Other practical considerations
Proxy consultations for oral EC
The current PGDs for oral EC require a face-to-face consultation to confirm clinical appropriateness, assess capacity to consent, and screen for safeguarding concerns. As a result, oral EC cannot be supplied via the contraceptive service on behalf of another person. While oral EC may be purchased through a proxy consultation at the pharmacist's discretion, the GPhC advises that this approach is less safe because it limits the ability to gather essential information.
If the patient cannot attend in person, a telephone consultation may be an acceptable alternative, allowing direct discussion of clinical and safeguarding questions – although verifying safeguarding concerns remains more challenging remotely.
Repeat requests for oral EC
PGDs for oral EC permit repeat supplies within the same cycle; however, frequent use should prompt a broader discussion with the patient. This conversation should remain non-judgmental and aim to explore underlying reasons for repeated requests, such as:
- Condom failure
- Possible safeguarding concerns or partner pressure, particularly in minors.
Repeat requests also provide an opportunity to discuss more effective, long-term contraceptive options, e.g. an intrauterine device (IUD) which is another EC option. This may be known more commonly by patients as a ‘coil’. It has a contraception failure rate below 0.1% and can have licensed duration of action of up to 10 years.
A helpful way to introduce this might be:
"There are other options to taking repeated oral EC, like a contraceptive implant or the coil. They provide long-lasting contraception once inserted. Would you like me to give you information about these and where you can access them?"
These devices are fitted at either a local sexual health clinic or some GP surgeries. Details of local services can be found online.