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GP services

GPs provide services that focus on maintaining people’s overall, long-term health. This is an important consideration for people with HIV. HIV-positive people are at higher risk of a number of medical conditions – some of which may be prevented, detected earlier or managed better, if you access GP services.

The services provided by a GP practice are divided into three types.

Essential services must be provided by all GP practices; these include GP consultations and a range of specialist services, including for cardiovascular disease and diabetes.

Additional services are those that most practices provide, but are not required to; these include contraceptive, cervical screening, vaccination, maternity and child services.

Enhanced services vary between practices; they address the needs of certain patients and specific health issues, such as substance misuse and depression.

Checking which additional and enhanced services are provided by a GP practice may be important to you when choosing a GP practice (see Finding and choosing a GP).

As well as registering with a GP you should continue to visit your HIV clinic or any other specialists you currently see. GPs do not prescribe HIV treatment and do not provide all the services that are available from specialist HIV care.

Flu and other vaccinations

Vaccinations are an important part of protecting your health and, in some cases, the health of those around you.

Most vaccinations are received in early childhood and protect your health into adulthood. Others are given to people throughout their lives, depending on their level of risk or need. Vaccinations are particularly important for people with HIV as they may be at higher risk of getting certain infections, or more likely to have a serious illness if they get an infection.

You can make an appointment with your GP for information and advice about vaccinations. Your GP will also administer most vaccinations. People with HIV are strongly advised to receive certain vaccinations. Some vaccinations may not be suitable or used only with caution, such as those using a live version of the virus (for example, yellow fever), but this may depend on your CD4 cell count. 

Disclosing your HIV status to your GP is important if you are likely to need vaccinations. If you do not disclose your HIV status, your GP will be unable to advise you accurately on the vaccinations you might need or whether it is safe for you to receive them. Without your GP knowing your HIV status, you may not be considered at high risk for certain conditions and could be asked to pay for the related vaccinations.

The following are vaccinations that adults with HIV are eligible to receive on the NHS (free of charge). For a list of vaccinations available for children see GP services for children below.

The flu vaccine. The influenza (‘flu’) virus is very common in the UK and is one of the main vaccinations you may visit your GP to receive.

The flu vaccine (or ‘jab’) is provided every year, free of charge to people considered at high risk, usually from October onwards. People with a weakened immune system, including people with HIV, are considered a high-risk group. The flu vaccine is available from your GP; surgeries often hold vaccination sessions in the autumn. Your GP or practice nurse will administer it. Having a flu jab is particularly important if you have a low CD4 count or are currently pregnant. Partners or carers who live with you may also be eligible.

The pneumococcal vaccine. People with HIV are considered at risk of pneumococcal infection, which can be prevented by the pneumococcal vaccine. This vaccine is provided free of charge to high-risk groups in the UK, which includes people with certain long-term conditions, including HIV. Whilst only one dose of this vaccine is usually required, people with a weakened immune system may need additional doses. Your GP can advise you on this.

Hepatitis B vaccine. The British HIV Association (BHIVA) recommends that people with HIV are vaccinated against hepatitis B unless they are immune. Tests can tell whether you currently have natural immunity to hepatitis B, perhaps because you have had an earlier infection with it. Unlike other vaccinations, you can get the hepatitis B vaccine (a series of three injections over six months) at your HIV clinic if you would prefer that.

Chickenpox (varicella) vaccine. The chickenpox vaccine is a ‘live’ vaccine and is generally not recommended for people with a weakened immune system. In some cases, though, the benefit of a person with HIV receiving this vaccine may outweigh the risks. BHIVA recommends people with HIV receive this vaccine if their CD4 count is above 200.

It is recommended that people who have close contact with people with HIV also have the chickenpox vaccine.

If you think you may have been exposed to the varicella zoster virus (through contact with either chickenpox or shingles), contact your GP within 96 hours; they can prescribe a drug (VariZIG) that may prevent infection.

Tuberculosis (BCG) vaccine. Although tuberculosis (TB) is a common co-infection in people with HIV, the tuberculosis (Bacillus Calmette-Guérin, orBCG) vaccine is not recommended for people with HIV. You may have already received a vaccination against TB if you were born in the UK.

