The Scottish Government

NHS Fife has used some of its new sexual health funding to improve capacity in GUM, both by employing new members of staff and investing in training of existing staff.

As a result of employing extra nursing staff, nine extra nurse practitioner-led clinics are being held in Fife each week, seven at Victoria Hospital, Kirkcaldy, one at Queen Margaret Hospital, Dunfermline and one in St Andrews.

This means that 50 extra new patients can be seen each week.

In 2005 a total of 1,151 additional new patients and 229 review patients were seen. This number reflects time taken out of direct clinical work by nurses undergoing prescribing training and the number of new patients is expected to be higher in 2006.

A redesign of sexual health services in Dumfries and Galloway is underway. The departments of family planning and sexual health and GU medicine are amalgamating and the redesign project is looking at the whole service. This includes taking into consideration access in rural areas, including peripheral clinics and the provision of direct microscopy.

New premises will be needed for the new amalgamated service and the Board has identified a modern building which would require some modification and extension to suit the new department's needs. Proposals were accepted by the Board in September 2006 and it is hoped the new department could be in new premises by Autumn 2007.

Patients have a much shorter time to wait for a GUM appointment in Ayrshire and Arran. New staff and changing working practices mean that waiting times have been cut from eight to nine weeks to one to two weeks. This has been made possible by examining the skill mix of the GU medicine team and training nurses to take on extended roles. Senior nurses in the service attended sexual health courses at Paisley or Caledonian Universities and did supervised practice as part of their course. The nurses are also nurse prescribers, which makes it easier for patients' needs to be met in one consultation rather than having to wait to see a doctor.

'Although we had to do without staff while they were attending courses, it resulted in worthwhile gains,' explained lead clinician Dr Ruth Holman. 'We created an additional GU clinic in East Ayrshire so that each area (North, East and South Ayrshire) has a clinic three times a week.'

Around three quarters of community pharmacies in Forth Valley now offer a service providing free emergency contraception.

The service is designed to improve access for socially excluded people, including young people and hard-to-reach groups, to help reduce teenage pregnancies and sexually-transmitted infections.

As well as accessing free emergency contraception through consultation with a pharmacist, people receive pregnancy testing where appropriate, a free condom supply and advice on contraception and STIs.

In the first 12 months, 50 per cent of community pharmacies signed up and undertook 891 consultations, with 97 per cent leading to emergency hormonal contraception being supplied. 38 per cent were aged 16 to 20.

For phase two of the project, sexual health strategy money was used to appoint a project support worker to do liaison and training with the remaining pharmacies and to improve publicity to clients. As a result, 48 out of 66 pharmacies in Forth Valley now offer this service.

A young people's service began in Tayside in May 2006. Aimed at 12 to 16 year olds, the clinic combines child protection with sexual health and family planning.

The clinic is particularly intended to help young people who might be considered at risk, for example, those in care homes.

Around 10-15 appointments are available each week and young people may be seen by a senior nurse or by a consultant.

Although the specialist clinic is in Dundee, NHS Tayside is widening access by offering a young persons' clinic in Perth.

The Sandyford Initiative in central Glasgow is a model of good practice, providing comprehensive services in sexual health and related areas. While the service is busy and popular, it has been recognised that not everyone is willing and able to go to the main building.

An outreach programme has been established to set up community clinics, or hubs, offering a range of services similar to Sandyford Central.

The Sandyford Southeast Hub was launched in Govanhill in October 2005 and a hub in Parkhead was launched in September 2006, plans are at an advanced stage for further hubs in Springburn and Pollok. There is also an intention to form a hub in Dunbartonshire and one has recently opened in the Clyde area.

Between the launch and the end of March 2006, Sandyford Southeast has seen a steady increase in the number of clients, particularly men.

Previously the existing Govanhill clinic saw around 300 clients per month, almost all women, but by March this had doubled and numbers of men had risen from around 10 to 105 per month.

NHS Western Isles is working with youth groups and other voluntary groups to provide internet access for young people in remote and rural areas. The NHS provided laptops while the groups themselves provided the internet access.

