GP incentive scheme increases long-term reversible contraceptive prescriptions

A UK policy to increase long-term contraceptive methods has boosted prescriptions by about 110,000 over three years.

The research, conducted by a team at Imperial College London, and funded by the National Institute for Health Research (NIHR) investigated the trends in GP prescriptions of long-acting reversible contraceptives (LARCs) after the introduction of an initiative to encourage GPs to improve women's awareness of them. 

LARCs are methods of birth control that work over an extended timeframe and include injections, hormonal implants, intrauterine devices and systems that work in the womb (see sidebar).

Although LARCS are more effective than contraceptive pills, the UK is currently lagging behind the rest of the world in its uptake of these methods. Globally about 14 - 15 per cent of women use LARC methods but in the UK the figure is only nine per cent. 

“LARCs are fantastic contraceptive methods but many people are unaware of their benefits,” said lead author Dr Sonia Saxena from the School of Public Health at Imperial College London. “They are much more reliable and effective than oral contraceptives and there are fewer side effects. They are particularly suitable for women after childbearing because many women don’t want the additional worry of falling pregnant or forgetting to take a pill while establishing a routine with a new baby and fertility is restored very quickly or, in the case of the coil, immediately on removal. We wanted to evaluate this national programme to assess its impacts on the number of GP prescriptions for LARCs.”

The pay-for-performance programme in the NHS provides incentives for GPs by linking their income to achieving certain targets for healthcare services. In 2009 the programme introduced targets for sexual health which focused on providing information on LARCS to women attending for contraceptive advice. The study published in PLOS ONE is the first to assess the impacts of this initiative.

The study analysed prescribing data for contraceptives from a sample of 581 general practices in England from April 2007 to March 2012. There was a wide variation across the practices in the numbers and type of contraceptives, but there was an overall annual increase of 4 per cent in LARC prescriptions from 2009 when the initiative was introduced.

Over the three years from 2009 to 2012 this has resulted in 8700 more women receiving prescriptions for LARCs. Since this data was based on a sample of GP surgeries, the researchers estimated that nationwide this would be the equivalent to 110,000 women receiving prescriptions for LARCs.

Injections were the most commonly prescribed form of LARCs, followed by implants and intrauterine systems or hormonal coils. The study also found parallel decreases over this time frame in prescriptions for oral contraceptives, suggesting that LARCs replaced this more commonly used form of contraception.

“The rise in LARC prescribing is a huge success story and reflects all the work GPs have put into counselling women towards choosing best options for their contraceptive needs,” said Dr Saxena. “In fact our figures may well underestimate the impact of the programme because sometimes women will receive contraceptive advice at a GP surgery but then attend a Family Planning Clinic to get the prescription. Considering the relative advantages of LARCs I think it would be a positive outcome to see a further increase in their use. In the UK the current preference for oral contraception may be due to several reasons including a common misconception that pills are the safest methods but if GPs can provide women with a balanced choice then this can allow them to make an informed decision on alternative contraceptives that are safer, more effective and cheaper for the health service.”

Dr Sonia Saxena holds an NIHR Career Development Fellowship award. This article presents independent research funded by the National Institute for Health Research (NIHR).

Reference: Arrowsmith et al. Impact of pay for performance on prescribing of long-acting reversible contraception in primary care: an interrupted time series study. PLOS ONE (2014) doi: 10.1371/journal.pone.0092205