The vast majority of the population in England live within 30 minutes of their nearest GUM clinic, only 3% have to travel further. However, there is a wide variation in geographical distribution with more difficult access in the South West and eastern regions.

A list of GUM clinics was obtained and using their postcodes, these clinics were then mapped onto an administrative map of England.

Trip planning software such as www.multimap.com and Google Maps was used to estimate point-to-point travelling time. A geographic information system (GIS) programme simplified the calculations by creating a sample of starting points evenly distributed within every area divided into a grid of 100m².

Assumptions were made about traveling speeds according to the roads, whether motorway or minor roads, or whether the journey was made on foot. A standard journey time of 30 minutes was taken as the reference based on a number of studies of the accessibility of the NHS.

The authors also recognised that some people may wish to travel further rather than choosing their nearest clinic in order to maintain anonymity so the results should only be interpreted as potential rather than actual accessibility.

Just 3% of the population of England lives more than 30 minutes from the nearest clinic; the longest journey time estimated was more than three hours and only 0.08% of the population had a journey time of more than one hour.

There were considerable regional variations though: while access was good in London, the South East, North West and East Midlands; the South West and East of England had the poorest level of accessibility with 7.7% and 9.2% respectively of the population unable to reach a clinic within 30 minutes. The ranking was the same when the data were reanalysed to calculate the proportion of the population aged 16-29 years who lived more than 30 minutes from a clinic.

The authors comment that GUM clinics are not the only providers of sexual health services in the UK and highlight the role of level 2 providers such as general practices providing enhanced sexual health services as well as community sexual health clinics. They make the important point that when commissioning sexual health services, consideration must also be given to geographical access for the population.

Despite apparently good access to sexual health services for the majority of the population, levels of STIs, unplanned pregnancies and HIV remain high.

According to this paper, no one in London has to travel more than 30 minutes to a GUM clinic and yet it has high rates of unplanned pregnancies, STIs and HIV. One explanation is that even if a clinic is within 30 minutes’ travelling time, those who need the service most may not access it; also, someone who may benefit from a sexual health screen may not travel to a GUM clinic.

It remains inequitable that some GPs offer a full range of sexual health services whereas others do not. Although timely access and close proximity may address sexual health needs, commissioners may need to work on improving the coverage of sexual health services in non-GUM settings such as general practice, community contraceptive clinics, youth services and pharmacies, where people are more likely to be offered a check-up opportunistically when they attend for another reason.

Dr Richard Ma

• Stuart B, Hinde A. Accessing genitourinary medicine clinics: does it matter where you live? J Fam Plann Reprod Health Care 2011;37:152-157