Portsmouth: Creating a Network of Contraception Champions

Portsmouth’s sexual health workforce has been upskilling frontline staff from other services to have healthy conversations about sexual health and in particular pregnancy planning. Staff including midwives, health visitors and social care workers have all received tailored training.

Rising abortion rate prompted rethink 

Faced with rising rates of abortions, Portsmouth City Council began re-thinking its approach on contraception support four years ago. 

Health Development Manager Hannah Byrne said: “Nationally other areas have seen similar things, but the rises were particularly big in Portsmouth, with higher abortion rates among over 25s.

“With the public purse strings tightening, as it also is for individuals, we knew there was a real benefit in being more proactive to support residents around contraceptive choices.”  

In 2019 the sexual health team expanded their programme of training to equip frontline staff to have healthy conversations around sexual health. The programme is based on the making every contact count model.  

Over the past four years the sexual health service has worked with around 20 different teams. They include midwives and health visitors, social care teams, including early help and the family safeguarding team, as well as voluntary sector groups working with a wide variety of people from sex workers to migrants.  

Ms Byrne said: “The aim is to give staff the skills and confidence to have these conversations. Alongside this they also have a named contact in the sexual health service so they can refer their clients on for further support where there are more complex needs.”  

As well as the core service, Portsmouth also has specialist support for under 18s, sex workers, those at risk of sexual exploitation, people with learning disabilities and gay, bisexual or other men who have sex with men. For the most complex cases there is an outreach team of nurses and behaviour support that provide one-to-one work.  

 Ms Byrne said one of the key steps is to make the training bespoke for individual teams. “Different teams have different needs. For example, the family safeguarding team is well versed in motivational interviewing techniques – they did not need that side of the training. But what we found is that they were not as comfortable initiating conversations about sex so we supported them with that as well as ensuring they knew about the wide range of services available.”  

'Training is really paying off’ 

Family Safeguarding Service Lead Amanda Haylock said the approach is really paying off. “We work with parents who have experienced repeated care proceedings or may be having difficulties which affect their ability to care for their children. This is a critical time for the family and effective pregnancy planning is often key to a family being able to move forward. 

 “The additional training has developed our skills and confidence to have critical conversations with parents regarding pregnancy planning. We now have these conversations routinely and are better able to support parents to access specialist sexual health services in a timely way.” 

 “This has had a really positive impact. There was one couple who were in care proceedings regarding their newborn baby and we were able to engage in conversation about their conception aspirations. Both parents agreed they did not want to have another child at this time, but wanted to plan for this in the future. The couple were supported to access a pregnancy planning group which could meet their specific learning needs as well as their sexual health needs.” 

She said children’s social workers have also been supported by the adult team to have conversations with parents regarding sexual health,  including making appointments regarding pregnancy planning – sometimes as quickly as the same day.  

Widening access to support 

Portsmouth has also worked closely with local GP practices. In 2019 the decision was taken to jointly commission contraceptive and non-contraceptive LARC (long-acting reversible contraception) services, which has helped pave the way for closer working with the LARC fitting teams across the city. GP and nurses are being encouraged to have conversations earlier about LARC. 

It seems to be having an impact. Coil fittings are now up 40 per cent on before the pandemic.  

Work with local pharmacies has also proved crucial. Portsmouth has been one of the key sites for piloting access to oral contraception. Ten local pharmacies have signed up to providing repeat prescriptions, with eight also offering the enhanced contraception initiation service.  

The pilots have been run with the help of the local pharmacy committee, Community Pharmacy South Central.  

Ms Byrne said: “It’s a really important offer. Our partners cannot realistically take their clients across the city to one of the sexual health clinics. But with this initiative they know there is a local pharmacy nearby – they can even ring ahead to check availability and let them know they have someone coming in. It is about making it much easier to access support.”  

Ms Byrne is keen to build on what has been achieved so far. Each of the teams that have had the healthy conversation training has champions in place and she is now seeking to develop a formal network of champions to evolve and sustain the approach. Work is also planned with a network of female business owners, so they too can have healthy conversations about sexual health with their colleagues and women they work with.  “There is a lot more we want to do,” she added.

Contact details 

[email protected] or linkedin.com/in/hannah-byrne-a0061591