GP cash incentive to promote long acting contraceptives

@Standrewsschool that should say "funding" not finding in the start of my reply to you

Sexual health clinics offer contraception. That's why they aren't called GUM clinics these days. GU medicine and contraception services have been amalgamated into integrated sexual health services.

I get what you’re saying and personally have for a long time preferred to go to sexual health clinics for gynae matters...

BUT there are 2 factors you haven’t accounted for

1 there’s still a HUGE stigma to going to/being seen at “the clap clinic” in most areas the location is known to locals and difficult to access via public transport and ime often in an obviously different location to other primary care services or even where I am currently the nearest hospital. It’s not even in the same part of town as the hospital! So if you bump into someone you know it’s outing and embarrassing for many

2 they’ve been hit VERY hard by the cuts possibly more than other areas of medicine I’d say. Our local one when I first moved here was open 5 days a week 8-6, it’s now only open 2 days a week 10-3 and you can’t just walk in any more, you have to make an appointment and it can take quite some time to get one and certain times are allocated to certain clinics which may well not be convenient for many patients.

Now yes “inconvenience” is one thing but I’m also thinking of all those shy teens and domestic abuse victims who may need to access the services outside the times designated for whatever reason they’re attending and are now no longer able to.

Also where I am is very much mostly rural residents and the sexual health clinic while relatively close for me personally covers I believe residents as much as 25 miles away (as the crow flies) and some of those residents have to get a ferry to the mainland first it’s quite a trek! Not something they can necessarily undertake discreetly

Postal services to the islands are quite hit and miss too and for vulnerable patients might not be a safe method of accessing contraception in terms of their home life

Another issue where I live (and before anyone says yes I know it SHOULDN’T be) is LACK of confidentiality. It’s a VERY small town and everyone DOES Know everyone! Not so much an issue with the gps but there have certainly been issues with certain practice nurses and admin staff! Yes it’s been dealt with afterwards, but by that point the damage was done!

I had the experience of a member of admin staff from my sisters surgery (we don’t even share a surgery) revealing my sisters last pregnancy to me in the bloody supermarket before she’d even had her first appointment relating to the pregnancy! It was unplanned and for all that staff member knew my sister wasn’t planning on continuing the pregnancy. I’ve also had someone from my and dds surgery call and tell me her pill prescription was ready to collect, now dd and I have an open and close relationship so I knew she was sexually active and on the pill BUT the person calling didn’t know that!

Made complaints on both occasions but both incidents if damage had been caused by those breaches of confidentiality it’s too late to undo that damage by that point.

@standrewsachool but by finding primary care in such a way bias and conflict of interests comes into play.

If gps come out better financially by “encouraging” patients to accept a specific type or brand of treatment then it affects their decisions on what to recommend to patients

The nhs is SUPPOSED to be protected from the influences of commercial pharmaceuticals and medical manufacturers yet practices like this make a nonsense of that.

What is recommended to a patient should be primarily based on CLINICAL best practice NOT on govt backed promotion of certain treatments/products

Given how hard the sell is on mirena in particular is happening I feel confident that someone somewhere has had a backhander!

Because it's not just hormonal iud's being pushed but a particular brand! There are other types and brands of hormonal and non hormonal iuds plus other LARC which doesn't get anything like the constant hard pushing mirena does!

You'd think they'd learn from the mesh debacle apparently not!

Agree that it should be across the board. We need to lobby LAs on this. If my county can do it, every county should be able to.

Doctors are encouraged to complete QOF targets, which means they get paid for fulfilling certain services. That’s not new. The money doctors get for basic services is actually quite small apparently, and they need all these extras to make the surgery viable.

I've just had a quick look on the local SH website as it's a while since I worked with the service, but I am able to order the pill online (either sort) and/or free condoms, all delivered by post. Appointments are available for injections, the implant and coil fittings. No walk in service, but that's just because of covid.

Very lucky. Many areas here have no such services anymore. It's the first to get cut probably, as of course, most users are female. I'm past the age of needing contraception but have plenty of friends who source contraception privately due to not being able to get a GP or appointment, no family planning clinics, GPs who tell them certain brands are no longer prescribed by the NHS (usually more expensive versions of the combined Pill) or what they want is unavailable but how about a Mirena instead.

There are under 25 clinics, but certainly in our area as an example, the majority of clinics are open to all ages. I agree about timings, although again our local service offers evening and weekend appointments. Maybe we are just lucky here.

Not sure about trusts, as SH services are commissioned by local authorities rather than trusts as it is a PH function rather than NHS, although trusts may actually deliver the service. We should be lobbying our LAs for improved services, although I don't expect we will get very far.

