To not understand why I have to talk to a nurse before I can book an appointment for implant removal?

[Alarae]

Considering I want it out to start to TTC?

Rang up my local GP today to book an appointment for removal, only to be told my the receptionist that I need to speak to the nurse first, and then she might schedule an appointment for me.

I don't see why I should need a conversation considering my reasons? Understandable if someone wanted it out for other reasons such as concerns on side effects, recent implantation etc but even then if someone wants something out why should someone be trying to convince me otherwise?

Just a bit annoyed as the earliest telephone appointment is in 10 days, and then who knows how long it will take to actually get an appointment considering only one person holds the clinic!

I can't even go to a walk in clinic as I need a GP referral for that in my area because I am not 25...

@Graphista this particular patient was having no problems or side effects from her implant, she just had some nebulous idea that she needed a break from her hormones. When reassured that this wasn't the case she was quite happy to keep it. Removing and refitting in such a short time scale does carry risks

And the point is that the fitting appt is 20 minutes. When I get uncounselled women booked in for fitting I'd say about half change their mind, which is a huge waste of double appts

I found threatening to pull it out myself if they didnt see me got the nurses attention. Mine was the mirena that wss forced upon me and made me very very poorly.
Apparantly gps get paid for every successful mirena (one that stays in longer than 6 months., like a bonus ) dunno how true this is but my mum told me years ago (she works in a surgery)
So i think this is why they drag their heels!

www.telegraph.co.uk/women/womens-health/11678916/IUS-hormonal-coil-The-troubling-truth.html

Didnt think i was wrong.
"Pay for performance "
So basically in a nutshell good luck getting them taken back out til the drs get their bonus
That's why they say leave it 6 months to settle...

@Imacliche

Apparantly gps get paid for every successful mirena (one that stays in longer than 6 months., like a bonus

This isn't true. We get funded to fit coils and implants, but the funding is for the fitting, it's the same whether it stays in one day or five years. We also get funded to remove them.

Funding has dropped in recent years and many practices lose money with each fitting.

So not a single solitary bit of profit is made. No disrespect to yourself i just find it very hard to believe. Im aware drs have quality care target things they have to reach for funding etc. Which is fair enough. I just think sometimes it leads to pushing a quick fix. I ended up with a hysterectomy 4 weeks ago to fix the issue. If theyd looked and listened instead of forcing contraception on me i wouldn't have spent years in agony.

@Imacliche

It is all part of the money that comes into the surgery, but in many areas the funding for a coil or implant fitting is less than the cost of the staff time and the materials needed to fit it.

The target is for letting women know that LARC is an option when discussing contraception, not for how many you fit.

And oddly enough, as a professional I work by a code of ethics. I find it quite insulting that it is suggested that I'd override a woman's autonomy for the sake of a few quid.

Okay. I’ll bite.
Imacliche the ‘pay for perfornance’ scheme you refer to is how GPs are paid. It’s a complicated system that I won’t bore you with, but it’s how the staff are paid, the buildings are maintained and so on. It’s not some kind of bonus scheme.

The incentives around LARC (long-acting removable contraception) were not about how many of anything we could fit. It was how many women we informed that there was a choice. For many years women saw a GP about contraception and we’re given the pill. That was it. Then new things were invented and - contrary apparently to this thread - they were types of contraception that many women would benefit from. But many GPs still only offered the pill. So the incentive was to offer all options to ensure that women had informed choice. This worked well - there was a large increase in numbers of women having coils, mirenas and implants. The incentive was then removed - there is now no money associated with ‘coercing’ women into anything.

Family planning services are stretched. Locally to me there are very limited sexual health services from the GUM clinic and many GP practices do not provide services likes fitting and removing implants and coils. At my practice we do, and I enjoy these clinics, but believe me we’re not doing it for the money. We do about one or two family planning clinics a fortnight, and accept referrals in from other practices. We operate a waiting list system and if you ring and ask for any practical family planning procedure you will be placed on the waiting list and booked in for a telephone appointment witb one of the drs who does the clinics. This is not to dissuade you from exercising your autonomy. It’s because we’re carrying out an invasive procedure and need to be sure it’s the right thing and the right time.

I know that everyone on mumsnet is an oracle of gynaecology but in the real world many women are not, as pp have said, always that knowledgeable about what is going on in their bodies. I do think it’s part of my job as a GP to make sure we’re giving or removing the right treatment.

