29 March 2006 RCOG / BMS Meeting fileGPSI Deanery (GP SRs *2) – GPSI Ealing PCT – GPSI A & E...

Setting Up & Providing a Menopause ServiceSetting Up & Providing a Menopause ServiceA Consultant’s PerspectiveA Consultant’s Perspective

2929thth March 2006March 2006RCOG / BMS MeetingRCOG / BMS Meeting

Nick Panay

Consultant GynaecologistQueen Charlotte’s & Chelsea Hospital and

Chelsea & Westminster HospitalHonorary Senior Lecturer, Imperial College

London

West London Menopause & PMS Centre 29th March 2006

Setting up a Menopause ServiceSetting up a Menopause ServiceIntroductionIntroduction : : Planning Planning

Mission statement

10 yr plan

Service development document

Protocols & guidelines


Setting up a Menopause ServiceSetting up a Menopause ServiceIntroductionIntroduction : : Planning Planning

Menopause service relevant to New NHS

• Lead clinician delivered service

• Nurse led services / limited prescribing

• Multidisciplinary

• Integration with primary & secondary care


Setting up a Menopause ServiceSetting up a Menopause ServiceDe Novo De Novo –– identifying needidentifying need

Identify need for service i.e. NHS (NSF’s), NICE, PCT’s, Hospital Trust, GP’s & Local population

Business case for new Staff & Services

Funding for clinicians, nurses, equipment, collaborative sessions

Submit to CSDB / Directorate Executive Board


Setting up a Menopause ServiceSetting up a Menopause ServiceFundingFunding

General– Trust board (via directorate business manager)

– PCT / Deanery

– Research moneyCulyerTrusteesGrantsIndustry


Setting up a Menopause ServiceSetting up a Menopause ServiceFundingFunding

Staff– SpR Trust– GPSI Deanery (GP SRs *2)– GPSI Ealing PCT– GPSI A & E waiting time – Dietician Alpro– Counseller Research Funds– Research Fellow Research Funds – Research Nurse Research Funds– Physiotherapists Altrusim!


Setting up a Menopause ServiceSetting up a Menopause ServiceThe costsThe costs

Clinician & nurse sessions

Clerical support

Secretarial support

Consumables

Sterilisation costs (implant sets)


Setting up a Menopause ServiceSetting up a Menopause ServiceSpaceSpace

Identify sufficient space for consultation – Number of patients

– Minor procedures e.g. hormone implants

Need sufficient room for expansion

– Collaborating specialists

– Multidisciplinary team

– Research team


Setting up a Menopause ServiceSetting up a Menopause ServicePre existing servicePre existing service

Problems faced initially at Queen Charlotte’s– Lead clinician only by name– SHO’s with no knowledge of the menopause– Overstretched menopause sister!– 50% long term patient’s on annual follow up– Routine aimless bloods, breast and pelvic examination– No teaching– No research


Setting up a Menopause ServiceSetting up a Menopause ServiceCurrent ServiceCurrent Service

West London Menopause & PMS Centre– Queen Charlotte’s & Chelsea and Chelsea &

Westminster Hospital

– Unified protocols and service provision to West London population

– Increased research and training opportunities


Setting up a Menopause ServiceSetting up a Menopause ServiceMultidisciplinary collaborationMultidisciplinary collaboration

Reproductive medicine unit

Other clinicians– Cardiovascular physicians– Breast specialists– Dietician– Clinical psychologist– GP specialists – menopause accreditation– Physiotherapists

Specialist clinical nurses– Menopause– Macmillan


Setting up a Menopause ServiceSetting up a Menopause ServiceSpecialist servicesSpecialist services

– Premature ovarian failure clinic

– Nurse led, low risk clinic

– Outreach / GP specialist clinic

– OP Hysteroscopy Clinic : direct GP access, see & treat

– Cardiovascular & Breast clinic collaboration (fast track)

– Dietician Clinic

– Physiotherapy Osteoporosis Clinic

– Psychologist clinic & self help groups


Setting up a Menopause ServiceSetting up a Menopause ServiceSpecialist servicesSpecialist services

