APPENDIX 18
Memorandum by Dr Beng Goh (SH 30)
1. SUMMARY
Prevention and treatment of sexually transmitted
infections (STI) including HIV is being undermined by the rapid
increase in STI and HIV and inadequate resources to cope with
the crisis. This led to longer waiting time for patients to be
seen with the potential for further spread of infection by untreated
patients and serious complications arising such as pelvic inflammatory
diseases, sterility and ectopic pregnancy as well genital cancers
and HIV related complications. The opportunity to prevent unwanted
pregnancy is missed as patients who had STI had unprotected intercourse
and therefore liable to get pregnant. Substantial resources are
required to maintain the success of GUM services over 60 years.
Immediate remedial action should be taken to ensure that current
GUM services do not deteriorate further and waiting time should
be kept to a minimum to prevent the transmission of STI/HIV.
2. THE EVIDENCE
2.1 The local GUM services are at crisis
point. North Thames carries a disproportionate burden of STI and
HIV patients within the United Kingdom. The increasing HIV workload
in many parts of North Thames is siphoning resources from traditional
GUM services into HIV. The current GUM services in North Thames
are finding it extremely difficult to cope with the needs of patients.
The huge demand has resulted in a waiting time of six weeks for
an appointment in some clinics. Patients had to shop around other
nearby clinics for shorter appointment date and those who cannot
wait then attend walk-in services. Clinics with a walk-in services
are inundated with patients from elsewhere who were seen on the
same day but had to wait for more than four to five hours to be
seen.
2.2 Patients particularly young people including
adolescents in Inner London have high rate of gonorrhoea and chlamydial
infection which can lead to chronic pelvic pain, sterility and
ectopic pregnancy. This has significant psychological and physical
morbidity with huge financial implications when it could be prevented
in the first place. The abortion rate among young women in Inner
London is amongst the highest which again is preventable.
2.3 Health promotion and screening of STI
lead to more workload and contact tracing/partner notification
of sexual partners, being an integral part in the prevention of
STIs, further aggravate the burden in GUM services, a "catch
22" situation. Currently there is a health promotion campaign
by Terence Higgins Trust targeting gay men in London to get screened
for syphilis as the outbreak of syphilis in gay men in North Thames
is continuing unabated.
2.4 Staff have had to work late beyond their
contracted hours on a regular basis which has lead to poor staff
recruitment and retention. The response of clinics with walk-in
services, which used to be the norm, is to "gate control"
patients by limiting the number of patients seen each day, the
rest being sent away while others clinics are moving to appointments
only, leading to long waiting list, thus aggravating the situation
further. This situation is completely against the fundamental
objective of reducing STIs/HIV and unwanted pregnancies.
2.5 There are many single-handed consultants
in North Thames, which is unsafe for clinical governance as patients
lack proper cover when the consultant goes on leave. The increasing
HIV workload with the increasing complexities in the management
of HIV infection has magnified the GUM workload in all the GUM
Clinics, more so for single-handed consultants.
2.6 North Thames has large ethnic population
eg Bangladeshis, Indians, Turkish and African communities. Ethnic
populations take longer time for consultations and frequently
need language line and interpreters/health advocates, which are
often not available. Health promotion material on sexual health
in ethnic languages is also lacking.
2.7 Sexual assault cases are on the increase
in Inner London and are seen by GUM clinics for STD/HIV screen
and psychological support which aggravating the excessive GUM
workload.
2.8 With the introduction of oral treatment
for erectile dysfunction, more men are accessing GUM Clinics for
psychosexual services as the services are viewed by patients as
confidential and user friendly. Psychosexual problem is a neglected
area particularly when funding is concern and many patients continue
to suffer in silence. Where psychosexual services are available
in North Thames, they contribute to the excessive workload in
the GUM clinics.
3. RECOMMENDATION
FOR ACTIONS
3.1 Urgent injection of substantial financial
resources to:
(a) Increase manpower to shorten waiting
time for patients to be seen to not more than two weeks for those
with appointment clinic. Financial incentives should be given
to provide more staff for "walk-in" clinics where patients
are seen immediately and to reduce the waiting time to be seen
to less than three hours.
(b) Fund new diagnostic tests such as genetic
probes for chlamydial infection which increase the detection rate.
(c) Fund HIV management and treatment adequately
so that resources are not siphoned off other essential GUM services.
(d) Increase contraception services within
GUM clinics to prevent unwanted pregnancies.
3.2 Sustainable Health Promotion campaigns
following the increased provision of GUM services.
June 2002
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