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Concerns about the future of LARC provision in primary care

Concerns about the future of LARC provision in primary care. Dr Anne Connolly GP Clinical Specialty Lead for maternity, women’s and sexual health; Bradford City, Bradford Districts and AWC CCGs Chair of the Primary Care Women’s Health Forum. Contraceptive Choice Project.

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Concerns about the future of LARC provision in primary care

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  1. Concerns about the future of LARC provision in primary care Dr Anne Connolly GP Clinical Specialty Lead for maternity, women’s and sexual health; Bradford City, Bradford Districts and AWC CCGs Chair of the Primary Care Women’s Health Forum

  2. Contraceptive Choice Project Contraceptive method choices after counselling (N=2,500)1 Long-acting Shorter-acting 33% 67% 69% of 14-17 year-olds chose a LARC with 63% of these choosing an implant2 • LARC=long-acting reversible contraceptive. • Secura GM et al. Am J Obstet Gynecol. 2010;203:115.e1–115.e7 • Mestad et al. Contraception 2011;84:495-8.

  3. Contraceptive Choice Project Pill Patch Ring Winner et al. N Eng J Med 2012

  4. A statistically significant association was observed between the increase of LARC usage in women aged 15-17 and the decrease of conception rates in that age group in England between 1998 and 2011 Evaluation of long-acting reversible contraceptive use, teenage pregnancy and abortion rates in England - is there an association?Connolly A, Pietri G, Yu J, Humphreys S (awaiting publication) Adjusted R2=0.91 P-value=0.002‡ * Per 1,000 women aged 15-17 † In thousand cycles sold ‡ Multiple regression of LARC usage on under 18 conception rates adjusted for time – LARC coefficient estimate = -0.0104

  5. Evaluation of long-acting reversible contraceptive use, teenage pregnancy and abortion rates in England - is there an association?Connolly A, Pietri G, Yu J, Humphreys S (awaiting publication) † P-values for rate of change over time ‡ P-values for the association between the rate change and LARC usage

  6. Commissioning changes

  7. What are our challenges? • Priorities – keeping contraception on the agenda • Trained clinicians – and future proofing • Funding – ring fenced until 2016 and then? • Commissioning – new, non-clinical commissioners • Communication - new teams • Planning – ‘procurement rules’ • Commissioning of contraception for non-contraceptive purposes – HMB pathways

  8. PCWHF survey • The purpose of the survey was to obtain a snap shot of the state of Women’s Sexual and Reproductive Health Care Provision across England, and to ascertain any impact that the new commissioning arrangements may be having  

  9. PCWHF survey • What is your role? • Which CCG do you work in? • Are you involved in commissioning? • Are you currently reimbursed for a contraceptive enhanced service? • Are you currently reimbursed for a sexual health enhanced service? • Did you have an enhanced service where funding stopped in April 2013? • Do you know if your contract for enhanced service provision ends in April 2014? • Have you seen any other changes to your local contraceptive service?

  10. PCWHF survey representing 72% (151/211) of the English CCGs. Table 1. Response to Survey: *answers to question 2 of survey “Which CCG do you work in” either not completed, or information not sufficiently specific to determine if located within England.

  11. PCWHF survey Figure 2. Professional designation of respondents

  12. PCWHF survey Percentage of responses currently reimbursed for enhanced contraceptive services.

  13. PCWHF survey • Enhanced service payment changes:

  14. PCWHF survey • Multiple different enhanced services and payments • Confusion about current/future changes • Few providers involved with commissioning decisions • Lack of direction • Reduction in services • Training implications • Planning implications • Poor communication between Public Health commissioners and providers

  15. PCWHF survey • Concerns: • What happens to older women >25 • What happens to recharging • Where are LARC device costs • Heavy Menstrual Bleeding pathways • Cervical cytology • Choice of providers • Clinical governance • Training

  16. PCWHF survey • Recommendations: • Better communication between the new commissioners and providers so that they can plan, organise training and develop new clear pathways for future service delivery (including for non-contraceptive use of LARC) • CCGs must be kept informed of service changes via the Health and Well Being Boards. The risk of service delivery becoming less accessible or acceptable could have an impact on extra costs to the CCG in TOPs and gynaecology referrals

  17. Thank-you anne.connolly@bradford.nhs.uk

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