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: Routine GUM clinic returns MalesFemales

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

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

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

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

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

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

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

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

Mapping GUM activity

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

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

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

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