Getting it right for women's health

women holding hands

27 September 2019

Dr Anne Connolly, RCGP Clinical Champion for Women's Health

Women are becoming increasingly vocal in their demands for improved understanding and management of their gender specific health concerns. Opportunities to improve women’s healthcare include using the quality improvement (QI) tools produced by RCGP.

The All Party Parliamentary Group on Women’s Health report Informed Choice? Giving women control of their healthcare, specifically focuses on endometriosis and fibroids. It demands improved understanding, faster diagnosis and provision of appropriate information to empower women in their decision-making.

The problem is multi-factorial. Limited education and reliable information is available about periods to help women understand what is ‘normal’ and ‘abnormal’. Many existing myths add confusion. Compounding factors can include the embarrassment of discussing period problems with family and colleagues. Women also report that primary care clinicians can be dismissive and unsupportive.

I have written before about the RCGP Menstrual Wellbeing Project and toolkit where guidelines, top tips, e-learning, podcasts and the women’s health library can be found in one place for ease of use. This work is currently expanding into a Women’s Health Hub to include resources covering women’s health concerns through the life course.

Additionally, the RCGP QI wheel can be used to define a local practice issue and make quality improvements. The expertise of the entire team and patient participation group is utilised to explore the problem and develop solutions. Change is implemented and embedded, ensuring sustainability and spread.  Outline examples of this approach include:

Example 1:  Culture and context

Improved management of women experiencing heavy menstrual bleeding (HMB). 

Diagnose: HMB is one of the commonest referrals to gynaecology. The National Heavy Menstrual Bleeding Audit demonstrated that 30% of referrals had no prior management offered in primary care. 

Examine consultation and referral data to understand workload and variation in practice. Improve consistency of management by updating the practice team on the latest NICE guideline on Heavy Menstrual Bleeding: assessment and management.

Implement and embed:

Agree pathways of care to understand risk assessment and appropriate use of investigations.  Use patient feedback to modify changes. 

Sustain and Spread:

Re-audit data, share outputs within the primary care network using opportunities to improve local delivery of care.

Example 2: Culture and context:

Improved uptake of cervical screening.

Diagnose:  Examine practice data for screening rates. Discuss concerns with the practice team to identify opportunities and solutions. Provide an update on the role of Human Papilloma Virus and changes to the national cervical screening programme to ensure a consistent message by involving and empowering all.

Implement and embed: Improve access to extended appointment times, perform opportunistic screens when possible, send personal invitations to women who fail or have failed to attend and include easy-to-read NHS England resources. Understand concerns by asking women who have not attended their reasons to help inform changes to the system.

Sustain and spread:

Re-audit numbers and feedback any learning to continue to modify practice.  Share learning with other practices in the Primary Care Network and explore opportunities to establish clinics increasing access for women who find daytime clinics hard to attend because of work or family commitments.

Further information about this work is available on the RCGP Menstrual Wellbeing Toolkit and QI Ready, the RCGP quality improvement tool. 

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