No vaccine, no cure: HIV and AIDS in the United Kingdom - Select Committee on HIV and AIDs in the United Kingdom Contents


The Committee visited the Royal Sussex County Hospital, the Sussex Beacon and St Peter's Medical Practice in Brighton.

Lord Fowler, Lord Gardiner of Kimble, Baroness Gould of Potternewton, Baroness Healy of Primrose Hill, Baroness Masham of Ilton, Lord Rea and Professor Anne Johnson (Specialist Adviser) were in attendance.

Royal Sussex County Hospital

The Committee visited the Royal Sussex County Hospital, part of the Brighton and Sussex University Hospitals Trust. The visit began with a presentation on services in Brighton by staff at the hospital. The Committee was then given a tour of facilities at the Royal Sussex County Hospital. Finally, the Committee was addressed by Duncan Selbie, Chief Executive of the Brighton and Sussex University Hospital Trust.

The Committee would like to thank the following personnel from the hospital for their work in arranging activities on the day, and for their time in providing information to the Committee:

  • Dr Martin Fisher, Consultant/Research director
  • Venessa Neylen, Clinical services manager, HIV/GUM service
  • Dr Daniel Richardson, Consultant manager
  • Dr Duncan Churchill, Consultant/Deputy chief of safety
  • Dr Yvonne Gilleece, Consultant
  • Dr Suneeta Soni, Consultant
  • Dr Gillian Dean, Consultant
  • Dr Debbie Williams, Consultant
  • Dr Laura Waters, Locum consultant
  • Gary Seaton, HIV clinical nurse specialist
  • Heather Leake-Date, Consultant pharmacist
  • Leigh Harvey, HIV/GUM matron
  • Alan Phillips, Senior sexual health nurse
  • Tracy Buckingham, Senior HIV outpatient nurse
  • Guido Tapia, Senior HIV inpatient nurse
  • Andy Parkhouse, Senior health adviser
  • Emma Collins, Sexual health practice development nurse
  • Catherine Hendricx, HIV/GUM patient access manager
  • Jonathan Roberts, Liaison health adviser

Multidisciplinary team presentation

Patient profile


Diagnosed HIV prevalence in Brighton was the eighth highest for any Primary Care Trust in the country, with 7.57 people per 1000 of population diagnosed with HIV.

Infection route

Approximately 80% of patients were infected with HIV through sex between men, and 17.5% through heterosexual sex. There was a disparity in levels of late diagnosis between heterosexual and homosexual cases: men who had sex with men were diagnosed late in 30% of cases; 60% of heterosexual patients were diagnosed late.

10% of the population in Brighton were men who have sex with men (MSM). One study estimated that HIV prevalence (including both those diagnosed and undiagnosed) amongst MSM was as high as 13.7%. Another study found that around 40% of men attending gay venues was infected with HIV, with one-third of those undiagnosed. Data from a third study indicated that around 50% of MSM reported unprotected sex in the previous twelve months, a figure which was higher amongst HIV-positive MSM.


Around 85% of patients were white; 11% were black African, with small numbers of patients from other ethnic groups.


Approximately one-third of patients were over 50, and around 15% of new diagnoses were of people aged over 50.

Patient pathway

Most patients were diagnosed in GUM services, during treatment for opportunistic infections or during routine testing.

After diagnosis, the multidisciplinary team met to discuss new patients. Subsequently, there were weekly meetings, where patient plans were drawn up and early progress monitored. This approach was designed to ensure consistent patient management.

Subsequently, there was a fixed programme with set treatment intervals; intervals could be extended depending on patient stability. This was facilitated by the CONNECT service, which allowed for results to be emailed, reducing time spent in hospital where appropriate.

Patient issues


The problems experienced by patients in dealing with their infection were manifold. Psychosocial issues, problems with adherence and sexual health and difficulties in primary care settings were all common. Monitoring, observation and collaboration with GPs were important in long-term patient management.

HIV-related dementia was an emerging issue as the cohort aged. Antiretrovirals were very effective at preventing dementia, but it remained of concern. The Sussex Beacon was considering dementia as part of its strategy for the future.

Treatment burden

The daily routine and burdens of treatment were lifelong, a fact which could lead to psychological problems; depression and anxiety were possible side-effects of treatment, a notion which it was important to investigate.

