Working groups bringing together all the different parts of the sexual health service are being set up in Nottinghamshire to enable closer cooperation. A year in, the project has already led to women being given easier access to LARC. This case study forms part of our sexual health resource.
Sexual health is a fragmented commissioning landscape, with different parts of the system being overseen by NHS England, CCGs and local government.
Historically in Nottinghamshire there has been relatively little in the way of collaborative working between these different parts of the system.
The worst case scenario resulting from this would be that services under pressure might make efforts to shift excess demand into other parts of the system for which they do not have responsibility, resulting in inefficiencies, poor patient satisfaction and outcomes.
Over the last year efforts have been made to facilitate greater integration of local sexual health services.
Nottinghamshire County Council commissions an integrated sexual health service across the county, which is provided by three different NHS Trusts.
In the last twelve months, the council’s public health team has led the development of working groups designed to get all relevant organisations around the table and working together more closely.
GPs, practice nurses, CCG leads, NHS providers, NHS England and council commissioners have all been invited to participate in this exercise to better understand the pressures and challenges that exist within different parts of the system, and to work together in overcoming them.
Groups covering the middle and the south of the county have been set up and include representatives from up to seven different organisations. They are meeting quarterly.
Improved patient referral pathways are now being developed with the aim of improving efficiency and ensuring that service users receive the testing and treatment they need in a timely manner and in a setting that best suits their needs.
One of the earliest successes from these working groups has been the development of an inter-practice referral system for LARC that has been set up in mid Nottinghamshire.
GP practices who lack the capacity or personnel to fit coils or implants are now able to make a referral to another practice, instead of having to direct people to the sexual health clinics.
Nottinghamshire’s Acting Public Health Consultant Daniel Flecknoe said: “We know that some women wishing to use LARC were having to travel long distances to already very busy clinics and wait to get their contraception.
“Now we have this new system set up they can be referred to a nearby practice instead. It is making a big difference to those patients.”
Mr Flecknoe said you should not underestimate the benefit of face-to-face meetings.
“It really helps to break down barriers. We are all working for different organisations with different priorities, but at the end of the day we all want the same thing – to provide a good service to patients and the public.
“By getting round the table together we can develop those personal relationships that can make all the difference when you are not working for the same organisation.”
How is the approach being sustained?
Work is under way to get a group covering the north of the county up and running. The hope is that it will start in the coming months and build on the successes of the two other groups.
The work has also highlighted some other issues that need addressing. One example is the discrepancies in how services are performance managed.
Mr Flecknoe said: “The key performance indicators for the same activity can be very different across the system and this creates its own incentives.
“For example, GPs are expected to provide a LARC fitting within four weeks of a referral, but the integrated sexual health clinics are currently expected to do so within five days.
“This obviously encourages service users to preferentially access LARC at the clinics, when their GP service may be a more appropriate venue for an uncomplicated fitting.
“We plan to review these KPIs in cooperation with our GP and CCG colleagues in order to create more equity across the sexual health system in Nottinghamshire.”
Acting Public Health Consultant, Nottinghamshire County Council