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HCR5001 Public Health Report on STIs: NCSP Model Extract
For information and reference only – not to be submitted as your own work. Use this extract to see how a Level 5 public health report is structured, how evidence is weighed and how each question is answered in turn, then build your own report around your own choice of intervention and country.
This model extract answers the HCR5001 Public Health report at Arden University, where one intervention addressing sexually transmitted infections (STIs) must be carried through all four questions. The intervention chosen here is the National Chlamydia Screening Programme (NCSP) in England. You can read the original HCR5001 Public Health assessment brief on our site. Figures marked “(illustrative)” are examples of targets, not published results.
Question 1: Concepts and principles of modern public health underpinning the NCSP
The NCSP was set up after an expert group advised in 1998 that opportunistic screening should be introduced in England. A phased roll-out began in 2003 and with full national coverage targeted for 2008 (Public Health England, 2021a). Its primary aim is to reduce the health harm caused by untreated chlamydia, with secondary aims of reducing reinfection and onward transmission and raising awareness of good sexual health (Public Health England, 2021a).
Levels of prevention
Screening is classically secondary prevention: it finds asymptomatic disease early so that treatment stops progression (Leavell and Clark, 1965). Treating a young woman’s infection before it ascends the genital tract reduces the risk of pelvic inflammatory disease (PID), ectopic pregnancy and tubal infertility. Partner notification adds a primary-prevention effect, because treating partners interrupts transmission before new infections occur.
Screening principles
Wilson and Jungner (1968) set out ten criteria for a screening programme, including an important health problem, a recognisable latent stage, an acceptable test, an agreed treatment policy and a natural history that is adequately understood. Chlamydia meets most of these. The weak point is the last: the English expert review noted uncertainty about how much harm screening actually prevents (Public Health England, 2021b). A good answer says so rather than claiming the criteria are met in full.
Population and high-risk strategies
Rose (1985) distinguished a population strategy, which shifts risk across everyone, from a high-risk strategy, which finds susceptible individuals. The NCSP started as an age-based offer to all sexually active people under 25 and, since 2021, concentrates proactive community offers on young women (Public Health England, 2021c). That is a deliberate move towards targeting, justified by the fact that the main harm falls on women.
Inequalities and the wider determinants
Marmot (2010) argues for proportionate universalism: universal services, delivered with a scale and intensity proportionate to disadvantage. This matters here because Natsal-3 found that chlamydia prevalence was higher among women in more deprived areas, yet testing did not follow the same pattern (Woodhall et al., 2016). The Dahlgren and Whitehead (1991) model reminds us that sexual health is also shaped by education, housing, income and access to services, so a test alone cannot carry the whole burden.
Health promotion
The Ottawa Charter (World Health Organization, 1986) calls for healthy public policy, supportive environments, community action, personal skills and reoriented health services. The NCSP maps best onto the last two: it reorients services such as general practice, pharmacy and contraception clinics towards opportunistic testing, and the external peer review panel recommended that health promotion accompany every test (Public Health England, 2019).
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Question 2: Key elements of the intervention and how they would be evaluated
The table separates the NCSP into its working parts. For the evaluation column, a logic model (inputs, activities, outputs, outcomes, impact) works well, and RE-AIM (reach, effectiveness, adoption, implementation, maintenance) is a sound check that no dimension is missed (Glasgow, Vogt and Boles, 1999).
