• sexually transmitted infections
• United Kingdom

Genitourinary medicine (GUM) services are consistently overstretched.^1,2 At St Thomas’ Hospital, and at our neighbour Kings College Hospital, the GUM service runs as an open access clinic (seeing the majority of patients without an appointment). The time to be seen in these clinics is frequently more than 3 hours and 4.5 hours, respectively.³ This is in the context of a local and national increase in all sexually transmitted infections (STIs),⁴ exacerbated by the combination of very little increase in resource and a government imperative in the form of the National Sexual Health Strategy.⁵ There is demonstrably an unmet need for sexual health services in our local community. The workload at Guy’s and St Thomas’ has increased by 10.1% between 2000 and 2002 despite an alteration in the ratio of new to follow up patient visits from 1.06 to 1.51. How can matters be improved? At the most basic level, there are four possible options:

• Make each consultation shorter

• Reduce the number of visits per patient

• Delegate the work to other providers, or

• Reduce the overall level of STIs and hence demand.

Leaving aside the last suggestion, how can we change practice to meet the other options?

There is a surprisingly poor evidence base for much of what we have traditionally done in our clinics. We decided, as an “old hand in the business” (senior consultant) and a “new pair of eyes” (first year specialist registrar), to look critically at all aspects of the GUM clinic service and arrive at what we hope may be useful or, at the very least, thought provoking suggestions. We are writing this from our own viewpoint of working in a London teaching hospital with a heavy workload, very high prevalence of STIs, and pressure from the HIV service. Our aim …