To expect a doctor or a nurse to fit my contraceptive implant

[Dalaidramailama]

And not a healthcare assistant?

Usually when I get my implant removed and a new one inserted I have a GP and a nurse who do this for me at my practice.

I would be happy for a nurse to do this, but I am uncomfortable with a healthcare assistant doing minor surgery on me, AIBU?

MbatataOwl
Usually the nurse assists with passing the instruments to help maintain as sterile an environment as possible but occasionally if the implant is tricky to locate (sometimes can be slippery!) so an extra finger to steady it can be helpful!

I’ve had 4 of these fitted/removed. By far the worst removal was done by a GP, I had to hold the incision open on both sides for her so that she could “focus on digging”. She admitted to have only removed “a few”, it took ages and my arm was black and blue for weeks.
Every other experience at a sexual health clinic (no idea whether they were nurses or HCAs), was much quicker and 10x less painful. Personally I’d want someone who had done that specific procedure as many times as possible, far more important than their job title.

I do agree with you that it is a slippery slope and it's all being done to save money.

Are they healthcare assistants or nursing associates?

HCA’s get trained now for things like this. They follow the same standard as a nurse or GP. It’s a standard procedure, very easy (I’ve had two). The HCA who did my second was far better than the GP who did my first. I felt the GP was rushed and the HCA had more time to do it

YANBU op. It’s an invasive procedure and as much as a HCA can be perfectly responsible, I’d want someone with accountability undertaking the task. What’s the point in sending nurses to university to study a 3 year degree to understand the theory behind practice otherwise? Is responsibility the new accountability in healthcare?

I agree - recent experience at the dentist was ‘You need two fillings - if you’re prepared to wait I can do it in 3 months time but if you want it done sooner we have a dental practitioner who is qualified to do fillings.’

Err, say what? I’ll have the 5 year qualified dentist please!

Hca fine for that sort of thing, but not for reviewing my meds. Just because they are a GP doesn't mean they are good at everything

I've had 4 implants, first at a sexual health clinic, the last 3 by a gp.
The sexual health clinic placed it in completely the wrong place, so it moved around, got badly bent and for the first 6 months had a huge painful lump around one end that i cought and banged constantly, it was miserable. It eventually shifted and settled and the lump went away, but i could move it around in my arm by a couple of inches. No idea what title the person who implanted it had, but i don't think they were even a nurse. I wouldn't book in with anyone but a GP now, and had the same one do all my subsequent 3 implants, and removal of the first.

But it is a simple 5 minute procedure. I've had 3 and they cut, grab and slide, Poke it open a bit and slide the new one back in. Off you pop!

Never ever heard of nerve damage being an issue. yes it is mooted as being possible, but is really rare, hypothetical. In fact more implants have been found to have migrated to the lungs than there have been reported instances of nerve damage - that I can find!

I wouldn't have an issue. It's a procedure you can be trained for, and then have to have so many supervised and assisted insertions for. Unless the issue is a person feels a HCA isn't smart enough to understand the training, as a procedure you can be trained on it, like Many simple procedures- suturing, applying casts, cannulation, etc. task based learning is something anyone can do, and if they are deemed competent, can perform- and I say that as a nurse. Would have no issue with it.

They will have been trained, risk assessed and insured.
would you rather have a GP who might fit one every blue moon, or a HCP who fits 10 a day?

@Soontobe60

My GP without a doubt. She’s fitted and removed three of my implants and it has always been seamless.

It sounds like you haven't actually had the appointment yet if I'm reading your OP correctly. How do you know that it is with a HCA? Are you sure it's not a computer glitch on your appointment card print out? I used to assist GPs doing minor ops and patients were booked in with both of us on our rotas if that makes sense, so it may have seemed like they were just seeing me. I'm wondering if it is a simple mistake and an overreaction on your part as another stick to beat hard working HCAs/support staff with. I'm a HCA (leaving at the end of August thank god!) I'm expected to take blood, administer injections and vaccines, remove sutures and staples, perform wound care, dressings and bandages, and carry out health checks. That list isn't exhaustive, I earn 70p an hour more than minimum wage for that - trust me when I say we have more than enough responsibility for the pay and are happy to not be doing minor surgeries as well🙄

@Junepassing

It is booked and I have checked it all out thoroughly, it is the HCA who is going to be inserting and removing. I will see if I can get booked into my local sexual health clinic tomorrow and if so I will cancel this appointment.

