Select Committee on Health Minutes of Evidence


\Memorandum submitted by Dr Chris Ford (SH 157)

  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 role.

  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 are many:

1.  RESOURCES:

  Problem:

    —  No new monies have been given to primary care for this increased role.

  Solution:

    —  Human and financial resources are needed to be able to implement the strategy.

2.  TRAINING:

  Problem:

    —  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.

  Solutions:

    —  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 AND CONTRACEPTION:

  Problem:

    —  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.

  Solutions:

    —  Training could address this.

    —  Ensuring the whole of sexual health is included in the new GP contract.

4.  QUALITY AND CAPACITY OF PRIMARY CARE AND THE NEW GP CONTRACT:

  Problem:

    —  The demands being placed upon Primary Care have rapidly increased during the past years including increasing patient demands.

    —  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.

  Solutions:

    —  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 AND TREATMENT

  Problem:

    —  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.

  Solution:

    —  Good screening and testing equipment is needed.

    —  Use of simple, effective and non-invasive testing to be used where available, such as the urine test for chlamydia.

    —  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:

  Problem:

    —  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.

  Solution:

    —  To develop a community equivalent of KC60.

7.  PARTNER NOTIFICATION:

  Problem:

    —  There is no system of partner notification and primary care can not screen people who are not registered with them.

  Solution:

    —  One possibility to improve this would be to have outreach workers working with local GUM services.

8.  HIV TESTING

  Problem:

    —  HIV testing in primary care is still patchy.

  Solution:

    —  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.

9.  SPECIALIST SEXUAL HEALTH SERVICES AND CLINICAL NETWORKS

  Problem:

    —  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.

  Solution

    —  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 services.

    —  Good local and regional clinical networks between GUM, contraception services and primary care need to be developed. Knowledge gained from HIV networks can inform this process.

10.  TREATMENT OF PEOPLE WHO USE DRUGS

  Problem:

    —  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 forgotten.

  Solution:

    —  Good resourced needle exchanges and treatment programmes.

11.  PERCEIVED LACK OF CONFIDENTIALITY IN PRIMARY CARE

  Problem:

    —  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.

  Solution:

    —  We would recommend that GPs stop doing personal medical reports on their own patients.

12.  PROVISION OF CONDOMS AND PREGNANCY TESTING

  Problem:

    —  There is no standarised provision of condoms and pregnancy testing to primary care.

  Solution:

    —  These need to be made available nationally.

November 2002


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2003
Prepared 11 June 2003