Assessment prior to COC supply

In future community pharmacists will be authorised to initiate COCs, so this section is included to give an overview of the assessment process: 

The NICE Clinical Knowledge Summary on contraception assessment (updated February 2023) suggests the following, which is largely based on NICE guidance on LARC use and the World Health Organization’s family planning decision-making tool:

Discussion of the patient’s needs and personal circumstances including:

• Potential to currently be pregnant
• Preferred method of contraception
• Future plans for having children
• Personal beliefs and views about contraception
• Attitudes of partner and family towards contraception.

Provision of information – which should be accessible and easy to understand (e.g. using resources such as those provided by the NHS or the FPA) on all contraceptive methods including long acting reversible contraception (LARC) to inform individual choice, including at least:

• Relative efficacy
• Method of action
• Common adverse effects
• Possible drug interactions
• Health risks and benefits
• Impact on subsequent fertility.

Assessment of suitability of the different contraceptive methods for the patient (referring to the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) for hormonal and intrauterine methods and WHO Medical Eligibility Criteria for Contraceptive Use for other methods), taking into consideration the following factors:

• Comorbidities such as hypertension and migraine
• Allergies including to latex or anaesthetics
• Lifestyle factors such as smoking
• Reproductive history (i.e. postpartum or breastfeeding)
• Medication (to check for the potential for interactions)
• Age, particularly whether the patient is approaching menopause or under 18 years.

Assessment of risk of sexually transmitted infections (keeping in mind that key groups at risk of STIs include the under-25s, people who frequently change sexual partners, sex workers, men who have sex with men, and individuals from or who have visited and been sexually active in areas of high HIV prevalence), taking into consideration the following:

• Local prevalence of STIs
• The individual’s current circumstances, including age of onset of sexual activity, type of sexual activity, current and recent sexual partners, current age and sexual activity, use of alcohol/other substances.

Assessment of risk of sexual abuse, rape and non-consensual sex, particularly if the person is vulnerable (e.g. under 16 years, from a disadvantaged background, in or leaving the care system, low educational attainment).

Consideration of other relevant legal and ethical issues, including:

• Ability to give consent to treatment if under 16 years including documentation of Gillick competence
• Disability, whether relating to physical ability or learning needs. Patients should be supported to make their own decisions, with an assessment made of competence to provide and express informed consent. If they are not able to understand or take responsibility for decisions about contraception, carers and other involved parties should establish a care plan.

Having followed the above, the option that is most appropriate and acceptable to the patient should be offered.