Annual Report 2005 to 2006 V2 by iyb5e9

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									                          South West London
          HIV & GUM Clinical Services Network




                 “SWAGNET”



…working together for better
Sexual Health & HIV services

    South West London HIV & GUM Clinical Services Network
 A Joint Initiative of Adult HIV and Genitourinary Medicine Services
                                Provided at
    Kingston Hospital, Mayday Hospital, Queen Mary’s Hospital,
                 St George’s Hospital & St Helier Hospital




                         www.swagnet.org
          SWAGNET ANNUAL REPORT 2005 - 2006

Lead Clinician’s Report                                        3

Network Development Manager’s Report                           4

Background                                                     5

Internal Structure                                             5

Sector Liaison                                                 7

External Liaison                                               7

Communication                                                  8

Full Network Meetings                                          9


SUBGROUP REPORTS

      HIV Service Delivery Subgroup                            10

      GUM Service Delivery Subgroup                            11

      GUM Young Persons’ Subgroup                              12

      IT Subgroup                                              13

      Community Subgroup                                       14

      Sexual Health Promotion Subgroup                         15

      Research Subgroup                                        16


UNI-PROFESSIONAL GROUP REPORTS

      Administration & Clerical Uni-Professional Group         17

      Health Advisers’ Uni-Professional Group                  18

      Nurses’ Uni-Professional Group                           19

      Pharmacists’ Uni-Professional Group                      20

      Clinical/Counselling Psychology Uni-Professional Group   21

CONTACT POINTS                                                 22




                                        PAGE 2
LEAD CLINICIAN’S REPORT 2005 - 2006
SWAGNET has now been established for over four years. The work has continued to be busy
and rewarding. This report catalogues the numerous achievements of the Network over the
past year. SWAGNET truly stands out as an excellent example of partnership working in the
field of Sexual Health and HIV. Our structure, which facilitates the sharing of good practice and
modernisation, has enabled change to respond to the ever increasing demand for services.

Despite the increasing pressures facing our services, many achievements have been made
and these are largely due to the tireless efforts of the various SWAGNET Subgroups and Uni-
Professional Groups. With only minimal real investment we have continued to strive with
modernisation initiatives, sharing of good practice and have continued to develop clinical
guidelines. Our HIV services have been benchmarked against the MedFASH Standards and
we will continue to strive for greater clinical excellence.

There are many challenges ahead. Services will need to continue to work with their PCTs,
ensuring the investment for GUM services from ‘Choosing Health’ are allocated as intended by
the Department of Health. As the champions of Sexual Health and HIV services in the sector
we have a responsibility to ensure that all patients seeking care for Sexual Health and HIV
have high standards of service. SWAGNET looks forward to future community STI and HIV
testing initiatives in the sector.

Each GUM provider in this sector has strong links with their local contraception service
providers and there are numerous examples of innovative joint working between the two
disciplines. We are continuing to build on these strong links with family planning and
contraceptive services in the future.

We have also been fortunate to have a good relationship with SW London Strategic Health
Authority (SHA), Public Health and the specialised commissioning team. I would like to thank
then all for their enthusiasm and leadership. As the SHAs across London merge to form a
London wide SHA, it is likely that for this region, a SW sector approach to sexual health and
HIV services planning and commissioning will remain for the time being. Our challenge is to
continue to work together, building on trust and focus on partnership added value: how can we
achieve more or better results through collaboration?

From a personal perspective, I have been lead clinician for nearly 18 months and will retreat to
being an active subgroup member later this year. I would like to thank the SWAGNET
management team, Janine Railton and Chris Nash for their tremendous support and
enthusiasm. I am confident Richard Lau will provide the leadership required to see SWAGNET
into the future when he assumes his role as lead clinician.

Dr Mark Pakianathan
Lead Clinician, SWAGNET




                                             PAGE 3
NETWORK DEVELOPMENT MANAGER’S REPORT
SWAGNET, whilst having been established over four years ago, has only been a ‘managed’
Network for just over two years.
As the first Network Development Manager for SWAGNET, I have had the privilege of seeing it
develop into a stronger, more mature and well respected organisation. Reasons for this include
active leadership from Mark Pakianathan, who I have to thank very much, and the continued
‘behind the scenes’ advice and support from Paul Lister, founder and first Lead Clinician of the
Network, who I am sure is aware of my respect and undying gratitude.

Subgroup Membership has remained constant, despite staffing levels in all clinics being under
increased pressure. There has been a rotation of membership and all members have actively
contributed to discussions, decision-making processes and work plans.
Subgroups do not work in isolation, but information and ideas are shared. Particularly
encouraging is the enthusiasm of new staff to become involved in the work of the Subgroups.
This is shown in the IT Subgroup, with their work on HPA Reporting, linking closely with the
GUM Service Delivery Subgroup. Ideas generated from all the Subgroups have also been fed
into the Research Subgroup, who have welcomed them.

