Smear Tests, Contraception, and the Pill: Why Your London GP Isn’t a Replacement for Your Gynaecologist

There is a moment that occurs in almost every consultation I have with a French woman who has been living in London for a while. She tells me about the last time she saw her gynaecologist in France. In a single appointment, her gynécologue performed her frottis, examined her breasts, discussed her contraception, reviewed her cycle, answered a question about a discharge she had been worried about, and renewed her prescription. Forty-five minutes, one specialist, everything covered. Then she tells me what happened when she tried to get the same thing in London.

The story is always a variation of the same theme: the smear was done by a nurse in five minutes with no discussion. The pill was prescribed by the GP in a ten-minute slot without a breast examination or a conversation about alternatives. The coil she wanted required a separate referral that took weeks. The question about discharge was addressed in a different appointment entirely. Five different encounters for what would have been one consultation in France.

I am not here to criticise the NHS. I work within the British system and I respect it. But I do think it is worth explaining clearly, for any woman who finds this fragmentation frustrating, exactly who does what in the UK — and why having one specialist who manages all of these things together makes a clinical difference.

Who does what in the UK

In the UK system, the gynaecological care that your French gynécologue provided is divided among several different professionals:

Your GP is the gatekeeper. She prescribes the combined pill, progestogen-only pill, patch, and ring. She manages straightforward menstrual complaints. She can prescribe HRT. She refers you to a hospital gynaecologist if something requires specialist input. Some GPs with additional training can fit coils and implants, but many do not offer these services — in which case you are referred elsewhere.

The practice nurse performs your cervical smear as part of the NHS Cervical Screening Programme. The appointment is typically brief — five to ten minutes. There is no clinical examination, no breast check, no broader gynaecological discussion. The nurse takes the sample and you are told the results by letter a few weeks later.

Sexual health clinics provide STI screening, emergency contraception, and some routine contraception services including coil and implant fitting. These clinics are free, walk-in, and anonymous. They are excellent for what they do — but they are not designed for ongoing care or comprehensive gynaecological assessment.

UK pharmacists can now supply certain oral contraceptives directly, without a GP prescription. Since late 2023, pharmacists in England have been able to provide the progestogen-only pill (such as desogestrel) to women after a brief consultation. This is a welcome development for access, but it is a supply service, not a clinical review.

A hospital gynaecologist enters the picture only on referral from your GP, and typically only for a specific clinical problem. She is a surgeon by training. Her role is to investigate, diagnose, and manage conditions that may require procedures or operations — not to provide the kind of ongoing preventive care your French gynaecologist offered.

The French approach: one specialist, everything integrated

In France, your gynécologue médicale handles all of this in a single, integrated consultation. She performs your frottis, examines your breasts, discusses your contraception in the context of your full hormonal and medical history, manages your cycle irregularities, screens for STIs if indicated, and provides ultrasound when clinically appropriate. She knows your history because she has been following you for years. She can spot changes because she has a baseline. She does not need a referral from anyone to do her job.

This is not a question of one system being good and the other bad. It is a question of integration versus fragmentation. And in gynaecology — where conditions are interlinked, where hormonal health affects everything from mood to bone density, where contraception choices depend on a woman’s full medical picture — integration has real clinical value.

Cervical screening: same test, different experience

Both the UK and France now use HPV-primary testing for cervical screening — an evidence-based approach where the sample is first tested for high-risk human papillomavirus, and cytology is only performed if HPV is detected.

In England, HPV-primary screening was fully rolled out by 2019. Since July 2025, the screening interval is every five years for all women aged 25 to 64 with a negative HPV result. Women who test HPV-positive are recalled more frequently. The test is performed by a practice nurse at your GP surgery.

In France, the HAS recommends cytology every three years for women aged 25 to 29 (where transient HPV infections are common), and HPV-primary testing every five years from age 30 to 65. The smear is typically performed by your gynaecologist during your annual consultation.

The scientific basis is similar. The difference lies in how the test fits into the broader picture. In France, your frottis is part of a holistic assessment. In the UK, it is a standalone five-minute procedure with no accompanying examination or discussion. For many women, particularly those who find the test uncomfortable or anxiety-provoking, the context matters as much as the test itself. Having a specialist who explains, examines, and reassures can make a significant difference to how the experience feels — and to whether women attend at all.

Contraception: more than just a prescription

In France, contraception is managed by your gynaecologist. She does not just prescribe — she assesses. She takes a detailed personal and family history of cardiovascular risk before prescribing oestrogen-containing methods. She discusses the full range of options — pill, patch, ring, implant, coil, natural methods — in the context of your age, your health, your lifestyle, and your plans. She reviews your method annually and adjusts it as your circumstances change.

In the UK, contraception prescribing is primarily handled by GPs. The quality of the conversation varies enormously. Some GPs are excellent and take the time to explore options thoroughly. Others, constrained by ten-minute appointment slots and heavy workloads, default to the method the patient already knows or the one that is quickest to prescribe. A comprehensive contraception review — including a discussion of long-acting reversible methods, a hormonal risk assessment, and a plan for the future — requires time and expertise that the average GP appointment does not always allow.

Coil fitting: a practical frustration

One of the most frequent practical frustrations French women in London report to me is coil fitting. In France, your gynaecologist fits your coil (IUD or IUS) as a matter of course — often in the same consultation where you discuss it. In the UK, the process is often more convoluted.

Not all GPs are trained and certified to fit coils. If your GP surgery does not offer the service, you may be referred to a sexual health clinic or a community gynaecology service — which may have its own waiting list. The fitting is then done by a different clinician who does not know your history, in a different setting, at a different time. What would have been a single, seamless appointment in France becomes a multi-step process spanning weeks.

In my practice, I offer coil fitting — both hormonal (IUS, such as Mirena) and copper (IUD) — as part of a specialist consultation. We discuss the options, I examine you, and if appropriate, the fitting can be done in the same appointment or scheduled shortly after. It is a straightforward process, and there is no reason it should involve the labyrinthine referral pathway that the NHS sometimes requires.

Why integration matters clinically

The fragmentation of gynaecological care in the UK is not merely inconvenient. It has clinical implications.

When your contraception, your screening, your hormonal health, and your sexual health are managed by different providers in different appointments, things get missed. The GP who prescribes your pill may not know about the irregular bleeding you mentioned to the nurse at your smear. The sexual health clinic that screened you for chlamydia may not know about your family history of ovarian cancer. The hospital gynaecologist who eventually sees you for a referral may not know that you have been trying three different contraceptive methods over the past two years without finding one that suits you.

A single specialist who holds the complete picture can connect these dots. She can see that your breakthrough bleeding on the pill, your recurrent thrush, and your low mood are not three separate problems but potentially one — a contraceptive method that is not right for you. She can notice that the fibroids she identified on ultrasound two years ago have grown and may be contributing to your heavier periods. She can recognise that your request for emergency contraception is the third in six months and that what you actually need is a proper conversation about long-acting methods.

This is what integrated care looks like in practice. And it is what I offer in my consultations — smears, contraception prescribing and fitting, HPV testing, breast examination, ultrasound, and ongoing follow-up, all under one roof and with one specialist who knows your history.