Guidance

Women's health hubs: core specification

Updated 21 March 2024

Applies to England

Introduction

The Women’s Health Strategy for England sets out our 10-year ambitions for boosting the health and wellbeing of women and girls, and for improving how the health and care system listens to women. The strategy encourages the expansion of women’s health hubs across the country to improve access to services and health outcomes. 

This document is intended to support commissioners, providers and other partners to establish women’s health hubs, in particular integrated care boards (ICBs) as they implement the £25 million investment in women’s health hubs. Recognising that the development of existing women’s health hubs has been led by many individual clinicians and commissioners, this document is also intended to support further locally led initiatives.

This document has been developed collaboratively with stakeholders and builds on a draft presented at the Department of Health and Social Care (DHSC) women’s health hubs ‘Shaping the future’ workshop on 6 April 2023. It is also informed by other evidence gathering and engagement activity undertaken by DHSC and partners, including the findings of the interim report, Early evaluation of women’s health hubs, commissioned by the National Institute for Health and Care Research (NIHR). 

Defining and describing women’s health hubs

Definition

Women’s health hubs bring together healthcare professionals and existing services to provide integrated women’s health services in the community, centred on meeting women’s needs across the life course. Hub models aim to improve access to and experiences of care, improve health outcomes for women, and reduce health inequalities.

Description of women’s health hubs

Women’s health hubs (‘hubs’) are understood as a model of care working across a population footprint and are not necessarily a single physical place.

Hub models address fragmentation in service delivery with the aim of improving access, experiences and outcomes. Hubs reflect the life course approach to women’s health, where care is not limited to interventions for a single condition, but instead is wrapped around the needs of an individual woman, which in some cases may be multiple needs. For example, hubs can provide management of contraception and heavy menstrual bleeding in one visit or integrate cervical screening with other aspects of women’s healthcare such as long-acting reversible contraception (LARC) fitting or removal.

Hubs involve partnership working across the NHS, local authorities and the voluntary and community sector. They also require collaborative commissioning of contraception services by NHS and local authority commissioners^{[footnote 1]}.

Hubs are in the community, often working at the interface between primary and secondary care. They provide intermediate care, where services are more advanced than typically seen in primary care, but are for health issues which do not necessarily need a referral to secondary care. Hubs do not have to be a building or specific place; they may employ digital resources to provide virtual triage or consultations, or alternatively they may make use of existing facilities, for example GP surgeries or community centres.

A number of hub models are already in existence and are mapped in the NIHR-commissioned evaluation of women’s health hubs^{[footnote 2]}. Examples include Liverpool, where the women’s health hub model operates across the city’s primary care networks. The Liverpool hub model is delivering a significant increase in appointments and prescribing rates for long-acting reversible contraception - both for prevention of pregnancy and managing menstrual problems. In Manchester, the hub has evolved from a community gynaecology service working closely with primary care and is well received by the women it serves.

Some hubs have incorporated a digital offer. For example, City and Hackney hub has pioneered the use of virtual menopause engagement events and virtual group consultations, with follow up in physical locations where needed, to improve access to and efficiency of menopause care. More broadly, improved interoperability between IT systems - for example for appointment booking, and shared patient records across providers - will also be important for delivering streamlined access to care. The NHS’s work to make it easier for patients to access GP-held records via the NHS App will also be important for supporting women to manage their own care.

Through these early adopter sites and initial findings from the evaluation, we have seen that hubs are helping to meet system priorities:

• delivering care closer to home
• improving patient experience
• tackling health inequalities
• reducing pressure on secondary care and waiting lists

The emerging evidence suggests potentially significant efficiency benefits over time.

Place-based partnerships are well-equipped to establish new models of care such as women’s health hubs^{[footnote 2]}. ‘Place’ tends to cover a population of around the size of a former clinical commissioning group (CCG) or local authority footprint (200,000 to 250,000), although this varies across the country.

