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RCGP warns of sex talk 'fiasco'

College response warns NICE proposals for GPs to counsel young people on sex would be counter-productive

Plans for GPs to counsel young people about sex would be counter-productive and deeply unpopular with doctors, the RCGP has warned.

In a strongly worded response to proposals by NICE, the college warns of a repeat of 'the fiasco' surrounding provision of drug counselling.

The consultation document, obtained by Pulse, also insists the college is 'strongly opposed' to plans for general practice to take on responsibility for contact tracing.

NICE draft guidance recommended GPs provide 15 to 20 minutes' counselling to all sexually active under-18s.

The RCGP, which is a registered stakeholder in the NICE guideline process, questioned whether counselling sessions can be effective, as 'some evidence suggests one-to-one interventions are associated with worse sexual health'.

The college warned: 'We should strongly oppose the imposition of contact tracing in general practice, where it is often inappropriate. Many practices even with financial incentives – which would be man- datory – would be less than enthusiastic to take on this work.'

The college called for pilot studies and further research 'before national implementation of recommendations'.

Dr Richard Ma, a member of the RCGP's sex, drugs and HIV task group and a GP in Islington, north London, said he would be making known to NICE his own reservations about the draft guidance .

'I disagree that people would be willing to take on partner notification. There is also conflicting evidence as to whether it changes sexual behaviour.'

Dr Gillian Vanhegan, medical spokesperson for Brook Advisory Centres, agreed that expecting all GPs to counsel young people would be unhelpful: 'There is a percentage of GPs who are very good at giving sexual health advice to young people – but those who don't want to do it shouldn't be forced to.'

Dr Ann McPherson, a GP in Oxford and chair of the RCGP's adolescent task group, said clarification was needed on the kind of counselling GPs would be asked to provide. 'GPs aren't going to solve everything, but it needs to be looked at both from providing good advice and promoting contraception but also not excluding encouraging people to say no.'

NICE plans to release final guidance in February.

RCGP reservations:

• Recommendations on identifying at-risk groups and taking full sexual histories 'need to be more explicit'

• One-to-one interventions may worsen sexual health

• Content of counselling sessions is unclear

• Provision of emergency contraception may contribute to an increase in STIs

• What training is to be given to counsellors?

• Contact tracing in general practice 'is often inappropriate'

• Pilot studies 'might be a good idea' before national implementation of guidelines

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