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How to set up an efficient chlamydia screening service

This guide by Dr Sebastian Kalwij will help your practice to implement chlamydia screening, which can provide a steady extra income stream

This guide by Dr Sebastian Kalwij will help your practice to implement chlamydia screening, which can provide a steady extra income stream

1 Contact your local chlamydia screening office

Each PCT has a chlamydia screening office (CSO) and contact details can be found on the National Chlamydia Screening Programme website (www.chlamydiascreening.nhs.uk). The CSO will make sure your practice gets allocated a code to be used to get information about how many people you have screened, on which your LES incentive payments at the end of the year will depend.

Invite the CSO co-ordinator to your practice. They will discuss logistics such as ordering forms and consumables (urine pots and swabs) and can also set up training with all practice staff.

2 Know the screening targets

This year, the national chlamydia target from the Department of Health is to screen 25% of patients aged 16 to 25 registered at your practice who are sexually active. Some top screening practices offer screening to all patients using contraceptives. This normalises screening and, by making it part of a pill-check routine, most patients find it acceptable. Embedding screening into your practice routine is the best way to make sure it will be offered on a regular basis. If targets are bite-sized they also seem less daunting.

3 Do the sums and make sure they add up

Say your practice has 6,000 patients and 1,600 of those are between aged 16 to 25. To meet the 25% target you will need to screen 400 patients. You must work out how much you will earn and whether this will pay for the staff costs and give you extra income.

As you will earn £5-10 per patient, if you are screening 400 patients you will earn a total of £2,000-4,000. Screening 400 patients will take about 33 extra hours of work a year (at five minutes each) at a rate of about two patients a week, so it is likely to be cost-effective only if a nurse or healthcare assistant carries out the work.

Consumables are free of charge so you should not have any other costs.

4 Allocate a chlamydia screening lead

The lead will maintain regular contact with the CSO and feed back to the practice during meetings.

5 Incorporate screening into consultations

Opportunistic screening has the advantage of using an existing consultation to offer screening. This means patients do not have to be specially invited to the practice – mailouts can be expensive – and there is no need to organise after-school clinics, which may be poorly attended. It is important to encourage patients to screen themselves by using a self-vaginal swab or urine test. There is no need for using a speculum or a full genital examination.

6 Involve practice nurses and healthcare assistants

Practice nurses are ideally placed to offer screening but it does take up extra time – five minutes is realistic. In many practices healthcare assistants do most of the regular health checks and new patient checks. This is a good time to offer screening as patients have provided a urine specimen already.

7 Involve receptionists

Receptionists can hand out information leaflets, forms and urine pots. Not all reception areas are suitable for handing out these items without other patients seeing, but a small screen can create more privacy.

8 And involve patients

The programme has been designed for young people to do themselves. The practice should send reminders when patients' tests are due, but then the screening kits could be picked up and left at reception.

9 Delegate dealing with positive results

You can expect 6-10% of screens to come back positive. Practice staff can assist in making sure they are dealt with promptly. In many PCTs the CSO will take on partner notification and this will save a lot of time.

10 Keep your staff motivated

Initial enthusiasm may wane. Successful practices have offered incentives to receptionists and those members of the team who screened the most patients.

Dr Sebastian Kalwij is a GP lead for the National Chalmydia Screening Programme and a GP in New Cross, London

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