Collaborative working between system partners has seen the launch of a new primary care gynaecology service across Coventry and Warwickshire. Katie Wardle, health and transformation project manager at NHS Arden and GEM CSU, Helen West, system lead for elective recovery at NHS Coventry and Warwickshire ICB and Dr Cristina Ramos, chair and senior responsible officer at South Warwickshire GP Federation share their work.
The pilot gynaecology service was set up to treat routine gynaecology conditions with the aim of tackling hospital waiting lists and improving patient outcomes. It was commissioned by Coventry and Warwickshire ICB using NHS Innovation Accelerator funding to benefit patients across the system, and was designed as a direct primary care referral pathway, but initially provided support to manage the backlog in secondary care. The service has already supported more than 400 patients, providing quicker and more convenient access to care in community-based local clinics. The service is also alleviating pressure on hospitals and is expected to reduce referrals from primary to secondary care by 20%.
Aims
Waiting lists for gynaecology treatment grew more rapidly than most specialties during the Covid-19 pandemic. A report published by the Royal College of Obstetricians and Gynaecologists (RCOG) in April 2022, revealed that gynaecology waiting lists had reached over 570,000 women by December 2021 – a 60% increase since pre-pandemic levels. In response to a call for innovative solutions to tackle post-covid backlogs, system partners in Coventry, Rugby and Warwickshire identified an opportunity to use gynaecological expertise within primary care to support secondary care in reducing their elective care backlog. The four GP federations in the system worked together to develop a proposal for a Primary Care Gynaecology Service (PCGS).
Developing a system-wide primary care service meant bringing together a range of different workstreams, stakeholders, processes and facilities at a time when all those involved remained under pressure from the ongoing challenges of the pandemic, re-establishing business as usual and the ongoing development of new structures and governance for integrated care systems (ICSs). Arden and GEM commissioning support unit (CSU) was engaged to provide additional capacity and project management experience to steer the project, working in partnership with the lead provider, South Warwickshire GP Federation.
The aim was to deliver a service that was both faster and more convenient for patients. Phase one focused on reaching patients already on a hospital waiting list, while phase two would enable direct referrals into the PCGS from GP practices.
Methods
Arden and GEM convened a clinically-led stakeholder group which included the ICB, four GP federations, three acute providers and representatives from local GP practices. Within this, a core project team was established comprising:
- A lead GP
- The ICB lead for elective recovery
- Secondary care managers
- Federation managers including the SRO
- Key administrative functions.
Weekly meetings with the core team drove the project implementation, including identifying challenges and ensuring milestones were met that would see phase one starting in August 2022 and phase two following in May 2023.
The service comprises both face to face clinics and telephone consultations which needed to be appropriately located and staffed, with the right governance and processes in place to enable safe and secure data sharing between multiple primary and secondary care partners. This included:
- Workforce – recruiting and onboarding the GP Clinical Lead, GPs with extended roles and healthcare assistants, and ensuring the team had completed the correct training. Recruitment was only offered to those able to provide support in addition to existing commitments to avoid any negative impact on other primary care services.
- Estates – finding appropriate venues for the clinics with the necessary facilities and availability, ensuring key checks such as health and safety were completed, and that stock was available. This was particularly challenging due to the limited space available at most GP practices and the need to provide relatively local clinics for patients across a wide geographical area.
- Information technology and governance – data sharing agreements and data protection impact assessments were essential to the success of this service. The PCGS could only receive patient information from acutes or practices where a DSA was in place. Working proactively with the local data protection officer and local medical council provided additional assurance for practices.
- Diagnostic testing – enabling direct referrals from PCGS clinics for blood tests, radiology and cervical screening analysis was complex. By building relationships and working directly with GP practices, system suppliers and diagnostic providers, a centralised hub-based digital test request system is now in place which can request tests and receive results electronically across Coventry and Warwickshire.
- Pathways and processes – putting in place the correct standard operating protocols and administrative processes to support the patient pathway.
Outcomes
Patients with routine gynaecology conditions can now access help from specialist GPs in local clinics much more quickly and closer to home. Face to face clinics went live in four locations in August 2022, with over 300 patients seen by the PCGS in phase one. The average wait time for a first appointment with the service was 39 days once transferred to the PCGS.
Within the first four weeks of launching phase two of the project (May 2023), over 120 patients were referred directly into the service from GP practices, with secondary care also using the electronic referral system to refer triaged patients into the PCGS when appropriate.
As a result, 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. This is a successful example of a referral optimisation intervention, as advocated by the national outpatient recovery and transformation programme. 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.
Future
This approach has laid firm foundations for similar primary care led programmes which provide faster treatment for patients, career development opportunities for GPs and more efficient use of specialist expertise in secondary care.
By Katie Wardle, health and transformation project manager, NHS Arden & GEM CSU, Helen West, system lead for elective recovery, Coventry and Warwickshire ICB, Dr Cristina Ramos, chair and senior responsible officer, South Warwickshire GP Federation
