Scope

This Lead and Inform Clinical Reference Group (CRG) covers complex obstetrics, services that fall within specialised maternity, termination of pregnancy, complex gynaecology services, and fertility preservation for people who are at high risk of losing fertility due to medical treatment such as chemotherapy, radiotherapy or radical surgery.

The CRG has been divided into two parts complex obstetrics and maternity and complex gynaecology and fertility preservation services.

Complex obstetrics and maternity

The complex obstetrics and maternity element of the CRG includes fetal medicine, perinatal pathology, termination services for patients presenting with medical complexity and or significant co-morbidities and placenta accreta spectrum (formerly known as abnormally invasive placenta.)

Complex gynaecology and fertility preservation services

The complex gynaecology and fertility preservation services element of the CRG covers all of the specialised elements of gynaecology services including congenital anomalies, fistulae, severe endometriosis, complex surgery for urinary incontinence and vaginal prolapse and specialised services for people with complications of mesh inserted for urinary incontinence, vaginal or internal and external rectal prolapse.

This part of the CRG also covers fertility preservation for people who are at high risk of losing fertility due to medical treatment such as chemotherapy, radiotherapy or radical surgery.

Membership of the complex obstetrics and maternity part of the CRG

Clinical Lead: Matthew Jolly National Speciality Advisor

• Anthony Prudhoe, Lead Commissioner
• Bernie Stocks Lead Commissioner (Highly Specialised)
• Christoph Lees, CRG Clinical Member
• Flora Jessop, CRG Clinical Member
• Ranav Pandya, CRG Clinical Member
• Rehan Khan, CRG Clinical Member
• Nevila Kallfa, Public Health Lead
• Tracey Williams, Pharmacy Leads
• Ellie Schulman, Patient and public voice representative
• Paula Goss, Patient and public voice representative
• Kate Hawley, Patient and public voice representative

Affiliated members:

• Sally Collins, Professor of Obstetrics Nuffield Department of Women’s and Reproductive Health, University of Oxford
• Eric Jauniaux, Professor in Obstetrics and Fetal Medicine EGA Institute for Women’s Health, Faculty of Population Health Sciences, University College London

Membership of the complex gynaecology and fertility preservation services part of the CRG

The complex gynaecology and fertility preservation services part of the CRG includes the following CRG members:

Clinical Lead: Rohna Kearney, National Specialty Advisor

• Anthony Prudhoe, Lead Commissioner
• Bernie Stocks, Lead Commissioner (highly Specialised)
• Karen Ward, CRG Clinical Member
• Josephine Sandwell, CRG Clinical Member
• Angela Rantel, CRG Clinical Member
• Ranee Thacker, CRG Clinical Member
• Mohamed Belal, CRG Clinical Member
• Sheila Lane, CRG Clinical Member
• Ellie Schulman, Patient and public voice representative
• Paula Goss, Patient and public voice representative
• Kate Hawley, Patient and public voice representative

Products

A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by 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 service standards.

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 women’s 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 Women’s CRG, please contact: england.npoc-womenandchildren@nhs.net