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ENHANCING SEXUAL WELLBEING IN SCOTLAND - A SEXUAL HEALTH AND RELATIONSHIPS STRATEGY: Analysis of Written Responses to the Public Consultation
CHAPTER 9: ROLE OF SEXUAL HEALTH AND REPRODUCTIVE HEALTH SERVICES
9.1 Broadly similar points were made by Health Professionals in relation to all the proposals about the role of sexual health and reproductive services as follows:
There is not enough recognition or inclusion of existing services in the voluntary and statutory sectors such as Practice Nurses, Public Health Nurses, Community Pharmacists, Relationship and Couple Counsellors, etc.
"The voluntary sector have largely been ignored." (Social Health)
There is a lack of recognition of the existing funding and resource problems within Genito-Urinary Medicine (GUM) and sexual health services and the Draft Strategy does not adequately identify the additional resource issues which will be needed to implement the Draft Strategy. Over a third of health professional respondents had concerns about funding for implementation of the Draft Strategy - there were particular comments relating to the fact that 'pump priming', though welcome, would not be sufficient and arrangements needed to be made for more long-term funding.
"Many GUM services currently have long waiting lists - this needs to be addressed" (Social Health)
There is a lack of clarity about how the Draft Strategy is to be implemented and how it will fit within existing frameworks such as Community Health Partnerships. It was suggested that a detailed implementation plan is required addressing many of the questions discussed in the following sections.
"(The Draft Strategy is) not well prioritised, lacking in specific actions and significant aspects are open to interpretation." (Medical Health)
LEAD CLINICIAN IN EACH NHS BOARD AREA
Each Director of Public Health should appoint a Lead Clinician to integrate sexual health services across each NHS Board area |
9.2 The notion of a Lead Clinician was broadly supported but there were serious concerns about the specific role of the clinician. It was strongly felt that the Lead Clinician should be a new and dedicated post rather than a role added to an existing job title, which would then divert clinicians from already under-staffed front-line services.
"The implementation guidance should specify more precisely the expected qualifications and experience and appointment process of the Lead Clinician, and give guidance on the amount of time required for this duty." (Medical Health)
"[Would wish to query] whether the dedicated local leads will be allocated additional time and resources." (Medical Health)
"Will local co-ordinators and lead clinicians will be additional posts and what funding/resources will be available?" (Medical Health)
IMPLEMENTING AN INTEGRATED TIERED APPROACH
In developing their tiered service approach, NHS Boards should ensure that everyone is able to choose from at least two sexual health service providers for all tiers. Health care practitioners must be able to demonstrate that they provide information and refer patients to alternative readily accessible services where they do not provide the sexual health services required. |
9.3 Generally, the recommendations relating to implementation of an integrated tiered approach were only commented on by those currently working within social or medical health services. Overall, around half of the Health Professionals who responded commented directly on this, with the considerable majority being generally positive (just under half of those commenting) or positive but with some qualifications.
"The tiered approach enables resources to be maximised" (Medical Health)
"The recommendation of a tiered level of service is preferable as practitioners will be able to operate within their own area of competence and be able to refer to a more specialist service if this cannot be provided locally." (Medical Health)
"The introduction of the tiered approach with regards to clinical services is both a practical and pragmatic approach to redressing the balance of inequitable service provision. It is encouraging that service providers unwilling or unable to provide specific services have a duty to clearly signpost individuals to appropriate services who can deal with the issue raised…[this is] particularly pertinent to young people who often have difficulties accessing mainstream services." (Education and Young People)
9.4 However, a small minority of Medical Health respondents were negative about implementation of a tiered approach, for example,
"Tiered systems have been shown to be inappropriate in other areas of work e.g. mental health because at any one time the individual may be accessing different tiers at the same time. Instead it is more appropriate to [organise] services in circles with the individual at the centre and the various services around this - operational services closest and planning/strategic functions further away. The tier also assumes that providers stay at their level when in reality we want to bring specialist services as close to the user as possible i.e. provision of GUM trained staff in drop-in centres for young people and direct input to schools etc." (Medical Health)
9.5 Additionally, the following issues and concerns were raised by medical and social health professionals in relation to the tiered system:
The tiered system is too NHS based and is not conducive to partnership working as it does not acknowledge the key role of some existing services (particularly the voluntary sector). It was felt that the potentially valuable role of the voluntary sector (particularly relationship counsellors and sexual health advisors) has been ignored and that the Draft Strategy would benefit from a section entitled 'What the voluntary sector can do to help'.
Similarly, it was felt that more clarity was required about the role of community pharmacists and there should be discussion about an extended role for them - particularly in relation to developing the provision of contraception. It was felt that community pharmacists should be included in each tier and were ideally placed to offer emergency contraception owing to their accessible hours (24/7).
It was also pointed out that adequate time would be needed to build up the system - perhaps over a number of years in some areas providing services at each tier (especially in 4 and 5) and that there would be particular difficulties in some rural areas. Particular and specific service standards need to be set for each of the tiers (Social Health). Many professionals felt that the tiered system would need to be tailored to reflect the realities of service delivery in rural areas where services may be shared between neighbouring Boards.
A few respondents thought that the tiered model was slightly confusing and suggested it would be possible to merge tiers one and two.
There were strong concerns relating to the implications of new GMS contracts in relation to GPs being able to opt-out of the provision of sexual health services which it was felt were not addressed in the Draft Strategy. Additionally, there was a suggestion that the GP role be expanded and GPs be encouraged to see non-registered patients for sexual health services (Medical Health) However, if local NHS Boards did not fund GPs to provide enhanced Sexual Health services, there were concerns that the role of primary care in delivering the Draft Strategy would be undermined.
It was suggested that outreach services are needed to meet the needs of homeless people (Social Health)
Some professionals believed that people should be able to self-refer to GUM clinics in any location and to be seen within 48 hours. The need for a cross-charging system was also noted to return costs to Boards who do not adequately develop the required tiered services (Medical Health)
"If the new NES for Sexual Health becomes a directed NES (i.e. one that has to be funded by PCOs) then this might balance the apparent contradiction at the moment where primary care is expected to have a key and expanding role in sexual health, but at the same time it has actually become a voluntary area of work for GPs, rather than an essential service." (Medical Health)
"The community pharmacy should be included in each tier where services can be delivered appropriately, rather than just in Tier Two. In particular, highlights the role it can play in health promotion in each tier." (Medical Health)
"[Given the genuine challenges faced by some rural areas] We would prefer to see a requirement to provide more meaningful access to a single route of service delivery for every person in the area, working in the longer term towards expanding this to ensure a choice of service provision." (Medical Health)
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