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

Guildford & Waverley Community Gynaecology Service 1

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 Guildford & Waverley Community Gynaecology Service 2

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 Guildford & Waverley Community Gynaecology Service 3

Pathways Included

:

( Problems managed at the time of service launch ) • AUB • Pelvic pain

Exclusion Criteria For CGS

• • • • • • Under 16 years of age Post menopausal bleeding* Post coital bleeding* Cervical lesion (excluding ectropion)* Pelvic mass* Pregnancy *Red flags

AUB pathway

• • • • •

High risk groups

Age > 45yrs PCOS Obesity Persistent IMB / Failed medical management Unopposed oestrogen or tamoxifen use

AUB Pathway

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

HMB – Treatment in primary care

No Requires (or prefers) a contraceptive method Trial tranexamic acid (1g QDS) & nsaid (if not contraindicated) and review after 3/12 Yes Consider using the following (in order of preference): 1.

IUS 2.

3.

COC (cyclical or tricycle) 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

Pelvic Pain Pathway

History & Examination including STI screen Is STI screen negative?

YES Is a gynaecological cause most likely?

YES Have you considered trial of medical treatment if appropriate?

YES Are you going to refer if USS is normal? YES Refer to CGS Abnormal NO NO NO NO Treat STI / refer GUM as appropriate Consider medical Rx e.g. COC / IUS USS Normal