Nada Khan is an Exeter-based NIHR Academic Clinical Fellow in general practice and GPST4/registrar, and an Associate Editor at the BJGP. She is on Twitter: @nadafkhan
Failings in women’s health have sadly been the focus of several recent scandals in the NHS, including but not limited to the Ockenden review of maternity services in Shrewsbury, maternity services in Morecombe Bay,and injuries from pelvic mesh surgery. This July, the Secretary of State for Health and Social Care published the ‘Women’s Health Strategy for England’, a wide-ranging report that aims to ‘right the wrongs’ of a patriarchal health care system that has historically ignored the voices of women.1 This health strategy aims to take a life-course approach to boost health outcomes for women and to develop a healthcare system that listens to women and girls. Reflecting on the Women’s Health Strategies published in the UK, Sharon Dixon and colleagues recently wrote in the BJGP about the need for primary care to the ‘at the heart of any strategy to support and enhance women’s health’.2 As they point out, GPs are ideally placed to support a life course approach, as we’re already there ‘for the journey’.
There are a lot of goals in the Women’s Health Strategy; the 10 year ambitions are certainly ambitious. There are three specific areas in which general practice is mentioned.
There are a lot of goals in the Women’s Health Strategy; the 10 year ambitions are certainly ambitious.
Firstly, in terms of access to NHS services, the strategy mentions the investment of £1.5 billion to create an additional 50 million general practice appointments by 2024. These appointments, the report explains, will be achieved through hiring a diverse workforce of 26,000 additional primary care professionals to deliver appointments and support GPs. I can only assume this relates to the 26,000 new roles funded through the Additional Roles Reimbursement Scheme (ARRS), which I wrote about recently in BJGP Life. Whether the new multidisciplinary teams under ARRS can actually deliver such a dramatic increase in appointment numbers or make a real impact on women’s health outcomes is uncertain.
Secondly, the report calls for curricula for GP specialist training to include teaching and assessment on women’s health. Some of this seems like political bluster; gynaecology, sexual health and a ‘woman-centred life course approach’ are already key components of the RCGP curriculum. As Sharon Dixon and colleagues note, ‘it’s a missed opportunity if the conclusion and outcome of these [Women’s Health Strategy] consultations defaulted to an explanation of ignorance and to pillorying GPs to simply know more.’2 Nevertheless, the strategy highlights the RCGP Women’s Health Toolkit and the Primary Care women’s Health Forum as important resources for maintaining professional development on reproductive health, menstrual wellbeing and menopause for practicing GPs.
More generally, the strategy has identified deep-seated problems that will need time, money and ambition to tackle.
Thirdly, the strategy is supportive of the expansion of women’s health hubs and ‘strongly encourages local commissioners and providers to consider adopting these models of care’. The vision is to have these hubs hosted in GP surgeries to provide a ‘one stop shop’ for contraception services, cervical screening, psychosexual services and management of for common issues including the menopause and heavy menstrual bleeding. For instance, the Primary Care Women’s Health Forum Health Hub Toolkit gives an example of how a women’s health hub might be able to streamline the patient pathway for heavy menstrual bleeding by reducing contacts and offering tests, examinations and management within one or two appointments. Sounds great for patients, if (big IF) there is capacity within the workforce to offer this service. The NIHR has commissioned research to evaluate existing women’s health hubs and provide information on performance, outcomes and costs to guide future development and policy in this area.
Gender inequalities in healthcare are entrenched in what we learn, how we practice, and what tools we have available to us. The Women’s Health Strategy has highlighted appointment access, education and delays in women’s health treatment as areas for general practice improvements. More generally, the strategy has identified deep-seated problems that will need time, money and ambition to tackle. As Dr Anne Connolly, Chair of the Primary Care Women’s Health Forum writes, ‘It will be difficult to realise the vision [in the Women’s Health Strategy] without extra financial support or a clear plan for workforce development at a time when health services are already at capacity.’3 We needed, and got, a women’s health strategy with clear performance goals. However, we need the resources and transparency to hold these ambitious ideals to account and ensure that they happen.
References
- Women’s Health Strategy for England. Department of Health and Social Care; 2022.
- Dixon S, McNiven A, Connolly A, Hinton L. Women’s health and primary care: time to get it right for the life course. Br J Gen Pract. 2021;71(713):536-7.
- Women’s Health Strategy for England published: Primary Care Women’s Health Forum; 2022 Available from: https://pcwhf.co.uk/news/womens-health-strategy-for-england-published/.
Featured image by Ugur Akdemir on Unsplash
“Gender inequalities in healthcare are entrenched in what we learn, how we practice, and what tools we have available to us.”
I would argue that gender inequalities in healthcare are entrenched in the “medically unexplained symptoms” (MUS) rhetoric and cost-cutting strategy that the NHS appears to have embraced. If doctors and healthcare commissioners are told that women are more likely than men to suffer from psychosomatic or ‘functional’ conditions – that being female is a risk factor for somatization – and that their health problems such as chronic pelvic pain, including painful periods and painful sex, are examples of ‘functional somatic syndromes’, then it’s hardly surprising if women’s health problems are being ignored on a massive scale in the UK. (I suggest that readers examine the 2017 JCPMH Guidance for commissioners of services for people with medically unexplained symptoms produced by the Joint Commissioning Panel for Mental Health which was co-chaired by the Royal College of Psychiatrists and the Royal College of General Practitioners -https://www.slideshare.net/jcpmh/guidance-for-commissioners-of-services-for-people-with-medically-unexplained-symptoms.) How can women possibly stand a chance if this is what doctors and commissioners are being taught by their Royal Colleges? And yet there appears to be no mention of this issue in “The Women’s Health Strategy”, well not as far as I can see. (Please point me to it, if I’ve missed it.)
So the notion of ‘hysteria’ would seem to be still alive and ruthlessly kicking within UK medicine and the NHS and yet nobody wants to talk about it? It’s better brushed under the carpet? To anyone with any genuine interest in this healthcare equality – Come on, please stop skirting around the issue and get to where the problem lies. Doctors are not only prejudiced against women, it looks like they’ve been taught to be prejudiced against them by their superiors. How is that acceptable in this day and age? Why hasn’t it been questioned?
Perhaps those who truly want to ” ‘right the wrongs’ of a patriarchal health care system that has historically ignored the voices of women” should start by denouncing “MUS” and its inherent sexism, then women might have a fighting chance in our struggling healthcare system. But, even if they do denounce it, I doubt things will change quickly enough. I suspect that unlearning prejudice will prove a much harder challenge for doctors than learning it in the first place.