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Focus on womens' health: an introduction

Redesigned services should offer an integrated approach at convenient locations, and not simply shift specialist work on to generalists, writes Rebecca Norris

Redesigned services should offer an integrated approach at convenient locations, and not simply shift specialist work on to generalists, writes Rebecca Norris

Women's specific health needs vary throughout their lifetime, requiring responses from sexual, reproductive and gynaecological NHS services. Often this care has been delivered distinctly and separately in terms of provider location, accessibility, staff and care approach.

In practice this means women generally find it easy to get contraception from their GP, but may hit long waits and numerous investigations when seeking to relieve the distressing and disruptive symptoms of heavy menstrual bleeding (about which one in 20 women aged 30-49 consult their GP each year).

The Department of Health's Shifting Care Closer to Home report published last October confirms that with the exception of cervical screening, contraception and sexual and reproductive health services, gynaecology has only recently started to make the shift in delivering care closer to patients.

PBC has the potential to change the pattern of service delivery and drive community provision, the report adds, but it has been inhibited by the difficulty in unbundling existing hospital-based contracts and the more general patchy uptake of PBC by GPs across the country.

Pioneers of redesigned women's health services, featured over the following pages (two from the pre-PBC era and the third a PBC consortium) offer salient lessons for today's GP commissioners.

They show that women want care delivered in convenient locations, such as the drop-in clinic run by nurses from a town centre-based GP surgery.

Women also want one-stop services that offer seamless care and rapid access to diagnostics. The drop-in clinic removes the stigma of STIs by offering chlamydia screening during the contraceptive clinic; the Bradford abnormal uterine bleeding service offers a nurse-led clinic in the morning and hysteroscopies in the afternoon; and the pathway drawn up by GPs in London was informed by patient feedback on their dissatisfaction with attending multiple appointments, often for duplicated tests.

Research commissioned by the DH has found similar concerns and also stresses the importance of:

• anonymity for sensitive services such as GUM

• back-up of a specialist on site if required

• the availability of pharmacy services, ideally on site

• allowing patients to book convenient appointment times (such as in school hours)

• providing good parking facilities

• offering direct access to 24-hour emergency care

• offering direct access to services for women without a GP

• having the same standard of equipment and facilities in the community as found in hospital

• involving self-help groups when designing services.

The DH report adds that little evidence exists on the quality and cost-effectiveness of GPSIs in gynaecology and warns against assuming they are cheaper or trying to simply shift specialist work to generalists.

Commissioners should aim for integrated services with some consultant involvement and also bear in mind that removing income from gynaecology hospital departments may also remove money from obstetrics, where consultants work in both areas.

Given that sexual and reproductive health is regarded as more advanced in community-based provision, an opportunity exists for gynaecology to capitalise on this, by sharing information, facilities, staff and strategies for overlapping care, concludes the DH report.

Rebecca Norris is associate editor of Practical Commissioning

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