Treatment side-effects ranged from gastrointestinal and kidney problems to increased cholesterol levels; such problems could be monitored and addressed, but affected the tolerability of treatment. Sometimes symptoms were attributed to antiretrovirals by patients.


Stigma often concerned prosaic issues—travel, insurance, the workplace. It persisted in minority communities; including within the gay community, where HIV sometimes invoked negative perceptions.


Modelling had shown that co-infections, such as syphilis, were linked with increases in infectivity levels of as much as 10 times. The Brighton Community HIV team had given intense focus to syphilis testing and partner notification, but 150 cases a year were still observed.

Another virus, Lymphogranuloma Venereum, was observed in MSM in 2005, but after intense testing and surveillance, in collaboration with the Health Protection Agency, case numbers had decreased to between 2 and 10 cases per year.

Hepatitis C cases were also a problem within the Brighton cohort, predominantly amongst MSM: there were 10-15 cases a year among HIV-positive patients.

Primary care

Primary care was an important element of HIV management. The default position was to keep GPs informed on patient progress where there was consent; particularly so if conditions changed, to avoid drug conflicts. For those who did not want GP involvement, engagement was encouraged but could not be mandated.

To ensure greater GP involvement, a local enhanced GP network had been established (see paras 90-91). This involved training and accreditation of participating practices by the Primary Care Trust (PCT). Payments were then made for each HIV patient in the practice whose primary care needs—such as vaccinations and management of cardiovascular risk—were addressed. This was not HIV management; it was primary care for those with HIV.

Such contracts had encouraged patient disclosure to GPs—St Peter's, for example, had 120 HIV-positive patients. The annual training course was being sent out to other areas as an example of good practice.



A study had looked at previous cases of those with HIV diagnosed following opportunistic infections: it showed that in 60% of cases, there were opportunities to test earlier that were missed; and for primary HIV infection, opportunities were missed in 50% of cases. The statistics highlighted the importance of promoting testing.


The team were asked about the main barriers to HIV testing. There were three main barriers: people living with HIV themselves; the healthcare environment; and wider societal aspects.

One major barrier was the fact that it was not normalised for the demographics most at risk to test frequently. This was being addressed: in previous studies, only 50% of MSM had ever been HIV tested; now, data in London indicated that around 50% of MSM had been tested within the last 12 months. The team had worked hard to improve the frequency of sexual health screens for HIV-positive patients. Amongst MSM, those screening yearly had increased markedly: offer and acceptance rates rose from 40% to offer rates approaching 100%, and acceptance rates of nearly 70%. This was possibly reflective of a culture shift, but stigma—over issues such as confidentiality—remained a major problem.

Another important barrier related to the reticence of healthcare professionals. There were a number of refrains common to hospital doctors, GPs and practice nurses: that there was insufficient time; that they were insufficiently trained; or that testing was unrelated to their role. The challenge therefore was in boosting offer rates; acceptance rates tended to be high. Research suggested that professionals were more likely to offer tests to younger people, despite the ageing cohort; and younger professionals were more likely to offer tests.


There was a false perception that gaining informed consent was a "lengthy process"; in fact, the average consent consultation lasted less than a minute, and was often significantly quicker. Antenatal testing had shown that obtaining consent was not a time barrier; education and training overcame initial hesitation by midwives, and acceptance rates were now very high.

The Committee queried whether consent was necessary for HIV testing. The Brighton team noted that GMC guidelines required clinicians to inform patients before testing, and to offer the right to refuse. These requirements were, however, the same for all HIV testing, including during antenatal screening; success there had shown that the requirements were was not necessarily a barrier to testing.

Testing research

In 2009 Brighton and Hove were awarded two Department of Health grants for testing pilots. One involved encouraging GPs to offer HIV tests to all new registrants: there were 800 tests offered in 6 months, with uptake rates ranging from 36% to 75%. The other was focused on acute admissions to the Royal Sussex hospital: the offer rate was around 40%, with a very high uptake rate of 91%.

These results led to the adoption of acute admissions testing as a CQUIN[543] funding point. Offer and uptake rate targets were set at 60% and 80% respectively; targets that were being met up to the end of February 2011.

Home testing

Home testing was currently illegal, but people were ordering tests online regardless. A study into home sampling had shown an acceptance rate above 70%, but home testing was very different. The problem was that referral pathways were not pronounced, an area of concern.



