In search of stars in sexual health improvement, the Terrence Higgins Trust has discovered innovative services dedicated to providing the best possible care for their users.

Sexual health services are often lambasted for their failure to tackle sexually transmitted infections.and teenage pregnancy in the UK, where rates are among the highest in Western Europe. Time and again we hear of overburdened staff running underfunded clinics in crumbling premises..

Times are undoubtedly tough, but the true picture is not as bleak as it seems..In May, the Terrence Higgins Trust began the search for rising stars in sexual health services and found initiatives all over the country that are listening to patients, providing local, accessible and integrated services, and working in partnership with other local organisations.

Here, two projects with true 'sex factor' are highlighted - Weston Area health trust and Cardiff and Vale trust -.while another three are highly commended.

Weston Area Health trust

Weston's sex factor comes from its team of clinical nurse specialists, who work between the Weston Integrated Sexual Health.Centre, 'No Worries' young people's local drop-in clinics and personal, social and health education.programmes in schools.

The development of the team was made possible by a synergy between North Somerset primary care trust.commissioning, Weston Area health trust management, and nursing and clinical leadership that successfully bid for£540,000 in.Department of Health.development funds to expand the area's sexual health facilities..

The team.developed key interlinked activities to improve access to services..Weston Area health trust.made a ward available for a new clinic, a nursing team was recruited and a consultant was appointed to design, teach and implement full integration of sexual health services. The nurses were trained as clinical specialists and deployed to locality centres and local schools. North Somerset PCT developed and advertised No Worries centres, and ongoing governance and support of the nurse-led services was provided via notes review and one-to-one supervision by the consultant.

The team now works in a welcoming, purpose-built clinic offering eight weekly sessions of integrated sexual healthcare. It has rapidly achieved 100 per cent 48-hour access. Teenage conceptions are now 20.8 per cent below baseline, on track to reach the 2010.target. Most patients are triaged and seen by nurse specialists, allowing senior clinicians to supervise and.manage more complex cases. Having the same nurses running community sexual health and in-school programmes.extends the network's reach and has helped in outbreak control.

The team's results speak for themselves: an outstanding improvement in 48-hour access from 4 per cent to 100 per cent, and a substantially reduced teenage conception rate. They deliver genuinely integrated nurse-led sexual health services linking hospitals with local community sexual health care. It is.a prime example of value for money from the.DoH genitourinary medicine.pilot project and is.already used as a regional example of best practice.

Further information: Peter Greenhouse, 07788 544622 peter.greenhouse@virgin.net

Cardiff and Vale trust

A partnership between the genito-urinary medicine.department of Cardiff Royal Infirmary and Terrence Higgins Trust.Cymru, honed over several years, has produced innovative and integrated sexual health and social care services.

This one-stop approach is particularly necessary in this area as people sometimes have to.travel great distances to attend the clinic.

The charity's participation in patient review means a holistic picture of patients' needs can be built, with people being referred back and forth as necessary without any delay.

Following a syphilis outbreak traced to a Cardiff gay sauna, Terrence Higgins Trust Cymru was asked to provide information and health promotion materials to men using the sauna. During discussions, it became clear that some men were not willing to attend a GUM clinic, partly because of.misinformation about how tests were carried out and the nature of the service.

With the sauna owners, Terrence Higgins Trust.Cymru's outreach team worked with GUM staff to provide syphilis testing on the premises. This allowed sauna visitors to meet the clinic's.staff and break down barriers. Just over 10 per cent of those tested were positive for syphilis.

For the past six months, GUM health advisers have been staffing Fastest, a one-hour HIV testing service at Terrence Higgins Trust Cymru's offices. The trust's.workers were trained by GUM staff and 113 people were.tested for HIV during the Welsh Assembly-funded six-moth pilot. Of these, 7 per cent tested HIV-positive. All attended the charity's partner clinic at Cardiff Royal Infirmary and so were available for follow-up.

When a number of young gay men attending GUM were recently diagnosed with HIV, a cluster was suspected. This represented a.very large number of contacts to be traced and tested on top of the already heavy workload of Cardiff Royal Infirmary's GUM department, so the Terrence Higgins Trust was asked to help by providing counselling and safer sex advice for the contacts traced.

Based at GUM, the Terrence Higgins Trust staff used skills acquired from the Fastest clinic and used Fastest procedures to ensure people were processed as quickly as possible without disrupting the existing GUM provision.

Further information: Sandra Smith, 02920 335169 sandra.smith@cardiffandvale.wales.nhs.uk

Gaol Street Clinic, Herefordshire PCT

The rural nature of Herefordshire - it is the most sparsely populated county in England and public transport is scarce - means many people living in Herefordshire find it difficult to attend.services based in the city.

