This content was originally published on the MEDFASH website as an e-feature on 9th December 2015 and it is reproduced here with kind permission of MEDFASH.
Dr Chris Wilkinson is a Consultant in Sexual and Reproductive Health and Medical Director of the Margaret Pyke Trust, and is part of a multidisciplinary clinical team delivering integrated specialist SRH services across several London boroughs. He is also President of the Faculty of Sexual and Reproductive Healthcare (FSRH), a cross specialty membership organisation for doctors and nurses working in SRH services, general practice, genitourinary medicine and obstetrics & gynaecology. In this month’s eFeature Chris unpacks several of the issues raised by the FSRH’s recently launched publication Better care, a better future: a new vision for sexual and reproductive health care. At a time when cuts to the public health budget are creating a climate of uncertainty surrounding provision of clinical services, the FSRH’s Vision sets out the fundamental principles that should underpin SRH provision for all to ensure that, even at this turbulent time, providers are held to account and service users can access high quality sexual and reproductive healthcare as standard.
The FSRH Vision is aimed at commissioners, managers and providers who share our ambition for a more joined up approach to SRH, HIV and gynaecological care. In it we set out what underpins good services, wherever and by whomever they are provided. The Vision development was led by our members, but with external consultation and collaboration. SRH is inherently personal and most people will need SRH information, care and support at some stage in their lives. That’s why it was paramount for us to define SRH in terms of the differing medical needs that span the life course. We drew on World Health Organization (WHO) definitions to define SRH as follows:
“Sexual and reproductive health care supports all people in having a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of infection, coercion, discrimination and violence; enabling them to decide if, when and how often to have children by informing them of, and providing access to, safe, effective, affordable and acceptable methods of fertility regulation of their choice. It also signposts women to the necessary support and care to go safely through pregnancy and childbirth, thus maximising the chance of having a healthy infant.” (1)
With a definition that embraces the complexities of SRH as our foundation, we were able to identify several themes that underpin the key principles of our Vision:
- The provision of easily accessible care.
- Integrating care around the needs of the individual, not medical, institutional or commissioning silos.
- A well trained and informed workforce, including education, training and clinical guidance appropriate to each healthcare professional’s role and area of work.
Patient experience and accessible care
The FSRH Vision makes clear that it should be the patient/service user experience that guides how we design and deliver services. The findings from a new, online ComRes survey of over 1000 British women aged 18-49, reveal a worrying reality for women trying to access a full range of contraceptive methods:
>One third (32%) of British women aged 18-24 and a quarter (25%) aged 18-49 agree that they find it difficult to get an appointment with their GP, nurse or clinician to talk about contraception
>one quarter (24%) of British women aged 18-24 agree that they do not feel comfortable discussing their choice of contraception with a relevant healthcare professional
>one in ten (11%) British women aged 18-49 agree that their preferred method of contraception is not always available from their GP, nurse or clinician.(2)
These findings highlight that choice (and by this we mean access to the full range of contraceptive options and “informed choice”, which we know impacts on correct use and continuation of a method), confidence (confidence in healthcare professionals being respectful and non-judgemental) and communication(listening to service experiences and feedback) are absolutely key to improving patient experience and truly meeting need.
All too often we hear of how patients are forced to navigate a fragmented system of care. We have known what the solution is for more than 20 years - integrate care. However the focus has been on integrating medical specialties, not care. Individual SRH needs cannot be compartmentalised to align with the current complexity of medical, institutional and commissioning silos.
FSRH members regard integration as not only essential, but also achievable. There are two building blocks on which integrational success hinges: high quality joined up commissioning and connecting services.
The FSRH believes that commissioning must be done on the basis of quality for the individual and society rather than cost alone. Equally, it should be recognised that health and wellbeing improvement requires a long-term commitment and commissioners must understand that frequent re-tendering creates instability and can hinder the development of effective networks and long term care. We therefore recommend that commissioners re-consider whether tendering is the best way to achieve necessary improvements in quality and cost effectiveness.
In terms of connecting services, local authority and NHS commissioners should be enabled to work much more closely together, combining budgets and services where this makes sense for patient care.
Is the workforce ‘Vision-ready’?
It’s a given that to implement our Vision our workforce must be fit for purpose. We believe that in order to develop a workforce with an optimum skill mix we need to ensure healthcare professionals have the following, appropriate to their role:
- Clinical knowledge, diagnostic and, for some, technical skills.
- Communications skills and cultural competency to ensure diverse population needs are met
- The ability to identify wider health and social issues and refer people to relevant pathways
At the FSRH we are committed to continuously developing our training programmes but training needs to be embedded in the contractual culture. Training clinicians costs money, a significant proportion of which has to be found locally which adds a tension to the commissioning process. However, we have a collective responsibility to ensure that the system is able to deliver trained healthcare professionals to staff the services of the future. The quality of an SRH consultation will directly impact on the outcome for that patient and investment in training of the workforce is cost effective.
Unlike the financial protection awarded to NHS funding, public health funding is not protected – so these clinical services that constitute the very foundation of a healthy society are facing the impact of significant cuts. Our members tell us about this on a daily basis and their experience is revealing worrying trends; for example, restrictions in access to care by age or place of residence, discontinuation of cervical screening, closure of clinics and women and men travelling increasing distances to obtain care.
The recently published FPA report Unprotected Nation - 2015 clearly sets out the costs averted in both health and social care spend through investment in SRH and especially in contraception. The conclusion is simple; it is the time for investment, not cuts, especially in contraception. We are now calling on the government to acknowledge it is cutting clinical services and to amend the decision made by the Coalition Government to put funding of SRH into local authority public health budgets.
At a time of major change, great advances can take place, but there are also risks. The FSRH Vision is particularly timely to ensure that we do not lose sight of the fundamental principles that should underpin SRH provision for all. We want to work in partnership with others to achieve this vision and we will be developing ‘implementation plans’ for each of the four nations of the UK to agree practical action to make progress. Please join us.
(1) FSRH (2015) Better care, a better future: a new vision for sexual and reproductive healthcare Available at: fsrh.org/pdfs/FSRH_Vision.pdf
(2) ComRes interviewed 1108 British women of reproductive age (18-49 years) online between 11 and 15 November 2015. Data were weighted by age, socio-economic grade and region to be representative of all GB women. Full data tables are available at www.comres.co.uk/polls/faculty-of-sexual-reproduction-and-healthcare-access-to-contraception-among-british-women/