Health promotion staff at the NHS Board compiled a list of recommended health information websites so that youth workers could help young people get the information they needed. This included information about where they could access support, advice and services locally as well as national organisations which might be able to help with particular issues.

Isabel Steele, senior health promotion officer ( HIV, Sexual Health and Youth Health) said: 'Some young people are reporting that this is the only opportunity they have to access sensitive and confidential information'.

The Govanhill area of Glasgow has a significant black and ethnic minority population, many of Asian origin.

To try to address their needs, the Sandyford Southeast Hub identified a female reproductive health doctor to work in the service one day a week.

The doctor is a fluent Urdu/Punjabi speaker and works to promote the service among the Urdu/Punjabi speaking community. This has included a programme on Awaz FM and visits to Asian women's groups.

The clinic has created protected appointments each week where women can be sure of seeing a female Urdu speaker.

The outreach work has resulted in a number of Asian women approaching the clinic to ask for the Urdu doctor. The service began in March 2006 and was accessed by 14 women in the first month.

Young people across Dumfries and Galloway have the opportunity to attend youth clinics aimed particularly at meeting their needs.

The clinics are held in every town with a secondary school (except Dalbeattie where it is closed while under review).

The Family Planning and Sexual Health team runs the clinics, supported by school nurses, practice nurses and health visitors.

Clients can make appointments or can drop-in. All have a sexual history taken and can be screened for sexually-transmitted infections if they want. The clinics also give advice on other issues, such as relationships and bullying.

NHS Orkney is soon to begin piloting a scheme to offer treatment, as well as testing for Chlamydia by post. The project is trying to access people of both sexes who are at risk of infection, by targeting education, leisure and employment settings.

The idea is to get a better idea of prevalence of Chlamydia in Orkney and to see if a more widespread postal testing and treatment programme would be viable.

Dr Anne Nicolson, NHS Orkney sexual health clinical lead, says: 'We see it as closing the loop. We're not only testing people by post but treating them too.'

The pilot involves distributing testing packs which are returned by post. People are asked how they want to receive results, by post, telephone or texting. 'If a test is positive, I will conduct a telephone consultation with the patient and send out a treatment pack,' explains Dr Nicolson. 'It's a way of offering convenience and choice, particularly in rural areas.'

NHS Shetland tries to make its condom distribution service as comprehensive as possible and free condoms are available in a variety of locations, including GP practices and village halls. The latest venue is barber shops.

Jane Gilbey, health promotion clinical specialist in sexual health, explains: 'Availability and accessibility are what's important. Yes, condoms are available in GP practices but how accessible are they to people, like young men, who often don't go to see their GP. So we tried to be a bit more imaginative and make sure condoms were available where men actually go.'

She approached Shetland's barber shops, which were happy to display information and make free condoms and lubricant available.

'It hasn't been formally evaluated but the barbers have been in touch to ask for more, so we know the service is popular,' she says.

Around 15 pharmacies in Ayrshire are offering free Chlamydia testing as part of a pilot project.

In the first three months of the project, which began in summer 2006, pharmacists handed out up to 40 kits, mostly to women who had attended for emergency hormonal contraception.

The programme has now been expanded to include young men and women.

'Pharmacists have been trained to give advice on Chlamydia and to offer postal testing kits where appropriate,' explains William Malcolm, specialist in pharmaceutical public health with NHS Ayrshire and Arran.

'People take them away and can either post the kit or can take it back to the pharmacist.'

If the test result is negative, the pharmacist offers advice and free condoms. Where it is positive, the patient is treated with antibiotics and, with their permission, sexual health services are asked to help with contact tracing.

In April 2006, around 120 people from the Slovakian community attended an event at Sandyford Southeast Hub to highlight Sandyford services and those of other health professionals and agencies.

It was an opportunity for people from the Slovakian community to become familiar with the location and premises of Sandyford Southeast Hub and to make connections with health professionals and other Slovakian people.

It also provided information about sexual, reproductive and emotional health services available at Sandyford Southeast Hub and gave the community the opportunity to access clothing and food provided by local agencies.

The event came about after staff had seen a number of women from the Slovakian community asking for late termination of pregnancy and with a lack of knowledge about contraception and sexual health.

