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Most trusts will not meet chlamydia screening target

BMJ 2007; 335 doi: (Published 15 November 2007) Cite this as: BMJ 2007;335:1010
  1. Caroline White
  1. London

    Most trusts in England will not meet their 2008 chlamydia screening target, the director of the national screening programme admitted last week.

    Speaking at the fourth annual conference of the national chlamydia screening programme, in London, Mary Macintosh said that great progress had been made.

    “Last year only 25% of [primary care trusts] were screening [for chlamydia]. Now 78% are screening, and a further 23% will be [doing so] by the end of the year,” she said.

    But the government target for all strategic health authorities to have offered 15% of 15-24 year olds a test for the infection between March 2007 and April 2008 was unlikely to be met, she said. “It won't be reached by all. But some will.”

    Figures presented to the conference showed that projections by the health authority had fallen well below the actual numbers reported to the Health Protection Agency for the first six months up to September this year.

    The average coverage in England has reached 1.5%, up from 0.6% of the target population in the first three months. But the best performing strategic health authority reached only 2.5%.

    Dr Macintosh added that the target was not an endpoint. “It's a stepping stone to getting high volume,” she said. “Fifteen per cent is not going to be adequate. But it's not just about the numbers; it's about how we do it.”

    In a bid to boost coverage, the programme announced a new strategy to raise sexual health awareness among men under the age of 25. About only one in five men come forward for chlamydia testing at the moment.

    But community contraceptive services, which account for almost a third of tests offered, have been under increasing financial pressure as cash strapped trusts have struggled to balance their books this year.

    And testing in general practice has fallen from 83% during the chlamydia screening pilots to 47% in 2006-7, with the proportion of cases diagnosed in general practice falling from 61% to 11%.

    GPs are not given a cash incentive under the quality and outcomes framework (QOF) to offer the test.

    The GP William Ford Young, who is a member of the national chlamydia screening advisory group, said that all GPs should be automatically offering core sexual health services, including this one.

    “This is what the government said in its national HIV and sexual health strategy, but the BMA's General Practitioners Committee didn't agree with government policy,” he told the BMJ.

    The London GP Richard Ma, who also sits on the advisory group, said that offering the test did not require much input from clinicians.

    “We have struggled to get sexual health in the QOF at all,” he told the BMJ. “We won't get chlamydia screening in this year, but I am cautiously optimistic that sexual health will be included.”

    Details of the revised framework are expected later this month.

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