When Louise Allen, the Head of Community Pharmacy in Cardiff and Vale University Health Board, and her team attended the Spread and Scale Academy in March of 2022, their programme of work which involved offering bridging contraception in community pharmacy was being piloted in six pharmacies in Cardiff. By April 2023, this service is due to be in 700 community pharmacies across Wales.

The bridging contraception service has also been championed by Welsh Government and influenced policy becoming part of the Clinical community pharmacy service (CCPS) from December 2022 and mandated for all CCPS listed pharmacies to offer from April 2023

Taking this service from a pilot to national policy, and implementing it in community pharmacy has been the focus of Louise and her team for the last 12 months with the aim to offer bridging contraception to at least 1,000 people at risk of pregnancy by the end of 2023.

Louise credits her team’s attendance at the Spread and Scale Academy with the instilled self-belief that they were able to hit this ambitious target and the tools and skills to support them to do so.

What is bridging contraception?

In February 2018, Public Health Wales carried out a review of sexual health in Wales, which found that “oral regular contraception should be available through an enhanced service within all community pharmacies.” It is clear that community pharmacies have a vital role in offering sexual health services.

When someone attends a pharmacy to receive the emergency contraceptive pill (commonly known as the “morning-after pill”), this additional service will now enable pharmacists to offer a 3-month supply of a contraceptive pill to bridge the gap which could be between the emergency contraception and longer-term contraception, allowing the patient to seek advice on their options with medical professionals and decide on a choice for a long-term method. This is known as bridging contraception.

This 3-month supply is available directly from pharmacists (similarly to the emergency contraceptive pill). And it is hoped this will release capacity and GP time without the need for an immediate GP appointment   as this service can be provided from local community pharmacies

The story so far

Deregulation of Desogetral in 2020 meant that this contraceptive drug became available for sale in pharmacies but at a substantial cost which was prohibitive for many. However, in line with the 2018 Public Health Wales report, Louise suggested to Welsh Government’s Chief Pharmaceutical Officer that a service providing an initial supply could be part of the community pharmacy NHS services offer thereby making it free to patients at the point of access.

By the end of 2021, Welsh Government endorsed the idea and set a goal of implementing the service in 700 pharmacies across Wales by April 2023, leaving Louise and her team with the task of implementing it at scale.

In March 2022, a pilot of the service began at six sites in Cardiff and the Vale of Glamorgan. In the same month Louise, Reem El-Sharkawi, a Welsh Government clinical leadership fellow and Hayley Jones, Pharmacist Independent prescriber in contraception from Cyncoed Pharmacy in CAVUHB, attended the Spread and Scale Academy in Cardiff.

The lessons learnt from the pilot, coupled with the academy’s teaching proved invaluable for Louise’s team, as the Model for Unleashing (the model for large-scale change delivered at the Spread and Scale Academy) gave them the tools to identify the key, non-negotiable elements of the service and the methodology to spread them at scale by raising awareness, building will and transferring skill, thereby ensuring that everything was in place for this national service to be developed and agreed with a national template enabling supply in each Health Board area.

One of the key lessons from the Spread and Scale Academy is how to identify the most essential, non-negotiable elements of the intervention or solution you are trying to spread, and the elements which could be adapted by those looking to implement it depending on their context. To teach this, the academy uses the metaphor of a turkey sandwich; the idea being that the only components technically necessary to make one are turkey and bread, anything else that you would add to it represents the adaptations solutions undergo to make them palatable and appropriate for others.

During their pilot, Louise and her team learnt that other than the supply of the medication itself, the most important thing for their intervention to work was simply a conversation the between patient and pharmacist where the bridging contraception is explained and offered as an option. They found that even if the patient did not accept the bridging contraception right away, the conversation could prompt a later behaviour change in a similar way to Public Health Wales’ Making Every Conversation Count methodology.

To facilitate this, Louise’s team worked with national partner organisations such as Health Education Improvement Wales (HEIW) and Digital Health and Care Wales (DHCW), whose input was invaluable in driving the spread of the intervention as well as making it viable.

Working with HEIW, they developed a national training module for community pharmacists to support the service provision and to ensure they were empowered to have these conversations, and understood why they were so important. Likewise, their work with DHCW ensured that a new module on the patient record system, Choose Pharmacy, was developed and available to pharmacists to record the outcome of their conversation with patients.

Another key lesson from the Spread and Scale is the high value of building one-to-one connection and relationships rather than transactional relationships when delivering large-scale change. As a methodology to build will, this can be much more impactful than implementing top-down change and targets. So ot help raise awareness of the new scheme and build these connections on a national level, Louise and her team conducted a series of roadshow sessions with community pharmacists across Wales in October 2022.

However, Louise believes that some of the most important lessons her team took away from the Spread and Scale Academy were the lessons they learnt about themselves. The opportunity to gel together as a team for three days was invaluable and one that they otherwise would not have had. Coupled with their 90-day plan of action (something which every team leaves the academy with), this team cohesion ensured that they continued to meet and remain invested in the project long after the Academy had past.

The Spread and Scale Academy also helped Louise and the team better understand their individual strengths and weaknesses, and how they can work together to optimise their performance. Further, they gained a deeper understand of how they relate to each other and their work, especially in times of stress. In the academy, this is taught using the idea of personas: a villain, victim or hero person that you slip into as a reaction to a stressful situation. It is taught with a certain humour and light-heartedness during the programme, but nevertheless the lesson can make a huge difference to the way delegates approach their work.

Louise says that she and her teammates had so much fun identifying and interrogating their personas at the academy and that her teammate’s hero persona, which they named “Positive Polly” will always stick with her and can actually help to counteract her own victim/villain persona.

For Louise, this inner work was the most important thing she gained from the Spread and Scale Academy; she says: “The Spread and Scale Academy gave me and my team the ability to think big and, crucially, the ambition and the self-belief that we could meet the aims that we set for ourselves. When we attended the academy, we were faced with a huge challenge of spreading our intervention to pharmacies across Wales, and it has enabled and inspired us to do this at pace. We are acutely aware of the impact our work will have on people’s lives and why it’s so important we meet our aim. I would sincerely recommend it to anyone.”

The Spread and Scale Academy returns to Cardiff in March 2023 and is currently accepting applications until 13th January 2023. Read more here and apply now!