GP contraceptive services cut as councils target public health budgets
Exclusive Local councils in England are scaling back GP-run contraceptive and sexual health services under a new wave of cost-saving plans that GP leaders have warned will reduce access for patients and cut off an important funding stream for practices.
A Pulse investigation has found more than 20 local councils so far that are potentially taking away the services from GP practices.
This includes complete closure of GP-run sexual health and contraceptive services in York, while 19 London boroughs are putting services out to tender, which GP leaders warn will mean fewer practices carrying out the services.
Funding cuts in Devon also mean some practices are being forced to drop contraceptive services.
It comes after Pulse revealed practices are also losing smoking cessation services and NHS Health Checks contracts amid Government cuts to public health grants, which have already seen local authorities stripped of £200m this year, and from April facing further cuts averaging out at 4% a year for the next five years.
Family planning experts have been warning that cutting such services could end up costing the health service billions of pounds in the longer term, and 'reverse a decade of progress’ on training and access to contraception.
The councils changing their current sexual health service provision include:
- York City Council, which told practices in December they would terminate long-running contracts for chlamydia screening and long-acting reversible contraception (LARC) ‘with effect from 31 March 2016’, despite being ‘fully aware of the concerns in general practice ... and the impact this may have on the wider provision of women’s sexual health and gynaecological services in primary care’;
- Nineteen London boroughs, which are putting LARC contracts out to tender as part of the London Sexual Health Transformation Programme. This is due to ‘the continued squeeze on public sector finances, and specifically public health budgets’;
- Devon and Torbay councils, which are cutting the number of LARC procedures GPs do to switch to a cheaper ‘nurse-led’ approach, meaning some practices will only be funded for six GP LARC fittings, with the rest paid for at a nurse hourly rate.
In London, the 19 boroughs are putting services out to tender.
Dr Andrew Howe, director of public health in Barnet and Harrow and programme director of the London Sexual Health Transformation Programme, said: ‘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.'
But Londonwide LMCs medical director Dr Tony Grewal warned 'the provider is not intended to be GP and it is unlikely a GP practice or even a federation of GPs would be able to successfully bid for the service’.
He added: ‘This will diminish patient choice, limit access to these forms of contraception and diminish GPs’ professional competency to undertake these procedures... in terms of the service to patients and the skills resource available to [public health] in the future, there are huge risks in getting rid of what is actually a very cheap service’.
Dr Mark Sanford-Wood, medical secretary at Devon LMC, told Pulse that it meant some practices - particularly smaller rural ones - without enough trained staff would no longer be able to cover the costs of running the service.
Dr Sanford-Wood said: ‘ ‘The danger is, they will simply have to send those patients to local family planning clinics that are not really resourced for those kinds of volumes of patients and not as accessible – the geography of Devon really doesn’t lend itself to easy access to centralised services.’
Meanwhile, Dr John Crompton, chair of North Yorkshire LMC, told Pulse local GPs were continuing to fight the move as they were concerned it could lead to a rise in unplanned pregnancies – and would mean GPs and practice nurses trained in fitting implants and coils would lose their accreditation to offer the services in the future.
Dr Crompton said: ‘For practices that have invested a lot of time and effort in training in fitting long-acting contraception and coils, this was a time-consuming but significant income stream, people have taken on staff and work plans around that, and it’s just going to disappear.’