Anna Hartley

Assessment of the impact of the London Olympics 2012 on selected non-genitourinary medicine clinic sexual health services

With minimal information on sexual health provision during mass-gathering events, our aim was to describe the use of sexual health, contraceptive, sex worker and sexual assault services during the London 2012 Olympics. We analysed data from five sources. One contraceptive service provider reported a 10% increase in attendance during the main Games, while emergency contraception prescriptions rose during the main Olympics, compared to the week before, but were similar or lower than at the beginning and end of the summer period. A health telephone advice line reported a 16% fall in sexual health-related calls during the main Olympics, but a 33% increase subsequently. London sexual assault referral centres reported that 1.8% of sexual assaults were Olympics-linked. A service for sex workers reported that 16% started working in the sex industry and 7% moved to London to work during the Olympics. Fifty-eight per cent and 45% of sex workers reported fewer clients and an increase in police crack-downs, respectively. Our results show a change in activity across these services during the 2012 summer, which may be associated with the Olympics. Our data are a guide to other services when anticipating changes in service activity and planning staffing for mass-gathering events.

Syphilis masquerading as focal segmental glomerulosclerosis

A patient referred to the genitourinary clinic for positive syphilis serology was found to have symptoms and signs of nephrotic syndrome. A renal biopsy showed focal segmental glomerulosclerosis (FSGS). Doxycycline 200 mg twice daily for 28 days coincided with considerable decrease in proteinuria and rise in serum albumin, suggesting a causal relationship.

Are specialist-led genital dermatology clinics a valuable and necessary part of sexual health service provision in the UK?

Dermatological conditions constitute a high proportion of presentations to sexual health services. In 2009, Sashidharan et al 1 conducted a survey of the management of patients with genital dermatological (GD) conditions in sexual health clinics in the UK. They found that 42% of sexual health clinics have dedicated GD clinics run by genitourinary physicians, dermatologists, gynaecologists or urologists. Training in GD varied significantly and they concluded that there was no uniform provision for GD within sexual health clinics in the UK. Furthermore, in our clinic, we have noted that although coding clinical practice is a key part of financial remuneration, there is no specialist code …

Survey of genitourinary medicine specialist registrars in the United Kingdom regarding genital dermatology training.

The British Association for Sexual Health and HIV Genital Dermatology Special Interest Group (SIG) conducted a survey of specialist registrar training in genital dermatology (GD) to inform future training provision provided by the group and other services. The survey shows that training in GD is variable with most trainees receiving GD training through formal lectures or ad hoc clinical teaching, with fewer trainees having access to specialist GD clinics. There is mixed confidence in diagnosis and use of topical steroids, and few trainees are independent in GD practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The GD SIG, in liaison with British Association for Sexual Health and HIV (BASHH), aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning. It is hoped this survey will also inform GD training at both local and national levels.

What impact has tendering had on trainees? Results of a national survey by British Association for Sexual Health and HIV Trainees’ Collaborative for audit, research and quality improvement projects:

In April 2013, local authorities gained responsibility for commissioning sexual health services in England. With many services going out to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. The aim of this study was to evaluate the impact of tendering on GUM trainees. An electronic survey designed by the British Association for Sexual Health and HIV Trainees’ Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Eighty-two individuals responded (74% GUM trainees, 25% newly appointed consultants, 1% locum appointed for service). Sixty-three per cent (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered during the tendering process and 20% (8/41) felt that it was. Forty-four per cent (18/41) felt adequately supported. Thirty per cent (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated: other than management experience the overall impact on all parameters was negative, namely morale, senior support and education. In conclusion, this survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering.

How to integrate quality improvement into GUM and HIV services

“Safety, effectiveness, patient centeredness, timeliness, efficiency & equity”1 are words which combine to form a comprehensive definition of quality in healthcare. It is only in recent years that there has been a concerted push towards truly improving quality in the National Health Service (NHS). A drive towards quality improvement (QI) is usually driven by an industry ‘wake up call’. In the NHS, this call came from the exposure of significant failings in patient care in certain trusts and departments across the UK.2–4 Since then, there has been huge progress in improving the care for our patients, with greater clinical governance and standards,5 ,6 regulation7 and focus on safety.8–10 However, we are yet to become a healthcare system which truly learns from its mistakes, shares its learning and is dedicated to continual improvement.11 ,12 Audit alone cannot bring about continual improvement. True QI methodology is poorly understood and poorly used. In this article, we discuss how to undertake QI and suggest how it might be integrated into GUM and HIV services. Understanding the quality of care we provide is the lever to delivering improvement work in our services. Four deceptively simple questions, which encompass audit and QI, can be used to comprehensively assess care delivered. These questions will be further explored throughout the article:13 Since 1989, when systematic use of clinical audit was strongly supported by the White Paper ‘Working for Patients’,14 audit has been applied as a methodology to improve healthcare service. At national and local levels, audit has raised both excellence and discrepancies in care in sexual …

