Safeguarding essential care in the time of COVID-19

The Faculty of Sexual and Reproductive Healthcare (FSRH), the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) have jointly produced a COVID-19 contingency plan outlining to Government what is necessary to support the delivery of essential sexual health, reproductive health and HIV healthcare. FSRH President Dr Asha Kasliwal, BASHH President Dr John McSorley and BHIVA Chair Dr Laura Waters present key elements of the plan, including a scaled up digital infrastructure to provide relief to services and maintain access to care.

It is becoming clear that the outbreak of COVID-19 will mean significant disruption for sexual health, reproductive health and HIV services in the UK. With many of our staff being redeployed to frontline hospital services, and restrictions on face-to-face interactions, clinics are having to make unprecedented service provision decisions, including temporarily suspending many ‘usual’ functions of their service. The sector faces a significant challenge in responding to patients who need urgent and essential care.

"Without a swift, well-coordinated response, we believe we may see significantly adverse sexual, reproductive health and HIV outcomes for the general population, including a rise in unplanned pregnancies, sexually transmitted infections and abortions.

"But this doesn’t have to happen. We are working hard to ensure that sexual health, reproductive health and HIV services are able to adapt to the changing times, so that we can continue to meet patients’ needs."

- Dr Asha Kasliwal, FSRH President; Dr John McSorley, BASHH President; and Dr Laura Waters, Chair of BHIVA

Setting out our contingency plan for sexual health, reproductive health and HIV services

The FSRH, BASHH and BHIVA have joined forces to set out four key areas where Government action is urgently needed to support the delivery of essential sexual, reproductive and HIV healthcare. 

Together, we outlined our recommendations in a memo to senior Government officials:

• Introduce a digital sexual health service across the UK to provide immediate relief to services and to support the maintenance of access to essential care – including contraception, STI and HIV testing and treatment, and abortion care.
• Make changes to specific legislation and regulatory frameworks in order to remove barriers to care.
• Secure access to emergency elements of STI and contraception care, including free, over-the-counter emergency contraception.
• Secure access to care which will prevent short, medium and long-term adverse outcomes, including maintaining access to contraception and HIV care.

Safeguarding essential care

Services will be stretched. It is therefore vital that we prioritise essential care, ensuring that the patients who need it most are treated effectively and safely. This should include HIV patients, pregnant women with complications, victims of sexual assault, and people suffering from acute STI symptoms.

We are also committed to maintaining access to routine forms of contraception during this time, as well as management of existing symptom-based STIs. Failure to provide these services would lead to an increase in adverse sexual health outcomes and may also increase pressure on other service providers, such as abortion clinics.

Creating a new infrastructure for sexual health, reproductive health and HIV services

The Government’s restrictions on non-essential travel and the redeployment of some medical staff have meant that many services have already made huge adjustments to their service provision. We know that many are already conducting digital triage and online consultations, and have also taken decisions to suspend non-essential care services.

Within the next few days, we are calling for temporary investment into current services to ensure their continued operation. In the following weeks, we need the support of the Government and the NHS to scale up our existing digital infrastructure, so that regional digital services can provide better and more comprehensive care.

Longer-term, we are calling for the creation of a national digital service platform, which will serve as a one-stop point of access for the general public. Within 9 months from now, we want to see this operating seamlessly with regional face-to-face services – providing effective triage and a streamlined care pathway for those patients referred for face-to-face treatment.

Legislative and regulatory change is also essential. We have asked the Government to relax restrictions regarding how and in what quantity contraception (including emergency contraception) is able to be provided. We have also asked for regulations to be amended so that the progesterone-only pill (POP) can be provided over the counter in pharmacies, and so that pharmacists can legally supply a 6-month supply of oral contraception instead of the current one-month supply limit.

In addition, the FSRH has signed a letter from the British Pregnancy Advisory Service (bpas) encouraging the Health Secretary to temporarily modernise the abortion law so that nurses and midwives, as well as doctors, can authorise abortions. These measures are all clinically safe, and they will be necessary to streamline services and to ensure that all our patients continue to have access to safe and timely healthcare.

These measures will only work where there is nationwide coordination and Government support. We are already hearing from individual clinics that they lack the experience and infrastructure to provide extensive digital consultation platforms and triage services. That’s why we’re asking for a centrally-coordinated effort to streamline healthcare and to effectively triage and prioritise urgent and essential care.

We are confident that our skilled and dedicated workforce will continue to provide the best care possible in these unprecedented times. We are clear that sexual health, reproductive health and HIV services will continue to be vital to the nation’s health and wellbeing in the months ahead.

You can download the contingency plan here.

Originally published in the March 2020 COVID-19 special edition of the Sexual Health, Reproductive Health and HIV Policy eBulletin. The content of all eFeatures represents the views and opinions of the authors. FSRH and coalition partners do not necessarily share or endorse the views expressed within them.