From Mr A. B. McCoig, MRPharmS, and others
SIR,-We note with increasing alarm that the Royal Pharmaceutical Society has still not defined a clear policy on the distribution of emergency hormonal contraception through community pharmacies. We attempted to lodge a motion for debate at the recent annual general meeting held in Lambeth on May 10 but were told 10 days after contacting the Secretary and Registrar that it had been received too late and there was no apparent authority to waive the deadline ruling.
Our position is identical to that of the National Pharmaceutical Association and the Pharmaceutical Services Negotiating Committee (clearly in closer touch with those of us who practise within community pharmacy) and that is that EHC should remain free for all women who need this essential drug service at the point of delivery.
Since oral contraception was granted an exemption from prescription charges in the early 1970s for all classes of female patients, there have been seven general elections with corresponding changes of Government administrations. In spite of increasing cost pressures in the National Health Service over three decades, not one Secretary of State for Health has dared to suggest that women should be compelled to pay for oral contraception. It is clearly seen as a vote-sensitive issue by politicians and the exemption has therefore been retained. No doubt similar political thought is behind the reduction in VAT on sanitary protection due to take effect on January 1, 2001. Accordingly, we are deeply concerned that the public will cynically misinterpret our co-operation with any Government which seeks to alter this status quo. We may well be creating our own elephant trap.
It would serve us well to note that the free distribution of EHC is already widening away from FP10s, family planning clinics and accident and emergency departments of major hospitals. Nurse practitioners, using agreed protocols at the new Soho walk-in centre, "dispensed" free packets of EHC to over 500 female patients in the first two months of opening. This piece of information failed to draw any comment from an audience of over 300 people in Croydon when presented to them as part of a walk-in centre stakeholder conference by the senior nurse manager of the Soho site. In fact, this number represented just over 25 per cent of all callers at the centre compared with minor injuries scoring a meagre 6 per cent. There is no talk or suggestion of this service being "capped" or withdrawn.
If the current policies being pursued by the Society are adopted, then we could face a number of scenarios in community pharmacy. Assuming that we could have a P classification product and a protocol agreement to dispense EHC free of charge running in parallel, a number of difficult questions will have to be answered:
We fear that the answers to these questions will weigh against us in all directions.
Emergency hormonal contraception is a life decision drug for a woman (and possibly her partner). It must be treated sensitively and carefully and, most importantly, immediately.
It makes absolute common sense to grant community pharmacists the legal right to "prescribe" this drug appropriately within the confines of a private area in a pharmacy. However, it should be supplied, as it always has been, free of charge to the patient and fully funded by Government.
Andrew McCoig
Secretary, Croydon Local Pharmaceutical Committee
Shailesh Amin
Chairman, Croydon LPC
Graham Phillips
Vice-chairman West Herts LPC
Raj Patel
Salford and Trafford LPC