SEXUAL HEALTH
screening. Macintosh suggests that any- body under the age of 25 should have a test. She said: “Raising awareness is important in young people but it’s also important in providers, so they understand that a young person without symptoms will be at risk.”
Challenges
When it comes to implementing the pro- gramme into the NHS, the NCSP has had to work to overcome issues concerning both funding and set-up, as well as helping practitioners to adapt to the new services and be willing to openly engage in conver- sations about STIs.
Macintosh said: “It’s been challenging, because sexual health itself hasn’t been ring-fenced. With the fi nance, it had to compete with all the other public health programmes and priorities. It’s obviously a challenge to set up new services, to take on board all the various enterprises which can develop middle-level sexual health services in the community.
Macintosh said: “We’ve had a national awareness campaign which was an um- brella campaign for ‘Sex: Worth Talking About’, about 18 months ago now that in- volved all aspects of media and was very highly researched. A project was under- taken by the Department of Health and there was a lot of consultation about the messages that young people actually want to hear, and what will engage them into be- ing tested appropriately,” she said.
“At local level, there’s been lots of diver- sity of practice of trying to engage young people. One of the things we’ve noticed is that men like to access services differently to women. Men are often tested through the outreach type of activities, and as a consequence, outreach has been great for raising awareness, although it’s not neces- sarily great for identifying those who are at most risk.
“It’s getting the balance right between get- ting the message out there and empower- ing young people to test themselves when they feel they are at risk. It also goes along with other preventative sexual health mea- sures such as using condoms and protect- ing yourself, and also how to prevent your- self getting re-infected again.”
The main way to focus on the groups that are most at-risk is the policy of universal
“I would see GUM as the acute services, for complicated sexual health cases. They also do Chlamydia screening, but they were very over-burdened with too many people trying to access their services and great improvements have occurred with the de- crease in waiting times.
“But middle-level services make sure that people are safely tested in the community and referred appropriately to GUM.
It’s
developing those services that can actu- ally offer basic sexual health services and identify and triage the more complicated cases in GUM. By and large, Chlamydia is uncomplicated.”
Other challenges include continuing to in- tegrate services and helping practitioners to feel comfortable conducting conversa- tions about Chlamydia.
Macintosh said: “There are barriers, espe- cially with men, attending health services and being offered tests, more than with women. And there are barriers with the ease with which some primary care provid- ers, such as general practitioners, feel com- fortable about initiating a conversation to ask about an STI screen.
“As it becomes more integrated and more normal, I think those barriers will begin to go away. That’s not going to happen over- night, but I think a lot of it has happened so far. There’s quite a lot of evidence now to show that young people are consistently much more aware of Chlamydia than they ever used to be.”
Moving forwards
The programme has had support from the Department of Health and will con- tinue to move forward with sexual health in England. The future direction of the programme is now to make use of exist- ing health services to promote testing, and targeting at-risk groups which are more dif- fi cult to reach.
Macintosh explained: “We’ll be focusing on trying to keep the volumes up, but improve the quality of the testing and improve the degree to which it comes through general practices, contraceptive services, pharma- cies, termination of pregnancy.
“We’ll be trying to make sure that they maximise the footfall going through those particular services and advise local provid- ers to perhaps use outreach only in circum- stances where people aren’t going to be ac- cessing those services; the diffi cult to reach young persons, people who don’t go to the doctor.
“If you look at the statistics, the vast ma- jority of both males and females visit their doctor at least once or twice a year. So we would say that those are opportunities to offer young people a test, and they aren’t being maximised at the moment.”
The focus will be on these services to pro- vide testing, rather than creating extra events outside of the NHS. Macintosh be- lieves this will ensure testing levels remain high whilst targeting the right audience.
“In the past, ineffi ciencies have arisen while people have been trying to get the num- bers up but have started doing more ad hoc awareness raising or events, which al- though they’ve contributed, for the future, we probably would want to focus more on the health services, maximising the oppor- tunities they’ve got.”
She concluded: “Its very much going in the right direction, if you look at the amount, you’ll see the volumes have gone up tre- mendously in the last two or three years of testing.
“A lot of that is because people were try- ing to meet the targets because they had to, but also because the services were becom- ing developed and now it’s becoming much more routine. It’s easier and more effi cient to deliver through primary care core ser- vices than it was in the past.”
FOR MORE INFORMATION
Visit
www.chlamydiascreening.nhs.uk national health executive Sep/Oct 11 | 83
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