Badger SRH Project Spring Clinical Meeting

Thursday 3rd March 2016

Liz Nyholm – SRHS Clinical Lead

Sue Bradbeer– SRHS – Administration

Support

Agenda

• Housekeeping

• Thanks to…….

• 13.15 – 14.15 Badger SRHS and Clinical Issues

• 14.30 – 16.15 Loudmouth Theatre Group

‘Working Positively with Young People’

• 16.30 – 18.00 New ASH Practice Meeting

IUS Insertions for gynaecological indications

• Agreement in principle with Birmingham

South and Central CCG

• Cross City – contract organisation issue –

what’s the problem? We are on the case

• Badger SRHS providing the governance

The BSRHS Documents Library • Documents Library - gone live – demonstration: Go to

Badger Medical website: http://www.badger-

group.com/ Click on the yellow umbrella (top right)

and password access for SRHS members is

Umbrella_1

• Gives you access to core contracts information and

downloads

• Up to date education and training information

• Financial matter and administration issues

http://www.badger-group.com/

Umbrella_1 - password

Documents Library

Umbrella Issues

• Umbrella website – we are not happy about patient or

GP access

• Advertising GP Services – we need to look at other

ways to do this

• Umbrella Clinic services are advertised

• Badger unified approach. PRACTICES: Please Check

your website entry and feedback to Badger if

inaccurate.

Umbrella www.umbrellahealth.co.uk

Umbrella website – GP details

• Log on to

www.umbrellahealth.co.uk<http://www.umbrellahealth.co

.uk>

• Click on the ‘Our Services’ tab near the top of the Umbrella

website home page, a drop down menu should appear.

• Click on the ‘Service Locator’ tab (third entry in the drop

down menu), the Service Locator home page should open.

• Click on ‘GPs’

• Look up your practice and check the details are correct.

Umbrella

e.g the OMNIA entry is WRONG

Communicating with GP’s - Unsatisfactory

• NOW REACHED THE POINT WHERE WE

NEED TO LOOK at DEVELOPING OUR OWN

COMMUNICATIONS for patients

• Coil network between GP’s for emergency

IUC? Please feedback any comments /

suggestions to Liz Nyholm

Education Issues

• Feeling of being overwhelmed

• Professionals: re-certify Diploma, LoC’s & STIF

• Personal, local training (WMCASH, SHAPE &

others), national

• What is Badger SRH education role?

E & T Survey Monkey

• Many thanks for completing this – really helpful!

• Overwhelming Thursday afternoon

• City centre or close suburb venue

• Parking vital

• Topics – EVERYTHING! We will aim to address the

main ones but audit and event learning also important

Badger SRHS aims to support members with SRH E & T:

• Termly afternoon Incorporate Umbrella generic

training (SHAPE)

• More focused issues related to IUC & Implants, STI

• Audit

• Running the service – validation and governance

• Badger SRHS cannot provide basic contraception

and STI training – use WMCASH, e learning, STIF

basic etc

Umbrella – core training from SHAPE – now rolling out

• Opportunities for Improving sexual health in General

Practice - .5d GP,PN

• Reducing undiagnosed HIV in GP .5d

• Basic contraception – overview and update GP,PN

• Working positively with young people and sexual

health

• Safeguarding: a General practice Strategy

STIF Core + Plus

• Core: 27.4.16

• Plus: 28.4.16

• Contact Cathy Taylor, Palm Training

• Venue: Birmingham Chamber of Commerce

Off Site Cx Cytology sample taker Update Training

• Can arrange an afternoon session

• Required by Nurses (not doctors)

• Is there interest fro Dr update? Please contact

Liz@nyholms.com

• Minimum 20 delegates needed to run this

What about STI training?

• Core STI ongoing education for all providers -

• STI Specific to ASH practices – alternate

Wednesdays 1-3 meetings at Whittall Street–

programme distributed to ASH practices

• Governance Group has agreed to run 2

evening sessions this year at Badger House –

to be notified

Patient Feedback form

• Patients: IUD and Implant, envelope and post to

Badger. Offer to all patients undergoing

procedure

• Form is in Documents Library (envelopes given

to PM’s on 16.3.16 meeting

• Professional Feedback – this provides the

evidence to negotiate on your behalf.

