Have sexual health services been cut too far?
The transformation in sexual health services in the past few years has resulted in a workforce with incomplete skills, but new resource from RCN will help
The transformation in sexual health services in the past few years has resulted in a workforce with incomplete skills, but new RCN resources will help
Sexual health services have seen significant upheaval and transformation since the Health and Social Care Act of 2012. While the principle of integrated delivery of contraception and infection care under one roof promoted in the act was welcomed, there have been unintended outcomes as a result of the shift from NHS to local authority commissioning.
One such outcome was a workforce with incomplete skill sets for the new model of delivery.
Nurses came from community provision skilled in contraception delivery or from secondary care services skilled in the management of sexually transmitted infections. The new model required the nursing cohort to be skilled in managing the holistic needs of patients and meeting the key performance indicators associated with the tightly managed contracts.
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There was also fragmentation of services that saw HIV care fractured from the familiar model of integration with genito-urinary services to a stand-alone service in secondary care. The demand for sexual health services, meanwhile, has never been higher – the level of syphilis is the highest since the end of the second world war and there has been an increase in gonorrhoea.
Staff working in sexual health have reported poor training opportunities, a lack of understanding of training needs, poor morale and lack of funding, leading to nurses with high skill sets leaving the speciality.
RCN report highlights four themes for nurses working in sexual and reproductive health
The RCN conducted a survey of members to understand the issues more fully, and analysed the results in a report highlighting four themes:
- Access to and availability of education and training at appropriate levels for nurses.
- Complexity of commissioning arrangements.
- Workforce planning and skill mix between support staff and registered nurses.
- Impact of current commissioning on services and users of services.
Nurses reported that there was a lack of understanding by service providers on appropriate levels of education, and no clear recognition of parity between courses. The lack of training for some nurses was being compounded by others being expected to duplicate training, all contributing to inefficient service delivery.
The RCN has developed resources to support the career progression of nurses working in sexual health with videos and career stories, and an education directory tool. It sets out what level of education staff need, from advanced level in integrated sexual health through to support workers and those working in services that have a sexual health component in their role, such as midwives working in termination services or general practice nurses delivering contraception.
Education directory will help make workforce effective
The Sexual health education directory will support individual nurses, managers and commissioners to ensure there is a safe, trained, effective and efficient workforce to deliver an holistic model of care that contributes to good patient and public health outcomes.
It is useful to support job description writing, and in ensuring equity and parity across amalgamated workforces and service delivery in all areas. The holistic model of care can ensure people are free from sexual ill health and are supported to lead fulfilling sex lives.
Many contracts commissioned by local authorities have expectations that different levels of sexual healthcare are delivered by different cohorts and workforces – such as school nurses or health visitors – with the expectation that non-specialist providers will be part of the solution in improving health outcomes and normalising sexual health discussion.
There are many opportunities for communication relating to sexual health, but they are often lost due to lack of skills or confidence and embarrassment.
The new RCN resources aims to support staff, provide clarity and ensure that nurses are able to practice safely and deliver robust evidence-based holistic clinical care while meeting the expectations of their medical colleagues, managers and commissioners.
Belinda Loftus is cluster manager for sexual health at Spectrum Community Health, a community interest company
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