1. LARC for London Conference Nurses and LARC Kathy French RN, BSC (Hons) PhD, MPhil 2 nd Dec 2011 The London Sexual Health Programme

2. Aim of this session Look back in time? Training Programmes/accreditation/re- accreditation Use of Patient Group Direction (PGDs) The role of Higher Educational Institutes (HEIs) in preparing nurses for this role? Highlight what nurses are doing in London in terms of LARC Links with practice nurses The London Sexual Health Programme

3. History of nurses and LARC In some parts of the world, nurses, midwives and physician assistants fit IUDs and SDIs as part of their role. Sweden, some states in America, South Africa, Vietnam and others In the late 1970s at Kings College Hospital London, six nurses in contraception were trained to fit IUDs

4. Nurses and LARC The clinics would fit as many as ten+ IUDs in one session The nurses were trained and supervised by the doctors and each nurse was assigned to a doctor until she was deemed competent Little was written about this work apart from a small piece in a midwives magazine -The Chronicle of Midwives 1979 The London Sexual Health Programme

5. Nurses and LARC In 2001/02 guidelines were drafted with others for nurses in the insertion of SDIs and IUDs These guidelines were based on the FSRH guidelines for doctors In 2005 we held two theory days at the RCN on IUDs and SDIs – both were over subscribed

6. Nurses and LARC The Margaret Pyke took this on and offered theory days in London and Birmingham This lead to many nurses in the four countries seeking accreditation at the RCN More nurses are inserting SDIs Re accreditation is every five years with a stated number of IUD/SDI to be fitted each year to maintain competencies

7. Nurses and LARC Nurses must hold a recognised course in contraception/sexual health See enough women seeking contraception to ensure they get enough wanting LARC Have the support of their manager to do this work Audit their work Ensure they have PGDs in place for the SDI, IUS and Lidocaine

8. Nurses and LARC Issues and barriers to training? Some nurses get trained without meeting the criteria It is not the responsibility of the trainer to ensure they have met the RCN criteria Vicarious liability rests with the employer Need to be a member of a professional body and union Cost of training and accreditation

9. Nurses and LARC Many nurses in SHS in London are fitting SDI’s and IUD/IUS’s Audit showed that over 126 nurses were fitting SDIs and 37 fitting IUDs (Nov 2011) Lewisham and Camden over 20 in each service but some services none. It may not be necessary for nurses to be trained in LARC? No feel for what practice nurses are doing in London? The London Sexual Health Programme

10. Nurses and LARC Few nurses are training others at the moment (external nurses) Many London nurses are not seeking RCN accreditation because of the increased fees (£300 for members and £400 for NM Pan London ‘standard’ drafted and on the LSHP website linked to the RCN/FSRH gold standard Pelvic bi -manual training needed for IUD/IUS

11. Nurses and LARC Encourage nurses who are training to write about their work More coordination is needed in London to link practice nurses with SRH services and the GP champions have assisted with this in some areas Empower women to ask about LARC Dispel the myths and separate the financial barriers to LARC The London Sexual Health Programme

12. References Faculty of Sexual and Reproductive Healthcare www.fsrh.orgwww.fsrh.org NICE – Long acting reversible contraception (2005) www.nice.org.ukwww.nice.org.uk Royal College of Nursing (2011) Intrauterine techniques (IUT) www.rcn.org.uk www.rcn.org.uk Royal College of Nursing (2011) Inserting and removing SDI www.rcn.org.ukwww.rcn.org.uk The London Sexual Health Programme

13. References London Sexual Health Programme www.londonsexualhealth.org The London Sexual Health Programme

14. Nurses and LARC Thank you all kathy.french@btopenworld.com