{"id":6,"date":"2010-01-11T22:16:43","date_gmt":"2010-01-11T22:16:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=6"},"modified":"2010-05-17T09:35:26","modified_gmt":"2010-05-17T09:35:26","slug":"chlamydia-screening-at-the-crossroads","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2010\/01\/11\/chlamydia-screening-at-the-crossroads\/","title":{"rendered":"Chlamydia screening at the crossroads"},"content":{"rendered":"
\n

As financial screws tighten, and a general election approaches, British clinical readers <\/span><\/span>are<\/span><\/span> expecting lean times ahead.\u00a0\u00a0 Services for sexually transmitted infections<\/span><\/span> (STI) <\/span><\/span>are unlikely to <\/span><\/span>get major billing in party manifestoes<\/span><\/span>, <\/span><\/span>and political support tends to be driven by committed individuals rather than public demand. <\/span><\/span><\/p>\n

T<\/span><\/span>hese are <\/span><\/span>particularly <\/span><\/span>interesting times for England\u2019s National Chlamydia Screening Programme (NCSP)<\/span><\/span>.\u00a0 The programme<\/span><\/span> has been the subject of a report by the National Audit Office, followed by a hearing of <\/span><\/span>Parliament\u2019s <\/span><\/span>Public Accounts Committee<\/span><\/span> before the Christmas break<\/span><\/span>. <\/span><\/span><\/p>\n

The NCSP was <\/span><\/span>announced in 2003, and differed from pilot studies in several respects.\u00a0 Both <\/span><\/span>English <\/span><\/span>pilots<\/span><\/span>(1,2,3)<\/span><\/sup><\/span> had achieved<\/span><\/span> high rates of coverage within their<\/span><\/span> single year<\/span><\/span> of operatio<\/span><\/span>n<\/span><\/span>, with general practice <\/span><\/span>a<\/span><\/span> predominant setting,<\/span><\/span> and <\/span><\/span>using some form <\/span><\/span>of payment<\/span><\/span> for general practitioners who participated, <\/span><\/span>while<\/span><\/span> only one<\/span><\/span>(<\/span><\/sup><\/span>3<\/span><\/sup><\/span>)<\/span><\/sup><\/span> had included males in the target group. <\/span><\/span><\/p>\n

During<\/span><\/span> the financial year April 2008<\/span><\/span>-2009 an estimated 15.9% of <\/span><\/span>England\u2019s<\/span><\/span> 6.7M 15-24 year old population had been tested <\/span><\/span>for Chlamydia <\/span><\/span>outside specialist genitourinary medicine clinics \u2013 still far short of the estimated one third which was achieved in the pilots and thought to be needed to achieve a real impact on incidence.\u00a0\u00a0\u00a0 However, <\/span><\/span>whatever happen<\/span><\/span>s<\/span><\/span> now <\/span><\/span>the programme <\/span><\/span>wil<\/span><\/span>l<\/span><\/span> continue to have a major impact on the organisation of sexual health services.\u00a0 The dissemination of testing into family planning (contraception) clinics, other young people\u2019s services and increasingly into general practice <\/span><\/span>has <\/span><\/span>already <\/span><\/span>mainstreamed<\/span><\/span> awareness of STIs<\/span><\/span> among the public and professionals<\/span><\/span>. <\/span><\/span>The next few months will be crucial in defining <\/span><\/span>public <\/span><\/span>policy <\/span><\/span>on<\/span><\/span> the <\/span><\/span>balance and <\/span><\/span>relationship between the NCSP (simple service, high throughput) and specialist STI services <\/span><\/span>(complex and expensive, and <\/span><\/span>focussing on the needs of individuals of higher than average risk behaviour or worse than average luck<\/span><\/span>)<\/span><\/span>. <\/span><\/span><\/p>\n

