Just over ten years since the National Strategy for Sexual Health and HIV was published, it seems that the ‘golden period’ of improved sexual health outcomes is coming to an abrupt end thanks to the Health and Social Care Bill. We have already seen examples of services being reconfigured, cut back or withdrawn. There will be few winners in the new era of sexual health commissioning but the main losers will the patients.
General practice has played a valuable role in control of STIs so far. Many primary care teams already offer chlamydia screening and test for other STIs including HIV. Some areas have been delivering these services as part of enhanced services successfully for many years.
However, a report on Sexually Transmitted Infections (STIs) and Chlamydia Screening in England in 2013 was recently published by Public Health England (PHE), with two groups of patients facing a disproportionate rise in STIs: heterosexuals under the age of 25 and men who have sex with men (MSM).1
There were 450,000 diagnoses of STIs made in England in 2013, almost half of which for chlamydia (208,755 diagnoses, with most affecting patients aged 15 -24).
There was also a large increase in gonorrhoea which went up by 15% overall (or 26%, in the case of MSM).
And sexual health services in general practice continue to be a ‘postcode lottery’ across the country, with variations in STI testing and diagnoses rates even within the same CCG areas.
Unfortunately, general practice may deter some individuals from consulting about their sexual health. For example a perceived lack of confidentiality prevents many individuals from seeking HIV and STI testing. A survey from Stonewall (a lesbian, gay and bisexual charity) also suggests that many people find it difficult to divulge their sexuality to their primary care teams for fear of being judged.2
We have seen sexual health services provided by GPs improve in capacity and quality over the decade due to better awareness, training and incentive structures such as enhanced services but this is currently under threat. We have been under enormous pressure: dwindling resources and increasing demands on appointments due to long term conditions management mean that sexual healthcare suffers.
To compound this problem, we now have a situation where there is no certainty that local authorities will commission sexual and reproductive health services from their local GPs or established sexual health service providers.
There are also plans to make current sexual health providers ’leaner and more specialised’, which means patients may be directed back to their GPs (who, as already discussed, and under pressure for appointments and other priorities). Patients will struggle to get appointments, and with falling attendance for sexual health problems GPs risk losing skills through lack of practice. Until politicians recognise the vital role of the GP in improving rates of STIs in the UK, awe need to encourage peers to deliver more sexual healthcare, and some might need to develop their confidence when, for example, taking a sexual history , recognising symptoms or signs of STIs, and treating sexual health problems or even explaining treatment.
There are many great training courses out there available through the RCGP, the British Association for Sexual Health and HIV (BASHH), and the Faculty of Sexual and Reproductive Healthcare (FSRH).
BASHH and RCGP have also produced a helpful booklet (available for free online) , Sexually Transmitted Infections in Primary Care, and the Medical Foundation for AIDS and Sexual Health (MEDFASH) offers an HIV in Primary Care booklet (which can also be downloaded from the web).4
The RCGP is campaigning to ‘Put Patients First’ and back general practice. The uncertainties regarding sexual health commissioning and competing priorities in general practice will soon see sexual health spun back out of the agenda with worsening sexual health statistics, undoing a decade’s worth of work.
Sexual health is such a stigmatised issue, if we are really going to ’put patients first’, we should be advocates for good sexual health for our patients. We will be doing our patients a disservice if we do not consider sexual health to be a clinical priority in the near future.
1 Public Health England. Sexually transmitted infections and chlamydia screening in England 2013. 20 June 2014. https://www.gov.uk/government/news/sexually-transmitted-infection-risk-in-england-is-greatest-in-gay-men-and-young-adults
2 Stonewall. Gay and Bisexual Men’s Health Survey. 2012. www.stonewall.org.uk/gaymenshealt
3 RCGP & BASHH. Sexually Transmitted Infections in Primary Care. 2013. http://www.bashh.org/
4 MEDFASH. HIV in Primary Care. 2011. http://www.medfash.org.uk/publications