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London Sexual Health E-Service and Sexual Health Advising

London Sexual Health E-Service and Sexual Health Advising. SSHA Annual Conference Saturday 22 nd September 2018. Sophie Jones – Senior Health Adviser. Sexual Health – Context and Case for Change.

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London Sexual Health E-Service and Sexual Health Advising

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  1. London Sexual Health E-Service and Sexual Health Advising SSHA Annual Conference Saturday 22nd September 2018

  2. Sophie Jones – Senior Health Adviser

  3. Sexual Health – Context and Case for Change • Health and Social Care Act moved commissioning of Public Health to Local Authorities, who have seen 50-70% central government funding cuts since 2010 • Demand increasing (up c.25% in three years) despite access issues and higher STI rates across London than elsewhere in the country • Services are required to be ‘open access’ • Significant cross-boundary flows, particularly into central locations but also between groups of councils around more localised services • Closure of clinics and restriction of services likely without an innovative solution

  4. New E-Services approach • Asymptomatic service users who want a check-up for sexually transmitted infections (STIs), can access information and register online to receive testing kits allowing them to bypass clinic visits completely. • Service uses online technology to help triage, test, diagnose, and in certain cases treat STIs • Only patients requiring treatment, or with safeguarding concerns, will need to physically attend a clinic.

  5. Role of CWFT • CWFT team – Clinical Lead, Safeguarding Lead, Project Manager, Relationship Manager, Senior Health Adviser and Recall Advisers • Responsible for results management • Responsible for Partner Notification for service users treated via Lloyd’s Online Doctor pathway • Responsible for safeguarding • Responsible for mobilising and training participating clinics • Providing a governance structure

  6. Service Overview • SHL ‘Sexual Health London’ launched in January 2018 • x27 participating London boroughs (45 GUM / HIV clinics). Clinical staff and Health Advisers working in participating clinics have their own individual log-ins so they can review results / notes / flags and inform us when they have seen / treated a service user • To date 62663 registered users • January 2018 – September 2018 return rate of 78.4% (48214 kits ordered and 37790 kits returned) ***CONFIDENTIAL***

  7. Service Overview • Eligibility - resident in a participating borough, > 16 years old, pin verified UK mobile phone number. Allocation of x4 kits in 12/12 period. Service users are asked to proceed if they have a good command of the English language • Service users who report symptoms or state that they are a contact of an STI are stopped from proceeding and are shown a list of their local services • Service users are shown tailored information, advice, signposting throughout their journey based on their responses (PEP, EHC, drug / alcohol support etc.) • Some responses trigger a safeguarding call back from the Health Adviser team

  8. Testing • HIV / Syphilis (EIA, TPHA and RPR if appropriate), Chlamydia and Gonorrhoea is the default offer • HepB (Surface Antigen and Core Antibody) and HepC (Antibody) tests offered if appropriate • Service users who test positive for genital Chlamydia only, treated via Lloyd’s Online Doctor remotely and managed by SHL Health Adviser team • Service users who test positive for anything else are notified by the SHL Health Adviser team and signposted to their local service ***CONFIDENTIAL***

  9. Service users • 49% of our service users are aged between 16-25 years old and 40% of all Chlamydia diagnoses to date belong to this group • 20% of our service users are BME and 25% of our service users identify as MSM / Trans / Other ***CONFIDENTIAL***

  10. Partner Notification • Positive / Reactive results at 8.4% of returned kits • (82%) contactable contacts are treated remotely or attend a service (patient and clinic verified combined value) • 0.97 contacts per index case are treated remotely or attend a service (national average is 0.6%) • Facilitated by HA call backs / responses to SMS / email templates ***CONFIDENTIAL***

  11. Safeguarding • All services users are asked if they have been recently sexually assaulted, if so they receive a call back from the Health Adviser team • All service users aged 16 and 17 years old are asked “spotting the signs” safeguarding questions and will also receive a call back from the Health Adviser team if they trigger a concern • For adults – x3 attempts of contact made, NFA if no response • For 16 and 17 years olds – x3 attempts of contact made, if no response the case is brought to the monthly Directorate Safety Net meeting where a decision will be made ***CONFIDENTIAL***

  12. Safeguarding • 236 (adult) and 277 (under 18’s) have triggered safeguarding concerns to date • 100% of 16 and 17 year olds have been successfully contacted • x7 referrals to Children’s Services have been made to date • x4 referrals to SARCs have been made to date • x2 anonymous reporting and sharing of intelligence to the Police has been made to date ***CONFIDENTIAL***

  13. Benefits of this being a Health Adviser led service • Experience of working with victims of sexual assault and making safeguarding assessments – more so than other staff groups working in a GU service • Experience of working with young people and talking about Child Sexual Exploitation and picking up on verbal cues • Experience of working in a multi-disciplinary team, lends itself well to consortium working • Experience of advocating for the patient / service user • Experience of assessing health anxiety and referring service users onto appropriate services • Strong links with other Health Adviser teams and creating mutual beneficial pathways ***CONFIDENTIAL***

  14. Learning • Evolving service, changes made regularly • Gaming • Locking accounts • “Bedding in period” for staff working in clinics • Including rationales for service users to make it clear why it is beneficial for them to attend a clinic for testing if they have symptoms ***CONFIDENTIAL***

  15. Next Steps • Expanding the team (increase amounts of Health Advisers and Recall Advisers) • Asking about Domestic Violence (needs to be managed carefully, need to ensure we are well resourced) • Uploading Version 2 – pathway changes and algorithm changes to make the journey more user friendly based on staff and service user feedback • Explore online booking • Explore option for service users to directly input Partner Notification data onto their portal ***CONFIDENTIAL***

  16. What we are proud of…. • That the entire team have continuously helped to improve and develop the service • That a consortium of multiple private companies and an NHS body can work so well and so successfully together to provide a great service to our service users • 98% of service users received all results within 3 working days of kit being delivered to the laboratory • Verification that 97% of service users with positive / reactive results completed treatment pathway / treated and managed appropriately • 98% of service users would recommend the service to family and friends • 82% of service users rated our service 5/5 stars

  17. Questions • Any questions? • Thank you, • Sophie Jones ***CONFIDENTIAL***

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