Annual Report 2008/09

Transcription

1 01 Annual Report 2008/09

2 Contents Introduction 3 Summary of Progress 4 Staffing 8 Service Provision 10 Teaching & Training 12 Data Collection and Activity Data 13 Audit 16 Appendix 1: Audit of HIV Test Uptake 18 Appendix 2: Chlamydia Partner Notification Audit

3 Introduction In 2008/9 Borders Sexual Health successfully managed substantial rises in demand in all aspects of our service, reflected in a 25% annual rise in overall patient contacts compared to 2007/8. We continue to balance public health priorities defined in Respect and Responsibility and the QIS Standards for Sexual Health, with providing a referral service for general practitioners, equitable access across the Borders and the requirement for recurring cost savings in P&CS. Local and national publicity and increasing public awareness of the service continues to drive demand, with a massive rise in the number of STI tests performed and the number of long acting contraceptives provided. With government and industry funded promotion of the benefits of longer-lasting contraception, requests for Implanon and IUD/IUS continue to increase and we provided 76% more Implanon insertions and double the number of IUS/IUD insertions within the service. We have started an additional monthly IUD/IUS clinic to improve provision and provide training opportunities. The demand for lasting contraception can only be expected to increase and will be a continuing challenge. Unlike some other areas in Scotland, the number of Chlamydia diagnoses in the Borders has not levelled off and continues to rise, with a further 26% annual increase in 2008/9. The increasing popularity of the services in Galashiels and Hawick is reflected in increasing STI diagnosis rates: As well as increases in the common STIs seen in previous years, there are small but increasing numbers of diagnoses of gonorrhoea (9), Hepatitis C (5) and HIV (2) diagnosed in clinics, reflecting success in providing services to higher risk individuals. In addition to new HIV diagnoses we have also accommodated a number of patients transferring HIV care from Lothian for convenience and moving from overseas. To try to improve HIV care, one clinic a month has been reserved as a HIV clinic, restricting the number of routine GUM patients seen. The HIV cohort is still small, but HIV care is an increasingly significant part of the workload and without any dedicated HIV care provision can be difficult to manage. The number of patients on antiretroviral therapy has doubled in the past year. We have made further efforts to improve publicity and information with government funding provided specifically for the purpose and have upgraded our website. Implementation of the national IT system for sexual health, NaSH, has required a massive input locally and nationally by all members of the team and our colleagues in the IT department. Many additional hours, largely unpaid, have been committed to installing, implementing and troubleshooting the system. We worked with pharmacy colleagues in NHS Borders to implement a revised national pharmacy contract in August 2008, establishing an arrangement to pay community pharmacies for the provision of emergency contraception and the testing and treatment of Chlamydia. We have also continued to maintain and develop links with other services and professionals through joint working, training and teaching. Two team members, Lou Graham and Gillian Elliot have completed training as Nurse Specialists in sexual health, improving our ability to provide outreach and drop-in services. Suzanne Balfour completed modules to achieve her degree in nursing. We helped develop services and governance locally and nationally through the Sexual Health Lead Clinicians and Lead Nurses groups, BASHH, BHIVA and SHIVAG, and contributions to the national HIV Action Plan, the National Sexual Health and HIV Advisory Committee and other national bodies. Locally we continue to contribute to undergraduate and postgraduate teaching and to the Borders/St Francis Hospital Twinning arrangement. We are active in effective and complete audit cycles locally, regionally and nationally. We performed a novel audit in 2008 to assess the utility of partner notification in identifying additional cases of chlamydial infection and this was published in

