Knowing is not the same as doing.

There is a big difference between knowing and doing. Despite knowing about the gaps in care, we are not doing enough to improve outcomes and experiences for women across their life course. Take endometriosis as one example of failing to bridge the gap in implementing better care in general practice. It takes 8 years on average between presenting with symptoms to a GP to getting a diagnosis, but despite knowing this, delays in diagnosis for endometriosis haven’t improved (and indeed may have worsened) over the past decade.1 The grim findings and essential actions recommended from the Ockenden review of maternity services at Shrewsbury and Telford Hospital NHS Trust should have been a watershed moment for change. Instead, Donna Ockenden’s team are now reviewing discriminatory and degrading maternity care in Nottingham, while the All-Party Parliamentary Group on Birth Trauma’s Inquiry, and the recent National Confidential Enquiry into Patient Outcome and Death’s review on endometriosis echo the original Ockenden review findings that women are not heard, they are not believed when they are in pain, and that medical professionals, including GPs, fail to provide women with compassionate care. We’ve heard these stories, we know them, and yet the recommendations from these reports are not widely adopted. Dame Donna herself thinks yet another public enquiry will only ‘kick the can down the road’, delaying action when we know what needs to be done.2 The evidence to practice gap is particularly challenging to overcome within primary care, with dynamic practice and context- specific factors potentiating how well any new intervention is actually going to work.3 In their editorial, Gemma Sharp and colleagues discuss the importance of interdisciplinary and community-informed research in women’s health to overcome the disjointed thinking and ‘silos in knowledge’ that can lead to ineffective implementation in practice. While part of knowing what to do comes from listening to women and their stories, research needs to continue to build on a historically fragmented evidence base in women’s health. In his editorial highlighting risks to women during the postnatal period, Stuart Stewart describes how an evidence gap in this area means we don’t yet know what effective care should look like, and again, points out that our inability to implement effective change is preventing better care for women in their postnatal maternal checks. Our learning, and listening, about systemic failings means that we are reaching a critical mass of knowledge about the unmet needs of women. Comfortable inaction is no longer an option. It’s time to focus on the ‘doing’ in practice, in funding, and in policy. You can call this a call to arms if you like, but it’s time to put what we know into practice to improve outcomes in women’s health. Nada Khan Associate Editor References 1. Endometriosis UK. “Dismissed, ignored and belittled”: the long road to endometriosis diagnosis in the UK. 2024. https://www.endometriosis-uk. org/sites/default/files/2024-03/Endometriosis%20 UK%20diagnosis%20survey%202023%20 report%20March.pdf (accessed 2 Aug 2024). 2. Murray J. Pregnant women suffer racist and discriminatory abuse at NHS trust, says inquiry head. The Guardian 2024; 24 Jul: https://www. theguardian.com/society/article/2024/jul/24/ pregnant-women-suffer-racist-and-discriminatory- abuse-at-nhs-trust-says-inquiry-head (accessed 2 Aug 2024). 3. Lau R, Stevenson F, Ong BN, et al. Achieving change in primary care — causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci 2016; 11: 40. DOI: https://doi.org/10.3399/bjgp24X739125 © British Journal of General Practice 2024; 74: 385–432 British Journal of General Practice, September 2024 EDITOR’S BRIEFING | 387 Editor’s Briefing EDITOR Euan Lawson, FRCGP Lancaster DEPUTY EDITOR Andrew Papanikitas, FRCGP, PhD, SFHEA Oxford ASSOCIATE EDITOR Nada Khan, MSc, DPhil, MRCGP Exeter ASSOCIATE EDITOR Samuel Merriel, MSc, PhD, MRCGP Manchester ASSOCIATE EDITOR Thomas Round, BSc, MRCGP, DRCOG London HEAD OF PUBLISHING Catharine Hull PRODUCTION MANAGER Christopher Clough SENIOR ASSISTANT EDITOR Amanda May-Jones ASSISTANT EDITOR Tony Nixon ASSISTANT EDITOR Thomas Bransby ASSISTANT EDITOR Jennifer Morris MULTIMEDIA EDITOR Erika Niesner DIGITAL & DESIGN EDITOR Simone Jemmott EDITORIAL ASSISTANT Margaret Searle EDITORIAL ADMINISTRATOR Mona Lindsay 2023 impact factor: 5.3 EDITORIAL OFFICE 30 Euston Square, London, NW1 2FB. (Tel: 020 3188 7400, Fax: 020 3188 7401). E-mail: [email protected] / bjgp.org / @BJGPjournal PUBLISHED BY The Royal College of General Practitioners. Registered charity number 223106. The BJGP is published by the RCGP, but has complete editorial independence. Opinions expressed in the BJGP should not be taken to represent the policy of the RCGP unless this is specifically stated. No endorsement of any advertisement is implied or intended by the RCGP. ISSN 0960-1643 (Print) ISSN 1478-5242 (Online) PRINTED BY WARNERS 01778 395111 Issue highlights More about the doing now that we know — in this issue, Abi Eccles and colleagues describe how GPs can support women with anal incontinence after childbirth, with recommendations on how and when to ask about it in practice, and how to manage and refer it. Her research and that of Holly Christina Smith and colleagues, along with Stuart Stewart’s editorial, highlights the importance and the inadequacies of postnatal care. Jen MacLellan and colleagues reinforce the need for a systems- level approach towards improving trauma-informed care for women. Clare Turnbull spoke to us for the BJGP Podcast on her work on how to communicate risk of breast cancer to women with a family history thinking of taking HRT. Often the risks are not as great as they might seem, but the key is ensuring that GPs and women have the right information to come to a shared decision together about what to do. Knowing is not the same as doing