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Sexual health in primary care: worth talking about

A new communications campaign from the Department of Health and Department for Children, Schools and Families to improve sexual health services for young people is being launched this December. In November, Nursing in Practice brought together a group of key professionals to discuss the role of frontline professionals and how we can work together to create a nationwide culture change to improve knowledge and confidence to look after our sexual health.

To watch videos of the round table in action, please click on the following links to open a new browser window.

There are four videos, each covering a different area of discussion:

A New Approach
What role do family and partners play?
Spoilt for Choice
Conversation Starters

Marilyn Eveleigh: Lead Nurse and Head of Clinical Performance, Brighton and Hove Primary Care Trust
Alison Hadley: Programme Manager, Teenage Pregnancy Unit, Department for Children, Schools and Families
Kathy French: Clinical Director, Brook
Viv Crouch: Lead Nurse, Bath and North East
Somerset Teenage Pregnancy Partnership Board
Wendy Majewska: Senior Health Advisor and Senior Clinical Services Manager, St George's Hospital, London
Stuart Beddard: Sexual Health Specialist Nurse, Brook, Birmingham
Ann Smith: Practice Nurse, Brighton

A new approach
On 30 November, the Department of Health (DH) and the Department for Children, Schools and Families (DCSF), together with the National Chlamydia Screening Programme, is launching a public information campaign. This will contribute to the continued efforts to tackle the important issues of teenage pregnancy and sexual health knowledge among young men and women.  

Thanks to the hard work done to date at a national and local level, this campaign has a solid bedrock of best practice to build on. Teenage pregnancy rates have been reduced by 10.7%, with teenage births at the lowest level for 15 years, and there has been a significant rise in awareness of sexually transmitted infections (STIs) and the importance of condom use.

Despite this progress, we are all on a journey that is not yet complete, and we need to do more. This campaign builds on the foundations already made and will be honest about where we all need to improve to meet ambitious targets. Our aim is to reduce the under-18 conception rate by 50% by 2010 and increase chlamydia testing rates to 35% of the 15-24 population of England by March 2011.

Through undertaking an in-depth review of existing campaigns, UK best practice, evidence from academics and international comparisons, the DH and DCSF have identified the need to create an open, positive and supportive environment in which people can have informed and meaningful conversations about safer sex and better relationships.

The overall brand, "Sex. Worth Talking About", will help to
establish sexual health knowledge and understanding as a key life skill and involve a broader audience than past campaigns have targeted. Through reaching parents, healthcare professionals, teachers and the wider youth workforce we will realise an opportunity for these audiences to have joined-up conversations - in particular about contraception and chlamydia testing. The initial advertising campaign will be "Contraception. Worth talking about", followed by a "Chlamydia. Worth talking about" campaign early next year.
Over the coming months you are likely to see the campaign on TV, radio or in newspapers and magazines. 

Right from the outset, the campaign will equip a whole range of health professionals to have well-informed, confident conversations more regularly with young people. To do this successfully we want to hear from you - be it through the specially-designed website ( or through talking directly at forums like this round table - as your experience will be vital in shaping future success.

Personalising conversations, creating the right environment and telling young people about their choices were all debated in the session. However, as the first focus of the campaign advertising kicks off at the end of November with messages dedicated to contraception, this discussion explored how we can improve young people's understanding of a broader range of choices available and how we can help them make more informed decisions.

Making it personal
Everyone at the event agreed that while it is important to help create a welcoming service environment to talk about contraception choices, there was also a need to address the challenge of how health professionals approach the conversation itself.

Through sharing experiences of what has worked for our attendees, it was clear that effective conversations were as much about listening as they are about talking. Through asking questions about school or about boyfriends/girlfriends, a practice nurse can start to establish trust and build a context for talking openly about sexual health and relationships.

As many practice nurses found, it also helps to talk through scenarios to enable them to start conversations. For example, if a young person says they use condoms as their only form of contraception, is it preferable to ask them what they have planned if that condom breaks, rather than listing the pros and cons? If a patient uses only the Pill, have they thought about how they are protected against infections?

As well as approaching the conversation in the right way, many attendees found that using the right words and expressions helped to convey information. Through listening to young patients, it is easy to pick up the words they feel comfortable and familiar with using, and sometimes understand more clearly than biological terms. 

Choice: there are no rights and wrongs
The theme of choice came up again and again. Young people are faced by many different influences that affect what contraception they choose: their mother's experience, that of friends and family - even soap operas and celebrities.

Everyone around the table agreed that because of the influence of friends and family, young people will often ask for a certain type of contraception without being aware there's a wide choice available and that there may be another method which they might prefer. Having all the right information to hand, you can easily correct misunderstandings and help young people make a decision they feel is right for their age and lifestyle.

Knowing the right route
In the same way attendees realised the importance of making young people feel comfortable and at ease with open and honest conversations, it is also crucial for health professionals to feel like they have the language, knowledge and information to help them.

To prepare many of the key audiences for the campaign, the DH and DCSF are sending out information packs to GP practices, pharmacies and contraception and sexual health service (CaSH) clinics throughout England. The packs include a range of contraception and sexual health leaflets from trusted organisations Brook, fpa, Terrence Higgins Trust and the National Chlamydia Screening Programme, with a three-month offer to order further free copies.

Everyone agreed that the packs would not only provide reliable information to offer to young people, but would also act as a "green light", giving permission for health professionals to start the conversations. 

While starting conversations is vital, it's important to know where to send young people when they ask questions you may not feel you are best placed to answer. For example, if your practice does not offer long-acting reversible contraception (LARC), attendees highlighted the importance of having at hand the details of local services that can provide the full range of contraception. They also discussed the importance of a "supported" referral, which means not only handing over a leaflet, but also finding out the names of members of staff working within local services so that the young person knows who to ask for - or even offering to phone up and make an appointment, to help them take that next step.

The right environment for talking
Many attendees were quick to cite that a successful consultation with a young person begins as soon as they walk in the door. As many readers will know, a good receptionist can be the key to a successful practice, and that will start with how they greet young people and make them feel comfortable.

Teenagers report feeling very anxious about asking for contraception or sexual health advice, so a friendly face at reception is particularly important. Training receptionists to be "young people-friendly" will also help practices meet the DH "You're Welcome" standards for youth-friendly services which all PCTs are now implementing.

While it is important to make the waiting area suitable for all ages, attendees also cited ways to make the environment welcoming to young people - with relevant information easily available in posters or leaflets. The importance of preserving confidentiality was also highlighted, with examples of some practices introducing a "ticketing" system where numbers are read out instead of names.

All attendees concluded that improved communication about contraception, sexual health and relationships is key to helping young people make safe and healthy choices, and agreed that "Sex. Worth Talking About" was just the right umbrella message for the new campaign.

With the first focus on contraceptive choices, if all practice nurses make sure they have all the information leaflets they need and start talking just a little more to young people about relationships and the contraceptive choices they have, the conversations will start to open up and young people's trust and willingness in seeking early advice will grow.

But the session also showed how important it is to share the good ideas and effective practice that is already happening in practices around the country and to hear from practice nurses how the campaign can help them in their everyday work. That's why the DH and DCSF have developed a website specifically for stakeholders where information about the campaign can be easily accessed, and where ideas and thoughts can be posted at:

Your comments (terms and conditions apply):

"I am a school nurse working in a British school in Spain. I have just read your article on contraception (sexual health in primary care). Although I am not a practice nurse, part of my extended role is to advise teenagers on contraception, and your article has given me some very good pointers on how to structure my approach on advice and information to our pupils.
Many thanks" - Ann Sinclair