Sexual Health Improvement for Populations and Patients
SHIPP – a Health Integration Team
John Macleod, 12th June 2015
SHIPP: a partnership between“people with a stake in sexual health improvement with shared ambitions and agreed vision of how to achieve them”
University of Bristol, University of the West of England, Bristol City Council, North Somerset Council, South Gloucester Council, Bristol Clinical Commissioning Group, University Hospitals Bristol NHS Foundation Trust, North Bristol NHS Trust, Public Health England, NHS England Area Team, Terrence Higgins Trust, Brook Bristol, Marie Stopes International, Aquarius Public Health – and patients
The SHIPP model• Assess and prioritise need • Advise on commissioning evidence based care
pathways to meet this effectively (and provide value for money)
• Identify evidence gaps and facilitate research to fill these
Examples of projects• Strengthening Chlamydia screening• Prevalence of TV in the community• Recognising and responding to IPV• Increasing earlier diagnosis of HIV• Refreshing the JSNA to inform re-
commissioning• Improving patient pathways with POC tests• Using routine data in evaluation
IMPACT-PC Improved Management of Patients with
Chlamydia trachomatis and Neisseria gonorrhoea diagnosed in Primary
Care Trial
IMPACT-PC• 16% probability that a CT episode will cause
PID and 45% of TFI are caused by CT• 10-15% of sexual health spend on NCSP• 50% of CT testing in primary care amongst
asymptomatic individuals• 5-10% of these tests are positive• Evidence that timely treatment and PN effective• Primary care not set up to provide these and
GPs say they would value help
IMPACT-PC• Evaluating feasibility and acceptability of
centralised nurse led Rx and PN• 6-month randomised feasibility study
INTERVENTION practices – option to choose the centralised telephone-based service for management of all CT and NG tests by specialist nurses where clinically appropriate
CONTROL practises – usual care
IMPACT-PC• Support obtained from CLAHRCwest and
HPRU (evaluation) in Spring 2014• Ethical approval Autumn 2014• NIHR portfolio adoption Winter 2014• Agreement of SSCs, practice recruitment etc
Winter 2014-15• Patient enrolment from Spring 2015
Discussion
• Primary research within the “HIT model” still takes time
• “HIT friendly” funding streams more suited to secondary research
Expertise mainly in data analysis and evidence synthesis
Limited ability to support fieldwork unless small scale and qualitative
Still confusion over portfolio eligibility (hence CRN input and SSCs) of CLAHRC studies
Conclusions
• HITs are a success and are supporting evidence based commissioning and practice
• HITs should be ambitious but their ambitions should be realistic
• HITs are evolving