As above, I’ve lost count of the number of planned pregnancies with women not taking folic acid. I’ve spoken to numerous women whose coils have expired months earlier and they haven’t been using additional contraception because “I didn’t think” or “I didn’t know the date” (despite being given the reminder card at the fitting). Or those who book an appointment for a cool but turn up having used no contraception and having had sex two days earlier. We can’t change or insert coils if there’s a chance of pregnancy (and mirenas aren’t licensed for emergency contraception) so if those women turn up to a long FP appointment it’s a waste of all of our time.

So my conversation with the OP would probably go like this:
“I’d like my implant removed please”
“Oh. Fine. Any problems with it?”
“No, I just want to try to conceive”
“Okay, great. Are you taking folic acid? It’s a good idea to start before you’re actually pregnant and your fertility returns very quickly after the implant is removed. You can get some just from the chemist. Let’s get you booked in.”

It may feel like an enormous inconvenience but it’s really not an inquisition and it’s done, genuinely, to make sure FP services run as efficiently as possible.

Cross post with diet. It makes me really sad as a female GP to see how poorly we are thought of.

I didn't mean to upset either of you at all im sure you are amazing gps. And there are some gps who go above and beyond. I may be speaking with a bitter twinge due to my personal experiences. Really wasn't out to offend anyone

I was chatted to a couple of times after I have birth this summer about contraception. Seemed more a formality. I pointed out that due to my pregnancy complications it was now strongly advised I never have hormonal contraception again (ICP) and they all seemed okay with that. The only longer term option was the coper coil, and I said we were good using condoms ta, espesially as we would like to TTC for a second in the next year or so

Thanks Imacliche that’s gracious of you. Sorry you’ve had bad experiences but please don’t take us all with the same brush.

tar us. Ffs

Exactly my reasons for fighting for sterilisation. No way was I being bullied into having a implant or coil that I would then need to ask for permission to be removed. I would be making a song and dance about this.

I always get hassled when I renew my bc pill and they really push for the implant. I always suspected (while feeling like I am being mad) that it's so they can decide things about my body and not me. Hugs op, hope it all goes smoothly.

I'm with the camp who are saying the nurse will help support with either TTC or further contraception, STI talks etc...

Yes perhaps patronising, but there are people out there who are very misinformed or ill informed about basics of TTC, sexual health and contraception - a receptionist cannot decide this, nor can a nurse do the talk about reasons and how to prepare yourself for the nExt step could actually save people a lot of time, problems, unwanted pregnancies or diseases

Perhaps it's not right for you, you may know things like folic acid, prepregnancy vitamins, when you're likely to be more or less fertile, number of times to have sex for the best chances.

I'm a biologist and I didn't realise that sperm can live quite a long time in the uterus when ttc and different times of the month your mucous can be quite toxic to sperm, others it's the opposite - i actually learnt more than I knew already, albeit I thought I was such a sound knowledge base

Also, theories and knowledge changes all the time so it's good to get up to date information.

"Too much time in a consult is taken up with questions about drinking, smoking, weight, smear tests and long lasting contraception."

Gp's also get "incentives" for giving "advice" on certain subjects I've read of patients who are non smokers and/or teetotal discovering upon reading their records for other reasons that they've supposedly been "advised" re "problem drinking" when they don't drink and have never had any such discussion! That to me is fraud! And bloody insulting AND dangerous to have incorrect info on a patient's OFFICIAL MEDICAL RECORDS!

"GPs can't complain about women's lack of knowledge while endlessly infantilising them." Totally agree!

"I am truly shocked at these shit GPS wasting everyone's time and all that suffering." I used to be a long time ago, I'm not any more and especially since learning why GP's act the way they do on certain ailments/treatments

DietCokeMegaFan - I find it VERY interesting that with the number of very valid comments and queries on this thread that show Gp's AREN'T acting ethical or in the best interest of the patients you choose to use the ONE POSSIBLE example of where you were "right" and it's not "nebulous" to feel or think that having artificial hormones or a foreign device in ones body is unwelcome. That is the patients choice. You think you've given a "good" reason why she needed to keep it in - instead (to me at least) it looks like you talked her out of her own perfectly valid feelings/thoughts rather than do what you were asked.

All the hcps on this thread giving it "once I explained..." Haven't even considered that they may well have been dealing with less confident, less assertive patients who simply didn't have the strength to tell you "no! I want it out!" And actually HAVEN'T left your office happy with the outcome but instead feel YET AGAIN dismissed and ridiculed for making a perfectly reasonable request that you denied them!

I too don't believe the money you get only covers costs and doesn't have to be repaid if the patient has the device removed. I'm certainly not buying it incurs a loss! If that were true no way they'd be pushing it as hard as they are!

