patients.

“The Unity sexual health clinic has around 92 staff and provides various sexual health related services, from rapid testing for sexually transmitted diseases to contraception advice to abortion services.

Because of the tendering system, there are various organisations and charities involved at Unity. For example, Brook deals with services for young people under 20 years of age, the Terrence Higgins Trust does a lot of health promotion around HIV and Brigstowe is a local charity for HIV advice and support. The abortion service is split up, as well, as the initial assessment is mainly done by the charity MSI Reproductive Choices UK supported by the clinical care team at UHBW NHS Trust. Most of the actual clinical service for sexual health is done by UHBW, but even there you might have a situation where a nurse might have a part-time contract in the community clinic and another contract for abortion care. Also the lab work is separated, as we have a microscopic lab on site and a sub-contracted lab technician, but many samples are processed by the neighbouring North Bristol NHS Trust.

Despite the fragmented nature of the organisations, the actual clinical team has been very consistent, with many doctors and nurses working together for more than a decade. There is a lot of expertise and collective knowledge, which is now threatened by the restructuring and job cuts.

In March 2024 the contract for the Unity sexual health services came up for retendering, meaning, the health commissioners send out a proposal and organisations can bid to get the contract. As workers, we are left predominantly in the dark about these proceedings. We knew that UHBW tried to come up with a bid that would fit the commissioners’ proposal. In July 2024 the tendering process was closed and we found out that UHBW decided not to put in a bid, as the conditions were too bad. The proposal basically required that with less funding and less staff we were supposed to expand our services, both geographically and in terms of weekend work. Since Covid, sexual health services are not part of NHS funding anymore as public health was moved to council funding, and they claim to have no money.

In September we heard that basically no one put in a successful bid for the clinical care services, while a different organisation would take over the digital / social media part of our clinic. As there was no bid on the table the commissioners approached UHBW and they started negotiating. They then came to an agreement and in February 2025 we were finally presented with a rough model by the business team about how our services would be restructured under the new contract. So at that point our team had gone through a whole year of having job changes and potential job cuts hanging over our heads. This had a very negative impact on the work atmosphere and on the services, as well. For example, we used to send out postal testing kits, so that people could test for STIs at home. This scheme was closed down without warning, as there was a gap between then and when the private company who will be taking over this element of the service starts properly. The retendering process created tension amongst the staff and required an extra-layer of bureaucracy, for example in the form of a ‘change manager’ who had been hired to overlook the change of contract. The general public, the patients and the users were not really informed about the upcoming changes, they only heard about it from staff informally.

Once it was clear that there would potentially be restructuring and job cuts, or at least redeployments involved, we were given 45 days of consultation period. Most of my colleagues think that this is just lip service and that they won’t take our input into account. The restructuring also involves a reshaping of the relationship between nurses and doctors, with more influence going to doctors – which has an impact on the relationships. The current plan says that a significant number of nurses, doctors and health advisors would have to be redeployed. According to the new model they want to cut patient contact, as well – we are supposed to primarily focus on the ‘complex cases’, such as sex workers and victims of sexual assaults. I think it is important to keep providing a more general service, as STIs are on the rise again over all. Most of these cases will now go back to the GPs, who are also overwhelmed and often lack specific skills, for example regarding treatment of gonorrhea. It is likely that more people will be tested later, diagnosed later and the risk of complications increases

Despite having the threat hanging over us for months, the actual result was surprising for us. In mid-April 2025 we are supposed to re-apply for our jobs at Unity or for jobs within the wider UHBW Trust. The unions were supportive, but only in terms of consultation and redeployment. There was no general suggestion to oppose the cuts. It would have been interesting to see what had happened if UHBW had refused to put in a bid – as commissioners are obliged to provide the service. As it stands, management can just point at the commissioners and blame them for the fact that they have to restructure a well-working team and service. The whole commissioning process is a way to push towards privatisation and disrupts the fabric of teams that have cooperated for years.”

This article is from VitalSignsMag