Sexual and reproductive health services provision consultation report Appendix
The following are responses from York sexual and reproductive health services provision consultation on issues important to sexual health.
These are shown alongside joint responses from the Specialist Service and local authority Public Health.
"More outreach needed"
Outreach is still part of the sexual health offer but funding restricts the extension of this.
"You struggle to get an appointment now, so reducing this would be catastrophic!"
The Sexual health service are looking at a new electronic patient record system. Dependent on the providers and their capabilities we are hoping to have additional booking capacity that may support online bookings. We also are looking at increasing walk in and wait services that wouldn't require appointment bookings.
"Offer services for older patients as well as the young."
The service offered by YorSexual Health are open to all regardless of age. Clarification of what services are meant here is required, as GPs offer menopause clinics.
"The chaotic homeless or sex worker population needs a flexible and responsive service. Great success has been had with a sexual health nurse going out into the community to interact with these patients."
Thank you for your positive feedback. We will strive to maintain this service for those most at risk to poor sexual health.
"I work with the homeless offering a GP service for them. I work very closely with the SCCOT team, we provide shared care for quite a number of very chaotic ladies. Their input, knowledge and ability to work flexibly is vital to prevent unplanned pregnancies.
"It's unrealistic to expect these chaotic and vulnerable ladies to access sexual health services in planned clinics in surgeries. This client group need an individualised approach which can involve accessing care in a variety of locations, such as drop in centres, breakfast venues, their accommodation and hostels.
"An example would be a member of the team visiting 4 different locations until she was able to catch up with a lady to administer her depo.
"This is not a style of service that a GP surgery can provide. These ladies are very vulnerable and often abused, and the need to build up a relationship with these patients is vital. By reducing the hours of the SCCOT team it will have a huge detrimental impact on one of the most vulnerable groups in society, and is highly likely to result in an increase in pregnancies and STIs."
There is no recommendation to reduce the hours of the SCCOT team and we hope to maintain this service. Thank you for your positive feedback.
"Location of sexual health clinic could be changed to reduced cost and increase ability to attend."
We have considered this but have worked to keep the Saturday morning service open at Monkgate and close Wednesday morning.
"Working more alongside young people's provision across the city for vulnerable risk young people and those that need outreach provision of support drop-ins."
Young people's provision is important to us, and we will continue to offer services specifically targeted at this group, with drop-in, walk-in and young people only sessions. There is also a dedicated text service for young people under 17 years, who can text at any time between 8.15am and 3.30pm to access support and help.
"I am very grateful to the sexual health clinic, they put my coil and removed it. I waited 1 year for the gynaecologist as I was bleeding, so I went back to the clinic and they did it for me. Now I have a 1 year old baby and I had a healthy pregnancy. Thank you so much."
Thank you for your positive feedback.
"Not for me personally, but I believe that cuts in social care support to those living with a diagnosis of HIV and/or hepatitis and those involved in risky sexual behaviours is short sighted."
We are not aware of any cuts to social care or support for those living with a diagnosis of HIV and/or hepatitis, this will continue to be part of the specialist service offer and is part of the national service specification which our service is based on.
"Keep it free and as available as possible. Contraception is a vital service."
All contraceptive and sexual health services are free at the point of use - this is a national directive. Unfortunately, the service costs a significant amount of funding and the budget does not meet demand. This is not something specific to York - many contraception and sexual health services across the country are facing this issue.
"I wouldn't go to my GP with an STI issue."
GP provision has a remit to offer some aspects of STI testing but we appreciate that some people would prefer to attend sexual health services for STI testing and treatment. Thank you for your feedback
"Sexual health are specialists, and I have found them to be more knowledgeable and up to date on all things related to sexual health and contraception than go surgeries."
Thank you for your feedback.
"Need to remain accessible for all which is why Saturday morning appointments shouldn’t be scrapped."
We have noted the response to this suggestion and we will work across the system to offer a service on Saturday mornings.
