How this PCN…set up a contraceptive service

Wolverhampton North Network PCN set up a pilot contraceptive service to address its higher-than-average abortion rate and prevalence of sexually transmitted infections. It was such a success that the service has become permanent. Dr Clare Libberton, Dr Shahid Rafiq and Elysia Robinson explain more.

Our PCN has set up a service to provide better access to Long-Acting Reversible Contraceptives (LARC) to the female population of North Wolverhampton. Many of our patients are from deprived populations. Our PCN, which comprises seven GP practices and serves a patient population of 55,000, has an average deprivation score (IMD 2019) of 36.3. That is significantly higher than the national average of 21.7.

In Wolverhampton, we have a higher prevalence of sexually transmitted infections (STIs) compared to the West Midlands region. Overall, our LARC uptake in general practice across the city is one of the lowest in the region. Total abortion rates and repeat abortion rates for over 25s are higher than the national average. The rate of abortions in ages 25-44 years for Wolverhampton is 28.9 per 1000, which is higher than England (17.9) and all of the West Midlands.

Therefore, we wanted to reduce inequalities by making services available in the local community to increase access and reduce travel and waiting times. So, in the summer of 2020, we launched a pilot in collaboration with the City of Wolverhampton Council public health department.

Aims

The aim of our contraceptive service was to provide better access and increase the uptake of LARC.

Before initiating this pilot, the waiting time for contraceptive services was over two months. In 2020, the pandemic significantly contributed to this increase. During this time, there was a significant decrease in the number of LARC prescriptions.

The service was set up in partnership between Wolverhampton North Network and the City of Wolverhampton Council. Both organisations recognised that this service was very much needed in Wolverhampton, and it was led by PCN clinical director Dr Shahid Rafiq, public health commissioning lead Ravi Seehra and LARC service GP lead Dr Clare Libberton.

The council supported us with set-up costs to purchase consumables. Now, they support us with funding for every procedure completed as part of the core LARC contract.

The pilot initially required the PCN to financially support the project in addition to its other work. It has only been within the last year that the service has become financially viable.

Methods

We offer this contraceptive service to the patients registered to the practices within our PCN. We launched in August 2020 in the middle of the pandemic, and, at the start, our biggest challenge was raising awareness.

From the outset, we focused on educating our practices to encourage them to promote and direct patients to the service.  The LARC team members still regularly visit each practice to meet reception teams, explain the need for the service and answer any questions. It is also regularly discussed at team/PCN-wide meetings.

Reception teams and clinicians can book patients into the service, and we have also advertised the service in practices with TV screen communications, waiting room posters and website adverts. We recognised the importance of raising awareness in the community to reach our target patients.

We have promoted the service outside general practice by doing leaflet/poster drops in hairdressers, toddler groups, midwife and health visitor hubs, pharmacies and so on. 

Recently, we sent out self-referral forms via text so women who are interested in the service can fill it out to be booked in by one of the admin team. This circumnavigates the need to book via reception teams.

The clinics are held at different sites and times to make it as easy as possible for patients to attend. We regularly change when and where the clinics are held so that patients have a choice of time of day and location.

We provide the service on a Saturday at the two practices already open to provide enhanced access – Prestbury Medical Practice on Saturday mornings and Showell Park on Saturday afternoons.

Outcomes

Our contraception service has brought about a significant reduction in waiting times to LARC. It has dropped to a 2-3-week wait from two months.

We regularly audit data for the number of coils and implants fitted/removed/replaced, as shown in the tables below.

Initially, we saw five patients every two weeks. Now, we see eight patients every week when possible. One of the benefits of the service is its flexibility. We can increase and decrease the frequency of the clinics we hold depending on demand.

The number of available clinicians has been challenging since our clinical team is small. It is made up of four GPs, two nurses and one nursing associate. We have actively encouraged other team members to take up the training and join the LARC service. Administrative support is provided by the PCN.

Over 18 months, we surveyed more than 200 women and 100% said they would recommend the service to others. As the pilot was such a success with positive feedback from patients, we decided to continue offering this service.

Future

We aim to continue offering a highly effective and efficiently run LARC service in our PCN.

The service is working well and the changes we introduced have been well-received by patients. Women have been pleased that we have made it even easier to self-refer and book appointments.

Our waiting times are now lower than the Wolverhampton Sexual Health Service (Embrace), which, as of January 2024, had a waiting time of around eight weeks. Our current wait time is two weeks. We have the advantage that our service can be increased if demand goes up.

There is also the opportunity to explore how this can be extended to provide a ‘women’s health’ hub, as we are based in the heart of the community.

Dr Shahid Rafiq is clinical director Wolverhampton North Network PCN, Dr Clare Libberton is LARC GP Lead and Elysia Robinson is PCN manager.