2 Understanding levers and setting priorities
to deliver improved services quickly
12. The Department lacked urgency in trying to
reach the high volume of testing necessary to reduce the prevalence
of chlamydia. Despite regarding chlamydia as a big enough problem
to warrant a national screening programme the Department addressed
this risk through a lengthy and drawn out roll out over five years.[35]
During the financial year 2007-08, five years after the Programme
was launched and ten years after the Chief Medical Officers report
had recommended a national screening programme, only 5% of 15
to 24 year-olds were tested, against a target of 15%.[36]
13. Against a climate of financial deficits and
the reorganisation of Primary Care Trusts (PCTs), the Programme
lost momentum at a crucial point when the Department attempted
to roll it out nationally.[37]
There was no compulsion for PCTs to take up chlamydia testing
under the Programme until 2008-09, and the Department recognised
that they could and should have given clearer national prioritisation
to the Programme earlier.[38]
14. When the Department made chlamydia testing
a priority under its 'Vital Signs' framework in 2008-09 the numbers
of tests completed under the programme dramatically increased
(Figure 1). Nevertheless, six years after the Programme's
launch only half of PCTs were testing over 26% of young people,
the minimum required to make significant progress in reducing
infection (Figure 2).[39]
15. The original vision for the Programme saw
GPs and community sexual health services as central. Most stakeholders
consulted in the Comptroller and Auditor General's report also
felt that GP involvement was vital to the success of the Programme,
but 61% of local screening coordinators said that difficulty engaging
with GPs was one of the greatest obstacles to achieving higher
testing rates.[40] To
encourage GPs to engage with the Programme, 59% of PCTs set up
Local Enhanced Services contracts which pay GPs for providing
chlamydia testing, on top of their normal remuneration. The structure
and payments under such contracts varied considerably, from £1
to £15 for testing activity and from £8 to over £100
for treatment and partner notification services.[41]
When the Programme started there was resistance and uncertainty
amongst some GPs about whether they should or could conduct testing.
The Department accepted that it should have worked harder from
the outset at getting more engagement for the initiative from
a wider group of clinical and senior managers in the NHS.[42]Figure
1: Annual testing numbers for the National Chlamydia Screening
Programme
Source: C&AG's report, Figure 6 page 22Figure
2: Estimated rates of testing in 2008-09 by PCTs
Source: Health Protection Agency data on PCT performance
against Vital Signs target, plus testing in genitor-urinary medicine
clinics
35 Qq 2-8 and 87 Back
36
Qq 3-8 Back
37
Qq 2 and 32 Back
38
Qq 32, 33 and 57-59 Back
39
Q 10; C&AG's Report, paras 8 and 15 Back
40
Q 17; C&AG's Report, para 3.5 Back
41
C&AG's Report, para 3.3 Back
42
Q 18 Back
| 
