The this means that provisions for these services are

access to the services in central and East Middlesbrough is very good, however
in the South the access does not meet the needs of the individuals who need to
have access to sexual health services. Young people and vulnerable groups who
need access to sexual health groups often struggle as there is limited
provisions within schools, colleges and settings that would reach the
vulnerable, this means that provisions for these services are going to need
more attention in the future to provide education and prevent the increase of
sexually transmitted diseases (Public Health England, 2015).

Middlesbrough Sexual health currently has one service hub
located in North Ormesby Health Village, there are others around the Teesside
area. The service hubs offer longer opening hours (9am to 8pm) to allow those
with other commitments to still be able to have access to the services. All hubs
offer a full range of contraceptives and GUM clinic services which are operated
by medical and nursing professionals. Sexual Health Teesside is working with
twenty general practices in Middlesbrough to provide sexual health services
such as chlamydia testing, C-card and general sexual health screening. As well
as the general practices thirty-seven community pharmacies are also providing
emergency sexual health services such as emergency contraception, the morning
after pill, and chlamydia testing (NICE, 2014).

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If the patient needs further specialized treatment, a referral
to a specialist medical professional can be made. This is referred to as tertiary
care and requires professionals such as surgeons or professional which specialize
health problems such as cancer or neurological diseases to carry out investigations and give
the best treatment for the patient (NICE, 2017).

When a patient needs further treatment that is either not
available from a GP or requires specialist treatment then they are referred to
a secondary care specialist. Secondary care is defined as medical care that is specialized
by a medical professional following a referral from a primary care physician as
the medical problem requires more specialized knowledge, skill and equipment
than available from a primary care practitioner (Webster, M, 2017).  Sexual health diseases such as HIV and AIDS are
treated and supported at the infectious diseases department in the James Cook
hospital. Community based combined sexual health services have replaced some of
the GUM and STI services that were provided through secondary care services
(Department of Health, 2013).

According to the
World Health Organisation (WHO, 2000), Service provision refers to the way
inputs such as money, staff, equipment and drugs are combined to allow the
delivery of health interventions. Health
service provision is the most visible and familiar product of the health care system. As previously stated Middlesbrough
has an issue with sexual health and sexually transmitted diseases, there have
been services in place since 2011 to help address this issue. The
first point of contact of healthcare for most people is usually their general practitioner
(GP) or accident and emergency (A&E) this is determined as primary
healthcare. The aim of primary care is to provide an accessible course of
healthcare to all patients no matter the query. Primary care however, treats
the patient rather than the specifics of the medical problem, meaning that a GP
is dealing with more generic diseases than specialising in particular areas
resulting in referrals to secondary care professionals (University of Bristol, 2017).
Sexual health services in
Middlesbrough are free of charge and are open access, a patient can self-refer and
chose to use a service at the location of their choice. The service; Sexual
Health Teesside is a community based facility which offers both appointments and walk in clinics to provide
patient centered care (Department of Health, 2013). This particular
service includes the previously hospital based Genio-Urinary Medicine (GUM
clinic) and the community based contraception and family planning service
(CASH), the service is predominately commissioned from local authorities and
provided by VirginCare. The service in Teesside offers a range of full sexual health
and contraceptive facilities, this includes screening for chlamydia, human
immunodeficiency virus (HIV) testing, STI treatment and testing, it also offers
contraception, long acting contraception (LARC), screening for cervical cancer,
smear and sterilization and vasectomy, psychosexual counselling is also
available to patients. Schools, colleges and other educational settings are
also available to provide education regarding sexual health services to young
people and high-risk groups such as homeless people (Public Health England,
2014). Some groups of people are not able to attend regular GP appointments or
clinics therefore work from the outreach team is essential to all people who are
unable to have access to regular sexual health clinics. The outreach team
provides information and advice on various topics such as contraception, STIs,
emergency hormonal contraception, condoms and chlamydia testing (Tees Valley
Public Health Shared Service, 2014). Middlesbrough offers many services within
the sexual health clinics such as HIV and STI testing, Chlamydia testing and
the C-card. The service is free, with open access. In the Middlesbrough clinic
they work with Teesside Positive Action to offer rapid HIV testing and several
satellite clinics (Public Health England, 2014).