Dear Sexual Health Adviser Team,

SSHA (Society of Sexual Health Advisers) and BASHH (British Association of Sexual Health and HIV) would like to look at the complex patient/client interventions that we know are being undertaken by Sexual Health Advisers and staff carrying out Sexual Health Advising roles across the UK. Our concern is that this work is largely unrecognised as there is no specific coding which covers these complex interventions. We would like to roll out a Complex Case Coding system to as many SHA teams as possible with the aim of standardising the recording of SHA work and producing both local and national audit. We would hope to give clinics 6 months to settle into using the codes and then aim to audit early 2019.

Please see the attached document which will give you more information about the project and answer some of your questions.

If you and your team would be interested in taking part in this unique initiative, please contact Ceri Evans on 020 33 15 9779 or so we can keep a list of clinics wishing to be involved and answer any questions you may have.

I am more than happy to come to your clinic (if reasonably possible) to discuss further with your SHA team or the MD Team, if that would be helpful. We look forward to working with Sexual Health Advisers across the country to offer a clearer and more comprehensive view of the work that we do.

With very best wishes,

Ceri Evans on behalf of SSHA

Senior Sexual Health Adviser, 10 Hammersmith Broadway (part of Chelsea and Westminster Foundation Trust)

Sexual Health Adviser (SHA) Complex Coding

The codeshave been developed to capture the complex and detailed content of consultation/interventions that Sexual Health Advisers have with patients.

The codes should be used when an interaction has gone beyond what might normally be expected in a consultation in supporting a patient with complex issues. We would not expect routine/straightforward PN, routine safer sex information, routine or low risk pre-test HIV discussion etc to be coded as complex. This is about going above and beyond basic information.

We appreciate that this is open to interpretation from individuals, but having tested it 3 different clinics, people generally feel very clear when they have seen a patient with complex issues. We would expect that documentation made by the SHA would support the application of an ‘HA complex’ code and would withstand scrutiny in any audit or by managers/commissioners.

We have found it helpful to laminate copies of the Complex codes and ensure that all rooms that SHAs use, have a copy on the wall – this means it is easier to code either in real time or on paper for it to be added to your particular system later.

Frequently Asked Questions:

Why is it necessary to have Complex SHA codes?

The role of the Sexual Health Adviser has often been quite hard to explain to other members of staff and more recently to Commissioners. Traditionally there has been very little actual coding of the work that we do, although some clinics have local codes that they use. This is an attempt to capture the work of Sexual Health Advisers and to aim for a national audit in early 2019. We also hope that it will support clinics in being able to keep Sexual Health Advisers in their job and to ensure that the “value added” role of the Sexual Health Adviser is recognised and appreciated.

If a patient has more than one issue (for example, drugs issues and herpes) which code do I use?

We have decided not to use more than ONE code for each episode, as giving more than one code might give the impression of more patients being seen than actually were. Therefore, pick the code that MOST represents the session you have had with the patient. Your documentation will pick up any extra issues that you cover.

What if I see a patient more than once over a period of time for a complex intervention?

Give a code for each visit and each complex intervention. However, please remember that a follow up session would still need to meet the requirements of “complex”, as documented above.

Can any member of clinic staff use the complex codes?

As this is primarily aimed at capturing Sexual Health Adviser work, we would ask that Doctors/nurses/Health Care assistants do NOT use the coding. However, if there are staff who have a dual Sexual Health Adviser/nurse role we would ask that they do use the coding as necessary.

How do we keep a record of patients that have been coded?

This will depend on the system your clinic uses. For example, at Chelsea and Westminster, we use the Lilie system and we have been able to add the codes to the system as “local” coding. This means that we can electronically pull all patients who have been given these codes so we can audit. If this is not possible in your clinic, then an old fashioned paper and stickers system is just as acceptable. We just need a way for you to document all the people that have been coded so we can do an audit of all the clinics who have taken part.

We regularly see people in our clinic for whom there is no specific coding in this list – how do we code these?

