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.

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.

HIV Treatment Charging Harms

posted: 28/06/2010

The UK rules that mean some migrants have to pay for HIV treatment are harming the health of migrants and the UK public, says a new study in the journal AIDS Care.

The study of African migrants with HIV in London found some migrants delay taking HIV tests, some only go for HIV treatment when they are so sick they need an ambulance to take them to hospital, some use herbal treatments that don't work, and others send abroad for HIV drugs but don't take enough of these.
 

Findings and the government review

This Wednesday the government ends its public consultation on changing the rules and guidance about who has a right to free NHS treatment. Anyone who has a sexually transmitted infection (STI) or an Infections Disease always has a right to free treatment, but not if they have HIV. The proposed new rules and guidelines still bar some migrants from automatic free HIV treatment. While asylum seekers and those with leave to remain are entitled to free care in NHS hospitals, refused asylum seekers and undocumented migrants, including pregnant women with HIV, among others, are sometimes handed very large bills for HIV and other medical treatment.
 

The researchers interviewed HIV-positive migrants from Zimbabwe, Zambia and South Africa who live in London. 70 people took part in eleven focus group discussions.
 

Problems getting a GP
Even though there is no law stopping migrants from having a GP or free primary care, people said they had problems even registering with a GP. They are often asked to show documents that they do not have (for example, their passport – these are often held by the Home Office / UK Borders Agency because they are making an asylum claim or other application).
 

Waiting until you need an ambulance
The law says all treatment in a hospital Accident & Emergency department is free-of-charge for everyone. Many people in the survey knew this, and said they did not try to get treatment until their condition was so serious that an ambulance was needed. One man said:
“You would rather wait for a situation where you get taken to hospital by ambulance because even if you walk in they want to know who is your GP. And if you don’t have one they become very suspicious.”
Accident & Emergency (A&E) treatment is extremely expensive to provide. Moreover, in most cases, the person then needed immediate HIV treatment and a lengthy stay in hospital.

The rules say if you are admitted to a hospital ward after A&E, or are referred to another department (eg the HIV clinic) then you will be charged; but HIV treatment should always be provided because it is 'immediately necessary.' If you can't pay the bills, the hospital will have to cancel the debt anyway.

Some people had received bills for several thousand pounds for hospital admissions, surgery and treatment. The researchers found that these experiences often affected people’s feelings toward health providers.
 

In hospital but fearing bills and immigration
People who were entitled to free NHS care feared intrusive visits from immigration and hospital officials. For example one woman who had been recently diagnosed with HIV received a bill for hospital treatment:
“I was worried how am I going to pay this £4000? So what kills you first is the stress and worry . . . I found myself thinking if I did not have indefinite leave to remain in this country then what would I do?... You’d just try to go away, you’d remove the drip and run away from there before immigration got there.”
 

Do it Yourself treatment
Some people said they treated themselves. Some sent for drugs in their home countries, but said they took too few pills for them to work properly, for example. Some had depended on herbal remedies and other alternative treatments, and sometimes delayed taking a HIV test until it was clear herbal and alternative treatments were not working. One woman said:
"There are some people who do not have papers in this country, who can’t have access to a GP or a hospital and they have to rely a lot on the traditional medicines."
Although HIV testing is free for all (on public health grounds), HIV treatment is not. People said this discouraged others from HIV tests:
“If I cannot access services, then there is no reason for me to test. If I test and I know I’m HIV-positive, I know it will be very difficult to access [treatment].”

The researchers end by saying that current policies for charging some migrants may appease a part of the UK electorate but act as a barrier to the uptake of HIV testing and treatment. Moreover, these policies are pushing some people to resort to other forms of treatment that may be costly, harmful or ineffective. As well as having implications for the health of individuals, the policies are likely to have an impact on the onward transmission of HIV.
 

Campaigning for free HIV treatment for all
This Wednesday the Department of Health closes its public consultation on planned changes to the rules and guidance for free NHS treatment. This does not include adding HIV to the list of sexually transmitted infections and infectious diseases that would mean free treatment for everyone. George House Trust and the HIV sector are campaigning for free HIV treatment for all.

Source and reference 
Thomas F et al. ‘‘If I cannot access services, then there is no reason for me to test’’: the impacts of health service charges on HIV testing and treatment amongst migrants in England. AIDS Care 22: 526-531, 2010.

HIV and Your GP Survey

posted: 02/12/2009

HIV positive people are collecting views on the GP service, your 'family doctor'. Please take a few moments to fill in this survey. It should take less then ten minutes to complete. They do not ask for any personal information, only your post code, if you are happy to give that.

This survey has been compiled by HIV positive people and is to help understand people's relation-ship with their GP and how you would like to see the GP and other Primary Care services change and grow.

Take part in the survey here - all the questions are plain to see on this page

The Forum Link Project is an associate member of HIV Europe and the United Kingdom Community Advisory Board for HIV.