OP Hysteroscopy Unit– Direct access – appt within 4 weeks

– Rigid referral guidelines

– Assessment, TV USS +/- …

– Diagnostic +/- Operative hysteroscopy


Setting up a Menopause ServiceSetting up a Menopause ServiceReferralsReferrals

Central booking system

Electronic booking (“Book & Go / Choose & Book”)

?NHS Net in future

Primary, secondary and tertiary care cross referrals

Referral of low risk patients back to primary care


Setting up a Menopause ServiceSetting up a Menopause ServiceProtocols Protocols

Evidence based practiceReferenced guidelines to common template

Accessible through Intranet

Internet access available in each consulting room– Pub med– Cochrane database– Medline– Journals


Setting up a Menopause ServiceSetting up a Menopause ServiceProtocols Protocols

Investigations– Mammograms– DEXAS : RCP guidelines

Side effects – Bleeding problems– Oestrogen / progestogen intolerance

Risk factors– Breast cancer, VTE– Premature ovarian failure (National Working Party)


Setting up a Menopause ServiceSetting up a Menopause ServiceService provisionService provision

Secondary/tertiary care - interfacing through patient held notes / NHS net/internet

Intermediate women’s health clinics e.g. Ealing / Wandsworth / H&F

GP hospital sessions / outreach clinics


Setting up a Menopause ServiceSetting up a Menopause ServiceService provisionService provision

Support for primary care from secondary/ tertiary level clinic– Helpline

Professionals (also BMS, NOS)Patients (also WHC, Daisy Network, NAPS, Women’s Health Alliance)


Setting up a Menopause ServiceSetting up a Menopause ServicePrescribing policyPrescribing policy

Guidelines available on intranet / NHS net

Negotiated with PCT – e.g. Ealing PCT

Cost effective prescribing

– Appropriate cost

– Minimise side effects

– Meets needs of individual


Setting up a Menopause ServiceSetting up a Menopause ServiceTrainingTraining

MedicalSHO’s, SpR’s (Menopause Special Skills Module)Reproductive medicine traineesGPSI’s (including FFP/BMS accreditation)Clinics, tutorials, lectures (Imperial, BMS, RCOG)

NursingStudents, Junior nurses & Clinical nurse specialistsMenopause Network Lectures - RCNNurse Menopause Accreditation – tba!


Setting up a Menopause ServiceSetting up a Menopause ServiceResearchResearch

Basic Science – University supported e.g. Wellbeing / MRC

Clinical research– Clinical grants e.g. Wellbeing / MRC / Trustees– Pharmaceutical / Neutraceutical industry sponsored

– Breadth of possible projectsHRT / Phytoestrogens / Magnotherapy / Androgens


Setting up a Menopause ServiceSetting up a Menopause ServiceResearch TeamResearch Team

Research Fellows / Nurses

Professional drug trials unit– GCP Accredited Staff– Research coordinators etc

Collaborative– Repro medicine unit– Cardiologists– Renal physicians


Setting up a Menopause ServiceSetting up a Menopause ServiceAuditAudit

Data entry in clinic via proforma to facilitate data retrieval

Infoflex (Access based database) – direct entry

Audit Projects e.g. POF service / Mx of Bleeding Problems


Setting up a Menopause ServiceSetting up a Menopause ServiceRole of pharmaceutical industryRole of pharmaceutical industry

Education & Training (Staff)– New products– General

Facilitation– Relationship with primary care e.g.sponsored meetings – NB. New ABPI rules

Research– Funding projects– Phase 1,2,3 clinical trials & post-marketing surveillance


Setting up & Providing a Setting up & Providing a Menopause ServiceMenopause Service

ConclusionConclusion

A service which integrates with primary care and offers support for

– Complex cases (and whilst confusion is high, low risk cases!)

– Training and

– Research


Thank you for your attention!Thank you for your attention!

29 March 2006 RCOG / BMS Meeting fileGPSI Deanery (GP SRs *2) – GPSI Ealing PCT – GPSI A & E...

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