on its website, while the CPPE has a menopause learning gateway for pharmacy professionals.