Implanon specification

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					           Contract for the provision of a local enhanced service
                                 2009-2011

                                   Version 5

This contract is for the provision of:
Implanon
The contract is entered into between NHS Hounslow and:


Name of Practice:_________________________________________________


The contract commences on: 1st April 2009

The contract will terminate on: 31st March 2011

The contract will be reviewed: Quarterly


The service is to be provided to: Patients registered with the practice
Specification for a Local Enhanced Service for: Implanon

Introduction
Implanon is a long-acting progesterone-only contraceptive implant that contains
the active ingredient etonogestrel. Etonogestrel is a synthetic form of the
naturally occurring female sex hormone, progesterone.

Implanon is used primarily for contraceptive purposes for women aged 18-40
years of age. It will provide contraception for three years if left in place, but can
be removed at any time by a doctor.

In October 2005, the National Institute for Health and Clinical Excellence (NICE)
and the National Collaborating Centre for Women’s and Children’s Health
produced a guideline recommending that LARC should be offered to all women
as part of their contraceptive choice.
Evidence shows that:
(i) the use of contraceptive implants has doubled since 2000, with over 10,000
implants being fitted in 2003.
(ii) contraceptive implants provide excellent contraceptive protection over a long
period. Implanon which is the only contraceptive implant currently licensed in the
UK is reported to have a Pearl Index of 0.0 (95% CI 0.00-0.09).
(iii) it is one of two areas of contraceptive provision with relatively high levels of
litigation. The most important factor influencing the incidence of problems relating
to insertion and removal is the competence of the professional inserting the
device.
(iv) high quality information and advice influences client satisfaction and
continuation rates with long acting methods of contraception.
(v) implant fitting and removal are not undertaken by all clinical practitioners in
general practices and maintaining expertise in fitting and removal can be difficult
and requires commitment from the practitioner.

Aims
To ensure that the full range of contraceptive options is provided by the Practice
to the patients.

To ensure that a specified and clinically approved contraceptive procedure is
conducted safely within a Primary Care setting.

To increase the availability of contraceptive implants through primary care.

To promote contraceptive implants as an effective Long Acting Reversible
Contraceptive (LARC) method of contraception and thereby reduce unintended
pregnancies

To reduce teenage pregnancy by easy access to a highly effective and safe
contraceptive option.
Eligibility
1. Practice lists must be open for the full term of this enhanced service.

2. Practices that have closed lists should contact Yasmin M Qureshi, Senior
   Commissioning Manager (Primary Care) on 020 8630 3172 to explain their
   plans for providing this premium service as well as maintaining essential
   service provision.

(See also Accreditation section)

Details
This locally enhanced service will fund:
   1. Fitting, monitoring, checking and removal of contraceptive implants
   2. Production of an up-to-date register of patients fitted with a contraceptive
       implant
   3. The provision of condoms (if the practice is participating in the relevant
       scheme) and/or advice on the use of condoms to prevent infection and
       public health information on safer sex practices
   4. Assessment and follow up as clinically indicated.
   5. Consent and patient information
   6. Production of an appropriate clinical record. Adequate recording should be
       made regarding the patient’s clinical, reproductive and sexual history, the
       counselling process, the results of any STI screening, HIV testing,
       problems with insertion, the type and batch number of the implant, expiry
       date of the device and follow-up arrangements.
   7. Coding. The insertion of an Implanon Contraceptive Implant should be
       coded on the Practice computer system:
       For insertions: 7G2AB
       For removals: 7G2H7
   8. Removal - The removal of contraceptive implants is carried out by the use
       of aseptic techniques – this has therefore been classified as a minor
       surgery invasive procedure. The practice facilities and equipment must
       therefore meet the requirements as set out in the Minor Surgery LES.

Accreditation
Practitioners undertaking these procedures must have a letter of competence in
subdermal implants (LoC-SDI) or Royal College of Nursing (RCN) Accreditation.

Practitioners should undertake regular Continuing Professional Development
(CPD) as per FFPRHC.




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Monitoring/Review

The practice will maintain an up to date register of patients with an Implanon
Contraceptive Implant.

Pricing
£30 per fitting and 3 month review if requested by the patient.
£50 per removal.

Payment
Practices will be paid quarterly in arrears using the PCT claiming system.

Termination

The PCT or the practice can give a minimum of three months notice to the other party
otherwise.

PCT contact
Yasmin M Qureshi
Senior Commissioning Manager (Primary Care)
NHS Hounslow
Sovereign Court
15-21 Staines Road
Hounslow
Middlesex
TW3 3HR

Tel: 020 8630 3172
Fax: 020 8630 1593

Email: Yasmin.qureshi@hounslowpct.nhs.uk




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