The expansion of online services and the new FSRH-BASHH standards for online and remote providers of SH/SRH services

Posted 12 Mar 2019

Date: 12 Mar 2019

Author: Dr Helen Munro

Increasing demand, limited resources and innovative testing technologies have all played a part in driving the rapid expansion in online sexual health and sexual and reproductive healthcare (SH/SRH) services. With an eye firmly fixed on patient safety and a desire to ensure consistency and quality of care across all settings, the Faculty of Sexual and Reproductive Healthcare (FSRH) and the British Association for Sexual Health and HIV (BASHH) have jointly developed the first set of quality standards for online and remote providers of SH/SRH services. Dr Helen Munro, Vice President of FSRH & Chair of the FSRH’s Clinical Standards Committee (CSC) and Dr Raj Patel, Chair of BASHH’s Clinical Standards Unit, provide background on the online standards, including key issues that came up during their development.

Helen Munro TrusteeIn recent years the UK has seen a rapid expansion of online and remote health services, driven in part by the need to accommodate the ever-increasing demands on an over-stretched and resource-limited NHS. The proportion of over-16s looking for health-related information on the internet has also increased by over 30% in the last decade and services have responded to this by offering online SH/SRH health information and care and internet-accessed testing to complement more traditional face-to-face services.

In 2018 the Care Quality Commission (CQC) published a report following initial inspections of those online providers of primary health care which were registered with them at that time. Many providers were found to offer management of sexual infections and provide contraception care in non face-to-face environments. The report highlighted specific concerns around safe prescribing practices, consent and capacity, proof of identity and safeguarding of children and vulnerable adults.

In January 2019 the Standards for Online and Remote Providers of Sexual and Reproductive Health Services were published; a set of standards co-authored by FSRH and BASHH. The document was written in response to a need, voiced by providers, commissioners and service users of SH/SRH services, to provide clear guidance on what to expect from the growing number of these providers.

In response to the CQC findings, FSRH and BASHH collaborated on developing a set of ‘best practice’ standards of care for those providing SH/SRH services through avenues other than traditional face-to-face services. These could include a range of consultation methods from real-time interactive health care via a video link to web-based questionnaires.

Whilst FSRH and BASHH support technological innovations and recognise that online and remote services have enormous potential for both public and private providers (NHS and non-NHS) to engage with the challenges of healthcare provision in the twenty-first century, we strongly believe that, irrespective of consultation modality, best practice and guidelines must be adhered to at every user contact to ensure safety and quality of care and that this should not be compromised.

A ‘standards’ working group was made up of members from BASHH and FSRH, but views and experiences were sought in a round-table discussion from other providers and stakeholders of SH/ SRH care including the Royal College of Nursing (RCN), Royal College of General Practitioners (RCGP), CQC, LloydsPharmacy™ Online Doctor and SH:24. There was also an opportunity during the public consultation for an even wider audience to comment, and the working group was appreciative of the feedback they received on the draft Standard which enabled them to shape the final document.

The Standard has five sections which mirror the lines of enquiry followed by the CQC during their investigations:

STANDARD 1. Safe Care: including remote prescribing, safeguarding, staff training, risk and performance
STANDARD 2. Effective Care: including valid consent, assessing capacity, management of information, record keeping, advertising standards
STANDARD 3. Treating People with Kindness, Respect and Compassion: including access to services, consultations, user involvement, confidentiality 
STANDARD 4. Ensuring Provision is Responsive: including promoting equality, responding to complaints, service user engagement 
STANDARD 5. Questions of Governance and Leadership: including accountability, culture, learning improvement  

One of the main themes highlighted by the CQC was the need for proof of identity (including age) for users of non-face-to-face services. Within primary health care proof of identity and residence is standard practice when registering. However, users of SH/SRH services have never had to prove their identity or residency prior to seeking sexual health care and the working group felt it was important to protect this even on a remote platform.

Dr Raj Patel, Chair of BASHH’s Clinical Standards UnitThe working group consulted widely regarding access to online services for individuals who are aged under 16 years. While it is recognised that there are many benefits to a young person accessing SH/ SRH services through a non-face-to-face environment, which create, as one study has found, a less pressured space for asking safeguarding questions, new GDPR and data protection laws expect services to demonstrate that individuals who are aged under 16 years have the capacity to consent to their data being collected and processed remotely. Legally this would be difficult to show through an online service without confirming age and identification, and, for this reason, we recommend individuals who are aged under 16 years are signposted to face-to-face services.

Current research around SH/ SRH provision through online services is still in its infancy, though growing, and we hope that any developing evidence will be used to shape the online services of the future. One piece of feedback from the public consultation concerned the lack of ‘key performance indicators (KPIs)’ within the standards e.g. such as test turnaround times. The working group recognises that the standards will evolve as evidence becomes available to support the creation of quantifiable measures and targets but did not feel that evidence-based robust measures could be identified at the time of publication. It is also important to highlight that this is a standard to be utilised across the UK, including the devolved nations where commissioning and KPIs are framed and used differently from England.

BASHH and FSRH recognise the changing landscape of SH/ SRH clinically and politically within the UK and the need for ‘smarter’ ways of working which are future proofed for every eventuality. However, we also fundamentally believe, as healthcare professionals, that the service accessed by the user needs to be safe and of the same quality and standard that would be expected irrespective of the provider, or mode of contact, and that is the main driver for this piece of work.

The FRSH/BASHH Standards for Online and Remote Providers of Sexual and Reproductive Health Services were published on 25 January 2019. You can read the press release here.

Piece originally published on the March 2019 issue of the Sexual Health, Reproductive Health & HIV Policy eBulletin