From Mrs J. Plows, MRPharmS
SIR,—Over the course of this year I have been persuaded that the right
way forward for the community supply of emergency hormonal contraception is
through patient group directions. The pilot schemes have been welcomed by women,
pharmacists and general practitioners alike — no mean feat! I was looking
forward to the protocols being rolled out nationally over the next couple of
years.
It was, then, with horror and disgust that I read that the Council of the Royal
Pharmaceutical Society has approved standards for the imminent reclassification
of levonorgestrel EHC to allow pharmacy only sale (PJ, October 14, p545).
Why is this? Is there a hidden agenda here? It has been widely reported in the
press recently that Britain has the worst teenage pregnancy rate in Europe.
No doubt selling EHC to teenagers might be seen by some as a quick-fix option
to reduce the statistics rapidly — much cheaper than providing good quality,
appropriate sex education from primary school onwards.
In the proposed standard for supply, why is there no requirement to inform the
patient’s GP that a supply of EHC has been made? To quote Dr Connie Smith,
“women receiving [EHC] would need advice in terms of follow-up and ongoing
contraception”. Why are repeat sales of EHC allowed within the same menstrual
cycle? To quote Dr Smith again, “use of emergency contraception repeatedly
after each episode of coitus was not acceptable because it led to menstrual
disruption”.
Does Mr Curphey really believe that the supply of EHC under patient group directions
would continue to grow rapidly once levonorgestrel had been released for pharmacy
sale? I wish I had his faith.
Janice Plows
Bristol
Ms BEVERLEY PARKIN (director of public affairs, Royal Pharmaceutical
Society) states: The Council framed its policy on contraception and sexual health
in July, 1999, supporting a role for pharmacists in the supply of EHC as a P
medicine from pharmacies. This policy was reaffirmed in May, 2000, when it was
recognised that availability of this product by other routes, including under
patient group direction from pharmacies, and walk-in centres, would be likely
to increase whether or not the product were to be available as a P medicine.
The Council also said that it would wish to see a mechanism to make the product
available free from pharmacies for those women who cannot afford to buy it.
In the light of an application made for an EHC product to be classified as a
P medicine, the Society considered that a standard for pharmacists should be
issued. Any restrictions on supply or repeat supply must be specified within
the marketing authorisation. The marketing authorisation proposed does not require
notification to a patient’s GP and, without the permission of the patient,
this would be a breach of patient confidentiality. Any restrictions on supply
or repeat supply must be specified within the marketing authorisation. The Society’s
standard supports members in the discharge of their role.