This document summarizes a review of the sexual health workforce in Greater Manchester. It finds variation in staffing structures, educational attainment, and achievement of targets across the region. It recommends establishing consistent understanding of roles like Assistant Practitioners across services. Education should be commissioned and delivered locally, including online learning. Cross-disciplinary collaboration and training should also be improved to enable sharing of less specialized services and monitoring of standards.

1. A Review of the Greater Manchester
Sexual Health Workforce
A review to establish fitness for purpose to deliver
the National Strategy for Sexual Health
Barbara Hastings-Asatourian
Lesley Greenhalgh

2. CONTENTS
Page
Executive Summary 3
Commonly Used Acronyms 4
Introduction 6
Background and National Context 6
The Local Context 13
Step 1 Defining the Plan 14
Step 2 Visioning the Future 15
Step 3 Assessing Demand 15
Step 4 Assessing Supply 17
Step 5 Action Plan 41
Step 6 Implementation and Review 44
Conclusion 46
References & Bibliography 47
Appendices
1 Base Line Data 48
2 The Greater Manchester Sexual Health Network Plan 53
3 Template for Developing a Workforce Plan 54
4 The PEST Analysis 60
5 Horizon Scanning – Voluntary Organisations 61
6 Horizon Scanning – Sexual Health Organisations 62
7 Questionnaires 63
8 Focus Group Themes 65
9 Review of Job Descriptions 66
10 Staffing at Time of Medfash Review 67

3. 2

4. Executive Summary
This project was commissioned by the Greater Manchester Sexual Health Network in
order to:
· Respond to national sexual health policy, Department of Health (2001)
· Establish fitness for purpose to deliver the strategy
· Address workforce issues originally highlighted in the Monks Report (1988)
Methodology
Data were collected via retrospective documentary analysis (job descriptions and
staffing levels), letters, questionnaires, a focus group discussion between May 2007
and January 2008. These were presented to the Priority Action Group 7 (PAG7) in
May 2008 to test data validity and reliability. Supplementary staffing data were then
provided by three services
Findings
The service configuration has a diverse range, with variation in staffing structure,
educational attainment and access to educational programmes. Similarly, variation
exists in clinic availability and outreach services, and the achievement of national
targets resulting in some areas within the network falling.
Conclusions and Recommendations
Clear and consistent understanding of roles and responsibilities for Assistant
Practitioners and Trainee Assistant Practitioners is required across all services.
Other staff roles require consistency of job description, whilst recognising the
uniqueness of each service provider, to enable transferability of skill and expertise
across the network.
Education should be commissioned and delivered locally, if possible on­site, and
incorporating the use of Virtual Learning Environments, to facilitate sharing of
resources on­line, and therefore minimise off­site study. This should enable staff to
build a portfolio of professional and academic learning through credited work based
learning.
Cross disciplinary collaboration and training should underpin the above, to enable
charitable and non­governmental organisations to share the less specialised services
and monitor standards.
3

5. Commonly used Acronyms
AP Assistant Practitioner
ART Anti­retroviral therapy
CD4 Cell enabling HIV entry to its host.
CPD Continuing Professional Development
GMS General Medical Services
GUM Genito Urinary Medicine
HCA Health Care Assistant
HCSW Health Care Support Worker
HIV Human Immuno­deficiency virus
HPA Health Protection Agency
HPV Human Papilloma Virus
IAG Independent Advisory Group
IUD Intra uterine device, a method of LARC
IUS Intra uterine system, a method of LARC
LARC Long acting reversible contraception
PEST Political, Educational/environmental/Socio­cultural /technological analysis
PCO Primary Care Organisation
PCT Primary Care Trust
SHA Strategic Health Authority
STIF Sexually Transmitted Infection Foundation
STI Sexually Transmitted Infection
TAP Trainee Assistant Practitioner
4

6. “In keeping with the need to devolve activity to local level,
PCTs and Strategic Health Authorities (SHAs) should be
encouraged to experiment and lessons should be learnt
and disseminated.”
Wanless Report 2004
5

7. Introduction
This project was commissioned by the Greater Manchester Sexual Health Network. Its
purpose is two fold, firstly to establish the readiness of the Greater Manchester Sexual
Health workforce to deliver the key requirements of the National Strategy for Sexual
Health and HIV (DH2001) and secondly to address specific local workforce issues
relating to competency, communication, organisation and delivery of an innovative
client focussed service.
Background and National Context
There is little evidence of early work relating to workforce planning for sexual health
services. Rogers and Adler (1987) had found that there was diversity and disparity in
Genito­Urinary Medicine (GUM) services and in the work carried out by nursing staff in
GUM. Their work recommended improvements in the education of GUM nurses, in
the definition of roles within GUM and in recruitment into GUM. The Monks Report
(DH 1988) examined the workforce issues in 20 GUM clinics in England, a sample of
approximately 10% of the service at the time. Recommendations from Monks covered
workforce, staff roles, training and distribution of GUM services, with a particular focus
on provision for HIV patients. The report highlighted the need for responding to
patients’ needs and preferences, as well as levels of satisfaction with the service.
Monks found both considerable variation and considerable overlap in the work carried
out in general in GUM. Additionally Monks (1988) recognised disparity in the role of
the Health Advisor, and recognised a need to have a Health Advisor who had
undertaken a recognised health advisor training programme in every clinic.
Further work was undertaken by Allen and Hogg (1993), confirming similar results,
and definitive action was taken when national policy was defined in the National
Strategy for Sexual Health and HIV (DH 2001).
The National Strategy for Sexual Health and HIV (DH 2001)
The National Strategy addresses the rising rates of sexually transmitted infection. The
aim is to have a positive impact on these rates by modernising sexual health and HIV
services in the UK. The Government has invested £47.5million in the Sexual Health
Strategy and has committed a further £20million. Of this, £15m has been invested in
Genito­Urinary Medicine (GUM), £9.5m for chlamydia screening, £5m on termination
of pregnancy services and £400,000 on HIV Health Promotion.
A three tier service model is proposed incorporating primary care, GUM and family
planning services.
Level I Services are those currently provided by Primary Care Organisations
(PCOs). It is acknowledged that service provision is variable and requires further
development in the following:
· Sexual history and risk assessment
6

