Chlamydia is the most common sexually transmitted infection in the UK, affecting both women and men.
Most people with this infection have no symptoms but if it is left untreated, chlamydia can cause pelvic infection leading to infertility, ectopic pregnancy and chronic pelvic pains. In men it can cause urethritis and epidydimitis. It can cause arthritis in both sexes.
The National Chlamydia Screening Programme (NCSP) for England offers a great opportunity for health promotion to those who are at risk of poor sexual health.
It is a control and prevention programme, targeted at 15- to 24-year-olds, the age group at highest risk of contracting chlamydia.
The programme was rolled out in three phases, starting in 2003 in 10 areas. Another 26 areas joined in 2004 and the roll-out across England was completed in 2007/8. The NCSP set screening uptake targets of 17 per cent for 2008/9, 25 per cent for 2009/10 and 35 per cent for 2010/11.
Role of general practice
GP practices are one of the most popular locations for receiving contraceptive care. A large number of young people attend general practice, and approximately 60 to 83 per cent of patients under 25 see their GP each year.
The NCSP pilot studies confirmed that the uptake of chlamydia testing was high in general practice with 76 per cent of females aged 15 to 24 agreeing to be screened.
The NCSP website for professionals states that any one in the practice team, including receptionists can offer a test and should at the same time give the patient appropriate written information such as the NCSP leaflet. But there must be pathways in place for the management of positive results and notification of sexual partners.
It also says that GPs can encourage screening by sending patients information about testing with a link to a website to obtain postal kits, or sending out kits directly to those on their list in the target age range.
Pathways for the management of positives including partner notification should be agreed.
Local screening programme Oldham joined the NCSP during the implementation of its third phase through the Greater Manchester RU Clear? scheme which is now the largest screening initiative in the UK.
Data collected for 2008/09 showed that Oldham screened 14 per cent of its target population, but only 6 per cent of uptake came via GP practices, as compared to the national target of 17 per cent.
To try to achieve the 25 per cent target by March 2010, NHS Oldham invited all GP practices to sign up to deliver chlamydia screening under a LES-local enhanced service contract.
The LES started on 1 October 2009 and practices first agreed a service plan with the PCT.
Only patients in the target age group 15 to 24 years who screen on the practice premises were counted towards the percentage target and attracted payments.
A sliding scale was set for fees. This ranged from £4.50 for each urine sample received in the laboratory for testing for practices screening less than 10 per cent of their target patients to a maximum £8 per test if the percentage screened was over 25 per cent.
The LES funding is continuing for 2010/11.
We organised a training session with a RU Clear? programme nurse that all staff, including the locum GP attended.
The nurse discussed how to order forms, urine pots, swabs, how to fill in forms and where to send the specimens.
Our healthcare assistant did a computer search of the target population. The total number of patients identified from our list was 435, so meeting the 25 per cent target meant screening 109 patients.
To maximise opportunities to offer screening we have a pop-up reminder in our EMIS clinical software for patients aged 15 to 24 years. Screening was integrated into normal clinical practice and every time a young person attended the surgery, a chlamydia test was offered.
Screening was also mentioned in specific consultations - for example, as part of the new patient health check, during any type of sexual health consultation and to all patients attending the family planning clinic. We had the right READ codes for chlamydia screening offered and accepted or refused in on-screen templates.
Promotional material was put in the waiting room and messages were displayed on notice boards, on the practice website and in practice leaflets.
At every practice meeting, the practice manager updated the team as to how many patients were screened, comparing our figure with the other practices in the Oldham area. Seeing the number of tests go up every month spurred on the staff to increase the uptake.
The practice achieved the 25 per cent target in March 2010 and it was the easiest target to reach that we have yet been set. It also required minimal input from me personally.
I am now NHS Oldham's chlamydia champion and my new role is to support, engage and motivate other practices to help achieve the screening target across the PCT.
I firmly believe that this is achievable if each GP and practice nurse can persuade one or two patients a week to have a test.
- Dr Sharma is a GP in Oldham