Guidelines for the appointment of
General Practitioners with Special Interests
in the Delivery of Clinical Services
Sexual Health
April 2003
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Sexual health
This general practitioner with special interest (GPwSI) framework is one of a
number which the Department of Health has commissioned the Royal College of
General Practitioners (RCGP) to produce. The frameworks have been written
following extensive consultation with general practitioners, secondary care
specialists, Primary Care Trust managers, patients, the Department of Health and
the PwSI team in the NHS Modernisation Agency. The frameworks are intended
to be advisory for the development of local services, providing good practice and
experience, offering recommendations to assist PCOs in determining how to
implement a local GPwSI service to meet their needs.
This guidance should be read in conjunction with the Department of Health and
Royal College of General Practitioners’ Implementing a scheme for General
Practitioners with Special Interests (April 2002, www.doh.gov.uk/pricare/gp-
specialinterests), and the NHS Modernisation Agency’s Practitioners with Special
Interests: A Step by Step Guide To Setting Up a General Practitioner with a
Special Interest (GPwSI) Service (April 2003, www.gpwsi.org).
Rationale for GPwSI service in sexual health
The risk of unwanted pregnancy and the risk of sexually transmitted infections are
often associated with each other. Evidence showing associations between mental
ill-health, drug and alcohol problems and sexual ill-health and high-risk sexual
behaviour supports the need for a GPwSI to take a broader approach to sexual
health.
a. The core activities of a GPwSI service in sexual health
It is recommended that the National Strategy for Sexual Health and HIV

• Vasectomy services.
• Psychosexual counselling.
Education and Liaison
This usually involves dissemination of good practice across the PCO training and
education, liaison with local specialist providers, and local laboratories.
Service Development/Leadership
• Contribute to the strategic direction of local sexual health services in
particular lead implementation of the National Strategy; participate in the
monitoring of outcomes and support development of integrated services.
• Provide sexual health clinical leadership for primary care in order to
champion change.
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The National Strategy for sexual health and HIV.ational for sexual health and
Level 1 Services
Sexual history and risk assessment.
Sexual Transmitted Infections testing for women.
HIV testing and counselling.
Pregnancy testing and referral.
Contraceptive information ad services.
Assessment and referral of men with STI symptoms.
Cervical cytology screening and referral.
Hepatitis B immunisation.
Level 2 Services
Intrauterine device insertion.
Testing and treating sexually transmitted infections.
Vasectomy.
Contraceptive implant insertion.
Partner notification.
Invasive sexually transmitted testing for men (until non-invasive tests are

history, complications,
investigation, treatment
(including antibiotic
resistance) of the
common Sexual
Transmitted Infections
and vaginal infections.
Harm reduction and
harm minimisation in
relation to illicit drug
use, especially injecting
drug use.
Use and
contraindications of the
full range of
contraceptive techniques.
Methods for TOP, their
relative advantages and
disadvantages indication
and contraindications.
Understanding of the
different test for STIs
including storage and
transport of specimens.
Understanding of
practice based methods
of record keeping and
how these may support
audit.
Indicators of sexual

providers.
National, local and
Professional
strategies and
guidelines and how
these may relate to
service configuration
within the PCO.
Good understanding
of roles,
responsibility and
structure of PCOs
and how to influence
them to bring about
improvement in
delivery of sexual
health services.
Understanding of
primary care
structures and how
these may affect
delivery of services
within the PCO.
Understanding of
service redesign and
care pathways.
Skills Able to carry out a full
sexual and contraceptive
history including risk
assessment.

Able to liaise with
educational
providers delivering
training etc to
primary care
practitioners, e.g.
deanery structures,
PCO protected
learning events.
Attitudes Able to engage with
patient group in a
manner that facilitates
good history taking and
treatment of sexual
health problems.
Able to work in a
multidisciplinary
team and use other
members of the
team.
Other competencies will be determined by the activities provided, for example
• Able to perform colposcopy examination and treatment.
• Able to perform vasectomy.
• Able to provide psychosexual counselling services.
• Able to test and treat sexually transmitted infections in men and women.
• Able to fit and remove Intra Uterine Contraceptive Devices, including Intra
Uterine Systems.
• Able to fit and remove contraceptive implants.
c. Evidence of training and experience for required competencies
Generalist skills

fulfilment of the required training experience and the acquisition of the
competencies enumerated in this document and others thought necessary by the
employing authority. This portfolio should form part of the GPwSI annual
appraisal.
and
Evidence of delivering a sexual health service of quality within his/her general
practice.
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Examples of different evidence of competencies for the service.
• Demonstration of skills under direct observation by a senior clinician.
• Demonstration of knowledge by personal study supported by appraisal.
• Evidence of gained knowledge via attendance at accredited courses or
conferences.
• Demonstration of ability to work in teams by evidence of taking part in
multidisciplinary teamwork to plan and deliver service provision and
individual patient care.
• Delivering multi- and uniprofessional training.
• Base line experience working as a clinical assistant.
e. Evidence of maintenance of competencies
The GPwSI would be expected to maintain his or her competencies through
continued professional development and education. It is recommended that he or
she undertakes a minimum of 15 hours CPD and undergoes annual appraisal in the
special interest and generalist areas.
It would be good practice for CPD to include multiprofessional and disciplinary
learning. Close links with specialist colleagues and others working in the field is
important for maintenance of competencies.
In order to maintain skills and expertise, it is recommended that the GPwSI spend
at least one session per week (ideally more) working in the special interest area
and at least one session per week (ideally more) in working as a generalist.

targeted or universal, gender or sexual orientation specific.
The service configuration will depend on the needs of the PCO and other local
factors. In all GPwSI services the caseload should be sufficient such that the
GPwSI is able to exercise their generic skills and deal with the physical,
psychological and social aspects of disease.
The GPwSI should be able to demonstrate that their skills are actively used and
audited, including evidence of development and adherence to national and local
guidance.
h. Local guidelines on the use of the service
These will be determined at local level and may include information for referring
clinicians about
• Referral pathways.
• Communication pathways.
• Inclusion and exclusion criteria for patients referred or treated by the service.
i. The facilities recommended for delivery of GPwSI in sexual health service
Although these will be determined by the service being provided, the following
should ideally be present irrespective of the location or configuration of the
service:
• Access to mentoring/educational supervisor.
• Direct access to specialist support.
• Access to educational and relevant material, including provision of courses,
conferences and protected time for CPD.
• Access to a network of professionals working within the special interest area.
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• Written confidentiality agreement for the service and other members of the
team.
• Appropriate sensitive and specific diagnosis tests for Chlamydia and other
STIs.
• Access to health advisor.

This should be determined locally; however it is recommended that the
monitoring process should include an assessment of the service ability to meet un-
met or unrecognised needs and hence the service should demonstrate an increase
in opportunistic sexual health care, STI testing and an increase in referral for
sexual health services to GPwSI colleagues.