That's not the case. Sexual health clinics offer contraception. That's why they aren't called GUM clinics these days. GU medicine and contraception services have been amalgamated into integrated sexual health services.

Sadly in more and more trusts these clinics are going the way of the dodo bird or are restricted by age (under 25s) or have such restricted hours they're inaccessible for many women. So women are left with GPs or going private to get certain forms of combined Pill/ring/etc. because the GPs tells them they can't have it and 'how about a Mirena/jab/implant'. Rather alarming how it's always about progestin-based hormonal contraception.

Really not surprised. I’ve had terrible experiences with, or are not suitable for, nearly every contraception type. I want to be sterilised as I’m tired of trying things and suffering for months, as well as having had a contraception fail.

I keep getting pressured to try the mirena instead. My negative experiences from the coil shape and mentally from multiple hormone types have been repeatedly ignored. Despite being offered as making periods lighter, the mirena’s website clearly states that it could actually make my heavy irregular periods worse, as has happened with the hormonal types I tried. It is also less effective than sterilisation (I really do not want a child).

Doctors have lied about these points when I mention them. One even continued the pitch after I explained why it was not suitable due to a personal medical reason which she couldn’t dispute! After I submitted a complaint and was accepted for sterilisation I still got another bloody mirena pitch at my pre-op appointment despite the doctor acknowledging my repeated opposition.

Honestly would not be surprised if I woke up after my sterilisation op to find I had been given a mirena instead, they seem cult like about it.

Eugenics by cash incentive. Never mind the reduced abortion rate what’s the difference in the birth rate “ among younger women and those from more disadvantaged backgrounds”?
I had to tell my gp practice to put on my notes do not attempt to discuss any LARC ever again as I was sick of it. I have PMDD. Extra progesterone results in suicidal ideation. I’ve managed 25 years of preventing unwanted pregnancies. I do not need a Mirena coil or contraceptive injection.

I declined the Mirena and was given Cerezette instead. Thank goodness I could stop taking them.

Remember the vaginal mesh scandal?

Contraception is the same. All side effects are dismissed, not actually recorded, even less seriously studied (except for the truly deadly ones, like risks of stroke... but that's setting the bar quite low!)

I got convinced to try the implant after my second child. Towards the end of the last year it was active, I started developing chronic pain in my arm. GP dismissed this as "unexplainable", yet it magically disappeared after the implant got (finally!) removed. I did not ask for a new one...
And given how hard it can be to get an appointment for what is, essentially, minor surgery, I found the whole implant concept invasive and disempowering (it's not like the pill where you can stop whenever you want if you notice side effects, or just change your mind)

Hmmm I've very mixed feelings on this one, a close family member is an addict and is having yet another abortion this week, plus has lost custody of her children this year. Sometimes I wish they could put contraceptives in the methadone :(

[quote EarthSight]@CaraDuneRedux

Just refuse to have it done next time until they give you the smaller one.

Some places have crap speculums - in one surgery they might have plasticy ones which are nicer, and in others they have stainless steel ones that are very cold and which would probably make the process worse for women who already find the whole thing difficult.

Honestly, all of this just wants me to record them all and send them in one massive essay complaint to somewhere in the NHS.[/quote]
The plastic ones are disposable single use.

The metal ones require proper washing and sterilising between patients. I didn't think they still used them - there were a few 'recalls' during the 90s because of incorrectly sanitised speculums.

Apologies as I haven't read the full thread.

Was ranting at the radio earlier when they discussed this. It sounded very infantilising if women to my ears.

Yes, the outcomes may well be less unwanted pregnancies if women have coils instead of the silly things forgetting to take their pill (or you know, having D&V or needing antibiotics and requiring additional contraception for a week, except that their HCP didn't tell them that bit). But women are allowed agency and should as a minimum have the education and information to make informed choices that work for them.

Might I point out that castration would also lead to fewer unwanted pregnancies. I wonder why there are no incentives in the GP contract for that even as an enhanced service.

Yep! Sick to the back teeth of hcps not listening and accepting we know our own bodies

Me: smallest speculum please.
HCP: but you've had a child
Me: by CS. Trust me you won't get a larger one in there.
HCP - uses larger speculum anyway.
Me (after having been scraped off the ceiling): now please use the smallest speculum.

Ugh don't get me started on smear tests! I have an oddly shaped and "over sensitive" cervix, I remind them of this EVERY TIME and that it's best achieved using a smaller speculum and in a particular position...

