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Commissioning for better sexual health

Commissioning for better sexual health. Chris Packham DPH, Nottingham. Rates of diagnoses of uncomplicated genital chlamydial infection by sex and country, GUM clinics, United Kingdom: 1998 - 2007. Males. Females. Routine GUM clinic returns.

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Commissioning for better sexual health

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  1. Commissioning for better sexual health Chris Packham DPH, Nottingham.

  2. Rates of diagnoses of uncomplicated genital chlamydial infection by sex and country, GUM clinics, United Kingdom: 1998 - 2007 Males Females Routine GUM clinic returns

  3. Rates of diagnoses of genital herpes (first attack) by sex and country, GUM clinics, United Kingdom: 1997 - 2007 Males Females Routine GUM clinic returns

  4. Policy and history • National Strategy for Sexual Health and HIV 2001 • English PCTs outside London completely reconfigured during that time • Practice Based Commissioning • Devolved and Independent provider services (including sexual health services) • MedFASH standards 2004 and 2005 • NHS Next Stage Review – High Quality Care for All 2008 • Progress and priorities – working together for high quality sexual health 2008

  5. ‘Progress and priorities – working together for high quality sexual health 2008’ • Prioritising sexual health and sustaining leadership: DPH • Building strategic partnerships: DPH • Investing more in prevention: DPH • Delivering modern sexual health services • Commissioning for improved sexual health

  6. Commissioning for better sexual health:What are we trying to achieve? • ‘Make it important’ • Targets to achieve • Sustainability • Commissioning • Needs assessments and equity audits • Models of delivery that work • Patient involvement • Gaps • Design, specify, tender and procure • Evaluate and audit

  7. Sexual health commissioning: some examples…. • How to target GP practices • Achieving Chlamydia targets • Mapping GUM activity and using segmentation

  8. How to target GP practices? • Targeting: • STI activity (80% GUM clinic) • Teenage pregnancy • Get agreement • PBC clusters, LMC • Develop a model • Locally Enhanced Service negotiations • LES targeted at top 40% for asymptomatic testing • Decide what to do with your monitoring and results • Eg. dual testing, chlamydia positivity

  9. STI Attendances at GUM by Lower SOA with location of GUM and LES clinics

  10. New GP sexual health activity and GUM outreach • Integrated chlamydia screening (9000+ annually) with asymptomatic STI screening in bottom 40% practices • Included GP practices serving both Universities • Symptomatic service at one • Achieved 100% GUM targets with no additional hospital investment • 5000 new community asymptomatic screens • Represented 40% of entire historical asymptomatic GUM activity. • Chlamydia screening target now above 15% • Positivity rates 10%, (2% University)

  11. Mapping GUM activity

  12. Comparison of location of residents in Group F (welfare borderline) with service uptake for Chlamydia by Group F. Group F Mosaic Group F New Chlamydia

  13. Other key topics • Sexual Assault Referral Centres (>500 a year) • Sex workers needs assessments • Teenage Pregnancy : outreach clinics (20% of all Contraception clinic activity) • HIV as a long term condition (450 known clients with HIV)

  14. ‘Progress and priorities – working together for high quality sexual health 2008’ • Prioritising sexual health and sustaining leadership: DPH • Building strategic partnerships: DPH • Investing more in prevention: DPH • Delivering modern sexual health services • Commissioning for improved sexual health

  15. Our FIVE STEPS… • Strengthening PH programmes • Vaccination • HPV, Hepatitis A and B • Expand prevention • Chlamydia, HIV and BBV screening programmes • Community sexual health services • HIV as a ‘long-term condition’

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