Complexities in Adult Nursing: Chlamydia and Service Development

This article discusses the challenges associated with sexually transmitted infections, particularly Chlamydia, in the Black and Minority Ethnic (BME) population in Southwark Borough of London. It analyzes the current service provision and associated challenges, and recommends actions to resolve the issue. The article emphasizes the need for integrating health and social care services and developing local networks of care to minimize the incidence rate of STIs.

Complexities in Adult nursing: Chlamydia and service
development

Table of Contents
Introduction..................................................................................................................................................................................................................3
Rationale.......................................................................................................................................................................................................................3
BME and challenges with STI......................................................................................................................................................................................4
Commissioning of required care services....................................................................................................................................................................5
Impact of fragmented care delivery..............................................................................................................................................................................6
Current positioning of service provision and associated challenges............................................................................................................................6
Required actions and impact........................................................................................................................................................................................7
Resolution.....................................................................................................................................................................................................................7
Recommendations........................................................................................................................................................................................................8
Conclusion....................................................................................................................................................................................................................8
References....................................................................................................................................................................................................................9

Introduction
Sexually transmitted infection [STI] is one major health and social care concerns, prevalent across England. In Southwark Borough of London,
STIs are a major healthcare issue. Chlamydia is one of the most commonly diagnosed STIs (Sexual Health Strategy 2014-2017, 2018). It is a
sexually transmitted bacterial infection. In case, the condition remains untreated for a long period of time may have an adverse impact on
reproductive health (Wellings, Mehl and Free, 2017).
Among the population suffering from the condition, the Black ethnic minority [BME] population within the age group of 15- 24, years can be
observed to be at higher risk. Factors like psychosocial influences, cultural influences have a major impact on the occurrence of conditions like
Chlamydia. It can be established with the help of the fact that, among the belonging from Black and Minority Ethnic Communities (BME), the
prevalence of such condition is more) (Lambeth, Southwark, and Lewisham Sexual and Reproductive Health Strategy 2018-23, 2019).
Rationale
On analyzing the scenario in England, it can be observed that as of, 2017, 422147 new cases of STI were identified in England, out of which
48% of the cases were of the chosen condition. This clearly reflects the severity of the situation (lambeth.gov.uk, 2019). Furthermore, in 2017, it
was observed that among the boroughs that had the highest rate of STIs, Southwark borough was in the third position (Lambeth, Southwark and
Lewisham Sexual and Reproductive Health Strategy 2018-23, 2019). This clearly reflects the fact that the chosen topic is of great relevance that
requires further research. It would help in identifying the issues resulting in the occurrence of the condition and ways of minimizing its relevance
rate (Clifton et al., 2017).
In addition to the above-discussed aspects, great disparity in the sexual health of BME and the white population can be clearly observed. It can
be established with the help of the fact that in the National Chlamydia Screening Program held for the year 2006-2007, among the population

suffering from Chlamydia, 14% of the population belonged to the black Caribbean young population and 9% among black African young
population. When compared to the white population it can be noticed that it was only 10% of the population who were tested positive (Gerressu,
2016). This clearly reflects that there remains a disparity in the service provider that results in an increased number of cases among the BME
population as compared to the rest of the white population. This further makes it essential to conduct the study for identifying the reason for the
disparity.
BME and challenges with STI
In order to gain an understanding of the changes associated BME population that result in increased incidents of STIs among the population, a
clear understanding of the section of the population that forms that BME is required. BME can be considered as a particular population, who
have non-white descents residing in the UK.
In the case of a particular section of the population, the increased prevalence of STIs like Chlamydia is observed primarily due to socio-
economic and cultural factors. To elaborate it further, it is their socio-economic positioning which plays a major role, in their lack of awareness
about sexual health. In terms of their social positioning, they have certain notions associated with sexual health and habits. As an instance,
section of the BME population has the perception that use of condoms and other preventive measure would adversely impact their sexual life
with their partner. Such a notion prevents them from having a safe sexual relationship with their partners (Wayal et al., 2017).
On analyzing such perception among the BME population, it can be noticed that such an understanding about the use of condoms or other
protections for safe sex, arises due to a lack of education and awareness associated with it. In addition to that, the increased prevalence of STIs
among the chosen population is also a result of their economic positioning. In other words, the lack of employment and economic empowerment
of a section of population among the BME, which prevents them from availing the required care services and prevent the risk of STIs among
them. Hence, a combination of the above-discussed factors results in creating a challenging in regards to the BME population in preventing the
rate of STIs among them (Mohammed et al., 2018).

