Abstract The London boroughs of Lambeth, Southwark, and Lewisham (LSL) have significant sexual and reproductive health (SRH) needs. Repeat use of levonorgestrel emergency contraception (LNG-EC) within 12 months is high in local pharmacies, indicating poor knowledge of and/or access to contraception. Access to contraception – and information about available methods – is important in helping women remain in control of their fertility and future. Until 1 April 2019, SRH pharmacy provision was disjointed and inconsistent across providers, with poor public health outcomes. In a novel, collaborative approach, we procured a new three-borough SRH pharmacy service centred on reducing unintended pregnancy and repeat use of EC by quick-starting women onto oral contraception or fast-tracking into long-acting reversible contraception (LARC), as well as providing a condom distribution service. Each person accessing the service receives a comprehensive consultation to discuss their preferred contraceptive method, assisted by digital technologies. This is the first instance of cross-border collaboration in primary care with a single service offer, payment structure and set of outcomes. It is also pharmacies' first experience competitively tendering for SRH services. Commissioners consider the challenges and learnings, including practicalities of cross-borough collaboration, engagement with key stakeholders, preparing pharmacies for competitive tendering, and mobilising a new service that required significant changes to practice. Given the novelty of such an approach, learnings and reflections from this process may support other commissioners in pursuing similar arrangements to improve SRH outcomes in primary care, and advance the involvement of pharmacists in SRH provision. External funding details