World class commissioning for HIV & sexual health services

1. World class commissioning for HIV & sexual health services Paul Ward Deputy Chief Executive March 2009

2. Contents • The scale of the challenge • World class commissioning for sexual health & HIV • Case study – Chlamydia screening • Commissioning new sexual health & HIV service models

3. The scale of the challenge • Growth in STI diagnoses since 1995 • Numbers of people with HIV growing by 10% p.a. • 25%+ undiagnosed HIV • Highest teenage pregnancy levels in W. Europe • Under achievement of Chlamydia screening and teenage pregnancy targets • Variation in use of long acting reversible contraception But: • Achievement of GUM access target • Falling teenage pregnancies

4. World class commissioning for sexual health • Provision of leadership for sexual health service delivery and development • Orchestration role working with NHS providers, Local Government and Voluntary/community organisations • Specific steps to engage with people using services, recognising health inequality & stigma as barriers to participation • Engagement of clinical and non clinical sexual health/HIV specialists in development & delivery • Regularly updated needs assessment, public health surveillance and contract delivery data to maximise PCT knowledge

5. World class commissioning for sexual health • Review of investment patterns to maximise value for money, eg balance of hospital & non hospital activity • Stimulation of sexual health market to ensure there is both choice and specialism available • Capitalise on innovation opportunities afforded by diagnostic technology, Next Stage Review & policy levers • Effective use of procurement policy to maximise impact of investment, and to promote collaborative working • Active facilitation of partnership working & care pathway management between providers

6. WCC Case study Chlamydia screening - defining success • Routine opportunistic screening for all people 15-24 yrs, using community contraception and sexual health (CASH) services, abortion services and antenatal services • Routine GP opportunistic screening for 15-24 year olds • Increase access to screening in other health settings used by 15-24 year olds, e.g. community pharmacy • Assertive outreach screening in youth settings, e.g. schools, colleges, youth services, bars/clubs, YOIs • Effective partner notification function • Postal testing programme • Social marketing support & approach • Achievement of 17%, 25% & 35% targets

7. WCC Case studyChlamydia screening – achieving success • Local Chlamydia Screening Plan in place • PCT Executive & Board attention, with clear delivery structure incl Local Chlamydia Screening Steering Grp • PCT engagement with full range of partners able to achieve the target, incl CASH, GUM, LA, VCOs • Delivery model focused on screening in core community sexual health & GP services supported by assertive outreach screening to maximise access • Motivational leadership by local Chlamydia Screening Office

8. WCC Case studyChlamydia screening – achieving success • Chlamydia screening as a performance requirement for all sexual & reproductive health contracts, incl abortion • Financial incentives in CASH, GP LES & Pharm contracts • Capacity building with GPs & Pharmacies • Screening agreements in place with all principal statutory and voluntary services used by young people • Assertive outreach contractor in place • High quality lab reporting to count all screens & tests

9. WCC case study - Chlamydia screening – checklist for PCTs • What do we know about local Chlamydia need? • What do we know about local service use by young people? • How do our services compare against NCSP best practice? • How does our performance compare with the 17%, 25% & 35% targets? • How should we change services to optimise screening in all settings used by 15-24yos? • Is good use made of contractual & financial levers? • Is there a local plan & timely/accurate dataflow to PCT managers/ Boards

10. Commissioning new sexual health & HIV service modelsSexual health promotion • Coordinated public health programmes • Targeted at those in greatest need • Media & face to face, behavioural & clinical • Young people coordination of HPV vaccination, SRE, Chlamydia screening & school nursing • Increased role of vaccination & regular testing • Integrated with clinical services

11. Commissioning new sexual health & HIV service modelsCommunity sexual health services • Integration of contraception & STI services • Level 1 & 2 services delivered from community based clinics, polyclinics, pharmacies, GPs and VCOs • Nurse & healthcare assistant delivery • Self management emphasis • Step up arrangements with Level 3 services for people with complex needs • Inclusion of all providers in managed service network • Referral pathways into other services, eg, TOP, HIV

12. Commissioning new sexual health & HIV service modelsHIV long term condition mgt • Expanded promotion & availability of HIV testing • Community delivered HIV ARV & primary care in polyclinics, & larger GP premises • HIV specialists for complex care & annual review • New models of HIV primary care • Proactive LTCM programmes, inc self management, health trainers, web delivered services, • Integrated health & social care for greatest need

13. Thank you paul.ward@tht.org.uk 020 7812 1850