Commissioning of required care services
On analyzing the initiatives taken on the part of Lambeth, Southwark, and Lewisham [LSL], it can be noticed that, since 1st April 2013, LSL is
liable for commissioning the majority of sexual health interventions and services. It has only become possible as, after the Health and Social care
Act 2012, responsibilities associated with public health have been provided to local authorities. In order to commission the strategies and
services associated with STIs, a joint commissioning approach has been taken on the part of LSL (lambeth.gov.uk, 2018). In order to proceed
with the joint commissioning approach, a tri-borough agreement has been signed. The tri-borough sexual health commissioning team is being
hosted by Lambeth. Combination of two factors, tri-borough approach, and responsibility of commissioning being provided to Local Authorities
have increased the opportunity of accomplishing enhanced outcome and effectively use resources. The enhancement of the outcome occurs in
two ways. One of the mentionable ways is a specific section of the society are vulnerable to poor sexual health along with homelessness,
substance use, and vulnerable young age. Hence, commissioning the services with the help of local authorities enhances the scope of providing
with targeted support and information to the vulnerable group. This has resulted in enhancing the outcome, form the provided services
(Education & Children Services scrutiny committee - 4 th Oct 2016, 2019).
The three areas being commissioned with services, implies that, residents of the area can have more service choices and utilize the resources in
an effective manner. In the process of commissioning the services, LSL can also be seen to have emphasized on prevention of sexual health
commissioning fragmentation. It has been ascertaining by the integration and collaboration of CCG and Local Authority commissioning. Herein,
the sexual health commissioning team that is based locally provides with views on strategic commissioning on behalf of LSL. In the process of
commissioning services, the emphasis is also given on health promotion, prevention of conditions, enhancing the accessibility of reproductive
and sexual health services on behalf of LSL authorities (Wellings, Mehl and Free, 2017).
The effectiveness of the commissioning of services associated with Chlamydia that is provided by LSL can be clearly observed with the help of
STI treatments. Its effectiveness can be re-established by the tests that are commissioned by primary care, which is associated with contracts in
local health and specialist services like Chlamydia screening. Such contracts have resulted in making Chlamydia screening and associated

services a part of the National Chlamydia Screening Programme. Its effectiveness can be further established with the help of the fact that health
care and social care has been integrated into the commissioning process of care services (Booth et al., 2012). It can be established with the help
of the fact that social care services have been integrated into the process under which support associated with STIs are provided. Furthermore,
under the Local authorities’ commission, the promotion of sexual health associated with sexual health services and its promotion in colleges and
schools has also been highlighted. This clearly reflects the fact that LSL emphasizes on integrating health and social care. The effectiveness of
the strategies can be well-established from the fact that since 2017 stability in the incidence rate of Chlamydia has been noticed. This reflects the
fact that the formulated strategies have been effective in preventing its occurrence and creates the required awareness.
Impact of fragmented care delivery
On analyzing the service provided by LSL in order to enhance sexual health, it can be noticed that, though efforts have been made to eliminate
the scope of sexual health commissioning fragmentation, in spite of that, its prevalence is noticeable. As a result of the fragmentation of health
care services, it has resulted in healthcare inequalities. The accessibility of associated services and health care benefits also becomes restricted
(Sheringham, 2012). It is due to the prevalence of fragmented care delivery and limited accessibility of the service provision, the resources
allocated for delivering quality care services and associated costs do not get utilized in a cost-effective manner. Hence, the allocated resources
for this purpose do not get effective distributed and allocated. Thus, it can be stated that it is due to the fragmented care delivery, the quality of
service provision and reason for developing it turns out to be ineffective and particular section of the society or specific community fails in
getting the required health care benefits, as observed in the case of BME (Sexual Health Strategy 2014-2017, 2018).
Current positioning of service provision and associated challenges

