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Sexual health is as important as ever but is it getting easier or more difficult for independent pharmacies to roll out services? Kathy Oxtoby investigates…

New data from the UK Health Security Agency (UKHSA) shows that syphilis diagnoses in England continued to rise in 2024 compared to 2023.¹

Overall, there were 9,535 diagnoses of early-stage syphilis diagnoses in 2024 compared to 9,375 diagnoses in 2023 – a 2 per cent rise.

“Concerningly, the overall figure for syphilis, including late-stage syphilis or complications from the infection, increased 5 per cent from 12,456 in 2023 to 13,030 in 2024,” says UKHSA.¹

There has been a “concerning acceleration in diagnoses of antibiotic-resistant gonorrhoea cases”, says UKHSA. While most gonorrhoea infections can be treated effectively, “certain strains present significant treatment challenges due to antibiotic resistance”. ¹

^{Thousands of gonorrhoea cases}

Thousands of gonorrhoea cases could be prevented over the next decade thanks to the NHS’ world-first vaccination programme against the infection.²

In May, NHS England announced that a vaccination for gonorrhoea, known as 4CMenB, which is already used for meningococcal B disease, will be rolled out on the NHS starting from early August.²

The vaccine will be delivered through sexual health services. In a letter issued to local systems, NHS England says: “Regional commissioners should now start working with integrated care boards and local authorities (including directors of public health) to commission sexual health service providers to deliver the routine programmes.”³

While the NHS England plans are just for specialist services to provide the gonorrhoea vaccine, pharmacists are also well placed to deliver it.

Pharmacies are involved in sexual health services - primarily contraception - so it makes “complete sense for pharmacists to deliver the vaccine”, says Lindsey Fairbrother, owner and superintendent pharmacist at Good Life Pharmacy in Hatton.

Pharmacies also have “a wide experience of delivering vaccinations, so there’s no reason why pharmacists couldn’t provide this vaccine too, subject to the correct funding and payment”, she says.

The funding for pharmacists to deliver this vaccine would need to reflect the time and cost required for any pharmacy training, and for giving the injection, registering consent, and filling in the necessary forms, as well as any other requirements, she says.

Working with local sexual health clinics

Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow, hopes pharmacists will have the opportunity to deliver the gonorrhoea vaccine in the future. 

Pharmacists could also reach people in their communities to encourage uptake of the vaccine, promoting the service with posters and leaflets in their pharmacies, and working with local sexual health clinics and GP surgeries, says Ms Thakerar. 

The roll out of a gonorrhoea vaccine is “a massive step forward in our attempts to introduce more preventative healthcare measures”, says Henry Gregg, the chief executive of the National Pharmacy Association.

"There is extensive evidence to suggest that pharmacies drive take up of vaccines, particularly among hard-to-reach groups and those in deprived areas. Therefore, we'd urge the government to consider utilising these skills and involving pharmacies in the roll out of the gonorrhoea vaccine.”

“Pharmacists are trusted, accessible healthcare professionals at the heart of their communities,” says Elen Jones, Royal Pharmaceutical Society (RPS) director of pharmacy.

“Expanding pharmacy-led vaccination services could help improve uptake, tackle health inequalities and reduce pressure on GPs by freeing up appointments.

“For this to be successful, pharmacy teams must have the right support in place, including appropriate funding, training and access to robust digital infrastructure.

“Consistent and sustainable commissioning across the country will also be key to delivering joined-up, person-centred care.”

Address populations’ unmet vaccination needs

Alastair Buxton, director of NHS Services at Community Pharmacy England, says: “We believe further commissioning of pharmacies to provide NHS vaccination programmes can help address falling vaccine coverage, particularly in relation to less well served groups of the population.

“Agreeing National Enhanced Services with NHS England is an approach we believe can support ICBs to easily commission community pharmacies to help address their populations’ unmet vaccination needs once ICBs take on delegated responsibility for vaccination commissioning in April 2026.”   

Another aspect of pharmacy’s involvement in sexual health is the Pharmacy Contraception Service (PCS). The DHSC and NHS England has increased the consultation fee for both initiation and repeat supplies of contraception to £25 (a 39% increase).⁴

“Suitably trained and competent Pharmacy Technicians will also be able to provide the service, supporting greater use of skill mix by pharmacy owners, where that fits within their business plans,” says the CPE briefing on the funding settlement for community pharmacy for 2024/25 and 2025/26.⁴

From October 2025, subject to the introduction of IT updates, the service will be expanded to include Emergency Hormonal Contraception (EHC), with a fee of £20 per consultation, plus the cost of any EHC provided to the patient.⁴

Mr Buxton says the introduction of the national Pharmacy Contraception Service was “a fantastic move for widening access and convenience for patients, and was something that Community Pharmacy England had long been advocating for”.

