48 hour access to Genito Urinary Medicine

1
48 hour access to Genito Urinary Medicine

• Pauline Handy
• Clinical Nurse Lead
• Genito Urinary Medicine
• Newcastle General Hospital
• Newcastle Primary Care Trust

2
48 hour access target

• NHS Plan (DOH 2000) recommended that any patient
  should be able to see a primary care professional
  such as a practice nurse within 24 hours and a GP
  within 48 hours of contact
• Choosing Health (DOH 2004) recommended that by
  2008 all patients referred to a GUM clinic will
  be able to have an appointment within 48 hours)
• 10 High Impact Changes (DOH 2006) looked at ways
  of alleviating pressure on GUM including meeting
  48 access target (change 5)
• (Change 9) identifies additional providers of
  sexual health care

3
(No Transcript)
4
Rationale for change2004/5

• STI diagnoses and other GUM workload more than
  doubled in the 5 years up to 2005
• Increase in syphilis of 23
• gt 750,000 cases of STI diagnosed in GUM in 2005
• Number of people receiving care for HIV doubled
  in the five years up to 2005
• One third of HIV infections in UK are undiagnosed
• More than one in ten young people have Chlamydia

5
Increase in Sexually Transmitted Infections

• Several potential factors for increase
• Increase in unprotected sexual intercourse
• Increased numbers of sexual partners
• Many of those infected remain asymptomatic and
  therefore unaware of infection
• Inability to access GUM quickly may lead to
  spread of infection
• Imported infection (especially HIV)

6
Imported HIV

• Of all heterosexually acquired HIV diagnosed in
  the UK during 2005, 85 (3115/3668) was acquired
  outside the UK
• Of these 89 (2760) was acquired in Africa, the
• region of the world with the highest HIV
  prevalence
• Health Protection Agency Annual Report A
  complex picture HIV and other STI in the UK
  2006

7
Asylum Seeker Access

• Difficult to implement 48 hour rule
• Asylum seekers normally present at GUM with a
  written referral from GP who will have already
  performed medical examination of patient.
• Letter normally posted. Appointment then sent out
  and interpreter booked. Can take several days in
  total.

8
Main problems (GUM)

• Difficulty in arranging interpreter of
  appropriate language/dialect
• High numbers of asylum seekers either fail to
  attend GUM or arrive late resulting in
  interpreter having left, or having to leave early
  for next appointment
• Expensive to book interpreters who then are
  unable to work when patient fails to attend

9
Interpreters

• Cost within Newcastle PCT now 21.50 per hour and
  17.50 per hour thereafter
• Also required to pay travelling expenses of
  interpreter
• Alternative Language Line cost now 1.50 per
  minute (but .equates to 90 per hour!)

10
Family Interpreters

• Not appropriate to use family members or friends
  as interpreters when screening for STI
• Embarrassing for the patient
• Less likely to get a true sexual history
• Possibility of missing infection or potential
  incubating infection if incorrect or incomplete
  information provided
• Unable to ascertain true level of understanding
  of interpreter or information passed to patient

11
(No Transcript)
12
48 hour access

• Wording of NHS Plan is .
• any patient should be able to see a primary care
  professional such as a practice nurse within 24
  hours and a GP within 48 hours of contact

13
However .

• Asylum seekers could be seen and triaged by a
  practice nurse within 24 hours using language
  line, taking only minimal information, and then
  provided with an appointment when an interpreter
  will be available.
• This meets the governments access target of being
  seen by a health care professional within 24 hours

14
Benefits Language Line

• Allows asylum seekers to be seen within 48 hour
  access targets either in GP surgery or GUM
• Removes possibility of asylum seeker knowing
  interpreter (same social/ethnic circle) and more
  likely correct information will be given
• Cheaper than using interpreter if only a short
  consultation

15
Problems with Language Line

• If using a speaker phone can be quite loud
  therefore could compromise confidentiality
• Need telephone in examination room and time to
  set up link to language line
• Expensive to use compared with traditional
  interpreter if more than 14 minutes (21.00)
• Difficult to give bad news (i.e. positive HIV
  result) over the phone

16
What can we do?
17
Potential changes

• Consider providing STI screening for asylum
  seekers in GP practice
• Vaginal/urethral swabs and cervical smears taken
  at routine medical health check. If asymptomatic
  include endocervical/urethral chlamydia and
  gonorrhoea swabs (urine test if possible for
  chlamydia)
• Serology taken at same visit. Train up practice
  nurses to perform pre test and post test HIV
  discussions, syphilis and hepatitis serology

18
Benefits of GP screening

• Less traumatic for the patient
• Full health screen (inc STI) on initial visit
  saves time and money on interpreters at other
  venues
• Helps reduce the numbers of asymptomatic patients
  attending GUM
• All results sent directly to person who
  responsible for all care of asylum seeker

19
Interpreter training

• Often difficult for interpreter to understand
  terminology used in GUM. Remember interpreter
  normally does not have English as their first
  language
• Consider interpreter training
• Newcastle PCT introduced training module for
  interpreters on the GUM patient
• Booklet produced covers various terminology

20

INDEX 2. Who can access GUM (how to attend the
department) 3. What happens when patients
attend 6. Confidentiality 7. Treatment 8.
Infections commonly seen in GUM 10.
Terminology 13. Symptoms 14. Tests and
Treatments 16. How do people feel about attending
GUM 17. Patient Registration Form 18. NHS Trusts
and Primary Care Trusts (STD) Directions 2000 20.
Female anatomy 21. Male anatomy 22. Appendix 1
(overview of service)
21
(No Transcript)
22
(No Transcript)
23
Patient best interests

• Consider what is best for the patient
• Consider what is most cost effective
• Arrange longer appointments as required
• Try to use interpreter if at all possible rather
  than language line
• Train interpreters to provide best possible
  service to the patient