Quality and resource management in genitourinary medicine service delivery

Quality and efficiency are the hallmarks of appropriate resource utilization. Performance indicators in the UK facilitate measurement of efficiency of sexual health services. These parameters include consultant ratio per unit population served, sessional requirement of service providers, duration of wait before an appointment, duration of wait in the clinic setting before being seen and the locality prevalence of gonorrhoea per 100,000 of the catchment population aged 16-64. In a survey of these standards in the Bure Clinic in Great Yarmouth where one consultant physician serves a population of 250,000-320,000, providing 6-7 outpatient sessions a week, with inpatient commitment for HIV/AIDS, 31.4% of patients waited over 2 weeks before being seen in the Genitourinary Medicine (GUM) Clinic. Over 57.5% of the patients surveyed had waited more than one week before their appointment. This had been in an environment of prevailing local high incidence of gonorrhoea--a marker of sexual ill health--from 1996-1998 (>25 per 100,000 in those aged 16-64). This defect in optimum access is inimical to early case detection, contact tracing, and intervention for appropriate behaviour modification and truncation of infectivity.