1. London Sexual Health E-Service and Sexual Health Advising
SSHA Annual Conference
Saturday 22nd September 2018

2. Sophie Jones – Senior Health Adviser

3. Sexual Health – Context and Case for Change
Health and Social Care Act moved commissioning of Public Health to Local Authorities, who have seen 50-70% central government funding cuts since 2010
Demand increasing (up c.25% in three years) despite access issues and higher STI rates across London than elsewhere in the country
Services are required to be ‘open access’
Significant cross-boundary flows, particularly into central locations but also between groups of councils around more localised services
Closure of clinics and restriction of services likely without an innovative solution

4. New E-Services approach
Asymptomatic service users who want a check-up for sexually transmitted infections (STIs), can access information and register online to receive testing kits allowing them to bypass clinic visits completely.
Service uses online technology to help triage, test, diagnose, and in certain cases treat STIs
Only patients requiring treatment, or with safeguarding concerns, will need to physically attend a clinic.

5. Role of CWFT
CWFT team – Clinical Lead, Safeguarding Lead, Project Manager, Relationship Manager, Senior Health Adviser and Recall Advisers
Responsible for results management
Responsible for Partner Notification for service users treated via Lloyd’s Online Doctor pathway
Responsible for safeguarding
Responsible for mobilising and training participating clinics
Providing a governance structure

6. Service Overview SHL ‘Sexual Health London’ launched in January 2018
x27 participating London boroughs (45 GUM / HIV clinics). Clinical staff and Health Advisers working in participating clinics have their own individual log-ins so they can review results / notes / flags and inform us when they have seen / treated a service user
To date registered users
January 2018 – September 2018 return rate of 78.4% (48214 kits ordered and kits returned)
***CONFIDENTIAL***

7. Service Overview
Eligibility - resident in a participating borough, > 16 years old, pin verified UK mobile phone number. Allocation of x4 kits in 12/12 period. Service users are asked to proceed if they have a good command of the English language
Service users who report symptoms or state that they are a contact of an STI are stopped from proceeding and are shown a list of their local services
Service users are shown tailored information, advice, signposting throughout their journey based on their responses (PEP, EHC, drug / alcohol support etc.)
Some responses trigger a safeguarding call back from the Health Adviser team

8. Testing
HIV / Syphilis (EIA, TPHA and RPR if appropriate), Chlamydia and Gonorrhoea is the default offer
HepB (Surface Antigen and Core Antibody) and HepC (Antibody) tests offered if appropriate
Service users who test positive for genital Chlamydia only, treated via Lloyd’s Online Doctor remotely and managed by SHL Health Adviser team
Service users who test positive for anything else are notified by the SHL Health Adviser team and signposted to their local service
***CONFIDENTIAL***

10. Service users
49% of our service users are aged between years old and 40% of all Chlamydia diagnoses to date belong to this group
20% of our service users are BME and 25% of our service users identify as MSM / Trans / Other
***CONFIDENTIAL***

11. Partner Notification
Positive / Reactive results at 8.4% of returned kits
(82%) contactable contacts are treated remotely or attend a service (patient and clinic verified combined value)
0.97 contacts per index case are treated remotely or attend a service (national average is 0.6%)
Facilitated by HA call backs / responses to SMS / templates
***CONFIDENTIAL***

12. Safeguarding
All services users are asked if they have been recently sexually assaulted, if so they receive a call back from the Health Adviser team
All service users aged 16 and 17 years old are asked “spotting the signs” safeguarding questions and will also receive a call back from the Health Adviser team if they trigger a concern
For adults – x3 attempts of contact made, NFA if no response
For 16 and 17 years olds – x3 attempts of contact made, if no response the case is brought to the monthly Directorate Safety Net meeting where a decision will be made
***CONFIDENTIAL***

13. Safeguarding
236 (adult) and 277 (under 18’s) have triggered safeguarding concerns to date
100% of 16 and 17 year olds have been successfully contacted
x7 referrals to Children’s Services have been made to date
x4 referrals to SARCs have been made to date
x2 anonymous reporting and sharing of intelligence to the Police has been made to date
***CONFIDENTIAL***

14. Benefits of this being a Health Adviser led service
Experience of working with victims of sexual assault and making safeguarding assessments – more so than other staff groups working in a GU service
Experience of working with young people and talking about Child Sexual Exploitation and picking up on verbal cues
Experience of working in a multi-disciplinary team, lends itself well to consortium working
Experience of advocating for the patient / service user
Experience of assessing health anxiety and referring service users onto appropriate services
Strong links with other Health Adviser teams and creating mutual beneficial pathways
***CONFIDENTIAL***

15. Learning Evolving service, changes made regularly Gaming
Locking accounts
“Bedding in period” for staff working in clinics
Including rationales for service users to make it clear why it is beneficial for them to attend a clinic for testing if they have symptoms
***CONFIDENTIAL***

16. Next Steps
Expanding the team (increase amounts of Health Advisers and Recall Advisers)
Asking about Domestic Violence (needs to be managed carefully, need to ensure we are well resourced)
Uploading Version 2 – pathway changes and algorithm changes to make the journey more user friendly based on staff and service user feedback
Explore online booking
Explore option for service users to directly input Partner Notification data onto their portal
***CONFIDENTIAL***

17. What we are proud of….
That the entire team have continuously helped to improve and develop the service
That a consortium of multiple private companies and an NHS body can work so well and so successfully together to provide a great service to our service users
98% of service users received all results within 3 working days of kit being delivered to the laboratory
Verification that 97% of service users with positive / reactive results completed treatment pathway / treated and managed appropriately
98% of service users would recommend the service to family and friends
82% of service users rated our service 5/5 stars

18. Questions
Any questions? Thank you, Sophie Jones
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