Herefordshire's approach is to integrate local services so it is possible to access a range of services in one place, the community centre. The majority of medical staff working at the clinic are trained in both contraception and GUM..They move seamlessly between clinics and offer a holistic package of care and treatment.....

The service also provides training for primary care and has delivered four sexually transmitted infection foundation courses since March 2005, training more than.125 multidisciplinary clinicians to recognise and treat common STIs. Next steps are to develop further partnership working with general practice and community pharmacy to improve access and choice for people living in Herefordshire.

Further information: Maggie Colwell, 01432 378979 maggie.colwell@herefordpct.nhs.uk

Wiltshire PCT

Vulnerable young people have an increased risk of teenage pregnancy and contracting sexually transmitted infection. They are often hard to reach and - either through poor school attendance, truancy or exclusion - are unlikely to receive adequate sex and relationship education.

Locality training has been designed for staff who work with, help and influence young people. It.takes place in high-risk, high teenage pregnancy areas across Wiltshire. It aims to develop staff confidence and knowledge to enable them to work with the most vulnerable and disadvantaged young people in a positive and proactive way, offering young people more choice and control in their relationships.

Training is delivered to mixed groups, including school and college staff, youth offending teams, youth development teams, Connexions, police community officers and.school nurses. The opportunity for networking has been greatly appreciated.

The PCT plans to continue to work in partnership with the government's teenage pregnancy initiative.and the local education authority.health team to develop and roll out the training across the county. The aim is to reduce teenage pregnancy and.sexually transmitted infections and to improve self-worth among vulnerable young people in Wiltshire.

Further information: Margaret Winskill, 01380 733808 margaret.winskill@wiltshire-pct.nhs.uk

The Greater Manchester Sexual Health Network

Established in July 2003 in response to concerns about the dramatic decline in local sexual health, this was the UK's first fully integrated sexual health network. It.includes services to address.HIV, GUM, family planning, contraception, sexual dysfunction, conception, teenage pregnancy and abortion,.provided by the statutory, community and voluntary sectors.

The aim is to provide more integrated prevention, treatment and care services by improving clinical outcomes, patient experience and equity of access to all sexual health services.

By working together and encouraging participation of all key stakeholders, the Sexual Health Network has ensured high-quality modern services that make the most of resources and meet performance targets..

Achievements include improvement in GUM access from 21 to 81 per cent, improved IT systems, local priority for sexual health and£13m additional investment in services

Further information: Neil Jenkinson, 0161 219 9443 neil.jenkinson@manchester.nhs.uk

Brighton and Hove City PCT

Brighton had high levels of STIs in the local population and sexual health services were feeling the strain of demand from patients and the need to meet the 48-hour access targets. The PCT joined forces with Brighton and Sussex University Hospitals trust and South Downs Health trust to develop a new primary care-based integrated STI and contraception service.

The collaborative service model, managed by specialist GUM clinic the Claude Nicol Centre, aimed to improve service provision, particularly for asymptomatic patients who did not necessarily require the specialist services of the GUM clinic. The initial focus was to address the gap in STI provision but because of the crossover in terms of service user needs, the final model developed was a one-stop shop, staffed by an integrated team that also included contraceptive service provision.

In addition to their role in service delivery, the role of practice nurses with specialist interests includes a specific remit to train and develop the wider primary care workforce, therefore helping to spread best practice and further improve the quality of local sexual health services..

The service has increased capacity, has been well received by patients, and has proved cost-effective. The PCT is now looking to fund an extension to this service model..

Further information: Anne Foster, 01273 545360 anne.foster@bhcpct.nhs.uk

Telford and.Wrekin PCT

Community sexual health services in Shropshire consist of.a small team of dedicated, ambitious and experienced sexual health nurses and outreach staff who deliver easily accessible, cost-effective sexual health screening, sexual health training, support and treatments. Their aim is to provide high-quality, patient-centred and cost-effective care..

They run two men-only clinics each week, situated in each major town in the county; two sexual health screening clinics, opening in July 2007 in substance misuse premises; and one weekly sexual health screening clinic situated in Terrence Higgins Trust.premises, targeting vulnerable and hard-to-reach groups.

All the clinics are nurse led and no appointments are necessary. Full sexual health screening is available, as is sexual health advice, cervical smears, free condoms and lube, hepatitis B immunisation and treatment for chlamydia.

Partner notification is integral to the clinic's philosophy. Care pathways and networks ensure transfer to secondary care is efficient and timely. There is also a community chlamydia health adviser and a young people's sexual health outreach service..

All services reflect the five key issues of the national HIV strategy 2001, as well as.the majority of the points highlighted in the government's white paper Our Health, Our Care, Our Say. The service has been recognised as providing high-quality patient care and was awarded a prestigious prize by the GPs of Shropshire in 2007..

Further information: Lesley Talbot, 01952 200070, lesley.talbot@nhs.net