Commissioning Commissioning for better sexual for better sexual

health health Chris PackhamChris Packham

DPH, Nottingham.DPH, Nottingham.

Rates of diagnoses of uncomplicated genital chlamydial infection by sex and country, GUM clinics, United Kingdom: 1998 - 2007

Routine GUM clinic returns

Males Females

0

20

40

60

80

100

120

140

160

180

200

220

19981999

20002001

20022003

20042005

20062007

Ra

te p

er

10

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po

pu

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England

Wales

Scotland

N Ireland

0

20

40

60

80

100

120

140

160

180

200

220

Rates of diagnoses of genital herpes (first attack) by sex and country, GUM clinics, United Kingdom: 1997 - 2007

Routine GUM clinic returns

MalesFemales

0

5

10

15

20

25

30

35

40

45

50

55

60

19981999

20002001

20022003

20042005

20062007

Ra

te p

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10

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England

Wales

Scotland

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0

5

10

15

20

25

30

35

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45

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19981999

20002001

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Policy and historyPolicy and history National Strategy for Sexual Health and HIV National Strategy for Sexual Health and HIV

20012001 English PCTs outside London completely English PCTs outside London completely

reconfigured during that time reconfigured during that time Practice Based Commissioning Practice Based Commissioning Devolved and Independent provider services Devolved and Independent provider services

(including sexual health services) (including sexual health services) MedFASH standards 2004 and 2005 MedFASH standards 2004 and 2005 NHS Next Stage Review – High Quality Care NHS Next Stage Review – High Quality Care

for All 2008for All 2008 Progress and priorities – working together for Progress and priorities – working together for

high quality sexual health 2008high quality sexual health 2008

‘‘Progress and priorities – working Progress and priorities – working together for high quality sexual together for high quality sexual

health 2008’health 2008’

Prioritising sexual health and sustaining Prioritising sexual health and sustaining leadership: DPHleadership: DPH

Building strategic partnerships: DPHBuilding strategic partnerships: DPH Investing more in prevention: DPHInvesting more in prevention: DPH Delivering modern sexual health services Delivering modern sexual health services Commissioning for improved sexual Commissioning for improved sexual

healthhealth

Commissioning for better sexual Commissioning for better sexual health:health:

What are we trying to achieve?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 workModels of delivery that work Patient involvementPatient involvement GapsGaps Design, specify, tender and procureDesign, specify, tender and procure Evaluate and auditEvaluate and audit

Sexual health commissioning: Sexual health commissioning:

some examples….some examples….

How to target GP practicesHow to target GP practices

Achieving Chlamydia targets Achieving Chlamydia targets

Mapping GUM activity and using Mapping GUM activity and using segmentationsegmentation

How to target GP How to target GP practices?practices?

Targeting: Targeting: STI activity (80% GUM clinic)STI activity (80% GUM clinic) Teenage pregnancyTeenage pregnancy

Get agreementGet agreement PBC clusters, LMCPBC clusters, LMC

Develop a modelDevelop a model Locally Enhanced Service negotiations Locally Enhanced Service negotiations LES targeted at top 40% for asymptomatic testingLES targeted at top 40% for asymptomatic testing

Decide what to do with your monitoring Decide what to do with your monitoring and resultsand results Eg. dual testing, chlamydia positivity Eg. dual testing, chlamydia positivity

Termination of pregnancy referral rates by GP practice deprivation quintiles, Nottingham City PCT, ages 11-49

0

50

100

150

200

250

300

C8

40

11

C8

46

82C

84

635

C8

465

0C

84

688

C8

406

0C

84

693

C8

404

4C

84

133

C8

463

8C

841

29

C8

466

4C

841

22

C84

06

4C

84

07

8C

84

11

6C

84

00

4C

84

04

6C

84

704

C8

46

19

C8

40

85C

84

694

C8

403

4C

84

081

C8

464

7C

84

665

C8

415

1C

840

43

C8

467

2C

841

35

C84

71

4C

84

63

3C

840

63

C8

46

36

C8

40

18

C8

46

02C

84

03

9C

84

023

C8

40

91

C8

414

5C

84

698

C8

410

3C

846

91

C8

409

6C

846

28

C8

413

8C

841

05

C84

10

8C

84

64

9C

847

17

C8

46

83

C8

46

32

C8

46

95C

84

674

C8

414

1C

84

117

C8

413

6C

84

144

C8

467

6C

840

92

C8

468

0C

841

04

C8

410

9C

847

06

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71

9C

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72

practice code[Red = quintile 1 (least deprived) Green = quintile 2 Blue = quintile 3 Purple = quintile 4 Lavender = quintile 5 (most

deprived)]

refe

rral

ra

tes

per

1,0

00

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

New GP sexual health activity and GUM New GP sexual health activity and GUM outreachoutreach

Integrated chlamydia screening (9000+ Integrated chlamydia screening (9000+ annually) with asymptomatic STI screening in annually) with asymptomatic STI screening in bottom 40% practices bottom 40% practices

Included GP practices serving both Included GP practices serving both UniversitiesUniversities

Symptomatic service at one Symptomatic service at one

Achieved 100% GUM targets with no Achieved 100% GUM targets with no additional hospital investment additional hospital investment

5000 new community asymptomatic screens5000 new community asymptomatic screens Represented 40% of entire historical asymptomatic GUM Represented 40% of entire historical asymptomatic GUM

activity. 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

GUM Patients and Deprivation

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

0 10 20 30 40 50 60 70 80 90IMD Score of Lower SOA

GU

M p

atie

nts

per

1000

pop

15-

49

City

County

Group F Mosaic Group F New Chlamydia

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

Other key topics Other key topics

Sexual Assault Referral Centres (>500 a Sexual Assault Referral Centres (>500 a year)year)

Sex workers needs assessments Sex workers needs assessments

Teenage Pregnancy : outreach clinics Teenage Pregnancy : outreach clinics (20% of all Contraception clinic activity) (20% of all Contraception clinic activity)

HIV as a long term condition (450 HIV as a long term condition (450 known clients with HIV) known clients with HIV)

‘‘Progress and priorities – working Progress and priorities – working together for high quality sexual together for high quality sexual

health 2008’health 2008’

Prioritising sexual health and sustaining Prioritising sexual health and sustaining leadership: DPHleadership: DPH

Building strategic partnerships: DPHBuilding strategic partnerships: DPH

Investing more in prevention: DPHInvesting more in prevention: DPH

Delivering modern sexual health services Delivering modern sexual health services

Commissioning for improved sexual Commissioning for improved sexual healthhealth

Our FIVE STEPS…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 Chlamydia, HIV and BBV screening

programmes programmes

Community sexual health services Community sexual health services HIV as a ‘long-term condition’ HIV as a ‘long-term condition’