National Chlamydia Screening Programme. National Audit Offi ce survey of Primary Care Trusts (PCTs)

Transcription

1 National Chlamydia Screening Programme National Audit Offi ce survey of Primary Care Trusts (PCTs)

2 Contents Introduction Background and main fi ndings from the National Audit Offi ce (NAO) survey of Primary Care Trusts (PCTs) 1 Section 1 NCSP commissioning overview 2 Section 2 NCSP expenditure 4 Section 3 Local coordination and Chlamydia Screening Offi ce 7 Section 4 Providers 8 Section 5 Notifi cation 11 Section 6 Marketing and communications 12 Section 7 PCT views of the NCSP 14

3 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Introduction 1 Introduction Background and main fi ndings from the National Audit Offi ce (NAO) survey of Primary Care Trusts (PCTs) 1 The overall aim of the NAO s report Young people s sexual health: The National Chlamydia Screening Programme was to examine the value for money of the Programme. As part of this, the NAO conducted a census of all 152 Primary Care Trusts, via between April and June We received responses from 145 PCTs. 2 The NAO report examined whether the Programme will be able to achieve its stated aims of reducing the levels of chlamydia infection in the population and the related consequences of untreated infection; and whether the local delivery model, in which individual PCTs are free to devise and deliver testing and treatment services locally, is providing value for money. The census data supported our examination of the local delivery model. 3 The questionnaire was subject to review by the Health and Social Care Information Centre Review of Central Returns (ROCR) Committee, who considered the data collection to be useful and reasonable (reference ROCR-Lite/09/0001). The questionnaire was pilot-tested with commissioners from three PCTs. 4 We provided the following guidance to PCTs on who should complete the questionnaire: We suggest that the PCT s commissioner with responsibility for sexual health is likely to be best placed to answer the majority of the questions. Prior to submission, we recommend that he or she should coordinate the response with any PCTs with whom there is joint commissioning of screening. The respondent should ensure that the survey response has been approved by the Chief Executive of the PCT, since the Chief Executive is the Accountable Offi cer for the PCT and therefore responsible for the submitted answers. The survey for the census was structured in the following sections: Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 NCSP commissioning overview NCSP expenditure Local coordination and Chlamydia Screening Offi ce Providers Notifi cation Marketing and communications PCT views of the NCSP

4 2 Section 1 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 1 NCSP commissioning overview This section asked for background information on the commissioning structure for the NCSP in each PCT. 1 Please provide the following details about the person with lead responsibility for NCSP commissioning in your PCT: a Grade: (117 PCTs provided data). Commissioner banding Band Band Band Band 8a Band 8b Band 8c 9 10 Band 8d 5 6 Senior Manager 1 1 Associate Director 1 1 Director 2 2 Consultant 7 8 Other 4 3 Bands 6 to 8d are NHS Agenda for Change pay scale bandings. Salary details for each band are available at: b Length of service in this post: (131 PCTs provided data). Length of service in post Less than 1 year to 2 years to 3 years to 4 years years or more 23 30

5 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section Please estimate the percentage of their time the person named as responsible for commissioning sexual health services devotes to sexual health activities: (134 PCTs provided data). of time

6 4 Section 2 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 2 NCSP expenditure The following section asked about the distribution of costs within your PCT s NCSP activities. PCTs were asked to provide fi gures for their PCT only, not for the whole programme area which may include more than one PCT. 3 What is your PCT s total annual spend on the National Chlamydia Screening Programme? Mean Minimum Maximum (actual) 172,534 7, , (actual) 275,730 47,691 1,094, (budget) 379,848 89,000 1,814, (budget) 361,233 91,021 1,099, Please provide a breakdown of your actual and budgeted expenditure on NCSP in the following categories: a Chlamydia Screening Office overheads: (e.g. equipment, accommodation). Please exclude any costs of the purchase and development of IT systems for processing NCSP data. Mean Minimum Maximum (actual) 31, , (actual) 54, , (budget) 73, , (budget) 61,465 2, , b If your programme area developed or purchased an IT system for NCSP data processing, please state the cost of purchase and development of the IT system. Mean Minimum Maximum 29,885 1, ,000 55

7 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 2 5 c Chlamydia Screening Office total staff costs Mean Minimum Maximum (actual) 68, , (actual) 99, , (budget) 130, ,175, (budget) 97,913 35, , Other activities: d Outreach initiatives Mean Minimum Maximum (actual) 23, , (actual) 36, , (budget) 49, , (budget) 7,296 1,666 15,000 9 e Marketing and communications Mean Minimum Maximum (actual) 20, , (actual) 36, , (budget) 22, , (budget) 23,562 1, , f Laboratory costs Mean Minimum Maximum (actual) 49, , (actual) 81,746 10, , (budget) 128,594 23, , (budget) 140,657 23, , g Outsourced patient notification Mean Minimum Maximum (actual) 2, , (actual) 4, , (budget) 4, , (budget) 2, ,500 5

