London LARC Network

1. London LARC Network Kevin Miles Head of Options UK

2. Introducing the LLN • Initiative of the London Sexual Health Programme • Commenced in April 2010 • Main aim is to support PCTs to develop mechanisms for improving access to LARC • Small steering group • Commissioning • Public health • Abortion services • SRH services • Medical & Nursing

3. Main barriers to increasing LARC uptake Lack of knowledge • Public not aware of options • Cultural issues • Public not aware of where to access LARC • Perpetuated by HCWs perceptions of LARC

4. Main barriers to increasing LARC uptake Training • Getting practical completed • Funding training • Improving Choices Programme seen as good although providers don’t know who has been trained • Maintaining competence • RCN £400 accreditation – providers going it alone • LARC training geared around contraception providers – need to consider alternative settings like abortion services • Willingness of staff to be trained

5. Main barriers to increasing LARC uptake Commissioning of services • Services that receive no funding • Capped budgets • Multiple and complex commissioning in general practice • Inequality of commissioning pathways

6. Main barriers to increasing LARC uptake Referral pathways • Service don’t know where to refer • Pathways that don’t work • Pathways for removals

7. Main barriers to increasing LARC uptake Data • Complex and incomplete data • Data from GUM not disaggregated - only P3 code • Who is currently trained and providing LARC unknown • Removal data skewed by ‘routine’ removals • Confusion over London target

8. Overcoming barriers • Equitable & informed commissioning • More efficient training pathways • Consistent data • Better knowledge & awareness • Clear referral pathways

9. Workplan 2010-2012 LARC in General Practice • Appoint London x8 GP LARC Champions • Appoint a London SRH Primary Care Lead Dissemination of Good Practice • Develop LLN Newsletter and utilise LSHP website to disseminate LLN progress, general information and clinical updates on all issues relating to LARC commissioning and service provision • Host London LARC Event • Showcasing and sharing successful models of: training and assessment Training Issues • Clarification on what prerequisites clinical staff require before undertaking LARC training • A pan-London standard for assessing competence and accreditation of nurses • Update and disseminate a bimanual training package for nurses • Lobby for the standardisation of training/accreditation fees

10. Commissioning • Prepare for new commissioning arrangements • Educate and lobby commissioners for an evidence informed, client centred choice approach to contraception provision, including abortion services Clinical Practice • Sharing of standardised patient group directions (PGDs) for nurses • More detailed evidence on implant removals and sharing of good practice where removal rates are low • LARC service provision commissioning practice • A consistent set of READ codes for general practice electronic patient record (EPR) systems • Lobby for the inclusion of nurses to insert implants and IUDs • A London network of services who can do deep implant removals and clear referral pathways and cross charging mechanisms for these services • Contemporary LARC user experience and acceptability data

11. For further information… Alexis Palfreyman at Options UK • 0207-430 5181 • a.palfreyman@options.co.uk • www.londonsexualhealth.org