The Postcode Lottery of PPC and Commissioning Barriers across England
• The format and length of contraceptive counselling received by the women • When the counselling and provision was provided throughout the maternity journey • What contraception methods were available to women and how they could access them • How consistently could this be provided to women within an area or service itself Additionally, the fragility of an existing PPC services was apparent in many service provider’s contributions to the report: “The removal of one of these clinicians [on the PPC service] would likely cause the collapse and loss of any contraception currently being provided.” Georgina Forbes, Specialist Doctor in SRH and the CoSRH Wales Committee Chair “Access remains limited and inconsistent. It is also reliant on the goodwill of all involved and subject to change at any time.” Norfolk and Waveney PPC service Even within established PPC services, the provision of certain contraceptive methods was inconsistent, for example at The Royal London Hospital: “The subdermal implant can theoretically be offered at all sites, depending on the availability of trained staff on any one day. Provision varies across sites.” Royal London Hospital, Barts NHS Foundation Trust PPC service
Across England, the provision of PPC is a postcode lottery and highly determined by chance of living in an area where dedicated and passionate local healthcare professionals have succeeded in overcoming systemic barriers. Most significantly these barriers include problematic commissioning structures, unsustainable funding arrangements, and often others within a local health system seeing PPC as a ‘nice to have,’ a ‘luxury’ or not a priority.
Findings from a Greater Manchester patient satisfaction survey demonstrate the inconsistency of PPC provision even within a specific geographic area:
49 % 54 % 53 %
of women reported that contraception was never discussed with them in the antenatal period prior to the piloting of the service.
of women would like to start contraception before leaving hospital, or within 4 weeks of birth.
of women reported that contraception was discussed with them on the postnatal ward before the piloting of the service.
This lack of standardised provision is despite a pregnant women frequently coming into contact with health services during their pregnancy journey, providing ample opportunity to consider PPC: Overall, contributions from providers to this report made clear the regional variability and lack of a standardised PPC offer to women. They called for a ‘Once for England’ approach – seen elsewhere in the UK in Wales and Scotland, where collaboration and a standardised approach improves efficiency, consistency, and quality of care. 44 In some areas of England, the provision of PPC is practically non-existent. Even in areas where there is some PPC provision or an established PPC service, significant variation exists between them as to:
44 ‘Once for Scotland’ Workforce Policies Programme
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