Audley Mills Surgery Family Planning Clinic and Training Programme for the Diploma Of

Audley Mills Surgery Family Planning Clinic and Training Programme for the Diploma of the Sexual and reproductive health care.

At Audley Mills Surgery , we provide all the long acting reversible contraception(LARC) methods —depot Medroxyprogesterone acetate injections, Intrauterine contraceptive devices (IUCD) and sub dermal implants ( SDI) in addition to offering the routine oral pills thereby offering our patient a wide range of contraceptive choices.

Two of our female GPs (Dr Horner and Dr Arikawe) are trained to provide the LARC methods and all our nurses can do routine pill checks. Dr Arikawe is also a Faculty Registered Trainer for the Faculty of the Sexual and Reproductive Healthcare (FSRH)and can train GPs for the Diploma of the sexual and reproductive health (DFSRH) and for the letter of competence(LOC) inSub dermal implants and Intrauterine devices.

18 months ago, we started a monthly family planning clinic which is also a training session for the DFSRH. The clinic is a 3 hour session offering LARCs and other contraceptive options. So far we have had 2 trainees; both are GP registrars from the practice, in future we hope to open this up to other trainees or GP from the local area. There has been fantastic feedback from the trainees and for patients using this service (seeattached).

In addition to the monthly (sometimes we book an extra session in the same month, depending on demand) family planning clinics, we also do routine IUCDs fitting in normal surgery session, thereby providing improved access and flexibility for our patients.

National Institute of clinical excellence (NICE) long acting reversible contraception guidelines in 2005 encouraged increase access to LARC methods as they are more cost effective than the combined contraceptive pill and will reduce the number of unintended pregnancies. The UK is lagging behind the rest of the world in its uptake of these methods. In Great Britain at around 12 % of women aged 16-49 in 2008-9 uses the LARC method. In Audley mills, the proportion of our eligible patients that use the LARC method is currently being audited but for reference, we fitted 88 IUS last year alone. We are likely to see an increase in these numbers as there has been a funding issue with the Southend family planning clinic who are now refusing to see Rayleigh patients and the family planning clinic in Rayleigh only open for 3 hours once a week

There are also non contraceptive benefits of the LARC especially the Levonogestrel Intrauterine device(LNG- IUS) which is also recommended by NICE as the first line non – pharmacological option to treat heavy menstrual bleeding (HMB) and this has been shown to decrease the rate of hysterectomy which was the only option in the 90’s to treat heavy menstrual bleeding.

We also offer the LNG-IUS to our post and premenopausal women who use this as a form of Hormone replacement therapy (HRT). NICE recommended that this can be used to provide the progesterone component of the HRT but only licenced for 4 years instead of the 5 years when used for contraception. Some of our patients have also found LNG- IUS useful for mood regulation in premenstrual syndrome (PMS). All these we provide in house without needing to refer to secondary care for the management of HMB and PMS. (From the last referral data, our referral rate to Gynaecology is 13% lower than the CCG average).