Nationally, between 90 and 92% of patients had undetectable viral loads; at Brighton, this was above 96%. This success related to high adherence rates, ensured through the work of the multidisciplinary adherence team. Treatment failure was rare; where it did occur, there were management plans in place to address issues of adherence, toxicity or tolerability.


Prescription of drugs remained with specialists. Research had shown that this was a sound distinction: GPs felt that they lacked the necessary skill; patients did not have sufficient confidence in antiretroviral prescription by non-specialists. Regardless of NHS reform, this was unlikely to change. There were clear benefits to the approach: clinicians found it useful to have peer support when devising a regime, and it was helpful to have a multidisciplinary team in place to monitor progress.


The centre had developed a number of innovations in the delivery of treatment. There was a home delivery service for antiretroviral drugs; used by 79% of patients on antiretroviral drugs, it saved around £60,000 per month in VAT payments.

The CONNECT service emailed blood results to consenting patients, reducing the number of visits required by stable patients. 350 patients received results using the service, with their confidentiality protected. This meant only one visit to hospital in a year for a stable patient, which freed up resources to attend to more complex patients.

Treatment and prevention

The question of treating all those infected, regardless of CD4 count, was raised. It was a model that had been adopted in San Francisco, but its adoption would require a "mind shift", as treatment would for the first time be geared towards the benefit of public, rather than individual, health; and ensuring adherence in such circumstances could prove to be difficult. Regardless, it was necessary to gather data in randomised trials before there could be any progress.

This approach perhaps missed the point; the bigger problem was reducing the fraction of those with HIV who were undiagnosed. This required more intensive testing strategies, and efforts to reduce onward transmission.


Patients were most infectious in the first few months following infection, and evidence suggested that undiagnosed or very recently diagnosed HIV-positive individuals transmitted HIV more than any other groups. Education, health promotion and earlier diagnoses were thus important for the benefit of both public and individual health.

Prevention messages were important; but there was a balance to strike between showing that treatment was a burden and encouraging people to get tested, as highlighting the benefits of treatment was a powerful message in engaging chaotic patients.

Migrant charging

For migrants not eligible for free NHS care, only HIV tests and pre-test counselling were available without charge. This was not as pronounced an issue in Brighton owing to the low numbers of ethnic minority patients, but it was a possible issue on the peripheries of the catchment area.

Charging regulations put doctors in a difficult position: treating HIV was in the public interest, and their core role did not involve law enforcement. Furthermore, patient circumstances meant it was often difficult to assess eligibility; and if mistakes were made, subsequent engagement of patients would be difficult.


The Brighton and Sussex University Hospitals Trust were not involved in prison sexual health services. When they were, it was often difficult for patients to access services, but information suggested that this was no longer the case. However, sexual health screening was still not as systematic as in some parts of the United States; such screening was a desirable model for the United Kingdom to follow.

Desired reforms

Health and Social Care Bill

NHS reforms proposed to split HIV funding through two different streams—with prevention and testing devolved locally, and treatment and care commissioned at a national level. This would disaggregate services, and was a risky move; the success of services in Brighton was related to the holistic approach that had been developed.

Funding was sometimes an ad hoc process at present—sperm washing, for example, was viewed as a fertility treatment rather than a prevention mechanism, with concomitant funding difficulties. It was important to ensure such services were still funded in any new regime; it was not enough to fund only mainline HIV services.

Service networks

The Royal Sussex covered a wide geographic area as a tertiary service. Best practice would feature a referral pathway which ensured that the Royal Sussex provided services for the most complex patients, whilst supporting other local hospitals to manage their services. 'Financial teeth' were required to establish this network as a commissioning model; there was presently no financial incentive to embrace it.


Standards outlined in guidelines by professional associations needed to be enforced: problems relating to HIV should be seen to in specialist units, with other care dealt with elsewhere. This was often not the case.


Collaborative work between specialists and non-specialists—particularly GPs—needed proper financial reward. This would not only improve patient care, but would engender trust between patients and those outside of the specialist setting.

Post-exposure prophylaxis (PEP) was becoming increasingly common, with 25-30 prescriptions per month; the lack of a formal commissioning structure for its prescription needed to be addressed. Though payment by results was being established for HIV, it was not clear who was responsible for commissioning PEP, and there was a risk that it could fall through the gaps.

