Public Health England survey finds commissioning of sexual health and HIV services is ‘fragmented’
Provision of sexual health and HIV services has become ‘fragmented’ in England since responsibility for commissioning was split across local authorities, clinical commissioning groups (CCGs) and NHS England, a survey published by Public Health England has found. PHE’s report concludes that the fragmentation of commissioning and contracting barriers needed to be reduced, and it called for improved data and monitoring of outcomes. Sexual health, reproductive health and HIV commissioning must be explicitly considered within the development of the new funding mechanisms for public health over the next three years.
The Role of Pharmacies in Service Delivery
Pharmacies could be used to provide more sexual health services in the future, as commissioners cut their spend on specialist services. The survey asked local authorities and CCGs what types of services they commissioned from different providers. The majority of local authorities (95%) responding reported commissioning services from pharmacies.
The following table summarizes the data on services commissioned from pharmacies by local authorities:
| Service Type | Commissioning Percentage |
|---|---|
| Emergency hormonal contraception (EHC) | 93% |
| Chlamydia screening | 73% |
| Condom distribution | 57% |
| Testing and treatment for sexually transmitted infections (STIs) | 11% |
| HIV testing | 6% |
| Provision of long acting reversible contraception (LARC) | 6% |
| Chlamydia treatment | 6% |
| Pregnancy testing | 5% |
In contrast, most CCGs are not commissioning any sexual health or HIV services from pharmacies. Over two-fifths (44%) of CCGs said that such commissioning was not relevant to them. Of the few that were commissioning services, the most likely was EHC (8%), while LARC, chlamydia screening, and STI testing were each commissioned by only 4% of CCGs.
Funding and Sustainability Challenges
Local authorities said that they may not be able to maintain current levels of service provision because of government cuts to the public health grant. Many expected to reduce access to specialist services and redirect patients requiring less specialist care to pharmacies and general practice. However, the report pointed out that “reduced capacity in general practice meant that there was a lack of confidence that the provision of services commissioned through GPs would actually be provided”.
Ian Green, chief executive of the Terrence Higgins Trust, said the report confirmed that vital sexual health and HIV services were ‘at breaking point’. He noted: “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.”
Future Directions for Integrated Commissioning
This guide looks at how to pull the whole commissioning system together, focusing on interfaces in commissioning responsibility. It articulates how commissioning bodies need to work together to ensure that the individual experiences seamless delivery of services to meet their needs. By considering the wider influencing factors, local areas are able to tackle the causes rather than just the symptoms, and really begin to make a difference to the health of their local populations.