Prescribing and fitting contraceptive implants

GP members fitting contraceptive implant devices must ensure they are specifically trained and competent in carrying out the procedure.

This will usually include an initial period of supervision by a trainer to check the correct insertion and removal techniques are followed.

In order to be indemnified, MDU members need a signed certificate of competence from an accrediting body such as the Faculty of Sexual and Reproductive Healthcare (FSRH), or an equivalent demonstration of suitable expertise and competence.

MDU advice

Doctors fitting contraceptive implants are advised to do the following.

  • Provide patients with full information about the risks and benefits of the implant, as well as the available alternatives, including the option of not having any intervention.
  • Inform patients of the failure rate and risk of complications at insertion and removal. This discussion, which should be noted in the patient's records, could also be backed up by patient information leaflets. The fact a patient has been given a leaflet should also be recorded.
  • Discuss with the patient and encourage them to ask questions, so they understand all the factors material to their decision making. Document the key points of that conversation.
  • Set up appropriate follow-up arrangements for all patients using contraceptive implants.
  • Consider and rule out the possibility of a uterine or ectopic pregnancy in patients using a contraceptive implant who present with symptoms which could indicate pregnancy.
  • Consider specialist referral sooner rather than later if location or removal problems are encountered.
  • Carefully record product details, batch numbers and expiry dates in the patient's records. If there is a fault regarding the manufacture of a device, rather than how it is administered, inserted or removed, any resulting claim would be likely to be directed to the manufacturer rather than the clinician, under product liability law.
  • Have an adverse incident reporting system in place so the practice can analyse and learn from any mistakes or near misses that occur.
  • Explain and apologise to patients if things go wrong, take the necessary steps to deal with any consequences and arrange appropriate follow up.

Prescribing contraceptive implants to teenagers

It's important to try to establish a good rapport with younger patients requesting contraception and give them as much support as possible. You should also inform them of the physical implications of sexual activity, including the risk of sexually transmitted infections and pregnancy.

Before deciding whether or not to prescribe contraception to an under-16, you should be aware of the following:

  • Is the patient Gillick-competent? This will determine whether they are capable of giving informed consent to medical treatment without the need for parental permission or knowledge.
  • If the patient is under 13 and seeking advice from you about sexual activity, you should notify your child safeguarding lead. A child under the age of 13 is not considered in law to be able to consent to sexual activity. You may also wish to discuss this with us.

If you assess the patient to be Gillick-competent, you may prescribe contraception, but it is advisable to discuss with the patient whether they have, or plans to, inform a parent, guardian or trusted adult.

If the patient does not wish to inform an adult of their decision, this shouldn't be a basis for not prescribing a contraceptive treatment. You should however, as much as it is appropriate, encourage the patient to tell their parents or a trusted adult, or to let you do so on their behalf.

Confidentiality

The duty of confidentiality owed to a young person is the same as that owed to an adult; there are, however, some circumstances which can override this.

Particularly relevant to the prescription of contraception is if you are aware that your patient is involved in an abusive relationship. This is often not straightforward unless you know the identity of the patient's partner. You should try to establish the nature of the sexual relationship where possible.

If you do suspect or establish that your patient is in an abusive relationship, you may consider that it would be in the patient's best interests to breach confidentiality. Abusive or seriously harmful sexual activity involving children should usually be reported. Discuss with your child safeguarding lead, or contact the MDU if you are unsure.

The GMC advises that factors which may indicate an abusive relationship could include the following:

  • A young person is too immature to understand or consent.
  • There is a big difference in age, maturity or power between sexual partners.
  • The young person's sexual partner is in a position of trust.
  • Evidence of force or threat of force, emotional or psychological pressure, bribery or payment, either to engage in sexual activity or to keep it a secret.
  • The use of drugs or alcohol to influence a young person to engage in sexual activity when they would otherwise not.
  • A person who is already known to the police or child protection agencies as having abusive relationships with a child or young person.

This guidance was correct at publication 21/03/2017. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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