And frankly the REAL insult is the many women left suffering for months sometimes years on end because Gp's don't listen, minimise, dismiss, infantilise, DX mh when there's physical symptoms, or only listen when a patient attends with a man!

Wrt the argument "lots of women don't know how their bodies or contraceptive methods work" that's no reason to hold women and their bodies hostage! Especially if they're experiencing side effects!

General education through public health methods is what should be happening because that applies to women NOT on invasive contraception methods too!

I'm old enough to remember when the advice to take folic acid first came in and was well advertised which means I'm also old enough to remember children with Abc babies born with spina bifida and other ntd's so I know how important it is. Personally I think we should do as the Americans on this issue and add it generally to a wide variety of commonly eaten foods - but that's also another thread.

"nor can a nurse do the talk about reasons and how to prepare yourself for the nExt step could actually save people a lot of time, problems, unwanted pregnancies or diseases" am I right in thinking you're saying here a nurse CAN'T advise on contraception, unplanned pregnancy or sti's? Seems to contradict your first paragraph hence confusion.

Think I touched on a subject that baffles not just me!

I do understand the reasons why a nurse may want a chat initially, such as for those misinformed, provide knowledge etc but I've already researched the beejeezus out of it but I don't get an opt out from the talk.

It also doesn't help that I know GP services are extremely stretched, so my actual removal appointment will be far flung in the future, delaying my chance to TTC.

Unfortunately in my area, the sexual health clinics will only take appointments/walk ins from those under 25. I have to get a GP referral otherwise (which defeats the whole purpose).

I am going to try an out of area clinic and hopefully get an appointment there. Hopefully I won't get any push back from it not being removed by my actual GP... Or in my home area.

@Graphista god that reminds me of when I was waiting at minor injuries to have my newly healing ankle x-rayed again as I suddenly couldn't weight bear that morning again. Anyway I was on 2 crutches and in a lot of pain.
I'd been sitting for 2 hours waiting when my name was called. Thanking god I didn't have to wait longer I followed the nurse up a corridor and into a room slowly on my crutches.
Turns out she wasn't taking me for an X-ray. She wanted to do a survey about how many units of alcohol I drink in a week.
Are you effing kidding me?! Not the time or the place. Especially making me go on crutches quite far up the corridor and then back for a bloody alcohol survey.

That is bloody ridiculous!

As you say neither the time nor the place!

Though if you read my thread I linked you'll see this is very far from the most shocking behaviour from hcps.

Personally I think that it all goes back to when the Nhs was formed, Gp's shouldn't have got away with blackmailing the govt into staying "self employed" while accepting govt/tax payer money to do their jobs.

You're either an Nhs employee or you're a private hcp who aims to run your surgery as a business and make a profit - I don't believe you can be both without there being a conflict of interests.

Luckily for my husband has now had a vasectomy so I don't have to worry about this any longer, but back when I was on the pill, two GP's and a nurse all insisted there were NO side effects from the pill at all! Even through the instruction leaflet that comes with the pill lists possible side effects. They implied I must have been either imagining the side effects or they were attributable to something else. I was very unsure of myself then and ended going on and off the pill a number of times until I was absolutely sure the pill was the problem.

We have to provide the advice to cover ourselves legally. We can't just assume you did the research because this could leave us open to potential negligence claims.

We're not trying to infantilize you. We're trying to make sure we don't get sued.

Wow! Your primary focus shouldn't be on not getting sued! (Which is rare in this country it's actually bloody hard to sue the Nhs) it should be on patient care.

This thread has been VERY insightful wrt primary care hcps attitudes!

We have to provide the advice to cover ourselves legally. We can't just assume you did the research because this could leave us open to potential negligence claims

I fail to see how NHS can be sued for removing a LARC on request. Usually a consent form with the risks on it should suffice. It does for an operation.

Perhaps it's about time patients sued for pain and endurance which the patient continued experiencing after they refused a removal. Perhaps a class action suit?

No, primary focus shouldn’t be on not getting sued. And it isn’t. But defensive medicine is very necessary.
agnurse you’ve given it a good go, but these threads never go well for HCPs. It’s bloody depressing that mumsnet perception is so poor and as toddler has said we all get tared with the same brush.
I’m off to open a coil and implant removal clinic. Free of charge of course, because HCPs don’t need to pay bills or eat.

Has anyone raised the issue of abused women seeking help?

Can you imagine how that will go with GPs pushing their own financially incentivised agendas!! Will they even have a clue?

Or will they just tell silly little girl what's best!