Case study 4 - Access in times of instability
Fragmented commissioning arrangements for Sexual and Reproductive Health Services (SRHS) mean that care is often delivered in silos, and pathways are difficult to navigate. Women may have to wait longer to access appropriate services or require multiple different appointments that could be streamlined. For example, women may book a consultation with their GP to discuss contraceptive options but then discover that they need to go to a different provider to receive their preferred method. Fragmentation poses particular problems for women from marginalised groups, especially those facing periods of instability, such as women experiencing homelessness, living in temporary accommodation, navigating financial instability or experiencing domestic or sexual violence.
Marie's story
Marie is currently living in temporary accommodation with her husband and two children. She previously lived in the London Borough of Hackney but has since been moved to temporary accommodation in Ilford. Marie has found it difficult to access a GP appointment to discuss contraception since her relocation.
Unsure about her future location, she has faced a dilemma – whether to register at a new GP in Ilford or maintain her registration in Hackney. She fears losing her place at her old GP in Hackney and remains registered there, despite the distance of 8.5 miles from Ilford. The uncertainty of future relocations makes choosing a local GP challenging for Marie. This uncertainty was compounded when Marie needed to seek urgent medical advice for heavy menstrual bleeding (HMB). When trying to seek advice, she was told she was too far from her GP in Hackney and should contact a new surgery in Ilford, where she was not registered, as she was only living there temporarily.
It was before her relocation to Ilford that Marie had a positive experience accessing contraception. After giving birth to her daughter, Marie was considering contraceptive options. Marie was concerned about potential weight gain due to contraception, and when initially discussing contraception with her GP, she was signposted to digital information about various methods and their potential side effects. After reviewing the NHS webpage, she chose the implant. Although the healthcare professional (HCP) supported and advised Marie throughout the process which involved two phone calls and a 25-minute in-person appointment, Marie felt the decision was individual and she appreciated the autonomy in making choices about her health. The HCP fitting the implant provided clear expectations of the procedure and assured her it was her decision when to have the implant removed and that she did not have to wait if it was not working for her. After experiencing unpleasant side effects from the implant, she sought help from her registered GP. However, because she was living in temporary accommodation far from the practice, the GP advised her it would be difficult to access care, but she was reluctant to re-register elsewhere - ultimately leading her to have the implant removed.