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The BMJ’s investigation into sexual health services makes for a thought provoking read. Sexual health clinics were created with a clear goal in mind: to provide free, open and convenient access for everyone regardless of sex, age, ethnic origin and sexual orientation. This has resulted in the lowest under 18s conception rate since the Office of National Statistics first began recording these rates.
Many small clinics were opened to provide easy access to care for their local community, a walk in service allowing vulnerable people of all ages to drop in when they had the opportunity, and providing joined up care with local social services to support their most at risk and vulnerable people. Indeed GUM clinics have long had a recognised role in safeguarding children, and in a number of recent news scandals it has been repeatedly shown that sexual health workers have been instrumental in identifying at risk individuals.
Many areas have responded to a slashed budget by amalgamating centres of care in an attempt to cut costs, and putting in booking systems in order to ensure maximum usage of services, with clinics only providing a walk in service for people under the age of 16 and MSM. Although there is an argument that this safeguards the most vulnerable, it makes the assumption that those outside of these groups are not also vulnerable. These types of person are not necessarily those who would book an appointment in advance. It is also important to remember the convenience factor when it comes to sexual health – that individuals using the walk in service are likely to be put off if they have to travel a long distance to a larger centre. Predictions have been made that this change will result in more unintended pregnancies and more sexually transmitted infection diagnoses by 2020.
We acknowledge that walk in clinic systems are not perfect: service users often have to wait a considerable amount of time to be seen, even for a simple task such as a repeat prescription of contraception. This is particularly problematic for those with a limited time during their day to look after their health. In attempts to counter this problem, many areas opened larger, state of the art sexual health services for access when smaller more local services were unavailable and to relieve pressure on these smaller sites. Unfortunately, as smaller services closed, these state of the art services have become the only available services, leading to even longer waiting times. Indeed, due to the number of service users, waiting times can be up to 5 hours to obtain contraception at some sites. Although walk in users are allocated a number and can leave the clinic and come back later, even so they do not have a definite time for an appointment and this can deter people as they may find they are unable to see a healthcare professional that day.
Additionally, the decrease in the number of sexual health clinics has led to a reduction in availability of clinics for medical education, leaving new doctors with poor exposure to this important field.
Finally, although there is an argument that amalgamated centres make economic sense in some respects, there is a risk that larger centres with greater numbers of patients will not have as deep an understanding of the local area and community they are serving and that therefore linking up with social services will be more challenging.
We feel that although cutting the budget for sexual health may achieve the short term budget savings CCGs have been asked to make, this policy is likely have wider consequences for our most vulnerable individuals, leaving them even more at risk.
Re: Cutting contraceptive services will have dire consequences
The BMJ’s investigation into sexual health services makes for a thought provoking read. Sexual health clinics were created with a clear goal in mind: to provide free, open and convenient access for everyone regardless of sex, age, ethnic origin and sexual orientation. This has resulted in the lowest under 18s conception rate since the Office of National Statistics first began recording these rates.
Many small clinics were opened to provide easy access to care for their local community, a walk in service allowing vulnerable people of all ages to drop in when they had the opportunity, and providing joined up care with local social services to support their most at risk and vulnerable people. Indeed GUM clinics have long had a recognised role in safeguarding children, and in a number of recent news scandals it has been repeatedly shown that sexual health workers have been instrumental in identifying at risk individuals.
Many areas have responded to a slashed budget by amalgamating centres of care in an attempt to cut costs, and putting in booking systems in order to ensure maximum usage of services, with clinics only providing a walk in service for people under the age of 16 and MSM. Although there is an argument that this safeguards the most vulnerable, it makes the assumption that those outside of these groups are not also vulnerable. These types of person are not necessarily those who would book an appointment in advance. It is also important to remember the convenience factor when it comes to sexual health – that individuals using the walk in service are likely to be put off if they have to travel a long distance to a larger centre. Predictions have been made that this change will result in more unintended pregnancies and more sexually transmitted infection diagnoses by 2020.
We acknowledge that walk in clinic systems are not perfect: service users often have to wait a considerable amount of time to be seen, even for a simple task such as a repeat prescription of contraception. This is particularly problematic for those with a limited time during their day to look after their health. In attempts to counter this problem, many areas opened larger, state of the art sexual health services for access when smaller more local services were unavailable and to relieve pressure on these smaller sites. Unfortunately, as smaller services closed, these state of the art services have become the only available services, leading to even longer waiting times. Indeed, due to the number of service users, waiting times can be up to 5 hours to obtain contraception at some sites. Although walk in users are allocated a number and can leave the clinic and come back later, even so they do not have a definite time for an appointment and this can deter people as they may find they are unable to see a healthcare professional that day.
Additionally, the decrease in the number of sexual health clinics has led to a reduction in availability of clinics for medical education, leaving new doctors with poor exposure to this important field.
Finally, although there is an argument that amalgamated centres make economic sense in some respects, there is a risk that larger centres with greater numbers of patients will not have as deep an understanding of the local area and community they are serving and that therefore linking up with social services will be more challenging.
We feel that although cutting the budget for sexual health may achieve the short term budget savings CCGs have been asked to make, this policy is likely have wider consequences for our most vulnerable individuals, leaving them even more at risk.
Competing interests: No competing interests