The integration of family planning and genitourinary medicine services.

planning and genitourinary medicine (GUM) services are in many ways imperfect as neither deals with the broad spectrum of sexual health needs in an holistic way. Client centred care focuses on equity of access, the provision of quality care, appropriate referral and management and achieving client satisfaction. Is the solution an extension of the recent trend of traditionally separate disciplines sharing clinical space, or is a more fundamental examination of clients’needs required if we are to address the sexual health needs of 21st Century men and women? The integration of services is a complex process; identifying and understanding the similarities in relation to client care is important and is perhaps the easy part of the equation. In contrast, the origins and subsequent evolution of the specialities of GUM and family planning are, in many ways, worlds apart. This means we have to consider several contrasting elements gynaecologists and physicians; sessional staff and full time staff; preventative medicine and managing disease, and the role of the doctor and of the nurse. Thus we have, at this moment in time, two specialities that are in many ways doing similar work and have similar aims for client care, but which work in different ways. The challenges for integration lie within ourselves, not with the medical problems or with the clients. For very good reasons GUM services developed along a medical model within hospitals and later within the NHS at its inception, initially to meet the needs of men returning from the army with venereal diseases at the end of the Great War; the emphasis being to provide confidential services free of charge. It is interesting that an early recommendation from the medical establishment on the prevention of the spread of STIs was to detain some women with STIs, not men, as hospital inpatients. Women’s rights campaigners successfully changed opinion on this matter. Family planning services evolved from female empowerment and, to begin with, had only limited support from much of the medical profession. The latter deemed the field too ‘social’ for medical responsibility. Family planning services only became freely available to all in the mid 1970s when FPA clinics were absorbed into the NHS and primary care providers started to receive remuneration for providing contraceptive care. When considering the integration of family planning and sexual health services, it is important to remember the breadth of providers involved – pharmacists (condoms, pregnancy tests, female barriers, Persona and, in the future, emergency contraception), obstetricians and gynaecologists, midwives, health visitors and health promotion staff, as well as doctors and nurses working in family planning services and GUM services in acute and community trusts and in primary care. Unlike in family planning, in GUM specific legislation exists to protect confidentiality. However, in practice, most family planning and GUM services work to similar standards. Until the mid 1980’s and the allocation of now huge budgets for HIV research, prevention and treatment, both family planning and GUM services could be considered ‘Cinderella’ specialities. Whilst GUM services have been