Liverpool City Council has worked with the local NHS to set up a network of women’s health hubs in GP surgeries. The hubs offer both NHS and council-commissioned services from cervical screening to long-acting reversible contraception (LARC).
How Liverpool set up a seamless service
Responsibility for women’s sexual health and reproductive services has always been a challenge because responsibility for commissioning is split between different organisations with NHS England, clinical commissioning groups and local government.
But Liverpool has created a seamless service by setting up a network of women’s health hubs across the city’s 10 primary care networks thanks to the collaborative work of a joint commissioning group set up between the council and local NHS. A strategic women’s health forum, consisting of commissioners and GPs, has then taken the plan forward.
The hubs offer a range of services from long-acting reversible contraceptives, such as coils, contraceptive implants and injections, through to cervical screening, psychosexual services and treatment for menopause and heavy periods.
The hubs are based in GP practices with local surgeries served by the hub referring their patients on if they need support. Local practices can still provide some basic advice and support however.
Liverpool City Council Sexual and Reproductive Health Commissioning Lead James Woolgar said: “There is a host of evidence to support the fact that women are disproportionately affected by the lack of co-commissioned services. Research shows around half of British women experience poor sexual and reproductive health, a much higher proportion than men.
“We first ran a pilot in 2019 looking at the health hub model. It worked really well, but then the pandemic slowed things down. However, over the last 18 months we have been able to make really good progress.
We have made sure there is good, easy access to the hubs, planning carefully where they are situated with particular emphasis on the most deprived communities.
“There are still some teething problems – the referral process is not as smooth as we would like. There are still some surgeries where women are going into their registered practice then being referred on. Ideally, we would like women to only have to make one appointment, which means having systems in place to best identify whether a referral to the women’s health hub is right.
“But we are making great progress – and I think it is really benefitting women locally. This approach has led to an improvement in access to services with a considerable increase in the number of appointments available as well as higher rates of LARC usage.”
Latest data shows the rate of LARC prescribing locally has increased from 13.1 per 1,000 women to 15.2 per 1,000. This is still below where Liverpool want to be, but is in fact the highest rate of LARC seen since 2012.
“We are now also starting to really think about moving further provision and services into hubs where relevant. This could, for example, include ring pessary fit and change and vulval dermatology that women would at present have to go to Liverpool Women’s Hospital for. This would make access much more convenient for women,” added Mr Woolgar.
Links with the sexual health and women’s hospital
The rollout of the hubs included an audit of LARC fitters and fresh training provided by the new sexual health provider Axess, Liverpool Women’s Hospital, all with support from Organon and Bayer. Both nurses and GPs came forward for the refresher training and extra care navigators were taken on to help support the running of the hubs.
The service has been further enhanced by the introduction of Axess. Inter-referral is now taking place between Axess and the women’s health hubs with women who are accessing specialist services for LARC able to be signposted and booked into slots to ensure even more effective access to care.
Mr Woolgar said there were, however, challenges setting up the new approach. “You have to be very thorough with the business case and cost modelling. When we started the pilot, we had not quite factored in the right costing for people not attending appointments or when the LARC fitting did not go to plan and could not be fitted. That’s still clinical time taken up so to make it viable for the service you need to take that into account.
But we got there in the end. And what we have now is a fast-growing women’s health hub model that sees budgets more effectively combined between the NHS and local authority and that is viable for primary care networks delivering the care. Clinicians are no longer restrained by one single commissioning body restricting certain procedures. This has all happened due to excellent collaboration and strategic planning.
Sexual and Reproductive Health Commissioning Lead
Liverpool City Council