Prompt access to sexual health clinics, especially for those with urgent symptoms, has got worse in recent years, according to a major new study of services across the UK.
The study found many genitourinary medicine (GUM) clinics were failing to meet national standards that recommend pretty much all patients should be offered an appointment within 48 hours.
“There has been a significant decline in access for patients presenting with urgent symptoms”
Researchers from Solent Trust, Southampton University and Public Health England also found women were less likely to be offered an appointment than men.
The study, published in the journal Sexually Transmitted Infections, was based on responses to questionnaires sent to lead clinicians at all 248 GUM clinics in the UK two years running.
Additional information was gathered by “mystery shoppers” – researchers posing as patients – who called most clinics to request appointments and visited a random sample.
Standards for sexual health services set by the British Association of Sexual Health and HIV recommend 98% of patients should be offered an appointment within 48 hours of making contact with a service.
However, survey responses showed the proportion of clinicians who said all their patients were offered an appointment within that timeframe dropped from 76% in 2014 to just over 67% in 2015.
“Overstretched clinics are struggling to recruit and retain staff”
Mystery shoppers, posing as people with both urgent and non-urgent needs, called 220 of the clinics that were contactable by phone and open two or more days a week.
In 2014, 95.5% of clinics offered those who said they had symptoms an appointment within 48 hours, but by 2015 this had fallen to just under 91%.
The decline in swift access was greatest for women, falling from 96% in 2014 to just over 90% in 2015.
The drop was also greater in clinics in England compared to those in other UK nations, falling from just over 96% in 2014 to just under 91% in 2015.
In contrast, the proportion of mystery shoppers without symptoms who were offered an appointment within 48 hours increased from just under 51% in 2014 to 74.5% in 2015.
But half these appointment were not fixed and were instead an invitation to attend a walk-in service. Nearly one in four – 18% – of “patients” were unable to book any fixed appointment.
“Ensuring gender equity in service access is a clear priority”
Again there were differences between men and women. The proportion of symptomless men offered an appointment increased from just over 58% in 2014 to just under 91% in 2015. However, the increase was significantly smaller for women, rising from 49% in 2014 to 59.6% in 2015.
Mystery shoppers visited nearly 60 clinics, posing as people with symptoms of an acute sexually transmitted infection to assess waiting time.
The vast majority – 95% – were offered a same-day appointment with a waiting time of around an hour.
The researchers acknowledged their study “only represents a snapshot for each of the years”. But they said the use of mystery shoppers “provides insight into the difficulties that real patients may encounter when trying to arrange an appointment at a GUM clinic”.
“The study shows that, while the majority of UK clinics can offer a consultation within two working days, there has been a significant decline in access for patients presenting with urgent symptoms,” they said in the study paper.
“Of particular concern, and in contrast to clinicians’ perceptions, women have greater difficulty accessing services than men, which is surprising given that many GUM services are integrated with contraceptive services which traditionally see mainly women. Ensuring gender equity in service access is a clear priority,” said the researchers.
Helen Donovan, professional lead for public health nursing at the Royal College of Nursing, described the research findings as “extremely concerning”.
RCN warns of ‘profound public health challenges’
“Many sexual health conditions require early treatment, and patients could suffer if they are not seen promptly,” she said. “Delayed appointments also risk further transmission, potentially turning individual cases into a much wider public health issue.”
Ms Donovan said staffing shortages in sexual health clinics were a factor. “As we see in many other areas of nursing, overstretched clinics are struggling to recruit and retain staff,” she said.
“This research also raises questions about the increasingly complex and opaque commissioning structure for GUM clinics,” she said. “Decades of progress in sexual health should not be undone by failure in workforce planning, or localised commissioning issues.”
In 2015, the study found services had been put out for competitive tender in nearly half the clinics with almost two thirds – 63% – of those tendered in the past year.
However, there was no significant difference in 48-hour access between services that had and had not been put out for tender.
STI self-screening kits may increase uptake among men
Men find self-testing acceptable to screen for sexually transmitted infections, a separate UK study has indicated.
Most men aged 18-35 would be willing to collect and send off a urine sample using a kit to test for STIs, according to a survey, with GP surgeries the most popular place to collect kits, followed by pharmacies and sexual health clinics.
The survey formed part of a larger programme called Ballseye, which was funded by the National Institute for Health Research and led by Dr Claudia Estcourt from Queen Mary University of London.
Around 400 men, aged 18-35, were asked about their sexual activity and which venues they would collect STI tests from. The survey found 85% of men were willing to test themselves for STIs.
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General practices (80%), sexual health clinics (67%) and pharmacies (65%) were the most acceptable places for men to pick up a self-testing kit.
Smaller proportions thought sporting venues, such as gyms (19%) and sports centres (13%), were acceptable pick-up points, although this rose to 54% among men who did sport regularly.
“These studies indicate that providing easy access to STI self-testing kits in various venues may increase uptake among men,” said the study authors
Jonathan Ross, professor of sexual health and HIV at University Hospitals Birmingham NHS Foundation Trust, said: “Up until recently, it was common practice in sexual health clinics to take a swab from the penis to look for evidence of an STI, even in men with no symptoms. Not surprisingly, this is not popular with men and might be a barrier to getting an STI test.
“This study shows that ‘remote STI screening’, in which an asymptomatic man can take their own sample (usually urine), send it in to the laboratory by post and receive their results by text message, is highly acceptable especially when testing kits are available from primary care, sexual health clinics or pharmacies,” he said.