MMR (measles, mumps and rubella) vaccine. This is a live vaccine, but is considered safe for people with HIV who have a CD4 cell count above 200. The MMR normally provides lifelong protection, but this may not be the case for someone with HIV. Talk to your doctor about whether you might need to be revaccinated. Vaccination against rubella is particularly important for women thinking of having a baby, because of the effects rubella can have on an unborn child.

Your GP can also provide other vaccinations, such as those recommended when travelling to certain countries. See Travel health below.

Contraception

Hormonal contraceptives (such as the ‘pill’ and injectable contraceptives) can be used as a family planning method and as a way to control your periods. However, condoms are the only contraceptives that also prevent the transmission of HIV and other sexually transmitted infections (STIs).

You can talk to your GP for advice about which type of contraception is best for you. Some hormonal contraceptives are not recommended for women on HIV treatment. This is because some anti-HIV drugs can reduce the effectiveness of the contraceptive. In addition, diaphragms and caps (flexible rubber or silicone dome-shaped devices which are placed in the vagina each time you have sex) are not recommended for women with HIV, as they should be used with a substance called a spermicide that can irritate the vagina.

Disclosing your HIV status to your GP will enable them to provide you with the correct help and advice.

Your GP or practice nurse can carry out most contraceptive procedures, including inserting or injecting contraceptives, such as the intrauterine device (IUD) or contraceptive injection, although not all practices will do so. Male sterilisation (or vasectomy), a permanent contraceptive method for men, is also performed at some GP surgeries, although often you will be referred to another service.

Your GP or practice nurse can also provide information about how to use your contraceptive method correctly and will do any necessary health checks, such as monitoring blood pressure, while you are using it. GPs will provide you with a prescription for contraceptives that can be collected from a pharmacy. All contraceptives are provided free of charge (including condoms at most surgeries).

You can find out more about contraceptive options for women in NAM’s booklet HIV & women.

Sexual health services

GP practices providetesting for some sexually transmitted infections (STIs), such as chlamydia, gonorrhoea and syphilis, free of charge. However, prescriptions for STI treatment may not be free through your GP in England (they will be free in other UK countries). Free treatment can be obtained by visiting a sexual health clinic (and often through your HIV clinic). However, some people may prefer to go to their GP.

If you are planning on seeing your GP for STI testing, do check which tests are available from your GP clinic, as this may vary.

Screening services

When you register with a GP, you may be offered screening for certain conditions. Your GP or practice nurse may carry this out for some conditions, and you will be referred to specialist services for others. Routine screening will help ensure any health conditions that do develop are detected as early as possible.

Cervical and anal cancer screening. Cervical and anal cancer are caused by some strains of the human papillomavirus (HPV). People with HIV are more likely to have HPV infection than people without HIV. Women living with HIV (especially aged 40 or older) are more likely to develop cervical cancer than women who don’t have HIV.

All women with HIV should have a cervical screen soon after they are diagnosed with HIV, again after six months and then every year after that (more frequently than HIV-negative women). Treatment for abnormal cervical cells is highly effective, provided they are detected early. Your GP will need to know about your HIV status to ensure you are offered annual screening. Talk to your HIV clinic staff if you would like them to arrange this with your GP.

There is no national screening programme for anal cancer, but if you feel you are at higher risk for anal cancer, talk to your GP. They may be able to arrange screening.

Breast cancer screening. Breast cancer can develop at any age in men and women. However, breast cancer usually affects women over 50. Women who are registered with a GP will be invited for breast cancer screening every three years, between the ages of 47 and 73 (from the end of 2012). You can also contact your GP at any time if you have concerns about the health of your breasts.

Prostate cancer screening. Cancer of the prostate (a gland below the bladder) is the most common cancer in men. It is more common in black African and black Caribbean men and men over 50, with most diagnoses in men over 70. There isn’t a national screening programme, so you won’t be offered any testing for prostate cancer automatically. If you’re concerned (for example, if you have a family history of prostate cancer), talk to your GP.

Travel health

Travel advice services are provided by some GP practices. They can provide information on how to stay well when travelling, and about travelling with medication. It’s important your GP knows about all the drugs (including anti-HIV drugs) you are taking, in case there are any possible interactions with drugs you might be given for travelling, such as anti-malarials or antibiotics.

