REDUCING GYNAECOLOGICAL WAITING TIMES USING THE PRIMARY CARE GYNAECOLOGY SERVICE

Area(s) of focus: Improving access to services especially primary care, Making services more effective and efficient through collaboration

Why Change was Needed

Gynaecological waiting times were identified as an area that we could utilise the skills and expertise across the Integrated Care System to improve patient experience. On average, patients were waiting 30 weeks for routine secondary care services. This delay negatively impacted patient experience and overloaded secondary care services with cases that could be managed in primary care settings.

What We Did

We developed a Primary Care Gynaecological Service (PCGS) to shift gynaecological services from acute hospitals to community settings. This collaborative initiative involved the Integrated Care Board (ICB), GP federations, acute providers, and local GP practices.

Key steps included:
1. Forming a Clinically Led Stakeholder Group: Weekly meetings facilitated project implementation, identifying challenges, and ensuring milestones were met.
2. Workforce Management: Recruitment and training of a GP Clinical Lead, GPs with extended roles, and healthcare assistants.
3. Securing Suitable Estates: Identifying venues and ensuring they met health and safety standards, despite limited space in GP practices.
4. Improving IT and Governance: Establishing data sharing agreements and data protection assessments for secure patient information exchange.
5. Streamlining Diagnostic Testing: Setting up a centralised digital test request system for efficient referrals and result management.
6. Standardising Pathways and Processes: Creating operating protocols and administrative processes to support patient pathways.

Results

• Significantly Reduced Waiting Times: The average wait time for a first appointment dropped to 56 days, a 74% reduction from the previous 30-week average.
• High Appointment Completion Rate: 70% of secondary care waiting list appointments were completed within the first four months, reducing the overall waiting list by 18-20%.
• Improved Access and Convenience: Patients received care closer to home, with 78% of appointments via telephone and 28% face-to-face in community settings.
• Low DNA Rate: The service achieved a 0.03% Did Not Attend (DNA) rate, well below other services.
• Positive Patient Feedback: 96% of patients rated the service as very good, appreciating the kind and informative staff.

Next Steps

• Expand Service Reach: Increase the number of GP practices referring to the PCGS.
• Continue Collaboration: Strengthen partnerships to further integrate primary and secondary care services.
• Monitor and Adapt: Regularly review and refine processes based on patient and staff feedback to ensure the service remains responsive and effective.

As a result of this whole system approach, this innovative service is reducing the amount of time women are waiting to receive specialist advice and treatment for common gynaecology conditions, as well as providing care in local community settings which are often more convenient for patients. The PCGS also allows local clinicians to extend their experience and expertise within gynaecology, helping to attract and retain staff in primary care across the region.