• On analyzing the present commissioning/care pathway, it can be noticed that various efforts have been made to ascertain that there remains
no prevalence of sexual health commissioning fragmentation.
• In spite of such efforts, it can be noticed that a particular section of the community like BME is not being able to avail healthcare services
associated with STIs like other sections of the society.
• As a result, there remains inequality in the current service provision and the provided resources for this purpose cannot be utilized in a
successful manner (Woodhall et al., 2013).
Required actions and impact
• In the process of delivering care services, the emphasis is needed to be given on delivering care services in such a manner wherein the GPs
would not be overstretched rather utilization of diverse staff would be focused.
Impact
• This would help in delivering care services in an effective manner.
• It would also require diverting the focus from traditional GP practice to effective utilization of resources and staffing in primary care.
• It would help in delivering care services to a wider population and cover the care needs of the population at a larger scale.
• The present and future health care demands of the members of the borough can also be effectively addressed with the help of such an
approach (Mohammed et al., 2016).
Resolution
• In order to resolve the issue, further emphasis is needed to be given on the development of local networks of care.

• For the purpose of ensuring the local care networks get developed in an effective manner, basing non-specialist care around the local
population would turn out to be effective in nature.
• As a result of basing non-specialist care around the local population, it would become easily accessible to the local population and patients.
• It would also provide with the scope to care providers of work and delivering care services with the local population and patients at a larger
scale, in an integrated manner.
• It would result in providing support and further promoting a holistic and preventive approach’s incorporation in the care provision of patients.
Recommendations
• Emphasizing on locality networks of care would help in working in partnership at a greater scale as the edifice of such working is collective
working.
• In the locality models of care, core PMS/GMS can be included.
• The inclusion of core PMS/GMS services would help in including various extended services along with enhanced non-core services and
community specialist services.
• These services would be required to be provided in accordance with the scale of the services i.e. whether it is being provided at the locality,
Borough or other (Booth et al., 2012).
Conclusion
Hence, based on the above-made discussion it may be concluded that STIs like Chlamydia acts as a major threat to public health. In order to
ascertain that the occurrence of such conditions remains restricted, health and social care services are needed to be integrated. This would help in
creating awareness associated with the condition. Other than that development of local networks of care would also be beneficial in partnership
working, which is integral in minimizing the incidence rate.

References
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Sheringham, J. R. (2012). Investigating socio-economic variations in access to chlamydia testing in young people in England. Doctoral
dissertation, UCL. pp.16-20
Wellings, K., Mehl, G. and Free, C. (2017). eSexual health interventions: promising, but more evidence needed. The Lancet Public Health, 2(4),
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Mohammed, H. et al., (2018). ‘100 years of STIs in the UK: a review of national surveillance data’, Sex Transm Infect, 94(8), pp. 553-558.
Wayal, S. et al., (2017). ‘Ethnic variations in sexual behaviours and sexual health markers: findings from the third British National Survey of
Sexual Attitudes and Lifestyles (Natsal-3)’. The lancet Public health, 2(10), pp. 458-472.
Clifton, S. et al., (2017). ‘Patterns of chlamydia testing in different settings and implications for wider STI diagnosis and care: a probability
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Education & Children Services scrutiny committee - 4 th Oct 2016. Available at:
http://moderngov.southwark.gov.uk/documents/s64301/Young%20Peoples%20Sexual%20Health%20services%20in
%20Southwark.pdf [Accessed 28 Feb. 2019].