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Setting up a sexual health clinic under a LES

A practice in Manchester has shown that primary care can provide high quality sexual health care and improve access to treatment.

The Bodey Medical Centre team: Dr Oliver Atkinson, practice nurse Chloe Woods, Dr Siobhan Macintyre, Dr Stephen Tomkinson and Dr Jenny Wilkins (Picture: Michele Jones)
The Bodey Medical Centre team: Dr Oliver Atkinson, practice nurse Chloe Woods, Dr Siobhan Macintyre, Dr Stephen Tomkinson and Dr Jenny Wilkins (Picture: Michele Jones)

The Bodey Medical Centre in Fallowfield, Manchester, has a large student population, which was a key reason it decided to set up its award-winning sexual health clinic.

‘We’ve always had a high demand for sexual health, family planning and young people’s health issues,’ explains GP partner Dr Siobhan Macintyre, who was the driving force behind the service.

‘I had experience in GUM and we’d always done some sexual health, but a lot of people were still being referred to GUM in secondary care, depending on the clinician they saw and if we didn’t have appointments available.’

The practice felt it could deliver more sexual health care and improve access, so it decided to set up a dedicated clinic when a sexual health local enhanced service (LES) became available in the area.

‘We were only able to do this once we knew that we could provide the LES, because we were then remunerated for the work that was actually being done,’ says Dr Macintyre.

Setting up the service

Before setting up the service Dr Macintyre reviewed the skills that already existed within the practice team.

‘We already had quite a lot of skill in terms of the clinical ability of the doctors and nurses because we’d been dealing with young people for years,’ she says.

‘But, there were criteria that we had to meet to show we were qualified to provide the LES. So we ensured that all of the clinicians involved in seeing patients were STIF (sexually transmitted infection foundation course) trained, which we did at our own expense.’

Dr Macintyre also spoke to other practices that were already providing the LES, which she says was invaluable in terms of setting up the templates, protocols and IT side of things. ‘All of that can be shared because we should all be adhering to the same standards and protocols,’ she says.

Since starting the service, the practice has had to take on extra nursing and medical staff to account for the extra work they are doing.

How the service works

In term time the practice now has a dedicated sexual health clinic on a Tuesday afternoon, which is run by a sexual health nurse. There are also emergency appointments available every day with the nurses for patients who are symptomatic – or patients can phone and book an appointment at a time that suits them with one of the nurses.

‘If patients have symptoms they go through our daily morning or afternoon emergency triage clinic like every other patient - and if they are symptomatic then they will be seen on the day,’ explains Dr Macintyre.

‘Because every doctor in the building is STIF trained then patients don’t have to see a particular doctor or nurse. What we want is really broad coverage, so sexual health is part of everyone’s work. We have made sure that it is something we can deal with in a normal working day.’

Dr Macintyre has developed close links with the local GUM service, to ensure the practice is providing care that meets local and national protocols and has access to specialist advice and support when required.

‘Doctors and specialist nurses from GUM have provided specialist training sessions on things like contact tracing, case studies and changes in treatment for ghonorrhea,’ she explains.

‘We also have regular GUM updates so we are adhering completely to national guidance and we’re doing things according to protocol as they do in GUM.’

What the service has achieved

The Bodey Medical Centre’s service has helped to improve access to advice and treatment for patients.

The clinic sees approximately 1,000 patients a year. A recent audit found that 60% of patients seen by the service were symptomatic. One in five actually needed treatment – and many of these people are now able to access that treatment immediately.

‘We get same day access for symptomatic sexual health patients, which is better than GUM locally where they can struggle to meet the 48-hour target,’ explains Dr Macintyre. ‘The feedback we get from patients is very favourable in terms of how quickly we responded to them.’

Patients also prefer to come and see doctors and nurses they are familiar with, in an environment that they know, Dr Macintyre says. She believes this helps ensure that patients attend appointments and access treatment.

‘Various studies have shown a very low percentage of people referred to GUM actually attend their appointments - so clearly there’s something about GUM that patients don’t like,’ she says.

The service is also more cost-effective than the secondary-care GUM clinic.

The clinic has been acknowledged nationally as providing an outstanding service. The practice has worked closely with the Lesbian & Gay Foundation, and was recently awarded the organisation’s highest level Gold Award, from its Pride in Practice initiative, for excellence in lesbian, gay and bisexual healthcare provision.

Future developments

There is currently some uncertainty about future funding because of the changes due to happen in April 2013. Money for sexual health will be moving with public health to the local authority, and there has been no final decision about whether it will continue to fund existing primary care services as yet.

But if this can be resolved, Dr Macintyre hopes that the service could be expanded to cover a wider population.

‘I’d like to see population coverage of the LES across Manchester. One of the things we would like to look at is developing so that one practice in a patch could provide the service so other practices locally could refer their patients in to us if they don’t want to provide this themselves.’

Dr Macintyre believes primary care has a key role to play in delivering sexual health services and hopes the local authority will acknowledge this.

‘The very important thing in this is patient choice. If patients want to come to primary care for sexual health services then they should be able to and not be forced to go to GUM.’

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