TY - JOUR T1 - Implementing integrated sexual and reproductive healthcare in a large sexual health service in England: challenges and opportunities for the provider JF - BMJ Sexual & Reproductive Health JO - BMJ Sex Reprod Health SP - 164 LP - 167 DO - 10.1136/bmjsrh-2018-200090 VL - 45 IS - 2 AU - Katie Boog AU - Johanna Heanue AU - Vinod Kumar Y1 - 2019/04/01 UR - http://jfprhc.bmj.com/content/45/2/164.abstract N2 - 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 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 SHS80% 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).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 … ER -