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3 Jul, 2023

On the Brink: Reality of LARC services in primary care

The PCWHF report has launched its new report, On the Brink: The reality of Long-Acting Reversible Contraception (LARC) provision in primary care examining the current issues surrounding payments, contracts and training for LARC in primary care

“Urgent action is needed to ensure sustainability and prevent further loss of services”

Top takeaways:

  • 49% thought there had been no change to the LARC training for new clinicians.
  • 43% said that they felt training had reduced.
  • Only 8% felt they had seen an increase in training.

For non-fitters or never-fitters, 89% were interested in training but: 

  • 25% cannot access training. 
  • 24% report there is not enough time to train. 
  • 23% say there is no practice support. 
  • 18% say the training is too costly. 

The Primary Care Women’s Health Forum is increasingly concerned about the viability of long-acting reversible contraception (LARC) fitting (implant and IUS/IUD) in primary care and the implications for wider women’s health and contraceptive care in the future if this is not addressed and prioritised.

Based on first-hand evidence from healthcare professionals in primary care, the forthcoming report provides an up-to-date overview of LARC fitting in the UK, comparing where we are in 2023 with the previous study from 2020. As well as providing an overview, the report also gives conclusions and offers recommendations. 

The report draws on newly collected quantitative and qualitative data from two surveys conducted in Spring 2023. 1119 healthcare professionals in the United Kingdom responded. It also refers to a survey conducted in 2020 of a total of 650 healthcare professionals across the UK. The report called upon fitters both past and present, as well as non-fitters, to gather an understanding of the current environment of LARC fitting.

The PCWHF has used these responses to shape the report and make sure it reflects the voices of healthcare professionals in women’s health across the country.


Funding 

Fees for fitting of LARC are still perceived to be inadequate, with respondents flagging this as a major issue, in many cases making the fitting unviable. A substantial proportion of respondents mentioned the service was costing them money and they, in turn, were incurring a loss to deliver. This was in line with 2020 results.  

The results of the study in 2020 and again in 2023 reflect the larger problem of limited funding for all indications, limited access to training, and limited training options. However, the demand for this service has remained the same, if not increased, in some areas.  

The results also highlight a need for commissioners and providers to work together to address this issue.

Variation in fees 

There remains a huge variation in reimbursement for fitting of LARCs across England for both insertion and removal and this has not changed since 2020. The variation in fees for fitting implants and IUS/D for all indications ranged between £25-£100+ with an average implant fitting between £25 and £75 and the average for an IUS/D procedure being £80. 

Training/workforce 

Training remains an issue with respondents saying it takes too long and is too expensive. Provision and access to LARC training continues to decline. Three years on, access to training and the cost of training/recertifying is still reported as a major issue.

Access to services and sustainability

Healthcare professionals have huge concerns about the impact that the loss of LARC services is having and will continue to have on women’s health. This includes waiting lists, and a de-skilled workforce in primary care. Some practices are continuing to perform services at a loss to support their local communities, however this is unsustainable in the long-term

Conclusions and recommendations 

The report provides a comprehensive and detailed analysis of the current issues surrounding LARC in primary care.

Recommendations based on the findings from both surveys include the following: 

  • A push for a national ‘fair’ fitting fee that covers the cost of running a LARC service is financially viable for primary care. 
  • To ensure LARC funding includes fitting for all indications (contraception and gynaecology).
  • Tackle inequalities and remove the current postcode lottery of care. 
  • To address training issues to support workforce and capacity. 
  • To review models of service and improve a patients journey whilst also making savings.
  • Advise community-based model of Women’s Health Hubs in line with the Women’s Health Strategy and explore access and spending the assigned £25 million. 

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