Sexual health needs quality points

Sexual health must be included in the quality framework if GPs are to provide services recommended by NICE, according to sexual health experts.

As it stands, GP practices are unlikely to have the resources to provide the one-to-one interventions introduced by NICE in February this year, says south London GP Dr Pippa Oakeshott.

The NICE guidance recommends that GPs use sexual history to identify individuals at high risk of STIs. This should be assessed during consultations on contraception, pregnancy, abortion, during routine checks for new patients and during travel immunisation.

Patients at high risk of STIs should then be offered one-to-one discussions lasting for at least 15 minutes.

GPs should also be able to help patients with an STI ensure that their partners are tested and provide them with information about avoiding reinfection.

But Dr Oakeshott said that unless funding was provided, GPs would have little time to identify these patients and arrange sexual health counselling.

Very few practices will have personnel trained in sexual health counselling who can provide structured sessions lasting 15-20 minutes, she said.

The NICE guidelines also recommend that GPs should provide sexual health advice for vulnerable young people aged under 18, with a focus on contraception and the benefits of reversible contraceptives.

But Dr Oakeshott questioned this recommendation, saying that it would be difficult for GPs to target young people because they may not return for follow-up appointments.

'They are more likely to access Brook Young People's Clinics and other youth counselling and sexual health services where available,' she said.

Providing NICE guidelines to GPs would not influence their behaviour but including sexual health in the quality framework would, concluded Dr Oakeshott.

North London GP Dr Richard Ma, who worked on the development of the NICE guidelines, said that they were helpful for GPs and would be cost-effective for practices.

But Dr Ma supported the idea of quality indicators for sexual health.

'Including sexual health in the quality framework would, however, help to motivate some GPs and practice nurses to provide better sexual health care,' he said.

'Other clinical areas can sometimes take priority over sexual health.'

Sex Transm Infect 2007; 83: 171

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