GPs reject pharmacists’ free contraception service proposal

GPs have strongly rejected proposals by the Irish Pharmacy Union that pharmacists should be given control of a State-funded, free national contraception services.

The IPU has urged the Department of Health to let them supply contraception directly and without charge, regardless of eligibility and without the need for a GP's prescription.

Currently, oral hormonal contraception pills, patches, rings and injections all require a prescription, but they could be directly dispensed by pharmacists if they were given extra training.

However, the Irish Medical Organisation reacted sharply, saying such a move would contradict long-established practice of putting distance between those who prescribe and those who sell drugs.

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The IMO’s GP spokesperson Dr Padraig McGarry said a pharmacy contraception service would undermine efforts to provide women with comprehensive sexual healthcare.

The IPU’s proposal is part of a trend of trying to disengage patients from regular contact with their GPs when such contact was vital to ensure a rounded knowledge of a patient’s circumstances and health record, he said.

“Removing that separation runs the risk of incentivising the retailer of medicines to dispense for the sake of dispensing rather than on the basis of understood healthcare needs,” he declared.

Prevent unwanted pregnancies

In accordance with the recommendations of the Oireachtas Committee on the Eighth Amendment, the Government has decided to provide free access to contraceptives as a measure to prevent unwanted pregnancies.

The Irish College of General Practitioners said it “welcomes any policy which broadens access to contraception for both women and men.

“International and national sexual and reproductive healthcare guidelines support the preferential recommendation of long-acting reversible contraception (called LARC) over the pill.

“It is therefore very important that any policies which broaden access to contraception are co-ordinated through general practitioners, to ensure the highest possible uptake of LARC. To do otherwise, would result in higher rates of crisis pregnancies, at a time when we want this to be reduced,” it said.

The chief executive of the National Association of GPs, Chris Goodey, said a pharmacy-delivered contraception service would do nothing to create an integrated care system.

"We've seen with the flu vaccines where it is delivered in pharmacies there is no co-ordination between the GP and the pharmacy," he told The Irish Times.

If free contraception is to be introduced it should be done by GP practices, which could include clinical pharmacists to help co-ordinate that care, he said.

Convenient contraception

However, pharmacists insist their plans would dramatically increase access to safe and convenient contraception, and could help reduce crisis pregnancies.

IPU president Daragh Connolly noted that hormonal birth control is already supplied by pharmacists without prescription in more than 100 countries, including many US states, parts of Canada, and New Zealand.

Pharmacists have directly provided the "morning after pill" in Ireland without a prescription since 2011 – a move resisted by GPs at the time.

Irish women are increasingly buying contraception online, which creates concerns about deep vein thrombosis, since blood pressure and weights are not checked in advance, he said.

Mr Connolly said that surely it would be safer for women to see pharmacists “for a proper contraception consultation, under protocol and under license” than using an online service.

The IPU contraception proposal is “not an attempt at excluding patients from seeing their GP or taking fees from GPs”, he said, adding that pharmacists want to work with GPs.