Actions needed to address long waits for gynaecological care

It is right to recognise the huge efforts of all professionals working across the system this past year, especially given workforce shortages and recruitment freezes, burnout, limited funding, and increasingly complex patient care needs. But three quarters of a million women across the UK are still waiting for gynaecology care, living in debilitating pain, their lives on hold, waiting for a way forward. Inequalities remain deep-rooted, with new data demonstrating that women living in areas of deprivation make up higher proportions of the waiting lists, and a postcode lottery remains in what services women can access.

In our 2024 report Waiting for a way forward, we set out comprehensive recommendations for the Government to reduce gynaecology waiting lists, and we also set out the urgent case to rapidly enhance support to women waiting, given the debilitating impact of gynaecological conditions on every aspect of women’s lives. The recommendations we made are now more important than ever: without urgent action from governments across the UK, their ambitions to recover elective waiting times risk being missed, inequalities could become further entrenched, and women will be left in pain, with a way forward out of reach.

Put driving down gynaecology waiting lists at the heart of all strategic health plans.

There are opportunities to address this in the delivery phase of the 10 Year Health Plan, the renewal of the Women’s Strategy for England and the NHS England Workforce Plan, the Women’s Health Plan for Wales, and the next phase of the Women's Health Plan in Scotland. Northern Ireland must urgently deliver on its promise and publish its plan for Women’s Health Action Plan in line with its 2024 commitment.

Protect and expand women’s health hubs in England, placing them at the heart of plans for neighbourhood health.

Hubs can enable women to receive faster diagnosis, manage symptoms, support rehabilitation and prevent more invasive procedures in secondary care, helping to reduce waiting lists in gynaecology. It is vital that the government acts now to expand women’s health hubs and protect them from funding cuts.

Deliver an urgent package of support to help women waiting now, to be delivered as soon as possible in all areas within the next year. This should include going further and faster to:

o Provide equitable access to specialist care to women across the UK to support them with pain, rehabilitation, incontinence and heavy menstrual bleeding.

o Ensure there are women’s health champions in place across all areas of the UK to support service delivery and that they are formally recognised by local commissioners. Champions will help to make sure women’s health remains a priority in local service delivery and facilitate meaningful engagement between professionals across the pathway, grass roots charities, and women using services.

o Direct system and local leads to urgently produce easy-to-read accessible summaries of the local networks and resources available to women waiting on gynaecology lists so they can access additional support. They should also ensure NHS websites cover the breadth of women’s health and that information is co-produced with service users, as is happening in Wales.

o Direct system and local leads working across gynaecology services to improve communication with women and people waiting for care and treatment, including giving women clarity on how long they should expect to wait.

Act now to deliver for the future to ensure progress can be achieved sustainably.

o Ensure that women’s health services are central to decisions on financial planning and allocation, to ensure sufficient funding to deliver sustainable workforce and infrastructure capacity across women’s health, especially to enable the digital transformation governments want to deliver.

o Support professionals across the system by building and enabling protected training time and providing health services with the resources they need so they can protect gynaecology services against operational pressures.

o Build data collection in gynaecology to better understand where people are waiting. There is an urgent need to ensure data sets are complete and fully disaggregated by ethnicity to understand the experiences of women in marginalised groups and better tackle inequalities.

o Drive further research, innovation and pilots that seek to improve gynaecology care and support for women, particularly around the core areas identified in the RCOG’s research.^iv

A note on language and terminology

In this report, we refer to ‘women’s health’, but it is important to acknowledge that it is not only women for whom it is necessary to access women’s health and reproductive services in order to maintain their gynaecological health and reproductive wellbeing. Gynaecological and obstetric services and delivery of care must be appropriate, inclusive, and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.

Our partners at LCP Health Analytics have used the publicly available data that has been published by the NHS England, Public Health Scotland, Stats Wales and the Northern Ireland Department for Health to develop our Elective Recovery Tracker. The NHS datasets used to create our dashboard record 'pathways' (individual entries on the waiting list) rather than people, which means if a patient is waiting for two procedures on the same wait list this will feature as two pathways.

Terms such as ‘women’, ‘people’, ‘cases’, ‘pathways’ ‘appointments’ are often used interchangeably when reporting waiting list numbers. In this report, we have used this data to provide illustrative examples to help the reader appreciate the scale and growth of waiting lists across the UK, and how many women are impacted by this.

Governments have acknowledged the vital importance of addressing elective waiting times, and members of our Expert Reference Group noted that this has been a welcome positive step.