8. · Sexually Transmitted Infection testing for women
· HIV testing and counselling
· Pregnancy testing and referral
· Contraception information services
· Assessment and referral of men with symptoms of sexually transmitted infections
· Cervical cytology screening and referral
· Hepatitis B immunization
Level 2 Services are to be provided by Primary Care Organisations with a special
interest in sexual health. Alternative models include Family Planning and GUM clinics
working in conjunction with primary care. Future services will include:
· Intrauterine device (IUD, “Coil”) insertion
· Testing and treating STI’s
· Vasectomy
· Contraceptive implant insertion
· Partner notification
· Invasive STI testing for men (until non invasive testing is available)
Level 3 specialist services are to be provided with the focus and expertise in
providing care for those with more complex, chronic or intensive needs. They will take
responsibility for sexual health service needs assessment, supporting provider
services quality and clinical governance at all levels. They will ensure that local
guidelines are in place and that there is a framework for monitoring and improving
practice. They will support the planning and delivery of sexual health/sex and
relationships education in schools, colleges and prisons, devolving them to level 2
services as part of their evolution. An expanded role for nurses is envisaged. Services
will include those aimed at individuals and those aimed at improving public health.
Where possible services will be open access. Services are to include:
· Specialist GUM services
· Specialised HIV services
· Termination and pregnancy services
· Specialised contraception for those with complex medical conditions
· Coordination of services for those with sexual dysfunction
· Services for those with psychological and sexual problems
In addition services may include:
· Outreach services for the prevention of sexually transmitted infections
· Specialised infection management – including coordination of partner notification
· Outreach contraceptive services
An independent advisory group (IAG) was set up by and chaired by Baroness Gould.
The group identified the following key themes:
· Holistic approach: to sexual health
· Provide: a sound evidence base
7

9. · Ensure: managed networks for HIV/sexual health services
· Develop: a programme of chlamydia screening
· Provide: open access to GUM services
· Ensure: a range of contraception services
· Set: standards for treatment of sexually transmitted infections
· Address: the training needs of the workforce
· Address: disparities in abortion service
The publication of the 10 High Impact Changes for Genito­Urinary Medicine 48 Hour
Access (DH 2006) raises many workforce issues facing sexual health services. It also
offers case study exemplars. The changes fall into four key themes: Capacity,
Resources, Efficiency and Commissioning/Contracting.
The 10 High Impact changes and their 4 themes
Theme 1: Identify how much capacity you need to meet the access target
· High Impact Change 1: Measure demand and capacity across the local health
economy
Theme 2: Maximise use of existing resources to increase capacity
· High Impact Change 2: Undertake a process improvement project to inform
service redesign
· High Impact Change 3: Analyse and improve utilisation of the multidisciplinary
team in GUM
· High Impact Change 4: Develop a separate pathway to manage screening of
patients at low risk for STIs
· High Impact Change 5: Review current access system and make it easier for
patients to access the service
· High Impact Change 6: Reorganise clinic opening hours to improve access
· High Impact Change 7: Reorganise the physical environment to maximise the
space available for seeing patients
Theme 3: Improve efficiency (and eliminate waste)
· High Impact Change 8: Reduce unnecessary clinical activity to increase capacity
to see new patients
Theme 4: Ensure effective commissioning and contracting
· High Impact Change 9: Assess the state of readiness of STI service providers
outside GUM, and prioritise developments that will help meet and sustain the
GUM access target
· High Impact Change 10: Make costs of GUM services transparent and develop
commissioning consortia which reflect patient flows
8

10. A consequence of resources not meeting the new demand was evident from the
national audit of GUM clinics, conducted in November 2006, which found that only
57% of clinic attendees were seen within 48 hours. Although this represented
improvement since the 38% achieved in May 2004, it meant that more than one in
three attendees having to wait longer than 48 hours to be seen. (DH 2006)
The subsequent best practice guide “Genito­Urinary Medicine: 48 hour access:
Getting to Target and Staying there” (DH 2008) provides recommendations with case
studies to help services achieve the target, narrow the gap between the numbers of
people offered an appointment and those actually seen (Figure 1), and then sustain
the target. This latest paper points to improved use of services, ensuring choice of
access (walk­in and pre­booked appointment), informed choice, making use of
outreach facilities to reduce travelling and barriers to attending, and delivery of a
quality service across the whole network.
Source: Genitourinary Medicine 48­hour Access: Getting to target and staying there
(DH 2008)
The following table illustrates a rise in the incidence and prevalence of STI’s giving
evidence of an increasing workload in GUM clinics country wide in terms of testing
9

11. and treating of STI’s. It therefore highlights the need to evaluate current practice and
consider better use of resources and new ways of working.
Figure 2 Incidence and Prevalence of Sexually Transmitted Infections (STI) in
the UK (HPA 2006)
Source: Testing Times (HPA 2007)
HIV & AIDS
According to HPA (2007) in 2006, 73000 persons were living with HIV in the UK. Of
these approximately 21600 were unaware of their infection. In the same year 7800
new cases of HIV were diagnosed, a similar rate to 2005. This is 13 people per
100000 population.
Specific examples include:
· Two fifths of newly diagnosed people were probably infected in the UK and of
these two thirds were men who had sex with men
· In 2006 a third of people newly diagnosed were diagnosed late with a CD4 cell
count below the recommended threshold for starting therapy
· 52000 people with HIV accessed care in the UK in 2006. This number has tripled
since 1997
· 4000 people aged 55 years and above which accounted for one in every thirteen
people accessed HIV related care in 2006
· The crude mortality rate among HIV infected people declined from 4.7% in 1997
to 0.95% in 2006
· The crude mortality declined at a slower rate among injecting drug users
compared to other high risk groups and was 2.9% in 2006
10

12. Gonorrhoea
In the heterosexual population the incidence of Gonorrhoea has declined however it
has continued to rise among men who have sex with men. This may be attributed to
improved management of patients and their partners at GUM clinics. Key issues are:
· Young adults, men who have sex with men and black ethnic minority populations
continue to be high risk groups. Therefore interventions should be targeted at
these groups
· The majority of diagnoses are made in GUM clinics however a significant
proportion of women are diagnosed in general practice
· Antimicrobial resistance for example ciprofloxacin resistance has risen sharply
· If untreated Gonorrhoea can lead to chronic pelvic pain, pelvic inflammatory
disease, ectopic pregnancy and infertility in women
Chlamydia
· This was the most commonly diagnosed bacterial infection in UK GUM clinics in
2006
· It accounted for 30% of all new STI diagnoses in GUM Clinics
· A significant number of women were diagnosed in General Practice.
· There is a high prevalence amongst heterosexuals and a high proportion of
asymptomatic cases
· Diagnostic tests and simple treatments have led to the introduction of various
screening approached across the UK.
· In England the target for PCTs was to have a plan for local opportunistic
screening for young adults in place by December 2007
· In 2006 in Sweden variant strains of Chlamydia Trachomatis emerged; no variant
strains were detected in England or Wales and the HPA is investing this further
Syphilis
There was as substantial rise in diagnoses in the UK, from 301 in 1997 to 3702 in
2006.
· The majority of cases were amongst men who have sex with men
· A quarter of those with infectious Syphilis in 2006 were also infected with HIV
· In 2006 men were 6 more likely to be diagnosed than women
· The majority of cases were accounted for by outbreaks in London and the North
West however this has recently increased throughout the UK overall
Genital HPV
Diagnoses of genital warts in GUM clinics increased by 3% between 2005 and 2006,
which continues the trend seen over the last 10 years in the UK.
11