T<\/span><\/span>he NCSP <\/span><\/span>was<\/span><\/span> criticised by the National Audit Office<\/span><\/span>(<\/span><\/sup><\/span>4<\/span><\/sup><\/span> )<\/span><\/sup><\/span> for <\/span><\/span>multiple and weak branding, disorganised and cost-<\/span><\/span>in<\/span><\/span>efficient commissioning, and highly variable partner notification (and even treatment) rates. <\/span><\/span>The report is definitely worth a read, <\/span><\/span>along with its<\/span><\/span> sister publication \u2013 a report on the NCSP to the Department of Health by Dr Ruth Hussey. <\/span><\/span>The <\/span><\/span>NCSP<\/span><\/span> was impleme<\/span><\/span>nted in a period of increasing<\/span><\/span> devolution of a wide range of <\/span><\/span>healthcare resource <\/span><\/span>decisions to local areas, with pressure applied <\/span><\/span>where needed <\/span><\/span>by <\/span><\/span>blunt instruments<\/span><\/span> such as <\/span><\/span>the<\/span><\/span> \u201cVital Signs Indicator\u201d which last year set a standard <\/span><\/span>of 17% coverage for<\/span><\/span> the NCSP .\u00a0 In this respect, its difficulties\u00a0 are <\/span><\/span>likely to be <\/span><\/span>a wider sign of the times <\/span><\/span>– <\/span><\/span>as suggested by the Chair<\/span><\/span> of the Public Accounts Committee<\/span><\/span>, who <\/span><\/span>remarked<\/span><\/span> in closing: \u201c<\/span><\/span>What went wrong? You ploughed ahead with local, fragmented implementation, the programme has been inefficient, it has wasted public funds and each programme has been buying its own kit, devising its own marketing and websites.<\/span><\/span>\u201d <\/span><\/span><\/p>\n

Although <\/span><\/span>the <\/span><\/span>Public Accounts Committee<\/span><\/span>\u2019s recommendations are<\/span><\/span> not yet published<\/span><\/span>, a flavour of what <\/span><\/span>we can<\/span><\/span> expect can be inferred from a webcast of the hearing at <\/span><\/span>http:\/\/www.parliamentlive.tv\/Main\/Player.aspx?meetingId=5227<\/span><\/span><\/span><\/a> or, if you prefer the written word, at <\/span><\/span>http:\/\/www.publications.parliament.uk\/pa\/cm\/cmpubacc.htm#uncorr<\/span><\/span><\/span><\/a><\/p>\n

A more coherent branding and commissioning of the NCSP will have implications for the branding, and prioritisation, of more specialist STI services. <\/span><\/span>Clinicians <\/span><\/span>and providers will need to think <\/span><\/span>and advocate <\/span><\/span>long and hard <\/span><\/span>for a locally effective<\/span><\/span> the future balance between <\/span><\/span>the<\/span><\/span> NCSP<\/span><\/span> (whatever form it may take)<\/span><\/span>, and the broader picture <\/span><\/span>of services for STIs<\/span><\/span>, including specialist services<\/span><\/span>. <\/span><\/span>Who<\/span><\/span> and what will they be for, if everyone offers a yearly chlamydia test? <\/span><\/span><\/p>\n

1.\u00a0 http:\/\/sti.bmj.com\/content\/79\/1\/22.full<\/a><\/div>\n
2.\u00a0 http:\/\/sti.bmj.com\/content\/79\/1\/16.full<\/a><\/div>\n
3.<\/span><\/span> <\/span>http:\/\/www.hta.ac.uk\/fullmono\/mon1108.pdf<\/span><\/span><\/span><\/a><\/div>\n
4.<\/span><\/span> <\/span>National Audit Office:\u00a0 Young People\u2019s Sexual Health. <\/span><\/span>http:\/\/www.nao.org.uk\/publications\/0809\/young_peoples_sexual_health.aspx<\/span><\/span><\/span><\/a><\/div>\n
5.<\/span><\/span> <\/span>Dr Ruth Hussey.\u00a0 Review of the National Chlamydia Screening Programme.\u00a0 Crown publication, London, 2009.<\/span><\/span> http:\/\/www.dh.gov.uk\/en\/Publicationsandstatistics\/Publications\/PublicationsPolicyAndGuidance\/DH_108285<\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

As financial screws tighten, and a general election approaches, British clinical readers are expecting lean times ahead.\u00a0\u00a0 Services for sexually transmitted infections (STI) are unlikely to get major billing in party manifestoes, and political support tends to be driven by committed individuals rather than public demand. These are particularly interesting times for England\u2019s National Chlamydia […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":79,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1648,264,1613,1614],"tags":[1650,1649,1651,692,4374],"class_list":["post-6","post","type-post","status-publish","format-standard","hentry","category-chlamydia-screening","category-health-policy","category-sexual-health-services","category-united-kingdom","tag-national-audit-office","tag-national-chlamydia-screening-programme","tag-public-accounts-commitee","tag-sexually-transmitted-infections","tag-united-kingdom"],"yoast_head":"\nChlamydia screening at the crossroads - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2010\/01\/11\/chlamydia-screening-at-the-crossroads\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chlamydia screening at the crossroads - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"As financial screws tighten, and a general election approaches, British clinical readers are expecting lean times ahead.\u00a0\u00a0 Services for sexually transmitted infections (STI) are unlikely to get major billing in party manifestoes, and political support tends to be driven by committed individuals rather than public demand. 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