Reducing gynaecological waiting times using the Primary Care Gynaecology Service
Why change was needed
The Covid pandemic and the pressure it placed on the health system caused waiting lists for secondary care to increase significantly. As a system, we are constantly looking at innovative ways to reduce the backlog and ensure patients are seen as soon as possible.
Gynaecological waiting times were identified as a possible area we could utilise the skills and expertise across the Integrated Care System in order to improve patient experience. There were patients on long waiting lists who had conditions that could be treated in primary care, but whose own GP may not have the necessary expertise to deliver the treatment, and so we created the Primary Care Gynaecology Service.
What we did
It was identified that there was gynaecological expertise in primary care that could be utilised to better support patients across Coventry and Warwickshire.
By treating patients in primary care who would otherwise be put onto long waiting lists, we are able to offer eligible patients’ quicker access to treatment whilst also benefitting the overall population by reducing secondary care waiting lists.
In addition, the service allows us to deliver on the NHS’s key strategic priorities by offering expert care closer to home, reducing our environmental impact by reducing patient travel for appointments, and offering patients greater choice over how they receive care.
Phase 1 of the service involved assessing patients on elective waiting lists and offering those patients that met the relevant criteria an appointment at one of the clinics. There were multiple clinics established across Coventry and Warwickshire as part of this phase, allowing patients to attend an appointment local to them.
Patients were offered appointments at a clinic for one of the following conditions/treatments:
- Menorrhagia (heavy bleeding)
- Irregular bleeding
- Complex Menopause
- Complex Contraception (excluding sterilisation)
- Mirena coil insertion
- Pessary insertion to relieve the symptoms of vaginal prolapse
The service was led by South Warwickshire GP Federation but close partnership working across system partners was essential. Collaboration between primary care, secondary care and other NHS organisations was vital to ensuring any issues were quickly ironed out and was ultimately key to the success of phase 1 the service. The key stakeholders from across the system who were involved included:
- NHS Coventry and Warwickshire ICB,
- George Eliot Hospital NHS Trust,
- University Hospitals Coventry and Warwickshire NHS Trust,
- South Warwickshire University NHS Foundation Trust,
- North Warwickshire GP Federation
- Coventry GP Alliance
- Consultant Connect
- Local GP Practices
In total, 305 patients who were deemed appropriate referrals by secondary care were accepted into the service with a range of conditions and treatments including menopause/HRT, Menorrhagia (heavy bleeding), Mirena Coils and pessaries. A variety of appointments were offered to suit the patient’s needs, including both telephone and face to face appointments where appropriate.
The service was extremely successful in helping to support with secondary care waiting lists. As of 4th April 2023, of the 305 patients seen by the service, 80% were discharged from secondary care, reducing the amount of people on elective waiting lists and freeing up appointments for other patients.
On the back of the success of the Primary Care Gynaecology Service, the service has now moved to phase 2 and a new system of direct primary care referrals went live on Tuesday 2nd May.
Phase 2 extends the service and allows GPs from across Coventry and Warwickshire to refer directly into it for the appropriate conditions. Furthermore, the service allows for referrals from secondary care where a patient has been triaged and a referral to the service is deemed appropriate.
To support the launch, GPs are being invited to webinars and patient Q&A leaflets are being produced to help inform patients of the services offered.
The service will continue to support with our aim of reducing elective waiting times and offering patients quicker and more convenient access to care.