Financial incentives combined with practice-based support, audit and feedback helped improve GP screening rates for chlamydia in practices in South London.

The London boroughs of Lambeth and Southwark have some of the highest rates of chlamydia infection in the UK. Both have developed financial incentives for chlamydia screening in general practice: a target-based incentive in Lambeth and a fee for service payment in Southwark.

In addition, Lambeth employed a GP champion to provide support for screening in local practices; this included peer support, educational workshops and regular feedback on screening performance. Southwark had a chlamydia screening co-ordinator who provided a similar package of practice support.

In both areas, practices identified with low screening rates were targeted for extra support to boost their screening rates.

All practices were provided with regular feedback on their chlamydia screening performance as well as audits of all positive screens; newsletters with league tables were also sent out regularly. The effects of these interventions were evaluated for the period April 2003 to March 2011.

There was a year on year increase in chlamydia screens across most sites. Lambeth GP practices represented 45% of all chlamydia screens in 2010/11 and in Southwark this figure was 46%. The positivity rate in Lambeth was 5.8% in men and 6.0% in women; in Southwark comparative figures were 3.9% and 5.3% respectively. There was also an increase in the proportion of men screened; in Lambeth, this rose from 13% in 2003/4 to 25% in 2010/11 and in Southwark from 20% to 27.6% respectively.

These interventions also appeared to improve screening rates in practices with low starting points (i.e. less than 10% of their target 15-24 population screened); in Lambeth, this increased from an average of 5.1% in 2008/9 to 10.3% in 2010/11 and in Southwark from 5.7% to 12.6%.

The design was a weakness of this study as it did not set out to compare PCTs that used these interventions with those that did not, so it is difficult to attribute the improvements entirely to educational outreach visits and financial incentives.

There could have been many confounders such as national media campaigns and other educational initiatives that might have contributed to improving screening coverage in general practice.

It would appear that there is no difference between the inputs of a GP champion and that of a chlamydia screening co-ordinator, although the former was only contracted to provide eight hours a month whereas the latter was full time.

Chlamydia diagnosis is one of the key indicators in the health protection domain of the Public Health Outcomes Framework against which local authorities’ performance will be judged. This study may offer some ideas on how to improve screening coverage in high prevalence areas.

Dr Richard Ma

• Kalwij, S, French S, Mugezi R, Baraitser P. Using educational outreach and a financial incentive to increase general practices’ contribution to chlamydia screening in South-East London 2003-2011. BMC Public Health 2012;12:802