EHC Statement

CCA, RPS and NPA Statement

Pharmacy bodies call for Emergency Hormonal Contraception to be commissioned nationally in England.

The Company Chemists’ Association (CCA), the National Pharmacy Association (NPA) and the Royal Pharmaceutical Society (RPS) are calling for a National Emergency Hormonal Contraception (EHC) service. This should be commissioned FREE (at the point of access) to women of all ages through community pharmacies in England. The service would not only transform access to care for all women, but directly tackle health inequalities and vastly improve health outcomes.

For decades, community pharmacy has played an integral role in women’s health, offering convenient healthcare and advice, without the need for an appointment. Pharmacies’ accessibility and extended opening hours, coupled with safety-netting and clinical advice are highly valued by women1.

More recently, NHS England commissioned a Pharmacy Contraception Service, allowing women to access the oral contraceptive pill free of charge, expanding pharmacies’ role in women’s health.

The incidence of unplanned pregnancies increases in areas of higher deprivation2,3.  Girls, adolescents, and women in the most deprived areas are more than two times more likely to have a termination than those in the least deprived4. It is known that access to healthcare is scarcer in more deprived areas where the need is often greater (the inverse care law)5. Unplanned pregnancies are also linked to increased risk of adverse health outcomes2,3.

However, contrary to other healthcare providers, there are more community pharmacies in areas with higher levels of deprivation6, meaning that they offer an essential tool in tackling health inequalities Evidence shows that pharmacies in more deprived areas, offer greater numbers of commissioned EHC consultations7.

National EHC services have been commissioned in Scotland and Wales for many years. In both nations, significantly fewer women attend General Practice for EHC, preferring the convenience of community pharmacies4,8. The ubiquitous nature of the service has undoubtably contributed to comparably lower levels of abortion per 10,000 female population4,8.

EHC services are already widely commissioned by an estimated 90% of local authorities in England, but only around 48% of community pharmacies are included in these services9.  Variance in local service design, such as restrictions on patient usage, means this there is no standard offer for patients across England. Furthermore, there are cases of pharmacies having to determine what level of care they can offer to a woman by literally asking her for her postcode.  Patchy and inconsistent local commissioning has created a postcode lottery of access for a service which clearly has significant national demand.

The CCA, NPA and RPS are calling for an end to the postcode lottery and for women of all ages to be able to access a nationally commissioned EHC service from their local community pharmacy.

The current arrangements are inadequate for women:

  • There is an incomplete understanding of the availability of free at-the point access EHC services.
  • As services are commissioned by local authorities, they cannot be promoted nationally.
  • There are currently no national standards to underpin the service.
  • There are no national training requirements for pharmacists and pharmacy teams.

All of these issues could be transformed through the commissioning of a nationwide EHC service, mirroring the successful approaches adopted in Scotland and Wales.

Access is important and there are a growing number of innovative routes to purchase EHC through pharmacies, including online private pharmacies. However, the greatest barrier to EHC, and tackling health inequalities, is the cost barrier. NHS commissioned services, free at the point of use, would ensure that women who need the service, can access it with ease, irrespective of their personal circumstances.

We are calling on the government and the NHS to follow the example of Wales and Scotland, and commission a national advanced EHC service in England. Additional investment in the commissioning of EHC and contraception services will support the recently published Women’s Health Strategy, whilst also dramatically improving access, and setting higher standards of care across the country.