The Wandsworth sexual health story 2020
You can read the Executive Summary below, and the full report is available in PDF format: Wandsworth Sexual Health Story 2020 (PDF)
The Wandsworth Sexual Health Story is a report of sexual health services delivered in GP surgeries and pharmacies in Wandsworth. 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 sexual health into councils, the mobilisation of a new integrated sexual health service and more recently the introduction of the NHS Long-Term Plan. Despite this changing context, Wandsworth 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 Wandsworth there are 40 GP Surgeries and 58 pharmacies contracted by the council to deliver sexual health services for residents. GP surgeries deliver Chlamydia screening, HIV Point Of Care Testing (POCT) and Long Acting Reversible Contraception (LARC) which includes coils and implants, but excludes injections. Pharmacies deliver Chlamydia screening and Oral-Emergency Contraception (Oral-EC).
Chapter three sets out the findings and outcomes. The Wandsworth Chlamydia detection rate is higher than London and England but has a declining trend. Wandsworth also performs better than London and England for the percentage of eligible population screened for Chlamydia. HIV testing coverage in Wandsworth is higher than London and England. The new HIV diagnosis rate is declining in Wandsworth but still remains higher than London and England. Total prescribed LARC excluding injections in Wandsworth is higher than London but lower than England. Teenage conception resulting in a termination rate in Wandsworth is higher than London and England figures.
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 11,124 sexual health interventions delivered in a primary care setting. This includes 3,321 LARC procedures undertaken by GP surgeries and 1,383 HIV POCTs, identifying three reactive cases. In pharmacies, there were 5,681 presentations for Oral-EC. Across both settings in primary care, 739 young people were screened for Chlamydia with 43 positive cases identified.
Chapter four includes the key findings, discussion and recommendations. The report finds that sexual health services in primary care are provided across the borough at locality and ward level with some available seven days a week. Sexual health activity in primary care is high, however a number of contractors are inactive and there is wide variation across services and providers with the majority being attributable to particular GP surgeries and pharmacies. Contraception activity is high and increasing, including presentations for Oral-EC; however, over half of GP surgeries delivered less than the NICE recommended minimum number of LARC insertions required within a 12-month period. Sexually Transmitted Infections (STI) screening activity is also decreasing and the available resource is underused. The Chlamydia detection rate is higher in pharmacies than GP surgeries although the Oral-EC to Chlamydia screening conversion rate in pharmacies is low. While HIV testing coverage is high, the number of HIV reactive cases is lower than expected given the boroughs HIV incidence rate. More women than men are accessing sexual health services in primary care. The majority of service users are aged 39 or under and the Black, Asian and Minority Ethnic (BAME) population is over-represented in comparison with the borough profile for age range.
The Wandsworth Sexual Health Story recommends that sexual health services should continue to be provided in GP surgeries and pharmacies. However, commissioning from 2020 should consider the variation in service activity that exists between providers, including those that are inactive. Work to rationalise GP surgeries and pharmacies should be undertaken with services 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.
Actions should be taken to optimise the effectiveness of services including work to increase the detection of Chlamydia and HIV and the total number of prescribed LARC in the borough. Commissioners and Public Health should explore the high demand for Oral-EC and consider ways to promote safer sex messaging and strengthen access to LARC and the combined oral contraceptive pill. Ways to maximise the primary care offer for sexual health should be explored and suggestions given. Commissioners and Public Health should consider and respond 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 and BAME and White service users. Campaigns to promote services to young people including men should be delivered.
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 Directorate of Adult Social Care and Public Health (DASCPH) and collaborative commissioning opportunities with other councils across South West London should be scoped.