\Memorandum submitted by Dr Chris Ford
The National Sexual Health & HIV Strategy
is welcomed by the RCGP as it is the first attempt to provide
guidance on sexual health matters and HIV infection on a national
basis with a key role for primary care. It is, however, not without
problems and challenges and was not universally welcomed by primary
care, whereas many feel ill-equipped to take on this expanded
Sexual relationships are for most people a very
positive and normal aspect of their lives and this must not be
lost in the drive to reduce morbidity related to sexual health.
The National Sexual Health & HIV Strategy
identifies an important role for primary care in delivering sexual
health services and its implementation depends on us taking up
that role. There are examples of good practice but in most places
primary care is currently unable to take on this role.
The reasons and the possible solutions for this
No new monies have been given to
primary care for this increased role.
Human and financial resources are
needed to be able to implement the strategy.
Complex educational needs lie behind
apparently simple level 1 and level 2 type skills and services.
Currently there is little consistency
in training for doctors and nurses working in primary care.
Training needs to encompass the range
of knowledge, skills and attitudes if it is to be effective, relevant
and sustained. It also needs to encompass team-training.
Need to develop some standardisation
around key subject areas.
There are some initiatives both locally
and nationally but this is going to take time and needs resourcing.
3. SEXUAL HEALTH
Contraception is traditionally provided
from primary care but the range offered is often limited (80 per
cent + combined pill).
This provision is often not accompanied
by a full sexual health assessment, sexual health promotion and
support around other areas of sexual health.
Training could address this.
Ensuring the whole of sexual health
is included in the new GP contract.
4. QUALITY AND
NEW GP CONTRACT:
The demands being placed upon Primary
Care have rapidly increased during the past years including increasing
The different teams have differing
priorities and there is enormous variation in practices, both
locally and nationally.
The support available from specialists
also varies enormously.
The new GP contract could help to
address this but currently sexual health does not seem to be a
key part of the developing quality standards.
Pressure should be placed on the
GP contract negotiators to ensure the whole of sexual health is
placed in Additional Services, and not just contraception.
Improvement and more standardisation
in primary care has occurred with the development of National
Service Frameworks (NSF). Developing an NSF for sexual health
would be beneficial.
5. TESTING, SCREENING
Testing and screening facilities
in primary care are generally woefully inadequate.
Screening for common infections,
such as chlamydia is not done systematically.
Often the tests used are not the
most effective, this is particularly true for chlamydia.
Good screening and testing equipment
Use of simple, effective and non-invasive
testing to be used where available, such as the urine test for
Screening will be requested more
commonly because of advertising campaigns explaining that STIs
are common without symptoms and information and testing needs
to be available.
At present all prescriptions are
charged, except contraception. This exemption must be extended
to treatment for STIs.
To develop standard, evidence guidelines
for treatment of STIs in primary care.
Promoting RCGP Minimal Standards
in Sexual Health.
6. DATA COLLECTION:
There is no equivalent data collection
system to that in GUM. This makes notification impossible.
This is an absolute essential if
future public health trends are to be relied on.
To develop a community equivalent
7. PARTNER NOTIFICATION:
There is no system of partner notification
and primary care can not screen people who are not registered
One possibility to improve this would
be to have outreach workers working with local GUM services.
8. HIV TESTING
HIV testing in primary care is still
The RCGP promotes more HIV testing
in primary care but many feel unskilled in doing this. A beginning
would be wide dissemination of the RCGP pre-HIV testing proformas
to all general practitioners.
In most areas Specialist Sexual Health
Services are overstretched and primary care is ill-prepared. With
no additional resources primary care could be seen as a cheaper
option and as a way of relieving these pressures. We are pleased
that GUM clinics are going to receive investment to improve staffing
but the amount is insufficient.
This money needs to be increased
and be recurrent.
Primary Care must receive the support
of, and work alongside, good quality and well-resourced specialist
Good local and regional clinical
networks between GUM, contraception services and primary care
need to be developed. Knowledge gained from HIV networks can inform
The role of primary care in the treatment
of people who use drugs has improved over the past few years.
Because the present strategy has joined "sexual health and
HIV" it pays less attention to this patient group. Although
this is being addressed in other arenas their needs must not be
Good resourced needle exchanges and
The fears about the lack of confidentiality
in primary care provision of sexual health and HIV services. This
is especially so in HIV-testing and the "Insurance issue"
and needs to be resolved.
We would recommend that GPs stop
doing personal medical reports on their own patients.
There is no standarised provision
of condoms and pregnancy testing to primary care.
These need to be made available nationally.