Getting value for money from your chlamydia screening campaign requires careful consideraton.
Last November, a National Audit Office report claimed chlamydia screening programmes had wasted money, with some trusts paying up to £255 per test. As a youth marketing agency, with two years involvement in the programme, Don’t Panic feels that NHS commissioners have rapidly learnt lessons about what is effective and, in partnership with other service providers, have developed very cost effective and incentive driven models to meet targets.
Payment per screen is the only model that makes sense. All of the primary care trusts that we work for have commissioned us on this basis, some are using different structures, such as accelerated payments once we reach certain benchmarks but the basic principle is payment per eligible screen. We feel like there is more scope for incentives within the system and will be recommending this going forward; for example higher payments/incentives for screening harder to reach groups, and lower payments for easy to reach populations.
A peer to peer approach works best. In fact the whole point of commissioning an outreach campaign is to reach populations who don’t communicate with medical professionals, in clinical environments, therefore our teams must offer something different. Our staff are all in their early twenties, they often hail from the area in which they’re working meaning they will be from similar ethnic backgrounds to the target population.
Our staff are often from a promotions background, meaning they are good at approaching young people on the street. To begin with they aren’t always that knowledgeable about clinical issues, therefore we always suggest our outreach teams are trained by NHS professionals in a clinic/hospital before the campaign begins, to bolster the training we give them. This assists the team with local knowledge but more importantly it infuses them with the importance of clinical governance and professionalism.
Safeguarding and signposting
Our staff do not deliberately approach under 16 year olds and so Gillik Competency and Fraser Guidelines are not crucial. However, our staff do meet vulnerable young people and do need to be aware of how to help them by directing them into the relevant service. In addition to their training, some PCTs use an online quiz which they find very useful.
It is important staff have NHS photo IDs and are CRB checked.
Common sense underlined by research determines that young people prefer being screened in colleges and universities than on the street. Moreover, screening people on the street proved to be extremely problematic during the long, cold winter months. However, we feel like a good campaign must include both “street work” and work within educational environments, as it is impossible to reach a broad mix of the population via further and higher education, however we make every effort to ensure street work takes place in gyms, five-a-side football centres, cinemas and shopping centres - in other words, covered and controlled environments.
A challenge for all screening campaigns is ensuring delivery of eligible screens. Age is easy to cope with, whereas postcodes tend to be a bit more challenging, depending on the area. Strangely, some areas only have a few postcode combinations, while other places have tens of thousands. Developing methods to ensure the staff don’t hand in loads of out-of-area screens should be a priority.
Training will reduce the likelihood of clients complaining, however we feel like there is always a possibility, when teams are roving the streets, that some people will take offence at the direct nature of our approach. On the few occasions complaints have been received we bring the team back to the PCT for more training.
We try and prevent complaints by sending mystery shoppers to engage with the teams. This allows us to identify staff who lack knowledge of chlamydia or of the service prior to complaints being made. We feedback positive and negative findings to the PCT.
We are currently producing a report to determine young people’s attitudes to incentives. Our feeling based on initial feedback is that offering clients HMV tokens, tickets for events or even Nintendo Wiis has fairly negligible appeal for young people. Our teams tell us young people just want to get tested and prefer condoms (surely the most apt/useful giveaway) or small items like USB sticks. Our findings indicate that this is partly due to young people’s nervousness about letters being posted to their homes. This additional layer of administration also pushes up the cost per screen and may lead to non-sexually active people requesting a screen.
A payment per screen approach ensures screening numbers will form the basis of any report. This should be cross referenced with locations to allow PCT to determine whether different populations across the borough have been reached.
Joe Wade is managing director of Don’t Panic