4 Table 1: Summary of Progress /9 2007/8 2006/7 Total patient attendances Professionals given sexual health training and Not resources: recorded Young people given sexual health information Not and training: recorded STI screens performed New attendances, Family Planning Clinics Chlamydia Postal Testing Kit Sites open Chlamydia postal testing kits returned Visits to Drop-in Clinics Implanon insertions Chlamydia partner notification success rate 71% 88% 84% Longer Acting Contraceptive Provision Increasing numbers of patients attended for LARC methods over the past year and this is expected to increase even more with national campaigns to promote LARC and the payment of QOF points to GPs for discussing long acting options. We have trained two more of our nurses to insert Implanon so that we are able to offer this method to help meet demand, providing 228 Implanon insertions in 2008/9. We have also started a dedicated monthly IUD clinic, specifically for insertion of IUS and IUD. This clinic is also for referrals for potentially difficult insertions and IUD or IUS problems as well as providing a dedicated teaching clinic for doctors wishing complete IUD training. We continue to provide IUDs at other routine clinics. Many GPs in the Borders continue to meet the demand for IUD and IUS insertions and colleagues in the Obs and Gynae dept also provide this service. Unfortunately it is unlikely that we will be able to keep up with demand long term unless there for a national or local arrangement to remunerate GPs appropriately for providing Implanon. Sexual and Reproductive Health Referral Clinic It has been increasingly apparent that consultations have changed from routine requests for contraception to more complex sexual and reproductive healthcare. This has become even more marked over the last year. Dr Ailsa Wylie, Lead Clinician Sexual and Reproductive Heathcare runs a weekly referral clinic, alternating between Hawick and Galashiels. Referrals come from GPs, Sexual Health team members and other health professionals e.g. the Continence Service. Referrals include contraceptive problems, women with other medical conditions requiring contraception and complex sexual and reproductive healthcare issues such as PMS, Menopause and Psychosexual issues. Chlamydia testing and management: The number of chlamydial infections diagnosed in the Borders increased by 26% in 2008/09. An increasing proportion are diagnosed and managed within sexual health services 195 in the last year, although there are also very significant increases in community diagnoses. This reflects the increase in the number of tests done in clinics, and the uptake of services by the highest risk individuals. In 2008/9 a Borders Chlamydia Protocol was developed and presented to Borders BIG. The protocol was distributed to all GP Practices in January Improvements to clinical management anticipated SIGN Guideline 109 and in Sept 2008 we initiated retesting patients for chlamydial infection 6 months after initial diagnosis. Patients are offered a choice of a letter, text or phone reminder to attend for retesting, or request a PTK (Postal testing kit). 4

5 We reviewed PTKs in 2009 and decided to continue to use them as an adjunct to clinics and drop-ins. We have improved supply to distribution points. We continue to assemble kits inhouse, which reduces costs but is a significant workload. The partner notification success rate for Chlamydia fell significantly from 88% to 71% with the increasing number of infections, but the number of cases treated per index case, at 1.02, remains well in excess of the QIS standard of HIV Care Although the number of patients under care has increased from only 13 to 17, the number of patients on treatment has risen from 7 to 16. There were 93 recorded HIV care visits in 2008/9, not including phone consultations and drop-in visits for minor problems. In the absence of any on site pharmacy, social work, psychology, dietetic or other specialist input, comprehensive care needs are difficult to address and a significant number of our patients have highly complex problems including Hepatitis C co-infection, social, residency and mental health issues. Lead Nurse Gillian Forbes is linked to the Regional Infectious Diseases Unit in Edinburgh for 1 day per week, to develop and maintain skills in HIV management. This is a fixed term post for 2 years and unfortunately she has been able to attend fairly infrequently due to the competing pressures of maintaining services in the Borders. To try to improve HIV care, one clinic a month has been reserved as a HIV clinic, restricting the number of routine GUM patients seen. We are hopeful that the national HIV Action Plan, to be published in 2009, will lead to the development of a formal HIV MCN and give us the opportunity to develop a more robust service. Pharmacy Contract for Sexual healthcare A revised pharmacy contract in August 2008 established a national arrangement to pay community pharmacies for the provision of emergency contraception and the testing and treatment of Chlamydia. Working closely with pharmacy colleagues in NHS Borders, we developed a PGD, local protocols and referral pathways and supporting promotional materials and leaflets for the service. A teaching and awareness session held in February 2009 was attended by over 40 community pharmacy staff and advertising of the service was commissioned to start with poster campaign using the Chlamydia Free logo on the cover - in shops and on local buses from June NaSH IT system Local implementation of the national IT system for sexual health (NaSH), planned for September 2008, went ahead on 20 th October Initially the system has been used for appointment scheduling, demographic data collection and limited family planning activity data collection. The system has had massive impact nationally due to technical issues affecting speed, causing significant delays in clinics and lengthy waiting lists. Thanks to a massive effort by staff, including frequently working over hours after the end of evening clinics, the impact on patients in the Borders has been minimal and we have managed to maintain and even increase activity. Two of our A&C staff jointly took on the role of systems administrators and we recruited additional reception staff to backfill these posts and fulfil the additional work required. However, the additional administrative and clerical support required to run the system carries a financial pressure that we have to address longer term. We are currently working on several fronts to move to full use of the system, including electronic lab results reporting, clinical data entry, letter generation and clinical coding. 5

