How to set up a women’s health hub

In Sutton, a specialised women’s health hub – The Sunflower Clinic – has been set up in primary care. It addresses health inequalities, improves holistic care and reduces the need for referrals to secondary care. Dr Anu Jacob, GP partner and non-executive director Sutton PCNs CIC; Dr Naomi Bennett, GP partner and British Menopause Society accredited specialist; and Jagdish Kumar, Nuria De Carvajal Garcia and Jodie Reader from Sutton PCNs CIC, explain how they did it.

In 2022, The Sunflower Clinic was established in Sutton, South West London, to provide a community-based service specialising in women’s health to address gaps in primary care provision.

While all practices across the area offered general contraceptive advice, less than half provided coils for heavy menstrual bleeding, indicating that there was limited provision of intrauterine options to treat common menopause symptoms. As a result, women were being pushed to secondary care but faced long waiting times to access community gynaecology services.

There was also the issue of health inequalities. Access to menopause care was particularly difficult for underserved groups, including those with learning disabilities, transgender people, and socioeconomically deprived communities.

So, there was a clear need to expand the provision of women’s healthcare closer to home with improved access to intrauterine options. It was decided to create a ‘one-stop-shop’ for menopause diagnosis and treatment plan design.

Sutton Primary Care Networks is a collaborative vehicle for the four Sutton PCNs – Carshalton PCN, Wallington PCN,  Central Sutton PCN, Cheam and South Sutton PCN – to work together as a single entity in a Community Interest Company (CIC), supporting a total population of 211,000 across 22 practices and four PCNs. We could see a huge resource of specialist knowledge within our primary care clinician population who could provide this service alongside the care delivered by women’s own GPs.

Aims  

The aim was to improve access to specialised care in a primary care setting for all women and to boost the care uptake by those in our diverse communities.

We envisaged the one-stop-shop model sitting alongside, rather than replacing, care from women’s GPs. So, a patient is referred to The Sunflower Clinic by GPs who feel unable to manage care needs in the practice. At Sunflower, a GP with a special interest in menopause sees the patient and creates a bespoke treatment plan. The clinic then shares notes via EMIS with the patient’s own GP, who manages the treatment and performs any follow-ups. 

Our initial objectives included addressing specialist menopause management and offering the 52mgLNG-IUD for endometrial protection and heavy menstrual bleeding. We aimed to reduce the burden on secondary care by meeting these needs in primary care. 

Initially focused on menopause, The Sunflower Clinic’s remit has grown to include treatment for menorrhagia, HRT and testosterone initiation. We are in discussion to expand the service to pessary management, long-acting reversible contraception and management of selected gynaecological conditions. 

Approach

As a PCN-led initiative, we could build on existing foundations, such as the infrastructure needed for extended-access appointments, sharing EMIS templates and access to patient records.

We developed it further by facilitating stakeholders’ involvement with the new model. For example, we invited GPs to help design an EMIS template for patient referral and discharge. This ensured that the model worked as intended from the outset and built buy-in from primary care clinicians.

We used existing clinical networks– including informal WhatsApp groups – to identify clinicians with menopause and coil fitting qualifications who were interested in women’s health. This secured a motivated team of qualified clinicians to run the clinic from day one, circumventing the costs and time associated with training.

To ensure we reached diverse communities, we conducted targeted outreach events. These included sessions with South Asian women, African Caribbean groups, women experiencing domestic violence, and those using drug and alcohol services. We led the work in close collaboration with local GPs, voluntary and community sector organisations and secondary care. A collaborative approach allowed us to leverage a wide range of expertise and resources.

To provide easier access for some groups of women and based on the feedback from outreach events, we decided to locate the clinic in a deprived area of the borough. It runs on a Saturday from 10am to 2pm.

Data

We piloted The Sunflower Clinic using funding from a pharmaceutical company to demonstrate proof of concept. Sutton PCNs bore financial risk in backfilling funding where required and releasing ARRS staff to be involved in outreach work. We are now collaborating with secondary care and ICB colleagues to explore novel funding streams to support the work on an ongoing basis, such as utilisation of the Elective Recovery Fund.

Last year, 340 women booked into The Sunflower Clinic, up from 232 patients between February and December 2023. This demonstrates a significant demand for specialised women’s healthcare in our community.

In terms of patient outcomes, we observed a general trend towards improvement in Greene Climacteric Scale scores, indicating reduced symptom severity.  And patient satisfaction rates have been high – 80% of patients rated their experience as ‘very good’ and 15% as ‘good’.

Outcomes

The Sunflower Clinic has yielded numerous benefits.

It has significantly improved access to specialised women’s healthcare in primary care and reduced the need for secondary care referrals.

Taking a holistic approach to our patients has enabled us to address related health issues alongside menopause symptoms. For example, the clinic has successfully identified cardiovascular risk factors with several patients diagnosed with elevated blood pressure, allowing for early intervention. Almost 50% of women were identified as having a BMI greater than 30.

Outreach efforts highlighted significant gaps in menopause awareness and support across different communities. Although we have helped to address that, we recognise the need for ongoing targeted work.

There are other areas for improvement too.

Qualitative feedback from service users revealed some had experienced long wait times for an appointment due to high demand, with GP practices being required to hold an internal waiting list until appointments become available on a weekly basis. However, the wait for a Sunflower Clinic appointment is around 2-3 weeks, compared to many months for one in secondary care. Although we designed our model with follow-up care delivered by women’s own GP, many patients preferred to be seen back at The Sunflower Clinic, which requires more appointments.

We also need to collect more robust data, particularly for follow-up assessments, to better evaluate our impact.

Future

The Sunflower Clinic has demonstrated significant potential as a model for specialised women’s healthcare provision in the primary care setting. It represents a step forward in improving holistic care whilst also addressing health inequalities by raising awareness through outreach work.

In the future, we plan to expand clinic capacity to reduce wait times and improve access and, in collaboration with our secondary care colleagues, increase the clinical scope of cases we see. We plan to enhance outreach efforts to reach more women from diverse and underserved communities.

This will require sustained funding, resource allocation and continued collaboration with local healthcare providers and the community. Policymakers’ support for integrating this model into broader healthcare strategies will be essential for its long-term success and potential replication in other areas.