Looking at the SH:24 EHC service, Terry Maguire wonders if its ‘co-design’ took place in Northern Ireland or back in London where demographics and lifestyles are very different…

SH:24, the sexual health not-for-profit organisation, is to provide free emergency contraceptive services in Northern Ireland. The on-line service has been commissioned by the Public Health Agency (PHA) and, in a company press release reported by BBC, we are told SH:24 will be providing free EHC “to the patient’s door.”

There are two main reasons for this. SH:24 believes that for women access to normal sexual health services might be hampered by “carer responsibilities” or “embarrassment.”

EHC and, if needed, the contraceptive pill and STI testing kits (with follow-up antibiotics if required), are ordered on-line by completing a form. The order is assessed by clinical staff and, if deemed appropriate, EHC is delivered to the patient’s home by a partner pharmacy.

The partner pharmacy, based in Bristol and an emerging player in on-line medicine supply, will ensure the EHC supply is posted first-class to arrive the next day.

SH:24 is without doubt a well-intentioned and a well-managed outfit and there is nothing to suggest that it will provide anything but a quality service. It was set up by sexual health professionals and has been active in London and across Great Britain for some time, so it has a proven track record.

That said, I do wonder whether the service will add much to what is currently available. Does the involvement of SH:24 run the risk of diluting what is already a pretty good service? I’m referring to the Pharmacy First Sexual Health Service, which provides EHC, bridging contraception and advice on STIs. It is provided face-to-face, locally with a real person, a pharmacist.

PHA and SH:24 claim their service was “co-designed” by service users which is a major policy requirement for most new services funded by our health service. Co-design has been defined as “a process where people with professional and lived experience partner as equals to improve health services by listening, learning and making decisions together.”

I have, perhaps, been too cynical about service co-design. I understand and appreciate the principle behind the idea but worry that in some cases, particularly where commissioners are less experienced that the service providers making the funding pitch, the extremes of this policy might produce unintended consequences, delivering services that make public health worse rather than better.

For example, pharmacy-based needle and syringe exchange services have been available in N. Ireland for over 20 years and the service has had an important role in reducing blood-borne infections associated with needle sharing among high-risk drug users.

The pharmacies involved have found the service challenging as it often can be associated with antisocial behaviour that is seldom good for business generally. As a provider, I find the pharmacy service poorly funded.

Yet in recent times other agencies, particularly social enterprise bodies which claim to be reducing harms associated with injectable drug use, have become interested in providing this service too. They claim to have a finger on the pulse of high-risk drug users, they employ ex-users in the organisation as counsellors and they talk daily to uses on the streets.

Because of this they feel best positioned to define what a needle-syringe exchange service should look like. One social enterprise organisation is commissioned by PHA to provide a service which I can only assume has stuck strictly to the co-design policy.

Extern, a charity that supports offenders, has extended the needle and syringe service to be a call-out service. Users call the Extern Team and needles and syringes, along with other necessary paraphernalia, are delivered to any street-corner around Belfast city centre at very short notice.

For service uses this is the ideal. To get this level of service it is funded much more generously than the pharmacy service. Funding supports staff employment, vehicle maintenance and the basic cost of service delivery. In direct competition with the pharmacy service, I wonder if PHA has assessed which is more cost-effective?

Going back to the SH:24 EHC service, I wonder if the co-design took place in N. Ireland or was this done at the organisation’s base in London where demographics and lifestyles are very different.

Also, I wonder why PHA would provide a service in direct competition with a newly implemented pharmacy service where the client has direct face-to-face access to a healthcare professional who provides EHC free of charge there and then rather than waiting for Royal Mail to deliver (and pray there is no postal strike).

I risk sounding like a sore loser unable to compete in the brave new world emerging from a collapsing NHS. Perhaps I am but I need community pharmacy leaders to be as canny about new ideologies such as co-design so we can compete for services.

And I don’t become irrelevant when the NHS has been fully Americanised.

Terry Maguire is a leading community pharmacist based in Northern Ireland.