By Gus Cairns
www.guscairns.com
19 February, 2007
Over a third of UK HIV clinic health workers, 40% of them in London, report that prescribing restrictions for HIV were either already in place, or have been discussed, a recent report by the Terrence Higgins Trust (THT) has found.
The survey also found that only 37% of £300 million extra funding specifically directed at STDs, HIV and pregnancy is actually being spent on sexual health; the rest of it is being diverted away to other services by cash-strapped Primary Care Trusts (PCTs).
PCT commissioners and clinicians answered the survey.
Both said that although sexual health services had improved to some degree, and 55% said more money had been invested in sexual health last year, the only way to get a fully-funded service back on track was to ‘ringfence’ the money so that it couldn’t be spent on other things.
The fifth, Disturbing Symptoms report, now an annual event, was carried out by the THT in collaboration with the British HIV Association (BHIVA), the British Association for Sexual Health & HIV (BASHH) and the Providers of Aids Care and Treatment (PACT),
Responses to the survey were received from 65 out of the 152 PCTs in England (43%), which was the same number as last year.
However there was a big increase in clinicians responding, up from 88 in 2005 to 231 in 2006.
“It is notable that so many more clinicians wished to give us their views, and suggests that there is real strength of feeling about recent developments in sexual health and HIV services,” comments the THT.
There is some good news. Two-thirds of PCTs said that there had been an increase in ‘non-acute primary or community based’ sexual health services in your area in the last year. This means that more money is being spent on sexual health services in places other than traditional GUM clinics, and on prevention as well as treatment.
And one in three doctors said that the GUM or HIV clinic services they ran had improved in 2006, whereas in 2005, only half that number reported a positive change in access to their services.
However patient numbers have soared without there being an accompanying increase in staff numbers to cope with them. Four out of five clinics said patient numbers had increased in 2006, while less than one in five said staffing levels had matched that increase.
And the cost of sexual health, especially of HIV treatment, continues to escalate: 56% of clinics said they had overspent their drugs budget this year. This is, however, an improvement for last year, when two-thirds had overspent.
This may be due partly to the £300m of extra money, but is more probably due to the new system of ‘Payment by Results’ (PBR) in the NHS, in which each individual treatment and operation is costed and money strictly allocated on the basis of the numbers performed. This already applies to GUM services and will do so to HIV services from next year.
While some NHS experts think that PBR will benefit GUM and HIV services as there will be an incentive to treat MORE people, the majority are worried that the cost of treating an HIV patient will be pegged to that of the simplest cases, leaving little money to spend on patients with complex needs such as major drug resistance.
More clinics were meeting their 48-hour waiting list target, but, as we have already seen with GPs’ surgeries, basically by rationing appointments so that it is impossible to book more than 48 hours ahead anyway.
Lisa Power, head of policy at the Terrence Higgins Trust, said it was crucial people could easily access clinics.
"We know that of the people with sexually transmitted infections who have difficulty getting appointments, a third will continue to have sex," she said.
