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Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey
  1. Elizabeth Foley1,
  2. Martina Furegato2,
  3. Gwenda Hughes2,
  4. Christopher Board3,
  5. Vanessa Hayden3,
  6. Timothy Prescott3,
  7. Eleanor Shone3,
  8. Rajul Patel4
  1. 1 Department of Sexual Health, Solent NHS Trust, Royal South Hants Hospital, Southampton, UK
  2. 2 Department of HIV and STIs, Public Health England, London, UK
  3. 3 Southampton University School of Medicine, Southampton, UK
  4. 4 Solent NHS Trust, Southampton University School of Medicine, Southampton, UK
  1. Correspondence to Dr Elizabeth Foley, Department of Sexual Health, Solent NHS Trust, Level B, Royal South Hants Hospital, St Mary's Road, Southampton SO14 0YG, UK; efoley{at}


Study design This study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards.

Methods In January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians of UK GUM clinics. In February 2014 and 2015, researchers posing as symptomatic and asymptomatic ‘patients’ contacted clinics by telephone, requesting to be seen. Clinic and patient characteristics associated with the offer of an appointment within 48 hours were examined using unadjusted and UK country and patient gender adjusted multivariable logistic regression analyses. In March 2015, a convenience sample (one in four) of clinics was visited by researchers with the same clinical symptoms. Ability to achieve a same-day consultation and waiting time were assessed.

Results In 2015, 90.8% of clinics offered symptomatic ‘patients’ an appointment within 48 hours when contacted by telephone, compared with 95.5% in 2014 (aOR=0.46 (0.26 to 0.83); p<0.01). The decline was greatest in women (96.0% to 90.1%; p<0.05), and clinics in England (96.2% to 90.7%; p<0.01). For asymptomatic patients, the proportion offered an appointment within 48 hours increased from 50.7% in 2014 to 74.5% in 2015 (aOR=3.06 (2.23 to 4.22); p<0.001), and in both men (58.2% to 90.8%; p<0.001) and women (49.0% to 59.6%; p<0.01). In adjusted analysis, asymptomatic women were significantly less likely to be offered an appointment than asymptomatic men (aOR=0.33 (0.23 to 0.45); p value<0.001). 95% of clinics were able to see symptomatic patients attending in person.

Conclusions Access to GUM services has worsened for those with symptoms suggestive of an acute STI and is significantly poorer for asymptomatic women. This evidence may support the reintroduction of process targets.


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  • Handling editor Jackie A Cassell

  • Contributors EF—designed study and questionnaire and drafted first manuscript and revisions. MF and GH—contributed to questionnaire design, performed statistical analysis and contributed to preliminary drafts and final draft of manuscript and revision. CB, VH, TP and ES––undertook mystery shopping element of study. RP—contributed to study design, manuscript drafting and final revisions.

  • Funding This service evaluation was supported by an education grant from BASHH to perform clinic visits.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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