GPwER framework for women’s health

Two women laughing in conversation

Introduction and overview of the GPwER in women's health

This framework aims to educate GPs who wish to develop an extended role in women’s health. A GPwER provides specialist skills in the community and is likely to also use these skills in their other GP role(s), benefiting women who do not need onward referral. The framework covers the areas of women’s health in which it is considered that GPwER roles are most likely to exist. The term ‘GP’ as used in this framework refers to the woman’s registered GP, rather than the GPwER in women’s health. 

Disclaimer

This framework signposts to external (non-RCGP) resources. While these are considered relevant to the extended role by the framework authors, their reference within the framework does not amount to an endorsement by the RCGP. Before committing yourself to a course, please check with providers to assure yourselves with regards to the financial interests of authors and other contributors, using Who pays this doctor, Companies House and other relevant sources of information. 

Principles of this framework

Women’s health is a wide clinical area and GPwERs may work in one or more sub-specialties. Every competency in this framework will therefore not apply to every GPwER. GPwERs in different areas must not however operate in silos – for example, any GPwER will need to consider whether the woman has a desire to conceive (now or in the future), or a need for contraception, and may also be presented with symptoms representing pathology which is outside of their GPwER role but needs appropriate referral. Every GPwER should therefore be familiar with common pathology such as endometriosis and adenomyosis. 

There will also be variation within sub-specialties – for example, some GPwERs managing AUB will have the skills/facilities to carry out ultrasound and/or hysteroscopy, but others will not. The necessary practical skills will therefore vary with the setting. It is the responsibility of an individual GPwER, and their employer, to ensure that they attain the competencies that they need and keep these skills up to date. A GPwER role should always be discussed during the annual GP appraisal, whether or not the GPwER  has had an annual performance review with their employer. 

Competencies and skills in this framework are over and above the RCGP curriculum; the management of women’s health conditions will always remain a part of core general practice. Where competencies are also expected of the GP, the GPwER will hold them to a higher level. The most relevant sections of the RCGP curriculum are gynaecology and breast health, maternity and reproductive health and sexual health, but the entire curriculum applies to women, and this may have particular relevance for some GPwER roles (for example mental health competencies for a GPwER in perinatal mental health). This framework does not seek to establish a rigid uniform model, rather it offers guidance around good practice in a way that is practically helpful. 

Women are increasingly turning to the private sector, in the UK and abroad, in-person or online. This may lead to a request for the GP to prescribe a regimen which they do not feel is indicated and/or safe, or which they recognise is outside of their competency, and to a referral to an NHS GPwER for a second opinion. The skill set of a GPwER in any area should include the ability to sensitively manage this situation, with regard to the obligations in Good Medical Practice around respect for colleagues, whilst also being clear if they do not feel that the proposed regimen is safe and can be recommended. 

This framework discusses the care of those who were registered female at birth and are of the female sex. The words woman/women, and the pronouns she/her are therefore used throughout. Some of our patients have a gender identity which does not match their sex registered at birth. Clinicians should be aware of this and be respectful of their patient’s gender, pronouns and form of address.  

The NHS in Scotland, Wales and Northern Ireland is devolved from that in England. Where commissioning arrangements or bodies such as NHS England are mentioned, the assumption is that GPs who practice in Scotland, Wales and Northern Ireland would use the equivalents for their country/area.  

The RCGP defines a GP as follows:

A GP is a doctor who is a consultant in general practice. GPs have expertise and experience in providing whole person medical care whilst managing the complexity, uncertainty and risk associated with the continuous care they provide.

GPs work at the heart of their communities, striving to provide comprehensive and equitable care for everyone, considering their health care needs, stage of life and background.

GPs work in, connect with and lead multidisciplinary teams that care for people and their families, respecting the context in which they live, aiming to ensure that all of their physical and mental health needs are met.

Every GP should be familiar with the RCGP curriculum in women’s health and be able to manage women’s health presentations with an initial history, examination and investigations, then deciding whether to treat in primary care or refer, possibly with reference to local or national pathways and guidelines.

The basic qualifications required for the role are as follows:
  • Evidence of a CCT or equivalent in general practice.
  • Currently registered and licensed and in good standing with the GMC.
  • Evidence of continued practice in a primary care role on a performers list (or equivalent) and active engagement in an annual medical (whole scope of practice) appraisal.
  • Level 3 safeguarding (adult and child).

