The purpose of setting standards for overall patient care is to address variations in care, to prevent inappropriate care and to address issues of inequity which have been reported in the past. The Royal College of Obstetricians and Gynaecologists (RCOG) takes a lead in developing evidence-based service standards to support local implementation protocols in all areas of gynaecological practice. Implementation of these standards should be supported by undertaking a constantly evolving audit cycle and by having multidisciplinary involvement to measure performance. The direction of travel of the National Health Service (NHS) is now for a patient-focused and quality-assured service, where patients' experience will influence service delivery models. The authors understand that professional bodies and NICE will be working together in developing a framework for service accreditation using some of the evidence used in their standards document.

Early pregnancy problems form a major part of all gynaecological emergencies. Approximately one in five pregnancies will end in pregnancy loss. The model of care for all early pregnancy events and complications provides the timeline base along which the core standards of care elements, care pathways and clinical protocols can support the care provision for best patient experience. Many agents, including prostaglandins, mifepristone, potassium chloride and dactinomycin, have all been used for the medical management of ectopic pregnancy. It is vital that only appropriately trained and competent staff should perform transabdominal and transvaginal early pregnancy scans. As an essential component of clinical governance, all early pregnancy assessment units and recurrent miscarriage clinics should have regular meetings to review clinical guidelines and protocols. This would provide an ideal opportunity to discuss audits, to generate research ideas and discuss recruitment to national or international multicentre trials.

All patients with infertility problems should have prompt access to an integrated multidisciplinary service that provides efficient and accurate assessment of their clinical situation. Pre-implantation genetic diagnostic services require care in planning relevant to the number of centres which should be resourced to meet a national need. The intimate relationship which the in vitro fertilisation (IVF) services require with specialist genetic clinical and laboratory personnel is an important consideration. The delivery of high-quality specialist services demands the availability of personnel with special skills. Medical and nurse training in infertility has been enhanced through accreditation courses in the general management of infertility and assisted conception. A rolling audit programme should be in place at all stages in the pathway of care for patients and should regularly assess clinic and laboratory standards. Engagement in research should be encouraged in all settings and specialist and subspecialist centres should engage with national trials initiatives.

Emergency gynaecology is rapidly developing in the UK but remains mostly fragmented into early pregnancy and acute gynaecology. There is a dearth of literature on patient and service surveys, treatment guidelines and protocols and standards for acute gynaecology. A nationwide audit was therefore commissioned for this work, to facilitate understanding of the state of acute gynaecology services in the UK. Units should be staffed by multidisciplinary teams that include specialist nurses, healthcare support workers and administrative staff, with local determination of numbers and ratios. Staff training should be a priority, irrespective of who provides care. Core staff should have knowledge of sexual health and should be duly certified where necessary. There should be a rolling programme of audit of clinical processes and outcomes determined by both local and national priorities. Research should be actively encouraged within individual units and as part of collaborative multicentre initiatives.

Sexual health service users expect a choice of free, confidential, non-judgmental services provided by trained staff to nationally recognised standards. Appropriate standards and nationally accepted guidelines are fundamental to the provision of any specialist service. Sexual and reproductive health services have been influenced for many years by several bodies, including: the Royal College of Obstetricians and Gynaecologists, and the National Institute for Health and Clinical Excellence (NICE). Provision of a competent and comprehensive sexual and reproductive health service requires an appropriate staffing capacity, equipped with the skills to deliver care of the highest standard. Nurses working in sexual and reproductive health services should have a recognised postgraduate qualification in sexual health and, again, require support to ensure continuing professional education and training. Incorporating audit and research into sexual and reproductive healthcare practice is essential to further improve sexual and reproductive health outcomes, at both individual and population levels.

