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London LARC Network. Kevin Miles Head of Options UK. Introducing the LLN. Initiative of the London Sexual Health Programme Commenced in April 2010 Main aim is to support PCTs to develop mechanisms for improving access to LARC Small steering group Commissioning Public health
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London LARC Network Kevin Miles Head of Options UK
Introducing the LLN • Initiative of the London Sexual Health Programme • Commenced in April 2010 • Main aim is to support PCTs to develop mechanisms for improving access to LARC • Small steering group • Commissioning • Public health • Abortion services • SRH services • Medical & Nursing
Main barriers to increasing LARC uptake Lack of knowledge • Public not aware of options • Cultural issues • Public not aware of where to access LARC • Perpetuated by HCWs perceptions of LARC
Main barriers to increasing LARC uptake Training • Getting practical completed • Funding training • Improving Choices Programme seen as good although providers don’t know who has been trained • Maintaining competence • RCN £400 accreditation – providers going it alone • LARC training geared around contraception providers – need to consider alternative settings like abortion services • Willingness of staff to be trained
Main barriers to increasing LARC uptake Commissioning of services • Services that receive no funding • Capped budgets • Multiple and complex commissioning in general practice • Inequality of commissioning pathways
Main barriers to increasing LARC uptake Referral pathways • Service don’t know where to refer • Pathways that don’t work • Pathways for removals
Main barriers to increasing LARC uptake Data • Complex and incomplete data • Data from GUM not disaggregated - only P3 code • Who is currently trained and providing LARC unknown • Removal data skewed by ‘routine’ removals • Confusion over London target
Overcoming barriers • Equitable & informed commissioning • More efficient training pathways • Consistent data • Better knowledge & awareness • Clear referral pathways
Workplan 2010-2012 LARC in General Practice • Appoint London x8 GP LARC Champions • Appoint a London SRH Primary Care Lead Dissemination of Good Practice • Develop LLN Newsletter and utilise LSHP website to disseminate LLN progress, general information and clinical updates on all issues relating to LARC commissioning and service provision • Host London LARC Event • Showcasing and sharing successful models of: training and assessment Training Issues • Clarification on what prerequisites clinical staff require before undertaking LARC training • A pan-London standard for assessing competence and accreditation of nurses • Update and disseminate a bimanual training package for nurses • Lobby for the standardisation of training/accreditation fees
Commissioning • Prepare for new commissioning arrangements • Educate and lobby commissioners for an evidence informed, client centred choice approach to contraception provision, including abortion services Clinical Practice • Sharing of standardised patient group directions (PGDs) for nurses • More detailed evidence on implant removals and sharing of good practice where removal rates are low • LARC service provision commissioning practice • A consistent set of READ codes for general practice electronic patient record (EPR) systems • Lobby for the inclusion of nurses to insert implants and IUDs • A London network of services who can do deep implant removals and clear referral pathways and cross charging mechanisms for these services • Contemporary LARC user experience and acceptability data
For further information… Alexis Palfreyman at Options UK • 0207-430 5181 • a.palfreyman@options.co.uk • www.londonsexualhealth.org