Feature

Can’t they go and see their GP?

Clinics can provide more than ‘clinical’ care, says Connie Smith

It is not always easy to go and see a doctor, especially when it comes to seeking information and advice about sex and its consequences. Since the first pioneering clinics were set up over 50 years ago — before the NHS was established — it has been understood that in order to try to make sure that women have access to good reliable information about their sexual and reproductive health it is necessary to provide facilities that they want to use if they have a problem.

Women want to be seen by well-trained, caring staff in clean, comfortable clinics where they can take the time to discuss things fully and have their questions answered. Some women specifically would prefer to see a woman doctor for examinations, although for others it is more important that the doctor has time, understanding and expertise.

Many women will feel comfortable and confident that they can go to see their GP if they need advice about their gynaecological health, but many will be put off going, and for these women, and for those not registered with GPs, health authority community clinics provide a very important facility.

Clinics should be open through the day and in the early evenings. Women at home with young children should have the opportunity to attend in the day-time (and clinics should have some facilities for looking after children). For women who work outside their homes, evening appointments on the way home from work are convenient. The possibility of ‘dropping in’ to a clinic without an appointment will make them available for women who have problems, but who don’t have diaries and telephones.

Despite the sophistication of much modern medicine, there are only a few reliable contraception methods, and all of them have risks as well as benefits. For some women the choice is narrowed by medical or other problems. Having the chance to discuss the pros and cons of the methods available, and to make your own informed choice of a method is important, as is knowing that you can take any problems back to expert, interested staff. With out this appropriate help, it can be difficult and frightening to use contraception at all.

Since the DHSS issued a memorandum of guidance in 1974, it has been NHS policy to provide a choice of sources of free and accessible advice for all who need information about contraception. However, in many parts of the country we are still a long way from that goal, and in many ways we are now going backwards.

There are very few specialist services provided by the NHS where it is not necessary to have been referred by a GP or another specialist. The community clinics are available to anyone who chooses to use them, and are especially important because they see healthy people for preventative health care. In recent years health authorities have increasingly been seeking to restrict access to clinics to those women who live within their boundaries, in order to save money by limiting the numbers to be seen.

The trouble is that setting up and running clinics that serve these needs cost dedication, time and money. In many areas where health authorities are constantly having to make savings and cut services, it can appear to make sense to save money on community clinics for women. Managers can almost be heard thinking out loud: ‘ Can’t they just go and see their GPs?’ The fact is that the medium term consequences of these cuts include unwanted pregnancies — with their medical, social financial and personal costs — is overlooked.

Community healthcare for women can include family planning (birth control and pre-conceptional advice), pregnancy-testing, cervical smear testing, teaching breast self-examination, psycho-sexual therapy, Well Women clinics, menopause clinics, termination of pregnancy clinics and a wide range of advice in health promotion.

It may seem to be a relatively unimportant and unglamorous kind of medicine to be fighting for when there are people dying for lack of NHS intensive care beds. But if there is to be any commitment to preventative health care, what could be more basic than ensuring access for women to services like this?

Alterations in current clinics, which are effectively cuts in the service, can be oposed with the help of the local community health council. If health authorities decide to close clinics an appeal can be launched to the regional health authority, and if necessary to the Department of Health.

For more information on defending family planning services, contact Barbara Kenmir, Family Planning Association, 27 Mortimer Street, London W1. Tel: 01 636 7866.