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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 integration 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 approximately 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 Partnership NHS Trust. This saw the transfer of GUM services from an acute hospital setting to join community contraceptive services, merging staff from both departments. 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 integrated 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, barracks, male saunas, sex workers, LGBT (lesbian, gay, bisexual and trans) services, educational facilities).
Two additional key performance indicators (KPIs):
98% of symptomatic patients to be offered 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 …
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