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Huge variation in LARC use by primary care

By Lilian Anekwe

Exclusive: There is a massive, 15-fold variation in the use of long-acting reversible contraception (LARC) between PCTs, according to prescribing data obtained by Pulse – prompting trusts to pledge better training provision for GPs.

Pulse first revealed in March 2009 that ministers had asked the South West Public Observatory and the Health Protection Agency to compile league tables scrutinising GP prescribing of LARCs, in a bid to cut rates of teenage pregnancy.

A year later the first tranche of results – which covers 2008/9 – shows GPs prescribed an average of 41.4 LARCs per 1,000 of the registered female population aged 15 to 44.

But the rate varied hugely. In the lowest PCT – NHS Kensington and Chelsea – only 5.1 women per 1,000 were prescribed an LARC. In the highest two – NHS Isle of Wight and NHS North Lincolnshire – 76.6 women per 1,000 received LARCs.

NICE published guidance five years ago urging GPs to offer LARCs to all young women for whom they are appropriate. But a lack of funding for training to fit LARCs has been blamed for poor implementation of the guidance, which is due for review in October.

It is hoped that the 10 points available in the 2009/10 QOF for keeping a register of women on prescribed contraception and offering women on other contraception information about LARCs will increase GP prescribing rates.

But Dr Richard Ma, a GP in Islington, London and an RCGP spokesperson on sexual health, said: ‘The QOF points are a foot in the door but it does not necessarily mean it will increase uptake. But even at the moment demand often outstrips supply and there's a bottleneck for LARC provision. I myself have requests coming out of my ears.'

Average rates of LARC prescribing have risen by only 2.5 per 2,000 women since 2007/8.

A spokesperson for NHS South East Coast said: ‘We are developing region-wide training to increase access to LARCs in primary care.'

Huge variation in LARC use Variation in LARC prescribing

Per 1,000 registered women aged 15-44 (2008/9)

Kensington & Chelsea 5.1
Westminster 6.3
Camden 11.2

Shropshire County 69.0
Cumbria 69.9
North Lincolnshire/Isle of Wight 76.6


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