A new report from the Primary Care Women’s Health Forum (PCWHF) highlights the challenges around the delivery of long-acting reversible contraception (LARC) for women across England. This is leading to a postcode lottery of access to contraceptive services. The report suggests solutions for service change, through Women’s Health Hubs, which can ensure access for all.
Long-acting reversible contraceptives are an attractive choice to many women. Lasting between 3 and 10 years, depending on type, they are more effective than user-dependent methods like the pill, patch and ring.
However, a perfect storm of funding, fitting, training and access means that not all women are able to receive LARC or know that it is a suitable contraceptive choice for them.
The new report, Workforce Needs Assessment to deliver patient access, provision and sustainability of Long-Acting Reversible Contraception (LARC) in primary care has been published today to shine a light on the situation and offer actionable solutions. Researched and written by Mimi Ismail and Lesley Wylde, published by the PCWHF, a membership organisation representing primary care clinicians with an interest in women’s health, with support from Public Health England. The report explores:
- Whether access to LARC services in general practice is at risk
- The challenges to maintaining services
- Organisational, commissioning and workforce needs
- Policy and service model recommendations.
The goal of the report is to ensure that ongoing and improved access to LARC for women in England is pushed up the women’s health agenda.
Drawing on the PCWHF’s recent survey of LARC provision, analysis of LARC services in six local authority areas and interviews with key stakeholders, the team analysed the themes to produce this important report.
- LARC provision is not deemed a priority when compared to other areas of healthcare and is not mandatory in primary care.
- The cost of LARC fitting is high and there are hidden associated costs.
- Many LARC-trained healthcare professionals are no longer fitting or are leaving the NHS.
- The cost of training is deemed expensive, there is little incentive to train, and it also requires backfill of HCPs whilst they are being trained.
- Women face a ‘postcode lottery’ of access to LARC services. Depending on who they see, women may not always be counselled on, or offered all contraceptive options available to them.
- When women do choose a LARC, this lack of counselling and training of healthcare professionals means they can often be wrongly referred for fitting, which is emotional for the patient, costing time and money.
- Common misperceptions can also make women reluctant to choose LARC.
- Commissioning impacts service delivery with the best results occurring where there is clear communication between commissioners and providers.
- Training nurses and other allied healthcare professionals in LARC fitting has the potential to relieve pressure on GPs.
Dr Anne Connolly MBE, Chair of the PCWHF, commented: “We’re proud to have launched our new report on long-acting reversible contraception and are very grateful to Mimi and Lesley for their hard work in producing it.
“Access to effective contraception is essential for women’s health and wellbeing. The ability to choose when and if to conceive is a reproductive right. There are challenges to access for women and also to the provision of the LARC services. We have made several recommendations to improve patient access, provision and sustainability of LARC across primary care.
“We believe that the centralised provision of women’s health services through Women’s Health Hubs offers an opportunity to increase capacity and streamline services, enabling more women to access to appropriate contraception. Providers, policymakers, and commissioners interested in the Women’s Health Hub service model can access the new Women’s Health Hub Toolkit, which is designed to support service change.”
The report makes a number of recommendations to improve access to LARC services for women across England. These include:
- Prioritisation of women’s health with integrated clinical leadership on contraception delivery from national to local level.
- Incentivisation schemes for improving access to a full range of contraceptive choices.
- Accountability from commissioners and providers to deliver and communicate a holistic approach to LARC access, to develop costed recovery and sustainability plans and specify access and outcomes metrics for benchmarking.
- National guidance to support commissioning with models of collaborative commissioning, fair fitting fees, return on investment, workforce planning tools and specification for a centralised self-referral booking system.
- New models of delivery such as Women’s Health Hubs, communication between stakeholders and providers, and a costed service model which can be adapted locally.
Women deserve to make informed choices and to be able to access the most appropriate contraception for them. With the Women’s Health Strategy for England due to be launched this year, putting increased emphasis on the need to deliver quality care for women, this report along with the suggested Women’s Health Hub model have the potential to address health inequalities for women and ensure they receive quality care, where and when they need it.
The full report is available to read on the Primary Care Women’s Health Forum’s website. It contains powerful stories from key stakeholders in contraceptive service delivery. One local authority commissioner told the researchers, “[There are] A lot of really passionate GPs around this topic. They do this [LARC fitting] because they think this is the right thing to do. We hope we reimburse them and see the business side of things as well, but they really care about this as a topic.”