NHS Care Services

Public Health Service

PHS Sexual Health Specifications

Service Aim

• To provide extended access through the NHS to advice and specific sexual health services as part of the Public Health Service (PHS) element of the community pharmacy contract.

Service Outline

• There are four components to the sexual health service; namely testing, advice, treatment and / or referral to another health care practitioner.

• The specific services are the free provision of Emergency Hormonal Contraception (EHC), testing for Chlamydia infection and treatment of Chlamydia infection, where clinically appropriate.

• The services are provided and funded as a national NHS service by NHS Scotland through the PHS element of the community pharmacy contract and comply with policies and standards set by the NHS for the provision of such services.

• A pharmacist who chooses not to supply EHC on the grounds of religious, moral or ethical reasons must treat the matter sensitively and advise the client on an alternative local source of supply (such as another pharmacy, GP or sexual health service). (see RPSGB Medicines, Ethics and Practice Guide).

• If a client is showing symptoms that indicate another sexually transmitted infection then they must be advised and encouraged to attend the local specialist sexual health service, GUM clinic or their GP practice for further investigation.

• The pharmacist must ensure, where appropriate, that the client is counselled on other sexual health matters and related topics. Written information should also be available on these topics.

• The pharmacist must use their professional judgement to consider, and where appropriate, act on any child protection issues brought to their attention. This should be in line with the local child protection procedures and any national or local guidance on under 16s sexual activity.

Service Standards

• There are two accompanying service specifications and standards for each of the two components of the sexual health service (see Appendices A and B to this specification).

• The service should be provided according to the standards set by the Royal Pharmaceutical Society of Great Britain (RPSGB).

• The pharmacist providing the service should ensure that a standard operating procedure is in place which covers all aspects of service provision.

Training

• The pharmacist providing the service must practise within their own competency.

• Distance learning resource packages are available from National Education Scotland (NES) Pharmacy for pharmacists who wish to develop their knowledge and skills in sexual health services.

• The pharmacist providing the service must be aware of and operate within the national service specifications.

Record keeping

• It is a requirement of the service that appropriate records, including patient medication records, are kept and maintained by the pharmacist, to enable verification of service provision and training requirements, and to provide information for internal and external audit and evaluation purposes.

Appendix A to the PHS Sexual Health Service Specification

Provision Of Emergency Hormonal Contraception (EHC)

Service Aim

• To provide, where clinically indicated, a free supply of emergency hormonal contraception (EHC) as specified within a Patient Group Direction (PGD).

Service Outline and Standards

• The service is available to any female client aged 13 years or over.

• The service must be provided by the pharmacist in person.

• The pharmacist takes a client history to ensure that they have sufficient information to assess the appropriateness of the supply.

• Clients who are excluded from the service must be referred to other services for treatment and advice within the time frame for emergency contraception treatment to be effective.

• The pharmacist supplies, according to a PGD and the procedure set out in section 3, Levonorgestrel as a single dose within 72 hours of unprotected sexual intercourse using the CPUS form.

• The pharmacist is responsible for ensuring that the service is user-friendly, non-judgemental, client-centred and confidential.

• A pharmacist who chooses not to supply EHC on the grounds of religious, moral or ethical reasons must treat the matter sensitively and advise the client on an alternative local source of supply (another pharmacy, GP or sexual health service) available within the time frame for emergency hormonal contraception treatment to be effective (within 72 hours of unprotected sexual intercourse). (see RPSGB Medicines, Ethics and Practice Guide).

• The service should be operated from premises that can provide an acceptable level of privacy to respect a client’s right to confidentiality and safety.

• The pharmacist must ensure maintenance of records for each supply and may be required to share information with appropriate parties in line with confidentiality protocols.

• The pharmacist must ensure, where appropriate, that the client is counselled on other sexual health matters and related topics. Written information should also be available on these topics.

• The pharmacist must use their professional judgement to consider, and where appropriate, act on any child protection issues coming to their attention as a result of providing the service. This should be in line with local child protection procedures and any national or local guidance on under 16s sexual activity.

• The service should be provided according to the standards set by the Royal Pharmaceutical Society of Great Britain (RPSGB).

Service Procedure

The pharmacist follows the procedure detailed below:

• The pharmacist consults with female client, takes a client history and establishes the need, any possibility of current pregnancy, any contra-indications, previous use and current medication to ensure the supply is safe and appropriate.

• The supply is made and recorded in the patient medication record.

• The client is counselled on the use of EHC and what to do if she vomits after taking the medication this includes returning to the pharmacy for a further supply if clinically appropriate.

• The pharmacist advises that the next period may be early or late and to contact their GP or family planning adviser if the period has not occurred within 3 weeks or if menstruation is unusually heavy or light or if there is any presence of lower abdominal pain.

• The pharmacist advises on the use of barrier contraception until the next period.

• The pharmacist counsels the client on the importance of using regular contraception if they are sexually active and promotes the role of condoms in preventing sexually transmitted infections.

• The pharmacist provides the client with an EHC and contraception information leaflet to support any verbal advice.

• The pharmacist provides the client with written advice on local agencies who can provide access to further treatment and services if required, this includes details of specific services for young people under the age of 18.

• The pharmacist provides any additional written and verbal advice on the risk of sexually transmitted infections as a result of unprotected sex and future contraceptive needs.

Training

• Training on the supply of EHC should involve all pharmacy staff in order to ensure that everyone is aware of the key issues regarding the supply of EHC and so that all staff respond sensitively and appropriately to enquiries about EHC. In particular, staff should recognise that all requests for EHC should be referred to the pharmacist early on in the consultation.

• Distance learning packages on Emergency Hormonal Contraception and Child Protection are available from NES Pharmacy for pharmacists who wish to develop their knowledge and skills in these areas.

Background Information

RPSGB Medicines, Ethics and Practice (current edition)

• http://www.rpharms.com/law-and-ethics/medicines-ethics-and-practice-guide.asp

• RPSGB practice guideline on supply of Emergency Hormonal Contraception as a pharmacy medicine

• http://faculty.ksu.edu.sa/hisham/Documents/Files_For_MS_Students/17.pdf

Local child protection protocols and policies

NES Child Protection Distance Learning Resource Pack

NES The Pharmaceutical Care of Sexual Health Distance Learning Resource Pack

NES Flavours of Pharmaceutical Public Health Distance Learning Resource Pack

Useful References

RPSGB practice guideline

RPSGB updated advice on EHC

RPSGB guidance on child protection