GP cash incentive to promote long acting contraceptives

[EarthSight]

www.theguardian.com/society/2020/sep/14/gp-cash-incentive-linked-to-fall-in-uk-abortion-rates-study-finds

My experience with GP healthcare is that I sense that many GPs, wishing to keep to their tight 10 min slots, seems to want to prescribe contraceptives for anything and everything. Sometimes I feel like they view the female body as something abhorrent in it's pesky complexity, it's cyclical nature, so it's simpler (for them), to just prescribes contraceptives.

Now that I've seen they apparently had cash incentives to do so, how can we ever know how many GPs recommended these, allowing the cash incentives cloud their judgement instead of focusing on what was right for the woman? How many cases could there have been where there was option a) b) or c), but only option b) was mentioned or encouraged?

Some might say 'but was the cash incentive ever really big enough to make a difference?'. I would say yes, hence why they offered it in the first place to individuals who are already well paid compared to the general population.

I'm not against contraceptives, but I am against lazy healthcare who treat women's bodies are troublesome.

Equally isn't it difficult to get coils and implants removed?

Like once they are in you have no say about whether they stay in your body or not.

I'm sure I've read many a thread here from women desperate to get their contraceptive removed

I think you do have a say, but I've heard I.U.Ds can be costly so once they're in they probably have to really justify why they're discontinuing it and some women might feel pressured to carry on when they din't want to.

Injections are great if they work well, but if they just don't agree with someone for whatever reason, then there's no pulling that out if the body. It can be a tough ride for a few months if you happen to not like it.

I find it amazing that hormonal contraceptive care isn't tailor-made to each women's body. There are different pills and other things to try of course of various strengths, but I don't think any GP tailor makes doses to suit individual women.

I have been talking about this on here for YEARS and certain posters inc ones claiming to be hcps even gps have accused me of exaggerating and even lying!

Well now it's there in clear black and white in a mainstream publication!

It's an outrageous policy which does women a huge disservice.

It's a massive conflict of interest in my opinion straight off!

There are quite a number of threads/posts on here by women who've been manipulated into accepting insertion of the mirena coil in particular who've had an absolutely HORRENDOUS experience both of the coil and in terms of huge obstacles in getting it removed.

I found some "allusions" to this scheme in various medical publications (lots of "ifs buts and maybes" though) and to what I believe to be fact that there are further incentives to insert and NOT remove these devices.

I'm not saying they don't have their place, for some women they can work very well and can be very helpful

BUT the way the whole situation has been handled smacks of medical coercion, there's been a huge lack of honesty on the whole matter and some women have been physically harmed permanently.

The patients needs MUST be the priority at all times and as soon as you introduce financial incentives for anything medical I truly believe that goes out the window!

Medical misogyny generally is a massive problem not just in the Uk but certainly is a factor in primary care here.

There is also financial DISincentive to gps referring patients to specialists

My own personal history is of long undx endo, many years of suffering and loss (mc) before finally getting a dx basically by accident due to needing surgery for last mc and surgeon seeing it!

Unfortunately we are socialised "not to make a fuss" PLUS if you DARE to complain about a gps actions you can very easily find yourself "black balled" and struggling to be registered with one - again denied on here, officially not meant to happen but it can and does!

Makes me so angry

According to the article, each practice would receive a measly £700 for a whole year of offering long acting contraception to all eligible patients. GP salaries are over £100,000, so I think you’re misguided to believe they’re doing this for the money!
The truth is simply that implants and coils are far more effective than the pill or barrier methods for teenagers (who forget to take them regularly or use them incorrectly) or women with chaotic lifestyles such as addicts.
An implant protects a teenager for three years against unwanted pregnancy, with no further action needed on their part - it’s an excellent way to reduce the abortion rate.
Do give doctors credit for trying to do the best for our patients. If we were motivated by money, we would have gone for careers in investment banking, not slogging our guts out in the NHS!

The incentives were not linked to actual uptake of the methods.
I think this point is important to note. I've certainly been asked, but not pressured. It felt more like a tick box exercise, TBH and I think LARC can make a lot of sense for some people, so information is a good thing.

@Babdoc you're erring dangerously close there if not actually saying that such decisions are necessary due to certain women being morally ineligible to make their own decisions on contraception!

