From the Trainer
Assistant Director (GP), South East Scotland, UK
E-mail: Judith.Richardson{at}nes.scot.nhs.uk
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Working in a University Health Service, I find a significant proportion of my consultations are related to sexual health matters and in particular contraception. The majority of the students still favour the combined contraceptive pill or at least that is what I thought until I attended a recent family planning update as part of my Personal Development Plan (PDP).
The Health Care Research Partnership were commissioned to do a market research study with women in Scotland looking into the attitudes of women to long-acting and reversible contraception (LARC). This was qualitative research with eight group discussions with 55 women of contraceptive age including 13 University Students. The work was therefore highly relevant to my clinical practice. The main learning points from this presentation for me were that:
- The use of language is very important as apparently the word ‘long acting’ was associated with a negative image, whereas ‘lasting’ was associated with a positive image of contraception.
- That to avoid talking about being sexually active, many women would ask for ‘the pill’ not necessarily because they wanted the combined contraceptive pill but because this was a way of introducing the idea that they would like to discuss contraception.
- That many women had little knowledge of LARC, but wanted to be told about it and that for those at University, it would be a very acceptable form of contraception.
- There is going to be a public campaign to raise awareness of LARC in the autumn.
So having learnt something from the presentation, what did I do with that newly found knowledge?
I thought about the service we are offering our patients for LARC. We currently have a doctor in the practice who is developing a special interest in sexual health and as part of this has been inserting implants, intrauterine devices (IUD) and intrauterine systems (IUS) for the past year. The nurses provide progesterone injections under a Patient Group Directive. We have advertised this service in our practice leaflet and the other GPs and nurses in the practice refer patients to her. Patients are seen within her normal appointment surgeries. In the autumn, the training post comes to an end and the doctor may leave the practice. This highlighted several issues for me:
- The current system for getting LARC was not easily accessible to the patients
- We were not actively promoting and informing our patient group about a valuable method of contraception
- The service we were currently providing was threatened as no one else in the practice was able to insert IUD/IUS
To address these issues, I arranged a meeting with the doctor and lead practice nurse to discuss how we could improve the service we are offering to our patients. We agreed that the number of patients wanting LARC was high enough to justify a weekly clinic to provide this service, with a nurse and doctor consulting in parallel. The nurses were keen to extend their role and be trained in insertions and they should attend the local family planning clinic for training. We were inserting enough IUD/IUS for two clinicians to maintain their skills in this procedure and therefore a second doctor would train to do this, thereby protecting the service for the future. We agreed that we should actively promote the service through the practice leaflet, website and posters in the waiting room. We would also raise awareness among our colleagues of the need to discuss LARC when someone asks for the pill, as the patient is not necessarily wanting a pill but requesting advice about contraception, through our clinical meetings.
Having agreed what we wanted to do, the next step was to agree the time-frame to introduce the changes. As we are approaching the end of the academic year, the obvious time to implement these was at the start of next academic semester which would also coincide with the national campaign to promote LARC. The only issue remaining to address was who would be the second clinician trained in IUD/IUS insertion.
So, I find myself back at the local family planning clinic retraining in inserting IUD/IUS some 10 years after I stopped inserting them in the practice. I am loving it, not only relearning a skill that I had let lapse but also new techniques such as cervical blocks to help with insertions in our predominately nulliparous patients. It is also interesting being on the receiving end of ‘education’ and has helped to remind me of the difficulties and anxieties associated with learning something new. That having an encouraging teacher in a positive educational environment is very important.
And I thought I was just attending a family planning update course to tick off my PDP for the year!
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