Menopause: diagnosis and management

Use newsletters, bulletins and education events to help ensure that GPs and other practice staff (in particular practice nurses) are aware of this change in practice and that they understand the evidence underpinning this recommendation.

Add a prompt to electronic requesting systems which remind primary care staff that this test should not be requested for women aged over 45.

Refer GPs to NICE's clinical knowledge summary for menopause.

Use the NICE costing report and template to estimate the local savings that can be made. A sample calculation using this template showed that savings of £16,500 could be made for a population of 100,000.

Use NICE's baseline assessment tool to establish current practice in requesting tests and carry out clinical audit so this can be monitored and improved. \

Engage with their local GP practices. For example, in NHS Lothian a GP/laboratory liaison group meets regularly every 2 months and holds an annual update meeting to which all GPs are invited. This continuing professional development (CPD) accredited meeting provides a good opportunity to promote changes in practice.

Encourage GPs to stop requesting FSH tests for women aged over 45 years by drawing attention to the fact that this test is unlikely to be informative and is not recommended. Lab Tests Online UK and the UK National External Quality Assessment Service (UK NEQAS) are also raising awareness of the new NICE guidance.

Help to develop formularies of good HRT prescribing for GPs. This could be done with input from GPs with a specialist interest in menopause and interested consultant gynaecologists.

Use briefings and newsletters to help disseminate prescribing knowledge on HRT.

Set up local meetings or teaching sessions (particularly those GPs with a specialist interest) to target interested GPs in each practice who can then take the information back to their partners.

Use the recommendations in the section on long-term benefits and risks of hormone replacement therapy of the guideline and the HRT section of NICE's clinical knowledge summary to ensure that they are informed of the actual long-term benefits and risks of HRT for each individual and are not basing decisions on perceived knowledge.

Use materials such as NICE's information for the public, the NHS website and the Women's Health Concern leaflet to help support women to make informed decisions when advising them about HRT.

Link with the menopause specialist in their area for advice. This could be by telephone or email about specific cases and/or through training delivered by the menopause specialist.

Complete the basic or advanced FSRH special skills course. Practice nurses may also complete this training.

Clarify current referral routes and communicate them if they are effective.

Identify lead clinicians to drive a change in service provision if a gap is identified. Ideally all clinical commissioning groups should have a GP with a specialist interest or a community gynaecologist who could do this.

Establish whether current referrals are appropriate. These may be to secondary care (hospitals), community services or a GP with a specialist interest and will vary according to local facilities. Ideally, services should be provided by a dedicated menopause clinic.

Confirm that care is provided by a healthcare professional with expertise in menopause (for example, women with breast cancer should have access to a specialist menopause clinic or professional but often receive treatment for menopause from their oncologist who may not have the appropriate training).

Consider the feasibility of providing dedicated menopause support by setting up clinics within current gynaecology services.

Menopause clinics may be multispecialist and so jointly led by a nurse consultant and a consultant ensuring that when a member of staff is unavailable the clinic may still run.

Establish regional menopause clinics if services are unable to have their own.

Use the learning from examples of practice where successful services have been set up to help. For example, a primary care service in Essex manages specialist clinic waiting lists through an established agreement whereby a GP with specialist interest accepts emails or written requests from all GPs within a clinical commissioning group. These requests are answered once a week. A specialist service in London has set up a helpline that receives calls outside of clinic times and can allow women to be given support and advice without the need for a clinic appointment.