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October 2021

LARC provision in primary care under threat

Primary care providers’ ability to continue to offer long-acting reversible contraception appears to be at risk, according to a report from the Primary Care Women’s Health Forum.

LARC provision is not considered a priority when compared with other areas of healthcare, the report found, because it is not a core service, it is time-consuming and viewed by many GP practices as not financially viable because it does not generate enough – or sometimes, any – profit.

In addition, the LARC ‘fitting’ workforce is ageing, and practices are losing their LARC-trained nurses and GPs. Replacing them can be difficult because training can be expensive and it is hard to find staff to cover for trainees, or trainers for the in-person, practical component of training.

Nurses who would be interested in training are struggling to qualify or are being put off by the process, the report warns, but increasing the numbers of nurses trained to fit LARCs could help ease the pressure on doctors. ‘With the right training and support, nurses can lead LARC fittings in primary care,’ the PCWHF says.

As a result of these financial, commissioning and workforce pressures, women’s ability to access LARC methods appears to be driven by postcode. Patients attending ‘fitting’ practices or specialist services are likely to be offered a full choice of available methods, whereas patients of non-fitting practices are not, and may not be referred to a suitable service.

The PCWHF is calling for the development of Women’s Health Hubs where fitting GPs and nurses can work with non-fitting practices to offer a referral service. The Forum is also calling for a fair fitting/removal fee for LARC methods in primary care, a simplified programme for LARC training and reaccredition, and training for all practices on counselling on all contraception methods.

PCWHF chair Dr Anne Connelly said: ‘Access to effective contraception is essential for women’s health and wellbeing. There are challenges to access for women and also to the provision of LARC services. We believe that the centralised provision of women’s health services through Women’s Health Hubs offers an opportunity to increase capacity and streamline services.’

A toolkit to help establish Women’s Health Hubs is available at

Practice Nurse 2021;51(9):11