Department tour

Outpatient services


Genitourinary medicine (GUM) and HIV services were co-located. There were 27,000 patients per year in GUM services, of whom 1,700 were HIV and AIDS service users. A hospital redevelopment, due to begin in 2012, would similarly co-locate outpatient and inpatient services.

Staff were multidisciplinary across both GUM and HIV services; this enabled flexibility according to service need, and a smoother patient journey to HIV services after a positive test result.

GUM services

The GUM clinic operated a mixture of appointment and walk-in services, including an under-20s walk-in clinic and appointment-only evening clinics. The clinic also operated a range of specialised services, such as a recognition system for commercial sex workers, advice services for HIV-positive and negative men who have sex with men and a clinic where chronic complaints could be seen by a consultant.

HIV services

The HIV unit offered a range of services, including annual general and sexual health screenings. An emergency HIV clinic, for urgent HIV-related concerns, was offered each day. This service could integrate, and facilitate appointments with, GP services where appropriate.

Upon being diagnosed, patients were seen in a new patient clinic, with routine follow-ups every 3 to 4 months. Staff from a range of specialisms, including research, pharmacy and nursing conferred to devise tailored treatment programmes; a level of integration not seen in a number of similar facilities. This enabled an integrated approach to care whilst also supporting the research functions of the hospital.

Inpatient services

Inpatient HIV care was provided in a six-bed unit within the main hospital building. Existing facilities were limited; the lack of negative-pressure facilities, for example, meant that TB co-infected patients had to be accommodated elsewhere. This would be addressed under the proposed redevelopment

The ward was covered by three regular members of staff, with consultant-led ward rounds two to three times each week. One of these rounds was attended by the full clinical team, including community specialists, representatives of the Sussex Beacon, the mental health team, a dietician and pharmacists; the aim was, to offer an integrated service.

Patient representatives

Patients were complimentary about the level of care received from staff on the HIV inpatient unit. However, they reported issues around service access in accident and emergency and primary care. One patient who had been admitted to the unit a number of times over the previous six months complained of having "hit a brick wall" in accident and emergency, with staff taking insufficient account of specialist input from the Lawson outpatient unit.

Elton John Centre


The Committee received a tour of the Elton John Centre, which combined the hospital's research department with day care and psychological care facilities. It was one of between eight and ten designated research departments in the country which were located within large HIV centres. There were 35 active projects, which featured extensive collaboration both nationally and internationally, with research support drawn from the medical school.

The centre operated as a 'mini-outpatient department'; a unique model where clinical services were integrated into the trial. To recruit trialists, research nurses attended multidisciplinary care meetings to identify suitable candidates for clinical trials, before obtaining their informed consent for participation.


The Centre was not NHS-funded. Though decreasing numbers of trials were backed by pharmaceutical companies—trials were increasingly funded by grants from the Medical Research Council, the Department of Health or the National Institute for Health Research—they were still involved in research at the centre. This was not necessarily a negative point; Gilead and Bristol Myers-Squibb had supported testing initiatives without seeking to take ownership of data.

National Institute for Health Research

The establishment of the National Institute for Health Research (NIHR) in 2008 had benefited research in a number of ways. It had established comprehensive research networks, which meant that larger centres could be funded to support smaller research units—this had improved equality of access to clinical trials. Its establishment had also been crucial in engaging clinicians in clinical trials. Furthermore, its establishment had enabled funding for more 'clinically relevant' trials: for example, the centre was bidding for a £1.5m grant to study HIV and ageing in a national project.

Research implementation

Impetus from the Department of Health (DH) in translating and implementing research was important. Following research which demonstrated its efficacy, primary care testing was now a CQUIN[544] target in Brighton; implementing this nationally required DH support. On a similar note, it was hoped that the Time to Test recommendations would be properly implemented.

Patient and staff views

Staff representatives

The Committee met with a number of staff representatives over lunch.

Pharmacy services

The role of HIV pharmacy services was highlighted. Brighton was the first location to establish a pharmacist-led antiretroviral clinic in 1996; and the hospital's six HIV-specialist pharmacists played an important role managing adherence and drug interactions. Home delivery of medicines had been pioneered in Brighton and about 40% of those on antiretrovirals were now receiving their medicines in this way.


Due to the scale of provision in Brighton—the drug budget ran to £10m—the pharmacy had been able to negotiate antiretroviral contract prices similar to those of the London HIV Consortium.


