Sexual Health Improvement for Populations and Patients (SHIPP) John Macleod, Thara Raj, Annette Billing 17 th June 2016 #BHPhitconf

“ SHIPP: A partnership between people with a stake in sexual health improvement with shared ambitions and agreed vision of how to achieve them” University of Bristol, University of the West of England, Bristol City Council, North Somerset Council, South Gloucester Council, Bristol Clinical Commissioning Group, University Hospitals Bristol NHS Foundation Trust, North Bristol NHS Trust, Public Health England, NHS England Area Team, Terrence Higgins Trust, Brook Bristol, Marie Stopes International, Aquarius Public Health – and patients

#BHPhitconf The SHIPP Model Assess and prioritise need Advise on commissioning evidence based care pathways to meet this effectively (and provide value for money) Identify evidence gaps and facilitate research to fill these

#BHPhitconf Examples of projects Strengthening management of chlamydia and gonorrhoea in primary care Extending screening for intimate partner violence to new settings Increasing earlier diagnosis of HIV Refreshing the JSNA Improving health outcomes in sex workers Evaluating PPI in sexual health services

#BHPhitconf Workstream on reducing late diagnosis of HIV in Bristol Diagnosed prevalence rate is 2.07 per 1000 population and is rising. Proportion of people presenting at a late stage of infection in is 44.7%. Late diagnosis is associated with: Increased mortality and morbidity Increased HIV transmission Source: Public Health England

#BHPhitconf Audit found evidence of missed opportunities for earlier HIV diagnosis in Bristol practices

#BHPhitconf Interventions to increase HIV testing in primary care Training in 20 high prevalence practices to increase knowledge and address barriers Screening pilot for newly registered patients in 6 highest prevalence practices Developing risk prediction algorithm tool which will flag when an HIV test might be appropriate

#BHPhitconf PARTNERSHIP APPROACH BCC sexual health commissioners Gatekeepers to practices, funded interventions GPs Advised on approach in primary care THT and Brigstowe Advice for practices on working with high risk groups PHE lab Provided data on HIV testing rates in practices HIV treatment service Advised on clinical and research approach Bristol Sexual Health Service Registrar developed and delivered training, model for screening pilot UoB Quantitative Researchers Overall coordination, evaluation, access to CPRD data HPRU Qualitative Researchers Interviews with GPs and practice nurses 3 months after training intervention

#BHPhitconf SHIPP plans for 2016/17 Steering group to refresh priorities and strategy, based on survey of SHIPP members. To consider:  Added value of SHIPP  Workstreams in line with JSNA  Frequency and structure of meetings  Reprocurement of sexual health services (opportunities and challenges arising) Wider stakeholder event to present, discuss and agree refreshed strategy towards end of 2016

#BHPhitconf Discussion Genuinely novel primary research within the “HIT model” still challenging and takes time Most HITs relatively under-resourced Power of “HIT brand” to lever support mainly confined to local, relatively small-scale funding schemes Ability of most HITs to meet rapidly emerging needs constrained

#BHPhitconf Conclusions There are good examples of HITs being successful in supporting evidence based commissioning and practice HITs should be ambitious but their ambitions should be realistic HITs are evolving