What GPs need for their new sexual health role
I refer to your news report concerning the new sexual health role for GPs (February 3). I feel there are a number of issues in providing sexual health services that need to be considered.
As GPs we are often the first person a patient will turn to when faced with a potentially embarrassing problem such as an STI, so we are well placed to deliver such services. There is still some stigma attached in attending GUM clinics and I have had several patients who, although recommended to attend for a
check-up, have not done so.
There is also the issue of access. Our local clinic is a significant distance from the practice which would mean some patients may not be able to travel there. As a result of this, there are a number of people who have undetected and untreated STIs which can lead to long-term health consequences. Primary care would be an effective way of plugging this gap and finding a non-threatening, non-stigmatising environment to carry out sexual health services.
Although there are added costs in undertaking such screening, there are also the costs of repeated prescribing for treated individuals (usually women) reinfected by their untreated partner and further costs through the consequences of infection such as infertility treatment.
Looking at some of the services we should be offering from April, I believe many doctors are already doing this. The services that may cause most difficulty are those such as chlamydial screening in men, HIV counselling and testing, sexual history taking and risk assessment and hepatitis B immunisation.
Although all worthy they all have significant training, financial and workload implications. I personally would feel I need extra training to counsel for HIV testing and, although I take a potted sexual history, I don't think a 10-minute consultation would be enough time to devote to a full sexual history.
This, in an ideal world, is a service we should be offering and which patients would certainly appreciate. But in order actually to carry out these services there are real areas of deficit in funding, workload and training which would need to be addressed.
Dr Elizabeth England
Honorary clinical research associate
Department of primary care and general practice
University of Birmingham