Our Women’s Health Hub experts answer your frequently asked questions about developing Women’s Health Hubs.
Dr Amanda Britton
Retired GP principle, Clinical Director of a GP federation in Basingstoke and a member of The Advisory Group on Contraception.
Advanced Public Health Lead – Sexual Health Commissioning Lead at Liverpool City Council.
Dr Julie Oliver
Clinical Lead of the Primary Care Women’s Health Forum, GPwSI women’s health, Durham, and Director of Durham Gynae.
Q. Can anyone access the toolkit or is it members only?
The PCWHF Women’s Health Hub Toolkit is available for healthcare professionals, commissioners and associate professionals. You do not have to be a member of the Primary Care Women’s Health Forum to access the toolkit.
Q. Should discussions with the PCN or ICS around future funding and sustainability be entered into when developing a Hub?
Amanda Britton: PCN buy-in to the Women’s Health Hub (WHH) concept is imperative. The practices within the PCN have to take the decision to work more closely delivering women’s healthcare and getting the structures / IT / pathways / appointments in place is an important starting point.
Discussion with the ICS is the next stage. The future arrangement is not about large-scale recommissioning but more about supporting those delivering healthcare to a population by working differently. This involves addressing education, mentoring and communication, but should save on administration and duplicated / unnecessary second appointments.
Q. What are your thoughts on midwives and health visitors being involved in Women's Health Hubs?
Amanda Britton: The aim should be to work with and include all health and allied health workers in the delivery of Hubs. However, this is a new concept, a new way of working, and we are all aware there are some rigid commissioning barriers to overcome. The important message is to start small and build on positive experiences rather than trying to make it too large a project. When the WHH is successful and functioning, you should get groups wanting to link and this will be an enabler in expanding the Hub offer. Hubs will have different population needs and differing services that they want to offer at the outset.
Q. What is the role for Gynaecology Consultants in Women’s Health Hubs? Will they be trying to compete with GPs in providing these services?
Amanda Britton: It is important to involve all of those delivering women’s healthcare in the discussion about Hub creation. Services need to be enabled to complement and support each other in care delivery and not compete. Locally we have had the input of consultations to support and mentor the nascent WHHs. This has meant that enhanced care has been delivered to women in primary care, reducing onward referrals and ensuring that consultants in secondary care are seeing patients with health issues more appropriately dealt with by their specialist skills. This rearrangement is deemed beneficial to all, especially the patient, but is where the all-important discussion with the commissioner and ICSs will be paramount.
Q. What level of insurance do you recommend?
Amanda Britton: Insurance cover depends on the healthcare professional having access to the whole medical record and is increased if this is not the case. Some PCNS are able to share patient records, which should overcome this. The insurance companies take different positions with regard to individuals and their sessional cover requirement. Individuals need to be separately contacting and discussing the situation with their insurance company as there is not a nationally agreed tariff or arrangement in place.
Q. How can interested individuals co-ordinate with others in their area to drive development of a Health Hub forward?
Amanda Britton: PCNs and Clinical Directors within an area are already working together and the development of WHHs could be an agreed collaborative project with some leadership funded. There may also be leaders in your commissioning group who would help drive this forward – it is an exciting concept now with positive results from pilots around the country. WHHs also address the drive for change proposed politically and by clinically-led organisations. It is important that the change is not led by a single service.
Q. Do you have any tips for trying to get commissioners on board to fund a local Hub?
James Woolgar: The most useful tip is to frame the current problem, outline the rationale for change (the ‘WHY’ – evidence, data, money, acute links, plus poor access and current demand in specialist provision) and take it to someone. That someone or key board might be a joint commissioning group tasked with looking at opportunities to collaborate across the system, as we have in Liverpool.
Equally, there are major links and opportunities to be afforded via the formation of ICSs and Integrated Care Partnerships where it would be advantageous to try and embed the conversation and plan future models with NHS colleagues.
- Write your documents, produce the evidence, float it from an inequity perspective and people will begin to listen.
- Never give up! Don’t let anyone tell you it can’t happen – or GPs and community clinicians are too busy – they are, but if it’s funded and modelled correctly it can be done.
- Pilot it, take a smaller PCN area and prove it – then back it with cases.
- Find a suitable strategic place to take it – e.g. a joint commissioning group, joint strategy group – and tell them it needs to happen.
- Build a group of key people across your system to help you produce the documents and background required for Point 1: sort funding, viability, a business case to take to PCNs to provide some idea of acute savings if care is diverted.
Q. How do you develop a Hub from a one-person band to a sustainable workforce?
Julie Oliver: You need a business plan; start small, identify your lead clinician, start with a limited number of clinical services within your Hub and encourage good communication with the hub to your service users and referrers.
Make referring easy. Once you have started receiving referrals, your business plan should have triggers whereby a second clinician is recruited early to start working and upskill. As you get established, expand and offer more services. Advertise your hub services over and over again as staff turn over. Ensure to promote via your marketing streams.
As your numbers expand, so does your workforce. Always review your workload to ensure that you are not doing work that can be passed onto a more appropriate member of the team.
Read the case study of how Dr Oliver developed a Women’s Health Hub in Durham.
Q. Is the Q&A session from your ‘Expert Highlights: The Women’s Health Hub Toolkit webinar’ available on the website?
The on-demand version of the webinar can be watched here. https://whh.pcwhf.co.uk/resources/expert-highlights-the-womens-health-hub-toolkit/
The Q&A session of the webinar begins at the timecode 27:34.