Last year’s POM to P switch of the mini pill highlighted the important role pharmacies play in supporting the nation’s sexual health. But there’s a lot more to it than contraception.
Like many aspects of the NHS, sexual health services have been adversely affected by the pandemic.
A survey conducted by the British Association for Sexual Health and HIV (BASHH) found that in-person services for patients needing sexually transmitted infection (STI) tests and treatments, contraception and medication have shrunk drastically since the pandemic hit the UK in March 2020. And Public Health England (PHE) estimates that one in three women cannot access contraception from their chosen setting.
For this reason – and others we will explore in this feature – it is likely that more people will be visiting their local pharmacy for sexual health advice and treatments this year and beyond.
While some forms of contraception are not available over the counter from pharmacies, the number that are was expanded last year when the Medicines and Healthcare Products Regulatory Agency (MHRA) announced that progestogen-only contraceptive pills (POPs) containing 75mcg desogestrel would switch from POM to P.
The two products reclassified were Lovima, manufactured by Maxwellia, and HRA Pharma’s Hana.
Pharmacy organisations welcomed the move, with the PAGB summing up their sentiments by saying: "Making these progestogen-only contraceptive pills available without prescription in the UK is a historic milestone for women and women’s health. This is the first time that any form of daily contraceptive pill has been licensed for over the counter sale in the UK, 60 years after the pill was originally offered by the NHS – initially to married women only."
President of the Faculty of Sexual and Reproductive Health Dr Asha Kasliwal added: "Availability over the counter in pharmacies will make it easier for women to access essential contraception to avoid unplanned pregnancies during and beyond Covid-19."
The switch presents a fantastic opportunity for pharmacy. The advertising of these pills as being available over the counter could open up once taboo conversations on contraceptive choices and highlight pharmacy’s expertise to a large part of the population.
"When women come into the pharmacy to either ask for more information about the pill switch or to request a supply, counter staff will be their first point of contact," says Royal Pharmaceutical Society English Pharmacy Board Chair Thorrun Govind. "So, it’s really important that we make sure it’s done right, and we make every contact count."
Both Maxwellia and HRA Pharma have created pharmacy training guides and suitability checklists to support pharmacies in their consultations and to help them make sure women are suitable candidates for the POP. According to Maxwellia, this training will help pharmacy teams "provide a better service to the woman than she could get from the GP."
Top tips for customer care when discussing the mini pill
Pharmacist Sultan ‘Sid’ Dajani, owner and superintendent pharmacist at Wainwrights chemist, has four top tips for pharmacy staff to bear in mind:
- First impressions count. Make sure you know how to talk to a customer asking about pharmacy progestogen-only contraceptive pills
- These conversations provide an opportunity to spot signs of domestic violence or abuse, so be aware of the ‘Ask for ANI’ protocol, as well as local safe havens for people who might need them
- Use WWHAM to find out if anything has changed for customers on repeat sales. Listen out for red flags, such as bleeding, and ask if they know about all the side effects if they are buying a repeat
- The ongoing aim for pharmacy staff is that they are upskilled and recognised as the professionals they are. If a team member still doesn’t think they are getting the training they need, they should keep asking until their voice is heard.
Whilst contraception stops pregnancy, most methods – except condoms – won’t stop people from catching or passing on a sexually transmitted infection (STI).
STIs are generally acquired by sexual contact when viruses or bacteria travel from person to person via bodily fluids such as semen or blood.
Despite a 32 per cent decline in STI diagnoses between 2019 and 2020 – largely thought to be due to Covid-19 restrictions keeping people apart – STI rates remain a concern.
Unfortunately, STIs can lead to many serious conditions, so it is important to help customers recognise symptoms and understand the importance of protecting themselves.
The importance of STI testing
As many people don’t develop symptoms once they have contracted an STI, it is important for customers to make sure they are tested regularly between partners. This ensures that infections can be detected and treated without being passed on to someone else.
The UK Health Security Agency recommends that everyone has an STI screen, including an HIV test, annually if they are having sex without a condom and/or with new or casual partners.
The guidance refers to two groups of people in particular:
- Sexually active women and other people with a uterus or ovaries under 25 years old, who should be screened for chlamydia on a change of a sexual partner, or every year
- Gay and bisexual men who have sex with other men should test for HIV and STIs annually or every three months if having sex without a condom with new or casual partners.
Testing is free and available through online services or local sexual health services such as STI clinics or drop-ins. The services are confidential, and staff will only liaise with other healthcare professionals if they suspect a person is at risk of harm.
In 2018, sildenafil, an erectile dysfunction drug, was made available as a pharmacy medicine. For the first time, male customers did not have to be prescribed the drug but could, after a quick consultation, purchase it for themselves from a pharmacy.
"When it comes to erectile dysfunction, although it is very common for many men, it’s one of those things that they rarely ever speak to a healthcare professional about," says Ade Williams MBE, lead pharmacist at Bedminster Pharmacy in Bristol, "which is not to say that they’re not seeking help, but they’re seeking help in the wrong place.
"Having the pharmacy, which is the most commonly accessible part of the healthcare system, helping to address this in a way that also looks much more holistically at men’s health, builds in a sense of trust, builds in a sense of confidence and also helps them to link that in to all the messages that we’re very keen to pass on."
Research has shown that men who visit a pharmacy for treatment for their erectile problems are more likely to return to the pharmacy for other healthcare advice.
“You may feel confident about the product and discussing erectile problems, but for your customer, it may be the first time”
As their first point of contact, it is important that pharmacy support staff approach the issue with professionalism and tact.
"You may feel confident about the product and discussing erectile problems, but for your customer, it may be the first time they have talked about it," says Viatris, manufacturer of Viagra Connect. "Remember to reflect the language they use, maintain a professional tone and if they have concerns, give them the option of speaking to the pharmacist. Similarly, if you think they might need additional support, you can also refer them to the pharmacist for further advice."
There are numerous lifestyle factors that could be influencing erectile problems. These include:
- An unhealthy diet
- Being overweight
- Alcohol consumption
- Recreational drug use
- Not exercising enough
Pharmacy staff can help customers by tactfully offering advice on how to minimise these risk factors. For example, you could signpost them to your pharmacy’s smoking cessation service or direct them towards the NHS Stop Smoking App. Providing information about weight management products and services can help too.
To initiative conversations, you could have a display of useful information with leaflets for customers to take away, as well as signposting to appropriate local services.
Top tips for customer care when discussing sildenafil
To help make sure you deliver the best possible customer care for men concerned about erectile dysfunction (ED), Viatris offers this advice:
- When conducting consultations, offer your customer use of the private consultation room, or the option to go to a discrete area away from the pharmacy counter if they want to. Make sure to look for visual signs of them feeling awkward
- Remember to check with the patient if they’ve had any health or medication changes since they previously bought the drug
- A pharmacist should authorise every sale of Viagra connect [and other sildenafil products]. Bear in mind the need to be discrete. It’s better to ask the customer to wait a moment while you go and check, rather than shout across the pharmacy
- Talk to the pharmacist about when they want customers to be referred to them when completing the pharmacy checklist. For example, should you get them as soon as you’re not sure about something or would they prefer you to take customers through the whole checklist before referring to them?
Once the pharmacist has confirmed that you can sell medication to the patient, make sure you give them four key pieces of advice in order for them to get the best results with the drug:
- Avoid taking it with grapefruit or grapefruit juice
- Take no more than one tablet a day. Swallow whole with water
- Take one hour before planned sexual activity
- It can start to work within 30 minutes and men can get an erection in response to sexual stimulation for up to four hours after taking the dose.
Access Viagra Connect learning resources here.
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