Speakers' Corner - This month's personal view comes from Dr Sebastian Kalwij.


Dr Sebastian Kalwij has been involved with the Chlamydia screening programme in Lambeth, London, as GP Lead, since 2005 and as GP Lead for the National Chlamydia Screening Programme from 2009-2011. Additionally he has written the recent e-learning module on Sexual Health in Primary Care for the RCGP. 

Being involved with Chlamydia screening at a National level I realised that though some Public Health targets are justifiable they are not always easy to implement. There are so many hurdles to overcome on a practical level. From using the right sample (urine vs self-taken swab) to using the right test request form, EMIS coding problems, laboratory feedback, patient management and partner treatment. On top of that the GP-landscape has changed dramatically.

Perhaps in the future this could be commissioned in a different way. Looking at the work done by GPs in Lambeth, primary care is certainly the right place to offer Chlamydia testing. GPs in Lambeth test more patients for Chlamydia than anywhere else in the country. Positivity rates remain high. The mantra; if you dont look, you dont find is certainly true. Over the years I followed my patients who were tested positive for Chlamydia trachomatis and though it is easy to treat, the after effects can be far reaching. Many a relationship has been destroyed because of it. One of my patients developed reactive arthritis in her knee and had to give up her career as a hairdresser.

Motivating GPs and Nurses to test more patients on top of an already busy working day can be difficult, especially as it is not part of QOF, and I tried to come up with something novel. I find writing fiction a good way to de-stress in the evening and I decided to write a medical story ‘Supercharged’ around Chlamydia screening, soon it developed into a medical thriller. Perhaps a work of fiction can convince more people than merely presenting the facts.

Motivating GPs and Nurses to test more patients on top of an already busy working day can be difficult, especially as it is not part of QOF, and I tried to come up with something novel. I find writing fiction a good way to de-stress in the evening and I decided to write a medical story ‘Supercharged’ around Chlamydia screening, soon it developed into a medical thriller. Perhaps a work of fiction can convince more people than merely presenting the facts.

book cover

Sexual Health is broad term and defined by the WHO in 2006 as: “…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”

From the definition it follows that most GPs will deal with most aspects of Sexual Health frequently.

 

In day to day practice Sexual Health means the following:

  1. Contraception. Negotiating the right contraception for each individual patient depends on many factors; age, BMI, smoking history, one’s stage in a relationship, interactions with medications and concurrent medical conditions. The right choice of contraception may change during a patient’s life too as personal circumstances change. Those at an increased risk of STI’s will need condoms in addition to their LARC or oral contraceptives (Double Dutch).
  2. Sexually Transmitted Infections. The list of STI’s is long, ranging from Scabies,Trichomonas, Gonorrhoea, Herpes and HPV to Hep B and C, Syphilis and HIV. In some cases patients may not always be aware of any symptoms whilst others, like herpes may present in a dramatic way. These consultations are never straightforward. You have to deal with the infection itself, sequelae, partner treatment and the impact it has on a patent’s relationship. When an infection has been aquired abroad you will have to discuss the right treatment with a microbiologist. Some infections are transient or easy to treat but others just change your patient’s life forever.
  3. Chlamydia screening. This should be offered to all patients < 25 who are having sex. The National Programme was rolled out in 2004 and since then millions of young people have been tested and treated. Chlamydia positivity remains high. In some areas as high as 8%. Chlamydia has been linked to PID, Tubal Factor Infertility, miscarriage and Reiter Syndrome. Tests are best offered opportunistically during a consultation. Treatment of Chlamydia is with a stat dose of Azithromycin.
  4. HIV testing in high risk areas. In areas of the UK where the HIV prevalence exceeds 2 in 1000 population (most inner city boroughs) routine HIV testing is recommended. 50% of HIV transmissions are from patients who are undiagnosed. As anti-retroviral medication is very effective, a near normal life-expectancy is achievable. But early diagnosis is the key and GPs must look out for so-called indicator signs.
  5. Sexual dysfunction, vaginismus, erectile dysfunction, sexual violence, FGM, sexual orientation and gender dysphoria. This is a broad field and GPs must make themselves familiar with secondary care referral pathways, support and save-havens. In some occasions liaison with adult and children social services or the police will be needed.

 Issues related to sexual health carry a stigma and some patients have to pluck up courage to discuss this. When they do, it is important to be non-judgmental and have an open attitude.

Last updated : 17 Sep 2015

 

Department of Health and Social Care rejects merger of Community Health Partnerships and NHS Property Services (19 Feb 2018)

The Department of Health and Social Care (DHSC) has rejected the proposed merger between NHS Property Services (NHSPS) and Community Health Partnerships (CHP), which was one of the recommendations of...
Read more »

Tips on submitting childhood immunisations (0-5) data to Open Exeter (19 Feb 2018)

At our recent finance event for GPs and practice managers NHS England London’s vaccinations and immunisations team gave the following advice to practices when submitting their childhood immunisations (0-5) data...
Read more »

Tips of the Month February 2018 (16 Feb 2018)

We provide weekly tips based on common queries which come through to us from London GPs and practice teams. These are shared via social media and collated for...
Read more »

General Data Protection Regulation (GDPR) – further guidance now available (16 Feb 2018)

The Information Governance Alliance (IGA), which includes the Department of Health, NHS England, NHS Digital and Public Health England, is in the process of producing guidance for GDPR ahead of...
Read more »

Practice resources for children and young people (16 Feb 2018)

Healthy London Partnership (HLP), brings together London CCGs, NHS England and other partners to assist with the delivery of better health and care for all Londoners. HLP has a range...
Read more »

Contacting the NHS England London premises team (16 Feb 2018)

At our recent finance event for GPs and practice managers, Sian Clapton from NHS England London’s premises team, provided us with contact details for the team. Any issues relating to premises...
Read more »

MP visit - Chuka Umunna meets with Lambeth LMC (16 Feb 2018)

On Friday 29 January 2018 members of Lambeth LMC met Chuka Umunna MP at the Exchange Surgery in his Streatham constituency. The LMC members covered the challenges around recruitment, retention...
Read more »

Influenza and the annual vaccine ordering challenge for practices (16 Feb 2018)

Kenny Gibson, Head of Public Health Commissioning (London) and NHS England London’s lead on flu vaccinations shares his tips for anticipating the cycle of winter illnesses and getting the best...
Read more »

It’s election year at Londonwide LMCs - make your voice heard (16 Feb 2018)

This year every LMC seat is up for election. Any GP working in one of the 27 London boroughs we represent may be nominated for election regardless of their contractual...
Read more »

Discount rates for flu vaccines for winter 2018 through Londonwide LMCs' Buying Group (13 Feb 2018)

Many practices are starting to plan for winter 2018 and are pre-ordering their flu vaccines. Londonwide LMCs' Buying Group, through our buying partner MidMeds, has negotiated a specially discounted rate...
Read more »
Next Page »
« Previous Page