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Independents' Day

GPs told to potentially offer millions more HIV tests under new NICE guidelines

GPs in areas of extremely high HIV prevalence have been advised to consider offering tests to anyone attending a routine appointment, potentially leading to millions more tests under new NICE guidance.

The guidance also recommends GPs in areas of high prevalence offer HIV testing to all patients registering with the practice or undergoing blood tests for an unrelated reason.

NICE estimates that 3.7 million people live in areas of very high prevalence - covering 18 London boroughs, Manchester and Brighton and Hove - while a further 7.9 million live in areas of high prevalence.

GPs welcomed the new guidance, released on World Aids Day, but emphasised that GPs are under no obligation to offer this as it is not part of the GP contract.

Previous guidance specified testing men in areas with high prevalence of HIV or men registered in a practice with a large population of men who have sex with men.

However, the new guidance said that all patients should be offered the test.

It said: 'In areas of high and extremely high prevalence, also offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who: registers with the practice or; is undergoing blood tests for another reason and has not had an HIV test in the previous year.

'Additionally, in areas of extremely high prevalence, consider HIV testing opportunistically at each consultation (whether bloods are being taken for another reason or not), based on clinical judgement.'

NICE defines areas of high prevalence as local authorities where there are 2-5 diagnosed infections per 1,000 patients aged 15-59, and extremely high as 5 or more per 1,000.

This includes 18 London boroughs, including Lambeth, which has a prevalence of 14.6 per 1,000 patients aged between 15-69 - the highest in the country.

Dr Andrew Green, the prescribing lead for the GPC, said: 'I fully understand and support efforts to improve the early diagnosis of patients who have been infected with HIV. Early treatment dramatically decreases infectivity and improves survival, and a co-ordinated approach is clearly important.

'However, the challenge now is on commissioners to provide this service, because screening activities are not part of essential GMS contracts and so GPs are not required to undertake this activity personally, whatever NICE may say. Indeed, they should not do so if it would harm the care of other patients. Many of the practices with high prevalence rates will be in inner city areas who will have high list-turnovers and will already be struggling to provide effective care.'

RCGP cinical lead for HIV, sexual and reproductive health, Dr Philippa Matthews, said the college welcomed the guidelines. 

However, she added: 'As the guidelines acknowledge, there are barriers for GP surgeries to offer wide-scale HIV testing. Funding for such initiatives is currently decided by local councils, and there is no uniformity across the country. There is also the issue of effective implementation - including training and support for practices to adopt these schemes.

'Furthermore, there are sensitivities that GPs need to take into account when offering HIV tests to patients who are usually visiting the GP for reasons not connected with HIV; a conversation that is  difficult within the frustrating constraints of the standard 10-minute consultation. Despite this, many doctors and nurses in high prevalence areas are doing an incredible job at integrating HIV testing into relevant routine care.'



Readers' comments (10)

  • Is the a GP is best placed again! Sounds like it should be a public health initiative.Oh I forgot they've been cut.

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  • million more test need millions more cash.

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  • Public health role, not general practice.

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  • Perhaps the term General practice should change to prevent everyone from dumping everything that does not fit into a neat category onto it?
    Perhaps it should be rebranded without the word general in it?
    Who can come up with a good choice of words?

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  • Dumping work onto General Practice that is Public Health responsibility.

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  • And where is the money for this? NICE should be completely and utterly ignored when it advocates extra work without resources to match. This is a classic example of power without responsibility. I thought with more supposed GP steerage they had grown out of this .

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  • Great idea shall we do the pre test counselling, breaking bad news and contact tracing as well? I mean we are all twiddling our thumbs as it is. Who's up for learning all the new HIV drugs for the 'shared care' protocol that Follows? Or maybe just maybe sign post these people to their local sexual health clinic where they are already set up to do this kind of work. Fund them properly for it and fund us for all the rubbish you've already put on our plate.

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  • The sexual health clinics are run by local councils, under their Public Health responsibility. These councils, especially in traditional Labour areas, have had overall funding cut by more than 50% in some cases. Thus, this vital service has been trashed. To now put the responsibility on GPs, without funding and without the personnel, is just another madness from the mind of Jeremy Hunt.
    Why not just give the sexual health clinics the money to run a proper service, including these HIV tests for anyone who wants them?

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  • Jmd

    Great idea, unfortunately this is a public health issue, not GP.
    It is time the NICE and DH do get together and come up with viable plan of implimentation before rushing to publish their comments to the public.
    There needs to be more resources!

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  • Well why should they do any research of a plan when all it would show that GPs are not the people to dump this as yet unfunded work on?
    They have found it far easier to make an announcement about this then when GPs complain, it is the gp seen to be causing the problem!
    It is all about PR now. Hunt's hand is very much behind this as this is his modus operandi

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