GP mythbuster 72: Sexual and reproductive healthcare

Everyone has a right to expect individualised, holistic sexual and reproductive healthcare (SRH) throughout their lives.

Practices should offer SRH services to patients of all ages without discrimination. Not all practices will provide all services. They should be able to offer signposting or access to this. Practices should have good links and referral pathways to SRH services being delivered in the community. High quality services should involve good administrative systems as well as good clinical care.

The Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynecologists have produced standards and guidance for practitioners.

Guidelines are available from the British HIV Association for the management of sexual and reproductive health of people living with HIV infections.

Information should be available on how patients can access services including:

• Sexually Transmitted Infection (STI) testing
• Chlamydia testing either at:
  • the GP Practice
  • a Genitourinary Medicine (GUM) clinic or
  • community sexual health clinic and
• cervical screening.

Patients should be offered ongoing support/follow up where needed.

Administrative systems

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.
• Consultation for advice about termination of pregnancy should be available within a few days. More information can be found in the Royal College of General Practitioners’ position statement on abortion.
• Routine requests for contraceptive appointments should consider expiry dates of devices, whether the patient has enough supply of pills to make sure continuity of contraception and if monitoring is needed.
• Practice staff, including reception staff should be aware of:
  • safeguarding
  • child sexual exploitation (CSE)
  • female genital mutilation (FGM), and
  • domestic abuse issues when dealing with young people and vulnerable adults.
• Confidential and comprehensive records should be kept. They should reflect care, treatment and consent in relation to sexual health services.

Conscientious objection

If a healthcare professional has a conscientious objection to providing any aspect of SRH, they must raise it with their manager. There should be arrangements within the practice to ensure patients can get the services they are entitled to from:

• another healthcare professional within the practice or
• by an alternative provider without delay or discrimination.

Clinical care

All healthcare providers delivering SRH care should be working within their professional competency. The FSRH provides current advice on standards and guidance.

NICE have produced quality standard guidelines for sexual health. They focus on preventing sexually transmitted infections (STIs). The guidelines also describe high-quality care in priority areas for improvement.

Practices should have protocols in place to make sure:

• Patients under the age of 16 requesting services are assessed appropriately.
  • see GP mythbuster 8 for details of the Fraser guidelines and Gillick competency.
  • NHS guidelines about children’s consent-to-treatment
  • the BMA article on the difference between Fraser guidelines and Gillick competence.
• Safeguarding issues are considered for those aged under 18 and for vulnerable adults.

Contraception

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 taking into consideration their medical history, family history and medication history. The importance and efficacy of the long acting reversible contraceptive methods (LARCS) should be promoted.

This consultation should be repeated and reviewed 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. This should tell patients how and where to access methods not provided at the practice. It should signpost to alternative providers. It is particularly important 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 and infection prevention and control measures in place.
• Have all the necessary equipment available, including emergency drugs and equipment.
• Make sure all staff carrying out IUD and implant fitting hold up to date letters of competence.
• Have clear referral pathways for difficult procedures. For example, failed IUD insertions, lost threads and deep implant removals that the practice cannot do.
• Audit complications occurring and consent following LARCs procedures undertaken in the practice.

Our key lines of enquiry (KLOEs)

Providing high quality sexual and reproductive healthcare is relevant to a number of our 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)
• Can people access the right care in the right way (R3)
• Whether the patient consent has been discussed, sought and recorded.