Primary Care

Introduction

This report looks at what opportunities primary care could contribute to the reduction of late diagnoses. With the recent publication of updated testing guidelines in England which call for more testing in general practice the moment to act in Scotland is here.

HIV Scotland's National GP Survey examines how relevant HIV and sexual health is to the day-to-day work of GPs in Scotland today. The survey results provide an insight into the experiences GPs have of HIV and sexual health, their previous training and their training needs. We are grateful to all the GPs who took time to take part in the survey and share their experiences with us and to the Royal College of General Practitioners Scotland (RCGP Scotland), representatives of the BritishMedical Association (BMA) in each Health Board, and primary care facilitator teams that supported the dissemination of this survey.

Currently 13% of people living with HIV in Scotland are undiagnosed, so it is vital to increase diagnostic opportunities. Whilst primary care settings have repeatedly been identified as an appropriate setting for HIV prevention and testing, evidence suggests that there are ongoing missed opportunities where individuals could and should have been tested.

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Survey Findings

The National Survey of GPs in Scotland carried out by HIV Scotland in December 2016 found that:

• GPs can, and do, diagnose HIV, albeit in relatively low numbers. It should be acknowledged that for an individual practice, new HIV diagnoses are very rare and will remain so, even in high prevalence areas.

• Even though over 90% of GP respondents told us that STI testing, STI treatment and HIV testing are provided in their respective practices, over a quarter of GPs do not feel comfortable raising the issues of sexual health and HIV with their patients.

• With no official Scotland-specific HIV testing guidelines for primary care, testing opportunities are almost certainly being missed when new patients register at GP practices. Only 15% of new patients registering at GPs in high prevalence areas are routinely offered an HIV test. With only 3% (13 from 419 GPs) of survey respondents correctly identifying each indicator condition opportunities are being missed.

• Patient presentations related to HIV are not common for most GPs. Diagnosis of symptomatic HIV is also very difficult given the diversity of common and minor conditions that it can mimic such as flu-like illnesses or common skin conditions. It is no surprise therefore that GPs expressed a low confidence and a lack of knowledge around HIV symptoms, regardless of HIV prevalence in their locality.

• Over 40% of GPs in high prevalence areas feel their training has not been
adequate to date.

• Uptake and awareness of available sexual health and HIV training and online resources is low amongst GP respondents. Taking all listed resources together, an average of only 11% of respondents have used or participated in them.

Recommendations

Over 10% (n=454) of all GPs in Scotland responded to our survey, and we recognise that this research uncovers issues that are not the fault of individual GP practices, and recommendations are aimed primarily at decision makers who are able to support the development and implementation of better HIV prevention and testing.

1. Improving training and HIV knowledge

1.1 Resources should be allocated for effective training that increases
confidence, knowledge and skills amongst GPs, particularly in high prevalence
areas in relation to raising sexual health and HIV with their patients.

1.2 Multidisciplinary training resources for GP practices should be available,
and such opportunities promoted to ensure greater uptake. GPs should also be provided with incentives to participate in training, including protected learning time and accredited courses.

2. Increasing testing

2.1 Primary care settings should seek to normalise HIV testing as part of routine health checks and GP registrations, especially in high prevalence areas.

2.2 Where GPs lack confidence or the resources to carry out HIV testing they
should be empowered to signpost to alternative methods of testing such as
sexual health services, home sampling or rapid self-testing kits.

2.3 Through increased knowledge and training opportunities GPs should be
confident to identify cases for HIV testing through indicator illnesses or risk
factors and to offer HIV testing in primary care settings.

3. Data collection

3.1 National and local data on testing and diagnoses in primary care settings
should be collated and fed into a central resource, such as Health Protection
Scotland, and published annually.