The delivery of services will often take place at primary care network (PCN) level, led by integrated neighbourhood teams to ensure services are accessible to and meet the needs of the populations they serve^{[footnote 3]}. For example, where hubs are delivered within PCNs, one or more GP practices may operate as the hub serving their PCN. Hub models have started small, for example serving one or two PCNs, and then expanded to a wider footprint. This may involve governance on a larger footprint for efficiencies and scale, with services still delivered locally within each PCN.

The size of the population covered by a hub and method of delivering services will likely vary across the country depending on local geography and demographics. In accordance with the principle of subsidiarity, decisions should continue to be made as close as possible to local communities.

There are also opportunities for working at system level where there are benefits of scale, for example, agreeing strategic priorities, minimum standards and consistent care pathways across a system, metrics and evaluation, digital transformation and workforce development.

When establishing hubs, commissioners and providers should consider how the location and services provided by hub models can best meet population needs and reduce inequalities, and help meet the priorities identified through local needs analysis and integrated care strategies. Patient voice should also be central to the development of hubs, including engagement with local populations throughout design, implementation and evaluation to ensure hub models meet local needs and improve patient experience.

While in this document we refer to women, we recognise that some people who do not identify as women also require access to the services listed and may benefit from care in women’s health hubs. These groups will also have specific needs and experiences which should be considered.

Types of hub models

Commissioners, providers and other delivery partners can take different approaches for how services within a women’s health hub are organised. The types of hub model are:

• hub and spoke: this model provides more specialised services such as investigations and diagnostics in a central hub, for example a hospital, which is linked to a network of local ‘spokes’, for example GP surgeries or community venues. The spokes can either be a physical location or virtual

• one stop shop: this model provides a wide range of services at the same venue, or provides multiple services in a single patient visit, which reduces the need for patients to attend numerous appointments

• primarily virtual: this model provides the majority of services virtually, for example patient consultations in online, telephone and/or video format, and virtual engagement and education sessions for women and/or healthcare professionals. The model would also need some in-person service provision to meet the aims of a hub and deliver the core services

• travelling clinician: this model involves a clinician travelling to GP surgeries or alternative community venues to deliver women’s health services as opposed to enhanced service delivery by an ‘in house’ clinician

• pop up: this model provides services in a main venue that is temporary or moves location

Hubs can also be a mixed model, for example where the main approach is a one stop shop but there is also a travelling clinician providing services to specific groups of women, or a hub and spoke model supported by virtual engagement sessions and group consultations.

What hubs are not

As well as describing women’s health hubs, it is important to be clear what hubs are not. They are not:

• a replacement for primary care, which should remain the first point of contact for most women seeking non-emergency healthcare, including for issues such as menstrual health or menopause

• a replacement for secondary care or specialist services where that is required. Similarly, hubs are not hospital outpatient services, as this would not align with the principle of bringing care closer to home for most women

• an additional barrier in the patient journey - hubs should not delay referral for specialist and/or urgent care where required, for example referral into cancer pathways

• a duplication of existing services - women’s health hubs should not duplicate other local services, and rather could improve pathways into other services, for example mental health services

• one size fits all - hubs should be tailored to meet local population needs and system objectives

Aims of women’s health hubs

When developing hub models locally, the specific goals and targets will need to be tailored to local population needs. Equally, there is benefit in having shared aims to help ensure that hub models help to deliver the ambitions set out in the Women’s Health Strategy.

The 10 aims of women’s health hubs

Aims for women and girls:

• better access to services, including preventative healthcare and early intervention, and reduced unmet need for healthcare

• improved patient experience, with care being delivered in one appointment where possible

• improved health outcomes and reduced health inequalities

• improved access to health information, in a range of formats, and supported patient self-management where appropriate

Aims for the workforce: 

• optimising the skills of multidisciplinary teams through joint working and training opportunities

• improved workforce experience and retention

• improved communication and partnership working between primary, community and secondary care

Aims for the health and care system:   

• greater efficiency, through care delivered at the right time, in the right place, and by the right person; fewer unnecessary secondary care referrals; and collaborative commissioning to make best use of resources

• more integration and partnership working between health system partners - NHS, local authorities, the voluntary and community sector, and patients - so that services better meet the needs of women and girls

• better collection and use of data by commissioners and providers to understand women’s health needs and improve service provision and outcomes

Services and care pathways

There is no ‘one size fits all’ approach as hub models must be tailored to local population needs. They should be wrapped around women and girls’ health needs across the life course. Evidence from existing hubs show that hub models may start with an initial service offer which is then expanded over time - with a long-acting reversible contraception (LARC) service often the first building block.  