The Subgroups have also seen an interest in attendance from non-clinic staff and their
contribution has proved very useful and encouraged a more eclectic approach. Their
involvement has also resulted in closer working relationships with a number of organisations,
including the SHA, Specialised Commissioning, Public Health, Family Planning and Voluntary
Sector groups.
This year has seen a close working relationship with both the established and new Sexual
Health Networks and we have enjoyed the sharing of new ideas.

The reputation of the Subgroups is excellent. They have maintained very high standards and
as a result, greater numbers of staff have been requesting membership. Clinics are regularly
reviewing their representation, supporting rotation of members and nominating other staff
members to join. This allows for greater opportunities for personal and professional
development and ensures ongoing lively debate.

The Uni-Professional Groups have established an effective and responsive framework for
working practices, clinical governance and training. Particular development has been made
with in-house training, beneficial to all clinics, faced with severe study leave restrictions and is
attempting to compensate for the financial constraints that the NHS is currently facing.

Effective communication has continued through the Full Network Meetings held four times a
year, the SWAGNET website and the recently introduced SWAGNET Electronic News. The
development of ‘Electronic News’ is a pilot aimed at the cascading of information and
encouraging contributions from all clinic staff.

The Patient & Public Involvement project (4Ps) have been working with all South West London
clinics towards patient-friendly recognition throughout the Network.

I would like again to thank Dr Mark Pakianathan for his dedication and leadership, Dr Paul
Lister for his continuing behind-the-scenes support and Chris Nash for his hard work as
Network Administrator over the year.

Janine Railton
Network Development Manager, SWAGNET




                                              PAGE 4
BACKGROUND
HIV & GUM services in South West London launched the South West London HIV & GUM
Clinical Services Network - “SWAGNET” in March 2002 and in addition to the clinical service
providers in the sector, the Network incorporates partnerships with:

      Public Health
      The Voluntary Sector
      Contraception/Family Planning Services
      Community HIV Nursing
      Primary Care
      Commissioners and PCT Leads in HIV & Sexual Health

The Clinical services include GUM/HIV services from:

      Kingston Hospital
      St George’s Hospital
      St Helier Hospital
      Queen Mary’s Hospital
      Mayday University Hospital

The Network is determined to strengthen its partnership working with its key stakeholders.
Currently we have put in place a strategy to engage and involve users of our services.

The Network aims to develop collaboration and co-ordination between the organisations and
professional groups who deliver clinical services for HIV & GUM within South West London, to
ensure that services are patient-focused, high quality, effective and equitable.

The national crisis in sexual health brings increasing pressures on local GUM and HIV services
and creates difficulties for patient access. The Government has highlighted sexual health as a
key national priority.

INTERNAL STRUCTURE
The Lead Clinician is supported by the Deputy Lead Clinician and a Network Development
Manager to create a responsive and stable management team. The Lead Clinician is Mark
Pakianathan, Consultant GU Physician at St George’s Hospital. Richard Lau, also Consultant
GU Physician at St George’s Hospital is the current Deputy Lead Clinician. Janine Railton was
appointed as part-time Network Development Manager in October 2003 and continues to
provide pro-active support to the broad spectrum of Network activities.

The Lead Clinician chairs a Steering Group, which oversees the strategic development of the
Network. The Steering Group has representation from all units and all professional groups as
well as Commissioners and Public Health. Informal networking is facilitated through day-to-day
clinical contact with all centres having Consultant posts that are linked with St George’s
Hospital. There is also a network of linked HIV Pharmacist posts. The formal structure of
SWAGNET is illustrated overleaf:




                                            PAGE 5
                    Structure of South West London
                  HIV & GUM Clinical Services Network

                                        Multidisciplinary            Lead & Deputy
                                           Steering                  Lead Clinicians
                                                                  Network Dev Manager
                                             Group



                                      Working Sub-groups            Uniprofessional
       Full Network
         Meetings                                                    Groups, ARV




 Research       HIV         Young            GUM            I.T   Sexual H    Community
             Service Del   Persons’       Service Del             Promotion    Sexual H




The Network operates through a rolling programme of Network meetings held on Wednesday
afternoons. There are six operational Subgroups, which work on specific practical issues with
direct relevance to patient care. Each subgroup meets 3 times per year and works on action
points between meetings. A summary of the membership and priorities of each Subgroup can
be viewed under “Subgroups” on www.swagnet.org. The individual professional groups from
different centres also meet up regularly as Uni-Professional Groups to work on Network issues.
Full Network Meetings are held four times per year and are open to anyone working within the
Network. These meetings are made up of a Network update with feedback of progress made
by Subgroups, followed by an educational meeting on a specific HIV or GUM topic.

SWAGNET is not a commissioning body, but it has an important role in identifying resource
issues and priorities for service development. Close collaboration has been maintained with
the SWL Specialised Commissioning Consortium, whose HIV Commissioning Manager is a
member of the Steering Group. The creation of a separate Commissioner/Provider Forum has
further increased the scope for constructive involvement in the commissioning process.
“Payment By Results” (PbR) and changes within NHS structures provide the opportunity for
SWAGNET to influence Commissioning across the sector.




