Scope

This Lead and Inform Clinical Reference Group (CRG) covers complex obstetrics and complex gynaecology services.

The complex obstetrics element covers specialised maternity and fetal medicine services, including specialised elements of maternity care and in particular, how individuals with conditions which might materially affect their choices and care during pregnancy and birth can best be supported. It also covers the more complex and rare fetal conditions.

The Specialised Women’s Services CRG also covers the more specialised elements of gynaecological care, which would typically fall outside of the experience of local GP and hospital care.

Membership

• Chair: Matthew Jolly, National Clinical Director and Janice Rymer
• Pranav Prandya, Clinical Member
• Rohna Kearney, Clinical Member
• Rehan Khan, Clinical Member
• Marta Cohen, Affiliate Member, Perinatal Pathology
• Christoph Lees, Affiliate Member, Royal College of Obstetrics and Gynaecology
• Dr Kate Lancaster, Affiliate Member, Royal College of Obstetrics and Gynaecology
• Dr Swati Jha, Affiliate Member, Royal College of Obstetrics and Gynaecology
• Karen Ward, Affiliate Member, Chair, Bristish Society of Urogynaecology (BSUG)
• Heather Weaver/Tracey Williams, Medicines Optimisation Leads
• E. Schulman, PPV Member
• Nevila Kallfa, Public Health Lead
• Anthony Prudhoe, Lead Commissioner

Products

A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.

Service specifications

Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.

The following service specifications fall within the scope of this CRG:

• Complex gynaecology: Congenital gynaecological anomalies
• Complex gynaecology/female urology: Genito-urinary tract fistulae (girls and women aged 16 years and above)
• Complex gynaecology: Severe endometriosis
• Fertility preservation for service users with ovarian tissue who are at high/very high risk of infertility and cannot store mature eggs
• Fertility preservation for service users with testicular tissue who are at high/very high risk of infertility and cannot store sperm
• Fertility and endocrine restoration using cryopreserved ovarian tissue
• Fetal medicine
• Gestational trophoblastic disease (choriocarcinoma – all ages)
• Perinatal pathology
• Provision NHS termination of pregnancy centres for patients presenting with medical complexity and/­or significant co-morbidities requiring NHS treatment
• Reconstructive surgery service for adolescents with congenital malformation of the female genital tract
• Specialised complex surgery for urinary incontinence and vaginal and uterine prolapse (16 years and above)
• Specialised maternity care for patients (child bearing age) diagnosed with abnormally invasive placenta
• Specialised maternity service specification insert for inclusion in other relevant specifications
• Specialised services for service users with complications of mesh inserted for urinary incontinence, vaginal or internal and external rectal prolapse (16 years and above)

Policies

A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.

The following policies fall within the scope of this CRG:

• Clinical commissioning policy: Sacral nerve stimulation for overactive bladder
• Clinical commissioning policy: Management of fetal anaemia secondary to red cell alloimmunisation (fetal transfusion)
• Clinical commissioning policy: Sapropterin for phenylketonuria – use in pregnancy
• Clinical commissioning policy: Management of twin to twin syndrome
• Clinical commissioning policy: Pre-implantation genetic diagnosis (PGD)

Policy statements

Policy statements are brief documents that define the current commissioning position to support service contracting.

The following policy statements fall within the scope of this CRG:

• Interim Clinical Commissioning Urgent Policy Statement: Perinatal post-mortem investigation of fetal and neonatal deaths (England, Scotland and Wales)
• Pembrolizumab for drug-resistant gestational trophoblastic neoplasia
• Surgical treatment for women who have undergone female genital mutilation

Get involved

If you are interested in the work of the specialised paediatric allergy, immunology and infectious disease CRG or its NPOC, you can register as a stakeholder.

For details on our latest consultations please visit the NHS England consultation hub.

Get in contact

For any questions or queries relating to the work of the specialised paediatric allergy, immunology and infectious disease CRG or its NPOC, please contact: england.npoc-womenandchildren@nhs.net