Background

We describe a simple quality improvement project leading to a change in the configuration of referral pathways within the sexual and reproductive health (SRH) service at Margaret Pyke Centre (MPC), London, UK. This service provides open access to contraception. In 2015 the MPC provided services for 14 604 patients. Some 39% of the patients were from the local boroughs of Camden and Islington, and 92% came from all London boroughs and were equally distributed among all deprivation scores. The majority (68%) of patients are white and 78% of all patients are aged between 21 and 35 years. While 95% of patients have their needs met in a single visit, 5% require onward referral to a Level 3 specialist clinic as specified in the Framework for Sexual Health Improvement in England.1 This accounts for about 150 patients per month, and due to the high demand women often wait up to 8 weeks for an appointment. In general it is known that “most dissatisfaction with the Health Service is due to long waiting times, staff shortages and lack of funding”.2 Patients who wait for a long time are less likely to keep their appointments.3 4

Many of the women who require referral at MPC could be managed in a single visit if same-day specialist care with an ultrasound scan carried out by a trained specialist was available. This project was therefore designed to determine whether same-day access to specialist SRH care improves efficiency, reduces rates of failure to keep appointments (DNA: did not attend) and improves patient experience. The project was based on PDSA (Plan Do Study Act) methodology5 where a small change is put into place; it is studied and then modified to address the findings. The idea was to implement same-day Level 3 service provision within MPC, modify change to the service as …