Endometriosis guideline a welcome step, but GPs need funded pathways to deliver better care for their patients

The Royal New Zealand College of General Practitioners (the College) welcomes the Government's announcement that Health New Zealand will adapt the RANZCOG Australian Living Evidence Guideline: Endometriosis for use in Aotearoa New Zealand. 

The College says the guideline is a positive step for women's health but warns that it will only improve outcomes if it is backed by funding, equitable access to services and education across the whole health workforce.

College Medical Director Dr Prabani Wood says the College supports any change in women's health practice that leads to better outcomes for patients. However, she says the way the change has been described risks giving the public the impression that general practice has not been part of endometriosis care until now.

“GPs are already diagnosing and treating endometriosis every day, and have been for years,” Dr Wood says. “What we do not have is easy, funded access to the wider services these women need. Pelvic physiotherapy and other allied health support are essential for the many women who need more than medication to manage their symptoms.”

The College's greater concern is the gap between the guideline and the system that has to deliver it. Access to diagnostic imaging, gynaecology services and allied health support varies sharply across the country, and in many places those services are only available if the patient pays for them privately. That means a woman's ability to get timely care still depends on her postcode and her income.

“We cannot ask general practice to shorten diagnosis times and improve management without also fixing what sits behind the diagnosis,” Dr Wood says. “A clinical diagnosis is only useful if the woman can then access the imaging, the treatment and the support services she needs. At the moment that depends far too much on where she lives and what she can afford. That is an equity issue, and a guideline on its own does not resolve it.”

The College also notes that surgery is not always the best option for women with endometriosis, and that understanding of contemporary diagnosis and management needs to improve across the entire medical profession, not only in general practice. 

Health New Zealand's commitment to training is welcome, and the College is willing to work on that education. It needs to be properly funded, developed for the New Zealand context, and extended across primary, secondary and allied health care.

“We want to see a guideline that works in a New Zealand context for New Zealand women in New Zealand practices,” Dr Wood says. “Equity of access and cost should be a large consideration of that work, given the health care inequities we face as a country.” 

The College has recently supported the work of the Ministry for Women and Health New Zealand through their women's health resources campaign and says that momentum should now be matched with investment in the services that sit behind it. Better outcomes for women require a whole-of-system approach, from the first appointment in general practice through to imaging, specialist care, allied health and long-term support.

“General practice is ready to play its part, as it always has,” Dr Wood says. “But a guideline is a document. What changes women's lives is a funded, connected system that lets us act on it.”

To speak to a College spokesperson, please email communications@rnzcgp.org.nz or call 021 027 81909.