badger srh project spring clinical meeting thursday 3rd ... · badger srh project spring clinical...
TRANSCRIPT
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Badger SRH Project Spring Clinical Meeting
Thursday 3rd March 2016
Liz Nyholm – SRHS Clinical Lead
Sue Bradbeer– SRHS – Administration
Support
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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
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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
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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
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http://www.badger-group.com/
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Umbrella_1 - password
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Documents Library
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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.
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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.
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Umbrella
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e.g the OMNIA entry is WRONG
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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
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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?
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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
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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
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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
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STIF Core + Plus
• Core: 27.4.16
• Plus: 28.4.16
• Contact Cathy Taylor, Palm Training
• Venue: Birmingham Chamber of Commerce
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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
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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
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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.
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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
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FSRH CEU (clinical effectiveness unit)
• Website – information ++
• Members enquiry service
• Updated MEC being launched in April at ASM
• Newsletter
• Some examples
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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
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Difficult implants
• Increasing concern about neurological injuries
• ? who should remove these? ? neurosurgeons
• Advice: be careful with your technique
• Insert into the correct plane
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Clinical Points
• PREGNANCY REGISTRY
• ellaOne® (ulipristal acetate 30 mg) post-
marketing surveillance
• http://news.hra-pregnancy.com
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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)
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LOST THREADS – NEW MANAGEMENT
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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…….
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Types and Duration of use
KJ February 2016
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• 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
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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
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KJ February 2016
Different methods of administering Cervical Anaesthesia
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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
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• 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
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• 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
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Whittall Street clinic
Whittall Street
Birmingham
B4 6DH
Referral to
KJ February 2016
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Any Questions?
• Then welcome to Loudmouth
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• 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
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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
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Fantastic – we have really begun the move of SRH into primary
care and as genuinely ‘integrated contraception and STI service’