GPs need women’s health training to end ‘medical misogyny’, say MPs

GPs need more training to improve diagnosis and care of women’s reproductive health conditions such as endometriosis, a group of MPs has argued. 

The House of Commons Women and Equalities Committee (WEC) has today published a report arguing that patients with these conditions experience ‘medical misogyny’ under the care of GPs and other health professionals. 

While MPs recognised the ‘workplace pressures’ GPs face due to high demand, they said the ‘overwhelming concern remains that women who do present with symptoms are not being listened to and are dismissed far too readily’. 

The report made a number of recommendations to the Government, including a call for increased funding and protected time for GP training on reproductive health conditions. 

MPs also argued that the GP annual appraisal process should include a ‘specific performance indicator’ on the care of conditions such as endometriosis, adenomyosis, fibroids, and PCOS.

The committee heard evidence from both patients and NHS staff, including Dr Sue Mann, NHS England’s national clinical director for women’s health, who told the committee that ‘GPs needed to get better at listening’. 

Witnesses also told the committee that GPs are ‘fundamental’ to the treatment of gynaecological conditions, but that they are ‘so pressured at the moment’ that they are ‘not getting the time’.

RCGP honorary secretary Dr Michael Mulholland told the committee that GPs could be doing more in this arena if they had the resources, and also noted that 60% of GPs do not have the time to adequately maintain their professional development. 

‘We feel that, if primary care or general practice is well funded, GPs have the skills to do an awful lot of those steps and to organise the investigations before secondary care referral is needed,’ Dr Mulholland said in his evidence.

The committee also heard evidence that there is ‘low awareness of reproductive health conditions among some GPs’, and that others ‘were not always aware of conditions such as PMDD [premenstrual dysphoric disorder] or adenomyosis’.

Overall, the report argued that patients who experience reproductive health conditions – which are ‘highly prevalent in the UK’ – often find that their symptoms are ‘dismissed and normalised by those they turn to for help’.

On GP capacity, it concluded: ‘Primary care is under pressure. GPs lack time for professional development and funding for training is prioritised for other long-term conditions.

‘However, professional bodies acknowledged the need to improve interactions with female patients and that medical training and education on women’s health should not be “left to choice”.’

Professor Azeem Majeed, a GP and head of the primary care department at Imperial College London, said there are ‘many good points’ in the report, but the recommendation on GP appraisal ‘isn’t one of them’.

He continued: ‘Every specialty wants more focus on its own clinical area in the primary care curriculum. What is important is that the primary care curriculum and ongoing continuing professional development for GPs are comprehensive, covering all the main conditions that GPs will see in primary care; thereby ensuring the care they offer to their patients is evidence-based and up to date.’

Professor Majeed also said access to specialist services for these conditions also needs to be improved, which is ‘as essential as improving primary care services’.

‘This requires systemic changes, including better integration between primary and secondary care, investment in specialist services, and training programs emphasizing patient-centred care,’ he added.

WEC chair Sarah Owen, who is a Labour MP, said it ‘cannot be right that despite the prevalence of these conditions’ such a ‘lack of understanding and awareness persists’.

She said: ‘This report must act as a wake-up call and the NHS must urgently implement a training programme to improve the experience of treatment and diagnosis of reproductive health conditions.

‘Improving early diagnosis, including follow-up appointments, should be a key performance indicator for the Women’s Health Strategy for England.’

DHSC said it is ‘totally unacceptable’ that women with such conditions are ‘not getting the care they need’ and ‘their voices are not being heard’.

A spokesperson for the department said: ‘That is why we will overhaul women’s healthcare, placing women’s equality at the heart of our agenda, and ensure women’s health is never again neglected.

‘We are investing an extra £26 billion in the health system and through our Plan for Change, we will get the NHS back on its feet so it delivers for all patients.’

DHSC did not confirm whether it would take forward the committee’s recommendations on GP training.

Last year, the then-Government rejected a recommendation to introduce mandatory menopause training for GPs, saying ‘it is not necessary.’

In 2023, the Women and Equalities Committee had recommended that the menopause should be given ‘more priority’ in initial training for GPs and become a ‘mandatory aspect’ of continuing GP professional development.

Last month, NICE confirmed that GPs should offer a transvaginal ultrasound to all patients with suspected endometriosis, in updated guidance on the condition.

In Wales, the Welsh Health and Social Care Committee claimed last year that GPs need more training to ‘improve their diagnostic skills’ for gynaecological cancers. 

The committee’s inquiry found that women presenting to their GP with symptoms were being ‘made to feel like a neurotic nuisance’.