Norfolk County Council: easing demand on clinics

Like many areas, Norfolk has seen rising numbers of people coming to their sexual health clinics for testing. To help ease the pressure, an online service for the four core STIs has been developed. It has proved remarkably successful. This case study forms part of our sexual health resource.


The challenge

In March 2015 Norfolk County Council commissioned an integrated sexual health service for the county including a section 75 agreement to pool budgets with the NHS England for HIV treatment and care.

Over the following years demand continued to rise, putting pressure on budgets that were being squeezed because of the cut in the public health grant by central government.

Around a third of patients coming to clinics were asymptomatic and so the council began to explore other ways to support those patients, in particularly looking at the potential of online testing.

The solution

Chlaymdia screening for under 25s and HIV testing for at-risk groups was already being done online through national programmes. So Norfolk asked its provider to take that a step further and develop an online service for chlamydia, gonorrhoea, syphilis and HIV.

The provider, Norfolk iCASH, developed its own online platform, using the same labs and kits that were used by the clinic team. 

The service launched in August 2017 with the target of decreasing clinic activity by 6 per cent to 7 per cent, which Norfolk estimated would save in the region of £100,000 a year.

All appropriate asymptomatic users are now signposted to the online service. It allows users to order a STI kit to be sent to their home, self-test, return via post and receive the result to their mobile phone within days.

The impact

The service has proved incredibly popular. Between November 2017 and November 2018 nearly 13,000 patients used the service. 

In fact only about one in 10 asymptomatic patients use the clinics - and they are ones who do not have mobile phones, are under 16 or where there are safeguarding concerns.

Sexual Health Commissioner Tracey Milligan said: “It has worked really well. We didn’t advertise it or really promote it. We just relied on clinicians telling people about it or people finding it on the website. “I think the fact that we are using the existing provider has made it really seamless – and patients appreciate that. The results come back quickly and we have even noticed a drop in the outof-area payments we have to make. “There are probably a variety of factors for that - our clinics are really busy, some people do not want to be recognised at their local clinics and others work out of area.

“What it shows is that there is a real demand for online testing. That should not come as a surprise - after all people conduct so much of their lives online from banking to shopping, health services should be no different.”

Lessons learned

In some ways, Norfolk has been a victim of its own success. “You could say we have been too popular,” said Ms Milligan. “We have seen the numbers of asymptomatic patients using our service increase by a third since we launched the online service.”

It means that while the numbers attending clinics have fallen by the target, the monetary savings have not been realised.

“We are beginning to look at how we react to that. The numbers returning positive tests are low with only achieving a 6 per cent positivity for chlamydia – so there are some signs people are coming forward too often or are the worried well,” added Ms Milligan.

To help mitigate against this, the online system is evolving to include more questions about sexual history and past tests to identify those who do not need to be tested. Although if they do have concerns they will have the option of contacting the service.

“With better triaging, the right tests can be sent to the right people and at the right time to mitigate the increasing costs of over testing,” Ms Milligan added.

How is the approach being sustained?

As well as trying to curb the number of tests being done unnecessarily, Norfolk has plans to improve the way it engages people, particular older ones.

The council is exploring introducing a webcast facility on its website so people can get real-time advice and support.
A Facebook campaign is also being planned to encourage more older people to use the online service – currently 85 per cent of online users are under 35 and national figures suggest it is the over 35’s heterosexuals who are becoming more at risk, particularly for HIV.

Contact details

Tracey Milligan
Sexual Health Commissioner Norfolk County Council
tracey.milligan@norfolk.gov.uk