Whatever the patients background they shouldn't be pressured to having an invasive form of contraception that cannot be stopped immediately if it causes them illness or distress (which many patients HAVE reported) AND they shouldn't be facing the obstacles they are in having them removed - even if it's only because they've changed their minds! Certainly if they're in pain/distress!

Whatever happened to bodily autonomy??

Sayings "it's not that much money" is a nonsense - if it weren't an effective incentive it never would have been introduced in the first place!

Plus we're constantly getting told on here that gps DON'T earn £100,000 high salaries - so what's the truth there? Starting salary is £60k Ish and if they're not working full time they won't even get that.

Please don't insult our intelligence by claiming all gps are altruistic saints! It's just not true

@StrawberrySquash I've had a LOT of pressure to "consider" mirena coil even to the point of implication that I would have "difficulty" getting pain relief prescribed for the endo.

There are numerous threads/posts on here by women who've had that experience and if you google you'll find more.

Just because that's not been your experience doesn't mean it's not happening.

I was on the COC for many years.

When I changed doctors, I could see my notes online. Apparently I was counselled on LARC on more than one occasion. I used to go for a review once a year, and the dates did not even line up with that.

Strangely I cannot remember any of the occasions, but I do remember endless questionnaires on my lifestyle (converting to low fat spread) and my alcohol intake. And if I smoked - over and over.

Why is advising women who have previously taken contraceptives including the map a bad thing? If women have been pressurised that's wrong, of course, but down to their individual GP.

I take various prescription drugs, and am advised about long term effects, potential alternatives etc. I can't see the difference.

Now if they were getting money paid by switching me to different drugs I'd certainly have an issue. But being advised of different drugs that may suit better is a good thing. GPs should be doing this routinely. I find it rather bizarre that they had to be encouraged to do so.

I wanted a copper coil. They were still offering me a mirena while I was on the bed with a speculum in. No thank you, I'll take the not hormonal one, I have enough of my own hormones

@queenpaws See, now that I'd be v. annoyed about. But sat in a consulting room discussing options I'd expect to be told all the options.

@housemdwaswrong yeah I knew my options, and talked through them in a previous appointment and then went to family planning to have it fitted. I booked for a copper one, confirmed I wanted the copper one and they were still "are you sure, mirena will make your periods better?"
Well yes but I'll also be a hormonal wreck so on balance I'll take the periods!

Yep. I'd have been annoyed...unless they were just double-checking you knew the ramifications. :/ health care for women generally isn't great. It still takes women longer to be diagnosed etc. I listened to an interesting radio programme talking about women and apparent hysteria, and how that is taking so long to die in the medical profession. The history of it all was fascinating. So yes, it's not great, but as per the op I think woven should be informed. Good practice I'd have thought.

GP,s have always had incentives for almost everything they do, they get paid for discussing contraception let alone providing it.

@Whatwouldscullydo

Equally isn't it difficult to get coils and implants removed?

Like once they are in you have no say about whether they stay in your body or not.

I'm sure I've read many a thread here from women desperate to get their contraceptive removed

I'm struggling to get one fitted. I want one because my periods are horrendous and I'm willing to try anything. GP surgery doesn't do them, local sexual health clinic has been moved a 40 minute drive away... I'm guessing that if I ever wanted it removed, there would be a similar story.

Graphista, GPs are not pinning down struggling teenagers and forcing implants into their arms! They’re telling them about the most reliable method of contraception, obtaining consent and then inserting it. The resulting reduction in abortion rate represents a huge benefit - both in less teens going through the potential emotional trauma, and cost to the NHS. This is a win/win.
It is sad that you seem so mistrustful of doctors that you prefer to think we are all in some money making scheme to damage women’s health. I can assure you that is not why I and my colleagues sacrificed our youth working 100 hour weeks as trainees!

I’m largely in favour of my mirena, it’s been in place for nearly 4 years now and has been pretty good. I have a breast lump, however, that changes with my hormone cycle, and I think might be mirena related (it’s been examined twice by ultrasound now and is apparently fine). So for this reason I would like it removed to see how I get on. But getting it removed is nigh on impossible - there are a limited number of appointments that can only be secured by calling at 8am on a Thursday or something silly like that. It’s a time I can’t ever quite manage because of school drop off etc. I’m not desperate to have it out so I’m fine but the barriers to getting it out are huge. And it has to be done at the sexual health clinic (the GP won’t do it). The strings are gone, so it’s not going to be simple to get out. So yes, my experience was very straight forward to put in, very difficult to remove.

