No improvement in access to sexual health clinics in England: urgent investment 'imperative'

Figures released last week by the Health Protection Agency (HPA) suggest that waiting times for genitourinary medicine (GUM) services in England have not improved following the publication of the Government's White Paper, Choosing Health in November 2004. The HPA survey found that in May 2005 only 40% of the patients attending English GUM clinics were seen within the recommended 48 hours, and a quarter were waiting more than two weeks. Dr Angela Robinson, president of the British Association for Sexual Health and HIV (BASHH), told aidsmap: "The recent waiting times survey shows no improvement in access in the past year which inevitably results in increasing STIs and onward transmission of HIV. Investment now in GUM services is imperative."

Last May, the first HPA survey of 28 English GUM clinics waiting times found that 62% of people trying to obtain a sexual health clinic appointment had to wait more than 48 hours.

This May, almost 17,000 people at 199 clinics (representing an 81% patient and a 97% clinic response rate) participated in the survey. Although the definition of 48 hours was adjusted to exclude weekends, unadjusted data suggest that the number waiting more than 48 hours is now 60%: in essence, no real improvement. Even when weekends were excluded, only 55% of patients were seen within 48 hours of first approaching the GUM clinic. The reason given for the delay in two-thirds of cases was lack of an earlier available clinic appointment or slot.

The survey also categorised waiting times by urgency. Waiting times at walk-in clinics, which are supposed to provide sexual health screening for emergencies, and emergency access at other GUM clinics, have actually worsened in the past year, according to the unadjusted figures. In May 2004, the 48 hour trend for walk-in clinics was 79%. In May 2005, it was 77%. Similarly, the 48 hour trend for emergency access dropped from 72% to 70%.

Although the survey found there were regional variations, the differences were not remarkably great. According to the adjusted figures, 32% of GUM attendees in London were seen with 48 hours, whereas 29% were seen within 48 hours in the North East, 30% in the North West and 31% in West Midlands. Nevertheless, whereas 14% of patients had to wait longer than two weeks to be seen at a GUM clinic in London, 31% had to wait longer than two weeks in the worst-performing region, Yorkshire and Humberside.

Last November, an investment in sexual health of £300m over three years was announced as part of Choosing Health. This included £130m to improve GUM services to ensure that all patients are seen in GUM clinics within 48 hours by 2008. In July 2005, Public Health Minister Caroline Flint announced a further £15m with immediate effect to help. This was, according to a Department of Health (DoH) press release, "to enable the NHS to make immediate improvements to buildings and facilities - allowing GUM clinics to expand their services as well as improving the overall experience for patients. In turn, this will lead to more and more people being offered a better service and access to early treatment.”

Another £50m will be spent on sexual health campaigns to educate people on the danger of the top five sexually transmitted infections (STIs). However, Dr Gillian Dean, head of GUM services at Brighton's Claude Nichol Centre, warns that this may overstretch services to breaking-point. "We're now at the point where we need urgent capital investment," she told aidsmap. "Without this, waiting times are unlikely to improve, and in fact will probably worsen with the advent of the DoH publicity campaign."

BASHH's Dr Angela Robinson hopes that Primary Care Trusts (PCTs) get the message, and begin allocating the money to GUM clinics immediately: "If the investment made by the government in its Choosing Health allocations to PCTs is invested now in GUM services, and in training of primary care clinicians, then there is a real opportunity to break out of the vicious cycle."