Any extended role in women’s health will require the GPwER to have good knowledge of the following, often over and above the level required by the GP:
  • The menstrual cycle and the changes which occur at menarche and menopause. 
  • How to take a comprehensive menstrual, reproductive and sexual history, with regard to cultural sensitivities and trauma-informed practice. 
  • How to use communication skills to engage a woman who may have had previous experiences where her symptoms were not believed. 
  • How to deal with inappropriate family pressure, for example by using a professional interpreter even if a family member is offered, and by usually insisting on seeing patients alone for at least part of the consultation.  
  • How to identify safety concerns in relation to coercion and abuse. 
  • The risk factors for gynaecological pathology and when a bleeding pattern or dysmenorrhoea is a variant of normal or represents possible pathology. 
  • When and how to perform an abdominal, pelvic or speculum examination. 
  • The biopsychosocial and psychosexual impact of menstrual and gynaecological symptoms.  
  • When it is appropriate to carry out investigations and conversely, when investigations will not change management. 
  • When findings represent a normal variant rather than pathology (examples might include Group B Streptococcus on a high vaginal swab, or polycystic ovaries on scan in a woman with no other symptoms of PMOS). 
  • The usual adverse effects of any treatment which is given, how to manage them and how/when to alter management if necessary.  
  • How to use shared decision-making to make a management plan.  
  • How to explain their diagnosis, investigation plan and management to women in language that the woman understands, considering their level of literacy and education, the need for an interpreter, and any neurodivergence, specific learning difficulties, impairments or disabilities. This includes situations where such decisions are very individual e.g. in the case of multiple UKMEC relative contraindications. 
  • How to communicate diagnoses and management to the woman’s GP and answer any queries from the GP, particularly when asking the GP to prescribe long-term. When long-term prescribing is outside of the remit of primary care or is something that the GP does not feel comfortable to do, a GPwER should have the skills to prescribe and monitor on a long-term basis.  
  • If necessary, how to co-ordinate care between the woman, her GP and other specialist teams who are involved in her care.  
  • An awareness of the relevant third-sector services available in their area, or to be able to sign to a social prescribing link worker to provide this information. 
  • The limits of their own expertise and when to seek a second opinion from a colleague in their own service, or refer on to secondary care, with a good understanding of local pathways for routine and urgent care. 
  • The ability to choose the most environmentally sustainable treatment options where relevant.  

This will vary by area – routes may include:  

  • Use of the RCGP mentoring platform.
  • Approaching consultants or existing GPwERs at a local clinic directly.  
  • Enquiring via the ICB, federation, health board or equivalent local organisations.  
  • Approaching the trainer/tutor from a course that the GPwER has done.  
  • The use of established social media groups, such as the Primary Care Women’s Health Society Group (PCWHS members only), SRH Delivery: Healthcare Professionals Peer Support (run by the CoSRH) and the Doctors Menopause Café on Facebook (only available to doctors registered female at birth). The RCGP cannot however endorse any particular group and users must understand that they use advice given in such groups at their own risk.

The RCGP does not mandate acquisition of any particular qualification. However, it recognises that the CoSRH Diploma and Letters of Competence in intrauterine device and contraceptive implant insertion and removal are nationally recognised benchmarks of educational standards for these procedures, and GPs undertaking these procedures are strongly encouraged to obtain the relevant qualifications.

The RCGP does not mandate ongoing membership of any organisation, although GPs may choose to maintain membership of relevant specialist organisations to support their continuing professional development and maintenance of competence. GPwERs should ensure that their contractual arrangements include appropriate indemnity and reimbursement for appropriate memberships and ongoing CPD.

Providers of the services in which GPwERs work, like other regulated healthcare professionals undertaking these procedures, are responsible for ensuring GPwER have acquired and maintain the competencies, governance arrangements, indemnity, and provide or enable required ongoing professional development, including where contractually specified, memberships, to perform these services safely.

Practical and consultation skills can be gained or improved in the following ways:

  • Observing or assisting at community or hospital clinics.
  • Attending diagnostic procedures to observe or assist.
  • Logging of clinical cases and discussion with a trainer.
  • Observed consultations in a joint clinic and subsequent discussion.
  • Structured tutorials.

The necessary qualifications will depend on the exact GPwER role - examples are given below. Some qualifications will be gained by assessment; for others, a trainer will have to be found, a logbook kept and cases discussed.

