Guide for GPs About HIV

posted: 19/05/2011

The popular booklet HIV in Primary Care has a brand new edition ideal for the many GPs unfamiliar with HIV, to help GPs provide high quality care for people living with HIV.

Tell your GP to use this
People living with HIV can help their GP provide better healthcare by telling them about this booklet – it is free to download from MedFASH, or doctors can buy a copy for only £10.

Diagnose and Test

With over a quarter people with HIV in the UK still undiagnosed, the new booklet HIV in Primary Care will help doctors and practice nurses to consider HIV as a possible diagnosis and to test new patients. Testing all new patients is advised in the UK National Guidelines for HIV Testing, which recommend the routine offer of HIV testing for patients with certain conditions or risk factors, and particularly in areas such as Greater Manchester and Blackpool, where HIV prevalence is high.

Better care for patients with HIV

GPs can also help improve their services accessible to people living with HIV by reassuring patients about confidentiality in their practices and by making links with local HIV clinics.

As well as covering testing, the booklet also offers up-to-date information on primary healthcare for patients with HIV, covering day-to-day issues such as contraception, immunisation and cervical screening, as well as side-effects of HIV antiretroviral drugs and potential drug interactions.

GPs who have traditionally not had any or much contact with patients with HIV will see more people with HIV in their surgeries for non-HIV-related problems, because HIV clinics are no longer providing general medical care.

Doctor says
Dr Surinder Singh, a GP from Deptford in London and co-author of the booklet, said: “With the move toward shared care models for people with long-term conditions, GPs will undoubtedly find themselves dealing with people with HIV. In fact it is no more difficult than managing patients with diabetes. The essential element is trust. Ensuring that patients feel confident to disclose their positive HIV status is key, and we hope this booklet will give GPs the information they need to feel confident to provide primary care for HIV-positive patients. Remember that the local HIV specialist unit is available to answer questions from GPs.”

Over 25,000 copies of the first edition of HIV in Primary Care have been distributed since its launch in 2004 and it has received excellent feedback from users.

Getting HIV in Primary Care booklet

Copies can be obtained from MedFASH at £10 per copy, or it can be downloaded free of charge  from MedFASH.
 

The direct download link is here

HIV in Primary Care: an essential guide for GPs, practice nurses and other members of the primary healthcare team by Dr Sara Madge, Dr Philippa Matthews, Dr Surinder Singh and Dr Nick Theobald.

Drs Matthews and Singh are practicing GPs, Drs Madge and Theobald are HIV specialists with a background in general practice. All the authors are involved in GP education.

Charging Migrants for HIV Treatment

posted: 04/04/2011

The government has said it will soon change the rules about charging people from abroad for most treatment at NHS hospitals in England. At the moment the rules do not affect many people in North West England with HIV but that is likely to change. New Rules will probably appear in June.

The government has also announced another, bigger review of NHS charges. This will look at anything and everything and is intended to save the NHS a lot of money.

The next step is the department of health will publish the new rules for NHS hospital and clinic charges and guidance quickly – probably before June.

They have just published their response to a public consultation so now we know something about what the new rules from June will probably say. George House Trust gave evidence and comments to this consultation.

The Department of Health's plans for the June rules are 

• They won’t change which treatments will be charged for yet – but may do so later.
• The rules will be changed to make it clear that refused asylum seekers who get Section 4 and Section 95 payments do not pay for NHS treatment
• Unaccompanied children will no longer have to pay, but children with parents here can be charged
• They will make clear in the new rules that anyone who has begun HIV treatment that is free of charge (e.g. because they have an asylum claim which has not been finally decided) will continue to receive free HIV treatment
• They will keep putting up posters about charging for treatment in hospitals and clinics, even though they know this frightens some people that need treatment away and can lead to discrimination by hospitals
• They will change the guidance that tells doctors to think about the cost of treatment, because this encourages discrimination
• They will start a new system of telling the UK Borders Agency about the people who owe the NHS money. This will mean people will be refused permission to stay longer, applications for citizenship may be refused and people will be refused a visa to return to the UK if they leave
• They will consider introducing a rule that will force visitors from overseas to have health insurance
• They will look at charging people for primary care (treatment by family doctors)

Free HIV treatment for all?
The Government still has not decided whether to make HIV treatment free for everyone who needs this on public health grounds, like for all other sexually transmitted infections. They say they are still considering this and will report “in due course”.