                                                PAGE 6
SECTOR LIAISON
Co-ordination and development of Sexual Health & HIV services across South West London is
achieved through 3 sector-wide bodies as illustrated below:



       Co-ordination of HIV & GUM Service Development &
                 Delivery in South West London

                                          South West
                                            London
                                          Specialised
                                         Commissioning




                                              PCTs
                                       Local Sexual Health
                                         Implementation
                                             Groups
                                             “SHIG”

                 SWL HIV & GUM
                Clinical Services                            SWL Sexual Health Expert
                     Network                                       Advisory Group
                   “SWAGNET”                                          ‘SHEAG’
                - practical issues                            Includes FP, PCT Leads,
                   of delivering                                    Public Health
                     services                                   & teenage pregnancy




SWAGNET links into the broader sexual health agenda through the South West London Sexual
Health Expert Advisory Group (SHEAG). Chairing of SHEAG has passed from Dr Paul Crook,
Consultant in Communicable Disease Control. Membership of SHEAG includes PCT &
Strategic Health Authority Leads for Sexual Health & HIV, Contraception Service Leads, the
SWL HIV/GUM Commissioning Manager and broad representation from SWAGNET.

Rachel Wells, Sexual Health Lead for the Strategic Health Authority provides further co-
ordination of Sexual Health services across South West London. On a local level, PCTs are
actively engaged in implementing the recommendations of The National Strategy for Sexual
Health & HIV. Each PCT has identified a Sexual Health Lead and set up a Sexual Health
Implementation Group (SHIG) so that local services are linked strategically. These partnerships
are constantly evolving and we look forward to new partnerships with other London Networks
and Commissioning bodies.

EXTERNAL LIAISON
South West Thames GUM Services             South West London GU Consultants have well-
established links with other GUM colleagues in South West Thames through regional audit and
other professional groups. In 2005/6 we identified several areas where consultants from outer
South West Thames GUM clinics can link into SWAGNET as Associate Members.

London Sexual Health Programme SWAGNET has welcomed this new initiative and is
actively involved in the work plan. It also provides a structure for liaising with all the London
sexual health networks, encouraging the sharing of ideas.
                                       PAGE 7
British Association for Sexual Health & HIV (BASHH) A regional branch of BASHH was
created in South West Thames in June 2004. It was been agreed to hold two Full Network
Meetings per year as joint meetings of SWAGNET and BASHH (SWT).


Medical Foundation for AIDS & Sexual Health (MedFASH) SWAGNET’s Lead Clinician
has collaborated with MedFASH to promote the development of clinical networks for HIV by
participating in several workshops held across the UK. This involvement has allowed
SWAGNET’s experiences to be shared by other regions and discussions have provided a
useful and interesting external stimulus to critically re-evaluate SWAGNET’s direction for
development.

COMMUNICATION
WEBSITE
Communication across the Network is facilitated by the Network website - www.swagnet.org
which:

   updates members on Network developments, meetings, documents and other items of
    interest
   provides an accurate database of Network members giving contact details, specialist
    interests and automatic e-mail links
   acts as a filing cabinet for easy access to meeting schedules, agendas and minutes for all
    Network working groups
   acts as a resource for access to local and national guidelines, service details, current
    clinical trials information, patient information resources, commissioning details, statistics,
    useful websites, clinical governance and teaching resources




                                             PAGE 8
ELECTRONIC NEWS
An electronic news update, distributed on a regular basis via email, has been set up in order to
provide regular updates and pieces of news and information to Network members. We are
actively encouraging participation from Network members, who may either provide news and
information or submit short articles of their own.




FULL NETWORK MEETINGS
Full Network Meetings are open to anyone involved in Sexual Health within the sector and are
a primary focus for educational and informal networking between individuals and organisations.
These meetings are held on Wednesday afternoons once per quarter and rotate between St
George’s and other SWL centres.
The meetings regularly attract over 100 attendees and have become increasingly interactive in
format. The meetings have a communication as well as educational function and commence
with a brief update on progress made by Subgroups and other SWAGNET news. This is
followed by a two hour educational meeting which is CME approved.
Topics in 2005/6 have included:
      Kidney failure and renal replacement therapy
      Prescribing in patients with HIVAN
      Ethics & the Law in Sexual Health
      HIV/Hepatitis Co-infection
      New-Fill
      Herpes - An Update
These high-quality meetings have received very positive feedback. We are sure that the
meetings scheduled for the next year will be just as informative and productive for all staff in
the Network.

                                            PAGE 9
HIV SERVICE DELIVERY SUBGROUP

The Network wide Newfill service led by Richard Simms, Lead Nurse Specialist at Kingston
Hospital has been positively evaluated.

The subgroup has now reviewed most of the MedFASH standards for care of HIV patients. The
group has made recommendations for practice within the network based on this work.

The clinical psychologist group has undertaken an in depth review of psychology services for
people with HIV across the Network. The need for neuropsychology assessment was identified
by the HIV sub group. The report recommended that such assessments take place locally and
identified the need for additional time, resources and training to support the service.