BMS:

BSVVD education and training page

CoSRH:

Diplomas run by universities:

IPM:

STI foundation:

RCOG:

  • The GPwER represents an accessible and intermediate tier of local service provision between the GP and secondary care.
  • They act as a clinical champion within the practice(s) where they do their usual GP role, as well as within local networks and commissioning bodies, to promote awareness and best practice, taking into account local health inequalities.
  • They will take a lead in complex case management in the community and work collaboratively with the GP, midwives, obstetricians, physiotherapists, health visitors, mental health teams, gynaecologists, HIV physicians, social care and any other professionals who are involved in the care of their patients.
  • Other aspects of their role may include the following: Contributing to audit and other quality improvement activities, which may include patient surveys. Supporting the development of realistic local pathways for primary care. Taking part in the induction of new members of staff. Taking part in the triage of referrals based on urgency. Preparation and submission of formulary applications. Working with secondary care in the preparation of pathways, to delineate at what point women move between different settings.
  • They may take part in education initiatives aimed at local GPs (for example webinars run by commissioners, federations or other GP organisations) – these may have the aim of improving basic women’s health knowledge, or of upskilling those who wish to know more without becoming a GPwER. They may also educate on cases where women’s health conditions may be missed within other diagnoses (for example PMS being treated as depression, or the musculoskeletal symptoms of the menopause being treated as fibromyalgia).

  • Demonstrate in their annual GP appraisal that they are keeping up to date for their GPwER role and undergo five-yearly revalidation.
  • The annual GP appraisal must cover the whole scope of work, including any GPwER roles.
  • If required to update a qualification for their role, as mandated by the awarding body (the timeframes for which should be checked with the awarding body), any expenses related to the updating of qualifications/ongoing membership of awarding bodies should be borne by the employer.
  • Keep up to date with any changes in national or local guidelines and management e.g. as local antibiotic resistance patterns change.  

Details of the setting:

  • GPwER roles are undertaken within a contract or setting that distinguishes them from standard general practice.
  • A GPwER will receive referrals for assessment and treatment from outside of the practice where they work as a GP.
  • Examples of settings for a GPwER role include community clinics, outreach clinics which go to the patients and hospitals.
  • A GPwER clinic may also be physically based within a general practice, but it would see patients who are not necessarily registered with that surgery and its funding would be separate from the core GP funding of the surgery where it is based.
  • Commissioners and employers are responsible for ensuring that appropriate facilities, equipment and clinical support during an emergency are available.
  • This will vary depending on the scope of the service – a clinic providing hysteroscopies will need more specialised facilities to one providing consultations only.
  • Employment contracts will vary and are outside of the scope of this document, but employers should always reimburse the costs of indemnity and of relevant memberships which are necessary for the GPwER role.
  • The GPwER clinic must be set up so that it can investigate, prescribe and do its own referrals to secondary care or other services, rather than expecting to delegate such tasks to the GP.
  • Where a long-term medication is started, it may be appropriate for the GP to take over prescribing. However, in some cases (for example if the medication is unlicensed, subject to shared care, or used at doses which are unusual), the GP may not feel able to do this, in which case the GPwER clinic will need to have arrangements in place to prescribe long-term, including electronic prescribing to community pharmacies.

Governance issues:

  • A GPwER is not the same as a consultant in sexual and reproductive health.
  • A GPwER who is new to the role is likely to need significant consultant supervision and mentorship, whereas a more experienced GPwER may not need mentorship on a routine day to day basis, but must still have access to clinical advice within an appropriate time frame, including urgently when needed.
  • The same obligations about working within one's competence apply for a GPwER role as they do for any other role in medicine.
  • Whilst governance responsibilities (including ensuring that the GPwER has the appropriate competencies for the role) rest with the employer, the individual GPwER should be aware of their responsibilities under Good Medical Practice to raise any concerns about governance or patient safety.
  • The GPwER may want to include a description of the governance arrangements of the service in the first appraisal after they start their GPwER role and may be expected to be asked about the governance arrangements at their annual GP appraisal.
  • This may include a reflective note on how they would respond to patient safety issues or concerns, potentially with documentation of any event in which they have had to do so.
  • The individual GPwER has a responsibility to ensure that they are working within appropriate clinical governance arrangements.
  • They should reflect on the clinical governance arrangements in place to ensure that patients are not put at risk by the environment within which they work and that they meet all appropriate regulatory standards.
  • The responsible officer will need to be assured that the governance arrangements are robust enough to provide timely information related to any concerns about the GPwER at any point in the revalidation cycle and be assured that there are no outstanding concerns in the period preceding the revalidation recommendation.

