Safety first: combined oral contraceptive prescribing in primary care  

Background/introduction:
80% of contraceptive care occurs in the general practice (GP) setting. UK Medical Eligibility Criteria (UKMEC) provides clear guidelines for the safe provision of appropriate contraception. The Faculty of Sexual and Reproductive Health (FSRH) and the National Institute of Clinical Excellence (NICE) offer further recommendations for combined oral contraceptive pill (COCP) initiation and continuation.

Aim(s)/objectives:
To establish if primary care COCP prescribing was compliant with national safety and best practice guidelines.

Methods:
The EMIS database of an average size, inner city GP surgery was used to analyse COCP consultations between 11/10/2015 and 11/01/2016.

Results:
56 women aged 14-39 years were prescribed the COCP. In 41% of consultations there was substandard documentation of medical eligibility.

UKMEC Condition	% Consultations Lacking Documentation
Venous thromboembolism 	28%
Smoking status	25%
Blood pressure 	16%
Body mass index	16%

The COCP was prescribed without specialist input for three patients with a UKMEC 3 condition: systolic blood pressure 143, undiagnosed breast lump and first degree family history of venous thromboembolism. 87% patients did not receive advice about missed pill rules; and 21% of eligible women were not advised on the benefits of long acting reversible contraception (LARC). Only 8% of patients were risk assessed for sexually transmitted infections (STIs) and no women were offered HIV screening. 

Discussion/conclusion:
The safety of COCP prescribing could be enhanced by improved application of UKMEC criteria. Promotion of safe sex was not undertaken despite high incidence of STIs and local availability of LARC options.