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.

Ugh. I'm so sick of how I've been treated for hormonal/contraceptive issues. Endless bloody gaslighting about how they don't cause side effects and mirena is localised progesterone so can't cause side effects. Which isn't true. A choice of hormonal contraception (which makes me feel miserable and apathetic 100% of the time) or antidepressants for perimenopausal issues. I've been taking ADs for 5 years,now I can't get off the bloody things.
Totally fed up of women's cycles being seen as something we have to just live with if we can't take hormones.
While flipping viagra is funded to the hilt cos penis needs.
I don't blame GPs but the way womens health is dealt with is patriarchy in action imo

@MoltenLasagne

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.

There isn't one. You're either disbelieved entirely or given further prescriptions for drugs to cope with the side effects. You're told it's nothing to do with the LARC, even after you find and download the leaflet that comes with the product and the side effect is listed in there.

Or you're given the Pill or similar to cope with constant bleeding on the Mirena or offered anti-depressants if it sinks your mood out of nowhere.

Mirena killed my libido like never before. I was told it would 'settle' and to carry on with it, because who cares about a woman's desire for sex?

I didn't even have it for bad periods but as contraception. It was fabulous for that!

My teenage daughter was continually hard sold LARC every single time she saw a GP or nurse for anything. She told them she is a devout Christian who doesn't believe in sex before marriage (true). She was told she still 'needed' LARC in case she was raped. She complained formally. They have since stopped. Teenage women are seen as stupid, amoral, uneducated creatures who are incapable of making any good decisions about themselves and their own bodies by the health service here.

I had to bleed non-stop for a year before my GP would remove a mirena coil on the grounds of its expense. I seem to remember not being terribly impressed.

@AnnaMagnani

£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.

No it dosn't, and that's fair enough.

I think certain newspapers (like the Daily Mail) love to spread nonsense about GPs getting 100k or more a year. Even someone I used to know said they were getting paid a lot more than that. I'm glad I made her look it up online. The reality is they get about half that amount.

@newtb

I had to bleed non-stop for a year before my GP would remove a mirena coil on the grounds of its expense. I seem to remember not being terribly impressed.

Fuckinghell. That's so, so bad. No treatment should not be discontinued because of its expense! Did the GP actually say that? What were their words exactly?

It's totally bizarre to force women to continue to be on unsuitable medication.....just because it was expensive in the first place. Isn't that doing the patient more harm than good.....which is against their oath....is it not? I'm not in healthcare so I don't know the details.

@batshitbeautycosmeticsltd

That is awful. That's press worthy of being sent to Women's Hour or the Guardian or any newspaper really.

For those of you with questions about libido, look up SHBG. If you bring that up with your GPs, I wouldn't be surprised if you see them try to cover up how little they know about it, or the difference between total vs free testosterone in the body.

Hormonal contraceptives and designed to make a woman infertile. I know it's not that simple (some women retain libidos during and after the menopause for example), but we really shouldn't be surprised that hormal contraceptives make some women lose their libido, and it can take months for the body to get back to normal after being on them for a while. There are some studies that show elevated SHBG for a year or more afterwards, although it's been some time since I read up on the subject. I'm not sure how many studies have been done since.

I really support access to hormonal contraception (who do women even need to go to the doctor to get on the pill seeing how easy it is to kill yourself with countertop painkillers). As I said, what I object to is lazy or sexist healthcare, or it's seen as given that women will carry the burden of taking hormones no matter the side effects. I mean, it's absolutely fantastic that the option is there, but I just don't want to see women being pushed into things that aren't right for them.

*why do women need

This is very interesting to me. I had 2 copper coils; with each coil I had pains off and on for 6-9 months until it dislodged and had to be removed. The only HCP who believed that my pain was caused by the coil was the nurse at the walk in family planning clinic who removed the 2nd coil. GP / Gynaecology both denied that they had ever heard of a woman experiencing pain from a coil.

@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.

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?

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)

@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. I lived in a country where women get a cancer check on the health insurance every year at the gynaecologist. This includes a smear test, breast check and an internal ultrasound to check the ovaries. And while I never thought I'd say that, I miss the chairs they use. They may look like a torture instrument, but are a damn sight more comfortable than lying on a couch, fists under the bum while the nurse pokes around for the smear test.

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?!

@Graphista

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?!

Oh yes... I know all about this one.

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.

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

@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.

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.

[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.

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 :(

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)

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

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.

@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.

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.

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.

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.