1. GP the Great Pragmatist!

2. Dr. Lucinda Dockeray M.I.C.G.P. GPwSI : KCLINC STI Service

3.  KClinic Lead by GPwSI Interferrals Initiative of KDOC OOH Mid-Leinster Region 130 GP 170,000 patients Staff 42  Established in 2008 Relocated to Vista Primary Care Centre Naas

5.  GP Assistant  KDOC AGM Clinic daytime GPwSI  Coincident 2 Referrals GUIDE Clinic

6.  GP supplements their core generalist role by offering an additional high quality service  Work principally in the community  Deliver service beyond the scope of their core professional role and not normally undertaken by their peers  Demonstrate appropriate skills and competencies through accreditation  Work without direct supervision

7.  Additional training, experience and qualifications in the clinical area  Take referrals for assessment and treatment of patients  Appointed to meet the needs of the local PCT  Typically undertake 2 sessions per week in their speciality  Draw extensively on their generalist expertise which allows them to act as gatekeepers to specialist services

8. 103 Patient M 52: F 51 Age Profile <171 <2522 <3029 <4033 <5012 <605

10.  MSM2  IVDU/P1  Ethnic11  Blood Trans1

12.  Single visit / Telephone Result85  Multiple visit  Cryo8  Hep B3 - 2S 1C  Window1  TOC2  Onward Referral  Gynae2  Tertiary STI1  Radiology1

17.  NHS National Strategy for Sexual Health and HIV 2001  Levels  1Primary Care  2Intermediate  3Specialist GUM Unit  Formal Care Pathways

19.  Asymptomatic STI screening and treatment  Excluding MSM and Rx Syphilis  Sexual Health History and Risk Assessment  Partner notification or onward referral  HIV testing  Screening and vaccination Hep B  At risk groups  Sexual Health Promotion

20.  GPwSI Staff grade Dr’s  GP Co-ops Initiatives Family Planning Clinic

21.  STI assessment and testing of symptomatic uncomplicated infections  Resource dependent  Men dysuria / genital discharge ( Microscopy)  Asymptomatic MSM/ Extra-genital Sites ( GC Culture)  Excluding  Symptomatic MSM  Genital Ulceration ( except Herpes)  Pregnant women

22. Guide Clinic SJH Mater ID Unit

23.  Full Mx STI  Tropical STI’s  Management Syphilis and BBV  Specialist HIV Treatment and Care  Post exposure prophylaxis PEP

25.  Represent best current practice  Level 1, 2, 3 Services  9 Standards

26.  Open Access  Self ReferralApt 48 Hrs  Choice of Where to access care  Confidentiality  Free of any prescription charge  (Instigate) Partner Notification

29.  Open AccessSelf ReferralApt 48 Hrs  Choice of Where to access care  Confidentiality  Free of any prescription charge  (Instigate) Partner Notification

30.  Competencies relevant to Service Level 100%  Training courses Standardised and Multidisciplinary  Leadership role of specialist GUM providers (Level 3)  Explicit and commissioned

31. CoursesAssessmentLevel eHIV-STI BASHH/RCP Some elements1,2,3 STIF 2 day No1 STIF Competencies 1,2 Yes1,2 Cert Comp TrainingYes2,3 STI Course BASHH No3 Dip GUMYes3

32.  Risk Assessment – STI HIV BBV  Medical and Sexual History – Onward Referral  Offered Genital Examination  Appropriate Specimens for Micro Tests – Onward Referral  Min Chlamydia Gonorrhoea Syphilis and HIV  100 % offered HIV 60% uptake

34.  Gold Standard Tests  Microscopy Level 3 GUM services - Onsite

35.  Turnaround times of 7 working days  Electronic requesting and reporting

38.  Empirical Management Index Case (Syndromic Sub –optimal unacceptable )  Epidemiological Management Contact  Results given both positive and negative  Treatment BASHH Guidelines  Free of prescription charge

41.  Partner Notification Choice of partner or provider referral – Instigate Rate PN 0.4 C/IC or 0.6 4 wks  Care Pathways for Onward Referral

42.  Health advice and information

44.  Safeguarding patient and personal information  Sharing information  Clinical case management  Data reporting and commissioning of services  Registration Data Protection Commissioner  Requirement to report information  Disease notification

46.  Formal  Care pathways explicit, agreed and utilised by all STI providers Referral criteria Triage criteria Out of hours advise  Leadership role specialist GUM provider (Level 3)

51.  Level 3 GUM specialist should provide clinical leadership for the management of STI’s within local health economies

52.  Each provider Support education training Annual Audit 100% Procedures to minimise risk

53.  Id Problem  Recording of Partner Notification – no mechanism linking contact to index case in clinical notes.  Set Criteria Standards  Recording of “contacts notified” in index case chart.  Partner notification rate of 0.4 contact/ index case  Data Collection 1  0% recorded  Compare Performance  Implement Change  Education via kind SHA please …. Then implement!  Data Collection 2

54.  Opportunity to develop user-centred services that are responsive to their needs  Patient-reported measures  Satisfaction questionnaires  Comment boxes in clinical settings  Focus groups  Mystery Shoppers ?!!

56.  Standard 1: Accessibility - break onward transmission STI  Open Access via self referral  Service of choice – Hosp/Locally  Free and without Prescription Charge

57. Hospital based Free Open Access Self Referral Mostly Dublin Long waiting times Private sector Entrepreneurial GP’s Family Planning Clinics Fast discreet weekend STI service... At a price

58.  National Sexual Health Strategy 2011  Equitable publically funded service  Choice access level –Specialist or Primary Care  Formal Links

59.  National Health Strategy 2001 M Martin  HSE  Promised Sexual Health Strategy  2011 FG/Labour  Dept Health  Universal Social Insurance ?

60.  GP colleagues late 1990’s Established OOH Coop Services  Currently Primary care is creating community based STI services … we now need to push for funding and resources to provide equitable care for our patients