Published: 17/03/2005, Volume II5, No. 5947 Page 20

Baroness Gould, chair, Independent Advisory Group for Sexual Health and HIV

This is an exciting time for those who work in sexual health (clinical management, pages 30-32, 10 March).

The government's commitment of an additional£300m and inclusion of sexual health in local delivery plans is warmly welcomed by the group.

Now is the time to think broadly and be imaginative.

Sharing best practice and looking at what happens across the country is key to making sure services improve.

There are non-conventional settings that work well in many areas like 'sauna surgeries' for gay men and mobile contraceptive clinics for young people.

These can reach people who do not normally use the services while not increasing demand on genito-urinary medicine and more specialist contraceptive clinics - at least initially. Even relatively simple things like using mobile phone texts for test results could cut down on unnecessary repeat visits.

The extra funding and priority for sexual health is an opportunity to consider the consultant-led structure which is under such pressure, and explore ways of enhancing the roles of nurses and other staff.

Looking at just one of the targets identified in the public health white paper - 48-hour referral for GUM services - throws into relief the complex challenges of modernising a service that has survived for many years on a shoestring.

During a recent meeting of the group, three main challenges to achieving GUM referral targets were identified, ranging from the pragmatic issue of when the 48-hour target 'countdown' begins, to how to ensure adequate capacity to deal with an increased workload.

Prioritising training - especially for nurses - is high on the list of 'must happens'. There is a lack of adequate training to cope with the added work load the increased referrals will bring.

What solutions were suggested?

. Having a standard procedure across GUM clinics to establish what constitutes the first point of contact.


Developing an equitable method of allocating additional resources for infrastructure and staff development - without penalising those who are 'coping' well under current funding.

. Enhancing the role of nurses and other support staff to provide a system of triage to free up more specialist staff.


Put in place a rolling programme of training to make best use of existing staff, especially nurses.

The next question has to be, when all is considered, will£300m be enough?