1. 1 Guildford & Waverley Community Gynaecology Service September 2014 Presented by Dr Helen Barnes

2. 2 Guildford & Waverley Community Gynaecology Service Objectives Reduce CCG planned care spend Improve access for patients Improve quality & patient satisfaction Reduce unnecessary follow ups and invasive procedures by providing a one stop service with expert clinician scanning. Good communication with GPs, including education

3. 3 Guildford & Waverley Community Gynaecology Service Service Delivery Model 2 year pilot, contract held by Shere Surgery One stop model: GPSI or Consultant appointment with USS undertaken by the treating clinician. GPSIs = Dr Helen Barnes, Dr Graham Tyrrell, Dr Charlotte Knight Close links with RSCH: Consultant support & plan for direct listing Initially GPSI clinics at Shere Surgery & Wodeland Avenue Surgery Procedures performed in house: TV USS, Pipelle biopsy, Cervical Polypectomies, IUCD fittings Referrals to go through RSS and Choose & Book

4. Pathways Included : ( Problems managed at the time of service launch ) AUB Pelvic pain

5. Exclusion Criteria For CGS Under 16 years of age Post menopausal bleeding* Post coital bleeding* Cervical lesion (excluding ectropion)* Pelvic mass* Pregnancy *Red flags

6. AUB pathway

7. High risk groups Age > 45yrs PCOS Obesity Persistent IMB / Failed medical management Unopposed oestrogen or tamoxifen use

8. AUB Pathway History & Examination (speculum & bimanual) & FBC +/- STI screen & Cx smear if indicated Red flag symptoms / signs YES NoNo Refer (+/-TWR) Try medical treatment Resistant to medical management in primary care or outside of scope of particular GP In high risk group Refer to CGS At risk of structural abnormality USS Normal Abnormal NoNo NoNo Secondary CareCGSGP YES Refer to CGS

9. HMB – Treatment in primary care Trial tranexamic acid (1g QDS) & nsaid (if not contraindicated) and review after 3/12 Requires (or prefers) a contraceptive method No Yes Consider using the following (in order of preference): 1.IUS 2.COC (cyclical or tricycle) 3.DMPA Norethisterone 5mg TDS Day 5- 26 of cycle* Resistant to medical treatment Refer CGS *NICE recommend the IUS as the first line treatment, all other treatment options are second or third line *Although this is not a licensed contraceptive it may affect a woman’s ability to become pregnant

10. Pelvic Pain Pathway History & Examination including STI screen Refer to CGS Is a gynaecological cause most likely? Is STI screen negative? Treat STI / refer GUM as appropriate Have you considered trial of medical treatment if appropriate? Are you going to refer if USS is normal? YES NO USS Abnormal Normal Consider medical Rx e.g. COC / IUS