Sexual Health Improvement for Populations and Patients

SHIPP – a Health Integration Team

John Macleod, 12th June 2015

SHIPP: a partnership between“people with a stake in sexual health improvement with shared ambitions and agreed vision of how to achieve them”

University of Bristol, University of the West of England, Bristol City Council, North Somerset Council, South Gloucester Council, Bristol Clinical Commissioning Group, University Hospitals Bristol NHS Foundation Trust, North Bristol NHS Trust, Public Health England, NHS England Area Team, Terrence Higgins Trust, Brook Bristol, Marie Stopes International, Aquarius Public Health – and patients

The SHIPP model• Assess and prioritise need • Advise on commissioning evidence based care

pathways to meet this effectively (and provide value for money)

• Identify evidence gaps and facilitate research to fill these

Examples of projects• Strengthening Chlamydia screening• Prevalence of TV in the community• Recognising and responding to IPV• Increasing earlier diagnosis of HIV• Refreshing the JSNA to inform re-

commissioning• Improving patient pathways with POC tests• Using routine data in evaluation

IMPACT-PC Improved Management of Patients with

Chlamydia trachomatis and Neisseria gonorrhoea diagnosed in Primary

Care Trial

IMPACT-PC• 16% probability that a CT episode will cause

PID and 45% of TFI are caused by CT• 10-15% of sexual health spend on NCSP• 50% of CT testing in primary care amongst

asymptomatic individuals• 5-10% of these tests are positive• Evidence that timely treatment and PN effective• Primary care not set up to provide these and

GPs say they would value help

IMPACT-PC• Evaluating feasibility and acceptability of

centralised nurse led Rx and PN• 6-month randomised feasibility study

INTERVENTION practices – option to choose the centralised telephone-based service for management of all CT and NG tests by specialist nurses where clinically appropriate

CONTROL practises – usual care

IMPACT-PC• Support obtained from CLAHRCwest and

HPRU (evaluation) in Spring 2014• Ethical approval Autumn 2014• NIHR portfolio adoption Winter 2014• Agreement of SSCs, practice recruitment etc

Winter 2014-15• Patient enrolment from Spring 2015

Discussion

• Primary research within the “HIT model” still takes time

• “HIT friendly” funding streams more suited to secondary research

Expertise mainly in data analysis and evidence synthesis

Limited ability to support fieldwork unless small scale and qualitative

Still confusion over portfolio eligibility (hence CRN input and SSCs) of CLAHRC studies

Conclusions

• HITs are a success and are supporting evidence based commissioning and practice

• HITs should be ambitious but their ambitions should be realistic

• HITs are evolving