Richard Ma

Safer ‘chemsex’: GPs’ role in harm reduction for emerging forms of recreational drug use

A rapidly changing pattern of drug use is emerging that requires health services to find new approaches to harm reduction. The widespread use of ‘club drugs’ has led to many serious harms that have attracted much media attention over the past few years.1 ‘Club drugs’ are drugs such as methylenedioxy-N-methylamphetamine (MDMA or ecstasy), methamphetamine, and ketamine that are used in a recreational fashion to enhance social experience, usually being taken at dance clubs, concerts, and parties. The number of people needing treatment for club drugs has increased; club drug users in England now constitute 5% of all adult presentations for drug treatment and 14% of all presentations by those <18 years of age.2 Since 2008, the use of novel psychoactive substances (NPS) or ‘legal highs’ (drugs that are synthesised to mimic the effects of traditional recreational drugs; currently marketed as plant food or bath salts in the UK) has grown exponentially3 but the latest evidence suggests further trends in who is using drugs and how they are being taken. One such emerging subculture is that of ‘chemsex’ or ‘party and play’. These terms refer to the use of recreational drugs immediately before and/or during sex to facilitate or enhance sexual pleasure. The drugs most commonly associated with chemsex are methamphetamine (crystal meth), gamma-hydroxybutyric acid (GHB), gamma-butyrolactone (GBL), and methylmethcathinone (mephedrone). These drugs can induce euphoria, increased energy, and disinhibition but also enhance sexual arousal and aid sexual …

Time to improve HIV testing and recording of HIV diagnosis in UK primary care

By reflecting on current practice, the paper by Evans et al 1 revisits a much-needed discussion about expanding HIV testing in UK general practice and the role of general practitioners (GPs) in the care of HIV-positive individuals (see page 520) . Discussions around shared care of HIV patients between specialists and GPs started with the introduction of highly active antiretroviral therapy (HAART) in the 1990s; people with HIV are becoming more stable and healthier, and like many long-term conditions, HIV can potentially be managed in primary care.2 One large HIV centre in central London audited their caseload and found at least a third of patients on HAART and 80% of those not on HAART and stable could have been managed by nurse practitioners or GPs; this has huge potential for freeing up capacity in busy urban clinics.3 However, this is a paradigm shift …

Managing menopause in women living with HIV: A survey of primary care practitioners

Objective One in three women living with HIV (WLHIV) in the UK is aged 45–56, and therefore of potentially menopausal age. Little is known about the management of menopause in WLHIV in primary care. We aim to describe current knowledge and practice in the management of menopause in WLWH among primary care practitioners (PCPs). Methods A questionnaire-based study of 88 PCPs attending two sexual and reproductive health conferences. Results Almost all respondents (n = 87, 99%) routinely managed women with menopause-related symptoms; however, only 18 (20%) reported having managed menopause in WLHIV. Over 95% (n = 85) reported being confident in managing menopause in general, whereas less than half (n = 40) reported confidence in managing menopause in WLHIV (p < 0.001). The majority of respondents (n = 84) felt that menopause should be routinely managed in primary care, whereas just over half thought that menopause in WLHIV should be managed in primary care (n = 50, p < 0.001). Almost all respondents (n = 85) reported concerns about managing menopause in WLHIV. Conclusion PCPs reported limited experience of and low levels of confidence in managing menopause-related symptoms in WLHIV. Nearly all PCPs had concerns about managing menopause-related symptoms in WLHIV, many stating that this should be managed outside primary care. Development of national guidance and specialised training, coupled with good liaison between HIV services and PCPs, may improve confidence in this area.

Are medical educators in general practice untapped potential to increase training capacity in sexual and reproductive healthcare? Results of a survey in London, UK

Abstract Background Long waiting times for training in sexual and reproductive healthcare (SRH) including long acting reversible contraception (LARC) might lead to attrition from training programmes, leading to reduced capacity for sexual health services, and reduced access to such contraception for women. Setting General practice in London, UK. Question Can medical educators in general practice be used as untapped potential to train other health care professionals in sexual and reproductive healthcare? Method We conducted an online survey to find out the qualifications, skills and willingness of established educators in primary care in London to train other clinicians in sexual and reproductive healthcare, including LARC. Results We received 124 responses from medical educators (10.1% response rate from general practitioner (GP) trainers and 59.0% of clinical supervisors for Foundation Year doctors). 86 (69.9%) had diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) qualification and further 18 (14.6%) were interested in obtaining this qualification. Eleven respondents were trained to fit intrauterine contraception only, three for contraceptive implants only and 37 were trained to fit both. 50 (40.3%) of 124 respondents were willing get involved in DFSRH training; 74% of these were willing to teach on any component of DFSRH including LARC. Discussion There is a shortage of training places and long waiting list for clinicians who wish to train in SRH. This survey suggests there is a pool of GP educators with skills and experience in SRH and are willing to train others. This can potentially increase the training capacity and improve overall access to good contraception and LARC for women.

