Transcript of VPS Podcast 6 - Vulval conditions and the new NHS: a presentation given by David Nunns

Working with a specialist – now, obviously you go into a hospital, usually. It’s less easy, isn’t it? You’ve got to drive to the hospital, or get transport, you’ve got to park, it’s a busy place, it’s less personal, perhaps, than your surgery down the road. Everything else applies – write your questions down. I think it’s very important to tell, perhaps what exactly the main problem is, because I think there is a perception in health professionals that with vulval problems, with vulvodynia, with lichen sclerosus, there are perhaps too many balls going up in the air. There may be pain issues, sexual problems, anxiety, worry, concern, worry about infection, fertility issues. It’s very difficult to articulate that in a consultation of 20 minutes, but I suppose you’ve got to think before you walk through the door: what is my main concern here? What is my main problem that I want this doctor to help me with? That will really focus the consultation.

What’s the follow-up plan? This is a very common problem. You see the specialist, you’re given a prescription, you leave the clinic, the next appointment’s in four months’ time, or there may be an open appointment, or you may be discharged back to general practice. It’s not unreasonable to have a follow-up appointment, so you should ask for that, and make sure that’s arranged.

What if that drug you’ve given me doesn’t suit me, or I have a problem? What’s Plan B? If I have a problem, can I get in contact? You can have a copy of your letter. I think that’s very important. You are all entitled to letters that your GP receives from the hospital, so you should ask for that. There are good letters, and there are bad letters. A good letter, you’ll be copied in, and it will have a clear plan of action. Poorer letters will have very patchy information. We’re all individuals, and I think we all dictate according to habit.

Access to a specialist… Where are these specialists? Are they that special? [Laughs] We don’t have a national database that’s comprehensive, but the best you’ll find is on the British Society for the Study of Vulval Disease’s website. A few years ago, we approached all the vulval clinics in the country, and we said: ‘Would you be happy to be included on a database that patients could access?’ With the exception of one clinic, they all said ‘yes’. This database of clinics includes a number of health professionals who want to help you and pretty much most of the country’s covered. It’s comprehensive, but it doesn’t go into that much detail, and we can’t validate who the health professionals are. All we know is that they’re usually senior health professional-led services by either gynaecologists, GU medicine doctors or dermatologists who have an interest in vulval problems.

Ask the GP about vulval service, yes? There may be one in your area. It’s a vulval clinic or a vulval service. Are there any other tests I could have that only a specialist could perform, or do I have unusual symptoms that a specialist might help with? That might be a question that you could ask your GP if you need to see a specialist. That’s not unreasonable, particularly if you’re not progressing with the treatment they’re offering you. Private healthcare – we know very little about vulval problems in private healthcare. There’s no national data collection on the outcomes of private healthcare, but many women do in desperation pay to go and see a private consultant. Many of the consultants who work within the BSSVD would see patients privately, but you’d have to do your own homework on that.

I’ll finish slightly sooner, Kay, [Kay Thomas of the VPS] but I suppose the big question is: what do you want from your GP? There’s a whole host of things that you might want from your GP, or even your specialist. One thing that we are acknowledging more and more now as doctors, health professionals is the unmet needs of the patient and sometimes we’re just not aware of what the needs are when you come in for a short consultation. All these issues on this slide cover vulval disease, like vulvodynia, lichen sclerosus. It may be something very simple like you need a sick note, you might want a new prescription, it might be that this is the main problem - anxiety management, you might want help with that, it may be sexual therapy referral, it may be that you’ve found a lump, and you’re concerned, and you just want reassurance. But all I’d say to you is yes, these issues, you can discuss with your GP or specialist and try and be very focused on what the main problem is, but some of these other options here – sexual therapy, anxiety management, can be instigated by yourself, and the VPS website’s got many links that you can tap into, where you can almost bypass the hospital specialists and go directly yourself. The physiotherapists, for example, have a very good website where you tap in your postcode and you can find a physiotherapist who’s local to you.

I’m going to stop there, actually. Is that all right? Perhaps we could take some questions?

There’s one thing I forgot to say – on the front table here, there are some pens and a couple of Post-It notes. I do a lot of these talks on vulvodynia, and I was thinking about the unmet needs of patients, what [inaudible] out as health professionals. It would be helpful, actually, when I speak to doctors, to tell them the things that you feel aren’t addressed in consultations. So, if you have time at lunchtime, please write any thoughts that you have down on one of those bits of paper and leave it there. I promise to take them away and share that with other health professionals. Any unmet needs that you think aren’t addressed in consultations, please let me know and then I promise to share those with the wider health community.