The aim of a termination of pregnancy service is to provide high quality, efficient, effective, and legal and comprehensive care, which respects the dignity, individuality and rights of women to exercise personal choice over their treatment. Any woman considering termination of pregnancy should have access to clinical assessment. An ideal service for termination of pregnancy should provide counselling, contraceptive advice, gestational age assessment by ultrasound, a specialist nurse and a clinician for clinical assessment and management. Training in termination of pregnancy care has become an integral part of generic and reproductive health care, with particular relevance for patient choice, communication skills and tolerance of diversity, as well as clinical and surgical care. Primary care organisations should ensure that the services provided are audited against Department of Health guidance for the registration of pregnancy advice bureaux and the Royal College of Obstetricians and Gynaecologists (RCOG) guideline.

Heavy menstrual bleeding interferes with a woman's physical, social and emotional quality of life. The National Institute for Health and Clinical Excellence (NICE) guideline on heavy menstrual bleeding provides the most up-to- date evidence-based recommendations both on provision of care and the areas that need to be researched further. All health professionals undertaking surgical or radiological procedures to diagnose and treat heavy menstrual bleeding should demonstrate their technical and counselling competence, either during their training or during subsequent practice. Clinical governance policies should be able to monitor treatment complications, patient choice, patient satisfaction and uptake rate. Staff involvement in risk management exercises should be monitored to ensure that appropriate incident forms have been completed and that the staffs involved have received feedback. NICE has suggested several research recommendations in this important aspect of women's health.

In the UK, unless surgery is required, most post-reproductive gynaecological care is delivered in the primary care setting. Clinical standards and guidelines are available from the Royal College of Obstetricians and Gynaecologists (RCOG), the Medicines and Healthcare products Regulatory Authority (MHRA), the British Menopause Society, and the National Osteoporosis Guideline Group and Clinical Knowledge summaries. Only women with complex problems need referral to a specialist hospital or community based sexual and reproductive healthcare service. The clinicians and nurse(s) need to maintain dedicated telephone, answer phone and email contact systems for women and health professionals. Staffs need to liaise with other allied health professionals who are involved in the care of post-menopausal women, such as radiographers, physiotherapists and continence advisors. Continuing training will need to be coordinated by the lead clinician to ensure that staffs are providing evidence-based advice.

The Royal College of Obstetricians and Gynaecologists (RCOG)'s clinical standards for urogynaecology have been jointly developed with the British Society of Urogynaecology (BSUG) to provide a framework that should ensure best and evidence-based practice. The initial assessment and management of women with urinary incontinence is detailed in the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) guidelines and these are equally applicable to all pelvic floor disorders, including prolapse, anal and faecal incontinence, with a specific NICE guideline being available for the latter. Subspecialty training allows the development of more clinical, surgical, analytical and research skills and experience in all aspects of urogynaecology. Patient-reported outcomes are strongly recommended for assessing the success of treatments. Data can be collected confidentially through the BSUG surgical audit database for urinary incontinence and prolapse, which provides validated instruments to assess outcome.

The formation of a service to appropriately deal with vulval problems inevitably requires time, enthusiasm and resources. Vulval disease may be the subject of shame and embarrassment, with some women delaying seeking advice for months or years because of fears about the source of the condition or the examinations and investigations that may be necessary. Clinics should have clear clinical and operational guidelines. Usually, the lead clinician would be responsible for these guidelines. All women with suspected vulval problems should have prompt access to a clinic specialising in the management of such disorders. This would usually be hospital-based but delivering care in a community setting may be more appropriate, depending on local needs. To facilitate audit, a clinic pro forma which captures the required dataset should be designed. Clinics should be adequately staffed by appropriately trained individuals including a specialist gynaecology nurse.

During the 1970s and 1980s, gynaecological surgeons with a special interest in oncology surgery established a number of services throughout Britain, mainly in university teaching hospitals. Most women diagnosed with cervical, uterine, ovarian, vulval or vaginal cancer continued to be managed within small district general hospitals or teaching hospitals by generalist obstetricians and gynaecologists. The Royal College of Obstetricians and Gynaecologists (RCOG) provides a complete set of standards for the provision of a streamlined service. The clinicians and commissioners should use these standards to develop national quality accounts. Research in the field of gynaecological oncology is performed as a separate entity, or the subspecialty training is extended to 3 years to include a significant component for research. Quality assurance minimum standards of care in gynaecological oncology relate to the timeliness of treatment, the functionality of multidisciplinary teams and audits of various outcomes.

