Supporting the Delivery and Evaluation of NHS Pharmacy Contraception Pilots

Background

As part of the Community Pharmacy Contractual Framework (CPCF) 2019-2024 a range of prevention services were tested within community pharmacy. The routine monitoring of patients taking oral contraception was flagged as a prevention service and a pilot to test the model was developed. The aim of the pilot was to determine if  additional capacity could be created to provide improved access to contraception services for patients. The pilot was composed of two tiers:

• Tier 1: the ongoing monitoring and management of repeat oral contraception prescriptions
• Tier 2: the initiation of oral contraception via patient group directions. 

An evaluation was undertaken exploring the implementation, delivery and progress of the pilot services, with a focus on pharmacy readiness, service user and other stakeholder acceptability, and safety. Data for the evaluation was collected from routine quantitative reporting, a post-consultation survey for service users, qualitative interviews with service users, staff and stakeholders, and a pharmacist survey. 

This project was a collaboration between NHS England and MLCSU MMO and the Strategy Unit.

Action

• Operational support: The MMO team produced toolkits for contractors and input into other key documentation, oversight of patient safety monitoring and investigations, facilitation of payments to participating pharmacies, PMO function and were the main point of contact for consultation tool and payment queries. The team supported NHS England to ensure smooth transition from pilot to advanced national service.
• Development of data capture system for community pharmacies: The MMO team created and managed a data consultation tool to capture patient history, consultation, patient pathways, patient safety and sign-posting. Data collected was used as part of the  evaluation of the pilot and to produce monthly invoices for participating pharmacies payment.
• Evaluation: The Strategy Unit conducted the evaluation of the two pilots, developing research materials for use in interviews, and surveys. They arranged and delivered qualitative data collection, and project managed the evaluation, keeping NHS England aware of evaluation progress and risks. The Strategy Unit coded and analysed qualitative data for reporting, and triangulated findings with routine consultation data.
• Communication materials produced: The Strategy Unit produced interim and final reports for both evaluation tiers, making recommendations for wider service implementation. They also produced slide packs to communicate the evaluation findings to different audiences.

Impact

• Tier 1 pilot: 118 pharmacies completed 4605 consultations
• Tier 2 pilot: 38 pharmacies completed 573 consultations
• Across the two evaluations, 45 pharmacists, 31 stakeholders, and 34 patients were interviewed 
• Pharmacist interviewees were selected based on geography, number of consultations completed, and pharmacy type, to ensure a wide sample
• The evaluation found that pharmacist confidence to supply and prescribe oral contraception was varied and the provision of guidance for delivering these consultations would support greater use of the service
• Decision support tools, such as Brook and Contraception Choices, were reported to increase pharmacists’ confidence when selecting the oral contraception formulation
• Raising patient awareness of the availability of oral contraception from their pharmacist was found to be important to the service's long-term delivery
• The pilot integrated pharmacists into the provision of oral contraception services alongside GPs and sexual health clinics 
• Following successful evaluations both the Tier 1 and Tier 2 pilots have been launched as the NHS Pharmacy Contraception Service