Gynaecology Primary Care Pathways May 2018

What is new? 5 clinical pathways reiterating primary care management of common problems Implementation of a virtual clinic to offer guidance on pathways and services Shared decision making training

Why do we need this? As Mansfield and Ashfield we spend £1,430,000 more per year than our 5 best matched peers Sherwood Forest Hospitals have higher than expected rates of Hysterectomy Genital Prolapse surgery Right Care and GIRFT data

What are we doing differently? An audit of Gynaecology referrals found much of what was referred was managed in primary care in other CCGs and was managed conservatively in secondary care Neighbouring CCGs have locally agreed pathways Derby has a similar group of pathways that have been in use for years

Reasons for Referral Uterine prolapse/ cystocoele/ rectocoele 8% Continence 6% Bi-tubal Ligation 6% Menorrhagia 5% PCOS 4% Cervical polyps 3% IUS/ Contraceptive Implants 1% Ovarian Cysts 1% A review of 95 referrals showed that a significant proportion did not have primary care/ conservative management complete.

Prolapse Each pathway is signed off by an SFH gynae consultant

Continence

Menorrhagia

PCOS

Cervical Polyps

Inter-Practice Referral LES contracts for Pessary (shelf and ring) and Cervical Polyp Removal Public Health Payment for LARC If your practice does not provide all these services you can refer patients to practices who do just for the procedure See where performs which procedures on Ardens (Orange Arrow>IPR) The pathways include primary care procedures and community services. IFR allows everyone to complete the pathways.

IPR

Community Services Newark Hospital and Kings Mill Hospital Specialist Gynaecology Physiotherapy Refer via Choose and Book e-referral Community Continence Clinic ran by Community Nurse with further qualification Refer through Call for Care

Shared Decision Making Making decisions with patients is important Patients are more likely to choose conservative treatment and be more satisfied after shared decision making Hysterectomy vs IUS Physiotherapy/Pessary vs Prolapse repair Cochrane review 2013 30,000 patients

Shared Decision Making Few patients referred to secondary care for sterilisation have surgery Bi-tubal ligation is less effective than IUS Risks of abdominal surgery Vasectomy is more effective (patients can self- refer to the Vasectomy Service by contacting the Nottingham Road Clinic directly on 01623 624137) Details on clinical pathways website. Excellent patient leaflets on patient.co.uk

Shared Decision Making E-LFH SDM module Face to Face Training sessions at KMH We can set up a training session for GPs if there is an appetite.

Already doing SDM? SURE Sure of myself:  Do you feel SURE about the best choice for you? Understanding information:  Do you know the benefits and risks of each option? Risk – benefit ratio:  Are you clear about which benefits and risks matter to you most? Encouragement:  Do you have enough support and advice to make a choice? CPD activity – give patients you have referred to surgical specialties a sure questionnaire. Should score 3 or 4 out of 4. Some tools and aids are on the Pathways website based on NHSE right care tools.

Gynaecology Virtual Clinic SystmOne e-referral GP with Gynaecology experience and interest Supported by SFH Gynaecology Provide guidance/interpretation of the pathways Signposting to community services Telephone contacts with patients at key times To help and support primary care we are trying to provide gynae VC. Not agreed yet in M and A but hopefully in near future. Ne and S starting next month. More information will be in snippets.

Message from SFH Gynaecology Please order a 2WW USS pelvis from ICE at the same time as referring patients on the 2WW pathway for post menopausal bleeding Reduces time to diagnosis and outpatient appointments A reminder is on the 2WW form Srini Vindla has asked for this as head of gynae

Questions Any questions, ideas for inter practice referral services, GP led community services, information on shared decision making, referral facilitation support please email Stephen.wormall1@nhs.net Stephanie.hart3@nhs.net