How symptomatic testing has transformed sexual health services in Kent

Implementing symptomatic testing in a pandemic

In March 2020 Kent implemented an innovative approach to online sexual health testing through two new pathways: one for mild symptomatic testing and a complex symptomatic testing pathway to support an unmet demand. This complemented the existing sexual health services provided at the then seven clinics they had in place across the county.

The implementation of COVID-19 social distancing restrictions, which came into place in March 2020, meant that many of the face-to-face services were unable to operate in their usual capacity. Maidstone and Tunbridge Wells NHS Trust (MTW) took the decision to undertake a forward-thinking service change, which allowed them to increase the range of online testing available so that individuals had access to the services and care they needed.

Preventx worked with MTW to introduce a mild symptomatic pathway which was created in collaboration with the consultants from the trust who developed a bespoke algorithm which enabled users with defined mild symptoms to order a test with no clinical intervention.

Amidst the pandemic onset, the service was quickly adapted to allow those reporting higher risk symptoms to enter their phone number on the SH.UK platform and receive a call back from one of MTW’s clinicians for further assessment. At this point, the clinician could then decide if the user should test online or arrange if they should be seen in clinic.

Lesley Navaratne is Clinical Director for sexual health services at MTW:

“Partnering with Preventx has enabled us to continuously improve our service offer ensuring patients have a safe option for testing. While we’d planned to start screening symptomatic patients online, the pandemic accelerated the need for this work. The fact Preventx has their own dedicated lab also meant that we had a solution that facilitated fast results – helping to ensure care is as seamless as it could be”.

The commissioning team at Kent County Council who are very supportive of sexual health testing were keen that money saved from face-to-face appointments during the pandemic was reinvested into the digital service to ensure access was maintained. 

Data making a difference

Data from the remote testing has also been available via a dashboard which MTW can access in real time. This has meant it is easier to understand the impact of the service in terms of who is using it, the quality of the results in comparison to testing in clinic and what infections are most prevalent in various demographics. Therefore, signposting and support has been able to be more targeted, and it is easier to understand reach into marginalised groups.

The data has helped MTW understand what needs exist in the population and then adapt services to suit. An example of this is the pilot for trichomonas vaginilas (TV). Working alongside Preventx MTW have been able to expand their testing regime to include additional tests for symptomatic patients which would usually be offered in clinic, including trichomonas vaginilas (TV). The remote testing pilot for TV has detected more instances of the infection than F2F testing as the PCR swabs used in self-sampling are more accurate than the traditional microscopy used in clinic to detect and diagnose TV.

Lesley adds:

“A practical benefit from the data is the ease with which it can be shared across the service and with commissioners so that performance and insight is available with minimal effort. We’re now trying to ensure our data from clinics is as thorough, as this really helps us understand the needs of those accessing the service.”

Patient choice and access

In Kent, this has meant, at-risk demographics have been contacted with wider prevention awareness as a direct result of their offering. An ethos of every contact matters means that whether a patient is accessing services online or face-to-face the level of care they receive is evenly matched. The online service has identified other people who are at risk too those who wouldn’t have used service before including young people and vulnerable people.  In the case of teenage pregnancy it has provided additional discretion and helps reduce additional face to face appointments.

‘The simplicity and ability for symptomatic users to test online has meant that 93.3% of people who wanted to test online were able to, with clinicians only triaging 6.7% of users with the most complex symptoms into clinic. Previously, only 69% of these users could have tested online. Patients will sometimes ask about the accuracy of results from online testing but as clinicians it is our responsibility to be confident of the safety and accuracy of and then reassure them of the safety and accuracy of online testing.”

Remote testing has meant different population groups can have different testing regimes; for example, men who have sex with men are able to undertake monthly testing. Capacity in the face-to-face clinics would be unable to cope with this level of testing and if this were to be offered appointments would quickly run out.

“Kent is a big area and it’s not always easy for people to get to a clinic so remote testing saves people having to travel. It’s a private, quick and rapid way to get screened. 45% of the people who access our services are over the age of 45 and many of them don’t want to come into clinic. And with other populations such as men who have sex with men, although they may have come into to see us occasionally before remote testing, they are now able to test monthly at home. Remote testing has increased access, widened availability and it’s really brought testing out into the open.”

The service is liked and trusted by those using it. Of patients testing in Kent, 98.8% said they would recommend remote sexual health testing.

Workforce transformation

One of the direct impacts of the increased use of symptomatic online testing is that the skills needed by staff and roles required have changed. In MTW the initial phase of the pandemic saw some staff retire or take the opportunity to change careers. Wider workforce challenges have meant that recruitment is difficult, not only in Kent but across the board for sexual health services. In this context the digital service means that there is flexibility to create new pathways and provision which relies less on some job roles therefore not limiting access for patients.

The digital service has evolved and so has the type of patients seen in clinic which are now often more complex and require more experience, skills, and knowledge. In the future it is predicted training needs will need to adapt to specifically focus on the changing needs of people attending clinics. This complexity means staff can feel more fully utilised, but it raises a challenge as some symptomatic infections are managed remotely it means more serious infections are seen in person and this can skew ‘what normal looks like’ in clinic.

Lesley adds:

“Remote testing fast and convenient for people and it has freed up capacity in our clinics to see the people that need to be seen and often they can be seen quicker as there are more appointments available.”

Staff working alongside the digital service are engaging with patients via the phone and signposting them to other support, advising them on next steps and helping to explain the service. This new way of delivering sexual health access means that some workforce requirements have changed. That being said, a key motivator for people to work in sexual health services is patient contact and there is a commitment to make sure this is part of the day-to-day job of people who are working with remote testing as well as those in clinic. 

Looking ahead

In a post-Covid world the plan at MTW is to be able to keep six of their clinics open while also keeping access to online symptomatic testing available. Face to face appointments are still crucial in helping to support service users with sexual health as well as contraception. Maintaining both digital and face to face care enables more choice for patients and will ensure a high level of care can be given no matter what point of patient entry.

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