The pro forma for newly diagnosed HIV patients was ratified by the group and is now available
for use across the Network. An evaluation of the form is currently being undertaken at St
George's and the results will be available shortly

The group is in the process of rolling out the ‘4Ps’ programme (www.4ps.com) through
SWAGNET clinics and Representatives from the 4P project will be rolling out the expert staff
programme in all clinics with in the next few months. The Courtyard Clinic was a DH 4P pilot
site and recently achieved the first level accreditation.

The group has tried to address the issue of the placement, treatment and care of people with
HIV related brain impairment. Although we have not been able to resolve this issue, the group
will continue to highlight the problem with the commissioners.

Future plans……….

The group’s priorities in the next twelve months will be service provision and audit. We aim to
continue to support a high quality service for people accessing HIV care in the Network, whilst
recognising the financial constraints faced by our services.

In order to ensure that the work of the sub group reflects the needs of service user, it has been
agreed that representatives from patient organisations (ACIA and THT) be invited to join the
group.

The home delivery service for HIV medications has been identified as a priority for the group.
This will be monitored closely as the service is rolled out across the Network

An audit of the Network adherence support guidelines is taking place at St George's, with plans
to include all clinics in the Network shortly.


              Key achievements
             Positive evaluation of Newfill service.
             Recommendations for practice based on work reviewing
              MedFash standards for care of patients with HIV .
             In depth review of psychology services for people with HIV
             Rolling out the 4P’s programme


Helen Webb & Dr Tom Harrison, Co-Chairs
HIV Service Delivery Subgroup


                                            PAGE 10
GUM SERVICE DELIVERY SUBGROUP
The uptake of HIV testing in GUM clinics in the Network continued to be monitored to assess
progress towards the Sexual Health Strategy targets (40% by end 2004 and 60% by end
2007). An increase had occurred at all clinics, but with a lower increase at Croydon where
funding issues had prevented routine testing. These funding issues have now been
successfully resolved and it is expected that there should be an appreciable increase in testing
at the Croydon clinic.

The statutory quarterly HPA GUM access survey has shown a continued improvement at all
Network sites with an average of 73% of pts being seen within 48 hours. The national average
was 39%. The target of 100% access within 48 hours by 2008 will be difficult to achieve without
additional resource. Monies identified for access in ‘Choosing Health’ may be diverted away
from GUM services.

Funding has finally been obtained for Chlamydia NAATs testing at Mayday Hospital. This
began in June 2005 and already an increase in the number of positive tests has been reported.
It is further proposed that NAATs for Neisseria gonorrhoea be evaluated at Mayday.

Guidelines for the A & E management of suspected pelvic infection, vaginal discharge, genital
ulceration and male dysuria have been finalised and ready for distribution to local A & E
departments in the Network.

The group has also focused on delivering the recommendations of the BASHH GUM
modernisation document.

A working group headed by Dorinda Thirlby has produced and distributed SWAGNET PEPSE
guidelines

Training for NCCG doctors has been formalised into quarterly sessions held in rotation around
the Network

The Network is undertaking an evaluation of rectal C. trachomatis NAATs (unlicensed) and will
review this after 6 months.

National Capital monies for GUM are to be distributed at the SHA level. The Network has
collaboratively applied to use this money to furnish the newly built clinic at Roehampton and to
extend the St Helier clinic. These were felt to be highest priority in providing services for
patients across the sector. Other priority areas will be considered for next years monies.


              Key achievements
                          Increased HIV testing in GUM Clinics
                          Continuous improvement towards targets
                          Development of links outside the Network
                          SWAGNET PEPSE guidelines
                          “In house” training programme for NCCG Doctors



Dr Steven Estreich and Dr Mette Rodgers
Co-chairs, GUM Service Delivery Subgroup


                                            PAGE 11
GUM YOUNG PERSONS’ SUBGROUP
     The Young Persons’ Subgroup was set up as a working group of the GUM subgroup in
      April 2004. The primary focus of the group was to focus on improving clinical services
      for adolescents across the sector and to reduce variations of care between the different
      specialist adolescent clinics.

     3 priority areas were identified
         o Sharing experiences and considering the development of a multidisciplinary
              training programme for healthcare workers involved in the delivery of adolescent
              sexual health services across South West London
         o To develop common written policies around child protection, which could be
              shared between the clinics
         o To develop a common pro forma so that a common data set can be collected in
              the individual clinics to facilitate audit and research

     Achievements
         o The subgroup has met 4 times in the last year
         o The subgroup has developed a confidentiality statement / approach for our
            young people’s services in the sector
         o The subgroup has agreed a minimum dataset of information that should be
            gathered during consultation with young people. Each clinic has modified their
            young people’s clinic proformas to ensure that the information is captured. An
            audit of the outcome will be presented at a meeting in September 2006
         o We had a successful multi-disciplinary ‘case discussion’ meeting where problem
            cases were discussed
         o We have ensured that group members remained up to date on child protection
            and related legal issues, enabling up to date cascading of information to
            colleagues

     Work in progress
        o Every Subgroup meeting from June 2006 will include an educational component
            and meetings will be open to all health professionals working in SWAGNET
        o A decision has been made to develop common branding of SW London’s
            specialist ‘one stop shop’ young people’s sexual health clinics. Such branding
            will make explicit to clients in the sector about the level of services available in
            our specialist clinics and facilitate the development of care pathways to and from
            other services which have more limited sexual health expertise.



