Abstract

In 2009 the East Lindsey Practice Based Commissioning Cluster (PBC) successfully secured funding from the Lincolnshire Primary Care Trust Rapid Improvement Fund to initiate a pilot site for a Level 2 Sexual Health Service within a Primary Care setting. This service, the Greta Ross Sexual Health Clinic, is housed at the Newmarket Medical Practice in Louth and has been fully operational since 5th June 2009.

The principal aim of the service is to meet the requirements of the local community and surrounding locality by providing a quality Level 2 Sexual Health Service. The specific aims of the service are:
• to widen access opportunities for sexual infection screening and diagnostics for clients in the Louth area.
• to provide a clinical learning environment where the host-clinicians can develop their theoretical knowledge of genitourinary medicine for clinical application and explore ways of integrating that with their sexual and reproductive health practice.

The Community and Public Health Research Group at the University of Lincoln were commissioned by NHS Lincolnshire to conduct an external and independent evaluation of the service. This report presents the methods and results of the evaluation, and in addition, makes recommendations for the future delivery of the service.

The aims of the evaluation were:
• To assess the extent to which the Greta Ross clinic is achieving its two key aims
• Conduct a cost-benefit analysis of clinic activity to date

The specific objectives were:
• To analyse all routinely collected data to build a profile of the service users
• To analyse all available cost data to conduct the cost-consequences analysis
• To conduct a content analysis of all relevant local policy documents and compare these with nationally recognised benchmarks of best practice, in the delivery of Level 2 sexual health services
• To analyse data from service users who accessed the service and who completed the quality improvement questionnaire provided by the clinic since it opened.
• To conduct a series of qualitative interviews with a small sample of service users to assess their experience of the service
• To conduct a series of qualitative interviews with a small sample of key stakeholders to explore their experiences of setting up and delivering the service
• To provide recommendations for the future delivery of the service.

The evaluation employed a range of data collection methods and for reasons of expediency, optimised the use of existing data wherever possible. The key data sources included analysis of routinely collected clinical and attendance data, content analysis of the clinic’s quarterly reports and policy documents, analysis of any available data pertaining to the cost of delivering the service, participant observation of the running of the clinic, a survey of clinic users and a series of in-depth interviews with service users and providers. Full details of each of these components are outlined in the main report.

This evaluation has provided good evidence that the Greta Ross clinic is providing a valued service to the population of Louth and the surrounding area. The clinic is generally performing very well and is meeting many of the national standards as set out by MedFASH (2005).

The evidence of high quality has been judged through eliciting the views of those accessing the services, both through the questionnaire data and through in-depth personal interviews. Detailed analysis of key policy documents written and utilised by the clinic helped to demonstrate that a safe and effective service is being delivered resulting in very positive patient experience. The service approach is holistic, flexible, non-judgemental, patient centred and confidential. It has been successful in attracting people of all age groups including those over the age of 60, whose numbers were not initially anticipated to be significant. The clinic provides a good training environment, with the valued opportunity for the nurses and GpswSI to work directly alongside the GU consultant: the staff clearly benefit from the presence of a GUM consultant on site one day per month. Those patients needing more specialist level 3 services also benefit by the involvement of the GU consultant as their care can be managed at the Greta Ross clinic thus removing the need to refer them to an alternative genitourinary medicine clinic. The availability of chlamydia screening also contributes towards helping the PCT to reach its local targets.

The evaluation did also reveal some areas for improvement, including exploring with the PCT ways of ensuring the clinic has the capacity to keep up with demand as client numbers continue to grow. It is also recommended that the service re-visit its advertising strategy and promotional materials, including those published by the Beautiful SHE counselling service to which Greta Ross clients are referred. Both services are encouraged to explore ways of widening their client base. Observations and recommendations have also been made in relation to prescribing polices and specimen testing.