More training is needed to improve diagnosis and care of women’s reproductive health conditions such as endometriosis, a group of MPs has argued.
The House of Commons Women and Equalities Committee (WEC) has published a report arguing that patients with these conditions experience ‘medical misogyny’ under the care of GPs and other health professionals.
While MPs recognised the ‘workplace pressures’ GPs face due to high demand, they said the ‘overwhelming concern remains that women who do present with symptoms are not being listened to and are dismissed far too readily’.
The report made a number of recommendations to the Government, including a call for increased funding and protected time for GP training on reproductive health conditions.
MPs also argued that the GP annual appraisal process should include a ‘specific performance indicator’ on the care of conditions such as endometriosis, adenomyosis, fibroids, and PCOS.
The committee heard evidence from both patients and NHS staff, including Dr Sue Mann, NHS England’s national clinical director for women’s health, who told the committee that ‘GPs needed to get better at listening’.
Witnesses also told the committee that GPs are ‘fundamental’ to the treatment of gynaecological conditions, but that they are ‘so pressured at the moment’ that they are ‘not getting the time’.
RCGP honorary secretary Dr Michael Mulholland told the committee that GPs could be doing more in this arena if they had the resources, and also noted that 60% of GPs do not have the time to adequately maintain their professional development.
‘We feel that, if primary care or general practice is well funded, GPs have the skills to do an awful lot of those steps and to organise the investigations before secondary care referral is needed,’ Dr Mulholland said in his evidence.
The committee also heard evidence that there is ‘low awareness of reproductive health conditions among some GPs’, and that others ‘were not always aware of conditions such as PMDD [premenstrual dysphoric disorder] or adenomyosis’.
Overall, the report argued that patients who experience reproductive health conditions – which are ‘highly prevalent in the UK’ – often find that their symptoms are ‘dismissed and normalised by those they turn to for help’.
On GP capacity, it concluded: ‘Primary care is under pressure. GPs lack time for professional development and funding for training is prioritised for other long-term conditions.
‘However, professional bodies acknowledged the need to improve interactions with female patients and that medical training and education on women’s health should not be “left to choice”.’
Women and Equalities Committee recommendations
- The Department of Health and Social Care (DHSC) should allocate increased funding and protected time for GP training on reproductive health conditions;
- The annual GP appraisal process should be strengthened to include a specific performance indicator on the diagnosis and treatment of women’s reproductive health conditions;
- NHS Digital should collect data on how many hours of training primary care practitioners undergo annually in the field of women’s reproductive health;
- The Government should work with the RCOG, RCGP and the GMC to improve the teaching of women’s health at undergraduate level and ensure it is an integral part of medical education;
- It should consider how to better incentivise healthcare professionals to specialise in women’s reproductive health, including making obstetrics and gynaecology a mandatory rotation;
- It should also consider the merits of using the quality and outcomes framework (QOF) or commissioning for quality and innovation (CQUIN) to incentivise better care.
- Primary care practitioners should be trained to use women’s common interactions with the healthcare system, such as cervical screening appointments, ante- and post-natal care checks and visits to STI clinics, as an opportunity to pick up hidden health concerns relating to reproductive health;
- DHSC and NHS England should commission NICE to develop comprehensive guidelines for all reproductive health conditions, which should be communicated to GPs.
Source: House of Commons Women and Equalities Committee
WEC chair Sarah Owen, who is a Labour MP, said it ‘cannot be right that despite the prevalence of these conditions’ such a ‘lack of understanding and awareness persists’.
She said: ‘This report must act as a wake-up call and the NHS must urgently implement a training programme to improve the experience of treatment and diagnosis of reproductive health conditions.
‘Improving early diagnosis, including follow-up appointments, should be a key performance indicator for the Women’s Health Strategy for England.’
DHSC said it is ‘totally unacceptable’ that women with such conditions are ‘not getting the care they need’ and ‘their voices are not being heard’.
A spokesperson for the department said: ‘That is why we will overhaul women’s healthcare, placing women’s equality at the heart of our agenda, and ensure women’s health is never again neglected.
‘We are investing an extra £26 billion in the health system and through our Plan for Change, we will get the NHS back on its feet so it delivers for all patients.’
Earlier this year, we took a look at how ICBs are setting up women’s health hubs.
A version of this story was first published on our sister title Pulse.
