GP the Great Pragmatist!

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

 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

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

 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

 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

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

 MSM2  IVDU/P1  Ethnic11  Blood Trans1

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

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

 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

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

 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

Guide Clinic SJH Mater ID Unit

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

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

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

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

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

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

 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

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

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

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

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

 Health advice and information

 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

 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)

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

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

 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

 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 ?!!

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

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

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

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

 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