Lack of clinical staff and expertise is affecting the quality of sexual health and HIV services, according to a review of the way services are commissioned.
The review by Public Health England sets out measures to strengthen service commissioning but charities from the sector also warned that services were at “breaking point” and cannot cope without extra funding.
“The issue is of sufficient concern that a key action… will be on building capacity and capability”
The review, which was undertaken in the light of concern about wide variation in local commissioning arrangements, paints a worrying picture of an unsatisfactory and disjointed system that is struggling to cope with rising demand and financial pressures.
It describes a complicated and fragmented set-up where commissioning of various sexual health services is spread across local authorities, clinical commissioning groups and NHS England.
Issues include poor communication between the different bodies involved and confusion about who is responsible for what. These problems are being made worse by a lack of collaboration between commissioners and providers of services, warned the report.
While the majority of local authorities who took part in a survey – 88% – had conducted generic needs assessments for sexual health services, only a minority had assessed the needs of vulnerable groups such as homeless people, victims of sexual assault, and drug and alcohol users.
Just 7% had specifically looked at the sexual health needs of people with mental health problems.
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The review also highlighted issues with contracting and concern about vacancies in genitourinary medicine (GUM) clinics, sexual and reproductive health (SRH) services and general practice.
There was also concern about a lack of knowledge and training among some providers when it came to long-acting reversible contraception (LARC).
“The concerns about vacancies related in the main to the quality of service provision and to the long-term sustainability of clinical services,” said the report.
“There is further work required to understand the issues fully, but the issue is of sufficient concern that a key action for PHE and partner organisations will be on building capacity and capability,” it said.
The review found all the commissioners it contacted were concerned about future funding, but these concerns were most pronounced in local authorities.
“Local authorities described moves to reduce access to specialist services and redirect those requiring less specialist care to GPs and pharmacies,” said the report.
“This is dependent on capacity in primary care which in turn requires effective co-commissioning to ensure that capacity is available and models across the pathway are effective,” it added.
The report sets out an action plan to improve commissioning, although PHE said the current overall commissioning model and contracting arrangements would remain.
“Sadly this confirms the fears that we, and many others, have highlighted – these vital services are at breaking point”
The plan includes testing new ways of working, including a pilot scheme for “collaborative cross-sectoral commissioning” in two areas, which will see different commissioning bodies working together.
It will also involve revising commissioning guidance, including a new service specification for pregnancy and termination services, and work to set up sexual health networks to share learning, discuss common issues, and address “an absence of managerial and clinical leadership”.
The findings of the review were based on a survey carried out in 2016 by PHE and the Association of Directors of Public Health, supported by NHS England and NHS Clinical Commissioners.
’It asked local authorities, NHS England and Clinical Commissioning Groups to highlight areas of challenge within the commissioning framework.
Ian Green, chief executive of the Terrence Higgins Trust, said the report confirmed sexual health services were “at breaking point”.
While he welcomed the action plan, he said it did not commit to new funding and did not address the shortfall from cuts to public health budgets.
“Without additional investment in HIV and sexual health services, it is unclear how a sexual health crisis can be avoided,” said Mr Green.
He added: “In these challenging times, commissioners need to work closely alongside affected communities and third sector organisations to find innovative ways to deliver services that meet the need – and clear unmet need – of local people at risk of HIV and poor sexual health.”