Sexual Health Developing the role of Primary Care using PBC

Health Needs Analysis - Key Points Ten wards in Birmingham have high levels of sexual health problems – eight in HoBTen wards in Birmingham have high levels of sexual health problems – eight in HoB High levels of unwanted and teenage pregnancy and repeat terminationsHigh levels of unwanted and teenage pregnancy and repeat terminations High levels of all STIsHigh levels of all STIs Problems meeting chlamydia screening targetsProblems meeting chlamydia screening targets Over reliance on specialist services for routine contraception and STIOver reliance on specialist services for routine contraception and STI Young people not accessing servicesYoung people not accessing services Long acting reversible methods of contraception (LARC) not widely availableLong acting reversible methods of contraception (LARC) not widely available Late presentation of HIV in Soho and LadywoodLate presentation of HIV in Soho and Ladywood

WardIMD Teen Concept ion Rate per 1000 women aged TOP Rate women per 1000 women aged BME >50% No of FPCs in ward seeing >6 people per session ? HIV Rate Chlamydia Infection Rate per 1000 population aged Gonorrhoea Infection Rate per 1000 population aged Priority Heart of Birmingham Teaching PCT Aston Yes0High6.83.2Highest Handsworth (now Lozells & East Sandwell) Yes1High Highest Ladywood Yes1*V High Highest Nechells Yes0Low Highest Perry Bar No0Low Lower Sandwell (now Handsworth Wood) Yes0High Highest Small Heath Yes0Low Medium Soho Yes1V High Highest Sparkbrook Yes3Average Higher Sparkhill Yes1High Medium

Local Issues Small single handed practices – few female GPsSmall single handed practices – few female GPs Cultural sensitivities (especially for women)Cultural sensitivities (especially for women) Good local training schemes but difficult for primary care staff to find time to attendGood local training schemes but difficult for primary care staff to find time to attend Limited engagement with the chlamydia screening programmeLimited engagement with the chlamydia screening programme Community providers swamped by routine workCommunity providers swamped by routine work No integration between GUM and RSHNo integration between GUM and RSH

Approach Radical change of approach needed to tackle major issues with existing systemRadical change of approach needed to tackle major issues with existing system Pan Birmingham Strategy in line with national guidancePan Birmingham Strategy in line with national guidance Consultation with local community through specially designed campaign and eventsConsultation with local community through specially designed campaign and events In HoB - PBC is leading on developing services in primary care – consultation through local GP meetingsIn HoB - PBC is leading on developing services in primary care – consultation through local GP meetings

City Wide Strategy Plurality of providers and services available for uncomplicated needs (primary and community care)Plurality of providers and services available for uncomplicated needs (primary and community care) Holistic integrated services at all levels – ideally one stop consultationHolistic integrated services at all levels – ideally one stop consultation Improve accessibility – especially for young people – times and venuesImprove accessibility – especially for young people – times and venues Strengthen role of specialist services in supporting Levels 1 and 2Strengthen role of specialist services in supporting Levels 1 and 2

Level 1 – Funded through PBC Local Enhanced Service to support practices to: –engage with SHIP training –adopt You’re Welcome quality standards –routinely risk assess patients and treat accordingly –increase targeted chlamydia testing –normalise HIV testing –improve recording LES for contraceptive implants (and improved training provision) to help improve access to long acting reversible contraception (LARC)

Level 2 Locality Centres Integrated (not just co-located) services from any willing provider (GP, HoB provider or third sector)Integrated (not just co-located) services from any willing provider (GP, HoB provider or third sector) Each centre sited in accessible community location to provide Level 2 services with failsafe for Level 1Each centre sited in accessible community location to provide Level 2 services with failsafe for Level 1 Shared Community Health Advisors to support contact tracingShared Community Health Advisors to support contact tracing Specification to cover range of services, staff competencies, and accessibility (particularly for young people)Specification to cover range of services, staff competencies, and accessibility (particularly for young people)

Training Increase the skills of people working in primary care and in the community to deliver integrated sexual health services –Co-ordination between SHIP and BRASH to cover primary and community care staff – risk assessment approach –Establish training database to allow monitoring of workforce development –Increase access to practical training for both GUM (STIF) and contraception (DFRSH) –Create clinical network and community of practice for local healthcare professionals

Level 3 (specialist) Reorganise and rationalise existing family planning services to move towards integrated provision of specialist services – discharge of Level 1 to primary careReorganise and rationalise existing family planning services to move towards integrated provision of specialist services – discharge of Level 1 to primary care Concentrate services at City Centre Hub (build on success at Boots) with outreach where appropriate for vulnerable groupsConcentrate services at City Centre Hub (build on success at Boots) with outreach where appropriate for vulnerable groups Build role for both GUM and RSH in signposting to and supporting Level 1 and 2 providers (training and advice)Build role for both GUM and RSH in signposting to and supporting Level 1 and 2 providers (training and advice)

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