Scrubbing Up: Is anonymous sexual health care being damaged?
Doctors, nurses and the entire medical profession are bound by confidentiality when they treat you - but there are even stronger rules to protect the anonymity of patients in sexual health clinics.
In this weeks's Scrubbing Up, two experts argue that changes to the law could damage this relationship and leave fewer people seeking treatment.
What would you do after a one-night stand, if you were worried you'd contracted a sexually transmitted infection (STI)?
What if you knew that any test you took would appear automatically and immediately on your patient records?
Any doctor, however irrelevant to their practice your sex life might be, could see intimate details of your personal affairs. Is it really appropriate or necessary that your family doctor should know you once had a test for gonorrhoea?
Thanks to current UK legislation, this isn't a problem you would have when accessing NHS sexual health or Genitourinary Medicine (GUM) clinics. This is because they assign unique identification numbers to attendees which are entirely separated from general medical records and NHS numbers.
There is no need for such cases to be recorded in full view of family doctors”
An oversight in the recent Health and Social Care Act is set to alter this status quo, however, and remove the requirement for STI Clinics to hold their data on separate stand alone systems.
The clinics may then be expected to use the standard general NHS number. This will have the effect of notifying your GP, and any other NHS care providers you may consult in the future, of your STI history, diagnoses and treatments.
The NHS already has very strict confidentiality rules, and our concern is not that these will be broken by the people caring for you, but that the legislation no longer exists to enable you to choose a service whereby your records remain anonymous and confidential.'No need'
Many STIs can be diagnosed and treated on a single visit and will not require medical care.
In our view there is no need for such cases to be recorded in full view of family doctors.
Indeed, surveys we have undertaken at our own clinics suggest that the removal of anonymity and confidentiality in this way would significantly reduce attendance, with all the negative impacts on prompt diagnosis and treatment.
Our aims must be to see, treat and trace partners in as speedy a manner as possible and to protect personal wellbeing whilst also preventing onward transmission.
If we don't plug the hole in the current Act, we may drive health-seeking behaviour underground, and ultimately contribute to an increase in the spread of infection.
NHS sexual health care is quite unique. We enjoy a very tight network of clinics all working to standards set by our professional bodies.
Clinics provide high-level data on diagnoses and treatment outcomes of the conditions we see - something GPs or private health providers are not required to do.
There is central co-ordination and analysis of epidemiological statistics linked with laboratory and outcome data. We therefore benefit from the wealth of data which is the envy of the world.
Thanks to this, we can currently track outbreaks of infections and trends in antibiotic resistance. If losing anonymity and confidentiality dissuades people from attending sexual health clinics, or forces them into a private sector with no obligation either to record the visit or report the resultant data, our ability to fight STIs and HIV will be damaged.Special case
On the other hand, there are good reasons why, in the case of HIV, we should be trying to break down the walls between the sexual health clinic and the GP practice.
HIV should now be regarded as a chronic medical condition. People living with HIV require hospital monitoring, but considerable support is also provided by primary care physicians.
They take complex antiretroviral drugs which can interact with a number of over-the counter and commonly prescribed medicines.
Any reforms must achieve just that: building on what we have achieved rather than dismantling it”
Asking GPs to care for individuals when they do not have access to their full records is dangerous and presents a significant health risk.
Not only that, but our success in finding better treatments for HIV over the last ten years means that many people with HIV are living longer - and will naturally develop conditions best addressed by their GP rather than an HIV specialist.
Once diagnosed, then, we believe it makes sense for HIV patients to use their generic NHS numbers.
Recognition of the huge benefits testing brings will only be fully realised when more GPs and hospital doctors look after patients infected with HIV. As we aim to normalise HIV testing and care, easing of confidentiality rules with regards to diagnosed cases of HIV may help us to achieve that goal.Dismantling
The choice of access for the testing and treatment of STIs, then, must be as wide as possible. The tried, tested and hugely successful STI clinic system provides a valuable and valued service.
Thanks to routine testing the majority of new cases of HIV each year are currently diagnosed via this system. We must maintain this high level of testing and build on it, to make testing much more widely available in both primary care and community settings.
Any reforms must achieve just that: building on what we have achieved rather than dismantling it.
We therefore urgently need to amend the Act, lest we stray too far from our aim of allowing and encouraging public access to free, anonymous, confidential and timely treatment for STIs, with the ultimate goal of protecting the public health.