8 6 Section 2 National Audit Offi ce Survey of Primary Care Trusts (PCTs) 5 Please state your PCT s average purchase cost per screening kit in : Mean Minimum Maximum Please state the number of screening kits purchased in : Mean Minimum Maximum 16,292 1,127 92, Have you carried out any costs analysis for chlamydia screening activity and treatment/partner notification? (134 PCTs provided data). Yes No

9 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 3 7 Section 3 Local coordination and Chlamydia Screening Offi ce This section relates to the relationship between the PCT and Chlamydia Screening Offi ce. 8 Who employs the Chlamydia Screening Office staff? (144 PCTs provided data). Your PCT Another PCT External organisation Please provide a copy of your PCT s contract/service level agreement with the Chlamydia Screening Office, including the budget: (120 PCTs provided data). Contract/SLA provided There is no contract How would you rate the following aspects of the relationship between the PCT commissioner(s) and the NCSP Chlamydia Screening Office lead Co-ordinator in your programme area? (142 PCTs provided data). Very good Fairly good Fairly poor s Communication Working as effective partners

10 8 Section 4 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 4 Providers This section relates to the various providers of chlamydia screening in the community and NCSP champions within those groups. A reference to a screen being through or inside the programme means that it is a screen carried out in the community and counted towards the NCSP screening target. A screen occurring outside the programme is not carried out in a registered NCSP screening venue and is not currently counted towards the NCSP target. 11 Please describe the nature of the contracts you have with your providers: Contract Type GPs Pharmacies Contraceptive and sexual health services Other provider Block contract Local Enhanced Services agreement Local Quality and Outcomes Framework n/a n/a n/a n/a 2 2 None Other Explanatory note A Block contract is a contract with a fi xed cost, regardless of the number of patients treated. A Local Enhanced Services contract deals with the delivery of locally developed services designed to meet local health needs. The Quality and Outcomes Framework is a voluntary annual reward and incentive programme for GP surgeries, detailing practice achievement results. It is intended to resource and then reward good practice.

11 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section Is the contract part of a general sexual health contract, or specifically for NCSP? GPs Pharmacies Contraceptive and sexual health service Other providers NCSP specific General sexual health Don't know Number of PCTS that provided data Does your PCT provide kits which people can use to test themselves? If so, please indicate the proportion of kits distributed which result in a sample returned for screening: a Online kit requests: Can kits be requested online? (137 PCTs provided data) Proportion of kits requested online returned: (77 PCTs provided data) Yes Mean: 47 No Minimum: 1 Don t know 4 6 Maximum: 90 b Kits picked up from bins (collection points where kits are made available to young people in appropriate locations): Are kits available from bins? (135 PCTs provided data) Proportion of kits obtained via bins returned: (36 PCTs provided data) Yes Mean 12 No Minimum 4 Don t know 7 9 Maximum In general, which aspects of screening and follow-up are provided in various settings in your PCT? (The number of PCTs responding to the various combinations possible in this question ranged between 126 and 144). Task Pharmacies GPs Contraception and sexual health services Other provider Screening Treatment Partner notification

12 10 Section 4 National Audit Offi ce Survey of Primary Care Trusts (PCTs) 15 Do you have any local NCSP champions in place? i.e. specific people who promote the Programme to other professionals such as a GP champion. No Yes Recruiting No, but lobbying for champion(s) Overall, which types of screening do you think are the most and least effective in helping to achieve the overall screening target in your area? a Most effective (128 PCTs provided data). Contraception and sexual health services GPs Outreach events Online services 0 0 Pharmacies 0 0 Other b Least effective (119 PCTs provided data). Pharmacies GPs Outreach events Contraception and sexual health services 6 7 Online services 0 0 Other 26 31

13 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 5 11 Section 5 Notifi cation This section asked about the notifi cation of results to those screened for chlamydia. 17 Which of the following methods of test result notification are used within your PCT? Text message Telephone Letters Who carries out test result notification? If more than one provider, please select all that apply: (143 PCTs provided data). CSO Screening provider 9 16 Contractor 8 14 Other 7 13

14 12 Section 6 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 6 Marketing and communications This section focused on the marketing of NCSP to young people. 19 Which type of marketing campaign have you used? Form of marketing Locally generated brand Of the locally generated brands, what proportion were developed in collaboration with other PCTs? National brand None used Which of the following methods are used to market and publicise the NCSP since it started in your PCT? Form of marketing Posters Stands at university/college events Leaflet/literature Talks at youth centres Website: pages within an existing website Talks in schools Website: specific for NCSP within PCT programme area Local/regional/newspaper campaign Mail-outs to NCSP target population: invitation Mail-outs to NCSP target population: test kit Sexual health helpline 26 36

15 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section Overall, how successful do you think the marketing of NCSP in your area has been? (143 PCTs provided data). Very successful Fairly successful Not very successful Not at all successful 1 2 Don't know If you have selected not very successful or not at all successful in question 21, what are the main barriers to successful NCSP marketing in your area? (34 PCTs provided data. Free text response permitted, responses coded into groups by NAO. Note that the 34 responses here exceeds the 22 PCTs who responded not very successful or not at all successful ). Recent implementation: results not seen yet 26 9 Difficulty in targeting young people correctly 18 6 Lack of resources 18 6 National campaign required 15 5 Lack of engagement with some community partners 6 2 Consistent message required across wider geographical area 6 2 Unsuccessful campaign 6 2 Other How useful, if at all, do you think it would be to collaborate more with other PCTs in your NCSP marketing activities? (143 PCTs provided data). Very useful Fairly useful Not very useful 6 9 Not at all useful 0 0 Don't know 0 0

