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New Guidance From DoH On Abortion Provision

23 May, 14 | by shaworth

New guidance was issued today by the Department of Health in relation to the provision of abortions in England and Wales. Following an independent, covert investigation by the UK newspaper The Daily Telegraph, concern was raised that abortion was being provided in the UK out with the provisions of the Abortion Act, andwhich would obviously be illegal. The reporter for the Daily Telegraph accessed two abortion providers attempting to seek abortion on the basis of fetal sex alone, which is not grounds for termination in the UK and the latest guidance has clarified that this would be an illegal act.

The guidance doesn’t change the law on termination, but is designed to clarify the interpretation of the rather vague conditions specified. Most “social” terminations in the UK are performed under Category C of the Abortion Act which states The pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. The guidance clarifies that fetal sex alone does not qualify as a valid reason.

The new guidance also does not remove the condition that two doctors must consent to the termination of pregnancy, and in particular, addresses the issue of “pre-signed” forms and whether or not it’s acceptable to have a verbal history from a colleague prior to signing the form: it’s not. According to the clarified guidance, the opinions of each doctor must be formed individually, and viewing the second signature as a “rubber-stamping” exercise goes against the principles of the act.

In addition to the new guidance, the DoH also produced the results of their analysis of the UK birth sex ratios, after the requests for termination of pregnancy on the grounds of fetal sex called in question whether or not the UK is affected by the phenomenon of “missing girls”, something which is well-described in other countries where a higher social value is placed on male children, resulting in female infanticide and termination of pregnancies on the basis of fetal sex. The results suggest that the UK is not affected, even when the results are broken down to assess the ratios on the basis of the ethnicity or country of origin of the mother.

Currently, to terminate a pregnancy on the grounds of fetal sex, the fetal sex must be identified prior to making this decision. Invasive testing such as amniocentesis and chorionic villus sampling have the risk of fetal loss, and ultrasound assessment is user, and fetal position, dependent. As access to these tests become more widely available, and uptake increases, the sex ratio imbalance gets worse in affected countries. It remains to see what effect the development of commercial testing for free fetal DNA in maternal plasma has on this problem. Currently it is possible to ascertain fetal sex for a £400 test from maternal blood, available on the NHS in a limited capacity for reasons such as congenital adrenal hyperplasia. It remains to be seen, as costs for these tests drop over time, what affect this has on fetal sex ratios. Readers of speculative fiction may wish to consider Ian MacDonald’s River of Gods for an exploration of this phenomenon, and the social consequences, in a near future India.

New Guidance For Young People At Risk

3 Apr, 14 | by shaworth

A joint document designed to help healthcare professionals identify young children who may be at risk of sexual exploitation has been launched today. The project, Spotting The Signs, was funded by the Department of Health and produced by BASHH (the lead professional representative body for those managing STIs and HIV in the UK) and Brook (a charity which provides sexual health services for young people) . The document is a pro-forma, aimed at those working in sexual health services and is designed to be used within existing social and sexual health history frameworks, supporting professionals to engage young people in conversations about their risk of sexual exploitations.

Based on current research and evidence, the document assists professionals in indentifying circumstances and behaviours which be concerning, and reminds us about the dangers of assumptions based on the stereotypes we hold of certain social groups and cultures. The project was developed through consultations with young people.

The proforma was written by Dr Karen Rogstad of BASHH and Georgia Johnston of Brook. Dr Karen Rogstad is a  Consultant in HIV and Sexual Health at Sheffield Teaching Hospitals NHS Foundation Trust, and previously chair of the BASHH Adolescent Special Interest Group “This is the first national proforma to be developed which covers all sexual health providers working with young people, and that has been developed with young people’s input. It is particularly valuable because of the range of services that have evaluated it, including General Practice, and its endorsement by a wide range of organisations.  I hope it will help in identifying those young people who are being exploited as well as those who may be at risk in the future.”

Spotting the Signs is available to download from Brook and BASHH’s websites. It can be used alongside existing Brook guidance documents such as the traffic light toolkit which helps identify behaviours which may be cause for concern.