Colposcopy has a well-developed training programme and commitment to continuing professional development. Women being referred for colposcopy expect a rapid and professional service with sufficient information being provided in a format that is easily understood by them. Colposcopy was one of the early proponents of standards, both in relation to service and to training. Certificated colposcopists are required to show continuing professional development and an audit of their activity, which is assessed every 3-year period in a recertification process. Clinic staffing requirements are detailed in national health service cancer screening programme (NHSCSP) guidelines, including advice in relation to nursing levels, administrative staff and secretarial support. At all times, the clinic environment should protect the woman's dignity and women should have the opportunity to discuss their care both before and after the colposcopy examination or treatment.

Gynaecological operative laparoscopy has progressed significantly over the past two decades. The process of laparoscopic surgery should be based on an appropriate risk management system that allows for improved quality of care. Regarding women with severe endometriosis, specialist referral centres should be developed. Units performing laparoscopic surgery should adopt recommendations and guidelines from scientific bodies (RCOG, NICE, BSGE) and should benchmark their audited activity against the national standards. The main components for consideration when developing models of service in laparoscopic surgery include: gynaecology outpatients, pre-operative preparation, operative and post-operative. Laparoscopic training can be developed and augmented with the use of simulators or laparoscopic trainers. Laparoscopic surgery necessitates a team approach between surgical, nursing and technical support staff. Audit of length of stay, analgesia requirement, complication rate and re-admission rate help to redesign and configure the service.

Models of care in women's health, whether addressing generalist or specialised care, should incorporate the management of risk. Risk management systematically identifies and evaluates factors that could expose patients, staff, visitors and hospital property to harm, and puts in place defences which minimise the likelihood that such hazards will produce harm. The RADICAL framework provides a convenient vehicle for implementing and monitoring risk management. This framework comprises the key steps of raising awareness and understanding of patient safety, and delivering women's health care in a manner designed to protect patient safety. It also includes steps of involving service users in enhancing the safety of women's health care, collecting and analyzing data on safety of care, using efficient systems, and learning from patient safety incidents. As with other aspects of clinical practice, interventions to promote patient safety should be supported by evidence.

Effective communication is a key role for the clinical director. The clinical director has a vital role in selling the Royal College of Obstetricians and Gynaecologists (RCOG) vision with zeal and determination. The clinical director must demonstrate their commitment and support for the implementation process. Allocation of time within the job plans of a lead consultant demonstrates support but also places a greater obligation on the individual consultant to deliver what is required. It may be necessary to offer advice in areas such as guidelines, patient information and audit. The annual report will be useful in terms of identifying progress towards the standards. It can also be shared with the trust clinical governance steering group, executive board, commissioners of services and even the general public. The reporting framework and reporting timetable should be shared with consultant leads one year in advance of production of an annual report.

The Royal College of Obstetricians and Gynaecologists (RCOG) published its document Standards for Gynaecology in 2008 and is being used widely by commissioners, providers and policy makers. It sets out the principles of quality assured gynaecological services. The recommendations cover issues such as gynaecological services, early pregnancy loss, ectopic pregnancy, recurrent miscarriage, infertility, urogynaecology, colposcopy, termination of pregnancy and laparoscopic surgery. All emotional and psychological counselling requirements should be provided within the early pregnancy assessment unit. All units should audit patient choice and uptake rates for medical, surgical and conservative management of miscarriage, together with complications and failure rates. Clear information on choice of anonymised testing, treatment and contact tracing through genitourinary medicine should be available. Counselling and advice on sterilisation procedures (both vasectomy and tubal occlusion) should be provided in the context of services providing a full range of information about and access to long-term reversible methods of contraception.