In England, the Government committed to utilise private sector capacity for gynaecology to bring down waiting lists^xxviii and the Welsh Government committed to deliver a women’s health hub in every area by March 2026. In Scotland there has been an increase in operating time and efforts to increase capacity at peripheral hospitals. In Northern Ireland, £215m was ringfenced in the 2025/2026 budget as part of the Elective Care Framework to support elective waiting times. ^xxix

However, demand for gynaecology services remains high - in England, on average, almost 124,000 new referrals have been made each month this year.^xxx Referrals into gynaecology are now consistently higher than pre-Covid levels. Between October 2019 and October 2020, England saw a total of around 1.22 million referrals into gynaecology - compared with around 1.61 million between October 2024 and October 2025 - an increase of around 24%.^xxxi As professionals reflected in our research last year, not only have referrals increased, but care needs are now increasingly complex given women’s conditions have worsened as a result of waiting.

It is testament to the hard work of professionals that some tentative progress has been seen in some areas of the UK this year. But, Expert Reference Group members described the challenge as ‘relentless’, with ‘staff stretched to breaking point’. Whilst one or two professionals mentioned that they had been able to secure an additional specialist clinical post and there had been a small amount of improvement, the resounding message was that current resources were not sufficient to deliver the levels of activity needed to drive down lists quickly, nor deliver the high quality care women deserve.

Members of our Expert Reference Group emphasised that the focus on increasing activity was compromising the quality of care for patients, with appointment slots across the system increasingly compressed, reducing the time available to deliver care. Understandably, this is resulting in increased patient dissatisfaction, re-representations and repeat referrals in both primary and secondary care. As one member reflected, ‘a more balanced approach—focused not only on reducing numbers but also on ensuring adequate consultation time and continuity—would better support both patients and staff in the long term.’

Some secondary care professionals from our Expert Reference Group said that referrals from primary care were increasing and that pressures to support A&E admissions – including supporting pregnant women or those requiring emergency gynaecology care – also continue to compound the difficulties teams face in delivering planned elective procedures.

Primary care professionals reflected that these pressures also impact primary care, with specialist clinics often cancelled and long waits for women to access diagnostics and investigations. These delays cause increasingly complex care needs, also resulting in an increased demand for primary care appointments.

Outside of this core work, professionals are working hard to review and redesign care pathways and services, develop business cases to secure further funding and deliver complex digital transformation, all of which further impact their capacity to deliver care.

Vital components of care within the gynaecology care pathway continue to be overlooked as part of elective recovery efforts. The UK Government announced that the number of surgical hubs and community diagnostic centres (CDCs) across England has increased since 2024, citing 170 CDCs open, 36 new CDCs delivered since July 2024, and 24 new - or ‘enhanced’ - surgical hubs. ^xxxii Whilst this is positive, critical challenges in diagnostics pathways remain, and the Government has stated that just over half of operational - elective surgical hubs in England provide gynaecology services.^xxxiii

Alongside diagnostics and scanning, there is also a ‘lack of available and appropriate clinical space to provide women’s health physiotherapy services’, and professionals report that only some Trusts received funding for such physiotherapy services. This has resulted in an increase in waiting times for these vital services.

Therefore, whilst Governments are claiming ‘very real progress’^xxxiv and that the NHS is ‘on the road to recovery,’^xxxv gynaecology remains incredibly challenged, and hard-won progress is at risk of being lost without further resources. As the recent Public Accounts Committee report concluded, NHSE ‘missed its recovery targets by significant margins’^xxxvi and and declared its lack of confidence about whether ‘the Department is being realistic about the immense effort needed to reduce NHS elective care waiting times.'^xxxvii

Governments must provide sustainable funding across the UK to support the women’s health workforce to build its capacity, including providing time for professionals to train. Funding to deliver all critical aspects of care across the pathway must also be considered together so that all women, wherever they live, can access the care they need when they need it.

Given the pressures across the system, it is unsurprising that low morale and burnout continue to be widespread. Staff resignations, sickness leave and feeling guilty for taking time off continue to be common. The RCOG’s recent Workforce Census found that nearly two thirds (65%) of obstetricians and gynaecologists across the UK are at risk of burnout and are experiencing significant mental and physical distress working in services stretched to their limits. ^xxxviii

Last year, professionals reported that they felt ‘moral injury’ at not having the time or resources to deliver the high quality care that women needed - this continued to be a resounding message from professionals across the system this year. Governments must act to ensure the NHS workforce is well-resourced to deliver both the volume and high-quality care needed to reduce waiting lists, with sufficient numbers of staff and greater measures to support wellbeing and time in for training and leadership.

The NHS England Workforce Plan expected later this year is an opportunity for the UK Government to prioritise safe, high-quality care for women by ensuring the women’s health workforce is adequately staffed and supported.