            Key achievements
                        Confidentiality statement
                        Minimum data set and development of proformas
                        Multi disciplinary case discussions group
                        Disseminating information on child protection issues




Dr Mark Pakianathan
Chair, Young Peoples’ Subgroup GUM Service Delivery Subgroup




                                           PAGE 12
IT SUBGROUP
In the past twelve months, the IT Subgroup met three times. The key areas that the Subgroup
wishes to highlight are:

   HIV & GUM data collection survey, February 2005. This was a significant piece of work that
    was initiated, compiled and published by Dr Paul Lister covering a census of existing data
    collection methods and IT infrastructure across the five clinics within the Network. The
    survey revealed a number of different practices, reflecting local systems and clinical
    activity. The survey also highlighted the need for better-defined conditions in the national
    KC60 dataset, as clinics interpreted KC60 conditions and data requirements differently.

   SHEAG (Sexual Health Expert Advisory Group) Sexual Health Data Reports. This is an
    exciting initiative in collaboration with the S W London Health Protection Unit (SWLHPU)
    that will provide Commissioners, consultants in public health and local sexual health PCT
    leads important epidemiological KC60 data collated quarterly from the five GUM service
    providers within the network. KC60 data is usually collected centrally and published
    annually, with little provision for understanding local trends. This initiative should provide a
    better understanding of local epidemiological trends in a more timely fashion.

   Representation from Health Protection Agency (HPA) on IT subgroup. The IT Subgroup
    welcomed on-going dialogue with representatives from the HPA. The Subgroup raised
    issues such as discrepancies in SOPHID duplicate reports from centres who saw the same
    patient in the same half-year, the antiretroviral drug count, as well as highlighting the extra
    time and staff resources required to produce more sophisticated reports.

   Presentations from IT suppliers. Presentations were given by the following companies:
    Blithe (Clinic Pro II and its successor, Lillie) and Telephonetics (an automated telephone
    results service).

   Informal reports from each clinic about IT and data collection issues continue to be a
    substantive agenda item at each meeting. The sharing of problems, solutions and best
    practice remains extremely worthwhile and is a good practical demonstration of the benefits
    of working within an effective clinical network.



          Key achievements
                      HIV and GUM data collection survey

                         More representation on subgroup

                         Guest presentations from IT Suppliers



Dr Paul Lister & Dr Richard Lau
Co-chairs, IT Subgroup




                                              PAGE 13
COMMUNITY SUBGROUP
SWAGNET are committed to ensuring improved access to sexual healthcare and support the
need for certain GUM services (e.g. STI screening) to be made more available in community
settings. Where specialist teams cannot provide services, SWAGNET are committed to support
the training and clinical governance needs of GPs and primary care staff. The Community
Subgroup is helping to achieve these SWAGNET objectives.

RECENT ACHIEVEMENTS

Sexually Transmitted Infection Foundation (STIF) Courses
The British Association for Sexual Health and HIV (BASHH) has developed a 2-day Sexually
Transmitted Infection Foundation course (STIF). This provides multi-disciplinary training in the
attitudes, skills, and knowledge required for the prevention and management of STIs. The
Community Subgroup has co-ordinated and supported the delivery of 10 STIF courses in South
West London over the last three years. Over 400 doctors and nurses working in SW London
have now completed a STIF course. The Community Subgroup will continue to oversee the
running of two STIF courses each year.

Partner Notification in the Community
Subsequent to the development of guidelines for testing and management of Chlamydia in
primary care, the Community Subgroup has developed a contact slip for Chlamydia specifically
for use in primary care. Both the Chlamydia testing guidelines and contact slip may be
downloaded at http://www.swagnet.org/. The Community Subgroup has also developed a half-
day training course on partner notification in community settings. This has been piloted in
Richmond and will be rolled out across the sector.

Work in Progress

Minimal Criteria for more specialised sexual health services
The Community Subgroup are currently developing recommendations for level 2 Sexual Health
services in primary care i.e. which services may be effectively provided. This will necessitate
the development of local care pathways in conjunction with the local GUM clinic. It is intended
that these recommendations will be helpful to PCTs wishing to commission local enhanced
services in sexual health.

Training for more specialised sexual health services
The Subgroup is using the Department of Health document (Competencies for providing more
specialised sexually transmitted infection services within primary care, September 2005) to
develop local training programmes for GPs and nurses to support the delivery of local
enhanced services for sexual health in the community.


              Key achievements
                          Delivery of STIF Courses across SWLondon
                          Partner Notification contact slip for Chlamydia
                          Developing greater primary care access and
                           training




Dr Gill McCarthy & Dr Mark Pakianathan
Co-chairs, Community Subgroup
                                            PAGE 14
SEXUAL HEALTH PROMOTION SUBGROUP
The Sexual Health Promotion Subgroup has been established since 2002. Its focus is Sexual
Health Promotion within GUM and HIV out-patient clinics.

