12 | Nursing in Practice | Autumn 2023
ANALYSIS
GPN shortages a ‘ real
barrier ’ to provision of contraception care
General practice is many people ’ s first port of call for contraception advice and provision , but workforce shortages , alongside funding issues and staff training gaps , have sparked concerns over access to these services , reports Megan Ford
A shortage of general practice nurses ( GPNs ) and those trained to fit increasingly popular coils and implants is having a ‘ major impact ’ on the provision of contraception care , with patients being referred elsewhere and facing lengthy wait times .
The situation is worrying GPNs , who are recognised as vital to delivery of sexual and reproductive services and , according to the Faculty of Sexual and Reproductive Healthcare ( FSRH ), make up the largest component of the workforce within this area of care .
Among the key concerns is a decline in provision of long-acting reversible contraception ( LARC ), such as implants and coils , prompted by a shortage of specialist nurses able to fit them . Figures 1 suggest LARC methods are gaining popularity , but practices are struggling to keep up with demand , leaving those wishing to use these methods ‘ disadvantaged ’. They can face long wait times , and in some cases be forced to travel to other practices or sexual health services .
GPNs have told Nursing in Practice of persistent and growing ‘ barriers ’ to meeting the needs of people seeking contraception services .
‘ Major impact ’ of staff shortages Ruth Bailey , an advanced nurse practitioner for sexual health and nurse representative to the FSRH Council , says ‘ high rates ’ of GPN vacancies are having ‘ a major impact on the provision of contraception ’.
‘ The majority of contraception is issued in primary care but there is a workforce crisis with GPNs ,’ she says . A complex cocktail of poor pay , terms and conditions , an ageing workforce and lack of succession planning has led to a ‘ real issue with staffing in general practice ’, warns Ms Bailey .
The government has this year confirmed new funding to set up at least one women ’ s health hub across every integrated care system in England . The aim is to improve access to care for contraception , menstrual problems , pelvic pain and menopause . But without adequate staffing , it ’ s questionable how effective these will be .
‘ I think one of the real barriers to women accessing contraception is the lack of provision of practice nurses ,’ Ms Bailey says . ‘ And I don ’ t think that is going to be fully addressed until nurses in general practice have standardised contracts that reflect their expertise and skill in a way that is fair and transparent .’
NHS Digital figures 2 suggest there were 16,952 full-time-equivalent GPNs working in England as of July
2023 – up just 1.3 % year-on-year . And at 23,369 the total GPN headcount is actually slightly down on last year .
And research by the Health Foundation ³ projects that , under current policies , the full-time-equivalent GPN shortfall could almost quadruple , from an estimated 1,700 in 2021 / 22 to around 6,400 by 2030 / 31 . This would be equivalent to nearly one in four posts .
While there are not enough nurses in general practice ‘ across the board ’, says Ms Bailey , practices also lack staff trained to fit LARCs , as well as registered trainers who can support nurses to develop these specialist skills . And this is having a negative impact on patient care .
Government statistics released earlier this year and analysed by the FSRH 1 show demand for LARC methods is increasing in England but provision within general practices and wider sexual health services has not returned to pre-pandemic levels . Latest data show that total prescribed LARC , excluding injections , stood at 41.8 per 1,000 in 2021 – much lower than the 50.8 in 2019 .
While many services were reduced during the pandemic , including face-to-face contraception appointments in practices , Ms Bailey says many of those providing LARC ‘ have not been re-established ’.
‘ We certainly know that the provision of LARCs is less than it was before the pandemic and that means women are disadvantaged ,’ she tells Nursing in Practice .
The provision of contraception is a specialist skill , and in order to fit and remove LARC devices nurses must undertake additional training . But Ms Bailey highlights the difficulty nurses face in accessing those courses .
There is ‘ no incentive for GPNs to undertake training to become LARC fitters . A shortage of trainers , plus no funding for backfill while nurses train , means a lack of LARC fitters ’, Ms Bailey says .
‘ This means many GP practices cannot offer LARC , so patients face referral to other practices or sexual health services , resulting in long waits or long travel ,’ she adds .
She also suggests there has been a ‘ rise in unplanned pregnancy and a rise in the demand for abortion ’, claiming this is ‘ the direct result of underfunding in women ’ s health and underinvestment in nursing in primary care ’.
She concludes : ‘ Put simply , contraception is a basic human right and should be easy for women to access . The situation now is unacceptable and failing women .’
Education is key Meanwhile , women ’ s health nurse Donna Loose , who runs the women ’ s health service in her general practice
The majority of contraception is issued in primary care but there is a workforce crisis with GPNs Ruth Bailey