HNY Policy and Pathway Repository - Humber

Referral should be considered when simple measures have been explored and failed and when the severity of the condition justifies gynaecological intervention

The service will accept referrals from GP or other Healthcare professionals only for diagnosis and management of conditions, including the following:

• Severe PMS – when simple measures (e.g., combined oral contraceptives [COCs], vitamin B6, selective serotonin reuptake inhibitors [SSRIs]) have been explored and failed and when the severity of the PMS justifies gynaecological intervention.

• Dysfunctional uterine bleeding following management in Primary Care

• Fitting of LARC for management of heavy menstrual bleeding

• Chronic pelvic pain not successfully managed within primary care

• Pelvic organ prolapse – managed conservatively

• Complex smears where 2 failed attempts have been made in Primary Care
• Impalpable or difficult to remove Implants

• Polycystic ovary syndrome

When the referral is made from the GP it would be anticipated that initial management options had been trialled before referral considered.  

• Women with Intermenstrual and Post coital bleeding should be referred to Colposcopy via local pathway
• Any post-menopausal bleeding needs to be referred through the PMB pathway 
• With PMS patients, hormonal treatment will be offered. Patients with serious mental health should be referred to a Community Mental Health Team. 

Do Not Refer

Referrals for the following conditions are excluded from our service acceptance criteria and should be directed to the gynaecology service at HUTH:

• Women whose definitive treatment can be reasonably anticipated as being surgical intervention

• Service users with suspected pelvic or abdominal mass (including suspected ovarian cyst) should be referred directly to their choice of secondary care provider able to provide the necessary surgical intervention as part of a cancer pathway if required

• Abnormal smears (should be referred via the appropriate cancer pathway)

• Intermittent or postcoital bleeding – refer to colposcopy or hysteroscopy as appropriate.

• Cervical polyps

• Genital skin disorder – Lichen sclerosis

• Fitting or change of LARC for period control.

• Termination of pregnancy

• Delivery of NHS cervical screening programme (comprising routine cervical cytology tests for women ages 25-64 plus consequent colposcopy, biopsy and treatment

• Women requiring treatment not normally commissioned (individual funding request IFR) unless the appropriate prior approval has been sought

• Endometriosis

• Psychosexual only – refer to counselling services.

• Menstrual disorders - follow NICE guidance on HMB: Check FBC and Ferritin. Oral treatment including combined or progesterone only pills can be trialled. Other treatment options may require further investigation before initiation as per NICE guidance
• PMS - for full up to date information see NAPS website accessed at www.pms.org.uk
• PCOS - for full up to date information regarding self-help and management see website: www.verity-pcos.org.uk 

Females that meet the inclusion criteria 

Referrals 

E-Referral (please note this is for indirect booking only) Issue the client with their ID number and ask them to ring 01482 247111 after 48 hours to initiate the referral.

Completed Healthcare Professional referral forms can be sent via email to CHCP.247111@nhs.net

NOTE: Referrals from GP/HCP must be completed in full with the relevant requested information attached failure to provide this will result in delay of appointment for client - All self referred patients must agree to have their GP contacted to provide relevant medical summary and must state the reason for requiring an appointment failure to provide this information will result in the referral not being accepted.

Patient Information:          

• Managing premenstrual syndrome (PMS)' (PDF) from the Royal College of Obstetricians and Gynaecologists
• Premenstrual syndrome' (URL) from Patient UK 

• A list of current medication (including contraception) and any relevant past medication.
• Any investigations or diagnostics already undertaken and the results of these (NB our service cannot access these results via SystmOne)
• Any significant operations including hysterectomy and sterilisation