Over-stretched and under strain: A Mystery Shopper Approach to Access to Sexual Health Services in England, Scotland and Wales.

We've launched a report on the state of sexual health services in the three home nations after a decade of austerity. Our findings indicate that resource constraints for sexual health services across Great Britain are resulting in an emerging trend of ‘gatekeeping’ face-to-face appointments, with too few alternatives provided.

Key findings

  • Face-to-face appointments were offered by only just over half of clinics (51%) contacted by telephone.
  • Waiting times for face-to-face appointments available to book via telephone averaged 13 days, rising to 19 days in rural parts of England.
  • Booking an appointment online is difficult, particularly outside of Scotland.
  • Very few sexual health services (11%) offer drop-in services that are available to all.
  • There are significant national and regional differences in access to postal STI testing.
  • Geography is sometimes used to exclude service users, particularly in the border areas.
  • In Scotland, the right to anonymity may inadvertently be compromised in attempts to identify service users based on their address, name and date of birth.

About the project


The report is based on research carried out in November and December 2022, with the support of the British Association of Sexual Health and HIV (BASHH). Using a ‘mystery shopper’ methodology, we contacted 57 clinics to schedule a face-to-face appointment for our persona ‘Gabriela’, a woman in her mid-twenties with no obvious STI symptoms. We also surveyed the provision of postal STI services, drop-in services, and online booking systems.

Our aim was to highlight the impact of the strain sexual health services are under on service users’ ability to access STI testing. The persona of ‘Gabriela’ was chosen to test whether the prioritisation of symptomatic patients amid resource constraints is undermining the universal access principle. To highlight regional and national discrepancies in service provision, we contacted clinics across England, Scotland, and Wales.

What we’re calling for


Our findings reflect a sexual health system that is under immense pressure. National governments in England, Wales and Scotland need to ensure there is increased funding specifically for sexual health services in order to meet the rising demand and deal with rising STI rates and unplanned pregnancy. Funding awards for sexual health services also need to increase each year by at least the rate of inflation plus 1%.

The national governments should also articulate a strategic vision for sexual health and develop mechanisms for accountability.

The full report makes 19 recommendations. Concrete steps that must be taken include:

  • The Scottish and UK governments should replicate the Welsh system of a free, all-nation, all-year-round postal STI testing service.
  • Sexual health appointments should be bookable via relevant NHS apps.
  • A 48-hour waiting time target for access to sexual health appointments should be implemented and monitored.