APPENDIX 4: VISIT TO BRIGHTON 15 MARCH
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
- Venessa Neylen, Clinical services manager, HIV/GUM
- Dr Daniel Richardson, Consultant manager
- Dr Duncan Churchill, Consultant/Deputy chief
- 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
- Catherine Hendricx, HIV/GUM patient access manager
- Jonathan Roberts, Liaison health adviser
Multidisciplinary team presentation
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.
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
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.
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.
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.
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
Stigma often concerned prosaic issuestravel,
insurance, the workplace. It persisted in minority communities;
including within the gay community, where HIV sometimes invoked
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 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 needssuch as vaccinations
and management of cardiovascular riskwere addressed. This
was not HIV management; it was primary care for those with HIV.
Such contracts had encouraged patient disclosure
to GPsSt 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 stigmaover
issues such as confidentialityremained 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
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.
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
funding point. Offer and uptake rate targets were set at 60% and
80% respectively; targets that were being met up to the end of
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
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.
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.
Health and Social Care Bill
NHS reforms proposed to split HIV funding through
two different streamswith 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 presentsperm
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.
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-specialistsparticularly
GPsneeded 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.
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
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
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.
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 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.
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
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 companiestrials
were increasingly funded by grants from the Medical Research Council,
the Department of Health or the National Institute for Health
Researchthey 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
unitsthis 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.
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
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
The Committee met with a number of staff representatives
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 Brightonthe
drug budget ran to £10mthe 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
reformswith prevention and testing, and treatment and care,
being commissioned through different routesposed a possible
threat to this now-mature configuration.
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 serviceswhich
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.
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
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
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
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
serviceboosting adherence levels, promoting disclosure
and managing risk behaviourscomprised one part of HIV prevention
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.
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
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
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
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
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: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091443 Back
Commissioning for Quality and Innovation payment framework: see