Understanding what makes it easier or harder for GP practices to apply the changes to the National Chlamydia Screening Programme

🧪 What was the study about?

In June 2021, Public Health England announced changes to the National Chlamydia Screening Programme (NCSP), to focus on negative effects to fertility and pregnancy from untreated chlamydia in young women. This is part of a broader strategic shift towards focusing on reducing the number of people experiencing reproductive harms rather than reducing the number of people with chlamydia. Therefore, UKHSA advise that chlamydia screening should focus on women and other people with a womb or ovaries. In practice, this means that chlamydia screening in community settings, such as General Practice (GPs) and pharmacies will only be offered to young women, but services provided by sexual health services will remain unchanged. However, early data suggests that the number of young men being screened for chlamydia outside of sexual health services actually increased between 2021 and 2024. This suggests that the changes to the NCSP are not being carried out. Our findings aim to understand why this is.

❓ Why is this important?

Untreated chlamydia can cause the most harm in young women, due to negative effects to fertility and pregnancy. It is important to focus testing efforts on this group, to reduce harm from chlamydia.

🔍 What did we do?

We carried out surveys of GP staff across England and asked them what would make it easier or harder to carry out the changes to the NCSP. We used established theories about why people do or don’t change their behaviour to turn the survey results into practical suggestions for GP practices. We then discussed these ideas with a group of GP staff, local authority staff and young people to help turn these ideas into practical suggestions.

📊 Key findings

· Many GP staff were unaware of the 2021 policy change and testing patterns reflect this, with testing of young men actually increasing after the policy change while testing of young women fell. Some staff felt that chlamydia testing should be left to sexual health services, and many found it difficult to raise the topic in appointments focused on other issues, either due to time pressure or worry about causing offence or embarrassment.

· Participants suggested several practical ways to help GP staff follow the new screening policy. Training sessions could help make sure GP staff know about the policy change, and explaining the reasons for it in terms of protecting women's health may help bring staff on board. Letting patients know in advance through waiting room posters or text messages before their appointment could make being offered a chlamydia test feel normal and expected, while giving staff a simple script could make it easier to bring up the topic without feeling awkward. Providing self-testing kits could save time during appointments, though some participants were concerned about the cost and the possibility that patients might still want to talk through their results. Automatic pop-up reminders on GP computers and tables showing how often different practices are offering screening were also suggested as ways to help staff remember to offer tests even when appointments are busy, as long as these are presented in an encouraging rather than critical way.

💡 What do these findings mean?

These findings show that improving chlamydia screening in GP surgeries will require more than simply making staff aware of the policy change. Even where staff understood the reasons for focusing screening on young women, not all agreed with the approach, and this needs to be directly addressed. Practical barriers around time and resources also need to be tackled alongside efforts to change attitudes and norms. The practical suggestions developed with GP staff, commissioners and members of the public in this study could help inform efforts to increase chlamydia testing among young women in general practice, ultimately reducing the harm caused by untreated infection.