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Bevan Exemplar Cohort 8 Projects

Establishing enhanced community gynaecology services in a rural healthcare setting Wales

Alan Treharne

Hywel Dda University Health Board


Post COVID recovery in gynaecology has received much focus. Establishing enhanced community gynaecology services (ECGS) in a rural healthcare setting in Ceredigion support the mid Wales Plan.

The project will support the specialist interests of 2 consultants and will deal primarily with:

– Heavy menstrual bleeding

– Post-menopausal bleeding

– Polycystic ovarian syndrome (PCOS)

The aims of a community based enhanced gynaecology service (ECGS) are:

– To provide a range of outpatient diagnostic and treatment services

– To reduce the need for in hospital treatment / operating

– To provide care as close to home as possible reducing the need to travel

– To provide one stop services reducing the need for multiple appointments, therefore providing prudent health care

– To reduce referrals through consultant to GP support via email / phone contact, formalising the informal system that exists in current practice

National upscaling

At present services are still in a traditional model with supporting hysteroscopy services. This model would provide a “hub” system for dealing with common problems in a community setting reserving secondary care resources for more complex cases. I am also certain that ultrasound training and delivery in Wales has been an issue for 10 or more years and this model would support not only service delivery but training and education. This project has the potential to reduce inpatient operating by the safe and effective community management in a streamlined and evidence-based way.

Prudent healthcare

  • Greatest need first: Enhanced services will operate a triage-based RAG rated system already developed in HDUHB Women and children
  • Doing what is needed: See and treat models of care reduce the inefficiency of multiple appointments
  • Reduce variation and evidence-based approaches: Enhanced services will develop standardised proforma assessment and investigation pathways using the most up to date clinical evidence.