13. · Genital warts were the most common STI diagnosed in GUM clinics in 2006,
accounting for 22% of all new STI diagnoses
· The great majority of Genital HPV infections are acquired through heterosexual
sex
· In 2006 3% of new diagnoses were in men who have sex with men; this group
has the greatest percentage increase in new diagnoses ( 64% over the last 10
years)
· Diagnoses have been consistently most frequent in young adults, where rates
have been steadily increasing
· The introduction of an HPV vaccination programme has stimulated further work
to increase knowledge about the epidemiology of HPV
The following table illustrates the numbers and percentage changes for each STI over
one year and also over the last 10 years.
Table 1 STD diagnoses at GUM (genitourinary medicine) clinics in the UK:
1997­2006
Genital
Syphilis Herpes
Gonorrhoea Chlamydia Warts All new
Year (primary and (first
(uncomplicated) (uncomplicated) (first diagnoses
secondary) attack)
attack)
1997 162 13,063 42,668 16,615 68,883 231,185
1998 139 13,212 48,726 17,248 70,291 244,282
1999 223 16,470 56,991 17,509 71,748 261,406
2000 342 21,800 68,332 17,823 71,317 284,035
2001 753 23,705 76,515 18,944 73,458 303,169
2002 1,258 25,599 87,592 19,426 74,991 324,196
2003 1,652 24,965 96,151 19,231 76,598 346,126
2004 2,282 22,321 104,733 19,073 80,055 363,248
2005 2,804 19,248 109,418 19,830 81,201 368,341
2006 2,766 19,007 113,585 21,698 83,745 376,508
%
change
­1% ­1% 4% 9% 3% 2%
(2005­
2006)
%
change
1,607% 46% 166% 31% 22% 63%
(1997­
2006)
Source Testing Times (HPA 2007)
12

14. The Local Context
According to the Baseline Data from 2003 (Appendix 1) the area covered by the
Greater Manchester Sexual Health Network has a population in excess of two and a
half million. The population column illustrates how some areas within the network
serve a population of around 100,000, whereas others serve a population of nearer
300,000. It is clear that services and the demands on services are geographically
very different. However services appear to have other differences in terms of opening
times, staffing levels and skill levels which had yet to be fully understood.
The Greater Manchester Project.
This project was commissioned by the Greater Manchester Sexual Health Network
and was carried out by academic staff from the University of Salford School of
Nursing. Within the Sexual Health Network, a Priority Action Group 7 (PAG7) was set
up to focus on the workforce development issues, and to act as a steering group for
this project. Appendix 2 illustrates the location of PAG 7 within the Sexual Health
Network and how it integrates with network activity as a whole. PAG7 assisted in the
development of the questionnaires, in their distribution and return, and were also
available to comment and advise the project team as the project progressed.
The Purpose of the Project
The purpose of the project was to evaluate the capacity and capability of the current
and future Greater Manchester sexual health workforce to deliver the national sexual
health strategy. (DH 2001).
Workforce planning is defined as “a systematic and integrated process to ensure that
organisations and wider economies strategically plan to have sufficient staff (clinical
and non clinical), with the appropriate skills, to meet the current and future needs of
their populations” National Workforce Projects (2007)
Ethical Consideration
This project was commissioned by the Greater Manchester Sexual Health Network,
who own the intellectual property. PAG 7 was a steering group, fully involved in
project design and implementation at all stages. PAG 7 validated and approved the
methods employed throughout. At operational level all participants were fully informed
of the project’s purpose and gave their consent for participation. Individuals’
contributions and responses have been anonymised, although services within the
network are identified within the report where relevant. Questionnaires and focus
group transcript data have been kept securely.
13

15. Project Delivery
The project team undertook on­line National Workforce Project training in order to
adopt the Six Step Guide to Planning the Workforce (2006) (Appendix 3):
· Step 1 Defining the Plan
· Step 2 Visioning the Future
· Step 3 Assessing Demand
· Step 4 Assessing Supply
· Step 5 Action Plan
· Step 6 Implementation and Review
Step 1: Defining the Plan
Project Outputs:
· To present an innovative workforce plan, that meets the needs of local sexual
health services and delivers high quality care to the people who use them.
· To establish a communications network across NHS Northwest
· To determine key stakeholders views about the development needs of the
current and future workforce.
· To undertake a baseline survey of the local sexual health workforce
· To review progress on the development of Levels 1,2, and 3 Sexual Health
Services in each Primary Care Organisation (PCO) across the network
· To undertake a scoping exercise of the current training/education provision.
· To recommend a training and education strategy for registered nurses.
· To recommend strategies to raise the profile of sexual health nursing within the
pre­ registration nursing curriculum, to key stakeholders for example the Council
of Deans of Health.
Scope of the Plan
This includes timescales, client group, geographic area and services involved.
The organisations and staff groups that participated in the project were
· Registered Nurses
· Health Advisors
· Support Staff (including Assistant Practitioners, Trainee Assistant Practitioners,
Healthcare Support Workers, Healthcare Assistants)
And represented the following areas
· Bolton
· Ashton, Wigan & Leigh
· Trafford
14

16. · Stockport
· Tameside and Glossop
· South Manchester
· Central Manchester
· North Manchester
· Rochdale
· Heywood and Middleton
· Bury
· Oldham
Step 2: Visioning the Future (Forces for change)
This Step looks at drivers for change and a PEST analysis was made for this purpose.
The detail of this can be found in Appendix 4.
Horizon Scanning (Warne et al 2006) was also employed for data collection. This
enabled the project team to look beyond the immediate services and to gather
information about sexual health education providers across the Network, as well as
the many other agencies delivering sexual health services, care, and education.
These data are presented in tables in Appendix 5 and 6.
Possible barriers
Mind mapping activities within the PEST analysis (Appendix 4) undertaken by the
Project Team produced a list of potential barriers such as:
· Insufficient numbers of educated staff
· High vacancy levels
· Some parts of the workforce sufficiently skilled, however not permitted to use
their skills
· Some sexual health services not willing to provide services outside of GUM
· Restricted service opening times in some areas
· Insufficient outreach service provision.
· Inappropriate skill mix for new ways of working
Step 3: Assessing Demand
This Step addresses data collection and is defined as “The assessment of population
health, demand for service, planned provision of services, using national and local
policy, service models planned to deliver the services, including current staffing
models, and new ways of working ­ new roles, skill mix and productivity changes.”
(National Workforce Projects 2006)
A baseline analysis of the workforce was produced in 2003 by the Greater Manchester
Sexual Health Network. (Appendix 1)
15

