Redesigning and reshaping SRH services in Scotland: a response to the pandemic

Rosie Ilett, FSRH Honorary Fellow and public affairs consultant for the FSRH Scotland Committee, outlines findings from a recent qualitative survey carried out in Summer 2020 during the COVID-19 pandemic. The survey sought the views of FSRH Scotland Committee members on changes to services, impact on inequalities affecting women and suggestions for restoring services and sustaining positive changes in Scotland. Most respondents are SRH consultants in SRH services and one is a GP.

How have services changed in Scotland during COVID-19?

 

FSRH Scotland Committee members described sudden changes affecting their service at the beginning of the pandemic:

‘From 20th March, we limited all clinical provision to urgent and essential care only. The SRH in XXX was closed and is still not available for clinical use’.

Face-to-face consultations in the SRH services within which the members worked reduced to 10%:

‘We maintained a skeleton service of face-to-face consultations mainly to provide contraceptive injections and emergency coil fitting and occasional examinations for pelviv inflammatory disease.We operated a telephone consultation service offering pills etc by post and occasionally posted out treatments for chlamydia or candida’.

Phone consultations were felt to be highly effective:

‘Telephone consultations take longer and include the holistic needs of women as they would if seen face to face. Although ‘there is loss of the intimacy of a face-to-face consultation’.

New systems of delivering contraception and medications were felt to be positive:

‘Postal testing kits, home HIV testing and pills by post, or pills at community pharmacy, has actually increased accessibility’. However, contraceptive choice has been affected. ‘Access to Long Acting Reversible Contraception (LARC) was completely obliterated during lockdown and will remain seriously restricted in months to come.’ Despite this ‘most women who contacted the service were started on, or continued on an effective contraceptive method’.

Temporary legislative change has led to the majority of medical abortions now being managed by phone consultation and home administration of medication:

‘The abortion service has been completely transformed and largely moved to a telemedicine service – women have received a quick and thorough service and feedback has been very positive’.

Impacts on inequalities affecting women who use SRH services

 

According to the respondents, women requiring more support, including those affected by sexual assault, have been prioritised. Efforts were made to continue provision in remote areas so ‘service users from these geographical locations were able to be managed remotely, or travel into clinic’. However, many felt that women experiencing inequalities have been further disenfranchised:

‘Vulnerable people and those from areas of deprivation have suffered most during the pandemic; going forward focus and energy should be put into addressing these issues and redirecting those more able to access care to primary or pharmacy care’.

Concerns related to women for whom English is not their first language, with lack of interpreter services affected their ability to access care, although it was felt that the Near Me video consultation system run by the NHS in Scotland and the Scottish Government has helped overcome some of these challenges. Significant and useful interventions on identification of violence by remote consultation were done, for example:

‘Support material for staff to safeguard women at risk of gender-based violence were developed in conjunction with Scottish Women’s Aid and Public Health Scotland for our service and shared widely via Public Health Scotland, Unison, FSRH’.

Restoring services and sustaining improvements emerging through COVID-19

 

Respondents felt that many of the changes should continue:

• Remote consultation for menopause, PMS, psychosex and some gynaecology is effective and reduces waiting times
• Near Me should be available in all clinic settings
• Improved IT to facilitate web-based consultation
• Abortion care via remote consultation and home administration of medicines
• Provision of contraception by post
• Supporting routine contraceptive provision in primary care
• Pharmacy provision of oral and injectable contraception

Addressing inequalities

 

Respondents made the following recommendations to reduce the increased gap of inequalities:

• Greater focus and investment in SRH services for those affected by deprivation and social exclusion
• Online SRH information available in multiple languages
• Campaign to destigmatise SRH services for vulnerable and young people
• Empower people to take personal responsibility for their SRH
• Funding for a national online postal testing kit service for STIs
• Continue good practice e.g. mobile van providing services to homeless people and proactive outreach in hostels

Clinicians in SRH care across Scotland have redesigned and reshaped services in quick response to the pandemic and in a very complex context, as one noted:

'The goalposts keep changing. There has been huge anxiety as there is so much uncertainty about transmission of coronavirus and personal risks for staff, as well as wider risks for family, friends and colleagues, plus the massive impact on lifestyles, the economy, wider society.'

There are challenges to restoring SRH services. Waiting lists for LARC are significant, compounded by ongoing staff redeployment, reduced footfall for social distancing and increased cleaning routines. There needs to be increased support for those most in need and urgent review of service delivery. Service efficiency could improve by triaging and redirecting resources to outreach, partnership working and provision of LARC.

FSRH Scotland Committee members work at the heart of SRH planning and service delivery in Scotland, and continue to engage with the continued challenges that the pandemic brings.