Patients who present to general practice with a suspected STI expect to be offered tests, given information and a formal referral to a GUM clinic if care is not offered on site. However, a qualitative study found that these expectations were often not met and many would prefer to be treated at a GUM clinic in future.

The expectations and experiences of men and women who initially present to their GP with a suspected STI were studied to identify ways to improve service delivery.

Patients were recruited from practices in Brent in NW London and Avon in SW England. Brent is an ethnically diverse population where 55% are from non-white groups compared with <10% in Avon. Subjects aged ≥16 with a diagnosed or suspected STI who presented first to a participating practice were eligible for the study. Participants were also recruited from GUM clinics: those who were ≥16 who had already seen their GP for their current problem were eligible.

Interviews were semi-structured and based on a topic guide which explored demographic information, reasons for attendance, experience of care, consultation, referral and treatment. They were carried out by phone and face to face.

Initially 22 patients were recruited from general practice but only 11 proceeded to interview; all 38 patients recruited from GUM clinics agreed to be interviewed. Three themes emerged from the interviews: accessing general practice; patients' experience and expectations; expectations and preferences for future STI care.

Most interviewees had chosen to see their GP in the first instance because of perceived speed and ease of access. One practice in Bristol provided an enhanced sexual health service and participants enrolled from that practice chose to attend that service because the practice nurse was perceived as a specialist. All respondents said it had been easy to book an appointment at their practice and many were seen within 48 hours.

Patients reported mixed expectations and experiences at their practice. Many expected to receive information about their condition either verbally or in written form but received neither.

Some felt their GP avoided discussing sexual matters with them. Some also expressed surprise that they were not questioned about their sexual partners, use of condoms or previous STIs.

Although many men and women had a physical examination, few had tests done; this was a disappointment for many as they thought they would be able to be tested for all STIs. Several also said they were surprised that they were not offered an HIV test.

For those patients who went to a GUM clinic, several had expected to be given a formal referral letter by their GP. Those who were given a letter were seen at the GUM clinic more quickly than those given only a telephone number to ring.

All participants expressed a preference to seek treatment for sexual problems in primary care; this included those who had been referred to the GUM clinic. They cited convenience, ease of access, having a good relationship with their GP and satisfaction with past consultations. Most wanted to be treated during normal surgery time rather than designated clinic time.

However, when asked where they would go to get treatment for a suspected STI, most said they would choose a GUM clinic because they perceived its staff as specialists and expressed satisfaction with the information, tests and advice provided.

The National Strategy for Sexual Health and HIV aspired to get more primary care teams to provide a range of sexual health services. It appears general practice is already responding to rising demands for sexual health services and provides an increasing proportion of STI diagnosis and treatment.

It is refreshing to see that the public chose to see their GP in the first instance for sexual health matters. They expected their sexual histories to be explored, genital examinations to be done, and tests for STI and HIV to be offered. It is unfortunate, however, that some of the patients did not get what they wanted from general practice. It feels to me that we as GPs sometimes create barriers so that people do not get the care they need and it doesn't just apply to sexual health. It is the old chestnut: PUNs and DENs - patients' unmet needs might be doctors' educational needs. Let's try to do something about it.

Dr Richard Ma