17. This comprehensive baseline analysed:
· Populations covered
· Staffing levels
· Service provision
· Baseline activity
· Waiting times
· Diagnoses
· Environment
· Training
· Patient involvement
· Health promotion activities
· Networking/relationships with other organisations
These data offered the way forward for new ways of working. For example
strategically developing collaboration with organisations across the different sectors
could potentially free GUM services to provide more complex care.
This Greater Manchester project builds on the data from the 2003 baseline analysis
(Appendix 1). The following methods of data collection were agreed with the Network
Board and were used to gather information about the nursing and health care support
workers in Sexual Health services.
Data Collection Instruments
1. Questionnaires (Appendix 7)
Three questionnaires were developed one for lead nurses, one for nurses and health
advisors and one for support staff. The questionnaires enabled a snap shot of staffing
levels, skill mix, education and training needs, and staff perceptions of their service’s
performance against Government targets. Questionnaire distribution and return were
coordinated by Lead Nurses in the participating organisations.
2. A Focus Group discussion was undertaken with PAG 7 members to customise
the data. This enabled descriptive insight into the participants’ experiences and
professional views relating to workforce capacity and capability. Nine lead nurse
members of PAG7 took part in unstructured nurse­led tape recorded discussion which
was later transcribed and analysed thematically.
3. Review of Job Descriptions (Appendix 9)
In addition to the questionnaires, requests for job descriptions were sent by letter to all
lead nurses in PAG7. A variety of job descriptions were returned from 6 organisations.
These were elicited and analysed from the following sample of organisations
participating in the project.
· North Manchester (4)
· Central Manchester (7)
16

18. · Trafford (4)
· Oldham (5)
· Salford (3)
· Withington (3)
Analysis
Figure 3 details the response rate by banding and also illustrates the complexity of job
titles within sexual health services. For this table all support workers were combined
Figure 3. Response Rate by Banding
Job title Response
Lead Nurses 12
Health Advisors 8
Senior Health Advisors 2
Staff Nurses 10
Sexual Health Nurse 10
Nurse Practitioner 9
Senior Nurse Practitioner, Family Planning Nurse 6
Sisters 4
Family Planning/Sexual Health Nurse 3
Young People’s Sexual Health Nurse 2
Clinical Nurse 1
Clinical Outreach Nurse 1
Clinical Lead/Senior Nurse 1
Instructing Family Planning Nurse 1
Nurse 1
Support Workers 23
In total there were 94 responses to the questionnaire, however 92 were able to specify
their roles as above. It is possible 2 respondents described their role in more than one
category above.
The qualitative data in the form of answers to open questions were collated and
themed, and the quantitative data in the form of responses to closed questions were
tabulated using spreadsheet software.
Step 4: Assessing Supply
This step of the model addresses the project findings.
According to National Workforce Projects (2006), this step explores the make­up of
the current workforce, the number and type of nursing staff available, flows in and out,
17

19. and what causes these levels to change and development options. Potential issues
which may have impact on supply are:
· New qualifiers
· Recruitment of volunteers
· Retention
· Effective utilisation and staff development
Staffing levels
In order to estimate the current GUM nursing workforce, lead nurses were asked
independently of the questionnaires to provide staffing information about their service.
Responses from 4 out of 12 organisations were received and follow.
Trafford PCT 2007
Job Title Band Numbers Hours WTE
Professional Clinical Manager 1 1
Nurse 5 1 1
Healthcare Assistants 2 1 4 sessions
Salford Integrated Sexual Health Staff 2007
Manager 1 37.5 1
Sexual Health & HIV Lead Nurse 2 37.5 2
Healthcare Assistants 3 1 37.5 1
Senior Registered Nurse 6 4 142.5 3.8
Registered Sexual Health Nurse 5 3 112.5 3
Specialist Nurse 1 22.5 0.6
Oldham PCT 2007
Job Title Band Numbers Hours WTE
Senior Nurse 7 1
Nurse Practitioners 6 3
Sexual Health Nurses 5 2
Healthcare Assistants 2 3
North Manchester PCT 2007
Including
Senior Nurse 7 management hours 1.7
Nurse Practitioners 6 1.0
Sexual Health Nurses 5 2.45
Healthcare Assistants 2 1.7
Central Manchester PCT 2007
Senior Nurse (including lead nurse) 7 1.8
Nurse Practitioners 6 8.6
Sexual Health Nurses 5 3.0
Assistant Practitioner 4 0.95
Trainee Assistant Practitioner 2 2.0
CWS 2 4.0
Of the Central Manchester numbers:
2.6 WTE Band 6 nurses are permanent Health Advisors (HA)
1.0 WTE Band 5 nurses rotate into the HA team.
HIV
1.0 WTE Band 7 permanently in HIV
18

20. Original data were collected in 2007, however as staffing levels had significantly
improved in 2008, more recent data from PAG 7 has been included in the report for
accuracy, as raised and agreed at the validation meeting with PAG7 in May 2008.
Salford Integrated Sexual Health Staff ­ 2008
Job Title Banding Hours WTE
Manager 37.5 1.0
Lead Nurse in Sexual
Health & HIV 7 75 2.0
Senior Registered
Nurse 6 225 4.0
Registered Sexual
Health Nurse 5 172.5 4.6
Health Care Assistant 3 101 2.6
Specialist Nurse 22.5 0.6
South Manchester / Withington Hospital 2007
Number Full/Part
Job Title Banding Time WTE
Clinic Manager 7 Full time 1.0
Senior Clinical Nurse 6 Full time 1.0
Specialist Nurse 6 4 3 FT 1 PT 3.6
Health Care Assistant 2 2 Full time 2.0
Health Adviser 7 2 Full time 2.
Counsellor/Psychosexual 7 Full time 1.0
HIV Pre/Post Counsellor 5 2 Part time 0.2
19

21. 1. Questionnaire Responses
Are there any Staff Vacancies?
At the initial time of completing the questionnaires, seven of the lead nurse
respondents reported services having at least one substantive post vacant. Four
services were fully staffed. Three areas had two nurse vacancies. Two areas had
three nurse vacancies. Two vacancies were for nurse practitioners, one was for a
health care support worker, one for a health care assistant, one for a sexual health
nurse and one for a specialist nurse, and one for a clinical nurse specialist. Five of
these vacancies were in band 6, and six were in band 2.
Is your service Hub or Spoke?
Lead nurse respondents believed that the service offered was currently Level 3
(“Hub”). Of the sexual health nurse/health advisor, respondents (56), twelve reported
working in Levels 1 and 2 (“Spoke”) environments.
Figure 4
Sexual Health Services – Hub and Spoke
Primary Care
Organisations
Levels 1,2
Private Youth
Practice Services
Levels 1,2 Level 1
GUM
HUB
Charities, e.g.
Brook, Levels
George 1,2,3 “Outreach”
House Trust Levels 1,2
Levels 1,2
School Health Family
Level 1 Planning
Clinics
Levels 1,2
20