6 Young People We have seen a large increase in young people across the service and drop-ins are particularly popular. We had an increase in attendances, especially young men, at our Selkirk clinic. This clinic is held in the evening, every second week. On average young men were attending, primarily for condom supplies. This was making it difficult to care for other attendees. To address the problem, we have collaborated with a Youth Club in Selkirk (Rowlands) to put in place a weekly Sexual Health drop in with a nurse specialist. Our input here is expected to be short term as we plan to train staff to issue condoms with the C card system (taking into account child protection issues). Young people are encouraged to attend the sexual health clinic if there are any medical or sexual health concerns. Following a review of this input, we will use a similar model to support other youth groups. Publicity and Website There has been a significant national push for patient information and publicity in 2008/9. Funds were allocated locally for this purpose and the Borders received 13,000. This was used to provide a poster campaign promoting Chlamydia testing in Community Pharmacies, bus advertising campaigns to promote the service, a series of radio advertisements, professional looking leaflets and partner notification cards and an upgrade to our existing website. We developed a full searchable service directory in 2008, allowing patients to identify the nearest clinic, drop-in or community pharmacy providing the specific service they require. In 2008/9, 3229 visitors made 3772 visits to the site, spending an average of 1.47 minutes. The most popular pages were on Contraceptive injection, Galashiels clinics, What we do and Chlamydia info. (Picture: Website Homepage of 6

7 Priorities for 2009/10 In 2009/10 our priorities will be to address the significant shortfall in recurrent funding generated by implementation of NaSH and increasing demand, to implement the HIV Action Plan when published, and to prepare for a QIS visit in We will work locally and nationally to try to meet the increasing demand for longer acting contraception. Work to fully implement a paper light IT system will require mapping of lab results, training of all staff in clinical coding and data entry, the development of monitoring reports and implementation of electronic audit and governance procedures. NaSH will therefore continue to be a significant draw on resources for the coming year. We will also work towards implementing nucleic acid testing for gonorrhoea and further improving support for STI testing and partner notification in BGH and general practice. New Team Members in 2008/09 Lorna Hutchison, Shirley Hill-Bauchop and Sheila Hardie joined us as Receptionists. Carol Campbell and Debbie White took on a joint shared new role as Systems Administrators for the NaSH system. Gillian Elliot and Lou Graham were appointed as Community Nurse Specialists (CNS). Team Members leaving in 2008/09 Dr Liz Clyde retired after 20 years service at the Family Planning Clinic in Peebles with our thanks and best wishes. Jan Skippon, Family Planning Nurse & Elizabeth Fairless, Receptionist both moved on from the service this year. 7

8 Staffing Total staff complement: Medical 1.0WTE, Nursing 2.6WTE, A&C/Clinical support 2.7 WTE Existing staff 31 st March 2009 Dr Dan Clutterbuck Consultant 4 sessions pw Dr Ailsa Wylie Associate Specialist 3 sessions pw Dr Shelagh King Staff Grade 1 session pw Dr Elizabeth Clyde Staff Grade (retired April 2009) 2 sessions pm Dr Helen Jeffreys Staff Grade 2 sessions pm Gillian Forbes Lead Nurse/Health Adviser 37 hours pw Suzanne Balfour Community Nurse Specialist 28 hours pw Amanda Irvine Family Planning Nurse 3 hours pw Margaret Cameron Family Planning Nurse 1.5 hours pw Louise Graham Community Nurse Specialist 16 hours pw Gillian Elliott Community Nurse Specialist 10 hours pw Marion Wood Service Manager 8 hours pw Hazel Mitchell Administrator/PA 20 hours pw Carol Campbell NaSH Administrator 27.5 hours pw Debbie White NaSH Administrator 19.5 hours pw Jacqui Bambrick Auxiliary 4 hours pw Barbara Sharrard Auxiliary 4 hours pw Cathy Thomson Receptionist 8 hours pw Lorna Hutchison Receptionist 16 hours pw Shirley Hill-Bauchop Receptionist 1.5 hours pw Sheila Hardie Receptionist 1.5 hours pw Accommodation Accommodation at March 2009: Duns: Eyemouth Galashiels: Hawick: Peebles: Selkirk: Shared rooms in Knoll Health Centre Shared rooms in Eyemouth Health Centre Dedicated rooms including specimen handling room, Galashiels Health Centre Shared rooms in Hawick Community Hospital + Use of Healthy Living Flat, Burnfoot shared rooms in Hay Lodge Health Centre + Hay Lodge House Shared rooms in Selkirk Health Centre 8