Travel vaccinations. If you are travelling abroad, you are entitled to receive some vaccinations free on the NHS. Which vaccinations you will need depends on where you are planning to go (in some cases, there is a legal obligation to be vaccinated for certain diseases before visiting a country). Your practice nurse can tell you which vaccines are recommended, and can advise you on how they are given and whether they are available on the NHS.

Vaccinations available on the NHS from your GP practice include polio (given as a tetanus, diphtheria and polio booster), typhoid, cholera and the first dose of hepatitis A.

Many GPs do not charge for the second (booster) dose of hepatitis A. GPs will charge for other travel vaccinations, such as yellow fever and rabies.

There are some vaccinations that should be avoided, or only used with caution, in people with HIV. Your GP or practice nurse can talk to you about this. You may also want to discuss this with staff at your HIV clinic, as the decision may vary, depending on the health of your immune system (indicated by your CD4 cell count) and the likelihood of catching the condition in question. This is the case with yellow fever, for example, where you will only be offered this vaccination if you are going to a high-prevalence area and are at real risk of infection and if your CD4 cell count is above 200.

Rabies vaccination is recommended for people with HIV who are travelling to areas with a high prevalence of dog rabies, especially if your CD4 cell count is under 200. Some people who have had a low CD4 cell count (under 200) may need a booster dose.

GP services for children

Having access to GP services is important if you have children. If your child is under 16, you can register your baby or child in the same way that you have registered with a GP. This applies to any children you have parental responsibility for.

Most of a person’s vaccinations and immunisations are received during the first months and years of their lives. Many of these are essential for your child’s health and wellbeing. Those available to babies and children on the NHS include:

  • DTaP/IPV/Hib (the 5-in-1 vaccine), which protects against diphtheria, tetanus, pertussis (whooping cough), polio and Hib (haemophilus influenza type B).

  • Pneumococcal.

  • Meningitis C (MenC).

  • Hib/MenC (a booster against Hib and meningitis C).

  • MMR (protecting against measles, mumps and rubella). This vaccine is ‘live’ and shouldn’t be given to children with weakened immune systems. There is no evidence to support the claim that the MMR vaccine may cause autism in children.

  • DTaP/IPV (or dTaP/IPV), a ‘pre-school’ booster protecting against diphtheria, tetanus, pertussis (whooping cough) and polio.

Vaccinations available free to ‘at-risk’ groups of babies and children include the chickenpox (varicella) vaccination and the flu vaccine. At-risk babies and children include those who have weakened immune systems.

Children with HIV should not receive the BCG vaccination for tuberculosis. This is also true for children whose HIV status is not yet known, i.e., they are waiting for confirmatory HIV tests.

GP practices may have a health visitor service based at the surgery, with staff who specialise in the healthcare needs of babies and young children. They also provide support and advice to parents and carers. Other GP services for children include long-term vision, height and weight monitoring as well as general health reviews.

If you're worried about your child's development or wellbeing and you think they need additional support, you can talk to the GP. They can assess your child and suggest services that can help.

Specialist clinics and other services

Clinics for a number of long-term medical conditions are provided by all GP practices, including clinics for asthma, diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular (CVD, or heart) disease. They are usually run by a practice nurse, who provides help and support with managing these conditions.

Practice nurses can change dressings and some GP practices will do minor surgery.

GP practices often have links to other services (in some cases, they will be based in the same surgery or building). These can include district nurses, health visitors, physiotherapists, midwives, and occupational therapists. Some surgeries also have a pharmacy in the building. 

Non-NHS services from your GP

Your GP can also provide you with services that are not available on the NHS. They will charge for these services, which include:

  • providing private ‘fit’ notes (these used to be called sick notes; used if your employer or an insurance company requires a sick note for less than seven days’ absence).

  • writing prescriptions to take medication abroad (not including anti-HIV drugs).

  • signing certificates of vaccination (needed to enter some countries).

  • signing insurance claim forms.

  • signing passport applications.

  • doing medical examinations for heavy goods vehicles (HGV) and other driving licences, job applications (pre-employment medicals) and sporting activities.

 

HIV, GPs & other primary care

Published October 2012

Last reviewed October 2012

Next review October 2014

Contact NAM to find out more about the scientific research and information used to produce this booklet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.