Historic News for Nurse Training in SRH

26 Nov, 13 | by shellraine, e-Media Editor

Members of the Faculty of Sexual & Reproductive Healthcare (FSRH) have voted overwhelmingly to widen membership to include nurses, paving the way for the development of a new nationally recognised qualification for nurses working in sexual health. This happened last Thursday at an extraordinary general meeting before the Current Choices Conference in London, after which Dr Chris Wilkinson made a formal announcement it in his President’s opening address to the conference. This brought forth spontaneous applause and positive comments from Minister for Public Health, Jane Ellison MP, who said:

“This announcement is a groundbreaking moment for multi-disciplinary working in the health service. I am delighted to see the Faculty of Sexual and Reproductive Healthcare leading the way in opening up their membership to nurses, ensuring that doctors and nurses work together to set standards and improve patient care. I hope this will act as an example for all services.”

and Director of Nursing for Public Health England, Professor Viv Bennett, who added:

“Effective accessible sexual health services need highly skilled teams. It is fantastic that the Faculty is valuing the key roles of nurses in the multi-disciplinary team, providing the opportunity for nurses in sexual health to gain a nationally recognised qualification and through membership to the Faculty ensuring nurses play a national strategic role in developing sexual health services as well as providing high quality services to people locally”

The FSRH becomes one of the very few medical Colleges and Faculties to include nurses within its membership, reflecting the key role that nurses play in the delivery of sexual health care, and the organisation’s desire to promote and develop multi-disciplinary working in sexual health.

What this means in practice is that from January 2014 nurses will be able to become full members of the FSRH by following the same route as doctors and completing the Nurse Diploma. Within the new training structure (for doctors and nurses) there will be a new online knowledge assessment (eKA) which will test the theoretical knowledge gained from the e-SRH or elsewhere. Those who wish to go on to complete a diploma will (after passing the eKA) complete the Course of 5 workshops followed by the ACPs (assessments of clinical practice) as doctors currently do. All of these will be logged via an online e-portfolio. An additional change is that doctors and nurses will, in future, be able to undertake the LoCs (Letters of Competence) for either SDIs or IUTs without first having to complete the diploma – they will, however, have to pass the eKA first.

Further information will be posted on the FSRH website nearer the time of launch.

NICE PGDs – Template & Baseline assessment tool

1 Oct, 13 | by shellraine, e-Media Editor

Two implementation tools have now been published to support the patient group directions NICE good practice guidance. These are available from the NICE website at the links below:

GPG 2 Patient group directions: baseline assessment tool

GPG 2 Patient group directions: template

ESC – 13thCongress and call for applications for project funding

16 Sep, 13 | by shellraine, e-Media Editor

Mark your calendar:

28 till 31 May 2014
Lisbon, Portugal

First announcement

Check out the first announcement including:

  • programme overview: 8 workshops, 21 congress sessions, 2 debates…
  • abstract submission instructions (deadline 1 December 2013)
  • registration form

Register now

Please find here an overview of the registration fees.
You can now register through the online registration form

General information / Programme overviewCall for abstracts (deadline = 1st December 2013)/ Registration

ESC newsletter

Call for project or course applications

The ESC provides funding to support a project within Europe

The available budget for applications received between 1 August and 31 December 2013 is 30,000 euro. Applications should meet the following minimal conditions:

  • The applicant must be a paid-up ESC member
  • The grant may be used to support an individual, group, institute or organisation with a project related to the aims of the ESC.
  • Examples of projects include: research, audit, review, needs assessment

Deadline for the application period:  31 December 2013

Application Form



NICE Good Practice Guidance: Patient Group Directions

2 Aug, 13 | by shellraine, e-Media Editor

The Good Practice Guidance for Patient Group Directions has been published today. Better late than never!

This guidance provides good practice recommendations for individual people and organisations involved with PGDs, with the aim of ensuring patients receive safe and appropriate care and timely access to medicines, in line with legislation.

The preferred way for patients to receive the medicines they need is for a prescriber to provide care for an individual patient on a one-to-one basis. Historically, a doctor (or dentist) would prescribe a medicine(s) for an individual patient. A pharmacist (or dispensing doctor) would then dispense the medicine against the prescription and supply the medicine(s) to the patient.

This traditional ‘medical model’ changed in the years after publication of the final Crown report Review of prescribing, supply and administration of medicines in 1999. Legal frameworks were developed that have allowed services to be redesigned and health professionals to work more flexibly for the benefit of patients. As a result of these changes, there are now several legal options for supplying and/or administering medicines, including Patient Group Directions (PGDs).

PGDs provide a legal framework that allows some registered health professionals to supply and/or administer a specified medicine(s) to a pre defined group of patients, without them having to see a doctor (or dentist). However, supplying and/or administering medicines under PGDs should be reserved for situations in which this offers an advantage for patient care, without compromising patient safety.

Legislation establishing PGDs was introduced in 2000 and the Health Service Circular (HSC 2000/026) provided additional guidance. The current legislation for PGDs is included in The Human Medicines Regulations 2012.

This guidance is written in the context of the NHS in England, including independent organisations or contractors who are commissioned to provide NHS services. It may also be applicable to individual people and organisations delivering non-NHS healthcare services, and to some of the devolved administrations.

The guidance can be found here.



Faculty 20th Anniversary Celebration & McGonagall’s Ode!

