title: Improving sexual health services in the city: can the NHS learn from clients and the service industry.
abstract: OBJECTIVE
  Genitourinary service providers are struggling to meet patient demand and have introduced changes in access structure to cope. In this study, we explored the perspectives of clients and providers upon the different models of access introduced and whether these maintained service quality using the SERQUAL model.
  
  
  METHODS
  Primary data were collected in May 2005 at two genitourinary medicine clinics, two Accident and Emergency Departments and from members of a university 'gay' society all of which were located in London. Forty-four high-risk clients and 11 health service providers underwent semi-structured face-to-face interviews.
  
  
  RESULTS
  Both the walk-in and appointment-based access systems were appreciated by clients. Clients said that the most important issue was that they were not turned away when they presented. Health-care providers had a variety of opinions about the two systems as they had different impacts on morale, training and service provision.
  
  
  CONCLUSIONS
  Service quality can be maintained by using both walk-in and appointment-based systems. This is because our data, in line with Parasuraman's model of service quality, showed that 'access' is but one determinant of quality. Having different modes of access facilitates patient choice, which is paramount in a modern health-care system. However, to provide a good service it is important to maintain a motivated staff, who can be affected by their working environment.
authors.affiliation: Chelsea and Westminster Hospital, London, UK. dochiteshpatel@hotmail.com
authors.forename: Hitesh
authors.initials: H
authors.lastname: Patel
authors.forename: Juan
authors.initials: J
authors.lastname: Baeza
authors.forename: Mitesh
authors.initials: M
authors.lastname: Patel
authors.forename: Linda
authors.initials: L
authors.lastname: Greene
authors.forename: Nick
authors.initials: N
authors.lastname: Theobald
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012307:Risk Factors; D012749:Sexually Transmitted Diseases; D013222:State Medicine; D019037:Urban Health Services / Q000592:standards*; D014566:Urogenital System