Table 4 Collective Action: work undertaken to drive the intervention forward and sustain it

Value of computer prompts:

“Definitely (computer) pop ups, that that’s key almost, I think that that’s the biggest influence it’s had on me is pop ups, so it’s just automatic, because you know you’re looking there (the computer screen) anyway and then you see (the prompt to) offer chlamydia and you think ah yeah.” (Nurse 03897)

Value of repeated contact from the Chlamydia Support Team:

“Well they (the Chlamydia Support Team) just kept on with it, so they’ve kept contacting us, they’ve kept the interest going, kept coming up and it’s not just lets visit once and clear off, you know they’ve been on several occasions and that’s good” (General Practitioner 04250)

Value of ongoing awareness raising in practice:

“I’ve brought it up at a couple of meetings since then, and also introduced the little (chlamydia patient invitation) cards and things into reception… and said look… you really have to think about it. And as a new receptionist has come in; I’ve said (to her) you know (be) aware that these little chlamydia cards could also be attached to a prescription for the pills, or you know contraceptive type of prescriptions, or anybody coming to the (reception) hatch who looks to be in that sort of age group.” (Nurse 04346)

Receptionist involvement:

“Most of our screening is done sort of across the counter at the front desk, where and when we see a lot of new patients registering from the university which is quite local to us. We offer chlamydia screening routinely to that particular age group.” (Receptionist 04430)

Barrier, perceived confidentiality issues:

“She (the chlamydia support worker) told us that (get the patient to complete screen in practice there and then) but the practice isn’t big enough to do that, because there is only one toilet… that leads right out into the waiting room area and people would see people coming out with a packet… and they wouldn’t like to do that.” (General Practitioner 03920)

“For one I would feel that I wouldn’t have the time,… so it would depend on how busy we were. And two I wouldn’t think it would be appropriate, it’s the sort of thing that somebody could complain about (if) you’re not keeping things confidential. So I would only ask if I knew there was no one behind them, even if it’s a woman coming in for a smear.” (Receptionist 04207)

Barrier, lack of ability or will to develop a computer prompt:

Well I suppose we could have done [developed a prompt] but there’s only three (practices) who have ours (computer system) they know (how) to deal with all those (other) sorts of computers but wouldn’t have known what to do (with ours).” (General Practitioner 03920)

“Because there are thousands of them, people ignore them. We have a little box at the bottom with lists of prompts that this patients (is) due their blood pressure check, their thyroid check, (lists 3 others), cervical smears and … just as a general practitioner if I’m very honest with you I ignore them.” (General Practitioner 04205)

“I think in reality probably half of time we just ignored it and thought I haven’t got time for that, but the other times it did trig your memory and you did it. We just changed to (a new computer) system a few months ago, and I don’t know whether it’s available on that, but we certainly don’t have it (any prompts) at the moment.” (General Practitioner 03730)

Barrier, some receptionists uncomfortable discussing chlamydia screening:

“I wouldn’t be comfortable sort of saying to a young person, when there’s a lot of say older people behind them, “would you want to do a chlamydia test” I just wouldn’t do it, so I don’t think it’s changed here in how we deal with the patients” (Receptionist 04207)

Barrier: concern that patient will not welcome chlamydia screening offer:

“I don’t think it’s appropriate to talk about these things (chlamydia screening), especially if you want to have a good relationship with your patients, it is just incredibly difficult.” (General Practitioner 03867)

Barrier, staff uncomfortable raising screening in non-sexual health consultation:

“I do however do quite a lot of telephone triage. Its slightly more difficult to think about chlamydia when you’re dealing with people with other health issues, be it sort of tonsillitis or you know whatever other issue they’ve got, it’s not always as easy on the phone to suddenly launch into sexual health question.” (Nurse 04346)

Barrier, problems with access to chlamydia swabs:

“Checking that nobody’s got any outdated swabs in their surgery, or you know the NAATS tubes, which sounds simple, but everybody (staff say) “I haven’t got any out of date ones” and then the following week you’ll get..a result back (from the lab) saying tube out of date, couldn’t do the test.” (Nurse 04388)

“I think perhaps we have had (some) difficulty getting hold of the packs. I think if it (were)….a bit smoother ordering the packs and that sort of thing, … that would make us do more” (Nurse 04254)