You do not get paid enough for the work you do but this is a public sector wide issue isn’t it?

Unqualified teachers, unqualified social workers picking up caseloads, dental practitioners doing fillings and not dentists, healthcare assistants completing minor surgery? Someone mentioned efficiency further up the thread. It’s not efficient to cut corners like this.

I mean like someone else said it’s not even a slippery slope anymore is it? Its just bloody tragic what’s happened to our services.

Wound care/bandages/removing sutures and vaccines are very much the role of a healthcare assistant. Minor surgery? Not so much. A nurse practitioner at the very minimum to do this in my opinion.

I’d be surprised at an HCA fitting implants - to have achieved the letter of competence to enable them to fit implants the FSRH requires you to be a doctor, nurse, midwife or physicians associate registered with a regulatory body. Which very few HCAs are especially in primary care.

I can only surmise that they haven’t gained the FSRH qualification and are practicing under another one, but I’m not sure to what standard that is. I understand the LoC from FSRH to be the “gold standard.”

@Putkettleonlove nurses certainly can remove implants, if they have done the LoC qualification with the FSRH. I’m doing it currently.

I’m in Scotland and have never had a GP involved and I’m on my 5th implant. I get mine done at a Sexual Health Clinic and HCAs do a brilliant job. They remove and insert them all day long so are complete experts.

@CherryPieface

If you’re on your 5th implant which therefore spans 15 years you have had nurses at sexual health clinics and not HCAs. HCAs were not the first to be trained in this procedure, it’s a very recent development by all accounts.

I mean how would you even know they were all HCAs? Did you ask each individual? I doubt it.

I only know as I was directly informed by the receptionist and then when I rang again to clarify I was informed again.

I'd expect this is a fairly large part of this HCAs job, they probably do several a day. I'd much rather them than a GP who might do one a week/fortnight. Training surrounding such procedures is very thorough, and is often more extensive the further down the 'ranks' you go, therefore it wouldn't worry me at all. What does worry me is that we are now severely underpaying very skilled HCAs who are taking on more and more work that would have once been a the responsibility of a dr or nurse.

Unqualified teachers, unqualified social workers picking up caseloads, dental practitioners doing fillings and not dentists, healthcare assistants completing minor surgery?

None of these professional people are unqualified. They just don't have the titles you assume they need to suit your snobbish habits.

How rude of you.

Couldn't agree more! For the money I earn and the support I would get if things go wrong, there's no way I would want to go anywhere near someone with a scalpel 😂I just don't believe it is an HCA doing it, as far as I'm aware the RCN, MDU and so on don't support HCAs inserting/removing them. Also to remove them you need to inject local anaesthetic and as far as I'm aware there is no legal framework that HCA's can administer it under.

I would actually feel quite cross if there were HCAs out there doing these skills, because we aren't fairly compensated or appreciated for the growing list of clinical skills we have already and it feels deeply exploitative. I worry that if things go wrong we just wont have the support that a nurse or a GP would.

Taking blood isn’t the same as a minor surgery though is it?

In what way? What complications of implant insertion are potentially worse than bloods?

In any case, your issue isn't with the procedure, it's whether the clinician is part of a professional body. Phlebotomists don't have to be registered.

Our HCAs will assist only.
Our receptionist was trained to take blood as we were so short of nurses and appointments. She's great.

If I have to go private then I will but I will not be getting another one inserted

I was thinking along these lines. YANBU OP

The quality of private medical professionals currently is worse than on the NHS IMO.

Cost cutting does not only happen on the NHS.