Commissioning for better sexual health

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Commissioning for better sexual health

• Chris Packham
• DPH, Nottingham.

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

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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

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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

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Sexual health commissioning some examples.

• How to target GP practices
• Achieving Chlamydia targets
• Mapping GUM activity and using segmentation

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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

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

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Mapping GUM activity
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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
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Other key topics

• Sexual Assault Referral Centres (gt500 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)

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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

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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