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What can the NHS do to improve wellbeing for women?

To mark World Menopause Day, the Implementation Lead for the Elective Care Transformation Programme shares some of the lessons learned in transforming gynaecology services to improve satisfaction and outcomes:

World Menopause Day aims to raise awareness globally of the menopause and support options for improving the health and wellbeing of women.

The estimated number of women with menopause aged 50 years or older is approximately 1.5 million for the population of England (NICE, 2015).

During and after the menopause it is not uncommon for women to experience gynaecological and sexual health conditions that can severely impair their relationships, mental health, social engagement and overall quality of life.

In 2017-18 there were over 3 million outpatient attendances for gynaecology, comprising almost 4% of all outpatient attendances. These conditions can often be managed in primary care or the community, meaning there is an opportunity for women to access treatment and support earlier and closer to home than through traditional outpatient services.

As part of the Elective Care Transformation Programme 100-day challenge in gynaecology, a cross-system team from West Lincolnshire developed a multidisciplinary virtual triage clinic. Out of the 114 referrals triaged during the pilot, six patients (5%) could be managed in primary care and 30 (26%) were directed to a community based special interest GP.

Teams from Chelsea and Westminster and Central Lancashire also developed new referral pathways for common gynaecology conditions so that women would only wait for a specialist appointment if they could not be managed in primary care.

The West Lincolnshire team also worked with Public Health colleagues to signpost patients and professionals to online resources. These are hosted on the United Lincolnshire Hospitals NHS Trust website.

By providing information and access to self-management education and support for women in a range of formats including structured education sessions, support groups, emails, text messages, coaching sessions and digital health tools, women are better informed about their pathways and treatment options.

Supported self-management and shared-decision making are both core components of the comprehensive model of personalised care and enable patients and health professionals to take ‘shared responsibility for health’.

The 100-day challenge team in Central Lancashire used the opportunity of supported self-management to reduce the need for a further outpatient appointment following surgery for benign conditions.

During the pilot 55 patients met the criteria for a patient-initiated follow up service and were given information to help monitor their condition post-surgery and instructed to call the hospital with any concerns. Seven patients (13%) required a follow up appointment, whereas previously all patients would have been routinely booked an appointment and would have had to attend the hospital.

All patients surveyed rated their experience as good or very good and patients noted the benefit of not having to pay hospital parking charges.

  • To find out more the interventions trialled as part of the 100 day challenge you can access the Transforming Elective Care Services: Gynaecology handbook, published in June 2019. You can also sign up to the Elective Care Community of Practice, which has examples of excellent gynecology services, case studies, and other resources. Please email ECDC-manager@future.nhs.uk for access if you are not already a member.
  • You can take part in the annual World Menopause Day by printing and sharing resources, organising events to engage communities, and sharing World Menopause Day social media posts.
  • Information about menopause and managing its symptoms can be found on the NHS.uk website.
Judith Barlow

Judith Barlow works as a community midwife in London, as well as working with the National Elective Care Transformation Programme site delivery team.

She has been part of the team working on all the specialty based specialty waves, case studies and handbooks.

‘Using the rapid implementation approach we were able to implement good practice in several sites for women needing care to support them through a significant life change which can be individually challenging’

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