Access to information and specialist advice

The majority of those waiting for gynaecology care are waiting for outpatient appointments. In England, the Government introduced the Advice and Guidance (A&G) scheme which enables GPs to seek specialist advice before making referrals into secondary care. 99% of general practices have signed up to the scheme,^xxxix and professionals from our Expert Reference Group hope it will reduce referrals into secondary care. RCOG members in Northern Ireland reflected that they too are now able to provide GPs with additional specialist advice or support monitoring of patient care. However, these schemes are dependent on secondary care specialists yet have not been built into secondary care job plans. Furthermore, primary care professionals warned that this support can often be short lived as women often need to see a specialist, and the measures outlined in Advice and Guidance have either already been exhausted or are not appropriate.

Although some areas have tried to develop pre-populated letters, questions remain over how sustainable the scheme is, as it could also displace other important activities that require protected time, such as digital transformation work or time for professionals to train.

Women with lived experience told us that despite some schemes to improve advice and information, there still remains a huge gap in what they can access while they are waiting. As one woman reflected:

“Women and people waiting want to know what steps they can take to make life better. These women want the appointments but also guidance on what to do in the meantime. The advice provided while women wait hasn’t changed in the last year.”

Providing more support to help women whilst they wait, as well as advice on preparing for appointments, has the potential to vastly improve the quality of appointments as it maximises both patient and professional time.

Women with lived experience also reflected that whilst the ambitions around improving digital patient care are welcome, in many areas of the country, electronic patient records are still not in place, further exacerbating inequalities. Many women are still ‘having to re-tell their stories multiple times’, all whilst living with debilitating conditions and symptoms, and there are varying degrees of professional confidence in recording care conversations digitally. Professionals in our Expert Reference Group recognised that virtual clinics can be helpful to patients, but it is important women waiting are not timed out or discharged from accessing further support if they need it.

This underlines the need for governments to ensure sufficient staff time and training is built in to digital transformation delivery plans and that equity is at the heart of digital transformation and that equity and patient choice are at the heart of plans to transform digital and outpatient care.

Access to specialist services, including women’s health hubs

Across the UK, governments have acknowledged the importance of shifting care out of hospital and improving access to care closer to home. In England, the UK Government cited women’s health hubs as a best practice example of this in the 10 Year Health Plan,^xl and the Welsh Government has committed to delivering a women’s health hub in every area by March 2026.^xli In Northern Ireland, funding has been ringfenced to increase capacity to deliver gynaecology care in primary care including via the GP Federation Primary Care Elective Service and the expansion of the Primary Care Elective Service.^xlii

Professionals across the system in our Expert Reference Group praised schemes that drive multi-disciplinary team working to provide improved and specialist care for women.

One member reflected that their area had recently introduced a women’s health hub which had already received positive feedback, and would support the Government’s strategic ambitions. However recent research found that women’s health hubs are still not in place across England, and only around a third of the physical hubs that have been established are providing the services as outlined in the NHSE core service specification.^xliii Without further support and investment, hubs could be rolled back or disappear, which could further perpetuate inequalities in access.

As the RCOG outlined in our recent evaluation of the Women’s Health Strategy for England, other essential specialist women’s health services are also being impacted by funding cuts. ^xliv Our Expert Reference Group highlighted that pelvic health physiotherapy services are only ‘implemented partially and in other areas, not at all’, and with ringfenced funding removed, this exacerbates existing geographical inequalities. In Northern Ireland, there is only one BSGE accredited endometriosis centre^xlv and very few clinical specialist nurses available, with Endometriosis UK reflecting that care is ’shockingly lacking’ in Northern Ireland.^xlvi Specialist services are an essential part of women’s care, enabling faster diagnosis, better symptom management, and rehabilitation, all of which prevent more invasive procedures in secondary care. Crucially, women want to see these services expanded, so governments protect and expand women’s health hubs and specialist clinical posts and services. These services must be scaled up as part of the shift to more neighbourhood health.

A core component of enhancing both the quality of information and services provided to women is recognising and addressing the research gap in women’s health.

Governments across the UK have played an important role in encouraging research, but too little is still understood about gynaecological conditions and why some groups of women experience worse experiences in care and outcomes than others. The RCOG’s recent work to understand what women would like to see prioritised in health research underscores that women want to see further research into gynaecological conditions and how to improve care.^xlvii Governments across the UK must act on this by funding, protect and encouraging research, including into gynaecology conditions, so that information, care and services can be better designed to meet the needs of all women living with gynaecological conditions.

Despite a series of national interventions aimed at improving elective gynaecology waiting times, evidence shows that demand continues to rise at a pace that far outstrips available capacity and the resources that have been allocated.

While targeted interventions from national and local policymakers are positive, they have been incremental rather than transformative and are not delivering equitable care. Workforce shortages, burnout, and a lack of equal access to specialist services and information remain critical risks, and Governments across the UK are not on track to meet their elective recovery ambitions.