Strategic overview of sexual health procurement Haringey and London Sarah Hart : March 2017
2 Context for redesign of sexual health services in Haringey and London From July 2017 there will be a new offer to local residents requiring sexual and reproductive health services - These are related to two programmes the London Sexual Health Transformation Programme (LSHTP) and the ongoing Haringey Step Change programme. Increase access locally though primary care healthy living pharmacies & GPs and 2 community based services. Re- focus create a london e services and reframe capacity of clinics across the capital Haringey Step Change programme LSHTP Increase access and improved quality of service to Haringey residents
Context for the Programmes 2013-2018 3 Issues High levels of sexually transmitted infections (STI) across London and Haringey (next slide ) Demand rising (3.5%) Provides have high, fixed tariff hard to negotiate savings 68% Haringey residents using a Genito-Urinary Medicine (GUM) service do so out of area, this is 5 th highest in London. Opportunity- it is a different world since the GUM clinics opened Advances in testing for sexually transmitted residents can self test, order kits on line with a 72 hour turn around on results New providers in the market i.e. pharmacies, voluntary sector 53% survey respondents would use GP or pharmacy if the service was offered.
Headlines on Haringey sexual and reproductive health needs Source - data is from 2015 Haringey local authority HIV, sexual and reproductive health epidemiology report (LASER 2015) STI diagnosis Age groups HIV Contraception Haringey is ranked 12th out of 326 LA`s in England 44% of male STIs were in MSM 9% women and 12% men are re infected within 12 months 31% of new STI were in young people aged 15-24 years HIV prevalence rate is 7.1 per 1,000 in those age 15-59 years which is higher than that of England at 2.1 HIV late diagnosis has dropped to 39.9%, lower than the England average of 40.3% the under 18 conception rate per 1,000 females in Haringey has dropped 22.6, England 22.8 Rate of LARC prescribed in clinics was 44 per 1,000 whilst England was 31 per 1,000 Subsequent abortions account for 29% of all local abortions, whilst England = 27%
Systems leadership 5 London Sexual Health Transformation Programme led by chief executive CEO Camden Council and director of public health (DPH) Barnet & Harrow 29 councils working together created 4 sub regional commissioning groups to re- commissioning local GUM services on behalf of all of London. Procurement of a E service Sub region North Central London (NCL) Islington, Camden, Barnet, Hackney & City, Enfield, Haringey have co designed a new system to jointly contract The above (not Enfield) have tendered for new services to start July 2017 Haringey step change programme Worked with clinicians, Health Watch to redesign local services to increase capacity in Haringey based services rather than relying on GUM clinics and to achieve competitive pricing.
The three programmes on a page 6 From July 2017- E Service contract Customer completes triage into system Order a sexually transmitted infection kit on line, if positive provides simple treatments or direct appointment into another service From July 2017 - NCL clinical contract 2 Clinics for GUM and a female reproductive health clinic in Camden, Islington. Outreach into Haringey for sex workers, training for primary care Access to clinics in Enfield and Hackney plus better price for all London clinics Local Step change 32 Healthy living pharmacies - condoms STI testing and emergency contraception plus 12 doing HIV GPs adult female oral contraception and HIV testing ( part of national contract )plus PH funded Long Acting Reversible Contraception (LARC) Embrace UK outreach service targeted BME CNWL - Community young people and female reproductive health (currently mobilising to open in July)
7 I think I have been at risk and want an STI test How system will work E service Triage and offered home testing and treatment Triaged and offered step change services Triaged and directed to clinic Step change Walk into a healthy living pharmacy Under 25 years - walk in or book an appointment at young peoples service Vulnerable group - embrace outreach service NCL Book an appointment on line, by phone or walk in (Enfield, Hackney, Camden and Islington) Go to any other GUM
Accessibility - are residents ready to switch to using a pharmacy? 9 This year there were 3,476 attendances by residents for sexual health services in pharmacies 53% of residents using the local GUM clinic who completed a survey would consider using a GP in the future & 32% a Pharmacist (Haringey survey 2016) Yes 32%
10 Acceptable will residents change to on line? 51% of NCL online respondents would consider using self-sample kits at home, and a further 27% were undecided. More women than men, and among heterosexual respondents than gay or lesbian. 36% of Haringey paper respondent would consider, highest acceptability in young people 53% Yes 53% young people
Suitability do people need to go to a clinic? 11 London survey showed that the majority of Londoners using clinics had no symptoms respondents were there for a check up Haringey Public Voice survey showed that 30% of participants attending the clinic for a check-up without having symptoms and further 36% for contraception
12 Haringey community sexual health services as an alternative Young people who don t want to use pharmacy or on line service There will be a nurse led service based in up to 4 community settings - offering STIs testing and treatment and contraception There are school nurses who cover community settings BME and other vulnerable adults if you don t want to use pharmacy or e service There will continue to be an adult outreach service offering testing Women wanting LARC Three options- GP contracted practices, Haringey young people and contraception service or NCL clinics (Camden clinic will offer women only sessions)
Next steps 13 Currently - Central North West London (CNWL) will be meeting key stakeholders and identifying buildings for young people and female reproduce health service. Working with new pharmacies and GPs From April - production of information for residents and professionals with clear pathways regarding where to go to get a service the new NCL provider will be mobilising From July services go live and we work on channel shift to self service
Ask of CCG Board 13 To work with public health to inform GPs of the changes so GPs are sign posting to correct services CCG communications team to work with public health to disseminate information to GPs to give to patients CCG to support PH at collaborative meetings around the changes CCG promote the changes in the GP news letter To explore ways to increase uptake of LARC (STP priority) To identify ways to create integrated care between GPs, pharmacies, community services and the NCL GUM clinics CCG to support GP leading on sexual health CCG to encourage GPs to attend training CCG to encourage collaborative working between primary care providers and between primary care and specialist services