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Melissa Hampton – The University of Sheffield

This research project was completed as a component of my MSc course in Reproductive and Developmental Medicine at the University of Sheffield. In March 2020, following the announcement of a UK national lockdown due to the Covid-19 pandemic, the Association of Reproductive and Clinical Scientists (ARCS) and the British Fertility Society (BFS) issued clinical guidance to all fertility clinics in the UK, recommending that no new fertility treatments were to be started and all ongoing treatments were to be completed by the 15th of April 2020. Fertility clinics were then closed to all patients with the exception of clinically urgent cases. Jessop Fertility reopened in June 2020 after receiving approval from the Human Fertilisation and Embryology Authority (HFEA) and permission from their NHS Trust (Figure 1). Upon reopening Jessop Fertility implemented many service changes to protect both patients and staff from Covid-19 infection. These service changes included, the introduction of remote appointments, the production of semen samples at home, patients were required to attend appointments alone and many staff members were redeployed or required to work remotely. The purpose of this study was to evaluate patient and staff experience of the service changes that were implemented at Jessop Fertility due to the Covid-19 pandemic.

Figure 1. A – Timeline of events for the progression of the Covid-19 pandemic in the UK (UK Government, 2020-2021). B – Key events for UK fertility centres throughout the Covid-19 pandemic (HFEA, 2020).

Patients who received treatment between March 2020 and June 2021 and all employees of Jessop Fertility were asked to complete a questionnaire to evaluate their experience of the service changes. The questionnaires consisted of both closed and open-ended questions. Statistical analysis was carried out on quantitative data using Kruskall-Wallis or Mann-Whitney U tests and qualitative data was analysed using thematic analysis.

Patient questionnaire results
There were 43 patients that participated in the study. Firstly, the majority of patients were either very satisfied or satisfied with communication from staff during clinic closure (n=30). Most patients reported high satisfaction rates for remote appointments (87.5%) and producing semen samples at home, with many indicating that they would like these services to be an option following on from the Covid-19 pandemic. When asked if they preferred having set times for scan appointments in comparison to the previous turn up and wait system, all patients indicated that they preferred being given a set appointment time. Interestingly, whilst the majority of patients reported that they felt they were given enough information regarding their procedure and felt supported throughout, many patients did not feel comfortable attending appointments and procedures alone (Figure 2). To further this, when asked what could be done to improve procedures, many patients suggested that partners should be able to attend appointments and procedures.

Figure 2. Patient experience of attending embryo transfer and IUI procedures at Jessop Fertility during the Covid-19 pandemic (n=36).

Staff questionnaire results
There were 22 staff members that participated in the study. Over half of the staff members that participated in the study reported they were required to work remotely during the Covid-19 pandemic (n=12). The staff members identified increased productivity, increased flexibility, and a lower risk of Covid-19 infection as benefits of remote working. On the other hand, IT issues and being unable to complete certain tasks from home were highlighted as challenges. When asked to identify the main challenges when carrying out their role throughout the Covid-19 pandemic, many staff members highlighted the redeployment of nursing staff as a challenge. For example, some redeployed nursing staff members reported they were unhappy with the lack of choice regarding if and where they were redeployed. Although most staff members reported positively on communication during remote appointments, many felt they were not able to provide the same quality of care (Figure 3). Furthermore, when asked if they would be happy to continue virtual appointments following on from the Covid-19 pandemic, 42.9% of staff members reported they would not. For telephone appointments, 22.2% of staff members reported they would not be happy to continue these appointments following on from the Covid-19 pandemic. The majority of staff members felt they received adequate support during the Covid-19 pandemic and felt they were able to maintain a good work-life balance. Staff members accurately perceived patient experience of the service changes, particularly their preference for set appointment times and dislike of partners being unable to attend appointments.

Figure 3. Staff experience of Attend Anywhere appointments during the Covid-19 pandemic (n=7).

The findings from this study suggest that despite the challenges faced during the Covid-19 pandemic, Jessop Fertility were able to successfully adapt their service to continue providing patients with high quality care. Continuing to offer set appointment times and providing patients with the option of remote appointments and producing a semen sample at home may be beneficial for patients. Furthermore, allowing partners to attend appointments and the return of redeployed employees should be considered when safe to do so to improve both patient and staff experience. Finally, this study highlighted the importance of communication between staff, patients and hospital Trusts. Following on from the pandemic, appropriate steps should be taken to ensure continued effective communication between staff and patients.

References available on request – Melissa.hampton29@hotmail.co.uk