‘Great fun, yet at the same time very sad as well.’ This is how Patricia McCormack, sexual health manager for Salford PCT, describes her work. She says that this field of nursing reminds her of the two theatrical masks that depict tragedy and comedy.
Ms McCormack feels ‘extremely privileged’ to work in sexual health. ‘It’s one of the few specialties that goes beyond the bedroom door and deals with the most intimate aspects of people’s lives,’ she says. She and her team have turned a ‘failing’ GUM service into a PCT-based, integrated sexual health service. This incorporates screening and services for contraception, erectile dysfunction and psychosexual issues.
Led by nurses, it provides a single access point to all services, reducing the need for multiple appointments with the associated embarrassment or stigma. Now 98.03% of patients have access to the sexual health service within the Department of Health target of 48 hours, compared with just 13% in 2006 before the service was transformed.
Last year, these impressive results were recognised when the team won the NT Award for Sexual Health, sponsored by Durex.
Ms McCormack has always worked in primary care in the Salford area, as a school nurse, a practice nurse, in family planning services and as a health visitor. ‘I always knew I wanted to work in sexual health. I felt I could bring about change,’ she says.
So, in 2002, when a post became vacant for a family planning manager at the PCT, she ‘jumped at the chance’.
The GUM service lacked direction, workload was high, morale low and clinics overcrowded. It needed transforming.
The aim was to have the needs of clients met in one visit at a clinic of their choice.
‘We wanted to reduce the number of times people had to give a history and reveal the most intimate details about their lives,’ Ms McCormack explains. ‘When people go to a service for contraception they may have to drop their pants for an examination. If they have another problem it can mean going to another service and going through the whole experience again.
‘Some poor person may have to drop their pants a few times before their sexual healthcare needs are met. We wanted to offer a service based on one visit at one location.’
The DH had already announced its sexual health and HIV strategy in 2001. This sought to reduce sexually transmitted infections and unintended pregnancies, improve the uptake of contraception and increase sexual health awareness.
It looked at moving away from GUM and family planning towards an integrated sexual health service, which mirrored Ms McCormack’s view. As part of the drive to improve sexual health services, funding was made available for GUM pilots. Salford PCT made a successful bid.
‘We seized the opportunity to merge the family planning and GUM clinics and to become a sexual health service,’ she says.
In 2003 the PCT set up a service redesign group that included Ms McCormack in her new role as sexual health manager, a public health consultant, a GUM consultant and representatives from the patient and public involvement service. The PCT also held consultation events with employees.
‘One of the problems we had was fear of change – such as concerns about new roles and responsibilities. So we needed to allay people’s fears,’ says Ms McCormack.
To equip staff with skills to care for people with different sexual health needs, the PCT liaised with Manchester Metropolitan University to deliver in-house training in reproductive and sexual health. To speed up access, the PCT purchased an IT system so appointments could be booked electronically.
After four years of preparation, the service was launched on World Aids Day in December 2006. To publicise it, information packs were sent to GPs and other primary care providers with the message: ‘Have you checked your sex factor?’
So that most patients’ needs can be met at their choice of clinic in just one visit, the service is based on a ‘hub and spoke’ model. The hub is the Goodman Centre, where specialist care is carried out by a sexual health consultant. The spokes are evening services that are run in different clinics and offer screening and reproductive healthcare.
Asymptomatic patients who call the hub for an appointment are given a choice of clinics and times. Clients in need of specialist services or with specific symptoms can visit the Goodman Centre.
All staff are multi-skilled and a career structure allows employees to progress from being an HCA to being a lead nurse.
Patients now find the experience of sexual healthcare less embarrassing, Ms McCormack believes. ‘Clients who come through the door are visiting a sexual health clinic. Nobody knows the specific reason they are here apart from the nurses.’
Overcoming negative attitudes towards sexual healthcare remains a challenge. ‘While we were setting up the service, one GP told us that “no self-respecting woman would ever be seen at a sexual health clinic”,’ Ms McCormack recalls. ‘So we work with other healthcare professionals to make them aware of the service benefits.’
Taking an integrated approach means problems that might previously have gone unnoticed are identified, she adds.
‘There are patients who come for contraception who, after a chat with a nurse, realise they may have an STI.’
Rather than another appointment being made, tests are done then. Results can be sent to patients by text if they so wish.
Young people are also benefiting. Keep It Sorted in Salford (KISS) is a youth clinic offering advice, screening and the chance to talk to trained staff about sexual health.
‘People feel comfortable coming to see us. For me, this has been one of our outstanding achievements,’ says Ms McCormack.
The NT judges were impressed with the scope of the service and the enthusiasm of the team. ‘What stood out was how well the team worked together to turn the service around,’ says NT’s sexual health category judge Leigh Chislett, clinic manager for the Victoria Clinic, Chelsea and Westminster NHS Trust. ‘The passion for what they were doing really did shine through.’
In keeping with the team spirit, the winnings will be spent on a staff social event. ‘We’re thrilled to win an award that helps put sexual health on the agenda. It’s opened up doors for us and given our work authority,’ says Ms McCormack.
She regularly talks to other PCTs about service redesign and receives frequent visits from people working in sexual health who want to know more about the project.
‘People always want to know how we negotiated change. I tell them it’s vital to get everyone on board early on, to make sure they’re well informed and to listen to suggestions.’
Since receiving the NT Award, the service has ‘taken on its own momentum’, she says. A service in a secondary school is one of many plans Ms McCormack has.
‘Our work is constantly evolving and challenging, and we’ll seize every opportunity we can until someone tells us not to!’ she says.
‘But whatever we do, I know we’ll all contribute and learn from each other – that’s what makes us a pretty special team.’
How to develop an integrated sexual health service
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