Hypothesis / aims of study
The Integrated Care Board (ICB) covers a region of the country that is home to just over 2 million women. At the start of this project, nearly 2000 women were waiting up to 78 weeks for a first appointment in secondary care urogynaecology services (across three regional hospitals). This transformation project initially aimed to conduct a comprehensive analysis of existing urogynaecology services across the ICB footprint, including mapping the patient pathway, assessing demand and capacity, and understanding the needs and experiences of the population. Following this foundational analysis, the aim evolved to co-design and implement responsive interventions—specifically Community Education Days (CEDs)— with the objective of enabling patients to “wait well” while reducing pressure on secondary care.
Study design, materials and methods
A multi-phase, mixed-methods service redesign was conducted across six boroughs within a single ICB footprint.
• Phase 1: Foundation Analysis. A multi-disciplinary Task and Finish Group mapped the existing patient pathway and completed demand and capacity analysis across primary and secondary care.
• Phase 2: Patient and Public Involvement (PPI). In-depth focus groups and interviews were held with women on waiting lists in secondary care and women living in the community who had yet to seek help but wanted to.
• Phase 3: Co-Design and Intervention Development. The partnership identified an urgent need to provide meaningful support to those waiting. Data from Phases 1 and 2 informed co-design workshops with stakeholders. Community Education Days (CEDs) were developed as a direct solution to help patients “wait well”—offering early, expert-led intervention while they awaited specialist input.
• Phase 4: Pilot Implementation. The CEDs will provide expert-led education classes on pelvic floor muscle training, bladder training and good bladder health and wayfinding to local services with members of the community weight management services, smoking cessation, talking therapies and social prescribing teams in attendance.
Results
• Pathway Analysis. In the previous year, around 13000 women had presented in primary care with urogynaecological symptoms and 68% were managed in primary care (predominantly single episode UTI’S). Baseline data revealed a fragmented pathway with 34% of secondary care referrals deemed potentially avoidable with earlier community-based support with significant variation in the use and access to the five community continence teams.
• Patient Insights. (n=32) Key themes included limited access to physiotherapy, embarrassment during treatment, challenges managing long-term conditions, and a desire for accessible community-based education.
• Community Education Days (CEDs) Pilot. Funded by £50k of secured ICB investment the CEDs will be piloted in May and June 2026. Invitations have been issued to women on existing waiting lists, with the aim of providing timely support to help them “wait well.” Impact, satisfaction data and service utilisation will be collected and analysed following completion of the pilot. A urogynaecology information bundle including recorded lectures, videos and information sheets has also been developed to support this education and standardise information across the region.
Interpretation of results
As the pilot is currently underway, formal impact data are pending. However, the foundational analysis and co-design process have established a robust rationale for the intervention. Post-pilot evaluation will determine whether empowering women with early, expert-led guidance can alleviate pressure on secondary care waiting lists while improving patient confidence and quality of life.