19 Jul, 13 | by shellraine, e-Media Editor

At the event to celebrate the Faculty’s 20th anniversary, those gathered were regaled, by the invited after-dinner speaker Professor James Drife, with the following ode – available as a podcast for best effect:

The Editor felt the Journal’s readers might like to share the experience, although nothing could compare with seeing the performance ‘live’.

When not engaged in composing and reciting poetry, Professor Drife’s day job is Professor of Obstetrics and Gynaecology at the University of Leeds, Leeds, UK.


McGonagall’s ode to the Faculty of Sexual and Reproductive Health


O what a very exciting place this is to be,

On Thursday the sixth of June, in the year 2-0-1-3

The Royal College of Obstetricians and Gynaecologists’ Committee Room One,

Where over the years many mighty medicopolitical deeds have been done.


O what beautiful portraits there are on the walls,

Showing how the president’s face lights up when the portrait painter calls!

If only the Faculty also had presidential portraits, I think they would look very fine,

And when viewed as a group would not be so overwhelmingly masculine.


The rest of the RCOG is fully occupied with a course right now,

So if you want to run a busy labour ward, there are experts here to tell you how:

But if you prefer your labour ward to be under-occupied and have rooms to spare,

You should follow the guidance of the Faculty of Sexual and Reproductive Healthcare.


For the Faculty tells people what to do with their cap, pill, condom, LARC or coil

If they wish to avoid pregnancy and parenthood and all that worry and toil,

And instead continue their careers, travel to far-off lands,

And feel free to buy new furniture, use moisturiser and eat from non-stick frying pans.


Tonight we are here to celebrate the Faculty’s 20th anniversary,

Which is why we have come from many distant places to London, NW1 4RG.

I myself have travelled from Dundee, by the new railway bridge over the silver Tay,

Which unlike the old one, has stayed up and has not been swept away.


But Professor Johannes Bitzer has had an even longer journey than mine –

All the way from Basel, Switzerland, with its historic bridge over the silvery Rhine,

A bridge that, I believe, has a chapel halfway across so you can offer up a prayer –

A feature that our new railway bridge could have done with, but it isnae there.


Tonight we also have a Liverpool delegation, which is small but select:

Meera Kishen, an ex-president, and John Ashton and David Richmond, presidents-elect.

The first RCOG president was from Liverpool, and still today if you’re feeling presidential,

Residence in Merseyside evidently remains desirable if not essential.


But there are exceptions to every rule, are there not?

President Chris Wilkinson is a Londoner and President Tony Falconer is a Scot,

And the Faculty has had presidents from Bournemouth and Southwark and all over the place,

So clearly my comment about Liverpool is not evidence-based.
For the Faculty is an international organisation, when all is said and done,

With a membership that now stands at 16,271

(Stretching alphabetically from Australia to Zimbabwe, which is many a mile)

And with Honorary Fellows in many exotic places including, as of today, Carlisle.


And also in the House of Lords, one of London’s most exclusive addresses,

For our roll-call of Honorary Fellows includes two distinguished baronesses.

Long may the House of Lords continue to play its part in the great political game:

May all the plans for reform be limited to giving it a gender-neutral name.


O how grateful we all are for that historic day, Friday the 26th March 1993,

The date of the founding, twenty years ago, of the FFPRHC!

In that same week, there had already been another advance in science and scholarship,

With the launch, on Monday the 22nd March, of the Intel Pentium microchip.


So today, both the Faculty and the Intel Pentium microprocessor are 20 years old –

A characteristic they share with three members of One Direction, or so I am told.

How marvellous to share a birthday with a successful microchip and famous boy band,

Neither of which a man of my age is able to understand.


But what I do know is that the Faculty is a major force for good in sexual health,

And that its members, fellows and friends represented here are its real wealth.

Aye, of movers and shakers, the honorary Fellows’ list is a veritable encyclopaedia

Which now includes Dr Mike Smith, known as the Big Daddy of doctors in the media.


And one other new fellow, who has never joined Mike in front of the microphones

Because other men have already done a show with the title, “Alias Smith and Jones”.

Corin Jones has been with the Faculty, man and boy, since it was called NAFPAD,

And is now retiring, which makes everyone, except Corin, extremely sad.


For Corin is the person who for this Faculty, and for over 20 years, has done the most,

And who, as this poem draws towards its end, deserves a toast!

So, to drink the health of Corin and the Faculty, let us rise, one and all,

With a big thank-you from everyone here, including your humble poetic servant, William McGonagall.


Jim Drife, with acknowledgments to the Great Bard of Dundee.


Fall in abortion rate and other news

15 Jul, 13 | by shellraine, e-Media Editor

Fall in abortion rates continues

Abortions carried out on women living in England and Wales fell 2.5% to 185,122 last year, Department of Health figures show.

