From the other side of the counter: Interview with pharmacist Deborah Evans

How does someone go about becoming a pharmacist? Could you talk us through the process?
Would pharmacists have any specific training on contraceptives?
Why is a progestogen-only pill now available over the pharmacy counter without prescription?
What is the difference between the consultation you’d do with a pharmacist to buy the progestogen-only pill and the one you’d do with a doctor?
Some people are concerned that medical checks and a doctor’s appointment are necessary before they can take the contraceptive pill.
What are the benefits of having the progestogen-only pill available over the counter?
What would you like people to know about the progestogen-only pill consultation?
There are some concerns that people have around paying for contraception when it is currently free on the NHS. What would you say about that?

How much do you know about pharmacists? Would you trust a pharmacist with your contraception?

This year, Hana, a progestogen-only daily contraceptive pill, became available to buy over the pharmacy counter without prescription.

The fact that you can now buy Hana and other progestogen-only pills (also known as PoPs or mini-pills) over the pharmacy counter has created another access route to this type of contraception so that people who cannot or don’t want to have a doctors appointment can still access it.

Hana is also available to buy online, if you’d prefer to access it that way. Whether you choose to buy Hana in a pharmacy or via Hana Direct, there is always a pharmacy consultation involved, in order to ensure that Hana is right for you. 

We know that some people are concerned about the progestogen-only pill being available without prescription.

How does someone go about becoming a pharmacist? Could you talk us through the process?

To become a pharmacist, you have to complete a four-year degree course followed by one pre-registration year. During the four years of the master’s degree, we study a range of scientific topics including pharmacology, pharmaceutics, chemistry. anatomy and physiology, microbiology and many more. In a number of schools of pharmacy they share some of their training with medical students.

Then, we have to do a pre-registration year in practice, which takes place somewhere like a community pharmacy or a hospital environment. At the end of the pre-registration year you have to do an exam. So, in total it takes five years to qualify as a pharmacist.

Pharmacists train as scientists and clinicians and have a unique set of skills and knowledge. Using this scientific knowledge, we advise patients on how to take medicines and recommend the best medicine for particular conditions and diseases.  We have a deep understanding of how medicines work at a molecular level as well as how they affect the human body. 

As experts in medicines, we know what medicines do and how they interact with each other. Our learning in practice continues when we finish their training to ensure our knowledge is current.

*Would pharmacists have any specific training on contraceptives?

Pharmacists will have done reproductive health as part of their training. We also come across many situations where we’re supporting women around their reproductive health, including supplying the morning after pill. 

Now that some progestogen-only pills are available to buy over the pharmacy counter, we will make sure that we’re fully trained and able to answer people’s questions. Pharmacists are trained in safeguarding and are aware of important issues such as non-consensual intercourse, child protection, vulnerable adults, consent and confidentiality.

 It is important that pharmacists have this training for many aspects of their role and for contraception, this could in some circumstances, be linked to abuse of children or vulnerable adults. Their training includes as a minimum a professional course and assessment in Safeguarding Children and Vulnerable Adults.

*Rigorous training on how to conduct the desogestrel consultation is available to all pharmacists.

Why is a progestogen-only pill now available over the pharmacy counter without prescription?

The progestogen-only pill containing desogestrel (the active ingredient in Hana) has been available since 2002. Over that time, millions of women have safely used the progestogen-only pill. 

The MHRA, who are the regulators that scrutinise all the data around a medicine before regulating it, are comfortable that some progestogen-only pills containing desogestrel can be sold under the supervision of a pharmacist. 

The Royal College of Obstetricians and Gynaecologists called in their Better for Women report for the progestogen-only pill to be reclassified from a Prescription Only Medicine (only available with a prescription) to a Pharmacy Medicine (can be bought over the counter in a pharmacy or online with a consultation)​​ in 2019. It’s all about increasing access to contraception.

I would say the availability of desogestrel over the counter has simply increased access to some daily contraceptive pills for more people.

What is the difference between the consultation you’d do with a pharmacist to buy the progestogen-only pill and the one you’d do with a doctor?

There shouldn’t be any difference in the consultation. The pharmacist will be asking women similar questions and talking to them about their contraceptive options. The difference is that a woman can walk into a pharmacy without an appointment and have a conversation with a qualified healthcare professional without having to potentially wait weeks for that appointment.

Some people are concerned that medical checks and a doctor’s appointment are necessary before they can take the contraceptive pill.

I welcome the availability of desogestrel, a progestogen-only pill (POP) that has been used in millions of women, without the need to see a doctor. A pharmacist will ensure that the appropriate questions are asked before supplying desogestrel to ensure that it is appropriate for the woman.

Unlike with the combined contraceptive pill, there is no requirement to take blood pressure before issuing the progestogen-only pill – this is the same whether you see a pharmacist or a doctor. If you would like to check your blood pressure, your pharmacist can provide this service.

Pharmacy-led provision of desogestrel has been authorised by the MHRA and is widely supported by doctors and the medical community to increase access to some daily contraceptive pills.

They have no need for concern. Pharmacists are highly trained healthcare professionals and the consultation that someone who can get pregnant receives in a pharmacy before they buy the daily contraceptive pill will be every bit as rigorous as the one they would get from a GP.

“This is good news for women and families. Pharmacists have the expertise to advise women on whether desogestrel is an appropriate and safe oral contraceptive pill for them to use and to give women the information they need, to make informed choices,” said Dr June Raine CBE, Chief Executive, Medicines and Healthcare products Regulatory Agency (MHRA).

What are the benefits of having the progestogen-only pill available over the counter?

The main benefits are access and choice; access in that you can now buy it without a doctor’s appointment, choice in that there are now more options available to you directly from the pharmacy.

For example, if you visit your pharmacy to buy the morning after pill, your pharmacist will be able to talk to you about desogestrel and your other contraceptive options.

What would you like people to know about the progestogen-only pill consultation?

Looking after your reproductive and sexual health as a woman is an important aspect of your overall health. It’s not anything to be embarrassed about.

In fact, being proactive and taking control of your reproductive health is a really positive thing. Your healthcare professional, whether it’s your GP or your pharmacist, will be trained and comfortable to have those conversations with you. 

The pharmacist will ask you very straightforward questions just to make sure that this form of contraception is appropriate for you, as well as listen to and address any concerns you might have. The consultation can also be done in a private room if you would prefer.

There are some concerns that people have around paying for contraception when it is currently free on the NHS. What would you say about that?

I would say the availability of desogestrel over the counter has simply increased access to some daily contraceptive pills for more people. It has made no difference to the accessibility of free contraception. We’re very fortunate in this country to have access to free contraception and that hasn’t been taken away.

If you want to keep seeing your doctor, that is absolutely fine, and if you’d rather see a pharmacist, that’s fine too. Access to contraception should include as many options as possible, so different people can find something that works for them.

If you have any questions about how Hana works, you can find out more here. Have a question we haven’t answered yet? Get in touch using #AskHana.

*Deborah Evans does not endorse any products or brands.