P152 Staff satisfaction improvement work: actively asking, listening and responding to the concerns of our staff

Introduction Contract tendering and service integration has resulted in great uncertainty for sexual health staff. Our service has recently integrated with sexual and reproductive health (SRH) and is currently under tender. We aimed to review and address the satisfaction of our staff. Methods An online survey was disseminated to staff at our sexual health service. Results 73% of staff responded: 13 doctors, 9 nurses, 6 technicians, 15 health advisors/psychologists, 8 receptionists, 8 administrators, 3 anonymous. On a scale of 1–10, staff rated: feeling valued 5.9; enjoying work 6.4; day-to-day support 5.7. Scores were lower among receptionists (4, 4.1, 3.6 respectively). 61% felt day-to-day issues were dealt with in a timely manner. Cascade of information from management to staff was deemed ‘too little’ by 53%. 34% stated they did not have the opportunity to contribute to decisions affecting them. Staff found it easier to raise concerns with their line manager (6.7/10) than with management (5.7/10). These scores were lower among receptionists (3.6/10, 4/10 respectively). Discussion Improvement work is addressing the issues raised by our staff. Initiatives include: Staff Member of the Month Award; Daily team huddle actively including receptionists, addressing day-to-day issues; Psychology session with receptionists to better understand their concerns; Clinic has relocated to be next to reception (rather than on a different floor); A buddying system for incoming SRH staff; Regular integration emails from management and whole team briefings. Discussion Our survey demonstrates the need to actively ask, listen and respond to staff’s satisfaction, especially during such uncertain times.

BASHH Doctors in Training

There are many opportunities for genitourinary medicine (GUM) specialist registrars (SpRs) to work with the British Association for Sexual Health and HIV BASHH. One such role is the Doctors in Training (DiT) representative on the BASHH Board. This two-year position is open to all GUM SpRs, provided they are BASHH members. The role includes membership of the Joint Royal Colleges of Physicians Training Board (JRCPTB) GUM Specialist Advisory Committee (SAC). Disseminating information to trainees across the UK is a key role of the DiT representative. This involves sharing relevant information from meetings as well as other useful information such as upcoming courses, training and job opportunities. Dissemination happens via the BASHH regional DiT representatives. The BASHH DiT webpage and new twitter account (@bashh_trainees) are other channels for information. Understanding how sexual health policies, such as changes to commissioning, affect GUM training enables training to be prioritised. In this way, the DiT representative acts as a voice …

P171 A case of extensive oral and penile ulceration

A 35-year-old Indian man was referred to the genitourinary clinic with a 3-month history of progressive, painful oral and penile ulceration. He had lost 10 kg in weight. He was anorexic secondary to mucosal pain but was otherwise well, with no reported rashes or eye problems. He had no significant medical history and took no regular medication. Last sexual intercourse was protected vaginal intercourse with a commercial sex worker 10 weeks earlier. On examination of the mouth, extensive ulceration was seen on the buccal mucosa and tongue; genital examination revealed superficial erosions on the glans penis and prepuce. Examination of the eyes, skin and joints was unremarkable. The differential diagnosis included: erosive lichen planus, aphthous ulcers, pemphigus vulgaris, cicatricial pemphigoid, Behçets disease and secondary syphilis. Swabs from the oral ulcers were positive for Herpes simplex virus (HSV) type 1 DNA but penile swabs were negative for both HSV type 1 and 2. Hepatitis B, C, and syphilis serology, HIV antibody, and autoimmune profile were negative. Indirect immunofluorescence for epithelial intercellular cement was positive at a titre of 1:160. Biopsy of the oral lesions showed marked suprabasal acantholysis with prominent Tzank cell formation, in keeping with pemphigus vulgaris (PV). The patient was maintained on oral prednisolone with gradual improvement. Azathioprine will be used as a long-term steroid sparing agent. PV is a potentially fatal autoimmune blistering disorder of the skin and mucous membranes, more common in Indians. Cutaneous lesions are often absent. HSV can both mimic immunobullous disorders and cause superinfection. Therefore, positive HSV swabs must be taken in context and interpreted carefully. Patients may present to the GUM clinic with a history of mucosal ulceration and PV should be included in the differential of such cases.