Shock, horror: there are plans for pharmacists to give out contraceptive pills without prescriptions to 13 to 16 year olds. My initial reaction was outrage, but a closer look convinced me to change my mind.
A report from a pioneering scheme in South London where five pharmacies issued contraceptive pills without GP prescriptions found it had successfully reached young women who had never previously taken the pill. The scheme was under a patient group direction, and access to pills included full explanation and information from the pharmacist.
The recommendation is for the scheme to be rolled out across the country and widening it to girls aged 13 to16. This report went viral, as the teenagers themselves would say, and I found myself on Woman’s Hour, with Richard Hoey, editor of Pulse, discussing it with Jenni Murray.
My view on contraception has always been pragmatic. There is no longer any place for high moral views from GPs. Preventing teenage pregnancies is our goal, and the UK does not have a good track record in this area. Pharmacists are already able to dispense emergency contraception, and so by extending the logic, why not give out planned contraceptives too?
Pharmacists are very thorough and effective at checking with patients whether it is appropriate to dispense other medicines, for example hydrocortisone and chloramphenicol, and I have every confidence that they would follow a protocol or guideline. Dare I say that they are probably more thorough than a GP in a hurry?
I made a strategic telephone call to our local pharmacist to check on some details and avoid making any clangers on Radio 4. I discovered that she already had extremely thorough safety nets in place for any girls under 16 who ask for emergency contraception, and that issues of child protection and safeguarding are included in the guidelines she uses.
One concern about rolling out the scheme to the 13 to 16 year olds is that these girls would have to prove that they are Fraser competent before being given a prescription. But as long as this is assessed safely, then there would be no legal consequences. On the Isle of Wight, where the scheme has been running for a couple of years, girls under the age of 16 are referred to a safeguarding nurse, and in all the national trials of schemes the girl is encouraged to talk to her parents about her decision.
Widening the access to teenage girls for pills in the end can only be beneficial in the goal to reduce unwanted teenage pregnancies. Newspaper headlines of girls ‘popping into the chemist to pick up pills’ will no doubt be misinterpreted as a vision of Microgynon on the shelf beside Maltesers; the reality is more likely to be a private discussion with a conscientious pharmacist in a proper consultation room.
The wider issue is, in fact, that of shifting activity out of GP practices. We now provide services which were once the realm of hospital specialists – for instance, it is hard to believe we used to refer patients to hospital to start on an ACE inhibitor.
We now monitor patients on drugs such as methotrexate, which were considered too high-powered for GPs, and many of our previously prized drugs you can now buy over the counter, such as omeprazole.
Everything has moved down the food chain, and the consequent feeling of being downgraded can make us uncomfortable. We are deluded if we think that only doctors can dish out medicines. Other highly trained competent staff are more than capable, with the right guidelines, for example monitoring of chronic diseases such as hypertension and COPD by nurses.
Are we throwing away the power and mystique of the doctor by all this delegation? There are some patients who still claim to feel better by seeing the doctor, and report feeling short-changed when directed to a nurse. The way forward must be to move with the times, delegate to nurses and health care assistants as the deluge of expectations cannot be managed by doctors alone.
Perhaps by the time I am dotty enough to need Aricept, I will be able to pick it up from the shelf in Sainsbury’s with my Maltesers, after having my blood taken by the supermarket phlebotomist.
Dr Fiona Cornish is a GP in Cambridge and president elect of the Medical Women’s Federation.