population.

Despite evidence of the effectiveness this study might be shared by other minority
of cardiac rehabilitation programmes, groups in other areas, and whether the lessons
encouraging attendance at sessions by learned could be successfully incorporated into
individuals from such backgrounds (particularly mainstream health services.
women) remains a problem. The objectives of
this study were to: P01
a) Explore the factors involved in engaging
women from South Asian communities in both The initial management of infertility
mainstream and specialist cardiac rehabilitation; in general practice: a focus group
b) Describe potential barriers and facilitators for study
this process; Scott Wilkes
c) Identify potential improvements to services Centre for Primary and Community Care, School
from participants’ perspectives. of Health Natural and Social Sciences, Benedict
Methods Building, St George's Way, Sunderland
This qualitative study utilised a combination of University, SR2 7BW
semi-structured interviews and a focus group in Coauthors: N Hall, A Crosland, A
order to elicit users’ perceptions of existing
cardiac rehabilitation services. Participants were Murdoch, G Rubin
Community Health Development Workers and Keywords: access, female health care
service users from the Westgate Heartbeat
project in Newcastle-upon-Tyne. All data were Introduction
analysed using a thematic approach. Assisted reproduction has advanced rapidly over
Results that last 2 decades. Historically, primary care has
A number of barriers to participation in cardiac been a mediator for referral of the infertile
rehabilitation programmes for South Asian couple. In recent years RCOG guidelines place
women were identified and these can be divided an emphasis on the role of primary care for the
into three main categories: initial management of the infertile couple. In
1. Individual barriers, including lack of April 2004, NICE further refined the guidance
knowledge, experience and confidence for the initial management of the infertile couple.
2. Cultural barriers, including language, diet and This includes semen analysis, mid-luteal
family commitments. progesterone, FSH and hysterosalpingography
3. Practical barriers, including timing, location (HSG) to assess the main causes of infertility.
and transport. Seven of the GP’s in this study had access to
However, several facilitators to participation open access HSG.
were also identified and these centred on whether Methods
the format and content of the rehabilitation Design
sessions were considered to be ‘appropriate’. For Qualitative study using three focus groups
example, an Asian Women’s Dance Group Participants
proved to be highly successful through the 11 General practitioners, 1 GP registrar, 1 Nurse
selection of a familiar venue in the local Practitioner
community, an enthusiastic session leader of a Setting
similar age to the participants, and an activity Seven general practices in Newcastle upon Tyne
that was felt to be both enjoyable and pitched at and Northumberland.
the right level for heart patients to receive Results
recognisable health benefits. The key themes to emerge were; perceived
Conclusions professional responsibilities, uncertainty and
This study has identified the potential for lack of knowledge, consistency of approach to
engaging women from a difficult-to-reach the initial management of infertility and access to
minority group in physical activity and cardiac infertility services. Enthusiasm, experience,
rehabilitation. Even a relatively short series of motivation and up to date knowledge were key
sessions can have tangible benefits in terms of influences on these themes. Some GPs felt that
physical and psychological health, as well as they should do all they possibly could do whilst
providing added-value in the form of an others felt it was the responsibility of the
opportunity for the women to socialise with one infertility specialist. Uncertainty and lack of
another. Further research should be carried out to knowledge was linked to the relative infrequency
determine whether the facilitators identified in of primary care infertility consultations and the

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difficulty ‘keeping up to date’ with rapidly Methods
advancing reproductive technologies. Some GPs Setting: We made HSG available to 6 general
subscribed to the notion of one suitably trained practices in Newcastle upon Tyne as an open
and competent clinician delivering the service on access investigation.
behalf of a group of GPs. There was an Participants: Using hospital clinical records we
acknowledgement that there is variation in tracked the outcome of all infertile couples from
clinical practice both in primary and secondary the 6 pilot practices over a 9-month period.
care. GPs considered that they had a Design: Descriptive survey.
responsibility to act as the couples’ advocate. Outcomes: Our main outcome measures were,
They were unsure where HSG fitted into the the uptake of open access HSG, speed of access
overall management plan, but they were to specialist services and the quality of the
comfortable with following recommended information recorded in the referral letter.
guidelines. Results
Conclusions Of the 39 referrals identified, ten women were
In managing the infertile couple, GPs recognise eligible for open access HSG, of which 6 HSGs
an advocacy role and some take on a significant were organised by GPs. Open access HSG was
degree of clinical responsibility. Nevertheless, used in 15% of all infertile couples and 60% of
GPs feel that they lack proficiency, find it those who fitted the criteria for its use. Couples
difficult to keep up to date and have little who had open access HSG reached a diagnosis
opportunity to rehearse the necessary skills. and management plan four weeks earlier than
These findings also contribute to an those who were referred directly (mean
understanding of the management of infrequently difference 4.0 weeks, 95% confidence interval
presenting problems in primary care. (CI) –8.8 to 0.4 weeks). The information
recorded in the referral letter was generally poor.
P02 However, all referrals made via the open access
HSG service had the prerequisite tests done.
Investigation of infertility Conclusions
management in primary care with Open access HSG allowed prompter access to
open access hysterosalpingography specialist services with more complete
(HSG): a pilot study information passed on in the referral letter. It
Scott Wilkes enabled a management plan to be established at
Centre for Primary and Community Care, School the first specialist consultation, which in turn
of Health Natural and Social Sciences, Benedict gave prompter access to definitive assisted
Building, St George’s Way, University of reproduction. ‘Near-patient testing’ in primary
Sunderland, SR2 7BW care such as open access HSG, may reduce the
overall patient journey (from GP referral to
Coauthors: A Murdoch, G Rubin, D specialist treatment) described in the NHS
Chinn, J Wilsdon Improvement Plan to less than 18 weeks. Open
Keyword: access access HSG together with semen analysis and
endocrine blood tests may allow GPs to make a
Introduction diagnosis and manage the initial stages of the
Infertility affects approximately one in seven infertile couple.
couples in the United Kingdom. The National
Institute for Clinical Excellence (NICE) issued
guidance on the management of the infertile
couple in February 2004, which includes the
statement ‘for the assessment of tubal damage,
women not known to have co-morbidities (pelvic
inflammatory disease, endometriosis or previous
ectopic pregnancy) should be offered
hysterosalpingography (HSG)’. Our aim was to
evaluate open access HSG as an open access
primary care investigation.

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