We can’t let sexual health services go without a fight
Enhanced services funding is under threat and the NHS reforms could see services fall between two stools, says Dr Anne Connolly
With the radical changes taking place to the NHS in April 2013, the demands on GPs working across England have never been greater. But, alongside this reorganisation, another is happening in sexual health. Services are going to be run and commissioned by entirely separate authorities. Unless GPs act now to get the best services for their community, provision will be substandard in some areas.
As things stand, sexual health services are already under threat. For example, Pulse recently reported that NHS Manchester is planning to cap GP funding for the provision of sexual health services to the under-25s, after claiming some practices exceeded budgets this year – a move heavily criticised by Manchester LMC.
So, if clinics don’t have the capacity to deal with demand, cutting GPs’ resources will have a catastrophic effect on patients and things are likely to get worse.
Next year, sexual health services will split. Enhanced contraception and sexual health will go to local authorities. Termination services will move to CCGs and core GP contraception services will be commissioned by the NHS Commissioning Board.
The risk is that service planning will disintegrate during the reorganisation. It is a worrying sign that the DH’s sexual health policy for the next year hasn’t been published yet.
For example, responsibility for enhanced contraceptive services and community-based contraceptive provision will be held by local authorities. Yet, the cost of an unplanned pregnancy in abortion services will be met by CCGs. Accountability will disappear as planning and funding of services become separated from the consequences of getting it wrong – except of course for the patient.
Funding is undecided
The amount of money local authorities will have to commission services is still in question. We know that public health funds will still be ring fenced but, within these, sexual health spending will not be.
The three public health outcomes targets – reducing teenage pregnancy, chlamydia screening and earlier diagnosis of HIV – are young people-focused. Some areas are already only looking at services for young people. If GP enhanced service funding is cut, over-25s will have more difficulty accessing services, particularly long-acting reversible contraception. This is a real worry, given that 80% of abortions are in women aged over 20.
Already, decisions about cutting and not developing services are being made. So few QOF points are awarded for sexual health, it is easy to see why it isn’t considered a priority for general practice. The worst-case scenario is that women’s GPs won’t be able to provide contraception. As 75% of women access contraception from their GPs, the result will be inreased rates of unplanned pregnancy and abortion.
The sexual health charities Brook and the FPA have launched a campaign in response to funding cuts, policy changes and opposition to patient choice.
Their website (wecantgobackwards.org.uk) has an interactive map where patients can rate experiences of sexual health services at GP practices and clinics. The charities plan to obtain data about what is happening in each area and lobby local authorities that have poor results. As elected local authorities govern public health, our role as GPs is to ensure ‘unpopular’ causes like sexual health are promoted as genuine health needs.
And there are things that we GPs can do now for sexual health. Many Scottish GPs, for example, have already lost their enhanced services for sexual health. If you have an enhanced service, make sure your commissioners are fighting for it to continue, as Manchester LMC has done. Enhanced services are being negotiated locally within the CCGs, but as sexual health funding will be transferring, it will be paid for by local authorities. So now is the time to lobby your public health lead and ensure that your services are factored in and budgeted for.
There is a real sense of urgency over this issue. The significant advances that have been made in sexual health are at risk of being reversed, and it will be too late to take action when the service is decommissioned.
The clinical and statistical evidence is very clear: investment in sexual health saves money. For every pound spent on contraception, £12.50 is saved by the NHS. But above all, our responsibility is to our patients, helping them avoid unplanned pregnancy and abortion and to enjoy good sexual health.
Dr Anne Connolly is founding member of the Primary Care Women’s Health Forum and a GP in Bradford