Guidelines for the appointment of General Practitioners with Special Interests in the Delivery of Clinical Services

Guidelines for the appointment of General Practitioners with Special Interests in the Delivery of Clinical Services Sexual Health April 2003 Sexual Health Sexual health This general practitioner with special interest (GPwSI) framework is one of a number which the Department of Health has commissioned the Royal College of General Practitioners (RCGP) to produce. The frameworks have been written following extensive consultation with general practitioners, secondary care specialists, Primary Care Trust managers, patients, the Department of Health and the PwSI team in the NHS Modernisation Agency. The frameworks are intended to be advisory for the development of local services, providing good practice and experience, offering recommendations to assist PCOs in determining how to implement a local GPwSI service to meet their needs. This guidance should be read in conjunction with the Department of Health and Royal College of General Practitioners’ Implementing a scheme for General Practitioners with Special Interests (April 2002, www.doh.gov.uk/pricare/gp-specialinterests), and the NHS Modernisation Agency’s Practitioners with Special Interests: A Step by Step Guide To Setting Up a General Practitioner with a Special Interest (GPwSI) Service (April 2003, www.gpwsi.org). Rationale for GPwSI service in sexual health The risk of unwanted pregnancy and the risk of sexually transmitted infections are often associated with each other. Evidence showing associations between mental ill-health, drug and alcohol problems and sexual ill-health and high-risk sexual behaviour supports the need for a GPwSI to take a broader approach to sexual health. a. The core activities of a GPwSI service in sexual health It is recommended that the National Strategy for Sexual Health and HIV (www.doh.gov.uk/nshs/bettersexualhealth.pdf) and the subsequent Tool Kit for Primary Care Trusts (www.doh.gov.uk/sexualhealthandhiv/pdfs/commissioning_toolkit.pdf) should underpin the development of a GPwSI service. The activities of a GPwSI service will depend on a number of factors, including the location of the service and its overall aims. In principle ,the main activities of the service will be based around education and improving standards of sexual health medicine within the primary care organisation as well as offering sexual health services. As best practice, it is recommended that GPwSI services include elements of the following: Clinical Service Offering Level 1 services with some additional Level 2 services (see table 1). These services can be offered either as part of an integrated general practice service with care being provided alongside other general medical services or as a stand-alone service located within a dedicated sexual health clinic within the NHS 1 Sexual Health or other provider and either targeted to a particular population or risk group (e.g. young people, drug users, hard-to-reach groups) or provided to a general population. At the time of writing much work has been done to ensure that GP practices are able to provide level 1 services. Therefore an initial role of a GPwSI service may be to support this further. Further activities of the GPwSI service depend on the needs of the Primary Care Organisation (PCO) and can include provision of: - • Enhanced Family Planning services. • Menopause care. • Infertility care. • Service to raise the awareness and respond to the needs of women who have undergone female genital mutilation. • Vasectomy services. • Psychosexual counselling. Education and Liaison This usually involves dissemination of good practice across the PCO training and education, liaison with local specialist providers, and local laboratories. Service Development/Leadership • Contribute to the strategic direction of local sexual health services in particular lead implementation of the National Strategy; participate in the monitoring of outcomes and support development of integrated services. • Provide sexual health clinical leadership for primary care in order to champion change. 2 Sexual Health The National Strategy for sexual health and HIV.ational for sexual health and Level 1 Services Sexual history and risk assessment. Sexual Transmitted Infections testing for women. HIV testing and counselling. Pregnancy testing and referral. Contraceptive information ad services. Assessment and referral of men with STI symptoms. Cervical cytology screening and referral. Hepatitis B immunisation. Level 2 Services Intrauterine device insertion. Testing and treating sexually transmitted infections. Vasectomy. Contraceptive implant insertion. Partner notification. Invasive sexually transmitted testing for men (until non-invasive tests are available). The RCGP is of the view that a Level 1 service should also include the ability to provide a confidential service and a service accessible to young people. New draft GMS contract The new draft GMS contract includes a number of quality markers relevant to sexual health medicine. The GPwSI would have an important role in helping practices reach the quality targets as well as supporting PCOs in developing and monitoring Enhanced services. b. The core competencies recommended for the GPwSI service These will depend on the core activities of the service provided though a GPwSI should be able to demonstrate elements of those listed below. Generalist The competencies to deliver a GPwSI service should be seen as a development of generalist skills including good communication skills, competence in teaching and training health care professionals and a commitment to cascading knowledge and skills. and Special interest area A GPwSI would be expected to be competent at providing all Level 1 services to a high level of expertise. 3 Sexual Health Competencies Clinical Knowledge Local and national of: epidemiology, presentation, natural history, complications, investigation, treatment (including antibiotic resistance) of the common Sexual Transmitted Infections and vaginal infections. Harm reduction and harm minimisation in relation to illicit drug use, especially injecting drug use. Use and contraindications of the full range of contraceptive techniques. Methods for TOP, their relative advantages and disadvantages indication and contraindications. Understanding of the different test for STIs including storage and transport of specimens. Understanding of practice based methods of record keeping and how these may support audit. Education and support Local STI and Family Planning services and supports available. Good knowledge of local guidance in relation to treatment of common STIs. Local management of sexual contacts and partner notification. Epidemiology and prevalence of STIs and Teenage pregnancy, and other relevant local sexual health issues, e.g. female genital mutilation, sickle cell disease. Legal framework of STIs in primary care including that relevant to young people and confidentiality. Knowledge of local educational providers. Leadership National, local and Professional strategies and guidelines and how these may relate to service configuration within the PCO. Good understanding of roles, responsibility and structure of PCOs and how to influence them to bring about improvement in delivery of sexual health services. Understanding of primary care structures and how these may affect delivery of services within the PCO. Understanding of service redesign and care pathways. Indicators of sexual health risk. Skills Able to carry out a full sexual and contraceptive history including risk assessment. Able to keep up to date with national and local priorities, treatment changes and services. Able to work across clinical networks with specialist and other services. 4 ... - tailieumienphi.vn