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Derby and Derbyshire: Tackling the fragmentation of the sexual health system

In Derby and Derbyshire, local government, the NHS and voluntary sector organisations have set up a partnership to encourage innovation and new ways of working in sexual health. The approach is helping to tackle some of the problems caused by the fragmentation of the system. 

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The section 75 move 

One of the biggest challenges for sexual and reproductive health is working collaboratively across commissioning and provider colleagues. Nationally and locally the sexual health system is diverse, fragmented and, at times, complex. 

For example local authorities have responsibility for STI testing and treatment, and HIV prevention, including PrEP, but HIV treatment, rests with NHS England. Meanwhile, integrated care boards run abortion, vasectomy and gynaecology services. 

This means there is a risk services are not always as joined up and integrated as they could be. The challenges prompted Derbyshire County Council to sign a section 75 agreement with the long-standing lead provider of its integrated sexual health service, Derbyshire Community Health Services NHS Foundation Trust.

The agreement covers all elements of the service, mandatory to the local authority including the LARC service provided by GPs and the emergency contraception element offered by pharmacies. It came into place in April 2022.

Derbyshire County Council Public Health Lead Mary Hague said: “The section 75 approach is acknowledged locally as better for both service and staff stability and collaborative working - enabling change and innovation at pace with opportunities for joint working across the system to jointly address population health need and maximising budgets available.” 

The ripple effect 

But the work setting up the section 75 agreement ended up having a ripple effect. Across the county work is not done in isolation – there has always been a close working relationship between both county and city councils, including working with the same lead service provider and a historical patient flow for sexual health services in and out of the city. 

Ms Hague said: “At the same time as we were setting up the section 75 agreement we were discussing new ways of working together. The wider changes to the NHS with the creation of integrated care systems across a regional footprint together with the section 75 became a trigger for more integration and the creation of the new Derby and Derbyshire Sexual Health Alliance.” 

The alliance was established in the summer of 2022 and brought together commissioners and providers from across the local sexual health system. There are more than 30 representatives on the group drawn from organisations including the city and council councils, local NHS trusts, the integrated care board, GP Provider Network and voluntary sector providers which specialise in working with vulnerable women such as sex workers and the LGBT community. 

Driving forward improvement

The alliance meets quarterly and is evolving a series of workstreams. One is leading on a comprehensive health needs assessment to inform future strategic development. Another is looking at emerging challenges for example the delivery of oral contraception, currently provided both via an online-ordering system and via GPs. Partly due to the pandemic, the online service is becoming increasingly popular and this presents a need to explore the way funding is distributed to reflect the shift in choices and behaviour. 

There is also an evolving programme of work to explore options for greater collaboration between HIV prevention and HIV treatment and another looking at cross-system support for the under 25s responding to the change in guidance for chlamydia screening and a teenage pregnancy partnership with relationships and sex education as a key focus for action. 

Ms Hague said, “The alliance is keen to place the patient at the heart of development and innovation. There are multiple examples of individuals who go back and forth between different parts of the system. For example a man who is tested and diagnosed for HIV currently receives treatment in a service commissioned by the NHS, while at the same time coming back to the local authority-commissioned service for STI testing and sexual health support as needed.  

“Or a woman with multiple vulnerability who has had unprotected sex resulting in an unplanned conception. She may well choose to have an abortion, but because of the way the system is split across different commissioning organisations, she may struggle to find the wider support she needs and her broader health needs may continue unaddressed.  

“By working as an alliance we can identify areas that need more integration and look to identify collaborative solutions that will provide better outcomes for our local residents.”

While these workstreams are only just getting under way, the alliance has already started to have an impact. This includes the decision by Derby City Council, as a partner within the alliance, to review the amount of funding it provides for sexual health.

Derby Director of Public Health Dr Robyn Dewis said the establishment of the alliance was a key influence. “This system-wide collaborative I feel gave added evidence to support a positive decision to increase investment into the local city service.”

The alliance now lies within the Governance arrangements of NHS Derby and Derbyshire Integrated Care Board / Joined Up Care Derbyshire Integrated Care System. “The alliance offers us so much potential to change and improve the way our local sexual health system works. We could even see budgets being pooled in the future – it is exciting to think what collaboration could bring,” added Ms Hague. 

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