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During the 1970s and 1980s, gynaecological surgeons with a special interest in oncology surgery established a number of services throughout Britain, mainly in university teaching hospitals. Most women diagnosed with cervical, uterine, ovarian, vulval or vaginal cancer continued to be managed within small district general hospitals or teaching hospitals by generalist obstetricians and gynaecologists. The Royal College of Obstetricians and Gynaecologists (RCOG) provides a complete set of standards for the provision of a streamlined service. The clinicians and commissioners should use these standards to develop national quality accounts. Research in the field of gynaecological oncology is performed as a separate entity, or the subspecialty training is extended to 3 years to include a significant component for research. Quality assurance minimum standards of care in gynaecological oncology relate to the timeliness of treatment, the functionality of multidisciplinary teams and audits of various outcomes.
The Royal College of Obstetricians and Gynaecologists (RCOG)'s clinical standards for urogynaecology have been jointly developed with the British Society of Urogynaecology (BSUG) to provide a framework that should ensure best and evidence-based practice. The initial assessment and management of women with urinary incontinence is detailed in the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) guidelines and these are equally applicable to all pelvic floor disorders, including prolapse, anal and faecal incontinence, with a specific NICE guideline being available for the latter. Subspecialty training allows the development of more clinical, surgical, analytical and research skills and experience in all aspects of urogynaecology. Patient-reported outcomes are strongly recommended for assessing the success of treatments. Data can be collected confidentially through the BSUG surgical audit database for urinary incontinence and prolapse, which provides validated instruments to assess outcome.
In the UK, unless surgery is required, most post-reproductive gynaecological care is delivered in the primary care setting. Clinical standards and guidelines are available from the Royal College of Obstetricians and Gynaecologists (RCOG), the Medicines and Healthcare products Regulatory Authority (MHRA), the British Menopause Society, and the National Osteoporosis Guideline Group and Clinical Knowledge summaries. Only women with complex problems need referral to a specialist hospital or community based sexual and reproductive healthcare service. The clinicians and nurse(s) need to maintain dedicated telephone, answer phone and email contact systems for women and health professionals. Staffs need to liaise with other allied health professionals who are involved in the care of post-menopausal women, such as radiographers, physiotherapists and continence advisors. Continuing training will need to be coordinated by the lead clinician to ensure that staffs are providing evidence-based advice.
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