LARC provision has not yet returned to pre-pandemic levels in general practice
Statistics from the Office for Health Improvement and Disparities (OHID, 2023) show that while demand for long-acting reversible contraception (LARC) is increasing, provision has not returned to pre-pandemic levels.
The statistics show that demand for LARC has increased since 2019, with 37.3% of women aged under 25 and 53.4% of women aged over 25 citing a form of LARC as their main method of contraception at sexual and reproductive healthcare (SRH) services. This is a significant rise in demand – an increase of 35.1% for under 25s and 22.8% for over 25s since 2019.
However, as demand rises, provision of LARC in SRH services and GP practices has not yet returned to pre-pandemic levels. The latest statistics show that although total LARC provision has increased since 2020 to 41.8 per 1000 in 2021, this is still significantly lower than the pre-pandemic 2019 rates of 50.8 per 1000. While general practice-prescribed LARC increased from 2020 levels in 2021, reaching 25.7 per 1000, this is 14.3% lower than the 30.0 per 1000 seen in 2019.
The reduced provision of LARC within GP practices is disproportionately affecting women from deprived backgrounds – with a lower LARC prescription rate to women in the most and second most deprived deciles (17.1 per 1000 and 15.0 per 1000 respectively) in comparison to the average rate.
Dr Janet Barter, President of the Faculty of Sexual and Reproductive Healthcare (FSRH) said: ‘It is concerning to see LARC provision is not yet back at even pre-pandemic levels, despite increasing demand. Access to the full range of contraceptive methods, including LARC, is a fundamental right. A combination of funding cuts and fragmented commissioning services means that care is not structured around women’s needs, negatively affecting access to essential healthcare.’
New training launched to make general practice nursing more accessible
Health Education England (HEE) has released a new training module that aims to make a career in general practice nursing more accessible.
The training was developed to improve understanding and awareness of general practice nursing, and encourage more pre-registration nurses to consider a career in this area. The 3-month module aims to equip nurses for a potential application and interview for a general practice nursing role, and was developed following feedback on why some applicants were failing to get through the recruitment process for roles in general practice.
Liz Fenton OBE, Deputy Chief Nurse at HEE, said: ‘We know that primary care and general practice provide some exciting career opportunities but nurses have told us that they have faced challenges when applying for vacancies. This is often because they are unable to evidence understanding of the work within these areas, for example working on a ward can be very different to working alone in a treatment room. This module aims to provide support to those looking for their first role in primary care and general practice, helping them to develop skills and gain knowledge. Additionally, it will provide an overview of what it means to deliver local care for a population so that those considering a role can be fully informed.’
The module is available to nurses and nursing associates at all levels who want to start a career in general practice. The module will be delivered using a variety of techniques from face-to-face learning to virtual reality. Topics include learning how the role fits within the multi-disciplinary team, developing one-to-one communications skills and understanding how to operate in a primary care environment.
Mother-to-child transmission of hepatitis B eliminated in England
Using a three-pronged approach, England has met the World Health Organization (WHO) criteria for elimination of mother to child transmission of hepatitis B.
Hepatitis B is a viral infection that affects the liver and if it is untreated it can lead to serious liver damage and death. It is estimated that 206 000 people have chronic hepatitis B infection in England.
Most cases are in migrants who have acquired infection in endemic countries before arrival in the UK. Communities at higher risk of getting hepatitis B in the UK include people who inject drugs, gay, bisexual and men who have sex with men who are having sex with multiple partners, sex workers and people detained in prisons or immigration detention centres. Pregnant women who have hepatitis B can pass the infection onto their baby.
Since the late 1990s all pregnant women in England have been offered an antenatal blood test for hepatitis B to try to prevent mother-to-child transmission. For women who test positive for hepatitis B, their newborn babies are offered a course of hepatitis B vaccination starting at birth. In addition to the targeted infant vaccination programme, in 2017 the UK introduced universal infant hepatitis B immunisation in the 6-in-1 vaccine at 8, 12 and 16 weeks of age.
In 2021, quarterly coverage for these 3 doses was 91–92%, exceeding the WHO target of 90%. Through this successful approach, England has now met the WHO criteria for elimination of mother-to-child transmission. The WHO has an aim for the overall elimination of viral hepatitis as a public health threat by 2030.
Alongside hepatitis B, progress towards eliminating hepatitis C as a public health problem by 2030 in England continues. Hepatitis C is passed on in similar ways to hepatitis B infection, but there is no vaccine – although testing and curative treatments are available.
Dr Sema Mandal, Deputy Director for Blood Borne Viruses at UKHSA, said: ‘With the elimination of mother-to-child transmission of hepatitis B, very low hepatitis related death rates and continued reduction of chronic hepatitis C levels, we are on our way to our goal of eliminating hepatitis B and C in England by 2030. Testing, vaccination for hepatitis B and curative treatments for hepatitis C have all played a significant role in driving down these infections.’
Pamela Healy OBE, Chief Executive, British Liver Trust, said: ‘It is excellent news that England has met the ambitious target set by WHO and eliminated the transmission of hepatitis B between mothers and children. The challenge now is for us to find the thousands of people living in England who have hepatitis but are completely unaware of it.’