The following guidelines were agreed at the trainers workshop of December 1994.

1. Introduction

The Royal College of General Practitioners holds the view that the provision of family planning
services is part of the core content of general practice and that the successful attainment of the MRCGP examination and the JCPTGP certificates are satisfactory evidence of competence to carry out family planning services.

Currently a new principal can apply to the NCHA to join the contraceptive list without any
particular additional qualifications. The Family Planning Certificate is not essential although it
is still to be recommended to our GP registrars: it provides basic theoretical training as well as
practical teaching, including the fitting of IUCDs. The Scheme will provide information on
locally run courses.

2. Overall aims

• The GP registrar shall be able to help those who request it, to choose a form of contraception suitable to their physical, psychological and social needs.
• Where appropriate, the GP registrar shall be able to raise the question of contraception with people of reproductive age who are consulting for other reasons; irrespective of their age, sex or marital status.
• He/she shall be able to do this with competence, with confidence, and without causing
  embarrassment to him\herself or the patient.

3. Objectives

The following is a list of the areas in which the GP registrar should have an appropriate level of knowledge and skills:

1. Hormonal contraception:

(i) Combined O.C. pill:
- Mode of action; reliability
- Risks, interactions, contra-indications
- Choice of appropriate pill
- How to start; missed pills; solving the problem of breakthrough bleeding, missed
periods, minor side effects
(ii) Progestogen only pill
As above
(iii) Depot Provera; Norplant
Indications, contra-indications, side effects, administration, follow up.
Some GP registrars may want to acquire the skills to fit Norplant: special sessions would have to be organised.

2. Barrier methods:

Uses and limitations; what`s` available; reliability; protection against STD, HIV.

3. IUCD:

• Mode of action; reliability
• Side effects, contra-indication
• Different types
• Method of insertion
• Use as postcoital contraception

Some, but not all trainees, will wish to acquire the skills for inserting IUCD`s.

4. POST COITAL CONTRACEPTION:

• Hormonal
• IUCD

Timing, risks, contra-indications, counselling, future contraception.

5. STERILISATION:

Methods; problems
Counselling
Follow-up

6. TERMINATION OF PREGNANCY:

Methods: medical, surgical
Risks, side effects
Abortion act: legal aspects
Ethical consideration
Follow up, future contraception

7. NATURAL METHODS:

What are they?
Reliability

The provision of contraception requires some broader knowledge and skills and GP registrars will need to be aware of the following:

1. Opportunities for health promotion: safe sex, sexual health (including cervical cytology,
   prevention of STD`s).
2. Presentation and management of simple psycho sexual problems.
3. Role of other members of primary health care team: e.g. practice nurses, health visitors.
4. Medicolegal issues - e.g. prescribing to under age adolescents. GMC guidelines, issues of confidentiality.
5. Contraception for mentally and physically handicapped.
6. Record keeping.
7. Contraceptive service payments - FP1001, FP1002.
8. Development of interpersonal skills to be able to talk about contraception\sexual problems comfortably..

4. Assessment and teaching methods

1. Assessment:
Use of problem cases, case reviews, MCQs, self confidence rating scales.
2. Teaching:
Tutorials; problem cases; role plays.

Suggested role plays:

1. Teenager, whose partner`s condom burst 2 nights ago, phones doctor for advice.
2. 16 year old girl is going to start combined OC:
advise her - how to take it
- what to do if forgets
- whether she should also use condoms.
3. 21 year old comes to request sterilisation; she is 12 weeks pregnant with an IUCD in place.

Thanks to Drs. Barnsley, Bestwick, Gray, Honeyman, Kennedy, Mitchell, Swan, Weston & Williamson