Practices are providing wide range of sexual health services
A study in the International Journal of STD & AIDS has compared the sexual health service provision in one PCT area with the targets from the National Strategy for Sexual Health and HIV.
Questionnaires were sent to 26 practices, seeking opinions from GPs, practice nurses and practice managers regarding level 2 service development.
There were high response rates from the three groups: 85% of GPs, 92% of practice nurses and 88% of practice managers replied.
Ninety-one per cent of GPs felt comfortable about taking sexual histories from patients, and half did so often. Seventy-seven per cent of the practices offered STI testing in symptomatic women and 91% of practice nurses provided this service.
Sixteen practices did high vaginal swabs (HVS) for Trichomonas vaginalis, 15 took endocervical swabs for chlamydia and nine took endocervical swabs for gonorrhoea.
Thirty-two per cent of practices provided syphilis and blood-borne virus screens at patients' request, but 50% did not offer any screening to high-risk patients.
Cervical cytology was offered in all practices. Thirteen practices offered pregnancy testing. Only eight practices (36%) supplied condoms.
Forty-one per cent of GPs thought that their patients wanted them to provide a specialised sexual health service, but 50% disagreed with this. A quarter of the GPs thought additional services need to be provided but 50% were satisfied with current provision.
When asked about proposed level 2 services, around 30% of GPs were prepared to treat patients not registered with their practice and more than 70% were happy for other GPs to offer STI treatment to their patients.
A fifth of GPs thought that it would be feasible to set up a small laboratory to read microscopy slides. The concerns about providing a specialised service included lack of training, space, funding and demand.
It is really encouraging that so many practices are willing to provide sexual healthcare to their patients, and that a large proportion are already doing so.
However, I am sceptical of the role of microscopy in general practice, especially since there has been debate on its value in GUM clinics.
I think that, in addition to an epidemiological needs assessment, a survey like this can help a PCT understand the current levels of interest and map out capacity in general practices to provide specialised sexual health services in their area. This is important, not only in implementing the National Strategy for Sexual Health and HIV, but also to support current GUM clinics with their access target.
In the end it is the public that will benefit from increased access to STI testing; if done well, this may even contribute to improving the sexual health of a population.
Cohen CE, Dawson SG, Theobald NJ et al. Primary care and the National Strategy for Sexual Health and HIV: an evaluation of one primary care trust Int J STD AIDS 2006;17:189-192Reviewer
Dr Richard Ma
GP principal, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre, London