Sexual Health Developing the role of Primary Care using PBC

1. Sexual HealthDeveloping the role of Primary Careusing PBC

2. Health Needs Analysis - Key Points • Ten wards in Birmingham have high levels of sexual health problems – eight in HoB • High levels of unwanted and teenage pregnancy and repeat terminations • High levels of all STIs • Problems meeting chlamydia screening targets • Over reliance on specialist services for routine contraception and STI • Young people not accessing services • Long acting reversible methods of contraception (LARC) not widely available • Late presentation of HIV in Soho and Ladywood

4. Local Issues • Small single handed practices – few female GPs • Cultural sensitivities (especially for women) • Good local training schemes but difficult for primary care staff to find time to attend • Limited engagement with the chlamydia screening programme • Community providers swamped by routine work • No integration between GUM and RSH

5. Approach • Radical change of approach needed to tackle major issues with existing system • Pan Birmingham Strategy in line with national guidance • Consultation with local community through specially designed campaign and events • In HoB - PBC is leading on developing services in primary care – consultation through local GP meetings

6. City Wide Strategy • Plurality of providers and services available for uncomplicated needs (primary and community care) • Holistic integrated services at all levels – ideally one stop consultation • Improve accessibility – especially for young people – times and venues • Strengthen role of specialist services in supporting Levels 1 and 2

7. Level 1 – Funded through PBC Local Enhanced Service to support practices to: • engage with SHIP training • adopt You’re Welcome quality standards • routinely risk assess patients and treat accordingly • increase targeted chlamydia testing • normalise HIV testing • improve recording LES for contraceptive implants (and improved training provision) to help improve access to long acting reversible contraception (LARC)

8. Level 2 Locality Centres • Integrated (not just co-located) services from any willing provider (GP, HoB provider or third sector) • Each centre sited in accessible community location to provide Level 2 services with failsafe for Level 1 • Shared Community Health Advisors to support contact tracing • Specification to cover range of services, staff competencies, and accessibility (particularly for young people)

9. Training Increase the skills of people working in primary care and in the community to deliver integrated sexual health services • Co-ordination between SHIP and BRASH to cover primary and community care staff – risk assessment approach • Establish training database to allow monitoring of workforce development • Increase access to practical training for both GUM (STIF) and contraception (DFRSH) • Create clinical network and community of practice for local healthcare professionals

10. Level 3 (specialist) • Reorganise and rationalise existing family planning services to move towards integrated provision of specialist services – discharge of Level 1 to primary care • Concentrate services at City Centre Hub (build on success at Boots) with outreach where appropriate for vulnerable groups • Build role for both GUM and RSH in signposting to and supporting Level 1 and 2 providers (training and advice)

11. Any questions? nuala.woodman@nhs.net