Sunday, 4 August 2013

The clinic was closed or busy! (The turn away tragedy)

We have a problem with matching capacity with demand for sexual & reproductive health care services.  If a clinic becomes popular then it can be difficult to be seen.  Some clinics use an appointment system for their consultations, others only walk-in whilst a large majority use a combination of the two.  

A walk-in service is crucial to meet the needs of service users who need urgent care and these patients include those requiring post exposure prophylaxis following sexual exposure to HIV or emergency contraception.  The earlier these services are delivered the better and the walk-in service is the only way to provide this.  Similarly the walk-in service is really important for those patients who are symptomatic (for example the first episode of anogenital herpes) or they have complications that affect the Fallopian tube or testicles.  If you make the whole service walk-in then it is possible that clients will arrive when the clinic opens and all the time slots over the day can be used up within the first hour.  The impact of this for those who are in work or school is that they can turn up later in the day only to find that the service is now closed for the day.

The use of an appointment system is attractive to clinics because they can spread out the work load across the service and it supports users who are unable to attend at the time when the clinic opens.  However, some of the problems with an appointment system are that it can be oversubscribed and the waiting time to access the service can become weeks, there are unused slots from non-attendance or the service is put under significant pressure because the appointments have been made but there are not enough staff because of sickness, compassionate leave etc. 

Getting the balance right is challenge to all services but this does not always have to be the case.  In many areas there are range of providers that are not been fully realized such as general practitioners with a special interest, pharmacies and online providers.  In big cities where there are more than one provider of sexual & reproductive health services it is possible that one is busy and the other one quiet that this imbalance can only be resolved by real-time information about where is the next service open that can serve this individual.

In SXT there are a number of verified clinics who have been partners since its inception in 2012.  The range of providers include condom providers to university teaching hospitals and this includes GPs & pharmacy services within its database.  The third iteration of SXT (launch 6th August 2013) will have all the sexual health providers in the UK, all the UK emergency departments for out of hours post exposure prophylaxis and a range of free emergency contraception providers in London.  The mission of SXT is to improve access to sexual & reproductive health services and these changes will be a significant step towards this goal. 

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