Consultant physicians working with patients - Royal College of ...

2 Specialties Genitourinary medicineAccess to information, patient support groupsand the role of expert patientInformation on STIs and other areas of sexual health isfreely available through written material and clinicalstaff. Many clinics have websites providing clinicinformation and general information on STIs.Patient support groups and expert patients have been along established and valuable feature of HIV care, but,in the field of STIs, similar support groups and expertpatients are notable by their rarity and should beencouraged. BASHH has establised a public panel and isproducing patient information leaflets through itsclinical effectiveness group. The Herpes Association andthe Vulval Pain Society provide sources of support andinformation.Availability of clinical records/resultsClinics increasingly provide results by text, email or24-hour telephone lines. GUM outpatient records andcomputer registration are kept separate from generalhospital records for reasons of confidentiality. Access totest results is increasingly linked to service laboratoriesby computer. Tests should be anonymised by codedidentifiers. These systems should be ‘firewalled’ fromusers outside the clinic and laboratories. Access to notesby patients or for medicolegal reasons is as for otherspecialties.4 Interspecialty and interdisciplinary liaisonMultidisciplinary team workingMultidisciplinary work is key to quality service delivery.Nurse-led clinics and nurse practitioners areincreasingly frequent. Health advisers are an importantpart of teams. Close links with microbiologists andvirologists are essential.Many HIV services hold regular multidisciplinary teammeetings which have an important training role.Working with other specialistsMost patients with STIs and allied conditions aremanaged within the clinics. Relationships with otherservices include obstetrics and gynaecology, urology,pathology, family planning and psychology. Close linkswith the Health Protection Agency (HPA) have beenforgedoverrecentyearsandhaveyieldedbenefitsinepidemiological surveillance and the targeting of healthpromotion.HIV patients require integrated care and collaborationbetween primary and secondary care and communityhealth services. National standards have recommendedthe development of clinical networks to manage HIVinfection. 2Working with GPs and GPs with a specialinterest (GPwSIs)Sexual health has been identified as a priority for thedevelopment of GPwSIs. GUM has many GPs who dosessional work and are ideally placed to take onenhanced roles in primary care. The specialty iscommitted to working closely with the Royal College ofGeneral Practitioners (RCGP) and commissioningorganisations to provide training programmes andclinical governance for these GPs.Other specialty activity beyond local servicesMany services have set up outreach clinics includingprimary healthcare settings and prisons. Mostconsultants take a leading role in local sexual health andHIV clinical networks.5 Delivering a high-quality serviceStandards that cover all aspects of management of STIs,including the diagnosis and treatment of individualsand the public health role of infection control, werepublished by BASHH in 2010. 3Characteristics of a high-quality serviceFor STIs All patients should be offered an appointmentwithin 48 hours of contacting the service. Patients with a suspected acute STI should be seenon the day that they present. Clinics should be in good quality, easily accessiblepremises. Interviewing rooms and examinationrooms should afford privacy. 4 Management includes taking a general and sexualhistory, a physical examination and collection ofappropriate specimens. Patients should be offered achaperone in line with General Medical Council(GMC) guidance. Clinical examination is supported by immediatemicroscopy of samples, requiring staff to be trainedand monitored in their practice of microscopy. Patients often have multiple infections. STIs may beasymptomatic, and for that reason patients areoffered screening for other common conditions.C○ Royal College of Physicians 2013 113