Pharmacist-led menopause clinics in the NHS

Pharmacist-led menopause clinics in the NHS

The provision of accessible and specialised menopause care within the National Health Service (NHS) has historically faced significant challenges, often leaving patients to navigate long waits or resort to private services. However, the Women’s Health Hub, established by Anthony Singh (Lead Pharmacist and accredited British Menopause Society specialist) at Northwest Leicester GP Federation, offers a useful model for innovation in primary care. In this interview he describes how the combination of clinical expertise, digital technology, and holistic patient engagement can significantly improve outcomes and efficiency, positioning menopause care as a core primary care function, comparable to the management of hypertension or diabetes.

Strategic goals and operational success

The Women’s Health Hub was designed three years ago to provide women with easier access to critical health services. It was initially focused on improving cervical smear management, reducing waiting times for long-acting contraception (coils and implants) and removing barriers to menopause care.

The menopause clinics operate around three core Key Performance Indicators (KPIs) designed to streamline care and enhance professional development:

1. Improving access: This tackled the 8:00 a.m. rush for appointments by offering additional capacity slots in the evenings and on Saturdays.
2. Reducing secondary care referrals: Part of the fundamental vision was to “move the specialist closer to the patient”, by providing menopause specialists in primary care rather than relying on traditional secondary care referrals.
3. Improving the primary care knowledge base: By training and utilising pharmacists across the 12 surgeries, the knowledge base within primary care has been raised. This, in turn, supports the achievement of the first two KPIs, notes Mr Singh.

The operational impact has been significant. The Northwest Leicester GP Federation has achieved a 24% reduction in secondary care referrals for menopause patients. This large reduction is attributed to the ability of the specialist primary care team to avoid inappropriate referrals and manage moderately complicated patient scenarios, reserving secondary care for more complex cases requiring physical intervention or specialised scans (e.g., fibroid removal or polyp removal).

The focus on hormone replacement therapy (HRT) access has resulted in a 21% increase in HRT prescribing compared to neighbouring federations. In addition, the service has also impacted mental health prescribing, managing to flatline a previous 6% annual increase in anti-depressant prescribing among its patient population. This could reflect adherence to the NICE guidance that stipulates HRT as the first-line treatment for menopausal symptoms rather than anti-depressants, suggests Mr Singh.

Since its inception the service has grown considerably; the number of additional appointments has grown from 40 to 140 appointments per week, and as a result some 1800 patients have been seen over the past two years.

Digital health as a Unique Selling Point (USP)

Digital technology is integral to the hub’s forward-thinking approach, ensuring efficiency and high standards of governance, explains Mr Singh. Key digital innovations include:

• Remote appointments: Consultations, typically lasting 20 minutes, are usually conducted via telephone or video link, maximising patient throughput.
• Digital reminders and DNA reduction: A communication system called AccuRx is used to send digital appointment reminders two weeks and two days prior to the slot. This system also allows patients to rebook easily, minimising the costly Did Not Attend (DNA) rate.
• Patient priming videos: Before their consultation, patients receive a video link via text message. This video educates them about risks and benefits of HRT and menopause symptoms, in preparation for the appointment. The video also serves as a governance tool, confirming the patient has been informed of risks such as breast cancer and clots.
• Workflow efficiency: A system called Phonebar automatically dials the patient (integrating with the GP record) and records the call for governance purposes. An AI scribe (Heidi AI) transcribes the appointment notes directly into the patient’s record, reducing the administrative burden.
• Medication education: One of the problems the team discovered at an early stage was that patients were requesting appointments for irregular bleeding resulting from incorrect use of complex HRT regimens. To combat this problem, the team now sends personalised, AI-generated videos detailing how to use the prescribed medication.
• Feedback mechanism: Immediately following the service, a digital feedback form is sent via AccuRx. High levels of patient satisfaction have been found with 96% of patients being ‘extremely satisfied’ or ‘satisfied’ with the service.

Specialist care in primary care: testosterone

The hub has successfully brought specialist functions, previously confined to secondary care or private practice, into the primary care setting. This is exemplified by testosterone prescribing. In line with NICE guidance (NG23) and British Menopause Society recommendations, testosterone is only prescribed for hypoactive sexual desire disorder (HSDD) (low libido).

For dosing accuracy, the service prefers the Tostran pump over Testogel, arguing that expecting a woman to measure accurately an eighth of a sachet (of Testogel) is clinically unrealistic. The team maintains rigorous governance, performing baseline blood tests (free androgen index, total testosterone, sex hormone binding globulin (SHBG) and oestradiol) followed by checks at three months, six months, and annually.

A holistic, community-focused model

Community and patient engagement is an important part of the Women’s Health Hub offering. “Menopause care isn’t just about HRT”, says Mr Singh. With this mind, he also developed Patient Participation Groups (PPGs) – evening group consultations which offer education on symptoms, risks, and treatment options, often leading to immediate appointment bookings.

To combat loneliness and address physical health needs, the hub funds external initiatives like the “menopause active group” at the local leisure centre, which provides access to nutritionists and pelvic floor exercises. Social prescribers are also utilised to connect women struggling with isolation to ongoing local support groups, such as menopause cafes.

Conclusions and call to action

The Northwest Leicester Women’s Health Hub demonstrates that specialised, high-quality, and holistic menopause care can and should be delivered free at the point of service within the NHS. With a strong focus on clinical governance, patient feedback, and leveraging digital infrastructure, this model is now being prepared for national rollout through the NHS Clinical Entrepreneur Program, says Mr Singh.

For frontline health care staff, his message is clear: Be curious about menopause management and use the many free resources that are available e.g. from the British Menopause Society or the NHS menopause website. “It’ll help you treat your patients better. It’ll help you have better clinics. It’ll help you have better relationships with your staff and your family”, concludes Mr Singh.

About Anthony Singh

Anthony Singh is an Accredited BMS Menopause Specialist and Lead Clinical Pharmacist for NWL GP Federation. In 2024 he received the Excellence in Primary Care award at the Clinical Pharmacy Congress. In 2025 he was selected for The NHS Clinical Entrepreneur Programme where he is leading a nationwide initiative to improve menopause care. Recently, he and his team received a British Menopause Society award for the evaluation of the NWL project. He has also been nominated for HSJ awards in the primary care and innovation categories.