HIV medical care

HIV medical care is part of what is called secondary care (i.e., those health services generally provided in a hospital rather than at a GP surgery). HIV care is normally provided by a team of doctors and nurses. At larger centres, the multi-disciplinary team may include specialist dieticians, pharmacists, psychologists and health advisers as well.

Hospital departments treating people with HIV are frequently linked to, or part of, a clinic for sexual health (also known as a genitourinary medicine or GUM clinic). In other places, treatment may be provided by the department of infectious diseases.

At the moment, NHS treatment and care of people with HIV in England is paid for by primary care trusts (PCTs). There is a primary care trust for each local area, often with a name like NHS Sheffield or NHS Surrey. They are the organisations that are responsible for funding (commissioning) local health services. The treatment and care services are provided by NHS Trusts (including acute trusts, hospital trusts and foundation trusts).

The Conservative/Liberal Government plans to replace PCTs with GP commissioning consortia (a larger number of smaller organisations responsible for funding local health services). All NHS trusts will become foundation trusts. These changes will affect England only.

In Wales and Scotland, HIV care is both paid for and provided by Health Boards. In Northern Ireland, care is commissioned by the Health and Social Care Board and provided by five Health and Social Care Trusts.

Not usually. Most HIV clinics are linked to a sexual health clinic, and these clinics will have an open-access policy - patients simply need to contact the clinic to make an appointment. This is not always the case when HIV care is provided by an infectious diseases department, in which case a referral from a medical professional may be required.

Not usually. Clinics that provide treatment for sexually transmitted infections, including HIV, allow patients to attend anonymously (it is perfectly legal to use a false name at the clinic) and do not check whether patients live close to the clinic.

Treatment is always free for people who are legally resident in the UK. There are no prescription charges for HIV drugs dispensed at a hospital pharmacy.

The rules on charging for the provision of treatment for HIV for migrants are complicated and are implemented differently around the country. See the chapter on Access to health care for detailed information.

In Scotland, Wales and Northern Ireland, HIV treatment is generally provided free of charge, on public-health grounds, to everyone who needs it, regardless of immigration status.

In England, the rules are basically the same as for other aspects of NHS secondary care. People who are in the process of applying for asylum, people with leave to remain, people working legally in the UK and full-time students are all entitled to free secondary care. People detained at an Immigration Removal Centre (IRC) are entitled to free health care, but this is not part of the NHS.

Those who may be charged for treatment in England include undocumented migrants, people who have over-stayed their visa and refused asylum seekers. Few of these people will have the means to pay for treatment. Nonetheless, HIV treatment is usually considered to be ‘immediately necessary’ and as such this cannot be withheld, even if it is unlikely that the NHS will ever recover the cost. Patients who receive bills for their treatment should get advice from an HIV-support agency with experience in this area.

Under the NHS Act 2006, the Secretary of State for Health has a duty to provide a comprehensive health service in England, but this will involve making ‘reasonable’ decisions about the best use of limited resources. Similar legislation exists for Scotland, Wales and Northern Ireland.

The NHS charter includes a number of ‘rights’ to NHS care which also apply to HIV clinics. There are targets in England, Scotland and Northern Ireland for patients at sexual health clinics to be seen within two working days.

Many HIV clinics have patient groups set up to provide a voice for patients and suggest improvements to services, with some patient representatives sitting on management committees.

Moreover, patient involvement is a key goal of the NHS across the UK and so formal organisations exist to promote it. There are LINks (Local Involvement Networks) in England, Scottish Health Councils, Community Health Councils in Wales and Patient and Client Councils in Northern Ireland. (In England, LINks will be replaced by an organisation called HealthWatch in 2012). All these organisations are independent of the NHS, with local offices that provide advice to patients and offer opportunities to become involved in improving NHS care.

In addition, when primary care trusts and health boards organise public consultations about changing services, details should be on their websites. In England, patients at a foundation trust can become a member of it, which gives them the right to stand and vote in elections for its Board of Governors.

In England, there is a Patient Advice and Liaison Service (PALS) in every NHS Trust whose function is to provide advice to patients, resolve problems in services and provide a focal point for good and bad feedback about the trust’s services.

All NHS organisations operate a formal complaints system, but you can often resolve issues and problems by raising them informally. If you do want to make a complaint, there are supporting services to help patients do so: in England, the Independent Complaints and Advisory Service; in Scotland, the Independent Advice and Support Service; in Wales, the nearest Community Health Council; and in Northern Ireland, the Patient and Client Council. Alternatively, a formal complaint can simply be made by writing to the Chief Executive of the NHS trust or Health Board outlining what went wrong and stating that you wish to complain about it.