The this means that provisions for these services are

Theaccess to the services in central and East Middlesbrough is very good, howeverin the South the access does not meet the needs of the individuals who need tohave access to sexual health services. Young people and vulnerable groups whoneed access to sexual health groups often struggle as there is limitedprovisions within schools, colleges and settings that would reach thevulnerable, this means that provisions for these services are going to needmore attention in the future to provide education and prevent the increase ofsexually transmitted diseases (Public Health England, 2015).Middlesbrough Sexual health currently has one service hublocated in North Ormesby Health Village, there are others around the Teessidearea. The service hubs offer longer opening hours (9am to 8pm) to allow thosewith other commitments to still be able to have access to the services. All hubsoffer a full range of contraceptives and GUM clinic services which are operatedby medical and nursing professionals.

Sexual Health Teesside is working withtwenty general practices in Middlesbrough to provide sexual health servicessuch as chlamydia testing, C-card and general sexual health screening. As wellas the general practices thirty-seven community pharmacies are also providingemergency sexual health services such as emergency contraception, the morningafter pill, and chlamydia testing (NICE, 2014).If the patient needs further specialized treatment, a referralto a specialist medical professional can be made. This is referred to as tertiarycare and requires professionals such as surgeons or professional which specializehealth problems such as cancer or neurological diseases to carry out investigations and givethe best treatment for the patient (NICE, 2017).When a patient needs further treatment that is either notavailable from a GP or requires specialist treatment then they are referred toa secondary care specialist. Secondary care is defined as medical care that is specializedby a medical professional following a referral from a primary care physician asthe medical problem requires more specialized knowledge, skill and equipmentthan available from a primary care practitioner (Webster, M, 2017).  Sexual health diseases such as HIV and AIDS aretreated and supported at the infectious diseases department in the James Cookhospital. Community based combined sexual health services have replaced some ofthe GUM and STI services that were provided through secondary care services(Department of Health, 2013).

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According to theWorld Health Organisation (WHO, 2000), Service provision refers to the wayinputs such as money, staff, equipment and drugs are combined to allow thedelivery of health interventions. Healthservice provision is the most visible and familiar product of the health care system. As previously stated Middlesbroughhas an issue with sexual health and sexually transmitted diseases, there havebeen services in place since 2011 to help address this issue. Thefirst point of contact of healthcare for most people is usually their general practitioner(GP) or accident and emergency (A&E) this is determined as primaryhealthcare. The aim of primary care is to provide an accessible course ofhealthcare to all patients no matter the query. Primary care however, treatsthe patient rather than the specifics of the medical problem, meaning that a GPis dealing with more generic diseases than specialising in particular areasresulting in referrals to secondary care professionals (University of Bristol, 2017).Sexual health services inMiddlesbrough are free of charge and are open access, a patient can self-refer andchose to use a service at the location of their choice. The service; SexualHealth Teesside is a community based facility which offers both appointments and walk in clinics to providepatient centered care (Department of Health, 2013).

This particularservice includes the previously hospital based Genio-Urinary Medicine (GUMclinic) and the community based contraception and family planning service(CASH), the service is predominately commissioned from local authorities andprovided by VirginCare. The service in Teesside offers a range of full sexual healthand contraceptive facilities, this includes screening for chlamydia, humanimmunodeficiency virus (HIV) testing, STI treatment and testing, it also offerscontraception, long acting contraception (LARC), screening for cervical cancer,smear and sterilization and vasectomy, psychosexual counselling is alsoavailable to patients. Schools, colleges and other educational settings arealso available to provide education regarding sexual health services to youngpeople and high-risk groups such as homeless people (Public Health England,2014).

Some groups of people are not able to attend regular GP appointments orclinics therefore work from the outreach team is essential to all people who areunable to have access to regular sexual health clinics. The outreach teamprovides information and advice on various topics such as contraception, STIs,emergency hormonal contraception, condoms and chlamydia testing (Tees ValleyPublic Health Shared Service, 2014). Middlesbrough offers many services withinthe sexual health clinics such as HIV and STI testing, Chlamydia testing andthe C-card.

The service is free, with open access. In the Middlesbrough clinicthey work with Teesside Positive Action to offer rapid HIV testing and severalsatellite clinics (Public Health England, 2014).