Improving access to sexual health

What: A sexual health service for the population of Bradford

Who: Belinda Loftus – Clinical Service Manager

Dr Sophie Brady – Consultant Clinical Lead

Background: Belinda commenced nurse training with Queen Alexandra’s Royal Army Nursing Corps in 1996 after she had completed my army basic training. Her nurse training was based at Royal Naval Hospital Haslar, specializing in sexual health at the main naval base in Portsmouth.

After qualifying she was posted to Catterick and worked in the Military Defense Hospital Unit (MDHU) Northallerton, in general surgery, urology and orthopaedic trauma. It was here where she spent time in the Army Genito-urinary service, before heading off to MDHU Frimley Park in Surrey for further training Following completion of this she was posted to Germany for two years and then Northern Ireland for another two years. During my ten years in the Army she did 4 operation tours; Kosovo, Bosnia, Iraq and Northern Ireland, after Northern Ireland she left Army.

Her first NHS job was as a Nurse Practitioner in Rotherham, spent three years in Rotherham before taking the position of Trinity Centre Manager (at the time Bradford’s GUM service). She was then appointed to her current position as Clinical Service Managerand remains committed to sexual health services.

Approach: Prevention, Promotion and Protection

Location: Bradford Sexual Health (BSH), West Yorkshire

Speciality: Sexual health, including management of sexually transmitted infections (STIs) and related conditions, contraception, cytology and chlamydia screening.

What initiative or project are you involved in?

Bradford Sexual Health Service (BSH) aims to provide open and accessible sexual health services that meet the needs of the local population.

The medical team is led by two consultants; specialists in genitourinary medicine (GUM) and contraception. Nursing staff work at bands six and seven and are all independent practitioners. The health advisors are all trained nurses with the skills to deal with partner notification, adjustment to diagnosis, HIV testing of high-risk groups, and complex cases of safeguarding.

Our highly trained staff aim to ensure that patients only have to tell their often embarrassing or distressing story once.

We care for patients with a range of sexual health needs, including:

  • concerns about acquiring an infection through recent behaviour
  • sexually transmitted infections (STIs) that have significant public health implications, for example HIV, syphilis, chlamydia and gonorrhoea
  • other infections such as herpes, warts and trichomonas
  • non-infectious conditions, for example vaginal and vulval candidiasis, bacterial vagninosis (BV) and genital skin conditions.

Our services include:

  • contraceptive methods
  • pregnancy testing
  • HIV point-of-care testing
  • cytology
  • motivational interviewing
  • harm reduction strategies.

We play a key role in safeguarding children, young people and adults, which includes dealing with issues such as child sexual exploitation (CSE), female genital mutilation (FGM) and domestic violence.

The workload for safeguarding continues to increase; as recently presented in a poster at the British Association of Sexual Health and HIV (BASHH) spring meeting, 2015. The team works co-operatively with other service providers to ensure that issues are dealt with swiftly and appropriately.

What prompted the work?

Embarrassment and stigma are major barriers to the use of sexual health services. It is hoped that the merger of contraception and genitourinary medicine (GUM) services will help to tackle this stigma and reduce barriers to treatment seeking. For example, patients attending a contraception appointment, once in a private setting, may feel comfortable enough to disclose other sexual health needs.

How did you initiate the work?

Under the 2012 Health and Social Care Act, responsibility for the commissioning of sexual health services transitioned from NHS Primary Care Trusts to designated receiver organisations.

The transition presents new challenges for sexual health services across the country, all of which are at different stages in the process. This was presented in a poster at the BASHH spring meeting, 2015.

On 31 July 2015, sexual health services across the Bradford district transferred from Bradford Teaching Hospitals NHS Foundation Trust to Locala Community Partnerships. The transition has been difficult for both staff and patients, but service levels have been successfully maintained.

The location of sexual health clinics across the Bradford district has changed to enable wider access by the population as a whole. The reception from patients has been mixed; for some their door step clinic has been closed and relocated, for others a new service has opened on their door step.

GPs have a key role to play in enabling good access to sexual health services for the whole community, including pregnancy testing, cervical smear testing, STI screening and referral to specialist sexual health services.

What difference has the project or initiative made?

In response to increasing cost pressures and quality demands, a new Assistant Practitioner (AP) role was created to provide extra capacity to the service. By taking on a range of routine activities, the AP can free up the time of our health advisors. This was presented in a poster at the BASHH spring meeting, 2015.

The merger of contraceptive and GUM nursing has introduced a disparity in competencies. In order to provide an integrated service, significant training has been required to ensure that all clinical staff have the skills to deliver both services.

Working with a local university, we designed and delivered staff training with minimal impact on service delivery. The nursing team also used the BASHH Intermediate Competency Framework, enabling knowledge and clinical skills to be gained whilst remaining in practice.