ABSTRACT
General practitioners (GPs) are often well placed to offer good contraceptive advice because they already know the patient’s health and circumstances. Some practices are excellent; others provide little beyond oral contraception and devote insufficient time and skill to counselling. Ideally there should be at least one dedicated family planning session each week to deal with first visits and methods such as intrauterine devices (IUDs) or systems (IUSs) and implants. Women raising more complex contraceptive problems may be asked to reattend, after the surgery. Much can, indeed should, be delegated to a practice nurse fully trained in family planning, usually with a gain rather than a loss in standards. The following may be appropriately delegated to her:
• Taking sexual and medical history, discussion of choices • Cap fitting, checking, teaching • Pill teaching • Pill reissuing, and emergency pill issuing against an agreed
protocol. (At present UK law does not permit appropriately trained nurses to prescribe contraceptive hormones, but hopefully this will change)
• Pill monitoring in the absence of risk factors • IUD and IUS checking • Cervical smear taking
The practice nurse should also be taught to detect, and then always seek advice for, the simple but important sign of cervical excitation tenderness.