Next, an even tougher review
They have also announced another major review which is designed to save the NHS a lot of money. This will look at

• Changing the residence rules, including the definition of ordinary residence
• Changing some or all of all the types of treatment and types of people who do not have to pay for NHS treatment
• Making people pay for primary care (that is treatment by family doctors and dentists)
• Changing which bit of the NHS has to pay when people cannot pay
• Making the procedures for checking who should pay tougher before treatment begins
  Making the procedures for collecting charges tougher
• Using new ways to collect charges 
• Requiring migrants to have health insurance 
• They will consider anything and everything else.

They try to soften this tough new cost-saving review by saying “the NHS is, and must remain, ultimately a humanitarian organisation. In undertaking the review, we will be mindful of the NHS’s core values, in particular its obligations to provide urgent treatment to any person irrespective of their status or ability to pay, to protect the vulnerable and respect our obligations on healthcare provision under international treaties . There is no intention to consider policies that would deny access to any group, only whether an individual should be charged. It will consider the full benefits and costs of introducing new charges including risks of deterred or delayed treatment and any other societal costs. In addition, we will ensure that public health considerations are fully factored into proposed rules and processes (ensuring in particular that access policies do not compromise the identification and control of infectious diseases).”

A comprehensive package of confirmed proposals will be put to full public consultation on completion of the review work, in 2012. We may consult separately at an earlier stage on some options, such as primary care charging.
 

You can read the details of the government's proposals for the June regulations and this new review here. The new review details begin on page 24. 

Proposals and Review report

Better Primary Care for HIV

posted: 11/02/2011

How should HIV clinics and GPs work together caring for people living with HIV, when HIV clinics look after the HIV, and the GP is responsible for general healthcare? Lots of people with HIV, GPs and HIV doctors find this split rather clumsy. Two central London NHS Trusts asked Positively UK to investigate what people want and how we can make things work better.

Their report gives Manchester as one example of how to offer better primary care for people with HIV.
 

Manchester Primary Care Trust did this by introducing compulsory HIV awareness training for GPs and offering guidelines about disclosure and confidentiality. It made this a compulsory part of every GPs contract.

Another way of improving GP care for people with HIV is being used in Brighton. There they didn’t try compulsion, but invited GPs there to sign up to offer a Local Enhanced Service (the doctors are paid extra for this) where there is HIV training, see a minimum number of HIV+ patients, and carry out some extra health tests and checks.

This Positively UK study surveyed people with HIV, primary care staff and HIV clinics about what would help patients make the change from using the HIV clinic for everything, to using a GP for day to day, non-HIV healthcare. The report includes these 15 recommendations.

15 suggestions for action and improvement

• Increase people with HIV’s use of primary care by providing services in new ways 
• Provide short training sessions for all general practices to raise awareness of HIV, patients’ concerns and to boost practice confidence
• Introduce enhanced GP services for HIV using a 2-day training course and annual update training
• All staff (including receptionists) of practices that offer an enhanced service for HIV must attend HIV awareness training
• Develop quality standards on the basic information GPs should gather on patients’ HIV health and medications; increase standard length of appointments for patients living with HIV; agree protocols for protecting patient confidentiality
• Incorporate these quality standards into the existing GP Quality Outcomes Framework, to help implementation and monitoring of progress
• Provide enhanced HIV services to patients outside the practice catchment area where people with HIV have no local practice offering an enhanced HIV service
• Encourage practices already offering an enhanced local STI service or HIV testing to extend this by offering an enhanced HIV service
• PCTs consider providing primary healthcare for people with HIV in any ‘one-stop shops’ that are developed
• Base a GP at HIV clinics to offer short-term primary care as a step to using a local GP for primary care
• Consider how to manage the transfer to primary care of people using clinics in another PCT district
• Provide a ‘hotline’ at HIV clinics for GPs with concerns about HIV patient care
• Use the CQUN standards as a basis for routine sharing of information between HIV clinics and General Practice
• Following past recommendations appoint a nurse specialist and community lead as ‘champions’ to promote good practice and care shared between General Practice and HIV Clinics
• Provide information for people with HIV about finding a GP, patient rights and telling the doctor.

