This article relates to the CQC key question: Is your practice effective?
The Faculty of Sexual and Reproductive Healthcare have recently published a document describing a vision for sexual and reproductive healthcare in the UK.
Everyone has a right to expect individualised, holistic sexual and reproductive healthcare (SRH) throughout their lives. The majority of SRH care is provided in general practice. This article describes what makes a high quality service.
Practices should offer comprehensive SRH services to patients of all ages without discrimination. High quality services involve good administrative systems as well as good clinical care.
Practices should display the SRH services they offer on their website.
Patients must be able to access timely appointments for SRH care:
- Requests for appointments for emergency contraception should be dealt with that day and face to face consultations provided whenever possible.
- Consultation for advice about termination of pregnancy should be available within a few days; more information in the RCGP position statement on abortion.
- Routine requests for contraceptive appointments should consider expiry dates of devices and whether the patient has adequate supplies of pills to ensure continuity of contraception.
- Reception staff should be aware of safeguarding issues when dealing with young people and vulnerable adults.
If a healthcare professional in the practice has a conscientious objection to providing any aspect of SRH, this must be clearly stated. There should be arrangements within the practice to ensure patients can get the services they are entitled to from an alternative provider without delay or discrimination.
All healthcare providers delivering SRH care should be working within their professional competency. The FSRH provides current advice.
Practices should have protocols in place to ensure:
- Patients under the age of 16 requesting services are assessed regarding their Fraser competence.
- Safeguarding issues are considered for those aged under 18 and for vulnerable adults.
Each patient should have a contraceptive choices consultation so they can select the method most appropriate to them at their stage of life. All current methods should be discussed but promote the importance and efficacy of the long acting reversible contraceptive methods (LARCS).
This consultation should be repeated as the patient’s circumstances change, in particular:
- At the time or shortly after emergency contraception
- Following termination of pregnancy
- Following delivery or miscarriage
- With changes to medication or medical condition.
If a practice does not provide all methods of contraception it should be able to give basic information so patients can make an informed choice.
They should make clear written information available about how and where to access methods not provided within the practice with signposting to alternative providers. It is particularly important that patients have timely access to emergency intrauterine device (IUD) fitting if they choose this method.
Practices who provide LARCS should:
- Offer timely appointments for these procedures - consider using bridging methods if there is a delay
- Have appropriate clinical facilities
- Have all the necessary equipment available, including emergency drugs and equipment
- Ensure all staff undertaking IUD and implant fitting hold up to date letters of competence
- Have clear referral pathways for difficult procedures such as failed IUD insertions, lost threads and deep implant removals that the practice cannot do
- Audit complications occurring following LARCs procedures undertaken in the practice.
Example: good care
On a Monday morning Hema, age 30, requested an appointment at her GP practice for emergency contraception because a condom had failed late on Friday night (day 10 of her cycle). Hema already had 3 children under 5 and was keen to avoid another pregnancy.
Hema saw the triage nurse at midday and they discussed her options. She decided a copper IUD would be best, both as emergency contraception and ongoing. The only IUD fitter in the practice was on a week’s holiday so the triage nurse gave Hema contact details of the local Contraception and Sexual Health Clinic (CaSH). She also gave Hema a prescription for oral emergency contraception to take immediately in case there were difficulties fitting the IUD.
Hema phoned the clinic and was given an appointment to have the IUD fitted on the Tuesday evening.
Example: poor care
Sarah, age 25, was due to start her new packet of combined pills but realised she had finished her last packet and run out. Sarah phoned the practice for an urgent prescription and was told she would have to be seen before one could be issued and the earliest appointment was a week away.
She was eventually seen and restarted on her pills 7 days late.
Sarah used condoms reliably from the day she did not restart her pills but had unprotected intercourse throughout her pill-free week. The doctor doing her pill check did not discuss the need for emergency contraception with her and she was upset to get a positive pregnancy test a few weeks later.
This could have been avoided if Sarah had been provided with a single packet of pills to allow contraceptive continuity.
CQC key lines of enquiry (KLOEs)
Providing high quality sexual and reproductive healthcare is relevant to a number of the CQC's KLOEs. In particular:
- Whether a practice has reliable systems, processes and practices in place to keep people safe and safeguarded from abuse (S3).
- Are people’s needs assessed and care and treatment delivered, in line with current legislation, standards and evidence-based guidance (E1).
- Whether staff have the skills, knowledge and experience to deliver effective care and treatment (E2).
Dr Anne Lashford is a GP and a council member of the Faculty of Sexual and Reproductive Healthcare (FSRH)
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection