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GPs fear sexual health will become ‘Cinderella service of NHS’

Bureaucratic, financial and training barriers are in danger of reversing major improvements

Mark Gould

Friday, 28 April 2017

Major improvements in the quality of sexual and reproductive healthcare - including halving teenage pregnancy rates and increased uptake of long-acting reversible contraceptives (LARC) – is at risk due to the bureaucratic, financial and training barriers facing GPs and practice teams, according to a survey of 50,000 GPs.

A Royal College of General Practitioners (RCGP) consultation reveals that GPs fear that services will suffer as vulnerable patients are being excluded from accessing the most appropriate forms of contraception, and that health inequalities are being widened as a result. GPs particularly cited the difficulties patients living in rural areas have in accessing sexual and reproductive health services, as well as younger patients who rely on their parents for transport.

Highlighting the findings at the Faculty of Sexual and Reproductive Health’s Annual Scientific Meeting Conference in Cardiff yesterday, RCGP chair Professor Helen Stokes-Lampard said: “As one of the most cost-effective services we provide, sexual and reproductive health must not become the ‘Cinderella’ service of the NHS, especially when it has the potential to save the NHS millions through the prevention of unwanted pregnancies and transmission of STIs, as well as playing such as vital role in helping women control their fertility and therefore their lives."

As a result of the consultation, the RCGP has made a series of recommendations including:

  • Commissioners from CCGs, local authorities and NHS England should use the Better Care Fund to agree joint plans for sexual and reproductive health (SRH), with the aim of maximising choice and creating the best outcomes for patients, according to assessed local need
  • A review of the contracts and payment systems used to commission SRH and genitourinary medicine services so that they focus on integration, incentivising prevention and early intervention
  • The introduction of a public health indicator which measures the availability of LARC through GPs’ surgeries
  • The Department of Health should give Public Health England responsibility for responding to the data collected around SRH, and mandate the organisation to make recommendations for action when outcomes decline
  • Training for local GPs, medical students and nurses must be a mandatory part of specialist SRH services’ contracts

Professor Helen Stokes-Lampard also criticised the "complex and fragmented" way that sexual and reproductive health services are currently commissioned in England, as well as the decreasing services available in the community.

“As it stands, some services are commissioned by NHS England, others by Clinical Commissioning Groups, and yet others by Local Authorities, causing confusion amongst healthcare professionals and patients as to how to effectively navigate the system, and unacceptable variation across the country,” she said.

She also raised concerns that the funding GP surgeries receive for providing patients with LARC does not often cover costs, meaning that practices are making a loss for delivering this service as a time when general practice is already under intense financial strain.

“In this day and age, all patients have the right to be provided with sufficient information to make the choice of contraception that is right for them, and be able to access that method without having to negotiate unnecessary hurdles – and GPs and our teams have the right to be properly trained and receive adequate recompense for carrying out these services," Prof Stokes-Lampard concluded.

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