22. What does your service provide and how often?
Lead nurse responses showed that services were provided every week­day, although
the hours of the service varied considerably.
· The Bolton Centre for Sexual Health provide two 10 hour days, one 9 hour day
and two 5 hour days, with no cover at the week­end.
· Central Manchester offers two 10.5 hour days, one 10 hour day and two 8.5 hour
days, with GU consultants on call at the week­ends.
· In contrast, Stockport provides clinics all day on only one day and the remaining
provision is half days.
· Three services were offered routinely on part of each Saturday. (Rochdale am,
North and South Manchester early pm)
· Two services extended until 8 p.m. during weekdays, for example North
Manchester, which provides a service through from 9 am to 8 pm on two days,
and later start and clinics though until 8 pm on two other days.
· The Palatine Centre offers evening clinics of a shorter duration on most days
until 8 pm.
Services Delivered
The services delivered (by percentage) are presented in the following table
Services Delivered by Nurses / Health Advisors %
Pregnancy testing & referral 87.9
Sexual history taking & assessment 86.2
STI testing for women 84.5
Assessment & referral of men with STI symptoms 79.3
Testing & treating STIs 79.3
Contraception information & services 74.1
Invasive STI testing for men 67.2
HIV testing & counselling 67.2
Hepatitis B Vaccination 63.8
Cervical cytology 58.6
Partner notification 55.2
Specialised infections management 53.4
Outreach for STI prevention 50.0
Specialised HIV & care 39.7
Outreach contraception 25.9
Highly specialised contraception 17.2
Contraceptive implant insertion 12.1
IUD insertion 3.4
Vasectomy 1.7
21

23. Analysis of the services delivered highlights that the 5 most delivered services are
GUM services
1) Pregnancy testing and referral (87.9%)
2) Sexual history taking and assessment (86.2%)
3) STI testing for women (84.5%)
4) Testing and treating STIs (79.3%)
5) Assessment and referral of men with STI symptoms (79.3%)
and that the 5 least delivered services are contraceptive services
1) Vasectomy (1.7%)
2) IUD Insertion (3.4%)
3) Contraceptive implant insertion (12.1%)
4) Highly specialised contraception (17.2%)
5) Outreach contraception (25.9%)
Do Lead Nurses undertake a Clinical case load?
Only one lead nurse did not carry a clinical caseload, and the clinical involvement of
the others varied considerably from one lead nurse who had a clinical role of 30­40%,
to others who stated 3­4 clinical session per week, or “as the service requires” or “ad
hoc”
Have staff been banded in relation to Agenda for Change / KSF?
(58 responses of 68 lead and sexual health nurses)
The qualified nurse/health advisor respondents identified that they were in the
following bandings:
Banding Number Job Title
7 10 Sexual Health Advisor/Senior Advisor (8), Nurse
Practitioner, Clinical Lead/Senior Nurse
6 33 Sister, Nurse Practitioner, Health Advisor/Senior Health
Advisor (1), Senior Staff Nurse
5 15 Staff Nurse
Are you able to meet the 48 Hour GUM Access Target?
The Ten High Impact Changes: 48 hour target (DH2006) provides important measures
for the workforce, for example measures of the improved use of resources to enable
clinics to be run more efficiently and to be scheduled at different times of the day,
measures of the extent of choice of walk­in clinics or pre­booked appointment, and
also measures of the availability of the use of outreach facilities to address barriers to
attendance. This guidance focuses on planning and service redesign, to optimise flow
through bottlenecks, enabling shorter patient journeys, and releasing resources for
increased capacity.
22

24. Eleven of the twelve lead nurse respondents (covering14 PCT’s) answered the 48
hour target question, five answered that they were achieving the 48 hour target, five
answered that they were not, and the Palatine Centre (Contraceptive Service)
answered “not applicable”
PCT Yes No Not No
Applicable response
Ashton, Leigh & Wigan ü
Bolton ü
Bury ü
Central Manchester ü
North Manchester ü
North Manchester (Higher Openshaw) ü
South Manchester ü
South Manchester (Palatine Centre) ü
Pennine Oldham ü
Rochdale ü
Salford ü
Stockport ü
Tameside ü
Trafford ü
Total 4 5 1 4
The reasons given in the questionnaires by the various respondents for non
achievement of the 48 hour target were:
“Demand for appointments ­ introduced screening clinics”
“Space ­ although soon to be remedied as we are moving some HIV clinics to another
part of the hospital”
“Part time nature of the service”
“We meet 48hr access for a high percentage of patients however if one of the medical
staff is absent and a list has to be closed, the percentage drops quite markedly”
“Too few staff to maintain clinical sessions e.g. only x1 Dr in each session so if on
study or annual leave the clinic is cancelled or changed to asymptomatic screening,
therefore unable to offer urgent appointments”
“Trained GU nurses within Community Services (contraception) ­ unable to obtain
clinical governance to commence this role from Lead Clinician. However, funding is
available for pharmacy. Need pathways in place for GUM ­ numerous meetings with
GUM for the way forward. National Support Team Visit 2007 agreed with this
development, still as yet unable to progress to offer HIV & syphilis blood tests”
23

25. Responses from individual nurses and health advisors will now be looked at in more
depth.
Hours worked by nurses and health advisors, and their “banding”
Twenty nine of the nurse/health advisor respondents worked full time hours, and 28
responded as working part time hours. The part time hours recorded ranged from 2.5
hours a week (1 sexual health nurse) to 35 hours per week.
In the health advisor/senior health advisor group hours worked varied from 9 hours
(1), 16 hours (1), 24 hours (1), 30 hours (1) and full time (7). Six were in Band 7 and
three were in Band 6
Post Banding Full or part time
Health Advisor / Nurse Practitioner 7 FT
Health Advisor (RGN essential criteria) 7 FT
Health Advisor (RGN essential criteria) 7 FT
Sexual health Advisor / Nurse Practitioner 7 FT
Sexual Health Advisor 6 FT
Health Advisor / Clinical Manager 7 FT
Senior Health Advisor 6 30 hours per week
Health Advisor 7 16 hours
Health Advisor 6 9 hours
Of the five respondents who identified themselves as Staff Nurses’ one works 8 hours
per week and the remaining 4 work full time. All were Band 5
Post Banding Full or part time
Staff Nurse 5 FT
Staff Nurse 5 FT
Staff Nurse 5 FT
Staff Nurse 5 FT
Staff Nurse 5 8 hours 1 day per week
Of the Nurses who identified themselves with a Family Planning only role, all were part
time and all were in band 6
Post Banding Full or part time
Family Planning Nurse 6 18 hours per week
Family Planning Nurse (Bank Nurse) 6 0
Family Planning Nurse 6 30 x 3 hours per year
Family Planning Nurse 6 PT
Instructing Nurse Family Planning 6 5.25
24

26. The remaining 18 nurses identified themselves by a variety of job titles and bands 5
(2), 6 (13) and 7(3). Eight work full time, and the remainder work part time ranging
from 2.5 hours (1) 18 hours (1), 20 hours (1), 21 hours (2), 25 hours (1) and 30 hours
(1) per week.
Post Banding Full or part time
Sexual Health Nurse Specialist 7 FT
Clinical Lead / Senior Nurse 7 30 hours per week
Sexual Health Nurse 7 FT
Sister / Nurse Practitioner 6 FT
Nurse Practitioner 6 FT
Nurse Practitioner 6 FT
Nurse Practitioner 6 FT
Senior Clinical Nurse 6 FT
Young Persons Specialist Sexual Health Nurse 6 18 hours
Clinical Nurse 6 21 hours
Clinical Outreach, Contraception and Sexual
Health Nurse 6 20 hours per week
Sexual Health Nurse 6 FT
Sexual Health Nurse 6 FT
Sexual Health Nurse 6 FT
Sexual Health Nurse 6 21 hours
Sexual Health Nurse 6 2.5
Sexual Health Staff Nurse 5 FT
Sexual Health Nurse 5 25 hours per week
25

