MintyChoc and CantChoose, thanks for taking the time to post. I really do sympathise that as GPs now you have a huge pressure not to refer, in the bizarre world that is the NHS. Also of the enormous pressures on primary care generally (staffing, access to timely appointments). You both sound like great GPs, but I’m sure you know that standards of individuals and practices vary yes, just as they do in any other branch of medicine!
I work in a pretty deprived area. Most of the women I see in the community do not easily access the knowledge of different conditions to ask their GP about, and are not empowered or in a financial position to access repeated appointments.
I am NOT suggesting that GPs refer all gynae conditions; that would be clearly be a waste of everyone’s time and money. I am simply suggesting that GPs ensure they, and their staff are appropriately trained to manage basic contraception, smears, menopause and gynae issues, for which there are robust national guidelines and training if this has not already been accessed.
I see many women that are told by their single-handed, male GP who doesn’t have a practice nurse at the moment “we don’t do women’s health here” (even though in their contract they are paid to do so). In the case of smears, there is nowhere else for women to go. Many areas have no menopause, psychosexual or vulval specialist, and contraception clinics vary widely in ease of access. I see women every day who have had effective contraception or HRT withheld by their GP (or worse, given something they are not medically suitable to have), and may have an unplanned pregnancy as a result. I see women belittled as they are told that flooding through clothes, taking time off work for pain, sex being painful, having debilitating hot flushes, and being incontinent after childbirth is normal. And that is just not good enough, ffs.
If this GP (or A&E Doctor) trained at undergraduate level outside the UK, he may NEVER have done a speculum examination. I have worked with many such doctors who do not do O&G as part of their UK training (this has not been compulsory for many years - not particularly recent), or manage to avoid speculums or do them badly during their O&G attachment. It’s difficult to address this unless that doctor admits he can’t do it, but I used to recognise and provide ad hoc training where I could.
The same clinicians also, if they do refer women to hospital, may not have done any investigations or tried simple treatments. A one sentence letter “please see this woman for her heavy periods” is just no use, and yes, is likely to result in the woman being referred back to her GP to follow, for example, NICE guidelines on HMB - which could have been started 6 months or more ago when she was referred, or instead of. She may no longer need to see a consultant, as in many cases COC or Mirena will have helped sufficiently to be discharged.
THESE are the clinicians that need to change, not those like yourselves (and many excellent ones I work with) who are doing their level best, and clinically appropriate, in a failing NHS.
Ideally, access to GP appointments would be better and community-based SRH would be extended, which improve care so much, and save a lot of money.