Access to female contraception via General Practitioners and Pharmacists in England

Funding

NHS Bristol, North Somerset and South Gloucestershire ICB Research Capability Funding­­.

What is the problem?

The NHS provides free contraception for people who have periods (referred to as women), primarily through primary care general practitioners (GPs), sexual health clinics and pharmacies. It is important that women can easily access contraception to prevent unwanted pregnancies and reduce abortion rates.

The Pharmacy Contraception Service (PCS)1 was piloted in some regions in 2021, and rolled out across England in 2023. This service meant that women could be prescribed oral contraceptives by a pharmacist, instead of by their GP. The aim of the PCS was to improve access to contraception and reduce pressure on GPs.

Evidence of PCS to date has measured patient and staff experiences of the pilot, and drug safety 2. No work has evaluated access to the service for different groups of women either in BNSSG or across England. Understanding which populations have/have not benefited from this service is crucial to make sure it is accessible to everybody who needs it.

Tackling inequalities is one of the five priorities identified in the Integrated Care Board strategy, so exploring barriers to contraception access and evaluating whether the PCS meets its aim of improving access to oral contraceptives, would be a valuable step towards meeting this objective.

What is the aim of the research?

The Research Capability Funding will be used to explore the availability and accuracy of data collected by GPs on female contraception use and describe current patterns in contraception use in England in terms of age, ethnicity and where people live. It will provide funding to engage with women locally, and fund researcher time to undertake research and provide recommendations.

We will explore the availability and accuracy of routinely collected GP data on female contraception use. In theory, pharmacy consultations should be linked to a woman’s GP 4 record, however this has not been validated. In the RCF, we will explore the Clinical Practice Research Datalink (CPRD) research resource which includes GP data from a representative population of England.

We will also run stakeholder groups to understand how the PCS has changed access to contraception; the PCS is commissioned by NHS England but understanding how it serves the demographics of the local population in BNSSG is central to its success and implementation.

This preliminary work will allow us to understand the quality of the data, the current evidence, and how we can best use the available data in a larger future NIHR grant application to explore the impact of the PCS.

How will this be achieved?

We will apply for NIHR Health and Social Care Delivery Research (HSDR) funding for an evaluation with two key parts.

  1. The first workstream will explore and compare access to oral contraception from GPs and from pharmacies before and after the roll-out of the PCS. We will provide insight on which specific groups (according to age, ethnicity and geographical location) are more or less likely to access oral contraception, and from where.
  2. The second workstream will investigate the barriers and facilitator to accessing contraception for women. Using focus groups and interviews, with women, GPs and clinicians, we will explore where women prefer to access contraception, what issues may be preventing them from doing so, and what services do help or could help to provide better access.

Taken together, these pieces of work will evaluate the success of the pharmacy contraceptive service in terms of improving access to contraception, reducing pressure on GPs, and tackling inequalities. We anticipate the findings will provide empirical evidence to inform commissioning, reduce inequalities and provide recommendations for policy makers and healthcare providers.

Who is leading the research?

This research is led by Dr Lauren Scott & Dr Isobel Ward, Senior Research Associate in Applied Health Research & Senior Research Fellow in Applied Health Research, Population Health Sciences, Bristol Medical School, University of Bristol.

For more information or to get involved with this project, please email bnssg.research@nhs.net.