MARGARET PYKE TRUST

Online use of sexual health services has seen a marked increase in recent years, driving a need to ensure quality of online services provided both by the NHS and private providers.

Reflecting this, the latest standards for online use of sexual health services came under the spotlight with Dr Helen Munro, Vice President of the Faculty of Sexual and Reproductive Health (FSRH), in her talk that looked at the recent development of Standards for Online and Remote Providers of Sexual and Reproductive Health Services.

“The standards were developed in response to the rapid expansion of online services in the UK,” said Dr Munro, who was Chair of the working group comprised of the British Association of Sexual Health and HIV (BASHH) and the FSRH.

There has been a surge in the number of people searching for overall health-related information on the internet. Figures from the Office for National Statistics (ONS) showed an increase of 30% in the proportion of over-16s using online health resources in the last decade, and more than half of adults surveyed doing so in 2018.

“With chlamydia for example, we have found the number of young people [15-24-year olds] accessing specialist sexual health services has dropped [since 2014] but that they appear to be moving towards online services,” reported Dr Munro. ESexual Health Services (internet, online or eServices) increased by 54% and now account for 17% of tests and 14% of chlamydia diagnoses in this age group, she pointed out. “The question is whether this is through choice or because of lack of access to STI (sexually transmitted infection) clinics locally.”

In 2018, a Health Protection report noted that in comparing 2018 to 2017 figures, there was a 5% increase in diagnosis of all STIs. In particular, there was a 26% increase in gonococcal diagnosis and a 5% increase in serological tests for syphilis diagnosis, with the greatest impact of STIs remaining in young heterosexuals aged 15-24 years, black ethnic minorities, and men who have sex with men (MSM). There was a 7% increase in the total number of consultations.

In March 2018, the Care Quality Commission (CQC) looked into the standards of online provision with a report, The State of Care in Independent Online Primary Health Services. In January 2019, the Joint BASHH/ FSRH Standard was published, aimed at improving safety in online services, and to help healthcare professionals, providers and service commissioners to promote standardised care procedures and consistency of care across all healthcare settings.

In recent years there has been a surge in the number of online sexual health providers, both from the NHS and private providers. Dr Munro added that by April 2020, practices will have to offer online consultations according to the GP Online Consultation Systems Fund. The FSRH supports online prescribing of the combined oral contraceptive pill. “It’s important to remember that eServices are acceptable to young people and as such they are an effective means of reaching a population with high rates of infection.”

“During public consultation, there were some concerns expressed, particularly with regard to identification of the online user. NHS Digital are currently looking at improving the NHS log in facility and we are working with them in this respect,” said Dr Munro. “But we felt it right to maintain the Standard as practised in a face-to-face service where they don’t have to give their proper name or date of birth.”

In summary, key recommendations of the Standard include:

• Safe prescribing practices: prescribers should adhere to national guidelines on prescribing. The mode of consultation should not interfere with best practice prescribing
• Capacity/ consent: it is recommended that under-16s are signposted to face-to face services.
• Safeguarding of children and vulnerable adults: limitations associated with online and remote consultations should be acknowledged and, where appropriate, service users should be referred for face-to-face consultations

“Online services are a complement, not a substitute, to face-to-face consultations,” concluded Dr Munro, adding that, “irrespective of consultation modality, best practice and guidelines must be adhered to at every user contact to ensure safety and quality of care.”