Modernising contraceptive services

Charlotte Fleming,Consultant & clinical directorGwent HealthcareNHS Trust

The patient’s experience: where to go?

• Clinics well advertised: GPs, pharmacists, phone directories, schools?

• May have been advised or brought to clinic by outreach worker

• Daytime, evening & weekend clinics• Open access and appointed clinics• Fewer sites, more sessions per site• Condoms from youth/ outreach workers• EHC (?C/T testing) from pharmacist• EHC within 24 hrs, appointments within 48 hrs• May have been involved in planning services!

The patient experience – on arrival

• GUM and contraceptive services share same building, reception, multi-use clinical rooms (not records yet)

• Males and females in waiting room• Statements on confidentiality & chaperones in waiting

room• Long waiting times (standard =max 2 hrs)• Patient self triage• Demographics recorded electronically• Repeat condoms – clerk can give• Questionnaire & self taken samples for chlamydia testing

done by clerk• Clerk trained in confidentiality & child protection

The patient experience:in the consulting room 1

• COC, POP, depo-provera, smears, chlamydia testing, IUD removal done by a (band 6) nurse under PGD/PSD

• IUD & implanon insertion by doctor or nurse• Supported by health care assistant• LARCs promoted• Evidence-based checklists in line with national

standards used for each method• Electronic patient record

LARCS

• All LARCS are more cost effective at 1 year of use than oral contraceptives

• IUDs and implants are more effective than injectables

• Typical failure rate of COC = 8% pa• IUDs can be used by nullips, teenagers• New partners cause infection, not IUDs!• IUDs don’t cause ectopic pregnancies• Continuation rates of LARCs is higher than OCs• No evidence depo/ implants cause mood

changes

The patient experience:in the consulting room 2

• May be given advance EHC, or 12 months of OCs

• Chlamydia NAAT testing for females by nurse• May get advice, information & onward referral (in

12 weeks) for medical gynaecology issues eg menopause, menorrhagia, PMS, ‘complex’ STIs, abortion, psychosexual counselling

• May be seen in training clinic

The patient experience: after leaving the clinic

• Clerk can give negative results over the phone

• Patient receives result by text• Community based nurse will undertake

contact tracing & treatment• Patient can check her own IUD threads.

Annual checkups not required• No follow up for implanon• Patients overdue for depo are not chased

Behind the scenes

• Services are consultant (MFFP) led, supported by secretary and good management team.

• Service is part of a Sexual Health Unit (abortion, STIs, HIV, psychosexual counselling)

• Computerised data collection, analysis• Service conforms to standards set by WAG, FFPRHC• Revalidation means staff are more dedicated, nursing

careers developing• Doctors and nurses work in both GUM and community• Service is actively involved with commissioning, budget

management, cost efficiency, performance reporting

Get business-like!

Gwent’s challenges in modernising contraception services

• Abandoning the term family planning!• Introducing patient self triage –

challenging former roles of ALL staff• Developing nurse confidence• Struggling with legalities of PGDs/ PSDs• Getting money for computer system• Urine testing for chlamydia not available• Shortage of staff grade doctors

Nurse providedroutine STI testing

& routine contraception

Contraception with medical complications

Difficult IUD insertions &

removalsDifficult

implanon removals

Training clinics

Complex GUMComplex GUM

Complex GUMComplex GUM

A model for the future

You rest, you rust