ABSTRACT
General practitioners (GPs) are often best placed to offer good contraceptive advice because they already know the patient’s health and family circumstances. Some practices are excellent; others provide little beyond oral contraception and devote insufficient time and skill to counselling. The 2002 Sexual Health Strategy established that primary care should always supply at least Level 1 basic contraceptive services, and be fully organized to refer as appropriate to services at Level 2 [including the fitting of implants and intrauterine devices (IUDs) or the intrauterine system (IUS)] or Level 3 (male and female sterilization, legal abortion). Women with more complex contraceptive or sexual problems may be asked to reattend after 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. Practice is changing fast, with more use of patient group directions and more trained nurse prescribers and practitioners, some of whom insert intrauterine and subdermal contraceptives. Aside from those, who are still relatively few, a good mainstream practice nurse may appropriately perform the following delegated functions:
Formal training is also desirable for doctors* and should include both theoretical and ‘apprenticeship’ training, as well as discussion of the often complex psychosexual and emotional factors involved in the use of contraception. All clinicians should be sensitive to hidden signals in this area.