| Element | Purpose | Evaluation indicator |
|---|---|---|
| Target group: sexually active women under 25 (men if a partner or symptomatic) | Focus resources where reproductive harm is greatest | Proportion of women under 25 tested each year; tests by deprivation quintile (reach) |
| Opportunistic offers in sexual health services, online services, contraception and termination services, GPs and pharmacies | Make testing routine and convenient | Tests by setting; number of providers delivering the offer (adoption) |
| Test on new partner and annually | Detect asymptomatic infection early | Positivity (proportion of tests positive); diagnoses per 100,000 (output) |
| Prompt results and treatment | Limit time in which infection can be transmitted or cause damage | Proportion treated within a set time, for example 14 days (illustrative target) |
| Partner notification | Treat partners and prevent reinfection | Partners notified and treated per index case (implementation) |
| Retest about three months after treatment | Detect reinfection, which carries higher PID risk | Proportion of positive patients retested (implementation) |
| Health promotion with every test | Build skills and condom and partner-change awareness | Audit of advice given; survey of knowledge (outcome) |
Outcomes would be judged at three levels. Process measures cover coverage and timeliness. Intermediate outcomes cover positivity and reinfection. Impact measures cover PID, ectopic pregnancy and tubal infertility, plus population prevalence from surveys such as Natsal. The external panel advised continued PID surveillance, with ectopic pregnancy as a secondary measure (Public Health England, 2019). Be explicit that process indicators are easy to measure and impact indicators are not.
Question 3: Review of the evidence and whether the NCSP is effective
| Source | Design | Key finding | Weight for this review |
|---|---|---|---|
| Scholes et al. (1996) | Randomised trial, 2,607 eligible women, US | PID in 9 screened women against 33 in usual care; relative risk 0.44 (95% CI 0.20 to 0.90) | Strong design; selected high-risk women, so transfer to English routine care is limited |
| Oakeshott et al. (2010) | Randomised trial, 2,529 female students, London | PID at 12 months 1.3% screened against 1.9% control; relative risk 0.65 (0.34 to 1.22) | Direction supports screening, but the interval includes no effect |
| Price et al. (2016) | Five methods using UK data before the NCSP | About 20% of PID in women aged 16 to 44 attributable to chlamydia; 35% at 16 to 24 | Shows the harm is real but chlamydia is not the main cause of PID |
| Hocking et al. (2018) | Cluster-randomised trial, Australian primary care | Prevalence fell in both arms; between-group odds ratio 0.9 (0.5 to 1.5) | Opportunistic testing may not cut prevalence sharply |
| Woodhall et al. (2016) | Natsal-3 survey, 2010 to 2012 | Prevalence 3.1% in women and 2.3% in men aged 16 to 24; higher prevalence in deprived areas without matching testing | Reach is uneven because testing did not follow the pattern of infection by deprivation; useful for equity analysis |
The evidence points in two directions. At the level of the individual woman, detecting and treating infection plausibly reduces PID, and the external panel accepted that randomised trials show detection and treatment can reduce PID risk. At the level of the population, the panel found no strong empirical evidence that screening has lowered prevalence, and a fall in PID, tubal infertility or ectopic pregnancy due to the programme has not been demonstrated, partly because outcome measures are weak (Public Health England, 2019).
My judgement is that the NCSP is probably effective in preventing harm to individuals but unproven as a means of reducing community prevalence. That is a defensible, Level 5 conclusion because it is tied to the quality of each study. Recent data add a further caution: between 2023 and 2024, tests in 15 to 24 year olds fell by 11% and diagnoses by 18%, and UKHSA says this fits both fewer infections and a change in who is tested (UK Health Security Agency, 2025). Falling diagnoses are therefore not automatically good news.
Question 4: One evaluation of the NCSP and its recommendations
The evaluation described here is the NCSP External Peer Review, chaired by Professor Johan Giesecke, which met in October 2017 and published its report in November 2019. It was commissioned because budgets were under pressure and services needed to show value for money (Public Health England, 2019). The panel reviewed an evidence pack and heard presentations on surveillance, impact and health economics, so it is an expert synthesis rather than a new trial.
Main recommendations
- Aim primarily to prevent the adverse consequences of untreated chlamydia, with health promotion at every test.
- Continue opportunistic screening of young women; test young men if they are partners, symptomatic, having other screening or request a test.
- Shift emphasis from annual testing to testing on partner change, and retest positives at three months.
- Provide results within seven days and treatment within a further seven, replacing the former six-week target.
- Target commissioning at at-risk groups, because testing coverage in the most deprived quintile was lower.
