Attendance by exception: Clinical safety in a national lockdown-prove it

Introduction: This cohort study of patient contacts to a SW London level 3 integrated sexual health service during initial stages of the COVID lockdown evaluated presenting complaints to a telephone management system for conversion to face to face attendances (F2F) and patient outcomes Findings, alongside BASHH COVID pandemic guidelines, shaped clinic protocols during the ongoing and now easing lockdown Methods: Patients booked to the telephone management system between 30/03/2020 and 30/04/2020 were included in the analysis Patient need was sub-categorised by clinical syndrome (vaginal discharge, dysuria) or contraceptive request and further evaluated Additional analysis of F2F attendances versus signposting to online testing, self-management and other NHS providers was performed along with a patient feedback survey Results: In the study period 805 calls were received: 467 sexual health, 190 contraception, 21 sexual health and contraception and 127 other (of which 98 call-backs failed) 97 patients attended the service: 73 for F2F sexual health and 24 for contraception including a 'click & collect' medication service Patients considered to have additional vulnerabilities were further managed to ensure an appropriate support offer Repeat calls to the service were low;serving as a proxy for reassurance that initial advice had been appropriate Further scrutiny of online patient survey feedback (low response numbers) indicated 91 97% (n = 12) satisfaction with the phone service and care or advice Surprisingly a small proportion of respondents (n = 13) reported accessing signposted online testing (13%) or order contraception (6%) Discussion: This analysis demonstrates phone management can be successful in the context of a lockdown The majority of queries received optimal first-line management with over the phone advice, sign posting to online testing and pharmacies and appropriate safety netting This approach appropriately utilised the significantly reduced level 3 clinical capacity for those most at need and has provided evidence to continue evolving into the 'new normal' as lockdown eases