How ICBs are setting up women’s health hubs

Women’s health hubs were a key pillar of the previous Government’s women’s health strategy, published in 2022. This July saw the deadline for the establishment of at least one hub per ICB providing at least two of the core services and by December there must be at least one hub providing all core services. Healthcare Leader asked the 42 ICBs about the hubs and updates from the 24 which responded are below

In August last year it was announced that integrated care boards (ICBs) were to receive £595,000 each for the establishment or expansion of at least one women’s health hub in their footprint.

The £25m funding was to be used to cover the costs of establishing and running the pilot hubs, and by the end of July this year at least three quarters of ICBs were expected to have one women’s health hub (WHH) operational and providing clinical support against at least two core services (see box below). By the end of December 2024, they are expected to have at least one hub triaging against all core services from the core specification.

Although there has been a change of Government the commitment to this programme remains.

A Department of Health and Social Care spokesperson said: ‘The government is committed to prioritising women’s health as we reform the NHS. We will be considering how to take forward the Women’s Health Strategy for England, including the work on women’s health hubs, to ensure that women’s health is never again neglected.

‘We will increase the proportion of resources going into primary care over time and shift the focus of care out of hospitals and into the community.’

Our research has found that these initial WHHs are being established in GP practices, community hospitals or being run by primary care networks (PCNs).

Hubs do not have to be a building or specific place; they may employ digital resources to provide virtual triage or consultations, or make use of existing facilities, for example GP surgeries or community centres.

East of England Women’s Health Hubs

Bedfordshire, Luton and Milton Keynes has a hub that is set up at Lea Vale PCN and will provide all core services by December with menopause assessment and treatment to be the final service added.

Hertfordshire and West Essex’s WHH is located in four centres across south and west Hertfordshire with the core services currently being provided for women with menstrual problems, menopause, contraceptive services, preconception care, pessary fitting and pessary removal. It also provides specialist outpatient clinic services for procedures including hysteroscopy. The remaining provisions will be in place by December.

Suffolk and North East Essex ICB has co-produced plans for the creation of a WHH which it anticipates will be in place by December.

London Women’s Health Hubs

North East London has three WHHs in City and Hackney, Tower Hamlets and Barking and Dagenham, Havering and Redbridge (BHR WHH). The BHR WHH was launched at the end of July with the initial service offering urogynaecology and menopause and it includes a new single point of access for gynaecology services.

City and Hackney WHH has a hub and spoke model including holistic PCN clinics based in GP practices led by GPs working as specialty doctors for routine gynaecology and contraception services not requiring invasive investigation. It also includes a programme of virtual patient engagement events and group consultations covering menopause, menstrual health and other topics, which have reached more than 2,500 women. It is located in a community hospital, with PCN clinics in GP practices.

Tower Hamlets WHH, is based in a community hospital and includes a new single point of access for gynaecology services and new multidisciplinary clinics in the community, including GPs with a special interest. It supports primary care management through timely and more detailed advice and pathways, while reducing pressures on secondary care.

A spokesperson said: ‘All three models are collaborations involving primary care, secondary care and community services, as well as patients. They include more interaction with primary care, including training, different forms of advice, shadowing of virtual and in-person clinics. NEL is also developing a GP compatibility framework for women’s health to support primary care and progression for GPs wishing to specialise in women’s health. Through this, hubs are breaking down barriers and building stronger working relationships to benefit women.’
 
North West London has set up virtually enabled hubs rather than a physical hub – this meets the requirement defined by NHS England. Initially this covered menstrual symptoms, preconception care, pessary fitting and removal, cervical screening and STI and HIV testing. Services to be added include menopause assessment and treatment, contraceptive counselling and long-acting reversible contraception (LARC) and breast pain assessment and care.

South West London is working with relevant partners to develop plans to have a WHH open before the end of December 2024 in line with national guidance.

Midlands Women’s Health Hubs

Black Country ICB has not launched a WHH but is planning to by December.

Coventry and Warwickshire ICB has a system wide hub model in place which brings together existing services across the area to support women alongside a virtual/remote support.

The hub provides the following core services; menstrual issues and treatment, menopause assessment and support, STI screening and treatment, HIV testing, full contraception assessment and provision including long-acting reversible contraception, pessary fit and removal, cervical screening. The aim is to provide all core services by December 2024.

In Leicester, Leicestershire and Rutland the three WHHs are already providing all core services with hubs in North-West Leicestershire and Leicester city run from GP practices. In addition to the core services the third WHH at Castle Medical Group offers a specialist menopause service.

Lincolnshire has a virtual WHH which has been in place for over a year, offering two core services: pre-conceptual care and contraception counselling. The hub signposts into gynae services at GP level and secondary care. Work is underway to ensure all eight services are in place by the end of the year.

In Nottingham and Nottinghamshire the WHH is located in Newgate PCN and provides breast and cervical screening, it will not, however, deliver all the core aims by December.