Sandyford Southeast Hub distributed translated flyers to publicise the event, which was attended by a community midwife, dietician, school nurses and social workers. There was a doctor present who could speak Polish and three translators.

Outcomes included a number of Slovakian people making appointments to attend Sandyford Southeast Hub. It also emerged that families were keen to access other services, particularly around oral health.

Sandyford Southeast Hub is continuing to engage and communicate with this community and plans to hold another event with more focus on information about services provided.

NHS Western Isles has worked in partnership with the children's charity NCH to develop drop-in nights with a health programme for young women in care or supported accommodation.

Up to eight young women with a variety of social problems attended each week for a programme which looked at things like body image, bullying, self-esteem, relationships, contraception, STIs, drugs and alcohol, peer pressure and risk-taking.

'They helped set the agenda each week,' explained Isabel Steele, senior health promotion officer ( HIV, Sexual Health and Youth Health). 'We worked with them to address issues such as contraception and relationships through informal chat, role play, drama and small group work exercises.'

The women reported that they had gained confidence and information from the programme and several have since accessed contraception from their GP and now know where they can get free condoms. All have since taken an STI test.

'The programme has been useful for us as workers to gain a further insight as to the issues these young people are facing every day in life. It has allowed us to directly work with them to empower them to address their sexual health and wellbeing,' said Ms Steele.

NHS Highland has been developing staff to allow the setting up of clinics in areas of higher deprivation.

One example is Easter Ross, where work is well underway to set up a new clinic combining sexual health, GUM, family planning and well woman services.

The idea is to focus on providing local, specialist clinics to improve contraceptive services for at-risk groups of women, particularly those who have undergone termination of pregnancy.

Each year Healthy Respect runs a special project to give young people a voice in particular aspects of the organisation's work.

In 2006, in partnership with LGBT (Lesbian, Gay, Bisexual and Transgender) Youth Scotland, a 'mystery shopper' initiative was developed to find out about young people's experiences in accessing sexual health services in Lothian.

The project involved 10 volunteers, aged 14-22, recruited by LGBT Youth. After training, they visited 10 services and their findings were then fed back to the service providers.

Dona Milne, head of Healthy Respect, says: 'It is important to include the views of young people in any evaluation of sexual health services and young people can, when properly trained and supported, contribute to the future design of services for other young people. Healthy Respect is now working with services to address the issues raised by young people in their report on the project.'

Members of NHS Lothian's sexual health team are going into GP practices to offer on-the-spot training.

The first visit took place at the Craigmillar Practice in Edinburgh in August 2006.

It followed a survey of Lothian's GP practices to find out about the current provision of sexual and reproductive health services, what services primary care might be interested in providing in the future and what training was needed.

Almost half of Lothian's 130 practices (46 per cent) responded to the survey, which showed considerable variation in what was provided in different areas.

A range of training needs were identified, but the most common were sexual history taking, including assessing men and women with symptoms of infection, hormonal contraception - particularly long-acting reversible methods - management of sexual problems and the menopause.

A quarter of the practices which responded had staff who would like to undertake formal family planning training, 10 practices would like to provide Implanon and six to provide intra-uterine contraception in the future.

As a first step, the sexual and reproductive health team has set up training for GP practices, where doctors and specialist nurses visit the surgery and train staff onsite.

Lothian sexual health lead Professor Anna Glasier says: 'The bulk of sexual health service provision takes place in primary care. We want to make sure patients across Lothian get access to high quality services which are as comprehensive as possible and realise that training is an important part of making that happen.'

Brook Inverness offers three sexual health clinics per week to young people in Highland, funded by the NHS Board and local council.

The clinics include a session on a Saturday to improve access to young people who live outside Inverness.

'We find that people who live in Inverness tend to visit Brook during the week after school. But it can be harder for those who have further to travel,' explains Lorraine Mann, specialist in sexual health and young people.

'So the Saturday clinic is popular with people who live outside Inverness because everyone can find an excuse to go shopping in the city on a Saturday.

'It's about designing services to suit young people.'

NHS Highland has also used sexual health strategy money to improve disabled access at Brook.