Across Hampshire, commissioning has been joined up by creating a commissioners group for the local councils, CCGs and NHS England. It has help maintain integrated services and led to the development of an improved digital offer and specialist services. This case study forms part of our sexual health resource.
The transfer of public health responsibilities to local government in 2013 presented a potential risk to the continued commissioning and delivery of integrated sexual health services in Hampshire.
The county already had an integrated sexual health service model where residents could access a range of services. But under the new system commissioning responsibility was handed to different organisations, and there was a concern that these services could become fragmented.
In addition, a significant number of Hampshire residents crossed council boundaries to access seek services in the two main cities of Portsmouth and Southampton.
A sexual health commissioners group was established in 2014 to support the continued commissioning and delivery of integrated sexual health services. It included representatives from all three councils and seven CCGs with input from NHS England.
The group has worked together to undertake a collaborative procurement exercise for sexual health. It was agreed services would be tendered on a county-wide basis including the two cities. A single provider was selected to work across the region, covering a total population of 1.7 million.
The service now provides council commissioned services for contraception, STI testing and treatment, chlamydia screening, psychosexual counselling and sexual health promotion and HIV prevention services as well as CCG services for termination of pregnancy and vasectomy and an HIV treatment service commissioned by NHS England
Hampshire Public Health Principal Rob Carroll said: “The collaborative procurement required a lot of work, but it has meant we continue to have an integrated one-stop shop approach to sexual health service delivery, which is better for residents and more cost-effective for commissioners, than standalone services.
“We have a single electronic patient record which means that no matter where a patient goes their records are immediately to hand, creating a more seamless service for patients.”
The collaboration has also enabled Hampshire to invest in other services. A big emphasis has been placed on the digital offer.
STI testing kits are available online for low-risk asymptomatic residents and there is also a webchat facility that guides residents to the most appropriate service for their immediate needs - whether that is an appointment at a clinic, services in primary care or STI selfsampling. Satisfaction rates with the service are running at over 95 per cent.
Specialist services have also been developed for at-risk groups.
- SHIELD clinics for people with learning disabilities
- ROSE clinics for people at risk of sexual exploitation
- TULIP clinics for people involved in commercial sex work
- XTRA clinics for men who have sex with men.
These are run in the main clinics at set times and are delivered by practitioners specially trained in helping these individual groups. The appointment times are also longer.
Mr Carroll said a guiding principle for all the work has been on designing services around the patient.
“We think about how we can make it easier for the patient - and work from there. There was a time when a woman coming in for an abortion would have to make a separate appointment for contraception and then another one if she wanted an STI test.
“Now that can be done within one pathway within one service – not only is that better for the patient but it is also more efficient too.”
How is the approach being sustained?
Improving access to LARC has been highlighted as a key priority. Hampshire, Portsmouth and Southampton are putting together a business case to the STP to increase investment in LARC, recognising that the majority of savings from preventing unintended pregnancies are gained by CCGs.
Mr Carroll said the creation of primary care networks - being championed as part of the NHS long term plan – is also offering opportunities to improve access to LARC.
“Not all GP practices provide LARC, but with practices working together across larger footprints, there are increased opportunities for practices to work together to provide specific LARC clinics for patients from other practices.”
Other developments being considered by the commissioners group include proposals for a community gynaecology service, telephone contraception counselling to increase the availability and uptake of contraception within abortion pathways and the introduction of selfreferral and online assessment for vasectomy.
“Sexual health commissioning is fragmented, but that does not mean we cannot work together and ensure services are not,” added Mr Carroll.
Public Health Principal
Hampshire County Council