An evaluation of commissioning arrangements for intrauterine and subdermal contraception services from general practitioners in London, UK

Objectives General practitioners (GPs) in the UK may be commissioned to provide long-acting reversible contraception (LARC), which may have a role in reducing rates of abortion and unintended pregnancies. Primary care trusts (PCTs) in England had commissioning arrangements with GPs to provide LARC but little is known about such contractual arrangements. We studied the commissioning arrangements in some London PCTs to evaluate the cost and clinical governance of these contracts. Methods We requested commissioning contract specifications and activities for intrauterine contraception (IUC) and subdermal implants (SDI) from responsible officers in each PCT in London relating to activities in three financial years, namely 2009/2010 to 2011/2012. We evaluated each contract using a structure, process and outcome approach. Results Half (15/31) the PCTs responded and submitted 20 contracts used to commission their GPs to provide IUC, SDI or a combination of these with testing for sexually transmitted infections. The information regarding service activity was inadequate and inconsistent so had to be abandoned. Information from 20 contracts suggested there was a variation in clinical governance and quality assurance mechanisms; there was also a range in the reimbursement for IUC insertion (£77.50 to £105.00), SDI insertion (£25.00 to £81.31) and SDI removal (£30.00 to £100.00) at 2011 prices. Conclusion It was not clear from non-responders if these PCTs had a service in place. Of those that did commission IUC and SDI services, some specifications were lacking in detail regarding aspects of clinical governance. New commissioners should make explicit references to quality and safety criteria as poor-quality specifications can give rise to serious untoward incidents and litigation.

Should all patients be asked about their sexual orientation

NHS England’s recent recommendation that professionals ask patients their sexual orientation at every opportunity is essential to improve services for non-heterosexual patients, says Richard Ma. But Michael Dixon thinks this erosion of medical autonomy is political correctness gone mad

Art: The Alien Sex Club: A Cheeky Look at Contemporary Gay Culture and HIV

The Alien Sex Club Ambika P3, The University of Westminster, London, 24 July 2015—14 August 2015, and The Homotopia Festival, Liverpool John Moores University, 30 October 2015–29 November 2015. Deliberately provocative or clever marketing? Imagine my initial thoughts when I was sent an invitation to The Alien Sex Club ! This art installation was John Walter’s PhD project at the University of Westminister, a joint collaboration with Dr Alison Rodger (a HIV specialist at UCL), and curated by Ellen Mara De Wachter. It was supported by the Wellcome Trust, Arts Council England, and Terrence Higgins Trust, among others. Unlike other exhibitions about HIV which are usually serious, sombre, and sometimes depressing, Walter …

Discrimination against doctors with HIV must end

The English Department of Health has consulted on its proposals to change the management of healthcare workers who are infected with HIV. It recommends relaxing the restriction on such workers performing “exposure prone procedures,” provided that they are taking combination antiretroviral therapy, they are regularly reviewed by HIV and occupational health doctors, and their plasma viral load is consistently suppressed to undetectable levels. This recommendation follows the initial suggestion by the health departments’ expert advisory group on AIDS (EAGA) in 2007 that restrictions on dentists with HIV be reviewed. A working group that included EAGA, the Health Protection Agency’s advisory panel for healthcare workers infected with bloodborne viruses, and the health departments’ advisory group on hepatitis was established to review national guidance on the management of healthcare workers infected with HIV, hepatitis B, or hepatitis C. The UK has one of the strictest regulations governing HIV infected healthcare workers in the world; only Australia, Ireland, Italy, and Malta take a similar stance. The proposed change allows healthcare workers to perform all …

Practice-based commissioning and sexual reproductive health services: opportunities and threats.

The National Health Service (NHS) in England is going through another reorganisation in the spirit of creating a patient-led NHS. Practice-based commissioning (PBC) refers to devolution of commissioning responsibilities from primary care trusts (PCTs) to individual or groups of primary care professionals; this may be a group of general practitioners (GPs) general practices private consortia or other health care professionals. Commissioning is a term that has a loose meaning within the NHS but can encompass the process of securing services from providers by contract as well as the planning and design of integrated care pathways. (excerpt)

Call for shake up in NHS funding: Few GPs among the 900 Doctors for Reform

EDITOR—Of the 900 doctors who signed up to support an insurance based funding for a national health service, only three are general practitioners and no one claims to be working in the discipline of public health. …