Indemnity:

  • A GPwER will typically require additional indemnity to their medical indemnity as a GP.
  • NHS bodies and organisations are financially responsible for the clinical negligence of their employees, and GPwERs providing an NHS service should seek written clarification from their employer before starting the role that they are fully covered by NHS indemnity.
  • GPwERs employed by private providers who are not NHS bodies (but may have been commissioned by the NHS) should seek written clarification from their employer before starting as to the medical indemnity arrangements before starting the role, GPs providing their GPwER service under a self-employed contract of service should seek written clarification, before starting the role, of whether the service provider (whether NHS or private), is providing indemnity directly or reimbursing it or whether it is the responsibility of the GPwER.
  • Employed and self-employed GPwERs, whether working for an NHS or non-NHS body are advised to maintain membership of a Medical Defence Organisation (MDO) for cover in respect of activities and services not covered by your state-backed or crown indemnity (such as CNSGP). These activities include non-NHS or private work, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities.
  • It is the responsibility of the GPwER to ensure that they have adequate and appropriate insurance or indemnity arrangements in place before they start the role.

Safeguarding issues:

  • The GPwER must understand the relevant safeguarding issues to do with the population that they are treating.
  • This will mainly consist of female adolescents and adults, but those who work in some services (e.g. sexual health) may also have male patients.
  • This includes a good understanding of issues around Gillick competency and Fraser guidelines, grooming (online/in person), coercion, peer pressure and non-consensual intercourse, including when to avoid an examination and escalate to a forensic setting.

Equality, Diversity, and Inclusion (EDI) issues:

EDI must be recognised as a core professional competency, not an optional adjunct. GPwERs should demonstrate expertise in trauma-informed, culturally competent, person-centred care, especially for those who experience disadvantage, marginalisation or barriers to care due to any of the following:  
  • Minority ethnic or migrant background. 
  • Religious or cultural needs. 
  • Lower socioeconomic status.
  • Digital exclusion. 
  • Disability or neurodiversity. 
  • LGBTQ+ identity. 
  • Younger or older age. 
  • Previous trauma, violence, or stigma. 
  • An occupation outside of the mainstream e.g. commercial sex workers.
  • Issues with addiction.
  • Limited health literacy or language barriers. 
  • Our workforce should reflect the diverse communities we serve. Provision of mentorship and training should do the following: Reflect diversity within the mentor/trainer pool. 
  • Proactively support clinicians from under-represented groups. 
  • Ensure equitable access to supervision, networking and career progression. 

A list of possible resources is given here for guidance and is not intended to be exhaustive. Some of the resources will require membership of the organisation for full access. Many of the organisations listed below also run annual conferences, either in person or online.

We would like to thank the following for their work in support of the development of this framework:

  • Dr Anne Connolly,
  • Dr Sarah Gray,
  • Dr Susheel Randhawa,
  • Dr Carrie Ladd,
  • Dr Louise Price,
  • Dr Lindsey Thomas,
  • Dr Maitrishila Tursnini,
  • Dr Itunuoluwa Johnson Sogbetun

Declarations of interest

The contributors above have declared the following Declarations of Interest:

  • Dr Toni Hazel (author), Director at Primary Care Women's Health Society, MD for primary care, Praktiki, Pharma/med tech funding from Bayer, MSD, Viatris, Hologic, ALK Abello, Exeltis and Thermo Fisher. Freelance medical writer, editor and speaker including work for Cogora, MIMS, Guidelines, iheed, BMJ Learning, Assura, PCM Scientific, emis, DNUK and Bluestream.
  • Paid presenter and chair role at conferences and webinars including for Livi, RCGP, PCWHF, Pulse, Nursing in Practice, Medscape, BMJ, Best Practice and MIMS.
  • Dr Sarah Gray, executive director of the Primary Care Women’s Health Society, provider of education for healthcare professionals including running the FSRH approved menopause special skills course, contributor to the RCGP one day essentials meeting, runs an independent sector GP practice which specialises in women’s health.
  • Dr Carrie Ladd, Clinical Rep & Clinical Advisor role for the RCGP.
  • Dr Susheel Randhawa, Clinical Lead and GP partner with Modality Community Gynaecology Service.
  • Dr Sigi Joseph, Clinical Lead for RCGP Scotland women's health plan, co-founder of The Doctor Explains as workplace wellbeing health education business and delivers talks for GSK, Pfizer, Theramex and Gedeon Richeter and the Primary Care women's Health Society.