@Flamingolingo

I’m largely in favour of my mirena, it’s been in place for nearly 4 years now and has been pretty good. I have a breast lump, however, that changes with my hormone cycle, and I think might be mirena related (it’s been examined twice by ultrasound now and is apparently fine). So for this reason I would like it removed to see how I get on. But getting it removed is nigh on impossible - there are a limited number of appointments that can only be secured by calling at 8am on a Thursday or something silly like that. It’s a time I can’t ever quite manage because of school drop off etc. I’m not desperate to have it out so I’m fine but the barriers to getting it out are huge. And it has to be done at the sexual health clinic (the GP won’t do it). The strings are gone, so it’s not going to be simple to get out. So yes, my experience was very straight forward to put in, very difficult to remove.

I'm not surprised.

Complain to the local healthboard. See how fast they jump.

All you need to do, is call your GP reception, say that you're not happy with a particular service at that surgery, and ask for the local health boards details. You can get these online but sometimes it's obvious where you should send your complaint to and your email might have to be forwarded before it reaches the right place.

If your receptionist asks what the complaint is about, just tell her that they are not providing proper provisions for women to get their Mirenas out, and that it is effectively forcing women to remain on medication that isn't right for them - you can stop taking pills, but you can't get coils and things like that out by yourself.

Your receptionist might not be forthcoming with the details, even though they should be. I had one head receptionist who (after I asked for the healthboard details) gave me details of the 'right place' to send my complaint to (choosing to not tell me that those details were for their own internal team). She was incredibly evasive and uncooperative and eventually claimed she didn't know what the local heath board's details were.........unbelievable.

The 2009 introduction of incentives for 'counselling' on LARC was covered in some depth on Womans Hour this morning.

I think if they are looking for reasons why women do not take it up or continue with it, they should come along to Mumsnet. There have been many threads of women who feel pushed onto facing barriers to getting help with unwanted side effects or getting the device removed.

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.

£700 per practice per year - it's not going directly into the GP's salary and it's hardly going to keep them in printer paper for the year.

Split across all the staff in the surgery - GP partners, salaried GPs, nurses, receptionists, cleaners, etc as that £700 is going into the business not one person's back pocket - it doesn't add up to much does it?

And no for the billionth time, v few GPs are getting £100K a year and there is a massive recruitment crisis in GP training. Possibly if they were getting £100K people would be keener to do it.

I can assure you that is not why I and my colleagues sacrificed our youth working 100 hour weeks as trainees!

You sound like you think you're owed something for the career choice you made. No one forced you to enter into the career your chose, you made that decision of your own volition as an adult, knowing what the training involved and with the ability to leave it at any time. It was in no way a sacrifice. What insulting and presumptive language.

I had a hell of a time getting my Mirena removed. Finally had to do what EarthSight suggested and state that I no longer consented to the treatment but this consent was being removed from me.

There is zero way a man would ever be treated in such a way.

The real scandal is that women have to see GPs for contraception of any sort. So many other countries have direct access to gynaecologists for women’s health- smear tests, contraception, pregnancy care, breast checks, menopause, etc. 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.

@Thehollyandtheirony

The real scandal is that women have to see GPs for contraception of any sort. So many other countries have direct access to gynaecologists for women’s health- smear tests, contraception, pregnancy care, breast checks, menopause, etc. 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.

So true.

On my online medical notes one of my medications is listed as the contraceptive injection. I’ve never had the injection but vaguely remember it being mentioned to me a few years ago.

After hearing stories of side effects that you’re stuck with until the injection wears, and a reluctance from some HCPs to remove things like coils I’d never use LARC.

What is the process with reporting side effects of these contraceptions? I was put off getting the implant as a number of my friends reported similar issues. When I said so to the doctor she said that none of those issues were linked to the implant. My friends tried to report the same side effects to their doctors and were dismissed and told they weren't linked to the implant.

Now possibly it is a coincidence that all of my friends had the same issue, but how can it be confirmed unless data is gathered? Essentially the women experiencing the side effects are ignored, so the women considering the implant are not informed of the real possibilities.