9 Borders Sexual Health: Summary of Clinic Sites & Times 31 st March 2009 Sexual Health Drop-ins GUM Clinics Family Planning Clinics Galashiels : The Health Centre Currie Road Tues: 9 to 10am Thurs: 11am to 1pm Fri: 9 to 10am Fri: 2.30 to 4.30pm Tues: 9am to 1pm Fri: 9am to 1pm Mon: 6 to 7.30pm Thurs: 6 to 7.30pm Wed: 9.30 to 11.30am (Referral Clinic alternate weeks) Selkirk: The Health Centre, Viewfield Lane 1 st & 3 rd Wed of month: 7 to 8.30pm Duns: The Knoll Health Centre Alternate Fri: 2.30 to 4.30pm Thurs (twice a month): 4 to 5.30pm Hawick: Alternate Tues: 10am to 12noon (Burnfoot Flat, next to Burnfoot Post Office) Weds: 9.30 to 12noon (Hawick Community Hospital) Mon: 7 to 8.30pm (Hawick Community Hospital) Wed: 9.30 to 11.30am (Referral Clinic alternate weeks) Peebles: Hay Lodge Health Centre Alternate Mon: 2.45 to 4.45pm 2 nd and 4 th Weds of month : 6.30 to 8.00pm Eyemouth: The Health Centre Alternate Fri: 2.30 to 4.30pm 9

10 Service Provision Telephone Telephone advice and bookings for the GUM clinic and all Borders Sexual Health/FP clinics is available on a single number ( ). We aim to cover the number from 9am to 1pm, Monday to Friday. We don t currently have a way of recording the volume of unanswered calls. Telephone advice to GPs and other professionals is available either through the BSHS number or direct by pager or mobile. Clinics All clinics provide advice, emergency contraception, routine contraceptive prescriptions, chlamydia testing and treatment. An increasing number of clinics provide much more than this. GP referrals by letter are seen in the appropriate specialist Consultant/Associate Specialist clinic. GALASHIELS: The Health Centre, Currie Road Monday pm: Family Planning (Nurse led ) Tuesday 9.00am to 1.00pm: GUM Clinic, Implanon Clinic Wednesdays 9.30 to 11.30am (Assoc Specialist - Referral Clinic alternate weeks) Thursday 11.00am-1.00pm: Drop-in Clinic Thursday pm: Family Planning (Dr led) Friday 9.00am to 1.00pm: GUM Clinic Friday pm: Drop-in Clinic Family Planning clinics offer the full range of contraception, with IUCD insertion available in Dr led clinics. The presence of a laboratory and incubator at the Galashiels clinic means that full STI testing can be offered at all clinics and Drop-ins. The GUM clinic provides appointments for formal referral, informal referral and self- referral as well as an urgent problems clinic for patients arriving in the first hour of each clinic. The clinic is staffed by 1 doctor, 1 health adviser/nurse practitioner and one further nurse or nurse practitioner. Receptionist/Auxiliaries work in both roles according to staffing levels. Many clinics also have a medical student, doctor in training or GP in attendance for training purposes. Contraception is available at all clinics, including Implanon insertion by appointment on Tuesday mornings and Thursday evenings. One clinic a month is an HIV clinic. Routine HIV care includes routine blood monitoring, prescribing, partner management, STI screening and adherence support. From August 2008 a new Referral clinic runs on Wednesdays 9.30 to 11.30am (Associate Specialist Referral Clinic alternate weeks Galashiels & Hawick). HAWICK Hawick Community Hospital Monday pm. Family Planning (Dr led alternate weeks) Wednesdays from 9.30 to Joint Sexual Health/Community Gynae clinic Wednesdays 9.30 to 11.30am (Assoc Specialist Referral Clinic, alternate weeks) The joint Sexual Health/Community Gynae clinic is staffed by Consultant Gynaecologist Dr Faye Rodger, Associate Specialist Ailsa Wylie and Community Nurse Specialist Gillian Forbes. 10