27. The chart below shows the distribution of the full and part time posts represented by
the respondents across the network. It does not indicate the actual number of part
time hours worked by those staff, nor is it the total picture of the workforce.
Full time and part time posts
7
6
5
No of posts
4
No of FT posts
No of PT posts
3
2
1
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PCT
Outreach services
Analysis of the questionnaires showed that there was a wide interpretation of what
outreach meant to different individuals and to different services. Consequently a
considerable variation of the services offered across the network exists, with some
offering comprehensive outreach clinic services and others offering education only.
Outreach appeared not to have been consistently defined and was variously
described, for example, as delivering services to vulnerable and harder to reach
groups in saunas, or to young offenders and also in areas where generally sex, drugs
and alcohol are more freely accessible (Canal Street, Manchester was cited). Some
included in their interpretation of outreach individual home visits where advice is given
on how to prevent the spread of infection. Some included the delivery of mainstream
health promotion campaigns, attending and presenting at conferences, providing
training events to wider populations and activities such as putting up posters
More detailed analysis at service level reveals disparity of provision of outreach
services across the network.
· One service offers no outreach work at all (Trafford)
· Six of the services questioned offered no outreach contraceptive services.
26

28. · Five of the twelve members of staff who responded from Tameside offered
outreach in both STI and Contraceptive services
· Of the ten staff nurse/health advisor respondents from Central Manchester seven
offered outreach in STI services, although none in contraceptive services
· In Salford three of the four respondents offered outreach in both STI and
contraceptive services
Outreach is an aspect of GUM and contraceptive services which is already shared
with charitable organisations like Brook, Marie Stopes, BPAS, George House Trust,
Body Positive, for example. Reference to the baseline analysis made in 2003
demonstrates how diverse the perception of relationships with other services like
these is, both voluntary and other branches of the NHS.
Contraceptive information and advice
The Monks Report (1988) and the work of Allen and Hogg (1993) identified the need
for “one stop” services, particularly for young people, and had recommended that all
staff should be able to advise more generally about contraception. The findings in this
report from 2007 show that it is still not the norm for GU staff to deliver contraceptive
services, and many family planning and sexual health staff operate independently.
Fifteen of the 56 nurse/health advisor respondents stated they were not currently
providing a contraceptive information service.
Those not delivering contraceptive information and advice were
· health advisors/senior health advisors (8)
· staff nurses (2)
· clinical nurse (1)
· specialist nurse practitioners (2)
· nurse (1)
· sexual and reproductive health nurse (1)
· None of the health advisors were involved in delivering the other contraceptive
services, although 8 of the 10 health advisors carried out pregnancy testing as
part of their role
Specialised Contraceptive Services
Teenage pregnancy statistics in Greater Manchester are on average higher than the
national average. There has been a recent decline in the rate of teenage pregnancies
in the network area of approximately 7% on the 1998 baseline, although the national
average decline is 13.3%.
One intervention which is known to have an impact on unwanted pregnancies is the
offer of long acting reversible contraception (LARC) to young women attending family
planning and sexual health services.
LARC can be attractive to young people for a number of reasons:
27

29. · It is highly cost effective for the service, as follow up appointments are less
frequently required
· It relieves the burden on an overstretched service when replacement is only
required every 3­5 years for implants and IUS, sometimes longer with some
IUD’s, compared with once every 3 months for long acting progestogen
intramuscular/subcutaneous injections, and once every 6­12 months for other
hormonal methods, for example oral contraceptives
· Regular follow up checks can be provided by a less skilled practitioner, freeing
up staff with more specialised training to deliver more specialised interventions
However LARC initiation remains in the five least delivered services by nurses working
in sexual health in this sample. Only two of fifty six nurse/health advisor respondents
fitted IUD’s, and seven inserted implants at the time of the questionnaires. Only one
nurse, who worked in highly specialised contraception carries out vasectomy.
Highly specialised contraceptive services are available in Salford, the
Palatine Centre, North Manchester and Bolton, the remaining 8 respondents offering
no highly specialised contraceptive services.
Testing and treating
A similar picture emerges in this section in respect of integration of sexual health
services. It appears that opportunistic services are not at their optimum level because
services are not all able to provide a comprehensive sexual health service
incorporating testing, treating, advising, pregnancy testing and contraception
· Twelve of the 56 nurse/health advisor respondents were not involved at all in
testing and treating for STI’s. (Focus group participants later pointed out that this
question should have been split into two, as respondents may have been
involved in testing but not treating.)
· Nine of the 56 nurse/health advisor respondents were not involved in STI testing
for women
· Twelve of 56 nurse/health advisor respondents were not involved in assessment
and referral of men with STI symptoms
· Nineteen of the 56 nurse/health advisor respondents responded that they were
not involved in invasive STI testing
Those not involved in STI screening were:
· family planning nurses (5)
· instructing family planning nurse (1)
· health advisor (1)
· specialist nurse practitioner (1)
· staff nurses (2)
· nurse (1)
· sexual health and reproductive health nurse (1)
28

30. Sexual History taking
Six of the 56 nurse/health advisor respondents stated that they were not involved in
sexual history taking. These were :
· family planning nurses (4)
· health advisor (1)
· Sexual health nurse (1)
Hep B Vaccine
Twenty one of 56 nurse/health advisor respondents were not involved in Hep B
vaccine administration,
These were:
· Family planning nurses (7)
· Health advisors(2)
· Young person’s specialist sexual health nurse (1)
· Staff nurses and sexual health nurses (46)
HIV Testing and Counselling
Nineteen of the 56 nurse/health advisor respondents were not involved in HIV testing
and counselling
Pregnancy Testing
Seven nurse/health advisor respondents were not involved in pregnancy testing, two
were health advisors, two were staff nurses, one nurse practitioner, one sexual and
reproductive health nurse and one nurse.
Cervical Cytology
Twenty four of the 56 nurse/health advisor respondents were not involved in cervical
cytology.
Partner Notification
Twenty six of the 56 nurse/health advisor respondents were not involved in partner
notification.
Specialised HIV services
Five responding areas (Salford, Trafford Family Planning, South Manchester Palatine
Centre, North Manchester Family Planning and Tameside) offer no specialised HIV
services.
29