For women aged 15-44, the abortion rate was down 5.4% to 16.5 per 1,000 women – the lowest since 1997.
From information included in abortion forms in 2012, almost half were medically-induced using drugs as opposed to surgery – similar to 2011.
Among under-18s, the abortion rate continued to fall last year.
The number of teenagers having abortions has been on a downward trend for the past five years. Between 2011 and 2012, the under-18 abortion rate fell again from 15 to 12.8 per 1,000.
The Department of Health report on the 2012 statistics said that 91% of abortions were carried out before the 13th week of pregnancy.
It also noted that fewer abortions were carried out on women from other countries, such as Ireland, than in any year since 1969.
Last year, non-residents accounted for 5,850 abortions.

The British Pregnancy Advisory Service (BPAS) said the drop in the number of teenagers experiencing an unwanted pregnancy could reflect improvements in access to contraception for young people.

In older age groups the fall in abortions could indicate that women are better able to avoid unplanned pregnancy in the first place, it said.

DH publishes “Integrated Sexual Health Services : National Service Specification”

This national service specification is provided to help local authorities to commission effective,high-quality, integrated sexual health care . It covers the rationale for commissioning effective and easy to access services and the objectives of service provision, key outcomes to consider, a description of what should be offered at various levels of service, professional and other quality standards covering sexual health, and the need to work in partnership with other services such as termination of pregnancy, general practice, and mental health services.

National curriculum review

From February to April a public consultation on the government’s proposal for the reform of the national curriculum in England was launched. The DfE has published the consultation report and government response. Having considered the responses to the consultation the government has published updated versions of the national curriculum framework and is now seeking feedback on this – deadline 8th August.

Responding to the publication Jules Hillier, Brook’s Deputy Chief Executive, said:

“Brook welcomes the inclusion of compulsory sex and relationships education in the National Curriculum, which means that secondary schools must provide young people with the education we know they very much want and need. It’s now up to schools to put this policy into action by ensuring that all children and young people are given high-quality SRE that puts young people at its heart. Getting this right will contribute to young people’s wider health and wellbeing and help them prepare for safe healthy, happy relationships. We look forward to supporting schools to do this.”

 PRAC recommendation on Diane 35 and generics

The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee (PRAC) has concluded that the benefits of Diane 35 (cyproterone acetate 2 mg / ethinylestradiol 35 micrograms) and its generics outweigh the risks in a specific patient group, provided that several measures are taken to minimise the risk of thromboembolism, including new contraindications and warnings.

The Committee adopted the recommendation following a thorough review in which it sought expert advice and considered feedback from healthcare professionals and users of these medicines.


Copenhagen Impressions

3 Jun, 13 | by shellraine, e-Media Editor

European Society of Contraception and Reproductive Health
First Global Conference


Highlights of the Congress included:

Crown Princess Mary opening the Congress followed by the amazing Copenhagen drummers                          drummers




Green contraception – estrogen in water an issue, rating methods for their ‘greenness’: hormones, packaging etc.

Lidegaard / Shulman / Dinger – continuing debate on VTE, interpreting research, epidemiology and practical applications.

Emergency Contraception – confirmation that pills have no impact globally on unintended pregnancy rates only IUDs do.

Meeting friends, old and new, from wider across the globe than usual, especially from the Baltic states, Africa and the Far East.

In addition the Board voted to set up a working group to investigate and promote multidisciplinary working across Europe.

bella sky

The startling Bella Sky hotel & conference centre

– especially the, trompe l’oeil, walkway between the 2 towers on the 23rd floor. It goes uphill from Tower 1 to 2 but from a distance appears to go the other way.



oresund  The Oresund Bridge

– the 5 mile rail and road link between Copenhagen and Malmo




bikesBicycles, bicycles and more bicycles

and particularly proper, separate, dedicated cycle lanes – at times quite scary and felt like being in the middle of the Tour de France peloton without the lycra and wrap-around shades!,

Great open sandwiches (smorrebrod) but hardly any danish pastries.

Herrrings, steak & frites. Not brilliant for veggies.

Good beer but not wine – used by next years hosts in Lisbon as an enticement to go there.




Help WHO revise its guidelines!

15 Apr, 13 | by shellraine, e-Media Editor

The WHO are currently preparing updates to its Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use, which will be finalized in 2014, and are soliciting feedback from various stakeholders in the field of family planning to inform this process. The goal is to ensure these guidelines remain relevant to family planning policies, programmes and service delivery. To that end, they have created a survey to help prioritize topics to review and to determine which new information to add to the guidelines. In addition they welcome other suggestions on how to improve the guidelines.

If you are familiar with the Medical Eligibility Criteria for Contraceptive Use or the Selected Practice Recommendations for Contraceptive Use fill out the survey and give your suggestions for the next edition.

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