Posted on: 4 March 2025
The Mid Yorkshire Teaching NHS Trust’s Gynaecology team has launched a series of webinars aimed at equipping primary care doctors and nurse practitioners with the skills and knowledge to better diagnose and treat gynaecological symptoms and illnesses. This initiative seeks to reduce the need for referrals to secondary care, ensuring that women receive timely and effective support, closer to home.
Furthermore, there has been collaborative work between the Trust, primary care, and the NHS West Yorkshire Integrated Care Board where the team have made remarkable progress around menopause care.
At the start of 2024, the waiting time for a menopause appointment stood at 62 weeks, and through innovative practices and collaborative efforts, the team has reduced this to just 20 weeks by the end of last year.
Consultant Gynaecologist and menopause specialist, Miss Veena Kaul, Advanced Clinical Pharmacist, Fiona Aspinall, and Dr Debbie Hallott, a GP at New Southgate Surgery, developed and subsequently launched the Mid Yorkshire Menopause Guidance and Hormone Replacement Therapy Formulary 12 months ago. This comprehensive guidance allows GPs to manage most menopause cases in primary care, reducing inappropriate referrals to secondary care.
In an initiative facilitated by Faye Dowle, Transformation Manager at the Trust, Miss Kaul, worked collaboratively with Dr Hallott, in triaging menopause referrals to the Trust.
The clinicians, who are both passionate about improving women’s healthcare, explained: “The pilot project involved joint reviews of 100 menopause referrals to secondary care. Findings revealed that 62% of these referrals were unnecessary and could be managed in primary care with tailored advice. This collaborative review process, along with monthly Women’s Health Lead meetings, with education and case discussion, has enhanced the confidence and competence of GPs in managing menopause cases.
Nicole Siswick, Primary Care Manager, NHS West Yorkshire Integrated Care Board, who facilitated these meetings, added: “We also identified disparities in menopause care among different ethnic groups and to address this, alongside NHS West Yorkshire Integrated Care Board, HRT information leaflets were published in five community languages: English, Polish, Romanian, Punjabi, and Urdu. This initiative ensures inclusivity and equitable access to vital health information, empowering women across diverse communities.”
Similarly, eRS referrals to the menopause service decreased from 45 per month in early 2024 to just 2 to 4 per month in the latter half of the year, with a further reduction in November and December.
The collaboration between primary and secondary care has also helped other innovations in women’s health to flourish. Dr Cath Reiss, Consultant Gynaecologist at the Trust, also collaborated with primary care, secondary care, and ultrasound departments to improve the management of unscheduled bleeding referrals. Clear guidelines now ensure appropriate referrals to ultrasound for unscheduled bleeding on HRT, reducing unnecessary gynaecology appointments and improving efficiency. Referrals to postmenopausal bleeding clinics dropped by 30% between August and October 2024 compared to the same period in 2023.
The team’s commitment to professional education is reflected in the creation of a Women’s Health Hub online channel for healthcare partners, and the creation of dedicated webpages on the Conexus Healthcare website. These platforms provide access to the latest guidance, complex case studies, and best practice, fostering continuous learning and collaboration. Beyond this, some Primary Care Networks have introduced menopause clinics, cafes, and group consultations as a direct result of this initiative.
Working with Conexus Healthcare, the federation of GP practices in the Wakefield District, and NHS West Yorkshire Integrated Care Board, the team, guided by Ben Pilmer, Conexus Training and Consultancy Operational Manager, also devised a training programme for primary care clinicians. GPs and health professionals wanting to provide pessary fitting in GP practices are trained and then mentored by secondary care clinicians until they have developed the skills required as set out in a newly devised competency framework. This reduces the time that women across Wakefield will have to wait to have treatment for vaginal prolapse and provide a treatment option in the community instead of hospital.
Miss Kaul noted: “By streamlining patient pathways and enhancing care delivery, we’ve ensured that women receive the right care at the right time, closer to home.
“We believe that our training partnership is one of the first of its kind in the country and it demonstrates that our shared learning approach has bridged the gap between primary and secondary care, creating a more supportive and inclusive healthcare environment.”
This initiative showcases the power of collaborative working between primary and secondary care. By addressing demand, standardising care, and improving professional education, the team has created a sustainable model for delivering high-quality women’s healthcare.