GPs should offer a small, advance supply of emergency contraception pills to young women relying on condoms or the pill for contraception, according to new NICE guidance aimed at reducing unwanted pregnancies in the under-25s.
NICE said the advice still means emergency contraception should only be advised ‘as a last resort’, and that GPs should advise patients to consider a long-acting reversible contraceptive (LARC) such as an intrauterine device as a more reliable alternative.
GP leaders said the advice was reasonable and should not lead to young women ‘stocking up’ on the ‘morning-after’ pill, as implied by some press reports, but warned the efforts to increase use of more reliable long-acting methods of contraception were being undermined by cuts in funding of family planning services and training to fit the devices.
The public health guidance advises GPs to ‘ensure arrangements are in place to provide a course of oral emergency contraception in advance, in specific circumstances where the regular contraceptive method being used, for example condoms or the pill, is subject to “user failure”’.
A spokesperson for NICE said: ‘It is important to note that emergency contraception should only be used as a last resort. The recommendations are clear that emergency contraception should only be provided in advance under certain circumstances – where the regular contraceptive method being used requires the person to think about it regularly or each time they have sex and which must be used according to instructions, for example condoms or the pill.’
She added: ‘If they are prescribed emergency contraception, they are likely to be given a very small number. This should also be used as an opportunity to talk to them about broader sexual health issues and discuss the contraceptive methods they are using and if a different approach may be better for them.’
The guidance also stresses that GPs should aim to offer the full range of contraceptive methods, including LARCS, or at least signpost young people to services that can provide them.
Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said: ‘I would fully support the NICE guidance on this, which has been widely misreported in the press. This is not about allowing teenagers to stock up with pills to facilitate promiscuity, but to ensure that where a contraceptive method is known to have failed the patient can take immediate steps to limit any damage. Far from encouraging irresponsible behaviour this supports responsible forward-planning.’
Dr John Ashcroft, deputy chair of Derbyshire LMC, said it was reasonable to offer emergency contraception in advance and did not think it would mean GPs would change practice much, but warned that while this would not in itself undermine efforts to get women to adopt LARCs, GPs were finding it increasingly difficult to offer adequate services with staff experienced in fitting implants and coils.
Dr Ashcroft said: ‘I have used [this approach] in the past – mainly for condom users – but we should be moving away from this to get patients onto long-acting contraception.’
He added: ‘There’s been significant cutbacks – a lot of local enhanced services for this have been cut back, you can’t get training and there’s not enough services available. Also while there is a payment system to fit and remove [certain LARCs] there is still nothing for implants.’
Dr Ashcroft added that removal of the QOF indicator on advice about LARCs (CON002) in this year’s contract was a further blow to improving access to contraception for young people.
He said: ‘The QOF indicator to give advice to women about LARCs – probably the thing that’s made the biggest difference in reducing unwanted pregnancies – is going to go with the new round of QOF changes.’
‘I have put a motion into the LMC conference that we should keep the indicator for this and remove the one to offer it [when consulted about] emergency contraception.’