London Sexual Health Programme

Project: A nurse specialist attends TOP assessment clinics and theatre sessions to promote and insert LARC. A database was created to register and monitor young people accessing services providing 1:1 pathway interventions where YP are through to be particularly at risk. The SRE coordinator and Young People’s development worker signposted YP into specialist services with the aim of increasing awareness and promoting LARC and Sexual Health screening. The success of the project has been due to strong stakeholder engagement with TOP providers, the Teenage Pregnancy team GUM services and colleagues in statutory and voluntary sector.

Outcomes: As of 2010/2011 Q4 there are 189 young people registered on the database and all of Wandsworth’s TOP providers promote and offer routine Chlamydia and Gonorrhoea screening. 153 young people were seen by the specialist nurse in StGH TOP service and 59% of those given contraception there chose a LARC method.  The project has been mainstreamed, further engagement with other service providers is needed to ensure all those at risk are followed up where appropriate.

Provider: Wandsworth PCT

Signpost: http://www.wandsworth.nhs.uk/Pages/Home.aspx

Project: Healthcare providers received training on how to deliver pregnancy options and counselling to young women, and afterwards noted that they were more comfortable and successful in supporting these women in pregnancy decision-making. This was previously a notable knowledge gap identified through pre-training questionnaires.

Outcomes: Despite a slightly lower uptake than anticipated, 185 health and social care professionals across 9 London boroughs were trained and feedback on the quality and relevance of the training has been very positive.

Provider: Education for Choice, which provides a range of training courses on pregnancy decision-making and abortion for professionals working with young people in and out of health settings.

Signpost: http://www.efc.org.uk/Home

Project: 20 pharmacies in Lewisham were part of a pilot project started in 2009 to train pharmacists to provide contraception in house.  In Q1 of 2010/2011, 45 initial POP consultations, and 8 follow-ups were achieved. In Q2, additional pharmacists were trained in handling requests for POP (31 pharmacists) and EHC (35 pharmacists), and there were 52 first consultations for these services with 3 follow-ups. Q3 saw 40 initial consultations with no follow-ups but full web-based recording of consultations resulting in a more efficient process.

Outcomes: By Q4, there were an additional 40 first consultations, making a total of 177 for the entire year. Ongoing issues with the supply of Cerazette have had an impact on the project as well as the rate of uptake among users.  A review of the project is currently underway.

Provider: Lewisham PCT

Signpost: http://www.lewishampct.nhs.uk/

Project: Lambeth and Southwark PCTs’ pharmaceutical services have recently expanded their provision of contraception and sexual health services, and it rendered very positive feedback. The service started in October 2009 with 3 pharmacies providing oral contraception and information on and referral for LARC.  In 2010/2011 Q1, the project began to grow with 87 consultations including  first-time contraceptive users, those receiving repeat supplies, and referrals for LARC products. Mystery shoppers were used to evaluate the service, with a lot of positive feedback received and only minor amendments to further improve the service, largely regarding information about the service given by counter staff.  In addition, a clinical audit was conducted and found that pharmacists were providing a high quality clinical service. Q2 saw a marked decrease in EHC use in Southwark, and 18 new pharmacists participating in training.

Outcomes: Finally in Q4, Lambeth/Southwark PCTs undertook 115 new consultations and recorded that 46% of initial oral contraceptive supplies were provided for first-time pill users.  By the end of June 2011, 741 oral contraception consultations had been conducted in Southwark and Lambeth, including 512 initial supplies of the pill and 181 repeat supplies given.  In addition, all level 1 Sexual Health providers in Southwark were trained to provide LARC information in all EHC consultations, which may have contributed to the significant decrease in demand for EHC. Research in one pharmacy suggested that the main reason people do not return for a repeat supply is due to a change in their relationship status and preferring condoms or EHC.  Pharmacists from three other London PCTs have now been trained to provide contraception in community pharmacy, and the service has been mainstreamed in Southwark. 

Provider: Southwark PCT

Signpost: http://www.southwarkpct.nhs.uk/

Project: CluedUp is a 10 session programme designed to empower young women with new skills, knowledge and support networks. During the initial stages Living Well worked with over 100 professionals and young people from across London during seven co-creation events to co-design the programme's structure and content to ensure that it is relevant, accessible and fit for purpose. As part of the development and piloted of the programme, CluedUp has now been delivered in 3 boroughs, Lambeth, Southwark and Wandsworth and has worked with 43 young women. Each programme is co-delivered by a professional and at least one trained peer co-facilitator and includes topics such as healthy relationships, stress management, resisting pressure, local services, contraception, STIs, and confidence building to help young women make better, more informed, decisions about their health and wellbeing. 

