Sexual HealthSexual Health

Developing the role of Developing the role of Primary CarePrimary Care

using PBCusing PBC

Health Needs Analysis - Key PointsHealth Needs Analysis - Key Points

• Ten wards in Birmingham have high levels of sexual Ten wards in Birmingham have high levels of sexual health problems – eight in HoBhealth problems – eight in HoB

• High levels of unwanted and teenage pregnancy and High levels of unwanted and teenage pregnancy and repeat terminationsrepeat terminations

• High levels of all STIsHigh levels of all STIs

• Problems meeting chlamydia screening targetsProblems meeting chlamydia screening targets

• Over reliance on specialist services for routine Over reliance on specialist services for routine contraception and STIcontraception and STI

• Young people not accessing servicesYoung people not accessing services

• Long acting reversible methods of contraception (LARC) Long acting reversible methods of contraception (LARC) not widely availablenot widely available

• Late presentation of HIV in Soho and LadywoodLate presentation of HIV in Soho and Ladywood

Ward IMD

Teen Conception Rate per 1000 women

aged 15-17

TOP Rate

women per 1000 women

aged 15-44

BME >50%

No of FPCs

in ward seeing

>6 people

per session

?

HIV Rate

Chlamydia Infection Rate per

1000 population aged 15-44

Gonorrhoea Infection Rate per

1000 population aged 15-44

Priority

Heart of Birmingham Teaching PCT

Aston 60.81 70.4 37.0 Yes 0 High 6.8 3.2 Highest

Handsworth (now Lozells & East Sandwell) 53.42 47.6 39.3 Yes 1 High 6.45 2.84 Highest

Ladywood 50.86 94.2 30.0 Yes 1* V High 6.73 3.09 Highest

Nechells 55.99 55.2 28.5 Yes 0 Low 4.1 2.37 Highest

Perry Bar 20.21 29.5 19.7 No 0 Low 2.62 0.47 Lower

Sandwell (now Handsworth Wood) 34.58 36.4 23.7 Yes 0 High 4.63 1.8 Highest

Small Heath 50.07 31.6 16.2 Yes 0 Low 2.26 1.07 Medium

Soho 57.54 65.3 38.3 Yes 1 V High 7.54 4.27 Highest

Sparkbrook 61.76 48.7 21.9 Yes 3Averag

e 3.34 1.22 Higher

Sparkhill 46.34 29 20.2 Yes 1 High 1.64 0.91 Medium

Local IssuesLocal Issues

• Small single handed practices – few female GPsSmall single handed practices – few female GPs

• Cultural sensitivities (especially for women)Cultural sensitivities (especially for women)

• Good local training schemes but difficult for primary care Good local training schemes but difficult for primary care staff to find time to attendstaff to find time to attend

• Limited engagement with the chlamydia screening Limited engagement with the chlamydia screening programmeprogramme

• Community providers swamped by routine work Community providers swamped by routine work

• No integration between GUM and RSHNo integration between GUM and RSH

ApproachApproach

• Radical change of approach needed to tackle major Radical change of approach needed to tackle major issues with existing systemissues with existing system

• Pan Birmingham Strategy in line with national guidancePan Birmingham Strategy in line with national guidance

• Consultation with local community through specially Consultation with local community through specially designed campaign and eventsdesigned campaign and events

• In HoB - PBC is leading on developing services in In HoB - PBC is leading on developing services in primary care – consultation through local GP meetingsprimary care – consultation through local GP meetings

City Wide StrategyCity Wide Strategy

• Plurality of providers and services available for Plurality of providers and services available for uncomplicated needs (primary and community care)uncomplicated needs (primary and community care)

• Holistic integrated services at all levels – ideally one stop Holistic integrated services at all levels – ideally one stop consultationconsultation

• Improve accessibility – especially for young people – Improve accessibility – especially for young people – times and venuestimes and venues

• Strengthen role of specialist services in supporting Strengthen role of specialist services in supporting Levels 1 and 2Levels 1 and 2

Level 1 – Funded through PBCLevel 1 – Funded through PBC

Local Enhanced Service to support practices to: Local Enhanced Service to support practices to: – engage with SHIP trainingengage with SHIP training– adopt You’re Welcome quality standardsadopt You’re Welcome quality standards– routinely risk assess patients and treat accordinglyroutinely risk assess patients and treat accordingly– increase targeted chlamydia testingincrease targeted chlamydia testing– normalise HIV testingnormalise HIV testing– improve recordingimprove recording

LES for contraceptive implants (and improved training LES for contraceptive implants (and improved training provision) to help improve access to long acting provision) to help improve access to long acting reversible contraception (LARC)reversible contraception (LARC)

Level 2 Locality CentresLevel 2 Locality Centres

• Integrated (not just co-located) services from any Integrated (not just co-located) services from any willing provider (GP, HoB provider or third sector)willing provider (GP, HoB provider or third sector)

• Each centre sited in accessible community location to Each centre sited in accessible community location to provide Level 2 services with failsafe for Level 1provide Level 2 services with failsafe for Level 1

• Shared Community Health Advisors to support contact Shared Community Health Advisors to support contact tracingtracing

• Specification to cover range of services, staff Specification to cover range of services, staff competencies, and accessibility (particularly for young competencies, and accessibility (particularly for young people)people)

TrainingTraining

Increase the skills of people working in primary care and in Increase the skills of people working in primary care and in the community to deliver integrated sexual health servicesthe community to deliver integrated sexual health services– Co-ordination between SHIP and BRASH to cover Co-ordination between SHIP and BRASH to cover

primary and community care staff – risk assessment primary and community care staff – risk assessment approachapproach

– Establish training database to allow monitoring of Establish training database to allow monitoring of workforce developmentworkforce development

– Increase access to practical training for both GUM Increase access to practical training for both GUM (STIF) and contraception (DFRSH)(STIF) and contraception (DFRSH)

– Create clinical network and community of practice for Create clinical network and community of practice for local healthcare professionalslocal healthcare professionals

Level 3 (specialist)Level 3 (specialist)

• Reorganise and rationalise existing family planning Reorganise and rationalise existing family planning services to move towards integrated provision of services to move towards integrated provision of specialist services – discharge of Level 1 to primary specialist services – discharge of Level 1 to primary carecare

• Concentrate services at City Centre Hub (build on Concentrate services at City Centre Hub (build on success at Boots) with outreach where appropriate success at Boots) with outreach where appropriate for vulnerable groupsfor vulnerable groups

• Build role for both GUM and RSH in signposting to Build role for both GUM and RSH in signposting to and supporting Level 1 and 2 providers (training and and supporting Level 1 and 2 providers (training and advice)advice)

Any questions?Any questions?

nuala.woodman@nhs.netnuala.woodman@nhs.net