If you notice any inaccuracies in the framework or have comments or suggestions on any of the content, please contact the professional standards team.

  • Date the framework was approved: September 2026
  • Date for next review: October 2029
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GPwER in specific areas of women's health

This framework will now list the knowledge, communication skills and practical skills which may be relevant to a GPwER in seven specific areas of women's health. 

A thorough understanding of the symptoms which may present to a gynaecology GPwER.

These may include abnormal uterine bleeding, vulval pain/lumps, vaginal discharge, PCOS, pelvic pain and oligo- or amenorrhoea, but this list is not exhaustive. The ability to investigate and manage such symptoms, including in the following situations:

  • When presentation is more complex than average or usual first-line management in general practice has not helped, has not been tolerated or is contraindicated.
  • When the woman’s co-morbidities put her at a higher than usual risk of complications, or her symptoms represent a likely significant pathology.
  • Where medication is indicated which is not generally started in primary care (e.g. GnRH agonists/antagonists).

Consultation and communication skills, including the following:

  • Taking a detailed menstrual, reproductive and sexual history, including the ability to sensitively gather information where discussing such matters goes against the woman’s usual cultural norms, or is distressing due to past experiences such as of abuse or stigma.
  • Counselling women with conditions such as PMOS and endometriosis or adenomyosis about the long-term effects of their condition on fertility, where this is a priority for the woman.
  • Counselling women with PMOS about the long-term metabolic effects of the condition.
  • Helping women with suspected or confirmed endometriosis or adenomyosis decide on whether to continue with medical care or be referred to discuss the possibility of surgery, considering the severity of their symptoms and any wish to conceive either now or in the future.
  • They should also understand that this decision may change over time and repeat discussions may be needed.
  • Decisions about whether to operate and consent for surgery remain the remit of secondary care.

Practical skills may include some of the following:

  • Successfully carrying out a speculum examination if the anatomy has made this difficult in primary care. Removal of cervical polyps, including the use of a local anaesthetic cervical block, and interpretation of their histology.
  • Carrying out a pelvic ultrasound scan.
  • Assessment of vaginal wall and gynaecological organ prolapse and the ability to fit an appropriate pessary. Assessment of vulval dermatoses and the ability to carry out a vulval biopsy.
  • Hysteroscopy and endometrial biopsy, including a discussion about appropriate analgesia, which may include cervical local anaesthetic blocks, inhaled methoxyflurane or other forms of analgesia.
  • Blind endometrial biopsy by pipelle.
  • Fitting and removing an intrauterine device or implant where this is relevant to the management of gynaecological symptoms and managing any complications around such procedures.
  • Management of a Bartholin’s cyst by marsupialisation or word catheter, including the provision of appropriate analgesia.

A thorough understanding of the presentation and management of menopause and perimenopause, including in the following situations:

  • Women with current or previous co-morbidities which may narrow their treatment options. This may include breast and other gynaecological cancers, history of cardiovascular disease, increased VTE risk due to personal or family history, HIV or any other condition which means that the GP feels uncomfortable treating the menopause. The GPwER needs to be familiar with the use of HRT, non-hormonal options and vaginal oestrogen in this cohort.

Use of regimens which are non-standard or have not been used first-line in the following cohorts:

  • Women who have had side-effects on standard regimens, which is beyond the expertise of their GP to manage.
  • Women who are requesting a higher dose of oestrogen than their GP feels comfortable to initiate and/or prescribe on an ongoing basis.
  • Women who experience intolerance to progestogen, either in their first-line regimen, or which is preventing them from appropriately increasing their progestogen proportionately with an increase in oestrogen beyond the standard dose.
  • Women who need assessment of the need for testosterone as part of an HRT regimen, if the GP does not feel comfortable doing this.
  • Women who wish to consider the use of regimens which are off-licence, and/or where there is a lack of evidence of safety and/or efficacy, either due to the regimen itself, or the woman’s co-morbidities.
  • Women who need an adjustment in HRT dose, to take account of enzyme inducing medication being taken for another condition.