The first hub in Shropshire, Telford and Wrekin is in Highley, South Shropshire. Launched in July, services for this initial hub will include contraceptive counselling and provision of a full range of contraceptive methods, preconception care and menopause support and treatment - starting with GP-led talks to raise awareness and understanding. The ICB is working towards providing all core services by December 2024. It is also developing a funding allocation, with details yet to be finalised. This will be used to support PCNs and enable them to work collaboratively to enhance their work for the hubs.

North East and Yorkshire Women’s Health Hubs

In Humber and North Yorkshire four PCNs began delivering WHHs in September 2024 with the aim for more PCNs to become Hubs through the funding period. Clinicians will be trained in LARC fitting, ring pessary fitting and menopause care with each PCN to improve access to women's health services and designate a Women's Health Champion.

In North East and North Cumbria there is one WHH up and running with two more planned. The first hub opened on International Women's Day, March 8, this year in Sunderland. This currently provides menopause care and LARC. Other hubs are set to follow over the coming months in Gateshead and north Cumbria which will provide all services by December.

A spokesperson said: ‘We're very strongly committed to improving the health of women and girls in the North East and North Cumbria and we have a really ambitious women's health programme in our region’.

South Yorkshire ICB alongside its local authority partners is developing its women’s hub arrangements by building on its existing fabric of provision with services being expanded in Rotherham and due to open in Doncaster. The expanded service is providing cervical screening, screening for HIV and screening and treatment for sexually transmitted infections (STIs).

In West Yorkshire’s Wakefield District, PCNs are also being used as the foundation for hubs, with ICB support for women’s health leads in each network and providing health education and training grants.  

In Leeds, the WHH in Harehills, focusses on general gynaecological care with an aim to strengthen good practice within primary care.

In Bradford District and Craven and Kirklees, the focus is on improving provision of LARC clinics as well as menopause support in priority areas.

West Yorkshire has also created an ICB-wide virtual hub to co-ordinate work across its places (Bradford District and Craven, Kirklees, Leeds and Wakefield District) focusing on cervical and STI screening and contraception (LARC, emergency contraception, termination of pregnancy) with female sex workers.

North West Women’s Health Hubs

Greater Manchester plans to have a WHH in each of its ten localities by the end of the year. It will be run with the local authorities which commissions sexual health services. A spokesperson said, ‘Each hub is currently at a different stage of implementation, but they are all delivering at least one element of the Women’s Health Hub service.’

Lancashire and South Cumbria plans to have a virtual network of services where there is a pathway for women to access a website and phone line to get answers to their initial queries. They will be referred to the hub by their GP or they can refer themselves. A team of appropriate healthcare professionals will prioritise these referrals and assign them to the right places for care promptly, the ICB spokesman explained, adding that, ‘We aim to deliver more care through primary care and have the healthcare workforce bring care into the community in an agile manner. Using a proportionate universalism framework, we will prioritise the areas of Barrow, Blackburn, Blackpool, and Burnley.’

The ICB plans to provide seven of the eight core services (see box above) by the December deadline. But as six models of the breast pain pathway are under national review, with data not being released until next year the ICB is working with the Lancashire and South Cumbria Cancer Alliance to ensure plans align with national recommendations.

South East Women’s Health Hubs

Surrey Heartlands ICB’s WHH currently meets the required specification and it is delivered as part of the Guildford and Waverley Community Gynaecology Service. This is an existing service that has been open for several years and the ICB is looking at how the service offer can be expanded.

Sussex has had a WHH in place in East Sussex since the end of July that meets the national requirements, and it is being run by primary care.

South West Women’s Health Hubs

Bath and North East Somerset, Swindon and Wiltshire plans to establish three hubs in the ICB area, with two already up and running.

In Bristol, North Somerset and South Gloucestershire the WHH is not site specific as most general practices are providing some or all of the core services required and there is work on-going to coordinate these services.

Cornwall and the Isles of Scilly is working with partners across the county, including the local authority and public health, voluntary sector and general practice colleagues, to complement what is already in existence for women locally and create more WHHs, specifically to target vulnerable groups in multiple locations. The first official women’s health hub is a pop-up super clinic for LARC and was delivered in Bodmin on July 27. A spokesperson said: ‘There are a number of existing women’s health initiatives already in action across Cornwall and the Isles of Scilly, which meet individual aspects of the women’s health hub specification’.

Devon is taking a phased approach to setting up WHH with provision already in place to increase capacity to fit LARC for non-contraception reasons and the first patients have been seen using these new pathways.

The ICB is using some of the national funding to commission a pilot with a local provider and a group of specialist GPs, who have undertaken menopause training, to provide a clinical support service to all GPs across Devon and aim to have this service in by Autumn 2024.

A spokesperson said: ‘This approach will enable more GPs across Devon to support a greater number of patients with their menopause care in their local primary care setting.

‘We will use the pilot as an opportunity to gather information and insight to inform the development of a service specification which will confirm the core services to be included in the next phase of the Women’s Health Hub development.'

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