Death leads to demand for Pill training for GPs

SPECIALIST TRAINING in prescribing the Pill should be made mandatory for GPs, family planning experts said last week after the Prime Minister promised an investigation into a teenage girl's death, writes Glenda Cooper.

Experts stressed that the Pill - taken by three million women in Britain - is safe for most women, but that doctors must be scrupulous in checking medical history in order not to endanger those who might be at a higher risk from its use. The Birth Control Trust believes around 15 deaths a year may have some link to the Pill.

Caroline Bacon was 15 when she suffered a stroke which left her paralysed and in a coma. She had been prescribed the contraceptive pill, despite suffering from migraines, without her parents' knowledge at the age of 14.

Her mother Jenny has campaigned for four years for a full public inquiry into her death and says she has compiled a dossier of 80 girls and young women who had been taking the Pill and died.

Mrs Bacon wrote a letter to Tony Blair who has asked health chiefs to look again at the files on Caroline's death. "He said he was going to investigate Caroline's death," said Mrs Bacon who has formed a group, Parents Against Oral Contraception for Children. "I had written to Tony Blair but never expected him to reply. I was very pleasantly surprised."

The Department of Health confirmed yesterday that it was looking into all the investigations that took place after Caroline's death and would be compiling a report for Downing Street and the department.

The Pill, first introduced in the 1960s, is 99 per cent effective as a contraceptive if used correctly. It came under fire in 1995 when the Government warned that the newer "third generation" pills carried a small but increased risk of causing blood clots.

But most experts believe that when things go wrong the Pill is not so much at fault as ill-informed prescribing of it. "At the Family Planning Association, we have always said that you have to separate the problem [from] the product and whether it is appropriately prescribed," said Toni Belfield, director of information at the FPA.

"You have to look at it in context. The Pill is very safe," added Ann Furedi of the Birth Control Trust. "Between four and 10 women in every 100,000 will suffer a blood clot in the course of a year. For women on the Pill that rises to between 15 and 30. But for women who get pregnant it is 60 in 100,000. Over three million women take the Pill safely every year."

Currently, family doctors receive "tiny details" in family-planning training as undergraduates and then again when they take their GP's diploma. "Now there is the view that GPs should take more specialised training in the Family Planning diploma, but it is not obligatory and we think it should be," said Ms Belfield.

She believes there are a number of areas GPs must always address when prescribing the Pill: family history of heart disease or circulatory problems, smoking, blood pressure, migraine history, reproductive history. For those who are obese or suffer from diabetes, care has to be taken about which type to prescribe.

"There are 32 brands of Pill, of which 23 are different," said Ms Belfield. "GPs often don't give women enough time to tell them all this. We would like GPs to give women a double booking the first time they come in for family planning so they do not have to squeeze everything into four minutes."

But Dr John Chisholm, chairman of the British Medical Association's GPs' committee maintains that current training is adequate. "Our view is that, ideally, all practices ought to be providing contraceptive services," he said. "It is one of the areas put forward as a core service, but we do not think that each and every GP in a practice needs to do a special certificate in family planning. When all doctors finish their vocational training, they should be equipped to do family planning."

"Prescribing the Pill needs to be taken a lot more seriously," replied Mrs Bacon. "We feel Caroline should never have been prescribed the Pill in the first place with her medical history, and the clinic should have looked into that.

"It is a big issue and one that needs to be addressed, not just for us but for the other parents out there."