From Acorns to Mighty Oaks: How to grow your own sexual and reproductive healthcare practitioners

Posted 02 Feb 2024

Date: 02 Feb 2024

Author: Sara Strodtbeck

As outlined within the 2018 Health Education England Scoping Report and the 2023 FSRH Workforce Report, Sexual and Reproductive Healthcare faces a looming staffing crisis. With one-third of the profession planning to retire in the next five years, developing the future workforce is key to sustaining and developing services. In her blog, Nurse Consultant Sara Strodtbeck explains how Axess Sexual Health services are growing their own practitioners.


Workforce challenges within Sexual and Reproductive Healthcare (SRH) identified in the 2019 Health Education England report “Improving the Delivery of Sexual Health Services: Sexual Health, Reproductive Health and HIV Workforce Scoping Project Report” reflected the experiences of Cheshire and Merseyside sexual health services. In 2019, The Cheshire and Merseyside Sexual Health Workforce Project (CMSHWP) was established with representation from clinicians within provider services, sexual health commissioning and Public Health England. Further to the recommendations within this report, and the establishment of Axess as a regional provider of sexual health services across Cheshire and Merseyside, this blog outlines the structured training programme we have created, which enables the development of practitioners at all levels and provides opportunities for career progression.

Health Care Assistants and Associate Practitioners

A key recommendation within the CMSHWP report was the development of a career pathway and structure for Health Care Assistants (HCA). HCAs are integral to the delivery of SRH services and have real development potential. Within Axess, Band 3 HCAs can be supported to become Band 4 Assistant Practitioners capable of, for example, administering contraceptive injections, vaccinations, and treatment for genital warts under Patient Specific Directions. Furthermore, Assistant Practitioners can be given the opportunity to apply for university placements to complete an 18-month ‘top-up’ training programme and return to the service as newly qualified nurses. On their return, they are appointed to the role of Trainee Clinical Practitioner. This is a training post in line with the ‘Annex 21’ section of the NHS Terms and Conditions of Service. Annex 21 outlines a percentage pay structure for those recruited to training posts between 1 and 4 years. A structured 1–2-year training programme is provided and on successful completion, the clinical practitioner enters the first pay point of the Band 6 scale.

Trainee and Clinical Practitioners

The use of Annex 21 posts was another recommendation of the CMSHWP. Typically, clinical practitioner posts within SRH are Band 6 as the expectation is that they perform as a largely autonomous practitioner using Patient Group Directions to provide care and treatments. However, as Axess provides integrated sexual health services regionally across Liverpool, Knowsley, Warrington, Halton, and East Cheshire, there are few Band 6 SRH practitioners who are not already working for the service. Those not working within SRH often lack the experience and clinical skills to enable them to perform as a Band 6 within the specialty. Annex 21 enables the recruitment of either newly qualified nurses or midwives, or those seeking a change in career, who may have no SRH experience.

Advanced and Consultant Practitioners

In line with national priorities to build a recognised and visible Advanced Clinical Practitioner Workforce, we also facilitate enhanced clinical skill development and theoretical study at Master’s level via Apprenticeship or traditional MSc routes. Annex 21 can also be utilised to recruit those who have potential but may not yet have advanced-level qualifications. Recently, the service has created its first Nurse Consultant post which completes the training and development pathway.

Our approach

Our approach to development not only offers structured and achievable career progression but also supports succession planning within an ageing workforce. Our core training incorporates nationally recognised training programmes such as FSRH Essentials Contraception and Menopause, DFSRH, Letters of Competence and STIF Foundation, Intermediate and Advanced level competencies. This supports the development of standardised competencies within each role to ensure consistent service delivery and facilitate cross-regional working. This augments the economies of scale derived from regional service provision. Underpinning this model of training and development are the recognised benefits to patients. Developing staff to achieve their full potential within each role increases access to services as it identifies the most appropriate clinician to meet the patient’s needs. Together with our other service initiatives to improve the sexual health of vulnerable populations such as young people, trans and non-binary people and commercial sex workers, inequalities in sexual health care may be significantly reduced.

I will end this blog with one of our many success stories relating to our approach to training portrayed below by Kate Rowlandson. Kate is a Trainee Advanced Practitioner and describes in her own words her meteoric career progression.

Kate RowlandsonKate’s story:

"Due to lack of prior sexual reproductive health (SRH) experience the transition from ITU into Sexual Health Nursing felt near impossible. During my fifth unsuccessful job interview *sigh*, the interview panel suggested I consider their upcoming Annex 21 post which seemed like an incredible development opportunity, emphasising attitude and values over prior SRH experience. Fast forward to a value-based (day-long!) interview process I was fortunate in securing the post and embarked on my journey.

Under the guidance of a fantastic and inspiring mentor, I was equipped with an extensive training plan and given every opportunity to develop valuable insights into the nuances of the world of sexual health and contraception. Through embracing a continuous professional development mindset, I found myself progressing steadily through multiple training programs and with encouragement from colleagues I pursued the pathway of Trainee Advance Clinical Practitioner as this felt like the natural progression of my career.

I'm now currently immersed in my Master's, my weeks are busy with university study, IUC clinics, and for added chaos we're renovating a house. It's been a dynamic and fulfilling journey, and I take pride in my progress. I wholeheartedly recommend others to seize similar opportunities and embark on this unique path. I've loved every second of it and I'm truly grateful to be a fully integrated Contraception and Sexual Health Nurse, with the qualifications to prove it! "