Concerns and cautions about prescribing and deregulating emergency contraception: a qualitative study of GPs using telephone interviews

Objectives. We aimed to describe GPs' responses to a clinical scenario of a request for a repeat prescription for hormonal emergency contraception (EC), their views about over-the-counter availability and beliefs about absolute contraindications. Design. We conducted semi-structured tape-recorded telephone interviews with 76 GPs randomly selected from the medical registers of three health authorities which were chosen for high, medium and low prescribing rates for EC. Results. There was a wide variation in the number of times that GPs would be happy to prescribe EC to the same woman in a year. The content of the consultations appeared patchy. While 59 (77.6%) of the GPs said that they would discuss future contraception with the woman, only 16 (27.1%) said they would talk about possible side effects and 28 (36.3%) would discuss the timing of the next menstrual period and the possibility of method failure. Fifty-two of the practices had a family-planning-trained practice nurse, yet only four (7.7%) had arrangements whereby the nurse could provide EC. Unqualified enthusiasm for deregulation was rare. Concerns included that women would lose out on the benefits of the consultation; worries about the safety of the method; that some women might 'abuse' it by using it frequently; and that certain characteristics of the pharmacy might make it an unsuitable setting for provision of EC. Conclusions. This qualitative telephone survey revealed concerns about repeated use of EC and caution about the prospects of deregulation. Respondents were worried that pharmacists might not be able to address all of the features of the consultation that may be valued, yet in this sample nor do most GPs. Family-planning-trained practice nurses are an under-utilized resource and could act as a halfway house between provision by GPs and deregulation.