31. The Health Advisors
Understandably health advisors were not as involved in some clinical aspects, unless
their role was a joint role. So seven of the Health Advisors did not provide outreach,
specialised infections management, highly specialised contraception, testing and
treating, although they did offer contraceptive advice and undertook pregnancy
testing.
The responses to these questions seem to have no relationship to banding.
Student Nurses
Participants were asked if they had students on placement, from which institution they
came, the length of the placement and whether it was a formal arrangement.
Does your service support pre­registration student nurses?
From the questionnaire data, pre­registration nurse placements appeared to come
from University of Manchester (9 network areas), University of Salford (2 network
areas), and Manchester Metropolitan University (3 network areas)
Chart illustrating pre­registration student placement origin
Pre­Registration Placements
2%
2% University of Salford
17% 21%
University of Manchester
Manchester Metropolitan
University
University of Central
Lancashire
Unsure
58%
Is this a formal arrangement with the University?
Three areas (Trafford Family Planning and North Manchester Family Planning and
GUM) answered “no”. One nurse answered “yes and no”
30

32. With the exception of Salford, all network areas reported having pre­registration
students at their place of work although those students did not necessarily spend time
with the particular nurse/health advisor respondents. Fourteen of the 56 nurse/health
advisor respondents did not have any involvement with pre­registration students
The length of pre­registration placement ranged from “spoke” placements of half to
one day, “sessions” (e.g. one clinic), longer placements of 3 weeks and 8 weeks, to a
maximum of 15 weeks (1 network area). Some staff stated that placement length
depended on both the institution and the course.
"We did have a student for 8 weeks in a year following an in­house training
programme. Other times student nurses will just attend having arranged a day /
session themselves"
Does your service support Post Registration nursing students?
Post registration placements were more plentiful and from more institutions, and
responding areas reported taking post registration students from courses at the
University of Manchester, Manchester Metropolitan University, University of Central
Lancashire, University of Huddersfield and the University of Salford.
Post Registration Placements
1%
3% University of Manchester
6%
Manchester Metropolitan
20% University of Central
46% Lancashire
University of Salford
University of
Huddersfield
24%
Informal arrangement
with students
Placement length is again dictated by the educational institution and varies from
sessions / 1 day to twelve weeks. Students on some longer placements may attend
only one day per week. Only 5 of the 56 nurse/health advisor respondents knew that
the placements were formally arranged.
There is wide variety of courses or places from which post­registration students come
to undertake placements, depending on the specialism.
Courses include:
· BSc (Hons) Sexual and Reproductive Health
31

33. · Family Planning
· Sexually transmitted infections
· GUM
· Community
· Gynaecology nurses
· Advanced practitioner (gynaecology)
· HIV courses
· Cytology trainees from Education Dept or GP surgeries
· Contraception training
· Level 3 CASH modules
· Health Advising module
· Mentorship
· First issue of hormonal contraception
· STI 1+2, CRASH (Contraception and Reproductive Sexual Health) 1+2
The Nursing and Midwifery Council (NMC) has developed standards to support
learning and assessment in practice that have outcomes for mentors, practice
teachers and teachers. The standards take the form of a developmental framework.
The NMC has agreed mandatory requirements for each part of the register, but in
essence all students are required to have a suitably qualified mentor or practice
educator. (NMC 2006)
Significantly therefore, fifteen of the 56 nurse/health advisor respondents did not hold
a recognised mentorship qualification. Respondents who did not have a mentoring
qualification included health advisors (4), sisters (3), sexual health nurses (2), staff
nurses(2) and family planning nurses (2)
An important part of the NMC Standards document (NMC 2006) gives the following
advice to staff who have undertaken mentorship training since 2002.
· Registrants already holding a mentor or practice teacher qualification recognised
by programme providers, should map their current qualification and experience
against the new NMC standard and meet any outstanding outcomes through
continuing professional development (CPD).
· Registrants who have existing teaching qualifications recorded on the NMC
register and who are actively engaged in teaching students on NMC approved
programmes should, by virtue of their qualifications and experience, already
meet the new standard. However they are advised to use the outcomes for
teachers in the framework to guide their CPD.
· Registrants who hold qualifications that may be considered comparable to
mentors or practice teachers, and which were not previously approved by one of
the previous National Boards or by a programme provider, e.g. NVQ assessor,
must use the AP(E)L processes available as specified previously and undertake
any further education as required by the programme providers to ensure that
they meet the standard. The nature of such education may be academic, work­
based or a combination of both.
32

34. Mentorship qualifications for 29 of the remaining 41 sexual health nurse/health advisor
respondents included:
· ENB 998 Teaching and Assessing in Clinical Practice (Nursing) (11
respondents)
· Preparation for Mentorship (Level 2/3) (6 respondents)
· Mentorship (no level specified) (4 respondents)
· ENB 997 Teaching and Assessing in Clinical Practice (Midwifery) (2
respondents)
· Associate Mentorship (2 respondents)
· Mentorship (Integrated in Specialist Practitioner Programme) (1 respondents)
· Family Planning Associate Mentor (1 respondent)
· Learning Teaching Counselling and Mentorship (Scottish equivalent of ENB 998)
(1 respondent)
· In house­mentoring updates (1 respondent)
It would therefore appear that an initiative may be required to skill up those nurses
who either do not hold a mentorship qualification, or to accredit staff who hold a
qualification since 2002 for their prior experience and learning.
Education and Training
Information was collected regarding the nature of the education and training
undertaken by sexual health nurses. These data included course name, academic
level and the name of the institution. Seventeen organisations countrywide had
provided some element of training and education for the respondents, three had
named Sexual Health Degrees or Diplomas, others referred to generic BSc’s, many
wrote about single modules, and four to specific skills training
The following list provides a synopsis of study undertaken by the sexual health nurses
and health advisors:
· University of Manchester (BSc Sexual Health)
· Manchester Metropolitan University (ENB courses, BSc and Diploma, Theory of
IUD fitting, Implanon Insertion)
· University of Salford (ENB courses, BSc Sexual Health and Diploma in Sexual
Health Modules)
· University of Central Lancashire (ENB courses and STIF)
· Liverpool John Moores (BSc in Sexual Health)
· Brighton University (Mentorship)
· Palatine Centre (STIF, cytology, family planning update)
· Margaret Pyke Centre (IUD/IUS training)
· Sheffield Centre for HIV – Assertiveness Trainer
· Sheffield Hallam (Certificate in Health Advising)
· ENB courses (no institution named)
· University of Lancaster (BSc)
· Marie Stopes (IUD/IUS Training)
· Palm Training (Working with sexually active young people)
33

