Table 6.

Key determinants of success and barriers identified and potential tools to overcome them

Key determinants of success	Actions needed to facilitate them
Attendance at workshop of all general practice staff	When workshops are organised ask and encourage all staff to attend.
Attendance at workshop by key staff able to drive forward screening	Ensure correct staff whose role it is to undertake, facilitate or lead screening attend the workshop.
Increased confidence to offer screening through using scripts and practice, so normalised into routine practice	Using scripts in the training, and encouragement post training – stressing that the process of offering tests will increase confidence and positive feedback from patients.
Provision of resources for flexible use	Ensure that resources provided are in a format that can be adapted for individual general practice needs.
Use of computer prompts	Raise this in training and when and how they are going to be used, and who is going to set them up.
Tests are performed in the general practice before the patient leaves	Stress importance in training and plan how this can be attained in each general practice.
Encouragement of reflective practice post workshop led by “chlamydia champion”	Encourage action planning and agree staff roles going forward. General practice lead to follow up with communications about successes and testing rates and sexual health news in general practice.
Feedback on screening efforts	Feedback general practice screening rates on a regular basis, and identify individual in the general practice to this to other staff.
Barriers	Tools to overcome barrier
Forgetting to offer chlamydia screen	Using computer prompts and posters, and identify individual to take this forward.
Not wishing to offer chlamydia screening in non-sexual health consultations	Staff changing the way they offer a chlamydia screen by stating that they are testing everyone aged between 15 and 24, and having a general prompt for all ages.
When sexual health is a low priority in the general practice	Ensure individual responsible for deciding if general practice will prioritise chlamydia screening attends the training. Having a designated general practice lead to drive screening. Ensure lead and general practice keep screening as a priority, and send around reminders and forward newsletters to all staff.
Perception of time involved in offering chlamydia screen, and monitoring screening rates	Use the scripts; stress that staff report that using them increases confidence and fluency in making the offer. Making sure there are posters to refer to, kits easily accessible and invitation cards available to give to patients. Suggest audits as part of professional development of all staff.
Patients not returning the chlamydia test	Feeding back that other general practice staff ask the patient to do the test prior to leaving the general practice, and this is what patients want too.
Ongoing perception that patients may be irritated if they are offered screening	Stress patients views in the training, lead to facilitate ongoing discussions in general practice around feedback from patients.
Lack of privacy in reception area to give out invitation cards	Stress in training that offer should be made to all in age group so not seen as judgemental by staff; and teach receptionists to use script saying "we are offering this test to all 15–24 year olds, read about it on this card."
Targets being too high for general practices with very low screening rates	Stress importance in the workshop training of discussing realistic screening rates for individual general practices with numbers and actions needed to attain them.