Establishing a gynaecology service in primary care

System partners in Coventry, Rugby and Warwickshire recognised that gynaecological expertise existed in primary care which could be used to support secondary care in reducing their elective care backlog by providing a primary care service.

In order to establish a system-wide primary care service, project management support from Arden & GEM was needed to ensure that the different workstreams were all captured in detail and the right people were brought together to deliver these activities. As a result, a primary care gynaecology service is now in place which comprises four clinics and has already seen 214 patients, representing 18-20% of the validated gynaecology waiting list.

The challenge

With the COVID-19 pandemic having a profound impact on waiting times for those patients referred to secondary care, all integrated care systems have been looking for innovative ways to reduce this backlog, with national accelerator funding made available to support some systems.

In Coventry and Warwickshire, system partners recognised that gynaecological expertise existed within primary care and that this expertise could help to manage those patients waiting for elective care. Tapping into this capability was particularly important give the unequal growth of gynaecology waiting lists compared to other specialties which was highlighted by the Royal College of Obstetricians and Gynaecologists (RCOG) in their recommendations for elective recovery.

While all local stakeholders were committed to establishing a gynaecology service within primary care, support was needed to manage the wide ranging elements that would be key to the project’s success, including IT systems, estates, administrative processes and access to diagnostic testing.

Our approach

Arden & GEM’s Healthcare Solutions team was already working closely with the project lead, South Warwickshire GP Federation, so was well placed and well connected to deliver the project management support needed.

Bringing stakeholders together
The CSU brought together a stakeholder group which included the ICB, three GP federations, three acute providers and representatives from local GP practices. Within this a core project team was established comprising:

• The ICB lead for elective recovery
• Secondary care managers
• Federation managers
• Key administrative functions.

Weekly meetings were set up with the core team to discuss project implementation, challenges and ensure milestones were met.

Defining the project scope
With a core project team established, the next task was to capture in detail exactly what was needed to get four clinics up and running by autumn 2022 in the following key areas:

• Workforce – identify and onboard GPs, recruit healthcare assistants and ensure the team had completed the correct training.
• Estates – find appropriate venues for the clinics with the necessary facilities and availability, ensure key checks such as health and safety were completed, and that stock was available.
• Information technology and governance – ensure that IT systems and telephony were in place, along with Data Sharing Agreements and Data Protection Impact Assessments.
• Pathways and processes – the correct Standard Operating Protocols and administrative processes needed to be put in place to support the patient pathway.

All of these elements were detailed within robust project documentation.

Overcoming challenges
One of the key barriers that needed to be addressed was clinic access to diagnostic testing. Referrals for blood tests, radiology and cervical screening analysis all needed to take place as part of an electronic workflow. By working with GP practices, system suppliers and diagnostic providers the correct access permissions are now in place for this to work seamlessly.

Capturing learning
The first clinic went live in August 2022 and regular dialogue was established with the delivery team, in particular the GP, so that rapid troubleshooting could take place and learning could be built into future processes ready for subsequent clinics to go live.

The outcomes

Within four months of the first clinic being established, 214 appointments had taken place out of a potential 305 patients identified as appropriate for the service. This is equivalent to 18-20% of the validated gynaecology waiting list of patients considered appropriate to be seen by a primary care GP.

For patients, this service means that those who are suitable for primary care clinics are seen more quickly. While those who aren’t suitable still experience shorter wait times as workload is taken out of the secondary care pathway.

For secondary care providers, capacity is released to enable them to focus on more complex cases while for the GPs involved in service delivery, they are able to make full use of their skillsets.

Following the success of the project in reducing the elective care backlog, from May 2023 patients can now be electronically referred straight into the service from primary care. A directory of clinical services has been agreed and a telephone triage process put in place. The aim of this pathway is to route 20% of patients referred from primary care into the service to reduce overall waiting times and pressure on secondary care.

What next?

The three GP federations are currently implementing a system-wide approach to collecting insight from patients and practices which will include feedback on the primary care gynaecology service.

The same approach is replicable wherever specialist expertise exists within primary care and the ICS is currently exploring opportunities to set up clinics for dermatology and musculoskeletal (MSK) pathways.