Background National Institute of Health and Clinical Excellence (NICE) Public Health guidance on the prevention of sexually transmitted infections and under 18s conception was produced in 2007 for implementation in sexual health services in England. We undertook to find out what impact these had on Genito-urinary Medicine (GUM) service providers across UK.
Methods In December 2009 lead consultants of UK GUM clinics were identified using the British Association for Sexual Health and HIV website and sent a postal survey as part of a larger study. Responses were analysed using a SPSS database.
Results Of 222 clinics, 152 responses were from UK clinics overall of which 136 were from England. 115 of 148 (78%) from UK clinics answered that they had read the guidelines, 80% (106/132) for England only. For England 39% (54/133) of respondents were aware of a local lead to implement the guidance of which 9 (16.7%) named the Director of Public Health, 17 (31.5%) GUM physician with a variety of other healthcare professionals for the remainder. Only 30% had compared current service activity to NICE recommendations and 20% (26/132) were aware of an action plan being developed by local strategic partners to implement the guidance; 8% (10/128) had developed a business plan. Only three clinics had formally audited their clinic practice against the guidelines. In total, only 18 of 131 (13.7%) had implemented the recommendations but 56 (42.6%) had partially or were doing so. The barriers to implementation were cost pressure, cost of staff skills training, lack of time and capacity to implement, lack of leadership.
Conclusion NICE takes an evidence-based approach to guidance development but has no mechanism to review implementation. There are no routine outcome measures to judge the effectiveness of this NICE guidance. The process measures above have demonstrated variable implementation in GUM services in England. With present resources, as one example providing 15–20 min of one-to-one structured discussions based on behavioural change theories is not deliverable. Service commissioners should ensure that services are implementing guidance and using recognised standards for the management of sexually transmitted infections. Prevention of sexually transmitted infections should be targeted, informed by the sexual health profile of local populations with resources identified by commissioners for prevention activities as integral to service delivery.
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