JSNA topic report: sexual and reproductive health

Whilst there are a series of indicators where Buckinghamshire is performing better than the CIPFA average, there are also a series of indicators where Buckinghamshire’s performance is similar to CIPFA average.

It is recommended that Buckinghamshire sexual health services should focus on the following indicators where Bucks is performing worse than CIPFA average or is ranked in the bottom 6 out of 16 CIPFA areas.

• Chlamydia proportion aged 15 to 24 screened
• Chlamydia detection rate aged 15 to 24 (Female)
• HIV late diagnosis
• HIV late diagnosis in men who have sex with men (MSM)
• HIV late diagnosis in heterosexual men
• HIV late diagnosis in heterosexual women
• Total abortion rate
• Over 25s abortion rate
• Under 25s repeat abortions
• Total prescribed LARC excluding injections rate
• GP prescribed LARC excluding injections rate

In addition, the following indicators should be monitored closely:

• HIV testing coverage total
• HIV testing coverage in women.
• HIV diagnosed prevalence rate aged 15-59
• New HIV diagnosis rate aged 15+
• New STI diagnoses
• Gonorrhoea diagnostic rate
• Total prescribed LARC excluding injections rate

The stakeholder engagement has identified areas where Buckinghamshire sexual health services could be improved.

The service users recommend:

• improving the opening hours
• offering appointments in the evenings and weekends
• improve waiting times for appointment
• make waiting areas more discreet
• make more sexual health services available online

The key stakeholders, GPs, pharmacists and sexual health staff identified the following key areas that should be improved:

• the lack of a surgical termination site in Buckinghamshire
• the lack of outreach sexual health services to Travellers, Roma and Gypsies
• difficulty in getting emergency oral contraception from pharmacies
• the telephone answering service
• delays in appointments to have an IUD fitted especially in GP practices

It was considered there should be more sexual health services offered by GPs and pharmacists and improved training of school nurses and relevant school staff.

A key focus of several interviews was how to make services more accessible for people with relevant protected characteristics, especially homeless people, women with HIV, transgender, looked after children and care leavers, travellers and young people.

Alongside this, the importance of normalising attending sexual health clinics and normalising being tested for STIs was recommended.

It was also recommended that sexual health information to the Buckinghamshire’s sexually active population should be improved, including signposting, ensuring they inform all current and future service users of what sexual health services are available and how they can be accessed.

The sexual health information should be age and ability appropriate, using different social media approaches to target all relevant demographic groups in Buckinghamshire.

Outreach sexual health initiatives should be introduced that target hard to reach and high-risk groups. Prevention and health promotion interventions should then be optimised to maintain low STI rates.

Recommendations directed at sexual health commissioners included:

• NHS to commission a surgical termination of pregnancy clinic within Buckinghamshire
• commission NHS psychosexual services as part of NHS sexual health services in Buckinghamshire
• review the increased housing in the north of the county and consider commissioning outreach clinics to support these new populations
• commission integrated Sexual Health services in Buckinghamshire from a single provider
• identify which groups of people have found it challenging to access sexual health services during Covid and how this has impacted on their sexual health and well-being