Case Study: Implementation of a See and Treat
Pathway for Abnormal Uterine Bleeding (AUB)
Background
Abnormal Uterine Bleeding (AUB) affects a significant number of women, with uterine polyps present in 20%-30% of cases and myomas in 25%-30% of cases. The burden of AUB is substantial, impacting patients both emotionally and financially while placing a considerable strain on the NHS. The current three-step outpatient treatment pathway contributes to long wait times and increased healthcare costs. To address these challenges, an NHS provider implemented a See and Treat hysteroscopy pathway.
Challenges with the traditional pathway
• Long waiting periods: Over 180,000 women wait more than 18 weeks for treatment, with 1 in 20 waiting over a year.
• Financial and social burden on patients: 43% of women require time off work, and 82% experience financial hardship due to AUB treatment.
• Inefficient use of NHS resources: The traditional pathway involves three separate appointments: a consultation, a diagnostic hysteroscopy, and a polypectomy. Each appointment requires multiple staff members and healthcare facilities, driving up costs and prolonging treatment times.
Introduction of the See and Treat pathway
The See and Treat pathway was introduced to streamline the AUB treatment process, reducing the number of appointments and improving patient experience. Following NICE guidelines, this pathway aims to enable hysteroscopy and necessary treatments in a single setting, where feasible.
Revised patient pathway
1. Initial consultation & scan: A 20-minute appointment with a consultant and nurse, including a scan and pipelle biopsy if required. This appointment codes to HRG WF02B, priced at £254.
2. See and Treat hysteroscopy: A 30-minute appointment for diagnostic hysteroscopy with polypectomy (if required), involving a consultant, nurse, and healthcare assistant. This appointment does not have a set national price and requires local pricing agreements but is expected to cost less than the combined MA12Z (£1,115) and MA31Z (£425) procedures of the traditional pathway.
Application of the See and Treat pathway
An NHS organisation introduced the See and Treat pathway during the latter half of the COVID-19 pandemic to address increased demand and enhance patient care. It was implemented for heavy menstrual bleeding (HMB) and post-menopausal bleeding pathways:
1. Heavy Menstrual Bleeding (HMB) pathway:
o Patients triaged into the HMB clinic.
o Information on local anaesthetic hysteroscopy provided before the appointment.
o On the day of the procedure, the clinician explains the process, offers pain relief, and discusses anaesthesia options.
o Most patients opt for local anaesthesia.
o Patients undergo diagnostic hysteroscopy, polypectomy (if needed), and LongActing Reversible Contraception (LARC) insertion in one appointment.
2. Post-Menopausal Bleeding (PMB) pathway:
o Initial triage with a scan.
o Based on scan results, patients are referred to a gynaecology clinic for a pipelle biopsy or directly to a See and Treat clinic.
o The remaining process mirrors the HMB pathway, ensuring diagnostic and treatment interventions occur in a single appointment.
Outcomes and Benefits
• Improved patient experience: Most patients receive complete treatment in a single appointment, reducing anxiety and inconvenience.
• Positive patient feedback: Increased satisfaction as evidenced by friends and family recommendations
• Reduced healthcare costs: Fewer appointments lead to cost savings in physical space, staff time, and patient attendance.
• More efficient resource utilisation: The pathway allows better allocation of healthcare resources, reducing the NHS backlog.
Conclusion
The implementation of the See and Treat pathway has significantly improved AUB patient management by reducing the number of required appointments, decreasing waiting times, and optimising NHS resources. This model serves as a successful case study for other NHS organisations looking to enhance gynaecological care and patient outcomes through streamlined treatment pathways.
Annex – comparison of traditional pathway and See and Treat pathway:
Traditional pathway; showing appointment description above appointment details, HRG code with description, and 2025/26 proposed outpatient unit price for the corresponding HRG.
See and treat pathway: