Most people self-refer for GUM care. Sexual health services are open access, enabling people to attend any clinic, independent of local authority of residence, or location of GP. People may choose to access a service away from their home for reasons of confidentiality or convenience (for example, proximity to work). Prevention of onward transmission of STIs requires rapid access to comprehensive sexual health care with the aim being to offer access to sexual health services within 48 working hours of contacting a GUM clinic. Increasingly, the demand for services is being met by the use of digital online services, booked appointments and walk-in sessions, with many providing late evening and Saturday clinics to facilitate access. With ever-increasing financial constraints on local authority public health budgets (in England), alternative methods of accessing STI testing are being encouraged, in particular on line testing for patients without symptoms. These require careful evaluation to ensure those at highest risk of sexual ill health continue to benefit from comprehensive, holistic sexual health care to minimise the risk of onward transmission, and future acquisition of STIs.
Online self-testing kits for STIs and HIV are increasingly available from both NHS (free of charge) and private providers (for sale). The rise in availability and popularity of home testing and home sampling kits requires careful governance. NHS providers ensure individuals using these methods of screening are rapidly linked in to GUM services and primary care through self-referral for appropriate treatment, safeguarding, support, partner notification, testing for other STIs and risk reduction/health promotion messages. Private providers may signpost individuals to NHS GUM services, primary care and pharmacists but unlike within the NHS there is no robust audit trail. Specialist GUM services are ideally placed to provide the ancillary support that a positive test, taken at home, necessitates.
Outreach services provide easier access to STI and HIV testing, usually for specific patient groups (eg teenagers) and usually located close to where users of these services spend a lot of their time (eg school-based outreach clinics). This person-centred approach is fundamental to the ethos of accessible GUM service provision.
Referrals to GUM are also made via primary care, secondary care providers (eg A&E, maternity services, gynaecology, rheumatology, ophthalmology), and other providers (eg sexual assault referral centres, drug and alcohol services, pupil referral units).