Learning from practice

Westwood Park diagnostics and treatment centre (DTC) in Bradford has been up and running for ten years and offers a gynaecology service to patients as an alternative to being treated in hospital.

It is a purpose-built building with a large recovery area which has also been doing gastroscopy, cystoscopy, and cataract surgery for some time. Patients who have been referred by their GP are triaged by the DTC’s GPwSI in gynaecology, Anne Connolly, who is also a practising GP hysteroscopist.

Anne sees the referral letters from all GPs in her PCT and decides whether the patient needs an OP hysteroscopy or a visit to see herself or Helen Ludkin - a practising nurse hysteroscopist who also runs her own clinic scoping women with menstrual disorders at BRI - first. Treatments include Mirena fits, hysteroscopies or ablations and all procedures are undertaken with a consultant present.

Some patients are referred straight on to the hospital if their treatment falls outside the DTC’s remit. The DTC capitalises on the excellent relationships between primary and secondary care services and the benefits of mutual working. It is also reasonably close to the main hospital. Sian Jones, who is Consultant Obstetrician and Gynaecologist and the President of the British Society for Gynaecological Endoscopy, says, “These relationships have been built up over many years and have benefited both parties in the collaborative working that goes on in other areas too.

These include TOP pathways, incontinence pathways and infertility pathways – all of which make the patient experience as streamlined as possible. We all work in the same way so the messages that the women get are always consistent.” Continues Sian; “In 2004 we started offering a see and treat service at BRI, removing polyps and treating fibroids for example. The next step was to offer OP ablations and hysteroscopic sterilisation. However we couldn’t do this at the BRI as we didn’t have a recovery area and the women we treat sometimes need a bed to lie down on for an hour after their treatment.”

At this point Sian joined forces with GPwSI Anne, who by this time was operating from the DTC. With the blessing of the trust, Sian set up an OP hysteroscopy service there with Anne and Helen, together with a nursing team. The OP hysteroscopy clinic is run weekly. Initially the clinic just did diagnostics but quickly moved to operating and more recently to OP ablation.

Sian is training Helen and Anne to remove polyps and treat fibroids and will teach them to do ablations going forward. The team is also planning to offer OP hysteroscopic sterilisation in the near future.

In the first year the team hysteroscoped over 200 women, fitted 50 Mirenas, removed 16 lost coils, removed nearly 40 polyps and fibroids and performed ten ablations. OP hysteroscopy has been available to the women of Bradford since 1994. This service is hospital-based although GPs have direct access to it through a series of guidelines for referral and a referral proforma (see below for more information). See BHT website www.bradfordhospitals.nhs.uk Sian feels that convenience and comfortable surroundings are among the many benefits to patients;

“Women really appreciate Westwood Park – they’re looked after often by people they know, the waiting time is good, the range of treatments is more than that available at the BRI – and there is always somewhere to park!”

Close links with BRI also offer benefits to patients; “If they need an operation such as a hysterectomy or the resection of large polyps they can be offered choice, but they often choose to come into the BRI. It’s less daunting as they have already met me and I can offer a date for surgery on the day of their visit to the DTC by making a phone call to my secretary.

If I’m not around Helen and Anne have direct access to the gynaecology waiting lists at BRI.” “Women across the city are aware of what is available at the DTC and are already enquiring about having an ablation there. Our neighbouring PCTs can also send patients to us if requested.” Other hospitals/PCTS are very interested in what the team is doing and have visited for advice and fact-finding.

As referrals rise Sian plans to open a second operating room in order to run two clinics in tandem, with Sian doing ablations and sterilisations and Anne and Helen doing the diagnostics. Concludes Sian; “OP hysteroscopy is perfect for Out of Hospital work - so is colposcopy, management of incontinence, infertility investigations etc, but for this to work you need good relationships and a team approach.

There’s no point just moving consultants out into ISTCs or DTCs – they need to work with the GPwSIs and develop good pathways of care which can be delivered out of hospital but with easy access to hospital care when needed.”

The Care Closer to Home Demonstration Project has been set up to consider how care can be shifted and delivered in innovative ways to make it more convenient for patients. The project is evaluating care pathways and models of care in six specialities - dermatology, orthopaedics, gynaecology, urology, ENT and general surgery. DH web page gives more details at http://digbig.com/4nken