29 March 2006 RCOG / BMS Meeting fileGPSI Deanery (GP SRs *2) – GPSI Ealing PCT – GPSI A & E...
Transcript of 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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
Setting up a Menopause ServiceSetting up a Menopause ServiceFundingFunding
General– Trust board (via directorate business manager)
– PCT / Deanery
– Research moneyCulyerTrusteesGrantsIndustry
West London Menopause & PMS Centre 29th March 2006
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!
West London Menopause & PMS Centre 29th March 2006
Setting up a Menopause ServiceSetting up a Menopause ServiceThe costsThe costs
Clinician & nurse sessions
Clerical support
Secretarial support
Consumables
Sterilisation costs (implant sets)
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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)
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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)
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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!
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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
West London Menopause & PMS Centre 29th March 2006
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