Modernising contraceptive services Charlotte Fleming, Consultant & clinical director Gwent Healthcare NHS 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 provided routine STI testing & routine contraception Contraception with medical complications Difficult IUD insertions & removals Difficult implanon removals Training clinics Complex GUM A model for the future

You rest, you rust