Discussion
The recommendations are specific and measurable, which is a strength. The 14-day pathway, for example, can be audited directly. Their limits are also clear: the panel itself noted gaps in the evidence pack, including non-UK studies and antibiotic resistance (Public Health England, 2019).
The recommendation on young men proved the most contested. In the 2020 consultation, 274 responses were received and only 32% supported the proposal to focus on young women, 45% did not and 23% were unsure; respondents raised stigma, reduced male engagement and resourcing for partner notification (Public Health England, 2021d). Public Health England nevertheless announced the refocused programme on 24 June 2021 (Public Health England, 2021c). A strong answer recognises that evidence and public acceptability can pull in different directions, and recommends investing in partner notification and clear messaging for men.
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References
Dahlgren, G. and Whitehead, M. (1991) Policies and strategies to promote social equity in health. Stockholm: Institute for Futures Studies.
Glasgow, R.E., Vogt, T.M. and Boles, S.M. (1999) ‘Evaluating the public health impact of health promotion interventions: the RE-AIM framework’, American Journal of Public Health, 89(9), pp. 1322-1327.
Hocking, J.S. et al. (2018) ‘Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial’, The Lancet, 392(10156), pp. 1413-1422. doi: 10.1016/S0140-6736(18)31816-6.
Leavell, H.R. and Clark, E.G. (1965) Preventive medicine for the doctor in his community. 3rd edn. New York: McGraw-Hill.
Marmot, M. (2010) Fair society, healthy lives: the Marmot Review. London: University College London Institute of Health Equity.
Oakeshott, P. et al. (2010) ‘Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial’, BMJ, 340, c1642. doi: 10.1136/bmj.c1642.
Price, M.J. et al. (2016) ‘Proportion of pelvic inflammatory disease cases caused by Chlamydia trachomatis: consistent picture from different methods’, The Journal of Infectious Diseases, 214(4), pp. 617-624. doi: 10.1093/infdis/jiw178.
Public Health England (2019) NCSP external peer review panel report. London: Public Health England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/858606/NCSP_external_peer_review_panel_report.pdf (Accessed: 13 October 2026).
Public Health England (2021a) NCSP programme overview. Available at: https://www.gov.uk/government/publications/ncsp-programme-overview/ncsp-programme-overview (Accessed: 13 October 2026).
Public Health England (2021b) Information on the changes to the National Chlamydia Screening Programme. London: Public Health England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/992294/NCSP_Information_on_the_changes_June_2021.pdf (Accessed: 13 October 2026).
Public Health England (2021c) Changes to the National Chlamydia Screening Programme (NCSP). Available at: https://www.gov.uk/government/publications/changes-to-the-national-chlamydia-screening-programme-ncsp/changes-to-the-national-chlamydia-screening-programme-ncsp (Accessed: 13 October 2026).
Public Health England (2021d) Changes to the National Chlamydia Screening Programme: consultation report. London: Public Health England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/994023/NCSP_Consultation_report_June_2021.pdf (Accessed: 13 October 2026).
Rose, G. (1985) ‘Sick individuals and sick populations’, International Journal of Epidemiology, 14(1), pp. 32-38.
Scholes, D. et al. (1996) ‘Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection’, New England Journal of Medicine, 334(21), pp. 1362-1366.
UK Health Security Agency (2025) Decreases in chlamydia tests, diagnoses and positivity in young people, England 2023 to 2024. Available at: https://www.gov.uk/government/publications/chlamydia-analyses-to-inform-control-interventions/decreases-in-chlamydia-tests-diagnoses-and-positivity-in-young-people-england-2023-to-2024 (Accessed: 13 October 2026).
Wilson, J.M.G. and Jungner, G. (1968) Principles and practice of screening for disease. Public Health Papers No. 34. Geneva: World Health Organization.
Woodhall, S.C. et al. (2016) ‘Is chlamydia screening and testing in Britain reaching young adults at risk of infection? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)’, Sexually Transmitted Infections, 92(3), pp. 218-227.
World Health Organization (1986) Ottawa Charter for Health Promotion. Geneva: World Health Organization.
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