35. · BASHH (Nurse Supply of Emergency Contraception)
· Napier University – STIF
· City University (London)
On analysis, education and training undertaken by the sexual health nurses and
health advisors shows no uniformity, and ranges from higher level academic courses
with recognised accreditation from universities, courses hosted by the voluntary sector
and charities like Marie Stopes to in­house programmes designed to develop
particular skills e.g. insertion of implants. Several nurses reported having attended
STIF courses, which are generally undertaken by medical staff and originate from the
professional organisation BASHH (formerly MSSVD). This diversity would seem to
indicate an absence of formally recognised education and training for sexual health
nurses, and considerable creativity within the workforce to achieve their own
recognised and required level.
Support workers
Twenty three questionnaires were received from support staff. Thirteen of these had
the job title of Health Care Assistant (HCA). Three were three Assistant Practitioners
(AP) (Bolton), two Trainee Assistant Practitioners (TAP) (Central Manchester), one
Trainee Clinical Support Worker (TCSW) (Central Manchester),one Clinical Support
Worker (CSW) (Central Manchester), two Support Worker (SW) (one in North
Manchester and one in Tameside) and one Health Care Support Worker
(HCSW)(Trafford)
The scope of activity undertaken by the various support workers ranges from stock
control, doctor’s assistant, to skilled clinical practice. There was both considerable
variation and considerable overlap in these roles which reflect the findings from Monks
(1988) and Allen and Hogg (1993)
Hours worked by the support workers
Seven of the 23 respondents worked part time hours. The hours ranged from 11
hours (1 HCA) to Full Time (13 including HCA’s, AP’s, TAP’s, HCSW’s).
Support Staff Bandings
Three were in Band 4 (AP)
Two were in Band 3 (HCA)
Eighteen were in Band 2 (HCA, TAP, CSW, SW, HCSW)
34

36. Support Staff Bandings
3, 13%
2, 9% Band 2
Band 3
Band 4
18, 78%
Below are the responses taken from the questionnaires of how the support staff
described their roles.
Assistant Practitioner
“I assist doctors and trained staff in clinical settings with procedures both for GU and
Family Planning, specialist clinics like erectile dysfunction, genito­dermatology and
colposcopy.”
“Run an Assistant Practitioner clinic giving results, doing follow up wart treatments and
test of compliance when patients have been treated”
“Outreach work ­ liaising with sauna workers providing condoms for them on a weekly
basis”
“Stock ordering and maintaining of Family Planning clinics”
Trainee Assistant Practitioner
“Nurse led blood clinics (HIV), Stock ordering, Assisting Doctors in GUM clinics,
Screening asymptomatic patients, Wart treatments (liquid nitrogen), Phlebotomy”
Health Care Assistant
“GUM ­ Assist doctors, venepuncture, order stock, obtain urine samples for testing,
stock room, reception, making sure the clinical area is prepared, data input on the
computer.
Family Planning ­ Set up all the rooms for nurses and doctors, to assist the doctor
with all procedures, dress all wounds when implants applied and inserted, make sure
rooms are stocked each week, ordering, reception”
35

37. Support worker
“I work in a sexual health clinic, preparing for patient examinations for the doctor or
nurse, taking blood tests if required from the patients, preparing urine samples for
microbiological testing as per clinical protocol and ensure safe transportation of
samples to the lab. I also chaperone the doctors and nurses when they are examining
a patient”
Support workers qualifications
Support workers were asked about their current level of training, and the following list
was compiled, again indicating wide variation, some with no formal qualification and
one with a foundation degree.
Support worker’s qualifications:
· NVQ2 ­ (10 , 2 named their NVQ as Health and Social Care)
· NVQ3 – (5 )
· Foundation Degree – (1)
· BTech National Diploma in Health Studies (1)
· BTech Level 2 IT – (1)
· Diploma in Health and Social Care –(1)
· FDA Health Care (1)
· “Basic Life Support, Health and Safety, child Protection, Fire Training” (1)
Support Worker Qualifications
1 1 1
1
1 10
1
5
NVQ2 NVQ3
Foundation Degree Btech National Diploma
Btech Level 2 IT Diploma Health & Social Care
FDA Health Care Basic Life Support etc
Support workers were then asked to define what they considered necessary training
for them in the future. Responses fell into four main categories:
1. Motivated/keen to learn
· Any training /any courses (5)
· NVQ3 (3)
36

38. · NVQ2 (2)
· Nurse training following completion of FDA course (1)
· “I am always keen to learn” (1)
· Specific – Microscopy (1)
· Specific ­ Venepuncture (1)
2. Happy
· “Happy with my role as it is” (1)
3. Unsure
· “Not quite sure yet” (1)
4. Unhappy (apparently related to lack of progression)
· “I have taken all the necessary training I could possibly take to further my
career, but have gained no financial benefits from all the training I have
undertaken over the past 18 months” (1)
2. Focus Group
The data were collated thematically as follows:
Theme 1: Historical considerations
Participants often referred to the influence exerted by the history of GUM, and how
GUM nursing was not in the past seen as a professional career pathway. Many
nurses in GUM worked sessions only, and did not undertake accredited training. Over
the last ten years or so many nurses have undertaken named sexual health degrees
and diplomas, and accredited modules.
Lead nurses were clear that the services had all evolved in a unique and isolated way
over time, and that it would be very unlikely that an agreement could be reached for
training or a model of service delivery applicable to the whole network.
For example, there is wide interpretation of outreach and concern was raised as to
how there are such diverse and inconsistent responses across the network. Factors
which may affect the level of outreach include how well the service is communicating
with other community services and how they perceive their relationship with other
organisations to be as well as the quality of services already being provided by the
other organisations and in schools and colleges.
Theme 2: Resistance to Change
There was also a feeling that some services were not ready to embrace the changes
necessary to meet new targets and delivery of a more comprehensive and accessible
service, that some were happy with the comfort of traditional ways.
“A lot of the staff are sessional as well, some people only come in the evenings”
37

39. “All of them are on email but they don’t access it (laughs). You know especially the
sessional staff, they don’t access it. Although we try to get people to access it”
Data suggested that some nurses are ready to deliver highly specialised services, and
that some have been trained to undertake them elsewhere in the UK, yet are unable to
use their skills in their current employment. There was suggestion that this might be
because of resistance from some doctors, resistance to change from the workforce in
general, or failure of some services to keep abreast with the pace of change required
to make an impact.
“Round here they’re horrified by nurses being capable of putting in an IUD”
Theme 3 : Staff Development Issues
One lead nurse participant explained her perception of the problems regarding nurse
development. She felt that there were inconsistencies across the services, citing one
particular service for example as not developing its staff as well as other services.
Two nurses said they felt that the Palatine Centre was more of a medical training
institution, not nursing. One lead nurse believes that nurse leaders are not fighting
hard enough for the service, or for accredited training, Non­accredited in­house
training is more available and accessible. It was also considered that medical staff
gain approval to attend conferences more easily than nurses.
“As far as attending conferences is concerned the medics have a stranglehold”
Theme 4: Career Pathways and Feelings about Academic Programmes
A clear message emerged that sexual health nursing needs a defined career pathway
if it is to attract capable nurses who are prepared to stay in the specialism. However
the education and training currently available in universities does not generally meet
the needs of the workforce. Respondents stated that they did not want universities to
dictate what was required in their specialism. Staff do not want to be away from the
workplace longer than absolutely necessary. They do not want to have to navigate
impracticalities like attending an educational institution education on the same day
each week. They want accreditation for practical programmes, preferably delivered in
the workplace. They want input into the content so that it is absolutely relevant to their
needs. The programme delivered by the Rcn/University of Greenwich was identified
as a good example of academic learning on­site which incorporates practice­based
learning.
Tensions were expressed between the requirements of universities for the
achievement of academic diplomas and degrees, and the intrinsically practical skills
identified as necessary for the workforce.
38