Assessment for any medications which may be new to the NHS and not yet commonly prescribed in primary care (e.g. neurokinin inhibitors).

  • For women who need referring to secondary care in relation to their menopause, an understanding of when this needs to happen and with what urgency.
  • When it is not clear if symptoms should be attributed to the (peri)menopause or to another physical or mental health condition, including chronic fatigue and long-COVID.
  • Women with premature ovarian insufficiency, including knowledge about when to investigate for genetic causes, management of bone risk and onward referrals regarding fertility.
  • Women who have had a sudden surgically or medically induced menopause.
  • Women whose history of conditions such as endometriosis and adenomyosis may have implications for their choice of HRT regimen.

Consultation and communication skills including the following:

  • The ability to present an evidence-based assessment of the risks and benefits of various management options, considering any relevant cultural norms or stigma around the menopause, to make a shared decision and to communicate a summary of this discussion to the woman and her GP.
  • The ability to communicate when it is reasonable to prescribe HRT in the presence of an increased risk of adverse effects, on the basis of shared decision-making, versus the situation where the requested regimen is not safe and should not be prescribed.
  • The ability to discuss off-licence prescribing where relevant.

Practical skills may include some of the following:

  • Insertion of an LNG-IUD as part of HRT. Insertion of a contraceptive implant to cover contraception during the perimenopause in women for whom this is the preferred option.
  • Ultrasound and/or hysteroscopy when managing unscheduled bleeding in women taking HRT.
  • Hysteroscopy should include appropriate analgesia e.g. cervical local anaesthetic blocks, inhaled methoxyflurane or other forms of analgesia.
  • Insertion of estradiol implants.
  • Fitting of gynaecological pessaries.

A thorough understanding of the theoretical basis for the provision of contraception and the UK medical eligibility criteria for contraceptive use, including in the following situations:

  • Women who have co-morbidities or multiple UKMEC relative contraindications.
  • Women who have UKMEC 3 relative contraindications but still want to pursue that method of contraception, either due to preference, or because all other methods are contraindicated/not tolerated.
  • Women who have potential complications related to LARC fitting/removal and how to manage these, including when a woman’s medical history means that the possible complications mandate fitting in secondary care rather than a GPwER clinic.

Consultation and communication skills, including the following:

  • The ability to present an evidence-based assessment of the risks and benefits of various contraceptive options, which informs a shared decision-making approach. This may include educating the woman on UKMEC criteria and explaining the relative contraindications which apply to her.
  • The ability to communicate decisions made in a GPwER clinic to the GP in a way which may make them feel comfortable to prescribe the ongoing contraception on a long-term basis, and an understanding that this is a discussion between two professionals, both of whom can make their own decision on what they are comfortable to prescribe, rather than an instruction to the GP which must be followed.
  • The ability to communicate when it is reasonable to prescribe a certain method in the presence of an increased risk of adverse effects, versus the situation where the requested method is absolutely contraindicated and should not be prescribed.
  • The ability to address hormone hesitancy with empathy and understanding.

Practical skills may include some of the following:

  • The ability to fit and remove LARC such as intrauterine devices and contraceptive implants, including in non-standard situations such as the removal of an impalpable deep implant or an intrauterine device whose threads are not visible.
  • The exact skills needed will depend on what the service is commissioned to do – some examples are as follows: Those working in an abortion service may fit but not remove LARC. Those working in a deep implant service may remove but not fit implants.
  • The use of bedside ultrasound to facilitate the activity in the bullet above i.e. pelvic ultrasound and ultrasound of the arm to visualise non-palpable implants.
  • The use of cervical local anaesthetic blocks, inhaled methoxyflurane or other forms of analgesia where appropriate to facilitate hysteroscopy or removal of an IUD with non-visible threads.
  • The ability to take and interpret an etonogestrel blood test when an implant is not palpable and not visible on ultrasound but there is no history of it having been removed.

A thorough understanding of the presentation and management of perinatal mental health conditions, including in the following situations:

  • Where risk management is important, for example regarding safeguarding concerns or maternal suicide risk.

  • Where the woman may have a less common diagnosis, including post-traumatic stress syndrome following birth trauma, perinatal obsessive-compulsive disorder or postpartum psychosis.

  • In the full perinatal period, including up to 12 months postpartum. Where an understanding of trauma-informed practice is important.

