Genitourinary medicine has two main specialist societies: the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) which ensure that there are comprehensive evidence-based guidelines and standards for genitourinary medicine and HIV. The two organisations work in partnership and have close ties with the Faculty of Sexual and Reproductive Health and the national public health bodies in the devolved countries.
The BASHH Clinical Governance Committee (CGC) is the advisory platform for ensuring high-quality services in connection with sexually transmitted infections for the UK.
The CGC is responsible for:
- the implementation of strategies and policies of BASHH approved by the governing board
- setting and monitoring standards and specifications and updating them in response to best practice
- identifying areas of best clinical practice within individual clinics or regions and promoting them for adoption where appropriate while recognising local differences.
The CGC also supports clinicians and services, exploring solutions to issues through discussion and shared experiences at committee level allowing action plans to be suggested. It coordinates a peer review system, on a local basis within each region across the UK, as required or in response to a member's request.
The CGC has several subcommittees:
- Clinical Effectiveness Group – responsible for developing guidelines
- National Audit Group – responsible for national audits
- Clinical Standards Unit.
The following service standards are currently in place and most can be accessed via the BASHH website:
- Standards for HIV clinical care (opens PDF, 1.73MB) produced by BASHH and BHIVA (November 2007)
- Standards for the management of sexually transmitted infections (STIs) BASHH and MEDFASH (2014)
- BASHH Recommendations for Core Service Provision in Genitourinary Medicine (opens PDF, 70KB. December 2005)
- Guidance on the Retention and Disposal of Hospital Notes
Public and patient involvement
BASHH has several initiatives to improve feedback about delivery and development of sexual health services, and to educate the general public about sexual health. It has a very proactive public and patient engagement group. The BASHH Public Panel includes members of the public, representatives of sexual health voluntary sector organisations, young people’s groups and sexual health professionals. It offers lay opinion on clinical guidelines, audit proposals and related public material and leaflets. Their webpage includes multiple patient and public engagement (PPE) resources.
A questionnaire to assess satisfaction with genitourinary medicine services has been developed. The questionnaire is based on five main themes identified following a systematic review, focus groups and individual patient interviews. The survey has undergone cognitive testing and piloting to assure validity in a GUM clinic setting.
BASHH National Audit Group
The National Audit Group (NAG) carries out audits of clinical practice in sexual health/genitourinary medicine clinics against the BASHH Clinical Effectiveness Group (CEG) National Guidelines. It also responds to requests for national audits on HIV-related topics by the British Association of Sexual Health and HIV. Participation in these audits is important for service quality assurance and to provide practitioners with data for performance review, as well as fulfilment of the GMC requirement of completing an audit cycle within 5 years.
All genitourinary/integrated sexual health clinics provide timely data regarding patient attendance, incidence and prevalence of all STIs and HIV. Each nation produces yearly reports via its respective health protection/public health body.
Accessing data for quality improvement
All services in genitourinary medicine submit regular returns for STI epidemiological monitoring to a central organisation, typically on a quarterly basis, to feed into datasets and annual reports. Specialty-specific datasets and tools to inform service development are available from Public Health England, Public Health Wales, and the Information Services Department for Scotland.
In England, the Public Health Outcomes Framework includes two targets relevant to this specialty:
- a reduction in chlamydia diagnoses in 15–24 year olds
- fewer people presenting with HIV at a late stage of infection.
There is an online tool that tracks performance on these targets.
The BASHH National Audit Group organises an annual audit on an agreed topic or disease specific area and returns are collected and analysed centrally.
BASHH has a regional structure with branches providing a network for clinicians to participate in regional educational events, audit presentations and peer support.