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The crisis in our sexual health services has recently received wide publicity, firstly, with the publication of the National Strategy for Sexual Health and HIV1 and, subsequently, with the report of the House of Commons Health Select Committee.2
The issue of how to cope with a seemingly impossible workload faces many clinics. Anecdotally, the solutions employed are many and varied (ranging from the use of a security guard to keep out the crowds to changes leading to a wide variety in clinical practice3). Some of the ideas raised by Bradbeer and Mears will already have been adopted by a number of clinics (including my own). Some are most certainly controversial. There is little hard evidence to inform this debate. The views that I express are based on over 20 years’ experience of working full time in genitourinary medicine (GUM) clinics, both teaching and non-teaching, in and outside of London.
Two main principles should allow us to decide which ideas to adopt for our own practice. Firstly, nothing that we alter should harm the health of individuals. Secondly, nothing that we alter should harm the public health. One important element underlying both of these principles is that in order to serve their function with respect to control of sexually transmitted infections (STIs), the public must regard clinics as places they are prepared to attend, which, in turn, requires that they provide a high quality of clinical care and high levels of patient satisfaction. Surveillance systems need to be amended, in the context of the new patterns of service delivery, to accurately record the incidence of STIs.
DIVERTING INAPPROPRIATE ATTENDERS
The work of GUM/sexual health clinics is, of course, much more varied than the sexually transmitted infections in the title of this debate. The workload measure (KC60 codes) showed that attendances for …