“The expansion to include emergency contraception is a natural step and we’re pleased to be rolling out this important new provision to further support women and girls.”

"The commissioning of a national emergency contraception service ends a postcode lottery of local authority commissioning and makes it easier for the public to understand what pharmacies can offer,” says Mr Gregg.

“Community pharmacies have a long track record in providing safe, convenient access to emergency contraception and other contraceptive methods. Providing consistent, standardised access to emergency contraception will significantly benefit women and increase efficiencies across the NHS,” says Ms Jones. 

“RPS had called for a commissioned emergency contraception service across England for many years to address inequalities in access but how that is configured is a matter of negotiation between the relevant bodies.⁵

“We are mindful of the intense pressures faced by community pharmacy which underlines the need for fair funding to ensure patients can continue to access a resilient community pharmacy network,” she says.

Service bundling is non-negotiable 

There is a contractual requirement that pharmacy owners register to deliver the bundle of three services – pharmacy contraception, hypertension case-finding and Pharmacy First – before June 1 this year - to get a monthly fixed payment.

On bundling, “data we have indicates that the majority of pharmacies were already signed up to provide all three of the bundled services prior to 1 June, but DHSC has been insistent in negotiations that ‘service bundling’ is non-negotiable if pharmacies are also to continue to be able to access fixed monthly payments for Pharmacy First”, says Mr Buxton.

"Providing a comprehensive and consistent package of NHS pharmacy services makes a lot of sense for patients, but we need to make sure this is rolled out in a way that pharmacies can manage,’ says Mr Gregg.

"It’s important to maximise the services pharmacies can offer, which means listening carefully to issues with implementation and ensuring that we don’t place barriers to pharmacies offering services that would limit the take up of brilliant services that patients really value," he says.

Ms Thakerar’s pharmacy has been providing all three services under the bundle - pharmacy contraception, hypertension case-finding and Pharmacy First - since they were introduced.

She says having to deliver the bundle of three services to get a monthly fixed payment is “putting pressure on some pharmacies".

“The Pharmacy Contraception Service from my perspective - and possibly a lot of other contractors as well - isn’t commonly used by women”, and uptake of the service is “very low”, she says.

Pharmacists are “reliant on referrals from GP surgeries for the Pharmacy Contraception Service”, she says.

“If we do not get a referral from a surgery, we cannot carry out a consultation, which means we lose out on the entire payment of the bundle, unless the patient walks in for the service.”

Given stretched pharmacy teams now have to spread their thin resources across the three services, this makes provision of contraception harder for them, she says. 

There is also the added pressure of training, and having the confidence to, and being comfortable with providing the Pharmacy Contraception Service, she says.

However, there are ways to help address these pressures, “to achieve your bundle target”, says Ms Thakerar. To help with the management of pharmacists' time in the pharmacy team, she recommends running a specific clinic to deliver the Pharmacy

Contraception Service at a certain time of the day, and recruiting another pharmacist to provide that service on an appointment only basis.

With the Pharmacy Contraception Service and Pharmacy First Service, pharmacists need to ensure any other pharmacists working at their pharmacy are trained and qualified to provide them.

And pharmacists can also talk to their GP surgeries to encourage them to make referrals to the Pharmacy Contraception Service, says Ms Thakerar. 

Looking ahead, “the commissioning of further pharmacy sexual health services has the potential to benefit both local communities and reduce pressure on other NHS providers”, says Mr Buxton.

“For example, we believe PCS should be developed into a more comprehensive women’s health service, such as through offering long-acting reversible contraception (for example, injectable contraceptives) and menopause advice, with prescribing of HRT.”

References

1. UK Health Security Agency (UKHSA) (2025) UKHSA publishes latest STI data. https://www.gov.uk/government/news/ukhsa-publishes-latest-sti-data

2. NHS England (2025) NHS and local government to roll out world-first vaccine programme to prevent gonorrhoea. https://www.england.nhs.uk/2025/05/nhs-and-local-government-to-roll-out-world-first-vaccine-programme-to-prevent-gonorrhoea/

3. NHS England (2025) Action needed for delivery of routine mpox and gonorrhoea vaccination programmes 2025. https://www.england.nhs.uk/long-read/action-needed-for-delivery-of-routine-mpox-and-gonorrhoea-vaccination-programmes-2025/

4. Community Pharmacy England (2025) Briefing 010/25: Funding Settlement for 2024/25 and 2025/26. https://cpe.org.uk/briefings/briefing-010-25-funding-settlement-for-2024-25-and-2025-26/

5. Royal Pharmaceutical Society (2024) RPS calls for a national EHC service in England. https://www.rpharms.com/about-us/news/details/rps-calls-for-a-national-ehc-service-in-england