Community Women's Health Hub models in England: a mixed methods evaluation.

backgroundWomen's sexual and reproductive health care in England is fragmented, with multiple providers, access inequalities, and commissioning barriers. In some areas health leaders, often based in primary care settings, have established 'Women's Health Hubs' to improve care and outcomes. The 2022 English Women's Health Strategy subsequently recommended national implementation of these models. This study aimed to explore Women's Health Hubs established before 2022 to inform national policy and practice: to describe models, explore experiences of implementation, delivery and care, key features and indicators of success.

methodMixed-methods evaluation included an online survey of identified UK hub leaders to identify and describe models and interviews with English regional and national stakeholders (n = 13). In-depth work in four purposively selected hubs included interviews with staff working in or connected to the hub (n = 40), women using hubs (n = 32), focus groups with underserved women in the local community (n = 48), and analysis of documents shared by hubs.

resultsSeventeen UK hubs were identified (13 in England). Hubs were diverse in size, maturity, commissioning and delivery models. Primary care leadership and settings predominated. Common services included long-acting reversible contraception and menopause care. Data availability limited the assessment of impact on health and inequalities, though there were examples of short waiting times, improved access to long-acting reversible contraception, and reduced secondary care referral in individual hubs. Women using hubs reported positive experiences. A need for equality in access and avoiding destabilising existing services was emphasised. Hubs were described as potentially improving primary care staff retention. Challenges included fragmented commissioning, workforce shortages, funding, and poorly-integrated infrastructure, including electronic patient records. Perspectives varied regarding the optimal model and leadership, including the role of primary care.

conclusionsWomen's Health Hubs have potential to integrate and improve women's care, though there are ongoing challenges in defining and implementing these models. Heterogeneity in models makes extrapolating conclusions difficult. Further evidence is needed of the impact on inequalities, population health and on the wider health system, including unintended or adverse consequences. Tailoring to local context is important. Sustainable national scale-up across England will require funding and time, and primary care professionals and organisations will be central to success.