In the last few years the group has produced an extremely comprehensive and detailed
document on “Standards for Sexual Health Promotion in GUM”. This has been a valuable piece
of work. The standards are being implemented by all the Subgroups and as such have made a
huge impact on the achievements of the Network as a whole. The Audit of SHP standards,
referring to the guidelines as laid out in the National Recommended Standards for Sexual
Health Services produced by MedFASH for the standards for sexual health promotion
document were incorporated into the latest standards as shown on the SWAGNET website.
We are pleased to report that the Network has already met most of these.

The group has been working on promoting sexual health on a sector-wide basis, discussing
information leaflets for various venues in order to reach the targeted audience. As part of this,
discussions are currently underway, regarding the possibility of a sector-wide Sexual Health
Information website.

The group have also discussed and progressed on joint purchasing of essential stock items
such as condoms and also taking forward the idea of reducing the cost of network-wide
advertising, e.g. Yellow Pages and Thompson Local by jointly advertising all the five clinics and
sharing the burden of cost.

Training initiatives have taken place during the year in all the clinics and in some of the Uni-
professional Subgroups. The Subgroup have both encouraged and helped to organise various
training sessions for both clinical and non-clinical staff over the year. These sessions have
included Sexual Health Promotion & Gay Men’s Issues, Sexual Health Issues for Africans,
GUM Referrals and Admin & Clerical training.

There has been specific focus on “Sexual Health for Gay Men in the GU setting” training
initiatives. The feedback from these sessions has been extremely positive. Sexual Health
Promotion has always been seen as integral to delivering a high standard of care in any GUM
service. This group supports a co-ordinated clinic approach from all disciplines.

The Subgroup has agreed to focus their work plan for the forthcoming year on sexual health
issues for Africans.


              Key achievements
                          Implementation of the subgroup’s document
                           ‘Standards for Sexual Health Promotion in GUM’
                          Development of a series of training initiatives for
                           clinical and non-clinical staff
                          Standardisation of leaflets across the sector



Dorinda Thirlby & Justin Schofield,
Co-Chairs, Sexual Health Promotion Subgroup




                                            PAGE 15
RESEARCH SUBGROUP
The membership of this Subgroup has been broadened over the last year to add a more multi-
professional dimension. The main aims of the Research Subgroup have been defined as:

      To share information about & access to clinical trials across the Network
      To identify local problems/interests suitable for new initiatives
      To share observational studies
      To share data collection, databases and common approaches to management
      To update website information about clinical trials
      To arrange a programme of academic meetings
      To organise cases and ARV updates

The Subgroup has been productive over the last year, commencing research (additional to
clinical trials) on:

      Proteomics of sexually transmitted infections
      A pan-STI pathogen microarray to diagnose multiple STIs
      Liquid-based cytology and CIN prediction
      Demographics of Syphilis infection in SW London
      A study of TDM Pharmaco-genetics
      Establishing a Network HIV cohort.

Pan-pathogen array: The group has won funding to make a pan STI array to diagnose multiple
STIs. The array will hopefully be ready by the Summer/Autumn, after which validation studies
will be conducted. Researchers are investigating proteomic markers of STIs to add to the
development of rapid STI tests. This study is an ongoing project that should be completed
during the 2006 – 2007 year.

A pilot study on Liquid-based cytology and CIN prediction commenced at the beginning of
2006.

As South London had the largest amount of syphilis outbreaks in the UK, there was potential
interest in testing women and clinics recruited patients to participate in these trials. This project
has been taken forward for work in the 2006 – 2007 year.

A study on the pharmacogenetics of Efavirenz in black Africans has started in the Network. The
pilot phase will be complete by the summer.

The HIV positive patient number now stands at around 1,700. The group is designing a formal
cohort study to collect blood for pharmacogenetic studies. Ethics for this will be submitted later
in the year.
This Subgroup is always happy to be contacted by staff from any clinical discipline with
suggestions for research and looks forward to the current studies coming to fruition over the
next year.

          Key achievements
                      Multi-professional dimension of subgroup
                      Pan-STI array funding to conduct studies.
                      Designing studies around key issues within sexual
                       health



Dr Tariq Sadiq & Dr Phillip Hay
Co-chairs, Research Subgroup
                                              PAGE 16
ADMINISTRATION & CLERICAL UNI-PROFESSIONAL GROUP
The Admin and Clerical Uni-Professional group was formed in late 2004 to enable all Admin
and Clerical staff to work as a Network to resolve common problems, share information, save
duplication of work and hold buying power as a single group. This has facilitated the sharing of
ideas and working practices and has also enabled a degree of standardisation of proformas
and procedures within clinics.

These have included discussions on:
    Patient surveys
    Standard letters to GPs,
    Male/female patient information leaflets
    General clinic information
    Registration forms
    Front and triage sheets

The A&C Uni-Professional group meets three times a year and is chaired on a rotational basis
by either Clinic or Office Managers. Membership is open to all A&C staff, though generally, two
or three representatives from each clinic attend the meetings. A representative from each clinic
gives a brief report on their own clinic’s progress. As part of these meetings, the host clinic
gives visiting staff a tour of their premises, so that they can better understand different working
practices and conditions for their colleagues.