11 Burnfoot Healthy Living Flat A nurse led drop-in clinic runs on alternate Tuesdays from 10am-12noon. It is staffed by a nurse practitioner without receptionist or other support. This clinic has a very low rate of attendance but serves a relatively deprived population. SELKIRK The Health Centre A Doctor & Nurse led clinic runs 1 st and 3 rd Wednesday of every month pm. Providing a full range of Family Planning services including IUCD & Implanon PEEBLES Hay Lodge Health Centre A Doctor & Nurse led Family Planning clinic runs 2 nd and 4 th Wednesday of each month from pm. Providing a full range of Family Planning services including IUCD & Implanon A community nurse-led drop-in clinic runs on alternate Monday afternoons, from pm in Hay Lodge House at the back of the Health Centre. This has a low rate of attendance (average 1 per clinic). DUNS The Knoll Health Centre A Doctor & Nurse led clinic runs Thursdays (twice per month) from pm Providing a full range of Family Planning services including IUCD & Implanon A nurse-led drop-in clinic runs on alternate Fridays from pm and is particularly targeted at young people and migrant workers. EYEMOUTH The Health Centre A nurse-led drop in runs on alternate Friday afternoons from pm. This is a well attended drop-in with a high proportion of complex cases, STI diagnosis and patients at high risk. Postal Testing Kits for chlamydia Postal testing kits continue to provide additional options for testing for those unable to attend clinics. We have undertaken a major drive to promote and supply kits to outlets in 2008/9 and this is reflected in a 62% rise in the number of kits returned to 278. The rate of positive results remains at 9.7% (27 positives) suggesting that uptake is by an appropriate population. 11

12 Teaching and Training Dr Wylie and Dr King continue to provide training for the Diploma Sexual and Reproductive Healthcare. We also provide training for Letter of Competence in Intrauterine Techniques and Subdermal Implants. Due to the number of doctors requesting training, we now have administrative support to manage this. Our current waiting list for trainees is one year. We have continued to maintain training for professionals, through visits to GP practices, teaching colleagues in Obs and Gynae, and our biannual study half-days. Community Nurse Specialists visit schools and youth groups in conjunction with Health promotion colleagues. External teaching commitments Training for BGH staff, students and other in the community provided through Border Sexual Health has included: Updates on sexual health and contraception for school doctors and nurses Occupational Blood Borne Virus exposure: training for A&E FY2s (3 times per year) STI training and training in family planning clinics: Obstetrics & Gynaecology (O&G) FY2s STI training: GP registrars Medical student teaching: Students attached to the BGH for O&G teaching block are timetabled a session at the GUM Clinic at Galashiels Health Centre. Students also attend teaching sessions in Family Planning clinics. BGH Grand Rounds twice yearly (Dr Dan Clutterbuck) TiME study afternoon Border Sexual Health 2 Study Afternoons. (April & September ) 12

