Pharmacy Contraception Service: Oral Contraception and Emergency Contraception

About this service

The NHS Pharmacy Contraception Service (PCS) is an Advanced Service enabling community pharmacies to initiate and supply oral contraception (OC) and oral emergency contraception (EC) under Patient Group Directions (PGDs). The service launched in April 2023, expanded to include initiation in December 2023, and was further extended from 29 October 2025 to include oral EC, provision by pharmacy technicians, and the addition of drospirenone to the progestogen-only pill (POP) formulary.

The current service specification is version 3.0 (valid from 29 October 2025; expiry 28 February 2029). Supply under the PGDs must be made by a GPhC-registered pharmacist or pharmacy technician who is authorised and competent to use the PGDs. Blood pressure and BMI measurements may be taken by a suitably trained pharmacy team member before the consultation.

The service does not require the person to be registered with a general practice. Verbal consent to receive the service must be obtained and recorded before the consultation begins. With the person's consent, the pharmacist or pharmacy technician should check the GP record via GP Connect before initiating or supplying.

Who to offer the service to

Include

• Any individual seeking initiation of oral contraception for the first time, restarting after a pill-free break, or switching to a different pill.
• Any individual seeking an ongoing supply of OC previously initiated in primary care or a sexual health clinic.
• Any individual seeking oral emergency contraception following unprotected sexual intercourse (UPSI) or where regular contraception has been compromised.
• Age ranges: COC from menarche to 49 years; POP (norethisterone, levonorgestrel, desogestrel) from menarche to 54 years; POP (drospirenone) from menarche to 49 years.
• Under 16s: supply is permitted if the individual is assessed as competent using Fraser Guidelines. If under 13, contact the local safeguarding lead and follow local safeguarding policy.

Exclude

• Individuals under 16 who are assessed as not competent using Fraser Guidelines.
• Individuals 16 or over assessed as lacking capacity to consent.
• Individuals assessed as clinically unsuitable or excluded under the relevant PGD (see clinical exclusion tables below).
• Advance supply of oral EC is not permitted under this service.
• Distance selling pharmacies (DSPs) cannot offer face-to-face consultations; they may deliver the service remotely but cannot measure BP or BMI on pharmacy premises.

How to deliver the service

1. Confirm the reason for attendance. Determine whether the person is seeking OC initiation, ongoing OC supply, or EC. This determines which PGD applies and the urgency of the consultation. For EC, respond as soon as reasonably possible given the time-sensitive nature of efficacy.
2. Obtain verbal consent and check the GP record. Record verbal consent to receive the service before proceeding. With consent, check the GP Connect record or equivalent. If the individual does not consent to GP record sharing, the consultation can still proceed; a notification to the GP practice will not be sent.
3. Assess blood pressure and BMI. Blood pressure and BMI must be assessed and recorded before COC supply. Measurements may be taken directly in the pharmacy or, where permitted by the PGD, obtained from recent records or self-reported by the individual and assessed as clinically appropriate. Self-reported values must be recorded as such.
   • Use a BIHS-validated blood pressure monitor if measuring in pharmacy.
   • Current or treated hypertension, or a reading above 140/90 mmHg, is an absolute exclusion for COC regardless of current treatment.
   • BMI assessment is required for COC. BMI 35 kg/m2 or above is an absolute exclusion for COC.
   • For EC: consider weight or BMI if clinically relevant (levonorgestrel EC is less effective over 70 kg or BMI above 26; ulipristal acetate is preferred in these cases).
4. Take a clinical history and screen for exclusions. Take a relevant medical, sexual, medication, and family history. Screen against the PGD exclusion criteria for the chosen method. Use the UKMEC framework and shared decision-making tools (Brook, Contraception Choices) to support the consultation.
   • Ask specifically about: migraine (with or without aura), history of VTE or clotting disorders, cardiovascular disease, tobacco smoking and nicotine vaping status, recent childbirth, breastfeeding, planned surgery, and current medicines including herbal products and OTC items.
   • Always ask about a current or previous diagnosis of meningioma before supplying desogestrel-containing products (POP or COC) or Zoely.
   • Enzyme-inducing drugs (including rifampicin, carbamazepine, phenytoin, and St John's Wort) exclude both COC and POP under the PGD. Refer to a prescriber.
   • GLP-1 receptor agonists may affect oral contraceptive effectiveness through delayed gastric emptying and gastrointestinal adverse effects. Follow current CoSRH guidance and provide the relevant patient information leaflet where indicated.
5. Choose between POP and COC. See the clinical decision table below. POP is suitable for most individuals, including those for whom COC is excluded. COC offers additional non-contraceptive benefits (cycle regulation, dysmenorrhoea, acne) but carries cardiovascular and thromboembolic risks that require careful assessment.
6. Choose the specific product. See the product selection tables below. For COC, the PGD recommends a preparation containing 30 mcg ethinylestradiol with levonorgestrel or norethisterone as a reasonable first-line choice to minimise cardiovascular risk. Refer to the local ICB formulary for any preferred product restrictions.
7. Discuss and supply. Discuss LARC as a more effective alternative for all individuals. Supply up to 3 months on initiation, in accordance with the PGD and clinical judgement. For ongoing supply, provide 6 to 12 months (minimum 6 months unless there is a documented clinical reason for a shorter supply). Provide the patient information leaflet, missed pill guidance, and counselling as set out below.
8. Record and notify. Record the consultation contemporaneously in the NHS-assured IT system. Send a notification to the individual's general practice on the day of supply or the following working day, unless consent was withheld. Claim via MYS as part of the normal month-end process.

