Scotland’s champion for women’s health has told a parliamentary committee that a new pilot project taking place in general practices in some of the most deprived areas of the country is seeking to improve care quality.

Professor Anna Glasier, Scotland’s first Women’s Health Champion, told Holyrood’s Health, Social Care and Sport Committee that progress in women’s health has been achieved since her appointment in January.

Professor Glasier said work around many women’s health challenges begins in general practice.

Tackling disparity in breast and cervical cancer screening is one of the plan’s priorities and she highlighted that a self-testing cervical screening initiative “should be happening fairly soon”.

However, she raised concerns around the difficulty of engaging women from more deprived backgrounds in awareness-raising campaigns and of their challenges in “negotiating” the NHS in the same way as their more-wealthy counterparts.

One way the team are trying to “take women’s health care to the practice”, Professor Glasier explained, is through a new pilot project, being developed with deep-end practices serving some of the most deprived communities in Scotland.

Professor Glasier said:

“We’ve talked to some GPs in those practices, they tell us that women really have confidence in their GP and are much less confident going elsewhere. It’s not just a matter of the practicalities of travelling costs to get your breast screening, for example – but it’s also the issue of trust.”

“We’re looking at a pilot study allocating a women’s health specialist for one session a week to a handful of deep-end practices to work alongside practice staff – GPs and practice nurses – to improve their skills in providing women’s healthcare.

“To also encourage them to take a more holistic view of women’s healthcare and see whether this will serve as a model for all the deep-end practices to improve the quality of women’s healthcare.”

Progress in the Women’s Health Plan

The first Women’s Health Plan was published in August 2021 which laid out wide-ranging recommendations to reduce health inequalities, abortion, clinical research and menstrual health.

Professor Glasier’s appointment as Women’s Health Champion – a key commitment in the plan – followed in January this year. She is tasked with working with NHS, public and third sector partners to drive forward the ambitions of the plan.

Among the greatest causes of death for women in Scotland are cardiovascular disease, dementia and Alzheimer’s disease, with recent calls for more action on women’s brain health.

While the women’s health plan briefly mentions dementia, its focus on heart disease is more extensive.

Professor Glasier told the committee that this is one area where both diagnosis and care have historically failed women:

“Women are less likely to be diagnosed with a heart attack and even when diagnosed, they’re less likely to be on secondary prevention than men and you have to ask yourself, why is that?”

To improve women’s heart health, Professor Glasier highlighted recognising increased risk during pregnancy and is currently exploring self-monitoring programmes and different forms of support.

Committee member Ivan McKee MSP asked whether she thinks the issues chosen for the plan are correct and she told the committee that it focuses on a lot of areas that are not included in other strategies or plans.

She added that she thinks the next iteration of the plan will “be even better” as a result of what the team have learned over the last year.

Measuring success

One area of the plan delivered on so far is placing a clinical menopause expert in each of Scotland’s health board areas – with a national clinical network of menopause specialists now meeting quarterly.

Professor Glasier outlined that these experts are key for when GPs cannot manage menopause symptoms or when people present out with the standard treatment needs of menopause.

However, she told the committee that Scotland must do better at measuring initiatives to monitor progress and understand how successful the plan is at reducing inequalities.

Returning to the deep-end project, she said a “sophisticated evaluation” is this work:

“For example, if we improve women's healthcare in these GPs, do women get referred less to specialists?  

“I think all GPs should have somebody good at dealing with menopause and prescribing standard HRT.

“If that’s delivered better through the various initiatives we’re setting up, then we should see fewer people referred to specialist services for menopause.”

She said the team are working with NHS Education for Scotland (NES) to prepare a menopause and menstrual health educational package for GPs and practice nurses.

She added that the impact of this must be evaluated to understand women’s awareness and experience of primary care support for these, but “there’s still work to be done” on measuring progress.

She added that with women in deprived areas less likely to raise a concern of menopause and less likely to be prescribed HRT, the responsibility lies with GPs to open up that conversation.

Looking forward, Professor Glasier said funding and staffing are key to delivering on the plan – specifically in meeting demand for long-acting contraception and sexual health services:

“Of course, I would say there hasn't been enough money behind the plan – I'd be mad not to. So yes, could we have some more money please?”

Read more: Has progress been made on women's health?; Breast screenings for over-71s to restart; Abortion clinic buffer zones - where are we now?; Deprivation remains key factor in young pregnancies; Action needed on women's brain health; ‘Substantial' impact of domestic abuse on brain

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