Bedford Borough, Central Bedfordshire and the City of Milton Keynes, have introduced new ways of working by embracing digital technologies and other innovations deployed during the pandemic to improve access to all the services provided from STI testing to contraception.
Changing our approach virtually overnight
The three councils have one director of public health and a shared public health team with contraception and sexual health services commissioned from iCaSH, part of Cambridgeshire Community Services NHS Trust. It is delivered via two contracts – one for the City of Milton Keynes and one jointly commissioned across Bedford Borough and Central Bedfordshire.
Like all areas, prior to the pandemic contraception and sexual health services were predominantly focused on the provision of face-to-face appointments. Only asymptomatic online testing was already available for residents of Bedford Borough and Central Bedfordshire – with the City of Milton Keynes getting the online service from 1 April 2020.
Following the announcement of a national lockdown, iCaSH worked quickly to develop the online testing platform to include the provision of symptomatic online testing. This required an extension to the existing platform to be built, a telephone triage and consultation model to be developed, along with ensuring that the laboratory services were also prepared for an increased demand in online testing activity.
In addition, Accelerated Partner Therapy (APT) for remote chlamydia treatment for people with a positive result and their partners was implemented. This included partner notification, testing and treatment without having to attend a clinic in-person.
Head of iCaSH Services Jo Radnor said: “Until Covid, symptomatic patients were seen in clinic for diagnosis, prompt treatment and partner notification. Due to lockdown, providers had to respond by offering services in innovative ways which also adhered to the national restrictions in place.
“These changes and developments were implemented at such pace, virtually overnight, as a means of meeting the needs of the community in order to ensure that residents could continue to access vital contraceptive and sexual health services.
“Staff training was provided to teams to ensure that they were appropriately equipped to undertake a telephone consultation, including additional online safeguarding guidance. Building a rapport with your patient over the phone is very different and consideration had to be given to check that the person was in a safe and appropriate place, for example not driving, not at work and in a confidential space.”
Remote offer still playing a role
The remote offer played a vital role during the first 18 months of the pandemic, until face-to-face consultations began to be re-introduced in September 2021. The learning and innovation from this work has continued to shape and improve services, with both models of service delivery remaining available in order to be deployed when needed.
Ms Radnor said: “When we have had staff shortages for example, we have utilised the online symptomatic STI testing platform as a means of ensuring service provision.
“We are also able to utilise this and the APT service for people who are unable to attend clinic for a face-to-face appointment. This may be people who would otherwise slip through the net and not get the tests, treatment or support they need.”
iCaSH has also developed their asymptomatic service provision, with people being able to access a telephone consultation if they require any advice or support.
Ms Radnor said: “Some people may have questions around new partners, or a young person may have recently heard information in school that they would like to discuss.”
In addition, LARC (long-acting reversible contraception) assessment appointments are now provided as a telephone consultation, negating the need for the person to attend the clinic for two separate appointments. This offers a saving in terms of NHS time as well as the patient’s time and potentially the need to take additional time off from work or education.
‘Pandemic pushed us on 10 years’
Building on the outcome of these successful interventions means that other services may be able to be offered in a variety of ways in the future, such as offering HIV preventative treatment (PrEP) by post. The details are still being ironed out as regular STI testing also needs to be provided, but it is another example of how services can be delivered remotely.
Ms Radnor said: “While face-to-face appointments are still crucial, the benefits of the new ways of working are significant. It is clear there are times when remote support is needed and it helps us reach people who are unable or prefer not to attend services.
“For some people the thought of going into a sexual health clinic is a real barrier to accessing support. The pandemic may have forced our hand, but it has probably pushed us on 10 years in terms of innovation and progress.”
Senior Public Health Officer for Bedford Borough, Central Bedfordshire and Milton Keynes City Councils, Sue Burridge agrees. “As commissioners, we are delighted with the progress that has been made. The changes have led to contraception and sexual health services becoming more accessible and cost-effective, offering ease of access to a range of groups with differing need and working patterns.
“However, we do need to make sure we get the balance right. Not everyone is digitally-savvy or has access to the technology needed to access services remotely.
“The value of face-to-face appointments cannot be underestimated in terms of our complex cases and identifying safeguarding issues.
What we are developing now provides a great balance between safety, quality, ease of access and efficiency.”