EVERY TIME I am initially ignored until during they have difficulties and very often the lab requests a repeat due to excessive blood on sample etc

But hey I'm just the patient what would I know about MY BODY?!

On the Woman's Hour piece, it was stated that in terms of pregnancy LARC is safer than vasectomy but then goes on to minimise the health & libido effects. But with vasectomy, the contraceptive responsiblity is shared within the relationship, and you can have libido and no babies which is a winner.

I suppose a load of synthetic progestogens and antidepressants is always going to look cheaper on paper.

www.bbc.co.uk/programmes/m000mj1g (from just before 25min)

Haven’t rtft but I was pushed mirena as “reversible sterilisation” when what I wanted was actual sterilisation (40+ and definitely enough kids). Told that the NHS no longer funds it and the best option was to get DH to have the snip. Clearly designed to save money in this case, but same issue of women being denied treatment they need: I was only too happy to present this news to DH, but what about women whose partners aren’t prepared to do that or who don’t have regular partners?

@babdoc wow! You think that “not pinning teenagers down” means they must be acting ethically? Talk about a fucking low bar!

Vulnerable women - teens due to age and inexperience and not yet having the confidence to assert themselves, addicts due to feeling stressed and anxious with their addiction and reliant on support from their gps...

STILL should not have those vulnerabilities taken advantage of and pressured and coerced into having a device that isn’t suitable for them which they then have huge difficulties having removed because gps are too focused on the financial aspects rather than what’s right for their patient and even more importantly WHAT THE PATIENT WANTS.

That’s like saying to domestic abuse victim suffering coercion and emotional abuse “well he didn’t touch you did he” I mean for goodness sake!

obtaining consent - consent “obtained” dishonestly is NOT consent

My distrust of Gp’s is not out of nowhere, it’s the result of MANY years of being dismissed, ignored, misled and let down! And not even just myself and not just on this issue. But on almost every major health issue my dd, mother, sister, aunts, female cousins and myself have been through. Multiple Gps across the Uk too.

This has for my family very likely and in a few cases proven to result in unnecessary hospital admissions, mc, ovarian torsion, cancer being dx extremely late to the point of in one case fatality and in others 2 women being unable to bear children.

I have damn good reason to mistrust! And I’m far from unique!

I had a thread running a couple years ago on medical misogyny and there was a long list of similar and equally bad experiences on that thread too.

It’s unconscionable that gps get away with such poor practice!

They started the piece saying contraception gives women control over their fertility, but it is obvious that it is lack of control with LARCs that is the problem. totally agree

You sound like you think you're owed something for the career choice you made

Yep! I’m kinda sick of this attitude too.

I think millions of women’s lives would be dramatically improved if they had direct access to a specialist gynae and I don’t believe it would be much more expensive for the NHS

Totally agree - but not just gynae. Gps are gatekeepers to all sorts of specialists but there are financial and other incentives/disincentives for referring to specialists generally - these need to go!

It’s such a short sighted healthcare approach too!

So so many times patients get treatment for symptoms without a dx, over many years even decades, which means they are suffering those symptoms over many years/decades.

I think overall it would save the country money if a different model were implemented, one which prioritised achieving a dx as soon as possible.

It may short term cost more in terms of specialist appointments but in the long term it would save money in terms of fewer gp appointments, fewer work days lost, fewer illness benefits/sick pay claims...

@MoltenLasagne there does also seem to be a lack of reporting or acknowledgement of side effects, a lot of hcps denying that certain symptoms ARE a side effect even when they’re ones acknowledged by the manufacturer! Again lots of posts/threads here and elsewhere of women who’ve been told that what they’re experiencing isn’t related to the LARC they’re on and yet when they eventually manage to get that LARC removed - those symptoms disappear! I’m genuinely concerned such reports are NOT being recorded as they should be either.

I was on the injection at one point, having been persuaded it would help me, it made my periods heavier and longer and made my POTs worse to the point I was regularly keeling over! Several years later another gp suggested it again and I queried why given I had reported all these difficulties clearly to the providing gp - there was ZERO comment of the problems I’d had on my records! I insisted that the “new” gp recorded NOT to suggest this to me again as had tried before and the problems I’d experienced. So so unethical!

My dd has ALSO had the hard sell on LARC again even when she wasn’t sexually active! She has a friend similar to pp who is religious and doesn’t believe in sex before marriage and she’s had the same experience, it’s well known locally that if you DO capitulate to having coil or implant it’s murder to get removed - even when it’s due to be!

It IS gaslighting of half the population by the medical profession and it needs to STOP.