Case study: Developing a community pharmacy-led LARC implant service in Liverpool

Background

Liverpool has historically had a limited community pharmacy offer for sexual and reproductive health, with only six pharmacies commissioned to provide oral Emergency Contraception (EC). A new commissioner with a strong interest in community pharmacy led a programme of extensive stakeholder engagement as part of the city’s wider sexual health strategy.

Liverpool LPC’s Chief Officer, Matt Harvey, developed a discussion paper exploring the potential for community pharmacies to deliver a broader range of contraception services, including long-acting reversible contraception (LARC) which was presented to the commissioner.

Following this, Liverpool City Council led a procurement exercise for a new sexual health service that included a three-tier community pharmacy delivered model. Tier 1 included oral EC and quick-start contraception; Tier 2 expanded provision to include contraception initiation and repeat supply, depot contraception and chlamydia treatment; and tier 3 introduced a pilot to test pharmacist-led contraceptive implant insertion and removal. Tier 1 and Tier 2 oral contraception services have now been de-commissioned since the expansion of the national Pharmacy Contraception Service (PCS).

The LARC implant journey

The journey from tender award to service go-live took several months and was not without challenges. Significant time was required to address training requirements, resolve professional indemnity insurance issues, and ensure governance arrangements were robust. While these challenges delayed implementation, they also generated valuable learning. The groundwork now in place means that onboarding additional pharmacies in the future should be more straightforward and efficient.

Learning and governance

Pharmacists participating in the implant pilot were required to complete the Faculty of Sexual and Reproductive Healthcare (now known as the College of Sexual and Reproductive Healthcare) Online Theory Assessment, alongside additional e-learning beyond standard contraception training. This was supplemented by one full day of face-to-face practical training. Pharmacists were formally signed off as competent before applying for the relevant Letter of Competence, ensuring patient safety and clinical governance were fully embedded.

Costs and resource implications

Delivering the service required upfront financial and resource investment from both the pharmacy owner and commissioner. The commissioner has also invested in local awareness campaign activity to raise public understanding of the new service.

Outcomes and impact

A total of 34 patients have accessed the pilot implant service so far. The service has attracted patients from all age ranges from under 13 to between 55 and 59. Implants have been administered for patients who were either not using any current contraception method (n=20) or another form of contraception (n=9).

Patient feedback has been overwhelmingly positive:

• 100% rated their overall experience as very good and felt the service met their needs.
• 97% reported the service was easy to access at a convenient time and more convenient than other settings they had tried.
• All patients felt they received sufficient information to make an informed choice and expressed confidence in the pharmacists’ skills.

These results demonstrate the potential for community pharmacy to play a significant role in expanding access to high-quality contraception services and the commissioner is keen to expand the LARC implant service to other pharmacies in Liverpool.