Supporting patients with female genital mutilation in primary care: a qualitative study exploring the perspectives of GPs’ working in England

Abstract

BackgroundFemale genital mutilation (FGM) includes all procedures that intentionally harm or alter female genitalia for non-medical reasons. In 2015, reporting duties were introduced, applicable to GPs working in England including a mandatory reporting duty and FGM Enhanced Dataset. Our patient and public involvement work identified the exploration of potential impacts of these duties as a research priority.AimTo explore the perspectives of GPs working in England on potential challenges and resource needs when supporting women and families affected by FGM.Design and settingQualitative study with GPs working in English primary care.MethodSemi-structured interviews focused around a fictional scenario of managing FGM in primary care. The authors spoke to 17 GPs from five English cities, including those who saw women who have experienced FGM often, rarely, or never. Interviews were audio recorded and transcribed verbatim for thematic analysis. Lipsky’s theory of street-level bureaucracy was drawn on to support analysis.ResultsManaging women with FGM was experienced as complex. Challenges included knowing how and when to speak about FGM, balancing care of women and their family’s potential care and safeguarding needs, and managing the mandated reporting and recording requirements. GPs described strategies to manage these tensions that helped them balance maintaining patient–doctor relationships with reporting requirements. This was facilitated by access to FGM holistic services.ConclusionFGM reporting requirements complicate consultations. The potential consequences on trust between women affected by FGM and their GP are clear. The tensions that GPs experience in supporting women affected by FGM can be understood through the theoretical lens of street-level bureaucracy. This is likely to be relevant to other areas of proposed mandated reporting.

Navigating possible endometriosis in primary care: a qualitative study of GP perspectives

“…A qualitative study was conducted using semi-structured telephone interviews based around a fictional scenario about a woman presenting to primary care with symptoms suggesting possible endometriosis (Box 1). We used a fictional scenario to create an arena for GPs to consider responses to possible issues they might face 14 . The scenario was co-developed with input from primary care (two GPs), a gynaecologist, and Public and Patient Involvement (PPI).…”

Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

“…To address this lack of direct evidence, we have also undertaken a primary qualitative study with GPs. 144 The lack of primary data about GPs necessitated complex searches and we may have inadvertently not identified important evidence.…”

“…To address this lack of direct evidence, we have also undertaken a primary qualitative study with GPs. 144 The lack of primary data about GPs necessitated complex searches and we may have inadvertently not identified important evidence. We identified limited evidence on the experiences and needs of women from outside of Africa and with forms of FGM other than type III.…”

“…Specialist services were seen as critical for enabling these conversations in primary care. 144 In their realist synthesis considering the experiences of UK maternity care by women with social risk factors, which included consideration of women with FGM, Rayment-Jones et al 147 also identified the importance of perceptions of kindness and respectfulness from HCPs, the value of trusting relationships and potential role for health advocates, and how factors such as language and access to interpreters contribute to the concept of candidacy for care. This review also identified fear of judgement by HCPs and perceptions of the health service role as surveillance rather than care were important Open access contextual factors relevant to accessing care.…”

Women’s health and primary care: time to get it right for the life course

“…In our work on endometriosis 12 and female genital mutilation (FGM), 13 – 14 we found that the majority of evidence deployed in primary care is derived from specialist settings and then extrapolated back to the primary care setting, where the populations and needs may significantly differ.…”