Under pressure and under scrutiny: supporting women’s health in general practice; a qualitative study

Problem

The consultation for the Women’s Health Strategy for England highlighted a need to understand and develop how general practice supports women’s health needs. This includes timely access for assessment and treatment and considering where and how women’s health services could/should be configured. General practice is currently under unprecedented strain, and the focus of adverse public and media attention.The majority of women’s healthcare contacts occur in general practice, but there is little research into clinician perspectives on delivering care including potential inequalities in access to care.

Approach

We aimed to understand the perspectives and experiences of primary care practitioners (PCPs) when supporting women’s healthcare.Interpretive qualitative research set in general practice (GP) in England. Forty-six PCPs working in a range of roles and GP settings were recruited through research and professional networks. Semi-structured interviews were conducted via phone or Microsoft Teams, audio-recorded, transcribed verbatim, and analysed through Reflexive Thematic Analysis.

Findings

Practitioners were acutely aware of, and concerned about, social and systemic barriers to access. PCPs valued and aspired to encompassing practice that recognised and responded to complex and diverse needs, and advocated for patients. Practitioners went above and beyond to try to achieve this, describing examples of reaching out to homeless women, mitigating against language barriers, and creating safe spaces for conditions or circumstances that may be experienced as stigmatising or isolating. However, resource constraints complicated this and generated additional strain. They experienced this as a driver towards patient-practitioner relationships becoming transactional rather than relational. This risk was exacerbated by reductive media reporting, which GPs experienced as hostile. Menopause care was a powerful exemplar of this. The net effect was an adverse impact on GP well-being. Strategies to help relieve strain were valued but could generate work, for example supervision. Recognising the value of specialisation (both within primary and secondary care), the PCPs reflected on maintaining a balance between general and specialist skills. Key to maintaining this balance was knowing that working together (rather than against each other) provided care that was more than the sum of its parts. A balance between upskilling and deskilling was highlighted as a tension. Where care was shared between primary and specialist services, the potential for bi-directional learning was valued.

Consequences

Relationships and advocacy are valued as fundamental for women’s health in general practice. GPs understanding of the populations they serve and commitment to equitable care could be actively recognised and valued, but is challenged by external constraints. The Women’s Health Strategy for England calls for women’s health hubs, but how these will interface with general practice is less clear; it is essential that core aspects of general practice are not diminished or devalued as services evolve.