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Logo of straninfSexually Transmitted InfectionsVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Sex Transm Infect. 2007 April; 83(2): 163–164.
PMCID: PMC2598618

GUM modernisation: ratios of follow‐up to new patients show sustained decrease

In order to meet current government targets for access to sexual health services in the UK, genitourinary medicine (GUM) clinics need to modernise their services. The rising incidence of sexually transmitted infections (STIs), coupled with an inadequate amount of investment in services, has led to unacceptable waiting times for patients requiring appointments. As a result, many clinics are exploring innovative ways to increase capacity and improve access to their services.

One significant strategy for releasing capacity within existing services has been a move towards reducing the number of follow‐up visits. A target follow‐up to new‐case ratio of 1 or lower has been recommended by the British Association for Sexual Health and HIV in 2003 (BASHH).1 The average follow‐up to new‐case ratio in England and Wales decreased from 2.2 in 1990 to 1.2 in 2002.2,3 This was largely due to a number of new developments in sexual healthcare including the introduction of new government targets for access to services, which provided a stimulus for change, and changes in working practices, introduction of novel services, advances in diagnostic techniques, and treatments for specific STIs that have made it possible to reduce follow‐ups without compromising the quality of care.

Feedback from the Department of Health (DH)‐commissioned review of GUM services in England undertaken by the Medical Foundation for Aids and Sexual Health (MedFASH) has suggested that many clinics were already achieving ratios that were even lower than those suggested by BASHH in 2003.

A review of Part C of the KC60 statutory returns submitted by GUM clinics to the Health Protection Agency was undertaken.2 Follow‐up to new ratios were reviewed for the period 1995–2005. Data were also analysed to check for completion of Part C of the KC60 return which relates to new/rebook and follow‐up attendances, and comparator GUM attendance data were also obtained from the Knowledge and Intelligence (K&I) Commissioning Directorate, Department of Health, who receive attendance reports from hospital trusts for purposes of triangulation (about 60% of clinics).

Follow‐up to new ratios dropped steadily during the period 1995–2005. The mean follow‐up to new ratio dropped from 1.9 (95% CI 0.2 to 3.6) in 1995 to 0.74 (95% CI 0.1 to 1.64) in 2005 (fig. 11).). Data collected for Part C of the KC60 returns were completed from 96% of clinics in England. The mean follow‐up to new ratio for 2005 based on data from the K&I Directorate was 0.77 (completed data received from about 60% of clinics).

figure st24851.f1
Figure 1 Follow‐up (FU) to new patient ratios for use of genitourinary medicine services in England.

GUM services in England have shown continuous reduction in follow‐up to new ratios over the last decade. This has resulted in a release of significant additional capacity to help deal with the ever increasing demand for services. Between 2004 and 2005, the number of new patients seen in GUM clinics increased from 919 597 to 1 005 004 (9%) while follow‐ups dropped from 822 501 to 766 976 (7%) (table 11).). A systematic approach for rationalising follow‐up rates undertaken by the 6‐sigma group3 has suggested that there is scope for further reduction of the ratio while ensuring that the quality of care for patients is not compromised.

Table thumbnail
Table 1 Number of attendees recorded in the KC60 Part C, England

Initial analysis of the data showed an interesting variation in mean follow‐up rates between clinics in London and the regions. The mean follow up to new ratios for London clinics also improved from 1.33 (0.0–3.61) to 1.03 (0.0–2.55) between 2004 and 2005, whereas the ratios for the regions improved from 0.83 (0.06–1.59) to 0.69 (0.06–1.37) during the same period. These data are being analysed further. Data for 48‐hour access to services and its relationship to improvements in follow‐up to new ratios is also being analysed.

BASHH recommends that a mean follow‐up to new ratio of 0.74 should be used as a benchmark for monitoring performance of GUM services. However, it is vitally important that a range of clinical as well as management benchmarks are used to performance‐manage GUM services and that this tangible benchmark is not used as a sole indicator, nor should GUM services base their strategy for meeting the 48‐hour access targets primarily on this factor.4 Reviewing roles of clinicians within the multidisciplinary team as well as introducing new work practices will also play a vital role in meeting this challenge. There is an urgent need for services to be able to measure demand and capacity in a consistent manner so as to better inform the process of commissioning and planning of services.


1. British Association for Sexual Health and HIV (BASHH) Modernisation Sub‐group Capacity building to reach 48 hour access; making the case to PCTs. (accessed 6 Mar 2007)
2. Health Protection Agency KC60 returns from Genitourinary Medicine Clinics in England. Health Protection Agency 2005.
3. Griffiths V, I Ahmed‐Jushuf, on behalf of the Six‐Sigma Group Releasing capacity through reduction in follow‐ups. Dublin: Poster presented at British Association for Sexual Health and HIV (BASHH) Spring Meeting, 2005
4. Department of Health GUM Clinics Waiting Times, Nov 2006. HIV and Sexually Transmitted Infections Department, Health Protection Agency, London. 10 High Impact Changes for Genitourinary Medicine 48‐hour Access. (accessed 6 Mar 2007)

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