Core services to bring into a hub model are^{[footnote 4]}: 

• menstrual problems assessment and treatment, including but not limited to care for heavy, painful or irregular menstrual bleeding, and care for conditions such as endometriosis and polycystic ovary syndrome

• menopause assessment and treatment

• contraceptive counselling and provision of the full range of contraceptive methods including LARC fitting for both contraceptive and gynaecological purposes (for example, LARC for heavy menstrual bleeding and menopause), and LARC removal, and emergency hormonal contraception

• preconception care^{[footnote 5]}

• breast pain assessment and care

• pessary fitting and removal

• cervical screening

• screening and treatment for sexually transmitted infections (STIs), and HIV screening

In many cases, primary care will already be providing these services, or some elements of these services, for example routine cervical screening and opportunistic STI testing. Hubs should not disrupt primary care where it is already operating effectively for women. However, by reflecting the life course approach and the need to wrap services around the needs of women, hubs can integrate pathways which are often not joined up. For example, when having LARC fitted or removed, a woman should be able to also have her cervical screening if due or STI testing if appropriate within the same appointment, minimising the need for multiple appointments and invasive procedures.  

Hubs have the potential to bring many services closer to home, and to streamline pathways of care. There are numerous other areas of women’s health where some or all elements of the care pathway could be built into a women’s health hub model. The specific services will vary depending on population health needs, the existing set up of services and workforce skills. Some areas for consideration are: 

• HPV vaccination, including catch up provision

• incontinence care - including provision of or signposting to continence assessment and/or services such as urodynamics and ultrasound, conservative management such as pelvic floor physiotherapy, and if needed referral into specialist services   

• pelvic organ prolapse care - including assessment, conservative management such as pelvic floor physiotherapy, and if needed referral into specialist services

• pelvic pain assessment and treatment, and if needed referral into specialist services

• recurrent urinary tract infections assessment and treatment

• outpatient diagnostic and/or treatment procedures, including but not limited to ultrasound, hysteroscopy, biopsy and colposcopy 

• vulval dermatology and/or vulva clinics

• sexual health services, including provision of or signposting to prevention and outreach services, HIV treatment services and psychosexual services

• fertility assessment and advice, diagnostic testing and referral into infertility treatment services

• other services for expectant, new or bereaved mothers, for example perinatal mental health services and maternal mental health services, pelvic health clinics and breastfeeding support

• provision of or signposting to abortion services

• provision of or referral to breast pain clinics

• breast screening and referral into breast cancer pathways

• osteoporosis assessment and care, for example DEXA (bone density) scanning or fracture liaison services

Women’s health hubs should also maintain clear pathways into secondary and specialist care, which would follow existing primary care pathways and not create an extra step in the patient journey. Examples include: 

• gynaecological cancer pathways

• specialist gynaecology services, for example specialist menopause clinics, specialist services for severe endometriosis, and specialist centres for women with mesh complications 

• maternity services and/or antenatal care

• early pregnancy units, and services for recurrent miscarriage

Reflecting the need to meet women’s health needs holistically, hubs could also develop care pathways into other health and public services, including but not limited to: 

• mental health services

• domestic violence and abuse services

• sexual assault referral centres (SARCs)

• specialist female genital mutilation (FGM) services

• women’s centres, which provide holistic community support for women with complex needs

• family hubs, which provide services for families with babies, children and young people 

• public health programmes, for example for smoking, obesity, drug and alcohol support

• adult social care

• social prescribing

Women’s health hubs delivery logic model

Following a review of literature, this logic model has been drafted to map the intended delivery of women’s health hubs. It shows how the policy can lead to its intended impacts and outcomes.

DHSC thanks the Birmingham, RAND and Cambridge Evaluation Centre (BRACE) team for sharing early findings and their theory of change in order to develop this logic model.

