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Badger SRH Project Spring Clinical Meeting Thursday 3 rd March 2016 Liz Nyholm – SRHS Clinical Lead Sue Bradbeer – SRHS – Administration Support
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 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
• 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’