  • Where a condition that presented during the perinatal period becomes chronic and needs appropriate handover to primary or secondary care for ongoing management. Where involvement of a perinatal psychiatrist or a crisis team is needed.

Consultation and communication skills, including the following:

  • Tailoring the consultation approach to consider the impact of trauma, including birth trauma or previous abuse and the impact of any relevant cultural factors or family pressure.

  • Tailoring the consultation approach to consider any neurodivergency.

  • Confidence in discussing the risk/benefit balance of prescribing in pregnancy and when breastfeeding, including for SSRIs, antipsychotics, mood stabilisers and situations where the discussion is more complex e.g. due to multiple medications.

  • An understanding of how cultural, social, and economic factors influence perinatal mental health and the ability to engage partners and families where appropriate, whilst also giving the woman the opportunity to be seen alone and to express when her priorities might not coincide with those of her partner or wider family.

  • Discussion where appropriate of the increasing evidence that those with PNMH conditions may be more likely to experience severe PMS and appropriate signposting e.g. to the National Association for Premenstrual Syndromes (NAPS).

A thorough understanding of all aspects of sexual health, including the following:

  • The diagnosis and management of all STIs, including less common presentations such as those relating to organ systems outside the genital area, presentation of late complications of STIs and management of STIs during pregnancy or in patients with co-morbidities.
  • When a test of cure is/isn’t needed after an STI diagnosis.
  • Symptoms which may prompt a patient to present to an STI clinic but actually represent non-STI pathology and need onward referral (e.g. a suspected genital wart which is suspicious for malignancy, a symptom such as dyspareunia which may be due to endometriosis or adenomyosis, or vaginal discharge which has a cause which is not related to sexual health).
  • The provision of pre- and post-exposure prophylaxis for HIV and post-exposure prophylaxis for syphilis. When to offer vaccination where relevant in a sexual health context, including the ability to assess whether the patient is eligible for a particular vaccine on the NHS.
  • The specific sexual health issues which affect sex workers. Partner notification.
  • The medical needs of patients who practice chemsex.
  • The initial management and onward referral of a patient who has been the victim of a sexual assault, balancing the need for immediate clinical care with the need not to destroy evidence which may be forensically important.

Consultation and communication skills, including the following:

  • An open, personalised and non-judgmental consultation style which allows patients to feel comfortable disclosing their sexual history to you, including those who have experienced past trauma including sexual abuse.
  • The ability to explain confidentiality and its limits as it relates to sexual health.
  • The ability to explain complex test results to patients, including syphilis and hepatitis serology, window periods for both laboratory and point of care tests and the difference between herpes swab results and herpes serology.
  • The ability to have a detailed conversation around the need for HIV testing, why the benefits of testing outweigh any risks and to allay any concerns that the patient might have, taking into account the history of HIV and its associated stigma.
  • The ability to give a result which is positive for HIV or viral hepatitis, answer the patient’s questions and refer on for definitive management.
  • The ability to have a basic discussion about psychosexual issues which may arise during the consultation and refer on to psychosexual services where appropriate.

Practical skills listed in levels 1, 2 and 3 of the integrated sexual health service specification for STIs which are relevant to the GPwER role being undertaken.

A thorough understanding of all aspects of urogynaecology, including the following:

  • The presentation and classification of female urinary incontinence, red flags which may indicate serious pathology and how classification affects investigation and management.
  • The presentation and diagnosis of all types of pelvic organ prolapse, initial conservative and medical management (including management of adverse effects) and when to refer on for a surgical opinion.
  • The interaction between urogynaecological symptoms and (peri)menopause and the use of vaginal oestrogen as part of the management of urogynaecological symptoms.
  • An understanding of systemic conditions which contribute to urogynaecological conditions, including diabetes, cognitive impairment and constipation.
  • An understanding of when a symptom initially thought to be due to a UTI is actually a presentation of another condition, gynaecological or otherwise.

Consultation and communication skills, including the following:

  • Explaining the interaction between different conditions (e.g. incontinence and prolapse) and how the management of one may affect the other.
  • The ability to take a detailed bladder, bowel and prolapse symptom history, including the impact of symptoms on daily activities.
  • The use of validated questionnaires or symptom diaries as part of information gathering and an understanding of their limitations.
  • The ability to teach the following, or to appropriately delegate this to another professional e.g. a pelvic floor physiotherapist: Pelvic floor muscle training (and to assess technique). Bladder training, including timed voiding and urge suppression techniques. Relevant lifestyle change.