16 14 Section 7 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section 7 PCT views of the NCSP This section asks what you think has worked well in your PCT and where things could be done more successfully. It also asks how you think the PCT will perform against NCSP targets in the future. 24 Please indicate below the importance you attach to the following sources of support for increasing screening rates and how satisfied or dissatisfied you are with the way they have worked in your PCT: a Importance of sources of support for increasing screening rates: (141 to 144 PCTs provided data in response to the various combinations). Very important Fairly important Not very important Not at all important Central Programme team Programme Regional Facilitators The sharing of knowledge and good practice between PCTs in your programme area The sharing of knowledge and good practice between PCTs outside your programme area b Satisfaction with sources of support for increasing screening rates: (135 to 141 PCTs provided data in response to the various combinations). Very satisfied Fairly satisfied Not very satisfied No support received Central Programme team Programme Regional Facilitators The sharing of knowledge and good practice between PCTs in your programme area The sharing of knowledge and good practice between PCTs outside your programme area

17 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section What type of support, advice and guidance would be useful to you in helping your PCT to achieve higher screening rates? (125 PCTs provided data. PCTs were permitted up to three free-text responses to this question. coded into groups by NAO). Response Greater opportunities to share best practice 40 National campaign to raise awareness 38 GP Quality and Outcomes Framework 8 Call and re-call approach to screening 7 Additional resources 6 Tariff for Local Enhanced Services contracts 6 Additional advice and support from NCSP 5 More emphasis on joined-up approach to improving sexual health 4 Including genito-urinary medicine (GUM) screens 3 Screening tariff 2 GP champion 1

18 16 Section 7 National Audit Offi ce Survey of Primary Care Trusts (PCTs) 26 What, in your view, are the greatest obstacles to progress towards your PCT s target (e.g. VSI target/increasing screening numbers)? (142 PCTs provided data. PCTs were permitted up to three free text responses to this question. coded into groups by NAO). Engagement of providers Engaging young people Insufficient funding from PCT Higher targets Local population distribution/culture Lack of awareness of Programme/inadequate marketing Capacity of Chlamydia Screening Office Lack of integrated service model for sexual health in the community Stigma and reluctance to discuss sexual matters in schools and homes Lack of national consistency in approach and templates 8 11 No central coordination or evaluation of the Programme 6 8 Call-recall approach to screening would work better 4 5 Genito-urinary medicine (GUM) screens are not counted towards the screening target 4 5 This PCT has been running the Programme for less time than others 4 5 Relationship between PCT and the Programme 4 5 IT system 3 4 Training of providers 2 3 Primary care engagement 2 3 No local Quality and Outcomes Framework 1 2 Young people do not attend screening more than once 1 2 No national brand recognisable across the country 1 2 Limited support and guidance from the Programme 1 1 Other 19 27

19 National Audit Offi ce Survey of Primary Care Trusts (PCTs) Section How effective would you say that collaboration between PCTs has been in each of the following areas? Area Very effective Fairly effective Not very effective Not at all effective Marketing Website development Working with providers Data management Contracting Sharing good practice GP champions What measures do you intend to take to meet the increased NCSP screening targets for future years? Increase activities at existing venues Increasing number of other venues participating in the Programme Increase the number of pharmacies participating in the Programme Adding new services Increase the number of GPs participating in the Programme Increase marketing activity Bringing non-programme activity within the Programme Increase the number of community and sexual health services participating in the Programme Blanket mail-outs with testing kits to members of the NCSP target population Increase fees/incentives to screening providers Blanket mail-outs to members of the NCSP target population Do you think your PCT will meet the screening target of 25 per cent? (142 PCTs provided data). Yes No Don t know 30 42

20 18 Section 7 National Audit Offi ce Survey of Primary Care Trusts (PCTs) 30 In your view, what one thing would improve the effectiveness of the NCSP in your PCT? (127 PCTs provided data. Free text responses were permitted. coded into groups by NAO). Make screening a compulsory service where possible Raise awareness e.g. national marketing campaign Increase the provision and quality of staff to meet targets Deliver through core services and embed in wider sexual health agenda 9 12 GP involvement champions, Quality and Outcome Frameworks 9 11 Better support from the national Programme team - guidance etc. 6 8 A change in the current targets 6 8 Register age group, then call and recall them 6 7 Greater coordination with other PCTs in region 6 7 Greater engagement and participation with schools 4 5 Increase funding to more appropriate levels 4 5 Make more use of the pre-existing community structure to offer screening to target audience 4 5 Better evaluation of progress so far 2 2 Encourage more use of postal testing 2 2 Include genito-urinary medicine (GUM) activity 1 1 Other 6 8