Outputs:  A documentary film detailing the development and piloting of the programme, a facilitator manual, weekly blogs from facilitators and young people uploaded to Vimeo, a well-attended end of programme event (Feb 2011 at City Hall) closed the first phase of delivery and five young people trained to co-deliver sessions. Feedback from the project so far has been excellent and can be seen at: http://vimeo.com/channels/cluedup and http://vimeo.com/cluedup/videos

Provider: Living Well - http://www.livingwellcic.com

Signpost: http://www.clueduplondon.com/

                http://www.livingwellcic.com/what-we-do/youth-services/cluedup/

Project: The C-card is designed to operate across borough boundaries using the integrated RFID chip (oyster card technology) or barcode for young people to access condoms in the places most convenient to them and their lifestyle whilst still collecting robust data on the scheme.  In 2009/2010 Camden, Havering and Haringey piloted the scheme and the eye-catching but anonymous branding was developed in partnership with young people.  A partnership with Durex© was established during the pilot to contribute a fixed number of condoms to participating boroughs. The highly innovative Medi+Vend kiosks designed to distribute Chlamydia testing, pregnancy testing, condoms, and referrals to nearby clinics were placed in several London boroughs over the course of the pilot phase which commenced in 2009.  3 pilot kiosks with on screen messaging around LARC, C-card and other sexual health information went live in Q4 2009/2010 and received a really positive response from young people.

Outcomes: By the end of 2010/2011 pilot phase of C-cards, 13 boroughs were live, with another 12 more committed to go live during 2011/12 and interest growing across London. So far (July 2011) over 100,000 condoms have been issued to 10,000 registered young people in total. The Come Correct programme has been a great success thus far, and its ambition is for 100,000 young people to be involved and 1 million condoms distributed by 31 March, 2012. Unfortunately there were issues with connectivity in several of the Medi+Vend kiosk locations and following the voluntary liquidation of the kiosk supplier it was decided to close the project in September 2010 with remaining stock repurchased or redistributed to local services.

Provider: Camden Provider Services

Signpost: http://gettingiton.org.uk/agency.asp?borough=5&service=0&postcode=&id=844

                http://www.medivend.co.uk/

Project: Since the ‘Improving Choices in Contraception through Training’ (ICCtT) project was launched, it has been widely successful: 105 HCPs have been trained to insert sub-dermal implants, and 56 are also competent in removals.  39 have completed training for inserting IUDs. In addition, 7 have completed clinical updates in SDI and 13 have completed clinical updates in IUT.

Outcomes: Awareness of the project among HCPs has increased significantly following promotion through LARC GP champions, London LARC network and LSHP. Online training resources and better communication during the training process has improved compliance although there are still issues with patients failing to attend pre-booked appointments.  This work is now being jointly funded by Bayer Healthcare and MSD.

Provider: CPCT/Margaret Pyke Centre and Lambeth RHS services

Signpost: http://www.margaretpyke.org/

Project: The project had a rocky start, as one of the two recruited nurses had to leave unexpectedly. However the remaining nurse succeeded in her dual training and was a huge asset to the PCT, greatly increasing the capacity to provide contraception and STI testing.  Having left the service in December 2010 for personal reasons, the dual trained nurse has recently returned (July 2011) permanently to the service as a Band 7 Lead Nurse with responsibility for Sexual Health consolidating all her experience in GUM and adding to her skills in contraception.

Her next aim is to complete bi manual training so that in time she can undertake IUD training.  This piece of work has produced a fantastic result for the Greenwich CASH Service.

Outcomes: Currently, a second nurse is undergoing the same dual training due to the success of the pilot and it is expected this model will be rolled out more widely in the future.

Provider: Greenwich PCT

Signpost: http://www.greenwichpct.nhs.uk/

Project: Research on adherence to the implant in young women has been commissioned at Greenwich University to follow-up anecdotal evidence of high rates of removal.  Recruitment is underway to interview women aged 16-19 about their experiences of the implant and contraceptive histories.  Health practitioners have also been interviewed regarding patients’ decisions to remove the implant to further understand the reasoning behind it.  

Outcomes: Although recruitment is difficult for such a sensitive topic area study, 13 interviews have taken place (with healthcare professionals and young women) and the researchers at Greenwich will consider expanding the duration of the project to obtain sufficient data if necessary.

Provider: Greenwich University

Signpost: http://www.gre.ac.uk/schools/health/research/the-sexual-health-research-and-practice-group

The projects: FESHyouthNet, FESHproNET, the FE Community of Practice and the FE College Pilot Programme are all part of FESH programme of work coordinated by MBARC.  The aim of FESH is to improve access to sexual health services, information and education in Further Education and 6^th Form Colleges.  

The FE College Pilot Programme has been implemented in Southgate, Lambeth, and Lewisham colleges and it has worked on setting standards for developing and delivering a range of high quality sexual health services in FE and 6^th Form Colleges.

FESHyouthNet is a group of students from FE and 6^th Form Colleges across London working to support the FESH programme.  FESHyouthNET has worked on projects and events including the Young People’s Sexual Health Showcase and the development of the weknowbest.co.uk website.  FESHyouthNET has worked in partnership with both Brook and Living Well. 

FESHproNET is a multi-disciplinary group of professionals from the NHS, further education and sexual health organisations who are responsible for driving the FESH programme forward and helping the programme reach its goals.  

FE Community of Practice is a web based resource hosted by MBARC and is a sexual health information exchange for all staff working in London based FE settings. 