13 Data Collection This year we moved over from the epex system and a variety of paper based records. The national IT system for sexual health (NaSH) can record all sexual health activity on one system and offer scheduling, prescribing, clinical data recording and the possibility of a paperless system. We have introduced NaSH for appointment scheduling, patient registration and data collection for contraception and procedures. We plan to move to letter generation, laboratory interface and full clinical note keeping over 2009/10. Activity has increased across the service as detailed in Table 3. The number of Implanon insertions jumped form around 130 per year for the last 3 years to 228 this year. Total STI screens (a minimum of a Chlamydia test) have doubled since 2006/07 although the number of full screens (including an HIV test, usually with Chlamydia, gonorrhoea and syphilis tests) remained stable at just over 800. This reflects the fact that attendances at the GUM clinic remain fairly stable, but opportunistic Chlamydia testing in drop-ins and family planning clinics continues to increase. Table 3: Sexual Health Activity /6 2006/7 2007/8 2008/9 Attendances Family Planning GUM Drop-in Total attendances PTKs Patient Contacts STI Screens* GUM + Drop-in Family Planning Total STI screen Contraception Implanon insertion IUD/IUS insertion Depo-Provera 104 * Chlamydia test alone or with other tests 13

14 Table 4: Drop-in Clinics There was a big increase in cancellation of drop-in clinics in 2008/09, due to staffing difficulties. Despite this, the number of attendances overall dropped only marginally. With the training of two new community nurse specialists we should be able to reduce cancelled nurseled drop-in clinics in future. Drop in Figures for Sexual Health 1 st April 2008 to 31 st March 2009 Drop in Clinics 1/04/08-31/03/09 Hawick Community Hospital Hawick Burnfoot No Clients Attended Cancelled Clinics Total Clinics Total attendance Mean No clients Eyemouth Duns Peebles Galashiels Thursday none Galashiels Friday Table 5: Attendances and cancelled clinics, Drop-in clinics Clinics Cancelled clinics Numbers seen Mean attendance per clinic April 2007-March 2008 April 2008-March Chlamydia Testing Totals Borders 2008/09 Chlamydia testing in the Borders continues to increase, with over 4000 tests performed in 2008/9. There is still an excess of testing in over 25s and a lack of testing in young men. The rate of positive diagnoses continues to increase with a further 26% rise in 2008/9 (whereas it has levelled off in some areas of Scotland). 14

15 Table 6: Summary of Chlamydia testing, Borders (Collated by Caroline Thomson, Senior MLSO, BGH Microbiology Lab) 2005/6 2006/7 2007/8 2008/9 2005/6 2006/7 2007/8 2008/9 Number Number Number Number Pos Pos Pos Pos Total GUM Non GUM Females Total Females GUM Females Non GUM Males Total Males GUM Males Non GUM Age <25 Total Age <25 GUM Age <25 Non GUM Age >25 Total Age >25 GUM Age >25 Non GUM Healthy Respect STI activity data from the national STISS (formerly ISD (D) 5) Data from the national STISS database is collated and published nationally by ISD. Some provisional local data is reported here. For clarity we have amalgamated all GUM Clinic/Drop-in/Postal Testing Data. This data includes all STI testing and screening occurring in the GUM clinic, drop-in clinics and postal testing kits. Table 7: STISS Data 2008/9 2007/8 2006/7 2005/6 Activity Code S1H STI Screen with HIV test S1D STI Screen, HIV test deferred/declined S1 STI Screen, HIV test not offered All STI screens S0 codes (new attendances without STI screen) Total episodes

16 Table 8: STI Diagnoses 2008/9 2007/8 2006/7 2005/6 C41A: Chlamydia C11A: Genital warts first episode Under 16 all episodes Under 25 all episodes Gonorrhoea 9 Infectious 2 syphilis HIV 2 Hepatitis C 5 Audit Activity: Audits 2008/9 National (data collected within clinic by the team for national collation) BASHH (British Association of Sexual Health and HIV): 2008 National Audit: Sexual History taking in GUM Clinics: complete BASHH Scotland BASHH Scotland: 2009 Scottish Audit: HIV Testing in patients diagnosed with an STI National data analysed by DC. In preparation for publication. BHIVA (British HIV Association): 2008 National Audit on TB/HIV Co-infection (no cases identified in Borders) Local Audits New cases of chlamydial infection identified by partner notification. Complete: Forbes G, Clutterbuck DJ. Audit: How many cases of Chlamydial infection would we miss by not seeing and testing contacts? Int Jour STD and AIDS 2009 Annual Audit of partner notification for Chlamydial infection (Performed annually date) Complete (appendix). Annual audit of HIV test uptake (Performed annually 2005-date) In progress. Removal rates for Implanon Contraception. Complete (see below). 16

