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Lessons from the experience in the Sexual Health Service at Thameside Community Healthcare NHS Trust

  • Why was the initiative launched?
  • What was done?
  • Durex award
  • Tips for Success
  • What happens next? - working with primary care
  • For more information contact

  • Why was the initiative launched?

    The publication of Health of the Nation prompted questions by South Essex Health Authority about the high rate of local teenage pregnancy because it had the third highest in the (then North East Thames) region and higher than many inner London districts. Subsequent discussions with local NHS Trusts identified the fragmented nature of local sexual health services as a cause for concern. The rise in rates seemed to coincide with cuts in the level of family planning services. It was argued that if cutting services had caused the problem - we should be able to solve the problem by developing a new sexual health service . The decision was taken to explore how to achieve a fully integrated sexual health service.

    What was done?

    The initial step brought the separate components into a single entity, an integrated Sexual Health Service, with a service manager. There had been five separate services. All had different histories, traditions and funding arrangements. They were widely spread across local organisations and geographically.

    Sexual Health Services - main components

    The single service structure led to some initial success, born on the better communications which the new structure provided. But there was a concern that these successes were simply scratching the surface. They were not tackling the real sexual health issues in the community such as teenage pregnancies and sexually transmitted infections. The interventions continued to be provided from separate boxes with little regards to wider questions about sexual health and its important influence on patients general well being.

    It was increasingly recognised that the complex problems being tackled required joined up solutions. To help the drive towards a joined-up solution the focus was on a shared understanding of the similarities and differences between the two largest elements of the service, i.e. family planning and genito-urinary medicine.

    The very nature of these services presented real barriers to integration (Table). Training and educational initiatives were organised to try to overcome these barriers and improve relationships. For example to help staff in the family planning service understand the issues involved in managing sexually transmitted diseases and vice versa. These initiatives were well received and successful. Increasingly, the service was able to portray itself as ‘integrated' and secure funding for a series of important developments, including initiatives to promote sexual health with schools, voluntary organisations and local authorities.

    Table: Comparison of the key features of the Family Planning service and Genito-Urinary Medicine Service

      Family Planning Service Genito-Urinary Medicine
    Leadership Nurse-led service Consultant led service
    Staffing Large numbers of part-time staff Small full-time staff
    Structure Evening clinics Day-time clinics
    Physical base Community based Hospital

    Although the initiatives did not seem to be having any noticeable impact on integration when seen from within the organisation, the quality of services being provided was improving. For example, when staff from individual services were working with other organisations, such as providing sessions in the 21 local secondary schools, they were increasingly involving their colleagues from other services. The fact that they were part of one service seemed to be improving collaboration between parts of the service and different disciplines. An integrated service was being provided to patients.

    Durex award

    An OFSTED inspection of a local college commended the sessions provided by a family planning nurse in a local college and the services and support which were available for students. Similarly, a local community development initiative The Hairdressers Project won the first ever Durex Award for innovation in sexual health.

    The Hairdressers Project

    Twelve local womens' hairdressers were recruited, provided some basic training on sexual health, a supply of condoms and information about the full range of services. Condoms on the counter opened the door for conversations about sexual health to come up in conversation and the hairdressers were able to provide reliable information. An improvement on the traditional image of the mens' hairdressers.

    A major landmark was achieved in December 1997 when the service won its Charter Mark for the quality of service it was providing to its customers, both patients individually and other local partner organisations.

    These successes demonstrated that the key measure of success in integration rested on relationships with other organisations and the extent to which the service was outward looking rather than any internal analysis. The essential feature was the quality of the relationships between the NHS based sexual health service and other services in the community. That relationship provided the basis on which influence could be brought to bear. The real challenge of integration was to get the NHS, the voluntary sector, other public sector organisations (schools, residential homes etc) and commercial organisations working in harmony to tackle the sexual health needs of the community, with each partner understanding the role played by others.

    Tips for Success

    √ Services that are outward looking and which care about how they are perceived by others are the more likely to succeed.
    √ Demonstrate that the reason for bringing services together is to improve service quality rather than reduce costs.
    √ Don't be lulled into believing that tidy organisation charts are an answer to service integration.
    √ Create reliable communications channels to keep all staff informed about new developments.
    √ Invest in training: allow staff time to learn about and understand the roles played by others and to push back professional boundaries.
    √ Remember that well motivated staff require a supportive environment to give their best.

    What happens next? - working with primary care

    The current challenge is to explore how the lessons so far learnt can guide the service as it looks towards closer collaboration with primary care groups. Again there are differences in perception, for example GPs often argue that they already provide family planning advice so why do we need a family planning service? Closer examination will show that they are providing complementary rather duplicate services. GPs and primary care teams tend to support women whose concern is to space their family while women whose principal concern is to avoid pregnancy use the Family Planning Service.

    The lessons about being outward-looking are already bearing fruit. Discussions are starting from the premise of how can the sexual health service support the primary care team. Work is in hand to explore ways enhancing skills and knowledge, of promoting the uptake of the services provided by all parties and to tackle adverse health and social outcomes including teenage pregnancies. The early spirit of co-operation augurs well for the future.

    For more information contact

    Hugh Johnston
    Sexual Health Services Manager
    Thameside Community Healthcare NHS Trust
    Gifford House
    Thurrock Community Hospital
    Long Lane
    GRAYS RM 16 2PX
    Telephone 01375 364474
    Fax 01375 364439

    ImpAct bottom line

    Services that are outward-looking and which care about how others perceive them are more likely to suceed. Influence is born of good relationships, not internal structures and systems.


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