An Exploration of Reputable Nurse-led Pelvic Floor Clinics in the UK, to facilitate the development of a nurse-led pelvic floor service within a University Health Board.

Faecal incontinence and obstructive defecation are common problems often hidden and not discussed. Whilst these problems have devastating personal effects, often making patients feel isolated, it also has an impact on both healthcare providers and a social-economic bearing.  Within our local trust there was a gap identified in the services offered to these patients. There was a very disjointed service with no clear dedicated treatment pathway. It was a combination of a lack of comprehensive service for the patients and empathy for them that motivated us to explore the possibilities of developing a nurse-led clinic to try and bridge the gap.

We were aware that some areas of the country provided robust, holistic services for patients with functional bowel problems. In order for us to provide a service we needed to witness best practice. We therefore selected reputable centres of excellence with nurse-led services within this field to visit and transfer their practice.  We therefore chose The Oxford Pelvic Floor Centre, St Marks Hospital London and The Manchester Royal Infirmary. During these visits we realised that the service we were providing was in fact part of what is on offer in these areas. However, they have access to wider therapies and services of a multidisciplinary team that we are yet to realise.

We have come to realise that the implications of trying to provide a single clinic for these patients is insufficient. This in turn has had an impact on our thoughts for the development of our service. However, in Wales unlike in England, trusts do not cross charge for patient treatment and therefore do not generate an income. Therefore, we have had to try and demonstrate how the trust can invest to save in the long term.

Despite all the obstacles we have encountered with financial constraints and lack of commitment of the wider MDT, we remain passionate and determined to provide the best service we can for these patients and implement the good practice we have witnessed during our visits.