Professional Feedback Form • In Documents Library

• Your opportunity to feedback about other

Umbrella Services

• Professional Feedback – this provides the

evidence to negotiate on your behalf.

• PLEASE COMPLETE WHERE THERE ARE

ISSUES AND SEND TO BADGER

FSRH CEU (clinical effectiveness unit)

• Website – information ++

• Members enquiry service

• Updated MEC being launched in April at ASM

• Newsletter

• Some examples

Difficult SDI removals and IUC Problem Clinic

• Complex contraception Clinic 5/6 clinics a week

• Run by Dr Jaffer

• Referral Form is in Documents Library

• Long waiting time now (increased activity, reduced clinics

after closure Erdington) – we are talking to Umbrella BUT

• We need the evidence – complain about waiting times and

any other issues so we can put on the pressure

Difficult implants

• Increasing concern about neurological injuries

• ? who should remove these? ? neurosurgeons

• Advice: be careful with your technique

• Insert into the correct plane

Clinical Points

• PREGNANCY REGISTRY

• ellaOne® (ulipristal acetate 30 mg) post-

marketing surveillance

• http://news.hra-pregnancy.com

IUC – feedback and sharing experience

• Lost threads management

• Difficult IUC - tips

• All IUC fitters need to be conversant with

advice in the IUC FSRH Update

April 2015 (updated Oct 2015)

LOST THREADS – NEW MANAGEMENT

Difficult IUC insertions- tips

• Tight Cx os / ‘stenosis’ – gentle dilatation

• Variety of IUC devices – Have a Nova T 380 in stock

• Anaesthetising the Cx – TRY IT!

• Interior Cx lip – just take your time

• Nullips – NOT A PROBLEM

• Experience, experience…….

Types and Duration of use

KJ February 2016

• Gold standard – T safe Cu380A-QL (can kink)

• NovaT 380 – more flexible and narrower

• Mini TT380 Slimline – uterine cavity of 5 cms or more

• Flexi T – small coil, can be used for emergency contraception

in nulliparous young girls

• Multiload 375/Gynefix - ?? Use in case of spontaneous

expulsions

Use of Various Devices

KJ February 2016

Procedure

• Instillagel- intra-cervical

• Application of vulsellum/ tenaculum (single

tooth)

• Cervical block – 3% Citanest with Octapressin

• Aligning of cervical canal with uterine cavity

Practical Points – IUT & the Cx canal

KJ February 2016

KJ February 2016

Different methods of administering Cervical Anaesthesia

Good View

• Lighting

• Sitting/Standing (you not the patient!)

• Bottom of the bed

• Use of stirrups

• Metal instruments (the only plastic instrument – sound)

• Visualization of the cervix

Practical Points - IUT

KJ February 2016

• Up to 5 days after a single episode of UPSI

• Up to 5 days after the earliest expected

ovulation date even after multiple episodes of

UPSI ie Day 19 of a 28 day cycle

Day 16 of a 25 day cycle

Day 27 of a 35 day cycle

IUD EC, when……

KJ February 2016

• Always more reliable than oral methods

- < 1 failure in 1000 insertions (Guillebaud)

• Should always be offered (faculty recommendation)

• Women should have the choice

• Copper device only, not IUS

• Practically how can we deliver ? GP IUC Network for

referrals?

IUC as Emergency Contraception

KJ February 2016

Whittall Street clinic

Whittall Street

Birmingham

B4 6DH

Referral to

KJ February 2016

Any Questions?

• Then welcome to Loudmouth

• Theatre Company

• Presentation about the issues in SRH as seen by young people

• Role plays with actors

• Workshop discussion of attitudes and behaviours.

• Very positive reception

• GP Feedback was that the image we present about GP reception

services is pretty negative.

• Need to look to how we can improve this. Sadly no materials to

take away as to how we might do it better…….

LOUDMOUTH

NEXT MEETING Please put into your diary now!

• To be held on THURSDAY 16TH JUNE PM

• Venue: to be notified

• Topic: 1.30 – 2.30: Implant audits

2.30 – 4.30: LBGT Agenda and general

practice

Fantastic – we have really begun the move of SRH into primary

care and as genuinely ‘integrated contraception and STI service’