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Challenges facing nurse-led STI care and sexual and reproductive health: education, education, education!
  1. Claudia Estcourt1,2,
  2. Claire Tyler3,
  3. Magnus Nelson4,
  4. Jane Bickford5
  1. 1Centre for Infectious Disease: Sexual Health & HIV, Blizard Institute of Cell and Molecular Science, Barts & The London School of Medicine & Dentistry, Barts Sexual Health Centre, Kenton & Lucas Wing, St Bartholomew's Hospital, London, UK
  2. 2Barts and the London NHS Trust, St Bartholomew's Hospital, London, UK
  3. 3Wensum Consulting Ltd, Norfolk, UK
  4. 4North East London Sexual Health & HIV Clinical Network, London, UK
  5. 5Barts and the London NHS Trust, London, UK
  1. Correspondence to Dr Claudia Estcourt, Barts and the London School of Medicine and Dentistry, Centre for Immunology and Infectious Disease, London EC1A 7BE, UK; c.s.estcourt{at}

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Nurse-delivered, consultant-led sexual health services are viewed by UK clinicians and commissioners as cost-effective service models that could widen access to sexual healthcare. Nurse-delivered care has a long tradition within sexual and reproductive health (SRH), while more recently there has been considerable advancement of the nursing role in genitourinary medicine settings and within primary care, prompted, in England at least, by the National Strategy for Sexual Health & HIV1 and heavily supported by the Department of Health.2

However, there are insufficient nurses within the current NHS workforce with the appropriate training and clinical competence to deliver independent sexually transmitted infection (STI) and SRH care. Although family planning courses and practical training are well established, a recent mapping of nursing postgraduate education revealed an almost complete absence of clinical courses offering training and assessment in STI care (please see online supplementary tables). This presents considerable difficulties for services and commissioners3 and impacts dramatically on the speed at which new services can develop and adapt to meet the population's needs.

The obvious solution to this skills and educational deficit is to develop a fully integrated clinical competency training and assessment programme in STI and SRH aimed at nurses wishing to deliver independent care. On successful completion of the programme, nurses could be provided with a certificate of competence, readily transportable between employers and services. This aligns well with the Department of Health's vision for developing the healthcare workforce, by providing ‘high quality education and training that supports safe high quality care and greater flexibility’.4

Over the last year, the British Association for Sexual Health and HIV and the Faculty for Sexual & Reproductive Healthcare have been working closely to develop a collaborative model for a nationally standardised but locally delivered learning and assessment programme in STI care and SRH. Work to date has focused on the development of a template for learning and assessment, drawing on the high-quality educational programmes such as STI Foundation IntermediateCompetency5 and Diploma of the Faculty of Sexual & Reproductive Healthcare6 (currently for doctors only) already offered by the respective professional bodies, and principles underlying the range of clinical competencies to include.

This type of programme could sit neatly as a prerequisite for advanced nursing practice in STI care and SRH. However, there appear to be no plans for accreditation of advanced practice from within the nursing profession. This in itself could be a significant hurdle in achieving the national uptake of any novel competency programme: high-quality competency training and assessment is costly to deliver as it requires one-to-one skills assessment across a range of STI and SRH competencies.7 Specialist services are unlikely to be able to provide this from existing resources and so the cost would need to be met by either the nurse her/himself or the commissioners.

It is easy to see in times of financial restraint that this may be very difficult to achieve. However, NHS trusts are required to provide funding for nurses to continue professional development, although this is often linked to one local higher education establishment. It might be possible to disentangle some of this funding to support education in STI care and SRH.

In spite of these difficulties, we cannot waste this opportunity for nursing development within our specialty nor can we afford to stall service modernisation by failing to provide high-quality education to underpin it. However, there has to be in place a fair mechanism for funding this type of training and assessment. Achieving this will be contingent on national recognition of the training programme as a prerequisite for advanced practice by an appropriate nursing professional body or the Department of Health: the challenge will be in obtaining it.


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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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