Some staff voiced concerns about reforms to the NHS proposed in the Health and Social Care Bill. There had been a level of integration of HIV services in Brighton over the past 20 years which had positive results for patient care, adherence and research. Fragmentation of HIV commissioning under the proposed reforms—with prevention and testing, and treatment and care, being commissioned through different routes—posed a possible threat to this now-mature configuration.

Patient representatives

The Committee spoke to service users, who were positive about their experiences of HIV services at the hospital. The CONNECT service had been a sound development, reducing the number of appointments required when there were no complications.

Experiences in other services, notably primary care, were more variable. One patient was refused permission to register at a dentist; the same patient, based just outside of Brighton, had to actively alert their GP to their HIV status during consultations. It was speculated that these experiences were less frequently encountered within Brighton, where development of locally enhanced GP services had improved the levels of HIV training and expertise amongst GPs (see paras 90-91).

Duncan Selbie, Chief Executive, Brighton and Sussex University Hospitals Trust

Concluding the visit, Mr Selbie gave an outline of the future challenges and opportunities for HIV services—which were the "jewel in the crown" of the Trust. A proposed redevelopment of the hospital, for which £420m was set aside by the Secretary of State, would feature a bespoke clinical infections unit, and would allow the team to raise standards of care.

However, there were persisting challenges: for one, there needed to be better working with GPs; and inside the hospital, levels of routine HIV testing during hospital admissions needed to increase to meet CQUIN testing targets.

The next development aim was to better-integrate HIV care, and to work better with surrounding hospitals. The development of clinical networks would allow clinicians to tackle infections earlier and more effectively.

Sussex Beacon

The Committee visited Sussex Beacon, a HIV-specialist residential centre. There, the Committee heard presentations by staff at the Sussex Beacon, and then by Anna Bamford from the Community HIV Specialist Team within the Sussex Community NHS Trust. The Committee was then taken on a tour of the building by Andrew Powell, clinical manager at the Beacon, and spoke with Kat Williams, its Chief Executive.

Sussex Beacon presentation


The Beacon opened in 1992, following the fundraising efforts of the local community. It was one of only two HIV-specialist residential centres in the UK; it provided residential and health management services, along with a service for women and families.


The Community HIV Team, the Sussex Beacon and the Royal Sussex General Hospital worked as a group of three, and integration had increased over time: a recent example was the introduction of medical workers onto the Sussex Beacon Board. The idea of a Sussex-wide HIV service network could alter funding arrangements; it was important to develop pathways that were sufficiently resilient to withstand any change.


Current turnover was £1.9m. 50% of this came from Primary Care Trust and statutory sources; the other 50% from fundraising and lottery funding.

The proportion of non-statutory funding had increased over recent years, a trend which was especially important in the fiscal climate. The Women and Families Service had received a £478,000 grant from Big Lottery over 5 years, and the Monument Grant had awarded funding for health management services.

Overall, the funding environment was unclear. The PCT grant to the Beacon, as an example, was frozen for two years despite increasing costs. Fundraising would be vital to the maintenance of services, but it was also important to rationalise provision where possible.


Residential care

Step-down care was provided for those recovering from serious illness. Staff were involved in adherence and side-effect management, as well as end-of-life care in a small number of cases. These services were a cheaper alternative to acute inpatient stays where appropriate.

Health management services

Health management services sought to "fill key gaps", such as through anxiety management and sleep support.

Women and families service

The Beacon provided a monthly women and families service, with capacity for casework, to a cohort of more than 50: a significant proportion of women affected by HIV in Brighton. There was also a Women's Forum Group, which liaised with community and local HIV services. These services provided peer support and counselling, and addressed stigma.


The potential effects of structural reform to the NHS upon HIV services were uncertain. However, there were aspects of current arrangements that suggested support would continue: HIV was recognised as a local priority, and a link nurse had established connections with primary and community care providers. This was bolstered by the knowledge that the Beacon provided additional value through its responsiveness and ability to draw on additional fundraising streams.

Community HIV team presentation


The Community HIV Specialist Team was part of the Sussex Community NHS Trust. In operation since 2002, the team brought together healthcare, social care and mental health into one service. The team included HIV nurses, mental health workers, psychiatrists, social workers and health promotion practitioners.


The core business of the service had a number of facets. One element was continuity of care for those newly diagnosed or recently discharged from hospital. Another was around social care interventions, with personalised budgets for service users. Health promotion was an emerging area of prominence where the team was keen to do more work. All together, the facets of the service—boosting adherence levels, promoting disclosure and managing risk behaviours—comprised one part of HIV prevention within Brighton.