Description of delivery logic model

The image shows a diagrammatic flow chart, which represents a women’s health hub delivery logic model. The top 5 rectangular text boxes are shaded grey and read:

• inputs (resources)
• activities (services, actions, processes)
• outputs (result of activities)
• outcomes (effects of outputs)
• impacts (long term vision for change)

These are the key elements that represent each stage of the logic model.

Under inputs, there is another text box, which includes:

• funding
• infrastructure (facilities or online)
• clinical space and equipment (depending on service)
• integration (IT systems and pathways)
• trained healthcare professionals
• admin staff
• project manager

From this box, there are 3 arrows. One that connects, and points to, a box under the activities text box which includes the activities:

• heavy menstrual bleeding consultation and treatment
• long-acting reversible contraception (LARC) fitting for gynaecological and contraceptive reasons
• LARC removal
• menopause consultation and treatment
• pessary fitting and removal
• cervical screening
• other contraception advice and provision
• assessment of incontinence and/or prolapse
• emergency contraception
• breast pain assessment and care
• screening and treatment for sexually transmitted infections (STIs), and HIV screening

Another arrow points to a text box under activities that says educational/information and events for women including group consultations, and another to another text box that says further training for healthcare professionals/upskilling.

These activities boxes then point to the 4 boxes under outputs. These boxes include a list of the activities a hub would be undertaking, including the first which has X number consultations, X number LARCs fitted or removed, X number pessary fitted or removed, X cervical screenings, X number STI screenings and treatments, X number clinics delivered, X contraception administered, and X incontinence treatments. Another which has X number of reduced appointments and X number reduced secondary care referrals. Another that has X number events and group consultations run, and another that includes X number healthcare professionals trained.

These output text boxes have arrows that point to 4 outcome boxes. The first one includes:

• increased access to services
• increased patient experience
• reduced pain
• reduced progression of illnesses
• reduction in length of pathway

The second includes:

• reduction in secondary care waiting lists and backlogs
• reduced unwanted pregnancies

The third includes:

• increased labour force and/or educational participation
• increased healthcare professionals women’s health skillset

The fourth reads: increased healthcare professionals’ experience.

These outcome boxes are followed by 5 connector arrows, pointing to the final column of text boxes on the chart, that represents impacts.

The first box, in large text, reads: women experience improved access to women’s health services and a reduction in inequalities. The second box reads: system level efficiency, and the third and final box reads: healthcare professionals’ retention. The logic model shows a simplified process of how the inputs associated with a women’s health hub lead to their associated outcomes and impacts.

Find further information on the Women’s Health Strategy for England. 

For ongoing NIHR-funded research into women’s health hubs, see early evaluation of women’s health hubs from the University of Birmingham.

For additional resources for commissioners and providers, see Primary Care Women’s Health Forum women’s health hub toolkit.  

1. The NHIR-funded early evaluation of women’s health hubs has found that the most commonly reported commissioning arrangement is co-commissioning between the local authority and the clinical commissioning group (CCG) (now replaced by integrated care boards (ICBs)). The Women’s Health Strategy encourages collaborative commissioning to ensure services are centred on women and girls’ health needs across the life course, rather than the needs of commissioners.  ↩

2. Hewitt review (2023): “In many ICSs, place partnerships, aligned with Health and Wellbeing Boards and building on their work over many years, will lead much of the work to transform local services and models of care, support population health and tackle health inequalities.” ↩ ↩²

3. Fuller Stocktake (2022): “At the heart of the new vision for integrating primary care is bringing together previously siloed teams and professionals to do things differently to improve patient care for whole populations. This is usually most powerful in neighbourhoods of 30,000 to 50,000, where teams from across primary care networks (PCNs), wider primary care providers, secondary care teams, social care teams and domiciliary and care staff can work together.” ↩

4. Taylor and others (2022). Early evaluation of women’s health hubs: interim summary report ↩

5. The DHSC maternity disparities taskforce is working to produce guidance that supports women to make informed choices about their health and wellbeing prior to pregnancy. This work is under development and will be shared with local health systems once complete. ↩