The first A&C training half-day was held on 1st March 2006, and was very well attended with
over thirty members of staff present. These educational sessions are intended to run twice a
year and it is hoped, will form part of the PDR process in training and developing staff.

All A&C Uni-Professional activities are co-ordinated by SWAGNET, who act as a central pool
for the distribution of information. In turn, A&C staff support the Network in preparing materials
and venues for the Sexually Transmitted Infections Foundation (STIF) Courses that are run in
South West London.

There have been suggestions via this group that all clinic advertising is undertaken centrally, in
order to reduce outlay for all clinics within the Network. It is hoped that this idea is carried
forward to fruition in the coming year.

Attendance at Full Network Meetings amongst A&C staff has increased considerably over the
last year, with feedback being very positive. In the coming year, the A&C Group will be
nominating a member to represent them on the Network Steering Group.

Lucy Tomlin & Sarah Quinnen have worked hard establishing this Uni-Professional group. The
decision has now been made to rotate the chair and the venue across the sector.


            Key achievements
                        A&C Training half-day
                        Greater involvement of A&C staff within the
                         network
                        Sharing of different working practices



Chris Nash, Network Administrator
On behalf of:
A&C Uni-Professional Group, March 2006
                                             PAGE 17
HEALTH ADVISERS UNI-PROFESSIONAL GROUP
The Health Advisers’ Uni-Professional Group meets three times a year and is currently co-
chaired by David Cox from the Courtyard Clinic and Joan Chappell from St Helier Medical GU.
These meetings alternate between business meetings and educational forums. In the past
year, topics in the business meetings have included Agenda for Change, case studies,
Department of Health guidelines and various policy proposals and changes. The educational
meetings feature both internal and external speakers. The organisation and location of the
meetings is rotated across clinics.

Links have been formed with Generate, a charity that works with people who have both
learning and physical disabilities. The Health Advisers undertook this work in relation to sexual
history taking and integrating this with HA professional practice. The next planned educational
meeting concerns the impact of cultural differences on the role of the Health Adviser and has
been carried forward by the staff from Mayday University Hospital.

The HA Uni-Professional Group is also linking in with the newly established Pan-London Young
Persons’ Health Advisers Group – these meetings have an educational interest and take place
quarterly, rotating between different clinics, concentrating on good working practices in relation
to young people’s sexual health concerns.

The Health Advisers group has also been heavily involved with staff in-house training, the first
of these sessions was held in Croydon and both organised and facilitated by Bernard Kelly and
Dorinda Thirlby, with support from Jane Sudlow, Health Adviser, Mortimer Market, focussing on
working with gay men who regularly put their sexual health at risk. This half day study
examined ways in which Health Advisers could challenge the attitudes and circumstances that
contribute to sexual risk-taking. The training was interactive and extremely well evaluated by
attendees.

Bernard Kelly has also been involved in the co-ordination and provision of training for the
Administration & Clerical Uni-Professional Group.

Dorinda Thirlby has chaired two task forces in partner notification for both GUM and HIV, which
were attended by Health Advisers from all the SWAGNET clinics and a Nurse Practitioner from
the Wolverton Centre at Kingston Hospital. Proformas have been drawn up and are being
piloted for use in clinics for both partner notification and as audit tools.

Health Advisers in SWAGNET have also been involved with the Network’s STIF courses as
trainers, speakers and mentors as well as making considerable contributions to the Full
Network Meetings. It has been an industrious and successful year and we hope that the next
year will prove to be just as productive.


          Key achievements
                      Building links with other agencies
                      Links with other Health Adviser groups
                      Planning & delivering in-house staff training
                      Key contributions to STIF courses.



Charlotte Jackson, Health Adviser
On behalf of:
Health Advisers Uni-Professional Group


                                             PAGE 18
NURSES UNI-PROFESSIONAL SUBGROUP
This group was chaired during 2005 by Sínéad O’Neill and is now chaired by Kara Dowie.
Previously this group had poor representation, however this year the group is very proud of its
achievements as well as the full representation of all the five clinics in the Network.

The group meets three times a year and a wide variety of topics have been discussed, such as
chaperone policy, Agenda for Change, microscopy policy, rotation of nursing amongst the five
clinics and the organisation of study afternoons for nursing staff.

Many ideas have been exchanged amongst the staff at these meetings and the sharing of work
has progressed well. The greatest achievement of the group in 2005 was the Nurses’ study
afternoon on the 14th September.
This afternoon was organised by sending out a questionnaire to all the nursing staff and asking
them which topics they would like to include on the day. The timetable was set up, speakers
chosen and lunch provided by Stiefel, Passante and SWAGNET.

TOPICS COVERED:
Michelle Arnold –       The extended role of a GUM nurse
Jacinta Jenkins –       Chlamydia
Kara Dowie      –       Triage
Jo Adams        –       Tops tips on contraception

The afternoon was evaluated very well and everyone who attended received a certificate.

