A new Terrence Higgins Trust report into the difficulty accessing sexual health services in England, Scotland and Wales has revealed half (49%) of all appointment requests are denied, long waits for those who get through and a postcode lottery of postal testing availability – against a dire backdrop of rocketing rates of sexually transmitted infections (STIs).

Today’s report – Over-Stretched and Under Strain: A Mystery Shopper Approach to Access to Sexual Health Services in England, Scotland and Wales – is published to shine a light on the barriers which exist when trying to take charge of your sexual health. It provides clear recommendations for urgent improvement.  

The worrying ‘mystery shopper’ research – using the persona of a woman in her 20s without any symptoms and trying to access a sexual health appointment – comes as the latest data from UK Health Security Agency (UKHSA) shows a 24% jump in new STIs in England.

Using the persona of ‘Gabriela’, a young woman who has recently had sex without a condom and wants to be tested, the research reveals a face-to-face appointment was offered by just half (51%) of clinics contacted by phone. Waiting times for these appointments averaged 13 days – rising to almost three weeks (19 days) in rural parts of England. 

Around 75% of women and 50% of men with chlamydia are asymptomatic, which shows why routine testing is so important. Untreated chlamydia can have long-lasting implications including pelvic inflammatory disease and infertility.  

Last year, 392,453 STIs were diagnosed in England, with gonorrhoea and syphilis at record high levels. But the new research from 57 clinics across England, Scotland and Wales found that even accessing an appointment is difficult and slow – despite fast testing and treatment being so crucial in preventing onward transmission.

There is widespread use of smartphones by young people – the group most impacted by STIs – but the research found booking an appointment online is difficult. In England just 1 in 10 clinics had appointments you can book online, while no clinics in Wales offered online booking. However, in Scotland the situation was better with 44% of clinics offering appointments via a centralised booking system.

The mystery shopper found those in rural areas, who are on average furthest away from a sexual health clinic, have the longest wait for appointment (19 days). They also have the least access to online test kits – just 70% of clinics in rural areas in England offered postal testing, compared to 91% in urban areas.

The fieldwork also found significant national and regional differences. For example, while all clinics in Wales offer postal testing, only half (56%) did in Scotland. 

Recommendations for improving sexual health 

  1. Free year-round STI postal testing service.
  2. Sexual health appointments bookable via relevant NHS apps.
  3. A 48-hour wait time target for access to sexual health appointments.

Terrence Higgins Trust, the charity behind the research, is calling for free postal STI testing to be available 365 days a year in Scotland and England – replicating the current system in Wales. 

The research also clearly demonstrates the need for sexual health appointments to be bookable via relevant NHS digital platforms to improve access in addition to the option of booking an appointment anonymously over the phone or online. To get through to clinics, the researchers had to make multiple calls, spend a long time on hold, and call within very limited hours – while online broken links sent them around in circles. These experiences will resonate with many and create unnecessary obstacles to services.

Access to sexual health clinics must urgently improve and waiting times driven down if rates of STIs are to ever be effectively tackled, according to Terrence Higgins Trust. That’s why the charity is also calling on government to commit to a 48-hour time target for access to sexual health appointments, which must be implement and monitored. 

Richard Angell, Chief Executive of Terrence Higgins Trust, said: 'The sexual health of the nation has consistently been ignored by Central Government. A wake up call is needed. If more than 1,000 new STIs being diagnosed each and every day does not incentivise policy change and renewed investment, it is hard to see what will.

'Ultimately, you get what you pay for – the lowest real terms spending on sexual health is matched by the highest rates of sexually transmitted infections. The Government should guarantee long-term funding settlements for sexual health services at a rate of inflation plus 1 per cent so as to address years of consistent under-funding.

'We’re working hard to normalise testing for STIs like gonorrhoea, chlamydia, syphilis and HIV against postcode lotteries in online availability. This is undermined by a system that is over-stretched, under strain and difficult to navigate. ‘Gabriela’ is a persona we’ve used to highlight the issues, but there are thousands of Gabrielas out there who are unable to take charge of their sexual health because the system is literally turning them away or putting them into long queues.

'The Government lacks a clear, strategic vision for the future of sexual health services. We need to see urgent investment and long over-due change if the system is going to be more than the management of symptomatic diseases. That includes a commitment to a 48-hour target for access to sexual health appointments, year-round access to free postal STI testing, and for appointments to be booked quickly and easily via an NHS app.'

Dr Claire Dewsnap, President of British Association for Sexual Health and HIV (BASHH), said: 'This work from Terrence Higgins Trust and partners is hugely welcome by BASHH. This mystery shopper report highlights inadequate access to sexual health services, which has been raised by others in the sector. The voice of the service user is often not heard in relation to poor access and obstacles to care. This is an essential read for all those delivering, designing and commissioning sexual health services highlighting some of the many challenges our users face in 2023.

'Of course, our colleagues across the sector work hard to deliver the best services possible in the context of structural reforms and reduced funding in a challenging public health environment and we recognise these messages will be hard to hear. We must hear the voice of the user and focus tirelessly on working together to deliver better funding, access and care to sexual health services.'

Read the full report.