Aims of the national strategy for sexual health and Hiv Dh 2001

  • reduce the transmission of HIV and STIs
  • reduce the prevalence of undiagnosed HIV and STIs
  • reduce unintended pregnancy rates
  • improve health and social care for people living with HIV
  • reduce the stigma associated with HIV and STIs

Table l Levels of practice (DH, 2001)

Level One

Level Two

Level Three

Sexual history and risk assessment STI testing for women

Assessment and referral of men with STI symptoms HIV testing and counselling Contraceptive information and services, including cytology screening, pregnancy testing and referral Hepatitis B immunisation

All of Level One plus:

Intrauterine device (IUCD) insertion, vasectomy, contraceptive implant insertion

Testing and treating sexually transmitted infections, including partner notification and invasive STI testing for men

All of Levels One and Two plus:

Outreach for sexually transmitted infection prevention Outreach of contraception services

Specialised infections management, including co-ordination of partner notification

Highly specialised contraception

Specialised HIV treatment and care

Plans exist to increase access by providing a choice of easily available services and exploring the benefits of more integrated sexual health services, including piloting of one-stop clinics. If these mirror the format of NHS walkin centres, they may well be nurse-led. The sexual health strategy states that:

'The growing role of nurses within the NHS generally is likely to be mirrored in sexual health practice' (DH, 2001, p. 46).

The strategy placed great emphasis on the importance of open access to genito-urinary services and, over time, improving access for urgent appointments. This is at a time when sexual health services especially are at breaking point. Open-access services are changing to appointments-only to better manage their ever-increasing workload, which has the knock-on effect of limiting access. Walk-in services commonly now shut the doors early because of the large volumes of service users, and four-hour waits are common. For departments to work shorter waiting times for urgent appointments and increasing access they will have to make better use of nurses' skills and abilities, and the strategy acknowledges this:

'Nurses will have an expanded role... as specialists and consultants' (DH, 2001, p. 26).

According to the position statement from the London Standing Conference for Nurses, Midwives and Health Visitors (Sexual Health Group) (LSC, 2002) an estimated 65 per cent of London departments of GUM already have nurses providing autonomous, first-line STI management.

This raises implications for the training, development and education of the workforce, which it plans to address across the whole range of sexual health and HIV services:

'The development of nurse referral and prescribing, and of nurse specialists and nurse consultants, raises issues for their training and ongoing education.' (DH, 2001, p. 46).

Currently, there are no specific advanced practice Genito-urinary nurse practitioner courses: therefore how will nurses acquire the skills and knowledge to achieve the objectives of the strategy? Also, since the demise of the Boards of the four countries there is no single recognised validating body for nursing courses. This leaves us with many inconsistencies; for example, each university may offer a variety of sexual health courses with varying content and assessment methods.

The NMC's consultation document suggests that this type of practice is clearly advanced: therefore will all practice nurses who deliver level one services need to undertake a Master's degree in order to implement the strategy? Will Genito-urinary nurses working at levels two and three need to be advanced nurse practitioners? Or is this really specialist practice? As we can see, there are many questions still to be answered.

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