1. Paul Ward Deputy Chief Executive March 2009 World class commissioning for HIV & sexual health services

2. Contents The scale of the challenge World class commissioning for sexual health & HIV Case study – Chlamydia screening Commissioning new sexual health & HIV service models

3. The scale of the challenge Growth in STI diagnoses since 1995 Numbers of people with HIV growing by 10% p.a. 25%+ undiagnosed HIV Highest teenage pregnancy levels in W. Europe Under achievement of Chlamydia screening and teenage pregnancy targets Variation in use of long acting reversible contraception But: Achievement of GUM access target Falling teenage pregnancies

4. World class commissioning for sexual health Provision of leadership for sexual health service delivery and development Orchestration role working with NHS providers, Local Government and Voluntary/community organisations Specific steps to engage with people using services, recognising health inequality & stigma as barriers to participation Engagement of clinical and non clinical sexual health/HIV specialists in development & delivery Regularly updated needs assessment, public health surveillance and contract delivery data to maximise PCT knowledge

5. World class commissioning for sexual health Review of investment patterns to maximise value for money, eg balance of hospital & non hospital activity Stimulation of sexual health market to ensure there is both choice and specialism available Capitalise on innovation opportunities afforded by diagnostic technology, Next Stage Review & policy levers Effective use of procurement policy to maximise impact of investment, and to promote collaborative working Active facilitation of partnership working & care pathway management between providers

6. WCC Case study Chlamydia screening - defining success Routine opportunistic screening for all people 15-24 yrs, using community contraception and sexual health (CASH) services, abortion services and antenatal services Routine GP opportunistic screening for 15-24 year olds Increase access to screening in other health settings used by 15-24 year olds, e.g. community pharmacy Assertive outreach screening in youth settings, e.g. schools, colleges, youth services, bars/clubs, YOIs Effective partner notification function Postal testing programme Social marketing support & approach Achievement of 17%, 25% & 35% targets

7. WCC Case study Chlamydia screening – achieving success Local Chlamydia Screening Plan in place PCT Executive & Board attention, with clear delivery structure incl Local Chlamydia Screening Steering Grp PCT engagement with full range of partners able to achieve the target, incl CASH, GUM, LA, VCOs Delivery model focused on screening in core community sexual health & GP services supported by assertive outreach screening to maximise access Motivational leadership by local Chlamydia Screening Office

8. WCC Case study Chlamydia screening – achieving success Chlamydia screening as a performance requirement for all sexual & reproductive health contracts, incl abortion Financial incentives in CASH, GP LES & Pharm contracts Capacity building with GPs & Pharmacies Screening agreements in place with all principal statutory and voluntary services used by young people Assertive outreach contractor in place High quality lab reporting to count all screens & tests

9. WCC case study - Chlamydia screening – checklist for PCTs What do we know about local Chlamydia need? What do we know about local service use by young people? How do our services compare against NCSP best practice? How does our performance compare with the 17%, 25% & 35% targets? How should we change services to optimise screening in all settings used by 15-24yos? Is good use made of contractual & financial levers? Is there a local plan & timely/accurate dataflow to PCT managers/ Boards

10. Commissioning new sexual health & HIV service models Sexual health promotion Coordinated public health programmes Targeted at those in greatest need Media & face to face, behavioural & clinical Young people coordination of HPV vaccination, SRE, Chlamydia screening & school nursing Increased role of vaccination & regular testing Integrated with clinical services

11. Commissioning new sexual health & HIV service models Community sexual health services Integration of contraception & STI services Level 1 & 2 services delivered from community based clinics, polyclinics, pharmacies, GPs and VCOs Nurse & healthcare assistant delivery Self management emphasis Step up arrangements with Level 3 services for people with complex needs Inclusion of all providers in managed service network Referral pathways into other services, eg, TOP, HIV

12. Commissioning new sexual health & HIV service models HIV long term condition mgt Expanded promotion & availability of HIV testing Community delivered HIV ARV & primary care in polyclinics, & larger GP premises HIV specialists for complex care & annual review New models of HIV primary care Proactive LTCM programmes, inc self management, health trainers, web delivered services, Integrated health & social care for greatest need

13. Thank you paul.ward@tht.org.uk 020 7812 1850