Profile: Dr Hugo McClean, National Audit Group Chair, BASHH

28 November 2011

The British Association for Sexual Health and HIV (BASHH) was formed in 2003 through the merger of the Medical Society for the  Study of Venereal Diseases (established 1922) and the Association for Genitourinary Medicine (established 1992).  It has over 1,000 members comprising consultants, junior doctors, specialty doctors, nurses, health advisors, microbiologists, epidemiologists, sociologists in a well-developed network in the UK and with important European and other international links.  It is no surprise then, that BASHH has an outstanding commitment to the quality agenda and a strong educational and learning strategy. 

HQIP spoke to Dr McClean about BASHH's progress and their clinical audit programme.  As a full-time consultant, Dr McClean works in and around Hull at a number of clinics which are part of a community-based and integrated sexual health service.  

HQIP:  Can you tell us more about your background and your role as part of the BASHH National Audit Group.  How has its audit programme grown?

My contributions to BASHH are like that of many other BASHH members.  Working to support my own organisation's need to improve the quality of local care, is reciprocally and productively linked to working for the Specialty quality needs.  In short, being involved in the BASHH national audit programme gives day-to-day work added value.

I had already been a Specialty regional audit chair and working for the National Audit Group was a logical step, knowing that the practice of audit was the key way to measure adherence to clinical standards, which in turn leads to improved patient outcomes.

Put simply, BASHH's National Audit Group is a sub-group of its Clinical Governance Committee which is responsible for setting and monitoring the standards for clinical services for sexual health.  The National Audit Group responds to Specialty quality needs and provides national audit programmes.  In addition, we develop audit questionnaire tools needed for the audit process, and provide as a forum for national and regional discussion.

The Group's first audit of sexual health/genitourinary medicine (GUM) clinics focused on the management of gonorrhoea, started in 2003.  Since then we have conducted an annual national audit covering early syphilis (2004), HIV antibody testing (2005), sexual healthcare of persons with HIV (2006), chlamydia (2007), sexual history taking (2008) and asymptomatic screening (2009).

We have established an equally important re-audit process, to measure progress against baseline results already collected.  In 2010, we re-audited sexual history taking to make ensure the right questions are being asked at point of first contact - the results showed an increase towards target in all areas. 

Is there a particular project that could be described as a landmark in BASHH's activity?

Last year, BASHH worked together with MedFASH (Medical Foundation for Aids and Sexual Health) to develop standards for the management of sexually transmitted infections (STIMS), to support the commissioning of and provision of high quality care for STIs.  This year, funded by the Department of Health,  we worked together again to audit against the key performance indicators set down in those Standards for both Level 3 specialist services (sexual health/GUM clinics) and those at Level 2 (non-GUM services).

The funding allowed for an online data collection function which in turn has enabled us to not only publish national results but provide data regionally, for further use by Regional Audit Chairs, networks and clinics, and, for the first time, to provide individual clinic reports. One of the subsequent actions has been to obtain feedback from Regional Audit Chairs (one appointed for each BASHH branch) in those local areas where significant improvements were madeand to identify initiatives that could be replicated elsewhere.  

Overall, while we found that further development of the STIMS is needed to provide auditable measures, the performance indicators within the Standards are achievable by both Level 2 and 3 services.  Performance was variable across the regions and there were some clear areas for improvement.  On information governance, services had some difficulty with documenting staff competences, and on patient management, the need was identified to improve the time for clinicians accessing test results, as well improvements in partner notification performance.

Also worth noting is the impact of the asymptomatic screening audit.  The audit highlighted variable test use between clinics; for example, making the optimal use of nucleic acid testing for the diagnosis of gonorrhoea.  At the re-audit scheduled for 2012, we will see how anticipated improvements have impacted on practice performance.

Is the collaboration with other agencies something you would like to replicate in the future?

Absolutely, a major part of the work in the recent and successful BASHH MedFASH proposal for a new national audit topic involved a wide range of key stakeholders working in sexual health and HIV infection care as well as the voluntary sector and the Health Protection Agency (to name only two other areas of working).

The British HIV Association (BHIVA) audit proposal was also successful and BASHH, MedFASH and BHIVA are now working together to produce specifications for a new joint national audit programme for the healthcare of people with sexually transmitted diseases and HIV infection. We also work closely with the National Chlamydia Screening Programme.

At a recent BASHH strategy day, a series of priority areas for future BASHH development were identified.  These include working with other specialities, as well as patient care and clinical governance, influencing national drivers for sexual health, education and training, and patient and public involvement.

Working with sexual health specialists societies like BHIVA and MedFASH will enable our work to reflect the more diverse groups of patients who are affected by STIs and HIV and who have particular support and access needs for example, younger people.

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How else are you supporting your audit programme?

As one of the smaller specialist societies, we are able to achieve much of our success as a result of a dedicated, close, membership network covering England, Scotland, Wales and Northern Ireland.  For us, it is vital to develop our audit strategy to fully support members' skills going forward.  Professional development is the key reward so that doctors, nurses, consultants and other professionals continue to see merit in the audit agenda.  

The Group communicates very effectively using email, and respond rapidly to queries about the BASHH audit programme. We are also work closely with the BASHH Clinical Effective Group and Clinical Standards Unit, including developing a statement for partner notification practice. The group also collaborates with the BHIVA and National Chlamydia Screening Programme.

Working with these other groups is aimed at working towards uniform quality standards across Sexual Health practice in various settings. A specific initiative has been an annual certification programme for the work done by the Regional Audit Chairs for use in appraisals or where other evidence of achievement is required. We are also looking at working with the NHS Institute for Innovation and Improvement to develop our audit methodology.

Do you think the discipline of clinical audit is receiving the recognition it deserves?

I think it is receiving the growing recognition it deserves.  The work with HQIP in particular has bolstered the profile and benefits of clinical audit in sexual health and HIV infection, especially at a national level.   We are very pleased to have been selected as one of 11 successful proposals for the forthcoming new national audit programmes (Healthcare for individuals with sexually transmitted diseases and HIV).  As you will know, there were 39 applications made and to pick up on an earlier point, we will be working with MedFASH and the British HIV Association to maximise the impact of the new national audit programme.

Working with HQIP in the near future, our next step is to get a set of specifications together so that we can start the process, as soon as funding is confirmed for 2012/13.

Click here to see the latest news release on the new national clinical audit programmes >>

Finally, what next?  What other developments are in the pipeline?

The new national audit of course represents a large piece of work for BASHH.  To reiterate, it's a crucial piece of work and represents another step to building the national voice for our area of work and for those patients who access sexual health and HIV services.  It also offers opportunity to engage with the public and extend BASHH influence to support and drive change within other services that offer STI management.  Some of these services are directed by those specialist sexual health groups, engaging with harder to reach patients.

The audit group is also aiming to be involved in the NICE Quality Standard programme and achieve a topic for STI and HIV management.  Along with the new national audit programme, this is another proposal with the key aim to influence and achieve improvement in patient care and governance.   

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BASHH homepage: www.bashh.org

BASHH National Audit Group: www.bashh.org/groups/national_audit_group