Outcomes: Work is underway to evaluate the current FESHyouthNET programme and recruit new members to FESHyouthNet.  A new programme of training for FESHyouthNET is also being produced.  The FE Community of Practice will launch in early September 2011 and the FE Pilot Project Evaluation will be published in early autumn.  This evaluation will inform the refresh of the Going All The Way accreditation including the development of a youth auditing process. FESHproNET will continue meeting on a quarterly basis and plans are underway to broaden the membership of FE and 6^th Form Colleges.

Provider: MBARC Ltd.

Signpost: http://www.mbarc.co.uk/our-work/our-work-details?id=16

                    www.weknowbest.co.uk

Project: YouthBytes has designed an innovative desktop widget for use in FE colleges to promote health and wellness with a strong emphasis on sexual health. At the start of the project, in 2009/2010 Q4, 16 out of 23 commissioned colleges went live with the technology, which averaged 186 clicks per week and had a total of 74,810 views in the quarter. In 2010/2011, the ‘WeKnowBest’ website was developed as an exciting site created by young people for young people and signposted to from the YouthBytes platform for more detailed information on sexual health. 

Outcomes: Both the desktop widget and WeKnowBest site have been consistently popular with viewers of the messaging and Q4 2010/11 saw 1,014,185 views of the sexual health messaging on the widget and 10,847 click-throughs to the WeKnowBest website across the 22 FE colleges that have gone live, which averages to a 0.5% click-through rate.

Provider: Youthbytes and MBARC

Signpost: http://www.youth-bytes.co.uk/

                http://weknowbest.co.uk/

Project: RITEstart is a free peer-led holistic sexual health and wellbeing programme designed to give young people the skills and confidence to make healthy decisions surrounding sex and relationships through a series of interactive workshops. In its initial year the programme trained over 20 young co-facilitators RITEstart had support from the Mayor’s Young London Team, FE Colleges, and FESH (Further Education on Sexual Health). Moving forward RITEstart will be working with a smaller group of young people working towards gaining qualifications in Youth Work and becoming peer professionals, able to deliver the programme in FE colleges in London.

Outcomes: Over its first year, the RITEstart programme delivered workshops to 170 participants in Hackney, Wandsworth, Merton, Hammersmith & Fulham, and Kensington & Chelsea. The first two cohorts of peer educators have now completed the course, gaining Open College Network accreditation and the RITEstart promotional video for the RITEstart projects can be found on Living Well’s website.

Provider: Living Well

Signpost: http://www.livingwellcic.com/what-we-do/youth-services/ritestart/

Project: This training project targeted teaching and learning support staff in FE colleges, and trained them in delivering Sex and Relationships education, including contraception and LARC, in order to give more comprehensive information and tutorials on sexual health to students. The program began in July 2010 with 15 interested colleges, but due to funding cuts and staff restructuring in the colleges, only 7 ultimately participated (West Thames College, City and Islington, Kingston, Southwark, Westminster Kingsway, College of Haringey, and Richmond upon Thames). Staff and students identified by online surveys and focus groups that the programs they would like further information on were sexual bullying, FGM, how to support LGBT learners, transgender awareness, and supporting LDD learners, as well as more general sexual health and healthy relationships. The project ran learning events to support the colleges.

Outcomes: Having completed the training, FE college staff noted that they felt much more prepared to discuss sexual health topics such as contraception, pregnancy options, deciding to have sex, faith and sex, and sexual orientation with students.

Provider: Brook London

Signpost: http://brook.org.uk/london

Project: Now entering its second year, the London LARC Network has been integral to addressing issues around improving the uptake of LARC in London.  Their work has included recruiting and supporting sector GP champions as well as a GP lead for SRH. The LLN has established a network of lead nurses, standardised read codes for LARC procedures in primary care in London, undertaken scoping of nurse training courses with Higher Education Institutes and are currently involved in developing Patient Group Directions (PGD) templates. In addition, the LLN has worked with the Contraception and Abortion Group as well as the London Sexual Health Commissioning Network.

Outcomes: Seven GP Champions were appointed in 2010/11 to oversee specific work relating to LARC in the sectors they represent.  A London GP lead has also been appointed to work more strategically to address pan-London issues.   The LLN were involved in a highly successful LARC information event in November 2010 attended by 150 delegates which is planned to be repeated in 2011. Currently, research and development is underway around SDI and IUD/IUS clinical care.

Provider: Options UK; weblink to be updated shortly

Project: A ‘Toolkit’ has been developed for use by commissioners, providers and service users to understand PPE and access examples of best practice to improve engagement in services.  This will be included in the Sexual Health Policy document by DH and supports the QIPP agenda. 

Outcomes: With support from Gilead, Snap Surveys, and ViiV Healthcare, the project was launched at an event in May 2011, where 170 delegates and several keynote speakers including Baroness Gould and Andrea Duncan gathered to discuss PPE in sexual health and how it can help their organisations.  This project will expand on the success of the toolkit by developing training in its use and increasing information on auditing PPE.

Provider: Thames Valley University

Signpost: http://www.londonsexualhealth.org/patient-public-engagement/ppe-toolbox/the-toolkit.html