The National Strategy for Sexual Health and HIV: a General Practitioner’s perspective
The National Strategy for Sexual Health and HIV: a General Practitioner’s perspective |
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Key words: strategy, sexual health, and general practice.
Introduction
The rise and rise of sexually
transmitted infections has in recent years brought this issue into the forefront
and into the political agenda. As often the case, the politicians and the
Department of Health have indicated the major roles to be played by general
practitioners. Before everything fits into place, there are still major points
to be considered. Under the
new General Medical Services (GMS) contract, Sexual Health is a national
enhanced service, which general practitioners (GPs) provide, as in the National
Strategy for Sexual Health and HIV (1). Sexual health services are
now split in primary care between Contraception
under Essential Services and other
sexual health services as Enhanced
Services.
I work as a General Practitioner at the Woodbridge Practice in Thornaby where there are seven partners- five male doctors and two female doctors. I have a special interest in sexual health and I do some sessions at the local Genito-Urinary medicine clinic (James Cook University Hospital, Middlesbrough) as a Hospital Practitioner. There should be willingness and funds to do so properly, however, the general feeling is that the PCT don't see it as a priority and are reluctant to commission the service. The general feeling among my colleagues is that the government has failed to grapple with some of the issues in the National Health Strategy in the context of the new GP contract. Some of the factors for consideration include skills, training and funding.
Factors for consideration
Staffing
In view of the variety of services we provide at The Woodbridge Practice, staffing is always an issue. We have six nurses, some work part-time and some work full-time. Each nurse has an area of special interest e.g. diabetes, asthma, and chronic obstructive airways diseases (COPD). In order to provide some services at level 2 or 3, it may be necessary to identify and train or even employ a nurse with a special interest in sexual health.
Funding
This is a major issue. The money allocated for enhanced Sexual Health Services is not enough. It includes a retainer fee of £2,000 plus an annual payment of £200 per HIV positive and £100 per other patients. As far as I am aware, in our region there is no consideration of local enhancement. This to me is obvious underfunding for training of nursing staff and doctors, and also for equipments like microscopes, condoms, pregnancy kits, printing leaflets etc.
Records and confidentiality
There is always the issue of case notes documentation and patient confidentiality (2). In our practice like in many GP practices all over the country, a lot of the staff live locally and will know patients or their partners. This may prevent some patients from disclosing sensitive details to familiar people for fear of disclosure to their partners or parents. Overcoming this barrier is an important way forward.
Necessities for successful implementation
In my opinion, a link between all the GP practices with the local Genito-Urinary Medicine Clinic for support, contact tracing, treatment and advice would be very valuable (3). It is essential to keep skills and training updated for all involved. It is equally important for appropriate remuneration to employ the right staff and for equipment and management training.
Conclusion
In spite of being a GP and a Hospital Practitioner in a Sexual Health Clinic, I do not think that under the present circumstances, I can provide the required services at the recommended levels. This is in spite of being in the right position to do so. The Department of Health and the Primary Care Trusts need to do more to encourage general practitioners to join hands in stemming the tide of poor sexual health statistics.
References
©2004 Sexual Health Matters. Published Quarterly by Express
Print Works, Middlesbrough, UK
ISSN 1469-7556
http://www.sexualhealthmatters.com