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How councils are cutting GP sexual health services

A number of local authorities are changing the way sexual health services are provided, which is likely to lead to less provision within general practice. We look at what is happening across England

York

York City Council have given GPs notice that they will be cutting the contracts for LARCS, alongside other public health services including Health Checks, from April.

It said in a statement: ‘All GP practices were notified of the council’s commissioning intentions in writing and were given an opportunity to raise concerns.

‘The council listened to the concerns and issues raised and were able to respond by revising the proposals to… allocate funding for the joint commissioning of Long Acting Reversible Contraception in primary care with the Vale of York CCG, pending their agreement.’

London

Under the London Sexual Health Transformation Programme, 19 London boroughs are putting LARCs contracts out to tender.

Its website explains that the programme has been set up in response to ‘the continued squeeze on public sector finances, and specifically public health budgets’ and aims to ‘design, agree and procure a system that will deliver measurably improved and cost-effective public health outcomes, meet increasing demand and deliver better value’.

Dr Andrew Howe, director of public health in Barnet and Harrow and programme director of the London Sexual Health Transformation Programme, said: ‘The programme is a partnership of 28 London boroughs working together to set up a new online triage, advice and testing service to improve access and provide better outcomes for patients.

‘We are currently looking in detail at capacity and demand to help our planning but we would hope that more services will be provided in primary care settings in the future. As well as being convenient for many patients this will free up clinic and hospital time for complex cases. The exact model for delivering future contraceptive services is a matter for local authorities and will depend on local needs.’

Devon and Torbay

The local Councils have cut the number of LARC procedures undertaken by GPs to switch to a cheaper ‘nurse-led’ approach.

The plans mean some GP practices will only be funded for six GP LARC fittings, with the rest paid for at a nurse hourly rate.

Torbay Council told Pulse: ‘The revised price [for LARC] has resulted in a reduction in the payment given to Torbay practices for providing this service and an increase in the payment given to practices providing this service within Devon County Council area.

‘The payments allow for GPs to retain their clinical expertise in providing this service, if they chose to do so, but encourages the practices to adopt a nurse led service which is not only more efficient, but frees up valuable GP time. This pricing mechanism fully recompenses the practices for the time taken to deliver the service and ensures that practices in Torbay and Devon are paid the same price for the same service.’

Readers' comments (2)

  • This is a real blow for womens' rights and for the protection of the most vulnerable.
    Firstly women should have the right to chose.If they want to have a coil fitted by a doctor who has known them for years and is aware of their medical and social needs, then they should be able to make that choice.
    Secondly, I work in an area of high ethnicity. Women are often coerced into having more children especially if they have not produced enough male children. At least once a month I fit a coil for a just such a woman who has come on another pretext but actually wants to have reliable contraception which they can hide from their partner/extended family ie an IUCD.
    Lastly, it is a blow for the vulnerable. IUCDs are fitted as post coital contraception where the 72 hour deadline for the oral option has expired. Sadly in my experience, this is most commonly in abused teenagers,rape victims and women with learning disability ie where presentation is delayed.Are councils going to have to pay for their terminations, not to mention the psychological damage and ramifications thereafter?
    Councils have to ask themselves if this move is really good value for money. If they say "Yes" then I would say that they know the price of everything and the human cost of nothing.

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  • I'd love to hear some comment from HM government who instigated the devolving of these services to councils, and whether they still think it was a good idea.

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