Modernising Genitourinary Medicine Services
in England and Wales
The incidence of STIs and HIV in England and
Wales has risen dramatically since 1997. Although most GUM departments
operate an open access policy for patients who need to be seen
urgently, recent surveys have shown that most GUM services are
experiencing severe workload pressures that are exacerbated by
restrictions in the physical infrastructure of clinics. This has
resulted in unacceptable patient waiting times for accessing GUM
services, which will inevitably have a very detrimental impact
on the control of STIs.
In April 2001, MSSVD and AGUM set up a working
group to investigate the need for improvements to clinic infrastructure
and to estimate the associated national costs. Clinics were classified
into units based at London teaching hospitals, at Regional Teaching
Hospitals, at District General Hospitals (subdivided into services
served by more than one and by single-handed consultants), and
within integrated sexual health services. The Group developed
a template for assessing needs. Building cost calculations were
based on detailed costings from nine representative units, which
have either been modernised recently or are about to undergo major
rebuilding programme. In addition an informal telephone survey
of other centres took place to identify their needs.
The survey identified the urgent need for substantial
investment to improve service effectiveness, accessibility and
acceptability. For most centres, this would mean refurbishment
(including extensions where necessary) to improved access, especially
for the disabled and facilities for patients with young children.
If all clinics were refurbished, we estimated the total cost to
be £151.5 million.
The deficiencies of some clinics are so great
that a major rebuild rather than refurbishment will be necessary.
We believe that this will apply to 20 per cent of current clinics.
This increases the estimated total building costs to £248
million. This figure does not include professional fees or VAT.
Service delivery and effectiveness were also
impaired by inadequate information technology. Virtually all units
need to improve or develop computer links with laboratories and
update of existing IT systems to enable efficient archiving of
clinical records, and improvements to telephone systems. We estimated
this to cost a further £28.5 million.
Extending opening hours, subject to availability
of resources and manpower, may also enhance accessibility to some
clinics. A separate working group is currently assessing these
The Group recommends that a clinic modernisation
programme be phased in over a period of six years. We recommend
that each region make its own comprehensive assessment of premises
over the next 12 months to enable fully costed proposals to be
made for a capital programme.