Cervical Screening Update  Cervical Screening  Pathways  IUCD/IUS& implant LCS  Camden fertility services commissioning policy  HRT guidance  Female Genital Mutilation

Cervical Screening in practice  Practice cervical screening protocol  Processing smears in Camden  Coding smears  EMIS- smear results not back  Right First time UCH cytology screening officer NHS England cancer screening

Pathways   Female urinary incontinence   Heavy menstrual bleeding   Irregular vaginal bleeding   Secondary amenorrhoea or oligomenorrhoea   Polycystic ovarian syndrome   Infertility   Vulval Problems

{

IUCD/IUS& implant LCS  New LCS to include implants  Complete service form for IUCD / IUS or implant   appendix 1 Practice information   appendix 2 Details of clinicians   appendix 3 Informing CCG of changes  Complete an annual quality monitoring audit  Claim for payment on a quarterly basis manually  Improved clinical governance  Planned template & electronic collection of data

Camden fertility services commissioning policy  Fertility: Assessment and treatment for people with fertility problems. Issued: February 2013 NICE clinical guideline 156  Female age, eligibility, iui  Under review- until agreed, use Camden’s commissioning policy on GP website  Individual funding request

HRT Guidance  New guidance from mmt  Available on GP website  NICE CKS: menopause revised June 2013  British Menopause Society Council Consensus Statement on Hormone Replacement Therapy 23/5/2013  WHI (women’s health initiative study)

What is FGM?   Form of child abuse   Physical & psychological consequences.   "procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons" (WHO, 2013).   1985 Prohibition of Female Circumcision Act- serious criminal offence to perform FGM or to assist a girl to perform FGM.   Female Genital Mutilation Act criminalise FGM being carried out on UK citizens overseas.

Statistics for UK  estimated 66,000 women with FGM in UK  >20,000 girls under 15 yrs are potentially at risk of FGM (England and Wales)  ref: “A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales: Summary Report”, FORWARD 2007  ? Numbers in Camden

WHEN AT RISK OF FGM At birth Infancy Teenagers After childbirth Neonatal period ChildhoodBefore marriage Nigeria, Eritrea & Mali, most girls undergo FGM before 5yrs Somalia & Chad, most girls undergo FGM 5- 9 yrs Kenya & Egypt, most girls undergo FGM after 10yrs 50% of cases FGM is carried out before the age of five Malaysia many under 1 yr When at risk of FGM

Proposed changes   Girl summit 22/07/14- UK gov and UNICEF   DH FGM prevention programme- recording FGM- how new rules affect GPs   Recording FGM in patient notes   NHS hospitals to record if pt has had FGM, FH FGM or if FGM related procedure has been carried out   Mandatory reporting- ?? statutory duty to report to police if FGM has occurred

Camden’s prevention programme  Camden’s multiagency FGM action plan  Raise awareness and training  Standardise coding  Develop a process for sharing information (midwife/ health visitor/ school nurse/ GP/ paediatrician)  Referrals into tertiary clinics  Liaise with multi-agency groups (police /social care)

Advise patients / families  FGM unlawful and harmful  Encourage to speak to police as a crime has been committed  Speak in confidence to Crime stoppers on  NSPCC FGM dedicated 24/7 helpline offers counselling & advice to public & professionals

Recording and coding   GPs/ practice nurses to check for FGM when taking a smear or performing a VE   Consider at sti screening, family planning, travel immunisations   Code Family history of Female Genital mutilation 12b Female Genital Mutilation K578 Deinfibulation of vulva 7D045 Deinfibulation of vulval to facilitate delivery 7F1B5

Resources   Practice managers to obtain ’passport’ opposing-female-genital-mutilation opposing-female-genital-mutilation   Posters for the practice   Training- Deborah Hodes

Is the child acutely sick, in pain, bleeding or has “medical” problems? YesNo Will the child be at immediate risk of abuse when he/she leaves the surgery? No Discuss with Mon- Fri 9-5 Child Protection Team Hotline Tel Refer for assessment to the Safeguarding Children Clinic Child Protection Team, Crowndale H.C 59 Crowndale Road, London NW1 1TU Fax Not Sure Discuss with Mon-Fri 9-5 Child Protection Team Hotline Tel GP Child Protection Lead Claire Taylor Designated Nurse for Safeguarding Children Jackie Dyer Tel Designated Doctor for Safeguarding Children Deborah Hodes Duty Social Worker Team Out of Hours On call Paediatric Registrar at acute trust Yes Refer to Mon - Fri 9 -5 Duty Social Worker Team Contact either Tel (North Team) Tel (South Team) Out of hours Or dial 999 in emergency NB. All referrals to be followed in writing within 48hrs Contact the on-call Paediatric Registrar University College Hospital Tel Whittington Hospital Tel Royal Free Hospital Tel You see a child and suspect abuse or neglect Child Protection Guidelines for General Practitioners in Camden