Table 3 Cognitive Participation: staff engagement in training and general practice implementation

How screening was promoted after the training:

“It’s prompted us to have the kits and things on our desks…so we have greater awareness, to kind of dish it (the screening tests) out.” (General Practitioner 04380)

“We have posters around the surgery and cards that L (a staff member) will give them, we offer a condom service here, the c-cards, they will attach on (to the) cards (information) about the chlamydia service to those (patients) when they come for the free condoms,… and just generally in … consultations.” (Nurse 04254)

Advantage of practitioners who are decision makers in general practice being at the training:

“A couple of the lady doctors have come to a couple of the talks… and that always helps if you’ve actually got a GP there at that time.” (Nurse 04243)

Value of being given possible scripts in the workshop to use with patients:

“You just say something like: “We are a chlamydia screening surgery would you like one of these tests, we offer them to everybody under 25”…. so yes, yes that definitely helped” (General Practitioner 03730)

“Let’s check your blood pressure; and you know you’re in the age group for a chlamydia screen have you had one in the last 12 months?” (Non clinical 71)

“You just say something like: “We are a chlamydia screening surgery would you like one of these tests we offer them to everybody under 25” it did (using the script) so yes yes that definitely helped” (General Practitioner 321)

Value of doing test immediately in the surgery:

“Well I think we’ve begun to realise (by) talking to the chlamydia support team and talking amongst ourselves, that probably they (the tests) only ever really get done, if you actually make the person go and do the swab there and then and then bring it back” (General Practitioner 03730)

Barrier, lack of interest in sexual health by all medical staff:

“I’m the only, you know, GP who’s actually interested in gynaecology in this practice and two of the other female doctors aren’t interested in doing it (or) taking over from me in that respect when I, … retire or whatever, … I think you know (it’s) quite a general attitude,… not everyone (GPs) is interested in that (screening) or feels it’s important or relevant.… Whereas the nurses, a lot of them … are well-qualified in family planning … and they’re more approachable, you know people find it easier to talk to nurses often, than a ….male older doctor.” (General Practitioner 03029)

Barrier: A practitioner talking about targets set nationally and not for individual general practices:

“No there is no credible (target)… because first of all (they Public Health England) decide that a group of people in an area has got a certain type of infection, (and) promiscuity etc. and you say the average of the whole country is like that. (But) here it’s totally different from the practice in town, how can you (set) the same target for me and B practice (in town) you cannot do that” (General Practitioner 03867)

Barrier: lack of confidentiality in reception area:

"Because it's such a small practice, and because of confidentiality the problems of that (chlamydia screening) in a small practice, … and knowing everyone." (Receptionist 04417)