'All singing, all dancing': staff views on the integration of family planning and genitourinary medicine in Lothian, UK.
BACKGROUND
UK policy documents advocate integrated approaches to sexual health service provision to ensure that everyone can access high-quality treatment. However, there is relatively little evidence to demonstrate any resultant benefits. The family planning and genitourinary medicine services in Lothian have been fully integrated and most care is now delivered from a purpose-built sexual health centre. We wished to study the views of staff on integrated sexual and reproductive care.


METHODS
Staff completed anonymous questionnaires before and after integration, looking at four main aspects: the patient pathway, specific patient groups, their own professional status, and their working environment. The surveys used a mixture of five-point Likert-type scales and open-ended questions.


RESULTS
Over 50% of staff completed the surveys on each occasion. Six months after the new building opened, staff attitudes about the integrated service were mixed. Staff reported more stress and less opportunity for specialisation but there was no change in their sense of professional status or development. There were concerns about how well the integrated service met the needs of specific patient groups, notably women. These concerns co-existed with a verdict that overall service quality was no worse following integration.


CONCLUSIONS
Staff views should form an important part of service redesign and integration projects. Although the results from the Lothian surveys suggest a perceived worsening of some aspects of the service, further evaluation is needed to unpick the different problems that have appeared under the catch-all term of 'integration'.
Senior Public Health Researcher, Public Health and Health Policy, NHS Lothian, Edinburgh, UK.
Martin
M
Higgins
PhD Student, School of Social and Political Science, University of Edinburgh, Edinburgh, UK.
Eric Zhong
EZ
Chen
Consultant Gynaecologist, NHS Lothian Sexual and Reproductive Health Service, Chalmers Centre, Edinburgh, UK.
Ailsa E
AE
Gebbie
Consultant Physician, NHS Lothian Sexual and Reproductive Health Service, Chalmers Centre, Edinburgh, UK.
Imali
I
Fernando
Public Health Specialist, Public Health and Health Policy, NHS Lothian, Edinburgh, UK.
Dona
D
Milne
Specialty Trainee, NHS Lothian Sexual and Reproductive Health Service, Chalmers Centre, Edinburgh, UK.
Rosemary
R
Cochrane
D000328:Adult; D001291:Attitude of Health Personnel; D003615:Dancing; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005193:Family Planning Services / Q000193:education* / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D060728:Reproductive Health / Q000193:education; D012736:Sex Education / Q000458:organization & administration*; D063346:Singing; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014566:Urogenital System / Q000502:physiology
family planning service provision; genitourinary medicine; service delivery; surveys