APPENDIX 23
Memorandum by Dr Helen Lacey (SH 38)
I have been a consultant in GUmedicine for 10
years and work single handed in Rochdale and Bury to provide sexual
health services to a population of <400,000. I am supported
by two assistant doctors and a team of nurses.
Despite instituting efficiency measures we are
finding that in the past 12 months demand for the services far
exceeds supply and we have a three week waiting list for appointments.
A recently presented audit of GUM services in the North-west commissioned
by the regional health authority also concluded—"demand
for services significantly outstrips supply, problems around access
will understate the need for GUM services, the rising trend in
STIs will exacerbate access to GUM services, many GUM staff work
beyond contracted hours and have limited opportunities for training".
Disappointingly—no action plan has been suggested to address
these problems.
Manpower—in my post—one consultant:
400,000 population—recommended ratio—from Royal college
of physicians one: 100,000 population. Many GUM consultants have
no junior doctors in training to support the clinical workload
and rely on non career grade Drs (rather poorly paid) to do much
of the clinical work. Most of us now find it impossible to recruit
suitable candidates even if we are successful in attracting additional
resources. I advertised a full time post recently—a national
advert—one unsuitable applicant!
I find I am doing more and more of the sort
of clinical work that should and could be undertaken by a junior
grade doctor. Consequently I have less time to do all those "extras"—audit,
appraisal, education etc.
So what about nurses taking on some of the more
traditional Drs roles?—recruitment to the higher grades
of nurse has been difficult and applicants for a nurse consultant
post disappointing. The funding arrangements for HIV treatments
put pressure on GUM drug budgets. Money does not follow these
patients but goes preferentially to the big centres making it
difficult to offer local services even where the expertise exists.
If this situation continues it will be difficult for me to continue
to offer HIV treatment services and I will have to send my patients
to the big centres—it does not take long for a clinician
to become deskilled in this area of medicine. Years to train—and
about 12 months to become deskilled!
Despite all the publicity about increasing STIs,
despite all the hype about the sexual health strategy , the specialist
services that manage these problems are understaffed, under resourced
and becoming increasingly overburdened and demoralised. We now
have major staff recruitment and retention problems which mean
that consultants are doing inappropriate tasks for their skill
levels.
The evidence is quite plain—outbreaks
of gonorrhoea and syphilis locally—high levels of teenage
pregnancy and chlamydia. How much more evidence is needed to convince
those who can make changes that the sexual health of the population
is deteriorating? I despair at the lack of interest and knowledge
about sexual health service commissioning shown amongst local
PCTs. I was able to offer a better STI service to local people
when I took up my GUM post 10 years ago.
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