Failure to fund improved access to sexual health services in the United Kingdom could “cost the public purse dearly in the long run”, an editorial in the journal Sexually Transmitted Infections warns. The editorial accompanies a week-long study conducted by staff at the sexual health clinic in Leeds that found that only 28% of individuals requesting an appointment could be offered one.
It is a government target that everybody requesting a sexual health appointment must be seen within 48 hours by 2008. The authors of the editorial express concern that in order to meet this target some clinics may adopt a “closed booking” system meaning that appointments can only be booked 48 hours in advance, therefore theoretically meeting the government target.
The Leeds sexual health clinic provided almost 25,000 appointments in 2004-2005, but in the Spring of 2005 it was only able to see a third of patients requesting appointments within the target. Complaints from patients and primary care providers about the difficulty of booking appointments led staff at the clinic to conduct an exercise to determine the true extent of demand for their services.
During the first five working days of July 2005 details of requests for appointments were recorded. Almost 500 requests for an appointment were made, but only 181 new appointment slots were available. Despite the clinic working at over 100% capacity, 72% of people requesting an appointment that week could not be seen.
The accompanying editorial notes, “there is clearly a continued crisis in GUM services in the UK.” Although substantial additional government funding has been allocated to sexual health services, the authors of the editorial write, “it is becoming clear that a considerable proportion of this will not reach sexual health as many primary care trusts struggle with deficits and other priorities.”
They warn that restrictive booking practices may be adopted by some clinics as a way of meeting government appointment targets. The authors made clear that they would not support this “as it creates major difficulties for patients trying to access services.”
Clinics have responded to increasing demands on their services in novel ways. Many now have nurse-led clinics for asymptomatic patients and most no longer provide follow-up appointments for people who received treatment. This has enabled clinics such as the one in Leeds to double its capacity despite only receiving a 10% real-terms increase in its funding. However, a recent BBC Panorama documentary highlighted how only 7% of sexual health clinics were able to provide a routine sexual health screen within the target 48 hours with over a quarter unable to see a patient within this time who described symptoms of gonorrhoea.
Although some clinics now have a triage system to prioritise those most in need, the researchers from Leeds argue that could mean that “the articulate and well informed patient may gain priority over those truly in need”. They note that women have a “large burden of asymptomatic disease”. Because of such considerations “triage at appointment is fraught with risk.”
Lack of funding for sexual health services does not just mean “patients are inconvenienced by long waits.” The authors of the editorial caution “increased waiting will lead to increased transmission of sexually transmitted infections and HIV. Improving access to…diagnosis and treatment services must be a public health priority at all levels.”
Clarke J et al. Supply and demand: estimating the real need for care while meeting 48 hour waiting time target in a genitourinary medicine clinic by a closed appointment system. Sex Transm Infect 82: 45 – 48, 2006.
Ward H et al. Still waiting: poor access to sexual health services in the UK. Sex Transm Infect 82: 3, 2006.