164 Boog K, et al. BMJ Sex Reprod Health 2019;45:164–167. doi:10.1136/bmjsrh-2018-200090 Implementing integrated sexual and reproductive healthcare in a large sexual health service in England: challenges and opportunities for the provider Katie Boog, Johanna Heanue, Vinod Kumar ► Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bmjsrh-2018-200090). Leicestershire Sexual Health Service, Staffordshire and Stoke- on-Trent Partnership NHS Trust, Leicester, UK Correspondence to Dr Katie Boog, Leicestershire Sexual Health Service, Staffordshire and Stoke-on- Trent Partnership NHS Trust, LeicesterLE2 0TA, UK; Katie. boog@nuh.nhs.uk Received 20 February 2018 Revised 7 July 2018 Accepted 24 July 2018 Published Online First 10 August 2018 To cite: Boog K, Heanue J, Kumar V. BMJ Sex Reprod Health 2019;45:164–167. Better way of working © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. INTRODUCTION This quality improvement project reports a provider perspective of service-level challenges associated with implementing integrated sexual and reproductive healthcare (SRH) services. Funding constraints and competitive tendering have led to rapid remodelling of sexual health services (SHS) in England, 1 2 with multiple contractual changes causing inte- gration and splitting of many components of SRH care, as well as changes to service management and delivery. 2 3 In January 2014, an integrated SHS was launched in Leicestershire, UK, providing Levels 1–3 contraception and genitourinary medicine (GUM) services and SRH promotion and prevention. The SHS serves a population of 1.1 million over 900 square miles, seeing approxi- mately 50 000 patients per year. Leicester City, Leicestershire County and Rutland County Councils co-commissioned the service and the contract was awarded to Staffordshire & Stoke on Trent Partner- ship NHS Trust. This saw the transfer of GUM services from an acute hospital setting to join community contraceptive services, merging staff from both depart- ments. HIV treatment, abortion care and vasectomies were no longer provided within the SHS. 4 WHAT WERE THE REQUIREMENTS OF THE NEW CONTRACT? ► Patients to receive comprehensive inte- grated SRH (previously attended separate services for different aspects of SRH). ► Introduction of ‘hub and spoke’ service model: – Two ‘hubs’ (Leicester City and Loughborough) – Twelve ‘spokes’ (across Leicestershire and Rutland) – Eighteen outreach clinics (prison, bar- racks, male saunas, sex workers, LGBT (lesbian, gay, bisexual and trans) ser- vices, educational facilities). ► Two additional key performance indica- tors (KPIs): – 98% of symptomatic patients to be of- fered an appointment within 48 hours of contacting SHS – 80% of walk-in (WI) patients to be seen within 2 hours of arrival. ► Extended opening hours – 9.00am to 8.00pm Monday to Friday, Saturday morning clinics (previously only one evening clinic/week). PHASE 1 – WALK-IN SYSTEM The new amalgamated service adopted a WI system for all patients. Reception staff asked patients their reason for attendance and placed notes in time order in one tray for all clinicians (doctors and nurses). The expectation was that clinicians would select the top notes from the tray. Phase 1 - What were the issues with this system? Staff had to adapt to working in a new service with new colleagues and most were not dual-trained, having previously provided either contraception or GUM services. They attempted to provide more holistic healthcare, but lack of dual- training and clinicians’ efforts to address multiple issues led to prolonged consul- tations. The resultant long waiting times caused complaints, with some patients Reproductive Healthcare - FSRH. Protected by copyright. on December 20, 2019 at Faculty of Sexual and http://jfprhc.bmj.com/ BMJ Sex Reprod Health: first published as 10.1136/bmjsrh-2018-200090 on 10 August 2018. Downloaded from