Staff training in integrated sexual health services.

T he move towards integration of family planning and genitourinary medicine (GUM) services (that is, the reorganisation of the two specialties, strategically and in terms of setting, in a more client centred approach) has recently been gathering momentum in the United Kingdom. Providers of family planning services are increasingly being urged to adopt a broader remit in respect of their clients’ needs for STI and HIV prevention and treatment, as are providers of STI services in respect of their clients’ contraceptive needs. Although fully integrated sexual health services are still comparatively rare, a growing number of family planning services provide STI diagnosis and treatment and a growing number of GUM clinics provide contraceptive services. 3 The trend may be accelerated as a result of the government’s sexual health strategy, in England. The systematic evaluation of three pilot ‘‘one stop shops’’ is likely to provide more robust evidence on the acceptability and effectiveness of integrated services which, if favourable, could provide the impetus to further expansion. In theory, the case for an integrated approach to sexual health service provision is compelling. Control of fertility and of sexually transmitted infection share common characteristics. The choice of contraceptive method may have implications for transmission of infectious agents and the presence of infection has consequences for fertility. The two services also share potential clients. Studies of GUM clinic attenders have shown a high proportion to be at risk of pregnancy and studies of family planning clinics attenders show sizeable proportions to be at risk of infection. 10 11 There is also evidence that service users prefer a one stop service providing coordinated sexual health care. 12 13 Advocates of integration claim that coordination of family planning and GUM services has the potential to boost the effectiveness of both, broadening opportunities for screening and prevention, reducing duplication of services, providing continuity of care, and making maximum use of finite resources. 14–16 The shift towards a broader remit has, however, clear implications for training of personnel working in each of the two specialties. Broader based training is seen as an essential prerequisite to more holistic provision. Healthcare professionals in each of the specialties need at least a basic knowledge and skills of the other in order to provide a holistic approach to sexual health care. Insecurities relating to the prospect of taking on new working roles are commonly attributed to limitations of previous training and experience. Until recently, training has not been conducive to integration. 18 Anxieties have been expressed that the move towards integrated care may be hindered by resistance from clinicians constrained by their training background. The evolution of integrated services clearly needs to take place in parallel with the training of those providing them. There are those who fear that the training plans may be jumping the gun, and that the organisational structures should perhaps remain unchanged until such a time that the staff are well enough equipped to run new integrated units. Yet the more commonly held view is that training is lagging behind, and so hindering the development of an integrated service. The move towards integration has been progressing faster than has progress towards the staff training needed to underpin it and this has been seen by some as a barrier to introducing STI services into family planning.