Primary Care Access: GPs responding better to the needs of people living with HIV – executive summary and recommendations
 

Primary Care Access full report and recommendations 
 

free to download HIV in Primary Care book from MedFash

GP Guide - Migrants' Health

posted: 26/01/2011

The Migrant Health Guide is a free new online “one stop information shop” for GPs and practice nurses who are working with migrants.

It comes from the Health Protection Agency who have produced it because migrants health needs are often more complex than for other people. HIV is included.

The online guide gives doctors and nurses easy access to the facts, so they can improve their patients’ care and quality of life.
 

Although most migrants to the UK are healthy, TB and HIV and other conditions are more common.

The guide supports diagnosing and managing a range of typical migrant health conditions. Early diagnosis and prompt treatment of HIV and other conditions is important for the health of the individual and to reduce onward transmission.
 

Produced by experts working with primary care practitioners, it comes with the blessings of the Royal College of General Practitioners and the Royal College of Nursing.

Key Recommendations

• Know your local migrant population and their rights to care
• Teach patients how the NHS works
• Assess new patients using the checklist and their country page
• Vaccinate and immunise as normal
• Watch and test for infectious diseases and conditions typical of their country
• Check and advise on any plans to visit friends and relatives abroad.

The Migrant Health Guide has

• detailed information for each country
• tools for assessing migrant patients – new patients, patients with symptoms, identifying more vulnerable patients
• how to talking about the NHS with migrants – explaining it, migrants rights to treatment, languages and interpreters, cultural awareness
• sections about migrant health conditions (including HIV), infectious diseases, vaccinations

Migrant Health Guide

HIV in Primary Care : The best HIV guide for GPs and primary care is (free download) HIV for non-specialists, by MedFash.

What Clinics Will Now Prescribe

posted: 10/12/2008

From 1 January 2009 prescribing at HIV clinics in Greater Manchester will change. The HIV clinics will then only prescribe HIV drugs and those for their side effects.

All other medication - for depression, sexual dysfunction, skin conditions, everything else - will have to be prescribed by a GP.

Here are the details sent to us by Greater Manchester Sexual Health Network.

Medicines for hospital prescriptions for HIV+ve patients
On 1 January 2009 all clinics providing HIV care for HIV+ patients will stop prescribing primary care medication. This is because it is not clinically safe to continue to do so and it is important that all patients, regardless of their diagnosis, are treated equitably and access primary care medication through a GP.
 

Drugs that will be prescribed by GU and HIV clinics include:

• All antiretrovirals
• Prophylactic antibiotics (Septrin, Dapsone, Atovoquone, Pentamidine etc) plus other drugs for opportunistic infection treatment (Valganciclovir, TB/MAI therapy etc.)
• Antifungals
• Aciclovir/Valaciclovir
• Antiemetics and antidiarrhoeals (e.g. Metoclopramide, Loperamide)
• Short term and/or urgent prescriptions (including antibiotics) on hospital outpatient scripts or FP10s if medicines are needed out of hours
• Contraception as usual 

Clinical colleagues should continue to encourage patients to register with a GP and to disclose their status to their GP. This will enable GPs and GU consultants to share information about patients care.

Primary Care Working Group of Greater Manchester Sexual Health Network                              Version 1.3 (5 December 2008) Review date: June 2009 Enquiries to: 0161 219 9468

Problems with prescribing?

If the new prescribing arrangements are causing you problems please contact our services team support@ght.org.uk or by phone on 0161 274 4499