Care model

Everything began with an initial assessment and the development of a care plan in agreement with the patient. This outlined intervention levels and the care pathway. Subsequently, partnership working was fundamental. A community multidisciplinary meeting allowed clear remits to be set among community providers, partners at the Royal Sussex General Hospital and in generic services; and the patient was proactively engaged through case conferences throughout the process. As HIV shifted from an acute to a chronic illness, this approach allowed greater self-management and was potentially empowering for patients.

This partnership working was a desirable outcome: it ensured that care could be properly co-ordinated, allowing expertise to be concentrated on appropriate cases. To this end, the HIV social worker for the team was now located within Brighton City Council, to ensure one port of call for social care services. The team was not aware of a similarly integrated model anywhere else in the country.


The team was constantly learning from both service users and providers to develop the model of working. Learning was distributed at national conferences, with the aim of spreading best practice elsewhere: personalised care plans, now commonplace, were in place for HIV well before other areas.

There were, though, ongoing challenges. The isolation and stigma felt by patients remained a concern, and there were issues around patient disengagement from care.

Patient views

The Committee met a service user at the Beacon, who spoke positively of the quality of service provision, particularly the multidisciplinary care. Patients were given control of their own drug schedules; this was a positive and empowering part of care.

St Peters Medical Centre

The Committee visited St Peters Medical Centre, a six-GP practice responsible for 11,500 patients, of whom approximately 120 were HIV positive. Presentations were given by Dr Jonathan Wastie, a GP at the practice, Gavin Stedman-Bryce, a consultant, and PCT representatives.


The most effective way of encouraging GPs to engage more directly with HIV would be to ensure that funding was allocated to successful delivery of HIV-related services. This could be through the Quality and Outcomes Framework or through a Local Enhanced Service, such as the one operating in Brighton.

Local Enhanced Services


The practice was one of 26 in Brighton that held a Local Enhanced Service (LES) contract for HIV care, managed through the Primary Care Trust. The LES required staff at participating practices to attend a two-day training course provided by the Lawson Unit and local HIV specialists.

Subsequently, participating practices had to undertake an annual health-check on each of their HIV positive patients, a practice similar to that for patients with diabetes and other chronic conditions. The aim of the health check was to monitor health and identify issues which required a response or treatment within the primary care setting. This relieved pressure on secondary and GUM services by providing a broader primary care response to HIV-positive patients; this was welcomed by secondary care representatives from the Lawson Unit. Prescription responsibility remained with specialists.


The main benefit of the LES provision was that it "normalised" the issue of HIV for primary care practitioners. The provision of such services encouraged primary care to engage more directly with HIV and to provide a level of care that would be thought routine for other 'chronic' patients such as those with diabetes. The offer of a HIV test to new registrants was also a potentially important step towards such "normalisation", by engaging patients and incorporating HIV more fully into routine medical discussions.


The LES had proven important in building links between primary care practitioners and HIV specialists based within the hospital. These links began with the initial training course and were developed through ongoing patient management. Such links were beneficial in building knowledge and confidence on HIV amongst primary care; they were also important in developing an integrated patient pathway.

Time to Test pilots

The practice had taken part in a pilot testing programme (one of eight nationally) in which HIV tests were offered to all new registrants as part of an initial health check. This pilot project had run for six months from May 2010 across ten practices in Brighton.

During this time approximately there were 5,000 new registrations at the participating practices. 2,400 of those new registrants completed health checks, and all were offered a HIV test. Approximately 1,450 people (60%) had accepted the offer of a test, two of whom tested HIV-positive.

The 950 patients who declined the offer of a test were offered the opportunity to complete an explanatory questionnaire, and around half did so. Despite having refused a test, over 80% of those surveyed thought that GP testing was a good idea and 91% thought that general practice was an appropriate setting for such testing to take place.

Results from this and the other national pilots had been fed back to the Department of Health for evaluation. This evaluation would include assessments of acceptability, feasibility and cost-effectiveness. In the interim period, six of the ten participating practices in Brighton were continuing to offer HIV testing as part of their new patient health check, without payment for doing so.

543   Commissioning for Quality and Innovation payment framework: Back

544   Commissioning for Quality and Innovation payment framework: see Back

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