The structure of healthcare services for urogynaecological conditions

This section covers:

  • GPs/primary care nurses and referrals
  • Specialist services (secondary care and tertiary clinics)
  • Accessing physiotherapy

GPs/primary care nurses and referrals

In the UK, the first healthcare professional someone is likely to see about urogynaecological symptoms is a GP or a nurse in primary care. People we spoke to had different expectations and experiences around GP support for their urogynaecological conditions.

Dr. Matthew Izett-Kay, a consultant urogynaecologist, gives an overview of some of the healthcare services available to those experiencing urogynaecological symptoms.

Some people we talked to mostly wanted their GP to arrange a referral to specialist services. Beth, Elly, and Parminder had been keen to be referred to specialist services but felt that their GP seemed unwilling. Others told us they were interested in what the GP could provide in terms of information and treatments and only wanted a referral if and when these options were then exhausted.

Not everyone wanted to be referred on to a specialist, or to have medical or surgical treatments for their conditions. Rose would have liked advice and support with pessaries but didn’t get this at her GP surgery.

Mary X has open and informed discussions with her GP about treatment options.

Alice was pleased that her GP prescribed her medication to try whilst she waits for her secondary care appointment.

For those who had problems with UTIs, some felt that their GPs had not given full consideration to the pattern and underlying causes, and they hoped that a hospital specialist would be able to explore this further. Leah feels “quite lucky” that the GPs she’s seen have been supportive, though she is aware of friends who have had issues with dismissive doctors. Anna felt that her GP was mainly a “drug dispensary”.

Anna thinks there is a stigma about having to regularly use health services for recurrent UTIs and that many people see UTIs as “mild problems”.

Specialist services

Specialist services, sometimes called secondary and tertiary care, are usually based at a hospital, and offer advice and treatment options that often are not available from a GP. GPs can refer patients to specialists, and specialists can also refer patients to other specialists.

Those who were referred to a specialist often saw a urogynaecologist (a sub-specialty of gynaecology), although some went to a general gynaecology department, to urology, or bladder and bowel services. Some people were referred to colorectal services because they had anal incontinence – the unintentional loss of faeces (poo) or gas (farts) – which can be caused by bowel prolapse.

People sometimes suspected that they had been referred to the wrong specialty and wondered whether their healthcare professionals were unsure or didn’t agree on which specialty could best address their symptoms.

Rose found her appointments with a physiotherapist and gynaecologist unproductive. After doing her own research, she learned about the sub-specialty of urogynaecology and a wider range of treatment options.

There are different specialist services available across the UK, and the routes to see healthcare professionals about different urogynaecological symptoms in the NHS vary. This could be confusing and frustrating.

Elly doesn’t understand why the health system is not set up to refer prolapse patients directly to urogynaecology, after being first referred to a bladder and bowel nurse and then to a gynaecologist.

There isn’t a urogynaecology department locally to Rose, so she asked her GP for a referral further away. It’s important to her that she sees a specialist, especially if she goes on to have surgery.

Helen feels that everyone gets put on a ‘standard path’ in healthcare and would like care to be individualised.

Phyllis and Helen had been seen at an NHS tertiary clinic for complex UTI, after they felt that other specialist services could not help them treat their symptoms. Tertiary clinics are highly specialised, focusing on specific conditions (or combinations of conditions) or groups of patients. Before the NHS tertiary clinic was set up, Phyllis had been a private patient because she didn’t think there were any NHS healthcare services at that time that could or would provide the care and treatment she had wanted.

There were sometimes long waits to see an NHS specialist. Delays and cancellations when trying to access specialists was frustrating and upsetting.

Fiona, Chelsea, and others were aware that the Covid-19 pandemic had added to the problem, with staff redeployment and waiting list backlogs. Kerry had been waiting for her urogynaecology appointment for 11 months. Georgina and Amy have both had specialist appointments cancelled and rescheduled three times. Alice, and Beth felt like that they were “left” waiting in the “queue” without knowing what was going on. Phoebe decided to pay for private healthcare because of the long delays to see an NHS specialist.

Accessing physiotherapy

Those who saw an NHS pelvic floor physiotherapist sometimes lived in an area where they could self-refer or be referred by their GP. Others were referred by a specialist. For Kerry, self-referral to physiotherapy was not available where she lives and, as her GP did not refer her either, she decided to see someone privately. You can read more here about people’s experiences of physiotherapy for urogynaecological conditions.

Jessy is interested in having pelvic floor physiotherapy but isn’t sure how to access these services.

When Jeannie self-referred to a physiotherapist for sciatic nerve pain, she mentioned that she has prolapse. Between the gynaecologist and physiotherapist, she hopes to get more support; if not, she plans to explore private healthcare options.

You can also read more here about people’s experiences of navigating and using healthcare services for urogynaecological conditions.