POP or COC: key clinical decision factors

Any one of the following factors excludes COC under the PGD. POP remains an option unless the individual also has a specific POP exclusion.

This table is a clinical aide-memoire based on the PGD exclusion criteria. Always refer to the current PGD and UKMEC for full clinical decision-making.

POP product selection

All POPs listed in the BNF can be supplied under the PGD. Choose in line with the local ICB formulary.

Desogestrel 75 mcg is generally the preferred first-line POP as it inhibits ovulation and has a more forgiving missed pill window. Drospirenone has important additional exclusions; check these carefully before supply.

COC product selection

The PGD recommends a preparation containing 30 mcg ethinylestradiol combined with levonorgestrel or norethisterone as a reasonable first-line choice to minimise cardiovascular risk. Refer to the local ICB formulary.

Desogestrel-containing COC (Mercilon, Marvelon, Gedarel) and Zoely are excluded in individuals with a current or previous meningioma. All monophasic COC products can be used in standard or tailored regimens (extended and continuous use) in line with CoSRH guidance.

Oral emergency contraception: choosing the right option

The PCS PGD for oral EC covers both levonorgestrel (LNG-EC) and ulipristal acetate (UPA-EC). Always discuss more effective EC options, including the copper intrauterine device (IUD), which is the most effective form of EC available.

The copper IUD is up to 99% effective as EC and should be mentioned in all EC consultations. Signpost individuals who want an IUD to a GP, sexual health clinic, or equivalent. After LNG-EC, regular contraception can be restarted immediately. After UPA-EC, delay restarting hormonal contraception for 5 days and advise barrier contraception in the interim.

Counselling essentials for every consultation

• Discuss long-acting reversible contraception (LARC) as a more effective alternative at every OC consultation: intrauterine device (IUD), intrauterine system (IUS), or contraceptive implant. Signpost to where the individual can access LARC if preferred.
• Oral contraception does not protect against sexually transmitted infections (STIs). Recommend condom use and signpost to STI testing services where appropriate.
• Missed pill guidance varies by pill type: 3-hour window for levonorgestrel and norethisterone POP; 12-hour window for desogestrel POP; 24-hour window for drospirenone POP; 7-day window for COC (9 days for Qlaira). Refer to CoSRH guidance for full missed pill rules.
• GLP-1 receptor agonists may affect oral contraceptive effectiveness through delayed gastric emptying and gastrointestinal adverse effects. Follow current CoSRH guidance and provide the relevant patient information leaflet where indicated.
• Enzyme-inducing medicines (including rifampicin, some antiepileptics, St John's Wort): both COC and POP are excluded under the PGD. Refer to a prescriber.
• Mood changes and depression: advise individuals to report mood changes or depressive symptoms shortly after starting. This applies to both POP and COC.
• Breast cancer: all hormonal contraception is associated with a small increased risk of breast cancer which reduces after stopping.
• COC only: advise the individual to stop the COC and seek urgent medical help if they develop calf pain or swelling, shortness of breath, chest pain, or their first ever migraine or new aura symptoms. Stop COC at least 4 weeks before planned major surgery or a period of expected immobility.
• COC only: cervical cancer risk is slightly increased with COC use beyond 5 years; risk reduces after stopping.

Recording and submission

• Record verbal consent, including Fraser Guideline assessment if the individual is under 16.
• Record relevant medical, sexual, medication, smoking, and family history.
• Record blood pressure and BMI for COC; record as self-reported if values were provided by the individual and assessed as clinically appropriate.
• Record the name, strength, and quantity of medicine supplied; the PGD under which supply was made; and all advice given.
• Send a GP notification on the day of supply or the following working day, unless the individual did not consent to sharing.
• If supply is not made: record the reason and any referral or signposting given.
• Retain records in the NHS-assured IT system for 3 years for post-payment verification; longer if relating to a child or as required by NHS Records Management guidance.
• Submit payment claims via the MYS portal as part of the normal month-end process. Claim window is 3 months from the end of the claim month.

Key takeaways

• COC supply requires assessment and recording of blood pressure and BMI. Current or treated hypertension, tobacco smoking at age 35 or over, migraine with aura, and certain cardiovascular risk factors are absolute exclusions under the PGD.
• Desogestrel (12-hour window) is generally the preferred first-line POP; drospirenone (Slynd, from October 2025) has a 24-hour missed pill window but carries significant additional exclusions including renal impairment, diabetes, and medicines that raise potassium.
• GLP-1 receptor agonists may affect oral contraceptive effectiveness: follow current CoSRH guidance and provide the patient information leaflet.
• LARC must be discussed at every OC consultation as a more effective alternative, and oral contraception does not protect against STIs.

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