"Any reduction in this service is going to impact women more significantly than men. The whole contraceptive industry is embedded in sexism and this element needs to be considered really carefully when reducing services. I'd be interested to understand the legal implications of reducing LARC provision for women based on cost. At the very least this would surely not be NICE compliant.
"All our sexual health services are compliant with the required regulations and guidelines including NICE. The National Service Specification requires us to offer all forms of contraception to those who require it - we will continue to do this, but the reality is we have reducing budgets.
"I have friends who have been unable to access clinics so have used the outreach services for a nurse hope this will continue."
The outreach service will continue for those who need it most.
"Hours opened at weekend for people who work. Online screening to be accessible to all with limits, what happens if you can’t get into clinic for mental health. Implants and coils not to be limited we are overpopulated already. Patient choice."
Thank you for your feedback. We will reconsider weekend opening, but we need to be efficient and effective in our offer of services. Service users still have opportunities to access the service, which shouldn't impact further on their mental health.
"Smear tests are difficult to book, appointments few and far between. Need to retain out of hours access for working women."
Cervical smears are outside the responsibility of Local Authority funded sexual health services. The funding for these is provided by NHS England. NHSE have commissioned a smear testing service within the sexual health service. Retaining the out of hours service is part of our service delivery plan as appointments will be offered across the week in the morning, afternoon and evenings. We are reconsidering options for the Saturday service.
"I belong to the LGBTQ+ community, I want to stress how important it is to keep in-person appointments open for us to address the specific needs of our community members (PrEP renewal). Many thanks!"
A mixed economy of appointments will continue to be offered including face to face appointments.
"Importance of a face-to-face meeting especially the first time somebody has to use the service. Subsequent checks could be achieved through the postal service but it can be important for somebody’s mental health to be able to meet somebody at the service face-to-face."
Thank you for your feedback. A mixed economy of Face to Face and virtual services helps to support those with additional sexual health needs.
"Pregnancy and midwife services are incredibly poor, midwife appointments for newly pregnant women should be conducted as soon as possible over the phone through a direct contact rather than GP referral and a waiting list."
Thank you for your feedback - unfortunately midwifery is outside the scope of this consultation and service.
"Availability, accessibility, acceptability and quality - needs to be benchmark."
Availability, accessibility, acceptability and quality for sexual health and reproductive rights are integrated in the in-service provision and Key Performance Indicators.
"Where possible I think is important that you can introduce the annual consultation for 20 years old to 55 years old, on free basis for Papanicolaou or other examinations on request."
This relates to a pap smear. Annual consultations to support broader health needs are best placed in primary care for those who don't have additional Sexual Health or HIV needs.
"Consider continuity of care and have clear policies for transfer of information back to primary care."
All NHS service have a commitment to continuity of care. Sexual health Services can only provide information to GPs if the service user consents to this. Not all users of sexual health services want this information on their patient records.
"People with previous infections that they need to manage and need a good choice of times for access. I take PrEP and get regular syphilis checks, but if I can’t get an appointment because I am at work when the service is open - and I work Monday to Fri 7 to 4 - how do I get an appointment?"
Thank you for your feedback, a mixed economy of access will be maintained to ensure access for all, and we will look for alternatives/options for weekend opening. However all individuals have a personal responsibility to practice preventative measures so they reduce their risk of STIs, by using condoms and practicing safe sex.
"As a foster carer I feel the outreach aspect of the service need to remain to meet the needs of the most vulnerable young people in the city."
Outreach will be maintained. Additionally walk in and wait services for Young People are well attended in the York service. This in clinic service ensures that we facilitate YP into clinical care to support them accessing their own health care needs.
"I notice that the majority of the measures you propose will negatively impact women rather than men. Have you done an equality impact assessment on these proposals?"
We have completed an EIA and are working with other providers of sexual health and contraceptive service to reduce the negative impact on women. This is why we support the access to contraceptives, repeat prescriptions etc form community pharmacist without the need for an appointment.