Another questionnaire was sent to all the clinics to complete, indicating which topics they would
like at the next study afternoon, which was planned for the 1/2/05. This was a brilliant example
of how SWAGNET has been working to bring all the clinics together and enabling the sharing
of knowledge and skills. We look further to another year of achievements and welcoming the
new Sister from Mayday GUM.


          Key achievements
                      Development & Delivery Network wide training
                      Sharing & meeting the needs of clinical governance
                      Working together to meet demands of Agenda for
                       change




Sinead O’Neill
On behalf of:
Nurses Uni-Professional Subgroup




                                            PAGE 19
PHARMACISTS UNI-PROFESSIONAL GROUP

The aim of the pharmacist subgroup is:
          To share information across the network
          To provide support to each Trust
          To share ideas and working practices

Home Delivery of HIV Medicines

During 2005/06, a primary objective to establish home delivery of HIV medicines has
required a lot of input from members of the group. This initiative has received wide
support from the HIV Consortium and the London Specialised Commissioning Group.
The Pharmacists have been developing procedures around procuring dispensing
services and sharing responsibilities for writing a Service Level Agreement with
Intecare, who successfully tendered for home delivery services in the South London
sector.

Adherence Support Guidelines

2005/06 saw the implementation of the Adherence Support guidelines across
SWAGNET clinics. These guidelines offer a patient pathway that includes crucial
events such as referral, pharmacist counselling, 2 and 4-week follow-up and the use of
a short adherence questionnaire for patients starting treatment. Similar events are
detailed for patients changing treatment and for ongoing support at least once a year.
The timing of events around planned treatment for each patient allows audit and it is
planned that pharmacist support to adherence clinics and relationship to clinical
outcomes would be a priority for audit in the coming year.

Antenatal/Post natal care for HIV positive women

The group has looked at improving pharmacist involvement and communication with
teams looking after pregnant women and their infants. At SGH, a pharmacist now
attends a regular antenatal meeting and acts as a link to support clinical governance
aims in provision of MTCT to mother and baby.

Future direction

In 2006/07, David Ogden will chair the Pharmacists Group and hopes to formalise the
focus on clinical issues, training and audit. Thanks to Vicky Wong for her role as Chair
during 2005/06.

       Key achievements

                 Establishment of Home Delivery procedures and SLA
                 Implementation of Adherence Support Guidelines
                 Future plans for clinical forums and audit



Vicky Wong, Principal Pharmacist, HIV Services
On behalf of:
Pharmacists Uni-Professional Subgroup

                                        PAGE 20
CLINICAL PSYCHOLOGISTS
UNI-PROFESSIONAL GROUP
A particular focus for recent meetings has been on the provision of neuro-psychological
assessment for HIV positive clients. The Uni-Professional Group has been able to suggest
options for clinics to address this gap in the services provided for HIV positive clients.
Outside of the regular meetings, the group keep in contact via email to share information about
SWAGNET meetings and opportunities for continuing professional development.
The Clinical and Counselling Psychology Uni-Professional Group is now represented on the
HIV and Research Subgroups. In addition, we are very happy to contribute to the work of other
Subgroups when a Clinical / Counselling Psychology perspective would be helpful.
Over the next year we aim to continue with our regular meetings. We hope to explore how our
meetings can be used to meet the continuing professional development needs of the group.



          Key achievements
                      Better organisation of the group
                      Good interaction with other subgroups
                      Provisions of Neuro-psychological assessment for
                       HIV+ clients shared with clinics.
                      Better representation across the network




Dr Claire Copland, Clinical Psychologist
On behalf of:
Clinical Psychologists Uni-Professional Group




                                            PAGE 21
South West London HIV & GUM Clinical Services Network

Dr Mark Pakianathan, Network Lead Clinician,
Courtyard Clinic, St George’s Hospital,
Blackshaw Road, London SW17 0QT
Tel 020 8725 1652
mark.pakianathan@stgeorges.nhs.uk

Dr Richard Lau, Network Deputy Lead Clinician,
Courtyard Clinic, St George’s Hospital,
Blackshaw Road, London SW17 0QT
Tel 020 8725 1652
richard.lau@stgeorges.nhs.uk

Janine Railton, Network Development Manager
c/o Roehampton Clinic, Queen Mary’s Hospital
Roehampton Lane, London SW15 5PN
Tel: 020 8487 6861
janine.railton@swlondon.nhs.uk

South West London HIV & GUM Commissioning Consortium
Matt Dixon, HIV/GUM Commissioning Consortium Manager,
Croydon PCT HQ, 13th Floor, Leon House,
201-241 High Street, Croydon CR9 1XT
Tel 020 8680 2418
Matt.dixon@croydonpct.nhs.uk


Annual Report 2005 -2006 compiled by Chris Nash




                             For further copies of this report contact :

                             Leanne Bobb Tel: 020 8487 6861
                             email: leanne.bobb@swlondon.nhs.uk

								
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