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.
Doctors fitting contraceptive implants are advised to do the following.
- Inform patients fully about the risks and benefits, as well as 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 should be noted in the patient's records alongside any information leaflets given to the patient.
- Discuss with the patient and encourage them to ask questions, so they understand all the factors involved. Document the key points of that conversation.
- Set up appropriate follow-up arrangements.
- Consider and rule out the possibility of a uterine or ectopic pregnancy in patients who show symptoms.
- Consider specialist referral sooner rather than later if there are location or removal problems.
- Carefully record product details, batch numbers and expiry dates in the patient's records. If there’s a fault with the device manufacture, rather than how it’s administered, inserted or removed, any resulting claim would likely be the manufacturer’s responsibility under product liability law, rather than the clinician.
- Have an adverse incident reporting system in place so the practice can analyse and learn from any mistakes or near misses.
- 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 asking about 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.
Read our guide on prescribing contraception to under-16s.
You owe the same duty of confidentiality to a young person as to an adult. However, there are circumstances that can override this – including if you suspect or establish that your patient is in an abusive relationship.
Try to establish the nature of the sexual relationship if possible.
If there are indications of an abusive relationship, you may consider it 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 factors that may indicate an abusive relationship:
- the 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
- there is force or threat of force, emotional or psychological pressure, bribery or payment to engage in sexual activity, or to keep it a secret
- drugs or alcohol are used to influence a young person to engage in sexual activity.
- the sexual partner known to the police or child protection as having abusive relationships with children or young people.
This page was correct at publication on 17/11/2021. Any guidance 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.