"GPs and this service are very poor at offering HIV testing and identifying the symptoms of late stage AIDS. They are in need of intensive training asap, to prevent deaths. The medical schools should be involved in this issue."
We are looking at this issue and will provide training for GPs around identifying HIV and syphilis in patients who may not fall into "at risk groups".
"Access to services working fulltime and weekends. People who are vulnerable will there still be a service for hard to reach people for children and adults."
We are looking at maintaining a weekend service. The service will always priorities those who are at risk or hard to reach regardless of age.
"I need the convenience of choice - I have a very busy life. I have heard you have nurses who work in the community too - I have friends who, due to severe mental health, will not access your clinic - and have seen your nurses at their house - so what are your proposals around that?"
Thank you for your feedback. We all need services to be convenient and we hope by providing services across the week and include morning, afternoon and evening appointments we can accommodate most people. We also offer walk-in services where no appointment is required. The reality is that the budget does not cover unlimited opening hours so we have looked at the busiest clinics and where we are quiet and have proposed changes based on service user footfall. The SCCOT team - who are the nurses you refer to and work in the community - is a service we will maintain as this works with our most vulnerable clients.
"I feel that there should be some walk-in services so that people who need to be seen can sit and wait, but be seen the same day if needed."
There are still walk-in or drop-in services available, where people can sit and wait.
"Online/postal testing has been a great service compared to when you had to go into the clinic. I hope that continues for all. If it helped the service by paying for reactive medications such as antibiotics, wart removal and topical treatments then I wouldn’t be averse to paying the prescription rate. Preventative measures such as contraceptives and PrEP should be free."
All contraceptive and sexual health services are free to the end user, this is a national directive. We are unable to implement payment for tests or prescriptions that are not advised clinically. Any that are required will be provided free of charge.
The provision of free, comprehensive, open access sexual health and contraceptive services is a mandated Public Health function of local authorities as part of the Health and Social Care Act 2012. Sexual health is an important part of public health and is funded via the ring-fenced Public Health Grant Allocation provided by central government.
"At the moment STI rates are phenomenally high and rising. All the evidence points to some of the worst infection rates in a generation.
"It is deeply irresponsible for CYC to not put any proposals or measures in this consultation to address this crisis, and frankly misleading to not even mention the crisis of sexual health in this consultation.
"Unfortunately, you cannot deliver better service efficiency and cost saving without spending more money to deliver that. There are undoubtedly ways to reduce numbers of patients in the sexual health system but those (advertising campaigns, school visits, large- scale distribution of contraceptives, targeted community work) all cost money.
"The reality is that just cutting this money from the budget without doing the work means that costs will go up and the taxpayer will pay more to resolve this mess."
We are aware that the STI rates are rising, and this increases the demand for services, we are not sure how referring to this would have influenced the consultation. The reality is that budgets are not keeping up with demand and we are committed to providing the best service possible to the residents of York that we can afford. This issue is not just in York, but is replicated around the country, where services are having to make very difficult decisions about services. The need for people to practice preventive measures to reduce their risk of Sexually Transmitted Infections and unwanted pregnancies is also required.
"I need the service to be accessible, currently it is difficult to get an appointment within 3 weeks. The service needs expansion not reduction. The service is already difficult to access. Postal testing needs to be Brough back universally for those who would be if it for it also."
We strive to make the service as accessible as possible with a range of ways to access the service from appointments and walk-in opportunities on weekday mornings, afternoons, and evenings. There is also an online offer but these need to be given based on need and risk, unfortunately we cannot afford to offer tests to all regardless of risk - these are expensive and need to be targeted.
"I would like to see an ability to book a face to face appointment with Yorsexual health online."
The Sexual Health Service are looking at a new electronic patient record system.
Dependent on the providers and their capabilities we are hoping to have additional booking capacity that may support online bookings. We also are looking at increasing walk in and wait services that wouldn't require appointment bookings.
"It seems ironic that as STI rates are increasing the council are looking to reduce services."
It is unfortunate that we have had to make this decision and it was not made lightly. The reality is that we have reducing public sector budgets and the services we commission have to come within these budgets.
