Women across Liverpool have easier access to a range of services, including contraception, thanks to a network of clinics, hubs and pharmacies. It has ensured that no woman in the city is more than a 15-minute walk from a contraception service.
Why was a new approach needed
Liverpool City Council and its sexual health service provider Axess embarked on an engagement exercise three years ago working with the NHS, voluntary sector and community partners to look at how sexual health services could be improved.
Feedback suggested women were confused about how and where to access services. In some parts of the city women reported not being able to get contraception because of the travelling and cost of getting to clinics.
A city-wide survey found demand for accessing contraception closer to home as well as online services for both STI kits and contraception. In particular, people reported being put off if they needed to travel too far and did not feel a central specialist clinic was for them.
Liverpool City Council Sexual and Reproductive Health Commissioning Lead James Woolgar said: “We had a rather fragmented set up, where links between our specialist services and GPs were not as clear. It meant some provision was a relatively long way from some residents. It was clear we were not reaching everyone we needed to – a new approach was needed.”
‘No-one more than 15-minute walk from a service’
A new integrated sexual and reproductive health service was launched in late 2021, and was designed to produce a truly integrated system. It consists of the three key integrated sexual health clinics supported by a network of women’s health hubs in each of the nine primary care network areas.
The women’s health hubs offer a range of services from long-acting reversible contraceptives (LARC), such as coils, contraceptive implants and injections, through to cervical screening, psychosexual services, ring pessary provision and treatment for menopause and heavy periods.
The hubs are based largely in GP practices with other practices in the network referring in for the broader offer. Local practices can still provide some basic advice and support however. The model operates on an “inter-network” referral basis, but also operates on a city-wide basis in that a person can access a service outside of their host GPs PCN.
The rollout of the hubs included an audit of LARC fitters and fresh training provided by the new sexual health provider Axess and Liverpool Women’s Hospital along with pharmaceutical industry support. Both nurses and GPs came forward for the refresher training and extra care navigators were taken on to help support the running of the hubs.
On top of that Liverpool has worked with its local pharmacies to develop an enhanced offer around contraception. There are now 18 pharmacies that are able to initiate pill prescriptions and another 66 that can provide repeat prescriptions and emergency contraception.
There is a single point of access for LARC as Axess can book across into the hubs. Repeat prescriptions for contraception are available online as are STI testing kits, while inter-referral can take place across the different settings. All women are routinely offered a contraception advice and appointment post birth.
Rising attendances and more LARCs
The new model has had a positive impact. The number of appointments available has doubled and attendances are increasing. LARC prescribing alone has increased from 13.1 per 1,000 women in 2018 to a projected high of 19.3 per 1,000 in the past year. It means an additional 820 women were able to access this provision last year, compared with the best-ever previous data in the city.
Mr Woolgar said: “We’re delighted with how access to our contraceptive services has improved. The results speak for themselves. The key has been working in partnership across the whole system – with the provider, local GPs, pharmacists and Liverpool’s Women’s Hospital.
“We have a monthly forum where training is offered and the progress and developments being made are discussed. There is also a regular newsletter to keep people informed about training and other updates”.
“The initiative is evolving all the time. At first we had an element of performance-related pay to reward increases in activity, but we found that did not work so well because we wanted services to refer between each other depending on what was the most appropriate for the individual so we had to adjust that and so we assessed our fees and ensured the baseline costs were viable for GPs.
“Liverpool used the Additional Roles Reimbursement Scheme (ARRS) within networks to fund and train physician associates and pharmacists to be able to fit LARC in hubs. This has made the model increasingly well-resourced and viable.
“We’re always assessing ways to improve it, but it’s quite clear we are now in a much stronger position. Before it was really fragmented and our system wasn’t linked, which was not good for patients. It was hard for them to navigate and women did not know where to go. We now have a digital front door, online bookable appointments and inter-referral between lead provider and women’s hubs. We’re very proud of the service.”