17 Audits 2009/10 National (data collected within clinic by the team for national collation) (From Jan 2009 DC is BASHH Audit Officer for Scotland) BASHH UK: STI screening in asymptomatic attendees Data collection complete. BASHH Scotland: Sexual healthcare of people with HIV (data collection early 2010) BHIVA: Case note review of HIV/Hepatitis B/C co-infection Local Priorities: 1) Audit of chlamydia retesting 6 months after treatment. (Clinic protocol changed in September 2008 to offer recall at 6 months. Recommendation included in revised SIGN Guideline on Chlamydia, published March 2009) 2) Audit of management of irregular bleeding on Implanon. (NICE Guideline on Long Acting Contraception 2006) 3) Annual Audit of partner notification for Chlamydial infection (QIS standard 4.3: 64 contacts per 100 infected individuals are verified as attended within 90 days) 4) HIV care Audit: Syphilis serology, sexual and reproductive histories, sexual health screening (QIS standards 5.1, 5.2, 5.3) 5) Annual audit of HIV test uptake 6) Removal rates and reasons for removal for Implanon Contraception 7) Audit of STISS coding Re audit: Contraceptive advice offered to women under 18 in GUM clinics (re-audit of BASHH Scotland audit 2006). Suzanne Balfour & Gillian Forbes, Community Nurse Specialists A BASHH national audit in 2006 showed that 68.4% of under 18 year old women attending our GU clinic, who were not using adequate contraception, were not receiving advice. We addressed this by further combining our STI and contraceptive services, modifying the clinic proforma to include prompts and training staff. Re-audit of 81 girls of 18yrs and under who accessed GUM services between 1st July 08 December 2008 was performed, using the same criteria as the 2006 national audit. 30 women (37%) were not using a reliable form of contraception (i.e. condoms only or no contraception at all). Of 30 women only 1 (2%) did not receive contraceptive advice (this includes information giving, provision and/or and appointment made at the Family Planning Clinic). This marked improvement can be attributed to the change in documentation. Since the previous audit the department have included a tick box as to whether the girl is receiving reliable contraceptive or not and if not, there is a further box which allows for the documentation of any contraceptive advice given during consultation. 17

18 Appendix 1: Frequency and staffing of clinics at March 2009 Location Description Frequency Staffing Galashiels Family Planning Clinic Mon pm FP Nurse Auxiliary Nurse Receptionist Family Planning Clinic Thurs pm Staff Grade FP Nurse Auxiliary Nurse Receptionist Referral Clinic Wed am (alternate weeks with Assoc Spec Receptionist/ Auxiliary Hawick) Implanon Clinic Tues am Nurse Specialist Drop-in Thurs 11am-1pm CNS Hawick - Community Hospital GUM Clinic (+HIV Clinic monthly) Fri pm Tues 9am-1pm Fri 9am-1pm Receptionist/Auxiliary Consultant CNS Health Adviser Auxiliary Receptionist Family Planning Clinic Mon pm Staff Grade/AS alt weeks FP Nurse Receptionist Joint Community Gynae/Sexual Health Drop-in Referral Clinic Weds am Wed am (alternate weeks with Galashiels) Consultant Gynaecologist CNS Auxiliary Assoc Spec Receptionist/ Auxiliary - Burnfoot Flat Drop-in Alt Tues 10-12am CNS Selkirk - HC Family Planning Clinic Weds pm Assoc Specialist FP Nurse Duns -HC Peebles - Hay Lodge HC Receptionist Family Planning Clinic Alt Thurs Staff Grade FP Nurse Receptionist Drop-in Alt Fri C NS Family Planning Clinic Alt Wed pm Staff Grade FP Nurse Receptionist Drop-in Alt Mon pm CNS Eyemouth - HC Drop-in Alt Fri pm CNS CNS Community Specialist Nurse 18

19 Appendix 2: Partner Notification Audit (January to December 2008) Percent Positive Index Contacts Treated treated contacts Males % 54 (38%) Females % 44 (32%) Total % 98 (35%) Partner notification rate 198 confirmed treated per 194 index cases (198/194) = 1.02 per index case. BASHH and QIS target is 0.64 per index case. 19

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