Practical skills may include some of the following:

  • Ultrasound scanning to identify a post-void residual or pelvic mass.
  • Assessment of pelvic floor muscle tone and contraction.
  • The ability to examine in the left lateral position where necessary and to use the Sims/Lucy speculum.
  • Fitting and removal of specialised pessaries of all types.

A thorough understanding of all aspects of premenstrual syndrome and premenstrual dysphoric disorder, including the following:

  • The definitions of PMS, PMDD, and PME, their diagnostic criteria, the ability to distinguish between them and the vital need for prospective data establishing cyclicity of symptoms before a diagnosis is made and any treatment started.
  • An understanding of the effect of PMS (from here used to encompass all variants) on a woman’s physical, psychological, social and economic wellbeing and the effect of any neurodiversity on a woman’s experience with PMS.
  • Situations in which a woman is at a high risk of suicide and how to escalate to psychiatric input with the appropriate degree of urgency.
  • An understanding that PMS is a clinical diagnosis, and of the use of blood tests to rule out other differential diagnoses.
  • A thorough knowledge of the treatments used for PMS, including lifestyle change, sleep management, psychological therapies, herbal remedies, prescribed medication (hormonal and non-hormonal) and surgery.
  • An understanding of the limits of the medication options which can be offered in a GPwER clinic (which may vary by area and commissioning strategy) and when to refer to secondary care, either for further medical options or for an opinion on surgery.
  • An understanding of which medications are used differently for PMS than for other conditions, e.g. luteal phase dosing of SSRIs compared to daily dosing for anxiety and depression.
  • The ability to manage a woman’s PMS in conjunction with her wish to conceive (or not to conceive) and with any gynaecological or other co-morbidities.

Consultation and communication skills, including the following:

  • The ability to explain to a woman what we know about the aetiology of PMS as well as where uncertainties remain.
  • The ability to conduct a consultation with a woman who may have had previous experiences where her symptoms were not believed, either at home, in the workplace, or in a healthcare setting, and to gain her trust.
  • The use of a non-judgmental approach to a woman’s current lifestyle, acknowledging that non-optimal lifestyle choices may at times have been coping strategies to manage symptoms of PMS.
  • The ability to explain the various treatment options, including where the evidence may be limited, and use a shared decision-making process to help the woman navigate all the possible options, taking into account the severity of her condition.
  • The ability to discuss management options which a woman may want to try but which have no evidence (e.g. vitamins and, acupuncture) and to reach agreement on their use.

Practical skills, which may include some of the following:

  • The ability to fit an LNG-IUD or contraceptive implant.

Abbreviations in Women's Health

The following abbreviations are used in this framework.

  • AUB -  Abnormal uterine bleeding
  • BGCS - British Gynaecological Cancer Society BMS British Menopause Society
  • BSVVD - British Society for the Study of Vulval Disease
  • CoSRH - College of Sexual and Reproductive Healthcare
  • EDI - Equality, Diversity, and Inclusion
  • ESHRE - European Society of Human Reproduction and Embryology
  • GnRH - Gonadotropin-releasing hormone
  • GPwER - GP with extended role
  • HRT - Hormone replacement therapy
  • IAWMH - International Association for Women’s Mental Health IPM Institute of Psychosexual Medicine
  • IUD - Intrauterine device
  • KCL - King’s College London LARC Long-acting reversible contraception
  • LNG-IUD - Levonorgestrel intrauterine device
  • NAPS - National Association for Premenstrual Syndromes
  • PMOS - Polyendocrine metabolic ovarian syndrome (known as PCOS, polycystic ovarian syndrome, before May 2026).
  • PMDD - Premenstrual dysphoric disorder
  • PME - Premenstrual exacerbation of symptoms
  • PMS - Premenstrual syndrome
  • POGP - Pelvic Obstetric and Gynaecological Physiotherapy
  • PNMH - Perinatal mental health
  • RCOG - Royal College of Obstetricians and Gynaecologists
  • RCPsych - Royal College of Psychiatrists
  • SSRI - Selective serotonin reuptake inhibitor
  • STI - Sexually transmitted infection
  • UKCS - United Kingdom Continence Society
  • UKMEC - UK Medical Eligibility Criteria for contraceptive use
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