Scope

This 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: David Rowlands, Consultant Obstetrician & Gynaecologist; Clinical Lead Maternity, North West Coast Strategic Clinical Network Maternity Children & Young People; Associate Medical Director Strategy & Partnerships, Wirral University Teaching Hospital NHS FT.

Mr Alastair McKelvey, Clinical Member
Dr Sarah Winfield, Clinical Member
Mr Pranav Prandya, Clinical Member
Dr Teresa Kelly, Clinical Member
Mr Andrew Kent, Clinical Member
Dr Rohna Kearney, Clinical Member
Mr Rehan Khan, Clinical Member
Dr Marta Cohen, Affiliate Member, Perinatal Pathology
Mr 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, Bristish Society of Urogynaecology
Mr Matthew Jolly, National Clinical Director
Jane Fisher, PPV Member
Nevila Kallfa, PHE Member
Anthony Prudhoe, Lead Contact

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
• 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 women with complications of mesh inserted for urinary incontinence and vaginal 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

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:

• Pembrolizumab for drug-resistant gestational trophoblastic neoplasia
• Surgical treatment for women who have undergone female genital mutilation