It was impossible to cover every single type of patient that was suggested without having a very long list of codes – meaning that people were less likely to use the coding system if they had to wade through dozens of options! Therefore we have stuck to what appeared to be the most common types of issues that SHAs come across regularly. We totally understand that this will not cover every situation you will see and people might feel upset that an important part of their job is not being recognised. If you feel this is relevant to you, then you could either create your own local code (or you may already be using one) and then just let us know when we start collating the information. Alternatively you can code these under “HA13: Other” and we will ask you to tell us the general themes when we audit.

Why is there no specific coding for Partner Notification?

PN is often routinely audited by clinics and this project is looking specifically at issues and situations that are often not coded as part of the Sexual Health Adviser job. However, in “HA13: Other”, it is perfectly possible to use this for a particularly complex piece of PN/Provider referral/contract referral if you feel it is relevant.

Doesn’t it take a lot of time to keep checking which code needs to be used?

It does take time initially, but we have found through using it regularly and having the code explanations easily available in each room, it becomes second nature. Also, it is very affirming and satisfying to be able to code the complex work we are all doing!

Sexual Health Adviser Complex Codes:

The codes below have been developed and piloted to provide greater detail for Sexual Health Adviser patient consultations. These codes should be applied to patients when time has been spent supporting someone around complex issues. The documentation made by the Sexual Health Adviser should support the application of a “complex” code.

HA01 Risk Reduction= all types of risk reduction work, including MI.

Documentation should demonstrate an interaction that goes beyond safe sex advice and providing condoms.

HA02 YP <18 = assessing risk, Fraser competence, child protection/safeguarding/Child sexual exploitation .

Documentation should demonstrate an interaction beyond a basic sexual history and demonstrate a clear understanding of issues affecting young people

HA03 HSV = detailed support session around herpes, either first diagnosis or ongoing management

Documentation should demonstrate full practical and emotional support to patients who are very distressed at diagnosis/anxious re: disclosure/PN/pregnancy/stigmaetc

HA04 Mental health/Psychological intervention = risk assessment, onward referral to psychology/psychiatry

Documentation should either demonstrate the above referral, a risk assessment re: safety,and/or document detailed support around mental health issues, excluding those covered by HA05.

HA05 HIV/STI anxiety = support/counselling re:health anxiety reduction regarding HIV and/or STIs

Documentation should demonstrate support, advice and information around complex sexual health anxiety issues, including managing repeat HIV/STI testing and onward referral if necessary

HA06 Psychosexual issues = assessment for psychosexual therapy, counselling /1:1 work re psychosexual issues

Documentation should include assessment for and referral to psychosexual services and detailed support around psychosexual issues.

HA07 Domestic violence/vulnerable adult/safeguarding issues = counselling/ 1:1 support re: historic or current sexual and/or domestic abuse

Documentation should demonstrate detailed support around historic or current concerns, including onward referral and risk assessment re: current situation and any dependents.

HA08 Drugs (including chemsex issues)/AlcoholHarm minimisation = detailed discussion of drug and/or alcohol use and sexual activity,information and support provided re: harm minimisation, onward referral

Documentation should demonstrate a discussion that goes beyond naming drug use and may include a risk assessment re: current situation, documented support and advice given, and referral to other specific services if necessary.

HA09 First HIV diagnosis follow up = Initial and or follow up appointment booked for new HIV diagnosis to discuss initial blood results, review coping, and support disclosure/PN. This could also be used for HCV and HBV if relevant

Documentation should demonstrate details of significant support given to a patient, issues of risk and partner notification and complex issues addressed.

HA10 PEP/PrEP= Full documented discussion of PEP or PrEP and options Documentation should demonstrate a full understanding of PEP/PrEP, including discussion with individual as to any pros or cons/support needed/referring to other resources

HA11 Sexual Assault (Male or female) = initial and/or ongoing support for sexual assault/referral to other services as necessary. Documentationshould demonstrate significant input and support as necessary for the patient.

HA12 Sexual exploitation/trafficking = initial and/or ongoing support and referral to other services as necessary. Knowledge of issues and local information. Documentation should demonstrate significant input and support as necessary for the patient.

HA13 Other Consultations requiring considerable time to discuss issues, e.g. people with Learning Disabilities/working with patients on a hospital ward/Commercial Sex Workers/transfer of HIV care/Pregnancy or TOP options/ complex Partner Notification and/ or Provider Referraletc

Documentation should demonstrate a significant interaction that would not be covered by another code.