"YorSexual Health provide an amazing service they are open longer than any GP practice or outpatient department within the hospital, why shouldn't why reduce slightly to continue providing the service, if the council want them to continue providing the same level or service including access they should give them the financial envelope to facilitate this!"
CYC agree that the service provided by the York and Scarborough NHS Hospital Foundation trust is an excellent one and as a local authority we would like to be able to give the financial budget required to offer service users the same level of service. But the reality is that we cannot afford this due to the reductions made nationally to the Public Health budget.
"Who is carrying out the testing? Could you shop around and get it done cheaper?"
It is unclear what testing this is referring to, but all the services provided including those by other organisations have been commissioned on best price and best value principles.
"YorSexual Health must continue to have good access so as not to disadvantage the most vulnerable people in our community."
This is agreed by all concerned.
"Sedation and pain management when accessing services such as coils, or having biopsies for cervical issues would make a huge difference to local women."
We facilitate local anaesthetic spray for coil insertion based on patient need. We would not undertake cervical biopsies in the sexual health service.
"STDs are on the rise nationally and locally. The services have fast moved from doctor delivered to nurse delivered. Now the move it for more non health practitioner delivered services, such as pharmacists. What is the point of being in one of the greatest and developed countries in the world with less and less quality health care services? It is appalling! Councils needs to find funding from the government to keep the existing good quality services running."
There has been a move form doctor led services to nurse led but it is Important to note that these are highly trained health care professionals as are pharmacists. Pharmacists are health care practitioners who train for over 5 years, they are a highly skilled underrated health care professional who form an important part of our primary care system along with GPs, Opticians, and dentists. The contraception service will be provided by appropriately trained, skilled community pharmacists who offer people a greater choice and access when considering starting or continuing their current form of oral contraception.
"Everything you have "suggested" will cause difficulties and an increase in STIs amongst the population"
We hope that the mitigating proposals will mean that we will not see a rise in STI rates. However, we do need to see a rise in preventative measures being adopted by all. STIs are preventable if safe sex is practiced, and condom use is increased. We all have a responsibility to look after our own health.
"This survey seems very incomplete. I would think you should require ID. Services should be made available only for residents, unless ID means costs can be reclaimed. Postal kits are excellent, but these should be restricted to a certain number a year, perhaps depending on risk level, but not depending on unprotected sex. 2 per year?
"Counselling or in person appointments should be used for those who need more. This survey has not been clear on where the costs are incurred and therefore it is not easy to help define what could realistically be cut."
When service users access the sexual health service contact and personal information is recorded, so in most cases we know where people are from who accesses our service.
The national policy is very clear that contraception is free to all to access anywhere in the country regardless of where your permanent residence is. Regarding STI testing an address is always requested and testing for out of area residents is recharged to their home authority, this happens across the country. However sometimes people attending for STI testing choose not to give an address or give false details as they feel this will help further ensure anonymity.
The postal kits are restricted to level of risk, and this is done by completing the online form. Counselling, in-person appointments and telephone consultation are offered to service users who require these.
"I want the service to focus on sexual infections testing and risk reduction and health promotion.
"I don't think online testing does this. I think consultations or tests should be by phone or in clinic. Being able to get advice from a person, based on my circumstances is very important."
The sexual health service we offer must offer both contraception and STI testing as mandated. We have no choice in this, the service must cover both elements. It is in our gift to decide based on service user, clinical recommendations, and requirements for our population how we do this. Online testing is available but any "red flags" or repeat users are asked to attend in person to be seen by a clinician.
"Already said. But young people much happier to use these kinds of services."
We have a very strong offer for young people, we offer young person walk in clinics, where there is no need for an appointment and where YP can access all forms of contraception, STI testing and treatment. There are also booked appointments for YP. A specialist texting service is offered specially for young people under the age of 17, which is open Monday to Friday 8.15am to 3.30pm, there are no proposals to reduce this service.
"No"
No response required.