Overview

Background

Contraception Types

• There are a variety of different types of contraception that can be prescribed in the practice:
• The contraceptive injection, Medroxyprogesterone Acetate (Depo-Provera), is given under the authority of a patient-specific direction which has been agreed in the Practice (See also 💉Depo-Provera (Contraceptive) Injections)
• Combined oral contraceptive
• Progesterone only pill
• Contraceptive patch
• Contraceptive vaginal ring
• For long-acting methods of contraception (LARC) such as the Copper coil, hormonal implant, and hormonal IUS, the patient should be directed to the local sexual health clinic
• Southwark only: LARCs are also provided in the extended care hubs
• The signing of prescription requests for contraceptives will ultimately be under the discretion of the Doctor if they are satisfied that the necessary checks have been properly carried out
• Before prescribing any of the above types of contraception, a health check should be carried out

Process for assessing for & prescribing contraception

Initial Assessment

UKMEC guidelines should always be followed. During each consultation, using the contraception template will be useful.

UKMEC Requires:

• Parity, time postpartum & breastfeeding status
• Health check, as detailed below
• Checking for the history of CVD, Neurological conditions (including headache & epilepsy), depressive disorders, breast, reproductive tract conditions, HIV & TB, Endocrine Conditions, GI Conditions, Blood Disorders & Rheumatic Diseases
• Drug Interactions

Health Check

• Each health check and review should consist of a blood pressure and body mass index (BMI) check, smoking status, and up-to-date cervical smear
• We should always make a routine enquiry about domestic violence. Ask ‘Do you feel safe at home/with your partner?’
• Check for intermenstrual/bleeding after sexual intercourse bleeding, migraine with aura
• If a patient is suitable for initiation or a repeat of a contraceptive, a prescription can then be forwarded for the Doctors to sign (or signed if the clinician is a prescriber)
• If the patient is experiencing any problems with their method or if their UKMEC status has changed, seek advice from an experienced nurse or a GP

Prescribing

• Depo-Provera: Should not be sent by EPS, but instead administered through the PSD using practice supplies. Each practice has access to Alliance Healthcare to order supplies.
• Contraceptive Pills: Through EPS, as normal (see also 💊EMIS Prescribing)

Follow-up & Review

• Practice Nurses or Pharmacists are to issue an initial 3-month supply, and then organize a subsequent follow-up
• Patients stable on their chosen method of contraception are then to be supplied with a 12-month prescription
• After the initiation period, annual contraception (’pill’) reviews are required, including BP and weight check (See also 🦋Contraceptive Pill Review)

Advice

• Chlamydia screening, sexual health advice, as well as long-acting reversible contraception (LARC) advice, should always be offered to patients during their reviews
• For more information on contraceptive options, useful resources to direct the patient to are the NHS website or Contraceptive Choices

Emergency Contraception

Please see ☔Emergency Contraception

Sexual Health Services Available by Borough

Borough of Lambeth

This applies to Knights Hill Surgery

Sexual health | Lambeth Council

Boroughs of Lewisham and Greenwich

This applies to Deptford Surgery, Lewisham Medical Centre, Kingfisher Medical Centre, Kingfisher Surrey Docks and Nightingale Surgery

https://www.lewishamandgreenwich.nhs.uk/sexual-health/

Borough of Southwark

This applies to Penrose Surgery and Penrose Maddock Way

https://localoffer.southwark.gov.uk/health/universal-health-services/sexual-health-services/