How this PCN developed menopause and women’s health clinics

Knowsley South and Central PCN will roll out women’s health clinics across its network this summer, following a successful pilot of monthly menopause sessions.

At Knowsley South and Central PCN, we will be rolling out dedicated women’s health clinics from July, following a successful pilot of monthly menopause clinics in one of our practices.

The initial aim was to improve health outcomes, to educate and empower our menopausal patients, and try to reduce the health inequalities that exist in menopause. Using a model of group consultations, we hoped to increase capacity and access to in-hours general practice appointments, while simultaneously offering better care to patients experiencing menopause.

In recent years, increased public awareness around menopause has resulted in a surge in demand. As a GP in Halewood, Knowsley, with a special interest in women’s health, it was getting to the point that approximately 20% of my appointments were related to menopause care. Inevitably these appointments end up using two appointment slots so I wanted to address this.

More importantly, we wanted to improve women’s health in chronic disease, breast and cervical screening and bone health as Knowsley has the lowest female life expectancy in the country.

Developing our menopause clinics

As the PCN clinical director I was able to provide leadership to get the clinics off the ground. We decided to use some of our capacity and access funding to pilot clinics before a full roll out. This involved just patients in my practice initially, but the next phase is to roll it out across the network, and then to other PCNs. We have three networks in Knowsley and the other two networks have contacted us asking for more information about the group consultations.

For the first clinic, reception staff kept a list of who was ringing up with menopause concerns. We’d say, ‘we can book you in for an appointment or would you like to come to this event?’  After that, we sent out an Accurx message to all women aged 40-65. We were soon fully booked. Now, it is mostly word of mouth with patients coming to us asking ‘can I book in?’.

Following a three-month pilot, clinics are now run monthly. We started with just a morning clinic on a Saturday but with more demand, we now host a full day split into two sessions. This is booked up until August for my practice and, from July, it’s going to roll out at network level.

The maximum number of patients who attend a session is 12. We have some DNAs for each session so we are going to start overbooking slightly to try and ensure that we are maximising access to the service.

As the GP in the service I am in the process of completing my training to be an accredited menopause specialist with the British Menopause Society. We also have our practice nurse, Amanda Vinue, who has the family planning and reproductive health diploma and an interest in this area as well, and we have administrative support from Megan Owens, Harvey Vinue, Jayne Birkett and Alex Birkett.

Team members opt-in to work the weekends which means that everyone is there because they want to be and have an interest in women’s health which I think this makes a real difference to the patient experience.

Clinic format

The clinics give practices the time and opportunity to connect with your patients, to deliver care the way you want to. You’re achieving a lot, not only for your patients but also in meeting parts of your QOF, your DES and your IIF.

We run two sessions once a month on a Saturday. The time blocked out for clinicians is 9am-12pm and then 12.30-2.30pm. Patients attending the morning session, for example, will come along and register between 9-9.30am and will complete questionnaires and speak to the practice nurse.

Through a previous part of the DES, we funded a self-check blood pressure machine, so patients will do their blood pressure and (if happy to do so) will get their height and weight measured. An administrator will input the information into the template on the computer.

Our practice nurse chats with people – we get them settled in with tea and biscuits – and then, between 9.30am and 10-30am, I’ll deliver the education part. This is very informal and I’m sitting with the patients, as opposed to across a desk. I have a presentation that I go through and  then discussions will come up which I facilitate so it feels really authentic and will be specific to the group that day. Women will start sharing their experiences and we have gone through a confidentiality agreement at the beginning that everyone signs.

Patients can then have a short one-to-one with me which can cover initiating HRT, HRT reviews or any specific symptoms they may wish to discuss.

Meanwhile, the practice nurse is booking patients in for any chronic disease reviews and smear tests and providing details about breast screening. We give people their blood forms and book that in also.

We’re also generate referrals to our local lifestyle hub which provides everything from structured exercise prescriptions in the gym to weight loss advice and smoking cessation; we’re picking up those people who wouldn’t ever really get round to going to the doctor about these things.

Benefits to practice, staff and patients

The pilot cost £6,000, based on six clinics across three months. Our digital lead for the PCN is in the process of getting us some solid data to demonstrate improvements. But there was a noticeable reduction in the number of menopause consultations in the weeks following the first sessions.

As an example, in one clinic we had approximately 50% of attendees go on to have a lifestyle referral and we’ve picked up three overdue chronic disease referrals. That’s going to translate into other benefits over the longer term for example, we’ve identified several cases of high cholesterol which we are now able to manage.

Just as with health inequalities, often the outcomes are only seen in the following years but it also benefits practices in terms of QOF data and clinicians in terms of job satisfaction. Added to that patients give the clinic overwhelmingly positive feedback; 100% of patients would refer the service to family and friends. Menopause is also one of the priorities in the 2024 Government Women’s Health Strategy.

Women love the shared experiences. One of our hopes was that the clinics would provide a sense of community for the women attending and reduce the feelings of isolation that can be felt when managing menopause alone.

The future – a broadened remit

When we roll out the clinics across the PCN, we’re going to expand it from just menopause to women’s health. We are working with the public health team and we’re going to try to get the breast screening van on site as well as increasing the number of nurses; we’ll have a smear taker and coil-fitting on site as well. These initiatives will reduce the number of people having to join waiting lists when we have them in front of us.

When we roll clinics out at PCN-level, we’re also hoping to have our own mental health workers in our sessions and have a yoga or Pilates practitioner to provide strength training.

The clinics are part of the PCN’s extended access plans. Ongoing funding will be required via either capacity and access or extended access funding.

My hope also is that if other PCNs want training, my team will be able to help them develop that.

Dr Victoria Hoyle is clinical director of Knowsley South and Central Primary Care Network.