Commissioning for Better Sexual Health: Achieving Progress and Priorities

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

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

12. 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)

13. Mapping GUM activity

14. 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

15. 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)

16. ‘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

17. 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’