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?

I'm a GP with an interest in women's health and an implant fitter. As far as I'm aware only doctors, nurses, physician's associates can train to fit implants and they have to be registered with a professional body, which I don't think HCAs are. see here www.fsrh.org/education-and-training/letter-of-competence-subdermal-implants-loc-sdi/ and expand the tab on entry requirements

I'd suggest an email to the practice asking to confirm if it's really an HCA that they are suggesting and whether they have the FSRH LoC. If it turns out that they are getting someone unqualified to fit implants then that's worthy of a formal complaint and escalate to NHSE if needed. But I have never heard of HCAs fitting them so I wonder if wires have been crossed somewhere. I'd be really interested to hear the outcome, will you feed back on the thread?

In my trust, hca's can be band 2,3 or 4. 4 either assistant practitioner or nursing associate, both require a lot of training, the latter have a PIN under NMC and a 2 year degree under their belt. All 3 bands wear the same uniform regardless of their training. Certain procedures they are allowed to do require further training. They would do it if they weren't trained. Prior to being a registered nurse, I was a HCA, I did a lot of training (to maximize my chances of getting into the uni I wanted) and it was the same training alongside nurses in many cases. The job title doesn't mean they arent skilled.

Why do you keep saying minor surgery?! It’s not minor surgery, unless you think having a smear test is minor surgery?! I’ve never had any anaesthetic with mine either?

You've never had an Implanon pushed up your fanny either.

@passport123

I will feed back and I am awaiting a response from the PM. I know it’s not right.

@Blankbias

I am saying having a subdermal implant insertion is minor surgery, because it is. Happy to provide links to clarify this for you if necessary. I don’t believe for one minute you have had an implant inserted with no anaesthetic. What a load of rubbish.

If you use the definition of minor surgery as 'a procedure involving a scalpel and done without a general anaesthetic' then implant removal (but not fitting alone) is minor surgery.

You would have had local anaesthetic, usually an injection but sometimes a freezing spray.

@maiafawnly

Yes I know band 4 NAs and APs have pins under their belts, I know the structure well. A HCA in a surgery is band 2/3 typically with no professional pin etc therefore no personal accountability and is being woefully exploited here by taking on such procedures.

@Dalaidramailama Can I ask if you work in healthcare? Whilst to an extent I think you have a point, I also sense you are more invested in this issue than perhaps an outsider might be?

@Duttercup

No I don’t work in healthcare, I am a surveyor.

I am however invested in my own health.

@Duttercup

I have done a degree in health and social care though, hence knowing certain things. Apologies for the multiple messages, a little busy. Will refer
again to this thread shortly.

@Dalaidramailama Ah, I see. I know there's a lot of debate in healthcare about Drs, nurses, ACPs, HCAs etc. at the moment Wondered if this was also a stealth testing of public opinion.

Good luck resolving - the implant turned me into a lunatic so I would have been quite happy for a binman to remove it if it got the bloody thing out!

@Duttercup

I think that debate would extend across the whole public sector the way things are currently going.

Ahh yes a lot of people do not get on well with the implant. It is great for me I use it off label for endometriosis for which it’s very helpful, and of course I would quite like never to be pregnant ever again 😂.

In reply to your question about whether or not I was talking about HCAs or Associate Practitioners. The two I work with are HCAs, we do also have 3 APs - they all have different working abilities based on the amount of training they have done. Two of them pay to the NMC for their registration and is on a band 4 wage. Starting wage for nurses is band 5

HCAs can specialise. They are what used to be known as auxiliary nurses and are trained for specific procedures. My sister is a specialist cancer care HCA trained in chemo and inserting IVs. I'd be happy with a HCA doing my implant.

Like PPs, I wasn't aware HCAs could do the FSRH course, which I thought was the only way to get the qualification to do these.
One of our GPs does ours, I could do the course as a nurse but we don't have much demand so it's not worth them paying £1k for the training for me. Also, our GP quite enjoys having some hands on work to do!

Like PPs, the idea of an HCA doing it makes me uncomfortable. Despite knowing some amazing HCAs. I champion and upskill the ones in my team whenever I can, but minor surgery would be a step too far. Also, I doubt they are being paid enough!

Many apologies, for some reason I read it as IUD!

The thing is, HCAs in hospitals are often quite different to HCAs in primary care. They may have extended roles, work under different protocols and may be covered under a hospital-wide indemnity scheme.

In primary care HCAs tend to be locally trained, won't usually hold any sort of registration with a regulatory body and will only be covered under a group practice scheme for 'simple' procedures and things that they carry out under Patient Group Directives and Patient Specific Directives. This is things like B12 injections, flu jabs, pneumonia jabs.

Implants should always be fitted using local anaesthetic (and DEFINITELY removed using it!) and HCAs aren't usually covered by PGDs for using LA. Implant removals definitely come under the 'minor surgery' definition as one is using local anaesthetic and a scalpel to surgically remove a rod; not comparable to an injection, or smear.

If a practice is using an HCA (not a Physician's Associate) to fit implants I'd be very concerned that they are using them to meet demand for fittings without appropriate training, supervision or regulation. As previously said, the FSRH Letter of Competency to fit/exchange/remove implants does not cover HCAs. If they are just doing 'in-house' training that is unacceptable.

This in no way denigrates the skills, value and capability of HCAs - ours is amazing and a very valued part of the team - but only within her remit.

This might sound brutal, but I’d be happy if the bin man fitted my coil, so long as he had training and was fully competent!
I think you’re overthinking it op, job titles don’t matter. Competencies do.

@ChampagneCharlieIsMyName

I think that’s over simplistic. It’s not the job title it’s the competency. When you visit a GP or a nurse you are somewhat assured of their competency. This isn’t to say there aren’t any bad eggs in either professions but in the grand scheme of things there has been appropriate training.

It is the not knowing if the HCA is fully competent or not that makes me uncomfortable.

*overly rather

@Sidge

Agree with what you’ve said. Still waiting on the PM response.

Do you know for certain that the sexual health clinic doesn’t also use the skills of HCAs for fitting implants? Are they not typically NHS run and therefore likely to follow a similar structure? I assume you mean going to a private sexual health clinic but same question applies…

@familyof4boys

Very valid question and one I have thought of. Not a private SH clinic.

If they’re all HCAs there then I’ll have to suck it up won’t I? Also, I presume even if they are, they will be inserting and removing on a daily basis and therefore more frequently than my practice HCA.

I don’t think this is the case though reading the implant guidelines and I think what my GP practice is doing sounds highly unusual and this has been confirmed by healthcare professionals further up the thread.

In my opinion it is certainly no bad thing to question guidelines in relation to your own health. Of course if you’re not happy with anything there’s always the option to go private.

My point was, in my trust, they call everyone wearing that uniform HCA, regardless of what level of training they have, as they all wear the same uniform. You don't know what level of training they have and are absolutely judging their skill based on what a receptionist has referred to them as over the phone. They will have had training in order to complete the procedure, and be covered by the liability of the service. Having a PIN doesn't equate to competency. For example, as a HCA I was trained in venipuncture and cannulation, in a trust I went to during my training, registered nurses weren't trained in them, junior drs performed them. I as a band 3 HCA was more competent than the nurses in that area. A PIN made no difference.

What will your plan be if the Sexual Health Clinic, also employ HCA to perform this procedure?