The Richmond sexual health story 2020

You can read the Executive Summary below, and the full report is available in PDF format: Richmond Sexual Health Story 2020 (PDF)

Executive Summary

The Richmond Sexual Health Story is a report of the sexual health services delivered in general practice GP surgeries and pharmacies in Richmond. The story aims to examine service demand and provision during 2018-19 and act as a resource for commissioners to manage sexual health programmes and inform procurement of services in primary care for   2020 and beyond.

Chapter one outlines the changing national and local level health and social care landscape that has been taking place over the last seven years. This includes the transition of some  sexual health commissioning functions into local authorities, the mobilisation of a new integrated sexual health service and more recently the introduction of the NHS Long-Term Plan. Despite this changing context, Richmond Council has continued to provide high quality, outcomes-based, accessible and sustainable sexual health services for residents.

Chapter two considers the methodology used and details the services that are delivered across primary care. In Richmond there are 20 GP surgeries and 5 pharmacies contracted by the local authority to deliver sexual health services for residents. GP surgeries deliver Chlamydia screening and long acting reversible contraception (LARC), which includes coils and implants. Pharmacies deliver Chlamydia screening and treatment and oral emergency contraception (Oral-EC).

Chapter three sets out the findings and outcomes. Richmond is similar to London and better than England for the percentage of population screened for Chlamydia, but the detection rate (the measure of Chlamydia control activity in England (DR), is lower than both. The proportion of under 18s conceptions leading to abortion in Richmond is lower than London but higher than England and for under 25s repeat abortions, Richmond is doing better than London and England. Total prescribed LARC (excluding injections) is increasing and Richmond is higher than London but lower than England.

Service Snapshot Cards, which summarise the key findings and outcomes for each service are provided. These show that during 2018-19 there were a total of 2,189 sexual health interventions delivered in a primary care setting. This includes 1,769 LARC administered by GP surgeries. In pharmacies, there were 305 presentations for Oral-EC and 13 young people who tested positive for Chlamydia through the National Chlamydia Screening Programme (NCSP) were referred to a pharmacy for Chlamydia treatment. Across both settings in primary care, 108 young people were screened for Chlamydia with 11 positive cases identified – a positivity rate of 10%.

Chapter four includes the key findings, discussion and recommendations. The report finds that the commissioning of sexual health services in GP surgeries and pharmacies is inconsistent and limited in geographical reach leaving gaps in provision in some areas of the borough. Among commissioned providers, activity varies with a small number inactive. Chlamydia screening is being delivered effectively and the Oral-EC conversation rate (the percentage of service users receiving an Oral-EC consultation who screen for Chlamydia) is good, indicating that pharmacies are implementing the MECC approach. LARC activity increased in relation to the previous year and not all GP surgeries delivered the recommended minimum number of insertions required within a given period. Almost 40% of Oral-EC service users were aged 18 or under. More women than men are accessing sexual health services in primary care and Black, Asian and Minority Ethnic (BAME) users of the Oral-EC service are slightly over-represented in comparison with the borough profile for age range.

The Richmond Sexual Health Story recommends that sexual health services should continue to be provided in GP surgeries and pharmacies. However, commissioning from 2020 should look to strengthen the accessibility of services and equity of access, so that they are commissioned more consistently with greater geographical reach, are situated in areas where they are most needed, where demand is highest and provided by those who have demonstrated that they are best able and motivated to deliver services to residents consistently.

Ways to maximise the primary care offer for sexual health should be explored, such as extending Chlamydia treatment in pharmacies beyond the NCSP. In response to the number of young people accessing Oral-EC, ways to promote safer sex messaging and strengthen access to LARC and the combined oral contraceptive pill, should be considered. Consideration should be given to the demographic characteristics of service users and the positive and negative drivers of the overrepresentation of particular groups. This includes differences in the demand and utilisation of services between male and female, specific age groups and BAME and White service users. Campaigns to promote services to young people including men should be delivered. Actions should be taken by commissioners to improve
the data capture of LARC and Chlamydia treatment to support improvements in the monitoring of service user demographics.

Qualitative work should be undertaken to compliment and contextualise the quantitative findings. Methods such as feedback from providers, consultation with service user groups, and mystery shopping exercises would add further value to the story by incorporating the patient and practitioner voice.

Commissioners should regularly assess the continually changing landscape seeking opportunities that may arise for service development and contractual delivery following the maturation of Primary Care Networks (PCNs), the transformation of Clinical Commissioning Groups (CCGs) and implementation of the NHS Long-Term Plan. Financial resources and expertise should be optimised through cross-divisional spending agreements between public health and commissioning departments within the Directorate of Adult Social Services and Public Health (DASCPH) in the council and collaborative commissioning opportunities with other councils across South West London should be scoped.