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GPs go forth

PHE report raises concerns over sexual health services provision

Sexual health services have suffered from 'fragmentation' since being put under the responsibility of local authorities, according to a Public Health England review.

Since April 2013, councils commission the majority of services relating to sexual health, reproductive health and HIV, although some of the responsibility sits with NHS England and CCGs.

But PHE's report said that since the overhaul, which came with the Health and Social Care Act 2012 replacement of Primary Care Trusts (PCTs), there have been issues with fragmentation of commissioning.

It said this had led to problems with 'ensuring access to services, particularly for those at greatest risk' as well as 'contracting problems including cross-charging for patients attending services outside of area'.

PHE's report, which was based on responses from local authorities, NHS England and CCGs, also unveiled workforce concerns including 'clinical expertise both in service delivery but also in commissioning'; 'increasing demand for some services'; and 'financial pressures due to reductions in budgets – particularly in local authorities'.

Among workforce concerns, the report highlighted 'vacancy levels in general practice, genitourinary medicine, and sexual and reproductive health’.

PHE also said the competitive tendering environment in England since the 2012 Act had led to sexual health services providers facing ‘constant uncertainty and regular rounds of re-tendering’.

In response to the concerns highlighted, PHE said fragmentation and 'contracting barriers' should be reduced, while outcomes should be monitored. It also called for sexual health, reproductive health and HIV commissioning to be 'explicitly considered' when new funding mechanisms for public health are developed over the next three years.

But leading UK sexual health charity the Terrence Higgins Trust said the report showed that vital services were on the brink of collapse.

Chief executive Ian Green said: ‘Sadly this confirms the fears that we, and many others, have highlighted – these vital services are at breaking point.

‘Demand is rising, while budgets are shrinking; HIV and sexual health services are reeling from a combination of national Government funding cuts to local authorities, a lack of prioritisation by some local councils, and lasting damage from the Health and Social Care Act, which led to fragmented and uncoordinated commissioning.

‘Without additional investment in HIV and sexual health services, it is unclear how a sexual health crisis can be avoided.’

Readers' comments (2)

  • Vinci Ho

    While I always believe in and respect the independece of the three separate powers , executive, legislative and judiciary, in western democracy. The British system, with an unwritten constitution, is never entirely independent as far as the first two powers are concerned. I think legislation like Health and Social Care Bill(particularly section 75) was born as a result of this inborn defect .We nearly had similar outcome when the prime minister wanted to exercise the Royal Prerogative to prevent the Brexit Bill going through House of Commons first last December.(In a way , that precipitated (1)the arrogant onslaughts from the government propaganda media on the Supreme Court which ruled against the government (2)the demotion of the Justice Secretary at the time , Elizabeth Truss , for failing to defend the independence of the judiciary .
    Thanks to section 75 of HSCB , the process of procurement and tendering of essential health services were recycled again and again . The cheaper the provider , the better . For private companies, to be fair , won a contract by making false financial promises while on the other hand , had to maintain profit margins for their shareholders. That was easily a no-man's land . Shame on Cameron and Clegg for passing HSCB. Well , what goes around, what comes around . The latter did retrieve a bit of dignity when he said , ' live by the sword , die by the sword' after being beaten in his own constituency in the general election this year .
    To save the day , this fallacy of treating the NHS as a purely economic model must stop.
    And of course , as Montesquieu wrote,
    ''Useless laws weaken the necessary laws.
    Book XXIX, Chapter 16.''

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  • Fragmentation is the right word.I have attended meetings with local authorities responsible for sexual health where their contract threatened to disrupt existing functioning coil fitting services by gp and family planning doctors, such as only accepting one certification for fitters with no budget for recertification of existing fitters and stuff like 'we pay for coil fittings for contraception but not hormone coil fittings for menorrhagia ' which is logical but could mean the demise of gp coilfitter provision where the practices are hardly likely to provide the service at its own expense.

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