Factors influencing the commissioning and provision of community pharmacy Emergency Hormonal Contraception services in England

Abstract

In England, community pharmacies provide services commissioned either nationally or locally. Local commissioning exhibits variation in specification and implementation, exemplified by Emergency Hormonal Contraception (EHC) services. A literature review did not reveal how routine data inform commissioning decisions. This study aimed to determine if analysis of data yield insights into factors influencing local service commissioning. The study uses data to evaluate factors influencing EHC services through a proxy-measure of GP EHC prescribing.

Freedom of Information requests were submitted to all Local Authorities in England, requesting EHC provision data for the financial year 2017/18. GP EHC prescribing, and data identified in the literature (deprivation, pharmacy organisation type (large chains, independent pharmacies etc.) and pharmacy provision) were collected. Analysis was undertaken at two levels of aggregation: Local Authority and individual pharmacy. Statistical methods included linear correlation and multiple regression. A model portraying EHC pathways was developed using path analysis.

Data from 80 Local Authorities were analysed (60% female population, aged 12-55). Significant negative correlation was found between rates of community pharmacy provision and GP EHC prescribing. Rates of community pharmacy provision positively correlated with the proportion of commissioned pharmacies and greater deprivation. Path analysis described factors influencing community pharmacy provision and GP EHC prescribing. Commissioning all community pharmacies in England (from 47% currently) may decrease GP EHC prescriptions by 15%.

Bivariate correlations indicated significant negative correlation between deprivation and individual pharmacy rates of EHC provision. Larger organisations provided greater volumes of national services (specifically Medicine Use Reviews). There was no relationship regarding EHC suggesting local commissioning should not be dependent on organisation type.

Analysis of routine data and path analysis provide insight into EHC provision and present a method to identify ways to guide commissioning decisions. Where data are available this method could be used to inform decisions for other services.