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Should EHC be reclassified?

Should EHC be available on the shelf as a GSL?

A leading family planning charity is calling for emergency hormonal contraception to be reclassified as a GSL medicine, citing what it describes as the inability of some pharmacies to offer confidential consultations, particularly in the context of social distancing requirements. Arthur Walsh reports

The British Pregnancy Advisory Service (BPAS) recently carried out a mystery shopper exercise in 34 pharmacies in England, identifying serious patient confidentiality issues in around a third. A lack of physical space was a common theme, with some pharmacies closing their consultation room during the pandemic, forcing women to discuss their health needs on the shop floor.

Others were still using their consultation room, but BPAS was concerned the room was not big enough to allow for social distancing. In a number of pharmacies, the space was booked for back-to-back flu jabs and could not be conveniently used for other consultations. Some pharmacies had tried to make consultation rooms Covidsecure “with varying levels of practicality”, according to BPAS, such as fitting a plastic screen.

The charity pointed to a decline in EHC sales during lockdown as a sign it should be easier to access. The PDA’s advice to pharmacies not to use their consultation rooms during the pandemic showed the present system doesn’t prioritise women’s needs, it said.

Switch to GSL

Describing the current state of EHC provision as an “avoidable mess”, BPAS said the need for a pharmacist consultation should be scrapped altogether by switching the morning-after pill to GSL status. EHC can already be sold “straight from the pharmacy shelf ” in the US, Canada and a number of European countries, it argued, pointing to recent survey data indicating that 55 per cent of UK women believe the same should be the case here. 

BPAS deputy chief executive Clare Murphy said that while pharmacists are “doing their best to provide emergency contraception at this very difficult time… women should not be forced to risk their confidentiality or health to prevent an unplanned pregnancy”.

She called on the health secretary to reclassify emergency contraception and in the meantime alerted women to online pharmacies where they can purchase EHC at the lowest prices in order to stockpile it should they need to take it in the future.

“At a time when many women are having trouble accessing their normal method of contraception, it is imperative that access to EHC is swift, safe, and convenient,” she said.

“The physical constraints that pharmacists are operating under cannot be changed, but the current regulatory framework, which places pharmacists under an obligation to undertake a consultation with every woman requesting EHC, can and should be,” commented Ms Murphy.

‘Bonkers’

Many pharmacists were unsure of the proposals, worrying about the possible patient safety implications. “This seems bonkers to me,” tweeted pharmacy academic Paul Rutter, while a pharmacist said: “When unable to use the consultation room, I asked patients to phone me. It’s easy to do a confidential consultation and easy to advise on the most appropriate EHC whether selling or providing it on a local PGD.”

RPS president Sandra Gidley told Pharmacy Magazine: “While Covid-19 has placed huge pressure on our profession, pharmacists must ensure appropriate levels of privacy are provided for all consultations.

“It is important a consultation takes place to help women who need emergency contraception. Pharmacists support women on their use of contraception and flag the risks of sexually transmitted infections. Changing EHC to GSL would remove these vital interventions.

“We want to see emergency contraception rolled out free of charge through community pharmacy as part of a wider NHS service in England, as it is in Scotland and Wales. Cost is a significant barrier to many women trying to access these vital medicines and it is unacceptable that they still have to pay.”

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